Sample records for intensive care physician

  1. Burnout Among Anesthetists and Intensive Care Physicians. (United States)

    Mikalauskas, Audrius; Benetis, Rimantas; Širvinskas, Edmundas; Andrejaitienė, Judita; Kinduris, Šarūnas; Macas, Andrius; Padaiga, Žilvinas


    Burnout is a syndrome of depersonalization, emotional exhaustion, and low personal accomplishment. Little is known about burnout in physicians. Our objective was to determine the prevalence of burnout among anesthetists and intensive care physicians, and associations between burnout and personal, as well as professional, characteristics. In total, 220 anesthetists and intensive care physicians were contacted by email, asking them to participate in the study. For depression screening the PHQ-2 questionnaire, for problem drinking, CAGE items were used. Burnout was measured by the Maslach Burnout Inventory. Overall, 34% anesthetists and intensive care physicians indicated high levels of emotional exhaustion, 25% indicated high levels of depersonalization, and 38% showed low personal accomplishment. Burnout was found more frequent among subjects with problem drinking (OR 3.2, 95% CI 1.5-6.8), depressiveness (OR 10.2, 95% CI 4.6-22.6), cardiovascular disorders (OR 3.4, 95% CI 1.7-7.1), and digestive disorders (OR 2.2, 95% CI 1.2-4.0). Some favorite after-work activities positively correlated with burnout, such as sedative medications abuse (OR 4.8, 95% CI 1.8-12.5), alcohol abuse (OR 2.4, 95% CI 1.3-4.5), eating more than usual (OR 1.9, 95% CI 1.1-3.5), and transferring the accumulated stress to relatives (OR 2.8, 95% CI 1.4-5.5). In contrast, reading of non-medical literature seemed to have a protective effect (OR 0.5, 95% CI 0.2-0.9). Burnout was highly prevalent among anesthetists and intensive care physicians with two fifths of them meeting diagnostic criteria. It was strongly correlated with problem drinking, depressiveness, cardiovascular and digestive disorders, use of sedatives and overeating.

  2. Invasive candidosis: contrasting the perceptions of infectious disease physicians and intensive care physicians

    Directory of Open Access Journals (Sweden)

    Vanessa Schultz


    Full Text Available Introduction We analyze how infectious disease physicians perceive and manage invasive candidosis in Brazil, in comparison to intensive care unit specialists. Methods A 38-question survey was administered to 56 participants. Questions involved clinicians' perceptions of the epidemiology, diagnosis, treatment and prophylaxis of invasive candidosis. P < 0.05 was considered statistically significant. Results The perception that candidemia not caused by Candida albicans occurs in less than 10% of patients is more commonly held by intensive care unit specialists (p=0.018. Infectious disease physicians almost always use antifungal drugs in the treatment of patients with candidemia, and antifungal drugs are not as frequently prescribed by intensive care unit specialists (p=0.006. Infectious disease physicians often do not use voriconazole when a patient's antifungal treatment has failed with fluconazole, which also differs from the behavior of intensive care unit specialists (p=0.019. Many intensive care unit specialists use fluconazole to treat candidemia in neutropenic patients previously exposed to fluconazole, in contrast to infectious disease physicians (p=0.024. Infectious disease physicians prefer echinocandins as a first choice in the treatment of unstable neutropenic patients more frequently than intensive care unit specialists (p=0.013. When candidemia is diagnosed, most infectious disease physicians perform fundoscopy (p=0.015, whereas intensive care unit specialists usually perform echocardiograms on all patients (p=0.054. Conclusions This study reveals a need to better educate physicians in Brazil regarding invasive candidosis. The appropriate management of this disease depends on more drug options being available in our country in addition to global coverage in private and public hospitals, thereby improving health care.

  3. Regional variations in health care intensity and physician perceptions of quality of care. (United States)

    Sirovich, Brenda E; Gottlieb, Daniel J; Welch, H Gilbert; Fisher, Elliott S


    Research has documented dramatic differences in health care utilization and spending across U.S. regions with similar levels of patient illness. Although patient outcomes and quality of care have been found to be no better in regions of high health care intensity, it is unknown whether physicians in these regions feel more capable of providing good patient care than those in low-intensity regions. To determine whether physicians in high-intensity regions feel better able to care for patients than physicians in low-intensity regions. Physician telephone survey. 51 metropolitan and 9 nonmetropolitan areas of the United States and a supplemental national sample. 10,577 physicians who provided care to adults in 1998 or 1999 were surveyed for the Community Tracking Study (response rate, 61%). The End-of-Life Expenditure Index, a measure of spending that reflects differences in the overall quantity of medical services provided rather than differences in illness or price, was used to determine health care intensity in the physicians' community. Outcomes included physicians' perceived availability of clinical services, ability to provide high-quality care to patients, and career satisfaction. Although the highest-intensity regions have substantially more hospital beds and specialists per capita, physicians in these regions reported more difficulty obtaining needed services for their patients. The proportion of physicians who felt able to obtain elective hospital admissions ranged from 50% in high-intensity regions to 64% in the lowest-intensity region (P market factors (for example, managed care penetration); the difference in perceived ability to provide high-quality care was no longer statistically significant (P = 0.099). The cross-sectional design prevented demonstration of a causal relationship between intensity and physician perceptions of quality. Despite more resources, physicians in regions of high health care intensity did not report greater ease in obtaining

  4. Benefits of High-Intensity Intensive Care Unit Physician Staffing under the Affordable Care Act

    Directory of Open Access Journals (Sweden)

    Sachin Logani


    Full Text Available The Affordable Care Act signed into law by President Obama, with its value-based purchasing program, is designed to link payment to quality processes and outcomes. Treatment of critically ill patients represents nearly 1% of the gross domestic product and 25% of a typical hospital budget. Data suggest that high-intensity staffing patterns in the intensive care unit (ICU are associated with cost savings and improved outcomes. We evaluate the literature investigating the cost-effectiveness and clinical outcomes of high-intensity ICU physician staffing as recommended by The Leapfrog Group (a consortium of companies that purchase health care for their employees and identify ways to overcome barriers to nationwide implementation of these standards. Hospitals that have implemented the Leapfrog initiative have demonstrated reductions in mortality and length of stay and increased cost savings. High-intensity staffing models appear to be an immediate cost-effective way for hospitals to meet the challenges of health care reform.

  5. Life-sustaining treatment decisions in Portuguese intensive care units: a national survey of intensive care physicians. (United States)

    Cardoso, Teresa; Fonseca, Teresa; Pereira, Sofia; Lencastre, Luís


    The objective of the present study was to evaluate the opinion of Portuguese intensive care physicians regarding 'do-not-resuscitate' (DNR) orders and decisions to withhold/withdraw treatment. A questionnaire was sent to all physicians working on a full-time basis in all intensive care units (ICUs) registered with the Portuguese Intensive Care Society. A total of 266 questionnaires were sent and 175 (66%) were returned. Physicians from 79% of the ICUs participated. All participants stated that DNR orders are applied in their units, and 98.3% stated that decisions to withhold treatment and 95.4% stated that decisions to withdraw treatment are also applied. About three quarters indicated that only the medical group makes these decisions. Fewer than 15% of the responders stated that they involve nurses, 9% involve patients and fewer than 11% involve patients' relatives in end-of-life decisions. Physicians with more than 10 years of clinical experience more frequently indicated that they involve nurses in these decisions (P atheist doctors more frequently involve patients' relatives in decisions to withhold/withdraw treatment (P religious beliefs of the respondents influences the way in which these decisions are made.

  6. The Leapfrog initiative for intensive care unit physician staffing and its impact on intensive care unit performance: a narrative review. (United States)

    Gasperino, James


    The field of critical care has changed markedly in recent years to accommodate a growing population of chronically critically ill patients. New administrative structures have evolved to include divisions, departments, and sections devoted exclusively to the practice of critical care medicine. On an individual level, the ability to manage complex multisystem critical illnesses and to introduce invasive monitoring devices defines the intensivist. On a systems level, critical care services managed by an intensivist-led multidisciplinary team are now recognized by their ability to efficiently utilize hospital resources and improve patient outcomes. Due to the numerous cost and quality issues related to the delivery of critical care medicine, intensive care unit physician staffing (IPS) has become a charged subject in recent years. Although the federal government has played a large role in regulating best practices by physicians, other third parties have entered the arena. Perhaps the most influential of these has been The Leapfrog Group, a consortium representing 130 employers and 65 Fortune 500 companies that purchase health care for their employees. This group has proposed specific regulatory guidelines for IPS that are purported to result in substantial cost containment and improved quality of care. This narrative review examines the impact of The Leapfrog Group's recommendations on critical care delivery in the United States. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  7. [Professional Burnout Syndrome of intensive care physicians from Salvador, Bahia, Brazil]. (United States)

    Tironi, Márcia Oliveira Staffa; Nascimento Sobrinho, Carlito Lopes; Barros, Dalton de Souza; Reis, Eduardo José Farias Borges; Marques Filho, Edson Silva; Almeida, Alessandro; Bitencourt, Almir; Feitosa, Ana Isabela Ramos; Neves, Flávia Serra; Mota, Igor Carlos Cunha; França, Juliana; Borges, Lorena Guimarães; Lordão, Manuela Barreto de Jesus; Trindade, Maria Valverde; Teles, Marcelo Santos; Almeida, Mônica Bastos T; Souza, Ygor Gomes de


    Describe prevalence of the Burnout syndrome in intensive care physicians of Salvador, associated to demographic data and aspects of the work environment (psychological demand and job control). This cross sectional study has investigated the association between work conditions and Burnout Syndrome in a population of 297 Intensive Care Physicians from Salvador, Bahia, Brazil. An individual, self-report questionnaire evaluated the physicians' psychological aspects of work, using the demand-control model (Job Content Questionnaire) and their mental health, using the Maslash Burnout Inventory (MBI). The study found work overload,a high proportion of on duty physicians and low income for the hours worked. Prevalence of the Burnout Syndrome was 7.4% and it was more closely associated with aspects of the job's psychological demand than with its control. Physicians under great stress (high demand and low control) presented prevalence of the Bornout Syndrome 10.2 times higher than those under low stress (low demand and high control) jobs.

  8. [Shortage of physicians in anaesthesiology and intensive care medicine - Causes, consequences and solutions]. (United States)

    Papenfuß, Tim; Roch, Carmen


    74% of all hospitals had vacant positions in 2011, also departments of anaesthesiology and intensive care medicine. More than 50% of these departments work with locums. There are couple of reasons for the shortage of physicians. The consequences in anaesthesiology and intensive care medicine can result in qualitative and financial loss. To solve the shortage of physicians one has to solve the reasons. Main reasons are increasing feminization of medical profession and part-time-work, work-life-balance and a poor specialised education. © Georg Thieme Verlag Stuttgart · New York.

  9. Moral distress, autonomy and nurse-physician collaboration among intensive care unit nurses in Italy. (United States)

    Karanikola, Maria N K; Albarran, John W; Drigo, Elio; Giannakopoulou, Margarita; Kalafati, Maria; Mpouzika, Meropi; Tsiaousis, George Z; Papathanassoglou, Elizabeth D E


    To explore the level of moral distress and potential associations between moral distress indices and (1) nurse-physician collaboration, (2) autonomy, (3) professional satisfaction, (4) intention to resign, and (5) workload among Italian intensive care unit nurses. Poor nurse-physician collaboration and low autonomy may limit intensive care unit nurses' ability to act on their moral decisions. A cross-sectional correlational design with a sample of 566 Italian intensive care unit nurses. The intensity of moral distress was 57.9 ± 15.6 (mean, standard deviation) (scale range: 0-84) and the frequency of occurrence was 28.4 ± 12.3 (scale range: 0-84). The mean score of the severity of moral distress was 88.0 ± 44 (scale range: 0-336). The severity of moral distress was associated with (1) nurse-physician collaboration and dissatisfaction on care decisions (r = -0.215, P intention to resign (r = 0.244, P intention of nurses to resign (r = -0. 209, P intention to resign, whereas poor nurse-physician collaboration appears to be a pivotal factor accounting for nurses' moral distress. Enhancement of nurse-physician collaboration and nurses' participation in end-of-life decisions seems to be a managerial task that could lead to the alleviation of nurses' moral distress and their retention in the profession. © 2013 John Wiley & Sons Ltd.

  10. Organizational and safety culture in Canadian intensive care units: relationship to size of intensive care unit and physician management model. (United States)

    Dodek, Peter M; Wong, Hubert; Jaswal, Danny; Heyland, Daren K; Cook, Deborah J; Rocker, Graeme M; Kutsogiannis, Demetrios J; Dale, Craig; Fowler, Robert; Ayas, Najib T


    The objectives of this study are to describe organizational and safety culture in Canadian intensive care units (ICUs), to correlate culture with the number of beds and physician management model in each ICU, and to correlate organizational culture and safety culture. In this cross-sectional study, surveys of organizational and safety culture were administered to 2374 clinical staff in 23 Canadian tertiary care and community ICUs. For the 1285 completed surveys, scores were calculated for each of 34 domains. Average domain scores for each ICU were correlated with number of ICU beds and with intensivist vs nonintensivist management model. Domain scores for organizational culture were correlated with domain scores for safety culture. Culture domain scores were generally favorable in all ICUs. There were moderately strong positive correlations between number of ICU beds and perceived effectiveness at recruiting/retaining physicians (r = 0.58; P organizational and safety culture. Differences in perceptions between staff in larger and smaller ICUs highlight the importance of teamwork across units in larger ICUs. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Patient-care time allocation by nurse practitioners and physician assistants in the intensive care unit. (United States)

    Carpenter, David L; Gregg, Sara R; Owens, Daniel S; Buchman, Timothy G; Coopersmith, Craig M


    Use of nurse practitioners and physician assistants ("affiliates") is increasing significantly in the intensive care unit (ICU). Despite this, few data exist on how affiliates allocate their time in the ICU. The purpose of this study was to understand the allocation of affiliate time into patient-care and non-patient-care activity, further dividing the time devoted to patient care into billable service and equally important but nonbillable care. We conducted a quasi experimental study in seven ICUs in an academic hospital and a hybrid academic/community hospital. After a period of self-reporting, a one-time monetary incentive of $2,500 was offered to 39 affiliates in each ICU in which every affiliate documented greater than 75% of their time devoted to patient care over a 6-month period in an effort to understand how affiliates allocated their time throughout a shift. Documentation included billable time (critical care, evaluation and management, procedures) and a new category ("zero charge time"), which facilitated record keeping of other patient-care activities. At baseline, no ICUs had documentation of 75% patient-care time by all of its affiliates. In the 6 months in which reporting was tied to a group incentive, six of seven ICUs had every affiliate document greater than 75% of their time. Individual time documentation increased from 53% to 84%. Zero-charge time accounted for an average of 21% of each shift. The most common reason was rounding, which accounted for nearly half of all zero-charge time. Sign out, chart review, and teaching were the next most common zero-charge activities. Documentation of time spent on billable activities also increased from 53% of an affiliate's shift to 63%. Time documentation was similar regardless of during which shift an affiliate worked. Approximately two thirds of an affiliate's shift is spent providing billable services to patients. Greater than 20% of each shift is spent providing equally important but not reimbursable

  12. More than half the families of mobile intensive care unit patients experience inadequate communication with physicians. (United States)

    Debaty, Guillaume; Ageron, François-Xavier; Minguet, Laetitia; Courtiol, Guillaume; Escallier, Christophe; Henniche, Adeline; Maignan, Maxime; Briot, Raphaël; Carpentier, Françoise; Savary, Dominique; Labarere, José; Danel, Vincent


    This study aimed to assess comprehension by family members of the patient's severity in the prehospital setting. We conducted a cross-sectional study in four mobile intensive care units (ICUs, medicalized ambulances) in France from June to October 2012. Nurses collected data on patients, patient's relatives, and mobile ICU physicians. For each patient, one relative and one physician independently rated the patient's severity using a simplified version of the Clinical Classification of Out-of-Hospital Emergency Patients scale (CCMS). Relatives were also asked to assess their interview with the physician. The primary outcome was agreement between the relative's and physician's ratings of the patient's severity. Data were available for 184 patients, their relatives, and mobile ICU physicians. Full and partial agreement between relatives and physicians regarding the patient's severity was found for 79 (43%) and 121 (66%) cases, respectively [weighted kappa = 0.32 (95% confidence interval, CI, 0.23-0.42)]. Relatives overestimated the patient's severity assessed by the physician [6 (5-8) vs. 4 (3-7), p communicated by mobile ICU physicians.

  13. A conceptual model of physician work intensity: guidance for evaluating policies and practices to improve health care delivery. (United States)

    Horner, Ronnie D; Matthews, Gerald; Yi, Michael S


    Physician work intensity, although a major factor in determining the payment for medical services, may potentially affect patient health outcomes including quality of care and patient safety, and has implications for the redesign of medical practice to improve health care delivery. However, to date, there has been minimal research regarding the relationship between physician work intensity and either patient outcomes or the organization and management of medical practices. A theoretical model on physician work intensity will provide useful guidance to such inquiries. To describe an initial conceptual model to facilitate further investigations of physician work intensity. A conceptual model of physician work intensity is described using as its theoretical base human performance science relating to work intensity. For each of the theoretical components, we present relevant empirical evidence derived from a review of the current literature. The proposed model specifies that the level of work intensity experienced by a physician is a consequence of the physician performing the set of tasks (ie, demands) relating to a medical service. It is conceptualized that each medical service has an inherent level of intensity that is experienced by a physician as a function of factors relating to the physician, patient, and medical practice environment. The proposed conceptual model provides guidance to researchers as to the factors to consider in studies of how physician work intensity impacts patient health outcomes and how work intensity may be affected by proposed policies and approaches to health care delivery.

  14. The communication between patient relatives and physicians in intensive care units. (United States)

    Cicekci, Faruk; Duran, Numan; Ayhan, Bunyamin; Arican, Sule; Ilban, Omur; Kara, Iskender; Turkoglu, Melda; Yildirim, Fatma; Hasirci, Ismail; Karaibrahimoglu, Adnan; Kara, Inci


    Patients in intensive care units (ICUs) are often physically unable to communicate with their physicians. Thus, the sharing of information about the on-going treatment of the patients in ICUs is directly related to the communication attitudes governing a patient's relatives and the physician. This study aims to analyze the attitudes displayed by the relatives of patients and the physician with the purpose of determining the communication between the two parties. For data collection, two similar survey forms were created in context of the study; one for the relatives of the patients and one for the ICU physicians. The questionnaire included three sub-dimensions: informing, empathy and trust. The study included 181 patient relatives and 103 ICU physicians from three different cities and six hospitals. Based on the results of the questionnaire, identification of the mutual expectations and substance of the messages involved in the communication process between the ICU patients' relatives and physicians was made. The gender and various disciplines of the physicians and the time of the conversation with the patients' relatives were found to affect the communication attitude towards the patient. Moreover, the age of the patient's relatives, the level of education, the physician's perception, and the contact frequency with the patient when he/she was healthy were also proven to have an impact on the communication attitude of the physician. This study demonstrates the mutual expectations and substance of messages in the informing, empathy and trust sub-dimensions of the communication process between patient relatives and physicians in the ICU. The communication between patient relatives and physicians can be strengthened through a variety of training programs to improve communication skills.

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

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


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

  16. Transfers from intensive care unit to hospital ward: a multicentre textual analysis of physician progress notes. (United States)

    Brown, Kyla N; Leigh, Jeanna Parsons; Kamran, Hasham; Bagshaw, Sean M; Fowler, Rob A; Dodek, Peter M; Turgeon, Alexis F; Forster, Alan J; Lamontagne, Francois; Soo, Andrea; Stelfox, Henry T


    Little is known about documentation during transitions of patient care between clinical specialties. Therefore, we examined the focus, structure and purpose of physician progress notes for patients transferred from the intensive care unit (ICU) to hospital ward to identify opportunities to improve communication breaks. This was a prospective cohort study in ten Canadian hospitals. We analyzed physician progress notes for consenting adult patients transferred from a medical-surgical ICU to hospital ward. The number, length, legibility and content of notes was counted and compared across care settings using mixed-effects linear regression models accounting for clustering within hospitals. Qualitative content analyses were conducted on a stratified random sample of 32 patients. A total of 447 patient medical records that included 7052 progress notes (mean 2.1 notes/patient/day 95% CI 1.9-2.3) were analyzed. Notes written by the ICU team were significantly longer than notes written by the ward team (mean lines of text 21 vs. 15, p notes; mean agreement of patient issues was 42% [95% CI 31-53%]. Qualitative analyses identified eight themes related to focus (central point - e.g., problem list), structure (organization, - e.g., note-taking style), and purpose (intention - e.g., documentation of patient course) of the notes that varied across clinical specialties and physician seniority. Important gaps and variations in written documentation during transitions of patient care between ICU and hospital ward physicians are common, and include discrepancies in documentation of patient information.

  17. Attitudes of pediatric intensive care unit physicians towards the use of cognitive aids: a qualitative study. (United States)

    Weiss, Matthew J; Kramer, Chelsea; Tremblay, Sébastien; Côté, Luc


    Cognitive aids are increasingly recommended in clinical practice, yet little is known about the attitudes of physicians towards these tools. We employed a qualitative, descriptive design to explore physician attitudes towards cognitive aids in pediatric intensive care units (PICUs). Semi-structured interviews elicited the opinions of a convenience sample of practicing PICU physicians towards the use of cognitive aids. We analyzed interview data for thematic content to examine the three factors of intention to use cognitive aids as defined by the Theory of Planned Behavior (TPB), attitudes, social norms, and perceived control. Analysis of 14 interviews suggested that in the PICU setting, cognitive aids are widely used. Discovered themes related to their use touched on all three TPB factors of intention and included: aids are perceived to improve team communication; aids may improve patient safety; aids may hinder clinician judgment; physicians may resist implementation if it occurs prior to demonstration of benefit; effective adoption requires cognitive aids to be integrated into local workplace culture; and implementation should take physician concerns into account. Our sample of PICU physicians were open to cognitive aids in their practice, as long as such aids preserve the primacy of clinical judgment, focus on team communication, demonstrate effectiveness through preliminary testing, and are designed and implemented with the local culture and work environment in mind. Future knowledge translation efforts to implement cognitive aids would benefit from consideration of these issues.

  18. Generalizable items and modular structure for computerised physician staffing calculation on intensive care units. (United States)

    Weiss, Manfred; Marx, Gernot; Iber, Thomas


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

  19. Ethical challenges in the neonatal intensive care units: perceptions of physicians and nurses; an Iranian experience. (United States)

    Kadivar, Maliheh; Mosayebi, Ziba; Asghari, Fariba; Zarrini, Pari


    The challenging nature of neonatal medicine today is intensified by modern advances in intensive care and treatment of sicker neonates. These developments have caused numerous ethical issues and conflicts in ethical decision-making. The present study surveyed the challenges and dilemmas from the viewpoint of the neonatal intensive care personnel in the teaching hospitals of Tehran University of Medical Sciences (TUMS) in the capital of Iran. In this comparative cross-sectional study conducted between March 2013 and February 2014, the physicians' and nurses' perceptions of the ethical issues in neonatal intensive care units were compared. The physicians and nurses of the study hospitals were requested to complete a 36-item questionnaire after initial accommodations. The study samples consisted of 284 physicians (36%) and nurses (64%). Content validity and internal consistency calculations were used to examine the psychometric properties of the questionnaire. Data were analyzed by Pearson's correlation, t-test, ANOVA, and linear regression using SPSS v. 22. Respecting patients' rights and interactions with parents were perceived as the most challenging aspects of neonatal care. There were significant differences between sexes in the domains of the perceived challenges. According to the linear regression model, the perceived score would be reduced 0.33 per each year on the job. The results of our study showed that the most challenging issues were related to patients' rights, interactions with parents, communication and cooperation, and end of life considerations respectively. It can be concluded, therefore, that more attention should be paid to these issues in educational programs and ethics committees of hospitals.

  20. Attitudes towards euthanasia among Greek intensive care unit physicians and nurses. (United States)

    Kranidiotis, Georgios; Ropa, Julia; Mprianas, John; Kyprianou, Theodoros; Nanas, Serafim


    To investigate the attitudes of Greek intensive care unit (ICU) medical and nursing staff towards euthanasia. ICU physicians and nurses deal with end-of-life dilemmas on a daily basis. Therefore, the exploration of their stances on euthanasia is worthwhile. This was a descriptive quantitative study conducted in three ICUs in Athens. The convenience sample included 39 physicians and 107 nurses. Of respondents, 52% defined euthanasia inaccurately, as withholding or withdrawal of treatment, while 15% ranked limitation of life-support among the several forms of euthanasia, together with active shortening of the dying process and physician - assisted suicide. Only one third of participants defined euthanasia correctly. While 59% of doctors and 64% of nurses support the legalization of active euthanasia, just 28% and 26% of them, respectively, agree with it ethically. Confusion prevails among Greek ICU physicians and nurses regarding the definition of euthanasia. The majority of staff disagrees with active euthanasia, but upholds its legalization. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Nurses' and physicians' perceptions of Confusion Assessment Method for the intensive care unit for delirium detection

    DEFF Research Database (Denmark)

    Oxenbøll-Collet, Marie; Egerod, Ingrid; Christensen, Vibeke


    of this study was to identify nurses' and physicians' perceived professional barriers to using the CAM-ICU in Danish ICUs. Methods: This study uses a qualitative explorative multicentre design using focus groups and a semi-structured interview guide. Five focus groups with nurses (n=20) and four with physicians......-ICU screening affected nursing care, clinical judgment and professional integrity; (2) Instrument reliability: nurses and physicians expressed concerns about CAM-ICU assessment in non-sedated patients, patients with multi-organ failure or patients influenced by residual sedatives/opioids; and (3) Clinical...... consequence: after CAM-ICU assessment, physicians lacked evidence-based treatment options, and nurses lacked physician acknowledgment and guidelines for disclosing CAM-ICU results to patients. Conclusion: In this study, ICU nurses and physicians raised a number of concerns regarding the use of the CAM...

  2. Attitudes of intensive care and emergency physicians in Australia with regard to the organ donation process: A qualitative analysis. (United States)

    Macvean, Emily; Yuen, Eva Yn; Tooley, Gregory; Gardiner, Heather M; Knight, Tess


    Specialized hospital physicians have direct capacity to impact Australia's sub-optimal organ donation rates because of their responsibility to identify and facilitate donation opportunities. Australian physicians' attitudes toward this responsibility are examined. A total of 12 intensive care unit and three emergency department physicians were interviewed using a constructionist grounded theory and situational analysis approach. A major theme emerged, related to physicians' conflicts of interest in maintaining patients'/next-of-kin's best interests and a sense of duty-of-care in this context. Two sub-themes related to this main theme were identified as follows: (1) discussions about organ donation and who is best to carry these out and (2) determining whether organ donation is part of end-of-life care; including the avoidance of non-therapeutic ventilation; and some reluctance to follow clinical triggers in the emergency department. Overall, participants indicated strong support for organ donation but would not consider it part of end-of-life care, representing a major obstacle to the support of potential donation opportunities. Findings have implications for physician education and training. Continued efforts are needed to integrate the potential for organ donation into end-of-life care within intensive care units and emergency departments.

  3. Effect of Pharmacist Participation During Physician Rounds and Prescription Error in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Marlina A. Turnodihardjo


    Full Text Available Patient’s safety is now a prominent issue in pharmaceutical care because of adverse drug events that is common in hospitalized patients. Majority of error are likely occured during prescribing, which is the first stage of pharmacy process. Prescription errors mostly occured in an Intensive Care Unit (ICU, which is due to the severity of the illness of its patients as well as the large number of medications prescribed. Pharmacist participation actually could reduce prescribing error made by doctors. The main objective of this study was to determine the effect of pharmacist participation during physician rounds on prescription errors in the ICU. This study was a quasi-experimental design with one group pre-post test. A prospective study was conducted from April to May 2015 by screening 110 samples of orders. Screening was done to identify type of prescription errors. Prescription error was defined as error in the prescription writing process – incomplete information and not according to agreement. Mann-Whitney test was used to analyze the differences in prescribing errors. The results showed that there was the differences between prescription errors before and during the pharmacist participation (p<0.05. There was also a significant negative correlation between the frequency of pharmacist recommendation on drug ordering and prescription errors (r= –0.638; p<0.05. It means the pharmacist participation was one of the strategies that can be adopted to prevent in prescribing errors and implementation of collaboration between both doctors and pharmacists. In other words, the supporting hospital management system which would encourage interpersonal communication among health care proffesionals is needed.

  4. The role of advance directives in end-of-life decisions in Austria: survey of intensive care physicians. (United States)

    Schaden, Eva; Herczeg, Petra; Hacker, Stefan; Schopper, Andrea; Krenn, Claus G


    Currently, intensive care medicine strives to define a generally accepted way of dealing with end-of-life decisions, therapy limitation and therapy discontinuation.In 2006 a new advance directive legislation was enacted in Austria. Patients may now document their personal views regarding extension of treatment. The aim of this survey was to explore Austrian intensive care physicians' experiences with and their acceptance of the new advance directive legislation two years after enactment (2008). Under the aegis of the OEGARI (Austrian Society of Anaesthesiology, Resuscitation and Intensive Care) an anonymised questionnaire was sent to the medical directors of all intensive care units in Austria. The questions focused on the physicians' experiences regarding advance directives and their level of knowledge about the underlying legislation. There were 241 questionnaires sent and 139 were turned, which was a response rate of 58%. About one third of the responders reported having had no experience with advance directives and only 9 directors of intensive care units had dealt with more than 10 advance directives in the previous two years. Life-supporting measures, resuscitation, and mechanical ventilation were the predominantly refused therapies, wishes were mainly expressed concerning pain therapy. A response rate of almost 60% proves the great interest of intensive care professionals in making patient-oriented end-of-life decisions. However, as long as patients do not make use of their right of co-determination, the enactment of the new law can be considered only a first important step forward.

  5. Conformity to the surviving sepsis campaign international guidelines among physicians in a general intensive care unit in Nairobi. (United States)

    Mung'ayi, V; Karuga, R


    There are emerging therapies for managing septic critically-ill patients. There is little data from the developing world on their usage. To determine the conformity rate for resuscitation and management bundles for septic patients amongst physicians in a general intensive care unit. Cross sectional observational study. The general intensive care unit, Aga Khan University Hospital,Nairobi. Admitting physicians from all specialties in the general intensive care unit. The physicians had high conformity rates of 92% and 96% for the fluid resuscitation and use of va so pressors respectively for the initial resuscitation bundle. They had moderate conformity rates for blood cultures prior to administering antibiotics (57%) and administration of antibiotics within first hour of recognition of septic shock (54%). There was high conformity rate to the glucose control policy (81%), use of protective lung strategy in acute lung injury/Acute respiratory distress syndrome, venous thromboembolism prophylaxis (100%) and stress ulcer prophylaxis (100%) in the management bundle. Conformity was moderate for use of sedation, analgesia and muscle relaxant policy (69%), continuous renal replacement therapies (54%) and low for steroid policy (35%), administration ofdrotrecogin alfa (0%) and selective digestive decontamination (15%). There is varying conformity to the international sepsis guidelines among physicians caring for patients in our general ICU. Since increased conformity would improve survival and reduce morbidity, there is need for sustained education and guideline based performance improvement.

  6. Determination of death after circulatory arrest by intensive care physicians: A survey of current practice in the Netherlands. (United States)

    Wind, Jentina; van Mook, Walther N K A; Dhanani, Sonny; van Heurn, Ernest W L


    Determination of death is an essential part of donation after circulatory death (DCD). We studied the current practices of determination of death after circulatory arrest by intensive care physicians in the Netherlands, the availability of guidelines, and the occurrence of the phenomenon of autoresuscitation. The Determination of Cardiac Death Practices in Intensive Care Survey was sent to all intensive care physicians. Fifty-five percent of 568 Dutch intensive care physicians responded. Most respondents learned death determination from clinical practice. The most commonly used tests for death determination were flat arterial line tracing, flat electrocardiogram (standard 3-lead electrocardiogram), and fixed and dilated pupils. Rarely used tests were absence pulse by echo Doppler, absent blood pressure by noninvasive monitoring, and unresponsiveness to painful stimulus. No diagnostic test or procedure was uniformly performed, but 80% of respondents perceived a need for standardization of death determination. Autoresuscitation was witnessed by 37%, after withdrawal of treatment or after unsuccessful resuscitation. Extensive variability in the practice of determining death after circulatory arrest exists, and a need for guidelines and standardization, especially if organ donation follows death, is reported. Autoresuscitation is reported; this observation requires attention in further prospective observational studies. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Seasonal variation in family member perceptions of physician competence in the intensive care unit: findings from one academic medical center. (United States)

    Stevens, Jennifer P; Kachniarz, Bart; O'Reilly, Kristin; Howell, Michael D


    Researchers have found mixed results about the risk to patient safety in July, when newly minted physicians enter U.S. hospitals to begin their clinical training, the so-called "July effect." However, patient and family satisfaction and perception of physician competence during summer months remain unknown. The authors conducted a retrospective observational cohort study of 815 family members of adult intensive care unit (ICU) patients who completed the Family Satisfaction with Care in the Intensive Care Unit instrument from eight ICUs at Beth Israel Deaconess Medical Center, Boston, Massachusetts, between April 2008 and June 2011. The association of ICU care in the summer months (July-September) versus other seasons and family perception of physician competence was examined in univariable and multivariable analyses. A greater proportion of family members described physicians as competent in summer months as compared with winter months (odds ratio [OR] 1.9; 95% confidence interval [CI] 1.2-3.0; P = .003). After adjustment for patient and proxy demographics, severity of illness, comorbidities, and features of the admission in a multivariable model, seasonal variation of family perception of physician competence persisted (summer versus winter, OR of judging physicians competent 2.4; 95% CI 1.3-4.4; P = .004). Seasonal variation exists in family perception of physician competence in the ICU, but opposite to the "July effect." The reasons for this variation are not well understood. Further research is necessary to explore the role of senior provider involvement, trainee factors, system factors such as handoffs, or other possible contributors.

  8. Perceptions of parents, nurses, and physicians on neonatal intensive care practices

    NARCIS (Netherlands)

    Latour, Jos M.; Hazelzet, Jan A.; Duivenvoorden, Hugo J.; van Goudoever, Johannes B.


    To identify satisfaction with neonatal intensive care as viewed by parents and healthcare professionals and to explore similarities and differences between parents and healthcare professionals. A 3-round Delphi method to identify neonatal care issues (round 1) and to determine the importance of

  9. The role of advance directives in end-of-life decisions in Austria: survey of intensive care physicians

    Directory of Open Access Journals (Sweden)

    Schopper Andrea


    Full Text Available Abstract Background Currently, intensive care medicine strives to define a generally accepted way of dealing with end-of-life decisions, therapy limitation and therapy discontinuation. In 2006 a new advance directive legislation was enacted in Austria. Patients may now document their personal views regarding extension of treatment. The aim of this survey was to explore Austrian intensive care physicians' experiences with and their acceptance of the new advance directive legislation two years after enactment (2008. Methods Under the aegis of the OEGARI (Austrian Society of Anaesthesiology, Resuscitation and Intensive Care an anonymised questionnaire was sent to the medical directors of all intensive care units in Austria. The questions focused on the physicians' experiences regarding advance directives and their level of knowledge about the underlying legislation. Results There were 241 questionnaires sent and 139 were turned, which was a response rate of 58%. About one third of the responders reported having had no experience with advance directives and only 9 directors of intensive care units had dealt with more than 10 advance directives in the previous two years. Life-supporting measures, resuscitation, and mechanical ventilation were the predominantly refused therapies, wishes were mainly expressed concerning pain therapy. Conclusion A response rate of almost 60% proves the great interest of intensive care professionals in making patient-oriented end-of-life decisions. However, as long as patients do not make use of their right of co-determination, the enactment of the new law can be considered only a first important step forward.

  10. Assessing and combining repeated prognosis of physicians and temporal models in the intensive care

    NARCIS (Netherlands)

    Minne, Lilian; Toma, Tudor; de Jonge, Evert; Abu-Hanna, Ameen


    Recently, we devised a method to develop prognostic models incorporating patterns of sequential organ failure to predict the eventual hospital mortality at each day of intensive care unit (ICU) stay. In this study, we investigate using a real world setting how these models perform compared to

  11. Prolonging life and delaying death: The role of physicians in the context of limited intensive care resources

    Directory of Open Access Journals (Sweden)

    Bagshaw Sean M


    Full Text Available Abstract Critical care is in an emerging crisis of conflict between what individuals expect and the economic burden society and government are prepared to provide. The goal of critical care support is to prevent suffering and premature death by intensive therapy of reversible illnesses within a reasonable timeframe. Recently, it has become apparent that early support in an intensive care environment can improve patient outcomes. However, life support technology has advanced, allowing physicians to prolong life (and postpone death in circumstances that were not possible in the recent past. This has been recognized by not only the medical community, but also by society at large. One corollary may be that expectations for recovery from critical illness have also become extremely high. In addition, greater numbers of patients are dying in intensive care units after having receiving prolonged durations of life-sustaining therapy. Herein lies the emerging crisis – critical care therapy must be available in a timely fashion for those who require it urgently, yet its provision is largely dependent on a finite availability of both capital and human resources. Physicians are often placed in a troubling conflict of interest by pressures to use health resources prudently while also promoting the equitable and timely access to critical care therapy. In this commentary, these issues are broadly discussed from the perspective of the individual clinician as well as that of society as a whole. The intent is to generate dialogue on the dynamic between individual clinicians navigating the complexities of how and when to use critical care support in the context of end-of-life issues, the increasing demands placed on finite critical care capacity, and the reasonable expectations of society.

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

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


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

  13. Physician-Assisted Suicide and Euthanasia in the Intensive Care Unit: A Dialogue on Core Ethical Issues (United States)

    Goligher, Ewan C.; Ely, E. Wesley; Sulmasy, Daniel P.; Bakker, Jan; Raphael, John; Volandes, Angelo E.; Patel, Bhavesh M.; Payne, Kate; Hosie, Annmarie; Churchill, Larry; White, Douglas B.; Downar, James


    Objective Many patients are admitted to the intensive care unit at or near the end of their lives. Consequently, the increasingly common debate regarding physician-assisted suicide and euthanasia (PAS/E) holds implications for the practice of critical care medicine. The objective of this manuscript is to explore core ethical issues related to PAS/E from the perspective of healthcare professionals and ethicists on both sides of the debate. Synthesis We identified four issues highlighting the key areas of ethical tension central to evaluating PAS/E in medical practice: (1) the benefit or harm of death itself, (2) the relationship between PAS/E and withholding or withdrawing life support, (3) the morality of a physician deliberately causing death, and (4) the management of conscientious objection related to PAS/E in the critical care setting. We present areas of common ground as well as important unresolved differences. Conclusions We reached differing positions on the first three core ethical questions and achieved significant agreement on how critical care clinicians should manage conscientious objections related to PAS/E. The alternative positions presented in this paper may serve to promote open and informed dialogue within the critical care community. PMID:28098622

  14. Strategic alliance between the infectious diseases specialist and intensive care unit physician for change in antibiotic use. (United States)

    Curcio, D; Belloni, R


    There is a general consensus that antimicrobial use in intensive care units (ICU) is greater than that in general wards. By implementing a strategy of systematic infectious disease consultations in agreement with the ICU chief, we have modified the antibiotic prescription habits of the ICU physician. A reduction was observed in the use of selected antibiotics (third-generation cephalosporins, vancomycin, carbapenems and piperacillin-tazobactam), with a significant reduction in the length of hospital stay for ICU patients and lower antibiotic costs without negative impact on patient mortality. Leadership by the infectious diseases consultant in combination with commitment by ICU physicians is a simple and effective method to change antibiotic prescription habits in the ICU.

  15. The ability of intensive care unit physicians to estimate long-term prognosis in survivors of critical illness. (United States)

    Soliman, Ivo W; Cremer, Olaf L; de Lange, Dylan W; Slooter, Arjen J C; van Delden, Johannes Hans J M; van Dijk, Diederik; Peelen, Linda M


    To assess the reliability of physicians' prognoses for intensive care unit (ICU) survivors with respect to long-term survival and health related quality of life (HRQoL). We performed an observational cohort-study in a single mixed tertiary ICU in The Netherlands. ICU survivors with a length of stay >48h were included. At ICU discharge, one-year prognosis was estimated by physicians using the four-option Sabadell score to record their expectations. The outcome of interest was poor outcome, which was defined as dying within one-year follow-up, or surviving with an EuroQoL5D-3L index <0.4. Among 1399 ICU survivors, 1068 (76%) subjects were expected to have a good outcome; 243 (18%) a poor long-term prognosis; 43 (3%) a poor short-term prognosis, and 45 (3%) to die in hospital (i.e. Sabadell score levels). Poor outcome was observed in 38%, 55%, 86%, and 100% of these groups respectively (concomitant c-index: 0.61). The expected prognosis did not match observed outcome in 365 (36%) patients. This was almost exclusively (99%) due to overoptimism. Physician experience did not affect results. Prognoses estimated by physicians incorrectly predicted long-term survival and HRQoL in one-third of ICU survivors. Moreover, inaccurate prognoses were generally the result of overoptimistic expectations of outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Psychosocial determinants of self-reported hand hygiene behaviour: a survey comparing physicians and nurses in intensive care units. (United States)

    von Lengerke, T; Lutze, B; Graf, K; Krauth, C; Lange, K; Schwadtke, L; Stahmeyer, J; Chaberny, I F


    Research applying psychological behaviour change theories to hand hygiene compliance is scarce, especially for physicians. To identify psychosocial determinants of self-reported hand hygiene behaviour (HHB) of physicians and nurses in intensive care units (ICUs). A cross-sectional survey using a self-administered questionnaire that applied concepts from the Health Action Process Approach on hygienic hand disinfection was conducted in 10 ICUs and two haematopoietic stem cell transplantation units at Hannover Medical School, Germany. Self-reported compliance was operationalized as always disinfecting one's hands when given tasks associated with risk of infection. Using seven-point Likert scales, behavioural planning, maintenance self-efficacy and action control were assessed as psychological factors, and personnel and material resources, organizational problems and cooperation on the ward were assessed as perceived environmental factors. Multiple logistic regression analysis was employed. In total, 307 physicians and 348 nurses participated in this study (response rates 70.9% and 63.4%, respectively). Self-reported compliance did not differ between the groups (72.4% vs 69.4%, P = 0.405). While nurses reported stronger planning, self-efficacy and action control, physicians indicated better personnel resources and cooperation on the ward (P Infection Society. Published by Elsevier Ltd. All rights reserved.

  17. A new safety event reporting system improves physician reporting in the surgical intensive care unit. (United States)

    Schuerer, Douglas J E; Nast, Patricia A; Harris, Carolyn B; Krauss, Melissa J; Jones, Rebecca M; Boyle, Walter A; Buchman, Timothy G; Coopersmith, Craig M; Dunagan, W Claiborne; Fraser, Victoria J


    Medical errors are common, and physicians have notably been poor medical error reporters. In the SICU, reporting was generally poor and reporting by physicians was virtually nonexistent. This study was designed to observe changes in error reporting in an SICU when a new card-based system (SAFE) was introduced. Before implementation of the SAFE reporting system, education was given to all SICU healthcare providers. The SAFE system was introduced into the SICU for a 9-month period from March 2003 through November 2003, to replace an underused online system. Data were collected from the SAFE card reports and the online reporting systems during introduction, removal, and reimplementation of these cards. Reporting rates were calculated as number of reported events per 1,000 patient days. Reporting rates increased from 19 to 51 reports per 1,000 patient days after the SAFE cards were introduced into the ICU (preporting increased most, rising from 0.3 to 5.8 reports per 1,000 patient days; nursing reporting also increased from 18 to 39 reports per 1,000 patient days (both preporting declined to 0 reports per 1,000 patient days (p=0.01) and rose to 8.1 (p=0.001) when the cards were returned, similar to nursing results. A higher proportion of physician reports were events that caused harm compared with no effect (p reporting system, combined with appropriate education, improved overall reporting in the SICU, especially among physician providers. Nurses were more likely to use reporting systems than were physicians. Physician reports were more likely to be of events that caused harm.

  18. Using simulation to isolate physician variation in intensive care unit admission decision making for critically ill elders with end-stage cancer: a pilot feasibility study. (United States)

    Barnato, Amber E; Hsu, Heather E; Bryce, Cindy L; Lave, Judith R; Emlet, Lillian L; Angus, Derek C; Arnold, Robert M


    To determine the feasibility of high-fidelity simulation for studying variation in intensive care unit admission decision making for critically ill elders with end-stage cancer. Mixed qualitative and quantitative analysis of physician subjects participating in a simulation scenario using hospital set, actors, medical chart, and vital signs tracings. The simulation depicted a 78-yr-old man with metastatic gastric cancer, life-threatening hypoxia most likely attributable to cancer progression, and stable preferences to avoid intensive care unit admission and intubation. Two independent raters assessed the simulations and subjects completed a postsimulation web-based survey and debriefing interview. Peter M. Winter Institute for Simulation Education and Research at the University of Pittsburgh. Twenty-seven hospital-based attending physicians, including 6 emergency physicians, 13 hospitalists, and 8 intensivists. Outcomes included qualitative report of clinical verisimilitude during the debriefing interview, survey-reported diagnosis and prognosis, and observed treatment decisions. Independent variables included physician demographics, risk attitude, and reactions to uncertainty. All (100%) reported that the case and simulation were highly realistic, and their diagnostic and prognostic assessments were consistent with our intent. Eight physicians (29.6%) admitted the patient to the intensive care unit. Among the eight physicians who admitted the patient to the intensive care unit, three (37%) initiated palliation, two (25%) documented the patient's code status (do not intubate/do not resuscitate), and one intubated the patient. Among the 19 physicians who did not admit the patient to the intensive care unit, 13 (68%) initiated palliation and 5 (42%) documented code status. Intensivists and emergency physicians (p = 0.048) were more likely to admit the patient to the intensive care unit. Years since medical school graduation were inversely associated with the

  19. Physician self-care

    African Journals Online (AJOL)

    impact on patient care, increasing the number of medical errors, lowering both patient and physician satisfaction and lengthening the recovery phase.[1-3]. Joan Halifax[4] has taught at programmes in palliative care for health professional caregivers for many years. She identified frequent challenges facing healthcare ...

  20. Improving Resident Communication in the Intensive Care Unit. The Proceduralization of Physician Communication with Patients and Their Surrogates. (United States)

    Miller, David C; McSparron, Jakob I; Clardy, Peter F; Sullivan, Amy M; Hayes, Margaret M


    Effective communication between providers and patients and their surrogates in the intensive care unit (ICU) is crucial for delivery of high-quality care. Despite the identification of communication as a key education focus by the American Board of Internal Medicine, little emphasis is placed on teaching trainees how to effectively communicate in the ICU. Data are conflicting on the best way to teach residents, and institutions vary on their emphasis of communication as a key skill. There needs to be a cultural shift surrounding the education of medical residents in the ICU: communication must be treated with the same emphasis, precision, and importance as placing a central venous catheter in the ICU. We propose that high-stakes communications between physicians and patients or their surrogates must be viewed as a medical procedure that can be taught, assessed, and quality controlled. Medical residents require training, observation, and feedback in specific communication skill sets with the goal of achieving mastery. It is only through supervised training, practice in real time, observation, and feedback that medical residents can become skillful practitioners of communication in the ICU.

  1. Knowledge and Attitude of ER and Intensive Care Unit Physicians toward Do-Not-Resuscitate in a Tertiary Care Center in Saudi Arabia: A Survey Study. (United States)

    Gouda, Alaa; Alrasheed, Norah; Ali, Alaa; Allaf, Ahmad; Almudaiheem, Najd; Ali, Youssuf; Alghabban, Ahmad; Alsalolami, Sami


    Only a few studies from Arab Muslim countries address do-not-resuscitate (DNR) practice. The knowledge of physicians about the existing policy and the attitude towards DNR were surveyed. The objective of this study is to identify the knowledge of the participants of the local DNR policy and barriers of addressing DNR including religious background. A questionnaire has been distributed to Emergency Room (ER) and Intensive Care Unit (ICU) physicians. A total of 112 physicians mostly Muslims (97.3%). About 108 (96.4%) were aware about the existence of DNR policy in our institute. 107 (95.5%) stated that DNR is not against Islamic. Only (13.4%) of the physicians have advance directives and (90.2%) answered they will request to be DNR if they have terminal illness. Lack of patients and families understanding (51.8%) and inadequate training (35.7%) were the two most important barriers for effective DNR discussion. Patients and families level of education (58.0%) and cultural factors (52.7%) were the main obstacles in initiating a DNR order. There is a lack of knowledge about DNR policy which makes the optimization of DNR process difficult. Most physicians wish DNR for themselves and their patients at the end of life, but only a few of them have advance directives. The most important barriers for initializing and discussing DNR were lack of patient understanding, level of education, and the culture of patients. Most of the Muslim physicians believe that DNR is not against Islamic rules. We suggest that the DNR concept should be a part of any training program.

  2. Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review. (United States)

    Visser, Mieke; Deliens, Luc; Houttekier, Dirk


    Although many terminally ill people are admitted to an intensive care unit (ICU) at the end of life, their care is often inadequate because of poor communication by physicians and lack of patient- and family-centred care. The aim of this systematic literature review was to describe physician-related barriers to adequate communication within the team and with patients and families, as well as barriers to patient- and family-centred decision-making, towards the end of life in the ICU. We base our discussion and evaluation on the quality indicators for end-of-life care in the ICU developed by the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup. Four electronic databases (MEDLINE, Embase, CINAHL and PsycINFO) were searched, using controlled vocabulary and free text words, for potentially relevant records published between 2003 and 2013 in English or Dutch. Studies were included if the authors reported on physician-related and physician-reported barriers to adequate communication and decision-making. Barriers were categorized as being related to physicians' knowledge, physicians' attitudes or physicians' practice. Study quality was assessed using design-specific tools. Evidence for barriers was graded according to the quantity and quality of studies in which the barriers were reported. Of 2,191 potentially relevant records, 36 studies were withheld for data synthesis. We determined 90 barriers, of which 46 were related to physicians' attitudes, 24 to physicians' knowledge and 20 to physicians' practice. Stronger evidence was found for physicians' lack of communication training and skills, their attitudes towards death in the ICU, their focus on clinical parameters and their lack of confidence in their own judgment of their patient's true condition. We conclude that many physician-related barriers hinder adequate communication and shared decision-making in ICUs. Better physician education and palliative care guidelines are needed to enhance

  3. Physician Approaches to Conflict with Families Surrounding End-of-Life Decision-making in the Intensive Care Unit. A Qualitative Study. (United States)

    Mehter, Hashim M; McCannon, Jessica B; Clark, Jack A; Wiener, Renda Soylemez


    Families of critically ill patients are often asked to make difficult decisions to pursue, withhold, or withdraw aggressive care or resuscitative measures, exercising "substituted judgment" from the imagined standpoint of the patient. Conflict may arise between intensive care unit (ICU) physicians and family members regarding the optimal course of care. To characterize how ICU physicians approach and manage conflict with surrogates regarding end-of-life decision-making. Semistructured interviews were conducted with 18 critical care physicians from four academically affiliated hospitals. Interview transcripts were analyzed using methods of grounded theory. Physicians described strategies for engaging families to resolve conflict about end-of-life decision-making and tending to families' emotional health. Physicians commonly began by gauging family receptiveness to recommendations from the healthcare team. When faced with resistance to recommendations for less aggressive care, approaches ranged from deference to family wishes to various persuasive strategies designed to change families' minds, and some of those strategies may be counterproductive or harmful. The likelihood of deferring to family in the event of conflict was associated with the perceived sincerity of the family's "substituted judgment" and the ability to control patient pain and suffering. Physicians reported concern for the family's emotional needs and made efforts to alleviate the burden on families by assuming decision-making responsibility and expressing nonabandonment and commitment to the patient. Physicians were attentive to repairing damage to their relationship with the family in the aftermath of conflict. Finally, physicians described their own emotional responses to conflict, ranging from frustration and anxiety to satisfaction with successful resolution of conflict. Critical care physicians described a complex and multilayered approach to physician-family conflict. The reported strategies

  4. A cross-country comparison of intensive care physicians' beliefs about their transfusion behaviour: a qualitative study using the Theoretical Domains Framework. (United States)

    Islam, Rafat; Tinmouth, Alan T; Francis, Jill J; Brehaut, Jamie C; Born, Jennifer; Stockton, Charlotte; Stanworth, Simon J; Eccles, Martin P; Cuthbertson, Brian H; Hyde, Chris; Grimshaw, Jeremy M


    Evidence of variations in red blood cell transfusion practices have been reported in a wide range of clinical settings. Parallel studies in Canada and the United Kingdom were designed to explore transfusion behaviour in intensive care physicians. The aim of this paper is three-fold: first, to explore beliefs that influence Canadian intensive care physicians' transfusion behaviour; second, to systematically select relevant theories and models using the Theoretical Domains Framework (TDF) to inform a future predictive study; and third, to compare its results with the UK study. Ten intensive care unit (ICU) physicians throughout Canada were interviewed. Physicians' responses were coded into theoretical domains, and specific beliefs were generated for each response. Theoretical domains relevant to behaviour change were identified, and specific constructs from the relevant domains were used to select psychological theories. The results from Canada and the United Kingdom were compared. Seven theoretical domains populated by 31 specific beliefs were identified as relevant to the target behaviour. The domains Beliefs about capabilities (confident to not transfuse if patients' clinical condition is stable), Beliefs about consequences (positive beliefs of reducing infection and saving resources and negative beliefs about risking patients' clinical outcome and potentially more work), Social influences (transfusion decision is influenced by team members and patients' relatives), and Behavioural regulation (wide range of approaches to encourage restrictive transfusion) that were identified in the UK study were also relevant in the Canadian context. Three additional domains, Knowledge (it requires more evidence to support restrictive transfusion), Social/professional role and identity (conflicting beliefs about not adhering to guidelines, referring to evidence, believing restrictive transfusion as professional standard, and believing that guideline is important for other

  5. Ethical decision making in intensive care units: a burnout risk factor? Results from a multicentre study conducted with physicians and nurses. (United States)

    Teixeira, Carla; Ribeiro, Orquídea; Fonseca, António M; Carvalho, Ana Sofia


    Ethical decision making in intensive care is a demanding task. The need to proceed to ethical decision is considered to be a stress factor that may lead to burnout. The aim of this study is to explore the ethical problems that may increase burnout levels among physicians and nurses working in Portuguese intensive care units (ICUs). A quantitative, multicentre, correlational study was conducted among 300 professionals. The most crucial ethical decisions made by professionals working in ICU were related to communication, withholding or withdrawing treatments and terminal sedation. A positive relation was found between ethical decision making and burnout in nurses, namely, between burnout and the need to withdraw treatments (p=0.032), to withhold treatments (p=0.002) and to proceed to terminal sedation (p=0.005). This did not apply to physicians. Emotional exhaustion was the burnout subdimension most affected by the ethical decision. The nurses' lack of involvement in ethical decision making was identified as a risk factor. Nevertheless, in comparison with nurses (6%), it was the physicians (34%) who more keenly felt the need to proceed to ethical decisions in ICU. Ethical problems were reported at different levels by physicians and nurses. The type of ethical decisions made by nurses working in Portuguese ICUs had an impact on burnout levels. This did not apply to physicians. This study highlights the need for education in the field of ethics in ICUs and the need to foster inter-disciplinary discussion so as to encourage ethical team deliberation in order to prevent burnout.

  6. Use of the ICU Nurse-Physician Questionnaire (ICU N-P-Q): testing reliability and validity in neonatal intensive care units in Japan. (United States)

    Sasaki, Hatoko; Yonemoto, Naohiro; Mori, Rintaro; Nishida, Toshihiko; Kusuda, Satoshi; Nakayama, Takeo


    Although communication among health providers has become a critical part of improving quality of care, few studies on this topic have been conducted in Japan. This study aimed to examine the reliability and validity of the Intensive Care Unit Nurse-Physician Questionnaire (ICU N-P-Q) for use among nurses and physicians in neonatal ICUs (NICUs) in Japan. A Japanese translation of the ICU N-P-Q was administered to physicians and nurses working at 40 NICUs across Japan, which were participating in the Improvement of NICU Practice and Team Approach Cluster randomized controlled trial (INTACT). We used the principal components analysis to evaluate the factor structure of the instruments. Convergent validity was assessed by examining correlations between the subscales of Communication and Conflict Management of the ICU N-P-Q and the subscales and total score of the Nurse-Physician Collaboration Scale (NPCS). Correlations between the subscales of Communication and Conflict Management by correlation with scales that refer to performance, including Job Satisfaction and Unit Effectiveness, were calculated to test the criterion validity. In total, 2006 questionnaires were completed by 316 physicians and 1690 nurses. The exploratory factor analysis revealed 15 factors in the physicians' questionnaire and 12 in the nurses' questionnaire. Convergent validity was confirmed, except for 'Between-group Accuracy' and 'Cooperativeness' in the physicians' scale, and for 'Between-group Accuracy' and 'Sharing of Patient Information' in the nurses' scale. Correlations between the subscales of communication and outcomes were confirmed in the nurses' questionnaire but were not fully supported in the physicians' questionnaire. Although the psychometric property behaved somewhat differently by occupation, the present findings provide preliminary support for the utility of the common item structure with the original scale, to measure the degree and quality of communication and collaboration

  7. The issue of legal protection of the intensive care unit physician within the context of patient consent to treatment. Part I: conscious patient, refusing treatment. (United States)

    Siewiera, Jacek; Trnka, Jakub; Kübler, Andrzej


    In daily clinical practice, physicians working in intensive care units (ICUs) face situations when their professional duty to protect the patient's life is in conflict with the obligation to respect the will of the patient and to assess his or her chances of treatment. Although the mere fact of conflict between these fundamental values for the ICU physician is a natural and obvious element in the chosen specialisation, many 'non-medical' circumstances make the given conflict not only very difficult but also dangerous for the physician. So far, the ethical and legal aspects of dying have been commented upon by a large group of lawyers and experts involved in the interpretation of the Polish regulations. The authors believe that a detailed analysis of the regulations should be carried out by persons of legal education, possessing a genuine medical experience associated with the specificity of end of life care in ICUs. In this paper, the authors have compared the current regulations of legislative acts of the common law relating to medical activities at anaesthesiology and intensive care units as well as based on the judgements of the common court of law over the past ten years. In the act of dissuading an ICU doctor from a medical procedure, all factors influencing the doctor's responsibility should be taken into account in accordance with the criminal law. In the case of a patient's death due to a refusal of treatment with the patient's full awareness, and given proper notification as to the consequences of refusing treatment, the doctor's responsibility lies under article 150 of the Polish penal code.

  8. The Effects of Emotional Intelligence (EI Items Education on Job Related Stress in Physicians and Nurses who Work in Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Kh Nooryan


    Full Text Available Background & Aim: Intensive care units (ICUs are recognized as stressful environments. The objective of this study was to determine the effects of emotional intelligence education items on job related stress on physicians and nurses who work in intensive care units at hospitals of Yerevan, Armenia. Methods: A interventional study design was implemented with 106 registered hospital physicians and nurses, who were widely distributed all the way through. Case group was taught about 15 E.I items. For data collection, the 20-question Berger situational (overt anxiety questionnaire, the 20-item personality (covert anxiety questionnaire, and the Bar-on emotional intelligence questionnaire with 133 questions were used. Statistical descriptive methods, chi-square (X2 and t-tests were used to analyze data. Results: The research achievements revealed that the average score of the case group`s situational anxiety was 46.59 before intervention, which decreased to 39.95 after the training of the items of emotional intelligence. The average score of situational anxiety of control group was 44.32 before intervention which increased to 44.76 after examination. There was a meaningful statistical difference between case and control group after education of emotional intelligence`s items (p=0.001. Conclusion: Results of the current study showed that physicians and nurses experience high level of stress. The ability to effectively deal with emotion intelligence and emotional information in the workplace assists employees in coping with occupational stress and should be developed in stress managing trainings.

  9. Physician self-care

    African Journals Online (AJOL)

    patient relationship. Both have a ... Doctors often struggle to balance the demands of their own personal and family ... In end-of-life care, especially for children, one can easily .... non-judgemental openness, self-kindness and compassion towards.

  10. Metabonomics and Intensive Care


    Antcliffe, D; Gordon, AC


    This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency medicine 2016. Other selected articles can be found online at Further information about the Annual Update in Intensive Care and Emergency Medicine is available from

  11. Is there a role for physician involvement in introducing research to surrogate decision makers in the intensive care unit? (The Approach trial: a pilot mixed methods study). (United States)

    Burns, K E A; Rizvi, L; Smith, O M; Lee, Y; Lee, J; Wang, M; Brown, M; Parker, M; Premji, A; Leung, D; Hammond Mobilio, M; Gotlib-Conn, L; Nisenbaum, R; Santos, M; Li, Y; Mehta, S


    To assess the feasibility of conducting a randomized trial comparing two strategies [physician (MD) vs. non-physician (non-MD)] for approaching substitute decision makers (SDMs) for research and to evaluate SDMs' experiences in being approached for consent. A pilot mixed methods study of first encounters with SDMs. Of 137 SDMs (162 eligibility events), 67 and 70 were randomized to MD and non-MD introductions, respectively. Eighty SDMs (98 events) provided consent and 21 SDMs (24 events) declined consent for studies, including 2 SDMs who provided and declined consent. We identified few missed introductions [4/52 (7.7 %)] and protocol violations [6/117 (5.1 %)], high comfort, satisfaction and acceptance scores and similar consent rates in both arms. SDMs provided consent significantly more often when a patient update was provided in the MD arm. Most SDMs (85.7 %) felt that physician involvement was inconsequential and preferred physician time to be dedicated to patient care; however, SDM experiences were closely related to their recall of being approached and recall was poor. SDMs highlighted 7 themes of importance to them in research surrogate decision-making. SDMs prioritized the personal attributes of the person approaching them over professional designation and preferred physician time to be dedicated to patient care. A mixed methods design evaluated intervention fidelity and provided the rationale for not proceeding to a larger trial, despite achieving all feasibility metrics in the pilot trial. NCT01232621.

  12. Physician work intensity among medical specialties: emerging evidence on its magnitude and composition. (United States)

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


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

  13. Physician-patient communication in managed care.


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


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

  14. Physicians Care for Connecticut, Inc. Business philosophy. (United States)

    Czarsty, C W; Coffey, J R


    Physicians Care will distinguish itself from competitors in the marketplace through the introduction of products with significant value. Physicians Care is dedicated to working closely with providers to identify the contributions made by each party to the building of product value and to appropriately reward providers for those efforts. The ultimate goal is the development of an insurance company in which physicians are truly invested and committed to best clinical practices and who exercise enhanced autonomy in managing their patient's care with clinical and administrative support from Physicians Care.

  15. [Quality management in intensive care medicine]. (United States)

    Martin, J; Braun, J-P


    Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to extern quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system.

  16. Physician fees and managed care plans. (United States)

    Zwanziger, Jack


    One of the objectives of managed care organizations (MCOs) has been to reduce the rate of growth of health care expenditures, including that of physician fees. Yet, due to a lack of data, no one has been able to determine whether MCOs have been successful in encouraging the growth of price competition in the market for physician services in order to slow the growth in physician fees. This study uses a unique, national-level data set to determine what factors influenced the physician fees that MCOs negotiated during the 1990-92 period. The most influential characteristics were physician supply and managed care penetration, which suggest that the introduction of competition into the health care market was an effective force in reducing physician fees.

  17. The future of intensive care medicine. (United States)

    Blanch, L; Annane, D; Antonelli, M; Chiche, J D; Cuñat, J; Girard, T D; Jiménez, E J; Quintel, M; Ugarte, S; Mancebo, J


    Intensive care medical training, whether as a primary specialty or as secondary add-on training, should include key competences to ensure a uniform standard of care, and the number of intensive care physicians needs to increase to keep pace with the growing and anticipated need. The organisation of intensive care in multiple specialty or central units is heterogeneous and evolving, but appropriate early treatment and access to a trained intensivist should be assured at all times, and intensivists should play a pivotal role in ensuring communication and high-quality care across hospital departments. Structures now exist to support clinical research in intensive care medicine, which should become part of routine patient management. However, more translational research is urgently needed to identify areas that show clinical promise and to apply research principles to the real-life clinical setting. Likewise, electronic networks can be used to share expertise and support research. Individuals, physicians and policy makers need to allow for individual choices and priorities in the management of critically ill patients while remaining within the limits of economic reality. Professional scientific societies play a pivotal role in supporting the establishment of a defined minimum level of intensive health care and in ensuring standardised levels of training and patient care by promoting interaction between physicians and policy makers. The perception of intensive care medicine among the general public could be improved by concerted efforts to increase awareness of the services provided and of the successes achieved. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  18. Intensive Care Unit Delirium

    Directory of Open Access Journals (Sweden)

    Yongsuk Kim


    Full Text Available Delirium is described as a manifestation of acute brain injury and recognized as one of the most common complications in intensive care unit (ICU patients. Although the causes of delirium vary widely among patients, delirium increases the risk of longer ICU and hospital length of stay, death, cost of care, and post-ICU cognitive impairment. Prevention and early detection are therefore crucial. However, the clinical approach toward delirium is not sufficiently aggressive, despite the condition’s high incidence and prevalence in the ICU setting. While the underlying pathophysiology of delirium is not fully understood, many risk factors have been suggested. As a way to improve delirium-related clinical outcome, high-risk patients can be identified. A valid and reliable bedside screening tool is also needed to detect the symptoms of delirium early. Delirium is commonly treated with medications, and haloperidol and atypical antipsychotics are commonly used as standard treatment options for ICU patients although their efficacy and safety have not been established. The approaches for the treatment of delirium should focus on identifying the underlying causes and reducing modifiable risk factors to promote early mobilization.

  19. Spiritual Care in the Intensive Care Unit: A Narrative Review. (United States)

    Ho, Jim Q; Nguyen, Christopher D; Lopes, Richard; Ezeji-Okoye, Stephen C; Kuschner, Ware G


    Spiritual care is an important component of high-quality health care, especially for critically ill patients and their families. Despite evidence of benefits from spiritual care, physicians and other health-care providers commonly fail to assess and address their patients' spiritual care needs in the intensive care unit (ICU). In addition, it is common that spiritual care resources that can improve both patient outcomes and family member experiences are underutilized. In this review, we provide an overview of spiritual care and its role in the ICU. We review evidence demonstrating the benefits of, and persistent unmet needs for, spiritual care services, as well as the current state of spiritual care delivery in the ICU setting. Furthermore, we outline tools and strategies intensivists and other critical care medicine health-care professionals can employ to support the spiritual well-being of patients and families, with a special focus on chaplaincy services.

  20. Trabalho e síndrome da estafa profissional (Síndrome de Burnout em médicos intensivistas de Salvador Professional Burnout Syndrome among intensive care physicians in Salvador, Brazil

    Directory of Open Access Journals (Sweden)

    Márcia Oliveira Staffa Tironi


    Full Text Available OBJETIVO: Descrever a prevalência da Síndrome de Burnout em médicos intensivistas de Salvador, associando-a a dados demográficos e aspectos da situação de trabalho (demanda psicológica e controle sobre o trabalho. MÉTODOS: Um estudo de corte transversal investigou a associação entre aspectos psicossocias do trabalho e a síndrome da estafa profissional em uma população de 297 médicos intensivistas de Salvador, Bahia. Um questionário individual autoaplicável avaliou aspectos psicossociais do trabalho, utilizando o modelo demanda-controle (Job Content Questionnaire e a saúde mental dos médicos, usando Inventário de Burnout de Maslach (MBI. RESULTADOS: Constatou-se elevada sobrecarga de trabalho e de trabalho em regime de plantão. A prevalência da Síndrome da Estafa Profissional (Burnout foi de 7,4% e estava mais fortemente associada com aspectos da demanda psicológica do trabalho do que com o controle deste por parte dos médicos intensivistas. CONCLUSÃO: Médicos com trabalho de alta exigência (alta demanda e baixo controle apresentaram 10,2 vezes mais burnout que aqueles com trabalho de baixa exigência (baixa demanda e alto controle.OBJECTIVE: Describe prevalence of the Burnout syndrome in intensive care physicians of Salvador, associated to demographic data and aspects of the work environment (psychological demand and job control. METHODS: This cross sectional study has investigated the association between work conditions and Burnout Syndrome in a population of 297 Intensive Care Physicians from Salvador, Bahia, Brazil. An individual, self-report questionnaire evaluated the physicians' psychological aspects of work, using the demand-control model (Job Content Questionnaire and their mental health, using the Maslash Burnout Inventory (MBI. RESULTS: The study found work overload,a high proportion of on duty physicians and low income for the hours worked. Prevalence of the Burnout Syndrome was 7.4% and it was more closely

  1. Physicians Experiencing Intense Emotions While Seeing Their Patients: What Happens? (United States)

    Silva, Joana Vilela Da; Carvalho, Irene


    Physicians often deal with emotions arising from both patients and themselves; however, management of intense emotions when they arise in the presence of patients is overlooked in research. The aim of this study is to inspect physicians' intense emotions in this context, how these emotions are displayed, coping strategies used, adjustment behaviors, and the impact of the emotional reactions on the physician-patient relationship. A total of 127 physicians completed a self-report survey, built from a literature review. Participants were recruited in 3 different ways: through a snowball sampling procedure, via institutional e-mails, and in person during service meetings. Fifty-two physicians (43.0%) reported experiencing intense emotions frequently. Although most physicians (88.6%) tried to control their reactions, several reported not controlling themselves. Coping strategies to deal with the emotion at the moment included behavioral and cognitive approaches. Only the type of reaction (but not the emotion's valence, duration, relative control, or coping strategies used) seemed to affect the physician-patient relationship. Choking-up/crying, touching, smiling, and providing support were significantly associated with an immediate positive impact. Withdrawing from the situation, imposing, and defending oneself were associated with a negative impact. Some reactions also had an extended impact into future interactions. Experiencing intense emotions in the presence of patients was frequent among physicians, and the type of reaction affected the clinical relationship. Because many physicians reported experiencing long-lasting emotions, these may have important clinical implications for patients visiting physicians while these emotions last. Further studies are needed to clarify these results.

  2. The changing face of neonatal intensive care in South Africa

    African Journals Online (AJOL)


    Aug 22, 2007 ... of neonatal intensive care facilities for public sector patients ... The main differences between the survivors and non-survivors were in their birth weight and ..... private hospital: comparison of individual physicians' rates, risk.

  3. Access to care: the physician's perspective. (United States)

    Tice, Alan; Ruckle, Janessa E; Sultan, Omar S; Kemble, Stephen


    Private practice physicians in Hawaii were surveyed to better understand their impressions of different insurance plans and their willingness to care for patients with those plans. Physician experiences and perspectives were investigated in regard to reimbursement, formulary limitations, pre-authorizations, specialty referrals, responsiveness to problems, and patient knowledge of their plans. The willingness of physicians to accept new patients from specific insurance company programs clearly correlated with the difficulties and limitations physicians perceive in working with the companies (p<0.0012). Survey results indicate that providers in private practice were much more likely to accept University Health Alliance (UHA) and Hawaii Medical Services Association (HMSA) Commercial insurance than Aloha Care Advantage and Aloha Quest. This was likely related to the more favorable impressions of the services, payments, and lower administrative burden offered by those companies compared with others. Hawaii Medical Journal Copyright 2011.

  4. The Danish Intensive Care Database

    DEFF Research Database (Denmark)

    Christiansen, Christian Fynbo; Møller, Morten Hylander; Nielsen, Henrik


    AIM OF DATABASE: The aim of this database is to improve the quality of care in Danish intensive care units (ICUs) by monitoring key domains of intensive care and to compare these with predefined standards. STUDY POPULATION: The Danish Intensive Care Database (DID) was established in 2007...... and standardized mortality ratios for death within 30 days after admission using case-mix adjustment (initially using age, sex, and comorbidity level, and, since 2013, using SAPS II) for all patients and for patients with septic shock. DESCRIPTIVE DATA: The DID currently includes 335,564 ICU admissions during 2005...

  5. When and Why Do Neonatal and Pediatric Critical Care Physicians Consult Palliative Care? (United States)

    Richards, Claire A; Starks, Helene; O'Connor, M Rebecca; Bourget, Erica; Lindhorst, Taryn; Hays, Ross; Doorenbos, Ardith Z


    Parents of children admitted to neonatal and pediatric intensive care units (ICUs) are at increased risk of experiencing acute and post-traumatic stress disorder. The integration of palliative care may improve child and family outcomes, yet there remains a lack of information about indicators for specialty-level palliative care involvement in this setting. To describe neonatal and pediatric critical care physician perspectives on indicators for when and why to involve palliative care consultants. Semistructured interviews were conducted with 22 attending physicians from neonatal, pediatric, and cardiothoracic ICUs in a single quaternary care pediatric hospital. Transcribed interviews were analyzed using content and thematic analyses. We identified 2 themes related to the indicators for involving palliative care consultants: (1) palliative care expertise including support and bridging communication and (2) organizational factors influencing communication including competing priorities and fragmentation of care. Palliative care was most beneficial for families at risk of experiencing communication problems that resulted from organizational factors, including those with long lengths of stay and medical complexity. The ability of palliative care consultants to bridge communication was limited by some of these same organizational factors. Physicians valued the involvement of palliative care consultants when they improved efficiency and promoted harmony. Given the increasing number of children with complex chronic conditions, it is important to support the capacity of ICU clinical teams to provide primary palliative care. We suggest comprehensive system changes and critical care physician training to include topics related to chronic illness and disability.

  6. The Danish Intensive Care Database

    Directory of Open Access Journals (Sweden)

    Christiansen CF


    Full Text Available Christian Fynbo Christiansen,1 Morten Hylander Møller,2 Henrik Nielsen,1 Steffen Christensen3 1Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, 2Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, 3Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark Aim of database: The aim of this database is to improve the quality of care in Danish intensive care units (ICUs by monitoring key domains of intensive care and to compare these with predefined standards. Study population: The Danish Intensive Care Database (DID was established in 2007 and includes virtually all ICU admissions in Denmark since 2005. The DID obtains data from the Danish National Registry of Patients, with complete follow-up through the Danish Civil Registration System. Main variables: For each ICU admission, the DID includes data on the date and time of ICU admission, type of admission, organ supportive treatments, date and time of discharge, status at discharge, and mortality up to 90 days after admission. Descriptive variables include age, sex, Charlson comorbidity index score, and, since 2010, the Simplified Acute Physiology Score (SAPS II. The variables are recorded with 90%–100% completeness in the recent years, except for SAPS II score, which is 73%–76% complete. The DID currently includes five quality indicators. Process indicators include out-of-hour discharge and transfer to other ICUs for capacity reasons. Outcome indicators include ICU readmission within 48 hours and standardized mortality ratios for death within 30 days after admission using case-mix adjustment (initially using age, sex, and comorbidity level, and, since 2013, using SAPS II for all patients and for patients with septic shock. Descriptive data: The DID currently includes 335,564 ICU admissions during 2005–2015 (average 31,958 ICU admissions per year. Conclusion: The DID provides a

  7. An evaluation of the diagnostic accuracy of the 1991 American College of Chest Physicians/Society of Critical Care Medicine and the 2001 Society of Critical Care Medicine/European Society of Intensive Care Medicine/American College of Chest Physicians/American Thoracic Society/Surgical Infection Society sepsis definition. (United States)

    Zhao, Huifang; Heard, Stephen O; Mullen, Marie T; Crawford, Sybil; Goldberg, Robert J; Frendl, Gyorgy; Lilly, Craig M


    Limited research has been conducted to compare the test characteristics of the 1991 and 2001 sepsis consensus definitions. This study assessed the accuracy of the two sepsis consensus definitions among adult critically ill patients compared to sepsis case adjudication by three senior clinicians. Observational study of patients admitted to intensive care units. Seven intensive care units of an academic medical center. A random sample of 960 patients from all adult intensive care unit patients between October 2007 and December 2008. None. Sensitivity, specificity, and the area under the receiver operating characteristic curve for the two consensus definitions were calculated by comparing the number of patients who met or did not meet consensus definitions vs. the number of patients who were or were not diagnosed with sepsis by adjudication. The 1991 sepsis definition had a high sensitivity of 94.6%, but a low specificity of 61.0%. The 2001 sepsis definition had a slightly increased sensitivity but a decreased specificity, which were 96.9% and 58.3%, respectively. The areas under the receiver operating characteristic curve for the two definitions were not statistically different (0.778 and 0.776, respectively). The sensitivities and areas under the receiver operating characteristic curve of both definitions were lower at the 24-hr time window level than those of the intensive care unit stay level, though their specificities increased slightly. Fever, high white blood cell count or immature forms, low Glasgow coma score, edema, positive fluid balance, high cardiac index, low PaO2/FIO2 ratio, and high levels of creatinine and lactate were significantly associated with sepsis by both definitions and adjudication. Both the 1991 and the 2001 sepsis definition have a high sensitivity but low specificity; the 2001 definition has a slightly increased sensitivity but a decreased specificity compared to the 1991 definition. The diagnostic performances of both definitions were

  8. How is intensive care reimbursed?

    DEFF Research Database (Denmark)

    Bittner, Martin-Immanuel; Donnelly, Maria; van Zanten, Arthur Rh


    Reimbursement schemes in intensive care are more complex than in other areas of healthcare, due to special procedures and high care needs. Knowledge regarding the principles of functioning in other countries can lead to increased understanding and awareness of potential for improvement. This can...... be achieved through mutual exchange of solutions found in other countries. In this review, experts from eight European countries explain their respective intensive care unit reimbursement schemes. Important conclusions include the apparent differences in the countries' reimbursement schemes---despite all...... of them originating from a DRG system, the high degree of complexity found, and the difficulties faced in several countries when collecting the data for this collaborative work. This review has been designed to help the intensivist clinician and researcher to understanding neighbouring countries...

  9. Studying physician effects on patient outcomes: physician interactional style and performance on quality of care indicators. (United States)

    Franks, Peter; Jerant, Anthony F; Fiscella, Kevin; Shields, Cleveland G; Tancredi, Daniel J; Epstein, Ronald M


    Many prior studies which suggest a relationship between physician interactional style and patient outcomes may have been confounded by relying solely on patient reports, examining very few patients per physician, or not demonstrating evidence of a physician effect on the outcomes. We examined whether physician interactional style, measured both by patient report and objective encounter ratings, is related to performance on quality of care indicators. We also tested for the presence of physician effects on the performance indicators. Using data on 100 US primary care physician (PCP) claims data on 1,21,606 of their managed care patients, survey data on 4746 of their visiting patients, and audiotaped encounters of 2 standardized patients with each physician, we examined the relationships between claims-based quality of care indicators and both survey-derived patient perceptions of their physicians and objective ratings of interactional style in the audiotaped standardized patient encounters. Multi-level models examined whether physician effects (variance components) on care indicators were mediated by patient perceptions or objective ratings of interactional style. We found significant physician effects associated with glycohemoglobin and cholesterol testing. There was also a clinically significant association between better patient perceptions of their physicians and more glycohemoglobin testing. Multi-level analyses revealed, however, that the physician effect on glycohemoglobin testing was not mediated by patient perceived physician interaction style. In conclusion, similar to prior studies, we found evidence of an apparent relationship between patient perceptions of their physician and patient outcomes. However, the apparent relationships found in this study between patient perceptions of their physicians and patient care processes do not reflect physician style, but presumably reflect unmeasured patient confounding. Multi-level modeling may contribute to better

  10. Delirium in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Suresh Arumugam


    Full Text Available Delirium is characterized by impaired cognition with nonspecific manifestations. In critically ill patients, it may develop secondary to multiple precipitating or predisposing causes. Although it can be a transient and reversible syndrome, its occurrence in Intensive Care Unit (ICU patients may be associated with long-term cognitive dysfunction. This condition is often under-recognized by treating physicians, leading to inappropriate management. For appropriate management of delirium, early identification and risk factor assessment are key factors. Multidisciplinary collaboration and standardized care can enhance the recognition of delirium. Interdisciplinary team working, together with updated guideline implementation, demonstrates proven success in minimizing delirium in the ICU. Moreover, should the use of physical restraint be necessary to prevent harm among mechanically ventilated patients, ethical clinical practice methodology must be employed. This traditional narrative review aims to address the presentation, risk factors, management, and ethical considerations in the management of delirium in ICU settings.

  11. The effect of physician staffing model on patient outcomes in a medical progressive care unit. (United States)

    Yoo, E J; Damaghi, N; Shakespeare, W G; Sherman, M S


    Although evidence supports the impact of intensivist physician staffing in improving intensive care unit (ICU) outcomes, the optimal coverage for progressive care units (PCU) is unknown. We sought to determine how physician staffing models influence outcomes for intermediate care patients. We conducted a retrospective observational comparison of patients admitted to the medical PCU of an academic hospital during 12-month periods of high-intensity and low-intensity staffing. A total of 318 PCU patients were eligible for inclusion (143 high-intensity and 175 low-intensity). We found that low-intensity patients were more often stepped up from the emergency department and floor, whereas high-intensity patients were ICU transfers (61% vs 42%, P = .001). However, Mortality Probability Model scoring was similar between the 2 groups. In adjusted analysis, there was no association between intensity of staffing and hospital mortality (odds ratio, 0.84; 95% confidence interval, 0.36-1.99; P = .69) or PCU mortality (odds ratio, 0.96; 95% confidence interval, 0.38-2.45; P = .69). There was also no difference in subsequent ICU admission rates or in PCU length of stay. We found no evidence that high-intensity intensivist physician staffing improves outcomes for intermediate care patients. In a strained critical care system, our study raises questions about the role of the intensivist in the graded care options between intensive and conventional ward care. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: Intensive care benefit for the elderly

    DEFF Research Database (Denmark)

    Sprung, Charles L; Artigas, Antonio; Kesecioglu, Jozef


    on mortality and intensive care unit benefit, specifically for elderly patients. DESIGN:: Prospective, observational study of triage decisions from September 2003 until March 2005. SETTING:: Eleven intensive care units in seven European countries. PATIENTS:: All patients >18 yrs with an explicit request......RATIONALE:: Life and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly. OBJECTIVE:: To determine the effect of intensive care unit triage decisions...... care unit rejections than younger patients and have a higher mortality when admitted, the mortality benefit appears greater for the elderly. Physicians should consider changing their intensive care unit triage practices for the elderly....

  13. Pharmaceutical industry gifts to physicians: patient beliefs and trust in physicians and the health care system. (United States)

    Grande, David; Shea, Judy A; Armstrong, Katrina


    Pharmaceutical industry gifts to physicians are common and influence physician behavior. Little is known about patient beliefs about the prevalence of these gifts and how these beliefs may influence trust in physicians and the health care system. To measure patient perceptions about the prevalence of industry gifts and their relationship to trust in doctors and the health care system. Cross sectional random digit dial telephone survey. African-American and White adults in 40 large metropolitan areas. Respondents' beliefs about whether their physician and physicians in general receive industry gifts, physician trust, and health care system distrust. Overall, 55% of respondents believe their physician receives gifts, and 34% believe almost all doctors receive gifts. Respondents of higher socioeconomic status (income, education) and younger age were more likely to believe their physician receives gifts. In multivariate analyses, those that believe their personal physician receives gifts were more likely to report low physician trust (OR 2.26, 95% CI 1.56-3.30) and high health care system distrust (OR 2.03, 95% CI 1.49-2.77). Similarly, those that believe almost all doctors accept gifts were more likely to report low physician trust (OR 1.69, 95% CI 1.25-2.29) and high health care system distrust (OR 2.57, 95% CI 1.82-3.62). Patients perceive physician-industry gift relationships as common. Patients that believe gift relationships exist report lower levels of physician trust and higher rates of health care system distrust. Greater efforts to limit industry-physician gifts could have positive effects beyond reducing influences on physician behavior.

  14. Bridges to Excellence--recognizing high-quality care: analysis of physician quality and resource use. (United States)

    Rosenthal, Meredith B; de Brantes, Francois S; Sinaiko, Anna D; Frankel, Matthew; Robbins, Russell D; Young, Sara


    To examine whether physicians who sought and received Bridges to Excellence (BTE) recognition performed better than similar physicians on a standardized set of population-based performance measures. Cross-sectional comparison of performance data. Using a claims dataset of all commercially insured members from 6 health plans in Massachusetts, we examined population-based measures of quality and resource use for physicians recognized by the BTE programs Physician Office Link and Diabetes Care Link, compared with nonrecognized physicians in the same specialties. Differences in performance were tested using generalized linear models. Physician Office Link-recognized physicians performed significantly better than their nonrecognized peers on measures of cervical cancer screening, mammography, and glycosylated hemoglobin testing. Diabetes Care Link-recognized physicians performed significantly better on all 4 diabetes process measures of quality, with the largest differences observed in microalbumin screening (17.7%). Patients of Physician Office Link-recognized physicians had a significantly greater percentage of their resource use accounted for by evaluation and management services (3.4%), and a smaller percentage accounted for by facility (-1.6%), inpatient ancillary (-0.1%), and nonmanagement outpatient services (-1.0%). After adjustment for patient age and sex, and case mix, Physician Office Link-recognized physicians had significantly fewer episodes per patient (0.13) and lower resource use per episode (dollars 130), but findings were mixed for Diabetes Care Link-recognized physicians. Our findings suggest that the BTE approach to ascertaining physician quality identifies physicians who perform better on claims-based quality measures and primary care physicians who use a less resource-intensive practice style.

  15. Nutritional Care in Iranian Intensive Care Units (United States)


    Intensive care units (ICUs) provides intensive treatment medicine to avoid complications such as malnutrition, infection and even death. As very little is currently known about the nutritional practices in Iranian ICUs, this study attempted to assess the various aspects of current nutrition support practices in Iranian ICUs. We conducted a cross-sectional study on 150 critically ill patients at 18 ICUs in 12 hospitals located in 2 provinces of Iran from February 2015 to March 2016. Data were collected through interview with supervisors of ICUs, medical record reviews and direct observation of patients during feeding. Our study showed that hospital-prepared enteral tube feeding formulas are the main formulas used in Iranian hospitals. None of the dietitians worked exclusively an ICU and only 30% of patients received diet counselling. Regular monitoring of nutritional status, daily energy and protein intake were not recorded in any of the participating ICUs. Patients were not monitored for anthropometric measurements such as mid-arm circumference (MAC) and electrolyte status. The nasogastric tube was not switched to percutaneous endoscopic gastrostomy or jejunostomy (PEG/PEGJ) in approximately 85% of patients receiving long-term enteral nutrition (EN) support. Our findings demonstrated that the quality of nutritional care was inappropriate in Iranian ICUs and improvement of nutritional care services within Iranian ICUs is necessary. PMID:29713622

  16. Parental perception of neonatal intensive care in public sector ...

    African Journals Online (AJOL)

    Background. Little is known about parental experience and decision making with regard to premature infants requiring intensive care in developing countries. We undertook this study to characterise parents' experience of physician counselling and their role in making life-support decisions for very low-birth-weight (VLBW) ...

  17. Management of Tracheostomy: A Survey of Dutch Intensive Care Units

    NARCIS (Netherlands)

    Veelo, Denise P.; Schultz, Marcus J.; Phoa, Kai Y. N.; Dongelmans, Dave A.; Binnekade, Jan M.; Spronk, Peter E.


    OBJECTIVE: To determine tracheostomy-management practices in Dutch intensive care units (ICUs) and post-ICU step-down facilities. METHODS: We surveyed the physician medical directors of all Dutch nonpediatric ICUs that have : 5 beds suitable for mechanical ventilation. The survey asked for

  18. Intensive and critical care medicine

    International Nuclear Information System (INIS)

    Aochi, Osamu; Amaha, Keisuke; Takeshita, Hiroshi


    Eight papers in this volume are in INIS scope, respectively dealing with the scientific use of the chest radiograph in intensive care unit, xenon computed tomography cerebral blood flow in diagnosis and management of symptomatic vasospasm and severe head injury, therapeutic relevance of MRI in acute head trauma, computerized tomography in the diagnosis of cerebral air embolism, thallium 201 myocardial perfusion during weaning from mechanical ventilation, thoracic computed tomography for ICU patients, and the effect of xenon inhalation upon internal carotid artery blood flow in awake monkeys. (H.W.). refs.; figs.; tabs

  19. Burnout syndrome among physicians working in primary health care ...

    African Journals Online (AJOL)

    Objective: The aim of the study was to reveal extent of burnout problem among primary care physicians and the socio-demographic factors affecting its occurrence. Methods: The target population included all physicians working in these two health regions in Kuwait. Two hundred physicians working in the primary health ...

  20. Communication and Decision-Making About End-of-Life Care in the Intensive Care Unit. (United States)

    Brooks, Laura Anne; Manias, Elizabeth; Nicholson, Patricia


    Clinicians in the intensive care unit commonly face decisions involving withholding or withdrawing life-sustaining therapy, which present many clinical and ethical challenges. Communication and shared decision-making are key aspects relating to the transition from active treatment to end-of-life care. To explore the experiences and perspectives of nurses and physicians when initiating end-of-life care in the intensive care unit. The study was conducted in a 24-bed intensive care unit in Melbourne, Australia. An interpretative, qualitative inquiry was used, with focus groups as the data collection method. Intensive care nurses and physicians were recruited to participate in a discipline-specific focus group. Focus group discussions were audio-recorded, transcribed, and subjected to thematic data analysis. Five focus groups were conducted; 17 nurses and 11 physicians participated. The key aspects discussed included communication and shared decision-making. Themes related to communication included the timing of end-of-life care discussions and conducting difficult conversations. Implementation and multidisciplinary acceptance of end-of-life care plans and collaborative decisions involving patients and families were themes related to shared decision-making. Effective communication and decision-making practices regarding initiating end-of-life care in the intensive care unit are important. Multidisciplinary implementation and acceptance of end-of-life care plans in the intensive care unit need improvement. Clear organizational processes that support the introduction of nurse and physician end-of-life care leaders are essential to optimize outcomes for patients, family members, and clinicians. ©2017 American Association of Critical-Care Nurses.

  1. Sleep in intensive care unit

    DEFF Research Database (Denmark)

    Boyko, Yuliya; Jennum, Poul; Nikolic, Miki


    PURPOSE: To determine if improving intensive care unit (ICU) environment would enhance sleep quality, assessed by polysomnography (PSG), in critically ill mechanically ventilated patients. MATERIALS AND METHODS: Randomized controlled trial, crossover design. The night intervention "quiet routine...... Medicine) sleep scoring criteria were insufficient for the assessment of polysomnograms. Modified classification for sleep scoring in critically ill patients, suggested by Watson et al. (Crit Care Med 2013;41:1958-1967), was used. RESULTS: Sound level analysis showed insignificant effect...... patients. We were not able to further reduce the already existing low noise levels in the ICU and did not find any association between the environmental intervention and the presence of normal sleep characteristics in the PSG....

  2. Physicians' opinions on palliative care and euthanasia in the Netherlands. (United States)

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


    In recent decades significant developments in end-of-life care have taken place in The Netherlands. There has been more attention for palliative care and alongside the practice of euthanasia has been regulated. The aim of this paper is to describe the opinions of physicians with regard to the relationship between palliative care and euthanasia, and determinants of these opinions. Cross-sectional. Representative samples of physicians (n = 410), relatives of patients who died after euthanasia and physician-assisted suicide (EAS; n = 87), and members of the Euthanasia Review Committees (ERCs; n = 35). Structured interviews with physicians and relatives of patients, and a written questionnaire for the members of the ERCs. Approximately half of the physicians disagreed and one third agreed with statements describing the quality of palliative care in The Netherlands as suboptimal and describing the expertise of physicians with regard to palliative care as insufficient. Almost two thirds of the physicians disagreed with the suggestion that adequate treatment of pain and terminal care make euthanasia redundant. Having a religious belief, being a nursing home physician or a clinical specialist, never having performed euthanasia, and not wanting to perform euthanasia were related to the belief that adequate treatment of pain and terminal care could make euthanasia redundant. The study results indicate that most physicians in The Netherlands are not convinced that palliative care can always alleviate all suffering at the end of life and believe that euthanasia could be appropriate in some cases.

  3. Physicians' impression on the elders' functionality influences decision making for emergency care. (United States)

    Rodríguez-Molinero, Alejandro; López-Diéguez, María; Tabuenca, Ana I; de la Cruz, Juan J; Banegas, José R


    This study analyzes the elements that compose the emergency physicians' criterion for selecting elderly patients for intensive care treatment. This issue has not been studied in-depth. A cross-sectional study was conducted at 4 university teaching hospitals, covering 101 randomly selected elderly patients admitted to emergency department and their respective physicians. Physicians were asked to forecast their plans for treatment or therapeutic abstention, in the event that patients might require aggressive measures (cardiopulmonary resuscitation or admission to critical care units). Data were collected on physicians' reasons for taking such decisions and their patients' functional capacity and cognitive status (Katz index and Informant Questionnaire on Cognitive Decline in the Elderly). A logistic regression model was constructed taking physicians' decisions as the dependent variables and adjusting for patient factors and physician impressions. The functional status reported by reliable informants and the mental status measured by validated instruments were not coincident with the physicians' perception (functional status κ, 0.47; mental status κ, 0.26). A multivariate analysis showed that the age and the functional and mental status of patients, as perceived by the physicians, were the variables that better explained the physicians' decisions. Physicians' impressions on the functional and mental status of their patients significantly influenced their selection of patients for high-intensity treatments despite the fact that some of these impressions were not correct. Copyright © 2010 Elsevier Inc. All rights reserved.

  4. The patient experience of intensive care

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Bergbom, Ingegerd; Lindahl, Berit


    : Nordic intensive care units. PARTICIPANTS: Patients in Nordic intensive care units. METHODS: We performed a literature search of qualitative studies of the patient experience of intensive care based on Nordic publications in 2000-2013. We searched the following databases: PubMed, CINAHL, Scopus, and Psyc...

  5. Physicians' fees and public medical care programs. (United States)

    Lee, R H; Hadley, J


    In this article we develop and estimate a model of physicians' pricing that explicitly incorporates the effects of Medicare and Medicaid demand subsidies. Our analysis is based on a multiperiod model in which physicians are monopolistic competitors supplying services to several markets. The implications of the model are tested using data derived from claims submitted by a cohort of 1,200 California physicians during the years 1972-1975. We conclude that the demand for physician's services is relatively elastic; that increases in the local supply of physicians reduce prices somewhat; that physicians respond strategically to attempts to control prices through the customary-prevailing-reasonable system; and that price controls limit the rate of increase in physicians' prices. The analysis identifies a family of policies that recognize the monopsony power of public programs and may change the cost-access trade-off. PMID:7021479

  6. Intensive Care for Eclampic Coma

    Directory of Open Access Journals (Sweden)

    V. V. Moroz


    Full Text Available Objective: to enhance the efficiency of treatment of puerperas with eclampic coma, by substantiating, developing, and introducing new algorithms for correction of systemic hemodynamic, metabolic disturbances, and perfusion-metabolic changes in brain tissues. Subjects and methods. Studies were conducted in 18 puerperas with eclampic coma (Group 2 in whom the authors used a new treatment algorithm aimed at maintaining baseline cerebral perfusion pressure (CPP, restoring volemic levels at the expense of interstitial fluid. A control group (Group 1 included 30 patients who received conventional standard therapy. Regional cerebral circulation was measured by a non-invasive (inhalation radioisotopic method, by applying the tracer 131Xe, as described by V. D. Obrist et al., on a modified КПРДИ-1 apparatus (USSR. The rate of brain oxygen uptake was determined from the oxygen content between the artery and the internal jugular vein. Central hemodynamic parameters were studied by the direct method of right heart catheterization using a flow-directed Swan-Ganz catheter. The volumes of total and extracellular fluids were estimated using 20% urea and mannitol solutions, respectively, at 0.2 g/kg weight by the procedure of V. M. Mogen. Circulating blood volume (CBV was determined by a radioisotopic method using 131iodine albumin on an УPI-7 apparatus (USSR. Cerebral spinal fluid pressure was measured by an ИиНД apparatus. Studies were made in four steps: 1 on admission; 2 on days 2—3; 3 during emergence from coma; 4 before transition. Results. The use of the new algorithm for intensive care for eclampic coma, which is aimed at improving the perfusion metabolic provision of brain structures, with a reduction in mean blood pressure by 10—15% of the baseline level, by administering magnesium sulfate and nimodipine, and at compensating for CBV by high-molecular-weight hydroxyethylated starch (stabizol, ensured early emergence from a comatose state

  7. Health care workplace discrimination and physician turnover. (United States)

    Nunez-Smith, Marcella; Pilgrim, Nanlesta; Wynia, Matthew; Desai, Mayur M; Bright, Cedric; Krumholz, Harlan M; Bradley, Elizabeth H


    To examine the association between physician race/ ethnicity, workplace discrimination, and physician job turnover. Cross-sectional, national survey conducted in 2006-2007 of practicing physicians (n = 529) randomly identified via the American Medical Association Masterfile and the National Medical Association membership roster. We assessed the relationships between career racial/ethnic discrimination at work and several career-related dependent variables, including 2 measures of physician turnover, career satisfaction, and contemplation of career change. We used standard frequency analyses, odds ratios and chi2 statistics, and multivariate logistic regression modeling to evaluate these associations. Physicians who self-identified as nonmajority were significantly more likely to have left at least 1 job because of workplace discrimination (black, 29%; Asian, 24%; other race, 21%; Hispanic/Latino, 20%; white, 9%). In multivariate models, having experienced racial/ethnic discrimination at work was associated with high job turnover (adjusted odds ratio, 2.7; 95% CI, 1.4-4.9). Among physicians who experienced workplace discrimination, only 45% of physicians were satisfied with their careers (vs 88% among those who had not experienced workplace discrimination, p value workplace discrimination, p value Workplace discrimination is associated with physician job turnover, career dissatisfaction, and contemplation of career change. These findings underscore the importance of monitoring for workplace discrimination and responding when opportunities for intervention and retention still exist.

  8. Occupational Variation in End-of-Life Care Intensity. (United States)

    Hyder, Joseph A; Haring, R Sterling; Sturgeon, Daniel; Gazarian, Priscilla K; Jiang, Wei; Cooper, Zara; Lipsitz, Stuart R; Prigerson, Holly G; Weissman, Joel S


    End-of-life (EOL) care intensity is known to vary by secular and geographic patterns. US physicians receive less aggressive EOL care than the general population, presumably the result of preferences shaped by work-place experience with EOL care. We investigated occupation as a source of variation in EOL care intensity. Across 4 states, we identified 660 599, nonhealth maintenance organization Medicare beneficiaries aged ≥66 years who died between 2004 and 2011. Linking death certificates, we identified beneficiaries with prespecified occupations: nurses, farmers, clergy, mortuary workers, homemakers, first-responders, veterinary workers, teachers, accountants, and the general population. End-of-life care intensity over the last 6 months of life was assessed using 5 validated measures: (1) Medicare expenditures, rates of (2) hospice, (3) surgery, (4) intensive care, and (5) in-hospital death. Occupation was a source of large variation in EOL care intensity across all measures, before and after adjustment for sex, education, age-adjusted Charlson Comorbidity Index, race/ethnicity, and hospital referral region. For example, absolute and relative adjusted differences in expenditures were US$9991 and 42% of population mean expenditure ( P EOL care intensity measures, teachers (5 of 5), homemakers (4 of 5), farmers (4 of 5), and clergy (3 of 5) demonstrated significantly less aggressive care. Mortuary workers had lower EOL care intensity (4 of 5) but small numbers limited statistical significance. Occupations with likely exposure to child development, death/bereavement, and naturalistic influences demonstrated lower EOL care intensity. These findings may inform patients and clinicians navigating choices around individual EOL care preferences.

  9. The Relationships among Physician Nonverbal Immediacy and Measures of Patient Satisfaction with Physician Care. (United States)

    Conlee, Connie J.; And Others


    Examines the relationship among four dimensions of patient satisfaction with physician care and nonverbal immediacy. Finds a significant positive correlation between nonverbal immediacy and overall patient satisfaction, with the strongest correlation to the attention/respect factor. (SR)

  10. Physician Networks and Ambulatory Care-sensitive Admissions. (United States)

    Casalino, Lawrence P; Pesko, Michael F; Ryan, Andrew M; Nyweide, David J; Iwashyna, Theodore J; Sun, Xuming; Mendelsohn, Jayme; Moody, James


    Research on the quality and cost of care traditionally focuses on individual physicians or medical groups. Social network theory suggests that the care a patient receives also depends on the network of physicians with whom a patient's physician is connected. The objectives of the study are: (1) identify physician networks; (2) determine whether the rate of ambulatory care-sensitive hospital admissions (ACSAs) varies across networks--even different networks at the same hospital; and (3) determine the relationship between ACSA rates and network characteristics. We identified networks by applying network detection algorithms to Medicare 2008 claims for 987,000 beneficiaries in 5 states. We estimated a fixed-effects model to determine the relationship between networks and ACSAs and a multivariable model to determine the relationship between network characteristics and ACSAs. We identified 417 networks. Mean size: 129 physicians; range, 26-963. In the fixed-effects model, ACSA rates varied significantly across networks: there was a 46% difference in rates between networks at the 25th and 75th performance percentiles. At 95% of hospitals with admissions from 2 networks, the networks had significantly different ACSA rates; the mean difference was 36% of the mean ACSA rate. Networks with a higher percentage of primary-care physicians and networks in which patients received care from a larger number of physicians had higher ACSA rates. Physician networks have a relationship with ACSAs that is independent of the physicians in the network. Physician networks could be an important focus for understanding variations in medical care and for intervening to improve care.

  11. Transition from specialist to primary diabetes care: A qualitative study of perspectives of primary care physicians

    Directory of Open Access Journals (Sweden)

    Liddy Clare


    Full Text Available Abstract Background The growing prevalence of diabetes and heightened awareness of the benefits of early and intensive disease management have increased service demands and expectations not only of primary care physicians but also of diabetes specialists. While research has addressed issues related to referral into specialist care, much less has been published about the transition from diabetes specialists back to primary care. Understanding the concerns of family physicians related to discharge of diabetes care from specialist centers can support the development of strategies that facilitate this transition and result in broader access to limited specialist services. This study was undertaken to explore primary care physician (PCP perspectives and concerns related to reassuming responsibility for diabetes care after referral to a specialized diabetes center. Methods Qualitative data were collected through three focus groups. Sessions were audio-taped and transcribed verbatim. Data were coded and sorted with themes identified using a constant comparison method. The study was undertaken through the regional academic referral center for adult diabetes care in Ottawa, Canada. Participants included 22 primary care physicians representing a variety of referral frequencies, practice types and settings. Results Participants described facilitators and barriers to successful transition of diabetes care at the provider, patient and systems level. Major facilitators included clear communication of a detailed, structured plan of care, ongoing access to specialist services for advice or re-referral, continuing education and mentoring for PCPs. Identified provider barriers were gaps in PCP knowledge and confidence related to diabetes treatment, excessive workload and competing time demands. Systems deterrents included reimbursement policies for health professionals and inadequate funding for diabetes medications and supplies. At the PCP-patient interface

  12. The Concept of Ethics in the Intensive Care

    Directory of Open Access Journals (Sweden)

    Kutay Alpir


    Full Text Available The concept of ethics in the intensive care unit has developed in the last 50 years along with the advancements and regulations in this area of medicine. Especially by the use of life-supportive equipment in the intensive care units and the resulting elongation in the terminal stage of life has led to newly described clinical conditions. These conditions include vegetative state, brain death, dissociated heart death. The current trend aiming to provide the best health care facilities with optimal costs resulted with regulations. The conflicts in the patient-physician relations resulting from these regulations has resolved to some extent by the studies of intensive care unit ethics. The major ethical topics in the intensive care are the usage of autonomy right, the selection of patients to be admitted to the intensive care unit and the limitation of the treatment. The patient selection is optimized by triage and allocation, the limitation of the treatment is done by the means of withdrawal and withhold, and the usage of autonomy right is tried to be solved by proxy, living will and ethics committee regulations. The ethical regulations have found partial solutions to the conflicts. For the ultimate solution much work about the subject has to be done. (Journal of the Turkish Society of Intensive Care 2010; 8: 77-84

  13. Predictors and Outcomes of Burnout in Primary Care Physicians. (United States)

    Rabatin, Joseph; Williams, Eric; Baier Manwell, Linda; Schwartz, Mark D; Brown, Roger L; Linzer, Mark


    To assess relationships between primary care work conditions, physician burnout, quality of care, and medical errors. Cross-sectional and longitudinal analyses of data from the MEMO (Minimizing Error, Maximizing Outcome) Study. Two surveys of 422 family physicians and general internists, administered 1 year apart, queried physician job satisfaction, stress and burnout, organizational culture, and intent to leave within 2 years. A chart audit of 1795 of their adult patients with diabetes and/or hypertension assessed care quality and medical errors. Women physicians were almost twice as likely as men to report burnout (36% vs 19%, P stress (P work conditions (P work control (P work-life balance (P burnout, care quality, and medical errors. Burnout is highly associated with adverse work conditions and a greater intention to leave the practice, but not with adverse patient outcomes. Care quality thus appears to be preserved at great personal cost to primary care physicians. Efforts focused on workplace redesign and physician self-care are warranted to sustain the primary care workforce. © The Author(s) 2015.

  14. Physician Knowledge and Attitudes around Confidential Care for Minor Patients. (United States)

    Riley, Margaret; Ahmed, Sana; Reed, Barbara D; Quint, Elisabeth H


    Minor adolescent patients have a legal right to access certain medical services confidentially without parental consent or notification. We sought to assess physicians' knowledge of these laws, attitudes around the provision of confidential care to minors, and barriers to providing confidential care. An anonymous online survey was sent to physicians in the Departments of Family Medicine, Internal Medicine-Pediatrics, Obstetrics/Gynecology, and Pediatrics at the University of Michigan. Response rate was 40% (259/650). The majority of physicians felt comfortable addressing sexual health, mental health, and substance use with adolescent patients. On average, physicians answered just over half of the legal knowledge questions correctly (mean 56.6% ± 16.7%). The majority of physicians approved of laws allowing minors to consent for confidential care (90.8% ± 1.7% approval), while substantially fewer (45.1% ± 4.5%) approved of laws allowing parental notification of this care at the physician's discretion. Most physicians agreed that assured access to confidential care should be a right for adolescents. After taking the survey most physicians (76.6%) felt they needed additional training on confidentiality laws. The provision of confidential care to minors was perceived to be most inhibited by insurance issues, parental concerns/relationships with the family, and issues with the electronic medical record. Physicians are comfortable discussing sensitive issues with adolescents and generally approve of minor consent laws, but lack knowledge about what services a minor can access confidentially. Further research is needed to assess best methods to educate physicians about minors' legal rights to confidential healthcare services. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  15. Fatores que tornam estressante o trabalho de médicos e enfermeiros em terapia intensiva pediátrica e neonatal: estudo de revisão bibliográfica Factors that cause stress in physicians and nurses working in a pediatric and neonatal intensive care unit: bibliographic review

    Directory of Open Access Journals (Sweden)

    Monalisa de Cássia Fogaça


    Full Text Available OBJETIVOS: Revisão de literatura sobre estresse ocupacional e síndrome de burnout em médicos e enfermeiros que trabalham em unidade de terapia intensiva pediátrica e neonatal. MÉTODOS: Os artigos foram identificados a partir das bases de dados MedLine, LILACS e SciElo, usando as palavras-chave estresse, burnout, médicos, enfermagem, unidade de terapia intensiva, unidade de cuidados intensivos pediátricos e unidades de cuidados intensivos neonatais. O período pesquisado foi de 1990 a 2007. RESULTADOS: Médicos e enfermeiros que trabalham em unidade de terapia intensiva pediátrica e neonatal são candidatos a apresentarem estresse, alterações psicológicas e síndrome de Burnout. Pesquisas sobre o tema identificaram alterações importantes que acometem médicos e enfermeiros intensivistas: sobrecarga de trabalho, burnout, desejo de abandonar o trabalho e níveis elevados de cortisol entre outros fatores. CONCLUSÕES: Os profissionais que trabalham em unidade de terapia intensiva pediátrica e neonatal , pela especificidade do seu trabalho, estão expostos ao risco do estresse ocupacional e, conseqüentemente ao Burnout. Estes dados sugerem a necessidade de serem feitas pesquisas, com o objetivo de desenvolver medidas preventivas e modelos de intervenção.OBJECTIVES: Bibliographic review on occupational stress and burnout presence in physicians and nurses that work in pediatric and neonatal intensive care units. METHODS: The articles were selected from the MedLine, LILACS and SciElo data base using the key words: stress, burnout, physicians, nursing, intensive care unit, pediatric intensive care unit and neonatal intensive care unit. The studied period ranged from 1990 to 2007. RESULTS: Health professionals who work in pediatric and neonatal intensive care units are strong candidates for developing stress, psychological alterations and burnout syndrome. Researches on this subject identified important alterations suffered by these

  16. Oncologists' perspectives on post-cancer treatment communication and care coordination with primary care physicians. (United States)

    Klabunde, C N; Haggstrom, D; Kahn, K L; Gray, S W; Kim, B; Liu, B; Eisenstein, J; Keating, N L


    Post-treatment cancer care is often fragmented and of suboptimal quality. We explored factors that may affect cancer survivors' post-treatment care coordination, including oncologists' use of electronic technologies such as e-mail and integrated electronic health records (EHRs) to communicate with primary care physicians (PCPs). We used data from a survey (357 respondents; participation rate 52.9%) conducted in 2012-2013 among medical oncologists caring for patients in a large US study of cancer care delivery and outcomes. Oncologists reported their frequency and mode of communication with PCPs, and role in providing post-treatment care. Seventy-five per cent said that they directly communicated with PCPs about post-treatment status and care recommendations for all/most patients. Among those directly communicating with PCPs, 70% always/usually used written correspondence, while 36% always/usually used integrated EHRs; telephone and e-mail were less used. Eighty per cent reported co-managing with PCPs at least one post-treatment general medical care need. In multivariate-adjusted analyses, neither communication mode nor intensity were associated with co-managing survivors' care. Oncologists' reliance on written correspondence to communicate with PCPs may be a barrier to care coordination. We discuss new research directions for enhancing communication and care coordination between oncologists and PCPs, and to better meet the needs of cancer survivors post-treatment. © 2017 John Wiley & Sons Ltd.

  17. Estimated time spent on preventive services by primary care physicians

    Directory of Open Access Journals (Sweden)

    Gradison Margaret


    Full Text Available Abstract Background Delivery of preventive health services in primary care is lacking. One of the main barriers is lack of time. We estimated the amount of time primary care physicians spend on important preventive health services. Methods We analyzed a large dataset of primary care (family and internal medicine visits using the National Ambulatory Medical Care Survey (2001–4; analyses were conducted 2007–8. Multiple linear regression was used to estimate the amount of time spent delivering each preventive service, controlling for demographic covariates. Results Preventive visits were longer than chronic care visits (M = 22.4, SD = 11.8, M = 18.9, SD = 9.2, respectively. New patients required more time from physicians. Services on which physicians spent relatively more time were prostate specific antigen (PSA, cholesterol, Papanicolaou (Pap smear, mammography, exercise counseling, and blood pressure. Physicians spent less time than recommended on two "A" rated ("good evidence" services, tobacco cessation and Pap smear (in preventive visits, and one "B" rated ("at least fair evidence" service, nutrition counseling. Physicians spent substantial time on two services that have an "I" rating ("inconclusive evidence of effectiveness", PSA and exercise counseling. Conclusion Even with limited time, physicians address many of the "A" rated services adequately. However, they may be spending less time than recommended for important services, especially smoking cessation, Pap smear, and nutrition counseling. Future research is needed to understand how physicians decide how to allocate their time to address preventive health.

  18. Knowledge of Primary Care Physicians Regarding Domestic Violence.

    African Journals Online (AJOL)

    Knowledge of Primary Care Physicians Regarding Domestic Violence. ... prevalence of DV, and 4 main aspects relevant to DV, namely deprivation, psychological, ... and instructions about DV from scientific formal sources as medical schools, ...

  19. Physician directed networks: the new generation of managed care. (United States)

    Bennett, T; O'Sullivan, D


    The external pressure to reduce cost while maintaining quality and services is moving the whole industry into a rapid mode of integration. Hospitals, vendors, MCOs, and now, physicians, are faced with the difficult decisions concerning how their operations will be integrated into the larger health care delivery system. These pressures have forced physicians to consolidate, build leverage, and create efficiencies to become more productive; thereby better positioning themselves to respond to the challenges and the opportunities that lie before them. This initial phase of consolidation has given many physicians the momentum to begin to wrestle back the control of health care and the courage to design the next generation of managed care: Physician Directed Managed Care. What will be the next phase? Perhaps, the next step will be fully-integrated specialty and multi-specialty groups leading to alternate delivery sites. "Everyone thinks of changing the world, but no one thinks of changing himself." - Leo Tolstoy

  20. Impact of Physician Asthma Care Education on Patient Outcomes (United States)

    Cabana, Michael D.; Slish, Kathryn K.; Evans, David; Mellins, Robert B.; Brown, Randall W.; Lin, Xihong; Kaciroti, Niko; Clark, Noreen M.


    Objective: We evaluated the effectiveness of a continuing medical education program, Physician Asthma Care Education, in improving pediatricians' asthma therapeutic and communication skills and patients' health care utilization for asthma. Methods: We conducted a randomized trial in 10 regions in the United States. Primary care providers were…

  1. US Approaches to Physician Payment: The Deconstruction of Primary Care


    Berenson, Robert A.; Rich, Eugene C.


    The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary ...

  2. African Journal of Anaesthesia and Intensive Care

    African Journals Online (AJOL)

    The purpose of the African Journal of Anaesthesia and Intensive Care is to provide a medium for the dissemination of original works in Africa and other parts of the world about anaesthesia and intensive care including the application of basic sciences ...

  3. Important questions asked by family members of intensive care unit patients. (United States)

    Peigne, Vincent; Chaize, Marine; Falissard, Bruno; Kentish-Barnes, Nancy; Rusinova, Katerina; Megarbane, Bruno; Bele, Nicolas; Cariou, Alain; Fieux, Fabienne; Garrouste-Orgeas, Maite; Georges, Hugues; Jourdain, Merce; Kouatchet, Achille; Lautrette, Alexandre; Legriel, Stephane; Regnier, Bernard; Renault, Anne; Thirion, Marina; Timsit, Jean-Francois; Toledano, Dany; Chevret, Sylvie; Pochard, Frédéric; Schlemmer, Benoît; Azoulay, Elie


    Relatives often lack important information about intensive care unit patients. High-quality information is crucial to help relatives overcome the often considerable situational stress and to acquire the ability to participate in the decision-making process, most notably regarding the appropriate level of care. We aimed to develop a list of questions important for relatives of patients in the intensive care unit. This was a multicenter study. Questions asked by relatives of intensive care unit patients were collected from five different sources (literature, panel of 28 intensive care unit nurses and physicians, 1-wk survey of nurses and 1-wk survey of physicians in 14 intensive care units, and in-depth interviews with 14 families). After a qualitative analysis (framework approach and thematic analysis), questions were rated by 22 relatives and 14 intensive care unit physicians, and the ratings were analyzed using principal component analysis and hierarchical clustering. The five sources produced 2,135 questions. Removal of duplicates and redundancies left 443 questions, which were distributed among nine predefined domains using a framework approach ("diagnosis," "treatment," "prognosis," "comfort," "interaction," "communication," "family," "end of life," and "postintensive care unit management"). Thematic analysis in each domain led to the identification of 46 themes, which were reworded as 46 different questions. Ratings by relatives and physicians showed that 21 of these questions were particularly important for relatives of intensive care unit patients. This study increases knowledge about the informational needs of relatives of intensive care unit patients. This list of questions may prove valuable for both relatives and intensive care unit physicians as a tool for improving communication in the intensive care unit.

  4. A conceptual framework of clinical nursing care in intensive care. (United States)

    da Silva, Rafael Celestino; Ferreira, Márcia de Assunção; Apostolidis, Thémistoklis; Brandão, Marcos Antônio Gomes


    to propose a conceptual framework for clinical nursing care in intensive care. descriptive and qualitative field research, carried out with 21 nurses from an intensive care unit of a federal public hospital. We conducted semi-structured interviews and thematic and lexical content analysis, supported by Alceste software. the characteristics of clinical intensive care emerge from the specialized knowledge of the interaction, the work context, types of patients and nurses characteristic of the intensive care and care frameworks. the conceptual framework of the clinic's intensive care articulates elements characteristic of the dynamics of this scenario: objective elements regarding technology and attention to equipment and subjective elements related to human interaction, specific of nursing care, countering criticism based on dehumanization.

  5. Primary Care Physicians' Perspectives About HPV Vaccine. (United States)

    Allison, Mandy A; Hurley, Laura P; Markowitz, Lauri; Crane, Lori A; Brtnikova, Michaela; Beaty, Brenda L; Snow, Megan; Cory, Janine; Stokley, Shannon; Roark, Jill; Kempe, Allison


    Because physicians' practices could be modified to reduce missed opportunities for human papillomavirus (HPV) vaccination, our goal was to: (1) describe self-reported practices regarding recommending the HPV vaccine; (2) estimate the frequency of parental deferral of HPV vaccination; and (3)identify characteristics associated with not discussing it. A national survey among pediatricians and family physicians (FP) was conducted between October 2013 and January 2014. Using multivariable analysis, characteristics associated with not discussing HPV vaccination were examined. Response rates were 82% for pediatricians (364 of 442) and 56% for FP (218 of 387). For 11-12 year-old girls, 60% of pediatricians and 59% of FP strongly recommend HPV vaccine; for boys,52% and 41% ostrongly recommen. More than one-half reported ≥25% of parents deferred HPV vaccination. At the 11-12 year well visit, 84% of pediatricians and 75% of FP frequently/always discuss HPV vaccination. Compared with physicians who frequently/always discuss , those who occasionally/rarely discuss(18%) were more likely to be FP (adjusted odds ratio [aOR]: 2.0 [95% confidence interval (CI): 1.1-3.5), be male (aOR: 1.8 [95% CI: 1.1-3.1]), disagree that parents will accept HPV vaccine if discussed with other vaccines (aOR: 2.3 [95% CI: 1.3-4.2]), report that 25% to 49% (aOR: 2.8 [95% CI: 1.1-6.8]) or ≥50% (aOR: 7.8 [95% CI: 3.4-17.6]) of parents defer, and express concern about waning immunity (aOR: 3.4 [95% CI: 1.8-6.4]). Addressing physicians' perceptions about parental acceptance of HPV vaccine, the possible advantages of discussing HPV vaccination with other recommended vaccines, and concerns about waning immunity could lead to increased vaccination rates. Copyright © 2016 by the American Academy of Pediatrics.

  6. Maternity care and maternal serum screening. Do male and female family physicians care for women differently? (United States)

    Woodward, C A; Carroll, J C; Ryan, G; Reid, A J; Permaul-Woods, J A; Arbitman, S; Domb, S B; Fallis, B; Kilthei, J


    To examine whether male and female family physicians practise maternity care differently, particularly regarding the maternal serum screening (MSS) program. Mailed survey fielded between October 1994 and March 1995. Ontario family practices. Random sample of 2000 members of the College of Family Physicians of Canada who care for pregnant women. More than 90% of eligible physicians responded. Attitudes toward, knowledge about, and behaviour toward MSS. Women physicians were more likely than men to practise part time, in groups, and in larger communities. Men physicians were more likely to perform deliveries; women were more likely to do shared care. Despite a shorter work week, on average, female physicians cared for more pregnant women than male physicians did. Among those providing intrapartum care, women performed more deliveries, on average, than men. Women physicians were more likely than men to offer MSS to all pregnant patients. Although average time spent discussing MSS before the test was similar, women physicians had better knowledge of when best to do the test and its true-positive rate. All differences reported were statistically significant (P women, women physicians cared for more pregnant women than men did. Both spent similar time discussing MSS with their patients before offering screening, but more women physicians offered MSS to all their patients and were more knowledgeable about MSS than men physicians.

  7. [Health care economics, uncertainty and physician-induced demand]. (United States)

    Domenighetti, G; Casabianca, A


    The health care market is a very particular one that is mainly characterized by the absence of information and transparency at every level, particularly between the physician-supplier and the patient-consumer. On this market it is up to the physician to evaluate and define the patient's needs and to decide which are the most effective goods for the patient. The determinants of medical prescription are not only related to the health status of the patient, but also to the payment system (fee for services, salary), to physician density, professional uncertainty, the role and status of the physician in his profession, the legal framework which rules the medical profession, and also the information level of the patient. Agency relationship and professional uncertainty are the most relevant determinants of supplier-induced demand. Professional uncertainty inherent in the practice of a stochastic art such as medicine will "always" give an ethical justification for supplier-induced demand or for the pursuit of "maximal" and/or "defensive" care when market competition is perceived by the physician as a threat to his/her income or employment. Time is ripe for consumers and physicians empowerment in the aim to promote better self-management of health and more thoughtful access to care (for consumers) and more evidences based medicine for physicians.

  8. The Exnovation of Chronic Care Management Processes by Physician Organizations. (United States)

    Rodriguez, Hector P; Henke, Rachel Mosher; Bibi, Salma; Ramsay, Patricia P; Shortell, Stephen M


    Policy Points The rate of adoption of chronic care management processes (CMPs) by physician organizations has been fairly slow in spite of demonstrated effectiveness of CMPs in improving outcomes of chronic care. Exnovation (ie, removal of innovations) by physician organizations largely explains the slow population-level increases in practice use of CMPs over time. Expanded health information technology functions may aid practices in retaining CMPs. Low provider reimbursement by Medicaid programs, however, may contribute to disinvestment in CMPs by physician organizations. Exnovation is the process of removal of innovations that are not effective in improving organizational performance, are too disruptive to routine operations, or do not fit well with the existing organizational strategy, incentives, structure, and/or culture. Exnovation may contribute to the low overall adoption of care management processes (CMPs) by US physician organizations over time. Three national surveys of US physician organizations, which included common questions about organizational characteristics, use of CMPs, and health information technology (HIT) capabilities for practices of all sizes, and Truven Health Insurance Coverage Estimates were integrated to assess organizational and market influences on the exnovation of CMPs in a longitudinal cohort of 1,048 physician organizations. CMPs included 5 strategies for each of 4 chronic conditions (diabetes, asthma, congestive heart failure, and depression): registry use, nurse care management, patient reminders for preventive and care management services to prevent exacerbations of chronic illness, use of nonphysician clinicians to provide patient education, and quality of care feedback to physicians. Over one-third (34.1%) of physician organizations exnovated CMPs on net. Quality of care data feedback to physicians and patient reminders for recommended preventive and chronic care were discontinued by over one-third of exnovators, while nurse

  9. The Exnovation of Chronic Care Management Processes by Physician Organizations (United States)



    Policy Points The rate of adoption of chronic care management processes (CMPs) by physician organizations has been fairly slow in spite of demonstrated effectiveness of CMPs in improving outcomes of chronic care.Exnovation (ie, removal of innovations) by physician organizations largely explains the slow population‐level increases in practice use of CMPs over time.Expanded health information technology functions may aid practices in retaining CMPs. Low provider reimbursement by Medicaid programs, however, may contribute to disinvestment in CMPs by physician organizations. Context Exnovation is the process of removal of innovations that are not effective in improving organizational performance, are too disruptive to routine operations, or do not fit well with the existing organizational strategy, incentives, structure, and/or culture. Exnovation may contribute to the low overall adoption of care management processes (CMPs) by US physician organizations over time. Methods Three national surveys of US physician organizations, which included common questions about organizational characteristics, use of CMPs, and health information technology (HIT) capabilities for practices of all sizes, and Truven Health Insurance Coverage Estimates were integrated to assess organizational and market influences on the exnovation of CMPs in a longitudinal cohort of 1,048 physician organizations. CMPs included 5 strategies for each of 4 chronic conditions (diabetes, asthma, congestive heart failure, and depression): registry use, nurse care management, patient reminders for preventive and care management services to prevent exacerbations of chronic illness, use of nonphysician clinicians to provide patient education, and quality of care feedback to physicians. Findings Over one‐third (34.1%) of physician organizations exnovated CMPs on net. Quality of care data feedback to physicians and patient reminders for recommended preventive and chronic care were discontinued by over one

  10. Burnout among physicians in palliative care: Impact of clinical settings. (United States)

    Dréano-Hartz, Soazic; Rhondali, Wadih; Ledoux, Mathilde; Ruer, Murielle; Berthiller, Julien; Schott, Anne-Marie; Monsarrat, Léa; Filbet, Marilène


    Burnout syndrome is a work-related professional distress. Palliative care physicians often have to deal with complex end-of-life situations and are at risk of presenting with burnout syndrome, which has been little studied in this population. Our study aims to identify the impact of clinical settings (in a palliative care unit (PCU) or on a palliative care mobile team (PCMT)) on palliative care physicians. We undertook a cross-sectional study using a questionnaire that included the Maslach Burnout Inventory (MBI), and we gathered sociodemographic and professional data. The questionnaire was sent to all 590 physicians working in palliative care in France between July of 2012 and February of 2013. The response rate was 61, 8% after three reminders. Some 27 (9%) participants showed high emotional exhaustion, 12 (4%) suffered from a high degree of depersonalization, and 71 (18%) had feelings of low personal accomplishment. Physicians working on a PCMT tended (p = 0.051) to be more likely to suffer from emotional exhaustion than their colleagues. Physicians working on a PCMT worked on smaller teams (fewer physicians, p < 0.001; fewer nonphysicians, p < 0.001). They spent less time doing research (p = 0.019), had fewer resources (p = 0.004), and their expertise seemed to be underrecognized by their colleagues (p = 0.023). The prevalence of burnout in palliative care physicians was low and in fact lower than that reported in other populations (e.g., oncologists). Working on a palliative care mobile team can be a more risky situation, associated with a lack of medical and paramedical staff.

  11. The Role of Focused Echocardiography in Pediatric Intensive Care: A Critical Appraisal (United States)

    Gaspar, Heloisa Amaral; Morhy, Samira Saady


    Echocardiography is a key tool for hemodynamic assessment in Intensive Care Units (ICU). Focused echocardiography performed by nonspecialist physicians has a limited scope, and the most relevant parameters assessed by focused echocardiography in Pediatric ICU are left ventricular systolic function, fluid responsiveness, cardiac tamponade and pulmonary hypertension. Proper ability building of pediatric emergency care physicians and intensivists to perform focused echocardiography is feasible and provides improved care of severely ill children and thus should be encouraged. PMID:26605333

  12. [Quality assurance concepts in intensive care medicine]. (United States)

    Brinkmann, A; Braun, J P; Riessen, R; Dubb, R; Kaltwasser, A; Bingold, T M


    Intensive care medicine (ICM) is characterized by a high degree of complexity and requires intense communication and collaboration on interdisciplinary and multiprofessional levels. In order to achieve good quality of care in this environment and to prevent errors, a proactive quality and error management as well as a structured quality assurance system are essential. Since the early 1990s, German intensive care societies have developed concepts for quality management and assurance in ICM. In 2006, intensive care networks were founded in different states to support the implementation of evidence-based knowledge into clinical routine and to improve medical outcome, efficacy, and efficiency in ICM. Current instruments and concepts of quality assurance in German ICM include core intensive care data from the data registry DIVI REVERSI, quality indicators, peer review in intensive care, IQM peer review, and various certification processes. The first version of German ICM quality indicators was published in 2010 by an interdisciplinary and interprofessional expert commission. Key figures, indicators, and national benchmarks are intended to describe the quality of structures, processes, and outcomes in intensive care. Many of the quality assurance tools have proved to be useful in clinical practice, but nationwide implementation still can be improved.

  13. Physicians and AIDS care: does knowledge influence their attitude ...

    African Journals Online (AJOL)

    Adequate knowledge, positive attitude, and feeling of comfort are important factors in providing compassionate care to patients. The purpose of this study was to assess physicians' knowledge, attitude and global comfort in caring for patients with AIDS (PWA), to determine the sociodemographic variables that could influence ...

  14. Physician education programme improves quality of diabetes care ...

    African Journals Online (AJOL)

    Objectives. To determine if a physician education programme and a structured consultation schedule would improve the quality of diabetes patient care in a diabetes clinic. Setting. Two tertiary care diabetes clinics at Kalafong Hospital, Pretoria. Study design. Quasi-experimental controlled before-and-after study. Methods.

  15. Job satisfaction of neonatal intensive care nurses. (United States)

    McDonald, Katie; Rubarth, Lori Baas; Miers, Linda J


    The purpose of this study was to describe the job satisfaction of neonatal intensive care unit (NICU) nurses in the Midwestern United States. The factors explored in job satisfaction were monetary compensation (pay), job stress, caring for patients in stressful situations, level of autonomy, organizational support, level of knowledge of the specialty, work environment, staffing levels, communication with physicians, communication with neonatal nurse practitioners, interdisciplinary communication, team spirit, and the amount of required "floating" to other nursing units. Participants were 109 NICU nurses working as either staff nurses (n = 72) or advanced practice nurses (n = 37). Of the participants, 96% worked in a level 3 NICU. A descriptive, correlational design was used to study job satisfaction among NICU nurses. Nurses were recruited at 2 regional NICU conferences in 2009 and 2010. The questionnaire was a researcher-developed survey consisting of 14 questions in a Likert-type response rating 1 to 5, with an area for comments. Descriptive statistics and correlations were used to analyze the resulting data. The majority of participants were moderately satisfied overall in their current position and workplace (mean ranking = 4.07 out of 5.0). Kendall's Tau b (TB) revealed that the strongest positive correlations were between organizational support and team spirit with overall job satisfaction (TB = 0.53). : The individual factors with the highest mean scores were caring for patients in a stressful situation, level of autonomy, and communication between nurses and neonatal nurse practitioners. This indicates that our population of NICU nurses feels most satisfied caring for patients in stressful situations (m = 4.48), are satisfied with their level of autonomy (M = 4.17), and are satisfied with the interdisciplinary communication in their units (m = 4.13). Nurses in the NICU are relatively satisfied with their jobs. The small sample size (n = 109) of Midwest NICU

  16. The evolution of physician-directed managed care. (United States)

    Unland, J J


    The health care industry is evolving. In the near term, POs will become the state of the art in physician-directed managed care. Eventually, POs will merge into fully integrated group practices. From there, regional POs and group practices will develop their own insurance products. But because these organizations will be dominated by physicians who wish to practice medicine, rather than sell insurance, money will be made by appropriately managing risk and providing high-quality care. In time, physicians will take control and "manage" managed care, as they are the only ones--not administrators, executives, or other business people--who are in a position to fundamentally revise the way medicine is practiced.

  17. Intensive Care Management of Patients with Cirrhosis. (United States)

    Olson, Jody C


    Cirrhosis is a major worldwide health problem which results in a high level of morbidity and mortality. Patients with cirrhosis who require intensive care support have high mortality rates of near 50%. The goal of this review is to address the management of common complications of cirrhosis in the ICU. Recent epidemiological studies have shown an increase in hospitalizations due to advanced liver disease with an associated increase in intensive care utilization. Given an increasing burden on the healthcare system, it is imperative that we strive to improve our management cirrhotic patients in the intensive care unit. Large studies evaluating the management of patients in the intensive care setting are lacking. To date, most recommendations are based on extrapolation of data from studies in cirrhosis outside of the ICU or by applying general critical care principles which may or may not be appropriate for the critically ill cirrhotic patient. Future research is required to answer important management questions.

  18. Apps and intensive care medicine. (United States)

    Iglesias-Posadilla, D; Gómez-Marcos, V; Hernández-Tejedor, A


    Technological advances have played a key role over the last century in the development of humankind. Critical Care Medicine is one of the greatest examples of this revolution. Smartphones with multiple sensors constitute another step forward, and have led to the development of apps for use by both professionals and patients. We discuss their main medical applications in the field of Critical Care Medicine. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  19. Physician Competition in the Era of Accountable Care Organizations. (United States)

    Richards, Michael R; Smith, Catherine T; Graves, Amy J; Buntin, Melinda B; Resnick, Matthew J


    To calculate physician concentration levels for all U.S. markets using detailed data on integration and accountable care organization (ACO) participation. 2015 SK&A office-based physician survey linked to all commercial and public payer ACOs. We construct three separate Herfindahl-Hirschman Index (HHI) measures and plot their distributions. We then investigate how prevailing levels of concentration change when incorporating more detailed organizational features into the HHI measure. Horizontal and vertical integration strongly influences measures of physician concentration; however, ACOs have limited impact overall. ACOs are often present in competitive markets, and only in a minority of these markets do ACOs substantively increase physician concentration. Monitoring ACO effects on physician competition will likely have to proceed on a case-by-case basis. © Health Research and Educational Trust.

  20. Stoicism, the physician, and care of medical outliers

    Directory of Open Access Journals (Sweden)

    Papadimos Thomas J


    Full Text Available Abstract Background Medical outliers present a medical, psychological, social, and economic challenge to the physicians who care for them. The determinism of Stoic thought is explored as an intellectual basis for the pursuit of a correct mental attitude that will provide aid and comfort to physicians who care for medical outliers, thus fostering continued physician engagement in their care. Discussion The Stoic topics of good, the preferable, the morally indifferent, living consistently, and appropriate actions are reviewed. Furthermore, Zeno's cardinal virtues of Justice, Temperance, Bravery, and Wisdom are addressed, as are the Stoic passions of fear, lust, mental pain, and mental pleasure. These concepts must be understood by physicians if they are to comprehend and accept the Stoic view as it relates to having the proper attitude when caring for those with long-term and/or costly illnesses. Summary Practicing physicians, especially those that are hospital based, and most assuredly those practicing critical care medicine, will be emotionally challenged by the medical outlier. A Stoic approach to such a social and psychological burden may be of benefit.

  1. [Travel times of patients to ambulatory care physicians in Germany]. (United States)

    Schang, Laura; Kopetsch, Thomas; Sundmacher, Leonie


    The time needed by patients to get to a doctor's office represents an important indicator of realised access to care. In Germany, findings on travel times are only available from surveys or for some regions. For the first time, this study examines nationwide and physician group-specific travel times in the ambulatory care sector in Germany and describes demographic, supply-side and spatial determinants of variations. Using a full review of patient consultations in the statutory health insurance system from 2009/2010 for 14 physician groups (approximately 518 million cases), case-related travel times by car between patients' places of residence and physician's practices were estimated at the municipal level. Physicians were reached in less than 30 min in 90.8% of cases for primary care physicians and up to 63% of cases for radiologists. Patients between 18 and under 30 years of age travel longer to get to the doctor than other age groups. The average travel time at the county level systematically differs between urban and rural planning areas. In the case of gynecologists, dermatologists and ophthalmologists, the average journey time decreases with increasing physician density at the county level, but remains approximately constant from a recognisable point of inflection. There is no association between primary care physician density and travel time at the district level. Spatial analyses show physician group-specific patterns of regional concentrations with an increased proportion of cases with very long travel times. Patients' travel times are influenced by supply- and demand-side determinants. Interactions between influential determinants should be analysed in depth to examine the extent to which the time travelled is an expression of regional under- or over-supply rather than an expression of patient preferences.

  2. Naturopathic physicians: holistic primary care and integrative medicine specialists. (United States)

    Litchy, Andrew P


    The use of Complimentary and Alternative Medicine (CAM) is increasing in the United States; there is a need for physician level practitioners who possess extensive training in both CAM and conventional medicine. Naturopathic physicians possess training that allows integration of modern scientific knowledge and the age-old wisdom of natural healing techniques. Naturopathic philosophy provides a framework to implement CAM in concert with conventional therapies. The naturopathic physician's expertise in both conventional medicine and CAM allows a practice style that provides excellent care through employing conventional and CAM modalities while utilizing modern research and evidence-based medicine.

  3. Parental perceptions of clown care in paediatric intensive care units. (United States)

    Mortamet, Guillaume; Merckx, Audrey; Roumeliotis, Nadia; Simonds, Caroline; Renolleau, Sylvain; Hubert, Philippe


    The objective of this study was to report family satisfaction with regards to the presence of clowns in the paediatric intensive care unit (PICU). This is a single-centre survey-based study, conducted over 4 months in a 12-bed third level PICU in a university hospital. All parents present at the bedside of their child during clowning were considered as potential participants. Eligible parents were approached by one of the two intensivists as investigators and asked to complete a survey within the 48 h following the clowns' intervention. Thirty-three parents consented to complete the survey. Median age of children was 14 months (15 days to 16 years) and median Pediatric Logistic Organ Dysfunction (PELOD) score was 1 (0-22). Twenty-four (72.7%) were considered as clinically stable while the clowns intervened. Twenty-eight parents (84.8%) and 27 (81.8%) considered that clowns had a positive effect on themselves and on their child, respectively. Clown care was considered as necessary in 19 cases (57.6%), optional in 13 (39.4%) and unnecessary in 1 (3.0%). The degree of parental satisfaction was not significantly associated with the child's clinical stability. We suggested that medical clowning in the PICU is well accepted by parents, regardless of severity of their child's condition. This study supports the adoption of medical clowning in PICUs as a patient- and family-centred care practice. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  4. Estudo preliminar sobre a qualidade de vida de médicos e enfermeiros intensivistas pediátricos e neonatais Estudio preliminar sobre la calidad de vida de médicos y enfermeros intensivistas pediátricos y neonatales Preliminary study about qualify of life of physicians and nurses working in pediatric and neonatal intensive care units

    Directory of Open Access Journals (Sweden)

    Monalisa de Cássia Fogaça


    Full Text Available Comparar a Qualidade de Vida (QV de médicos e enfermeiros que trabalham em UTI Pediátrica (PED e Neonatal (NEO e, também, avaliar se há diferença entre a QV na mesma categoria profissional, mas diferindo de acordo com a unidade de trabalho. Estudo descritivo com 37 médicos e 20 enfermeiros. O WHOQOL-100 foi utilizado. Médicos da PED diferiram estatisticamente no domínio VI (p=0,003, quando comparados com médicos da NEO. Médicos e enfermeiros da PED apresentaram diferença estatística significante no domínio V (p Comparar la Calidad de Vida (QV de médicos y enfermeros que trabajan en UTI Pediátrica (PED y neonatal (NEO y, también evaluar si existe diferencia entre la QV en la misma categoría profesional, aunque variando de acuerdo con la unidad de trabajo. Estudio descriptivo con 37 médicos y 20 enfermeros. Fue utilizado el WHOQOL-100. Los médicos de PED diferían estadísticamente en el dominio VI (p=0,003 en comparación con los médicos de NEO. Médicos y enfermeros de PED presentaron una diferencia estadística significativa en el dominio V (pCompare the Quality of Life (QL of doctors and nurses who work in Pediatric (PED and Neonatal (NEO Intensive Care Units, and to evaluate whether there are differences between the QL in the same job category, but differing according to the work unit. This descriptive study was performed with 37 physicians and 20 nurses. The WHOQOL100 was used. Physicians from the PED differ statistically in the field VI (p=0.003 compared with physicians from the NEO. Physicians and nurses from the PED showed a statistically significant difference in field V (p<0.01, while physicians and nurses from the NEO showed a statistically significant difference in field VI (p=0.05. The QL assessment of physicians and nurses working in pediatric and neonatal intensive care units was below the scores found in scientific literature, compared to studies that evaluated patients with chronic pain and mental health

  5. Physicians' and consumers' conflicting attitudes toward health care advertising. (United States)

    Krohn, F B; Flynn, C


    The purpose of this paper is to explore the conflicting attitudes held by physicians and health care consumers toward health care advertising in an attempt to resolve the question. The paper introduces the differing positions held by the two groups. The rationale behind physicians' attitudes is then presented that advertising can be unethical, misleading, deceptive, and lead to unnecessary price increases. They believe that word-of-mouth does and should play the major role in attracting new patients. The opposite view of consumers is then presented which contends that health care advertising leads to higher consumer awareness of services, better services, promotes competitive pricing, and lowers rather than raises health care costs. The final section of the paper compares the arguments presented and concludes that health care advertising clearly has a place in the health care industry.

  6. Job satisfaction among primary care physicians: results of a survey. (United States)

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


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

  7. Intensive care patient diaries in Scandinavia

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Storli, Sissel Lisa; Åkerman, Eva


    Critical illness and intensive care therapy are often followed by psychological problems such as nightmares, hallucinations, delusions, anxiety, depression, and symptoms of posttraumatic stress. Intensive care patient diaries have been kept by nurses and the patients' family since the early 1990s...... in the Scandinavian countries to help critically ill patients come to terms with their illness after hospital discharge. The aim of the study was to describe and compare the emergence and evolution of intensive care patient diaries in Denmark, Norway, and Sweden. The study had a comparative international design using...... secondary analysis of qualitative data generated by key-informant telephone interviews with intensive care nurses (n=114). The study showed that diaries were introduced concurrently in the three Scandinavian countries as a grass-roots initiative by mutual cross-national inspiration. The concept has evolved...

  8. Patient's dignity in intensive care unit: A critical ethnography. (United States)

    Bidabadi, Farimah Shirani; Yazdannik, Ahmadreza; Zargham-Boroujeni, Ali


    Maintaining patient's dignity in intensive care units is difficult because of the unique conditions of both critically-ill patients and intensive care units. The aim of this study was to uncover the cultural factors that impeded maintaining patients' dignity in the cardiac surgery intensive care unit. The study was conducted using a critical ethnographic method proposed by Carspecken. Participants and research context: Participants included all physicians, nurses and staffs working in the study setting (two cardiac surgery intensive care units). Data collection methods included participant observations, formal and informal interviews, and documents assessment. In total, 200 hours of observation and 30 interviews were performed. Data were analyzed to uncover tacit cultural knowledge and to help healthcare providers to reconstruct the culture of their workplace. Ethical Consideration: Ethical approval for the study from Ethics committee of Isfahan University of Medical Sciences was obtained. The findings of the study fell into the following main themes: "Presence: the guarantee for giving enough attention to patients' self-esteem", "Instrumental and objectified attitudes", "Adherence to the human equality principle: value-action gap", "Paternalistic conduct", "Improper language", and "Non-interactive communication". The final assertion was "Reductionism as a major barrier to the maintaining of patient's dignity". The prevailing atmosphere in subculture of the CSICU was reductionism and paternalism. This key finding is part of the biomedical discourse. As a matter of fact, it is in contrast with dignified care because the latter necessitate holistic attitudes and approaches. Changing an ICU culture is not easy; but through increasing awareness and critical self-reflections, the nurses, physicians and other healthcare providers, may be able to reaffirm dignified care and cure in their therapeutic relationships.

  9. Dutch criteria of due care for physician-assisted dying in medical practice: a physician perspective

    NARCIS (Netherlands)

    Buiting, H. M.; Gevers, J. K. M.; Rietjens, J. A. C.; Onwuteaka-Philipsen, B. D.; van der Maas, P. J.; van der Heide, A.; van Delden, J. J. M.


    Introduction: The Dutch Euthanasia Act (2002) states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient's suffering should be unbearable

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

    Directory of Open Access Journals (Sweden)

    Fetters Michael D


    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.

  11. Teamwork in the Neonatal Intensive Care Unit (United States)

    Barbosa, Vanessa Maziero


    Medical and technological advances in neonatology have prompted the initiation and expansion of developmentally supportive services for newborns and have incorporated rehabilitation professionals into the neonatal intensive care unit (NICU) multidisciplinary team. Availability of therapists specialized in the care of neonates, the roles of…

  12. The comprehensive care project: measuring physician performance in ambulatory practice. (United States)

    Holmboe, Eric S; Weng, Weifeng; Arnold, Gerald K; Kaplan, Sherrie H; Normand, Sharon-Lise; Greenfield, Sheldon; Hood, Sarah; Lipner, Rebecca S


    To investigate the feasibility, reliability, and validity of comprehensively assessing physician-level performance in ambulatory practice. Ambulatory-based general internists in 13 states participated in the assessment. We assessed physician-level performance, adjusted for patient factors, on 46 individual measures, an overall composite measure, and composite measures for chronic, acute, and preventive care. Between- versus within-physician variation was quantified by intraclass correlation coefficients (ICC). External validity was assessed by correlating performance on a certification exam. Medical records for 236 physicians were audited for seven chronic and four acute care conditions, and six age- and gender-appropriate preventive services. Performance on the individual and composite measures varied substantially within (range 5-86 percent compliance on 46 measures) and between physicians (ICC range 0.12-0.88). Reliabilities for the composite measures were robust: 0.88 for chronic care and 0.87 for preventive services. Higher certification exam scores were associated with better performance on the overall (r = 0.19; pmeasures and by sampling feasible numbers of patients for each condition. © Health Research and Educational Trust.

  13. Intensive Care Nursing And Time Management


    ÖZCANLI, Derya; İLGÜN, Seda


    Time is not like other resources, because it can not be bought, sold, stolen, borrowed, stored, saved, multiplied or changed. All it can be done is spent. Time management means the effective use of resources, including time, in such a way that indi- viduals are effective in achieving important personal goals. With the increasing emphasis on efficiency in health care, how a nurse manages her time is an important consideration. Since intensive care nurs- ing is focused on the care and tr...

  14. Communication-related allegations against physicians caring for premature infants. (United States)

    Nguyen, J; Muniraman, H; Cascione, M; Ramanathan, R


    Maternal-fetal medicine physicians (MFMp) and neonatal-perinatal medicine physicians (NPMp) caring for premature infants and their families are exposed to significant risk for malpractice actions. Effective communication practices have been implicated to decrease litigious intentions but the extent of miscommunication as a cause of legal action is essentially unknown in this population. Analysis of communication-related allegations (CRAs) may help toward improving patient care and physician-patient relationships as well as decrease litigation risks. We retrospectively reviewed the Westlaw database, a primary online legal research resource used by United States lawyers and legal professionals, for malpractice cases against physicians involving premature infants. Inclusion criteria were: 22 to 36 weeks gestational age, cases related to peripartum events through infant discharge and follow-up, and legal records with detailed factual narratives. The search yielded 736 legal records, of which 167 met full inclusion criteria. A CRA was identified in 29% (49/167) of included cases. MFMp and/or NPMp were named in 104 and 54 cases, respectively. CRAs were identified in 26% (27/104) and 35% (19/54) of MFMp- and NPMp-named cases, respectively, with a majority involving physician-family for both specialties (81% and 74%, respectively). Physician-family CRAs for MFMp and NPMp most often regarded lack of informed consent (50% and 57%, respectively), lack of full disclosure (41% and 29%, respectively) and lack of anticipatory guidance (36% and 21%, respectively). This study of a major legal database identifies CRAs as significant causes of legal action against MFMp and NPMp involved in the care of high-risk women and infants delivered preterm. Physicians should be especially vigilant with obtaining genuine informed consent and maintaining open communication with families.

  15. Physician leadership: a health-care system's investment in the future of quality care. (United States)

    Orlando, Rocco; Haytaian, Marcia


    The current state of health care and its reform will require physician leaders to take on greater management responsibilities, which will require a set of organizational and leadership competencies that traditional medical education does not provide. Physician leaders can form a bridge between the clinical and administrative sides of a health-care organization, serving to further the organization's strategy for growth and success. Recognizing that the health-care industry is rapidly changing and physician leaders will play a key role in that transformation, Hartford HealthCare has established a Physician Leadership Development Institute that provides advanced leadership skills and management education to select physicians practicing within the health-care system.

  16. Frequency of candidemias in a tertiary care intensive care unit

    International Nuclear Information System (INIS)

    Yaqub, K.M.; Usman, J.; Zaidi, S.B.H.; Khalil, A.; Noor, N.; Gill, M.M.


    Objective: To determine the frequency of fungal infections in intensive care unit (ICU) of Military Hospital, Rawalpindi, a tertiary care health facility. Study Design: Cross sectional study. Place and Duration of Study: Intensive Care Department of Military Hospital Rawalpindi from 01 Jan 2012 to 30 Jun 2012. Methodology: A total of 89 patients were screened with stay of more than 5 days in intensive care unit. Thirty cases were enrolled in the study for investigation of fungal infections that had fever even after 05 days of being on broad spectrum antibiotics. Culture was done on blood, urine and catheter tip samples as per clinical condition of a patient. Results: Candida infection was found in 23.4% of study cases. The mean age of study patients was 41.2 +- 20.0 years while 63.4% were female patients as compared to 36.7% males. Conclusion: Fungal infections especially candidemias are quite frequent in the intensive care units. (author)

  17. Providing primary health care with non-physicians. (United States)

    Chen, P C


    The definition of primary health care is basically the same, but the wide variety of concepts as to the form and type of worker required is largely due to variations in economic, demographic, socio-cultural and political factors. Whatever form it takes, in many parts of the developing world, it is increasingly clear that primary health care must be provided by non-physicians. The reasons for this trend are compelling, yet it is surprisingly opposed by the medical profession in many a developing country. Nonetheless, numerous field trials are being conducted in a variety of situations in several countries around the world. Non-physician primary health care workers vary from medical assistants and nurse practitioners to aide-level workers called village mobilizers, village volunteers, village aides and a variety of other names. The functions, limitations and training of such workers will need to be defined, so that an optimal combination of skills, knowledge and attitudes best suited to produce the desired effect on local health problems may be attained. The supervision of such workers by the physician and other health professionals will need to be developed in the spirit of the health team. An example of the use of non-physicians in providing primary health care in Sarawak is outlined.

  18. Burnout among primary care physicians in Jos-Plateau, north ...

    African Journals Online (AJOL)

    Background: Developing countries health systems are bedeviled with numerous challenges including resource scarcity, high workload, unfavourable working conditions, Physical and Psychosocial stress. The Aim of this study was to assess the burden of burnout among primary care physicians working in such challenging ...

  19. Overweight and Obesity and the Demand for Primary Physician Care

    DEFF Research Database (Denmark)

    Datta Gupta, Nabanita; Greve, Jane

    -60 years drawn from the National Health Interview (NHI) survey 2000 and merged to Danish register data, we compare differences in the impact of being overweight and obese relative to being normal weight on the demand for primary physician care. Estimated bodyweight effects vary across latent classes...

  20. Determinants of nutrition guidance practices of primary-care physicians

    NARCIS (Netherlands)

    Hiddink, G.J.


    The aim of the studies described in this thesis was to analyze nutrition guidance practices of primary-care physicians (PCPs), their nutritional attitudes and knowledge and their interest in the role of nutrition in health and disease. A second objective was to identify the determinants

  1. Ultrasound for critical care physicians: tiny bubbles

    Directory of Open Access Journals (Sweden)

    Aslam K


    Full Text Available No abstract available. Article truncated after first page. A 59 year old woman with a past medical history significant for stage IV MALT lymphoma (after chemotherapy and in remission presented from a long term care facility for respiratory distress and altered mental status. The patient was in hypercarbic respiratory failure with a severe lactic acidosis. Her blood pressure deteriorated, she was begun on vasopressors and intubated. Pertinent labs demonstrated a white blood cell count of 0.9 X106 /ml, a hemoglobin of 7.1 g/dl, and a platelet count 66 X106 /ml. The patient was started on Cefepime and Linezolid presumptively for septic shock. Ultrasounds of her thorax were performed (Videos 1 & 2. What is the best explanation for the ultrasound findings shown above?1. Large pleural effusion; 2. Pneumothorax; 3. Consolidation due to pneumonia; 4. Ruptured diaphragm; 5. Lung abscess

  2. Impact of patient satisfaction ratings on physicians and clinical care

    Directory of Open Access Journals (Sweden)

    Zgierska A


    Full Text Available Aleksandra Zgierska,1 David Rabago,1 Michael M Miller2–4 1Department of Family Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, 2American Society of Addiction Medicine, Chevy Chase, MD, 3Department of Psychiatry, University of Wisconsin-Madison, School of Medicine and Public Health, 4Herrington Recovery Center, Rogers Memorial Hospital, Oconomowoc, WI, USA Background: Although patient satisfaction ratings often drive positive changes, they may have unintended consequences. Objective: The study reported here aimed to evaluate the clinician-perceived effects of patient satisfaction ratings on job satisfaction and clinical care. Methods: A 26-item survey, developed by a state medical society in 2012 to assess the effects of patient satisfaction surveys, was administered online to physician members of a state-level medical society. Respondents remained anonymous. Results: One hundred fifty five physicians provided responses (3.9% of the estimated 4,000 physician members of the state-level medical society, or approximately 16% of the state's emergency department [ED] physicians. The respondents were predominantly male (85% and practicing in solo or private practice (45%, hospital (43%, or academia (15%. The majority were ED (57%, followed by primary care (16% physicians. Fifty-nine percent reported that their compensation was linked to patient satisfaction ratings. Seventy-eight percent reported that patient satisfaction surveys moderately or severely affected their job satisfaction; 28% had considered quitting their job or leaving the medical profession. Twenty percent reported their employment being threatened because of patient satisfaction data. Almost half believed that pressure to obtain better scores promoted inappropriate care, including unnecessary antibiotic and opioid prescriptions, tests, procedures, and hospital admissions. Among 52 qualitative responses, only three were positive. Conclusion

  3. Analgesia, sedation, and memory of intensive care. (United States)

    Capuzzo, M; Pinamonti, A; Cingolani, E; Grassi, L; Bianconi, M; Contu, P; Gritti, G; Alvisi, R


    The purpose of this article was to investigate the relationship between analgesia, sedation, and memory of intensive care. One hundred fifty-two adult, cooperative intensive care unit (ICU) patients were interviewed 6 months after hospital discharge about their memory of intensive care. The patient was considered to be cooperative when he/she was aware of self and environment at the interview. The patients were grouped as follows: A (45 patients) substantially no sedation, B (85) morphine, and C (22) morphine and other sedatives. The patients having no memory of intensive care were 38%, 34%, and 23% respectively, in the three groups. They were less ill, according to SAPS II (P memories was not different among the three groups. Females reported at least one emotional memory more frequently than males (odds ratio 4.17; 95% CI 10.97-1.59). The patients receiving sedatives in the ICU are not comparable with those receiving only opiates or nothing, due to the different clinical condition. The lack of memory of intensive care is present in one third of patients and is influenced more by length of stay in ICU than by the sedation received. Sedation does not influence the incidence of factual, sensation, and emotional memories of ICU admitted patients. Females have higher incidences of emotional memories than males. Copyright 2001 by W.B. Saunders Company

  4. Medicare managed care. How physicians can make it better. (United States)

    Roggin, G M


    The federal government is attempting to control anticipated, increased Medicare health care costs by providing the senior population with incentives to encourage their movement into managed care programs. For-profit corporate HMOs that currently dominate the managed care arena are coming under increased competitive pressure at a time when their perception of profiteering is undergoing increased public scrutiny. If physicians are to take advantage of this window of opportunity and successfully enter the Medicare managed care marketplace, they must identify the major deficiencies existing in the current model, and fashion a new product that divests itself of the profit orientation of current corporate HMOs. A nonprofit version of a highly integrated, multispecialty provider service organization (PSO) provides an appropriate model to effectively compete with the corporate HMO. The ideal physician-controlled managed care model must: develop a responsive policy board structure; create practice guidelines that decrease variation in physician practice; achieve an appropriate balance between primary and specialty medical care; and adopt a quality-assurance program that effectively addresses both process and outcome data.

  5. Evaluating topic model interpretability from a primary care physician perspective. (United States)

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


    Probabilistic topic models provide an unsupervised method for analyzing unstructured text. These models discover semantically coherent combinations of words (topics) that could be integrated in a clinical automatic summarization system for primary care physicians performing chart review. However, the human interpretability of topics discovered from clinical reports is unknown. Our objective is to assess the coherence of topics and their ability to represent the contents of clinical reports from a primary care physician's point of view. Three latent Dirichlet allocation models (50 topics, 100 topics, and 150 topics) were fit to a large collection of clinical reports. Topics were manually evaluated by primary care physicians and graduate students. Wilcoxon Signed-Rank Tests for Paired Samples were used to evaluate differences between different topic models, while differences in performance between students and primary care physicians (PCPs) were tested using Mann-Whitney U tests for each of the tasks. While the 150-topic model produced the best log likelihood, participants were most accurate at identifying words that did not belong in topics learned by the 100-topic model, suggesting that 100 topics provides better relative granularity of discovered semantic themes for the data set used in this study. Models were comparable in their ability to represent the contents of documents. Primary care physicians significantly outperformed students in both tasks. This work establishes a baseline of interpretability for topic models trained with clinical reports, and provides insights on the appropriateness of using topic models for informatics applications. Our results indicate that PCPs find discovered topics more coherent and representative of clinical reports relative to students, warranting further research into their use for automatic summarization. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Maternity Care Services Provided by Family Physicians in Rural Hospitals. (United States)

    Young, Richard A

    The purpose of this study was to describe how many rural family physicians (FPs) and other types of providers currently provide maternity care services, and the requirements to obtain privileges. Chief executive officers of rural hospitals were purposively sampled in 15 geographically diverse states with significant rural areas in 2013 to 2014. Questions were asked about the provision of maternity care services, the physicians who perform them, and qualifications required to obtain maternity care privileges. Analysis used descriptive statistics, with comparisons between the states, community rurality, and hospital size. The overall response rate was 51.2% (437/854). Among all identified hospitals, 44.9% provided maternity care services, which varied considerably by state (range, 17-83%; P maternity care, a mean of 271 babies were delivered per year, 27% by cesarean delivery. A mean of 7.0 FPs had privileges in these hospitals, of which 2.8 provided maternity care and 1.8 performed cesarean deliveries. The percentage of FPs who provide maternity care (mean, 48%; range, 10-69%; P maternity care who are FPs (mean, 63%; range, 10-88%; P maternity care services in US rural hospitals, including cesarean deliveries. Some family medicine residencies should continue to train their residents to provide these services to keep replenishing this valuable workforce. © Copyright 2017 by the American Board of Family Medicine.

  7. Canadian physicians' responses to cross border health care. (United States)

    Runnels, Vivien; Labonté, Ronald; Packer, Corinne; Chaudhry, Sabrina; Adams, Owen; Blackmer, Jeff


    The idea for this survey emanated from desk research and two meetings for researchers that discussed medical tourism and out-of-country health care, which were convened by some of the authors of this article (VR, CP and RL). A Cross Border Health Care Survey was drafted by a number of the authors and administered to Canadian physicians via the Canadian Medical Association's e-panel. The purpose of the survey was to gain an understanding of physicians' experiences with and views of their patients acquiring health care out of country, either as medical tourists (paying out-of-pocket for their care) or out-of-country care patients funded by provincial/territorial public health insurance plans. Quantitative and qualitative results of the survey were analyzed. 631 physicians responded to the survey. Diagnostic procedures were the top-ranked procedure for patients either as out-of-country care recipients or medical tourists. Respondents reported that the main reason why patients sought care abroad was because waiting times in Canada were too long. Some respondents were frustrated with a lack of information about out-of-country procedures upon their patients' return to Canada. The majority of physician respondents agreed that it was their responsibility to provide follow-up care to medical travellers on return to Canada, although a substantial minority disagreed that they had such a responsibility. Cross-border health care, whether government-sanctioned (out-of-country-care) or patient-initiated (medical tourism), is increasing in Canada. Such flows are thought likely to increase with aging populations. Government-sanctioned outbound flows are less problematic than patient-initiated flows but are constrained by low approval rates, which may increase patient initiation. Lack of information and post-return complications pose the greatest concern to Canadian physicians. Further research on both types of flows (government-sanctioned and patient-initiated), and how they affect

  8. US approaches to physician payment: the deconstruction of primary care. (United States)

    Berenson, Robert A; Rich, Eugene C


    The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary care payment play such a prominent role in the PCMH discussion. FFS payment for office visits has never effectively rewarded all the activities that comprise prototypical primary care and may contribute to the "hamster on a treadmill" problems in current medical practice. Capitation payments are associated with risk adjustment challenges and, perhaps, public perceptions of conflict with patients' best interests. Most payers don't employ and therefore cannot generally place physicians on salary; while in theory such salary payments might neutralize incentives, operationally, "time is money;" extra effort devoted to meeting the needs of a more complex patient will likely reduce the services available to others. Fee-for-service, the predominant physician payment scheme, has contributed to both the continuing decline in the primary care workforce and the capability to serve patients well. Yet, the conceptual alternative payment approaches, modified fee-for-service (including fee bundles), capitation, and salary, each have their own problems. Accordingly, new payment models will likely be required to support restoration of primary care to its proper role in the US health care system, and to promote and sustain the development of patient-centered medical homes.

  9. Physicians Perceptions of Shared Decision-Making in Neonatal and Pediatric Critical Care. (United States)

    Richards, Claire A; Starks, Helene; O'Connor, M Rebecca; Bourget, Erica; Hays, Ross M; Doorenbos, Ardith Z


    Most children die in neonatal and pediatric intensive care units after decisions are made to withhold or withdraw life-sustaining treatments. These decisions can be challenging when there are different views about the child's best interest and when there is a lack of clarity about how best to also consider the interests of the family. To understand how neonatal and pediatric critical care physicians balance and integrate the interests of the child and family in decisions about life-sustaining treatments. Semistructured interviews were conducted with 22 physicians from neonatal, pediatric, and cardiothoracic intensive care units in a single quaternary care pediatric hospital. Transcribed interviews were analyzed using content and thematic analysis. We identified 3 main themes: (1) beliefs about child and family interests; (2) disagreement about the child's best interest; and (3) decision-making strategies, including limiting options, being directive, staying neutral, and allowing parents to come to their own conclusions. Physicians described challenges to implementing shared decision-making including unequal power and authority, clinical uncertainty, and complexity of balancing child and family interests. They acknowledged determining the level of engagement in shared decision-making with parents (vs routine engagement) based on their perceptions of the best interests of the child and parent. Due to power imbalances, families' values and preferences may not be integrated in decisions or families may be excluded from discussions about goals of care. We suggest that a systematic approach to identify parental preferences and needs for decisional roles and information may reduce variability in parental involvement.

  10. Primary care physician insights into a typology of the complex patient in primary care. (United States)

    Loeb, Danielle F; Binswanger, Ingrid A; Candrian, Carey; Bayliss, Elizabeth A


    Primary care physicians play unique roles caring for complex patients, often acting as the hub for their care and coordinating care among specialists. To inform the clinical application of new models of care for complex patients, we sought to understand how these physicians conceptualize patient complexity and to develop a corresponding typology. We conducted qualitative in-depth interviews with internal medicine primary care physicians from 5 clinics associated with a university hospital and a community health hospital. We used systematic nonprobabilistic sampling to achieve an even distribution of sex, years in practice, and type of practice. The interviews were analyzed using a team-based participatory general inductive approach. The 15 physicians in this study endorsed a multidimensional concept of patient complexity. The physicians perceived patients to be complex if they had an exacerbating factor-a medical illness, mental illness, socioeconomic challenge, or behavior or trait (or some combination thereof)-that complicated care for chronic medical illnesses. This perspective of primary care physicians caring for complex patients can help refine models of complexity to design interventions or models of care that improve outcomes for these patients. © 2015 Annals of Family Medicine, Inc.

  11. Physiotherapy patients in intensive care unit

    Directory of Open Access Journals (Sweden)

    Agnieszka Miszewska


    Full Text Available Regulation of the Minister of Health dated 20/12/2012 on medical standards of conduct in the field of Anaesthesiology and intensive therapy, for carrying out the activities of healing in section § 2.2 intense therapy defines as: "any proceedings to maintain vital functions, and treatment of patients in life-threatening States, caused by potentially reversible renal failure one or more basic body systems, in particular the respiration, cardiovascular, central nervous system". However, in point § 12.1. We read that "Treatment of patients under intensive care in the hospital is an interdisciplinary". Annex 1 to this regulation refers to the work of physiotherapist in the ICU (INTENSIVE CARE UNITS and reads as follows: "the equivalent of at least 0.5 FTE-physical therapist-up to a range of benefits to be performed (the third reference level". [6

  12. End-of-life decisions in the intensive care unit

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene


    be interdisciplinary, but the literature shows that this is not always the case. Research on end-of-life issues in Danish ICUs is limited. Aim The aims of this thesis were to • Examine Danish practices regarding end-of-life decisions in the ICU. • Examine the opinions of nurses and physicians who work in Danish ICUs...... and decision-making. Hypotheses • Nurses, intensivists, and primary physicians have different experiences of interdisciplinary collaboration regarding end-of-life decision-making in the ICU. • Specific interventions targeting end-of-life decision-making in the ICU, such as interdisciplinary audits......Background When making end-of-life decisions in intensive care units, the different staff groups have different roles in the decision-making process and may not always assess the situation identically. Practice recommendations for withholding or withdrawing therapy state that decisions should...

  13. Caring for LGBTQ patients: Methods for improving physician cultural competence. (United States)

    Klein, Elizabeth W; Nakhai, Maliheh


    This article summarizes the components of a curriculum used to teach family medicine residents and faculty about LGBTQ patients' needs in a family medicine residency program in the Pacific Northwest region of the United States. This curriculum was developed to provide primary care physicians and physicians-in-training with skills to provide better health care for LGBTQ-identified patients. The curriculum covers topics that range from implicit and explicit bias and appropriate terminology to techniques for crafting patient-centered treatment plans. Additionally, focus is placed on improving the understanding of specific and unique barriers to competent health care encountered by LGBTQ patients. Through facilitated discussion, learners explore the health disparities that disproportionately affect LGBTQ individuals and develop skills that will improve their ability to care for LGBTQ patients. The goal of the curriculum is to teach family medicine faculty and physicians in training how to more effectively communicate with and treat LGBTQ patients in a safe, non-judgmental, and welcoming primary care environment. © The Author(s) 2016.

  14. [Intensive care medicine-survival and prospect of life]. (United States)

    Valentin, A


    Intensive care medicine has achieved a significant increase in survival rates from critical illness. In addition to short-term outcomes like intensive care unit or hospital mortality, long-term prognosis and prospect of life of intensive care patients have recently become increasingly important. Pure survival is no longer a sole goal of intensive care medicine. The prediction of an intensive care patient's individual course should include the period after intensive care. A relevant proportion of all intensive care patients is affected by physical, psychological, cognitive, and social limitations after discharge from the intensive care unit. The prognosis of the status of the patient after discharge from the intensive care unit is an important part of the decision-making process with respect to the implementation or discontinuation of intensive care measures. The heavy burden of intensive care treatment should not solely be argued by pure survival but an anticipated sound prospect of life.

  15. Physician burnout, work engagement and the quality of patient care. (United States)

    Loerbroks, A; Glaser, J; Vu-Eickmann, P; Angerer, P


    Research suggests that burnout in physicians is associated with poorer patient care, but evidence is inconclusive. More recently, the concept of work engagement has emerged (i.e. the beneficial counterpart of burnout) and has been associated with better care. Evidence remains markedly sparse however. To examine the associations of burnout and work engagement with physicians' self-perceived quality of care. We drew on cross-sectional data from physicians in Germany. We used a six-item version of the Maslach Burnout Inventory measuring exhaustion and depersonalization. We employed the nine-item Utrecht Work Engagement Scale to assess work engagement and its subcomponents: vigour, dedication and absorption. We measured physicians' own perceptions of their quality of care by a six-item instrument covering practices and attitudes. We used continuous and categorized dependent and independent variables in linear and logistic regression analyses. There were 416 participants. In multivariable linear regression analyses, increasing burnout total scores were associated with poorer perceived quality of care [unstandardized regression coefficient (b) = 0.45, 95% confidence interval (CI) 0.37, 0.54]. This association was stronger for depersonalization (b = 0.37, 95% CI 0.29, 0.44) than for exhaustion (b = 0.26, 95% CI 0.18, 0.33). Increasing work engagement was associated with higher perceived quality care (b for the total score = -0.20, 95% CI -0.28, -0.11). This was confirmed for each subcomponent with stronger associations for vigour (b = -0.21, 95% CI -0.29, -0.13) and dedication (b = -0.16, 95% CI -0.24, -0.09) than for absorption (b = -0.12, 95% CI -0.20, -0.04). Logistic regression analyses yielded comparable results. Physician burnout was associated with self-perceived poorer patient care, while work engagement related to self-reported better care. Studies are needed to corroborate these findings, particularly for work engagement. © The Author 2017. Published by Oxford

  16. Physician Religion and End-of-Life Pediatric Care: A Qualitative Examination of Physicians' Perspectives. (United States)

    Bateman, Lori Brand; Clair, Jeffrey Michael


    Physician religion/spirituality has the potential to influence the communication between physicians and parents of children at the end of life. In order to explore this relationship, the authors conducted two rounds of narrative interviews to examine pediatric physicians' perspectives (N=17) of how their religious/spiritual beliefs affect end-of-life communication and care. Grounded theory informed the design and analysis of the study. As a proxy for religiosity/spirituality, physicians were classified into the following groups based on the extent to which religious/spiritual language was infused into their responses: Religiously Rich Responders (RRR), Moderately Religious Responders (MRR), and Low Religious Responders (LRR). Twelve of the 17 participants (71%) were classified into the RRR or MRR groups. The majority of participants suggested that religion/spirituality played a role in their practice of medicine and communication with parents in a myriad of ways and to varying degrees. Participants used their religious/spiritual beliefs to support families' spirituality, uphold hope, participate in prayer, and alleviate their own emotional distress emerging from their patients' deaths.

  17. Managing the overflow of intensive care patients

    NARCIS (Netherlands)

    van Rijsbergen, M.; Boucherie, Richardus J.; van Houdenhoven, M.; Litvak, Nelli


    Many hospitals in the Netherlands are confronted with capacity problems at their Intensive Care Units (ICUs) resulting in cancelling operations, overloading the staff with extra patients, or rejecting emergency patients. In practice, the last option is a common choice because juridically, as well as

  18. Patients' experiences of intensive care diaries

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Bagger, Christine


    The aim of the study was to explore patients' experiences and perceptions of receiving intensive care diaries. A focus group and intensive care diaries for four former ICU patients were analysed to understand what works and what needs further development for patients who receive a diary. The stud......-ICU patients to gradually construct or reconstruct their own illness narrative, which is pieced together by their fragmented memory, the diary, the pictures, the hospital chart and the accounts from family and friends.......The aim of the study was to explore patients' experiences and perceptions of receiving intensive care diaries. A focus group and intensive care diaries for four former ICU patients were analysed to understand what works and what needs further development for patients who receive a diary. The study...... that the diary alone provided incomplete information and reading the diary did not necessarily bring back memories, but helped complete their story. The patients needed to know what they had gone through in ICU and wished to share their story with their family. We conclude that diaries might help post...

  19. Performance and burnout in intensive care units

    NARCIS (Netherlands)

    Keijsers, GJ; Schaufeli, WB; LeBlanc, P; Zwerts, C; Miranda, DR


    The relationship between three different performance measures and burnout was explored in 20 Dutch Intensive Care Units (ICUs). Burnout (i.e. emotional exhaustion and depersonalization) proved to be significantly related to nurses' perceptions of performance as well as to objectively assessed unit

  20. [Medication errors in Spanish intensive care units]. (United States)

    Merino, P; Martín, M C; Alonso, A; Gutiérrez, I; Alvarez, J; Becerril, F


    To estimate the incidence of medication errors in Spanish intensive care units. Post hoc study of the SYREC trial. A longitudinal observational study carried out during 24 hours in patients admitted to the ICU. Spanish intensive care units. Patients admitted to the intensive care unit participating in the SYREC during the period of study. Risk, individual risk, and rate of medication errors. The final study sample consisted of 1017 patients from 79 intensive care units; 591 (58%) were affected by one or more incidents. Of these, 253 (43%) had at least one medication-related incident. The total number of incidents reported was 1424, of which 350 (25%) were medication errors. The risk of suffering at least one incident was 22% (IQR: 8-50%) while the individual risk was 21% (IQR: 8-42%). The medication error rate was 1.13 medication errors per 100 patient-days of stay. Most incidents occurred in the prescription (34%) and administration (28%) phases, 16% resulted in patient harm, and 82% were considered "totally avoidable". Medication errors are among the most frequent types of incidents in critically ill patients, and are more common in the prescription and administration stages. Although most such incidents have no clinical consequences, a significant percentage prove harmful for the patient, and a large proportion are avoidable. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  1. Information needs of physicians, care coordinators, and families to support care coordination of children and youth with special health care needs (CYSHCN). (United States)

    Ranade-Kharkar, Pallavi; Weir, Charlene; Norlin, Chuck; Collins, Sarah A; Scarton, Lou Ann; Baker, Gina B; Borbolla, Damian; Taliercio, Vanina; Del Fiol, Guilherme


    Identify and describe information needs and associated goals of physicians, care coordinators, and families related to coordinating care for medically complex children and youth with special health care needs (CYSHCN). We conducted 19 in-depth interviews with physicians, care coordinators, and parents of CYSHCN following the Critical Decision Method technique. We analyzed the interviews for information needs posed as questions using a systematic content analysis approach and categorized the questions into information need goal types and subtypes. The Critical Decision Method interviews resulted in an average of 80 information needs per interview. We categorized them into 6 information need goal types: (1) situation understanding, (2) care networking, (3) planning, (4) tracking/monitoring, (5) navigating the health care system, and (6) learning, and 32 subtypes. Caring for CYSHCN generates a large amount of information needs that require significant effort from physicians, care coordinators, parents, and various other individuals. CYSHCN are often chronically ill and face developmental challenges that translate into intense demands on time, effort, and resources. Care coordination for CYCHSN involves multiple information systems, specialized resources, and complex decision-making. Solutions currently offered by health information technology fall short in providing support to meet the information needs to perform the complex care coordination tasks. Our findings present significant opportunities to improve coordination of care through multifaceted and fully integrated informatics solutions. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email:

  2. Médicos plantonistas de unidade de terapia intensiva: perfil sócio-demográfico, condições de trabalho e fatores associados à síndrome de burnout Intensive care unit physicians: socio-demographic profile, working conditions and factors associated with burnout syndrome

    Directory of Open Access Journals (Sweden)

    Dalton de Souza Barros


    of this study was to describe socio-demographic characteristics of intensive care unit physicians and evaluate factors associated to the presence of Burnout syndrome in this population. METHODS: A cross-sectional study was performed to evaluate physicians who have worked in intensive care units from the city of Salvador (Bahia - Brazil with a minimum weekly workload of 12-hour. An anonymous self-reported questionnaire was used and it was divided into two parts: socio-demographic characteristics and evaluation of Burnout syndrome through Maslach Burnout Inventory. RESULTS: We studied 297 physicians and most of them were male (70%. The mean age and time of graduation were, respectively, 34.2 and 9 years. High levels of emotional exhaustion, depersonalization, and reduced personal accomplishment were found in respectively, 47.5%, 24.6% and 28.3%. The prevalence of Burnout syndrome, considered as high level in at least one dimension, was of 63.3%. This prevalence was statistically lower in physicians specialized on intensive care, those with more than nine years of graduation and those who intend to continue working in intensive care units for more than 10 years. The prevalence was higher in the doctors with more than 24-hours of uninterrupted intensive care work per week. CONCLUSIONS: Burnout syndrome was common among intensive care physicians and it was more frequent in the youngest doctors, with higher workload and without specialization on intensive care.

  3. The desired moral attitude of the physician: (III) care. (United States)

    Gelhaus, Petra


    In professional medical ethics, the physician traditionally is obliged to fulfil specific duties as well as to embody a responsible and trustworthy personality. In the public discussion, different concepts are suggested to describe the desired moral attitude of physicians. In a series of three articles, three of the discussed concepts are presented in an interpretation that is meant to characterise the morally emotional part of this attitude: "empathy", "compassion" and "care". In the first article of the series, "empathy" has been developed as a mainly cognitive and morally neutral capacity of understanding. In the second article, the emotional and virtuous core of the desired professional attitude-compassion-has been presented. Compassion as a professional attitude has been distinguished from a spontaneous feeling of compassion, and has been related to a general idea of man as vulnerable and solidary being. Thus, the dignity of the patient is safeguarded in spite of the asymmetry of compassion. In this article, the third concept of the triad-"care"-is presented. Care is conceived as an attitude as well as an activity which can be directed to different objects: if it is directed to another sentient being, it is regarded as intrinsically morally valuable; implying (1) the acceptance of being addressed, (2) a benevolent inclination to help and to foster, and (3) activity to realize this. There are different forms of benevolence that can underlie caring. With regard to the professional physician's ethos, the attitude of empathic compassion as developed in the two previous articles is proposed to be the adequate underlying attitude of care which demands the right balance between closeness and professionalism and the right form of attention to the person of the patient. 'Empathic compassionate care' does not, however, describe the whole of the desired attitude of a physician, but focuses on the morally-emotive aspects. In order to get also the cognitive and practical

  4. Increasing Military Physician Productivity in a Managed Care Environment (United States)


    allows us to obtain to a common denominator, or one single rating even though the services are dissimilar and the input units are not "weighted." Serway ...many ideas as possible to catalyze the process. In removing barriers to productivity in the work environment, a thorough analysis of the physical ...physician and the organization has increased. The whole text of the book "Doctor’s Decisions and the Cost of Medical Care" is dedicated to this concept

  5. [Evolution of burnout and associated factors in primary care physicians]. (United States)

    Matía Cubillo, Angel Carlos; Cordero Guevara, José; Mediavilla Bravo, José Javier; Pereda Riguera, Maria José; González Castro, Maria Luisa; González Sanz, Ana


    To analyse the course of burnout and develop an explanatory model. Prospective cohort dynamics. SITE: All primary health care centres in Burgos. All physicians except medical emergencies, paediatrics and residents. Anonymous self-report questionnaire: Maslach Burnout Inventory (MBI) and related variables. An analysis was performed using the Student-t, X(2) test and logistic regression. The response rate was 47.76% in 2007, which was lower than that of 2005. There were significant differences between 2005 and 2007, for increases in the percentage of physicians who smoked, postgraduate training, residency, and those who believe that coordination with nursing and specialist care and institutional communication is appropriate. There was an increase in the prevalence of burnout by almost one point compared with 2005, a decrease in maximum burnout and emotional exhaustion (EC), and an increase in depersonalisation (DP) and personal accomplishment (RP). The incidence density of burnout was 1/113. 5 primary care physicians per year. The existence of burnout is associated with the use of chronic medication and inadequate coordination between nursing and EC, and also with the high workload. The increase in the prevalence found is consistent with the idea of burnout as a dynamic development and the theoretical model described. Stable and quality employment is one way to indirectly mitigate (by encouraging internal communication) professional burnout. In the multivariate analysis, the most critical variable in the onset of burnout is the inadequate coordination with nursing. Copyright © 2008 Elsevier España, S.L. All rights reserved.

  6. ICU nurses and physicians dialogue regarding patients clinical status and care options-a focus group study. (United States)

    Kvande, Monica; Lykkeslet, Else; Storli, Sissel Lisa


    Nurses and physicians work side-by-side in the intensive care unit (ICU). Effective exchanges of patient information are essential to safe patient care in the ICU. Nurses often rate nurse-physician communication lower than physicians and report that it is difficult to speak up, that disagreements are not resolved and that their input is not well received. Therefore, this study explored nurses' dialogue with physicians regarding patients' clinical status and the prerequisites for effective and accurate exchanges of information. We adopted a qualitative approach, conducting three focus group discussions with five to six nurses and physicians each (14 total). Two themes emerged. The first theme highlighted nurses' contributions to dialogues with physicians; nurses' ongoing observations of patients were essential to patient care discussions. The second theme addressed the prerequisites of accurate and effective dialogue regarding care options, comprising three subthemes: nurses' ability to speak up and present clinical changes, establishment of shared goal and clinical understanding, and open dialogue and willingness to listen to each other. Nurses should understand their essential role in conducting ongoing observations of patients and their right to be included in care-related decision-making processes. Physicians should be willing to listen to and include nurses' clinical observations and concerns.

  7. [Refusal of care in the intensive care: how makes decision?]. (United States)

    Borel, M; Veber, B; Villette-Baron, K; Hariri, S; Dureuil, B; Hervé, C


    Decision-making bringing to an admission or not in intensive care is complex. The aim of this study is to analyze with an ethical point of view the making decision process leading to the refusal and its consequences. It is proposed a setting in prospect through the principles of beneficence, non-maleficience, respect for autonomy, justice, and the Leonetti law. Prospective study in surgical reanimation at the University Hospital of Rouen over 9 months (November 2007-September 2008). Systematic collection for each non-admitted patient of the general characters, the methods of decision making, immediate becoming and within 48 h Constitution of two groups: patients for whom an admission in intensive care could be an unreasonable situation of obstinacy, and patients for whom an admission in reanimation would not be about unreasonable if it occurred. One hundred and fifty situations were analyzed. The potentially unreasonable character of an admission does not involve necessarily a refusal of care in intensive care. The question of the lack of place and equity in the access to the care is real but relative according to the typology of the patients. The research of the respect of the autonomy of the patient is difficult but could be facilitated. The Leonetti law does not appear to be able to be a framework with the situation of refusal of care in intensive care. It is not a question of going towards a systematic admission in intensive care of any patient proposed, but to make sure that so if there is a refusal, it is carried out according to a step ethically acceptable.

  8. Medical staffing in Ontario neonatal intensive care units. (United States)

    Paes, B; Mitchell, A; Hunsberger, M; Blatz, S; Watts, J; Dent, P; Sinclair, J; Southwell, D


    Advances in technology have improved the survival rates of infants of low birth weight. Increasing service commitments together with cutbacks in Canadian training positions have caused concerns about medical staffing in neonatal intensive care units (NICUs) in Ontario. To determine whether an imbalance exists between the supply of medical personnel and the demand for health care services, in July 1985 we surveyed the medical directors, head nurses and staff physicians of nine tertiary level NICUs and the directors of five postgraduate pediatric residency programs. On the basis of current guidelines recommending an ideal neonatologist:patient ratio of 1:6 (assuming an adequate number of support personnel) most of the NICUs were understaffed. Concern about the heavy work pattern and resulting lifestyle implications has made Canadian graduates reluctant to enter this subspecialty. We propose strategies to correct staffing shortages in the context of rapidly increasing workloads resulting from a continuing cutback of pediatric residency positions and restrictions on immigration of foreign trainees.

  9. Intubação orotraqueal: avaliação do conhecimento médico e das práticas clínicas adotadas em unidades de terapia intensiva Orotracheal intubation: physicians knowledge assessment and clinical practices in intensive care units

    Directory of Open Access Journals (Sweden)

    Caroline Setsuko Yamanaka


    Full Text Available OBJETIVOS: Avaliar o conhecimento médico sobre as técnicas de intubação e identificar as práticas mais realizadas. MÉTODOS: Estudo prospectivo, envolvendo três diferentes unidades de terapia intensiva de um hospital universitário: da anestesiologia (ANEST, da pneumologia (PNEUMO e do pronto socorro (PS. Todos os médicos que trabalham nessas unidades e que concordaram em participar do estudo, responderam um questionário contendo dados demográficos e questões sobre intubação orotraqueal. RESULTADOS: Foram obtidos 85 questionários (90,42% dos médicos. ANEST teve maior média de idade (p = 0,001, com 43,5% sendo intensivistas. Foi referido uso da associação hipnótico e opióide (97,6% e pré oxigenação (91,8%, mas apenas 44,6% referiram utilização de coxim suboccipital, sem diferença entre as UTIs. Na ANEST, referiu-se maior uso de bloqueador neuromuscular (p OBJECTIVES: To assess the physician’s knowledge on intubation techniques and to identify the common practices. METHODS: This was a prospective study, involving three different intensive care units within a University hospital: Anesthesiology (ANEST, Pulmonology (PULMO and Emergency Department (ED. All physicians working in these units and consenting to participate in the study completed a questionnaire with their demographic data and questions on orotracheal intubation. RESULTS: 85 completed questionnaires were retrieved (90.42% of the physicians. ANEST had the higher mean age (p=0.001, being 43.5% of them intensivists. The use of hypnotic and opioid association was reported by 97.6%, and pre-oxygenation by 91.8%, but only 44.6% reported sub-occipital pad use, with no difference between the ICUs. On ANEST an increased neuromuscular blockade use was reported (p<0.000 as well as increased caution with full stomach (p=0.002. The rapid sequence knowledge was restricted (mean 2.20 ± 0.89, p=0.06 between the different units. The Sellick maneuver was known by 97.6%, but 72

  10. Variability of intensive care admission decisions for the very elderly.

    Directory of Open Access Journals (Sweden)

    Ariane Boumendil

    Full Text Available Although increasing numbers of very elderly patients are requiring intensive care, few large sample studies have investigated ICU admission of very elderly patients. Data on pre triage by physicians from other specialities is limited. This observational cohort study aims at examining inter-hospital variability of ICU admission rates and its association with patients' outcomes. All patients over 80 years possibly qualifying for ICU admission who presented to the emergency departments (ED of 15 hospitals in the Paris (France area during a one-year period were prospectively included in the study. Main outcome measures were ICU eligibility, as assessed by the ED and ICU physicians; in-hospital mortality; and vital and functional status 6 months after the ED visit. 2646 patients (median age 86; interquartile range 83-91 were included in the study. 94% of participants completed follow-up (n = 2495. 12.4% (n = 329 of participants were deemed eligible for ICU admission by ED physicians and intensivists. The overall in-hospital and 6-month mortality rates were respectively 27.2% (n = 717 and 50.7% (n = 1264. At six months, 57.5% (n = 1433 of patients had died or had a functional deterioration. Rates of patients deemed eligible for ICU admission ranged from 5.6% to 38.8% across the participating centers, and this variability persisted after adjustment for patients' characteristics. Despite this variability, we found no association between level of ICU eligibility and either in-hospital death or six-month death or functional deterioration. In France, the likelihood that a very elderly person will be admitted to an ICU varies widely from one hospital to another. Influence of intensive care admission on patients' outcome remains NCT00912600.

  11. Antibiotic Policies in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Nese Saltoglu


    Full Text Available The antimicrobial management of patients in the Intensive Care Units are complex. Antimicrobial resistance is an increasing problem. Effective strategies for the prevention of antimicrobial resistance in ICUs have focused on limiting the unnecessary use of antibiotics and increasing compliance with infection control practices. Antibiotic policies have been implemented to modify antibiotic use, including national or regional formulary manipulations, antibiotic restriction forms, care plans, antibiotic cycling and computer assigned antimicrobial therapy. Moreover, infectious diseases consultation is a simple way to limit antibiotic use in ICU units. To improve rational antimicrobial using a multidisiplinary approach is suggested. [Archives Medical Review Journal 2003; 12(4.000: 299-309

  12. Reducing nosocomial infections in neonatal intensive care. (United States)

    Rogers, Eileen; Alderdice, Fiona; McCall, Emma; Jenkins, John; Craig, Stanley


    Nosocomial infection is a common problem in neonatal intensive care. A pilot quality improvement initiative focussing on hand hygiene and aimed at reducing nosocomial infection in very low birth weight (VLBW) infants was introduced in five Neonatal Intensive Care Units. Line associated laboratory confirmed bloodstream infection (LCBSI) and ventilator associated pneumonia (VAP) were chosen as main outcome measures. In VLBW infants, the rate of line associated LCBSI per 1000 central venous catheter days fell by 24%. The rate of VAP per 1000 ventilator days in VLBW infants fell by 38%. Pre- and post-intervention questionnaires showed a statistically significant increase in use of alcohol-based gels and increased knowledge of hand hygiene.

  13. Computed radiography in neonatal intensive care

    International Nuclear Information System (INIS)

    Merlo, L.; Bighi, S.; Cervi, P.M.; Lupi, L.


    The Authors report their experience in the employment of a computerized digital radiographic system in Neonatal Intensive Care. The analog screen-film system is replaced by photosensitive imaging plates, scanned after X-ray exposure by a laser that releases the digital image, which can then be manipulated on computer work-stations. In a period of twelve months about 200 chest-abdomen X-ray examinations in Neonatal Intensive Care have been performed using this method with good technical and diagnostic results. The use of digital radiography in the neonatal area is of high interest: this system produces good quality images, there is a reduction in radiation dose and 'retakes', the system allows selective enhancement of different structures and their magnification. (orig.)

  14. Primary care careers among recent graduates of research-intensive private and public medical schools. (United States)

    Choi, Phillip A; Xu, Shuai; Ayanian, John Z


    Despite a growing need for primary care physicians in the United States, the proportion of medical school graduates pursuing primary care careers has declined over the past decade. To assess the association of medical school research funding with graduates matching in family medicine residencies and practicing primary care. Observational study of United States medical schools. One hundred twenty-one allopathic medical schools. The primary outcomes included the proportion of each school's graduates from 1999 to 2001 who were primary care physicians in 2008, and the proportion of each school's graduates who entered family medicine residencies during 2007 through 2009. The 25 medical schools with the highest levels of research funding from the National Institutes of Health in 2010 were designated as "research-intensive." Among research-intensive medical schools, the 16 private medical schools produced significantly fewer practicing primary care physicians (median 24.1% vs. 33.4%, p schools. In contrast, the nine research-intensive public medical schools produced comparable proportions of graduates pursuing primary care careers (median 36.1% vs. 36.3%, p = 0.87) and matching in family medicine residencies (median 7.4% vs. 10.0%, p = 0.37) relative to the other 66 public medical schools. To meet the health care needs of the US population, research-intensive private medical schools should play a more active role in promoting primary care careers for their students and graduates.

  15. The management of health care service quality. A physician perspective. (United States)

    Bobocea, L; Gheorghe, I R; Spiridon, St; Gheorghe, C M; Purcarea, V L


    Applying marketing in health care services is presently an essential element for every manager or policy maker. In order to be successful, a health care organization has to identify an accurate measurement scale for defining service quality due to competitive pressure and cost values. The most widely employed scale in the services sector is SERVQUAL scale. In spite of being successfully adopted in fields such as brokerage and banking, experts concluded that the SERVQUAL scale should be modified depending on the specific context. Moreover, the SERVQUAL scale focused on the consumer's perspective regarding service quality. While service quality was measured with the help of SERVQUAL scale, other experts identified a structure-process-outcome design, which, they thought, would be more suitable for health care services. This approach highlights a different perspective on investigating the service quality, namely, the physician's perspective. Further, we believe that the Seven Prong Model for Improving Service Quality has been adopted in order to effectively measure the health care service in a Romanian context from a physician's perspective.

  16. Views of US physicians about controlling health care costs. (United States)

    Tilburt, Jon C; Wynia, Matthew K; Sheeler, Robert D; Thorsteinsdottir, Bjorg; James, Katherine M; Egginton, Jason S; Liebow, Mark; Hurst, Samia; Danis, Marion; Goold, Susan Dorr


    Physicians' views about health care costs are germane to pending policy reforms. To assess physicians' attitudes toward and perceived role in addressing health care costs. A cross-sectional survey mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile. Enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale. A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a "major responsibility" for reducing health care costs, whereas only 36% reported that practicing physicians have "major responsibility." Most were "very enthusiastic" for "promoting continuity of care" (75%), "expanding access to quality and safety data" (51%), and "limiting access to expensive treatments with little net benefit" (51%) as a means of reducing health care costs. Few expressed enthusiasm for "eliminating fee-for-service payment models" (7%). Most physicians reported being "aware of the costs of the tests/treatments [they] recommend" (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they "should be solely devoted to individual patients' best interests, even if that is expensive" (78%) and that "doctors need to take a more prominent role in limiting use of unnecessary tests" (89%). Most (85%) disagreed that they "should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more." In multivariable logistic regression models testing associations with enthusiasm for key cost-containment strategies, having a salary plus bonus or salary-only compensation type was independently associated with enthusiasm for "eliminating fee for service" (salary plus bonus: odds ratio [OR], 3.3, 99% CI, 1

  17. Improving care by understanding the way we work: human factors and behavioural science in the context of intensive care (United States)

    Sevdalis, Nick; Brett, Stephen J


    Effectiveness and efficiency of care of the critically ill patient are subject to a number of systemic influences, including skills of individual physicians/nurses (technical and non-technical), team-working in the intensive care unit (ICU), and the ICU environment. We first discuss the paper of Fackler and colleagues as a contribution to the systems approach to clinical performance in the context of intensive care. We then highlight features of care delivery that are unique to intensive care and discuss the need for better understanding of human and non-human elements of the system of care of the critically ill patient as a driver for improvement of care delivery. PMID:19439048

  18. Hand hygiene in the intensive care unit. (United States)

    Tschudin-Sutter, Sarah; Pargger, Hans; Widmer, Andreas F


    Healthcare-associated infections affect 1.4 million patients at any time worldwide, as estimated by the World Health Organization. In intensive care units, the burden of healthcare-associated infections is greatly increased, causing additional morbidity and mortality. Multidrug-resistant pathogens are commonly involved in such infections and render effective treatment challenging. Proper hand hygiene is the single most important, simplest, and least expensive means of preventing healthcare-associated infections. In addition, it is equally important to stop transmission of multidrug-resistant pathogens. According to the Centers for Disease Control and Prevention and World Health Organization guidelines on hand hygiene in health care, alcohol-based handrub should be used as the preferred means for routine hand antisepsis. Alcohols have excellent in vitro activity against Gram-positive and Gram-negative bacteria, including multidrug-resistant pathogens, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, Mycobacterium tuberculosis, a variety of fungi, and most viruses. Some pathogens, however, such as Clostridium difficile, Bacillus anthracis, and noroviruses, may require special hand hygiene measures. Failure to provide user friendliness of hand hygiene equipment and shortage of staff are predictors for noncompliance, especially in the intensive care unit setting. Therefore, practical approaches to promote hand hygiene in the intensive care unit include provision of a minimal number of handrub dispensers per bed, monitoring of compliance, and choice of the most attractive product. Lack of knowledge of guidelines for hand hygiene, lack of recognition of hand hygiene opportunities during patient care, and lack of awareness of the risk of cross-transmission of pathogens are barriers to good hand hygiene practices. Multidisciplinary programs to promote increased use of alcoholic handrub lead to an increased compliance of healthcare

  19. Monitoring quality in Israeli primary care: The primary care physicians' perspective

    Directory of Open Access Journals (Sweden)

    Nissanholtz-Gannot Rachel


    Full Text Available Abstract Background Since 2000, Israel has had a national program for ongoing monitoring of the quality of the primary care services provided by the country's four competing non-profit health plans. Previous research has demonstrated that quality of care has improved substantially since the program's inception and that the program enjoys wide support among health plan managers. However, prior to this study there were anecdotal and journalistic reports of opposition to the program among primary care physicians engaged in direct service delivery; these raised serious questions about the extent of support among physicians nationally. Goals To assess how Israeli primary care physicians experience and rate health plan efforts to track and improve the quality of care. Method The study population consisted of primary care physicians employed by the health plans who have responsibility for the quality of care of a panel of adult patients. The study team randomly sampled 250 primary-care physicians from each of the four health plans. Of the 1,000 physicians sampled, 884 met the study criteria. Every physician could choose whether to participate in the survey by mail, e-mail, or telephone. The anonymous questionnaire was completed by 605 physicians – 69% of those eligible. The data were weighted to reflect differences in sampling and response rates across health plans. Main findings The vast majority of respondents (87% felt that the monitoring of quality was important and two-thirds (66% felt that the feedback and subsequent remedial interventions improved medical care to a great extent. Almost three-quarters (71% supported continuation of the program in an unqualified manner. The physicians with the most positive attitudes to the program were over age 44, independent contract physicians, and either board-certified in internal medicine or without any board-certification (i.e., residents or general practitioners. At the same time, support for the

  20. Physician and staff turnover in community primary care practice. (United States)

    Ruhe, Mary; Gotler, Robin S; Goodwin, Meredith A; Stange, Kurt C


    The effect of a rapidly changing healthcare system on personnel turnover in community family practices has not been analyzed. We describe physician and staff turnover and examine its association with practice characteristics and patient outcomes. A cross-sectional evaluation of length of employment of 150 physicians and 762 staff in 77 community family practices in northeast Ohio was conducted. Research nurses collected data using practice genograms, key informant interviews, staff lists, practice environment checklists, medical record reviews, and patient questionnaires. The association of physician and staff turnover with practice characteristics, patient satisfaction, and preventive service data was tested. During a 2-year period, practices averaged a 53% turnover rate of staff. The mean length of duration of work at the current practice location was 9.1 years for physicians and 4.1 years for staff. Longevity varied by position, with a mean of 3.4 years for business employees, 4.0 years for clinical employees, and 7.8 years for office managers. Network-affiliated practices experienced higher turnover than did independent practices. Physician longevity was associated with a practice focus on managing chronic illness, keeping on schedule, and responding to insurers' requests. No association was found between turnover and patient satisfaction or preventive service delivery rates. Personnel turnover is pervasive in community primary care practices and is associated with employee role, practice network affiliation, and practice focus. The potentially disruptive effect of personnel turnover on practice functioning, finances, and longitudinal relationships with patients deserves further study despite the reassuring lack of association with patient satisfaction and preventive service delivery rates.

  1. Validation of Surgical Intensive Care-Infection Registry: a medical informatics system for intensive care unit research, quality of care improvement, and daily patient care. (United States)

    Golob, Joseph F; Fadlalla, Adam M A; Kan, Justin A; Patel, Nilam P; Yowler, Charles J; Claridge, Jeffrey A


    We developed a prototype electronic clinical information system called the Surgical Intensive Care-Infection Registry (SIC-IR) to prospectively study infectious complications and monitor quality of care improvement programs in the surgical and trauma intensive care unit. The objective of this study was to validate SIC-IR as a successful health information technology with an accurate clinical data repository. Using the DeLone and McLean Model of Information Systems Success as a framework, we evaluated SIC-IR in a 3-month prospective crossover study of physician use in one of our two surgical and trauma intensive care units (SIC-IR unit versus non SIC-IR unit). Three simultaneous research methodologies were used: a user survey study, a pair of time-motion studies, and an accuracy study of SIC-IR's clinical data repository. The SIC-IR user survey results were positive for system reliability, graphic user interface, efficiency, and overall benefit to patient care. There was a significant decrease in prerounding time of nearly 4 minutes per patient on the SIC-IR unit compared with the non SIC-IR unit. The SIC-IR documentation and data archiving was accurate 74% to 100% of the time depending on the data entry method used. This accuracy was significantly improved compared with normal hand-written documentation on the non SIC-IR unit. SIC-IR proved to be a useful application both at individual user and organizational levels and will serve as an accurate tool to conduct prospective research and monitor quality of care improvement programs.

  2. Diagnostic imaging in intensive care patients

    International Nuclear Information System (INIS)

    Afione, Cristina; Binda, Maria del C.


    Purpose: To determine the role of imaging diagnostic methods in the location of infection causes of unknown origin in the critical care patient. Material and methods: A comprehensive medical literature search has been done. Recommendations for the diagnostic imaging of septic focus in intensive care patients are presented for each case, with analysis based on evidence. The degree of evidence utilized has been that of Oxford Center for Evidence-based Medicine. Results: Nosocomial infection is the most frequent complication in the intensive care unit (25 to 33%) with high sepsis incidence rate. In order to locate the infection focus, imaging methods play an important role, as a diagnostic tool and to guide therapeutic procedures. The most frequent causes of infection are: ventilation associated pneumonia, sinusitis, intra-abdominal infections and an acute acalculous cholecystitis. This paper analyses the diagnostic imaging of hospital infection, with the evaluation of choice methods for each one and proposes an algorithm to assess the septic patient. Conclusion: There are evidences, with different degrees of recommendation, for the use of diagnostic imaging methods for infectious focuses in critical care patients. The studies have been selected based on their diagnostic precision, on the capacity of the medical team and on the availability of resources, considering the risk-benefit balance for the best safety of the patient. (author)

  3. Family-Centered Care in Neonatal Intensive Care Units: Combining Intensive Care and Family Support. (United States)

    Araki, Shunsuke; Saito, Tomoko; Ichikawa, Saori; Saito, Kaori; Takada, Tsuzumi; Noguchi, Satoko; Yamada, Miki; Nakagawa, Fumi

    Advances in treatment in neonatal intensive care units (NICU) for preterm and sick newborns have improved the mortality rate of patients, but admission to the NICU may disrupt parent-infant interaction, with adverse consequences for infants and their families because of physical, psychological, and emotional separation. The concept of family centered care (FCC), in which family members are part of the care team and infants are close to the family, is important and has become popular in NICU. In 2013, we created a team called "Kodomo-Kazoku Mannaka" to promote FCC in Japan, and visited the NICU at Uppsala University Hospital in Sweden, which is internationally famous for FCC. Since this fruitful visit, we have been promoting FCC in Japan by exhibitions and presentations of the FCC ideas at academic conferences and using internet services. A questionnaire survey conducted in 2015 revealed that the importance and the benefits of FCC in NICU are recognized, although there are some barriers to FCC in each facility. It is hard to change facilities and social systems right away, but it is easier and more important to change people's minds. Our role is to spread the concept of FCC and to help each facility find its own way to adopt it. We will continue to make efforts encourage to promote FCC in Japan.

  4. Infection control in the intensive care unit. (United States)

    Osman, Mohamed F; Askari, Reza


    It is critical for health care personnel to recognize and appreciate the detrimental impact of intensive care unit (ICU)-acquired infections. The economic, clinical, and social expenses to patients and hospitals are overwhelming. To limit the incidence of ICU-acquired infections, aggressive infection control measures must be implemented and enforced. Researchers and national committees have developed and continue to develop evidence-based guidelines to control ICU infections. A multifaceted approach, including infection prevention committees, antimicrobial stewardship programs, daily reassessments-intervention bundles, identifying and minimizing risk factors, and continuing staff education programs, is essential. Infection control in the ICU is an evolving area of critical care research. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Aberdeen polygons: computer displays of physiological profiles for intensive care. (United States)

    Green, C A; Logie, R H; Gilhooly, K J; Ross, D G; Ronald, A


    The clinician in an intensive therapy unit is presented regularly with a range of information about the current physiological state of the patients under care. This information typically comes from a variety of sources and in a variety of formats. A more integrated form of display incorporating several physiological parameters may be helpful therefore. Three experiments are reported that explored the potential use of analogue, polygon diagrams to display physiological data from patients undergoing intensive therapy. Experiment 1 demonstrated that information can be extracted readily from such diagrams comprising 8- or 10-sided polygons, but with an advantage for simpler polygons and for information displayed at the top of the diagram. Experiment 2 showed that colour coding removed these biases for simpler polygons and the top of the diagram, together with speeding the processing time. Experiment 3 used polygons displaying patterns of physiological data that were consistent with typical conditions observed in the intensive care unit. It was found that physicians can readily learn to recognize these patterns and to diagnose both the nature and severity of the patient's physiological state. These polygon diagrams appear to have some considerable potential for use in providing on-line summary information of a patient's physiological state.

  6. [Refusal of care in the intensive care: how makes decision?].


    Borel , Marie; Veber , Benoit; Villette-Baron , Karen; Hariri , S.; Dureuil , Bertrand; Hervé , Christian


    International audience; It is not a question of going towards a systematic admission in intensive care of any patient proposed, but to make sure that so if there is a refusal, it is carried out according to a step ethically acceptable.

  7. Selective mutism: are primary care physicians missing the silence? (United States)

    Schwartz, Richard H; Freedy, Alicia S; Sheridan, Michael J


    To survey parents of children with selective mutism (SM) in regard to (1) the role of the primary care physician in the diagnosis of SM; (2) the social and school consequences of SM; and (3) their opinion of the effectiveness of different treatment modalities, a 39-item written survey was mailed to 27 parents with at least one child diagnosed with SM on the basis of diagnostic and statistical manual IV-text revision (DSM IV-TR) criteria. Twenty-seven parents (100%), with a total of 33 children with SM, completed the survey. There were 24 girls and 9 boys. The mean age when parents had strong concerns about symptoms of SM was 3.8 years, but diagnosis did not occur until nearly a year later. Twenty-three (69.7%) of the children with SM were never diagnosed accurately or referred by their primary care physicians. SM caused important school/social problems for 17 (51.5%) of the children. Speech therapy was provided for 36.4% of children and was thought to have been helpful for 30% of them. Behavior modification was the treatment for 45.5% of children and perceived to be helpful for 66.7% of them. Selective serotonin re-uptake inhibitor pharmacotherapy was prescribed for 17 (51.5%) of the children and believed to be effective for 11 (65%) of them. Primary care physicians in this study rarely diagnosed accurately or referred children with SM in a timely fashion, even though symptoms of the condition were generally very apparent and parents had expressed concern. Behavioral modification, pharmacotherapy with SSRIs, and early intervention are viable treatment options. Early diagnosis is key to preventing long-term effects of this condition.

  8. [Managed care. Its impact on health care in the USA, especially on anesthesia and intensive care]. (United States)

    Bauer, M; Bach, A


    Managed care, i.e., the integration of health insurance and delivery of care under the direction of one organization, is gaining importance in the USA health market. The initial effects consisted of a decrease in insurance premiums, a very attractive feature for employers. Managed care promises to contain expenditures for health care. Given the shrinking public resources in Germany, managed care seems attractive for the German health system, too. In this review the development of managed care, the principal elements, forms of organisation and practical tools are outlined. The regulation of the delivery of care by means of controlling and financial incentives threatens the autonomy of physicians: the physician must act as a "double agent", caring for the interest for the individual patient and being restricted by the contract with the managed care organisation. Cost containment by managed care was achieved by reducing the fees for physicians and hospitals (and partly by restricting care for patients). Only a fraction of this cost reduction was handed over to the enrollee or employer, and most of the money was returned with profit to the shareholders of the managed care organisations. The preeminent role of primary care physicians as gatekeepers of the health network led to a reduced demand for specialist services in general and for university hospitals and anesthesiologists in particular. The paradigm of managed care, i.e., to guide the patient and the care giver through the health care system in order to achieve cost-effective and high quality care, seems very attractive. The stress on cost minimization by any means in the daily practice of managed care makes it doubtful if managed care should be an option for the German health system, in particular because there are a number of restrictions on it in German law.

  9. Intensive care bereavement practices across New Zealand and Australian intensive care units: a qualitative content analysis. (United States)

    Coombs, Maureen; Mitchell, Marion; James, Stephen; Wetzig, Krista


    End-of-life and bereavement care is an important consideration in intensive care. This study describes the type of bereavement care provided in intensive care units across Australia and New Zealand. Inductive qualitative content analysis was conducted on free-text responses to a web-based survey exploring unit-based bereavement practice distributed to nurse managers in 229 intensive care units in New Zealand and Australia. A total of 153 (67%) surveys were returned with 68 respondents making free-text responses. Respondents were mainly Australian (n = 54, 85·3%), from the public sector (n = 51, 75%) and holding Nurse Unit Managers/Charge Nurse roles (n = 39, 52·9%). From the 124 free-text responses, a total of 187 individual codes were identified focussing on bereavement care practices (n = 145, 77·5%), educational provision to support staff (n = 15, 8%) and organisational challenges (n = 27, 14·4%). Bereavement care practices described use of memory boxes, cultural specificity, annual memorial services and use of community support services. Educational provision identified local in-service programmes, and national bereavement courses for specialist bereavement nurse coordinators. Organisational challenges focussed on lack of funding, especially for provision of bereavement follow-up. This is the first Australasian-wide survey, and one of the few international studies, describing bereavement practices within intensive care, an important aspect of nursing practice. However, with funding for new bereavement services and education for staff lacking, there are continued challenges in developing bereavement care. Given knowledge about the impact of these areas of care on bereaved family members, this requires review. Nurses remain committed to supporting bereaved families during and following death in intensive care. With limited resource to support bereavement care, intensive care nurses undertake a range of bereavement care practices at time of death

  10. Exodus of male physicians from primary care drives shift to specialty practice. (United States)

    Tu, Ha T; O'Malley, Ann S


    An exodus of male physicians from primary care is driving a marked shift in the U.S. physician workforce toward medical-specialty practice, according to a national study by the Center for Studying Health System Change (HSC). Two factors have helped mask the severity of the shift--a growing proportion of female physicians, who disproportionately choose primary care, and continued reliance on international medical graduates (IMGs), who now account for nearly a quarter of all U.S. primary care physicians. Since 1996-97, a 40 percent increase in the female primary care physician supply has helped to offset a 16 percent decline in the male primary care physician supply relative to the U.S. population. At the same time, primary care physicians' incomes have lost ground to both inflation and medical and surgical specialists' incomes. And women in primary care face a 22 percent income gap relative to men, even after accounting for differing characteristics. If real incomes for primary care physicians continue to decline, there is a risk that the migration of male physicians will intensify and that female physicians may begin avoiding primary care--trends that could aggravate a predicted shortage of primary care physicians.

  11. Ethical challenges in neonatal intensive care nursing. (United States)

    Strandås, Maria; Fredriksen, Sven-Tore D


    Neonatal nurses report a great deal of ethical challenges in their everyday work. Seemingly trivial everyday choices nurses make are no more value-neutral than life-and-death choices. Everyday ethical challenges should also be recognized as ethical dilemmas in clinical practice. The purpose of this study is to investigate which types of ethical challenges neonatal nurses experience in their day-to-day care for critically ill newborns. Data were collected through semi-structured qualitative in-depth interviews. Phenomenological-hermeneutic analysis was applied to interpret the data. Six nurses from neonatal intensive care units at two Norwegian hospitals were interviewed on-site. The study is designed to comply with Ethical Guidelines for Nursing Research in the Nordic Countries and the Helsinki declaration. Findings suggest that nurses experience a diverse range of everyday ethical challenges related to challenging interactions with parents and colleagues, emotional strain, protecting the vulnerable infant, finding the balance between sensitivity and authority, ensuring continuity of treatment, and miscommunication and professional disagreement. A major finding in this study is how different agents involved in caring for the newborn experience their realities differently. When these realities collide, ethical challenges arise. Findings suggest that acting in the best interests of the child becomes more difficult in situations involving many agents with different perceptions of reality. The study presents new aspects which increases knowledge and understanding of the reality of nursing in a neonatal intensive care unit, while also demanding increased research in this field of care. © The Author(s) 2014.

  12. Screening for cancer: advice for high-value care from the American College of Physicians. (United States)

    Wilt, Timothy J; Harris, Russell P; Qaseem, Amir


    Cancer screening is one approach to reducing cancer-related morbidity and mortality rates. Screening strategies vary in intensity. Higher-intensity strategies are not necessarily higher value. High-value strategies provide a degree of benefits that clearly justifies the harms and costs incurred; low-value screening provides limited or no benefits to justify the harms and costs. When cancer screening leads to benefits, an optimal intensity of screening maximizes value. Some aspects of screening practices, especially overuse and underuse, are low value. Screening strategies for asymptomatic, average-risk adults for 5 common types of cancer were evaluated by reviewing clinical guidelines and evidence syntheses from the American College of Physicians (ACP), U.S. Preventive Services Task Force, American Academy of Family Physicians, American Cancer Society, American Congress of Obstetricians and Gynecologists, American Gastroenterological Association, and American Urological Association. "High value" was defined as the lowest screening intensity threshold at which organizations agree about screening recommendations for each type of cancer and "low value" as agreement about not recommending overly intensive screening strategies. This information is supplemented with additional findings from randomized, controlled trials; modeling studies; and studies of costs or resource use, including information found in the National Cancer Institute's Physician Data Query and UpToDate. The ACP provides high-value care screening advice for 5 common types of cancer; the specifics are outlined in this article. The ACP strongly encourages clinicians to adopt a cancer screening strategy that focuses on reaching all eligible persons with these high-value screening options while reducing overly intensive, low-value screening.

  13. Management of infections in critically ill returning travellers in the intensive care unit-II

    DEFF Research Database (Denmark)

    Rello, Jordi; Manuel, Oriol; Eggimann, Philippe


    This position paper is the second ESCMID Consensus Document on this subject and aims to provide intensivists, infectious disease specialists, and emergency physicians with a standardized approach to the management of serious travel-related infections in the intensive care unit (ICU) or the emerge...

  14. [Job satisfaction among primary care physicians at the IMSS]. (United States)

    Valderrama-Martínez, José Arturo; Dávalos-Díaz, Guillermina


    To know factors related to job satisfaction among primary care Physicians from the Mexican Social Security Institute. Cross-sectional survey applied to physicians of outpatient visit areas in four Family Medicine Units in Leon, Guanajuato, from February to May 2007. The survey explored six areas. We used 95% confidence intervals and One-Way ANOVA to compare means among clinics and Chi square and OR'95% confidence intervals to compare proportions. One hundred sixty physicians participated (response rate 88.9%), three were excluded. Most physicians were satisfied with their work (86%). Half of the doctors feel satisfied with their economic benefits (48%), non-economic benefits (52%), and those from the collective bargaining agreement (53%), as well as with the labor union (46%) and their actual insurances (45%). Only one third or less of participants refer to receive incentives (31%) or recognitions for their work (33%), were satisfied with the opportunities for training (31%), the economic incentives (29%), or the salary (24%). The satisfaction's means of work, benefits, insurances, labor union and collective bargaining agreement were significantly higher than the means of salary and economic incentives. Satisfaction means were significantly higher in Clinic #53 than in Clinic #51 for job satisfaction and opportunities for training, as well as percentages of response in institutional support, incentives and recognitions for their work, were higher in Clinic 53 compared to all other clinics; however, it's the smallest clinic in this study. Family doctors find satisfaction in their practice, and factors such as institutional support, recognition and incentives may improve their general job satisfaction.

  15. Computed tomography for neurological intensive care patients

    International Nuclear Information System (INIS)

    Rodiek, S.; Neu, I.


    The first 100 computed tomographic (CT) examinations of the patients on the neurological intensive care ward are discussed and reported on the basis of selected typical findings. Characteristic patterns of the CT findings in determined cerebral diseases are explained. The possibility and necessity of CT observations of the development of inflammatory and cerebrovascular processes in particular are emphasized. A comparison of our experience with CT and other neuroradiological methods, is made. The clinical diagnoses, including the respective number of cases and the pertinent CT findings, are presented in a Table. (orig.) [de

  16. Quality of intensive care chest imaging

    International Nuclear Information System (INIS)

    Adam, G.; Wein, B.; Keulers, P.; Stargardt, A.; Guenther, R.W.


    The authors have evaluated the image quality of a stimulable phosphorous plate system in intensive care chest radiography. Four radiologists examined 308 chest radiographs (200 conventional, 108 digital) according to the following criteria: visibility of catheters, tubes (artificial objects), bronchi, central and peripheral vessels, diaphragm, trachea, and retrocardial lung parenchyma. Detectability of these structures was classified as good, poor, or impossible to see. In addition, optical density was measured in the region of liver, heart, and lung. Results were evaluated by Student and υ test

  17. Gastroesophageal reflux disease: A clinical overview for primary care physicians. (United States)

    Pandit, Sudha; Boktor, Moheb; Alexander, Jonathan S; Becker, Felix; Morris, James


    GERD is among the most common outpatient disease processes encountered by clinicians on a daily basis. This review provides insights about how to approach GERD in terms of disease management and treatment. Review articles were searched using PUBMED and MEDLINE using criteria that included English language articles published in the last 5 years concerning studies carried out only in humans. The key words used in the searches were GERD, PPI, and erosive esophagitis. Recommendations from the American College of Gastroenterology are also included in this manuscript. The search resulted in ∼260 articles. The manuscript brings together and presents the results of recent recommendations from professional societies and recently published review articles on GERD. GERD is one of the most common diagnoses made by gastroenterologists and primary care physicians. It is important to recognize the typical and atypical presentations of GERD. This paper helps primary care physicians understand the disease's pathophysiology, and when, how, and with what to treat GERD before referring patients to gastroenterologists or surgeons. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Intensive care unit audit: invasive procedure surveillance

    Directory of Open Access Journals (Sweden)

    Mariama Amaral Michels


    Full Text Available Rationale and objective: currently, Healthcare-associated Infections (HAIs constitute a serious public health problem. It is estimated that for every ten hospitalized patients, one will have infection after admission, generating high costs resulting from increased length of hospitalization, additional diagnostic and therapeutic interventions. The intensive care unit (ICU, due to its characteristics, is one of the most complex units of the hospital environment, a result of the equipment, the available technology, the severity of inpatients and the invasive procedures the latter are submitted to. The aim of the study was to evaluate the adherence to specifi c HAI prevention measures in invasive ICU procedures. Methods: This study had a quantitative, descriptive and exploratory approach. Among the risk factors for HAIs are the presence of central venous access, indwelling vesical catheter and mechanical ventilation, and, therefore, the indicators were calculated for patients undergoing these invasive procedures, through a questionnaire standardized by the Hospital Infection Control Commission (HICC. Results: For every 1,000 patients, 15 had catheter-related bloodstream infection, 6.85 had urinary tract infection associated with indwelling catheter in the fi rst half of 2010. Conclusion: most HAIs cannot be prevented, for reasons inherent to invasive procedures and the patients. However, their incidence can be reduced and controlled. The implementation of preventive measures based on scientifi c evidence can reduce HAIs signifi cantly and sustainably, resulting in safer health care services and reduced costs. The main means of prevention include the cleaning of hands, use of epidemiological block measures, when necessary, and specifi c care for each infection site. KEYWORDS Nosocomial infection. Intensive care units.

  19. Palliative care and the intensive care nurses: feelings that endure. (United States)

    Silveira, Natyele Rippel; Nascimento, Eliane Regina Pereira do; Rosa, Luciana Martins da; Jung, Walnice; Martins, Sabrina Regina; Fontes, Moisés Dos Santos


    to know the feelings of nurses regarding palliative care in adult intensive care units. qualitative study, which adopted the theoretical framework of Social Representations, carried out with 30 nurses of the state of Santa Catarina included by Snowball sampling. Data were collected through semi-structured interviews conducted from April to August 2015, organized and analyzed through the Collective Subject Discourse. the results showed how central ideas are related to feelings of comfort, frustration, insecurity and anguish, in addition to the feeling that the professional training and performance are focused on the cure. the social representations of nurses regarding the feelings related to palliative care are represented mainly by negative feelings, probably as consequence of the context in which care is provided.

  20. Developing a decision support system for tobacco use counselling using primary care physicians

    Directory of Open Access Journals (Sweden)

    Theodore Marcy


    Conclusions A multi-method evaluation process utilising primary care physicians proved useful for developing a CDSS that was acceptable to physicians and patients, and feasible to use in their clinical environment.

  1. Dermatology in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Uwe Wollina


    Full Text Available Introduction: The intensive care unit (ICU represents a special environment for patients. We analyzed patients in the ICU/ high care unit (HCU with respect to dermatology counselling and skin problems.Setting: Academic Teaching Hospital over a 10 month period.Methods: The total number of patients of the ICU was 1,208 with a mean stay of 4.1 days. In the HCU the mean stay was 16 days. Diagnosis leading to admission were analyzed. All files of dermatological counselling were evaluated in detail.Results: Fifty-five patients with dermatologic problems were identified: 19 women and 26 males. The age ranged from 22 to 90 years of life (mean ± standard deviation: 67.2 ± 17.4 years. The total number of consultations were 85. The range of repeated dermatological consultation ranged from two to ten. The major reasons were skin and soft tissue infections, adverse drug reactions, chronic wounds including pressure sores and skin irritation or dermatitis. Pre-existing skin conditions may complicate the treatment and care during ICU/HCU stay.Conclusion: A tight collaboration between of the medical staff of ICU/HCU and dermatology department will ensure a rapid diagnosis and treatment of various skin conditions in the ICU, without increasing the costs significantly. Interdisciplinary education of nursing staff contributes to improved skin care in the ICU/HCU and helps to prevent acute skin failure.

  2. When doctor becomes patient: challenges and strategies in caring for physician-patients. (United States)

    Domeyer-Klenske, Amy; Rosenbaum, Marcy


    The current study was aimed at exploring the challenges that arise in the doctor-patient relationship when the patient is also a physician and identifying strategies physicians use to meet these challenges. No previous research has systematically investigated primary care physicians' perspectives on caring for physician-patients. Family medicine (n=15) and general internal medicine (n=14) physicians at a large Midwestern university participated in semi-structured interviews where they were asked questions about their experiences with physician-patients and the strategies they used to meet the unique needs of this patient population. Thematic analysis was used to identify common responses. Three of the challenges most commonly discussed by physician participants were: (1) maintaining boundaries between relationships with colleagues or between roles as physician/colleague/friend, (2) avoiding assumptions about patient knowledge and health behaviors, and (3) managing physician-patients' access to informal consultations, personal test results, and opinions from other colleagues. We were able to identify three main strategies clinicians use in addressing these perceived challenges: (1) Ignore the physician-patient's background, (2) Acknowledge the physician-patient's background and negotiate care, and (3) Allow care to be driven primarily by the physician-patient. It is important that primary care physicians understand the challenges inherent in treating physicians and develop a strategy with which they are comfortable addressing them. Explicitly communicating with the physician-patient to ensure boundaries are maintained, assumptions about the physician-patient are avoided, and physician-patient access is properly managed are key to providing quality care to physician-patients.

  3. Primary care physician perceptions of the nurse practitioner in the 1990s. (United States)

    Aquilino, M L; Damiano, P C; Willard, J C; Momany, E T; Levy, B T


    To evaluate factors associated with primary care physician attitudes toward nurse practitioners (NPs) providing primary care. A mailed survey of primary care physicians in Iowa. Half (N = 616) of the non-institutional-based, full-time, primary care physicians in Iowa in spring 1994. Although 360 (58.4%) responded, only physicians with complete data on all items in the model were used in these analyses (n = 259 [42.0%]). There were 2 principal dependent measures: physician attitudes toward NPs providing primary care (an 11-item instrument) and physician experience with NPs in this role. Bivariate relationships between physician demographic and practice characteristics were evaluated by chi 2 tests, as were both dependent variables. Ordinary least-squares regression was used to determine factors related to physician attitudes toward NPs. In bivariate analyses, physicians were significantly more likely to have had experience with an NP providing primary care if they were in pediatrics or obstetrics-gynecology (78.3% and 70.0%, respectively; P < .001), had been in practice for fewer than 20 years (P = .045), or were in practices with 5 or more physicians. The ordinary least-squares regression indicated that physicians with previous experience working with NPs providing primary care (P = .01), physicians practicing in urban areas with populations greater than 20,000 but far from a metropolitan area (P = .03), and general practice physicians (P = .04) had significantly more favorable attitudes toward NPs than did other primary care physicians. The association between previous experience with a primary care NP and a more positive attitude toward NPs has important implications for the training of primary care physicians, particularly in community-based, multidisciplinary settings.

  4. Data privacy considerations in Intensive Care Grids. (United States)

    Luna, Jesus; Dikaiakos, Marios D; Kyprianou, Theodoros; Bilas, Angelos; Marazakis, Manolis


    Novel eHealth systems are being designed to provide a citizen-centered health system, however the even demanding need for computing and data resources has required the adoption of Grid technologies. In most of the cases, this novel Health Grid requires not only conveying patient's personal data through public networks, but also storing it into shared resources out of the hospital premises. These features introduce new security concerns, in particular related with privacy. In this paper we survey current legal and technological approaches that have been taken to protect a patient's personal data into eHealth systems, with a particular focus in Intensive Care Grids. However, thanks to a security analysis applied over the Intensive Care Grid system (ICGrid) we show that these security mechanisms are not enough to provide a comprehensive solution, mainly because the data-at-rest is still vulnerable to attacks coming from untrusted Storage Elements where an attacker may directly access them. To cope with these issues, we propose a new privacy-oriented protocol which uses a combination of encryption and fragmentation to improve data's assurance while keeping compatibility with current legislations and Health Grid security mechanisms.

  5. [Reimbursement of intensive care services in the German DRG system : Current problems and possible solutions]. (United States)

    Riessen, R; Hermes, C; Bodmann, K-F; Janssens, U; Markewitz, A


    The reimbursement of intensive care and nursing services in the German health system is based on the diagnosis-related groups (G-DRG) system. Due to the lack of a central hospital planning, the G‑DRG system has become the most important influence on the development of the German health system. Compared to other countries, intensive care in Germany is characterized by a high number of intensive care beds, a low nurse-to-patient ratio, no official definition of the level of care, and a minimal available data set from intensive care units (ICUs). Under the given circumstances, a shortage of qualified intensive care nurses and physicians is currently the largest threat for intensive care in Germany. To address these deficiencies, we suggest the following measures: (1) Integration of ICUs into the levels of care which are currently developed for emergency centers at hospitals. (2) Mandatory collection of structured data sets from all ICUs including quality criteria. (3) A reform of intensive care and nursing reimbursement under consideration of adequate staffing in the individual ICU. (4) Actions to improve ICU staffing and qualification.

  6. Guideline for stress ulcer prophylaxis in the intensive care unit

    DEFF Research Database (Denmark)

    Madsen, Kristian Rørbaek; Lorentzen, Kristian; Clausen, Niels


    Stress ulcer prophylaxis (SUP) is commonly used in the intensive care unit (ICU), and is recommended in the Surviving Sepsis Campaign guidelines 2012. The present guideline from the Danish Society of Intensive Care Medicine and the Danish Society of Anesthesiology and Intensive Care Medicine sums...

  7. Withholding or withdrawing therapy in intensive care units: improving interdisciplinary cooperation

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Ammentorp, Jette; Ørding, Helle

    INTRODUCTION. Decisions regarding withholding or withdrawing therapy are common in the intensive care units. The health care professionals involved in the decision-making process do not always assess the situation identically, leading to potential conflicts. Studies have suggested that improving...... (conducted at two hospitals) with participation of primary care physicians, anaesthesiologists (both with and without ICU as their main workplace) and intensive care nurses. A total of 29 participated in the audits. The participants received beforehand three complicated cases (borrowed from other hospitals...... unit conflicts: the conflicus study. Am J Respir Crit Care Med180:853-860. (2) Halvorsen K, Forde R, Nortvedt P (2009) Value choices and considerations when limiting intensive care treatment: a qualitative study. Acta Anaesthesiol Scand 53:10-17 GRANT ACKNOWLEDGMENT. The study was supported...

  8. Validation of a 10-item care-related regret intensity scale (RIS-10) for health care professionals. (United States)

    Courvoisier, Delphine S; Cullati, Stéphane; Haller, Chiara S; Schmidt, Ralph E; Haller, Guy; Agoritsas, Thomas; Perneger, Thomas V


    Regret after one of the many decisions and interventions that health care professionals make every day can have an impact on their own health and quality of life, and on their patient care practices. To validate a new care-related regret intensity scale (RIS) for health care professionals. Retrospective cross-sectional cohort study with a 1-month follow-up (test-retest) in a French-speaking University Hospital. A total of 469 nurses and physicians responded to the survey, and 175 answered the retest. RIS, self-report questions on the context of the regret-inducing event, its consequences for the patient, involvement of the health care professionals, and changes in patient care practices after the event. We measured the impact of regret intensity on health care professionals with the satisfaction with life scale, the SF-36 first question (self-reported health), and a question on self-esteem. On the basis of factor analysis and item response analysis, the initial 19-item scale was shortened to 10 items. The resulting scale (RIS-10) was unidimensional and had high internal consistency (α=0.87) and acceptable test-retest reliability (0.70). Higher regret intensity was associated with (a) more consequences for the patient; (b) lower life satisfaction and poorer self-reported health in health care professionals; and (c) changes in patient care practices. Nurses reported analyzing the event and apologizing, whereas physicians reported talking preferentially to colleagues, rather than to their supervisor, about changing practices. The RIS is a valid and reliable measure of care-related regret intensity for hospital-based physicians and nurses.

  9. Understanding the private worlds of physicians, nurses, and parents: a study of life-sustaining treatment decisions in Italian paediatric critical care. (United States)

    Carnevale, Franco A; Benedetti, Monica; Bonaldi, Amabile; Bravi, Elena; Trabucco, Gaetano; Biban, Paolo


    This study's aim was to describe: (a) How life-sustaining treatment (LST) decisions are made for critically ill children in Italy; and (b) How these decisional processes are experienced by physicians, nurses and parents. Focus groups with 16 physicians and 26 nurses, and individual interviews with 9 parents were conducted. Findings uncovered the 'private worlds' of paediatric intensive care unit (PICU) physicians, nurses and parents; they all suffer tremendously and privately. Physicians struggle with the weight of responsibility and solitude in making LST decisions. Nurses struggle with feelings of exclusion from decisions regarding patients and families that they care for. Physicians and nurses are distressed by legal barriers to LST withdrawal. Parents struggle with their dependence on physicians and nurses to provide care for their child and strive to understand what is happening to their child. Features of helpful and unhelpful communication with parents are highlighted, which should be considered in educational and practice changes.

  10. Patients report better satisfaction with part-time primary care physicians, despite less continuity of care and access. (United States)

    Panattoni, Laura; Stone, Ashley; Chung, Sukyung; Tai-Seale, Ming


    The growing number of primary care physicians (PCPs) reducing their clinical work hours has raised concerns about meeting the future demand for services and fulfilling the continuity and access mandates for patient-centered care. However, the patient's experience of care with part-time physicians is relatively unknown, and may be mediated by continuity and access to care outcomes. We aimed to examine the relationships between a physicians' clinical full-time equivalent (FTE), continuity of care, access to care, and patient satisfaction with the physician. We used a multi-level structural equation estimation, with continuity and access modeled as mediators, for a cross-section in 2010. The study included family medicine (n = 104) and internal medicine (n = 101) physicians in a multi-specialty group practice, along with their patient satisfaction survey responses (n = 12,688). Physician level FTE, continuity of care received by patients, continuity of care provided by physician, and a Press Ganey patient satisfaction with the physician score, on a 0-100 % scale, were measured. Access to care was measured as days to the third next-available appointment. Physician FTE was directly associated with better continuity of care received (0.172% per FTE, p part-time PCPs in practice redesign efforts and initiatives to meet the demand for primary care services.

  11. [Communication between the primary care physician, hospital staff and the patient during hospitalization]. (United States)

    Menahem, Sasson; Roitgarz, Ina; Shvartzman, Pesach


    HospitaL admission is a crisis for the patient and his family and can interfere with the continuity of care. It may lead to mistakes due to communication problems between the primary care physician and the hospital medical staff. To explore the communication between the primary care physician, the hospital medical staff, the patient and his family during hospitalization. A total of 269 questionnaires were sent to all Clalit Health Services-South District, primary care physicians; 119 of these questionnaires (44.2%) were completed. Half of the primary care physicians thought that they should, always or almost always, have contact with the admitting ward in cases of internal medicine, oncology, surgery or pediatric admissions. However, the actual contact rate, according to their report, was only in a third of the cases. A telephone contact was more common than an actual visit of the patient in the ward. Computer communication between the hospital physicians and the primary care physicians is still insufficiently developed, although 96.6% of the primary care physicians check, with the aid of computer software, for information on their hospitalized patients. The main reasons to visit the hospitalized patient were severe medical conditions or uncertainty about the diagnosis; 79% of the physicians thought that visiting their patients strengthened the level of trust between them and their patients. There are sometimes communication difficulties and barriers between the primary care physicians and the ward's physicians due to partial information delivery and rejection from the hospital physicians. The main barriers for visiting admitted patients were workload and lack of pre-allocated time on the work schedule. No statistically significant differences were found between communication variables and primary care physician's personal and demographic characteristics. The communication between the primary care physician and the hospital physicians should be improved through

  12. Noise in contemporary neonatal intensive care. (United States)

    Williams, Amber L; van Drongelen, Wim; Lasky, Robert E


    Weekly sound surveys (n = 63) were collected, using 5 s sampling intervals, for two modern neonatal intensive care units (NICUs). Median weekly equivalent sound pressure levels (LEQ) for NICU A ranged from 61 to 63 dB (A weighted), depending on the level of care. NICU B L(EQ) measurements ranged from 55 to 60 dB (A weighted). NICU B was recently built with a focus on sound abatement, explaining much of the difference between the two NICUs. Sound levels exceeded 45 dB (A weighted), recommended by the American Academy of Pediatrics, more than 70% of the time for all levels of care. Hourly L(EQ)s below 50 dB (A weighted) and hourly L10s below 55 dB (A weighted), recommended by the Sound Study Group (SSG) of the National Resource Center, were also exceeded in more than 70% of recorded samples. A third SSG recommendation, that the 1 s L(MAX), should not exceed 70 dB (A weighted), was exceeded relatively infrequently (< 11% of the time). Peak impulse measurements exceeded 90 dB for 6.3% of 5 s samples recorded from NICU A and 2.8% of NICU B samples. Twenty-four h periodicities in sound levels as a function of regular staff activities were apparent, but short-term variability was considerable.

  13. Effects of online palliative care training on knowledge, attitude and satisfaction of primary care physicians

    Directory of Open Access Journals (Sweden)

    Agra Yolanda


    Full Text Available Abstract Background The Spanish Palliative Care Strategy recommends an intermediate level of training for primary care physicians in order to provide them with knowledge and skills. Most of the training involves face-to-face courses but increasing pressures on physicians have resulted in fewer opportunities for provision of and attendance to this type of training. The effectiveness of on-line continuing medical education in terms of its impact on clinical practice has been scarcely studied. Its effect in relation to palliative care for primary care physicians is currently unknown, in terms of improvement in patient's quality of life and main caregiver's satisfaction. There is uncertainty too in terms of any potential benefits of asynchronous communication and interaction among on-line education participants, as well as of the effect of the learning process. The authors have developed an on-line educational model for palliative care which has been applied to primary care physicians in order to measure its effectiveness regarding knowledge, attitude towards palliative care, and physician's satisfaction in comparison with a control group. The effectiveness evaluation at 18 months and the impact on the quality of life of patients managed by the physicians, and the main caregiver's satisfaction will be addressed in a different paper. Methods Randomized controlled educational trial to compared, on a first stage, the knowledge and attitude of primary care physicians regarding palliative care for advanced cancer patients, as well as satisfaction in those who followed an on-line palliative care training program with tutorship, using a Moodle Platform vs. traditional education. Results 169 physicians were included, 85 in the intervention group and 84 in the control group, of which five were excluded. Finally 82 participants per group were analyzed. There were significant differences in favor of the intervention group, in terms of knowledge (mean 4.6; CI

  14. Effects of online palliative care training on knowledge, attitude and satisfaction of primary care physicians. (United States)

    Pelayo, Marta; Cebrián, Diego; Areosa, Almudena; Agra, Yolanda; Izquierdo, Juan Vicente; Buendía, Félix


    The Spanish Palliative Care Strategy recommends an intermediate level of training for primary care physicians in order to provide them with knowledge and skills. Most of the training involves face-to-face courses but increasing pressures on physicians have resulted in fewer opportunities for provision of and attendance to this type of training. The effectiveness of on-line continuing medical education in terms of its impact on clinical practice has been scarcely studied. Its effect in relation to palliative care for primary care physicians is currently unknown, in terms of improvement in patient's quality of life and main caregiver's satisfaction. There is uncertainty too in terms of any potential benefits of asynchronous communication and interaction among on-line education participants, as well as of the effect of the learning process.The authors have developed an on-line educational model for palliative care which has been applied to primary care physicians in order to measure its effectiveness regarding knowledge, attitude towards palliative care, and physician's satisfaction in comparison with a control group.The effectiveness evaluation at 18 months and the impact on the quality of life of patients managed by the physicians, and the main caregiver's satisfaction will be addressed in a different paper. Randomized controlled educational trial to compared, on a first stage, the knowledge and attitude of primary care physicians regarding palliative care for advanced cancer patients, as well as satisfaction in those who followed an on-line palliative care training program with tutorship, using a Moodle Platform vs. traditional education. 169 physicians were included, 85 in the intervention group and 84 in the control group, of which five were excluded. Finally 82 participants per group were analyzed. There were significant differences in favor of the intervention group, in terms of knowledge (mean 4.6; CI 95%: 2.8 to 6.5 (p = 0.0001), scale range 0-33), confidence

  15. Resistance Elasticity of Antibiotic Demand in Intensive Care. (United States)

    Heister, Thomas; Hagist, Christian; Kaier, Klaus


    The emergence and spread of antimicrobial resistance (AMR) is still an unresolved problem worldwide. In intensive care units (ICUs), first-line antibiotic therapy is highly standardized and widely empiric while treatment failure because of AMR often has severe consequences. Simultaneously, there is a limited number of reserve antibiotics, whose prices and/or side effects are substantially higher than first-line therapy. This paper explores the implications of resistance-induced substitution effects in ICUs. The extent of such substitution effects is shown in a dynamic fixed effect regression analysis using a panel of 66 German ICUs with monthly antibiotic use and resistance data between 2001 and 2012. Our findings support the hypothesis that demand for reserve antibiotics substantially increases when resistance towards first-line agents rises. For some analyses the lagged effect of resistance is also significant, supporting the conjecture that part of the substitution effect is caused by physicians changing antibiotic choices in empiric treatment by adapting their resistance expectation to new information on resistance prevalence. The available information about resistance rates allows physicians to efficiently balance the trade-off between exacerbating resistance and ensuring treatment success. However, resistance-induced substitution effects are not free of charge. These effects should be considered an indirect burden of AMR. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  16. Sexual minorities and selection of a primary care physician in a midwestern U.S. city. (United States)

    Labig, Chalmer E; Peterson, Tim O


    How and why sexual minorities select a primary care physician is critical to the development of methods for attracting these clients to a physician's practice. Data obtained from a sample of sexual minorities in a mid-size city in our nation's heartland would indicate that these patients are loyal when the primary care physician has a positive attitude toward their sexual orientation. The data also confirms that most sexual minorities select same sex physicians but not necessarily same sexual orientation physicians because of lack of knowledge of physicians' sexual orientation. Family practice physicians and other primary care physicians can reach out to this population by encouraging word of mouth advertising and by displaying literature on health issues for all sexual orientations in their offices.

  17. Patient and Physician Characteristics Associated with the Provision of Weight Loss Counseling in Primary Care (United States)

    Dutton, Gareth R.; Herman, Katharine G.; Tan, Fei; Goble, Mary; Dancer-Brown, Melissa; Van Vessem, Nancy; Ard, Jamy D.


    Background A variety of physician and patient characteristics may influence whether weight loss counseling occurs in primary care encounters. Objectives This study utilized a cross-sectional survey of primary care patients, which examined patient characteristics, physician characteristics, and characteristics of the physician-patient relationship associated with weight loss counseling and recommendations provided by physicians. Participants Participants (N=143, mean age=46.8 years, mean BMI=36.9 kg/m2, 65% Caucasian) were overweight and obese primary care patients participating in a managed care weight loss program. Measures Participants completed self-report surveys in the clinic prior to the initial weight loss session. Surveys included items assessing demographic/background characteristics, weight, height, and a health care questionnaire evaluating whether their physician had recommended weight loss, the frequency of their physicians’ weight loss counseling, and whether their physician had referred them for obesity treatment. Results Patient BMI and physician sex were most consistently associated with physicians’ weight loss counseling practices. Patients seen by female physicians were more likely to be told that they should lose weight, received more frequent obesity counseling, and were more likely to have been referred for obesity treatment by their physician. Length and frequency of physician-patient contacts were unrelated to the likelihood of counseling. Conclusions These findings add to previous evidence suggesting possible differences in the weight loss counseling practices of male and female physicians, although further research is needed to understand this potential difference between physicians. PMID:24743007

  18. Palliative Care Physicians' Attitudes Toward Patient Autonomy and a Good Death in East Asian Countries. (United States)

    Morita, Tatsuya; Oyama, Yasuhiro; Cheng, Shao-Yi; Suh, Sang-Yeon; Koh, Su Jin; Kim, Hyun Sook; Chiu, Tai-Yuan; Hwang, Shinn-Jang; Shirado, Akemi; Tsuneto, Satoru


    Clarification of the potential differences in end-of-life care among East Asian countries is necessary to provide palliative care that is individualized for each patient. The aim was to explore the differences in attitude toward patient autonomy and a good death among East Asian palliative care physicians. A cross-sectional survey was performed involving palliative care physicians in Japan, Taiwan, and Korea. Physicians' attitudes toward patient autonomy and physician-perceived good death were assessed. A total of 505, 207, and 211 responses were obtained from Japanese, Taiwanese, and Korean physicians, respectively. Japanese (82%) and Taiwanese (93%) physicians were significantly more likely to agree that the patient should be informed first of a serious medical condition than Korean physicians (74%). Moreover, 41% and 49% of Korean and Taiwanese physicians agreed that the family should be told first, respectively; whereas 7.4% of Japanese physicians agreed. Physicians' attitudes with respect to patient autonomy were significantly correlated with the country (Japan), male sex, physician specialties of surgery and oncology, longer clinical experience, and physicians having no religion but a specific philosophy. In all 12 components of a good death, there were significant differences by country. Japanese physicians regarded physical comfort and autonomy as significantly more important and regarded preparation, religion, not being a burden to others, receiving maximum treatment, and dying at home as less important. Taiwanese physicians regarded life completion and being free from tubes and machines as significantly more important. Korean physicians regarded being cognitively intact as significantly more important. There are considerable intercountry differences in physicians' attitudes toward autonomy and physician-perceived good death. East Asia is not culturally the same; thus, palliative care should be provided in a culturally acceptable manner for each country

  19. Physicians' Perspectives on Caring for Cognitively Impaired Elders.(author Abstract) (United States)

    Adams, Wendy L.; McIlvain, Helen E.; Geske, Jenenne A.; Porter, Judy L.


    Purpose: This study aims to develop ah in-depth understanding of the issues important to primary care physicians in providing care to cognitively impaired elders. Design and Methods: In-depth interviews were conducted with 20 primary care physicians. Text coded as "cognitive impairment" was retrieved and analyzed by use of grounded theory analysis…

  20. How sequestration cuts affect primary care physicians and graduate medical education. (United States)

    Chauhan, Bindiya; Coffin, Janis


    On April 1, 2013, sequestration cuts went into effect impacting Medicare physician payments, graduate medical education, and many other healthcare agencies. The cuts range from 2% to 5%, affecting various departments and organizations. There is already a shortage of primary care physicians in general, not including rural or underserved areas, with limited grants for advanced training. The sequestration cuts negatively impact the future of many primary care physicians and hinder the care many Americans will receive over time.

  1. [Management of the esophageal candidiasis by the primary care physician]. (United States)

    Behrens, Garance; Bocherens, Astrid; Senn, Nicolas


    Esophageal candidiasis is one of the most common opportunistic infections in patients infected by human immunodeficiency virus (HIV). This pathology is also found in patients without overt immunodeficiency. Other risk factors are known to be associated with this disease like inhaled or systemic corticosteroid treatment or proton-pump inhibitors and H2 receptor antagonists. In the absence of identified risk factors, a primary immune deficiency should be sought. Prevention of esophageal candidiasis is based primarily on the identification of risk factors, and a better control of them. This article presents a review of the physiopathology, clinical presentation and management of esophageal candidiasis by primary care physicians. We will also discuss ways of preventing esophageal candidiasis when necessary.

  2. Social anxiety disorder. A guide for primary care physicians. (United States)

    Elliott, H W; Reifler, B


    Social anxiety disorder is prevalent, potentially disabling, but quite treatable. A thorough and directed history can distinguish social phobia from depression, panic disorder, and OCD. It can also screen for and identify possible substance abuse. Once the diagnosis is made, a combination of pharmacologic and psychotherapy is indicated. The SSRIs, MAOIs, benzodiazepines, and beta-blockers--as well as CBT--can effectively treat social anxiety symptoms. Primary care physicians may well want to begin by prescribing an SSRI like paroxetine, along with a high potency benzodiazepine to be taken on a regular or an as-needed basis, and a beta-blocker to take as needed in anticipation of stressful social situations. A referral for CBT should be considered. If the patient has marked side effects from drug treatment or a lack of adequate response to medication, psychiatric referral is definitely indicated.

  3. The Complexity Of Billing And Paying For Physician Care. (United States)

    Gottlieb, Joshua D; Shapiro, Adam Hale; Dunn, Abe


    The administrative costs of providing health insurance in the US are very high, but their determinants are poorly understood. We advance the nascent literature in this field by developing new measures of billing complexity for physician care across insurers and over time, and by estimating them using a large sample of detailed insurance "remittance data" for the period 2013-15. We found dramatic variation across different types of insurance. Fee-for-service Medicaid is the most challenging type of insurer to bill, with a claim denial rate that is 17.8 percentage points higher than that for fee-for-service Medicare. The denial rate for Medicaid managed care was 6 percentage points higher than that for fee-for-service Medicare, while the rate for private insurance appeared similar to that of Medicare Advantage. Based on conservative assumptions, we estimated that the health care sector deals with $11 billion in challenged revenue annually, but this number could be as high as $54 billion. These costs have significant implications for analyses of health insurance reforms.

  4. Extreme metabolic alkalosis in intensive care. (United States)

    Tripathy, Swagata


    Metabolic alkalosis is a commonly seen imbalance in the intensive care unit (ICU). Extreme metabolic alkalemia, however, is less common. A pH greater than 7.65 may carry a high risk of mortality (up to 80%). We discuss the entity of life threatening metabolic alkalemia by means of two illustrative cases - both with a pH greater than 7.65 on presentation. The cause, modalities of managing and complications of this condition is discussed from the point of view of both the traditional method of Henderson and Hasselbalch and the mathematical model based on physiochemical model described by Stewart. Special mention to the pitfalls in managing patients of metabolic alkalosis with concomitant renal compromise is made.

  5. Reducing false asystole alarms in intensive care. (United States)

    Dekimpe, Remi; Heldt, Thomas


    High rates of false monitoring alarms in intensive care can desensitize staff and therefore pose a significant risk to patient safety. Like other critical arrhythmia alarms, asystole alarms require immediate attention by the care providers as a true asystole event can be acutely life threatening. Here, it is illustrated that most false asystole alarms can be attributed to poor signal quality, and we propose and evaluate an algorithm to identify data windows of poor signal quality and thereby help suppress false asystole alarms. The algorithm combines intuitive signal-quality features (degree of signal saturation and baseline wander) and information from other physiological signals that might be available. Algorithm training and testing was performed on the MIMIC II and 2015 PhysioNet/Computing in Cardiology Challenge databases, respectively. The algorithm achieved an alarm specificity of 81.0% and sensitivity of 95.4%, missing only one out of 22 true asystole alarms. On a separate neonatal data set, the algorithm was able to reject 89.7% (890 out of 992) of false asystole alarms while keeping all 22 true events. The results show that the false asystole alarm rate can be significantly reduced through basic signal quality evaluation.

  6. Radiation doses to neonates requiring intensive care

    International Nuclear Information System (INIS)

    Robinson, A.; Dellagrammaticas, H.D.


    Radiological investigations have become accepted as an important part of the range of facilities required to support severely ill newborn babies. Since the infants are so small, many of the examinations are virtually ''whole-body'' irradiations and it was thought that the total doses received might be appreciable. A group of such babies admitted to the Neonatal Intensive Care Unit in Sheffield over a six-month period have been studied. X-ray exposure factors used for each examination have been noted and total skin, gonad and bone marrow doses calculated, supplemented by measurements on phantoms. It is concluded that in most cases doses received are of the same order as those received over the same period from natural background radiation and probably less than those received from prenatal obstetric radiography, so that the additional risks from the diagnostic exposure are small. The highest doses are received in CT scans and barium examinations and it is recommended that the need for these should be carefully considered. (author)

  7. Exploring performance obstacles of intensive care nurses. (United States)

    Gurses, Ayse P; Carayon, Pascale


    High nursing workload, poor patient safety, and poor nursing quality of working life (QWL) are major issues in intensive care units (ICUs). Characteristics of the ICU and performance obstacles may contribute to these issues. The goal of this study was to comprehensively identify the performance obstacles perceived by ICU nurses. We used a qualitative research design and conducted semi-structured interviews with 15 ICU nurses of a medical-surgical ICU. Based on this qualitative study and a previously reported quantitative study, we identified seven main types of performance obstacles experienced by ICU nurses. Obstacles related to the physical environment (e.g., noise, amount of space), family relations (e.g., distractions caused by family, lack of time to spend with family), and equipment (e.g., unavailability, misplacement) were the most frequently experienced performance obstacles. The qualitative interview data provided rich information regarding the factors contributing to the performance obstacles. Overall, ICU nurses experience a variety of performance obstacles in their work on a daily basis. Future research is needed to understand the impact of performance obstacles on nursing workload, nursing QWL, and quality and safety of care.

  8. Helicobacter pylori infection: approach of primary care physicians in a developing country

    Directory of Open Access Journals (Sweden)

    Ali Shah Hasnain


    Full Text Available Abstract Background The aim of the study was to assess the knowledge and practices of primary care physicians in diagnosis and management of Helicobacter pylori (H. pylori infection in developing country. Methods This convenient sample based, cross sectional study was conducted in primary care physicians of Karachi, Pakistan from March 2008 to August 2008 through a pretested self-designed questionnaire, which contained 11 items pertaining to H. pylori route of transmission, diagnosis, indication for testing, treatment options, follow up and source of information. Results Out of 509 primary care physicians, 451 consented to participate with the response rate of 88.6%. Responses of 426 primary care physicians were analyzed after excluding 19 physicians. 78% of the physicians thought that contaminated water was the source of spread of infection, dyspepsia was the most frequent indication for investigating H. pylori infection (67% of the physicians, while 43% physicians were of the view that serology was the most appropriate test to diagnose active H. pylori infection. 77% of physicians thought that gastric ulcer was the most compelling indication for treatment, 61% physicians preferred Clarithromycin based triple therapy for 7–14 days. 57% of the physicians would confirm H. pylori eradication after treatment in selected patients and 47% physicians preferred serological testing for follow-up. In case of treatment failure, only 36% of the physicians were in favor of gastroenterologist referral. Conclusion The primary care physicians in this study lacked in knowledge regarding management of H. pylori infection. Internationally published guidelines and World gastroenterology organization (WGO practice guideline on H. pylori for developing countries have little impact on current practices of primary care physicians. We recommend more teaching programs, continuous medical education activities regarding H. pylori infection.

  9. Nurse Practitioner-Physician Comanagement: A Theoretical Model to Alleviate Primary Care Strain. (United States)

    Norful, Allison A; de Jacq, Krystyna; Carlino, Richard; Poghosyan, Lusine


    Various models of care delivery have been investigated to meet the increasing demands in primary care. One proposed model is comanagement of patients by more than 1 primary care clinician. Comanagement has been investigated in acute care with surgical teams and in outpatient settings with primary care physicians and specialists. Because nurse practitioners are increasingly managing patient care as independent clinicians, our study objective was to propose a model of nurse practitioner-physician comanagement. We conducted a literature search using the following key words: comanagement; primary care; nurse practitioner OR advanced practice nurse. From 156 studies, we extracted information about nurse practitioner-physician comanagement antecedents, attributes, and consequences. A systematic review of the findings helped determine effects of nurse practitioner-physician comanagement on patient care. Then, we performed 26 interviews with nurse practitioners and physicians to obtain their perspectives on nurse practitioner-physician comanagement. Results were compiled to create our conceptual nurse practitioner-physician comanagement model. Our model of nurse practitioner-physician comanagement has 3 elements: effective communication; mutual respect and trust; and clinical alignment/shared philosophy of care. Interviews indicated that successful comanagement can alleviate individual workload, prevent burnout, improve patient care quality, and lead to increased patient access to care. Legal and organizational barriers, however, inhibit the ability of nurse practitioners to practice autonomously or with equal care management resources as primary care physicians. Future research should focus on developing instruments to measure and further assess nurse practitioner-physician comanagement in the primary care practice setting. © 2018 Annals of Family Medicine, Inc.

  10. Identification of physicians providing comprehensive primary care in Ontario: a retrospective analysis using linked administrative data. (United States)

    Schultz, Susan E; Glazier, Richard H


    Given the changing landscape of primary care, there may be fewer primary care physicians available to provide a broad range of services to patients of all age groups and health conditions. We sought to identify physicians with comprehensive primary care practices in Ontario using administrative data, investigating how many and what proportion of primary care physicians provided comprehensive primary care and how this changed over time. We identified the pool of active primary care physicians in linked population-based databases for Ontario from 1992/93 to 2014/15. After excluding those who saw patients fewer than 44 days per year, we identified physicians as providing comprehensive care if more than half of their services were for core primary care and if these services fell into at least 7 of 22 activity areas. Physicians with 50% or less of their services for core primary care but with more than 50% in a single location or type of service were identified as being in focused practice. In 2014/15, there were 12 891 physicians in the primary care pool: 1254 (9.7%) worked fewer than 44 days per year, 1619 (12.6%) were in focused practice, and 1009 (7.8%) could not be classified. The proportion in comprehensive practice ranged from 67.5% to 74.9% between 1992/93 and 2014/15, with a peak in 2002/03 and relative stability from 2009/10 to 2014/15. Over this period, there was an increase of 8.8% in population per comprehensive primary care physician. We found that just over two-thirds of primary care physicians provided comprehensive care in 2014/15, which indicates that traditional estimates of the primary care physician workforce may be too high. Although implementation will vary by setting and available data, this approach is likely applicable elsewhere. Copyright 2017, Joule Inc. or its licensors.

  11. Families' experiences of intensive care unit quality of care

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Gerritsen, Rik T; Koopmans, Matty


    PURPOSE: The purpose of the study is to adapt and provide preliminary validation for questionnaires evaluating families' experiences of quality of care for critically ill patients in the intensive care unit (ICU). MATERIALS AND METHODS: This study took place in 2 European ICUs. Based on literature...... validity. RESULTS: A total of 110 family members participated. Response rate was 87%. For all questions, a median of 97% (94%-99%) was assessed as relevant, and a median of 98% (97%-100%), as understandable. Median ceiling effect was 41% (30%-47%). There was a median of 0% missing data (0%-1%). Test......-retest reliability showed a median weighted κ of 0.69 (0.53-0.83). Validation showed significant correlation between total scores and key questions. CONCLUSIONS: The questions were assessed as relevant and understandable, providing high face and content validity. Ceiling effects were comparable to similar...

  12. The impact of a lean rounding process in a pediatric intensive care unit. (United States)

    Vats, Atul; Goin, Kristin H; Villarreal, Monica C; Yilmaz, Tuba; Fortenberry, James D; Keskinocak, Pinar


    Poor workflow associated with physician rounding can produce inefficiencies that decrease time for essential activities, delay clinical decisions, and reduce staff and patient satisfaction. Workflow and provider resources were not optimized when a pediatric intensive care unit increased by 22,000 square feet (to 33,000) and by nine beds (to 30). Lean methods (focusing on essential processes) and scenario analysis were used to develop and implement a patient-centric standardized rounding process, which we hypothesize would lead to improved rounding efficiency, decrease required physician resources, improve satisfaction, and enhance throughput. Human factors techniques and statistical tools were used to collect and analyze observational data for 11 rounding events before and 12 rounding events after process redesign. Actions included: 1) recording rounding events, times, and patient interactions and classifying them as essential, nonessential, or nonvalue added; 2) comparing rounding duration and time per patient to determine the impact on efficiency; 3) analyzing discharge orders for timeliness; 4) conducting staff surveys to assess improvements in communication and care coordination; and 5) analyzing customer satisfaction data to evaluate impact on patient experience. Thirty-bed pediatric intensive care unit in a children's hospital with academic affiliation. Eight attending pediatric intensivists and their physician rounding teams. Eight attending physician-led teams were observed for 11 rounding events before and 12 rounding events after implementation of a standardized lean rounding process focusing on essential processes. Total rounding time decreased significantly (157 ± 35 mins before vs. 121 ± 20 mins after), through a reduction in time spent on nonessential (53 ± 30 vs. 9 ± 6 mins) activities. The previous process required three attending physicians for an average of 157 mins (7.55 attending physician man-hours), while the new process required two

  13. The duty of the physician to care for the family in pediatric palliative care: context, communication, and caring. (United States)

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


    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.

  14. [Perceptions of primary care physicians in Madrid on the austerity measures in the health care system]. (United States)

    Heras-Mosteiro, Julio; Otero-García, Laura; Sanz-Barbero, Belén; Aranaz-Andrés, Jesús María


    To address the current economic crisis, governments have promoted austerity measures that have affected the taxpayer-funded health system. We report the findings of a study exploring the perceptions of primary care physicians in Madrid (Spain) on measures implemented in the Spanish health system. We carried out a qualitative study in two primary health care centres located in two neighbourhoods with unemployment and migrant population rates above the average of those in Madrid. Interviews were conducted with 12 primary health care physicians. Interview data were analysed by using thematic analysis and by adopting some elements of the grounded theory approach. Two categories were identified: evaluation of austerity measures and evaluation of decision-making in this process. Respondents believed there was a need to promote measures to improve the taxpayer-funded health system, but expressed their disagreement with the measures implemented. They considered that the measures were not evidence-based and responded to the need to decrease public health care expenditure in the short term. Respondents believed that they had not been properly informed about the measures and that there was adequate professional participation in the prioritization, selection and implementation of measures. They considered physician participation to be essential in the decision-making process because physicians have a more patient-centred view and have first-hand knowledge of areas requiring improvement in the system. It is essential that public authorities actively involve health care professionals in decision-making processes to ensure the implementation of evidence-based measures with strong professional support, thus maintaining the quality of care. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

  15. Delirium screening in intensive care: A life saving opportunity. (United States)

    Lamond, E; Murray, S; Gibson, C E


    Delirium is described as 'acute brain failure' and constitutes a medical emergency which presents a hazard for people cared for in intensive care units. The Scottish intensive care society audit group recommend that all people cared for in intensive care units be screened for signs of delirium so that treatment and management of complications can be implemented at an early stage. There is inconsistent evidence about when and how the assessment of delirium is carried out by nursing staff in the intensive care setting. This narrative review explores the pathophysiology and current practices of delirium screening in intensive care. Consideration is given to the role of the nurse in detecting and managing delirium and some barriers to routine daily delirium screening are critically debated. It is argued that routine delirium screening is an essential element of safe, effective and person centred nursing care which has potential to reduce morbidity and mortality. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  16. [Geriatric intensive care patients : Perspectives and limits of geriatric intensive care medicine]. (United States)

    Müller-Werdan, U; Heppner, H-J; Michels, G


    Critically ill geriatric patients are vitally endangered due to the aging processes of organs, the frequently existing multimorbidity with subsequent polypharmacy and the typical geriatric syndrome of functional impairments. Aging processes in organs lower the clinical threshold for organ dysfunction and organ failure. Physiological organ aging processes with practical consequences for intensive care medicine are atypical manifestion of sepsis in immunosenescence, altered pharmacokinetics, reduced tolerance to hypovolemia due to proportionally reduced water compartment of the body in old age, the frequently only apparently normal function of the kidneys and the continuous reduction in pulmonary function in old age. The main reasons for changes in therapeutic targets are the will of the patient and risk-benefit considerations. The guidelines of the ethics section of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) provide assistance and suggestions for a structured decision-making process.

  17. Physicians' experiences of caring for late-stage HIV patients in the post-HAART era: challenges and adaptations. (United States)

    Karasz, Alison; Dyche, Larry; Selwyn, Peter


    As medical treatment for AIDS has become more complex, the need for good palliative and end-of-life care has also increased for patients with advanced disease. Such care is often inadequate, especially among low-income, ethnic minority patients. The current study investigated physicians' experiences with caring for dying HIV patients in an underserved, inner city community in the Bronx, NY. The goals of the study included: (1) to investigate the barriers to effective end-of-life care for HIV patients; and (2) to examine physicians' experiences of role hindrance and frustration in caring for dying patients in the era of HAART. Qualitative, open-ended interviews were conducted with 16 physicians. Physicians identified two core, prescriptive myths shaping their care for patients with HIV. The 'Good Doctor Myth' equates good medical care with the delivery of efficacious biomedical care. The role of the physician is defined as technical curer, while the patient's role is limited to consultation and compliance. The 'Good Death Myth' envisions an ideal death which is acknowledged, organized, and pain free: the role of the physician is defined as that of comforter and supporter in the dying process. Role expectations associated with these myths were often disappointed. First, late-stage patients refused to adhere to treatment and were thus dying "unnecessarily." Second, patients often refused to acknowledge, accept, or plan for the end of life and as a result died painful, chaotic deaths. These realities presented intense psychological and practical challenges for providers. Adaptive coping included both behavioral and cognitive strategies. Successful adaptation resulted in "positive engagement," experienced by participants as a continuing sense of fascination, gratification, and joy. Less successful adaptation could result in detachment or anger. Participants believed that engagement had a powerful impact on patient care. Working with dying HIV patients in the post

  18. Seniors’ Perceptions Of Health Care Not Closely Associated With Physician Supply (United States)

    Nyweide, David J.; Anthony, Denise L.; Chang, Chiang-Hua; Goodman, David


    We conducted a national random survey of Medicare beneficiaries to better understand the association between the supply of physicians and patients’ perceptions of their health care. We found that patients living in areas with more physicians per capita had perceptions of their health care that were similar to those of patients in regions with fewer physicians. In addition, there were no significant differences between the groups of patients in terms of numbers of visits to their personal physician in the previous year; amount of time spent with a physician; or access to tests or specialists. Our results suggest that simply training more physicians is unlikely to lead to improved access to care. Instead, focusing health policy on improving the quality and organization of care may be more beneficial. PMID:21289342

  19. Young adult cancer survivors' follow-up care expectations of oncologists and primary care physicians. (United States)

    Hugh-Yeun, Kiara; Kumar, Divjot; Moghaddamjou, Ali; Ruan, Jenny Y; Cheung, Winson Y


    Young adult cancer survivors face unique challenges associated with their illness. While both oncologists and primary care physicians (PCPs) may be involved in the follow-up care of these cancer survivors, we hypothesized that there is a lack of clarity regarding each physician's roles and responsibilities. A self-administered survey was mailed to young adult cancer survivors in British Columbia, Canada, who were aged 20 to 39 years at the time of diagnosis and alive at 2 to 5 years following the diagnosis to capture their expectations of oncologists and PCPs in various important domains of cancer survivorship care. Multivariate logistic regression models that adjusted for confounders were constructed to examine for predictors of the different expectations. Of 722 young cancer survivors surveyed, 426 (59%) responded. Among them, the majority were White women with breast cancer. Oncologists were expected to follow the patient's most recent cancer and treatment-related side effects while PCPs were expected to manage ongoing and future cancer surveillance as well as general preventative care. Neither physician was perceived to be responsible for addressing the return to daily activities, reintegration to interpersonal relationships, or sexual function. Older survivors were significantly less likely to expect oncologists (p = 0.03) and PCPs (p = 0.01) to discuss family planning when compared to their younger counterparts. Those who were White were significantly more likely to expect PCPs to discuss comorbidities (p = 0.009) and preventative care (p = 0.001). Young adult cancer survivors have different expectations of oncologists and PCPs with respect to their follow-up care. Physicians need to better clarify their roles in order to further improve the survivorship phase of cancer care for young adults. Young adult cancer survivors have different expectations of their oncologists and PCPs. Clarification of the roles of each physician group during follow-up can

  20. Examining the Role of Primary Care Physicians and Challenges Faced When Their Patients Transition to Home Hospice Care. (United States)

    Shalev, Ariel; Phongtankuel, Veerawat; Lampa, Katherine; Reid, M C; Eiss, Brian M; Bhatia, Sonica; Adelman, Ronald D


    The transition into home hospice care is often a critical time in a patient's medical care. Studies have shown patients and caregivers desire continuity with their physicians at the end of life (EoL). However, it is unclear what roles primary care physicians (PCPs) play and what challenges they face caring for patients transitioning into home hospice care. To understand PCPs' experiences, challenges, and preferences when their patients transition to home hospice care. Nineteen semi-structured phone interviews with PCPs were conducted. Study data were analyzed using standard qualitative methods. Participants included PCPs from 3 academic group practices in New York City. Measured: Physician recordings were transcribed and analyzed using content analysis. Most PCPs noted that there was a discrepancy between their actual role and ideal role when their patients transitioned to home hospice care. Primary care physicians expressed a desire to maintain continuity, provide psychosocial support, and collaborate actively with the hospice team. Better establishment of roles, more frequent communication with the hospice team, and use of technology to communicate with patients were mentioned as possible ways to help PCPs achieve their ideal role caring for their patients receiving home hospice care. Primary care physicians expressed varying degrees of involvement during a patient's transition to home hospice care, but many desired to be more involved in their patient's care. As with patients, physicians desire to maintain continuity with their patients at the EoL and solutions to improve communication between PCPs, hospice providers, and patients need to be explored.

  1. Auditing an intensive care unit recycling program. (United States)

    Kubicki, Mark A; McGain, Forbes; O'Shea, Catherine J; Bates, Samantha


    The provision of health care has significant direct environmental effects such as energy and water use and waste production, and indirect effects, including manufacturing and transport of drugs and equipment. Recycling of hospital waste is one strategy to reduce waste disposed of as landfill, preserve resources, reduce greenhouse gas emissions, and potentially remain fiscally responsible. We began an intensive care unit recycling program, because a significant proportion of ICU waste was known to be recyclable. To determine the weight and proportion of ICU waste recycled, the proportion of incorrect waste disposal (including infectious waste contamination), the opportunity for further recycling and the financial effects of the recycling program. We weighed all waste and recyclables from an 11-bed ICU in an Australian metropolitan hospital for 7 non-consecutive days. As part of routine care, ICU waste was separated into general, infectious and recycling streams. Recycling streams were paper and cardboard, three plastics streams (polypropylene, mixed plastics and polyvinylchloride [PVC]) and commingled waste (steel, aluminium and some plastics). ICU waste from the waste and recycling bins was sorted into those five recycling streams, general waste and infectious waste. After sorting, the waste was weighed and examined. Recycling was classified as achieved (actual), potential and total. Potential recycling was defined as being acceptable to hospital protocol and local recycling programs. Direct and indirect financial costs, excluding labour, were examined. During the 7-day period, the total ICU waste was 505 kg: general waste, 222 kg (44%); infectious waste, 138 kg (27%); potentially recyclable waste, 145 kg (28%). Of the potentially recyclable waste, 70 kg (49%) was actually recycled (14% of the total ICU waste). In the infectious waste bins, 82% was truly infectious. There was no infectious contamination of the recycling streams. The PVC waste was 37% contaminated

  2. The craft of intensive care medicine. (United States)

    Carmel, Simon


    The practice of medicine is often represented as a dualism: is medicine a 'science' or an 'art'? This dualism has been long-lasting, with evident appeal for the medical profession. It also appears to have been rhetorically powerful, for example in enabling clinicians to resist the encroachment of 'scientific' evidence-based medicine into core areas of medical work such as individual clinical judgement. In this article I want to make the case for a more valid conceptualisation of medical practice: that it is a 'craft' activity. The case I make is founded on a theoretical synthesis of the concept of craft, combined with an analysis of ethnographic observations of routine medical practice in intensive care. For this context the craft aspects of medical work can be seen in how biomedical and other types of knowledge are used in practice, the embodied skills and practical judgement of practitioners and the technological and material environment. These aspects are brought together in two conceptual dimensions for 'craft': first, the application of knowledge; second, interaction with the material world. Some practical and political implications of a 'craft' metaphor for medical practice are noted. © 2013 The Author. Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

  3. Invasive candidiasis in pediatric intensive care units. (United States)

    Singhi, Sunit; Deep, Akash


    Candidemia and disseminated candidiasis are major causes of morbidity and mortality in hospitalized patients especially in the intensive care units (ICU). The incidence of invasive candidasis is on a steady rise because of increasing use of multiple antibiotics and invasive procedures carried out in the ICUs. Worldwide there is a shifting trend from C. albicans towards non albicans species, with an associated increase in mortality and antifungal resistance. In the ICU a predisposed host in one who is on broad spectrum antibiotics, parenteral nutrition, and central venous catheters. There are no pathognomonic signs or symptoms. The clinical clues are: unexplained fever or signs of severe sepsis or septic shock while on antibiotics, multiple, non-tender, nodular erythematous cutaneous lesions. The spectrum of infection with candida species range from superficial candidiasis of the skin and mucosa to more serious life threatening infections. Treatment of candidiasis involves removal of the most likely source of infection and drug therapy to speed up the clearance of infection. Amphotericin B remains the initial drug of first choice in hemodynamically unstable critically ill children in the wake of increasing resistance to azoles. Evaluation of newer antifungal agents and precise role of prophylactic therapy in ICU patients is needed.

  4. Intelligent ventilation in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Sigal Sviri


    Full Text Available Objectives. Automated, microprocessor-controlled, closed-loop mechanical ventilation has been used in our Medical Intensive Care Unit (MICU at the Hadassah Hebrew-University Medical Center for the past 15 years; for 10 years it has been the primary (preferred ventilator modality. Design and setting. We describe our clinical experience with adaptive support ventilation (ASV over a 6-year period, during which time ASV-enabled ventilators became more readily available and were used as the primary (preferred ventilators for all patients admitted to the MICU. Results. During the study period, 1 220 patients were ventilated in the MICU. Most patients (84% were ventilated with ASV on admission. The median duration of ventilation with ASV was 6 days. The weaning success rate was 81%, and tracheostomy was required in 13%. Sixty-eight patients (6% with severe hypoxia and high inspiratory pressures were placed on pressure-controlled ventilation, in most cases to satisfy a technical requirement for precise and conservative administration of inhaled nitric oxide. The overall pneumothorax rate was less than 3%, and less than 1% of patients who were ventilated only using ASV developed pneumothorax. Conclusions. ASV is a safe and acceptable mode of ventilation for complicated medical patients, with a lower than usual ventilation complication rate.

  5. Potential intravenous drug interactions in intensive care

    Directory of Open Access Journals (Sweden)

    Maiara Benevides Moreira

    Full Text Available Abstract OBJECTIVE To analyze potential intravenous drug interactions, and their level of severity associated with the administration of these drugs based on the prescriptions of an intensive care unit. METHOD Quantitative study, with aretrospective exploratory design, and descriptive statistical analysis of the ICU prescriptions of a teaching hospital from March to June 2014. RESULTS The sample consisted of 319 prescriptions and subsamples of 50 prescriptions. The mean number of drugs per patient was 9.3 records, and a higher probability of drug interaction inherent to polypharmacy was evidenced. The study identified severe drug interactions, such as concomitant administration of Tramadol with selective serotonin reuptake inhibitor drugs (e.g., Metoclopramide and Fluconazole, increasing the risk of seizures due to their epileptogenic actions, as well as the simultaneous use of Ranitidine-Fentanyl®, which can lead to respiratory depression. CONCLUSION A previous mapping of prescriptions enables the characterization of the drug therapy, contributing to prevent potential drug interactions and their clinical consequences.

  6. Airborne fungi in an intensive care unit

    Directory of Open Access Journals (Sweden)

    C. L. Gonçalves


    Full Text Available Abstract The presence of airborne fungi in Intensive Care Unit (ICUs is associated with increased nosocomial infections. The aim of this study was the isolation and identification of airborne fungi presented in an ICU from the University Hospital of Pelotas – RS, with the attempt to know the place’s environmental microbiota. 40 Petri plates with Sabouraud Dextrose Agar were exposed to an environment of an ICU, where samples were collected in strategic places during morning and afternoon periods for ten days. Seven fungi genera were identified: Penicillium spp. (15.18%, genus with the higher frequency, followed by Aspergillus spp., Cladosporium spp., Fusarium spp., Paecelomyces spp., Curvularia spp., Alternaria spp., Zygomycetes and sterile mycelium. The most predominant fungi genus were Aspergillus spp. (13.92% in the morning and Cladosporium spp. (13.92% in the afternoon. Due to their involvement in different diseases, the identified fungi genera can be classified as potential pathogens of inpatients. These results reinforce the need of monitoring the environmental microorganisms with high frequency and efficiently in health institutions.

  7. Pharmacovigilance in Intensive Care Unit - An Overview

    Directory of Open Access Journals (Sweden)

    Bimla Sharma


    Full Text Available The drug related complications are on the rise warranting special attention towards patient safety in Intensive Care Unit (ICU setup. Pharmacovigilance is the science about the detection, assessment and prevention of drug related problems. This review is aimed to highlight significant problems arising from medication errors with emphasis on special drugs used in ICU (oxygen, antibiotics, sedatives, analgesics and neuromuscular blocking drugs and their risk reduction strategies in ICU utilizing practice of pharmacovigilance. Human error, lack of communication among various health providers, inadequate knowledge about drugs, failure to follow protocols or recommended guidelines are important causes of drug related problems in ICU. It is imperative that ICU administrators and medical directors of hospitals consider adverse drug events (ADEs as system failures. Pharmacovigilance, an observational science is the need of the hour for patients admitted in ICUs. We need to give more emphasis on prevention rather than treating the potentially fatal complications arising from ADEs. Eternal vigilance is the key. Protocol based management, improvement of medication system, frequent audits, improved communication, good team work, a blame free environ-ment, inclusion of a pharmacist, leadership involvement and use of information technology in the ICU are possible solutions.

  8. Substitution of physicians by nurses in primary care: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Martinez-Gonzalez, N.A.; Djalali, S.; Tandjung, R.; Huber-Geismann, F.; Markun, S.; Wensing, M.; Rosemann, T.


    BACKGROUND: In many countries, substitution of physicians by nurses has become common due to the shortage of physicians and the need for high-quality, affordable care, especially for chronic and multi-morbid patients. We examined the evidence on the clinical effectiveness and care costs of

  9. Patient Care Physician Supply and Requirements: Testing COGME Recommendations. Council on Graduate Medical Education, Eighth Report. (United States)

    Council on Graduate Medical Education.

    This report reassesses recommendations made by the Council on Graduate Medical Education in earlier reports which had, beginning in 1992, addressed the problems of physician oversupply. In this report physician supply and requirements are examined in the context of a health care system increasingly dominated by managed care. Patterns of physician…

  10. Effect of Early Intensive Care on Recovery From Whiplash-Associated Disorders: Results of a Population-Based Cohort Study. (United States)

    Skillgate, Eva; Côté, Pierre; Cassidy, J David; Boyle, Eleanor; Carroll, Linda; Holm, Lena W


    To determine whether the results from previous research suggesting that early intensive health care delays recovery from whiplash-associated disorders (WADs) were confounded by expectations of recovery and whether the association between early health care intensity and time to recovery varies across patterns of health care. Population-based inception cohort. All adults (≥18y) injured in motor vehicle collisions who received treatment from a regulated health professional or reported their injuries to the single provincially administered motor vehicle insurer. Participants with WAD (N=5204). Self-report visits to physicians, chiropractors, physiotherapists, massage therapists, and other professionals during the first 42 days postcollision were used to define health care intensity. Not applicable. Self-perceived recovery. Individuals with high utilization health care had slower recovery independent of expectation of recovery and other confounders. Compared with individuals who reported low utilization of physician services, recovery was slower for those with high health care utilization, regardless of the type of profession. For instance, those with high physician (hazard rate ratio [HRR]=.56; 95% confidence interval [CI], .42-.75), physician and high physiotherapy utilization (HRR=.68; 95% CI, .61-.77), physician and high chiropractor utilization (HRR=.74; 95% CI, .64-.85), and physician and high massage therapy utilization (HRR=.78; 95% CI, .68-.90) had significantly slower recovery. Our study adds to the existing evidence that early intensive care is associated with slower recovery from WAD, independent of expectation of recovery. The results have policy implications and suggest that the optimal management of WADs focuses on reassurance and education instead of intensive care. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  11. Collaboration between physicians and a hospital-based palliative care team in a general acute-care hospital in Japan

    Directory of Open Access Journals (Sweden)

    Nishikitani Mariko


    Full Text Available Abstract Background Continual collaboration between physicians and hospital-based palliative care teams represents a very important contributor to focusing on patients' symptoms and maintaining their quality of life during all stages of their illness. However, the traditionally late introduction of palliative care has caused misconceptions about hospital-based palliative care teams (PCTs among patients and general physicians in Japan. The objective of this study is to identify the factors related to physicians' attitudes toward continual collaboration with hospital-based PCTs. Methods This cross-sectional anonymous questionnaire-based survey was conducted to clarify physicians' attitudes toward continual collaboration with PCTs and to describe the factors that contribute to such attitudes. We surveyed 339 full-time physicians, including interns, employed in a general acute-care hospital in an urban area in Japan; the response rate was 53% (N = 155. We assessed the basic characteristics, experience, knowledge, and education of respondents. Multiple logistic regression analysis was used to determine the main factors affecting the physicians' attitudes toward PCTs. Results We found that the physicians who were aware of the World Health Organization (WHO analgesic ladder were 6.7 times (OR = 6.7, 95% CI = 1.98-25.79 more likely to want to treat and care for their patients in collaboration with the hospital-based PCTs than were those physicians without such awareness. Conclusion Basic knowledge of palliative care is important in promoting physicians' positive attitudes toward collaboration with hospital-based PCTs.

  12. Viscosupplementation for Osteoarthritis: a Primer for Primary Care Physicians (United States)


    Introduction Osteoarthritis (OA) constitutes a growing public health burden and the most common cause of disability in the United States. Non-pharmacologic modalities and conservative pharmacologic therapies are recommended for the initial treatment of OA, including acetaminophen, and topical and oral non-steroidal anti-inflammatory drugs. However, safety concerns continue to mount regarding the use of these treatments and none have been shown to impact disease progression. Viscosupplementation with injections of hyaluronans (HAs) are indicated when non-pharmacologic and simple analgesics have failed to relieve symptoms (e.g., pain, stiffness) associated with knee OA. This review evaluates literature focusing on the efficacy and/or safety of HA injections in treating OA of the knee and in other joints, including the hip, shoulder, and ankle. Methods Relevant literature on intra-articular (IA) HA injections as a treatment for OA pain in the knee and other joints was identified through PubMed database searches from inception until January 2013. Search terms included “hyaluronic acid” or “hylan”, and “osteoarthritis”. Discussion Current evidence indicates that HA injections are beneficial and safe for patients with OA of the knee. IA injections of HAs treat the symptoms of knee OA and may also have disease-modifying properties, potentially delaying progression of OA. Although traditionally reserved for second-line treatment, evidence suggests that HAs may have value as a first-line therapy in the treatment of knee OA as they have been shown to be more effective in earlier stages and grades of disease, more recently diagnosed OA, and in less severe radiographic OA. Conclusion For primary care physicians who treat and care for patients with OA of the knee, IA injection with HAs constitutes a safe and effective treatment that can be routinely administered in the office setting. PMID:24203348

  13. The Phoenix Physician: defining a pathway toward leadership in patient-centered care. (United States)

    Good, Robert G; Bulger, John B; Hasty, Robert T; Hubbard, Kevin P; Schwartz, Elliott R; Sutton, John R; Troutman, Monte E; Nelinson, Donald S


    Health care delivery has evolved in reaction to scientific and technological discoveries, emergent patient needs, and market forces. A current focus on patient-centered care has pointed to the need for the reallocation of resources to improve access to and delivery of efficient, cost-effective, quality care. In response to this need, primary care physicians will find themselves in a new role as team leader. The American College of Osteopathic Internists has developed the Phoenix Physician, a training program that will prepare primary care residents and practicing physicians for the changes in health care delivery and provide them with skills such as understanding the contributions of all team members (including an empowered and educated patient), evaluating and treating patients, and applying performance metrics and information technology to measure and improve patient care and satisfaction. Through the program, physicians will also develop personal leadership and communication skills.

  14. Obstetric intensive care admissions at a tertiary hospital in Limpopo ...

    African Journals Online (AJOL)

    mortality of between 1 and 5%,[2,12] while others have reported .... ICU, and the need for a critical care specialist should be considered. ... Madan I, Jain NJ, Grotegut C, Nelson D, Dandolu V. Characteristics of obstetric intensive care.

  15. Veterans’ Health Care: Improved Oversight of Community Care Physicians Credentials Needed (United States)


    five of the most common types of care— obstetrics and gynecology, ophthalmology, primary care, psychiatry, and surgery—across each of the four census...Bank for verifying malpractice history .16 The standards also call for documentation of credentials verification activities, such that there is...Health Net and TriWest verify licenses, education and training, and malpractice history for each PC3 physician, and conduct reverification at least

  16. Repertoire of intensive care unit pneumonia microbiota.

    Directory of Open Access Journals (Sweden)

    Sabri Bousbia

    Full Text Available Despite the considerable number of studies reported to date, the causative agents of pneumonia are not completely identified. We comprehensively applied modern and traditional laboratory diagnostic techniques to identify microbiota in patients who were admitted to or developed pneumonia in intensive care units (ICUs. During a three-year period, we tested the bronchoalveolar lavage (BAL of patients with ventilator-associated pneumonia, community-acquired pneumonia, non-ventilator ICU pneumonia and aspiration pneumonia, and compared the results with those from patients without pneumonia (controls. Samples were tested by amplification of 16S rDNA, 18S rDNA genes followed by cloning and sequencing and by PCR to target specific pathogens. We also included culture, amoeba co-culture, detection of antibodies to selected agents and urinary antigen tests. Based on molecular testing, we identified a wide repertoire of 160 bacterial species of which 73 have not been previously reported in pneumonia. Moreover, we found 37 putative new bacterial phylotypes with a 16S rDNA gene divergence ≥ 98% from known phylotypes. We also identified 24 fungal species of which 6 have not been previously reported in pneumonia and 7 viruses. Patients can present up to 16 different microorganisms in a single BAL (mean ± SD; 3.77 ± 2.93. Some pathogens considered to be typical for ICU pneumonia such as Pseudomonas aeruginosa and Streptococcus species can be detected as commonly in controls as in pneumonia patients which strikingly highlights the existence of a core pulmonary microbiota. Differences in the microbiota of different forms of pneumonia were documented.

  17. Core Competencies in Integrative Pain Care for Entry-Level Primary Care Physicians. (United States)

    Tick, Heather; Chauvin, Sheila W; Brown, Michael; Haramati, Aviad


    The objective was to develop a set of core competencies for graduating primary care physicians in integrative pain care (IPC), using the Accreditation Council for Graduate Medical Education (ACGME) domains. These competencies build on previous work in competencies for integrative medicine, interprofessional education, and pain medicine and are proposed for inclusion in residency training. A task force was formed to include representation from various professionals who are involved in education, research, and the practice of IPC and who represent broad areas of expertise. The task force convened during a 1.5-day face-to-face meeting, followed by a series of surveys and other vetting processes involving diverse interprofessional groups, which led to the consensus of a final set of competencies. The proposed competencies focus on interprofessional knowledge, skills, and attitudes (KSAs) and are in line with recommendations by the Institute of Medicine, military medicine, and professional pain societies advocating the need for coordination and integration of services for effective pain care with reduced risk and cost and improved outcomes. These ACGME domain compatible competencies for physicians reflect the contributions of several disciplines that will need to be included in evolving interprofessional settings and underscore the need for collaborative care. These core competencies can guide the incorporation of KSAs within curricula. The learning experiences should enable medical educators and graduating primary care physicians to focus more on integrative approaches, interprofessional team-based, patient-centered care that use evidence-based, traditional and complementary disciplines and therapeutics to provide safe and effective treatments for people in pain. Wiley Periodicals, Inc.

  18. Use of spirometry among chest physicians and primary care physicians in India. (United States)

    Vanjare, Nitin; Chhowala, Sushmeeta; Madas, Sapna; Kodgule, Rahul; Gogtay, Jaideep; Salvi, Sundeep


    Although spirometry is the gold-standard diagnostic test for obstructive airways diseases, it remains poorly utilised in clinical practice. We aimed to investigate the use of spirometry across India, the change in its usage over a period of time and to understand the reasons for its under-utilisation. Two nationwide surveys were conducted in the years 2005 and 2013, among four groups of doctors: chest physicians (CPs), general physicians (GenPs), general practitioners (GPs) and paediatricians (Ps). A total of 1,000 physicians from each of the four groups were randomly selected from our database in the years 2005 and 2013. These surveys were conducted in 52 cities and towns across 15 states in India. A questionnaire was administered to the physicians, which captured information about their demographic details, type of practice and use of spirometry. The overall response rates of the physicians in 2005 and 2013 were 42.8% and 54.9%, respectively. Spirometry was reported to be used by 55% CPs, 20% GenPs, 10% GPs and 5% Ps in 2005, and this increased by 30.9% among CPs (P value spirometry varied between 2005 and 2013. In all, 32.2% of physicians were unaware of which predicted equation they were using. The use of spirometry in India is low, although it seems to have improved over the years. The reasons identified in this study for under-utilisation should be used to address initiatives to improve the use of spirometry in clinical practice.

  19. Physician education programme improves quality of diabetes care

    African Journals Online (AJOL)

    diabetes have been compiled and circulated to health care workers, but ... studied and attempted to improve the quality of diabetes care in primary care ..... project indicators in the Indian Health Service primary care setting. Diabetes Care ...

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

    Directory of Open Access Journals (Sweden)

    Johnston Grace


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

  1. Patient care information systems and physicians: the transition from technology icon to health care instrument. (United States)

    Bria, W F


    We have discussed several important transitions now occurring in PCIS that promise to improve the utility and availability of these systems for the average physician. Charles Babbage developed the first computers as "thinking machines" so that we may extend our ability to grapple with more and more complex problems. If current trends continue, we will finally witness the evolution of patient care computing from information icons of the few to clinical instruments improving the quality of medical decision making and care for all patients.

  2. Building relationships with physicians. Internal marketing efforts help strengthen organizational bonds at a rural health care clinic. (United States)

    Peltier, J W; Boyt, T; Westfall, J E


    Physician turnover is costly for health care organizations, especially for rural organizations. One approach management can take to reduce turnover is to promote physician loyalty by treating them as an important customer segment. The authors develop an information--oriented framework for generating physician loyalty and illustrate how this framework has helped to eliminate physician turnover at a rural health care clinic. Rural health care organizations must develop a more internal marketing orientation in their approach to establishing strong relationship bonds with physicians.

  3. The impact of the hospital work environment on social support from physicians in breast cancer care. (United States)

    Ansmann, Lena; Wirtz, Markus; Kowalski, Christoph; Pfaff, Holger; Visser, Adriaan; Ernstmann, Nicole


    Research on determinants of a good patient-physician interaction mainly disregards systemic factors, such as the work environment in healthcare. This study aims to identify stressors and resources within the work environment of hospital physicians that enable or hinder the physicians' provision of social support to patients. Four data sources on 35 German breast cancer center hospitals were matched: structured hospital quality reports and surveys of 348 physicians, 108 persons in hospital leadership, and 1844 patients. Associations between hospital structures, physicians' social resources as well as job demands and control and patients' perceived support from physicians have been studied in multilevel models. Patients feel better supported by their physicians in hospitals with high social capital, a high percentage of permanently employed physicians, and less physically strained physicians. The results highlight the importance of the work environment for a good patient-physician interaction. They can be used to develop interventions for redesigning the hospital work environment, which in turn may improve physician satisfaction, well-being, and performance and consequently the quality of care. Health policy and hospital management could create conditions conducive to better patient-physician interaction by strengthening the social capital and by increasing job security for physicians. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Tracheotomy in the intensive care unit: Guidelines from a French expert panel: The French Intensive Care Society and the French Society of Anaesthesia and Intensive Care Medicine. (United States)

    Trouillet, Jean-Louis; Collange, Olivier; Belafia, Fouad; Blot, François; Capellier, Gilles; Cesareo, Eric; Constantin, Jean-Michel; Demoule, Alexandre; Diehl, Jean-Luc; Guinot, Pierre-Grégoire; Jegoux, Franck; L'Her, Erwan; Luyt, Charles-Edouard; Mahjoub, Yazine; Mayaux, Julien; Quintard, Hervé; Ravat, François; Vergez, Sébastien; Amour, Julien; Guillot, Max


    Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the grading of recommendations assessment, development and evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de réanimation de langue française) and the French Society of Anesthesia and Intensive Care Medicine (Société francaise d'anesthésie réanimation) with the participation of the French Emergency Medicine Association (Société française de médecine d'urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1±) and 6 a low level of proof (Grade 2±). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced. Copyright © 2018 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.

  5. Family physicians' attitude and practice of infertility management at primary care--Suez Canal University, Egypt. (United States)

    Eldein, Hebatallah Nour


    The very particular natures of infertility problem and infertility care make them different from other medical problems and services in developing countries. Even after the referral to specialists, the family physicians are expected to provide continuous support for these couples. This place the primary care service at the heart of all issues related to infertility. to improve family physicians' attitude and practice about the approach to infertility management within primary care setting. This study was conducted in the between June and December 2010. The study sample comprised 100 family physician trainees in the family medicine department and working in family practice centers or primary care units. They were asked to fill a questionnaire about their personal characteristics, attitude, and practice towards support, investigations, and treatment of infertile couples. Hundred family physicians were included in the study. They were previously received training in infertility management. Favorable attitude scores were detected among (68%) of physicians and primary care was considered a suitable place for infertility management among (77%) of participants. There was statistically significant difference regarding each of age groups, gender and years of experience with the physicians' attitude. There was statistically significant difference regarding gender, perceiving PHC as an appropriate place to manage infertility and attitude towards processes of infertility management with the physicians' practice. Favorable attitude and practice were determined among the study sample. Supporting the structure of primary care and evidence-based training regarding infertility management are required to improve family physicians' attitude and practice towards infertility management.

  6. Medical futility at the end of life: the perspectives of intensive care and palliative care clinicians. (United States)

    Jox, Ralf J; Schaider, Andreas; Marckmann, Georg; Borasio, Gian Domenico


    Medical futility at the end of life is a growing challenge to medicine. The goals of the authors were to elucidate how clinicians define futility, when they perceive life-sustaining treatment (LST) to be futile, how they communicate this situation and why LST is sometimes continued despite being recognised as futile. The authors reviewed ethics case consultation protocols and conducted semi-structured interviews with 18 physicians and 11 nurses from adult intensive and palliative care units at a tertiary hospital in Germany. The transcripts were subjected to qualitative content analysis. Futility was identified in the majority of case consultations. Interviewees associated futility with the failure to achieve goals of care that offer a benefit to the patient's quality of life and are proportionate to the risks, harms and costs. Prototypic examples mentioned are situations of irreversible dependence on LST, advanced metastatic malignancies and extensive brain injury. Participants agreed that futility should be assessed by physicians after consultation with the care team. Intensivists favoured an indirect and stepwise disclosure of the prognosis. Palliative care clinicians focused on a candid and empathetic information strategy. The reasons for continuing futile LST are primarily emotional, such as guilt, grief, fear of legal consequences and concerns about the family's reaction. Other obstacles are organisational routines, insufficient legal and palliative knowledge and treatment requests by patients or families. Managing futility could be improved by communication training, knowledge transfer, organisational improvements and emotional and ethical support systems. The authors propose an algorithm for end-of-life decision making focusing on goals of treatment.

  7. Measuring the satisfaction of intensive care unit patient families in Morocco: a regression tree analysis. (United States)

    Damghi, Nada; Khoudri, Ibtissam; Oualili, Latifa; Abidi, Khalid; Madani, Naoufel; Zeggwagh, Amine Ali; Abouqal, Redouane


    Meeting the needs of patients' family members becomes an essential part of responsibilities of intensive care unit physicians. The aim of this study was to evaluate the satisfaction of patients' family members using the Arabic version of the Society of Critical Care Medicine's Family Needs Assessment questionnaire and to assess the predictors of family satisfaction using the classification and regression tree method. The authors conducted a prospective study. This study was conducted at a 12-bed medical intensive care unit in Morocco. Family representatives (n = 194) of consecutive patients with a length of stay >48 hrs were included in the study. Intervention was the Society of Critical Care Medicine's Family Needs Assessment questionnaire. Demographic data for relatives included age, gender, relationship with patients, education level, and intensive care unit commuting time. Clinical data for patients included age, gender, diagnoses, intensive care unit length of stay, Acute Physiology and Chronic Health Evaluation, MacCabe index, Therapeutic Interventioning Scoring System, and mechanical ventilation. The Arabic version of the Society of Critical Care Medicine's Family Needs Assessment questionnaire was administered between the third and fifth days after admission. Of family representatives, 81% declared being satisfied with information provided by physicians, 27% would like more information about the diagnosis, 30% about prognosis, and 45% about treatment. In univariate analysis, family satisfaction (small Society of Critical Care Medicine's Family Needs Assessment questionnaire score) increased with a lower family education level (p = .005), when the information was given by a senior physician (p = .014), and when the Society of Critical Care Medicine's Family Needs Assessment questionnaire was administered by an investigator (p = .002). Multivariate analysis (classification and regression tree) showed that the education level was the predominant factor

  8. Follow-up after intensive care treatment

    DEFF Research Database (Denmark)

    Kjer, C K W; Estrup, S; Poulsen, L M


    common early ICU-aftercare items were as follows: respiratory care (82%), tracheostomy care (59%) and nutritional care (59%). For late ICU-aftercare, the most common eligibility criterion was LOS (41%). Guidelines (71%), but not checklist at patient contact (35%), were more common. Most frequent late ICU...

  9. Training Physicians to Provide High-Value, Cost-Conscious Care A Systematic Review

    NARCIS (Netherlands)

    Stammen, L.A.; Stalmeijer, R.E.; Paternotte, E.; Pool, A.O.; Driessen, E.W.; Scheele, F.; Stassen, L.P.S.


    Importance Increasing health care expenditures are taxing the sustainability of the health care system. Physicians should be prepared to deliver high-value, cost-conscious care. Objective To understand the circumstances in which the delivery of high-value, cost-conscious care is learned, with a goal

  10. Parental Decision-Making Preferences in Neonatal Intensive Care. (United States)

    Weiss, Elliott Mark; Barg, Frances K; Cook, Noah; Black, Emily; Joffe, Steven


    To explore how characteristics of medical decisions influence parents' preferences for control over decisions for their seriously ill infants. In qualitative interviews, parents of infants in the neonatal intensive care unit (NICU) were asked to consider all medical decisions they could recall, and were prompted with decisions commonly encountered in the NICU. For each decision, parents were asked detailed questions about who made each decision, whom they would have preferred to make the decision, and why. Using standard qualitative methods, responses were coded and organized such that decision-level characteristics could be analyzed according to preferred decision-making role. Parents identified 2 factors that were associated with a preference to delegate decisions to the medical team (high degree of urgency, high level of required medical expertise) and 4 factors associated with a preference to retain parental control (high perceived risk, high personal experience with the decision, involvement of foreign bodily fluids, and similarity to decisions that they perceived as part of the normal parental role). Characteristics of decisions influence preferences for control over medical decisions among parents of patients in the NICU. These insights may guide improvements in physician-parent communication and consent. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Applications of Temporal Reasoning to Intensive Care Units

    Directory of Open Access Journals (Sweden)

    J. M. Juarez


    Full Text Available Intensive Care Units (ICUs are hospital departments that focus on the evolution of patients. In this scenario, the temporal dimension plays an essential role in understanding the state of the patients from their temporal information. The development of methods for the acquisition, modelling, reasoning and knowledge discovery of temporal information is, therefore, useful to exploit the large amount of temporal data recorded daily in the ICU. During the past decades, some subfields of Artificial Intelligence have been devoted to the study of temporal models and techniques to solve generic problems and towards their practical applications in the medical domain. The main goal of this paper is to present our view of some aspects of practical problems of temporal reasoning in the ICU field, and to describe our practical experience in the field in the last decade. This paper provides a non-exhaustive review of some of the efforts made in the field and our particular contributions in the development of temporal reasoning methods to partially solve some of these problems. The results are a set of software tools that help physicians to better understand the patient's temporal evolution.

  12. Fiberoptic endoscopic evaluation of swallowing in intensive care unit patients (United States)

    Hafner, Gert; Neuhuber, Andreas; Hirtenfelder, Sylvia; Schmedler, Brigitte


    Aspiration in critically ill patients frequently causes severe co-morbidity. We evaluated a diagnostic protocol using routine FEES in critically ill patients at risk to develop aspiration following extubation. We instructed intensive care unit physicians on specific risk factors for and clinical signs of aspiration following extubation in critically ill patients and offered bedside FEES for such patients. Over a 45-month period, we were called to perform 913 endoscopic examinations in 553 patients. Silent aspiration or aspiration with acute symptoms (cough or gag reflex as the bolus passed into the trachea) was detected in 69.3% of all patients. Prolonged non-oral feeding via a naso-gastric tube was initiated in 49.7% of all patients. In 13.2% of patients, a percutaneous endoscopic gastrostomy was initiated as a result of FEES findings, and in 6.3% an additional tracheotomy to prevent aspiration had to be initiated. In 59 out of 258 patients (22.9%), tracheotomies were closed, and 30.7% of all 553 patients could be managed with the immediate onset of an oral diet and compensatory treatment procedures. Additional radiological examinations were not required. FEES in critically ill patients allows for a rapid evaluation of deglutition and for the immediate initiation of symptom-related rehabilitation or for an early resumption of oral feeding. PMID:17968575

  13. [Bioethics, deontology, and law in neonatal intensive care]. (United States)

    Zamboni, G


    Neonatal intensive care has greatly improved the survival chances but, at the same time, it has also given rise to serious ethical problems. Different contexts influence both physicians attitude and end-of-life practices in neonatology. The clinicians can not ever follow the principles of bioethics, as they are sometimes in conflict. Also, the strategies or guidelines proposed as approaches to neonatal decision-making are difficult to practise. Probably a neonatologist makes his decision even on the basis of his interior conviction and it is well known that in Italy the debate on bioethics is the subject of confrontation between Roman Catholic and secular viewpoint, expressing two positions: the so-called sanctity and the quality of life. However, a clinician has also an obligation to follow the Code of Professional Medical Ethics which cautions against therapeutic aggressiveness; but this document has not legal status. In addition, Italian law is strongly protective of infant life and any discrimination on the basis of malformation or poor prognosis violates constitutional law; moreover, the resuscitation of a preterm infant is mandatory even when the birth is the result of induced late abortion. The author concludes emphasizing the importance, in decision making, of accepting difference as opposed to the logic of the absoluteness of normality, because many handicaps may be accepted and a society expresses its moral richness also by the solidarity reserved to its weakest sons.

  14. Safety of milrinone use in neonatal intensive care units

    NARCIS (Netherlands)

    S. Samiee-Zafarghandy; S.R. Raman (Sudha R.); J.N. van den Anker (John); K. McHutchison (Kerstin); C.P. Hornik; R.H. Clark; P.B. Smith; D.K. Benjamin (Daniel K.); K. Berezny (Katherine); J. Barrett (Jeffrey); E.V. Capparelli (Edmund); M. Cohen-Wolkowiez (Michael); G.L. Kearns (Greg); M. Laughon (Matthew); A. Muelenaer (Andre); T. Michael O'Shea; I.M. Paul (Ian M.); K. Wade (Kelly); T.J. Walsh (Thomas J.)


    textabstractBackground: Milrinone use in the neonatal intensive care unit has increased over the last 10. years despite a paucity of published safety data in infants. We sought to determine the safety of milrinone therapy among infants in the neonatal intensive care unit. Methods: We conducted a

  15. Surgery in Brazilian Health Care: funding and physician distribution. (United States)

    Alonso, Nivaldo; Massenburg, Benjamin B; Galli, Rafael; Sobrado, Lucas; Birolini, Dario


    to analyze demographic Brazilian medical data from the national public healthcare system (SUS), which provides free universal health coverage for the entire population, and discuss the problems revealed, with particular focus on surgical care. data was obtained from public healthcare databases including the Medical Demography, the Brazilian Federal Council of Medicine, the Brazilian Institute of Geography and Statistics, and the National Database of Healthcare Establishments. Density and distribution of the medical workforce and healthcare facilities were calculated, and the geographic regions were analyzed using the public private inequality index. Brazil has an average of two physicians for every 1,000 inhabitants, who are unequally distributed throughout the country. There are 22,276 board certified general surgeons in Brazil (11.49 for every 100,000 people). The country currently has 257 medical schools, with 25,159 vacancies for medical students each year, with only around 13,500 vacancies for residency. The public private inequality index is 3.90 for the country, and ranges from 1.63 in the Rio de Janeiro up to 12.06 in Bahia. A significant part of the local population still faces many difficulties in accessing surgical care, particularly in the north and northeast of the country, where there are fewer hospitals and surgeons. Physicians and surgeons are particularly scarce in the public health system nationwide, and better incentives are needed to ensure an equal public and private workforce. analisar dados demográficos do Sistema Único de Saúde (SUS) brasileiro, que promove cobertura de saúde universal a toda população, e discutir os problemas revelados, com particular ênfase nos cuidados cirúrgicos. os dados foram obtidos a partir dos bancos de dados de saúde pública da Demografia Médica, do Conselho Federal de Medicina, do Instituto Brasileiro de Geografia e Estatística e do Cadastro Nacional dos Estabelecimentos de Saúde. A densidade e a

  16. Potential intravenous drug interactions in intensive care. (United States)

    Moreira, Maiara Benevides; Mesquita, Maria Gefé da Rosa; Stipp, Marluci Andrade Conceição; Paes, Graciele Oroski


    To analyze potential intravenous drug interactions, and their level of severity associated with the administration of these drugs based on the prescriptions of an intensive care unit. Quantitative study, with aretrospective exploratory design, and descriptive statistical analysis of the ICU prescriptions of a teaching hospital from March to June 2014. The sample consisted of 319 prescriptions and subsamples of 50 prescriptions. The mean number of drugs per patient was 9.3 records, and a higher probability of drug interaction inherent to polypharmacy was evidenced. The study identified severe drug interactions, such as concomitant administration of Tramadol with selective serotonin reuptake inhibitor drugs (e.g., Metoclopramide and Fluconazole), increasing the risk of seizures due to their epileptogenic actions, as well as the simultaneous use of Ranitidine-Fentanyl®, which can lead to respiratory depression. A previous mapping of prescriptions enables the characterization of the drug therapy, contributing to prevent potential drug interactions and their clinical consequences. Analisar as potenciais interações medicamentosas intravenosas e seu grau de severidade associadas à administração desses medicamentos a partir das prescrições do Centro de Terapia Intensiva. Estudo quantitativo, tipologia retrospectiva exploratória, com análise estatística descritiva das prescrições medicamentosas do Centro de Terapia Intensiva de um Hospital Universitário, no período de março-junho/2014. A amostra foi composta de 319 prescrições e subamostras de 50 prescrições. Constatou-se que a média de medicamentos por paciente foi de 9,3 registros, e evidenciou-se maior probabilidade para ocorrência de interação medicamentosa inerente à polifarmácia. O estudo identificou interações medicamentosas graves, como a administração concomitante de Tramadol com medicamentos inibidores seletivos da recaptação da serotonina, (exemplo: Metoclopramida e Fluconazol

  17. [Alternative and complementary medicine from the primary care physician's viewpoint]. (United States)

    Soós, Sándor Árpád; Eőry, Ajándék; Eőry, Ajándok; Harsányi, László; Kalabay, László


    The patients initiate the use of complementary and alternative medicine and this often remains hidden from their primary care physician. To explore general practitioners' knowledge and attitude towards complementary and alternative medicine, and study the need and appropriate forms of education, as well as ask their opinion on integration of alternative medicine into mainstream medicine. A voluntary anonymous questionnaire was used on two conferences for general practitioners organized by the Family Medicine Department of Semmelweis University. Complementary and alternative medicine was defined by the definition of the Hungarian Academy of Sciences and certified modalities were all listed. 194 general practitioners answered the questionnaire (39.8% response rate). 14% of the responders had licence in at least one of the complementary and alternative therapies, 45% used complementary and alternative therapy in their family in case of illness. It was the opinion of the majority (91.8%) that it was necessary to be familiar with every method used by their patients, however, 82.5% claimed not to have enough knowledge in complementary medicine. Graduate and postgraduate education in the field was thought to be necessary by 86% of the responders; increased odds for commitment in personal education was found among female general practitioners, less than 20 years professional experience and personal experience of alternative medicine. These data suggest that general practitioners would like to know more about complementary and alternative medicine modalities used by their patients. They consider education of medical professionals necessary and a special group is willing to undergo further education in the field.

  18. Physicians' Psychosocial Work Conditions and Quality of Care: A Literature Review

    Directory of Open Access Journals (Sweden)

    Peter Angerer


    Full Text Available Background: Physician jobs are associated with adverse psychosocial work conditions. We summarize research on the relationship of physicians' psychosocial work conditions and quality of care. Method: A systematic literature search was conducted in MEDLINE and PsycINFO. All studies were classified into three categories of care quality outcomes: Associations between physicians' psychosocial work conditions and (1 the physician-patient-relationship, or (2 the care process and outcomes, or (3 medical errors were examined. Results: 12 publications met the inclusion criteria. Most studies relied on observational cross-sectional and controlled intervention designs. All studies provide at least partial support for physicians’ psychosocial work conditions being related to quality of care. Conclusions: This review found preliminary evidence that detrimental physicians’ psychosocial work conditions adversely influence patient care quality. Future research needs to apply strong designs to disentangle the indirect and direct effects of adverse psychosocial work conditions on physicians as well as on quality of care.Keywords: psychosocial work conditions, physicians, quality of care, physician-patient-relationship, hospital, errors, review, work stress, clinicians

  19. Assessing the critical behavioral competencies of outstanding managed care primary care physicians. (United States)

    Duberman, T L


    This study used job competence assessment to identify the behavioral characteristics that distinguish outstanding job performances of primary care physicians (PCPs) within a network-model HMO. Primary care physicians were chosen for the study based on six standard performance measures: (1) member satisfaction, (2) utilization, (3) patient complaints, (4) emergency room referrals, (5) out-of-network referrals, and (6) medical record completeness. Outstanding PCPs (N = 16) were identified as those performing within one standard deviation above the mean on all six of the performance measures. A control group of typical PCPs (N = 10) was selected from those performing outside the peer group mean on at least two performance measures. Subjects were administered the Behavioral Event Interview and the Picture Story Exercise. Higher overall competency levels of achievement orientation, concern for personal influence, empathic caregiving, and empowerment drive distinguished outstanding from typical PCPs. Outstanding PCPs also had higher overall frequency of competency in building team effectiveness and interpersonal understanding when compared with typical PCPs. This study suggests that PCP performance is the product of measurable competencies that are potentially amenable to improvement. Competency assessment and development of PCPs may benefit both organizational efficiency and physician and patient satisfaction.

  20. Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain (United States)

    Davis, Matthew A.; Yakusheva, Olga; Gottlieb, Daniel J.; Bynum, Julie P.W.


    Background Whether availability of chiropractic care affects use of primary care physician (PCP) services is unknown. Methods We performed a cross-sectional study of 17.7 million older adults who were enrolled in Medicare from 2010 to 2011. We examined the relationship between regional supply of chiropractic care and PCP services using Spearman correlation. Generalized linear models were used to examine the association between regional supply of chiropractic care and number of annual visits to PCPs for back and/or neck pain. Results We found a positive association between regional supply of chiropractic care and PCP services (rs = 0.52; P neck pain was apparent. The number of PCP visits for back and/or neck pain was 8% lower (rate ratio, 0.92; 95% confidence interval, 0.91–0.92) in the quintile with the highest supply of chiropractic care compared to the lowest quintile. We estimate chiropractic care is associated with a reduction of 0.37 million visits to PCPs nationally, at a cost of $83.5 million. Conclusions Greater availability of chiropractic care in some areas may be offsetting PCP services for back and/or neck pain among older adults. (J Am Board Fam Med 2015;28:000–000.) PMID:26152439

  1. Impact of physician-less pediatric critical care transport: Making a decision on team composition. (United States)

    Kawaguchi, Atsushi; Nielsen, Charlene C; Saunders, L Duncan; Yasui, Yutaka; de Caen, Allan


    To explore the impact of a physician non-accompanying pediatric critical care transport program, and to identify factors associated with the selection of specific transport team compositions. Children transported to a Canadian academic children's hospital were included. Two eras (Physician-accompanying Transport (PT)-era: 2000-07 when physicians commonly accompanied the transport team; and Physician-Less Transport (PLT)-era: 2010-15 when a physician non-accompanying team was increasingly used) were compared with respect to transport and PICU outcomes. Transport and patient characteristics for the PLT-era cohort were examined to identify factors associated with the selection of a physician accompanying team, with multivariable logistic regression with triage physicians as random effects. In the PLT-era (N=1177), compared to the PT-era (N=1490) the probability of PICU admission was significantly lower, and patient outcomes including mortality were not significantly different. Associations were noted between the selection of a physician non-accompanying team and specific transport characteristics. There was appreciable variability among the triage physicians for the selection of a physician non-accompanying team. No significant differences were observed with increasing use of a physician non-accompanying team. Selection of transport team compositions was influenced by clinical and system factors, but appreciable variation still remained among triage physicians. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

  2. Impact of a clinical microbiology-intensive care consulting program in a cardiothoracic intensive care unit. (United States)

    Arena, Fabio; Scolletta, Sabino; Marchetti, Luca; Galano, Angelo; Maglioni, Enivarco; Giani, Tommaso; Corsi, Elisabetta; Lombardi, Silvia; Biagioli, Bonizella; Rossolini, Gian Maria


    A preintervention-postintervention study was carried out over a 4-year period to assess the impact of an antimicrobial stewardship intervention, based on clinical microbiologist ward rounds (clinical microbiology-intensive care partnership [CMICP]), at a cardiothoracic intensive care unit. Comparison of clinical data for 37 patients with diagnosis of bacteremia (18 from preintervention period, 19 from postintervention period) revealed that CMICP implementation resulted in (1) significant increase of appropriate empirical treatments (+34%, P = .029), compliance with guidelines (+28%, P = .019), and number of de-escalations (+42%, P = .032); and (2) decrease (average = 2.5 days) in time to optimization of antimicrobial therapy and levofloxacin (Δ 2009-2012 = -74 defined daily dose [DDD]/1,000 bed days) and teicoplanin (Δ 2009-2012 = -28 DDD/1,000 bed days) use. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  3. Management of Pediatric Delirium in Pediatric Cardiac Intensive Care Patients: An International Survey of Current Practices. (United States)

    Staveski, Sandra L; Pickler, Rita H; Lin, Li; Shaw, Richard J; Meinzen-Derr, Jareen; Redington, Andrew; Curley, Martha A Q


    The purpose of this study was to describe how pediatric cardiac intensive care clinicians assess and manage delirium in patients following cardiac surgery. Descriptive self-report survey. A web-based survey of pediatric cardiac intensive care clinicians who are members of the Pediatric Cardiac Intensive Care Society. Pediatric cardiac intensive care clinicians (physicians and nurses). None. One-hundred seventy-three clinicians practicing in 71 different institutions located in 13 countries completed the survey. Respondents described their clinical impression of the occurrence of delirium to be approximately 25%. Most respondents (75%) reported that their ICU does not routinely screen for delirium. Over half of the respondents (61%) have never attended a lecture on delirium. The majority of respondents (86%) were not satisfied with current delirium screening, diagnosis, and management practices. Promotion of day/night cycle, exposure to natural light, deintensification of care, sleep hygiene, and reorientation to prevent or manage delirium were among nonpharmacologic interventions reported along with the use of anxiolytic, antipsychotic, and medications for insomnia. Clinicians responding to the survey reported a range of delirium assessment and management practices in postoperative pediatric cardiac surgery patients. Study results highlight the need for improvement in delirium education for pediatric cardiac intensive care clinicians as well as the need for systematic evaluation of current delirium assessment and management practices.

  4. Guidelines for Percutaneous Dilatational Tracheostomy (PDT) from the Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM)

    DEFF Research Database (Denmark)

    Madsen, Kristian Rørbæk; Guldager, Henrik; Rewers, Mikael


    Percutaneous dilatational tracheostomy is a common procedure in intensive care. This guideline from the Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM) describes indications and contraindications, timing, complications...

  5. Health care reform and job satisfaction of primary health care physicians in Lithuania

    Directory of Open Access Journals (Sweden)

    Blazeviciene Aurelija


    Full Text Available Abstract Background The aim of this research paper is to study job satisfaction of physicians and general practitioners at primary health care institutions during the health care reform in Lithuania. Methods Self-administrated anonymous questionnaires were distributed to all physicians and general practitioners (N = 243, response rate – 78.6%, working at Kaunas primary health care level establishments, in October – December 2003. Results 15 men (7.9% and 176 women (92.1% participated in the research, among which 133 (69.6% were GPs and 58 (30.4% physicians. Respondents claimed to have chosen to become doctors, as other professions were of no interest to them. Total job satisfaction of the respondents was 4.74 point (on a 7 point scale. Besides 75.5% of the respondents said they would not recommend their children to choose a PHC level doctor's profession. The survey also showed that the respondents were most satisfied with the level of autonomy they get at work – 5.28, relationship with colleagues – 5.06, and management quality – 5.04, while compensation (2.09, social status (3.36, and workload (3.93 turned to be causing the highest dissatisfaction among the respondents. The strongest correlation (Spearmen's ratio was observed between total job satisfaction and such factors as the level of autonomy – 0.566, workload – 0.452, and GP's social status – 0.458. Conclusion Total job satisfaction of doctors working at primary health care establishments in Lithuania is relatively low, and compensation, social status, and workload are among the key factors that condition PHC doctors' dissatisfaction with their job.

  6. 'Targeting' sedation: the lived experience of the intensive care nurse. (United States)

    Everingham, Kirsty; Fawcett, Tonks; Walsh, Tim


    To discuss the findings from a phenomenological study that provides insights into the intensive care nurses' 'world' following changes in the sedation management of patients in an intensive care unit. Intensive care sedation practices have undergone significant changes. Patients, where possible, are now managed on lighter levels of sedation, often achieved through the performance of sedation holds (SHs). The performance of SHs is normally carried out by the bedside nurse but compliance is reported to be poor. There has been little exploration of the nurses' experiences of these changes and the implications of SHs and subsequent wakefulness on their delivery of care. Following ethical approval, 16 intensive care nurses, experienced and inexperienced, from within a general intensive care unit. A Heideggerian phenomenological approach was used. Data collection consisted of interviews guided by an aide memoir and a framework adapted from Van Manen informed the analysis. The findings reveal new insights into the world of the intensive care nurse in the light of the changes to sedation management. They demonstrate that there have been unforeseen outcomes from well-intentioned initiatives to improve the quality of patients' care. There were implications from the changes introduced for the nurses care delivery. The main themes that emerged were 'working priorities' and 'unintended consequences', in turn revealing embedded tensions between evidence-based targets and holistic care. Intensive care nurses find that the current approach to the changes in sedation management can threaten their professional obligation and personal desire to provide holistic care. The 'targeted' approach by healthcare organisations is perceived to militate against the patient-centred care they want to deliver. Sedation management is complex and needs further consideration particularly the potential constraints 'target-led' care has on nursing practice. © 2013 Blackwell Publishing Ltd.

  7. Effect of communication style and physician-family relationships on satisfaction with pediatric chronic disease care. (United States)

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


    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 relationships (p communication style and the quality of the ongoing relationship contribute to pediatric chronic disease visit satisfaction.

  8. Ethical issues recognized by critical care nurses in the intensive care units of a tertiary hospital during two separate periods. (United States)

    Park, Dong Won; Moon, Jae Young; Ku, Eun Yong; Kim, Sun Jong; Koo, Young-Mo; Kim, Ock-Joo; Lee, Soon Haeng; Jo, Min-Woo; Lim, Chae-Man; Armstrong, John David; Koh, Younsuck


    This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P ethical issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behaviorrelated issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-oflife (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behaviorrelated issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.

  9. SimCare: A Model for Studying Physician Decisionmaking Activity

    National Research Council Canada - National Science Library

    Dutta, Pradumna; Biltz, George R; Johnson, Paul E; Sperl-Hillen, JoAnn M; Rush, William A; Duncan, Jane E; O'Connor, Patrick J


    A major factor that contributes to the high rates of medical error in the treatment of patients with diabetes and other chronic diseases is the complexity of the tasks that physicians must complete...

  10. Time-trend of melanoma screening practice by primary care physicians: A meta-regression analysis


    Valachis, Antonis; Mauri, Davide; Karampoiki, Vassiliki; Polyzos, Nikolaos P; Cortinovis, Ivan; Koukourakis, Georgios; Zacharias, Georgios; Xilomenos, Apostolos; Tsappi, Maria; Casazza, Giovanni


    Objective To assess whether the proportion of primary care physicians implementing full body skin examination (FBSE) to screen for melanoma changed over time. Methods Meta-regression analyses of available data. Data Sources: MEDLINE, ISI, Cochrane Central Register of Controlled Trials. Results Fifteen studies surveying 10,336 physicians were included in the analyses. Overall, 15%?82% of them reported to perform FBSE to screen for melanoma. The proportion of physicians using FBSE screening ten...

  11. End-of-life care beliefs among Hindu physicians in the United States. (United States)

    Ramalingam, Vijaya Sivalingam; Saeed, Fahad; Sinnakirouchenan, Ramapriya; Holley, Jean L; Srinivasan, Sinnakirouchenan


    Several studies from the United States and Europe showed that physicians' religiosity is associated with their approach to end-of-life care beliefs. No such studies have focused exclusively on Hindu physicians practicing in the United States. A 34-item questionnaire was sent to 293 Hindu physicians in the United States. Most participants believed that their religious beliefs do not influence their practice of medicine and do not interfere with withdrawal of life support. The US practice of discussing end-of-life issues with the patient, rather than primarily with the family, seems to have been adopted by Hindu physicians practicing in the United States. It is likely that the ethical, cultural, and patient-centered environment of US health care has influenced the practice of end-of-life care by Hindu physicians in this country. © The Author(s) 2013.

  12. Improving Decision Making in Intensive Care

    NARCIS (Netherlands)

    I.A. Meynaar (Iwan)


    textabstractMany decisions are made during a day’s work in critical care. Should this octogenarian with pneumonia and cancer be admitted to the ICU or left on the ward with palliative care? And if admitted to the ICU, will she benefit from being ventilated or should she only be treated with

  13. Evaluating physician performance at individualizing care: a pilot study tracking contextual errors in medical decision making. (United States)

    Weiner, Saul J; Schwartz, Alan; Yudkowsky, Rachel; Schiff, Gordon D; Weaver, Frances M; Goldberg, Julie; Weiss, Kevin B


    Clinical decision making requires 2 distinct cognitive skills: the ability to classify patients' conditions into diagnostic and management categories that permit the application of research evidence and the ability to individualize or-more specifically-to contextualize care for patients whose circumstances and needs require variation from the standard approach to care. The purpose of this study was to develop and test a methodology for measuring physicians' performance at contextualizing care and compare it to their performance at planning biomedically appropriate care. First, the authors drafted 3 cases, each with 4 variations, 3 of which are embedded with biomedical and/or contextual information that is essential to planning care. Once the cases were validated as instruments for assessing physician performance, 54 internal medicine residents were then presented with opportunities to make these preidentified biomedical or contextual errors, and data were collected on information elicitation and error making. The case validation process was successful in that, in the final iteration, the physicians who received the contextual variant of cases proposed an alternate plan of care to those who received the baseline variant 100% of the time. The subsequent piloting of these validated cases unmasked previously unmeasured differences in physician performance at contextualizing care. The findings, which reflect the performance characteristics of the study population, are presented. This pilot study demonstrates a methodology for measuring physician performance at contextualizing care and illustrates the contribution of such information to an overall assessment of physician practice.

  14. Is more neonatal intensive care always better? Insights from a cross-national comparison of reproductive care. (United States)

    Thompson, Lindsay A; Goodman, David C; Little, George A


    Despite high per capita health care expenditure, the United States has crude infant survival rates that are lower than similarly developed nations. Although differences in vital recording and socioeconomic risk have been studied, a systematic, cross-national comparison of perinatal health care systems is lacking. To characterize systems of reproductive care for the United States, Australia, Canada, and the United Kingdom, including a detailed analysis of neonatal intensive care and mortality. Comparison of selected indicators of reproductive care and mortality from 1993-2000 through a systematic review of journal and government publications and structured interviews of leaders in perinatal and neonatal care. Compared with the other 3 countries, the United States has more neonatal intensive care resources yet provides proportionately less support for preconception and prenatal care. Unlike the United States, the other countries provided free family planning services and prenatal and perinatal physician care, and the United Kingdom and Australia paid for all contraception. The United States has high neonatal intensive care capacity, with 6.1 neonatologists per 10 000 live births; Australia, 3.7; Canada, 3.3; and the United Kingdom, 2.7. For intensive care beds, the United States has 3.3 per 10 000 live births; Australia and Canada, 2.6; and the United Kingdom, 0.67. Greater neonatal intensive care resources were not consistently associated with lower birth weight-specific mortality. The relative risk (United States as reference) of neonatal mortality for infants birth weight rates were notably higher in the United States, partially explaining the high crude mortality rates. The United States has significantly greater neonatal intensive care resources per capita, compared with 3 other developed countries, without having consistently better birth weight-specific mortality. Despite low birth weight rates that exceed other countries, the United States has proportionately

  15. The effect of reimbursement on medical decision making: do physicians alter treatment in response to a managed care incentive? (United States)

    Melichar, Lori


    The empirical literature that explores whether physicians respond to financial incentives has not definitively answered the question of whether physicians alter their treatment behavior at the margin. Previous research has not been able to distinguish that part of a physician response that uniformly alters treatment of all patients under a physician's care from that which affects some, but not all of a physician's patients. To explore physicians' marginal responses to financial incentives while accounting for the selection of physicians into different financial arrangements where others could not, I use data from a survey of physician visits to isolate the effect that capitation, a form of reimbursement wherein physicians receive zero marginal revenue for a range of physician provided services, has on the care provided by a physician. Fixed effects regression results reveal that physicians spend less time with their capitated patients than with their non-capitated patients.

  16. Nursing management and organizational ethics in the intensive care unit. (United States)

    Wlody, Ginger Schafer


    This article describes organizational ethics issues involved in nursing management of an intensive care unit. The intensive care team and medical center management have the dual responsibility to create an ethical environment in which to provide optimum patient care. Addressing organizational ethics is key to creating that ethical environment in the intensive care unit. During the past 15-20 yrs, increasing costs in health care, competitive markets, the effect of high technology, and global business changes have set the stage for business and healthcare organizational conflicts that affect the ethical environment. Studies show that critical care nurses experience moral distress and are affected by the ethical climate of both the intensive care unit and the larger organization. Thus, nursing moral distress may result in problems related to recruitment and retention of staff. Other issues with organizational ethics ramifications that may occur in the intensive care unit include patient safety issues (including those related to disruptive behavior), intensive care unit leadership style, research ethics, allocation of resources, triage, and other economic issues. Current organizational ethics conflicts are discussed, a professional practice model is described, and multidisciplinary recommendations are put forth.

  17. Comunicação verbal de uma equipe médica: percepções e necessidades de visitantes de uma UTI - DOI: 10.4025/actascihealthsci.v25i2.2233 Physician team verbal communication: perceptions and needs of visitors at an adult intensive care unit - DOI: 10.4025/actascihealthsci.v25i2.2233

    Directory of Open Access Journals (Sweden)

    Silvia Maria dos Santos Saalfeld


    Full Text Available O presente estudo contou com 27 sujeitos e investigou o conteúdo e as formas como a comunicação se processa entre a equipe médica e os visitantes de uma UTI-adulto. Os dados foram coletados por intermédio de entrevista estruturada, após consentimento por escrito. Dentre os resultados, 8 não compreenderam todas as informações, 24 não receberam informações por escrito, 25 não foram solicitados para fazer feedback e 12 não receberam estímulos para fazer perguntas. Sobre o que foram informados, mencionaram: a respeito da doença (22, resultados de exames e tratamento (8 respectivamente. 14 referiram que gostariam de receber informações sobre o estado geral do cliente e 8 apontaram o prognóstico. As sugestões mais citadas para melhoria foram: mais detalhes a respeito do estado geral, abertura para fazer perguntas e receber informações por escrito. Observou-se que o processo de comunicação entre os dois grupos necessita ser otimizada. Sugere-se, para tanto, a perspectiva da interdisciplinaridade.The present study, consisted by 27 subjects, investigated the content and the forms of verbal communication between physician team and visitors of an Adult Intensive Care Unit (ICU. Data were collected through a structured interview after written consent. The results showed that 8 subjects did not understand all information given, 24 did not receive written information, 25 were not requested to do feedback and 12 did not feel free to make questions. Regarding to what was informed to the visitors, they mentioned topics concerning: the disease (22; exams results and treatment (8 respectively. Some visitors (14 affirmed that they would like to receive information about the client general condition and 8 referred to the prognostic. The most mentioned suggestions for improvement were: receiving more details regarding to the client general condition, an overture to make questions and written information. In conclusion, the communication

  18. Initial quantitative evaluation of computed radiography in an intensive care unit

    International Nuclear Information System (INIS)

    Hillis, D.J.; McDonald, I.G.; Kelly, W.J.


    The first computed radiography (CR) unit in Australia was installed at St Vincent's Hospital, Melbourne, in February 1994. An initial qualitative evaluation of the attitude of the intensive care unit (ICU) physicians to the CR unit was conducted by use of a survey. The results of the survey of ICU physicians indicated that images were available faster than under the previous system and that the use of the CR system was preferred to evaluate chest tubes and line placements. While it is recognized that a further detailed radiological evaluation of the CR system is required to establish the diagnostic performance of CR compared with conventional film, some comments on the implementation of the system and ICU physician attitudes to the CR system are put forward for consideration by other hospitals examining the possible use of CR systems. 11 refs., 1 tab

  19. Consultation with specialist palliative care services in palliative sedation: considerations of Dutch physicians. (United States)

    Koper, Ian; van der Heide, Agnes; Janssens, Rien; Swart, Siebe; Perez, Roberto; Rietjens, Judith


    Palliative sedation is considered a normal medical practice by the Royal Dutch Medical Association. Therefore, consultation of an expert is not considered mandatory. The European Association of Palliative Care (EAPC) framework for palliative sedation, however, is more stringent: it considers the use of palliative sedation without consulting an expert as injudicious and insists on input from a multi-professional palliative care team. This study investigates the considerations of Dutch physicians concerning consultation about palliative sedation with specialist palliative care services. Fifty-four physicians were interviewed on their most recent case of palliative sedation. Reasons to consult were a lack of expertise and the view that consultation was generally supportive. Reasons not to consult were sufficient expertise, the view that palliative sedation is a normal medical procedure, time pressure, fear of disagreement with the service and regarding consultation as having little added value. Arguments in favour of mandatory consultation were that many physicians lack expertise and that palliative sedation is an exceptional intervention. Arguments against mandatory consultation were practical obstacles that may preclude fulfilling such an obligation (i.e. lack of time), palliative sedation being a standard medical procedure, corroding a physician's responsibility and deterring physicians from applying palliative sedation. Consultation about palliative sedation with specialist palliative care services is regarded as supportive and helpful when physicians lack expertise. However, Dutch physicians have both practical and theoretical objections against mandatory consultation. Based on the findings in this study, there seems to be little support among Dutch physicians for the EAPC recommendations on obligatory consultation.

  20. Democratic and Republican physicians provide different care on politicized health issues (United States)

    Hersh, Eitan D.; Goldenberg, Matthew N.


    Physicians frequently interact with patients about politically salient health issues, such as drug use, firearm safety, and sexual behavior. We investigate whether physicians’ own political views affect their treatment decisions on these issues. We linked the records of over 20,000 primary care physicians in 29 US states to a voter registration database, obtaining the physicians’ political party affiliations. We then surveyed a sample of Democratic and Republican primary care physicians. Respondents evaluated nine patient vignettes, three of which addressed especially politicized health issues (marijuana, abortion, and firearm storage). Physicians rated the seriousness of the issue presented in each vignette and their likelihood of engaging in specific management options. On the politicized health issues—and only on such issues—Democratic and Republican physicians differed substantially in their expressed concern and their recommended treatment plan. We control for physician demographics (like age, gender, and religiosity), patient population, and geography. Physician partisan bias can lead to unwarranted variation in patient care. Awareness of how a physician’s political attitudes might affect patient care is important to physicians and patients alike. PMID:27698126

  1. Primary health care physicians' treatment of psychosocial problems: implications for social work.

    NARCIS (Netherlands)

    Gross, R.; Rabinowitz, J.; Feldman, D.; Boerma, W.


    This study explores the extent to which primary care physicians serve as gatekeepers for the treatment of psychosocial problems and the extent to which they have contact with social workers. We also attempted to identify physician variables related to gatekeeping and amount of contact with social

  2. Transition from neonatal intensive care unit to special care nurseries: Experiences of parents and nurses

    NARCIS (Netherlands)

    Dr. A.L. van Staa; O.K. Helder; J.C.M. Verweij


    To explore parents' and nurses' experiences with the transition of infants from the neonatal intensive care unit to a special care nursery. Qualitative explorative study in two phases. Level IIID neonatal intensive care unit in a university hospital and special care nurseries (level II) in five

  3. Physician's sociodemographic profile and distribution across public and private health care: an insight into physicians' dual practice in Brazil. (United States)

    Miotto, Bruno Alonso; Guilloux, Aline Gil Alves; Cassenote, Alex Jones Flores; Mainardi, Giulia Marcelino; Russo, Giuliano; Scheffer, Mário César


    The intertwined relation between public and private care in Brazil is reshaping the medical profession, possibly affecting the distribution and profile of the country's medical workforce. Physicians' simultaneous engagement in public and private services is a common and unregulated practice in Brazil, but the influence played by contextual factors and personal characteristics over dual practice engagement are still poorly understood. This study aimed at exploring the sociodemographic profile of Brazilian physicians to shed light on the links between their personal characteristics and their distribution across public and private services. A nation-wide cross-sectional study using primary data was conducted in 2014. A representative sample size of 2400 physicians was calculated based  on the National Council of Medicine database registries; telephone interviews were conducted to explore physicians' sociodemographic characteristics and their engagement with public and private services. From the 2400 physicians included, 51.45% were currently working in both the public and private services, while 26.95% and 21.58% were working exclusively in the private and public sectors, respectively. Public sector physicians were found to be younger (PR 0.84 [0.68-0.89]; PR 0.47 [0.38-0.56]), less experienced (PR 0.78 [0.73-0.94]; PR 0.44 [0.36-0.53]) and predominantly female (PR 0.79 [0.71-0.88]; PR 0.68 [0.6-0.78]) when compared to dual and private practitioners; their income was substantially lower than those working exclusively for the private (PR 0.58 [0.48-0.69]) and mixed sectors (PR 0.31 [0.25-0.37]). Conversely, physicians from the private sector were found to be typically senior (PR 1.96 [1.58-2.43]), specialized (PR 1.29 [1.17-1.42]) and male (PR 1.35 [1.21-1.51]), often working less than 20 h per week (PR 2.04 [1.4-2.96]). Dual practitioners were mostly middle-aged (PR 1.3 [1.16-1.45]), male specialists with 10 to 30 years of medical practice (PR 1.23 [1

  4. Patient safety event reporting in critical care: a study of three intensive care units. (United States)

    Harris, Carolyn B; Krauss, Melissa J; Coopersmith, Craig M; Avidan, Michael; Nast, Patricia A; Kollef, Marin H; Dunagan, W Claiborne; Fraser, Victoria J


    To increase patient safety event reporting in three intensive care units (ICUs) using a new voluntary card-based event reporting system and to compare and evaluate observed differences in reporting among healthcare workers across ICUs. Prospective, single-center, interventional study. A medical ICU (19 beds), surgical ICU (24 beds), and cardiothoracic ICU (17 beds) at a 1,371-bed urban teaching hospital. Adult patients admitted to these three study ICUs. Use of a new, internally designed, card-based reporting program to solicit voluntary anonymous reporting of medical errors and patient safety concerns. During a 14-month period, 714 patient safety events were reported using a new card-based reporting system, reflecting a significant increase in reporting compared with pre-intervention Web-based reporting (20.4 reported events/1,000 patient days pre-intervention to 41.7 reported events/1,000 patient days postintervention; rate ratio, 2.05; 95% confidence interval, 1.79-2.34). Nurses submitted the majority of reports (nurses, 67.1%; physicians, 23.1%; other reporters, 9.5%); however, physicians experienced the greatest increase in reporting among their group (physicians, 43-fold; nurses, 1.7-fold; other reporters, 4.3-fold) relative to pre-intervention rates. There were significant differences in the reporting of harm by job description: 31.1% of reports from nurses, 36.2% from other staff, and 17.0% from physicians described events that did not reach/affect the patient (p = .001); and 33.9% of reports from physicians, 27.2% from nurses, and 13.0% from other staff described events that caused harm (p = .005). Overall reported patient safety events per 1,000 patient days differed by ICU (medical ICU = 55.5, cardiothoracic ICU = 25.3, surgical ICU = 40.2; p reporting system increased reporting significantly compared with pre-intervention Web-based reporting and revealed significant differences in reporting by healthcare worker and ICU. These differences may reveal

  5. Rethinking the intensive care environment: considering nature in nursing practice. (United States)

    Minton, Claire; Batten, Lesley


    With consideration of an environmental concept, this paper explores evidence related to the negative impacts of the intensive care unit environment on patient outcomes and explores the potential counteracting benefits of 'nature-based' nursing interventions as a way to improve care outcomes. The impact of the environment in which a patient is nursed has long been recognised as one determinant in patient outcomes. Whilst the contemporary intensive care unit environment contains many features that support the provision of the intensive therapies the patient requires, it can also be detrimental, especially for long-stay patients. This narrative review considers theoretical and evidence-based literature that supports the adoption of nature-based nursing interventions in intensive care units. Research and theoretical literature from a diverse range of disciplines including nursing, medicine, psychology, architecture and environmental science were considered in relation to patient outcomes and intensive care nursing practice. There are many nature-based interventions that intensive care unit nurses can implement into their nursing practice to counteract environmental stressors. These interventions can also improve the environment for patients' families and nurses. Intensive care unit nurses must actively consider and manage the environment in which nursing occurs to facilitate the best patient outcomes. © 2015 John Wiley & Sons Ltd.

  6. Physician's self-perceived abilities at primary care settings in Indonesia. (United States)

    Istiono, Wahyudi; Claramita, Mora; Ekawati, Fitriana Murriya; Gayatri, Aghnaa; Sutomo, Adi Heru; Kusnanto, Hari; Graber, Mark Alan


    Southeast Asian countries with better-skilled primary care physicians have been shown to have better health outcomes. However, in Indonesia, there has been a large number of inappropriate referrals, leading to suboptimal health outcomes. This study aimed to examine the reasons underlying the unnecessary referrals as related to Indonesian physicians' standard of abilities. This was a multiple-case study that explored physicians' self-evaluation of their abilities. Self-evaluation questionnaires were constructed from the Indonesian Standards of Physicians Competences of 2006-2012 (ISPC), which is a list of 155 diseases. This study was undertaken in three cities, three towns, and one "border-less developed" area during 2011-2014. The study involved 184 physicians in those seven districts. Data were collected using one-on-one, in-depth interviews, focus group discussions (FGDs), and clinical observations. This study found that primary care physicians in Indonesia felt that they were competent to handle less than one-third of "typical" primary care cases. The reasons were limited understanding of person-centered care principles and limited patient care services to diagnosis and treatment of common biomedical problems. Additionally, physical facilities in primary care settings are lacking. Strengthening primary health care in Indonesia requires upscaling doctors' abilities in managing health problems through more structured graduate education in family medicine, which emphasizes the bio-psycho-socio-cultural background of persons; secondly, standardizing primary care facilities to support physicians' performance is critical. Finally, a strong national health policy that recognizes the essential role of primary care physicians in health outcomes is an urgent need.

  7. Moral distress experienced by intensive care nurses

    African Journals Online (AJOL)

    the patient's best interests, when patient safety is compromised[13] or when the medical team ... exacerbated in the acute-care environment and add to the potentially .... income and request to work in ICU, relying on the expertise of the.

  8. Intensive care of the neonatal foal. (United States)

    Koterba, A M; Drummond, W H; Kosch, P


    The basic concepts of diagnosis and treatment in the abnormal neonatal foal are presented. Methods of restraint, sedation, and general nursing care are discussed, as well as more specific techniques of respiratory and circulatory system support.

  9. The pediatric intensive care unit business model. (United States)

    Schleien, Charles L


    All pediatric intensivists need a primer on ICU finance. The author describes potential alternate revenue sources for the division. Differentiating units by size or academic affiliation, the author describes drivers of expense. Strategies to manage the bottom line including negotiations for hospital services are covered. Some of the current trends in physician productivity and its described metrics, with particular focus on clinical FTE management is detailed. Methods of using this data to enhance revenue are discussed. Some of the other current trends in the ICU business related to changes at the federal and state level as well as in the insurance sector, moving away from fee-for-service are covered. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Using attachment theory in medical settings: implications for primary care physicians. (United States)

    Hooper, Lisa M; Tomek, Sara; Newman, Caroline R


    Mental health researchers, clinicians and clinical psychologists have long considered a good provider-patient relationship to be an important factor for positive treatment outcomes in a range of therapeutic settings. However, primary care physicians have been slow to consider how attachment theory may be used in the context of patient care in medical settings. In the current article, John Bowlby's attachment theory and proposed attachment styles are proffered as a framework to better understand patient behaviors, patient communication styles with physicians and the physician-patient relationship in medical settings. The authors recommend how primary care physicians and other health care providers can translate attachment theory to enhance practice behaviors and health-related communications in medical settings.

  11. Unethical business practices in U.S. health care alarm physician leaders. (United States)

    Weber, David O


    Learn the results of ACPE's recent survey on ethical business practices and find out why physician executives are very concerned about the impact unethical behaviors appear to be having on health care.

  12. Physician office vs retail clinic: patient preferences in care seeking for minor illnesses. (United States)

    Ahmed, Arif; Fincham, Jack E


    Retail clinics are a relatively new phenomenon in the United States, offering cheaper and convenient alternatives to physician offices for minor illness and wellness care. The objective of this study was to investigate the effects of cost of care and appointment wait time on care-seeking decisions at retail clinics or physician offices. As part of a statewide random-digit-dial survey of households, adult residents of Georgia were interviewed to conduct a discrete choice experiment with 2 levels each of 4 attributes: price ($59; $75), appointment wait time (same day; 1 day or longer), care setting-clinician combination (nurse practitioner in retail clinic; physician in private office), and acute illness (urinary tract infection [UTI]; influenza). The respondents indicated whether they would seek care under each of the 16 resulting choice scenarios. A cooperation rate of 33.1% yielded 493 completed telephone interviews. The respondents preferred to seek care for both conditions; were less likely to seek care for UTI (beta = -0.149; P = .008); preferred to seek care from a physician (beta = 1.067; P clinic and $82.12 to wait 1 day or more. Time and cost savings offered by retail clinics are attractive to patients, and they are likely to seek care there given sufficient cost savings. Appointment wait time is the most important factor in care-seeking decisions and should be considered carefully in setting appointment policies in primary care practices.

  13. Sleep and sedation in the pediatric intensive care unit. (United States)

    Carno, Margaret-Ann; Connolly, Heidi V


    Sleep is an important and necessary function of the human body. Somatic growth and cellular repair occur during sleep. Critically ill children have disturbed sleep while in the pediatric intensive care unit related both to the illness itself and to light, noise, and caregiver activities disrupting an environment conducive to sleep. Medications administered in the pediatric intensive care unit can also disrupt sleep. This article reviews what is known about sleep in the pediatric intensive care unit and the effects of common sedation medications on sleep.

  14. [Structure and functional organization of integrated cardiac intensive care]. (United States)

    Scherillo, Marino; Miceli, Domenico; Tubaro, Marco; Guiducci, Umberto


    The early invasive strategy for the treatment of acute coronary syndromes and the increasing number of older and sicker patients requiring prolonged and more complex intensive care have induced many changes in the function of the intensive care units. These changes include the statement that specially trained cardiologists and cardiac nurses who can manage patients with acute cardiac conditions should staff the intensive care units. This document indicates the structure of the units and specific recommendations for the number of beds, monitoring system, respirators, pacemaker/defibrillators and additional equipment.

  15. Guideline for stress ulcer prophylaxis in the intensive care unit

    DEFF Research Database (Denmark)

    Madsen, Kristian Rørbaek; Lorentzen, Kristian; Clausen, Niels


    Stress ulcer prophylaxis (SUP) is commonly used in the intensive care unit (ICU), and is recommended in the Surviving Sepsis Campaign guidelines 2012. The present guideline from the Danish Society of Intensive Care Medicine and the Danish Society of Anesthesiology and Intensive Care Medicine sums...... critically ill patients in the ICU outside the context of randomized controlled trials (GRADE 1C). No robust evidence supports recommendations for subpopulations in the ICU such as septic, burn, trauma, cardiothoracic or enterally fed patients. However, if SUP is considered clinically indicated in individual...

  16. arriba-lib: evaluation of an electronic library of decision aids in primary care physicians

    Directory of Open Access Journals (Sweden)

    Hirsch Oliver


    Full Text Available Abstract Background The successful implementation of decision aids in clinical practice initially depends on how clinicians perceive them. Relatively little is known about the acceptance of decision aids by physicians and factors influencing the implementation of decision aids from their point of view. Our electronic library of decision aids (arriba-lib is to be used within the encounter and has a modular structure containing evidence-based decision aids for the following topics: cardiovascular prevention, atrial fibrillation, coronary heart disease, oral antidiabetics, conventional and intensified insulin therapy, and unipolar depression. The aim of our study was to evaluate the acceptance of arriba-lib in primary care physicians. Methods We conducted an evaluation study in which 29 primary care physicians included 192 patients. The physician questionnaire contained information on which module was used, how extensive steps of the shared decision making process were discussed, who made the decision, and a subjective appraisal of consultation length. We used generalised estimation equations to measure associations within patient variables and traditional crosstab analyses. Results Only a minority of consultations (8.9% was considered to be unacceptably extended. In 90.6% of consultations, physicians said that a decision could be made. A shared decision was perceived by physicians in 57.1% of consultations. Physicians said that a decision was more likely to be made when therapeutic options were discussed “detailed”. Prior experience with decision aids was not a critical variable for implementation within our sample of primary care physicians. Conclusions Our study showed that it might be feasible to apply our electronic library of decision aids (arriba-lib in the primary care context. Evidence-based decision aids offer support for physicians in the management of medical information. Future studies should monitor the long-term adoption of

  17. Job satisfaction of primary care physicians in Switzerland: an observational study. (United States)

    Goetz, Katja; Jossen, Marianne; Szecsenyi, Joachim; Rosemann, Thomas; Hahn, Karolin; Hess, Sigrid


    Job satisfaction of physicians is an important issue for performance of a health care system. The aim of the study was to evaluate the job satisfaction of primary care physicians in Switzerland and to explore associations between overall job satisfaction, individual characteristics and satisfaction with aspects of work within the practice separated by gender. This cross-sectional study was based on a job satisfaction survey. Data were collected from 176 primary care physicians working in 91 primary care practices. Job satisfaction was measured with the 10-item Warr-Cook-Wall job satisfaction scale. Stepwise linear regression analysis was performed for physicians separated by gender. The response rate was 92.6%. Primary care physicians reported the highest level of satisfaction with 'freedom of working method' (mean = 6.45) and the lowest satisfaction for 'hours of work' (mean = 5.38) and 'income' (mean = 5.49). Moreover, some aspects of job satisfaction were rated higher by female physicians than male physicians. Within the stepwise regression analysis, the aspect 'opportunity to use abilities' (β = 0.644) showed the highest association to overall job satisfaction for male physicians while for female physicians it was income (β = 0.733). The presented results contribute to an understanding of factors that influence levels of satisfaction of female and male physicians. Therefore, research and intervention about job satisfaction should consider gender as well as the stereotypes that come along with these social roles. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:

  18. Effects of a physician-led home care team on terminal care. (United States)

    Zimmer, J G; Groth-Juncker, A; McCusker, J


    Inconsistent results in studies of cost-effectiveness of home health care have led to the need for identification of target populations for whom cost-savings can be anticipated if expanded home care programs are introduced. This analysis of results of a randomized controlled study of efficacy of a physician/geriatric nurse practitioner/social worker home care team identifies such a potential target population. The team provides round-the-clock on-call medical services in the home when needed, in addition to usual nursing and other home care services, to home-bound chronically or terminally ill elderly patients. Overall health services utilization and estimated costs were not substantially different for the patients who did not die while in the study; however, for those who did die, team patients had considerably lower rates of hospitalization and overall cost than controls, and more frequently died at home. Of 21 team and 12 control patients who died but had at least two weeks of utilization experience in the study, team patients had about half the number of hospital days compared with controls during the terminal two weeks, and although they had more home care services, had only 69 per cent of the estimated total health care costs of the controls. Satisfaction with care received was significantly greater among the total group of team patients, and especially among their family caretakers, than among controls. This model is effective in providing appropriate medical care for seriously ill and terminal patients, and in enabling them to die at home if they so wish, while at the same time reducing costs of care during the terminal period.

  19. Physicians' professionalism at primary care facilities from patients' perspective: The importance of doctors' communication skills. (United States)

    Sari, Merry Indah; Prabandari, Yayi Suryo; Claramita, Mora


    Professionalism is the core duty of a doctor to be responsible to the society. Doctors' professionalism depicts an internalization of values and mastery of professionals' standards as an important part in shaping the trust between doctors and patients. Professionalism consists of various attributes in which current literature focused more on the perspective of the health professionals. Doctors' professionalism may influence patients' satisfaction, and therefore, it is important to know from the patients' perspectives what was expected of medical doctors' professionalism. This study was conducted to determine the attributes of physician professionalism from the patient's perspective. This was a qualitative research using a phenomenology study design. In-depth interviews were conducted with 18 patients with hypertension and diabetes who had been treated for at least 1 year in primary care facilities in the city of Yogyakarta, Indonesia. The results of the interview were transcribed, encoded, and then classified into categories. Communication skills were considered as the top priority of medical doctors' attributes of professionalism in the perspectives of the patients. This study revealed that communication skill is the most important aspects of professionalism which greatly affected in the process of health care provided by the primary care doctors. Doctor-patient communication skills should be intensively trained during both basic and postgraduate medical education.

  20. Adherence of Primary Care Physicians to Evidence-Based Recommendations to Reduce Ovarian Cancer Mortality


    Stewart, Sherri L.; Townsend, Julie S.; Puckett, Mary C.; Rim, Sun Hee


    Ovarian cancer is the deadliest gynecologic cancer. Receipt of treatment from a gynecologic oncologist is an evidence-based recommendation to reduce mortality from the disease. We examined knowledge and application of this evidence-based recommendation in primary care physicians as part of CDC gynecologic cancer awareness campaign efforts and discussed results in the context of CDC National Comprehensive Cancer Control Program (NCCCP). We analyzed primary care physician responses to questions...

  1. Physician Acceptance of Gateway to Care at Irwin Army Community Hospital (United States)


    frontier cavalry post once commanded by General George Armstrong Custer. Today it is the home of almost 20,000 soldiers of the Big Red One, First Infantry...especially important for the future. Physicians, as key "players" in healthcare organizations, are also key to the success of Gateway to Care. Kotler and...research (3rd ed.). New York: Holt. Physician Acceptance 32 Kotler , P., & Clarke, R. (1987). Marketing for health care organizations. Englewood Cliffs

  2. The views of primary care physicians on health risks from electromagnetic fields

    DEFF Research Database (Denmark)

    Berg-Beckhoff, Gabi; Heyer, Kristina; Kowall, Bernd


    The aim of this study was to find out what primary care physicians in Germany think about the possible health risks of electromagnetic fields (EMF) and how they deal with this topic in discussions with patients.......The aim of this study was to find out what primary care physicians in Germany think about the possible health risks of electromagnetic fields (EMF) and how they deal with this topic in discussions with patients....

  3. Burnout syndrome--assessment of a stressful job among intensive care staff. (United States)

    Cubrilo-Turek, Mirjana; Urek, Roman; Turek, Stjepan


    The purpose of the study was to investigate the degree of burnout experienced by intensive care staff particularly, in Medical (MICU) and Surgical Intensive Care Units (SICU) General Hospital "Sveti Duh", Zagreb. A sample group of 41 emergency physicians and nurses from MICU and 30 from SICU was tested. The survey included demographic data and Maslach Burnout Inventory (MBI) scoring test identified by the three main components associated with burnout: emotional exhaustion (MBI-EE), depersonalization (MBI-DEP), and personal accomplishment (MBI-PA) were assessed using 22-item questionnaire. The degrees of burnout were stratified into low, moderate, and high range. Mean total MBI (X +/- SD) were high in both groups: higher for the MICU (65.5 +/- 6.7) than for SICU staff (55.7 +/- 3.8, p burnout represented in a moderate degree. The presence of burnout is a serious phenomenon, because it can lead to psychosomatic complaints, work-associated withdrawal behaviour, and a lower quality of care at intensive care units. Early recognition of burnout phenomenon as a result of prolonged stress and frustration among intensive care staff, contributes to better professional behavior, organizational structure changes in the work environment and better health care quality for critically ill patients.

  4. [Evaluations by hospital-ward physicians of patient care management quality for patients hospitalized after an emergency department admission]. (United States)

    Bartiaux, M; Mols, P


    patient management in the acute and sub-acute setting of an Emergency Department is challenging. An assessment of the quality of provided care enables an evaluation of failings. It contributes to the identification of areas for improvement. to obtain an analysis, by hospital-ward physicians, of adult patient care management quality, as well as of the correctness of diagnosis made during emergency admissions. To evaluate the consequences of inadequate patient care management on morbidity, mortality and cost and duration of hospitalization. prospective data analysis obtained between the 1/12/2009 and the 21/12/2009 from physicians using a questionnaire on adult-patient emergency admissions and subsequent hospitalization. questionnaires were completed for 332 patients. Inadequate management of patient care were reported for 73/332 (22 %) cases. Incorrect diagnoses were reported for 20/332 (6 %) cases. 35 cases of inadequate care management (10.5 % overall) were associated with morbidity (34 cases) or mortality (1 case), including 4 cases (1.2 % ) that required emergency intensive-care or surgical interventions. this quality study analyzed the percentage of patient management cases and incorrect diagnoses in the emergency department. The data for serious outcome and wrong diagnosis are comparable with current literature. To improve performance, we consider the process for establishing a diagnosis and therapeutic care.

  5. Physician Burnout and the Calling to Care for the Dying: A National Survey. (United States)

    Yoon, John D; Hunt, Natalie B; Ravella, Krishna C; Jun, Christine S; Curlin, Farr A


    Physician burnout raises concerns over what sustains physicians' career motivations. We assess whether physicians in end-of-life specialties had higher rates of burnout and/or calling to care for the dying. We also examined whether the patient centeredness of the clinical environment was associated with burnout. In 2010 to 2011, we conducted a national survey of US physicians from multiple specialties. Primary outcomes were a validated single-item measure of burnout or sense of calling to end-of-life care. Primary predictors of burnout (or calling) included clinical specialty, frequency of encounters with dying patients, and patient centeredness of the clinical environments ("My clinical environment prioritizes the need of the patient over maximizing revenue"). Adjusted response rate among eligible respondents was 62% (1156 of 1878). Nearly a quarter of physicians (23%) experienced burnout, and rates were similar across all specialties. Half of the responding physicians (52%) agreed that they felt called to take care of patients who are dying. Burned-out physicians were more likely to report working in profit-centered clinical environments (multivariate odds ratio [OR] of 1.9; confidence interval [CI]: 1.3-2.8) or experiencing emotional exhaustion when caring for the dying (multivariate OR of 2.1; CI: 1.4-3.0). Physicians who identified their work as a calling were more likely to work in end-of-life specialties, to feel emotionally energized when caring for the dying, and to be religious. Physicians from end-of-life specialties not only did not have increased rates of burnout but they were also more likely to report a sense of calling in caring for the dying.

  6. Knowledge, attitudes and misconceptions of primary care physicians regarding fever in children: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Demir Figen


    Full Text Available Abstract Background Fever is an extremely common sign in paediatric patients and the most common cause for a child to be taken to the doctor. The literature indicates that physicians and parents have too many misconceptions and conflicting results about fever management. In this study we aim to identify knowledge, attitudes and misconceptions of primary care physicians regarding fever in children. Methods This cross-sectional study was conducted in April-May 2010 involving primary care physicians (n=80. The physicians were surveyed using a self-administered questionnaire. Descriptive statistics were used. Results In our study only 10% of the physicians knew that a body temperature of above 37.2°C according to an auxiliary measurement is defined as fever. Only 26.2% of the physicians took into consideration signs and symptoms other than fever to prescribe antipyretics. 85% of the physicians prescribed antipyretics to control fever or prevent complications of fever especially febrile seizures. Most of the physicians (76.3% in this study reported that the height of fever may be used as an indicator for severe bacterial infection. A great majority of physicians (91.3% stated that they advised parents to alternate the use of ibuprofen and paracetamol. Conclusions There were misconceptions about the management and complications of fever. There is a perceived need to improve the recognition, assessment, and management of fever with regards to underlying illnesses in children.

  7. Self-care as a professional imperative: physician burnout, depression, and suicide. (United States)

    Kuhn, Catherine M; Flanagan, Ellen M


    Burnout has been identified in approximately half of all practicing physicians, including anesthesiologists. In this narrative review, the relationship between burnout, depression, and suicide is explored, with particular attention to the anesthesiologist. Throughout this review, we highlight our professional imperative regarding this epidemic. The authors searched the existing English language literature via PubMed from 1986 until present using the search terms physician burnout, depression, and suicide, with particular attention to studies regarding anesthesiologists and strategies to address these problems. Burnout and depression have increased among physicians, while the rate of suicide has remained relatively the same. There are many factors associated with burnout and depression as well as many causes. Certain individual factors include sex, amount of social support, and mental health history. Systems factors that play a role in burnout and depression include work compression, demands of electronic health records, production pressure, and lack of control over one's professional life. Medical license applications include questions that reinforce the stigma of psychological stresses and discourage physicians from seeking appropriate care. The concept of physician well-being is multidimensional and includes factors related to each physician as an individual as well as to the working environment. Anesthesiologists must actively engage in self-care. Anesthesiology practices and healthcare organizations should evaluate the balance between demands they place on physicians and the resources provided to sustain an engaged, productive, and satisfied physician workforce. National efforts must be rallied to support physicians seeking help for physical and psychological health problems.

  8. Design and Implementation of the Intensive Care Unit Quality Management Registry: Monitoring Quality and Cost of an Adult Intensive Care Unit in a Greek State Hospital. (United States)

    Kosmidis, Dimitrios; Koutsouki, Sotiria; Lampiri, Klairi; Nagy, Eva Ottilia; Papaioannou, Vasilios; Pneumatikos, Ioannis; Anastassopoulos, George


    Intensive care electronic registries have been instrumental in quality measurement, improvement, and assurance of intensive care. In this article, the development and pilot implementation of the Intensive Care Unit Quality Management Registry are described, with a particular focus on monitoring the quality and operational cost in an adult ICU at a northern Greek state hospital. A relational database was developed for a hospital ICU so that qualitative and financial data are recorded for further analysis needed for planning quality care improvement and enhanced efficiency. Key features of this database registry were low development cost, user friendliness, maximum data security, and interoperability in existing hospital information systems. The database included patient demographics, nursing and medical parameters, and quality and performance indicators as established in many national registries worldwide. Cost recording was based on a mixed approach: at patient level ("bottom-up" method) and at department level ("top-down" method). During the pilot phase of the database operation, regular monitoring of quality and cost data revealed several fields of quality excellence, while indicating room for improvement for others. Parallel recording and trending of multiple parameters showed that the database can be utilized for optimum ICU quality and cost management and also for further research purposes by nurses, physicians, and administrators.

  9. Predictors of intensive care unit refusal in French intensive care units: a multiple-center study. (United States)

    Garrouste-Orgeas, Maité; Montuclard, Luc; Timsit, Jean-François; Reignier, Jean; Desmettre, Thibault; Karoubi, Philippe; Moreau, Delphine; Montesino, Laurent; Duguet, Alexandre; Boussat, Sandrine; Ede, Christophe; Monseau, Yannick; Paule, Thierry; Misset, Benoit; Carlet, Jean


    To identify factors associated with granting or refusing intensive care unit (ICU) admission, to analyze ICU characteristics and triage decisions, and to describe mortality in admitted and refused patients. Observational, prospective, multiple-center study. Four university hospitals and seven primary-care hospitals in France. None. Age, underlying diseases (McCabe score and Knaus class), dependency, hospital mortality, and ICU characteristics were recorded. The crude ICU refusal rate was 23.8% (137/574), with variations from 7.1% to 63.1%. The reasons for refusal were too well to benefit (76/137, 55.4%), too sick to benefit (51/137, 37.2%), unit too busy (9/137, 6.5%), and refusal by the family (1/137). In logistic regression analyses, two patient-related factors were associated with ICU refusal: dependency (odds ratio [OR], 14.20; 95% confidence interval [CI], 5.27-38.25; p refused patients, and 1.03 (95% CI, 0.28-1.75) for later-admitted patients. ICU refusal rates varied greatly across ICUs and were dependent on both patient and organizational factors. Efforts to define ethically optimal ICU admission policies might lead to greater homogeneity in refusal rates, although case-mix variations would be expected to leave an irreducible amount of variation across ICUs.

  10. A comprehensive approach to quality management of intensive care services. (United States)

    Hariharan, Seetharaman; Dey, Prasanta Kumar


    The purpose of this paper is to develop a comprehensive framework for improving intensive care unit performance. The study introduces a quality management framework by combining cause and effect diagram and logical framework. An intensive care unit was identified for the study on the basis of its performance. The reasons for not achieving the desired performance were identified using a cause and effect diagram with the stakeholder involvement. A logical framework was developed using information from the cause and effect diagram and a detailed project plan was developed. The improvement projects were implemented and evaluated. Stakeholders identified various intensive care unit issues. Managerial performance, organizational processes and insufficient staff were considered major issues. A logical framework was developed to plan an improvement project to resolve issues raised by clinicians and patients. Improved infrastructure, state-of-the-art equipment, well maintained facilities, IT-based communication, motivated doctors, nurses and support staff, improved patient care and improved drug availability were considered the main project outputs for improving performance. The proposed framework is currently being used as a continuous quality improvement tool, providing a planning, implementing, monitoring and evaluating framework for the quality improvement measures on a sustainable basis. The combined cause and effect diagram and logical framework analysis is a novel and effective approach to improving intensive care performance. Similar approaches could be adopted in any intensive care unit. The paper focuses on a uniform model that can be applied to most intensive care units.

  11. Team working in intensive care: current evidence and future endeavors. (United States)

    Richardson, Joanne; West, Michael A; Cuthbertson, Brian H


    It has recently been argued that the future of intensive care medicine will rely on high quality management and teamwork. Therefore, this review takes an organizational psychology perspective to examine the most recent research on the relationship between teamwork, care processes, and patient outcomes in intensive care. Interdisciplinary communication within a team is crucial for the development of negotiated shared treatment goals and short-team patient outcomes. Interventions for maximizing team communication have received substantial interest in recent literature. Intensive care coordination is not a linear process, and intensive care teams often fail to discuss how to implement goals, trigger and align activities, or reflect on their performance. Despite a move toward interdisciplinary team working, clinical decision-making is still problematic and continues to be perceived as a top-down and authoritative process. The topic of team leadership in intensive care is underexplored and requires further research. Based on findings from the most recent research evidence in medicine and management, four principles are identified for improving the effectiveness of team working in intensive care: engender professional efficacy, create stable teams and leaders, develop trust and participative safety, and enable frequent team reflexivity.

  12. [Quality assurance in intensive care: the situation in Switzerland]. (United States)

    Frutiger, A


    The movement for quality in medicine is starting to take on the dimensions of a crusade. Quite logically it has also reached the intensive care community. Due to their complex multidisciplinary functioning and because of the high costs involved, ICUs are model services reflecting the overall situation in our hospitals. The situation of Swiss intensive care is particularly interesting, because for over 25 years standards for design and staffing of Swiss ICUs have been in effect and were enforced via onsite visits by the Swiss Society of Intensive Care without government involvement. Swiss intensive care thus defined its structures long before the word "accreditation" had even been used in this context. While intensive care in Switzerland is practised in clearly defined, well equipped and adequately staffed units, much less is known about process quality and outcomes of these services. Statistics on admissions, length of stay and length of mechanical ventilation, as well as severity data based on a simple classification system, are collected nationwide and allow some limited insight into the overall process of care. Results of intensive care are not systematically assessed. In response to the constant threat of cost containment, Swiss ICUs should increasingly focus on process quality and results, while maintaining their existing good structures.

  13. Prescription opioid use and misuse: piloting an educational strategy for rural primary care physicians. (United States)

    Srivastava, Anita; Kahan, Meldon; Jiwa, Ashifa


    To evaluate the feasibility and effectiveness of a multifaceted educational intervention to improve the opioid prescribing practices of rural family physicians in a remote First Nations community. Prospective cohort study. Sioux Lookout, Ont. Family physicians. Eighteen family physicians participated in a 1-year study of a series of educational interventions on safe opioid prescribing. Interventions included a main workshop with a lecture and interactive case discussions, an online chat room, video case conferencing, and consultant support. Responses to questionnaires at baseline and after 1 year on knowledge, attitudes, and practices related to opioid prescribing. The main workshop was feasible and was well received by primary care physicians in remote communities. At 1 year, physicians were less concerned about getting patients addicted to opioids and more comfortable with opioid dosing. Multifaceted education and consultant support might play an important role in improving family physician comfort with opioid prescribing, and could improve the treatment of chronic pain while minimizing the risk of addiction.

  14. Using the theory of reasoned action to model retention in rural primary care physicians. (United States)

    Feeley, Thomas Hugh


    Much research attention has focused on medical students', residents', and physicians' decisions to join a rural practice, but far fewer studies have examined retention of rural primary care physicians. The current review uses Fishbein and Ajzen's Theory of Reasoned Action (TRA) to organize the literature on the predictors and correlates of retention of rural practicing physicians. TRA suggests turnover behavior is directly predicted by one's turnover intentions, which are, in turn, predicted by one's attitudes about rural practice and perceptions of salient others' (eg, spouse's) attitudes about rural practice and rural living. Narrative literature review of scholarship in predicting and understanding predictors and correlates of rural physician retention. The TRA model provides a useful conceptual model to organize the literature on rural physician retention. Physicians' subjective norms regarding rural practice are an important source of influence in the decision to remain or leave one's position, and this relation should be more fully examined in future research.

  15. Addressing domestic violence in primary care: what the physician ...

    African Journals Online (AJOL)

    Domestic violence (DV) is quite prevalent and negatively impacts the health and mental wellbeing of those affected. Victims of DV are frequent users of health service, yet they are infrequently recognized. Physicians tend to treat the presenting complaints without addressing the root cause of the problem. Lack of knowledge ...

  16. Health Care Resource Utilization for Outpatient Cardiovascular Disease and Diabetes Care Delivery Among Advanced Practice Providers and Physician Providers in Primary Care. (United States)

    Virani, Salim S; Akeroyd, Julia M; Ramsey, David J; Deswal, Anita; Nasir, Khurram; Rajan, Suja S; Ballantyne, Christie M; Petersen, Laura A


    Although effectiveness of diabetes or cardiovascular disease (CVD) care delivery between physicians and advanced practice providers (APPs) has been shown to be comparable, health care resource utilization between these 2 provider types in primary care is unknown. This study compared health care resource utilization between patients with diabetes or CVD receiving care from APPs or physicians. Diabetes (n = 1,022,588) or CVD (n = 1,187,035) patients with a primary care visit between October 2013 and September 2014 in 130 Veterans Affairs facilities were identified. Using hierarchical regression adjusting for covariates including patient illness burden, the authors compared number of primary or specialty care visits and number of lipid panels and hemoglobinA1c (HbA1c) tests among diabetes patients, and number of primary or specialty care visits and number of lipid panels and cardiac stress tests among CVD patients receiving care from physicians and APPs. Physicians had significantly larger patient panels compared with APPs. In adjusted analyses, diabetes patients receiving care from APPs received fewer primary and specialty care visits and a greater number of lipid panels and HbA1c tests compared with patients receiving care from physicians. CVD patients receiving care from APPs received more frequent lipid testing and fewer primary and specialty care visits compared with those receiving care from physicians, with no differences in the number of stress tests. Most of these differences, although statistically significant, were numerically small. Health care resource utilization among diabetes or CVD patients receiving care from APPs or physicians appears comparable, although physicians work with larger patient panels.

  17. Mobility of US Rural Primary Care Physicians During 2000-2014. (United States)

    McGrail, Matthew R; Wingrove, Peter M; Petterson, Stephen M; Bazemore, Andrew W


    Despite considerable investment in increasing the number of primary care physicians in rural shortage areas, little is known about their movement rates and factors influencing their mobility. We aimed to characterize geographic mobility among rural primary care physicians, and to identify location and individual factors that influence such mobility. Using data from the American Medical Association Physician Masterfile for each clinically active US physician, we created seven 2-year (biennial) mobility periods during 2000-2014. These periods were merged with county-level "rurality," physician supply, economic characteristics, key demographic measures, and individual physician characteristics. We computed (1) mobility rates of physicians by rurality; (2) linear regression models of county-level rural nonretention (departure); and (3) logit models of physicians leaving rural practice. Biennial turnover was about 17% among physicians aged 45 and younger, compared with 9% among physicians aged 46 to 65, with little difference between rural and metropolitan groups. County-level physician mobility was higher for counties that lacked a hospital (absolute increase = 5.7%), had a smaller population size, and had lower primary care physician supply, but area-level economic and demographic factors had little impact. Female physicians (odds ratios = 1.24 and 1.46 for those aged 45 or younger and those aged 46 to 65, respectively) and physicians born in a metropolitan area (odds ratios = 1.75 and 1.56 for those aged 45 or younger and those aged 46 to 65, respectively) were more likely to leave rural practice. These flndings provide national-level evidence of rural physician mobility rates and factors associated with both county-level retention and individual-level departures. Outcomes were notably poorer in the most remote locations and those already having poorer physician supply and professional support. Rural health workforce planners and policymakers must be cognizant of

  18. Job Resources, Physician Work Engagement, and Patient Care Experience in an Academic Medical Setting. (United States)

    Scheepers, Renée A; Lases, Lenny S S; Arah, Onyebuchi A; Heineman, Maas Jan; Lombarts, Kiki M J M H


    Physician work engagement is associated with better work performance and fewer medical errors; however, whether work-engaged physicians perform better from the patient perspective is unknown. Although availability of job resources (autonomy, colleague support, participation in decision making, opportunities for learning) bolster work engagement, this relationship is understudied among physicians. This study investigated associations of physician work engagement with patient care experience and job resources in an academic setting. The authors collected patient care experience evaluations, using nine validated items from the Dutch Consumer Quality index in two academic hospitals (April 2014 to April 2015). Physicians reported job resources and work engagement using, respectively, the validated Questionnaire on Experience and Evaluation of Work and the Utrecht Work Engagement Scale. The authors conducted multivariate adjusted mixed linear model and linear regression analyses. Of the 9,802 eligible patients and 238 eligible physicians, respectively, 4,573 (47%) and 185 (78%) participated. Physician work engagement was not associated with patient care experience (B = 0.01; 95% confidence interval [CI] = -0.02 to 0.03; P = .669). However, learning opportunities (B = 0.28; 95% CI = 0.05 to 0.52; P = .019) and autonomy (B = 0.31; 95% CI = 0.10 to 0.51; P = .004) were positively associated with work engagement. Higher physician work engagement did not translate into better patient care experience. Patient experience may benefit from physicians who deliver stable quality under varying levels of work engagement. From the physicians' perspective, autonomy and learning opportunities could safeguard their work engagement.

  19. Roles of primary care physicians in managing bipolar disorders in adults

    Directory of Open Access Journals (Sweden)

    CPG Secretariat


    Full Text Available Management of bipolar disorder (BD is challenging due to its multiple and complex facets of presentations as well as various levels of interventions. There is also limitation of treatment accessibility especially at the primary care level. Local evidence-based clinical practice guidelines address the importance of integrated care of BD at various levels. Primary care physicians hold pertinent role in maintaining remission and preventing relapse by providing systematic monitoring of people with BD. Pharmacological treatment in particular mood stabilisers remain the most effective management with psychosocial interventions as adjunct. This paper highlights the role of primary care physicians in the management of BD.

  20. Intensive care management of severe tetanus at the university of ...

    African Journals Online (AJOL)

    Intensive care management of severe tetanus at the university of Benin teaching ... Journal Home > Vol 14, No 1 (2015) > ... Open Access DOWNLOAD FULL TEXT ... protocol in the centre, in line with evidence-based medical principles.

  1. The continuous glucose monitoring sensor in neonatal intensive care


    Beardsall, K; Ogilvy-Stuart, A; Ahluwalia, J; Thompson, M; Dunger, D


    Objective: To determine the feasibility of continuous glucose monitoring in the very low birthweight baby requiring intensive care, as these infants are known to be at high risk of abnormalities of glucose control.

  2. Incidence of constipation in an intensive care unit


    Guerra, Tatiana Lopes de Souza; Mendonça, Simone Sotero; Guimarães Marshall, Norma


    Objectives To evaluate the incidence of constipation in critical patients on enteral nutrition in a hospital intensive care unit and to correlate this incidence with the variables found for critical patients. Methods The present investigation was a retrospective analytical study conducted in the intensive care unit of Hospital Regional da Asa Norte (DF) via the analysis of medical records of patients admitted during the period from January to December 2011. Data on the incidence of constipati...

  3. Myasthenic crisis patients who require intensive care unit management. (United States)

    Sakaguchi, Hideya; Yamashita, Satoshi; Hirano, Teruyuki; Nakajima, Makoto; Kimura, En; Maeda, Yasushi; Uchino, Makoto


    The purpose of this report was to investigate predictive factors that necessitate intensive care in myasthenic crisis (MC). We retrospectively reviewed MC patients at our institution and compared ICU and ward management groups. Higher MG-ADL scale scores, non-ocular initial symptoms, infection-triggered findings, and higher MGFA classification were observed more frequently in the ICU group. In patients with these prognostic factors, better outcomes may be obtained with early institution of intensive care. Copyright © 2012 Wiley Periodicals, Inc.

  4. Ethics and law in the intensive care unit. (United States)

    Danbury, C M; Waldmann, C S


    Intensive Care Medicine epitomises the difficulties inherent in modern medicine. In this chapter we examine some key medicolegal and ethical areas that are evolving. The principles of autonomy and consent are well established, but developments in UK caselaw have shown that the courts may be moving away from their traditional deference of the medical profession. We examine some recent cases and discuss the impact that these cases may have on practice in Intensive Care.

  5. Patient autonomy and advance care planning: a qualitative study of oncologist and palliative care physicians' perspectives. (United States)

    Johnson, Stephanie B; Butow, Phyllis N; Kerridge, Ian; Tattersall, Martin H N


    Patients' are encouraged to participate in advance care planning (ACP) in order to enhance their autonomy. However, controversy exists as to what it means to be autonomous and there is limited understanding of how social and structural factors may influence cancer patients' ability to exercise their autonomy. The objective of this study is to explore oncologists' and palliative care physicians' understanding of patient autonomy, how this influences reported enactment of decision-making at the end of life (EOL), and the role of ACP in EOL care. Qualitative semi-structured interviews were conducted with consultant oncologists (n = 11) and palliative medicine doctors (n = 7) working in oncology centres and palliative care units across Australia. We found that doctors generally conceptualized autonomy in terms of freedom from interference but that there was a profound disconnect between this understanding of autonomy and clinical practice in EOL decision-making. The clinicians in our study privileged care, relationships and a 'good death' above patient autonomy, and in practice were reluctant to 'abandon' their patients to total non-interference in decision-making. Patient autonomy in healthcare is bounded, as while patients were generally encouraged to express their preferences for care, medical norms about the quality and 'reasonableness' of care, the availability of services and the patients' family relationships act to enhance or limit patients' capacity to realize their preferences. While for many, this disconnect between theory and practice did not diminish the rhetorical appeal of ACP; for others, this undermined the integrity of ACP, as well as its relevance to care. For some, ACP had little to do with patient autonomy and served numerous other ethical, practical and political functions. The ethical assumptions regarding patient autonomy embedded in academic literature and policy documents relating to ACP are disconnected from the realities of clinical care

  6. Clinical risk assessment in intensive care unit

    Directory of Open Access Journals (Sweden)

    Saeed Asefzadeh


    Full Text Available Background: Clinical risk management focuses on improving the quality and safety of health care services by identifying the circumstances and opportunities that put patients at risk of harm and acting to prevent or control those risks. The goal of this study is to identify and assess the failure modes in the ICU of Qazvin′s Social Security Hospital (Razi Hospital through Failure Mode and Effect Analysis (FMEA. Methods: This was a qualitative-quantitative research by Focus Discussion Group (FDG performed in Qazvin Province, Iran during 2011. The study population included all individuals and owners who are familiar with the process in ICU. Sampling method was purposeful and the FDG group members were selected by the researcher. The research instrument was standard worksheet that has been used by several researchers. Data was analyzed by FMEA technique. Results: Forty eight clinical errors and failure modes identified, results showed that the highest risk probability number (RPN was in respiratory care "Ventilator′s alarm malfunction (no alarm" with the score 288, and the lowest was in gastrointestinal "not washing the NG-Tube" with the score 8. Conclusions: Many of the identified errors can be prevented by group members. Clinical risk assessment and management is the key to delivery of effective health care.

  7. Utilisation of home-based physician, nurse and personal support worker services within a palliative care programme in Ontario, Canada: trends over 2005-2015. (United States)

    Sun, Zhuolu; Laporte, Audrey; Guerriere, Denise N; Coyte, Peter C


    With health system restructuring in Canada and a general preference by care recipients and their families to receive palliative care at home, attention to home-based palliative care continues to increase. A multidisciplinary team of health professionals is the most common delivery model for home-based palliative care in Canada. However, little is known about the changing temporal trends in the propensity and intensity of home-based palliative care. The purpose of this study was to assess the propensity to use home-based palliative care services, and once used, the intensity of that use for three main service categories: physician visits, nurse visits and care by personal support workers (PSWs) over the last decade. Three prospective cohort data sets were used to track changes in service use over the period 2005 to 2015. Service use for each category was assessed using a two-part model, and a Heckit regression was performed to assess the presence of selectivity bias. Service propensity was modelled using multivariate logistic regression analysis and service intensity was modelled using log-transformed ordinary least squares regression analysis. Both the propensity and intensity to use home-based physician visits and PSWs increased over the last decade, while service propensity and the intensity of nurse visits decreased. Meanwhile, there was a general tendency for service propensity and intensity to increase as the end of life approached. These findings demonstrate temporal changes towards increased use of home-based palliative care, and a shift to substitute care away from nursing to less expensive forms of care, specifically PSWs. These findings may provide a general idea of the types of services that are used more intensely and require more resources from multidisciplinary teams, as increased use of home-based palliative care has placed dramatic pressures on the budgets of local home and community care organisations. © 2016 John Wiley & Sons Ltd.

  8. Bringing quality improvement into the intensive care unit. (United States)

    McMillan, Tracy R; Hyzy, Robert C


    During the last several years, many governmental and nongovernmental organizations have championed the application of the principles of quality improvement to the practice of medicine, particularly in the area of critical care. To review the breadth of approaches to quality improvement in the intensive care unit, including measures such as mortality and length of stay, and the use of protocols, bundles, and the role of large, multiple-hospital collaboratives. Several agencies have participated in the application of the quality movement to medicine, culminating in the development of standards such as the intensive care unit core measures of the Joint Commission on Accreditation of Healthcare Organizations. Although "zero defects" may not be possible in all measurable variables of quality in the intensive care unit, several measures, such as catheter-related bloodstream infections, can be significantly reduced through the implementation of improved processes of care, such as care bundles. Large, multiple-center, quality improvement collaboratives, such as the Michigan Keystone Intensive Care Unit Project, may be particularly effective in improving the quality of care by creating a "bandwagon effect" within a geographic region. The quality revolution is having a significant effect in the critical care unit and is likely to be facilitated by the transition to the electronic medical record.

  9. [Structure, organization and capacity problems in emergency medical services, emergency admission and intensive care units]. (United States)

    Dick, W


    Emergency medicine is subjected worldwide to financial stringencies and organizational evaluations of cost-effectiveness. The various links in the chain of survival are affected differently. Bystander assistance or bystander CPR is available in only 30% of the emergencies, response intervals--if at all required by legislation--are observed to only a limited degree or are too extended for survival in cardiac arrest. A single emergency telephone number is lacking. Too many different phone numbers for emergency reporting result in confusion and delays. Organizational realities are not fully overcome and impair efficiency. The position of the emergency physician in the EMS System is inadequately defined, the qualification of too many emergency physicians are unsatisfactory. In spite of this, emergency physicians are frequently forced to answer out-of-hospital emergency calls. Conflicts between emergency physicians and EMTs may be overcome by providing both groups with comparable qualifications as well as by providing an explicit definition of emergency competence. A further source of conflict occurs at the juncture of prehospital and inhospital emergency care in the emergency department. Deficiencies on either side play a decisive role. At least in principle there are solutions to the deficiencies in the EMSS and in intensive care medicine. They are among others: Adequate financial compensation of emergency personnel, availability of sufficient numbers of highly qualified personnel, availability of a central receiving area with an adjacent emergency ward, constant information flow to the dispatch center on the number of available emergency beds, maintaining 5% of all beds as emergency beds, establishing intermediate care facilities. Efficiency of emergency physician activities can be demonstrated in polytraumatized patients or in patients with ventricular fibrillation or acute myocardial infarction, in patients with acute myocardial insufficiency and other emergency

  10. Word of mouth and physician referrals still drive health care provider choice. (United States)

    Tu, Ha T; Lauer, Johanna R


    Sponsors of health care price and quality transparency initiatives often identify all consumers as their target audiences, but the true audiences for these programs are much more limited. In 2007, only 11 percent of American adults looked for a new primary care physician, 28 percent needed a new specialist physician and 16 percent underwent a medical procedure at a new facility, according to a new national study by the Center for Studying Health System Change (HSC). Among consumers who found a new provider, few engaged in active shopping or considered price or quality information--especially when choosing specialists or facilities for medical procedures. When selecting new primary care physicians, half of all consumers relied on word-of-mouth recommendations from friends and relatives, but many also used doctor recommendations (38%) and health plan information (35%), and nearly two in five used multiple information sources when choosing a primary care physician. However, when choosing specialists and facilities for medical procedures, most consumers relied exclusively on physician referrals. Use of online provider information was low, ranging from 3 percent for consumers undergoing procedures to 7 percent for consumers choosing new specialists to 11 percent for consumers choosing new primary care physicians

  11. An Evolving Identity: How Chronic Care Is Transforming What it Means to Be a Physician. (United States)

    Bogetz, Alyssa L; Bogetz, Jori F


    Physician identity and the professional role physicians play in health care is rapidly evolving. Over 130 million adults and children in the USA have complex and chronic diseases, each of which is shaped by aspects of the patient's social, psychological, and economic status. These patients have lifelong health care needs that require the ongoing care of multiple health care providers, access to community services, and the involvement of patients' family support networks. To date, physician professional identity formation has centered on autonomy, authority, and the ability to "heal." These notions of identity may be counterproductive in chronic disease care, which demands interdependency between physicians, their patients, and teams of multidisciplinary health care providers. Medical educators can prepare trainees for practice in the current health care environment by providing training that legitimizes and reinforces a professional identity that emphasizes this interdependency. This commentary outlines the important challenges related to this change and suggests potential strategies to reframe professional identity to better match the evolving role of physicians today.

  12. Migraine-preventive prescription patterns by physician specialty in ambulatory care settings in the United States. (United States)

    Takaki, Hiroko; Onozuka, Daisuke; Hagihara, Akihito


    Many adults with migraine who require preventive therapy are often not prescribed the proper medications. The most likely reason is that primary care physicians are unacquainted with preventive medications for migraine. The present study assessed the migraine-preventive prescription patterns in office visits using data from the National Ambulatory Medical Care Survey from 2006 to 2009 in the United States. Patients who were 18 years or older and diagnosed with migraine were included in the analysis. In accordance with the recommendations of the headache guidelines, we included beta-blockers, antidepressants, triptans for short-term prevention of menstrual migraine, and other triptans for acute treatment. Weighted visits of adults with migraine prescribed with preventive medication ranged from 32.8% in 2006 to 38.6% in 2009. Visits to primary care physicians accounted for 72.6% of the analyzed adult migraine visits. Anticonvulsants (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.14-0.57, p  < 0.001) and triptans for menstrual migraine (OR 0.50, 95% CI 0.28-0.91, p  = 0.025) were less frequently prescribed by primary care physicians compared with specialty care physicians, such as neurologists and psychiatrists. There were no significant differences in the prescription patterns of antidepressants and beta-blockers between primary and specialty care physicians. Beta-blockers were prescribed to patients with comorbidity of hypertension, and antidepressants were used by patients with comorbidity of depression. There are differences in the prescription patterns of certain type of preventive medications between primary care physicians and specialty care physicians.

  13. Migraine-preventive prescription patterns by physician specialty in ambulatory care settings in the United States

    Directory of Open Access Journals (Sweden)

    Hiroko Takaki


    Full Text Available Many adults with migraine who require preventive therapy are often not prescribed the proper medications. The most likely reason is that primary care physicians are unacquainted with preventive medications for migraine. The present study assessed the migraine-preventive prescription patterns in office visits using data from the National Ambulatory Medical Care Survey from 2006 to 2009 in the United States. Patients who were 18 years or older and diagnosed with migraine were included in the analysis. In accordance with the recommendations of the headache guidelines, we included beta-blockers, antidepressants, triptans for short-term prevention of menstrual migraine, and other triptans for acute treatment. Weighted visits of adults with migraine prescribed with preventive medication ranged from 32.8% in 2006 to 38.6% in 2009. Visits to primary care physicians accounted for 72.6% of the analyzed adult migraine visits. Anticonvulsants (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.14–0.57, p < 0.001 and triptans for menstrual migraine (OR 0.50, 95% CI 0.28–0.91, p = 0.025 were less frequently prescribed by primary care physicians compared with specialty care physicians, such as neurologists and psychiatrists. There were no significant differences in the prescription patterns of antidepressants and beta-blockers between primary and specialty care physicians. Beta-blockers were prescribed to patients with comorbidity of hypertension, and antidepressants were used by patients with comorbidity of depression. There are differences in the prescription patterns of certain type of preventive medications between primary care physicians and specialty care physicians.

  14. Emergency Physicians, Beware of the Consent Standard of Care


    Moore, Gregory P.; Matlock, Aaron G.; Kiley, John L.; Percy, Katherine D.


    Many emergency physicians view informed consent as a necessary component of treatments or procedures to be performed on their patients. When such procedures are necessary, often there is a discussion of risks, benefits and alternatives with forms signed to validate the discussion. Two Wisconsin emergency department medical-legal cases have expanded liability of the duty of informed consent. These cases have focused on withholding medication and diagnostic tests.

  15. The effect of financial incentives on the quality of health care provided by primary care physicians. (United States)

    Scott, Anthony; Sivey, Peter; Ait Ouakrim, Driss; Willenberg, Lisa; Naccarella, Lucio; Furler, John; Young, Doris


    The use of blended payment schemes in primary care, including the use of financial incentives to directly reward 'performance' and 'quality' is increasing in a number of countries. There are many examples in the US, and the Quality and Outcomes Framework (QoF) for general practitioners (GPs) in the UK is an example of a major system-wide reform. Despite the popularity of these schemes, there is currently little rigorous evidence of their success in improving the quality of primary health care, or of whether such an approach is cost-effective relative to other ways to improve the quality of care. The aim of this review is to examine the effect of changes in the method and level of payment on the quality of care provided by primary care physicians (PCPs) and to identify:i) the different types of financial incentives that have improved quality;ii) the characteristics of patient populations for whom quality of care has been improved by financial incentives; andiii) the characteristics of PCPs who have responded to financial incentives. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library), MEDLINE, HealthSTAR, EMBASE, CINAHL, PsychLIT, and ECONLIT. Searches of Internet-based economics and health economics working paper collections were also conducted. Finally, studies were identified through the reference lists of retrieved articles, websites of key organisations, and from direct contact with key authors in the field. Articles were included if they were published from 2000 to August 2009. Randomised controlled trials (RCT), controlled before and after studies (CBA), and interrupted time series analyses (ITS) evaluating the impact of different financial interventions on the quality of care delivered by primary healthcare physicians (PCPs). Quality of care was defined as patient reported outcome

  16. Organizational factors affecting the adoption of diabetes care management processes in physician organizations. (United States)

    Li, Rui; Simon, Jodi; Bodenheimer, Thomas; Gillies, Robin R; Casalino, Lawrence; Schmittdiel, Julie; Shortell, Stephen M


    To describe the extent of adoption of diabetes care management processes in physician organizations in the U.S. and to investigate the organizational factors that affect the adoption of diabetes care management processes. Data are derived from the National Survey of Physician Organizations and the Management of Chronic Illness, conducted in 2000-2001. A total of 1,104 of the 1,590 physician organizations identified responded to the survey. The extent of adoption of four diabetes care management processes is measured by an index consisting of the organization's use of diabetic patient registries, clinical practice guidelines, case management, and physician feedback. The ordinary least-squares model is used to determine the association of organizational characteristics with the adoption of diabetes care management processes in physician organizations. A logistic regression model is used to determine the association of organizational characteristics with the adoption of individual diabetes care management processes. Of the 987 physician organizations studied that treat patients with diabetes, 48% either do not use any or use only one of the four diabetes care management processes. A total of 20% use two care management processes, and 32% use three or four processes. External incentives to improve quality, computerized clinical information systems, and ownership by hospitals or health maintenance organizations are strongly associated with the diabetes care management index and the adoption of individual diabetes care management processes. Policies to encourage external incentives to improve quality and to facilitate the adoption of computerized clinical information technology may promote greater use of diabetes care management processes. Copyright 2004 American Diabetes Association

  17. Educational outreach and collaborative care enhances physician's perceived knowledge about Developmental Coordination Disorder. (United States)

    Gaines, Robin; Missiuna, Cheryl; Egan, Mary; McLean, Jennifer


    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

  18. Living with Dying in the Pediatric Intensive Care Unit: A Nursing Perspective. (United States)

    Stayer, Debbie; Lockhart, Joan Such


    Despite reported challenges encountered by nurses who provide palliative care to children, few researchers have examined this phenomenon from the perspective of nurses who care for children with life-threatening illnesses in pediatric intensive care units. To describe and interpret the essence of the experiences of nurses in pediatric intensive care units who provide palliative care to children with life-threatening illnesses and the children's families. A hermeneutic phenomenological study was conducted with 12 pediatric intensive care unit nurses in the northeastern United States. Face-to-face interviews and field notes were used to illuminate the experiences. Five major themes were detected: journey to death; a lifelong burden; and challenges delivering care, maintaining self, and crossing boundaries. These themes were illuminated by 12 subthemes: the emotional impact of the dying child, the emotional impact of the child's death, concurrent grieving, creating a peaceful ending, parental burden of care, maintaining hope for the family, pain, unclear communication by physicians, need to hear the voice of the child, remaining respectful of parental wishes, collegial camaraderie and support, and personal support. Providing palliative care to children with life-threatening illnesses was complex for the nurses. Findings revealed sometimes challenging intricacies involved in caring for dying children and the children's families. However, the nurses voiced professional satisfaction in providing palliative care and in support from colleagues. Although the nurses reported collegial camaraderie, future research is needed to identify additional supportive resources that may help staff process and cope with death and dying. ©2016 American Association of Critical-Care Nurses.

  19. What matters in the patients' decision to revisit the same primary care physician? (United States)

    Antoun, Jumana M; Hamadeh, Ghassan N; Adib, Salim M


    To assess the priority of various aspects of the patient-primary care physician relationship in the decision to visit again that same physician. STUDY SETTINGS: A total of 400 community residents in Ras Beirut, Lebanon. A cross-sectional community based study sampled by a nonrandom sex-education quota-based procedure. Participants were asked to fill a survey where they indicated the ranking of nine items by importance in their decision to revisit the same physician. The nine items were chosen from three categories of factors: professional expertise of the physician; characteristics of the patient-physician relationship, office organization. Having a physician that gives the patient adequate time for discussion prevailed as rank 1 and luxurious clinic ranked as 9th. Affordability was one of the main concerns among men, those with poor health and those of lower socioeconomic status. Accessibility of the physician's phone was considered highly important among women and those of lesser education status. This study emphasizes the importance of adequate time with the patient, accessibility and affordability of the physician in maintaining continuity of care and patient satisfaction, beyond mere medical expertise.

  20. Intensive Care in India: The Indian Intensive Care Case Mix and Practice Patterns Study. (United States)

    Divatia, Jigeeshu V; Amin, Pravin R; Ramakrishnan, Nagarajan; Kapadia, Farhad N; Todi, Subhash; Sahu, Samir; Govil, Deepak; Chawla, Rajesh; Kulkarni, Atul P; Samavedam, Srinivas; Jani, Charu K; Rungta, Narendra; Samaddar, Devi Prasad; Mehta, Sujata; Venkataraman, Ramesh; Hegde, Ashit; Bande, B D; Dhanuka, Sanjay; Singh, Virendra; Tewari, Reshma; Zirpe, Kapil; Sathe, Prachee


    To obtain information on organizational aspects, case mix and practices in Indian Intensive Care Units (ICUs). An observational, 4-day point prevalence study was performed between 2010 and 2011 in 4209 patients from 124 ICUs. ICU and patient characteristics, and interventions were recorded for 24 h of the study day, and outcomes till 30 days after the study day. Data were analyzed for 4038 adult patients from 120 ICUs. On the study day, mean age, Acute Physiology and Chronic Health Evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores were 54.1 ± 17.1 years, 17.4 ± 9.2 and 3.8 ± 3.6, respectively. About 46.4% patients had ≥1 organ failure. Nearly, 37% and 22.2% patients received mechanical ventilation (MV) and vasopressors or inotropes, respectively. Nearly, 12.2% patients developed an infection in the ICU. About 28.3% patients had severe sepsis or septic shock (SvSpSS) during their ICU stay. About 60.7% patients without infection received antibiotics. There were 546 deaths and 183 terminal discharges (TDs) from ICU (including left against medical advice or discharged on request), with ICU mortality 729/4038 (18.1%). In 1627 patients admitted within 24 h of the study day, the standardized mortality ratio was 0.67. The APACHE II and SOFA scores, public hospital ICUs, medical ICUs, inadequately equipped ICUs, medical admission, self-paying patient, presence of SvSpSS, acute respiratory failure or cancer, need for a fluid bolus, and MV were independent predictors of mortality. The high proportion of TDs and the association of public hospitals, self-paying patients, and inadequately equipped hospitals with mortality has important implications for critical care in India.

  1. Patient stress in intensive care: comparison between a coronary care unit and a general postoperative unit (United States)

    Dias, Douglas de Sá; Resende, Mariane Vanessa; Diniz, Gisele do Carmo Leite Machado


    Objective To evaluate and compare stressors identified by patients of a coronary intensive care unit with those perceived by patients of a general postoperative intensive care unit. Methods This cross-sectional and descriptive study was conducted in the coronary intensive care and general postoperative intensive care units of a private hospital. In total, 60 patients participated in the study, 30 in each intensive care unit. The stressor scale was used in the intensive care units to identify the stressors. The mean score of each item of the scale was calculated followed by the total stress score. The differences between groups were considered significant when p < 0.05. Results The mean ages of patients were 55.63 ± 13.58 years in the coronary intensive care unit and 53.60 ± 17.47 years in the general postoperative intensive care unit. For patients in the coronary intensive care unit, the main stressors were “being in pain”, “being unable to fulfill family roles” and “being bored”. For patients in the general postoperative intensive care unit, the main stressors were “being in pain”, “being unable to fulfill family roles” and “not being able to communicate”. The mean total stress scores were 104.20 ± 30.95 in the coronary intensive care unit and 116.66 ± 23.72 (p = 0.085) in the general postoperative intensive care unit. When each stressor was compared separately, significant differences were noted only between three items. “Having nurses constantly doing things around your bed” was more stressful to the patients in the general postoperative intensive care unit than to those in the coronary intensive care unit (p = 0.013). Conversely, “hearing unfamiliar sounds and noises” and “hearing people talk about you” were the most stressful items for the patients in the coronary intensive care unit (p = 0.046 and 0.005, respectively). Conclusion The perception of major stressors and the total stress score were similar between patients

  2. Perceptions of community health center impact on private primary care physician practice. (United States)

    Duffrin, Christopher; Jackson, Natalie; Whetstone, Lauren; Cummings, Doyle; Watson, Ricky; Wu, Qiang


    Community health centers (CHCs) were created in the mid-1960s to expand access to care in impoverished and underserved areas. The number of CHC sites has more than tripled in eastern North Carolina from 28 primary care centers in 2000 to 89 in 2010. This study determined the perceptions of physicians on the impact of CHC expansion on the local practice environment. Descriptive statistics and correlations were used to compare responses regarding perceptions and differences between practice characteristics as well as physician ratios by year. Both CHC and private practice physician addresses were mapped using ArcGIS. Surveys were sent to 1422 (461 returns/32.5% response rate) primary care physicians residing in 43 predominantly rural eastern North Carolina counties. A large percentage of the respondents (82.7%) affirmed that they felt neutral or did not view CHCs to be competitors, whereas a minority (17%) did view them to be difficult to compete against. Forty-two percent of private practice respondents disagreed that CHCs offer a wider range of services despite significantly more CHC physicians than private practice respondents indicating that their facility provided basic services. The CHCs were perceived to offer a wider range of services, employ more staff, and have more practice locations than private practices. However, private practice physicians did not perceive CHCs to have a competitive advantage or to unfairly impact their practices, possibly due to inconsistent population growth in relation to the physician retention during the last 10 years.

  3. Takotsubo Cardiomyopathy in Intensive Care Unit: Prevention, Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Hannah Masoud


    Full Text Available Accurate diagnosis of Takotsubo Cardiomyopathy has substantial prognostic implications in an intensive care unit, given its increased mortality risk and association with life-threatening complications. This report seeks to discuss diagnostic modalities that can be useful in accurately differentiating Takotsubo Cardiomyopathy from Acute Coronary Syndrome, and also briefly discuss prevention and management of this cardiomyopathy in an intensive care unit. For critically ill Takotsubo patients, intensive clinicians can consider establishment of diagnosis by specific electrocardiograph changes, distinctive marked release of cardiac enzymes, characteristic echocardiograph findings, as well as invasive coronary angiography or noninvasive cardiac magnetic imaging.

  4. Inadequate follow-up after tracheostomy and intensive care

    DEFF Research Database (Denmark)

    Mondrup, Frederik; Skjelsager, Karen; Madsen, Kristian Rørbæk


    When patients are transferred from intensive care units (ICUs) to general wards with a tracheostomy in situ, there is a risk of suboptimal care and increased morbidity. The aim of this study was to elucidate the management of patients with a tracheostomy in situ at discharge from the ICU...

  5. The role of anaesthetists in paediatric intensive care units

    African Journals Online (AJOL)


    to various surgical and critical care disciplines, the usefulness of a paediatric intensive care unit (PICU) rotation was investigated. A brief overview of the experiences of anaesthetic registrars at a. South African teaching hospital rotating through a PICU is pre- sented, as well as the potential advantages for both trainees and.

  6. Magnesium, calcium and phosphorus in the intensive care unit: Do ...

    African Journals Online (AJOL)

    Magnesium, calcium and phosphorus are important electrolytes involved in the regulation of homeostasis. However the utility in monitoring them in critically ill patients is still unclear. We therefore undertook a prospective, non-interventional, single center study in the intensive care unit of a tertiary care hospital in ...

  7. Evaluation of DICE, a terminological system for intensive care

    NARCIS (Netherlands)

    de Keizer, N. F.; Abu-Hanna, A.; Cornet, R.


    Evaluative research and the introduction of the Patient Data Management System to support care have increased the need for structured and standardized registration of diagnostic information in Dutch intensive cares (IC). To this end a terminological system to describe diagnoses is needed. A

  8. Empowerment of parents in the neonatal intensive care unit by ...

    African Journals Online (AJOL)

    Parents of infants who are admitted to the neonatal intensive care unit (NICU) need to be empowered to improve bonding, attachment and care-giving skills. Neonatal nurses play a critical role in the empowerment of such parents, but often find it difficult due to a lack of clarity on how it has to be done. A qualitative contextual ...

  9. Neonatal intensive care unit: Reservoirs of Nosocomial pathogens ...

    African Journals Online (AJOL)

    Improvement in the care and treatment of neonates had contributed to their increased survival. Nosocomial infection remains an important problem in intensive care units. Hospital wards had been shown to act as reservoirs of pathogenic microorganisms associated with infection. To assess the prevalence of pathogenic ...

  10. Mothers of Pre-Term Infants in Neonate Intensive Care (United States)

    MacDonald, Margaret


    In this study, eight mothers of pre-term infants under the care of nursing staff and neonatologists in the Neonatal Intensive Care Unit (NICU) of Children's Hospital in Vancouver, British Columbia, were observed and interviewed about their birth experience and their images of themselves as mothers during their stay. Patterns and themes in the…

  11. Health care management of sickness certification tasks: results from two surveys to physicians. (United States)

    Lindholm, Christina; von Knorring, Mia; Arrelöv, Britt; Nilsson, Gunnar; Hinas, Elin; Alexanderson, Kristina


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

  12. Prescribing exercise for older adults: A needs assessment comparing primary care physicians, nurse practitioners, and physician assistants. (United States)

    Dauenhauer, Jason A; Podgorski, Carol A; Karuza, Jurgis


    To inform the development of educational programming designed to teach providers appropriate methods of exercise prescription for older adults, the authors conducted a survey of 177 physicians, physician assistants, and nurse practitioners (39% response rate). The survey was designed to better understand the prevalence of exercise prescriptions, attitudes, barriers, and educational needs of primary care practitioners toward older adults. Forty-seven percent of primary care providers report not prescribing exercise for older adults; 85% of the sample report having no formal training in exercise prescription. Practitioner attitudes were positive toward exercise, but were not predictive of their exercise prescribing behavior, which indicates that education efforts aimed at changing attitudes as a way of increasing exercise-prescribing behaviors would not be sufficient. In order to facilitate and reinforce practice changes to increase exercise-prescribing behaviors of primary care providers, results suggest the need for specific skill training on how to write an exercise prescription and motivate older adults to follow these prescriptions.

  13. Physician attitude toward depression care interventions: Implications for implementation of quality improvement initiatives

    Directory of Open Access Journals (Sweden)

    Chanin Johann C


    Full Text Available Abstract Background Few individuals with depression treated in the primary care setting receive care consistent with clinical treatment guidelines. Interventions based on the chronic care model (CCM have been promoted to address barriers and improve the quality of care. A current understanding of barriers to depression care and an awareness of whether physicians believe interventions effectively address those barriers is needed to enhance the success of future implementation. Methods We conducted semi-structured interviews with 23 primary care physicians across the US regarding their experience treating patients with depression, barriers to care, and commonly promoted CCM-based interventions. Themes were identified from interview transcripts using a grounded theory approach. Results Six barriers emerged from the interviews: difficulty diagnosing depression, patient resistance, fragmented mental health system, insurance coverage, lack of expertise, and competing demands and other responsibilities as a primary care provider. A number of interventions were seen as helpful in addressing these barriers – including care managers, mental health integration, and education – while others received mixed reviews. Mental health consultation models received the least endorsement. Two systems-related barriers, the fragmented mental health system and insurance coverage limitations, appeared incompletely addressed by the interventions. Conclusion CCM-based interventions, which include care managers, mental health integration, and patient education, are most likely to be implemented successfully because they effectively address several important barriers to care and are endorsed by physicians. Practices considering the adoption of interventions that received less support should educate physicians about the benefit of the interventions and attend to physician concerns prior to implementation. A focus on interventions that address systems-related barriers is

  14. Difficulties faced by family physicians in primary health care centers in Jeddah, Saudi Arabia. (United States)

    Mumenah, Sahar H; Al-Raddadi, Rajaa M


    The aim was to determine the difficulties faced by family physicians, and compare how satisfied those working with the Ministry of Health (MOH) are with their counterparts who work at some selected non-MOH hospitals. An analytical, cross-sectional study was conducted at King Abdulaziz University Hospital, King Faisal Specialist Hospital and Research Center (KFSH and RC), and 40 MOH primary health care centers across Jeddah. A structured multi-item questionnaire was used to collect demographic data and information on the difficulties family physicians face. The physicians' level of satisfaction and how it was affected by the difficulties was assessed. Women constituted 71.9% of the sample. Problems with transportation formed one of the main difficulties encountered by physicians. Compared to non-MOH physician, a significantly higher proportion of MOH physicians reported unavailability of radiology technicians (P = 0.011) and radiologists (P building maintenance (P < 0.001). Family physicians with the MOH were less satisfied with their jobs compared with non-MOH physicians (P = 0.032). MOH family physicians encountered difficulties relating to staff, services, and infrastructure, which consequently affected their level of satisfaction.

  15. Factors affecting experiences of intensive care patients in Turkey: patient outcomes in critical care setting. (United States)

    Demir, Yurdanur; Korhan, Esra Akin; Eser, Ismet; Khorshid, Leyla


    To determine the factors affecting a patient's intensive care experience. The descriptive study was conducted at an intensive care unit in the Aegean Region of Turkey, and comprised 158 patients who spent at least 48 hours at the unit between June and November 2009. A questionnaire form and the Intensive Care Experience Scale were used as data collection tools. SPSS 11.5 was used for statistical analysis of the data. Of the total, 86 (54.4%) patients related to the surgical unit, while 72 (45.5%) spent time at the intensive care unit. Most of the subjects (n=113; 71.5%) reported that they constantly experienced pain during hospitalisation. Patients receiving mechanical ventilation support and patients reporting no pain had significantly higher scores on the intensive care experience scale. Patients who reported pain remembered their experiences less than those having no pain. Interventions are needed to make the experiences of patients in intensive care more positive.

  16. Managing social awkwardness when caring for morbidly obese patients in intensive care: A focused ethnography. (United States)

    Hales, Caz; de Vries, Kay; Coombs, Maureen


    Critically ill morbidly obese patients pose considerable healthcare delivery and resource utilisation challenges in the intensive care setting. These are resultant from specific physiological responses to critical illness in this population and the nature of the interventional therapies used in the intensive care environment. An additional challenge arises for this population when considering the social stigma that is attached to being obese. Intensive care staff therefore not only attend to the physical and care needs of the critically ill morbidly obese patient but also navigate, both personally and professionally, the social terrain of stigma when providing care. To explore the culture and influences on doctors and nurses within the intensive care setting when caring for critically ill morbidly obese patients. A focused ethnographic approach was adopted to elicit the 'situated' experiences of caring for critically ill morbidly obese patients from the perspectives of intensive care staff. Participant observation of care practices and interviews with intensive care staff were undertaken over a four month period. Analysis was conducted using constant comparison technique to compare incidents applicable to each theme. An 18 bedded tertiary intensive care unit in New Zealand. Sixty-seven intensive care nurses and 13 intensive care doctors involved with the care and management of seven critically ill patients with a body mass index ≥40kg/m(2). Interactions between intensive care staff and morbidly obese patients were challenging due to the social stigma surrounding obesity. Social awkwardness and managing socially awkward moments were evident when caring for morbidly obese patients. Intensive care staff used strategies of face-work and mutual pretence to alleviate feelings of discomfort when engaged in aspects of care and caring. This was a strategy used to prevent embarrassment and distress for both the patients and staff. This study has brought new understandings

  17. Sleep in the Intensive Care Unit measured by polysomnography

    DEFF Research Database (Denmark)

    Andersen, J H; Boesen, Hans Christian Toft; Olsen, Karsten Skovgaard


    Sleep deprivation has deleterious effects on most organ systems. Patients in the Intensive care unit (ICU) report sleep deprivation as the second worst experience during their stay only superseded by pain. The aim of the review is to provide the clinician with knowledge of the optimal sleep-frien......-friendly care and environment.......Sleep deprivation has deleterious effects on most organ systems. Patients in the Intensive care unit (ICU) report sleep deprivation as the second worst experience during their stay only superseded by pain. The aim of the review is to provide the clinician with knowledge of the optimal sleep...

  18. International variations in primary care physician consultation time: a systematic review of 67 countries. (United States)

    Irving, Greg; Neves, Ana Luisa; Dambha-Miller, Hajira; Oishi, Ai; Tagashira, Hiroko; Verho, Anistasiya; Holden, John


    To describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes. This is a systematic review of published and grey literature in English, Chinese, Japanese, Spanish, Portuguese and Russian languages from 1946 to 2016, for articles reporting on primary care physician consultation lengths. Data were extracted and analysed for quality, and linear regression models were constructed to examine the relationship between consultation length and health service outcomes. One hundred and seventy nine studies were identified from 111 publications covering 28 570 712 consultations in 67 countries. Average consultation length differed across the world, ranging from 48 s in Bangladesh to 22.5 min in Sweden. We found that 18 countries representing about 50% of the global population spend 5 min or less with their primary care physicians. We also found significant associations between consultation length and healthcare spending per capita, admissions to hospital with ambulatory sensitive conditions such as diabetes, primary care physician density, physician efficiency and physician satisfaction. There are international variations in consultation length, and it is concerning that a large proportion of the global population have only a few minutes with their primary care physicians. Such a short consultation length is likely to adversely affect patient healthcare and physician workload and stress. © 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.

  19. Environmental Design for Patient Families in Intensive Care Units


    Mahbub Rashid


    The purpose of this paper is to define the role of environmental design in improving family integration with patient care in Intensive Care Units (ICUs). It argues that it is necessary to understand family needs, experience and behavioral responses in ICUs to develop effective models for family integration. With its two components—the “healing culture” promoting effective relationships between caregivers and care seekers, and the “environmental design” supporting the healing culture—a “healin...

  20. Seeking optimal renal replacement therapy delivery in intensive care units. (United States)

    Kocjan, Marinka; Brunet, Fabrice P


    Globally, critical care environments within health care organizations strive to provide optimal quality renal replacement therapy (RRT), an artificial replacement for lost kidney function. Examination of RRT delivery model literature and a case study review of the multidisciplinary-mixed RRT delivery model utilized within a closed medical surgical intensive care unit illustrates the organizational and clinical management of specialized resource and multidisciplinary roles. The successful utilization of a specific RRT delivery model is dependent upon resource availability.

  1. [The coma awakening unit, between intensive care and rehabilitation]. (United States)

    Mimouni, Arnaud


    After intensive care and before classic neurological rehabilitation is possible, patients in an altered state of consciousness are cared for at early stages in so-called coma awakening units. The care involves, on the one hand, the complex support of the patient's awakening from coma as a neurological and existential process, and on the other, support for their families. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  2. Physician workload in primary care: what is the optimal size of practices? A cross-sectional study.

    NARCIS (Netherlands)

    Wensing, M.J.P.; Hombergh, P. van den; Akkermans, R.P.; Doremalen, J.H.M. van; Grol, R.P.T.M.


    OBJECTIVE: To determine the impact of practice size and scope of services on average physician workload in primary care practices in The Netherlands, and to examine the associations between average physician workload, average assistant volume and organisational practice characteristics. METHODS:

  3. Intensity of interprofessional collaboration among intensive care nurses at a tertiary hospital. (United States)

    Serrano-Gemes, G; Rich-Ruiz, M

    To measure the intensity of interprofessional collaboration (IPC) in nurses of an intensive care unit (ICU) at a tertiary hospital, to check differences between the dimensions of the Intensity of Interprofessional Collaboration Questionnaire, and to identify the influence of personal variables. A cross-sectional descriptive study was conducted with 63 intensive care nurses selected by simple random sampling. Explanatory variables: age, sex, years of experience in nursing, years of experience in critical care, workday type and work shift type; variable of outcome: IPC. The IPC was measured by: Intensity of Interprofessional Collaboration Questionnaire. Descriptive and bivariate statistical analysis (IPC and its dimensions with explanatory variables). 73.8% were women, with a mean age of 46.54 (±6.076) years. The average years experience in nursing and critical care was 23.03 (±6.24) and 14.25 (±8.532), respectively. 77% had a full time and 95.1% had a rotating shift. 62.3% obtained average IPC values. Statistically significant differences were found (P<.05) between IPC (overall score) and overall assessment with years of experience in critical care. This study shows average levels of IPC; the nurses with less experience in critical care obtained higher IPC and overall assessment scores. Copyright © 2016 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Open intensive care units: a global challenge for patients, relatives, and critical care teams. (United States)

    Cappellini, Elena; Bambi, Stefano; Lucchini, Alberto; Milanesio, Erika


    The aims of this study were to describe the current status of intensive care unit (ICU) visiting hours policies internationally and to explore the influence of ICUs' open visiting policies on patients', visitors', and staff perceptions, as well as on patients' outcomes. A review of the literature was done through MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. The following keywords were searched: "visiting," "hours," "ICU," "policy," and "intensive care unit." Inclusion criteria for the review were original research paper, adult ICU, articles published in the last 10 years, English or Italian language, and available abstract. Twenty-nine original articles, mainly descriptive studies, were selected and retrieved. In international literature, there is a wide variability about open visiting policies in ICUs. The highest percentage of open ICUs is reported in Sweden (70%), whereas in Italy there is the lowest rate (1%). Visiting hours policies and number of allowed relatives are variable, from limits of short precise segments to 24 hours and usually 2 visitors. Open ICUs policy/guidelines acknowledge concerns with visitor hand washing to prevent the risk of infection transmission to patients. Patients, visitors, and staff seem to be inclined to support open ICU programs, although physicians are more inclined to the enhancement of visiting hours than nurses. The percentages of open ICUs are very different among countries. It can be due to local factors, cultural differences, and lack of legislation or hospital policy. There is a need for more studies about the impact of open ICUs programs on patients' mortality, length of stay, infections' risk, and the mental health of patients and their relatives.

  5. Attitudes of palliative home care physicians towards palliative sedation at home in Italy. (United States)

    Mercadante, Sebastiano; Masedu, Francesco; Mercadante, Alessandro; Marinangeli, Franco; Aielli, Federica


    Information about the attitudes towards palliative sedation (PS) at home is limited. The aim of this survey was to assess the attitudes of palliative care physicians in Italy regarding PS at home. A questionnaire was submitted to a sample of palliative care physicians, asking information about their activity and attitudes towards PS at home. This is a survey of home care physicians in Italy who were involved in end-of-life care decisions at home. One hundred and fifty participants responded. A large heterogeneity of home care organizations that generate some problems was found. Indications, intention and monitoring of PS seem to be appropriate, although some cultural and logistic conditions were limiting the use of PS. Specialized home care physicians are almost involved to start PS at home. Midazolam was seldom available at home and opioids were more frequently used. These data should prompt health care agencies to make a minimal set of drugs easily available for home care. Further research is necessary to compare attitudes in countries with different sociocultural profiles.

  6. A personal letter to an aspiring physician or nurse (or other caring professional). (United States)

    Savett, Laurence A


    In a letter to an aspiring physician or nurse, the author describes some of the important dimensions and timeless values of a fulfilling career in health care, the importance of the professional-patient relationship, ways to make an informed career choice, the guidance provided by sound values, and his response to some of the myths about health care careers.

  7. The primary care physician and Alzheimer's disease: an international position paper.

    NARCIS (Netherlands)

    Villars, H.; Oustric, S.; Andrieu, S.; Baeyens, J.P.; Bernabei, R.; Brodaty, H.; Brummel-Smith, K.; Celafu, C.; Chappell, N.; Fitten, J.; Frisoni, G.; Froelich, L.; Guerin, O.; Gold, G.; Holmerova, I.; Iliffe, S.; Lukas, A.; Melis, R.J.F.; Morley, J.E.; Nies, H.; Nourhashemi, F.; Petermans, J.; Ribera Casado, J.; Rubenstein, L.; Salva, A.; Sieber, C.; Sinclair, A.; Schindler, R.; Stephan, E.; Wong, R.Y.; Vellas, B.


    This paper aims to define the role of the primary care physician (PCP) in the management of Alzheimer's disease (AD) and to propose a model for a work plan. The proposals in this position paper stem from a collaborative work of experts involved in the care of AD patients. It combines evidence from a

  8. Physicians' perceptions about the quality of primary health care services in transitional Albania

    NARCIS (Netherlands)

    Kellici, Neritan; Dibra, Arvin; Mihani, Joana; Kellici, Suela; Burazeri, Genc

    AIM: To date, the available information regarding the quality of primary health care services in Albania is scarce. The aim of our study was to assess the quality of primary health care services in Albania based on physicians' perceptions towards the quality of the services provided to the general

  9. 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


    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

  10. Breast and Cervical Cancer Screening Among Medicaid Beneficiaries: The Role of Physician Payment and Managed Care. (United States)

    Sabik, Lindsay M; Dahman, Bassam; Vichare, Anushree; Bradley, Cathy J


    Medicaid-insured women have low rates of cancer screening. There are multiple policy levers that may influence access to preventive services such as screening, including physician payment and managed care. We examine the relationship between each of these factors and breast and cervical cancer screening among nonelderly nondisabled adult Medicaid enrollees. We combine individual-level data on Medicaid enrollment, demographics, and use of screening services from the Medicaid Analytic eXtract files with data on states' Medicaid-to-Medicare fee ratios and estimate their impact on screening services. Higher physician fees are associated with greater screening for comprehensive managed care enrollees; for enrollees in fee-for-service Medicaid, the findings are mixed. Patient participation in primary care case management is a significant moderator of the relationship between physician fees and the rate of screening, as interactions between enrollee primary care case management status and the Medicaid fee ratio are consistently positive across models of screening.

  11. The physician-administrator as patient: distinctive aspects of medical care. (United States)

    Cappell, Mitchell S


    This article examines distinctive aspects of medical care experienced by a 55-year-old hospitalized for quintuple coronary artery bypass surgery who was also a senior physician-administrator (chief of gastroenterology) at the same hospital. The article describes eight distinctive aspects of administrator-physicians as patients, including special patient treatment; exalted patient expectations by hospital personnel; patient suppression of emotions; patient denial; self-doctoring; job stress contributing to disease; self-sacrifice to achieve better health; and rational medical decisions when not under stress. Health-care workers should recognize how these distinctive aspects of medical care and behavior affect administrator-physicians as patients, in order to mitigate their negative effects, potentiate their positive effects, and optimize the care of these patients.

  12. Family-centered bereavement practices in Danish intensive care units

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Kaldan, Gudrun; Coombs, Maureen


    : Self-administered computerized cross-sectional nation-wide survey of Danish ICUs. RESULTS: Nurses at 46 of 48 (96%) ICUs in Denmark responded. Bereavement care at the time of patient death included viewing the patient in ICU (100%), and in the hospital mortuary (59%). Information about hospital...... of death, a letter of condolence, a phone call to the family, referral to a priest or clergyman, or referral to other counseling. Although many interventions were common, there were variations within the elements offered. Nurses and physicians were the most consistent health care staff involved...

  13. Non-physician providers of obstetric care in Mexico: Perspectives of physicians, obstetric nurses and professional midwives

    Directory of Open Access Journals (Sweden)

    DeMaria Lisa M


    Full Text Available Abstract Background In Mexico 87% of births are attended by physicians. However, the decline in the national maternal mortality rate has been slower than expected. The Mexican Ministry of Health’s 2009 strategy to reduce maternal mortality gives a role to two non-physician models that meet criteria for skilled attendants: obstetric nurses and professional midwives. This study compares and contrasts these two provider types with the medical model, analyzing perspectives on their respective training, scope of practice, and also their perception and/or experiences with integration into the public system as skilled birth attendants. Methodology This paper synthesizes qualitative research that was obtained as a component of the quantitative and qualitative study that evaluated three models of obstetric care: professional midwives (PM, obstetric nurses (ON and general physicians (GP. A total of 27 individual interviews using a semi-structured guide were carried out with PMs, ONs, GPs and specialists. Interviews were transcribed following the principles of grounded theory, codes and categories were created as they emerged from the data. We analyzed data in ATLAS.ti. Results All provider types interviewed expressed confidence in their professional training and acknowledge that both professional midwives and obstetric nurses have the necessary skills and knowledge to care for women during normal pregnancy and childbirth. The three types of providers recognize limits to their practice, namely in the area of managing complications. We found differences in how each type of practitioner perceived the concept and process of birth and their role in this process. The barriers to incorporation as a model to attend birth faced by PMs and ONs are at the individual, hospital and system level. GPs question their ability and training to handle deliveries, in particular those that become complicated, and the professional midwifery model particularly as it relates to

  14. Cutting out the middleman: physicians can contract directly with employers--a viable alternative to adversarial managed care agreements. (United States)

    Lester, Howard


    HMOs, PPOs, and other managed care "middlemen" control the means by which most physicians do business with employers. As physicians face dwindling reimbursements, greater practice restrictions, and increased pressure to sign adversarial middleman contracts, interest in direct contracting has grown. This article introduces direct contracting as an important alternative to commercial managed care agreements; cites the key advantages and process of direct contracting; and offers practical recommendations for helping physician practices successfully negotiate direct physician/employer agreements.

  15. Physician self-care | Kirby | South African Medical Journal

    African Journals Online (AJOL)

    They make significant sacrifices in family life, sleep, personal time and hobbies to be able to pursue this ideal. Moving away from cure to compassionate care of dying patients, is a paradigm shift. This can be particularly difficult when caring for children with terminal illness. It is easier to accept death in the elderly as it is part ...

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


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

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


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

  18. Addressing the primary care physician shortage in an evolving medical workforce

    Directory of Open Access Journals (Sweden)

    Lakhan Shaheen E


    Full Text Available Abstract Background Primary care physicians have been shown to play an important role in the general health of the communities in which they serve. In spite of their importance, however, there has been a decrease in the number of physicians interested in pursuing primary care fields, while the proportion of specialists continues to increase. The prediction of an overall physician shortage only augments this issue in the US, where this uneven distribution is particularly evident. As such, serious effort to increase the number of practicing primary care physicians is both necessary and beneficial for meeting this country's health care needs. Discussion There are several factors at play which contribute to the decrease in the number of practicing physicians in primary specialties. Lifestyle concerns, such as schedule and income, as well as the lack of prestige associated with this field seem to be among the most prevalent reasons cited for the diminishing interest. Multifaceted concerns such as these, however, are difficult to adequately invalidate; doing so would not only require a great deal research, but also a good deal of time – a resource which is in short supply given the current physician shortage being faced. Thus, a more immediate solution may lie in the increased recruitment and continued support of those individuals who are already associated with primary care service. This is particularly relevant given the Association of American Medical College's goal of increasing medical school enrollment by 15% over the next 10 years. Several groups have been shown to be large contributors to primary care in the US. Here, we focus on three such groups: minority students, International Medical Graduates (IMGs and Osteopathic Physicians (DOs. Although these groups are highly diverse individually, they all share the distinction of being underutilized in regard to the current primary care shortages faced. Thus, through more fully accentuating these

  19. Job satisfaction among primary health care physicians and nurses in Al-madinah Al-munawwara. (United States)

    Al Juhani, Abdullah M; Kishk, Nahla A


    Job satisfaction is the affective orientation that an employee has towards his work. Greater physician satisfaction is associated with greater patient adherence and satisfaction. Nurses' job satisfaction, have great impact on the organizational success. Knowing parts of job dissatisfaction among physicians and nurses is important in forming strategies for retaining them in primary health care (PHC) centers. Therefore, this study aimed at assessing the level of job satisfaction among PHC physicians and nurses in Al- Madina Al- Munawwara. Also, to explore the relationship of their personal and job characteristics with job satisfaction. A descriptive cross- sectional epidemiological approach was adopted. A self completion questionnaire was distributed to physicians and nurses at PHC centers. A multi-dimensional job scale adopted by Traynor and Wade (1993) was modified and used. The studied sample included 445 health care providers, 23.6% were physicians and 76.4% were nurses. Job dissatisfaction was highly encountered where 67.1% of the nurses & 52.4% of physicians were dissatisfied. Professional opportunities, patient care and financial reward were the most frequently encountered domains with which physicians were dissatisfied. The dissatisfying domains for majority of nurses were professional opportunities, workload and appreciation reward. Exploring the relation between demographic and job characteristics with job satisfaction revealed that older, male, non-Saudi, specialists physicians had insignificantly higher mean score of job satisfaction than their counterparts. While older, female, non-Saudi, senior nurses had significantly higher mean score than their counterparts. It is highly recommended to reduce workload for nurses and provision of better opportunities promotional for PHC physicians and nurses.

  20. Psychosocial determinants of physicians' intention to practice euthanasia in palliative care. (United States)

    Lavoie, Mireille; Godin, Gaston; Vézina-Im, Lydi-Anne; Blondeau, Danielle; Martineau, Isabelle; Roy, Louis


    Euthanasia remains controversial in Canada and an issue of debate among physicians. Most studies have explored the opinion of health professionals regarding its legalization, but have not investigated their intentions when faced with performing euthanasia. These studies are also considered atheoretical. The purposes of the present study were to fill this gap in the literature by identifying the psychosocial determinants of physicians' intention to practice euthanasia in palliative care and verifying whether respecting the patient's autonomy is important for physicians. A validated anonymous questionnaire based on an extended version of the Theory of Planned Behavior was mailed to a random sample of 445 physicians from the province of Quebec, Canada. The response rate was 38.3% and the mean score for intention was 3.94 ± 2.17 (range: 1 to 7). The determinants of intention among physicians were: knowing patients' wishes (OR = 10.77; 95%CI: 1.33-86.88), perceived behavioral control-physicians' evaluation of their ability to adopt a given behavior-(OR = 4.35; 95%CI: 1.44-13.15), moral norm-the appropriateness of adopting a given behavior according to one's personal and moral values-(OR = 3.22; 95%CI: 1.29-8.00) and cognitive attitude-factual consequences of the adoption of a given behavior-(OR = 3.16; 95%CI: 1.20-8.35). This model correctly classified 98.8% of physicians. Specific beliefs that might discriminate physicians according to their level of intention were also identified. For instance, physicians' moral norm was related to the ethical principle of beneficence. Overall, physicians have weak intentions to practice euthanasia in palliative care. Nevertheless, respecting patients' final wishes concerning euthanasia seems to be of particular importance to them and greatly affects their motivation to perform euthanasia.

  1. Value choices and considerations when limiting intensive care treatment: a qualitative study. (United States)

    Halvorsen, K; Førde, R; Nortvedt, P


    To shed light on the values and considerations that affect the decision-making processes and the decisions to limit intensive care treatment. Qualitative methodology with participant observation and in-depth interviews, with an emphasis on eliciting the underlying rationale of the clinicians' actions and choices when limiting treatment. Informants perceived over-treatment in intensive care medicine as a dilemma. One explanation was that the decision-making base was somewhat uncertain, complex and difficult. The informants claimed that those responsible for taking decisions from the admitting ward prolonged futile treatment because they may bear guilt or responsibility for something that had gone wrong during the course of treatment. The assessments of the patient's situation made by physicians from the admitting ward were often more organ-oriented and the expectations were less realistic than those of clinicians in the intensive care unit who frequently had a more balanced and overall perspective. Aspects such as the personality and the speciality of those involved, the culture of the unit and the degree of interdisciplinary cooperation were important issues in the decision-making processes. Under-communicated considerations jeopardise the principle of equal treatment. If intensive care patients are to be ensured equal treatment, strategies for interdisciplinary, transparent and appropriate decision-making processes must be developed in which open and hidden values are rendered visible, power structures disclosed, employees respected and the various perspectives of the treatment given their legitimate place.

  2. Recommendations on basic requirements for intensive care units: structural and organizational aspects. (United States)

    Valentin, Andreas; Ferdinande, Patrick


    To provide guidance and recommendations for the planning or renovation of intensive care units (ICUs) with respect to the specific characteristics relevant to organizational and structural aspects of intensive care medicine. The Working Group on Quality Improvement (WGQI) of the European Society of Intensive Care Medicine (ESICM) identified the basic requirements for ICUs by a comprehensive literature search and an iterative process with several rounds of consensus finding with the participation of 47 intensive care physicians from 23 countries. The starting point of this process was an ESICM recommendation published in 1997 with the need for an updated version. The document consists of operational guidelines and design recommendations for ICUs. In the first part it covers the definition and objectives of an ICU, functional criteria, activity criteria, and the management of equipment. The second part deals with recommendations with respect to the planning process, floorplan and connections, accommodation, fire safety, central services, and the necessary communication systems. This document provides a detailed framework for the planning or renovation of ICUs based on a multinational consensus within the ESICM.

  3. Delirium the under-recognised syndrome: survey of healthcare professionals' awareness and practice in the intensive care units. (United States)

    Selim, Abeer A; Wesley Ely, E


    To survey intensive care unit healthcare professionals' awareness and practice related to delirium. Despite the current evidence revealing the risks linked to delirium and advances in practice guidelines promoting delirium assessment, healthcare professionals show little sensitivity towards delirium and evident training needs. The study had a cross-sectional survey design. A sample of 168 intensive care unit healthcare professionals including nurses and physicians completed a semistructured questionnaire to survey their awareness, screening and management of delirium in intensive care units. The survey took place at 11 intensive care units from academic (university) and nonacademic (nonuniversity) governmental hospitals in Mansoura, Egypt. The mean score of delirium awareness was 64·4 ± 14·0 among intensive care unit healthcare professionals. Awareness of delirium was significantly lower when definition of delirium was not provided, among diploma nurses compared to bachelor degree nurses and physicians, among those who did not attend any workshop/lecture or read an article related to delirium and lastly, those who work in an intensive care unit when delirium. The survey found that only 26·8% of the healthcare professionals screen for delirium on a routine basis, and 14·3% reported attending workshops or lectures or reading an article related to delirium in the last year. In screening delirium, healthcare professionals did not use any tools, nor did they follow adopted protocols or guidelines to manage delirium. To manage delirium, 52·4% of the participants reported using sedatives, 36·9% used no drugs, and 10·7% reported using antipsychotics (primarily haloperidol). Intensive care unit healthcare professionals do not have adequate training or routine screening of delirium. There is an evident absence of using standardised tools or adapting protocols to monitor and manage delirium. This study has the potentials to shed some lights on the variables that

  4. Using Nurse Ratings of Physician Communication in the ICU To Identify Potential Targets for Interventions To Improve End-of-Life Care. (United States)

    Ramos, Kathleen J; Downey, Lois; Nielsen, Elizabeth L; Treece, Patsy D; Shannon, Sarah E; Curtis, J Randall; Engelberg, Ruth A


    Communication among doctors, nurses, and families contributes to high-quality end-of-life care, but is difficult to improve. Our objective was to identify aspects of communication appropriate for interventions to improve quality of dying in the intensive care unit (ICU). This observational study used data from a cluster-randomized trial of an interdisciplinary intervention to improve end-of-life care at 15 Seattle/Tacoma area hospitals (2003-2008). Nurses completed surveys for patients dying in the ICU. We examined associations between nurse-assessed predictors (physician-nurse communication, physician-family communication) and nurse ratings of patients' quality of dying (nurse-QODD-1). Based on 1173 nurse surveys, four of six physician-nurse communication topics were positively associated with nurse-QODD-1: family questions, family dynamics, spiritual/religious issues, and cultural issues. Discussions between nurses and physicians about nurses' concerns for patients or families were negatively associated. All physician-family communication ratings, as assessed by nurses, were positively associated with nurse-QODD-1: answering family's questions, listening to family, asking about treatments patient would want, helping family decide patient's treatment wishes, and overall communication. Path analysis suggested overall physician-family communication and helping family incorporate patient's wishes were directly associated with nurse-QODD-1. Several topics of physician-nurse communication, as rated by nurses, were associated with higher nurse-rated quality of dying, whereas one topic, nurses' concerns for patient or family, was associated with poorer ratings. Higher nurse ratings of physician-family communication were uniformly associated with higher quality of dying, highlighting the importance of this communication. Physician support of family decision making was particularly important, suggesting a potential target for interventions to improve end-of-life care.

  5. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. (United States)

    Chapman, Elizabeth N; Kaatz, Anna; Carnes, Molly


    Although the medical profession strives for equal treatment of all patients, disparities in health care are prevalent. Cultural stereotypes may not be consciously endorsed, but their mere existence influences how information about an individual is processed and leads to unintended biases in decision-making, so called "implicit bias". All of society is susceptible to these biases, including physicians. Research suggests that implicit bias may contribute to health care disparities by shaping physician behavior and producing differences in medical treatment along the lines of race, ethnicity, gender or other characteristics. We review the origins of implicit bias, cite research documenting the existence of implicit bias among physicians, and describe studies that demonstrate implicit bias in clinical decision-making. We then present the bias-reducing strategies of consciously taking patients' perspectives and intentionally focusing on individual patients' information apart from their social group. We conclude that the contribution of implicit bias to health care disparities could decrease if all physicians acknowledged their susceptibility to it, and deliberately practiced perspective-taking and individuation when providing patient care. We further conclude that increasing the number of African American/Black physicians could reduce the impact of implicit bias on health care disparities because they exhibit significantly less implicit race bias.

  6. Assessing the Impact of Telemedicine on Nursing Care in Intensive Care Units. (United States)

    Kleinpell, Ruth; Barden, Connie; Rincon, Teresa; McCarthy, Mary; Zapatochny Rufo, Rebecca J


    Information on the impact of tele-intensive care on nursing and priority areas of nursing care is limited. To conduct a national benchmarking survey of nurses working in intensive care telemedicine facilities in the United States. In a 2-phased study, an online survey was used to assess nurses' perceptions of intensive care telemedicine, and a modified 2-round Delphi study was used to identify priority areas of nursing. In phase 1, most of the 1213 respondents agreed to strongly agreed that using tele-intensive care enables them to accomplish tasks more quickly (63%), improves collaboration (65.9%), improves job performance (63.6%) and communication (60.4%), is useful in nursing assessments (60%), and improves care by providing more time for patient care (45.6%). Benefits of tele-intensive care included ability to detect trends in vital signs, detect unstable physiological status, provide medical management, and enhance patient safety. Barriers included technical problems (audio and video), interruptions in care, perceptions of telemedicine as an interference, and attitudes of staff. In phase 2, 60 nurses ranked 15 priority areas of care, including critical thinking skills, intensive care experience, skillful communication, mutual respect, and management of emergency patient care. The findings can be used to further inform the development of competencies for tele-intensive care nursing, match the tele-intensive care nursing practice guidelines of the American Association of Critical-Care Nurses, and highlight concepts related to the association's standards for establishing and sustaining healthy work environments. ©2016 American Association of Critical-Care Nurses.

  7. Physicians in health care management: 2. Managing performance: who, what, how and when?


    Lemieux-Charles, L


    Physicians are becoming more involved in performance management as hospitals restructure to increase effectiveness. Although physicians are not hospital employees, they are subject to performance appraisals because the hospitals are accountable to patients and the community for the quality of hospital services. The performance of a health care professional may be appraised by the appropriate departmental manager, by other professionals in a team or program or by peers, based on prior agreemen...

  8. Controlling health costs: physician responses to patient expectations for medical care. (United States)

    Sabbatini, Amber K; Tilburt, Jon C; Campbell, Eric G; Sheeler, Robert D; Egginton, Jason S; Goold, Susan D


    Physicians have dual responsibilities to make medical decisions that serve their patients' best interests but also utilize health care resources wisely. Their ability to practice cost-consciously is particularly challenged when faced with patient expectations or requests for medical services that may be unnecessary. To understand how physicians consider health care resources and the strategies they use to exercise cost-consciousness in response to patient expectations and requests for medical care. Exploratory, qualitative focus groups of practicing physicians were conducted. Participants were encouraged to discuss their perceptions of resource constraints, and experiences with redundant, unnecessary and marginally beneficial services, and were asked about patient requests or expectations for particular services. Sixty-two physicians representing a variety of specialties and practice types participated in nine focus groups in Michigan, Ohio, and Minnesota in 2012 MEASUREMENTS: Iterative thematic content analysis of focus group transcripts Physicians reported making trade-offs between a variety of financial and nonfinancial resources, considering not only the relative cost of medical decisions and alternative services, but the time and convenience of patients, their own time constraints, as well as the logistics of maintaining a successful practice. They described strategies and techniques to educate patients, build trust, or substitute less costly alternatives when appropriate, often adapting their management to the individual patient and clinical environment. Physicians often make nuanced trade-offs in clinical practice aimed at efficient resource use within a complex flow of clinical work and patient expectations. Understanding the challenges faced by physicians and the strategies they use to exercise cost-consciousness provides insight into policy measures that will address physician's roles in health care resource use.

  9. How do high cost-sharing policies for physician care affect total care costs among people with chronic disease? (United States)

    Xin, Haichang; Harman, Jeffrey S; Yang, Zhou


    This study examines whether high cost-sharing in physician care is associated with a differential impact on total care costs by health status. Total care includes physician care, emergency room (ER) visits and inpatient care. Since high cost-sharing policies can reduce needed care as well as unneeded care use, it raises the concern whether these policies are a good strategy for controlling costs among chronically ill patients. This study used the 2007 Medical Expenditure Panel Survey data with a cross-sectional study design. Difference in difference (DID), instrumental variable technique, two-part model, and bootstrap technique were employed to analyze cost data. Chronically ill individuals' probability of reducing any overall care costs was significantly less than healthier individuals (beta = 2.18, p = 0.04), while the integrated DID estimator from split results indicated that going from low cost-sharing to high cost-sharing significantly reduced costs by $12,853.23 more for sick people than for healthy people (95% CI: -$17,582.86, -$8,123.60). This greater cost reduction in total care among sick people likely resulted from greater cost reduction in physician care, and may have come at the expense of jeopardizing health outcomes by depriving patients of needed care. Thus, these policies would be inappropriate in the short run, and unlikely in the long run to control health plans costs among chronically ill individuals. A generous benefit design with low cost-sharing policies in physician care or primary care is recommended for both health plans and chronically ill individuals, to save costs and protect these enrollees' health status.

  10. Non-verbal communication between primary care physicians and older patients: how does race matter? (United States)

    Stepanikova, Irena; Zhang, Qian; Wieland, Darryl; Eleazer, G Paul; Stewart, Thomas


    Non-verbal communication is an important aspect of the diagnostic and therapeutic process, especially with older patients. It is unknown how non-verbal communication varies with physician and patient race. To examine the joint influence of physician race and patient race on non-verbal communication displayed by primary care physicians during medical interviews with patients 65 years or older. Video-recordings of visits of 209 patients 65 years old or older to 30 primary care physicians at three clinics located in the Midwest and Southwest. Duration of physicians' open body position, eye contact, smile, and non-task touch, coded using an adaption of the Nonverbal Communication in Doctor-Elderly Patient Transactions form. African American physicians with African American patients used more open body position, smile, and touch, compared to the average across other dyads (adjusted mean difference for open body position = 16.55, p non-verbal communication with older patients. Its influence is best understood when physician race and patient race are considered jointly.

  11. The development of pediatric anesthesia and intensive care in Scandinavia. (United States)

    Nilsson, Krister; Ekström-Jodal, Barbro; Meretoja, Olli; Valentin, Niels; Wagner, Kari


    The initiation and development of pediatric anesthesia and intensive care have much in common in the Scandinavian countries. The five countries had to initiate close relations and cooperation in all medical disciplines. The pediatric anesthesia subspecialty took its first steps after the Second World War. Relations for training and exchange of experiences between Scandinavian countries with centers in Europe and the USA were a prerequisite for development. Specialized pediatric practice was not a full-time position until during the 1950s, when the first pediatric anesthesia positions were created. Scandinavian anesthesia developed slowly. In contrast, Scandinavia pioneered both adult and certainly pediatric intensive care. The pioneers were heavily involved in the teaching and training of anesthetists and nurses. This was necessary to manage the rapidly increasing work. The polio epidemics during the 1950s initiated a combination of clinical development and technical innovations. Blood gas analyses technology and interpretation in combination with improved positive pressure ventilators were developed in Scandinavia contributing to general and pediatric anesthesia and intensive care practice. Scandinavian specialist training and accreditation includes both anesthesia and intensive care. Although pediatric anesthesia/intensive care is not a separate specialty, an 'informal accreditation' for a specialist position is obtained after training. The pleasure of working in a relatively small group of devoted colleagues and staff has persisted from the pioneering years. It is still one of the most inspiring and pleasant gifts for those working in this demanding specialty. © 2014 John Wiley & Sons Ltd.

  12. Geriatric patient profile in the cardiovascular surgery intensive care unit. (United States)

    Korhan, Esra Akin; Hakverdioglu, Gulendam; Ozlem, Maryem; Ozlem, Maryem; Yurekli, Ismail; Gurbuz, Ali; Alp, Nilgun Akalin


    To determine hospitalization durations and mortalities of elderly in the Cardiovascular Surgery Intensive Care Unit. The retrospective study was conducted in a Cardiovascular Surgery Intensive Care Unit in Turkey and comprised patient records from January 1 to December 31, 2011. Computerized epicrisis reports of 255, who had undergone a cardiac surgery were collected. The patients were grouped according to their ages, Group I aged 65-74 and Group II aged 75 and older. European society for Cardiac Operative Risk Evaluation scores of the two groups were compared using SPSS 17. Overall, there were 80 (31.37%) females and 175 (68.62%) males. There were 138 (54.1%) patients in Group I and 117 (45.9%) in Group II. Regarding their hospitalization reasons, it was determined that 70 (27.5%) patients in Group I and 79 (30.9%) patients in Group II were treated with the diagnosis ofcoronary artery disease. The average hospitalization duration of patients in the intensive care unit was determined to be 11.57 +/- 0.40 days. Regarding the EuroSCORE score intervals of patients, 132 (51.8%) had 3-5 and 225 (88.2%) patients were transferred to the Cardiovascular Surgery and then all of them were discharged; 5 (4.1%) had a mortal course; and 11 (7.7%) were transferred to the anaesthesia intensive care unit. The general mortality rates are very low in the Cardiovascular Surgery Intensive Care Unit and the patients have a good prognosis.

  13. The Intensive Care Lifeboat: a survey of lay attitudes to rationing dilemmas in neonatal intensive care. (United States)

    Arora, C; Savulescu, J; Maslen, H; Selgelid, M; Wilkinson, D


    Resuscitation and treatment of critically ill newborn infants is associated with relatively high mortality, morbidity and cost. Guidelines relating to resuscitation have traditionally focused on the best interests of infants. There are, however, limited resources available in the neonatal intensive care unit (NICU), meaning that difficult decisions sometimes need to be made. This study explores the intuitions of lay people (non-health professionals) regarding resource allocation decisions in the NICU. The study design was a cross-sectional quantitative survey, consisting of 20 hypothetical rationing scenarios. There were 119 respondents who entered the questionnaire, and 109 who completed it. The respondents were adult US and Indian participants of the online crowdsourcing platform Mechanical Turk. Respondents were asked to decide which of two infants to treat in a situation of scarce resources. Demographic characteristics, personality traits and political views were recorded. Respondents were also asked to respond to a widely cited thought experiment involving rationing. The majority of respondents, in all except one scenario, chose the utilitarian option of directing treatment to the infant with the higher chance of survival, higher life expectancy, less severe disability, and less expensive treatment. As discrepancy between outcomes decreased, however, there was a statistically significant increase in egalitarian responses and decrease in utilitarian responses in scenarios involving chance of survival (P = 0.001), life expectancy (P = 0.0001), and cost of treatment (P = 0.01). In the classic 'lifeboat' scenario, all but two respondents were utilitarian. This survey suggests that in situations of scarcity and equal clinical need, non-health professionals support rationing of life-saving treatment based on probability of survival, duration of survival, cost of treatment or quality of life. However, where the difference in prognosis or cost is very

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

    Directory of Open Access Journals (Sweden)

    Bruce D. White


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

  15. US primary care physicians' opinions about conscientious refusal: a national vignette experiment. (United States)

    Brauer, Simon G; Yoon, John D; Curlin, Farr A


    Previous research has found that physicians are divided on whether they are obligated to provide a treatment to which they object and whether they should refer patients in such cases. The present study compares several possible scenarios in which a physician objects to a treatment that a patient requests, in order to better characterise physicians' beliefs about what responses are appropriate. We surveyed a nationally representative sample of 1504 US primary care physicians using an experimentally manipulated vignette in which a patient requests a clinical intervention to which the patient's physician objects. We used multivariate logistic regression models to determine how vignette and respondent characteristics affected respondent's judgements. Among eligible respondents, the response rate was 63% (896/1427). When faced with an objection to providing treatment, referring the patient was the action judged most appropriate (57% indicated it was appropriate), while few physicians thought it appropriate to provide treatment despite one's objection (15%). The most religious physicians were more likely than the least religious physicians to support refusing to accommodate the patient's request (38% vs 22%, OR=1.75; 95% CI 1.06 to 2.86). This study indicates that US physicians believe it is inappropriate to provide an intervention that violates one's personal or professional standards. Referring seems to be physicians' preferred way of responding to requests for interventions to which physicians object. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  16. Knowledge sharing behavior and intensive care nurse innovation: the moderating role of control of care quality

    DEFF Research Database (Denmark)

    Li-Ying, Jason; Paunova, Minna; Egerod, Ingrid


    Aims This study investigates the influence of intensive care unit nurses’ knowledge sharing behaviour on nurse innovation, given different conditions of care quality control. Background Health-care organisations face an increasing pressure to innovate while controlling care quality. We have littl...

  17. Study of relation of continuing medical education to quality of family physicians' care. (United States)

    Dunn, E V; Bass, M J; Williams, J I; Borgiel, A E; MacDonald, P; Spasoff, R A


    A random sample of 120 physicians in Ontario was studied to assess quality of care in primary care and test an hypothesis that quality of care was related to continuing medical education (CME) activities. The quality-of-care scores were obtained by an in-office audit of a random selection of charts. The scores were global scores for charting, prevention, the use of 13 classes of drugs, and care of a two-year period for 182 different diagnoses. There were no relationships between global quality-of-care scores based on these randomly chosen charts and either the type or quantity of the physicians' CME activities. These activities were reading journals, attending rounds, attending scientific conferences, having informal consultations, using audio and video cassettes, and engaging in self-assessment. The implications of these findings are significant for future research in CME and for planners of present CME programs.

  18. The patient-centered medical home neighbor: A primary care physician's view. (United States)

    Sinsky, Christine A


    The American College of Physicians' position paper on the patient-centered medical home neighbor (PCMH-N) extends the work of the patient-centered medical home (PCMH) as a means of improving the delivery of health care. Recognizing that the PCMH does not exist in isolation, the PCMH-N concept outlines expectations for comanagement, communication, and care coordination and broadens responsibility for safe, effective, and efficient care beyond primary care to include physicians of all specialties. As such, it is a fitting follow-up to the PCMH and moves further down the road toward improved care for complex patients. Yet, there is more work to be done. Truly transforming the U.S. health care system around personalized medical homes embedded in highly functional medical neighborhoods will require better staffing models; more robust electronic information tools; aligned incentives for quality and efficiency within payment and regulatory policies; and a culture of greater engagement of patients, their families, and communities.

  19. Does trust of patients in their physician predict loyalty to the health care insurer? The Israeli case study. (United States)

    Gabay, Gillie


    This pioneer study tests the relationship between patients' trust in their physicians and patients' loyalty to their health care insurers. This is a cross-sectional study using a representative sample of patients from all health care insurers with identical health care plans. Regression analyses and Baron and Kenny's model were used to test the study model. Patient trust in the physician did not predict loyalty to the insurer. Loyalty to the physician did not mediate the relationship between trust in the physician and loyalty to the insurer. Satisfaction with the physician was the only predictor of loyalty to the insurer.

  20. Employed family physician satisfaction and commitment to their practice, work group, and health care organization. (United States)

    Karsh, Ben-Tzion; Beasley, John W; Brown, Roger L


    Test a model of family physician job satisfaction and commitment. Data were collected from 1,482 family physicians in a Midwest state during 2000-2001. The sampling frame came from the membership listing of the state's family physician association, and the analyzed dataset included family physicians employed by large multispecialty group practices. A cross-sectional survey was used to collect data about physician working conditions, job satisfaction, commitment, and demographic variables. The response rate was 47 percent. Different variables predicted the different measures of satisfaction and commitment. Satisfaction with one's health care organization (HCO) was most strongly predicted by the degree to which physicians perceived that management valued and recognized them and by the extent to which physicians perceived the organization's goals to be compatible with their own. Satisfaction with one's workgroup was most strongly predicted by the social relationship with members of the workgroup; satisfaction with one's practice was most strongly predicted by relationships with patients. Commitment to one's workgroup was predicted by relationships with one's workgroup. Commitment to one's HCO was predicted by relationships with management of the HCO. Social relationships are stronger predictors of employed family physician satisfaction and commitment than staff support, job control, income, or time pressure.

  1. Use of humour in primary care: different perceptions among patients and physicians. (United States)

    Granek-Catarivas, M; Goldstein-Ferber, S; Azuri, Y; Vinker, S; Kahan, E


    (1) To explore the frequency with which humorous behaviour and statements occur in family medicine practice in Israel, and (2) to quantitatively assess the correlation between the subjective perceptions of humour in medical encounters between patients and physicians. In a cross sectional study, two populations (doctors and patients) were surveyed with paired structured questionnaires completed immediately after primary care practice visits. Two hundred and fifty consecutive encounters from 15 practices were sampled. The physician questionnaire was self administered, and patient questionnaire was administered by a trained research assistant. A mean of 16.7 questionnaires was completed per physician (range 6-20). The physicians reported having used some humour in only 95 encounters (38%), whereas almost 60% of patients agreed with the statement, "The doctor used some humour during the visit". At the same time, for specific encounters, the agreement between patients' perception and physicians' perceptions on the use of humour, although not completely by chance (p = 0.04), is low (kappa = 0.115). Patient characteristics (age, education, gender, family status, mother tongue, self perceived heath status, stress, mood, and expectations) were not related to the degree of agreement between the patients' and physicians' perceptions. Humour was used in a large proportion of encounters, independently of patient characteristics. Patients seem to be more sensitised to humour than physicians, probably because of their high stress level during medical encounters. Cultural differences may also play a part. Physicians should be made aware of this magnifying effect, and the issue should be discussed in medical schools.

  2. Physician Practice Participation in Accountable Care Organizations: The Emergence of the Unicorn (United States)

    Shortell, Stephen M; McClellan, Sean R; Ramsay, Patricia P; Casalino, Lawrence P; Ryan, Andrew M; Copeland, Kennon R


    Objective To provide the first nationally based information on physician practice involvement in ACOs. Data Sources/Study Setting Primary data from the third National Survey of Physician Organizations (January 2012–May 2013). Study Design We conducted a 40-minute phone survey in a sample of physician practices. A nationally representative sample of practices was surveyed in order to provide estimates of organizational characteristics, care management processes, ACO participation, and related variables for four major chronic illnesses. Data Collection/Extraction Methods We evaluated the associations between ACO participation, organizational characteristics, and a 25-point index of patient-centered medical home processes. Principal Findings We found that 23.7 percent of physician practices (n = 280) reported joining an ACO; 15.7 percent (n = 186) were planning to become involved within the next 12 months and 60.6 percent (n = 717) reported no involvement and no plans to become involved. Larger practices, those receiving patients from an IPA and/or PHO, those that were physician-owned versus hospital/health system-owned, those located in New England, and those with greater patient-centered medical home (PCMH) care management processes were more likely to have joined an ACO. Conclusions Physician practices that are currently participating in ACOs appear to be relatively large, or to be members of an IPA or PHO, are less likely to be hospital-owned and are more likely to use more care management processes than nonparticipating practices. PMID:24628449

  3. Physician practice participation in accountable care organizations: the emergence of the unicorn. (United States)

    Shortell, Stephen M; McClellan, Sean R; Ramsay, Patricia P; Casalino, Lawrence P; Ryan, Andrew M; Copeland, Kennon R


    To provide the first nationally based information on physician practice involvement in ACOs. Primary data from the third National Survey of Physician Organizations (January 2012-May 2013). We conducted a 40-minute phone survey in a sample of physician practices. A nationally representative sample of practices was surveyed in order to provide estimates of organizational characteristics, care management processes, ACO participation, and related variables for four major chronic illnesses. We evaluated the associations between ACO participation, organizational characteristics, and a 25-point index of patient-centered medical home processes. We found that 23.7 percent of physician practices (n = 280) reported joining an ACO; 15.7 percent (n = 186) were planning to become involved within the next 12 months and 60.6 percent (n = 717) reported no involvement and no plans to become involved. Larger practices, those receiving patients from an IPA and/or PHO, those that were physician-owned versus hospital/health system-owned, those located in New England, and those with greater patient-centered medical home (PCMH) care management processes were more likely to have joined an ACO. Physician practices that are currently participating in ACOs appear to be relatively large, or to be members of an IPA or PHO, are less likely to be hospital-owned and are more likely to use more care management processes than nonparticipating practices. © Health Research and Educational Trust.

  4. Family Physicians May Benefit From Cognitive Behavioral Therapy Skills in Primary Care Setting.

    Directory of Open Access Journals (Sweden)

    Omer Serkan Turan


    Full Text Available Dr Francis Peabody commented that the swing of the pendulum toward specialization had reached its apex, and that modern medicine had fragmented the health care delivery system too greatly. Thus the system was in need of a generalist physician to provide comprehensive personalized care. Family physician is the perfect candidate to fill the gap which Dr Peabody once speaks of and grants biopsychosocial model as its main philosophy. Biopsychosocial model proposes physician to consider multiple aspects of patient's life in order to manage disease. Behavioral pathogens such as poor diet, lack of physical activity, stress, substance abuse, unsafe sexual activity, inadequate emotional support, nonadherence to medical advice contribute to disease progress. Family physician can guide patient like a coach to obtain higher levels in Maslow’s hierarchy of needs as biopsychosocial model suggests and obtain the change in behavior towards a healthier life with using cognitive behavioral therapy skills. So family physician, biopsychosocial model and cognitive behavioral skills are three pillars of comprehensive personalized care and family physicians having these skill sets can be very helpful in making positive changes in the life of the patient. [JCBPR 2017; 6(2.000: 98-100

  5. Barriers to optimal care between physicians and lesbian, gay, bisexual, transgender, and questioning adolescent patients. (United States)

    Kitts, Robert Li


    The objective of this article was to identify barriers to optimal care between physicians and LGBTQ (lesbian, gay, bisexual, transgender, and questioning) adolescents. To this end, 464 anonymous, self-administered surveys were distributed in 2003 to residents and attending physicians in pediatrics, internal medicine, obstetrics-gynecology, psychiatry, emergency medicine, and family practice at Upstate Medical University. The survey included questions pertaining to practice, knowledge, and attitude pertaining to lesbian, gay, transgender, or questioning (LGBTQ) adolescents. One hundred eight four surveys were returned. The majority of physicians would not regularly discuss sexual orientation, sexual attraction, or gender identity while taking a sexual history from a sexually active adolescent. As well, the majority of physicians would not ask patients about sexual orientation if an adolescent presented with depression, suicidal thoughts, or had attempted suicide. If an adolescent stated that he or she was not sexually active, 41% of physicians reported that they would not ask additional sexual health-related questions. Only 57% agreed to an association between being a LGBTQ adolescent and suicide. The majority of physicians did not believe that they had all the skills they needed to address issues of sexual orientation with adolescents, and that sexual orientation should be addressed more often with these patients and in the course of training. This study concludes that barriers in providing optimal care for LGBTQ adolescents can be found with regard to practice, knowledge, and attitude regardless of medical field and other demographics collected. Opportunities exist to enhance care for LGBTQ adolescents.

  6. Factors and outcomes in primary care physician retention in rural ...

    African Journals Online (AJOL)


    2 ... that will reduce disparities and increase access to quality health care. ... in the specialties of family medicine (58%), general internal medicine (53%) .... satisfaction was lack of shopping or restaurants (15%). However, 80% ...

  7. Moral distress within neonatal and paediatric intensive care units: a systematic review. (United States)

    Prentice, Trisha; Janvier, Annie; Gillam, Lynn; Davis, Peter G


    To review the literature on moral distress experienced by nursing and medical professionals within neonatal intensive care units (NICUs) and paediatric intensive care units (PICUs). Pubmed, EBSCO (Academic Search Complete, CINAHL and Medline) and Scopus were searched using the terms neonat*, infant*, pediatric*, prematur* or preterm AND (moral distress OR moral responsibility OR moral dilemma OR conscience OR ethical confrontation) AND intensive care. 13 studies on moral distress published between January 1985 and March 2015 met our inclusion criteria. Fewer than half of those studies (6) were multidisciplinary, with a predominance of nursing staff responses across all studies. The most common themes identified were overly 'burdensome' and disproportionate use of technology perceived not to be in a patient's best interest, and powerlessness to act. Concepts of moral distress are expressed differently within nursing and medical literature. In nursing literature, nurses are often portrayed as victims, with physicians seen as the perpetrators instigating 'aggressive care'. Within medical literature moral distress is described in terms of dilemmas or ethical confrontations. Moral distress affects the care of patients in the NICU and PICU. Empirical data on multidisciplinary populations remain sparse, with inconsistent definitions and predominantly small sample sizes limiting generalisability of studies. Longitudinal data reflecting the views of all stakeholders, including parents, are required. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  8. Artificial intelligence applications in the intensive care unit. (United States)

    Hanson, C W; Marshall, B E


    To review the history and current applications of artificial intelligence in the intensive care unit. The MEDLINE database, bibliographies of selected articles, and current texts on the subject. The studies that were selected for review used artificial intelligence tools for a variety of intensive care applications, including direct patient care and retrospective database analysis. All literature relevant to the topic was reviewed. Although some of the earliest artificial intelligence (AI) applications were medically oriented, AI has not been widely accepted in medicine. Despite this, patient demographic, clinical, and billing data are increasingly available in an electronic format and therefore susceptible to analysis by intelligent software. Individual AI tools are specifically suited to different tasks, such as waveform analysis or device control. The intensive care environment is particularly suited to the implementation of AI tools because of the wealth of available data and the inherent opportunities for increased efficiency in inpatient care. A variety of new AI tools have become available in recent years that can function as intelligent assistants to clinicians, constantly monitoring electronic data streams for important trends, or adjusting the settings of bedside devices. The integration of these tools into the intensive care unit can be expected to reduce costs and improve patient outcomes.

  9. Physician attitudes regarding pregnancy, fertility care, and assisted reproductive technologies for HIV-infected individuals and couples. (United States)

    Yudin, Mark H; Money, Deborah M; Cheung, Matthew C; Loutfy, Mona R


    Family and pregnancy planning are important for HIV-infected individuals and couples. There is a paucity of data regarding physician attitudes with respect to reproduction in this population, but some evidence suggests that attitudes can influence the information, advice, and services they will provide. To determine physician attitudes toward pregnancy, fertility care, and access to assisted reproductive technologies for HIV-infected individuals, and to determine whether attitudes differed based on specific physician characteristics. A survey was sent electronically to obstetrician/gynecologists and infectious disease specialists in Canada. Items were grouped into 5 key domains: physician demographics, physician attitudes toward pregnancy and adoption, physician attitudes toward fertility care, physician attitudes toward assisted reproductive technology, and challenges for an HIV-infected population. Attitudes were determined based on answers to individual questions and also for each domain. Univariate and logistic regression analyses were used to determine the influence of specific physician characteristics on attitudes. Completed surveys were received from 165 physicians. Most had positive attitudes regarding pregnancy or adoption (89%), fertility care (72%), and assisted reproductive technology (79%). In multivariate analyses, having cared for HIV-infected patients was significantly associated with having a positive attitude toward fertility care or assisted reproductive technology. In this national survey of Canadian physicians, most had positive attitudes toward pregnancy, adoption, fertility care, and use of assisted reproductive technology among HIV-infected persons. Physicians who had cared for HIV-infected individuals in the past were more likely to have positive attitudes than those who had not.

  10. Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care. (United States)

    Radbruch, Lukas; Leget, Carlo; Bahr, Patrick; Müller-Busch, Christof; Ellershaw, John; de Conno, Franco; Vanden Berghe, Paul


    In recognition of the ongoing discussion on euthanasia and physician-assisted suicide, the Board of Directors of the European Association for Palliative Care commissioned this white paper from the palliative care perspective. This white paper aims to provide an ethical framework for palliative care professionals on euthanasia and physician-assisted suicide. It also aims to provide an overview on the available evidence as well as a discourse of ethical principles related to these issues. Starting from a 2003 European Association for Palliative Care position paper, 21 statements were drafted and submitted to a five-round Delphi process A panel with 17 experts commented on the paper in round 1. Board members of national palliative care or hospice associations that are collective members of European Association for Palliative Care were invited to an online survey in rounds 2 and 3. The expert panel and the European Association for Palliative Care board members participated in rounds 4 and 5. This final version was adopted as an official position paper of the European Association for Palliative Care in April 2015. Main topics of the white paper are concepts and definitions of palliative care, its values and philosophy, euthanasia and physician-assisted suicide, key issues on the patient and the organizational level. The consensus process confirmed the 2003 European Association for Palliative Care white paper and its position on the relationship between palliative care and euthanasia and physician-assisted suicide. The European Association for Palliative Care feels that it is important to contribute to informed public debates on these issues. Complete consensus seems to be unachievable due to incompatible normative frameworks that clash. © The Author(s) 2015.

  11. Acceptance of New Medicaid Patients by Primary Care Physicians and Experiences with Physician Availability among Children on Medicaid or the Children's Health Insurance Program (United States)

    Decker, Sandra L


    Objective To estimate the relationship between physicians' acceptance of new Medicaid patients and access to health care. Data Sources The National Ambulatory Medical Care Survey (NAMCS) Electronic Health Records Survey and the National Health Interview Survey (NHIS) 2011/2012. Study Design Linear probability models estimated the relationship between measures of experiences with physician availability among children on Medicaid or the Children's Health Insurance Program (CHIP) from the NHIS and state-level estimates of the percent of primary care physicians accepting new Medicaid patients from the NAMCS, controlling for other factors. Principal Findings Nearly 16 percent of children with a significant health condition or development delay had a doctor's office or clinic indicate that the child's health insurance was not accepted in states with less than 60 percent of physicians accepting new Medicaid patients, compared to less than 4 percent in states with at least 75 percent of physicians accepting new Medicaid patients. Adjusted estimates and estimates for other measures of access to care were similar. Conclusions Measures of experiences with physician availability for children on Medicaid/CHIP were generally good, though better in states where more primary care physicians accepted new Medicaid patients. PMID:25683869

  12. Rotation placements help students' understanding of intensive care. (United States)

    Abbott, Lisa


    It is vital that children's nursing students are fit for practice when they qualify and are able to meet various essential skills as defined by the Nursing and Midwifery Council (NMC). To gain the knowledge and skills required, students need placements in areas where high dependency and potentially intensive care are delivered. Efforts to maximise the number of students experiencing intensive care as a placement have led to the development of the paediatric intensive care unit (PICU) rotation, increasing placements on the PICU from 5 to 40 per cent of the student cohort per year. The lecturer practitioner organises the rotation, providing credible links between university and practice areas, while supporting students and staff in offering a high-quality placement experience. Students say the rotation offers a positive insight into PICU nursing, helping them develop knowledge and skills in a technical area and creating an interest in this specialty.

  13. Patients’ Admissions in Intensive Care Units: A Clustering Overview

    Directory of Open Access Journals (Sweden)

    Ana Ribeiro


    Full Text Available Intensive care is a critical area of medicine having a multidisciplinary nature requiring all types of healthcare professionals. Given the critical environment of intensive care units (ICUs, the need to use information technologies, like decision support systems, to improve healthcare services and ICU management is evident. It is proven that unplanned and prolonged admission to the ICU is not only prejudicial to a patient's health, but also such a situation implies a readjustment of ICU resources, including beds, doctors, nurses, financial resources, among others. By discovering the common characteristics of the admitted patients, it is possible to improve these outcomes. In this study clustering techniques were applied to data collected from admitted patients in an intensive care unit. The best results presented a silhouette of 1, with a distance to centroids of 6.2 × 10−17 and a Davies–Bouldin index of −0.652.

  14. Stress ulcer prophylaxis in the intensive care unit

    DEFF Research Database (Denmark)

    Krag, Morten Brøgger; Perner, A; Wetterslev, J


    Stress ulcer prophylaxis (SUP) is regarded as standard of care in the intensive care unit (ICU). However, recent randomized, clinical trials (RCTs) and meta-analyses have questioned the rationale and level of evidence for this recommendation. The aim of the present systematic review was to evaluate...... incidence of gastrointestinal (GI) bleeding varies considerably. Data on the incidence and severity of GI bleeding in general ICUs in the developed world as of today are lacking. The best intervention for SUP is yet to be settled by balancing efficacy and harm. In essence, it is unresolved if intensive care...... patients benefit overall from SUP. The following clinically research questions are unanswered: (1) What is the incidence of GI bleeding, and which interventions are used for SUP in general ICUs today?; (2) Which criteria are used to prescribe SUP?; (3) What is the best SUP intervention?; (4) Do intensive...

  15. Who steers the ship? Rural family physicians' views on collaborative care models for patients with dementia. (United States)

    Kosteniuk, Julie; Morgan, Debra; Innes, Anthea; Keady, John; Stewart, Norma; D'Arcy, Carl; Kirk, Andrew


    Little is known about the views of rural family physicians (FPs) regarding collaborative care models for patients with dementia. The study aims were to explore FPs' views regarding this issue, their role in providing dementia care, and the implications of providing dementia care in a rural setting. This study employed an exploratory qualitative design with a sample of 15 FPs. All rural FPs indicated acceptance of collaborative models. The main disadvantages of practicing rural were accessing urban-based health care and related services and a shortage of local health care resources. The primary benefit of practicing rural was FPs' social proximity to patients, families, and some health care workers. Rural FPs provided care for patients with dementia that took into account the emotional and practical needs of caregivers and families. FPs described positive and negative implications of rural dementia care, and all were receptive to models of care that included other health care professionals.

  16. Primary Care Physician Involvement in Shared Decision Making for Critically Ill Patients and Family Satisfaction with Care. (United States)

    Huang, Kevin B; Weber, Urs; Johnson, Jennifer; Anderson, Nathanial; Knies, Andrea K; Nhundu, Belinda; Bautista, Cynthia; Poskus, Kelly; Sheth, Kevin N; Hwang, David Y


    An intensive care unit (ICU) patient's primary care physician (PCP) may be able to assist family with certain ICU shared medical decisions. We explored whether families of patients in nonopen ICUs who nevertheless report involvement of a patient's PCP in medical decision making are more satisfied with ICU shared decision making than families who do not. Between March 2013 and December 2015, we administered the Family Satisfaction in the ICU 24 survey to family members of adult neuroscience ICU patients. We compared the mean score for the survey subsection regarding shared decision making (graded on a 100-point scale), as well as individual survey items, between those who reported the patient's PCP involvement in any medical decision making versus those who did not. Among 263 respondents, there was no difference in mean overall decision-making satisfaction scores for those who reported involvement (81.1; SD = 15.2) versus those who did not (80.1; SD = 12.8; P = .16). However, a higher proportion reporting involvement felt completely satisfied with their 1) inclusion in the ICU decision making process (75.9% vs 61.4%; P = .055), and 2) control over the care of the patient (73.6% vs 55.6%; P = .02), with no difference regarding consistency of clinical information provided by the medical team (64.8% vs 63.5%; P = 1.00). Families who report involvement of a patient's PCP in medical decision making for critically ill patients may be more satisfied than those who do not with regard to specific aspects of ICU decision making. Further research would help understand how best to engage PCPs in shared decisions. © Copyright 2018 by the American Board of Family Medicine.

  17. Conceptual framework of knowledge management for ethical decision-making support in neonatal intensive care. (United States)

    Frize, Monique; Yang, Lan; Walker, Robin C; O'Connor, Annette M


    This research is built on the belief that artificial intelligence estimations need to be integrated into clinical social context to create value for health-care decisions. In sophisticated neonatal intensive care units (NICUs), decisions to continue or discontinue aggressive treatment are an integral part of clinical practice. High-quality evidence supports clinical decision-making, and a decision-aid tool based on specific outcome information for individual NICU patients will provide significant support for parents and caregivers in making difficult "ethical" treatment decisions. In our approach, information on a newborn patient's likely outcomes is integrated with the physician's interpretation and parents' perspectives into codified knowledge. Context-sensitive content adaptation delivers personalized and customized information to a variety of users, from physicians to parents. The system provides structuralized knowledge translation and exchange between all participants in the decision, facilitating collaborative decision-making that involves parents at every stage on whether to initiate, continue, limit, or terminate intensive care for their infant.

  18. Use of tobacco and alcohol by Swiss primary care physicians: a cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Künzi Beat


    Full Text Available Abstract Background Health behaviours among doctors has been suggested to be an important marker of how harmful lifestyle behaviours are perceived. In several countries, decrease in smoking among physicians was spectacular, indicating that the hazard was well known. Historical data have shown that because of their higher socio-economical status physicians take up smoking earlier. When the dangers of smoking become better known, physicians began to give up smoking at a higher rate than the general population. For alcohol consumption, the situation is quite different: prevalence is still very high among physicians and the dangers are not so well perceived. To study the situation in Switzerland, data of a national survey were analysed to determine the prevalence of smoking and alcohol drinking among primary care physicians. Methods 2'756 randomly selected practitioners were surveyed to assess subjective mental and physical health and their determinants, including smoking and drinking behaviours. Physicians were categorised as never smokers, current smokers and former smokers, as well as non drinkers, drinkers (AUDIT-C Results 1'784 physicians (65% responded (men 84%, mean age 51 years. Twelve percent were current smokers and 22% former smokers. Sixty six percent were drinkers and 30% at risk drinkers. Only 4% were never smokers and non drinkers. Forty eight percent of current smokers were also at risk drinkers and 16% of at risk drinkers were also current smokers. Smoking and at risk drinking were more frequent among men, middle aged physicians and physicians living alone. When compared to a random sample of the Swiss population, primary care physicians were two to three times less likely to be active smokers (12% vs. 30%, but were more likely to be drinkers (96% vs. 78%, and twice more likely to be at risk drinkers (30% vs. 15%. Conclusion The prevalence of current smokers among Swiss primary care physicians was much lower than in the general

  19. Physician Communication in Pediatric End-of-Life Care: A Simulation Study. (United States)

    Bateman, Lori Brand; Tofil, Nancy M; White, Marjorie Lee; Dure, Leon S; Clair, Jeffrey Michael; Needham, Belinda L


    The objective of this exploratory study is to describe communication between physicians and the actor parent of a standardized 8-year-old patient in respiratory distress who was nearing the end of life. Thirteen pediatric emergency medicine and pediatric critical care fellows and attendings participated in a high-fidelity simulation to assess physician communication with an actor-parent. Fifteen percent of the participants decided not to initiate life-sustaining technology (intubation), and 23% of participants offered alternatives to life-sustaining care, such as comfort measures. Although 92% of the participants initiated an end-of-life conversation, the quality of that discussion varied widely. Findings indicate that effective physician-parent communication may not consistently occur in cases involving the treatment of pediatric patients at the end of life in emergency and critical care units. The findings in this study, particularly that physician-parent end-of-life communication is often unclear and that alternatives to life-sustaining technology are often not offered, suggest that physicians need more training in both communication and end-of-life care. © The Author(s) 2015.

  20. Transfusional profile in different types of intensive care units

    Directory of Open Access Journals (Sweden)

    Ilusca Cardoso de Paula


    Full Text Available Background and objectives: anemia is a common clinical finding in intensive care units. The red blood cell transfusion is the main form of treatment, despite the associated risks. Thus, we proposed to evaluate the profile of transfusional patients in different intensive care units. Methods: prospective analysis of patients admitted in the intensive care units of a tertiary university hospital with an indication for transfusion of packed red blood cells. Demographic profile and transfusional profile were collected, a univariate analysis was done, and the results were considered significant at p = 0.05. Results: 408 transfusions were analyzed in 71 patients. The mean hemoglobin concentration on admission was 9.7 ± 2.3 g/dL and the pre-transfusional concentration was 6.9 ± 1.1 g/dL. The main indications for transfusion were hemoglobin concentration (49% and active bleeding (32%. The median number of units transfused per episode was 2 (1-2 and the median storage time was 14 (7-21 days. The number of patients transfused with hemoglobin levels greater than 7 g/dL and the number of bags transfused per episode were significantly different among intensive care units. Patients who received three or more transfusions had longer mechanical ventilation time and intensive care unit stay and higher mortality after 60 days. There was an association of mortality with disease severity but not with transfusional characteristics. Conclusions: the practice of blood products transfusion was partially in agreement with the guidelines recommended, although there are differences in behavior between the different profiles of intensive care units. Transfused patients evolved with unfavorable outcomes. Despite the scarcity of blood in blood banks, the mean storage time of the bags was high.

  1. Physician self-referral for imaging and the cost of chronic care for Medicare beneficiaries. (United States)

    Hughes, Danny R; Sunshine, Jonathan H; Bhargavan, Mythreyi; Forman, Howard


    As the cost of both chronic care and diagnostic imaging continue to rise, it is important to consider methods of cost containment in these areas. Therefore, it seems important to study the relationship between self-referral for imaging and the cost of care of chronic illnesses. Previous studies, mostly of acute illnesses, have found self-referral increases utilization and, thus, probably imaging costs. To evaluate the relationship between physician self-referral for imaging and the cost of episodes of chronic care. Using Medicare's 5% Research Identifiable Files for 2004 to 2007, episodes of care were constructed for 32 broad chronic conditions using the Symmetry Episode Treatment Grouper. Using multivariate regression, we evaluated the association between whether the treating physician self-referred for imaging and total episode cost, episode imaging cost, and episode nonimaging cost. Analyses were controlled for patient characteristics (eg, age and general health status), the condition's severity, and treating physician specialty. Self-referral in imaging was significantly (P nonimaging costs were much more often significantly higher (in 24 combinations) with self-referral than being lower (in 4 combinations). We find broad evidence that physician self-referral for imaging is associated with significantly and substantially higher chronic care costs. Unless self-referral has empirically demonstrable benefits, curbing self-referral may be an appropriate route to containing chronic care costs.

  2. Perceptions of substance use, treatment options and training needs among Iranian primary care physicians

    Directory of Open Access Journals (Sweden)

    Dolan Kate A


    Full Text Available Abstract In order to be optimally effective, continuing training programmes for health-care professionals need to be tailored so that they target specific knowledge deficits, both in terms of topic content and appropriate intervention strategies. A first step in designing tailored treatment programmes is to identify the characteristics of the relevant health-care professional group, their current levels of content and treatment knowledge, the estimated prevalence of drug and alcohol problems among their patients and their preferred options for receiving continuing education and training. This study reports the results of a survey of 53 primary care physicians working in Iran. The majority were male, had a mean age of 44 years and saw approximately 94 patients per week. In terms of their patients' drug use, primary care physicians thought most patients with a substance use problem were male, women were most likely to use tobacco (52%, opium (32% and marijuana/hashish and young people were most likely to use tobacco, alcohol, marijuana and heroin. Counselling and nicotine patches were the treatments most commonly provided. Although the majority (55% reported referring patients to other services, more than a third did not. Most primary care physicians reported being interested in attending further training on substance abuse issues. The implications of these data for ongoing education and training of primary care physicians in Iran are discussed.

  3. [Social change in the physician's role and medical practice caused by managed care in Switzerland]. (United States)

    Meyer, P C; Denz, M D


    Switzerland is the first European country where health maintenance organizations (HMOs) characterised by capitation (per capita lumpsum) and gatekeeping were implemented according to the HMO staff model known in the USA. The development of managed health care in Switzerland relies on the belief that adequate economic incentives and competition result in cost reduction and high quality health care. Whether this is true or not--in any case the deregulation of legally accepted forms of health insurance and managed care result in profound changes in the Swiss health care system. Observations are made by using expert interviews and analysis of documents. The implementation of managed care induces socio-cultural changes of the medical profession which are as profound as the induced economic changes. We discuss conflicts of interests among physicians using four main dimensions of conflict: (1) control, (2) monopolization, (3) valuation, and (4) specialization. In the HMOs we observe pronounced conflicts of the physicians' role. The changes of the physicians' role in HMOs is on the one hand the result of new duties. On the other hand it expresses strategies of coping with the role conflict between the main clinical duties and the new obligation to control cost and to monitor treatment via gatekeeping. In HMOs the teamwork of doctors and the quality control of care promotes the satisfaction of physicians with their work, however, it can also have dysfunctional effects.

  4. Physician satisfaction with a critical care clinical information system using a multimethod evaluation of usability. (United States)

    Hudson, Darren; Kushniruk, Andre; Borycki, Elizabeth; Zuege, Danny J


    Physician satisfaction with electronic medical records has often been poor. Usability has frequently been identified as a source for decreased satisfaction. While surveys can identify many issues, and are logistically easier to administer, they may miss issues identified using other methods This study sought to understand the level of physician satisfaction and usability issues associated with a critical care clinical information system (eCritical Alberta) implemented throughout the province of Alberta, Canada. All critical care attending physicians using the system were invited to participate in an online survey. Questions included components of the User Acceptance of Information Technology and Usability Questionnaire as well as free text feedback on system components. Physicians were also invited to participate in a think aloud test using simulated scenarios. The transcribed think aloud text and questionnaire were subjected to textual analysis. 82% of all eligible physicians completed the on-line survey (n = 61). Eight physicians were invited and seven completed the think aloud test. Overall satisfaction with the system was moderate. Usability was identified as a significant factor contributing to satisfaction. The major usability factors identified were system response time and layout. The think aloud component identified additional factors beyond those identified in the on-line survey. This study found a modestly high level of physician satisfaction with a province-wide clinical critical care information system. Usability continues to be a significant factor in physician satisfaction. Using multiple methods of evaluation can capture the benefits of a large sample size and deeper understanding of the issues. Copyright © 2018 Elsevier B.V. All rights reserved.

  5. Abnormal environmental light exposure in the intensive care environment. (United States)

    Fan, Emily P; Abbott, Sabra M; Reid, Kathryn J; Zee, Phyllis C; Maas, Matthew B


    We sought to characterize ambient light exposure in the intensive care unit (ICU) environment to identify patterns of light exposure relevant to circadian regulation. A light monitor was affixed to subjects' bed at eye level in a modern intensive care unit and continuously recorded illuminescence for at least 24h per subject. Blood was sampled hourly and measured for plasma melatonin. Subjects underwent hourly vital sign and bedside neurologic assessments. Care protocols and the ICU environment were not modified for the study. A total of 67,324 30-second epochs of light data were collected from 17 subjects. Light intensity peaked in the late morning, median 64.1 (interquartile range 19.7-138.7) lux. The 75th percentile of light intensity exceeded 100lx only between 9AM and noon, and never exceeded 150lx. There was no correlation between melatonin amplitude and daytime, nighttime or total light exposure (Spearman's correlation coefficients all 0.5). Patients' environmental light exposure in the intensive care unit is consistently low and follows a diurnal pattern. No effect of nighttime light exposure was observed on melatonin secretion. Inadequate daytime light exposure in the ICU may contribute to abnormal circadian rhythms. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Physicians' perceptions of capacity building for managing chronic disease in seniors using integrated interprofessional care models. (United States)

    Lee, Linda; Heckman, George; McKelvie, Robert; Jong, Philip; D'Elia, Teresa; Hillier, Loretta M


    To explore the barriers to and facilitators of adapting and expanding a primary care memory clinic model to integrate care of additional complex chronic geriatric conditions (heart failure, falls, chronic obstructive pulmonary disease, and frailty) into care processes with the goal of improving outcomes for seniors. Mixed-methods study using quantitative (questionnaires) and qualitative (interviews) methods. Ontario. Family physicians currently working in primary care memory clinic teams and supporting geriatric specialists. Family physicians currently working in memory clinic teams (n = 29) and supporting geriatric specialists(n = 9) were recruited as survey participants. Interviews were conducted with memory clinic lead physicians (n = 16).Statistical analysis was done to assess differences between family physician ratings and geriatric specialist ratings related to the capacity for managing complex chronic geriatric conditions, the role of interprofessional collaboration within primary care, and funding and staffing to support geriatric care. Results from both study methods were compared to identify common findings. Results indicate overall support for expanding the memory clinic model to integrate care for other complex conditions. However, the current primary care structure is challenged to support optimal management of patients with multiple comorbidities, particularly as related to limited funding and staffing resources. Structured training, interprofessional teams, and an active role of geriatric specialists within primary care were identified as important facilitators. The memory clinic model, as applied to other complex chronic geriatric conditions, has the potential to build capacity for high-quality primary care, improve health outcomes,promote efficient use of health care resources, and reduce healthcare costs.

  7. What Does Change with Nutrition Team in Intensive Care Unit?

    Directory of Open Access Journals (Sweden)

    Ahmet Fatih Yılmaz


    Full Text Available Intrroduction: Clinical nutrition is the nutrition support therapy provided to patients under medical supervision at the hospital or home setting. It is a multidisciplinary task performed under the control of the physician, dietician, pharmacist and nurse. In this study, the changes in the patient admission statistics to the general intensive care unit (GICU, the exitus ratios, decubitus ulcer formation rates, albumin use rates, duration of the hospital stay, Acute Physiology and Chronic Health Evaluation (APACHE II scores, rate of usege of parenteral and enteral products, and the change in expenses per patient within the first year of activity of the nutrition team in comparison to the previous year was presented. Material and Method: In this study a 6-bed GICU was used. The patients who was admitted through retrospective file scanning between 1 January 2012 and 31 December 2012 and between 1 January 2013 and 31 December 2013 were compared. Results: The number of the patients admitted to the GICU was 341 in 2012 and 369 in 2013. The number of the patients who died in 2012 was 86 (25.2%, while it was 106 in 2013 (28.7%. In 2012, 122 patients (35.7% had decubitus ulcers, while this number was 92 (24.7% in 2013. Human albumin usage was reduced by 23% for the 100 mL (225 in 2012, 175 in 2013 and by 33% for the 50 mL doses (122 in 2012, 82 in 2013. Duration of stay in the hospital was 6.3±0.9 vs. 5.8±0.9 (days (p=0.06. The mean APACHE II scores were observed to be 24.7±6.9 vs. 30.5±11.4 (p=0.03. When the distribution of product types were analyzed, it was observed that the ratio of parenteral products: enteral products was 2:1 in 2012, however the ratio of enteral products to parenteral products was 2:1 in 2013. The daily expense of a patient decreased from 100 TL to 55 TL. Conclusion: The nutrition team directly influences the clinical process outcomes of patients under treatment in the ICU. It was thought that using appropriate nutritional

  8. Fighting antibiotic resistance in the intensive care unit using antibiotics. (United States)

    Plantinga, Nienke L; Wittekamp, Bastiaan H J; van Duijn, Pleun J; Bonten, Marc J M


    Antibiotic resistance is a global and increasing problem that is not counterbalanced by the development of new therapeutic agents. The prevalence of antibiotic resistance is especially high in intensive care units with frequently reported outbreaks of multidrug-resistant organisms. In addition to classical infection prevention protocols and surveillance programs, counterintuitive interventions, such as selective decontamination with antibiotics and antibiotic rotation have been applied and investigated to control the emergence of antibiotic resistance. This review provides an overview of selective oropharyngeal and digestive tract decontamination, decolonization of methicillin-resistant Staphylococcus aureus and antibiotic rotation as strategies to modulate antibiotic resistance in the intensive care unit.

  9. Scope of Nursing Care in Polish Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Mariusz Wysokiński


    Full Text Available Introduction. The TISS-28 scale, which may be used for nursing staff scheduling in ICU, does not reflect the complete scope of nursing resulting from varied cultural and organizational conditions of individual systems of health care. Aim. The objective of the study was an attempt to provide an answer to the question what scope of nursing care provided by Polish nurses in ICU does the TISS-28 scale reflect? Material and Methods. The methods of working time measurement were used in the study. For the needs of the study, 252 hours of continuous observation (day-long observation and 3.697 time-schedule measurements were carried out. Results. The total nursing time was 4125.79 min. (68.76 hours, that is, 60.15% of the total working time of Polish nurses during the period analyzed. Based on the median test, the difference was observed on the level of χ2=16945.8, P<0.001 between the nurses’ workload resulting from performance of activities qualified into the TISS-28 scale and load resulting from performance of interventions within the scopes of care not considered in this scale in Polish ICUs. Conclusions. The original version of the TISS-28 scale does not fully reflect the workload among Polish nurses employed in ICUs.

  10. Prevalence of nursing diagnoses in an intensive care unit

    Directory of Open Access Journals (Sweden)

    Vinicia de Holanda Cabral


    Full Text Available To identify the main nursing diagnostic titles used in the care of critically ill patients hospitalized in an Intensive Care Unit, verifying the presence thereof in the diagnoses of NANDA International’s Taxonomy II. Methods: descriptive and documental study, in which 69 medical records of patients aged over 18 years were consulted. Results: 22 nursing diagnostic titles were found; the most frequent was risk for infection (99.0%, risk for skin integrity (75.0% and risk for aspiration (61.0%. Most diagnoses were in the domains safety/ protection (43.0% and activity/rest (26.5%. Conclusions: authors identified the main nursing diagnostic titles used in the care of critically ill patients admitted to the Intensive Care Unit and the presence thereof in the diagnoses of NANDA International’s Taxonomy II.

  11. Differences in cardiovascular disease risk factor management in primary care by sex of physician and patient. (United States)

    Tabenkin, Hava; Eaton, Charles B; Roberts, Mary B; Parker, Donna R; McMurray, Jerome H; Borkan, Jeffrey


    The purpose of this study was to evaluate differences in the management of cardiovascular disease (CVD) risk factors based upon the sex of the patient and physician and their interaction in primary care practice. We evaluated CVD risk factor management in 4,195 patients cared for by 39 male and 16 female primary care physicians in 30 practices in southeastern New England. Many of the sex-based differences in CVD risk factor management on crude analysis are lost once adjusted for confounding factors found at the level of the patient, physician, and practice. In multilevel adjusted analyses, styles of CVD risk factor management differed by the sex of the physician, with more female physicians documenting diet and weight loss counseling for hypertension (odds ratio [OR] = 2.22; 95% confidence interval [CI], 1.12-4.40) and obesity (OR = 2.14; 95% CI, 1.30-3.51) and more physical activity counseling for obesity (OR = 2.03; 95% CI, 1.30-3.18) and diabetes (OR = 6.55; 95% CI, 2.01-21.33). Diabetes management differed by the sex of the patient, with fewer women receiving glucose-lowering medications (OR = 0.49; 95% CI, 0.25-0.94), angiotensin-converting enzyme inhibitor therapy (OR = 0.39; 95% CI, 0.22-0.72), and aspirin prophylaxis (OR = 0.30; 95% CI, 0.15-0.58). Quality of care as measured by patients meeting CVD risk factors treatment goals was similar regardless of the sex of the patient or physician. Selected differences were found in the style of CVD risk factor management by sex of physician and patient.

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

    Directory of Open Access Journals (Sweden)

    Dantas Guilherme


    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.

  13. Evidence-based medicine in primary care: qualitative study of family physicians. (United States)

    Tracy, C Shawn; Dantas, Guilherme Coelho; Upshur, Ross E G


    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. 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. 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. 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.

  14. Burnout of Physicians Working in Primary Health Care Centers under Ministry of Health Jeddah, Saudi Arabia. (United States)

    Bawakid, Khalid; Abdulrashid, Ola; Mandoura, Najlaa; Shah, Hassan Bin Usman; Ibrahim, Adel; Akkad, Noura Mohammad; Mufti, Fauad


    Introduction The levels of physicians' job satisfaction and burnout directly affect their professionalism, punctuality, absenteeism, and ultimately, patients' care. Despite its crucial importance, little is known about professional burnout of the physicians in Saudi Arabia. The objectives of this research are two-fold: (1) To assess the prevalence of burnout in physicians working in primary health care centers under Ministry of Health; and (2) to find the modifiable factors which can decrease the burnout ratio. Methodology Through a cross-sectional study design, a representative sample of the physicians working in primary health care centers (PHCCs) Jeddah (n=246) was randomly selected. The overall burnout level was assessed using the validated abbreviated Maslach burnout inventory (aMBI) questionnaire. It measures the overall burnout prevalence based on three main domains i.e., emotional exhaustion, depersonalization, and personal accomplishment. Independent sample T-test, analysis of variance (ANOVA), and multivariate regression analysis were performed using Statistical Package for the Social Sciences (SPSS Version 22, IBM, Armonk, NY). Results Overall, moderate to high burnout was prevalent in 25.2% of the physicians. Emotional exhaustion was noted in 69.5%. Multivariate regression analysis showed that patient pressure/violence (p burnout. The patient's pressure/violence was the only significant independent predictor of overall burnout. Conclusion Emotional exhaustion is the most prominent feature of overall burnout in the physicians of primary health care centers. The main reasons include patient's pressure/violence, unorganized patient flow, less cooperative colleague doctors, fewer support services at the PHCCs, more paperwork, and less cooperative colleagues. Addressing these issues could lead to a decrease in physician's burnout.

  15. Addressing domestic violence in primary care: what the physician ...

    African Journals Online (AJOL)


    Mar 14, 2014 ... stance abuse, suicidal behavior, somatizing disorders, eating disorders, and ... anxiety disorders, and PTSD are at a higher risk of experiencing adult ... reported by mental health and primary care professionals. (29) included ... about the nature and course of DV and assessing the level of readiness to ...

  16. Are primary care physicians equipped enough to act as first ...

    African Journals Online (AJOL)

    Background: Prompt and appropriate management of dental trauma has been shown to significantly improve the prognosis of the resulting injuries in numerous cases. Frequently it is other health professionals that provide emergency care following traumatic dental injuries including tooth avulsion. The objective of this study ...