Sample records for referring physician expectations

  1. Justification: How to get referring physicians involved

    International Nuclear Information System (INIS)

    Remedios, D.


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

  2. Aligning Career Expectations with the Practice of Medicine: Physician Satisfaction (United States)

    Gibson, Denise D.; Borges, Nicole J.


    This study examined physicians' level of satisfaction with their job and the match between expectations and actual practice of specialty. Quantitative results suggested that physicians (N = 211) had a moderately high level of overall job satisfaction with no significant differences found between men and women physicians. Among those in primary…

  3. Perceptions, Experiences and Expectations of Physicians ...

    African Journals Online (AJOL)

    research assistant explained the study aims and the various parts of the questionnaire to the physicians. Data collection was conducted by a single trained research assistant to ensure consistency. The questionnaire used in this investigation was adapted with minor modifications from previously published studies [12-15].

  4. Radiologic reports : attitudes, preferred type, and opinion of referring physicians

    International Nuclear Information System (INIS)

    Kim, Won Young; Hwang, Seong Su; Ahn, Myeong Im and others


    To determine referring physicians' general attitudes, preferred reporting types, and opinions on radiologic reports. A survey questionnaire was distributed to the 315 staff and residents of four university hospitals with 400 to 800 beds, and a total of 228 physicians responded. The questionnaire aimed to determine of the general attitude of referring physicians to radiologic reports, the type of report they preferred, and other opinions and suggestions. The responses elicited, as well as discrepancies among residents, staff, internist, and surgeons, were analyzed. Most referring physicians replied that they read an entire report regardless of its length, and the second majority read the conclusion first and then the remainder of the report only if clarification was required. With regard to report length, physicians answered that reports describing the findings of conventional radiography were often too short, while those dealing with MRI were verbose. The majority experienced occasional confusion when reading a report, the major cause being grammatical errors and incomprehensible sentence structure. When confused, most physicians consulted the radiologist ; staff showed a greater inclination than residents to pursue this option. Most physicians preferred brief phrases or telegraphic-style sentences to a style which stressed completeness and detail, a preference which was statistically higher among residents than staff. Whereas physicians favored a brief radiologic report in cases of normal radiologic findings, conventional radiologic studies or no clinical findings, they wished to see a more detailed report in cases of abnormal radiologic findings, specific radiologic studies (special radiographs, US, CT, or MRI), or positive clinical findings. This need for more detail was expressed more frequently by internists than by surgeons. If implemented, the results of this study can be expected to enhance the quality and comprehensibility of radiologic reports, and may

  5. Physicians' and Pharmacists' Experience and Expectations of the ...

    African Journals Online (AJOL)

    Purpose: To investigate physicians' and pharmacists' experience and expectations of the roles of pharmacists in hospital setting in Macau for the development of physician-pharmacist collaborative working relationship (CWR). Methods: A survey was conducted to address the research questions. The study population ...

  6. Conscientious refusals to refer: Findings from a national physician survey (United States)

    Combs, Michael P.; Antiel, Ryan M.; Tilburt, Jon C.; Mueller, Paul S.; Curlin, Farr A.


    Background Regarding controversial medical services, many have argued that if physicians cannot in good conscience provide a legal medical intervention for which a patient is a candidate, they should refer the requesting patient to an accommodating provider. This study examines what US physicians think a doctor is obligated to do when the doctor thinks it would be immoral to provide a referral. Method We conducted a cross-sectional survey of a random sample of 2000 U.S. physicians from all specialties. Our primary criterion variable was agreement that physicians have a professional obligation to refer patients for all legal medical services for which the patients are candidates, even if the physician believes that such a referral is immoral. Results Of 1895 eligible physicians, 1032 (55%) responded. Fifty-seven percent of physicians agreed that doctors must refer patients regardless of whether or not the doctor believes the referral itself is immoral. Holding this opinion was independently associated with being more theologically pluralistic, describing oneself as sociopolitically liberal, and indicating that respect for patient autonomy is the most important bioethical principle in one’s practice (multivariable odds ratios, 1.6 to 2.4). Conclusions Physicians are divided about a professional obligation to refer when the physician believes that referral itself is immoral. These data suggest there is no uncontroversial way to resolve conflicts posed when patients request interventions that their physicians cannot in good conscience provide. PMID:21335574

  7. Referring physician satisfaction: toward a better understanding of hospital referrals. (United States)

    Ponzurick, T G; France, K R; Logar, C M


    Customer satisfaction literature has contributed significantly to the development of marketing strategies in the health-care arena. The research has led to the development of hospital-driven relationship marketing programs. This study examines the inclusion of referring physicians as partners in the hospital's relationship marketing program. In exploring this relationship, medical and hospital facility characteristics that referring physicians find important in making patient referrals to specialty care hospitals are identified and analyzed. The results lead to the development of strategic initiatives which hospital marketers should consider when developing relationship marketing programs designed to satisfy their referring physicians.

  8. Filmless reading and digital imaging distribution with refering to physicians

    International Nuclear Information System (INIS)

    Matzko, M.; Nissen-Meyer, S.; Sprenger, D.


    In healthcare, cost effectiveness as well as the quality of examinations and procedures are subjected to quickly increasing expectations and demands: We like to demonstrate how the resulting challenges and problems can be met with implementation of modern information technology. Analysing the respective demands (pattern of quantities) and choosing the adequate technical solution/ technical approach, we found filmless reading and the usage of digital image distribution to communicate with referring physicians to be cost effective as well as of higher quality. Special attention should be paid to the rigorous maintenance of data security and access. Today's information technology allows individual adjustment to the respective size and requirements of a radiological department or practice for filmless reading and digital image distribution. Working with the systems as a matter of routine and using all of the expanding technological possibilities, an important improvement of service and quality can be achieved. Amortisation will be obtained despite high investments, due to the subsequent savings in personal- and enterprise costs. (orig.) [de

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

    Directory of Open Access Journals (Sweden)

    Bynum Debra L


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

  10. Physicians' and Pharmacists' Experience and Expectations of the ...

    African Journals Online (AJOL)

    Tropical Journal of Pharmaceutical Research December 2013; 12 (6): 1077-1085 ... knowledge and participate in patient care [Error! Reference ..... recommendations in the use of prescription .... for refinement of survey questions, translation of.

  11. Physicians' perceptions, expectations, and experience with pharmacists at Hamad Medical Corporation in Qatar. (United States)

    Zaidan, Manal; Singh, Rajvir; Wazaify, Mayyada; Tahaineh, Linda


    The purpose of this study was to investigate the physicians' perceptions, and expectations of their experiences with the pharmacists at Hamad Medical Corporation (HMC) in Qatar. A cross-sectional study was conducted at HMC between January and March 2006 using a validated questionnaire. The self-administered questionnaire was distributed to 500 physicians who were working at HMC comprising Hamad General Hospital, Women's Hospital, Rumaila Hospital, Al-Amal Hospital, Al Khor Hospital, and primary health centers. The questionnaire was composed of four parts, investigating the physicians' expectations, experiences, and perceptions of the pharmacists. A total of 205 questionnaires were completed (response rate 41%). A total of 183 physicians (89%) expected the pharmacist to educate patients about safe and appropriate use of drugs, whereas 118 (57%) expected the pharmacist to be available for health-care team consultation during bedside rounds. The indices of physicians showing how comfortable they were with pharmacists, and their expectations of pharmacists, were 61% and 65%, respectively, whereas the index on experience of physicians with pharmacists was lower (15%). Physicians were comfortable with pharmacists and had high expectations of pharmacists in performing their duties. However, physicians reported a poor experience with pharmacists, who infrequently informed them about the effectiveness of alternative drugs, patients experiencing problems with prescribed medications, and who took personal responsibility to resolve any drug-related problem.

  12. A Comparison of Expectations of Physicians and Patients with Chronic Pain for Pain Clinic Visits. (United States)

    Calpin, Pádraig; Imran, Ather; Harmon, Dominic


    The patient-physician encounter forms the cornerstone of every health service. However, optimal medical outcomes are often confounded by inadequate patient-physician communication. Chronic pain is estimated to affect over 25% of the population. Its effects are multifaceted with patients at increased risk of experiencing emotional and functional disturbances. Therefore, it is crucial to address all components of the patient's pain experience, including beliefs and expectations. It is our understanding that no other study to date has evaluated the expectations of physicians and compared them to those of patients for pain clinic visits. We sought to describe and compare expectations of chronic pain patients and their physicians during a clinic consultation. We performed a retrospective review on patients attending the pain clinic for the first time who were enrolled and completed a questionnaire asking their expectations for their clinic visit as well as outcomes that would satisfy and disappoint them. Pain physicians were also included. We compared physicians' to patients' responses and evaluated relationships between patient responses and age, gender, pain location, Pain Self-Efficacy, Pain Catastrophizing Scale, and the Hospital Anxiety and Depression Scale. One hundred chronic pain patients and 10 pain physicians were surveyed. Patients' clinical expectations for visits focused primarily on some pain relief (34%), education on the cause of pain (24%), and a definitive diagnosis (18%). Physician's expectations included formulation and communication of a management plan (70%), patient assessment for cause of pain (50%), and the education of patients on the cause of pain (40%) as important aims. Pain relief would satisfy the majority of patients (74%) and physicians (70%). No improvement would cause greatest dissatisfaction for patients (52%), but causing more harm would be disappointing to physicians (50%). Gender, age, pain location, and sleep quality all

  13. 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.

  14. Knowing Your Worth: Salary Expectations and Gender of Matriculating Physician Assistant Students. (United States)

    Streilein, Annamarie; Leach, Brandi; Everett, Christine; Morgan, Perri


    The male-female wage gap is present and persistent in the health care sector, even among physician assistants (PAs). Explanations for the persistent gender earnings gap include differential salary expectations of men and women based, in part, on women's lower pay entitlement. The purpose of this study was to examine differences in salary expectations between male and female matriculating PA students nationwide, adjusting for other factors expected to affect salaries and pay expectations of both male and female matriculants. Using data from the Physician Assistant Education Association Matriculating Student Survey of 2013, 2014, and 2015, we investigated the relationship between first-year PA students' gender and their salary expectations after graduation using a multinomial logistic regression analysis. We controlled for possible confounders by including independent variables measuring student demographics, background characteristics, qualifications, future career plans, and financial considerations. We found that female PA students were less likely than male PA students to expect a salary of $80,000-$89,999 (Odds Ratio [OR] = 0.73), $90,000-$99,999 (OR = 0.58), or $100,000 or greater (OR = 0.42) in comparison to an expected salary of less than $70,000, when controlling for our independent variables. Our analysis shows that on entry into PA training programs, female PA students' earnings expectations are less than those of male PA students. Our results are consistent with research, suggesting that women typically expect lower pay and systematically undervalue their contributions and skills in comparison to men. Physician assistant programs should consider strategies to promote realistic salary expectations among PA students as one way to promote earnings equity.

  15. Physician and medical student perceptions and expectations of the pediatric clerkship: a Qatar experience

    Directory of Open Access Journals (Sweden)

    Hendaus MA


    Full Text Available Mohamed A Hendaus,1,2 Shabina Khan,1 Samar Osman,1 Yasser Alsamman,2 Tushar Khanna,2 Ahmed H Alhammadi1,2 1Department of Pediatrics, General Academic Pediatrics Division, Hamad Medical Corporation, Doha, 2Weill Cornell Medical College-Qatar, Al Rayyan, Qatar Background: The average number of clerkship weeks required for the pediatric core rotation by the US medical schools is significantly lower than those required for internal medicine or general surgery. Objective: The objective behind conducting this survey study was to explore the perceptions and expectations of medical students and pediatric physicians about the third-year pediatric clerkship. Methods: An anonymous survey questionnaire was distributed to all general pediatric physicians at Hamad Medical Corporation and to students from Weill Cornell Medical College-Qatar. Results: Feedback was obtained from seven attending pediatricians (100% response rate, eight academic pediatric fellow physicians (100% response rate, 36 pediatric resident physicians (60% response rate, and 36 medical students (60% response rate. Qualitative and quantitative data values were expressed as frequencies along with percentages and mean ± standard deviation and median and range. A P-value <0.05 from a 2-tailed t-test was considered to be statistically significant. Participants from both sides agreed that medical students receive <4 hours per week of teaching, clinical rounds is the best environment for teaching, adequate bedside is provided, and that there is no adequate time for both groups to get acquainted to each other. On the other hand, respondents disagreed on the following topics: almost two-thirds of medical students perceive postgraduate year 1 and 2 pediatric residents as the best teachers, compared to 29.4% of physicians; 3 weeks of inpatient pediatric clerkship is enough for learning; the inpatient pediatric environment is safe and friendly; adequate feedback is provided by physicians to

  16. 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

  17. CT coronary angiography versus conventional invasive coronary angiography. The view of the referring physician

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    Maurer, Martin H. [Charite - Universitaetsmedizin Berlin (Germany). Dept. of Radiology; Universitaetsspital Bern (Switzerland). Dept. fuer Diagnostische, Interventionelle und Paediatrische Radiologie; Zimmermann, E.; Hamm, B. [Charite - Universitaetsmedizin Berlin (Germany). Dept. of Radiology; Dewey, M.


    Assessment of experience gained by local referring physicians with the procedure of coronary computed tomographic angiography (CCTA) in the everyday clinical routine. A 25-item questionnaire was sent to 179 physicians, who together had referred a total of 1986 patients for CCTA. They were asked about their experience to date with CCTA, the indications for coronary imaging, and their practice in referring patients for noninvasive CCTA or invasive catheter angiography. 53 questionnaires (30%) were assessable, corresponding to more than 72% of the patients referred. Of the referring physicians who responded, 94% saw a concrete advantage of CCTA in the treatment of patients, whereby 87% were 'satisfied' or 'very satisfied' with the reporting. For excluding coronary heart disease (CHD) where there was a low pre-test probability of disease, the physicians considered CCTA to be superior to conventional coronary diagnosis (4.2 on a scale of 1-5) and vice versa for acute coronary syndrome (1.6 of 5). The main reasons for unsuitability of CCTA for CT diagnosis were claustrophobia and the absence of a sinus rhythm. The level of exposure to radiation in CCTA was estimated correctly by only 42% of the referring physicians. 90% of the physicians reported that their patients evaluated their coronary CT overall as 'positive' or 'neutral', while 87% of the physicians whose patients had undergone both procedures reported that the patients had experienced CCTA as the less disagreeable of the two. CCTA is accepted by the referring physicians as an alternative imaging procedure for the exclusion of CHD and received a predominantly positive assessment from both the referring physicians and the patients.

  18. Fostering excellence: roles, responsibilities, and expectations of new family physician clinician investigators. (United States)

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


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

  19. Referring Physicians' Tendency to Collaborate With Radiologists in Managing Contrast Media-Related Risk Factors. (United States)

    İmamoğlu, Hakan; Doğan, Serap; Erdoğan, Nuri


    The aim of this study was to investigate the tendency of referring physicians to collaborate with radiologists in managing contrast media (CM)-related risk factors. The study was conducted at a single academic hospital. Among 150 referring physicians from various specialties, 51 referring physicians (34%) responded to the invitation letter asking for an interview with a radiologist. During the interview, a modified form of the Control Preferences Scale was administered, in which there were five preferences (each displayed on a separate card) that ranged from the fully active to fully passive involvement of referring physicians in managing CM-related risk factors. A descriptive analysis was performed through categorization of the results depending on the respondents' two most preferred roles. Thirty-six referring physicians (70.5%) preferred a collaborative role, and 15 (29.4%) preferred a noncollaborative role (i.e., remained on either the fully active or fully passive side). Among the referring physicians who preferred a collaborative role, the most common response (n = 15 [29.4%]) was collaborative-active. Referring physicians at the authors' institution have basic cognitive and motivational-affective tone toward collaboration in future teamwork aimed at the management of CM-related risk factors. A modified form of the Control Preferences Scale, as in this study, can be used to investigate the tendency of referring physicians to collaborate with radiologists. The results are discussed from ethical and legal perspectives. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  20. Valued Components of a Consultant Letter from Referring Physicians' Perspective: a Systematic Literature Synthesis. (United States)

    Rash, Arjun H; Sheldon, Robert; Donald, Maoliosa; Eronmwon, Cindy; Kuriachan, Vikas P


    Effective communication between the consultants and physicians form an integral foundation of effective and expert patient care. A broad review of the literature has not been undertaken to determine the components of a consultant's letter of most value to the referring physician. We aimed to identify the components of a consultant's letter preferred by referring physicians. We searched Embase and MEDLINE (OVID) Medicine (EBM) Reviews and Cochrane Database of Systematic Reviews for English articles with no restriction on initial date to January 6, 2017. Articles containing letters from specialists to referring physicians regarding outpatient assessments with either an observational or experimental design were included. Studies were excluded if they pertained to communications from referring physicians to consultant specialists, or pertained to allied health professionals, inpatient documents, or opinion articles. We enumerated the frequencies with which three common themes were addressed, and the positive or negative nature of the comments. The three themes were the structure of consultant letters, their contents, and whether referring physicians and consultants shared a common opinion about the items. Eighteen articles were included in our synthesis. In 11 reports, 91% of respondents preferred structured formats. Other preferred structural features were problem lists and brevity (four reports each). The most preferred contents were oriented to insight: diagnosis, prognosis, and management plan (16/21 mentions in the top tertile). Data items such as history, physical examination, and medication lists were less important (1/23 mentions in the top tertile). Reports varied as to whether referring physicians and consultants shared common opinions about letter features. Referring physicians prefer brief, structured letters from consultants that feature diagnostic and prognostic opinions and management plans over unstructured letters that emphasize data elements such as

  1. Different reference frames can lead to different hand transplantation decisions by patients and physicians. (United States)

    Edgell, S E; McCabe, S J; Breidenbach, W C; Neace, W P; LaJoie, A S; Abell, T D


    Different frames of reference can affect one's assessment of the value of hand transplantation. This can result in different yet rational decisions by different groups of individuals, especially patients and physicians. In addition, factors other than frames of reference can affect one's evaluation of hand transplantation, which can result in different decisions.

  2. When referring physicians and researchers disagree on equipoise: the TOTAL trial experience. (United States)

    Rodrigues, H C M L; Deprest, J; v d Berg, P P


    In this article, we reflect on whether randomized controlled trials (RCTs) are adequate for the clinical evaluation of maternal-fetal surgery for congenital diaphragmatic hernia (CDH), focusing on the role of patients' preferences in the setting up of research protocols, on the requirement of equipoise and on the concept of therapeutic misconception (TM). We describe the conception and setting up of the tracheal occlusion (TO) to accelerate lung growth trial and analyze the ethical dilemmas faced by the research team during that time. Depending on the view adopted regarding the scope of equipoise, there are two ways of dealing with patient's preferences concerning fetoscopic endoluminal TO and expectant management during pregnancy for CDH. The solution adopted for fetoscopic endoluminal tracheal occlusion (FETO) is justified by the extended period of time it has been available to patients before the start of the RCT. Strong patient and referring physician preferences do not entail a right to have FETO, since it is a procedure of yet unproven efficacy and safety. In the future, to avoid the dilemmas posed by the TM and in name of the right of future generations of patients to have access to treatment of proven safety and efficacy, researchers must be able to plan RCT in due time. Copyright © 2011 John Wiley & Sons, Ltd.

  3. Electronic health record in the internal medicine clinic of a Brazilian university hospital: Expectations and satisfaction of physicians and patients. (United States)

    Duarte, Jurandir Godoy; Azevedo, Raymundo Soares


    To evaluate the satisfaction and expectations of patients and physicians before and after the implementation of an electronic health record (EHR) in the outpatient clinic of a university hospital. We conducted 389 interviews with patients and 151 with physicians before and after the implementation of a commercial EHR at the internal medicine clinic of Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HC-FMUSP), Brazil. The physicians were identified by their connection to the outpatient clinic and categorized by their years since graduation: residents and preceptors (with 10 years or less of graduation) or assistants (with more than 10 years of graduation). The answers to the questionnaire given by the physicians were classified as favorable or against the use of EHR, before and after the implementation of this system in this clinic, receiving 1 or 0 points, respectively. The sum of these points generated a multiple regression score to determine which factors contribute to the acceptance of EHR by physicians. We also did a third survey, after the EHR was routinely established in the outpatient clinic. The degree of patient satisfaction was the same before and after implementation, with more than 90% positive evaluations. They noted the use of the computer during the consultation and valued such use. Resident (younger) physicians had more positive expectations than assistants (older physicians) before EHR implementation. This optimism was reduced after implementation. In the third evaluation the use of EHR was higher among resident physicians. Resident physicians perceived and valued the EHR more and used it more. In 28 of the 57 questions on performance of clinical tasks, resident physicians found it easier to use EHR than assistant physicians with significant differences (pclinical setting should be preceded by careful planning to improve physician's adherence to the use of EHR. Patients do not seem to notice much difference to the

  4. Strengthening your ties to referring physicians through RIS/PACS integration. (United States)

    Worthy, Susan; Rounds, Karla C; Soloway, Connie B


    Many imaging centers are turning to technology solutions to increase refering physician satisfaction, implementing such enhancements as automated report distribution, picture archiving and communications system (PACS), radiology information systems (RIS), and web-based results access. However, without seamless integration, these technology investments don't address the challenge at its core: convenient and reliable, two-way communication and interaction with referring physicians. In an integrated RIS/PACS solution, patient tracking in the RIS and PACS study status are logged and available to users. The time of the patient's registration at the imaging center, the exam start and completion time, the patient's departure time from the imaging center, and results status are all tracked and logged. An integrated RIS/PACS solution provides additional support to the radiologist, a critical factor that can improve the turnaround time of results to referring physicians. The RIS/PACS enhances the interpretation by providing the patient's history, which gives the radiologist additional insight and decreases the likelihood of missing a diagnostic element. In a tightly integrated RIS/PACS solution, results information is more complete. Physicians can view reports with associated images selected by the radiologist. They will also have full order information and complete imaging history including prior reports and images. Referring physicians can access and view images and exam notes at the same time that the radiologist is interpreting the exam. Without the benefit of an integrated RIS/PACS system, the referring physician would have to wait for the signed transcription to be released. In a seamlessly integrated solution, film-tracking modules within the RIS are fused with digital imaging workflow in the PACS. Users can see at a glance if a historical exam is available on film and benefit when a complete study history--both film-based and digital--is presented with the current

  5. Bilingualism affects 9-month-old infants' expectations about how words refer to kinds. (United States)

    Byers-Heinlein, Krista


    Infants are precocious word learners, and seem to possess systematic expectations about how words refer to object kinds. For example, while monolingual infants show a one-to-one mapping bias (e.g. mutual exclusivity), expecting each object to have only one basic level label, previous research has shown that this is less robust in bi- and multilinguals aged 1.5 years and older. This study examined the early origins of such one-to-one mapping biases by comparing monolingual and bilingual 9-10-month-olds' expectations about the relationship between labels and object kinds. In a violation of expectation paradigm, infants heard a speaker name hidden objects with either one label ('I see a mouba! I see a mouba!') or two labels ('I see a camo! I see a tenda!'). An occluder moved to reveal two objects that were either identical or of different kinds. Monolingual infants looked longest when two labels were associated with identical objects, and when one label was associated with objects of different kinds, showing that they found these outcomes unexpected. This replicated previous findings showing that monolinguals expect that distinct words label distinct object kinds (Dewar & Xu, ). Bilinguals looked equally to the outcomes regardless of the number of labels, showing no such expectations. This finding indicates that bilingualism influences young infants' expectations about how words refer to kinds, and more broadly supports the position that language experience contributes to the development of word learning heuristics. © 2016 John Wiley & Sons Ltd.

  6. [Clinical pharmacy: Evaluation of physician's satisfactions and expectations in a French regional hospital]. (United States)

    Jennings, P; Lotito, A; Baysson, H; Pineau-Blondel, E; Berlioz, J


    The purpose of the study was to evaluate physician's satisfaction with the clinical pharmacy activities in a French regional hospital. Data were collected by face-to-face interviews carried out by a public health intern with physicians from 14 different departments of medicine and surgery. A specifically designed questionnaire was used for this study. This contained 18 closed-ended questions, 3 open-ended questions and 6 questions relating to the multidisciplinary analysis of prescriptions of elderly patients. The questionnaire was proposed to 78 physicians, of which 62 replied (participation rate of 79%). Thirty-seven percent were interns (23/62), 19% were assistants (12/62) and 44% were senior physicians (27/62). Clinical pharmacy satisfaction levels were generally very high. In regard to clinical skills, 87% of the physicians were satisfied with pharmacists' competencies and 91% by the pertinence of transmitted information. Ninety-five percent of the physicians were also satisfied by the logistical aspect and the relationship with pharmacists (reactivity, availability and communication). Analysis of the open-ended questions showed that physicians were in favour of the increased presence of clinical pharmacists on the wards. This study shows a high level of physician satisfaction in relation to the clinical pharmacy activities in our hospital, and should be viewed as a strong endorsement of the work of the clinical pharmacy. This study highlights some areas of improvement such as increase presence of the clinical pharmacists on the wards. In order to assess periodically our activity, this study must be repeated in the future. Copyright © 2016 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

  7. Expectations

    DEFF Research Database (Denmark)

    depend on the reader’s own experiences, individual feelings, personal associations or on conventions of reading, interpretive communities and cultural conditions? This volume brings together narrative theory, fictionality theory and speech act theory to address such questions of expectations...

  8. The architecture of smart surveys: core issues in why and how to collect patient and referring physician satisfaction data. (United States)

    Lexa, Frank J; Berlin, Jonathan W


    Radiology practices are facing challenges on many fronts. As the field becomes more competitive, leaders must pay more attention to the quality of the service that groups provide to their customers. This need is also being driven by higher expectations from customers, particularly patients, who will likely act much more like consumers in the 21st century. For practices to succeed in providing exemplary service, they must pay attention to the voices of their key customer groups. It is dismaying to see practices that are struggling or even dissolving over issues created by poor service. As much as we are experts in imaging, we are unlikely to be able to provide superlative service by reading books, talking among ourselves, or hiring consultants. Rather, we must do what should be obvious, which is to actually ask our customers how we are doing. Surveys are one of the important tools that can be brought to bear on this issue. For many groups, surveying is the starting point for understanding what their patients, referring physicians, and other key stakeholders want. Groups can also find out what customers like and dislike about their experiences, and how groups compare with their competitors. This article provides a guide on how to get off to a good start in designing and deploying surveys that can help optimize the way groups take care of their patients and help their referring physicians.

  9. Public and physician's expectations and ethical concerns about electronic health record: Benefits outweigh risks except for information security. (United States)

    Entzeridou, Eleni; Markopoulou, Evgenia; Mollaki, Vasiliki


    Electronic Health Record systems (EHRs) offer numerous benefits in health care but also pose certain risks. As we progress toward the implementation of EHRs, a more in-depth understanding of attitudes that influence overall levels of EHR support is required. To record public and physicians' awareness, expectations for, and ethical concerns about the use of EHRs. A convenience sample was surveyed for both the public and physicians. The Public's Questionnaire was distributed to the public in a printed and an online version. The Physicians' Questionnaire was distributed to physicians in an online version. The questionnaires requested demographic characteristics followed by close-ended questions enquiring about awareness, perceived impact, perceived risks, and ethical issues raised by EHR use. In total, 46% of the public and 91% of physicians were aware of EHRs. Physicians' and public opinions were comparable concerning the positive impact of EHRs on better, more effective, and faster decisions on the patients' health, on better coordination between hospitals/clinics and on quality and reduced cost of health care. However, physicians were concerned that an EHR system would be a burden for their finances, for their time concerning training on the system, for their everyday workload and workflow. The majority of the public generally agreed that they would worry about the possibility that a non-authorized, third party might gain access to their personal health information (48.8%), and that they would worry about future discriminations due to possible disclosure of their health information (48.8%). Most physicians disagreed that EHRs will disrupt the doctor-patient relationship (58.1%) but they would worry about the safety of their patients' information (53.1%). Overall, both the public and physicians were in favor of the implementation of an EHR system, evaluating that possible benefits are more important than possible risks. The majority of the public believed that

  10. Acceptance of speech recognition by physicians: A survey of expectations, experiences, and social influence

    DEFF Research Database (Denmark)

    Alapetite, Alexandre; Andersen, Henning Boje; Hertzum, Morten


    The present study has surveyed physician views and attitudes before and after the introduction of speech technology as a front end to an electronic medical record. At the hospital where the survey was made, speech technology recently (2006–2007) replaced traditional dictation and subsequent secre...

  11. Giving Context to the Physician Competency Reference Set: Adapting to the Needs of Diverse Populations (United States)

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


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

  12. Referral expectations of radiology

    International Nuclear Information System (INIS)

    Smith, W.L.; Altmaier, E.; Berberoglu, L.; Morris, K.


    The expectation of the referring physician are key to developing a successful practice in radiology. Structured interviews with 17 clinicians in both community care and academic practice documented that accuracy of the radiologic report was the single most important factor in clinician satisfaction. Data intercorrelation showed that accuracy of report correlated with frequency of referral (r = .49). Overall satisfaction of the referring physician with radiology correlated with accuracy (r = .69), patient satisfaction (r = .36), and efficiency in archiving (r = .42). These data may be weighted by departmental managers to allocate resources for improving referring physician satisfaction

  13. Bridging the Millennial Generation Expectation Gap: Perspectives and Strategies for Physician and Interprofessional Faculty. (United States)

    Williams, Valerie N; Medina, Jose; Medina, Andria; Clifton, Shari


    Assigning attributes to a birth cohort is one way we identify society-wide, shared life experiences within a group collectively called a "generation." Such assigned attributes influence society's adoption of generation-based expectations held by and about people from a particular birth cohort. Census data and generational attributes inform perspectives on millennial generation birth cohort experiences and engagement as students. The eldest living generation in U.S. society has given way to 3 subsequent generations, the youngest of which is called the millennial generation. What generational attributes influence the effectiveness of teaching and learning between millennial learners and faculty members from other generations? Understanding the role of life cycle effects, period effects and cohort effects can offer medical and health professions educators' insights into different strategies for learner engagement. Discussion includes specific strategies and teaching tactics faculty members can use to engage millennials across a continuum of learning to bridge the "expectation gap." Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  14. Referring physicians' experiences of outsourcing radiological examinations – A variety of views on the consequences

    International Nuclear Information System (INIS)

    Olofsson, P.T.; Blomqvist, L.; Fridell, K.; Aspelin, P.


    Introduction: There are strengths, weaknesses, opportunities and challenges when outsourcing advanced radiological examinations such as magnetic resonance examinations from university hospitals to external private institutions. Aim: The aim of this study was to explore the experiences of referring physicians when their referrals for radiological examinations are outsourced from a university hospital in Stockholm, Sweden. Method: This qualitative study is a part of a larger study investigating the consequences of outsourcing referrals for radiological examinations from a university hospital to private external units. Ten referring physicians from orthopedic and oncology departments, representing clinics with large volumes of radiological referrals at a university hospital, were interviewed. Results: The results showed that the requirements for radiological services differ between these specialties. The overall opinion was that examinations performed by external radiology departments needed additional re-assessment work which causes higher costs for their clinics. This indicates that there is insufficient communication between referring physicians and the radiological department at the University Hospital. Conclusions: For better planning of radiological services, radiology departments must consider the referring physicians' needs and develop suitable contract when organizing the practice of outsourcing. The management structure in radiology departments and communication between referring physicians and radiologists in the radiology departments should be studied further, to promote better understanding and improve the efficiency of the outsourcing process. - Highlights: • The requirements for radiological services differ between specialties. • Outsourced examinations need more frequent re-assessment. • Outsourced examinations cause higher costs for referring departments. • Outsourcing radiological examinations entail more administrative work.

  15. [Needs and expectations of general physicians exposed to emergency medicine: a study in Neuchâtel]. (United States)

    Hanhart, W-A; Gusmini, W; Kehtari, R


    The emergency ward constitutes the main extra/intra-hospital interface most in demand by general physicians (GP). In order to evaluate the needs and the expectations of GP and, thus, to improve the cooperation between different partners, we underwent a study over 150 GP in Neuchâtel, Switzerland. The rate of participation within the time limit was 61.3%. The results showed that only 49% of GP find an interest in emergency medicine and less than a half (43%) feel not at ease when facing to vital emergencies. However 67% of GP confirmed being highly interested to attend special training in emergency field. The cooperation with medical emergency team (SMUR) and paramedics came out to be satisfactory. Facilities to access to the medico-technical platform of the emergency ward is also highly requested.

  16. Electrophysiological Responses to Expectancy Violations in Semantic and Gambling Tasks: A Comparison of Different EEG Reference Approaches (United States)

    Li, Ya; Wang, Yongchun; Zhang, Baoqiang; Wang, Yonghui; Zhou, Xiaolin


    Dynamically evaluating the outcomes of our actions and thoughts is a fundamental cognitive ability. Given its excellent temporal resolution, the event-related potential (ERP) technology has been used to address this issue. The feedback-related negativity (FRN) component of ERPs has been studied intensively with the averaged linked mastoid reference method (LM). However, it is unknown whether FRN can be induced by an expectancy violation in an antonym relations context and whether LM is the most suitable reference approach. To address these issues, the current research directly compared the ERP components induced by expectancy violations in antonym expectation and gambling tasks with a within-subjects design and investigated the effect of the reference approach on the experimental effects. Specifically, we systematically compared the influence of the LM, reference electrode standardization technique (REST) and average reference (AVE) approaches on the amplitude, scalp distribution and magnitude of ERP effects as a function of expectancy violation type. The expectancy deviation in the antonym expectation task elicited an N400 effect that differed from the FRN effect induced in the gambling task; this difference was confirmed by all the three reference methods. Both the amplitudes of the ERP effects (N400 and FRN) and the magnitude as the expectancy violation increased were greater under the LM approach than those under the REST approach, followed by those under the AVE approach. Based on the statistical results, the electrode sites that showed the N400 and FRN effects critically depended on the reference method, and the results of the REST analysis were consistent with previous ERP studies. Combined with evidence from simulation studies, we suggest that REST is an optional reference method to be used in future ERP data analysis. PMID:29615858

  17. 20 CFR 10.301 - May the physician designated on Form CA-16 refer the employee to another medical specialist or... (United States)


    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false May the physician designated on Form CA-16 refer the employee to another medical specialist or medical facility? 10.301 Section 10.301 Employees... another medical specialist or medical facility? The physician designated on Form CA-16 may refer the...

  18. Real-world practice and Expectation of Asia-Pacific physicians and patients in Helicobacter Pylori eradication (REAP-HP Survey). (United States)

    Chuah, Yoen-Young; Wu, Deng-Chyang; Chuah, Seng-Kee; Yang, Jyh-Chin; Lee, Tzong-Hsi; Yeh, Hong-Zen; Chen, Chan-Lin; Liu, Yu-Hwa; Hsu, Ping-I


    The aims of the study were: 1, to survey the most popular anti-H. pylori regimens in Asia-Pacific region and the real-world effectiveness of these regimens; and 2, to investigate the expectation gaps of eradication rate between physicians and patients. A questionnaire was distributed to Asia-Pacific physicians who attended the Asia-Pacific Digestive Week 2015 meeting. Reported eradication rates from the literatures were compared with real-world rates of surveyed popular regimens within the region. In addition, a questionnaire was distributed to H. pylori-infected patients in three regions of Taiwan. A total of 691 physicians and 539 patients participated in the survey. The top five most commonly used regimens were 7-day clarithromycin-based standard triple therapy (50.4%), 14-day clarithromycin-based standard triple therapy (31.0%), 10-day sequential therapy (6.1%), 14-day bismuth quadruple therapy (3.9%), and 14-day hybrid therapy (3.6%). All countries except for China had a significant gap between the expectation of physicians on anti-H. pylori therapy and the real-world eradication rate of most commonly adopted regimens (all P value Asia-Pacific countries to adopt newer and more efficacious anti-H. pylori regimens to meet the Kyoto consensus recommendation and their patients' expectations. © 2017 John Wiley & Sons Ltd.

  19. Normatology: a review and commentary with reference to abortion and physician-assisted suicide. (United States)

    Brodie, H K; Banner, L


    This article opens with a review of the concept of "normatology," which was developed by Sabshin and Offer in four books published over a period of 30 years. Normatology seeks to produce an "operational definition of normality and health" over the life cycle. Such a definition can be used as a guideline in the deliver of health care. The importance of this field of study is highlighted when considering issues such as abortion or physician-assisted suicide. Fortunately, the proclivity of Americans to conduct public opinion polls helps researchers determine what is considered "normal" at any given time. Gallup Polls, which have posed the same question about the legality of abortion from 1975 to 1995, indicate that about half of all Americans continuously occupy the middle ground on this issue despite a somewhat liberalizing trend. In general, public opinion holds that it is normal to want to avoid giving birth to a damaged child, to place the mother's health and safety above that of the fetus, and to terminate a pregnancy resulting from rape. It is less normal to abort a healthy fetus on demand. Thus, abortion will likely continue to be a source of controversy and confusion in our society and among psychiatric patients. In comparison, psychiatrists express attitudes about abortion that are more liberal than normal. In the case of physician-assisted suicide, public approval has increased since 1950 as scientific advancements have facilitated the prolongation of unproductive and painful life. If legalized, physician-assisted suicide may depend upon psychiatric assessment of an absence of mental disease. Such an assessment is required in the Northern Territory of Australia, where voluntary euthanasia is legal, but not in the Netherlands, where it is government-regulated. Psychiatrists must understand public opinion in order to influence it or deal with it competently.

  20. Psychopathology of the General Population Referred by Primary Care Physicians for Urgent Assessment in Psychiatric Hospitals

    Directory of Open Access Journals (Sweden)

    Judith McLenan


    Full Text Available Objective: The aim of this study was to evaluate the type, severity and progression of psychiatric pathologies in a sample of 372 outpatients (age range 18–65 years referred by their primary general practitioners (GPs to an Urgent Referral Team (URT based in a psychiatric hospital in Aberdeen, Scotland. This team offers immediate appointments (1- to 7-day delays for rapid assessments and early interventions to the outpatients referred by their primary family doctors.Method: One-sample t-test and z statistic were used for data analysis. From the total population, a convenience sample of 40 people was selected and assessed to evaluate whether follow-up appointments after the first visit could reduce the severity of suicidal ideation, depression and anxiety in the outpatients seen by the URT. A two-sample t-test and a Wilcoxon signed-rank test were used to assess the variations in the scores during the follow-up visits.Results: We found a statistically significant prevalence of depressive disorders, comorbid with anxiety at first presentation in people who were females, white, never married, living with a partner, not studying and not in paid employment. The common presentation of borderline personality disorder and dysthymia in this population underscores its vulnerability to major socioeconomic challenges.Conclusion: The data confirmed the impact that primary care cooperation with psychiatric hospitals can have on the psychiatric system, and as a reflection, on the population’s mental health and well-being. In fact, active cooperation and early diagnosis and intervention will help detect cases at risk in the general population and reduce admissions into hospitals.

  1. Validation Studies for Numerical Simulations of Flow Phenomena Expected in the Lower Plenum of a Prismatic VHTR Reference Design

    International Nuclear Information System (INIS)

    Richard W. Johnson


    The final design of the very high temperature reactor (VHTR) of the fourth generation of nuclear power plants (Gen IV) has not yet been established. The VHTR may be either a prismatic (block) or pebble bed type. It may be either gas-cooled or cooled with an as yet unspecified molten salt. However, a conceptual design of a gas-cooled VHTR, based on the General Atomics GT-MHR, does exist and is called the prismatic VHTR reference design, MacDonald et al [2003], General Atomics [1996]. The present validation studies are based on the prismatic VHTR reference design. In the prismatic VHTR reference design, the flow in the lower plenum will be introduced by dozens of turbulent jets issuing into a large crossflow that must negotiate dozens of cylindrical support columns as it flows toward the exit duct of the reactor vessel. The jets will not all be at the same temperature due to the radial variation of power density expected in the core. However, it is important that the coolant be well mixed when it enters the power conversion unit to ensure proper operation and long life of the power conversion machinery. Hence, it is deemed important to be able to accurately model the flow and mixing of the variable temperature coolant in the lower plenum and exit duct. Accurate flow modeling involves determining modeling strategies including the fineness of the grid needed, iterative convergence tolerance, numerical discretization method used, whether the flow is steady or unsteady, and the turbulence model and wall treatment employed. It also involves validation of the computer code and turbulence model against a series of separate and combined flow phenomena and selection of the data used for the validation. The present report describes progress made to date for the task entitled ''CFD software validation of jets in crossflow'' which was designed to investigate the issues pertaining to the validation process

  2. "Professional Helper" or "Helping Professional?" The Patient-Physician Relationship in the Chronic Pain Setting, With Special Reference to the Current Opioid Debate. (United States)

    Bäckryd, Emmanuel


    There seems to be a strong cultural expectation among patients for effective pain relief. As a result, physicians often find themselves trying to bridge the gap between the chronic pain patient's expectations and harsh biomedical reality. The typology of Emanuel and Emanuel of four models for the patient-physician relationship is used in this article as a conceptual tool to examine the possible roles of physicians in the context of chronic noncancer pain. Their typology is reconceptualized as a "pathway" along which the physician is able to walk more or less far, starting from the "information" end of the path. The other end of the pathway is "caring deliberation." I then propose that, in pain medicine today, consumerism is a powerful incentive for physicians to stay at the information end of the spectrum. Against this background, I discuss the current opioid epidemic in the United States and the need for what has been called a new medical professionalism. I conclude by challenging educators involved in pain medicine continuing professional development to not only design adequate biomedical-educational programs, but also consider issues like professionalism, personal development, critical self-reflection, and the ethics of engaging in caring deliberation with chronic pain patients.

  3. Cardiac stress testing for the diagnosis and management of coronary artery disease: a reference for the primary care physician. (United States)

    Gajulapalli, Rama Dilip; Aneja, Ashish; Rovner, Aleksandr


    Choosing the appropriate stress test is important in the workup of patients with possible myocardial ischemia. This choice often is challenging and sometimes confusing because of the plethora of tests and guidelines available. We present a broad overview of commonly available stress tests and indications to help physicians select the most appropriate stress test for their patients.

  4. Triggering risk factors of the burnout syndrome in OB/GYN physicians from a reference public university of Brazil. (United States)

    Ferreira Bortoletti, Fátima; Teresa Benevides-Pereira, Ana Maria; Vasconcellos, Esdras Guerreiro; Siqueira, José Oliveira; Araujo Júnior, Edward; Nardozza, Luciano Marcondes Machado; Sebastiani, Ricardo Werner; Moron, Antonio Fernandes


    Objective. To identify the risk factors to the development of Burnout Syndrome in Ob/Gyn Brazilian physicians in four dimensions: emotional exhaustion (EE), professional repression (PR), dehumanization (De), and emotional distancing (EmD). Methods. A prospective cross-sectional study was realized with 48 Ob/Gyn physicians (12 lecturers, 12 attending physicians, 12 medical residents, and 12 graduate students) from Department of Obstetrics, São Paulo Federal University (UNIFESP). We used a sociodemographic questionnaire focusing on the activities (administrative, educational, healthcare, and research). We applied a Burnout Syndrome Inventory (BSI) composed of two parts: triggering factors (ISB1) and the Burnout Syndrome (ISB2). The ISB1 is composed of two scales: positive organizational conditions (POC) and negative organizational conditions (NOC). The ISB2 is composed of four scales: EE, PR, De, and EmD. Results. We observed a rate below and above average to POC and NOC, respectively. The dimensions recorded a level above average to EE, an index at the upper limit of the average to De, a median index to EmD, and a median index to PR. Conclusions. The Ob/Gyn physicians are in an area of vulnerability for the development of Burnout Syndrome due to the high level of EE and De, associated with a median index of PR. The high rate of NOC contributes to the triggering of this scenery.

  5. Added value of coronal reformations for duty radiologists and for referring physicians or surgeons in the CT diagnosis of acute appendicitis

    International Nuclear Information System (INIS)

    Lee, Kyoung Ho; Kim, Young Hoon; Hahn, Seo Kyung; Lee, Kyung Won; Lee, Hak Jong; Kim, Tae Jung; Kang, Sung Bum; Shin, Joong Ho; Park, Byung Joo


    To assess the added value of coronal reformation for radiologists and for referring physicians or surgeons in the CT diagnosis of acute appendicitis. Contrast-enhanced CT was performed using 16-detector-row scanners in 110 patients, 46 of whom had appendicitis. Transverse (5-mm thickness, 4-mm increment), coronal (5-mm thickness, 4-mm increment), and combined transverse and coronal sections were interpreted by four radiologists, two surgeons and two emergency physicians. The area under the receiver operating characteristic curve (Az value), sensitivity, specificity, (McNemar test), diagnostic confidence and appendiceal visualization (Wilcoxon signed rank test) were compared. For radiologists, the additional coronal sections tended to increase the Az value (0.972 vs 0.986, ρ=0.076) and pooled sensitivity (92% [95% CI: 88,96] vs. 96% [93,99]), and enhanced appendiceal visualization in true-positive cases (ρ= 0.031). For non-radiologists, no such enhancement was observed, and the confidence for excluding acute appendicitis declined (ρ=0.013). Coronal sections alone were inferior to transverse sections for diagnostic confidence as well as appendiceal visualization for each reader group studied (ρ<0.05). The added value of coronal reformation is more apparent for radiologists compared to referring physicians or surgeons in the CT diagnosis of acute appendicitis

  6. Knowledge and Attitude of Physicians toward Prescribing Antibiotics and the Risk of Resistance in Two Reference Hospitals

    Directory of Open Access Journals (Sweden)

    Adel Alothman


    Full Text Available Introduction Antibiotics are essential and abundantly prescribed in hospitals because of their effectiveness and lifesaving benefits. However, the unnecessary use of antibiotics has been observed in earlier studies, and it has persisted through recent years as a major issue since it is one of the leading causes of antibiotic resistance. The increase in antibiotic resistance nowadays is one of the most critical concerns in global public health around the world. The objective of this study was to evaluate the knowledge and perceptions related to antibiotic prescription among physicians at our medical centers. Method A cross-sectional survey of non-infectious diseases specialized physicians. The study was conducted during 2015 at two tertiary care centers in Riyadh, Saudi Arabia. Result Of the 107 returned questionnaires, 93 were complete and valuable. Most respondents (82% perceived antibiotic resistance to be a critical problem globally, and 78% also think that it is a very important national problem. These attitudes did not differ across specialty or level of training. Widespread antibiotic use and inappropriate empirical choices were believed by 81% of the participants to be important general causes of resistance. Only half of respondents thought that antibiotic restriction is a useful intervention to decrease the antibiotic resistance. The physicians believed educational interventions are the most useful and effective way to improve prescription patterns and decrease antibiotic resistance. Complications due to infection with resistant organisms were acknowledged by almost all of the participants, with some differences in their estimations of how often it will occur. Conclusion Antimicrobial resistance, globally and nationally, is considered as a serious threat, and physicians in this survey acknowledged that. Among the most significant factors is antimicrobial misuse, either by overprescribing or providing inappropriate drugs with some

  7. Perceptions, Expectations, and Attitudes about Communication with Physicians among Chinese American and non-Hispanic White Women with Early-Stage Breast Cancer (United States)

    Wang, Judy Huei-yu; Adams, Inez F.; Pasick, Rena J.; Gomez, Scarlett L.; Allen, Laura; Ma, Grace X.; Lee, Michael X.; Huang, Ellen


    Purpose Asian Americans have consistently reported poorer communication with physicians compared with non-Hispanic Whites (NHW). This qualitative study sought to elucidate the similarities and differences in communication with physicians between Chinese and NHW breast cancer survivors. Methods Forty-four Chinese and 28 NHW women with early-stage breast cancer (stage 0-IIa) from the Greater Bay Area Cancer Registry participated in focus group discussions or individual interviews. We oversampled Chinese women because little is known about their cancer care experiences. In both interview formats, questions explored patients’ experiences and feelings when communicating with physicians about their diagnosis, treatment, and follow-up care. Results Physician empathy at the time of diagnosis was important to both ethnic groups; however, during treatment and follow-up care, physicians’ ability to treat cancer and alleviate physical symptoms was a higher priority. NHW and US-born Chinese survivors were more likely to assert their needs, whereas Chinese immigrants accepted physician advice even when it did not alleviate physical problems (e.g., pain). Patients viewed all physicians as the primary source for information about cancer care. Many Chinese immigrants sought additional information from primary care physicians and stressed optimal communication over language concordance. Conclusions Physician empathy and precise information were important for cancer patients. Cultural differences such as the Western emphasis on individual autonomy vs. Chinese emphasis on respect and hierarchy can be the basis for the varied approaches to physician communication we observed. Interventions based on cultural understanding can foster more effective communication between immigrant patients and physicians ultimately improving patient outcomes. PMID:23903797

  8. The knowledge and expectations of parents about the role of antibiotic treatment in upper respiratory tract infection – a survey among parents attending the primary physician with their sick child

    Directory of Open Access Journals (Sweden)

    Ron Adi


    Full Text Available Abstract Background Upper respiratory tract infections (URTI are common. The etiologic factor is usually viral, but many physicians prescribe antibiotics. We aimed to evaluate parents' expectations of and knowledge about the role of antibiotics in childhood URTI. Methods The study was conducted in thirteen primary care pediatric clinics. Parents of children aged 3 months to 6 years who attended with URTI symptoms were included when it was the first attendance in the current illness. Questionnaire about the current illness, reasons for attending and expectations from the visit, knowledge about URTI was filled before the visit. Results In 122 visits the average age was 2.8 ± 1.9 years. The main reasons for the visit were to avoid complications (81% and to be examined (78%. Expected treatment was: cough suppressants (64%, anti-congestants (57%, paracetamol (56%, natural remedies (53% and antibiotics (25%. In 28% the child had received antibiotics in past URTI. Only 37% thought that antibiotics would not help in URTI and 27% knew that URTI is a self-limited disease. 61% knew that URTI is a viral disease. Younger parental age and higher education were associated with lower expectations to receive antibiotics (p = 0.01, p Conclusions A quarter of the parents attending the physician with URTI are expecting to get antibiotics. Predictors were lower education, older parental age, receiving antibiotics in the past and the belief that antibiotics help in URTI.

  9. [German physicians' access to professional knowledge. Acceptance, quality and availability of professional information with special reference to electronic information media]. (United States)

    Reng, Carl-Michael; Friedrich, Hans-Jürgen; Timmer, Antje; Schölmerich, Jürgen


    The growing relevance of continuous medical education is evident. Also information retrieval helping to solve clinical problems yet at the patient's bedside becomes more and more important. This study challenges common and coming methods of information retrieval applied by German physicians. It helps answering the question which advantage or disadvantage due to the chosen method of information acquisition may arise. It also shows which practical relevance and which grade of quality the information seeking doctor may anticipate. A questionnaire was sent out to all registered clinicians in hospital and practice in Germany. Not only traditional means of information retrieval were analyzed. Also, a lot of the questions posed focused on the acceptance and use of new media in the professional context. About 16,000 colleagues answered by filling in the complete form therewith allowing a deep insight into their informational needs and habits. While traditional media like books and scientific papers enjoy wide public confidence, the acceptance and estimated reliability of virtual sources of information today still remain restrained. The lack of transparency of the virtual sources and ways of information within the web according to often imprecise rules for quality assurance lead to major complaint. Information offered directly by the industry has a very low rate of acceptance. To gain higher confidence in electronic media presenting professional knowledge and advanced medical training, the development of technological advantages today seems to be less relevant. Work on the transparency of the informational structures including clear definition of resources and clear indication of possible conflicts of interest are just as important as a comprehensible quality of forthcoming medical content.

  10. Primary care physicians' perceptions about and confidence in deciding which patients to refer for total joint arthroplasty of the hip and knee. (United States)

    Waugh, E J; Badley, E M; Borkhoff, C M; Croxford, R; Davis, A M; Dunn, S; Gignac, M A; Jaglal, S B; Sale, J; Hawker, G A


    The purpose of this study is to examine the perceptions of primary care physicians (PCPs) regarding indications, contraindications, risks and benefits of total joint arthroplasty (TJA) and their confidence in selecting patients for referral for TJA. PCPs recruited from among those providing care to participants in an established community cohort with hip or knee osteoarthritis (OA). Self-completed questionnaires were used to collect demographic and practice characteristics and perceptions about TJA. Confidence in referring appropriate patients for TJA was measured on a scale from 1 to 10; respondents scoring in the lowest tertile were considered to have 'low confidence'. Descriptive analyses were conducted and multiple logistic regression was used to determine key predictors of low confidence. 212 PCPs participated (58% response rate) (65% aged 50+ years, 45% female, 77% >15 years of practice). Perceptions about TJA were highly variable but on average, PCPs perceived that a typical surgical candidate would have moderate pain and disability, identified few absolute contraindications to TJA, and overestimated both the effectiveness and risks of TJA. On average, PCPs indicated moderate confidence in deciding who to refer. Independent predictors of low confidence were female physicians (OR = 2.18, 95% confidence interval (CI): 1.06-4.46) and reporting a 'lack of clarity about surgical indications' (OR = 3.54, 95% CI: 1.87-6.66). Variability in perceptions and lack of clarity about surgical indications underscore the need for decision support tools to inform PCP - patient decision making regarding referral for TJA. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  11. Physicians Experience with and Expectations of the Safety and Tolerability of WHO-Step III Opioids for Chronic (Low Back Pain: Post Hoc Analysis of Data from a German Cross-Sectional Physician Survey

    Directory of Open Access Journals (Sweden)

    Michael A. Ueberall


    Full Text Available Objective. To describe physicians’ daily life experience with WHO-step III opioids in the treatment of chronic (low back pain (CLBP. Methods. Post hoc analysis of data from a cross-sectional online survey with 4.283 Germany physicians. Results. With a reported median use in 17% of affected patients, WHO-step III opioids play a minor role in treatment of CLBP in daily practice associated with a broad spectrum of positive and negative effects. If prescribed, potent opioids were reported to show clinically relevant effects (such as ≥50% pain relief in approximately 3 of 4 patients (median 72%. Analgesic effects reported are frequently related with adverse events (AEs. Only 20% of patients were reported to remain free of any AE. Most frequently reported AE was constipation (50%, also graded highest for AE-related daily life restrictions (median 46%. Specific AE countermeasures were reported to be necessary in approximately half of patients (median 45%; nevertheless AE-related premature discontinuation rates reported were high (median 22%. Fentanyl/morphine were the most/least prevalently prescribed potent opioids mentioned (median 20 versus 8%. Conclusion. Overall, use of WHO-step III opioids for CLBP is low. AEs, especially constipation, are commonly reported and interfere significantly with analgesic effects in daily practice. Nevertheless, beneficial effects outweigh related AEs in most patients with CLBP.

  12. Characteristics of complex regional pain syndrome in patients referred to a tertiary pain clinic by community physicians, assessed by the Budapest clinical diagnostic criteria. (United States)

    Mailis-Gagnon, Angela; Lakha, Shehnaz Fatima; Allen, Matti D; Deshpande, Amol; Harden, Robert Norman


    The aim of this study was to describe the characteristics of patients referred with complex regional pain syndrome (CRPS) diagnosis to a tertiary care pain center. Descriptive chart review study of all patients referred by family physicians or community specialists as having CRPS (2006-2010). Data extraction included demographics, pain ratings, and diagnosis utilizing the Budapest CRPS criteria. The study population consisted of 54 subjects (male [M] =7, female [F] =47). Only 27.7% were classified as CRPS by the clinical expert. Four additional subjects carrying other diagnoses but found to have CRPS were added to the analysis. The non-CRPS group consisted of 39 subjects (M=8, F=31) and the CRPS group of 19 (M=2, F=17). CRPS patients were statistically significantly more likely to 1) have suffered a fracture; 2) report symptoms in each of the four symptom categories, as well as signs in three or four categories collectively; and 3) have allodynia/hyperalgesia alone or in combination (85/90%) as compared with the non-CRPS group (23/25%, respectively). The non-CRPS group was much more likely to report no symptoms or signs at all in the different symptom and sign categories. Of the 39 non-CRPS patients, 74% had other diagnosable entities (1/3 suffering from specific neuropathic pain conditions, e.g., radiculopathy, diabetic neuropathy, etc. and 2/3 from discreet musculoskeletal entities), while 18% were diagnosed with psychogenic pain disorders including conversion reaction associated with immobility or paralysis. Besides fulfilling the Budapest CRPS diagnostic criteria, the most important other factor for diagnosing CRPS is the exclusion of a neuropathic, musculoskeletal, or non-biomedical condition accounting for the presentation. Wiley Periodicals, Inc.

  13. Value-Based Assessment of Radiology Reporting Using Radiologist-Referring Physician Two-Way Feedback System-a Design Thinking-Based Approach. (United States)

    Shaikh, Faiq; Hendrata, Kenneth; Kolowitz, Brian; Awan, Omer; Shrestha, Rasu; Deible, Christopher


    In the era of value-based healthcare, many aspects of medical care are being measured and assessed to improve quality and reduce costs. Radiology adds enormously to health care costs and is under pressure to adopt a more efficient system that incorporates essential metrics to assess its value and impact on outcomes. Most current systems tie radiologists' incentives and evaluations to RVU-based productivity metrics and peer-review-based quality metrics. In a new potential model, a radiologist's performance will have to increasingly depend on a number of parameters that define "value," beginning with peer review metrics that include referrer satisfaction and feedback from radiologists to the referring physician that evaluates the potency and validity of clinical information provided for a given study. These new dimensions of value measurement will directly impact the cascade of further medical management. We share our continued experience with this project that had two components: RESP (Referrer Evaluation System Pilot) and FRACI (Feedback from Radiologist Addressing Confounding Issues), which were introduced to the clinical radiology workflow in order to capture referrer-based and radiologist-based feedback on radiology reporting. We also share our insight into the principles of design thinking as applied in its planning and execution.

  14. [The effect of gender on the physician's role. Attitudes and expectations of medical students examined by a questionnaire at the start of their studies]. (United States)

    Odborg, M H; Eriksen, T R; Petersson, B H


    A questionnaire was given to 254 medical students matriculated in 1992/93 concerning their motivation for wanting to become a doctor, attitudes towards which qualities a doctor should have and their potential choice of medical specialty. The analysis focuses on whether answers are relation-orientated (i.e. directed towards relations to others) or autonomy-orientated (i.e. directed towards rationality and independence). The results show that motivations for becoming a doctor are both relation- and autonomy-orientated. Most students expect the doctor to both be able to relate to the patient and be professionally competent. No gender differences could be demonstrated concerning motivations for becoming a doctor or which qualities a good doctor should possess. Significant gender differences were displayed concerning choice of specialty, most women aiming towards relation-orientated specialties and most men aiming towards autonomy-orientated specialties. It is concluded that the growing proportion of women doctors could change the medical profession towards becoming more patient- and relation-orientated, however their choice of relation-orientated and lower prestige specialties could result in less overall influence than one might otherwise expect.

  15. Life Expectancy of Brazilian Neurosurgeons. (United States)

    Botelho, Ricardo Vieira; Jardim Miranda, Bárbara Cristina; Nishikuni, Koshiro; Waisberg, Jaques


    Life expectancy (LE) refers to the number of years that an individual is expected to survive. Emphasis is frequently placed on the relationship between LE and the conditions under which a population lives, but fewer studies have investigated the relationship between stress factors associated with specific professions and their effects on LE. The aim of this study is to evaluate Brazilian neurosurgeons' life expectancies (BNLEs) and compare them with those of physicians (both Brazilian and foreign) from other fields, as well as with Brazilian nondoctors. The Brazilian Society of Neurosurgery death registry was used to obtain data that compared LEs from non-neurosurgeon physicians, as described in the national and international literature. BNLEs were also compared with the LEs of Brazilian citizens. Fifty-one neurosurgeons died between 2009 and 2016. All were males. The mean age at death was 68.31 ± 17.71 years. Among all-cause mortality, the breakdown was 20% cardiovascular diseases, 39% malignancies, 10% external factors, 6% gastrointestinal disorders, 12% neurologic illnesses, and 14% unknown causes. BNLE was shorter than LE of male Brazilian citizens. LE was similar among neurosurgeons and other doctors but shorter compared with Brazilian citizens. Further research is needed to provide data that can add to and confirm these results. Copyright © 2018 Elsevier Inc. All rights reserved.

  16. Physician Compare (United States)

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

  17. Survey of the Satisfaction and Dissatisfaction of Referring Physicians Concerning the Radiologic Report of Plain Radiography Except for Chest Plain Radiography

    International Nuclear Information System (INIS)

    Moon, Soon Young; Park, Noh Hyuck; Kim, Mi Sung; Park, Chan Sub; Park, Ji Yeon; Park, Hee Jin; Kim, Sam Soo; Jeon, Hyun Jun


    To assess the satisfaction, attitude, dissatisfaction and general opinion of radiologic reports on the plain radiography, except for chest plain radiographs. A questionnaire was distributed to the 63 physicians of our hospital. The questionnaire aimed to investigate physician's general attitude, dissatisfaction and opinions. The responses elicited, as well as discrepancies among residents, staff, medical clinicians and surgical clinicians were assessed. Chi-square and t-tests were used to determine the value of the data. The mean rate of satisfaction for the reading report by medical clinicians (64%) was higher than surgical clinicians (25%) (p < 0.001). The mean satisfaction score was 3.1 (2.8-3.61). The main cause for dissatisfaction was the absence of reports when they were needed, especially for residents. The medical clinician's dependence on radiologic reports was higher than that of the surgical clinicians. The satisfaction score was in the middle range and the main cause of dissatisfaction was absence of the reports when they were needed.

  18. Early pregnancy failure management among family physicians. (United States)

    Wallace, Robin; Dehlendorf, Christine; Vittinghoff, Eric; Gold, Katherine J; Dalton, Vanessa K


    Family physicians, as primary care providers for reproductive-aged women, frequently initiate or refer patients for management of early pregnancy failure (EPF). Safe and effective options for EPF treatment include expectant management, medical management with misoprostol, and aspiration in the office or operating room. Current practice does not appear to reflect patient preferences or to utilize the most cost-effective treatments. We compared characteristics and practice patterns among family physicians who do and do not provide multiple options for EPF care. We performed a secondary analysis of a national survey of women's health providers to describe demographic and practice characteristics among family physicians who care for women with EPF. We used multivariate logistic regression to identify correlates of providing more than one option for EPF management. The majority of family physicians provide only one option for EPF; expectant management was most frequently used among our survey respondents. Misoprostol and office-based aspiration were rarely used. Providing more than one option for EPF management was associated with more years in practice, smaller county population, larger proportions of Medicaid patients, intrauterine contraception provision, and prior training in office-based aspiration. Family physicians are capable of providing a comprehensive range of options for EPF management in the outpatient setting but few providers currently do so. To create a more patient-centered and cost-effective model of care for EPF, additional resources should be directed at education, skills training, and system change initiatives to prepare family physicians to offer misoprostol and office-based aspiration to women with EPF.

  19. Accountability and pediatric physician-researchers: are theoretical models compatible with Canadian lived experience?

    Directory of Open Access Journals (Sweden)

    Czoli Christine


    Full Text Available Abstract Physician-researchers are bound by professional obligations stemming from both the role of the physician and the role of the researcher. Currently, the dominant models for understanding the relationship between physician-researchers' clinical duties and research duties fit into three categories: the similarity position, the difference position and the middle ground. The law may be said to offer a fourth "model" that is independent from these three categories. These models frame the expectations placed upon physician-researchers by colleagues, regulators, patients and research participants. This paper examines the extent to which the data from semi-structured interviews with 30 physician-researchers at three major pediatric hospitals in Canada reflect these traditional models. It seeks to determine the extent to which existing models align with the described lived experience of the pediatric physician-researchers interviewed. Ultimately, we find that although some physician-researchers make references to something like the weak version of the similarity position, the pediatric-researchers interviewed in this study did not describe their dual roles in a way that tightly mirrors any of the existing theoretical frameworks. We thus conclude that either physician-researchers are in need of better training regarding the nature of the accountability relationships that flow from their dual roles or that models setting out these roles and relationships must be altered to better reflect what we can reasonably expect of physician-researchers in a real-world environment.

  20. Evolutionary Expectations

    DEFF Research Database (Denmark)

    Nash, Ulrik William


    , they are correlated among people who share environments because these individuals satisfice within their cognitive bounds by using cues in order of validity, as opposed to using cues arbitrarily. Any difference in expectations thereby arise from differences in cognitive ability, because two individuals with identical...... cognitive bounds will perceive business opportunities identically. In addition, because cues provide information about latent causal structures of the environment, changes in causality must be accompanied by changes in cognitive representations if adaptation is to be maintained. The concept of evolutionary......The concept of evolutionary expectations descends from cue learning psychology, synthesizing ideas on rational expectations with ideas on bounded rationality, to provide support for these ideas simultaneously. Evolutionary expectations are rational, but within cognitive bounds. Moreover...

  1. Unequal Expectations

    DEFF Research Database (Denmark)

    Karlson, Kristian Bernt

    the role of causal inference in social science; and it discusses the potential of the findings of the dissertation to inform educational policy. In Chapters II and III, constituting the substantive contribution of the dissertation, I examine the process through which students form expectations...... of the relation between the self and educational prospects; evaluations that are socially bounded in that students take their family's social position into consideration when forming their educational expectations. One important consequence of this learning process is that equally talented students tend to make...... for their educational futures. Focusing on the causes rather than the consequences of educational expectations, I argue that students shape their expectations in response to the signals about their academic performance they receive from institutionalized performance indicators in schools. Chapter II considers...

  2. Great Expectations

    NARCIS (Netherlands)

    Dickens, Charles


    One of Dickens's most renowned and enjoyable novels, Great Expectations tells the story of Pip, an orphan boy who wishes to transcend his humble origins and finds himself unexpectedly given the opportunity to live a life of wealth and respectability. Over the course of the tale, in which Pip

  3. Physician suicide. (United States)

    Preven, D W


    The topic of physician suicide has been viewed from several perspectives. The recent studies which suggest that the problem may be less dramatic statistically, do not lessen the emotional trauma that all experience when their lives are touched by the grim event. Keeping in mind that much remains to be learned about suicides in general, and physician suicide specifically, a few suggestions have been offered. As one approach to primary prevention, medical school curriculum should include programs that promote more self-awareness in doctors of their emotional needs. If the physician cannot heal himself, perhaps he can learn to recognize the need for assistance. Intervention (secondary prevention) requires that doctors have the capacity to believe that anyone, regardless of status, can be suicidal. Professional roles should not prevent colleague and friend from identifying prodromal clues. Finally, "postvention" (tertiary prevention) offers the survivors, be they family, colleagues or patients, the opportunity to deal with the searing loss in a therapeutic way.

  4. Experiments expectations


    Gorini, B; Meschi, E


    This paper presents the expectations and the constraints of the experiments relatively to the commissioning procedure and the running conditions for the 2015 data taking period. The views about the various beam parameters for the p-p period, like beam energy, maximum pileup, bunch spacing and luminosity limitation in IP2 and IP8, are discussed. The goals and the constraints of the 2015 physics program are also presented, including the heavy ions period as well as the special...

  5. Comparisons of CVID and IgGSD: Referring Physicians, Autoimmune Conditions, Pneumovax Reactivity, Immunoglobulin Levels, Blood Lymphocyte Subsets, and HLA-A and -B Typing in 432 Adult Index Patients

    Directory of Open Access Journals (Sweden)

    James C. Barton


    Full Text Available Common variable immunodeficiency (CVID and immunoglobulin (Ig G subclass deficiency (IgGSD are heterogeneous disorders characterized by respiratory tract infections, selective Ig isotype deficiencies, and impaired antibody responses to polysaccharide antigens. Using univariable analyses, we compared observations in 34 CVID and 398 IgGSD adult index patients (81.9% women referred to a hematology/oncology practice. Similarities included specialties of referring physicians, mean ages, proportions of women, reactivity to Pneumovax, median serum IgG3 and IgG4 levels, median blood CD56+/CD16+ lymphocyte levels, positivity for HLA-A and -B types, and frequencies of selected HLA-A, -B haplotypes. Dissimilarities included greater prevalence of autoimmune conditions, lower median IgG, IgA, and IgM, and lower median CD19+, CD3+/CD4+, and CD3+/CD8+ blood lymphocytes in CVID patients. Prevalence of Sjögren’s syndrome and hypothyroidism was significantly greater in CVID patients. Combined subnormal IgG1/IgG3 occurred in 59% and 29% of CVID and IgGSD patients, respectively. Isolated subnormal IgG3 occurred in 121 IgGSD patients (88% women. Logistic regression on CVID (versus IgGSD revealed a significant positive association with autoimmune conditions and significant negative associations with IgG1, IgG3, and IgA and CD56+/CD16+ lymphocyte levels, but the odds ratio was increased for autoimmune conditions alone (6.9 (95% CI 1.3, 35.5.

  6. Comparisons of CVID and IgGSD: referring physicians, autoimmune conditions, pneumovax reactivity, immunoglobulin levels, blood lymphocyte subsets, and HLA-A and -B typing in 432 adult index patients. (United States)

    Barton, James C; Bertoli, Luigi F; Barton, J Clayborn


    Common variable immunodeficiency (CVID) and immunoglobulin (Ig) G subclass deficiency (IgGSD) are heterogeneous disorders characterized by respiratory tract infections, selective Ig isotype deficiencies, and impaired antibody responses to polysaccharide antigens. Using univariable analyses, we compared observations in 34 CVID and 398 IgGSD adult index patients (81.9% women) referred to a hematology/oncology practice. Similarities included specialties of referring physicians, mean ages, proportions of women, reactivity to Pneumovax, median serum IgG3 and IgG4 levels, median blood CD56+/CD16+ lymphocyte levels, positivity for HLA-A and -B types, and frequencies of selected HLA-A, -B haplotypes. Dissimilarities included greater prevalence of autoimmune conditions, lower median IgG, IgA, and IgM, and lower median CD19+, CD3+/CD4+, and CD3+/CD8+ blood lymphocytes in CVID patients. Prevalence of Sjögren's syndrome and hypothyroidism was significantly greater in CVID patients. Combined subnormal IgG1/IgG3 occurred in 59% and 29% of CVID and IgGSD patients, respectively. Isolated subnormal IgG3 occurred in 121 IgGSD patients (88% women). Logistic regression on CVID (versus IgGSD) revealed a significant positive association with autoimmune conditions and significant negative associations with IgG1, IgG3, and IgA and CD56+/CD16+ lymphocyte levels, but the odds ratio was increased for autoimmune conditions alone (6.9 (95% CI 1.3, 35.5)).

  7. Administrative skills for academy physicians. (United States)

    Aluise, J J; Schmitz, C C; Bland, C J; McArtor, R E

    To function effectively within the multifaceted environment of the academic medical center, academic physicians need to heighten their understanding of the economics of the health care system, and further develop their leadership and managerial skills. A literature base on organizational development and management education is now available, which addresses the unique nature of the professional organization, including academic medical centers. This article describes an administration development curriculum for academic physicians. Competency statements, instructional strategies, and references provide health care educators with a model for developing administrative skills programs for academic physicians and other health care professionals. The continuing success of the academic medical center as a responsive health care system may depend on the degree to which academic physicians and their colleagues in other fields gain sophistication in self-management and organizational administration. Health care educators can apply the competencies and instructional strategies offered in this article to administrative development programs for physicians and other health professionals in their institutions.

  8. Physicians and Insider Trading. (United States)

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


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

  9. Description of 1,108 older patients referred by their physician to the "Geriatric Frailty Clinic (G.F.C) for Assessment of Frailty and Prevention of Disability" at the gerontopole. (United States)

    Tavassoli, N; Guyonnet, S; Abellan Van Kan, G; Sourdet, S; Krams, T; Soto, M E; Subra, J; Chicoulaa, B; Ghisolfi, A; Balardy, L; Cestac, P; Rolland, Y; Andrieu, S; Nourhashemi, F; Oustric, S; Cesari, M; Vellas, B


    Frailty is considered as an early stage of disability which, differently from disability, is still amenable for preventive interventions and is reversible. In 2011, the "Geriatric Frailty Clinic (G.F.C) for Assessment of Frailty and Prevention of Disability" was created in Toulouse, France, in association with the University Department of General Medicine and the Midi-Pyrénées Regional Health Authority. This structure aims to support the comprehensive and multidisciplinary assessment of frail older persons, to identify the specific causes of frailty and to design a personalized preventive plan of intervention against disability. In the present paper, we describe the G.F.C structure, organization, details of the global evaluation and preventive interventions against disability, and provide the main characteristics of the first 1,108 patients evaluated during the first two years of operation. Persons aged 65 years and older, considered as frail by their physician (general practitioner, geriatrician or specialist) in the Toulouse area, are invited to undergo a multidisciplinary evaluation at the G.F.C. Here, the individual is assessed in order to detect the potential causes for frailty and/or disability. At the end of the comprehensive evaluation, the team members propose to the patient (in agreement with the general practitioner) a Personalized Prevention Plan (PPP) specifically tailored to his/her needs and resources. The G.F.C also provides the patient's follow-up in close connection with family physicians. Mean age of our population was 82.9 ± 6.1 years. Most patients were women (n=686, 61.9%). According to the Fried criteria, 423 patients (39.1%) were pre-frail, and 590 (54.5%) frail. Mean ADL (Activities of Daily Living) score was 5.5 ± 1.0. Consistently, IADL (Instrumental ADL) showed a mean score of 5.6 ± 2.4. The mean gait speed was 0.78 ± 0.27 and 25.6% (272) of patients had a SPPB (Short Physical Performance Battery) score equal to or higher than 10

  10. Community expectations

    International Nuclear Information System (INIS)

    Kraemer, L.


    Historically, the relationship between the nuclear generator and the local community has been one of stability and co-operation. However in more recent times (2000-2003) the nuclear landscape has had several major issues that directly effect the local nuclear host communities. - The associations mandate is to be supportive of the nuclear industry through ongoing dialogue, mutual cooperation and education, - To strengthen community representation with the nuclear industry and politically through networking with other nuclear host communities. As a result of these issues, the Mayors of a number of communities started having informal meetings to discuss the issues at hand and how they effect their constituents. These meetings led to the official formation of the CANHC with representation from: In Canada it is almost impossible to discuss decommissioning and dismantling of Nuclear Facilities without also discussing Nuclear Waste disposal for reasons that I will soon make clear. Also I would like to briefly touch on how and why expectation of communities may differ by geography and circumstance. (author)

  11. Perceptions of trust in physician-managers. (United States)

    Cregård, Anna; Eriksson, Nomie


    The purpose of this paper is to explore the dual role of physician-managers through an examination of perceptions of trust and distrust in physician-managers. The healthcare sector needs physicians to lead. Physicians in part-time managerial positions who continue their medical practice are called part-time physician-managers. This paper explores this dual role through an examination of perceptions of trust and distrust in physician-managers. The study takes a qualitative research approach in which interviews and focus group discussions with physician-managers and nurse-managers provide the empirical data. An analytical model, with the three elements of ability, benevolence and integrity, was used in the analysis of trust and distrust in physician-managers. The respondents (physician-managers and nurse-managers) perceived both an increase and a decrease in physicians' trust in the physician-managers. Because elements of distrust were more numerous and more severe than elements of trust, the physician-managers received negative perceptions of their role. This paper's findings are based on perceptions of perceptions. The physicians were not interviewed on their trust and distrust of physician-managers. The healthcare sector must pay attention to the diverse expectations of the physician-manager role that is based on both managerial and medical logics. Hospital management should provide proper support to physician-managers in their dual role to ensure their willingness to continue to assume managerial responsibilities. The paper takes an original approach in its research into the dual role of physician-managers who work under two conflicting logics: the medical logic and the managerial logic. The focus on perceived trust and distrust in physician-managers is a new perspective on this complicated role.

  12. Ethical principles for physician rating sites. (United States)

    Strech, Daniel


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

  13. Administrative skills for academic physicians. (United States)

    Aluise, J J; Scmitz, C C; Bland, C J; McArtor, R E


    To function effectively within the multifaceted environment of the academic medical center, academic physicians need to heighten their understanding of the economics of the health care system, and further develop their leadership and managerial skills. A literature base on organizational development and management education now exists that addresses the unique nature of the professional organization, including academic medical centers. This article describes an administration development curriculum for academic physicians. Competency statements, instructional strategies and references provide the academic physician with guidelines for expanding their professional expertise to include organizational and management skills. The continuing success of the academic medical center as a responsive health care system may depend upon the degree to which academic physicians gain sophistication in self-management and organizational administration.

  14. Vaccines provided by family physicians. (United States)

    Campos-Outcalt, Doug; Jeffcott-Pera, Michelle; Carter-Smith, Pamela; Schoof, Bellinda K; Young, Herbert F


    This study was conducted to document current immunization practices by family physicians. In 2008 the American Academy of Family Physicians (AAFP) conducted a survey among a random sample of 2,000 of its members who reported spending 80% or more of their time in direct patient care. The survey consisted of questions regarding the demographics of the practice, vaccines that are provided at the physicians' clinical site, whether the practice refers patients elsewhere for vaccines, and participation in the Vaccines for Children (VFC) program. The response rate was 38.5%, 31.8% after non-office-based respondents were deleted. A high proportion of respondents (80% or more) reported providing most routinely recommended child, adolescent, and adult vaccines at their practice sites. The exceptions were rotavirus vaccine for children and herpes zoster vaccine for adults., A significant proportion, however, reported referring elsewhere for some vaccines (44.1% for children and adolescent vaccines and 53.5% for adult vaccines), with the most frequent referral location being a public health department. A higher proportion of solo and 2-physician practices than larger practices reported referring patients. A lack of adequate payment was listed as the reason for referring patients elsewhere for vaccines by one-half of those who refer patients. One-half of responders do not participate in the VFC program. Provision of recommended vaccines by most family physicians remains an important service. Smaller practices have more difficulty offering a full array of vaccine products, and lack of adequate payment contributes to referring patients outside the medical home. The reasons behind the lack of participation in the VFC program deserve further study.

  15. Accountability and pediatric physician-researchers: are theoretical models compatible with Canadian lived experience? (United States)

    Czoli, Christine; Da Silva, Michael; Shaul, Randi Zlotnik; d'Agincourt-Canning, Lori; Simpson, Christy; Boydell, Katherine; Rashkovan, Natalie; Vanin, Sharon


    Physician-researchers are bound by professional obligations stemming from both the role of the physician and the role of the researcher. Currently, the dominant models for understanding the relationship between physician-researchers' clinical duties and research duties fit into three categories: the similarity position, the difference position and the middle ground. The law may be said to offer a fourth "model" that is independent from these three categories.These models frame the expectations placed upon physician-researchers by colleagues, regulators, patients and research participants. This paper examines the extent to which the data from semi-structured interviews with 30 physician-researchers at three major pediatric hospitals in Canada reflect these traditional models. It seeks to determine the extent to which existing models align with the described lived experience of the pediatric physician-researchers interviewed.Ultimately, we find that although some physician-researchers make references to something like the weak version of the similarity position, the pediatric-researchers interviewed in this study did not describe their dual roles in a way that tightly mirrors any of the existing theoretical frameworks. We thus conclude that either physician-researchers are in need of better training regarding the nature of the accountability relationships that flow from their dual roles or that models setting out these roles and relationships must be altered to better reflect what we can reasonably expect of physician-researchers in a real-world environment. © 2011 Czoli et al; licensee BioMed Central Ltd.

  16. Physicians' perceptions of physician-nurse interactions and information needs in China. (United States)

    Wen, Dong; Guan, Pengcheng; Zhang, Xingting; Lei, Jianbo


    Good communication between physicians and nurses is important for the understanding of disease status and treatment feedback; however, certain issues in Chinese hospitals could lead to suboptimal physician-nurse communication in clinical work. Convenience sampling was used to recruit participants. Questionnaires were sent to clinical physicians in three top tertiary Grade-A teaching hospitals in China and six hundred and seventeen physicians participated in the survey. (1) Common physician-nurse interactions were shift-change reports and provisional reports when needed, and interactions expected by physicians included face-to-face reports and communication via a phone or mobile device. (2) Most respondents believed that the need for information in physician-nurse interactions was high, information was moderately accurate and timely, and feedback regarding interaction time and satisfaction indicated that they were only average and required improvement. (3) Information needs in physician-nurse interactions differed significantly according to hospital category, role, workplace, and educational background (p < .05). There was a considerable need for information within physician-nurse interactions, and the level of satisfaction with the information obtained was average; requirements for the improvement of communication differed between physicians and nurses because of differences in their characteristics. Currently, the use of information technology in physician-nurse communication was less common but was highly expected by physicians.

  17. Physician self-referral and physician-owned specialty facilities. (United States)

    Casalino, Lawrence P


    Physician self-referral ranges from suggesting a follow-up appointment, to sending a patient to a facility in which the doctor has an ownership interest or financial relationship. Physician referral to facilities in which the physicians have an ownership interest is becoming increasingly common and not always medically appropriate. This Synthesis reviews the evidence on physician self-referral arrangements, their effect on costs and utilization, and their effect on general hospitals. Key findings include: the rise in self-referral is sparked by financial, regulatory and clinical incentives, including patient convenience and doctors trying to preserve their income in the changing health care landscape. Strong evidence suggests self-referral leads to increased usage of health care services; but there is insufficient evidence to determine whether this increased usage reflects doctors meeting an unmet need or ordering clinically inappropriate care. The more significant a physician's financial interest in a facility, the more likely the doctor is to refer patients there. Arrangements through which doctors receive fees for patient referrals to third-party centers, such as "pay-per-click," time-share, and leasing arrangements, do not seem to offer benefits beyond increasing physician income. So far, the profit margins of general hospitals have not been harmed by the rise in doctor-owned facilities.

  18. Sex and life expectancy. (United States)

    Seifarth, Joshua E; McGowan, Cheri L; Milne, Kevin J


    A sexual dimorphism in human life expectancy has existed in almost every country for as long as records have been kept. Although human life expectancy has increased each year, females still live longer, on average, than males. Undoubtedly, the reasons for the sex gap in life expectancy are multifaceted, and it has been discussed from both sociological and biological perspectives. However, even if biological factors make up only a small percentage of the determinants of the sex difference in this phenomenon, parity in average life expectancy should not be anticipated. The aim of this review is to highlight biological mechanisms that may underlie the sexual dimorphism in life expectancy. Using PubMed, ISI Web of Knowledge, and Google Scholar, as well as cited and citing reference histories of articles through August 2012, English-language articles were identified, read, and synthesized into categories that could account for biological sex differences in human life expectancy. The examination of biological mechanisms accounting for the female-based advantage in human life expectancy has been an active area of inquiry; however, it is still difficult to prove the relative importance of any 1 factor. Nonetheless, biological differences between the sexes do exist and include differences in genetic and physiological factors such as progressive skewing of X chromosome inactivation, telomere attrition, mitochondrial inheritance, hormonal and cellular responses to stress, immune function, and metabolic substrate handling among others. These factors may account for at least a part of the female advantage in human life expectancy. Despite noted gaps in sex equality, higher body fat percentages and lower physical activity levels globally at all ages, a sex-based gap in life expectancy exists in nearly every country for which data exist. There are several biological mechanisms that may contribute to explaining why females live longer than men on average, but the complexity of the

  19. Physicians in transition: practice due diligence. (United States)

    Paterick, Timothy E


    The landscape of healthcare is changing rapidly. That landscape is now a business model of medicine. That rapid change resulting in a business model is affecting physicians professionally and personally. The new business model of medicine has led to large healthcare organizations hiring physicians as employees. The role of a physician as an employee has many limitations in terms of practice and personal autonomy. Employed physicians sign legally binding employment agreements that are written by the legal team working for the healthcare organization. Thus physicians should practice due diligence before signing the employment agreement. "Due diligence" refers to the care a reasonable person should take before entering into an agreement with another party. That reasonable person should seek expertise to represent his or her interests when searching a balanced agreement between the physician and organization.

  20. The Internet and primary care physicians: coping with different expectations

    NARCIS (Netherlands)

    Woerkum, van C.M.J.


    The birth of the Internet is one of the most important developments in the past 2 decades. It is a new medium, especially in the sense that the initiative now rests on the information user, who is no longer just a receiver of information. In part, the use of the Internet to find answers to

  1. When Patients Divorce: The Family Physician's Legal Position


    Mesbur, Ruth E.


    When divorce and family disintegration loom, the family physician is often the first outsider on the scene. The family physician may, indeed, have a critical role to play in handling the crisis; he may advise, refer to other professionals like therapists or lawyers, or appear in court as an expert witness. The physician must consider his legal position. Is reconciliation counselling confidential, privileged information? Can he recommend a lawyer for a patient? What is the physician's vulnerab...

  2. Physician wages across specialties: informing the physician reimbursement debate. (United States)

    Leigh, J Paul; Tancredi, Daniel; Jerant, Anthony; Kravitz, Richard L


    Disparities in remuneration between primary care and other physician specialties may impede health care reform by undermining the sustainability of a primary care workforce. Previous studies have compared annual incomes across specialties unadjusted for work hours. Wage (earnings-per-hour) comparisons could better inform the physician payment debate. In a cross-sectional analysis of data from 6381 physicians providing patient care in the 2004-2005 Community Tracking Study (adjusted response rate, 53%), we compared wages across broad and narrow categories of physician specialties. Tobit and linear regressions were run. Four broad specialty categories (primary care, surgery, internal medicine and pediatric subspecialties, and other) and 41 specific specialties were analyzed together with demographic, geographic, and market variables. In adjusted analyses on broad categories, wages for surgery, internal medicine and pediatric subspecialties, and other specialties were 48%, 36%, and 45% higher, respectively, than for primary care specialties. In adjusted analyses for 41 specific specialties, wages were significantly lower for the following than for the reference group of general surgery (wage near median, $85.98): internal medicine and pediatrics combined (-$24.36), internal medicine (-$24.27), family medicine (-$23.70), and other pediatric subspecialties (-$23.44). Wage rankings were largely impervious to adjustment for control variables, including age, race, sex, and region. Wages varied substantially across physician specialties and were lowest for primary care specialties. The primary care wage gap was likely conservative owing to exclusion of radiologists, anesthesiologists, and pathologists. In light of low and declining medical student interest in primary care, these findings suggest the need for payment reform aimed at increasing incomes or reducing work hours for primary care physicians.

  3. [The physician's role in various clinical contexts. Physician counseling on in vitro fertilization (IVF) and preimplantation genetic diagnosis (PGD)]. (United States)

    Kentenich, H; Tandler-Schneider, A


    The role of the physician in the context of in vitro fertilization and preimplantation genetic diagnosis has certain distinct characteristics. Involuntary childlessness by definition of the WHO is a disease with good treatment options. As it is not considered a medical emergency, the focus lies more on intensive information giving, education, and counseling. Because the diagnosis and treatment can be a medical and psychological strain for the couple, counseling should address both medical and psychological aspects. The physician needs to have detailed medical knowledge as well as good communication skills to be able to meet the specific needs of the couple. Moreover, the physician should point out the realistic success rates of treatment and should refer to alternatives, such as remaining childless, adoption, and sperm or egg donation. The concurrent inclusion of biological, psychological, social, and ethical aspects in terms of psychosomatic basic care (Psychosomatische Grundversorgung) seems to be useful. There is potential for conflicts, for example, due to the economic interests of the physician. On the other hand, the treatment can be a financial burden for the couple. Of importance are the physician's and the patient's moral concepts, especially concerning some aspects of therapy (sperm and egg donation, surrogacy). The expected welfare of the intended child should also be respected (e.g., higher risk of preterm birth in multiple pregnancies). Further possible conflicts in reproductive medicine arise because of the crossing of moral boundaries (oocyte donation for postmenopausal women, surrogacy, cloning of human beings). The framework of counseling is based on the guidelines of the German Medical Association (Bundesärztekammer) for assisted reproduction (2006). Preimplantation genetic diagnosis has special requirements from a medical and psychosocial point of view.

  4. Physician Fee Schedule Search (United States)

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

  5. Physicians' Job Satisfaction.

    African Journals Online (AJOL)


    doctors and retention of the existing doctors, in addition to the ... an employee's well-being Examples of job resources are job ..... increase physician job satisfaction for ensuring the .... both pay and benefits physicians at private hospitals.

  6. Physician Appraisals: Key Challenges

    Directory of Open Access Journals (Sweden)

    Klich Jacek


    Full Text Available The main purpose of the article is to identify key criteria being used for physician appraisals and to find how communication skills of physicians are valued in those appraisals. ScienceDirect and EBSCOhost databases were used for this search. The results show that a physician appraisal is underestimated both theoretically and empirically. The particular gap exists with respect to the communication skills of physicians, which are rarely present in medical training syllabi and physician assessments. The article contributes to the theoretical discourse on physician appraisals and points out at the inconsistency between the high status of physicians as a key hospital resource on the one hand and, on the other hand, at inadequate and poorly researched assessment of their performance with a special emphasis on communication skills. The article may inspire health managers to develop and implement up-to-date assessment forms for physicians and good managerial practices in this respect in hospitals and other health care units.

  7. Physician heal thyself

    African Journals Online (AJOL)

    Compared to overweight or obese physicians, normal‑weight physicians were significantly more likely to discuss weight loss with their obese patients, according to a study among. 500 primary care physicians, undertaken by researchers at the Johns Hopkins Bloomberg School of Public Health.[4]. A recent, highly accessed ...

  8. Business plan writing for physicians. (United States)

    Cohn, Kenneth H; Schwartz, Richard W


    Physicians are practicing in an era in which they are often expected to write business plans in order to acquire, develop, and implement new technology or programs. This task is yet another reminder of the importance of business principles in providing quality patient care amid allocation of increasingly scarce resources. Unfortunately, few physicians receive training during medical school, residencies, or fellowships in performing such tasks. The process of writing business plans follows an established format similar to writing a consultation, in which the risks, benefits, and alternatives to a treatment option are presented. Although administrative assistance may be available in compiling business plans, it is important for physicians to understand the rationale, process, and pitfalls of business planning. Writing a business plan will serve to focus, clarify, and justify a request for scarce resources, and thus, increase its chance of success, both in terms of funding and implementation. A well-written business plan offers a plausible, coherent story of an uncertain future. Therefore, a business plan is not merely an exercise to obtain funding but also a rationale for investment that can help physicians reestablish leadership in health care.

  9. Family physicians' perspectives regarding palliative radiotherapy

    International Nuclear Information System (INIS)

    Samant, Rajiv S.; Fitzgibbon, Edward; Meng, Joanne; Graham, Ian D.


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

  10. The physician executive in a changing world. (United States)

    Kaiser, L R


    Physicians are losing their historic franchise as sole and primary providers of medical care. In addition to eroding moral and scientific authority, physicians are also losing income and status. It is no wonder that physicians are retrenching--confused and angry about the increasing marginalization of their profession and about society's changing expectations. Physicians are caught in a transition zone between the world that was and the one that will soon be. This is destabilizing and causes great anxiety. Rather than being buffeted by changing social and cultural definitions of health care, physicians must become proactively involved in the future of their profession. Physicians can only do this by offering a better mental model of health, medicine, and the community. This cannot be a defensive retreat from engagement. Rather, it must be an imaginative vision, vigorously set forth--a vision that will enlist the support of all constituencies involved in the effort to improve the health and well-being of all members of our society. The physician executive needs to work with physicians to orchestrate this effort to create a new vision of health in the 21st century.

  11. The quality assessment of family physician service in rural regions, Northeast of Iran in 2012. (United States)

    Vafaee-Najar, Ali; Nejatzadegan, Zohreh; Pourtaleb, Arefeh; Kaffashi, Shahnaz; Vejdani, Marjan; Molavi-Taleghani, Yasamin; Ebrahimipour, Hosein


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

  12. Organizational commitment of military physicians. (United States)

    Demir, Cesim; Sahin, Bayram; Teke, Kadir; Ucar, Muharrem; Kursun, Olcay


    An individual's loyalty or bond to his or her employing organization, referred to as organizational commitment, influences various organizational outcomes such as employee motivation, job satisfaction, performance, accomplishment of organizational goals, employee turnover, and absenteeism. Therefore, as in other sectors, employee commitment is crucial also in the healthcare market. This study investigates the effects of organizational factors and personal characteristics on organizational commitment of military physicians using structural equation modeling (SEM) on a self-report, cross-sectional survey that consisted of 635 physicians working in the 2 biggest military hospitals in Turkey. The results of this study indicate that professional commitment and organizational incentives contribute positively to organizational commitment, whereas conflict with organizational goals makes a significantly negative contribution to it. These results might help develop strategies to increase employee commitment, especially in healthcare organizations, because job-related factors have been found to possess greater impact on organizational commitment than personal characteristics.

  13. Hope and persuasion by physicians during informed consent. (United States)

    Miller, Victoria A; Cousino, Melissa; Leek, Angela C; Kodish, Eric D


    To describe hopeful and persuasive messages communicated by physicians during informed consent for phase I trials and examine whether such communication is associated with physician and parent ratings of the likelihood of benefit, physician and parent ratings of the strength of the physician's recommendation to enroll, parent ratings of control, and parent ratings of perceived pressure. Participants were children with cancer (n = 85) who were offered a phase I trial along with their parents and physicians. Informed consent conferences (ICCs) were audiotaped and coded for physician communication of hope and persuasion. Parents completed an interview (n = 60), and physicians completed a case-specific questionnaire. The most frequent hopeful statements related to expectations of positive outcomes and provision of options. Physicians failed to mention no treatment and/or palliative care as options in 68% of ICCs and that the disease was incurable in 85% of ICCs. When physicians mentioned no treatment and/or palliative care as options, both physicians and parents rated the physician's strength of recommendation to enroll in the trial lower. Hopes and goals other than cure or longer life were infrequently mentioned, and a minority of physicians communicated that the disease was incurable and that no treatment and/or palliative care were options. These findings are of concern, given the low likelihood of medical benefit from phase I trials. Physicians have an important role to play in helping families develop alternative goals when no curative options remain. © 2014 by American Society of Clinical Oncology.

  14. Burnout among physicians


    Romani, Maya; Ashkar, Khalil


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

  15. How Digital Health Technology Aids Physicians

    Directory of Open Access Journals (Sweden)

    Nik Tehrani


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

  16. Becoming a Physician (United States)

    ... the Payment Process Physician Payment Resource Center Reinventing Medical Practice Managing Your Practice CPT® (Current Procedural Terminology) Medicare & Medicaid Private Payer Reform Claims Processing & Practice ...

  17. American College of Physicians (United States)

    ... Plus In this Section Clinical Guidelines & Recommendations Performance Measures Journals & Publications Clinical Resources & Products High Value Care Ethics & Professionalism Practice Resources Physician and Practice Timeline Upcoming important dates ...

  18. Fall prevention and monitoring of assisted living patients: an exploratory study of physician perspectives. (United States)

    Nyrop, Kirsten A; Zimmerman, Sheryl; Sloane, Philip D; Bangdiwala, Srikant


    Explore physician perspectives on their involvement in fall prevention and monitoring for residential care/assisted living (RC/AL) residents. Exploratory cross-sectional study; mailed questionnaire. Four RC/AL communities, North Carolina. Primary physicians for RC/AL residents. Past Behavior and future Intentions of physicians with regard to (1) fall risk assessment and (2) collaboration with RC/AL staff to reduce falls and fall risks among RC/AL residents were explored using Theory of Planned Behavior (TPB) constructs. Predictor variables examined (1) physicians' views on their own responsibilities (Attitude), (2) their views of expectations from important referent groups (Subjective Norms), and (3) perceived constraints on engaging in fall prevention and monitoring (Perceived Behavioral Control). Physicians reported conducting fall risk assessments of 47% of RC/AL patients and collaborating with RC/AL staff to reduce fall risks for 36% of RC/AL patients (Behavior). These proportions increased to 75% and 62%, respectively, for future Intentions. TPB-based models explained approximately 60% of the variance in self-reported Behavior and Intentions. Physician's involvement in fall prevention and monitoring was significantly associated (P beliefs regarding their involvement in fall risk assessment of RC/AL patients and collaboration with RC/AL staff to reduce fall risks of individual patients. Challenges to physician involvement identified in our study are not unique or specific to the RC/AL setting, and instead relate to clinical practice and reimbursement constraints in general. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

  19. Communication Skills of Physicians and Patients’ Satisfaction (United States)

    Biglu, Mohammad-Hossein; Nateq, Farnaz; Ghojazadeh, Morteza; Asgharzadeh, Ali


    Background: The communication skills of physicians is an effective step of making effective relationship between doctor and patient. It plays essential role through diagnosis and treatment processes. This current study was performed to investigate the impact of communication skillfulness of physicians on patients’ satisfaction. Methods: A cross-sectional descriptive study was done to determine the impact of communication capability of practitioners on patients’ satisfaction. The DiMatto’s Patient Satisfaction Scale was administered among patients referring to the all 8 specialized clinics of Tabriz University of Medical Sciences. The validity and reliability of Persian translation of questionnaire of DiMatto’s Patient Satisfaction was verified by 10 specialists. The validity of the questionnaire was measured by content and structural analysis, and Cronbach’s alpha coefficients. The data were analyzed by software package of SPSS version 16 using Pearson’s correlation coefficient, U Mann-Whitney, Kruskal-wallis Test, Regression. Results: The study showed that there was a significant correlation between patients’ satisfaction and the communication skills of physicians (devoting the appropriate time for visiting the patients, explaining diagnosis and treatment procedures). In addition, the therapeutic skills of physicians, their friendly manners, respecting the patients’ feelings, and careful examination of patients by physician, revealed a significant correlation with patient satisfaction (P Communication skills of physician play an important role on patients’ satisfaction; therefore, we propose strongly to improve the communication skills of physicians by improving the communication skills through related training courses. PMID:29109665

  20. Communication Skills of Physicians and Patients' Satisfaction. (United States)

    Biglu, Mohammad-Hossein; Nateq, Farnaz; Ghojazadeh, Morteza; Asgharzadeh, Ali


    The communication skills of physicians is an effective step of making effective relationship between doctor and patient. It plays essential role through diagnosis and treatment processes. This current study was performed to investigate the impact of communication skillfulness of physicians on patients' satisfaction. A cross-sectional descriptive study was done to determine the impact of communication capability of practitioners on patients' satisfaction. The DiMatto's Patient Satisfaction Scale was administered among patients referring to the all 8 specialized clinics of Tabriz University of Medical Sciences. The validity and reliability of Persian translation of questionnaire of DiMatto's Patient Satisfaction was verified by 10 specialists. The validity of the questionnaire was measured by content and structural analysis, and Cronbach's alpha coefficients. The data were analyzed by software package of SPSS version 16 using Pearson's correlation coefficient, U Mann-Whitney, Kruskal-wallis Test, Regression. The study showed that there was a significant correlation between patients' satisfaction and the communication skills of physicians (devoting the appropriate time for visiting the patients, explaining diagnosis and treatment procedures). In addition, the therapeutic skills of physicians, their friendly manners, respecting the patients' feelings, and careful examination of patients by physician, revealed a significant correlation with patient satisfaction (P Communication skills of physician play an important role on patients' satisfaction; therefore, we propose strongly to improve the communication skills of physicians by improving the communication skills through related training courses.

  1. Consultation and referral between physicians in new medical practice environments. (United States)

    Schaffer, W A; Holloman, F C


    The traditional exchange of medical expertise between physicians for patient benefit has been accomplished by referral. Physicians have traditionally decided when and to whom to refer patients. Health care "systems" now dominate medical practice, and their formats can alter spontaneous collegial interaction in referral. Institutional programs now pursue patient referrals as part of a marketing strategy to attract new patients who then become attached to the institution, rather than to a physician. Referral behavior can affect a physician's personal income in prepaid insurance programs where referrals are discouraged. The referring physician may bear legal liability for actions of the consultant. New practice arrangements and affiliations may place physicians in financial conflict-of-interest situations, challenge ethical commitments, and add new moral responsibility.

  2. Prepaid entitlements. A new challenge for physician-patient relationships. (United States)

    Schroeder, J L; Clarke, J T; Webster, J R


    The transition from a fee-for-service model to a prepaid health care system creates new challenges for both physicians and patients. Occasionally both can feel trapped in the new setting and must rely on new or different strategies to reach sometimes divergent objectives. This may alter the physician-patient relationship in ways that neither likes. Based on our experience in a large multispecialty academic group practice, we have developed management strategies to mitigate such stresses on both parties. These include review of marketing efforts; education of new patients to foster realistic expectations; a physician-generated, prospective internal policy for dealing with dissatisfied patients and physicians; a strong central administrative physician to serve as a "lightning rod" and counselor; and continuing physician orientation and education to improve judgment and attitudes. These strategies promote the physician's role as expert consultant-educator with the best interests of the patient as the first priority.

  3. Kentucky physicians and politics. (United States)

    VonderHaar, W P; Monnig, W B


    Approximately 19% of Kentucky Physicians are KEMPAC members or contribute to state legislative and Gubernatorial candidates. This limited study of political activity indicates that a small percentage of physicians participate in the political process. Despite the small number of contributors to state legislative candidates, KMA's legislative and lobbying effort is highly effective and members receive high quality service and representation in the political arena.

  4. Expecting the unexpected

    DEFF Research Database (Denmark)

    Mcneill, Ilona M.; Dunlop, Patrick D.; Heath, Jonathan B.


    People who live in wildfire-prone communities tend to form their own hazard-related expectations, which may influence their willingness to prepare for a fire. Past research has already identified two important expectancy-based factors associated with people's intentions to prepare for a natural......) and measured actual rather than intended preparedness. In addition, we tested the relation between preparedness and two additional threat-related expectations: the expectation that one can rely on an official warning and the expectation of encountering obstacles (e.g., the loss of utilities) during a fire...

  5. Growth references

    NARCIS (Netherlands)

    Buuren, S. van


    A growth reference describes the variation of an anthropometric measurement within a group of individuals. A reference is a tool for grouping and analyzing data and provides a common basis for comparing populations.1 A well known type of reference is the age-conditional growth diagram. The

  6. Best Practice Life Expectancy

    DEFF Research Database (Denmark)

    Medford, Anthony


    been reported previously by various authors. Though remarkable, this is simply an empirical observation. Objective: We examine best-practice life expectancy more formally by using extreme value theory. Methods: Extreme value distributions are fit to the time series (1900 to 2012) of maximum life......Background: Whereas the rise in human life expectancy has been extensively studied, the evolution of maximum life expectancies, i.e., the rise in best-practice life expectancy in a group of populations, has not been examined to the same extent. The linear rise in best-practice life expectancy has...... expectancies at birth and age 65, for both sexes, using data from the Human Mortality Database and the United Nations. Conclusions: Generalized extreme value distributions offer a theoretically justified way to model best-practice life expectancies. Using this framework one can straightforwardly obtain...

  7. "I do not have time. Is there a handout I can use?": combining physicians' needs and behavior change theory to put physical activity evidence into practice. (United States)

    Clark, R E; McArthur, C; Papaioannou, A; Cheung, A M; Laprade, J; Lee, L; Jain, R; Giangregorio, L M


    Guidelines for physical activity exist and following them would improve health. Physicians can advise patients on physical activity. We found barriers related to physicians' knowledge, a lack of tools and of physician incentives, and competing demands for limited time with a patient. We discuss interventions that could reduce these barriers. Uptake of physical activity (PA) guidelines would improve health and reduce mortality in older adults. However, physicians face barriers in guideline implementation, particularly when faced with needing to tailor recommendations in the presence of chronic disease. We performed a behavioral analysis of physician barriers to PA guideline implementation and to identify interventions. The Too Fit To Fracture physical activity recommendations were used as an example of disease-specific PA guidelines. Focus groups and semi-structured interviews were conducted with physicians and nurse practitioners in Ontario, stratified by type of physician, geographic area, and urban/rural, and transcribed verbatim. Two researchers coded data and identified emerging themes. Using the behavior change wheel framework, themes were categorized into capability, opportunity and motivation, and interventions were identified. Fifty-nine family physicians, specialists, and nurse practitioners participated. Barriers were as follows: Capability-lack of exercise knowledge or where to refer; Opportunity-pragmatic tools, fit within existing workflow, available programs that meet patients' needs, physical activity literacy and cultural practices; Motivation-lack of incentives, not in their scope of practice or professional identity, competing priorities, outcome expectancies. Interventions selected: education, environmental restructuring, enablement, persuasion. Policy categories: communications/marketing, service provision, guidelines. Key barriers to PA guideline implementation among physicians include knowledge on where to refer or what to say, access to

  8. Educational needs of family physicians in Yazd province

    Directory of Open Access Journals (Sweden)

    M Karimi


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

  9. [Determinants in the careers of male and female physicians from the viewpoint of chief physicians]. (United States)

    Buddeberg-Fischer, B; Spindler, A; Peter, Y; Buddeberg, C


    Chief physicians play an important role for physicians' careers by providing advanced training and allocating time and research resources. This study examined which characteristics will help physicians to achieve a leadership position and how chief physicians conduct career promotion. All 532 chief physicians in Switzerland's German speaking cantons with medical schools were approached with a questionnaire covering professional motivation and personal attributes of career-oriented physicians career-promoting personal and institutional factors, and type of career promotion. 207 chief physicians (189 men, 18 women; participation rate 38.9 %;) participated. Respondents rated achievement motivation combined with professional interest and job enjoyment (intrinsic), and interest in advancement and social prestige (extrinsic motivation) as beneficial. Extraprofessional concerns such as family obligations and leisure interests were viewed as less important. Instrumental attributes were rated as advantageous. Expressive qualities were also seen as beneficial but less crucial. Ratings were independent of respondents' age, specialty, or type of workplace. The following personal factors were named: professional commitment, professional and social competence, goal orientation, endurance, and strength of character. The institutional factors referred to quality of training and teaching, a good work atmosphere, a transparent and flexible clinic structure. Career promotion was offered predominantly in the form of coaching, career planning, and support in job search. Career promotion should be more targeted and structured, e. g. be conducted in mentoring programmes, thus providing the prerequisites for a truly equal career promotion of female and male physicians.

  10. Gender difference on patients' satisfaction and expectation towards ...

    African Journals Online (AJOL)

    Background: Recognizing patient satisfaction and expectation is considered as important components of assessing quality of care. Aim: The aim of this study was to determine the gender difference on the patient satisfaction with psychiatrists and explore their expectation from physicians to mental health care needs. Design: ...

  11. Determining health expectancies

    National Research Council Canada - National Science Library

    Robine, Jean-Marie


    ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Jean-Marie Robine 9 1 Increase in Life Expectancy and Concentration of Ages at Death . . . . France Mesle´ and Jacques Vallin 13 2 Compression of Morbidity...

  12. [Reference citation]. (United States)

    Brkić, Silvija


    Scientific and professional papers represent the information basis for scientific research and professional work. References important for the paper should be cited within the text, and listed at the end of the paper. This paper deals with different styles of reference citation. Special emphasis was placed on the Vancouver Style for reference citation in biomedical journals established by the International Committee of Medical Journal Editors. It includes original samples for citing various types of articles, both printed and electronic, as well as recommendations related to reference citation in accordance with the methodology and ethics of scientific research and guidelines for preparing manuscripts for publication.

  13. Hitler's Jewish Physicians. (United States)

    Weisz, George M


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

  14. Physician Referral Patterns (United States)

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

  15. Physician-Owned Hospitals (United States)

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

  16. Physician Shared Patient Patterns (United States)

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

  17. Performance appraisal of expectations

    Directory of Open Access Journals (Sweden)

    Russkikh G.A.


    Full Text Available this article provides basic concepts for teachers to estimate and reach planned students’ expectations, describes functions and elements of expectations; nature of external and internal estimate, technology to estimate the results, gives recommendations how to create diagnostic assignments.

  18. Spiking the expectancy profiles

    DEFF Research Database (Denmark)

    Hansen, Niels Chr.; Loui, Psyche; Vuust, Peter

    Melodic expectations are generated with different degrees of certainty. Given distributions of expectedness ratings for multiple continuations of each context, as obtained with the probe-tone paradigm, this certainty can be quantified in terms of Shannon entropy. Because expectations arise from s...

  19. Are physicians strikes ever morally justifiable? A call for a return to tradition

    Directory of Open Access Journals (Sweden)

    Munyaradzi Mawere


    Full Text Available Though physicians strike provides an opportunity to generate more knowledge about the process in which legitimacy of an organization can be restored, it meets with a great deal of resistance not only by the public but from within the medical profession. This paper critically examines the legitimacy of strike by medical doctors heretofore referred to as physicians. Though critically reflecting on strikes of physicians in general, the paper makes more emphasis on Africa where physician strikes are rampant. More importantly, the paper argues that strike implies a failure for everyone in the organization (including the strikers themselves, not only the responsible government or authority. This is because when a strike occurs, an organization/fraternity is subjected to questions, scrutiny and slander. It becomes difficult to decouple what is said, decided and done. Traditionally, all medical fraternities the world-over are committed to acting comfortably to external demands- guaranteeing the patients lives and public health. By paying attention to external reactions, the medical fraternity adapts and learns what ought and should be done so that it is never again caught in the same messy. At the same time, the fraternity prepares itself for the future strikes. When the fraternity and those outside consider it is doing up to the external expectations, its lost legitimacy is restored. When legitimacy is restored, external pressure like once disturbed water returns to normal

  20. Reference Assessment (United States)

    Bivens-Tatum, Wayne


    This article presents interesting articles that explore several different areas of reference assessment, including practical case studies and theoretical articles that address a range of issues such as librarian behavior, patron satisfaction, virtual reference, or evaluation design. They include: (1) "Evaluating the Quality of a Chat Service"…

  1. Physician dual practice: A review of literature

    DEFF Research Database (Denmark)

    Socha, Karolina; Bech, Mickael


    Objectives A combination of public and private practice by physicians, referred to as physician dual practice, has been receiving attention in connection with arguments about its negative impact for the public health care. This paper aims to review and critically discuss findings on the subject...... of dual practice effects for the public health care. Methods A systematic literature review identified 23 positions on the subject consisting of journal articles, academic working papers, book chapter, and publications of the WHO. Results The subject is short on evidence. Theoretical analyses indicate...

  2. Factors affecting cardiac rehabilitation referral by physician specialty. (United States)

    Grace, Sherry L; Grewal, Keerat; Stewart, Donna E


    Cardiac rehabilitation (CR) is widely underutilized because of multiple factors including physician referral practices. Previous research has shown CR referral varies by type of provider, with cardiologists more likely to refer than primary care physicians. The objective of this study was to compare factors affecting CR referral in primary care physicians versus cardiac specialists. A cross-sectional survey of a stratified random sample of 510 primary care physicians and cardiac specialists (cardiologists or cardiovascular surgeons) in Ontario identified through the Canadian Medical Directory Online was administered. One hundred four primary care physicians and 81 cardiac specialists responded to the 26-item investigator-generated survey examining medical, demographic, attitudinal, and health system factors affecting CR referral. Primary care physicians were more likely to endorse lack of familiarity with CR site locations (P negatively impacting CR referral practices than cardiac specialists. Cardiac specialists were significantly more likely to perceive that their colleagues and department would regularly refer patients to CR than primary care physicians (P Marketing CR site locations, provision of standardized referral forms, and ensuring discharge summaries are communicated to primary care physicians may improve their willingness to refer to CR.

  3. Recent references

    International Nuclear Information System (INIS)

    Ramavataram, S.


    In support of a continuing program of systematic evaluation of nuclear structure data, the National Nuclear Data Center maintains a complete computer file of references to the nuclear physics literature. Each reference is tagged by a keyword string, which indicates the kinds of data contained in the article. This master file of Nuclear Structure References (NSR) contains complete keyword indexes to literature published since 1969, with partial indexing of older references. Any reader who finds errors in the keyword descriptions is urged to report them to the National Nuclear Data Center so that the master NSR file can be corrected. In 1966, the first collection of Recent References was published as a separate issue of Nuclear Data Sheets. Every four months since 1970, a similar indexed bibliography to new nuclear experiments has been prepared from additions to the NSR file and published. Beginning in 1978, Recent References was cumulated annually, with the third issue completely superseding the two issues previously published during a given year. Due to publication policy changes, cumulation of Recent Reference was discontinued in 1986. The volume and issue number of all the cumulative issues published to date are given. NNDC will continue to respond to individual requests for special bibliographies on nuclear physics topics, in addition to those easily obtained from Recent References. If the required information is available from the keyword string, a reference list can be prepared automatically from the computer files. This service can be provided on request, in exchange for the timely communication of new nuclear physics results (e.g., preprints). A current copy of the NSR file may also be obtained in a standard format on magnetic tape from NNDC. Requests for special searches of the NSR file may also be directed to the National Nuclear Data Center

  4. Primary care physician management, referral, and relations with specialists concerning patients at risk for cancer due to family history. (United States)

    Wood, M E; Flynn, B S; Stockdale, A


    Risk stratification based on family history is a feature of screening guidelines for a number of cancers and referral guidelines for genetic counseling/testing for cancer risk. Our aim was to describe primary care physician perceptions of their role in managing cancer risk based on family history. Structured interviews were conducted by a medical anthropologist with primary care physicians in 3 settings in 2 north-eastern states. Transcripts were systematically analyzed by a research team to identify major themes expressed by participants. Forty interviews were conducted from May 2003 through May 2006. Physicians provided a diversity of views on roles in management of cancer risk based on family history, management practices and patient responses to risk information. They also provided a wide range of perspectives on criteria used for referral to specialists, types of specialists referred to and expected management roles for referred patients. Some primary care physicians appeared to make effective use of family history information for cancer risk management, but many in this sample did not. Increased focus on efficient assessment tools based on recognized guidelines, accessible guides to management options, and patient education and decision aids may be useful directions to facilitate broader use of family history information for cancer risk management. Copyright © 2013 S. Karger AG, Basel.

  5. The Changing Dynamics of Health Care: Physician Perceptions of Technology in Medical Practices (United States)

    Hatton, Jerald D.


    Political, economic, and safety concerns have militated for the adoption of electronic health records (EHR) by physicians in the United States, but current rates of adoption have failed to achieve the expected levels. This qualitative phenomenological study of practicing physicians reveals obstacles to adoption. Maintaining the physicians'…

  6. Life expectancy and education

    DEFF Research Database (Denmark)

    Hansen, Casper Worm; Strulik, Holger


    , we find that US states with higher mortality rates from cardiovascular disease prior to the 1970s experienced greater increases in adult life expectancy and higher education enrollment. Our estimates suggest that a one-standard deviation higher treatment intensity is associated with an increase...... in adult life expectancy of 0.37 years and 0.07–0.15 more years of higher education....

  7. Expected Classification Accuracy

    Directory of Open Access Journals (Sweden)

    Lawrence M. Rudner


    Full Text Available Every time we make a classification based on a test score, we should expect some number..of misclassifications. Some examinees whose true ability is within a score range will have..observed scores outside of that range. A procedure for providing a classification table of..true and expected scores is developed for polytomously scored items under item response..theory and applied to state assessment data. A simplified procedure for estimating the..table entries is also presented.

  8. Expected utility without utility


    Castagnoli, E.; Licalzi, M.


    This paper advances an interpretation of Von Neumann–Morgenstern’s expected utility model for preferences over lotteries which does not require the notion of a cardinal utility over prizes and can be phrased entirely in the language of probability. According to it, the expected utility of a lottery can be read as the probability that this lottery outperforms another given independent lottery. The implications of this interpretation for some topics and models in decision theory are considered....

  9. Direct-to-consumer pharmaceutical advertising: physician and public opinion and potential effects on the physician-patient relationship. (United States)

    Robinson, Andrew R; Hohmann, Kirsten B; Rifkin, Julie I; Topp, Daniel; Gilroy, Christine M; Pickard, Jeffrey A; Anderson, Robert J


    Previous studies have shown that direct-to-consumer (DTC) pharmaceutical advertising can influence consumer behavior and that many physicians have negative views of these advertisements. Physician and public opinions about these advertisements and how they may affect the physician-patient relationship are not well established. Mail survey of 523 Colorado physicians and 261 national physicians and telephone survey of 500 Colorado households asking respondents to rate their agreement with statements about DTC advertising. Most physicians tended to view DTC advertisements negatively, indicating that such advertisements rarely provide enough information on cost (98.7%), alternative treatment options (94.9%), or adverse effects (54.8%). Most also believed that DTC advertisements affected interactions with patients by lengthening clinical encounters (55.9%), leading to patient requests for specific medications (80.7%), and changing patient expectations of physicians' prescribing practices (67.0%). Only 29.0% of public respondents agreed that DTC advertising is a positive trend in health care and 28.6% indicated that advertisements make them better informed about medical problems; fewer indicated that advertisements motivated them to seek care (10.5%) or led them to request specific medications from their physicians (13.3%). Most physicians have negative views of DTC pharmaceutical advertising and see several potential effects of these advertisements on the physician-patient relationship. Many public respondents have similarly negative views, and only a few agree that they change their expectations of or interactions with physicians. While these advertisements may be influencing only a few consumers, it seems that the impact on physicians and their interactions with patients may be significant.

  10. Spirituality and the physician executive. (United States)

    Kaiser, L R


    The "s" word can now be spoken without flinching in health care organizations. Spirituality is becoming a common topic in management conferences around the world. Many U.S. corporations are recognizing the role of spirituality in creating a new humanistic capitalism that manages beyond the bottom line. Spirituality refers to a broad set of principles that transcend all religions. It is the relationship between yourself and something larger, such as the good of your patient or the welfare of the community. Spirituality means being in right relationship to all that is and understanding the mutual interdependence of all living beings. Physician executives should be primary proponents of spirituality in their organizations by: Modeling the power of spirituality in their own lives; integrating spiritual methodologies into clinical practice; fostering an integrative approach to patient care; encouraging the organization to tithe its profits for unmet community health needs; supporting collaborative efforts to improve the health of the community; and creating healing environments.

  11. Anomalous vacuum expectation values

    International Nuclear Information System (INIS)

    Suzuki, H.


    The anomalous vacuum expectation value is defined as the expectation value of a quantity that vanishes by means of the field equations. Although this value is expected to vanish in quantum systems, regularization in general produces a finite value of this quantity. Calculation of this anomalous vacuum expectation value can be carried out in the general framework of field theory. The result is derived by subtraction of divergences and by zeta-function regularization. Various anomalies are included in these anomalous vacuum expectation values. This method is useful for deriving not only the conformal, chiral, and gravitational anomalies but also the supercurrent anomaly. The supercurrent anomaly is obtained in the case of N = 1 supersymmetric Yang-Mills theory in four, six, and ten dimensions. The original form of the energy-momentum tensor and the supercurrent have anomalies in their conservation laws. But the modification of these quantities to be equivalent to the original one on-shell causes no anomaly in their conservation laws and gives rise to anomalous traces

  12. [Hippocrates' treatise physician]. (United States)

    Frøland, Anders


    This small treatise does not appear to have been published in Danish in its entirety. It gives a vivid picture of the physician in ancient Greece. The well known first chapter describes the attitudes and attributes of the doctor. It goes on discussing in some detail how the light should be in the surgery, the instruments to be used, the preparations of bandages and drugs, and the use of cupping instruments. The author stresses both the needs of the patient and the necessity of the physician's dignity and integrity.

  13. Female Physicians and the Future of Endocrinology. (United States)

    Pelley, Elaine; Danoff, Ann; Cooper, David S; Becker, Carolyn


    Given that approximately 70% of current endocrinology fellows are women, female physicians will compose the majority of the future endocrinology workforce. This gender shift partly reflects an apparent waning of interest in endocrinology among male trainees. It also coincides with a projected shortage of endocrinologists overall. Female physicians face unique challenges in the workplace. To continue to attract trainees to the specialty and support their success, it is imperative that these challenges be recognized, understood, and addressed. A PubMed search using the terms "female physician" and "physician gender" covering the years 2000-2015 was performed. Additional references were identified through review of the citations of the retrieved articles. The following topics were identified as key to understanding the impact of this gender shift: professional satisfaction, work-life balance, income, parenthood, academic success, and patient satisfaction. Several changes can be predicted to occur as endocrinology becomes a female-predominant specialty. Although professional satisfaction should remain stable, increased burnout rates are likely. Work-life balance challenges will likely be magnified. The combined effects of occupational gender segregation and a gender pay gap are predicted to negatively impact salaries of endocrinologists of both genders. The underrepresentation of women in academic leadership may mean a lesser voice for endocrinology in this arena. Finally, gender biases evident in patient satisfaction measures--commonly used as proxies for quality of care--may disproportionately impact endocrinology. Endocrinology is predicted to become the most female-predominant subspecialty of internal medicine. The specialty of endocrinology should take a lead role in advocating for changes that support the success of female physicians. Strengthening and supporting the physician workforce can only serve to attract talented physicians of both genders to the

  14. Mad scientists, compassionate healers, and greedy egotists: the portrayal of physicians in the movies. (United States)

    Flores, Glenn


    Cinematic depictions of physicians potentially can affect public expectations and the patient-physician relationship, but little attention has been devoted to portrayals of physicians in movies. The objective of the study was the analysis of cinematic depictions of physicians to determine common demographic attributes of movie physicians, major themes, and whether portrayals have changed over time. All movies released on videotape with physicians as main characters and readily available to the public were viewed in their entirety. Data were collected on physician characteristics, diagnoses, and medical accuracy, and dialogue concerning physicians was transcribed. The results showed that in the 131 films, movie physicians were significantly more likely to be male (p film physicians has declined steadily in recent decades. Movie physicians are most commonly surgeons (33%), psychiatrists (26%), and family practitioners (18%). Physicians were portrayed negatively in 44% of movies, and since the 1960s positive portrayals declined while negative portrayals increased. Physicians frequently are depicted as greedy, egotistical, uncaring, and unethical, especially in recent films. Medical inaccuracies occurred in 27% of films. Compassion and idealism were common in early physician movies but are increasingly scarce in recent decades. A recurrent theme is the "mad scientist," the physician-researcher that values research more than patients' welfare. Portrayals of physicians as egotistical and materialistic have increased, whereas sexism and racism have waned. Movies from the past two decades have explored critical issues surrounding medical ethics and managed care. We conclude that negative cinematic portrayals of physicians are on the rise, which may adversely affect patient expectations and the patient-physician relationship. Nevertheless, films about physicians can serve as useful gauges of public opinion about the medical profession, as tools for medical education, and as

  15. Performance expectation plan

    Energy Technology Data Exchange (ETDEWEB)

    Ray, P.E.


    This document outlines the significant accomplishments of fiscal year 1998 for the Tank Waste Remediation System (TWRS) Project Hanford Management Contract (PHMC) team. Opportunities for improvement to better meet some performance expectations have been identified. The PHMC has performed at an excellent level in administration of leadership, planning, and technical direction. The contractor has met and made notable improvement of attaining customer satisfaction in mission execution. This document includes the team`s recommendation that the PHMC TWRS Performance Expectation Plan evaluation rating for fiscal year 1998 be an Excellent.

  16. The Qualitative Expectations Hypothesis

    DEFF Research Database (Denmark)

    Frydman, Roman; Johansen, Søren; Rahbek, Anders


    We introduce the Qualitative Expectations Hypothesis (QEH) as a new approach to modeling macroeconomic and financial outcomes. Building on John Muth's seminal insight underpinning the Rational Expectations Hypothesis (REH), QEH represents the market's forecasts to be consistent with the predictions...... of an economistís model. However, by assuming that outcomes lie within stochastic intervals, QEH, unlike REH, recognizes the ambiguity faced by an economist and market participants alike. Moreover, QEH leaves the model open to ambiguity by not specifying a mechanism determining specific values that outcomes take...

  17. The Qualitative Expectations Hypothesis

    DEFF Research Database (Denmark)

    Frydman, Roman; Johansen, Søren; Rahbek, Anders

    We introduce the Qualitative Expectations Hypothesis (QEH) as a new approach to modeling macroeconomic and financial outcomes. Building on John Muth's seminal insight underpinning the Rational Expectations Hypothesis (REH), QEH represents the market's forecasts to be consistent with the predictions...... of an economist's model. However, by assuming that outcomes lie within stochastic intervals, QEH, unlike REH, recognizes the ambiguity faced by an economist and market participants alike. Moreover, QEH leaves the model open to ambiguity by not specifying a mechanism determining specific values that outcomes take...

  18. Comparison of the quality of patient referrals from physicians, physician assistants, and nurse practitioners. (United States)

    Lohr, Robert H; West, Colin P; Beliveau, Margaret; Daniels, Paul R; Nyman, Mark A; Mundell, William C; Schwenk, Nina M; Mandrekar, Jayawant N; Naessens, James M; Beckman, Thomas J


    To compare the quality of referrals of patients with complex medical problems from nurse practitioners (NPs), physician assistants (PAs), and physicians to general internists. We conducted a retrospective comparison study involving regional referrals to an academic medical center from January 1, 2009, through December 31, 2010. All 160 patients referred by NPs and PAs combined and a random sample of 160 patients referred by physicians were studied. Five experienced physicians blinded to the source of referral used a 7-item instrument to assess the quality of referrals. Internal consistency, interrater reliability, and dimensionality of item scores were determined. Differences between item scores for patients referred by physicians and those for patients referred by NPs and PAs combined were analyzed by using multivariate ordinal logistical regression adjusted for patient age, sex, distance of the referral source from Mayo Clinic, and Charlson Index. Factor analysis revealed a 1-dimensional measure of the quality of patient referrals. Interrater reliability (intraclass correlation coefficient for individual items: range, 0.77-0.93; overall, 0.92) and internal consistency for items combined (Cronbach α=0.75) were excellent. Referrals from physicians were scored higher (percentage of agree/strongly agree responses) than were referrals from NPs and PAs for each of the following items: referral question clearly articulated (86.3% vs 76.0%; P=.0007), clinical information provided (72.6% vs 54.1%; P=.003), documented understanding of the patient's pathophysiology (51.0% vs 30.3%; P<.0001), appropriate evaluation performed locally (60.3% vs 39.0%; P<.0001), appropriate management performed locally (53.5% vs 24.1%; P<.0001), and confidence returning patient to referring health care professional (67.8% vs 41.4%; P<.0001). Referrals from physicians were also less likely to be evaluated as having been unnecessary (30.1% vs 56.2%; P<.0001). The quality of referrals to an

  19. Patients' Expectations as to Doctors' Behaviors During Appointed Visits. (United States)

    Sobczak, Krzysztof; Leoniuk, Katarzyna; Janaszczyk, Agata; Pietrzykowska, Małgorzata


    Numerous guidelines for students and medical professionals provide the instructions of proper behavior during encounters with patients in a doctor's office. However, they quite often do not consider cultural differences that may affect the doctor-patient relationship. In our study we analyzed Polish patients' expectations (N = 976) for their physicians' actual behavior. We compared our results with analogue studies performed in the United States. We determined that patient expectations concerning a desirable form of verbal and nonverbal communication with a physician vary to a considerable degree. Relatively universal, however, is the wish that the doctors introduce themselves and apply personalized forms of contact.

  20. Ethical issues and societal expectations

    International Nuclear Information System (INIS)

    Metlay, D.


    Daniel Metlay (NWTRB) declared that institutions had always recognised an ethical obligation to manage high- level radioactive waste in unprecedented ways. This obligation has not only endured, but has become more explicit and multidimensional and it now subsumed under a more general rubric of 'societal expectations'. D. Metlay directed attention toward the proceedings of previous RWMC-RF workshop ', which contains five essays, authored by Kjell Andersson, Andrew Blowers, Carl-Reinhold Braakenhielm, Francois Dermange, and Patricia Fleming, that are relevant to the question of ethical issues and societal expectations. D. Metlay observed that 'societal expectations' are hard to define and thus very hard to measure. They may vary considerably with time and from country to country. As an illustration he referred to an inquiry performed by a task group 30 years ago in a document entitled 'Proposed Goals for Radioactive Waste Management' (NUREG-0300) on behalf of the U.S. Nuclear Regulatory Commission. Conclusions from D. Metlay are that, for the most part, societal expectations in the United States appear to be quite stable over a period of more than 30 years. In two areas, however, there are clear differences in emphasis between expectations articulated in the last few years and those recorded in 1978. (1) While then there was emphasis on the operational reliability of organisations and institutions. In particular, much care was taken to discuss the inherent limitations on bureaucratic error-correction in the future. The focus is nowadays more on bureaucratic behaviours associated with carrying out decision-making processes in the present. (2) While there is current emphasis on the importance of trust, transparency, and accountability, the NRC document may cast some doubt on the reliability of a stepwise decision-making process. In the domain of radioactive waste management, error signals are notoriously unclear, and strong disagreements over objectives and value trade

  1. The African Family Physician

    African Journals Online (AJOL)

    North America and Europe, and these serve us well up to a point. When a colleague ... Maybe we need a different set of principles to work by in the Afri- ... base the balance. ... The African Family Physician is dedicated to life-long learning and.

  2. 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 ...

  3. Physician-owned companies. (United States)

    Kostuik, John P


    The author relates his experience in the development of a spinal implant development company (K2M) that is significantly advised by physicians. To provide information about the development of a spinal implant company (K2M) advised by a group of professional spinal surgeons. To relate the federal laws (STARK and anti-kickback) as they pertain to surgeon-influenced companies. To discuss the role of a scientific advisory board. A self-developed company was developed together with significant, but minority physician financial input and majority scientific advice. A privately owned spinal implant development corporation (K2M) was developed 3 years ago. Physician financial participation was less than 20% (Stark laws state no more than 40%). Users of product are greater than 60% non-investor physicians. The development of a large scientific advisory board has been very influential in product development. A privately owned spinal implant company (K2M) has been developed strictly within Federal laws. Its board of scientific advisors that receives recompense commissurate only with effort significantly impacts the company policy.

  4. Behavior, Expectations and Status (United States)

    Webster, Jr, Murray; Rashotte, Lisa Slattery


    We predict effects of behavior patterns and status on performance expectations and group inequality using an integrated theory developed by Fisek, Berger and Norman (1991). We next test those predictions using new experimental techniques we developed to control behavior patterns as independent variables. In a 10-condition experiment, predictions…

  5. Life Expectancy in 2040

    DEFF Research Database (Denmark)

    Canudas-Romo, Vladimir; DuGoff, Eva H; Wu, Albert W.


    We use expert clinical and public health opinion to estimate likely changes in the prevention and treatment of important disease conditions and how they will affect future life expectancy. Focus groups were held including clinical and public health faculty with expertise in the six leading causes...

  6. Factors driving physician-hospital alignment in orthopaedic surgery. (United States)

    Page, Alexandra E; Butler, Craig A; Bozic, Kevin J


    The relationships between physicians and hospitals are viewed as central to the proposition of delivering high-quality health care at a sustainable cost. Over the last two decades, major changes in the scope, breadth, and complexities of these relationships have emerged. Despite understanding the need for physician-hospital alignment, identification and understanding the incentives and drivers of alignment prove challenging. Our review identifies the primary drivers of physician alignment with hospitals from both the physician and hospital perspectives. Further, we assess the drivers more specific to motivating orthopaedic surgeons to align with hospitals. We performed a comprehensive literature review from 1992 to March 2012 to evaluate published studies and opinions on the issues surrounding physician-hospital alignment. Literature searches were performed in both MEDLINE(®) and Health Business™ Elite. Available literature identifies economic and regulatory shifts in health care and cultural factors as primary drivers of physician-hospital alignment. Specific to orthopaedics, factors driving alignment include the profitability of orthopaedic service lines, the expense of implants, and issues surrounding ambulatory surgery centers and other ancillary services. Evolving healthcare delivery and payment reforms promote increased collaboration between physicians and hospitals. While economic incentives and increasing regulatory demands provide the strongest drivers, cultural changes including physician leadership and changing expectations of work-life balance must be considered when pursuing successful alignment models. Physicians and hospitals view each other as critical to achieving lower-cost, higher-quality health care.

  7. Investigating performance of rural family physicians in Fars province working as part of Family Physician Program

    Directory of Open Access Journals (Sweden)

    Mansour Kashfi


    Full Text Available Background & Objective: Health family physician program is a complete system which eliminates the bewilderment of people and increases the satisfaction with health services as its most important results in medical care. The aim of this study was to evaluate the performance of family physicians and their strengths and weaknesses. Material & Methods: In this study, 52 family physicians were chosen via Random Stratified Sampling to participate in the study. A questionnaire titled “Performance of Family Physicians” with 5 domains of management, performance, contract guidelines, community involvement and results was used to collect data. Data were analyzed using SPSS-19 via t-test, ANOVA, Pearson correlation coefficient, and non-parametric tests. Results: Among the 52 studied family physicians, 56.9% were female and 43.1% were male. The lowest and the highest scores were obtained for the community involvement and results, respectively. Based on the results of this study, there were significant relationships among most of the domains. However, there was no significant correlation between the gender and different domains. Conclusion: In order to solve the problems of family physician program and improve the quality of services, more researches should be carried out soon to determine the types and causes of referring to the family physicians. Accordingly, appropriate interventions should be implemented to reduce the burden of visits and improve the quality of health services by guiding the society towards the prevention measures.

  8. Appealing to an important customer. Physicians should be the target of marketing. (United States)

    Weiss, R


    Although many healthcare professionals are turning to the general public to increase market share and referrals, they should be directing their attention to physicians instead. One of the major challenges facing hospitals is determining physician needs. A survey may be necessary to identify physicians' perceptions, attitudes, values, expectations, market, and hospital loyalty. Another important research document is the physician profile, which includes each doctor by age, specialty, office location, admitting and outpatient referral activity, financial contribution, and referral and other affiliations. Surveying should not end with the physician. One of the best means of evaluating patient and physician satisfaction is by questioning physicians' office staff. To centralize physician services, a number of hospitals have established physician liaison programs, which bridge the gap between the hospital and the physician's office, heighten physician satisfaction, and increase referrals. Physician orientation is a key element of most outreach programs, providing an opportunity to develop relationships with new physicians. Other means of directly aiding physicians are physician referral services and practice enhancement and assistance.

  9. Forecasting Japan's Physician Shortage in 2035 as the First Full-Fledged Aged Society (United States)

    Yamaguchi, Rui; Matsumura, Tomoko; Murashige, Naoko; Kodama, Yuko; Minayo, Satoru; Imai, Kohzoh; Kami, Masahiro


    Introduction Japan is rapidly becoming a full-fledged aged society, and physician shortage is a significant concern. The Japanese government has increased the number of medical school enrollments since 2008, but some researchers warn that this increase could lead to physician surplus in the future. It is unknown how many physicians will be required to accommodate future healthcare needs. Materials and Methods We simulated changes in age/sex composition of the population, fatalities (the number of fatalities for the consecutive five years), and number of physicians from 2010 to 2035. Two indicators were defined: fatalities per physician and fatalities by physician working hour, based on the data of the working hours of physicians for each tuple of sex and age groups. We estimated the necessary number of physicians in 2035 and the number of new physicians to maintain the indicator levels in 2010. Results The number of physicians per 1,000 population is predicted to rise from 2·00 in 2010 to 3·14 in 2035. The number of physicians aged 60 years or older is expected to increase from 55,375 (20% of physicians) to 141,711 (36%). In 2010 and 2035, fatalities per physician were 23·1 and 24·0 for the total population, and 13·9 and 19·2 for 75 years or older, respectively. Fatalities per physician working hour are predicted to rise from 0·128 to 0·138. If working hours are limited to 48 hours per week in 2035, the number of fatalities per physician working hour is expected to be 0·196, and the number of new physicians must be increased by 53% over the current pace. Discussion The number of physicians per population continues to rise, but the estimated supply will not fulfill the demand for healthcare in the aging society. Strategies to increase the number of physicians and improve working conditions are urgently needed. PMID:23233868

  10. The assessment of pathologists/laboratory medicine physicians through a multisource feedback tool. (United States)

    Lockyer, Jocelyn M; Violato, Claudio; Fidler, Herta; Alakija, Pauline


    There is increasing interest in ensuring that physicians demonstrate the full range of Accreditation Council for Graduate Medical Education competencies. To determine whether it is possible to develop a feasible and reliable multisource feedback instrument for pathologists and laboratory medicine physicians. Surveys with 39, 30, and 22 items were developed to assess individual physicians by 8 peers, 8 referring physicians, and 8 coworkers (eg, technologists, secretaries), respectively, using 5-point scales and an unable-to-assess category. Physicians completed a self-assessment survey. Items addressed key competencies related to clinical competence, collaboration, professionalism, and communication. Data from 101 pathologists and laboratory medicine physicians were analyzed. The mean number of respondents per physician was 7.6, 7.4, and 7.6 for peers, referring physicians, and coworkers, respectively. The reliability of the internal consistency, measured by Cronbach alpha, was > or = .95 for the full scale of all instruments. Analysis indicated that the medical peer, referring physician, and coworker instruments achieved a generalizability coefficient of .78, .81, and .81, respectively. Factor analysis showed 4 factors on the peer questionnaire accounted for 68.8% of the total variance: reports and clinical competency, collaboration, educational leadership, and professional behavior. For the referring physician survey, 3 factors accounted for 66.9% of the variance: professionalism, reports, and clinical competency. Two factors on the coworker questionnaire accounted for 59.9% of the total variance: communication and professionalism. It is feasible to assess this group of physicians using multisource feedback with instruments that are reliable.

  11. Spiking the expectancy profiles

    DEFF Research Database (Denmark)

    Hansen, Niels Chr.; Loui, Psyche; Vuust, Peter

    Melodic expectations have long been quantified using expectedness ratings. Motivated by statistical learning and sharper key profiles in musicians, we model musical learning as a process of reducing the relative entropy between listeners' prior expectancy profiles and probability distributions...... of a given musical style or of stimuli used in short-term experiments. Five previous probe-tone experiments with musicians and non-musicians are revisited. Exp. 1-2 used jazz, classical and hymn melodies. Exp. 3-5 collected ratings before and after exposure to 5, 15 or 400 novel melodies generated from...... a finite-state grammar using the Bohlen-Pierce scale. We find group differences in entropy corresponding to degree and relevance of musical training and within-participant decreases after short-term exposure. Thus, whereas inexperienced listeners make high-entropy predictions by default, statistical...

  12. Attitudes of Chinese Oncology Physicians Toward Death with Dignity. (United States)

    Chen, Hui-Ping; Huang, Bo-Yan; Yi, Ting-Wu; Deng, Yao-Tiao; Liu, Jie; Zhang, Jie; Wang, Yu-Qing; Zhang, Zong-Yan; Jiang, Yu


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

  13. Chinese students' great expectations

    DEFF Research Database (Denmark)

    Thøgersen, Stig


    The article focuses on Chinese students' hopes and expectations before leaving to study abroad. The national political environment for their decision to go abroad is shaped by an official narrative of China's transition to a more creative and innovative economy. Students draw on this narrative to...... system, they think of themselves as having a role in the transformation of Chinese attitudes to education and parent-child relations....

  14. Expectancy Theory Modeling (United States)


    accomplish the task, (2) the instrumentality of task performance for job outcomes, and (3) the instrumentality of outcomes for need satisfaction . this discussion: effort, performance , outcomes, and needs. In order to present briefly the conventional approach to the Vroom models, another...Presumably, this is the final event in the sequence of effort, performance , outcome, and need satisfaction . The actual research reported in expectancy

  15. Family Physicians Managing Medical Requests From Family and Friends. (United States)

    Giroldi, Esther; Freeth, Robin; Hanssen, Maurice; Muris, Jean W M; Kay, Margareth; Cals, Jochen W L


    Although guidelines generally state that physicians should not treat their family members or friends (nonpatients), physicians regularly receive medical requests from nonpatients. We aimed to explore junior and senior family physicians' experiences with and attitudes toward managing medical requests from nonpatients. We conducted a qualitative study with 7 focus groups with junior and senior physicians. We performed a thematic analysis during an iterative cycle of data collection and analysis. When confronted with a medical request from a nonpatient, physicians first oriented themselves to the situation: who is this person, what is he or she asking of me, and where are we? Physicians next considered the following interrelated factors: (1) nature/strength of the relationship with the nonpatient, (2) amount of trust in his/her own knowledge and skills, (3) expected consequences of making mistakes, (4) importance of work-life balance, and (5) risk of disturbing the physician-patient process. Senior physicians applied more nuanced considerations when deciding whether to respond, whereas junior physicians experienced more difficulties dealing with these requests, were less inclined to respond, and were more concerned about disturbing the existing relationship that a person had with his/her own physician. This study provides insight into the complexity that physicians face when managing medical questions and requests from nonpatients. Facilitated group discussions during which experiences are shared can help junior physicians become more confident in dealing with these complex issues as they formulate their own personal strategy regarding provision of medical advice or treatment to family and friends. © 2018 Annals of Family Medicine, Inc.

  16. Expectations from the child

    Directory of Open Access Journals (Sweden)

    Erdal Atabek


    Full Text Available Transition from agricultural society to industry society, from industrial society to science society has taken place. In all these societies, expectations from children also vary. In the agricultural community, human labor is based on arm power. For this reason, expectation from children is to increase work power. Having more children is the basis for the expectations in this community to see that the boy is valuable because he has increased his work power. In the industrial society, the power of the arm changed its place with the machine power. The knowledgeable person is not a family grown-up but a foreman. Childhood was distinguished during this period. It has been investigated that the child has a separate development.  In the information society, communication and information has never been as fast as it is in this period.  The widespread use of the Internet, and the use of social networks such as Facebook and Twitter are in this period. In this society, families are panicked to prepare a future in their own heads for their children. Because the parents thought of their children, they decided about the child's life instead of the child making these decisions. This has had a negative impact on children's sense of autonomy and their ability to take responsibility. To change this, parents should train their children in auto control and develop children's impulse control skills. The children should be able to understand their emotions and make decisions by reasoning and reasoning.

  17. Physician exposure to violence: a study performed in Turkey. (United States)

    Baykan, Zeynep; Öktem, İbrahim Suat; Çetinkaya, Fevziye; Naçar, Melis


    Recently, in Turkey, there has been an increase in the number of violent acts against healthcare workers, towards doctors in particular. This study aimed to investigate the extent of violence, the causes of violence and to evaluate proposed solutions to violence. Out of 597 physicians, 86.4% indicated that they were exposed to at least one type of violence (physical, verbal, sexual) throughout their careers. Among the physicians participating in the study, 27.5% suffered physical threats and 68.6% suffered verbal violence in the past year. Only 40.4% reported the physical violence to their institution. Physicians indicated that the top three causes of violent behavior were excessive demands of patients, the expectation that the issue will be solved immediately and blaming physicians for their problems. To stop violence against themselves, physicians need to raise their voices, along with those of their personal or professional organizations, and should report and follow up incidents.

  18. Due diligence during the integration of physician groups. (United States)

    Ealey, Tom


    While contemplating physician group integration, providers should perform due diligence and ask questions in several key areas to ensure successful integrations: Financial--Is the group producing the revenue expected, and is the revenue cycle managed effectively? Statistical--What are the numbers of encounters, procedures, surgeries, and ancillaries? Compliance--Has the group developed and operated a sound compliance program, and has compliance been a priority? Succession--How many physicians are within three to five years of retirement?

  19. Demystify Learning Expectations to Address Grade Inflation (United States)

    Hodges, Linda C.


    This article describes the subject of "grade inflation," a reference to educators giving higher grades to student work than their expectations for student achievement warrant. Of the many reasons why this practice happens, Hodges specifically discusses inflating grades as "a natural consequence" when the faculty really…

  20. [Burnout in physicians]. (United States)

    Kurzthaler, Ilsemarie; Kemmler, Georg; Fleischhacker, W Wolfgang


    Burnout is a syndrome characterized by emotional exhaustion, depersonalization and low personal accomplishment. The primary objective of this study was to investigate both the prevalence and severity of burnout symptoms in a sample of clinical physicians from different speciality disciplines. A total of 69 clinical physicians ≤55 years who are working at the Medical University/regional Hospital Innsbruck were included into a cross-sectional study. Next to the assessment of sociodemographic and work-related variables the Maslach Burnout Inventory (MBI) was used to investigate burnout symtoms. Overall, 8.8% of the study population showed high emotional exhaustion with high or moderate depersonalization and low personal accomplishment and therefore had a high risk to develop a burnout syndrom. 11.8% showed a moderade burnout risk. Neither sociodemographic variables nor the degree of educational qualification or speciality discipline had an influence on burnout symptoms. However, there was a positive correlation between scientific activity and personal accomplihment. Our results suggest that the dimension of burnout symtoms among clinical physicians in Austria has be taken seriously. Further research is needed to develop specific programs in terms of burnout prevention and burnout therapy.

  1. Expected Term Structures

    DEFF Research Database (Denmark)

    Buraschi, Andrea; Piatti, Ilaria; Whelan, Paul

    We construct and study the cross-sectional properties of survey-based bond risk premia and compare them to their traditional statistical counterparts. We document large heterogeneity in skill, identify top forecasters, and learn about the importance of subjective risk premia in long-term bonds...... dynamics. The consensus is not a sufficient statistics of the cross-section of expectations and we propose an alternative real-time aggregate measure of risk premia consistent with Friedmans market selection hypothesis. We then use this measure to evaluate structural models and find support...

  2. Agreeing on expectations

    DEFF Research Database (Denmark)

    Nielsen, Christian; Bentsen, Martin Juul

    Commitment and trust are often mentioned as important aspects of creating a perception of reliability between counterparts. In the context of university-industry collaborations (UICs), agreeing on ambitions and expectations are adamant to achieving outcomes that are equally valuable to all parties...... involved. Despite this, our initial probing indicated that such covenants rarely exist. As such, this paper draws on project management theory and proposes the possibility of structuring assessments of potential partners before university-industry collaborations are brought to life. Our analysis suggests...

  3. Physicians and administrators can work together. (United States)

    Fuller, G W; Beaupre, E M


    This article describes the working relationship between the administration and medical staff of the Mid-Maine Medical Center which is comprised of two separate modern hospitals. The authors advocate the philosophy that "a hospital which harnesses the medical staff's considerable talent and expertise through sound organizational input will be a stronger institution." They explain that patient care is becoming increasingly complex and that management decisions impact heavily on the care provided. In 1973, the Medical Center changed from its traditional organizational form of having a full-time medical director and an administrator report to the board of directors, to a modified corporate model designed to increase physician involvement. In the new organization, the vice president of finance and a part-time chief of staff (acting as vice president for medical affairs) report to the president (former medical director) who, in turn, is responsible to the board of trustees. The authors attribute the success of the reorganization to the CEO's willingness to delegate and share authority, not to the CEO's physician background. Planning at the institution involves a committee of six physicians, four administrators, and one full-time planner. A budgeting committee of three physicians and three administrators is responsible for the review of the budget as well as for making recommendations for the executive board for the expected volume of services. It is concluded that there is no perfect way to run a hospital, but the involvement of doctors in hospital decisions is necessary.

  4. Physician Order Entry Clerical Support Improves Physician Satisfaction and Productivity. (United States)

    Contratto, Erin; Romp, Katherine; Estrada, Carlos A; Agne, April; Willett, Lisa L


    To examine the impact of clerical support personnel for physician order entry on physician satisfaction, productivity, timeliness with electronic health record (EHR) documentation, and physician attitudes. All seven part-time physicians at an academic general internal medicine practice were included in this quasi-experimental (single group, pre- and postintervention) mixed-methods study. One full-time clerical support staff member was trained and hired to enter physician orders in the EHR and conduct previsit planning. Physician satisfaction, productivity, timeliness with EHR documentation, and physician attitudes toward the intervention were measured. Four months after the intervention, physicians reported improvements in overall quality of life (good quality, 71%-100%), personal balance (43%-71%), and burnout (weekly, 43%-14%; callousness, 14%-0%). Matched for quarter, productivity increased: work relative value unit (wRVU) per session increased by 20.5% (before, April-June 2014; after, April-June 2015; range -9.2% to 27.5%). Physicians reported feeling more supported, more focused on patient care, and less stressed and fatigued after the intervention. This study supports the use of physician order entry clerical personnel as a simple, cost-effective intervention to improve the work lives of primary care physicians.

  5. Physician-industry relations. Part 1: individual physicians. (United States)

    Coyle, Susan L


    This is part 1 of a 2-part paper on ethics and physician-industry relationships. Part 1 offers advice to individual physicians; part 2 gives recommendations to medical education providers and medical professional societies. Physicians and industry have a shared interest in advancing medical knowledge. Nonetheless, the primary ethic of the physician is to promote the patient's best interests, while the primary ethic of industry is to promote profitability. Although partnerships between physicians and industry can result in impressive medical advances, they also create opportunities for bias and can result in unfavorable public perceptions. Many physicians and physicians-in-training think they are impervious to commercial influence. However, recent studies show that accepting industry hospitality and gifts, even drug samples, can compromise judgment about medical information and subsequent decisions about patient care. It is up to the physician to judge whether a gift is acceptable. A very general guideline is that it is ethical to accept modest gifts that advance medical practice. It is clearly unethical to accept gifts or services that obligate the physician to reciprocate. Conflicts of interest can arise from other financial ties between physicians and industry, whether to outside companies or self-owned businesses. Such ties include honorariums for speaking or writing about a company's product, payment for participating in clinic-based research, and referrals to medical resources. All of these relationships have the potential to influence a physician's attitudes and practices. This paper explores the ethical quandaries involved and offers guidelines for ethical business relationships.

  6. Physician practice management companies: should physicians be scared? (United States)

    Scott-Rotter, A E; Brown, J A


    Physician practice management companies (PPMCs) manage nonclinical aspects of physician care and control physician groups by buying practice assets. Until recently, PPMCs were a favorite of Wall Street. Suddenly, in early 1998, the collapse of the MedPartners-PhyCor merger led to the rapid fall of most PPMC stock, thereby increasing wariness of physicians to sell to or invest in PPMCs. This article explores not only the broken promises made by and false assumptions about PPMCs, but also suggests criteria that physicians should use and questions would-be PPMC members should ask before joining. Criteria include: demonstrated expertise, a company philosophy that promotes professional autonomy, financial stability, freedom from litigation, and satisfied physicians already in the PPMC. The authors recommend that physicians seek out relatively small, single-specialty PPMCs, which hold the best promise of generating profits and permitting professional control over clinical decisions.

  7. Probability via expectation

    CERN Document Server

    Whittle, Peter


    This book is a complete revision of the earlier work Probability which ap­ peared in 1970. While revised so radically and incorporating so much new material as to amount to a new text, it preserves both the aim and the approach of the original. That aim was stated as the provision of a 'first text in probability, de­ manding a reasonable but not extensive knowledge of mathematics, and taking the reader to what one might describe as a good intermediate level'. In doing so it attempted to break away from stereotyped applications, and consider applications of a more novel and significant character. The particular novelty of the approach was that expectation was taken as the prime concept, and the concept of expectation axiomatized rather than that of a probability measure. In the preface to the original text of 1970 (reproduced below, together with that to the Russian edition of 1982) I listed what I saw as the advantages of the approach in as unlaboured a fashion as I could. I also took the view that the text...

  8. Gender Roles and Expectations

    Directory of Open Access Journals (Sweden)

    Susana A. Eisenchlas


    Full Text Available One consequence of the advent of cyber communication is that increasing numbers of people go online to ask for, obtain, and presumably act upon advice dispensed by unknown peers. Just as advice seekers may not have access to information about the identities, ideologies, and other personal characteristics of advice givers, advice givers are equally ignorant about their interlocutors except for the bits of demographic information that the latter may offer freely. In the present study, that information concerns sex. As the sex of the advice seeker may be the only, or the predominant, contextual variable at hand, it is expected that that identifier will guide advice givers in formulating their advice. The aim of this project is to investigate whether and how the sex of advice givers and receivers affects the type of advice, through the empirical analysis of a corpus of web-based Spanish language forums on personal relationship difficulties. The data revealed that, in the absence of individuating information beyond that implicit in the advice request, internalized gender expectations along the lines of agency and communality are the sources from which advice givers draw to guide their counsel. This is despite the trend in discursive practices used in formulating advice, suggesting greater language convergence across sexes.

  9. ATLAS: Exceeding all expectations

    CERN Multimedia

    CERN Bulletin


    “One year ago it would have been impossible for us to guess that the machine and the experiments could achieve so much so quickly”, says Fabiola Gianotti, ATLAS spokesperson. The whole chain – from collision to data analysis – has worked remarkably well in ATLAS.   The first LHC proton run undoubtedly exceeded expectations for the ATLAS experiment. “ATLAS has worked very well since the beginning. Its overall data-taking efficiency is greater than 90%”, says Fabiola Gianotti. “The quality and maturity of the reconstruction and simulation software turned out to be better than we expected for this initial stage of the experiment. The Grid is a great success, and right from the beginning it has allowed members of the collaboration all over the world to participate in the data analysis in an effective and timely manner, and to deliver physics results very quickly”. In just a few months of data taking, ATLAS has observed t...

  10. Perceived risks from radiation and nuclear testing near Semipalatinsk, Kazakhstan: a comparison between physicians, scientists, and the public. (United States)

    Purvis-Roberts, Kathleen L; Werner, Cynthia A; Frank, Irene


    Determining the difference in perception of risk between experts, or more educated professionals, and laypeople is important so that a potential hazard can be effectively communicated to the public. Many surveys have been conducted to better understand the difference between expert and public opinions, and often laypeople exhibit higher perceptions of risk to hazards in comparison to experts. This is especially true when health risk is due to radiation, nuclear power, and nuclear waste. This article focuses on one section of a risk perception survey given to two groups of individuals with a more specialized education (scientists and physicians) and laypeople (villagers) in the Semipalatinsk region of Kazakhstan. All of these groups live near the former Soviet nuclear test site. Originally, it was expected that the scientists and physicians would have similar perceptions of radiation risk, while the public perceptions would be higher, but this was not always the case. For example, when perceptions of risk pertain to the health impacts of nuclear testing or the dose-response nature of radiation exposure, the physicians tend to agree with the laypeople, not the scientists. The villagers are always the most risk-averse group, followed by the physicians and then the scientists. These differences are likely due to different frames of reference for each of the populations.

  11. Energy providers: customer expectations

    International Nuclear Information System (INIS)

    Pridham, N.F.


    The deregulation of the gas and electric power industries, and how it will impact on customer service and pricing rates was discussed. This paper described the present situation, reviewed core competencies, and outlined future expectations. The bottom line is that major energy consumers are very conscious of energy costs and go to great lengths to keep them under control. At the same time, solutions proposed to reduce energy costs must benefit all classes of consumers, be they industrial, commercial, institutional or residential. Deregulation and competition at an accelerated pace is the most likely answer. This may be forced by external forces such as foreign energy providers who are eager to enter the Canadian energy market. It is also likely that the competition and convergence between gas and electricity is just the beginning, and may well be overshadowed by other deregulated industries as they determine their core competencies

  12. Customer experiences and expectations

    International Nuclear Information System (INIS)

    Morton, C. R.


    Customer experiences and expectations from competition and cogeneration in the power industry were reviewed by Charles Morton, Director of Energy at CPC International, by describing Casco's decision to get into cogeneration in the early 1990s in three small corn milling plants in Cardinal, London and Port Colborne, Ontario, mainly as result of the threat of a 40 per cent increase in power prices. He stressed that cost competitiveness of cogeneration is entirely site-specific, but it is generally more attractive in larger facilities that operate 24 hours a day, where grid power is expensive or unreliable. Because it is reliable, cogeneration holds out the prospect of increased production-up time, as well as offering a hedge against higher energy costs, reducing the company's variable costs when incoming revenues fall short of costs, and providing an additional tool in head-to-head competition

  13. Feedback data sources that inform physician self-assessment. (United States)

    Lockyer, Jocelyn; Armson, Heather; Chesluk, Benjamin; Dornan, Timothy; Holmboe, Eric; Loney, Elaine; Mann, Karen; Sargeant, Joan


    Self-assessment is a process of interpreting data about one's performance and comparing it to explicit or implicit standards. To examine the external data sources physicians used to monitor themselves. Focus groups were conducted with physicians who participated in three practice improvement activities: a multisource feedback program; a program providing patient and chart audit data; and practice-based learning groups. We used grounded theory strategies to understand the external sources that stimulated self-assessment and how they worked. Data from seven focus groups (49 physicians) were analyzed. Physicians used information from structured programs, other educational activities, professional colleagues, and patients. Data were of varying quality, often from non-formal sources with implicit (not explicit) standards. Mandatory programs elicited variable responses, whereas data and activities the physicians selected themselves were more likely to be accepted. Physicians used the information to create a reference point against which they could weigh their performance using it variably depending on their personal interpretation of its accuracy, application, and utility. Physicians use and interpret data and standards of varying quality to inform self-assessment. Physicians may benefit from regular and routine feedback and guidance on how to seek out data for self-assessment.

  14. Better Physician's 'Black Bags' (United States)


    The "black bag" is outgrowth of astronaut monitoring technology from NASA's Johnson Space Center. Technically known as the portable medical status system, a highly advanced physician's "black bag" weighs less than 30 pounds, yet contains equipment for monitoring and recording vital signs, electrocardiograms, and electroencephalograms. Liquid crystal displays are used to present 15 digits of data simultaneously for long periods of time without excessive use of battery power. Single printed circuit card contains all circuitry required to measure and display vital signs such as heart and respiration rate, temperature, and blood pressure.

  15. Medicare, physicians, and patients. (United States)

    Hacker, Joseph F


    There are many other provisions to the MMA. It is important to remind our patients that these changes are voluntary. If patients are satisfied with their current Medicare benefits and plan, they need not change to these new plans. However, as physicians we should familiarize ourselves with these new Medicare options so as to better advise our patients. For more information, visit The Medical Society of Delaware will strive to keep you informed as these new changes are implemented.

  16. Macro Expectations, Aggregate Uncertainty, and Expected Term Premia

    DEFF Research Database (Denmark)

    Dick, Christian D.; Schmeling, Maik; Schrimpf, Andreas

    Based on individual expectations from the Survey of Professional Forecasters, we construct a realtime proxy for expected term premium changes on long-term bonds. We empirically investigate the relation of these bond term premium expectations with expectations about key macroeconomic variables as ...

  17. A comparative study of expectant parents ' childbirth expectations. (United States)

    Kao, Bi-Chin; Gau, Meei-Ling; Wu, Shian-Feng; Kuo, Bih-Jaw; Lee, Tsorng-Yeh


    The purpose of this study was to understand childbirth expectations and differences in childbirth expectations among expectant parents. For convenience sampling, 200 couples willing to participate in this study were chosen from two hospitals in central Taiwan. Inclusion criteria were at least 36 weeks of gestation, aged 18 and above, no prenatal complications, and willing to consent to participate in this study. Instruments used to collect data included basic demographic data and the Childbirth Expectations Questionnaire. Findings of the study revealed that (1) five factors were identified by expectant parents regarding childbirth expectations including the caregiving environment, expectation of labor pain, spousal support, control and participation, and medical and nursing support; (2) no general differences were identified in the childbirth expectations between expectant fathers and expectant mothers; and (3) expectant fathers with a higher socioeconomic status and who had received prenatal (childbirth) education had higher childbirth expectations, whereas mothers displayed no differences in demographic characteristics. The study results may help clinical healthcare providers better understand differences in expectations during labor and birth and childbirth expectations by expectant parents in order to improve the medical and nursing system and promote positive childbirth experiences and satisfaction for expectant parents.

  18. 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

  19. Physician trainees' decision making and information processing: choice size and Medicare Part D. (United States)

    Barnes, Andrew J; Hanoch, Yaniv; Martynenko, Melissa; Wood, Stacey; Rice, Thomas; Federman, Alex D


    Many patients expect their doctor to help them choose a Medicare prescription drug plan. Whether the size of the choice set affects clinicians' decision processes and strategy selection, and the quality of their choice, as it does their older patients, is an important question with serious financial consequences. Seventy medical students and internal medicine residents completed a within-subject design using Mouselab, a computer program that allows the information-acquisition process to be examined. We examined highly numerate physician trainees' decision processes, strategy, and their ability to pick the cheapest drug plan-as price was deemed the most important factor in Medicare beneficiaries' plan choice-from either 3 or 9 drug plans. Before adjustment, participants were significantly more likely to identify the lowest cost plan when facing three versus nine choices (67.3% vs. 32.8%, pinformation on each attribute (pdecision strategies focusing on comparing alternate plans across a single attribute (search pattern, pdecision process and strategy, numeracy, and amount of medical training, the odds were 10.75 times higher that trainees would choose the lowest cost Medicare Part D drug plan when facing 3 versus 9 drug plans (pdecision environment are needed and suggest physicians' role in their patients' Part D choices may be most productive when assisting seniors with forecasting their expected medication needs and then referring them to the Medicare website or helpline.

  20. When do we communicate stereotypes? Influence of the social context on the linguistic expectancy bias

    NARCIS (Netherlands)

    Wigboldus, DHJ; Spears, R; Semin, GR

    The linguistic expectancy bias (LEB) refers to the tendency to describe expectancy consistent information at a higher level of linguistic abstraction than expectancy inconsistent information. Two experiments examined the influence of the social communicative context on the production of this

  1. The properties of inflation expectations: Evidence for India


    Naresh Kumar Sharma; Motilal Bicchal


    Empirical inferences about particular forms of agents’ inflation expectations are crucial for the conduct of monetary policy. This paper is an attempt to explore the properties of the Reserve Bank of India’s survey data of households’ inflation expectations. The paper shows that survey respondents do not form expectations rationally, regardless of the reference measures of inflation used. Further, results indicate that inflation expectations are formed purely in backward-looking manner, sugge...

  2. Physician-Rating Web Sites: Ethical Implications. (United States)

    Samora, Julie Balch; Lifchez, Scott D; Blazar, Philip E


    To understand the ethical and professional implications of physician behavior changes secondary to online physician-rating Web sites (PRWs). The American Society for Surgery of the Hand (ASSH) Ethics and Professionalism Committee surveyed the ASSH membership regarding PRWs. We sent a 14-item questionnaire to 2,664 active ASSH members who practice in both private and academic settings in the United States. We received 312 responses, a 12% response incidence. More than 65% of the respondents had a slightly or highly unfavorable impression of these Web sites. Only 34% of respondents had ever updated or created a profile for PRWs, although 62% had observed inaccuracies in their profile. Almost 90% of respondents had not made any changes in their practice owing to comments or reviews. One-third of respondents had solicited favorable reviews from patients, and 3% of respondents have paid to improve their ratings. PRWs are going to become more prevalent, and more research is needed to fully understand the implications. There are several ethical implications that PRWs pose to practicing physicians. We contend that it is morally unsound to pay for good reviews. The recourse for physicians when an inaccurate and potentially libelous review has been written is unclear. Some physicians have required patients to sign a waiver preventing them from posting negative comments online. We propose the development of a task force to assess the professional, ethical, and legal implications of PRWs, including working with companies to improve accuracy of information, oversight, and feedback opportunities. It is expected that PRWs will play an increasing role in the future; it is unclear whether there will be a uniform reporting system, or whether these online ratings will influence referral patterns and/or quality improvement. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. The metrics and correlates of physician migration from Africa

    Directory of Open Access Journals (Sweden)

    Arah Onyebuchi A


    which gives a different but proportionate picture of which African countries stand to lose relatively more of its physicians with unchecked migration. The nature of health policies geared at health-worker migration can be expected to depend on the choice of migration metrics.

  4. Development of physician leadership competencies: perceptions of physician leaders, physician educators and medical students. (United States)

    McKenna, Mindi K; Gartland, Myles P; Pugno, Perry A


    Research regarding the development of healthcare leadership competencies is widely available. However, minimal research has been published regarding the development of physician leadership competencies, despite growing recognition in recent years of the important need for effective physician leadership. Usingdata from an electronically distributed, self-administered survey, the authors examined the perceptions held by 110 physician leaders, physician educators, and medical students regarding the extent to which nine competencies are important for effective physician leadership, ten activities are indicative of physician leadership, and seven methods are effective for the development of physician leadership competencies. Results indicated that "interpersonal and communication skills" and "professional ethics and social responsibility" are perceived as the most important competencies for effective physician leadership. Furthermore, respondents believe "influencing peers to adopt new approaches in medicine" and "administrative responsibility in a healthcare organization" are the activities most indicative of effective physician leadership. Finally, respondents perceive"coaching or mentoring from an experienced leader" and "on-job experience (e.g., a management position)" as the most effective methods for developing physician leadership competencies. The implications of these findings for the education and development of physician leaders are discussed.

  5. Expectations from ethics

    International Nuclear Information System (INIS)

    Fleming, P.


    Prof. Patricia Fleming, centred her presentation on ethical expectations in regulating safety for future generations. The challenge is to find a just solution, one that provides for a defensible approach to inter-generational equity. The question on equity is about whether we are permitted to treat generations differently and to still meet the demands of justice. And the question must be asked regarding these differences: 'in what ways do they make a moral difference?' She asked the question regarding the exact meaning of the ethical principle 'Radioactive waste shall be managed in such a way that predicted impacts on the health of future generations will not be greater than relevant levels of impact that are acceptable today'. Some countries have proposed different standards for different time periods, either implicitly or explicitly. In doing so, have they preserved our standards of justice or have they abandoned them? Prof. Fleming identified six points to provide with some moral maps which might be used to negotiate our way to a just solution to the disposal of nuclear waste. (author)

  6. Expectations from Society

    International Nuclear Information System (INIS)

    Blowers, A.


    Prof. A. Blowers observed that the social context within which radioactive waste management is considered has evolved over time. The early period where radioactive waste was a non-issue was succeeded by a period of intense conflict over solutions. The contemporary context is more consensual, in which solutions are sought that are both technically sound and socially acceptable. Among the major issues is that of inter-generational equity embraced in the question: how long can or should our responsibility to the future extend? He pointed out the differences in timescales. On the one hand, geo-scientific timescales are very long term, emphasizing the issue of how far into the future it is possible to make predictions about repository safety. By contrast, socio cultural timescales are much shorter, focusing on the foreseeable future of one or two generations and raising the issue of how far into the future we should be concerned. He listed. the primary expectations from society which are: safety and security to alleviate undue burdens to future generations and flexibility in order to enable the future generations to have a stake in decision making. The need to reconcile the two had led to a contemporary emphasis on phased geological disposal incorporating retrievability. However, the long timescales for implementation of disposal provided for sufficient flexibility without the need for retrievability. Future generations would inevitably have sold stake in decision making. Prof. A.. Blowers pointed out that society is also concerned with participation in decision making for implementation. The key elements for success are: openness and transparency, staged process, participation, partnership, benefits to enhance the well being of communities and a democratic framework for decision making, including the ratification of key decisions and the right for communities to withdraw from the process up to a predetermined point. This approach for decision making may also have

  7. Expected years ever married

    Directory of Open Access Journals (Sweden)

    Ryohei Mogi


    Full Text Available Background: In the second half of the 20th century, remarkable marriage changes were seen: a great proportion of never married population, high average age at first marriage, and large variance in first marriage timing. Although it is theoretically possible to separate these three elements, disentangling them analytically remains a challenge. Objective: This study's goal is to answer the following questions: Which of the three effects, nonmarriage, delayed marriage, or expansion, has the most impact on nuptiality changes? How does the most influential factor differ by time periods, birth cohorts, and countries? Methods: To quantify nuptiality changes over time, we define the measure 'expected years ever married' (EYEM. We illustrate the use of EYEM, looking at time trends in 15 countries (six countries for cohort analysis and decompose these trends into three components: scale (the changes in the proportion of never married - nonmarriage, location (the changes in timing of first marriage - delayed marriage, and variance (the changes in the standard deviation of first marriage age - expansion. We used population counts by sex, age, and marital status from national statistical offices and the United Nations database. Results: Results show that delayed marriage is the most influential factor on period EYEM's changes, while nonmarriage has recently begun to contribute to the change in North and West Europe and Canada. Period and cohort analysis complement each other. Conclusions: This study introduces a new index of nuptiality and decomposes its change into the contribution of three components: scale, location, and variance. The decomposition steps presented here offer an open possibility for more elaborate parametric marriage models.

  8. Manager-physician relationships: an organizational theory perspective. (United States)

    Kaissi, Amer


    Manager-physician relationships are a critical determinant of the success of health care organizations. As the health care industry is moving toward a situation characterized by higher scarcity of resources, fiercer competition, more corporitization, and strict cost-containment approaches, managers and physicians should, more than ever, work together under conjoint or shared authority. Thus, their relationship can be described as one of high rewards, but also of high risk because of the wide range of differences that exist between them: different socializations and trainings resulting in different worldviews, value orientation and expectations and different cultures. In brief, managers and physicians represent different "tribes," each with its language, values, culture, thought patterns, and rules of the game. This article's main objective is to determine the underlying factors in the manager-physician relationship and to suggest ways that make this relationship more effective. Four different organizational perspectives will be used. The occupational perspective will give insights on the internal characteristics of the occupational communities of managers and physicians. The theory of deprofessionalization of physicians will also be discussed. The structuring perspective will look at the manager-physician relationship as a structure in the organization and will determine the effects of contextual factors (size, task uncertainty, strategy, and environment) on this relationship and the resulting effect on performance and effectiveness of the organization. The culture and control perspective will help detect the cultural differences between managers and physicians and how these interact to affect control over the decision-making areas in the hospital. The power, conflict, and dialectics perspective will shed the light on the conflicting interests of managers and physicians and how these shape the "power game" in the organization. Consequently, a theoretical model of

  9. The physician leader as logotherapist. (United States)

    Washburn, E R


    Today's physicians feel helpless and angry about changing conditions in the medical landscape. This is due, in large part, to our postmodernist world view and the influence of corporations on medical practice. The life and work of existentialist psychiatrist Viktor Frankl is proposed as a role model for physicians to take back control of their profession. Physician leaders are in the best position to bring the teachings and insight of Frankl's logotherapy to rank-and-file physicians in all practice settings, as well as into the board rooms of large medical corporations. This article considers the spiritual and moral troubles of American medicine, Frankl's answer to that affliction, and the implications of logotherapy for physician organizations and leadership. Physician executives are challenged to take up this task.

  10. Physician 'defiance' towards hand hygiene compliance: Is there a theory-practice-ethics gap? (United States)

    Mortell, Manfred; Balkhy, Hanan H; Tannous, Elias B; Jong, Mei Thiee


    The theory-practice gap has always existed [1,2]. This gap is often cited as a culmination of theory being idealistic and impractical, even if practical and beneficial, is often ignored. Most of the evidence relating to the non-integration of theory and practice assumes that environmental factors are responsible and will affect learning and practice outcomes, hence the gap. Therefore, the author believes that to 'bridge the gap' between theory and practice, an additional dimension is required: ethics. A moral duty and obligation ensuring theory and practice integrate. In order to effectively implement new practices, one must deem these practices as worthy and relevant to their role as healthcare providers (HCP). Hence, this introduces a new concept which the author refers to as the theory-practice-ethics gap. This theory-practice-ethics gap must be considered when reviewing some of the unacceptable outcomes in healthcare practice [3]. The literature suggests that there is a crisis of ethics where theory and practice integrate, and healthcare providers are failing to fulfill our duty as patient advocates. Physician hand hygiene practices and compliance at King Abdulaziz Cardiac Centre (KACC) are consistent with those of other physicians in the global healthcare arena. That is one of noncompliance to King Abdulaziz Medical City (KAMC) organizational expectations and the World Health Organization (WHO) requirements? An observational study was conducted on the compliance of cardiac surgeons, cardiologists and nurses in the authors' cardiac center from January 2010 to December 2011. The hand hygiene (HH) compliance elements that were evaluated pertained to the WHO's five moments of HH recommendations. The data was obtained through direct observation by KAMC infection prevention and control practitioners. Physician hand hygiene compliance at KACC was consistently less than 60%, with nurses regularly encouraging physicians to be diligent with hand hygiene practices in the

  11. Family Violence and Family Physicians (United States)

    Herbert, Carol P.


    The acronym IDEALS summarizes family physicians' obligations when violence is suspected: to identify family violence; document injuries; educate families and ensure safety for victims; access resources and coordinate care; co-operate in the legal process; and provide support for families. Failure to respond reflects personal and professional experience and attitudes, fear of legal involvement, and lack of knowledge. Risks of intervention include physician burnout, physician overfunctioning, escalation of violence, and family disruption. PMID:21228987

  12. Emergency Physicians at War. (United States)

    Muck, Andrew E; Givens, Melissa; Bebarta, Vikhyat S; Mason, Phillip E; Goolsby, Craig


    Operation Enduring Freedom (OEF-A) in Afghanistan and Operation Iraqi Freedom (OIF) represent the first major, sustained wars in which emergency physicians (EPs) fully participated as an integrated part of the military's health system. EPs proved invaluable in the deployments, and they frequently used the full spectrum of trauma and medical care skills. The roles EPs served expanded over the years of the conflicts and demonstrated the unique skill set of emergency medicine (EM) training. EPs supported elite special operations units, served in medical command positions, and developed and staffed flying intensive care units. EPs have brought their combat experience home to civilian practice. This narrative review summarizes the history, contributions, and lessons learned by EPs during OEF-A/OIF and describes changes to daily clinical practice of EM derived from the combat environment.

  13. Physician revalidation in Europe. (United States)

    Merkur, Sherry; Mossialos, Elias; Long, Morgan; McKee, Martin


    Despite the increasing attention on patient mobility, there remains a lack of European-level interest in assuring the sustained competence of health professionals. Specifically, the existing European legal framework fails to recognise the introduction of periodic revalidation and requirements to participate in continuing professional development in some countries. This study shows that the definitions and mechanisms of revalidation vary significantly across member states. While some countries, eg Austria, Germany and Spain, look to continuing medical education as a means to promote recertification and quality of care, other countries, eg Belgium, France and the Netherlands, also incorporate peer review. In the UK the proposed revalidation scheme would include elements of relicensure through appraisal and feedback as well as physician recertification. Divergence between countries also exists in monitoring and enforcement. The European Commission should explore the implications for professional mobility of the diversity in the regulation of the medical profession.

  14. Emergency Physicians at War

    Directory of Open Access Journals (Sweden)

    Melissa Givens


    Full Text Available Operation Enduring Freedom (OEF-A in Afghanistan and Operation Iraqi Freedom (OIF represent the first major, sustained wars in which emergency physicians (EPs fully participated as an integrated part of the military’s health system. EPs proved invaluable in the deployments, and they frequently used the full spectrum of trauma and medical care skills. The roles EPs served expanded over the years of the conflicts and demonstrated the unique skill set of emergency medicine (EM training. EPs supported elite special operations units, served in medical command positions, and developed and staffed flying intensive care units. EPs have brought their combat experience home to civilian practice. This narrative review summarizes the history, contributions, and lessons learned by EPs during OEF-A/OIF and describes changes to daily clinical practice of EM derived from the combat environment.

  15. Motivations of physicians and nurses to practice voluntary euthanasia: a systematic review. (United States)

    Vézina-Im, Lydi-Anne; Lavoie, Mireille; Krol, Pawel; Olivier-D'Avignon, Marianne


    While a number of reviews have explored the attitude of health professionals toward euthanasia, none of them documented their motivations to practice euthanasia. The objective of the present systematic review was to identify physicians' and nurses' motives for having the intention or for performing an act of voluntary euthanasia and compare findings from countries where the practice is legalized to those where it is not. The following databases were investigated: MEDLINE/PubMed (1950+), PsycINFO (1806+), CINAHL (1982+), EMBASE (1974+) and FRANCIS (1984+). Proquest Dissertations and Theses (1861+) was also investigated for gray literature. Additional studies were included by checking the references of the articles included in the systematic review as well as by looking at our personal collection of articles on euthanasia. This paper reviews a total of 27 empirical quantitative studies out of the 1 703 articles identified at the beginning. Five studies were in countries where euthanasia is legal and 22 in countries where it is not. Seventeen studies were targeting physicians, 9 targeted nurses and 1 both health professionals. Six studies identified the motivations underlying the intention to practice euthanasia, 16 the behavior itself and 5 both intention and behavior. The category of variables most consistently associated with euthanasia is psychological variables. All categories collapsed, the four variables most frequently associated with euthanasia are past behavior, medical specialty, whether the patient is depressed and the patient's life expectancy. The present review suggests that physicians and nurses are motivated to practice voluntary euthanasia especially when they are familiar with the act of euthanasia, when the patient does not have depressive symptoms and has a short life expectancy and their motivation varies according to their medical specialty. Additional studies among nurses and in countries where euthanasia is legal are needed.

  16. Team physicians in college athletics. (United States)

    Steiner, Mark E; Quigley, D Bradford; Wang, Frank; Balint, Christopher R; Boland, Arthur L


    There has been little documentation of what constitutes the clinical work of intercollegiate team physicians. Team physicians could be recruited based on the needs of athletes. A multidisciplinary team of physicians is necessary to treat college athletes. Most physician evaluations are for musculoskeletal injuries treated nonoperatively. Descriptive epidemiology study. For a 2-year period, a database was created that recorded information on team physician encounters with intercollegiate athletes at a major university. Data on imaging studies, hospitalizations, and surgeries were also recorded. The diagnoses for physician encounters with all undergraduates through the university's health service were also recorded. More initial athlete evaluations were for musculoskeletal diagnoses (73%) than for general medical diagnoses (27%) (P respiratory infections and dermatologic disorders, or multiple visits for concussions. Football accounted for 22% of all physician encounters, more than any other sport (P athletes did not require a greater number of physician encounters than did the general undergraduate pool of students on a per capita basis. Intercollegiate team physicians primarily treat musculoskeletal injuries that do not require surgery. General medical care is often single evaluations of common conditions and repeat evaluations for concussions.

  17. Expectations from implementers

    International Nuclear Information System (INIS)

    Biurrun, E.; Zuidema, P.


    Enrique Biurrun (DBE) presented the expectations from the implementer. He explained that the implementer needs a framework to successfully develop a repository which means the definition of requirements and guidance (for repository system development, analysis, licences, etc.) as well as the decision-making process (stepwise approach, roles of different players, etc.). He also needs a reasonable stability of the regulatory system. The regulatory framework should be developed in a clear, reasonable and consistent manner. In the context of the long duration of the project (100 years) there will be technological progress. In that context E. Biurrun asked what is the meaning of best practice. How can one deal with judgmental issues in a step-wise approach? Regulatory criteria and guidance must deal with the repository system for which an iterative process is necessary where dialogue is needed with the regulator despite the need to maintain his independence. The safety case, which is a periodic documentation of the status of the project, must provide a synthesis of the underlying scientific understanding and evidence and becomes part of the design process through feedback. E. Biurrun pointed out that safety is not calculated or assessed, but designed and built into the repository system (by geological and engineered barriers). He stressed the importance of the operational aspects since the implementer has to build and operate the repository safely. He asked the question: is it 'Ethical' to buy 'peace of mind' of some stakeholders with casualties of the implementer's staff because of mining accidents if the repository is left open during a phase of reversibility. The implementer needs dependable criteria, legal security and investment security. He interpreted the 'Precautionary principle' as meaning 'do it now'. Long-lasting solutions are very uncertain. Will we heave the money and the technology to do it later? He made some reflections regarding the ethical need to

  18. Education and training of physicians for radiation emergency management

    International Nuclear Information System (INIS)

    Reiners, Christoph; Schneider, Rita


    The project orders implied the development, testing, and evaluation of a curriculum for educating and training physicians in prehospital radiation accident management and the development of a master curriculum. Objectives were to develop, preserve, and enlarge medical competence concerning prehospital care of radiation accident patients. The project is expected to contribute to qualify emergency physicians challenged by scenarios related to radiological and nuclear hazards. The development and the content of the curriculum for educating and training physicians in prehospital radiation accident management are being described. The conduction and evaluation of two pilot training courses with a total of 40 participating physicians are being presented. Successful testing of the pilot courses proves the value of the curriculum developed. Self-contained courses can be performed according to the master curriculum and the respective master presentations. Moreover, single modules can be integrated in existing education and training programmes. Suggestions for the implementation and accreditation of the curriculum are being made. (orig.)

  19. (Re)disclosing physician financial interests: rebuilding trust or making unreasonable burdens on physicians? (United States)

    Sperling, Daniel


    Recent professional guidelines published by the General Medical Council instruct physicians in the UK to be honest and open in any financial agreements they have with their patients and third parties. These guidelines are in addition to a European policy addressing disclosure of physician financial interests in the industry. Similarly, In the US, a national open payments program as well as Federal regulations under the Affordable Care Act re-address the issue of disclosure of physician financial interests in America. These new professional and legal changes make us rethink the fiduciary duties of providers working under new organizational and financial schemes, specifically their clinical fidelity and their moral and professional obligations to act in the best interests of patients. The article describes the legal changes providing the background for such proposals and offers a prima facie ethical analysis of these evolving issues. It is argued that although disclosure of conflicting interest may increase trust it may not necessarily be beneficial to patients nor accord with their expectations and needs. Due to the extra burden associated with disclosure as well as its implications on the medical profession and the therapeutic relationship, it should be held that transparency of physician financial interest should not result in mandatory disclosure of such interest by physicians. It could lead, as some initiatives in Europe and the US already demonstrate, to voluntary or mandatory disclosure schemes carried out by the industry itself. Such schemes should be in addition to medical education and the address of the more general phenomenon of physician conflict of interest in ethical codes and ethical training of the parties involved.

  20. Physicians’ perceptions, expectations, and experience with pharmacists at Hamad Medical Corporation in Qatar (United States)

    Zaidan, Manal; Singh, Rajvir; Wazaify, Mayyada; Tahaineh, Linda


    Objectives: The purpose of this study was to investigate the physicians’ perceptions, and expectations of their experiences with the pharmacists at Hamad Medical Corporation (HMC) in Qatar. Method: A cross-sectional study was conducted at HMC between January and March 2006 using a validated questionnaire. The self-administered questionnaire was distributed to 500 physicians who were working at HMC comprising Hamad General Hospital, Women’s Hospital, Rumaila Hospital, Al-Amal Hospital, Al Khor Hospital, and primary health centers. The questionnaire was composed of four parts, investigating the physicians’ expectations, experiences, and perceptions of the pharmacists. Results: A total of 205 questionnaires were completed (response rate 41%). A total of 183 physicians (89%) expected the pharmacist to educate patients about safe and appropriate use of drugs, whereas 118 (57%) expected the pharmacist to be available for health-care team consultation during bedside rounds. The indices of physicians showing how comfortable they were with pharmacists, and their expectations of pharmacists, were 61% and 65%, respectively, whereas the index on experience of physicians with pharmacists was lower (15%). Conclusions: Physicians were comfortable with pharmacists and had high expectations of pharmacists in performing their duties. However, physicians reported a poor experience with pharmacists, who infrequently informed them about the effectiveness of alternative drugs, patients experiencing problems with prescribed medications, and who took personal responsibility to resolve any drug-related problem. PMID:21544250

  1. Physician relationships: make your first impression count. (United States)

    Crepeau, Jason


    Strategies for physician recruitment should include the following: Consider creating an in-house recruiting system to save money and to "own" the health system's first impression. Gain a competitive advantage by nurturing relationships with prospects over the long-term. Use innovative recruitment techniques, such as video interviewing and electronic reference checking, to better coordinate recruitment, follow-up, and mentoring. Make a new hire's job satisfaction and home life a top priority during the first 90 days of employment, and then plan regular follow-ups to maintain a positive relationship.

  2. Social gradient in life expectancy and health expectancy in Denmark

    DEFF Research Database (Denmark)

    Brønnum-Hansen, Henrik; Andersen, Otto; Kjøller, Mette


    Health status of a population can be evaluated by health expectancy expressed as average lifetime in various states of health. The purpose of the study was to compare health expectancy in population groups at high, medium and low educational levels.......Health status of a population can be evaluated by health expectancy expressed as average lifetime in various states of health. The purpose of the study was to compare health expectancy in population groups at high, medium and low educational levels....

  3. Social media: physicians-to-physicians education and communication. (United States)

    Fehring, Keith A; De Martino, Ivan; McLawhorn, Alexander S; Sculco, Peter K


    Physician to physician communication is essential for the transfer of ideas, surgical experience, and education. Social networks and online video educational contents have grown exponentially in recent years changing the interaction among physicians. Social media platforms can improve physician-to-physician communication mostly through video education and social networking. There are several online video platforms for orthopedic surgery with educational content on diagnosis, treatment, outcomes, and surgical technique. Social networking instead is mostly centered on sharing of data, discussion of confidential topics, and job seeking. Quality of educational contents and data confidentiality represent the major drawbacks of these platforms. Orthopedic surgeons must be aware that the quality of the videos should be better controlled and regulated to avoid inaccurate information that may have a significant impact especially on trainees that are more prone to use this type of resources. Sharing of data and discussion of confidential topics should be extremely secure according the HIPAA regulations in order to protect patients' confidentiality.

  4. Are Australasian academic physicians an endangered species? (United States)

    Wilson, A


    It has been stated that academic medicine is in a worldwide crisis. Is this decline in hospital academic practice a predictable consequence of modern clinical practice with its emphasis on community and outpatient-based services as well as a corporate health-care ethos or does it relate to innate problems in the training process and career structure for academic clinicians? A better understanding of the barriers to involvement in academic practice, including the effect of gender, the role and effect of overseas training, expectation of further research degrees and issues pertaining to the Australian academic workplace will facilitate recruitment and retention of the next generation of academic clinicians. Physician-scientists remain highly relevant as medical practice and education evolves in the 21st century. Hospital-based academics carry out a critical role in the ongoing mentoring of trainees and junior colleagues, whose training is still largely hospital based in most specialty programmes. Academic clinicians are uniquely placed to translate the rapid advances in medical biology into the clinical sphere, by guiding and carrying out translational research as well as leading clinical studies. Academic physicians also play key leadership in relations with government and industry, in professional groups and medical colleges. Thus, there is a strong case to assess the problems facing recruitment and retention of physician-scientists in academic practice and to develop workable solutions.

  5. Ninth Biennial Congress of the Association of Physicians

    African Journals Online (AJOL)

    4 Mei 1974 ... The 9th Biennial Congress of the Association of. Physicians of South Africa takes place on the campus of the University of Pretoria during the first week in July. There is every reason to expect that this will be a particularly interesting and im- portant congress and every effort is being made to ensure its ...

  6. Family physicians' attitude and practice of infertility management at ...

    African Journals Online (AJOL)

    Introduction: 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 ...

  7. Pain and symptom control. Patient rights and physician responsibilities. (United States)

    Emanuel, E J


    In considering the care of patients with incurable and terminal diseases, there are three types of interventions: (1) palliative care and symptom management; (2) experimental therapies; and (3) active life-ending interventions. Relief of pain, other symptoms, and suffering should be the basic and standard treatment; the other interventions are meant to supplement, not replace, this intervention. This means the physician's primary obligation is to inform patients about the options for palliative care and to provide quality palliative care. Thus, physicians who care for terminally ill patients have an obligation to keep their knowledge base and skills in palliative care current. In those circumstances in which a patient's needs exceeds the physician's knowledge and skills, physicians have a responsibility to refer the patient to a palliative care specialist. With regard to experimental therapies, physicians must obtain full informed consent, provide especially accurate data on the risks and benefits of experimental therapies, and ensure that the patient understands the aims of the proposed therapy. Regarding active life-ending therapies, physicians have the obligation to withhold or withdraw life-sustaining treatment if the patient so desires and to provide adequate pain medication even if this hastens death. Even if euthanasia or physician-assisted suicide are legalized, there is unlikely to be an obligation to provide this intervention.

  8. Should physicians have facial piercings? (United States)

    Newman, Alison W; Wright, Seth W; Wrenn, Keith D; Bernard, Aline


    The objective of this study was to assess attitudes of patrons and medical school faculty about physicians with nontraditional facial piercings. We also examined whether a piercing affected the perceived competency and trustworthiness of physicians. Survey. Teaching hospital in the southeastern United States. Emergency department patrons and medical school faculty physicians. First, patrons were shown photographs of models with a nontraditional piercing and asked about the appropriateness for a physician or medical student. In the second phase, patrons blinded to the purpose of the study were shown identical photographs of physician models with or without piercings and asked about competency and trustworthiness. The third phase was an assessment of attitudes of faculty regarding piercings. Nose and lip piercings were felt to be appropriate for a physician by 24% and 22% of patrons, respectively. Perceived competency and trustworthiness of models with these types of piercings were also negatively affected. An earring in a male was felt to be appropriate by 35% of patrons, but an earring on male models did not negatively affect perceived competency or trustworthiness. Nose and eyebrow piercings were felt to be appropriate by only 7% and 5% of faculty physicians and working with a physician or student with a nose or eyebrow piercing would bother 58% and 59% of faculty, respectively. An ear piercing in a male was felt to be appropriate by 20% of faculty, and 25% stated it would bother them to work with a male physician or student with an ear piercing. Many patrons and physicians feel that some types of nontraditional piercings are inappropriate attire for physicians, and some piercings negatively affect perceived competency and trustworthiness. Health care providers should understand that attire may affect a patient's opinion about their abilities and possibly erode confidence in them as a clinician.

  9. Physician evaluation and acceptance of remote transmission of CT, digital subtraction angiography, and US annotated images

    International Nuclear Information System (INIS)

    Haskin, M.E.; Robbins, C.; Kohn, M.; Laffey, P.A.; Haskin, P.H.; Teplick, J.G.; Teplick, S.K.; Peyster, R.G.


    The authors have found annotated images an effective way of communicating the results of imaging studies to referring physicians. Of particular value is the collation of representative images from several modalities. Previously, hard copy of this collation was sent to the referring physician as an integrated imaging report. Recently they developed a computer-based station that transmits annotated images to remote personal computer (PC) terminals via a telephone modem which requires 30 seconds to send each image. This annotated image report can be quickly accessed by the referring physician at the remote PC terminal The prototype system, utility, diagnostic fidelity, and potential of this remote system are described

  10. Physicians’ perceptions, expectations, and experience with pharmacists at Hamad Medical Corporation in Qatar

    Directory of Open Access Journals (Sweden)

    Zaidan M


    Full Text Available Manal Zaidan1, Rajvir Singh2, Mayyada Wazaify3, Linda Tahaineh41Department of Pharmacy, Al-Amal Hospital, 2Medical Research Centre, Hamad Medical Corporation, Doha, Qatar; 3Department of Clinical Pharmacy and Biopharmaceutics, Faculty of Pharmacy, University of Jordan, Amman, Jordan; 4Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, JordanObjectives: The purpose of this study was to investigate the physicians’ perceptions, and expectations of their experiences with the pharmacists at Hamad Medical Corporation (HMC in Qatar.Method: A cross-sectional study was conducted at HMC between January and March 2006 using a validated questionnaire. The self-administered questionnaire was distributed to 500 physicians who were working at HMC comprising Hamad General Hospital, Women’s Hospital, Rumaila Hospital, Al-Amal Hospital, Al Khor Hospital, and primary health centers. The questionnaire was composed of four parts, investigating the physicians' expectations, experiences, and perceptions of the pharmacists.Results: A total of 205 questionnaires were completed (response rate 41%. A total of 183 physicians (89% expected the pharmacist to educate patients about safe and appropriate use of drugs, whereas 118 (57% expected the pharmacist to be available for health-care team consultation during bedside rounds. The indices of physicians showing how comfortable they were with pharmacists, and their expectations of pharmacists, were 61% and 65%, respectively, whereas the index on experience of physicians with pharmacists was lower (15%.Conclusions: Physicians were comfortable with pharmacists and had high expectations of pharmacists in performing their duties. However, physicians reported a poor experience with pharmacists, who infrequently informed them about the effectiveness of alternative drugs, patients experiencing problems with prescribed medications, and who took personal responsibility to resolve any drug

  11. When authenticity matters most: Physicians' regulation of emotional display and patient satisfaction. (United States)

    Yagil, Dana; Shnapper-Cohen, Moran


    The emotions expressed by physicians in medical encounters have significant impact on health outcomes and patient satisfaction. This study explored how physicians' regulation of displayed emotions affects patients' satisfaction, under low and high levels of patient distress and length of physician-patient acquaintance. Questionnaires were administered to 46 physicians and 230 of their patients (before and after the medical encounter) in outpatient clinics of two hospitals. Data were analyzed with hierarchical linear modeling which takes the nested data structure into account. We found a significant interaction effect of physician regulation of displayed emotions and patient distress on satisfaction: When distress was high, physician regulation of emotions was negatively related to patient satisfaction. The results also show a significant interaction effect of physician regulation of displayed emotions and length of physician-patient acquaintance: With a longer acquaintance, physician regulation of emotions was negatively related to patient satisfaction. The effect of the physicians' emotional display on patient satisfaction depends on contextual factors, such as patient distress and length of physician-patient acquaintance, which affect patients' emotional needs and expectations. When patients have high emotional involvement in the encounter it is suggested that physicians consider presenting genuine emotions to patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Physicians' obligations in radiation issues

    International Nuclear Information System (INIS)

    Loken, M.K.


    Physicians have responsibilities to develop effective radiation programs that will (1) protect the public's physical and emotional health, (2) prevent and/or minimize illnesses and injury, and (3) treat and rehabilitate all exposed individuals. To accomplish these goals, physicians should understand the basic elements of radiation physics, radiation biology, benefit/risk, radiation regulations, nuclear power production, and world energy needs

  13. HMO penetration and physicians' earnings. (United States)

    Hadley, J; Mitchell, J M


    The goal of this study is to estimate whether cross-sectional variations in enrollment in health maintenance organizations (HMOs) affected physicians' earnings and hourly income in 1990. Using data from a nationally representative sample of 4,577 younger physicians (penetration is endogenous and used the instrumental variables approach to obtain unbiased estimates. HMO penetration had a negative and statistically significant impact on physicians earnings in 1990. A doubling of the average level of HMO penetration in the market is estimated to reduce annual earnings by 7% to 10.7%, and hourly earnings by approximately 6% to 9%. It appears that HMOs were successful in reducing physicians' annual and per hour earnings in 1990, presumably through a combination of fewer visits and lower payment rates for people covered by HMOs. Although these results cannot be generalized to all physicians, the experience of a younger cohort of physicians may still be a good indicator of the future effects of HMOs because younger physicians may be more susceptible to market forces than older and more established physicians. Moreover, these results may be somewhat conservative because they reflect market behavior in 1990, several years before the rapid growth and more aggressive market behavior of HMOs in recent years.

  14. Physician Requirements-1990. For Cardiology. (United States)

    Tracy, Octavious; Birchette-Pierce, Cheryl

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

  15. Guidance levels, achievable doses and expectation levels

    International Nuclear Information System (INIS)

    Li, Lianbo; Meng, Bing


    The National Radiological Protection Board (NRPB), the International Atomic Energy Agency (IAEA) and the Commission of the European Communities (CEC) published their guidance levels and reference doses for typical X-ray examination and nuclear medicine in their documents in 1993, 1994 and 1996 respectively. From then on, the concept of guidance levels or reference doses have been applied to different examinations in the field of radiology and proved to be effective for reduction of patient doses. But the guidance levels or reference doses are likely to have some shortcomings and can do little to make further reduction of patient dose in the radiology departments where patient dose are already below them. For this reason, the National Radiological Protection Board (NRPB) proposed a concept named achievable doses which are based on the mean dose observed for a selected sample of radiology departments. This paper will review and discuss the concept of guidance levels and achievable doses, and propose a new concept referred to as Expectation Levels that will encourage the radiology departments where patient dose are already below the guidance levels to keep patient dose as low as reasonably achievable. Some examples of the expectation levels based on the data published by a few countries are also illustrated in this paper

  16. Family physicians and HIV infection. (United States)

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


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

  17. Physician Self-directed Learning and Education

    Directory of Open Access Journals (Sweden)

    Masami Tagawa


    Full Text Available Physicians are expected to be life-long learners because updated and effective patient care should be provided while medical and clinical knowledge and skills and social requirements for patient care are rapidly changing. Also, qualified clinical competence needs long periods of training and each physician has to continually learn as long as he/she works as a professional. Self-directed learning is an important factor in adult learning. Medical students' readiness for self-directed learning is not high, and should be improved by medical school and postgraduate training curricula. Garrison proposed a comprehensive model of self-directed learning, and it has dimensions of motivation (entering and task, self-monitoring (responsibility, and self-management (responsibility. To teach individual self-directed learning competencies, the following are important: (1 situate learners to experience “real” problems; (2 encourage learners to reflect on their own performance; (3 create an educational atmosphere in clinical training situations. In 2005, a 2-year mandatory residency program was implemented in Japan, and fewer medical school graduates took residency programs in medical school hospitals and advanced specialty programs provided by medical school departments. Medical school departments provide traditional, but life-long clinical training opportunities. Under the new residency program, an additional postgraduate and continuing medical training system has to be built up to maintain and confirm a physician's competencies. If physicians do clinical work using a scholarly way of thinking with critical analysis of their own competencies and improvement by reflection, they will become an excellent life-long learner.

  18. Willingness to pay for physician services at a primary contact in Ukraine: Results of a contingent valuation study

    Directory of Open Access Journals (Sweden)

    Danyliv, Andriy


    Full Text Available BACKGROUND. Reforming healthcare system in Ukraine would imply changing financial mechanisms and involving patients into copayment for physician services. Therefore, it is important to understand patients’ willingness to pay (WTP and its main drivers. This study aims to investigate patients’ willingness to pay for physician services at a primary contact, its levels and determinants.METHODS. Contingent valuation method was applied to a nationally representative sample of 303 adult respondents surveyed in 2009. Respondents stated their willingness to pay for a visit to four hypothetical physicians, whose profiles were designed in a way to estimate separate effects of physician’s specialization and joint improvement in three quality-related attributes of a service: the state of medical equipment, maintenance of the physician’s office, and reduction in waiting time. A random effect tobit regression was applied to model effect of these service characteristics and socio-demographic characteristics on WTP.RESULTS. The strongest predictors (insensitive to model specifications associated with higher WTP for physician services were quality improvements in the three characteristics of the physician’s profile, higher income, and presence of private insurance policy, while the one associated with reduced WTP was age over 70. Consultation with a medical specialist instead of a general practitioner was also associated with higher WTP, though the magnitude of effect was much lower than for the abovementioned factors.CONCLUSIONS. Ukrainians are willing to pay for physician services at a primary contact, but the highest WTP would be expected for services of improved clinical and social quality and access. There might be an intention in the society or some of its groups to avoid the gatekeeper general practitioner at a primary level and to refer directly to the medical specialist. Finally, if patient payments are introduced, special caution should be

  19. Physicians and domestic violence


    Joslin, Jonathan


    Domestic violence, spouse abuse, and battering all refer to the victimization of a person with whom the abuser has or has had an intimate relationship. Domestic violence may take the form of physical, sexual and psychological abuse, is generally repeated, and often escalates within relationships. Most evidence indicates that domestic violence is predominantly perpetrated by men against women. Some evidence suggests that women are just as likely to use violence against male partners as men are...

  20. Shared consultant physician posts.

    LENUS (Irish Health Repository)

    Cooke, J


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

  1. Yellow pages advertising by physicians. Are doctors providing the information consumers want most? (United States)

    Butler, D D; Abernethy, A M


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

  2. Euthanasia or physician-assisted suicide? A survey from the Netherlands. (United States)

    Kouwenhoven, Pauline S C; van Thiel, Ghislaine J M W; Raijmakers, Natasja J H; Rietjens, Judith A C; van der Heide, Agnes; van Delden, Johannes J M


    Legalizing euthanasia or physician-assisted suicide (PAS) is a current topic of debate in many countries. The Netherlands is the only country where legislation covers both. To study physicians' experiences and attitudes concerning the choice between euthanasia and PAS. A questionnaire including vignettes was sent to a random sample of 1955 Dutch general practitioners, elderly care physicians and medical specialists. In total, 793 physicians (41%) participated. There was no clear preference for euthanasia (36%) or PAS (34%). Two thirds of physicians thought that PAS underlines the autonomy and responsibility of the patient and considered this a reason to choose PAS. Reasons for not choosing PAS were expected practical problems. A minority (22%) discussed the possibility of PAS with their patient in case of a request for assistance in dying. Patients receiving PAS more often experienced psychosocial suffering in comparison with patients receiving euthanasia. In vignettes of patients with a request for assistance in dying due to psychosocial suffering, physicians agreed more often with the performance of PAS than with euthanasia. Dutch physicians perceive a difference between euthanasia and PAS. Although they believe PAS underlines patient autonomy and responsibility, the option of PAS is rarely discussed with the patient. The more psychosocial in nature the patient's suffering, the more physicians choose PAS. In these cases, PAS seems to fulfil physicians' preferences to emphasize patient autonomy and responsibility. Expected technical problems and unfamiliarity with PAS also play a role. Paradoxically, the choice for PAS is predominantly a physician's one.

  3. Lifetime earnings for physicians across specialties. (United States)

    Leigh, J Paul; Tancredi, Daniel; Jerant, Anthony; Romano, Patrick S; Kravitz, Richard L


    Earlier studies estimated annual income differences across specialties, but lifetime income may be more relevant given physicians' long-term commitments to specialties. Annual income and work hours data were collected from 6381 physicians in the nationally representative 2004-2005 Community Tracking Study. Data regarding years of residency were collected from AMA FREIDA. Present value models were constructed assuming 3% discount rates. Estimates were adjusted for demographic and market covariates. Sensitivity analyses included 4 alternative models involving work hours, retirement, exogenous variables, and 1% discount rate. Estimates were generated for 4 broad specialty categories (Primary Care, Surgery, Internal Medicine and Pediatric Subspecialties, and Other), and for 41 specific specialties. The estimates of lifetime earnings for the broad categories of Surgery, Internal Medicine and Pediatric Subspecialties, and Other specialties were $1,587,722, $1,099,655, and $761,402 more than for Primary Care. For the 41 specific specialties, the top 3 (with family medicine as reference) were neurological surgery ($2,880,601), medical oncology ($2,772,665), and radiation oncology ($2,659,657). The estimates from models with varying rates of retirement and including only exogenous variables were similar to those in the preferred model. The 1% discount model generated estimates that were roughly 150% larger than the 3% model. There was considerable variation in the lifetime earnings across physician specialties. After accounting for varying residency years and discounting future earnings, primary care specialties earned roughly $1-3 million less than other specialties. Earnings' differences across specialties may undermine health reform efforts to control costs and ensure adequate numbers of primary care physicians.

  4. Physicians' strikes and the competing bases of physicians' moral obligations. (United States)

    MacDougall, D Robert


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

  5. Women physicians as healthcare leaders: a qualitative study. (United States)

    Roth, Virginia R; Theriault, Anne; Clement, Chris; Worthington, Jim


    Purpose - The purpose of this paper is to explore the under-representation of women physicians in clinical leadership by examining the issue from their perspective. Design/methodology/approach - The authors used large group engagement methods to explore the experiences and perceptions of women physicians. In order to capture common themes across this group as a whole, participants were selected using purposeful sampling. Data were analysed using a structured thematic analysis procedure. Findings - This paper provides empirical insights into the influences affecting women physicians' decision to participate in leadership. The authors found that they often exclude themselves because the costs of leadership outweigh the benefits. Potential barriers unique to healthcare include the undervaluing of leadership by physician peers and perceived lack of support by nursing. Research limitations/implications - This study provides an in-depth examination of why women physicians are under-represented in clinical leadership from the perspective of those directly involved. Further studies are needed to confirm the generalizability of these findings and potential differences between demographic groups of physicians. Practical implications - Healthcare organizations seeking to increase the participation of women physicians in leadership should focus on modifying the perceived costs of leadership and highlighting the potential benefits. Large group engagement methods can be an effective approach to engage physicians on specific issues and mobilize grass-roots support for change. Originality/value - This exploratory study provides insights on the barriers and enablers to leadership specific to women physicians in the clinical setting. It provides a reference for healthcare organizations seeking to develop and diversify their leadership talent.

  6. Patient (customer) expectations in hospitals. (United States)

    Bostan, Sedat; Acuner, Taner; Yilmaz, Gökhan


    The expectations of patient are one of the determining factors of healthcare service. The purpose of this study is to measure the Patients' Expectations, based on Patient's Rights. This study was done with Likert-Survey in Trabzon population. The analyses showed that the level of the expectations of the patient was high on the factor of receiving information and at an acceptable level on the other factors. Statistical meaningfulness was determined between age, sex, education, health insurance, and the income of the family and the expectations of the patients (pstudy, the current legal regulations have higher standards than the expectations of the patients. The reason that the satisfaction of the patients high level is interpreted due to the fact that the level of the expectation is low. It is suggested that the educational and public awareness studies on the patients' rights must be done in order to increase the expectations of the patients.

  7. The impact of provider consolidation on physician prices. (United States)

    Carlin, Caroline S; Feldman, Roger; Dowd, Bryan


    When a clinic system is acquired by an integrated delivery system (IDS), the ownership change includes both vertical integration with the hospital(s), and horizontal integration with the IDS's previously owned or "legacy" clinics, causing increased market concentration in physician services. Although there is a robust literature on the impact of hospital market concentration, the literature on physician market concentration is sparse. The objective of this study is to determine the impact on physician prices when two IDSs acquired three multispecialty clinic systems in Minneapolis-St Paul, Minnesota at the end of 2007, using commercial claims data from a large health plan (2006-2011). Using a difference-in-differences model and nonacquired clinics as controls, we found that four years after the acquisitions (2011), average physician price indices in the acquired clinic systems were 32-47% higher than expected in absence of the acquisitions. Average physician prices in the IDS legacy clinics were 14-20% higher in 2011 than expected. Procedure-specific prices for common office visit and inpatient procedures also increased following the acquisitions. Copyright © 2017 John Wiley & Sons, Ltd.

  8. Macro Expectations, Aggregate Uncertainty, and Expected Term Premia

    DEFF Research Database (Denmark)

    Dick, Christian D.; Schmeling, Maik; Schrimpf, Andreas


    as well as aggregate macroeconomic uncertainty at the level of individual forecasters. We find that expected term premia are (i) time-varying and reasonably persistent, (ii) strongly related to expectations about future output growth, and (iii) positively affected by uncertainty about future output growth...... and in ation rates. Expectations about real macroeconomic variables seem to matter more than expectations about nominal factors. Additional findings on term structure factors suggest that the level and slope factor capture information related to uncertainty about real and nominal macroeconomic prospects...

  9. Position of the physician's nametag--a randomized, blinded trial.

    Directory of Open Access Journals (Sweden)

    Samuel Luca Schmid

    Full Text Available The patient-physician relation begins when the physician introduces himself with name and function. Most institutions request a nametag with name and function to be worn. Although nametags are consequently worn, the optimal position for the nametag is unknown. It was the purpose of this study to identify whether positioning the nametag on the right or the left chest side provides better visibility to the patient.One hundred volunteers, blinded to the experimental setup, presented for an orthopedic consultation in a standardized manner. The nametag of the physician was randomly positioned on the left chest side and presented to 50 individuals (age 35 years (range 17 to 83 or the right chest side and then presented to 50 other individuals (35 years (range 16 to 59. The time of the participant noticing the nametag was documented. Subsequently, the participant was questioned concerning the relevance of a nametag and verbal self-introduction of the physician.38% of the participants noticed the nametag on the right as opposed to 20% who noticed it if placed on the left upper chest (p = 0.0473. The mean time to detection was 9 (range 1-40 seconds for nametags on the right and 25.2 seconds (range 3 to 49, p = 0.006 on the left. For 87% of the participants, a nametag is expected and important and nearly all participants (96% expected the physician to introduce himself verbally.It is expected that a physician wears a nametag and introduce himself verbally at the first encounter. Positioning the nametag on the right chest side results in better and faster visibility.

  10. Writing more informative letters of reference. (United States)

    Wright, Scott M; Ziegelstein, Roy C


    Writing a meaningful and valuable letter of reference is not an easy task. Several factors influence the quality of any letter of reference. First, the accuracy and reliability of the writer's impressions and judgment depend on how well he knows the individual being described. Second, the writer's frame of reference, which is determined by the number of persons at the same level that he has worked with, will impact the context and significance of his beliefs and estimations. Third, the letter-writing skills of the person composing the letter will naturally affect the letter. To support the other components of a candidate's application, a letter of reference should provide specific examples of how an individual's behavior or attitude compares to a reference group and should assess "intangibles" that are hard to glean from a curriculum vitae or from test scores. This report offers suggestions that should help physicians write more informative letters of reference.

  11. Improving marital relationships: strategies for the family physician. (United States)

    Starling, B P; Martin, A C


    Marital conflict and divorce are prevalent in our society, and patients frequently ask family physicians to assist them with marital difficulties. These difficulties are often associated with a decline in health, resulting in additional stress to the marital unit. A MEDLINE search was undertaken using the key words "family medicine," "marital therapy," "marital counseling," "brief psychotherapy," and "short-term psychotherapy." The bibliographies of generated articles were searched for additional references. The authors used the resources of their individual behavioral science libraries, as well as their clinical experiences. With adequate training, many family physicians can include marital counseling skills in their clinical repertoires. Family life cycle theory provides a framework for understanding the common stresses of marital life and also guides the family physician in recommending strategies to improve marital satisfaction. The physician's role is twofold: (1) to identify couples in crisis, and (2) to provide preventive strategies geared to assist couples in achieving pre-crisis equilibrium or higher levels of functioning. For physicians whose practices do not include marital counseling, an understanding of the basic techniques can be beneficial in effectively referring appropriate couples for marital therapy.

  12. A quantitative day in the life of a Saskatchewan rural physician. (United States)

    Harrison, Emmett; Dhillon, Paul B A


    Rural family physicians are often required to meet a wide variety of medical service demands that are otherwise the responsibility of specialty physicians in urban centres. However, many rural physicians enjoy the practice variety and ability to meet patients' medical needs through this wider spectrum of care. We aimed to quantify and summarize the workload and clinical disorders seen by rural family physicians in Saskatchewan relative to urban family physicians. We used Saskatchewan Ministry of Health billing data for 2015/16 to compare rural and urban care provision. The data were summarized in a graphic 1-month format to portray a typical month in the life of a rural physician in the province. In the office setting, rural family physicians saw 16.8% more cardiac presentations in adults over 65 years of age than did urban family physicians; otherwise, there were no significant differences in the top office diagnosis categories seen by the 2 groups. Differences were apparent, however, in the hospital setting: urban family physicians saw more patients presenting with pain and, reflective of centralization of obstetric delivery services, performed more deliveries than did rural physicians. There are differences in the clinical presentations seen by rural and urban family physicians, and these need to be considered by new physicians considering rural practice. Our simple visual depiction of average workload, vacation and activity levels of rural physicians can further inform medical residents on the realities of working in rural Saskatchewan as a family physician. A more complete understanding of clinical workload expectations may promote recruitment of resident physicians.

  13. Impact, regulation and health policy implications of physician migration in OECD countries

    Directory of Open Access Journals (Sweden)

    Simoens Steven


    Full Text Available Abstract Background In the face of rising demand for medical services due to ageing populations, physician migration flows are increasingly affecting the supply of physicians in Organisation for Economic Co-operation and development (OECD countries. This paper offers an integrated perspective on the impact of physician migration on home and host countries and discusses international regulation and policy approaches governing physician migration. Methods Information about migration flows, international regulation and policies governing physician migration were derived from two questionnaires sent to OECD countries, a secondary analysis of EUROSTAT Labour Force Surveys, a literature review and official policy documents of OECD countries. Results OECD countries increasingly perceive immigration of foreign physicians as a way of sustaining their physician workforce. As a result, countries have entered into international agreements regulating physician migration, although their success has been limited due to the imposition of licensing requirements and the protection of vested interests by domestic physicians. OECD countries have therefore adopted specific policies designed to stimulate the immigration of foreign physicians, whilst minimising its negative impact on the home country. Measures promoting immigration have included international recruitment campaigns, less strict immigration requirements and arrangements that foster shared learning between health care systems. Policies restricting the societal costs of physician emigration from developing countries such as good practice guidelines and taxes on host countries have not yet produced their expected effect or in some cases have not been established at all. Conclusions Although OECD countries generally favour long-term policies of national self-sufficiency to sustain their physician workforce, such policies usually co-exist with short-term or medium-term policies to attract foreign physicians

  14. Managing expectations of antibiotics for upper respiratory tract infections: a qualitative study

    NARCIS (Netherlands)

    Mustafa, M.; Wood, F.; Butler, C.C.; Elwyn, G.


    PURPOSE: Communication experts have suggested that it is good practice to ask patients' directly whether they expect to receive antibiotics as part of asking about the triad of ideas, concerns, and expectations for health care. Our aim was to explore the views and experiences of family physicians

  15. Heterogeneous inflation expectations and learning


    Madeira, Carlos; Zafar, Basit


    Using the panel component of the Michigan Survey of Consumers, we estimate a learning model of inflation expectations, allowing for heterogeneous use of both private information and lifetime inflation experience. “Life-experience inflation” has a significant impact on individual expectations, but only for one-year-ahead inflation. Public information is substantially more relevant for longer-horizon expectations. Even controlling for life-experience inflation and public information, idiosyncra...

  16. Expectations on Track? High School Tracking and Adolescent Educational Expectations

    DEFF Research Database (Denmark)

    Karlson, Kristian Bernt


    This paper examines the role of adaptation in expectation formation processes by analyzing how educational tracking in high schools affects adolescents' educational expectations. I argue that adolescents view track placement as a signal about their academic abilities and respond to it in terms...... of modifying their educational expectations. Applying a difference-in-differences approach to the National Educational Longitudinal Study of 1988, I find that being placed in an advanced or honors class in high school positively affects adolescents’ expectations, particularly if placement is consistent across...... subjects and if placement contradicts tracking experiences in middle school. My findings support the hypothesis that adolescents adapt their educational expectations to ability signals sent by schools....

  17. American College of Emergency Physicians (United States)

    ... these... Read More More Than 850 Hours of Online Education Log In Now > Physicians Podcasts and Apps Reimbursement Quality Issues MOC Resource Center International Residents & Students Contracts & ... Medicine Foundation Online Buyers' Guide Emergency Care For You ...

  18. Physician Compare National Downloadable File (United States)

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

  19. [Physicians' strikes--ethical considerations]. (United States)

    Glick, Shimon; Schwarzfuchs, Dan


    Strikes in general represent a solution based on a form of coercion. Historically, the striker caused direct damage to his employer, who was responsible for the perceived unfair treatment of the employee. In the case of strikes in the public sector, the employer is generally not harmed, but innocent citizens suffer in order to pressure the government agencies, a questionable practice from an ethical viewpoint. Physicians' strikes have more serious ethical problems. They cause suffering and death to innocent citizens. They violate the ethical codes to which physicians have committed themselves as professionals, and they seriously impair the trust of the public in physicians. Better and more ethical ways to provide fair compensation for physicians must be employed, perhaps like those used for judges and members of the IDF.

  20. Structuring competitive physician compensation models. (United States)

    Mobley, Kim; Turcotte, Claire


    When developing and reviewing their physician compensation programs, healthcare organizations should: Understand the market data. Test outcomes of incentive plans for fair market value. Check total compensation for fair market value and reasonableness.

  1. The physician as a manager. (United States)

    McDonagh, T J


    The practice of occupational medicine has undergone considerable change over the last decade. Increased awareness of potential health hazards associated with the workplace and its products and wastes, the interest of society and workers in these subjects, and related governmental regulation have resulted in expanded occupational health programs within industry. The occupational physician has become a key company resource in the optimal management of the business impacts of health-related issues. Health-related matters often have noteworthy business implications, and the occupational physician needs to spend considerable time as a manager in the planning, resourcing, implementation, evaluation, and stewardship of programs. Thus he is experiencing greater demands and often is inadequately prepared for this nonclinical, nonscientific role. Therefore, the preparation of occupational physicians to assume such managerial responsibilities needs to receive high priority. The physician must be willing to accept this challenge both to ensure the program's success and to retain a leadership position in occupational health programs.

  2. Influence of pharmacists expertise on physicians prescription ...

    African Journals Online (AJOL)

    the prescribing behaviour of physicians. ... Keywords: Physician prescription behaviour, Pharmacist factor, Collaboration, Trustworthiness ... provide information relating to drug prescription, ... processing [22], which takes into consideration.

  3. Unique Physician Identification Number (UPIN) Directory (United States)

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

  4. Abortion and compelled physician speech. (United States)

    Orentlicher, David


    Informed consent mandates for abortion providers may infringe the First Amendment's freedom of speech. On the other hand, they may reinforce the physician's duty to obtain informed consent. Courts can promote both doctrines by ensuring that compelled physician speech pertains to medical facts about abortion rather than abortion ideology and that compelled speech is truthful and not misleading. © 2015 American Society of Law, Medicine & Ethics, Inc.

  5. Regulatory and cost barriers are likely to limit biosimilar development and expected savings in the near future. (United States)

    Grabowski, Henry G; Guha, Rahul; Salgado, Maria


    In March 2010 Congress established an abbreviated Food and Drug Administration approval pathway for biosimilars-drugs that are very similar but not identical to a reference biological product and cost less. Because bringing biosimilars to the market currently requires large investments of money, fewer biosimilars are expected to enter the biologics market than has been the case with generic drugs entering the small-molecule drug market. Additionally, given the high regulatory hurdles to obtaining interchangeability-which would allow pharmacists to substitute a biosimilar for its reference product, subject to evolving state substitution laws-most biosimilars will likely compete as therapeutic alternatives instead of as therapeutic equivalents. In other words, biosimilars will need to compete with their reference product on the basis of quality; price; and manufacturer's reputation with physicians, insurers, and patient groups. Biosimilars also will face dynamic competition from new biologics in the same therapeutic class-including "biobetters," which offer incremental improvements on reference products, such as extended duration of action. The prospects for significant cost savings from the use of biosimilars appear to be limited for the next several years, but their use should increase over time because of both demand- and supply-side factors. Project HOPE—The People-to-People Health Foundation, Inc.

  6. Expectation-based intelligent control

    International Nuclear Information System (INIS)

    Zak, Michail


    New dynamics paradigms-negative diffusion and terminal attractors-are introduced to control noise and chaos. The applied control forces are composed of expectations governed by the associated Fokker-Planck and Liouville equations. The approach is expanded to a general concept of intelligent control via expectations. Relevance to control in livings is emphasized and illustrated by neural nets with mirror neurons

  7. Decomposing change in life expectancy

    DEFF Research Database (Denmark)

    Vaupel, James W.; Canudas Romo, Vladimir


    We extend Nathan Keyfitz's research on continuous change in life expectancy over time by presenting and proving a new formula for decomposing such change. The formula separates change in life expectancy over time into two terms. The first term captures the general effect of reduction in death rates...... in Sweden and Japan....

  8. Sibling Status Effects: Adult Expectations. (United States)

    Baskett, Linda Musun


    This study attempted to determine what expectations or beliefs adults might hold about a child based on his or her sibling status alone. Ratings on 50 adjective pairs for each of three sibling status types, only, oldest, and youngest child, were assessed in relation to adult expectations, birth order, and parental status of rater. (Author/DST)

  9. University-industry coupling: exaggerated expectations

    Energy Technology Data Exchange (ETDEWEB)

    Roy, R.

    This coupling, formally disdainful to university presidents and leading scientists, is now all the rage, according to the author. The presidents' enthusiasm is sparked apparently by hopes of making killings on patents and gaining equity participation in the Silicon Valleys of the future, he notes. The reality of the situation, the cautions, is that all ventures are highly speculative; further, the performance of most universities in knowledge transfer is mixed. He supports research interactions between universities and industries where natural and effective, but warms against the public's grossly exaggerated expectations. 6 references

  10. Aggression and violence directed toward general medicine physicians

    Directory of Open Access Journals (Sweden)

    Petrov-Kiurski Miloranka


    .60%, providing security personnel (49.3% and stricter punishments for such offences (50.0%. Conclusion: Aggression and violence directed toward physicians are largely present, predominantly in the form of aggression. The most often offenders are patients, the cause is patients' dissatisfaction with their unfulfilled expectations and the most common consequence on physicians is decreased satisfaction with the job they are doing.

  11. How to save distressed IDS-physician marriages: a case study. (United States)

    Collins, H; Johnson, B A


    A hospital-driven IDS that encounters serious problems resulting from ownership of a physician practice should address those problems by focusing on three core areas: vision and leadership, effectiveness of operations, and physician compensation arrangements. If changes in these areas do not lead to improvements, the IDS may need to consider organizational restructuring. In one case study, a hospital-driven IDS faced the problem of owning a poorly performing MSO with a captive physician group. The IDS's governing board determined that the organization lacked effective communication with the physicians and that realization of the organization's vision would require greater physician involvement in organizational decision making. The organization is expected to undergo some corporate reorganization in which physicians will acquire an equity interest in the enterprise.

  12. Considering culture in physician-- patient communication during colorectal cancer screening. (United States)

    Ge Gao; Burke, Nancy; Somkin, Carol P; Pasick, Rena


    Racial and ethnic disparities exist in both incidence and stage detection of colorectal cancer (CRC). We hypothesized that cultural practices (i.e., communication norms and expectations) influence patients' and their physicians' understanding and talk about CRC screening. We examined 44 videotaped observations of clinic visits that included a CRC screening recommendation and transcripts from semistructured interviews that doctors and patients separately completed following the visit. We found that interpersonal relationship themes such as power distance, trust, directness/ indirectness, and an ability to listen, as well as personal health beliefs, emerged as affecting patients' definitions of provider-patient effective communication. In addition, we found that in discordant physician-patient interactions (when each is from a different ethnic group), physicians did not solicit or address cultural barriers to CRC screening and patients did not volunteer culture-related concerns regarding CRC screening.

  13. The Physician-Patient Working Alliance in Hemodialysis Treatment. (United States)

    Fuertes, Jairo N; Rubinstein, Sofia; Reyes, Mariela; Iampornpipopchai, Pichet; Mujeeb, Shanza; Smith, Carroll R; Toporovsky, Arielle


    Over the past 20 years, the role of psychological and social factors, including the physician-patient working alliance, have emerged as integral components of medical care for patients with a myriad of health conditions. The current study examines a model comprised of psychological-interpersonal factors and the extent to which it explains patient satisfaction with and adherence to hemodialysis treatment. One hundred and seven adults with end-stage renal disease who were receiving regular outpatient hemodialysis participated in the study. Path analyses show that the physician-patient working alliance indirectly predicts patient adherence through patient satisfaction and patients' outcome expectations. The working alliance directly predicts patients' quality of life. It is concluded that consistent with previous research, the physician-patient working alliance is a significant factor in predicting key patient behaviors in medical care.

  14. Health practices of Canadian physicians. (United States)

    Frank, Erica; Segura, Carolina


    To study the health and health practices of Canadian physicians, which can often influence patient health. Mailed survey. Canada. A random sample of 8100 Canadian physicians; 7934 were found to be eligible and 3213 responded (40.5% response rate). Factors that influence health, such as consumption of fruits and vegetables, amount of exercise and alcohol consumption, smoking status, body mass idex, and participation in preventive health screening measures, as well as work-life balance and emotional stability. Canadian physicians are healthy. More than 90% reported being in good to excellent health, and only 5% reported that poor physical or mental health made it difficult to handle their workload more than half the time in the previous month (although a quarter had reduced work activity because of long-term health conditions). Eight percent were obese, 3% currently smoked cigarettes, and 1% typically consumed 5 drinks or more on days when they drank alcohol. Physicians averaged 4.7 hours of exercise per week and ate fruits and vegetables 4.8 times a day. Their personal screening practices were largely compliant with Canadian Task Force on Preventive Health Care recommendations. They averaged 38 hours per week on patient care and 11 hours on other professional activities. Fifty-seven percent agreed that they had a good work-life balance, and 11% disagreed with the statement "If I can, I work when I am ill." Compared with self-reports from the general Canadian population, Canadian physicians, like American physicians, seem to be healthy and to have generally healthy behaviour. There is, however, room for improvement in physicians' personal and professional well-being, and improving their personal health practices could be an efficient and beneficent way to improve the health of all Canadians.

  15. Evaluation of Physicians' Cognitive Styles. (United States)

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


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

  16. Complexities in euthanasia or physician-assisted suicide as perceived by Dutch physicians and patients' relatives. (United States)

    Snijdewind, Marianne C; van Tol, Donald G; Onwuteaka-Philipsen, Bregje D; Willems, Dick L


    The practice of euthanasia and physician-assisted suicide (EAS) is always complex, but some cases are more complex than others. The nature of these unusually complex cases is not known. To identify and categorize the characteristics of EAS requests that are more complex than others. We held in-depth interviews with 28 Dutch physicians about their perception of complex cases of EAS requests. We also interviewed 26 relatives of patients who had died by EAS. We used open coding and inductive analysis to identify various different aspects of the complexities described by the participants. Complexities can be categorized into relational difficulties-such as miscommunication, invisible suffering, and the absence of a process of growth toward EAS-and complexities that arise from unexpected situations, such as the capricious progress of a disease or the obligation to move the patient. The interviews showed that relatives of the patient influence the process toward EAS. First, the process toward EAS may be disrupted, causing a complex situation. Second, the course of the process toward EAS is influenced not only by the patient and his/her attending physician but also by the relatives who are involved. Communicating and clarifying expectations throughout the process may help to prevent the occurrence of unusually complex situations. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  17. Sports medicine in The Netherlands: consultation with a sports physician without referral by a general practitioner

    Directory of Open Access Journals (Sweden)

    de Bruijn MC


    Full Text Available Matthijs C de Bruijn,1 Boudewijn J Kollen,2 Frank Baarveld21Center for Sports Medicine, 2Department of General Practice, University Medical Center Groningen, University of Groningen, The NetherlandsBackground: In The Netherlands, sports medicine physicians are involved in the care of about 8% of all sports injuries that occur each year. Some patients consult a sports physician directly, without being referred by a general practitioner. This study aims to determine how many patients consult a sports physician directly, and to explore differences in the profiles of these patients compared with those who are referred.Methods: This was an exploratory cross-sectional study in which all new patients presenting with an injury to a regional sports medical center during September 2010 were identified. The characteristics of patients who self-referred and those who were referred by other medical professionals were compared.Results: A total of 234 patients were included (mean age 33.7 years, 59.1% male. Most of the injuries occurred during soccer and running, particularly injuries of the knee and ankle. In this cohort, 39.3% of patients consulted a sports physician directly. These patients were significantly more often involved in individual sports, consulted a sports physician relatively rapidly after the onset of injury, and had received significantly less care before this new event from medical professionals compared with patients who were referred.Conclusion: In this study, 39.3% of patients with sports injuries consulted a sports physician directly without being referred by another medical professional. The profile of this group of patients differed from that of patients who were referred. The specific roles of general practitioners and sports physicians in medical sports care in The Netherlands needs to be defined further.Keywords: sports injuries, sports medicine physician, primary care, secondary care

  18. Developing a Physician׳s Professional Identity Through Medical Education. (United States)

    Olive, Kenneth E; Abercrombie, Caroline L


    Professionalism represents a fundamental characteristic of physicians. Professional organizations have developed professionalism competencies for physicians and medical students. The aim of teaching medical professionalism is to ensure the development of a professional identity in medical students. Professional identity formation is a process developed through teaching principles and appropriate behavioral responses to the stresses of being a physician. Addressing lapses and critical reflection is an important part of the educational process. The "hidden curriculum" within an institution plays an important role in professional identity formation. Assessment of professionalism involves multiple mechanisms. Steps in remediating professionalism lapses include (1) initial assessment, (2) diagnosis of problems and development of an individualized learning plan, (3) instruction encompassing practice, feedback and reflection and (4) reassessment and certification of competence. No reliable outcomes data exist regarding the effectiveness of different remediation strategies. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  19. Neural correlates of rhythmic expectancy

    Directory of Open Access Journals (Sweden)

    Theodore P. Zanto


    Full Text Available Temporal expectancy is thought to play a fundamental role in the perception of rhythm. This review summarizes recent studies that investigated rhythmic expectancy by recording neuroelectric activity with high temporal resolution during the presentation of rhythmic patterns. Prior event-related brain potential (ERP studies have uncovered auditory evoked responses that reflect detection of onsets, offsets, sustains,and abrupt changes in acoustic properties such as frequency, intensity, and spectrum, in addition to indexing higher-order processes such as auditory sensory memory and the violation of expectancy. In our studies of rhythmic expectancy, we measured emitted responses - a type of ERP that occurs when an expected event is omitted from a regular series of stimulus events - in simple rhythms with temporal structures typical of music. Our observations suggest that middle-latency gamma band (20-60 Hz activity (GBA plays an essential role in auditory rhythm processing. Evoked (phase-locked GBA occurs in the presence of physically presented auditory events and reflects the degree of accent. Induced (non-phase-locked GBA reflects temporally precise expectancies for strongly and weakly accented events in sound patterns. Thus far, these findings support theories of rhythm perception that posit temporal expectancies generated by active neural processes.

  20. 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

  1. Recruiting physicians without inviting trouble. (United States)

    Hoch, L J


    Many hospitals use physician recruitment strategies--generally assistance or employment strategies--to ensure medical staff loyalty. Although these strategies appeal to both hospitals and physicians, they are becoming increasingly problematic. Over the past three years, the government has issued pronouncements that question their legality. Thus any hospital considering physician recruitment strategies would be wise to evaluate them in light of various legal issues. such as reimbursement, nonprofit taxation, corporate practice of medicine, and certificate-of-need statutes. The consequences of failing to consider these issues can be ominous. The penalties for violating the proscribed remuneration provision of the Medicare act can include a fine, imprisonment, suspension from the Medicare and Medicaid programs, or loss of license. Payment issues can result in reduced reimbursement levels. Nonprofit taxation issues can trigger the loss of tax exemption. As a result of the corporate practice of medicine, a physician recruitment strategy may not be reimbursable by third-party payers or may even constitute the unauthorized practice of medicine. Finally, in some states, physician recruitment may trigger certificate-of-need review.

  2. Psychiatric rehabilitation education for physicians. (United States)

    Rudnick, Abraham; Eastwood, Diane


    As part of a rapidly spreading reform toward recovery-oriented services, mental health care systems are adopting Psychiatric/Psychosocial Rehabilitation (PSR). Accordingly, PSR education and training programs are now available and accessible. Although psychiatrists and sometimes other physicians (such as family physicians) provide important services to people with serious mental illnesses and may, therefore, need knowledge and skill in PSR, it seems that the medical profession has been slow to participate in PSR education. Based on our experience working in Canada as academic psychiatrists who are also Certified Psychiatric Rehabilitation Practitioners (CPRPs), we offer descriptions of several Canadian initiatives that involve physicians in PSR education. Multiple frameworks guide PSR education for physicians. First, guidance is provided by published PSR principles, such as the importance of self-determination ( Second, guidance is provided by adult education (andragogy) principles, emphasizing the importance of addressing attitudes in addition to knowledge and skills (Knowles, Holton, & Swanson, 2011). Third, guidance in Canada is provided by Canadian Medical Education Directives for Specialists (CanMEDS) principles, which delineate the multiple roles of physicians beyond that of medical expert (Frank, 2005) and have recently been adopted in Australia (Boyce, Spratt, Davies, & McEvoy, 2011). (PsycINFO Database Record (c) 2013 APA, all rights reserved).

  3. Dialysis centers - what to expect (United States)

    ... kidneys - dialysis centers; Dialysis - what to expect; Renal replacement therapy - dialysis centers; End-stage renal disease - dialysis ... to a tube that connects to the dialysis machine. Your blood will flow through the tube, into ...

  4. Life expectancy in bipolar disorder

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Vradi, Eleni; Andersen, Per Kragh


    OBJECTIVE: Life expectancy in patients with bipolar disorder has been reported to be decreased by 11 to 20 years. These calculations are based on data for individuals at the age of 15 years. However, this may be misleading for patients with bipolar disorder in general as most patients have a later...... onset of illness. The aim of the present study was to calculate the remaining life expectancy for patients of different ages with a diagnosis of bipolar disorder. METHODS: Using nationwide registers of all inpatient and outpatient contacts to all psychiatric hospitals in Denmark from 1970 to 2012 we...... remaining life expectancy in bipolar disorder and that of the general population decreased with age, indicating that patients with bipolar disorder start losing life-years during early and mid-adulthood. CONCLUSIONS: Life expectancy in bipolar disorder is decreased substantially, but less so than previously...

  5. FastStats: Life Expectancy (United States)

    ... What's this? Submit What's this? Submit Button NCHS Home ... expectancy at birth, at 65, and 75 years of age by sex, race and Hispanic origin Health, United States 2016, table 15 [PDF – 9.8 MB] Life ...

  6. Physical activity extends life expectancy (United States)

    Leisure-time physical activity is associated with longer life expectancy, even at relatively low levels of activity and regardless of body weight, according to a study by a team of researchers led by the NCI.

  7. Subjective expected utility without preferences


    Bouyssou , Denis; Marchant , Thierry


    This paper proposes a theory of subjective expected utility based on primitives only involving the fact that an act can be judged either "attractive" or "unattractive". We give conditions implying that there are a utility function on the set of consequences and a probability distribution on the set of states such that attractive acts have a subjective expected utility above some threshold. The numerical representation that is obtained has strong uniqueness properties.

  8. What Do We Mean by Physician Wellness? A Systematic Review of Its Definition and Measurement. (United States)

    Brady, Keri J S; Trockel, Mickey T; Khan, Christina T; Raj, Kristin S; Murphy, Mary Lou; Bohman, Bryan; Frank, Erica; Louie, Alan K; Roberts, Laura Weiss


    Physician wellness (well-being) is recognized for its intrinsic importance and impact on patient care, but it is a construct that lacks conceptual clarity. The authors conducted a systematic review to characterize the conceptualization of physician wellness in the literature by synthesizing definitions and measures used to operationalize the construct. A total of 3057 references identified from PubMed, Web of Science, and a manual reference check were reviewed for studies that quantitatively assessed the "wellness" or "well-being" of physicians. Definitions of physician wellness were thematically synthesized. Measures of physician wellness were classified based on their dimensional, contextual, and valence attributes, and changes in the operationalization of physician wellness were assessed over time (1989-2015). Only 14% of included papers (11/78) explicitly defined physician wellness. At least one measure of mental, social, physical, and integrated well-being was present in 89, 50, 49, and 37% of papers, respectively. The number of papers operationalizing physician wellness using integrated, general-life well-being measures (e.g., meaning in life) increased [X 2  = 5.08, p = 0.02] over time. Changes in measurement across mental, physical, and social domains remained stable over time. Conceptualizations of physician wellness varied widely, with greatest emphasis on negative moods/emotions (e.g., burnout). Clarity and consensus regarding the conceptual definition of physician wellness is needed to advance the development of valid and reliable physician wellness measures, improve the consistency by which the construct is operationalized, and increase comparability of findings across studies. To guide future physician wellness assessments and interventions, the authors propose a holistic definition.

  9. Motivations of physicians and nurses to practice voluntary euthanasia: a systematic review (United States)


    Background While a number of reviews have explored the attitude of health professionals toward euthanasia, none of them documented their motivations to practice euthanasia. The objective of the present systematic review was to identify physicians’ and nurses’ motives for having the intention or for performing an act of voluntary euthanasia and compare findings from countries where the practice is legalized to those where it is not. Methods The following databases were investigated: MEDLINE/PubMed (1950+), PsycINFO (1806+), CINAHL (1982+), EMBASE (1974+) and FRANCIS (1984+). Proquest Dissertations and Theses (1861+) was also investigated for gray literature. Additional studies were included by checking the references of the articles included in the systematic review as well as by looking at our personal collection of articles on euthanasia. Results This paper reviews a total of 27 empirical quantitative studies out of the 1 703 articles identified at the beginning. Five studies were in countries where euthanasia is legal and 22 in countries where it is not. Seventeen studies were targeting physicians, 9 targeted nurses and 1 both health professionals. Six studies identified the motivations underlying the intention to practice euthanasia, 16 the behavior itself and 5 both intention and behavior. The category of variables most consistently associated with euthanasia is psychological variables. All categories collapsed, the four variables most frequently associated with euthanasia are past behavior, medical specialty, whether the patient is depressed and the patient’s life expectancy. Conclusions The present review suggests that physicians and nurses are motivated to practice voluntary euthanasia especially when they are familiar with the act of euthanasia, when the patient does not have depressive symptoms and has a short life expectancy and their motivation varies according to their medical specialty. Additional studies among nurses and in countries where

  10. What factors affect the productivity and efficiency of physician practices? (United States)

    Sunshine, Jonathan H; Hughes, Danny R; Meghea, Cristian; Bhargavan, Mythreyi


    Increasing the productivity and efficiency of physician practices could help relieve the rapid growth of US healthcare costs and the expected physician shortage. Radiology practices are an attractive specific focus for research on practices' productivity and efficiency because they are home to many purportedly productivity-enhancing operational technologies. This affords an opportunity to study the effect of production technology on physicians' output. As well, radiology is a leader in the general movement of physicians out of very small practices. And imaging is by the fastest-growing category of physician expenditure. Using data from 2003 to 2007 surveys of radiologists, we estimate a stochastic frontier model to study the effects of practice characteristics, such as work hours, practice size, and output mix, and technologies used in work production, on practices' productivity and efficiency. At the mean, the elasticities of output with respect to practice size and annual hours worked per full-time physician were 0.73 and 0.51, respectively. Some production technologies increase productivity by 15% to 20%; others generate no increase. Using "nighthawks"--ie, contracting out after-hours work to external firms that consolidate workflow--significantly increases practice efficiency. The general US trend toward larger practice size is unlikely to relieve cost or physician shortage pressures. The actual effect of purportedly productivity-enhancing operational technologies needs to be carefully evaluated before they are widely adopted. As the recently-developed innovations of nighthawks and hospitalists show, practices should give more attention to a possible choice to "buy," rather than "make," part of their output.

  11. Qualitative Research on Emergency Medicine Physicians

    DEFF Research Database (Denmark)

    Paltved, Charlotte; Musaeus, Peter


    Aim: This study aims to systematically review the qualitative research studying Emergency Medicine (EM) physicians in Emergency Departments (ED). Background: Qualitative research aims to study complex social phenomena. EM is a highly complex medical and social environment that can be investigated...... with qualitative research. Methods: Electronic databases of English peer-reviewed articles were searched from 1971 to 2012 using Medline through PubMed and PsychINFO. This search was supplemented with hand-searches of Academic Emergency Medicine and Emergency Medicine Journal from 1999 to 2012 and cross references...... and training, communication, professional roles, and organizational factors, and into 12 sub-themes. Conclusion: The strength of qualitative research is its ability to grasp and operationalize complex relations within EM. Although qualitative research methodologies have gained in rigour in recent years and few...

  12. Medical registrars in 2010: experience and expectations of the future consultant physicians of the UK. (United States)

    Goddard, Andrew F; Evans, Timothy; Phillips, Christopher


    In 2010, 2,176 medical registrars in England (43%) responded to a survey of attitudes to current and future working conditions. Regarding current working, 88% were currently happy with their job with respect to their specialty but only 49% were happy with respect to acute medicine. Even if pay was increased, 59% would only want to work a 48-hour week or less. Regarding future jobs, 59% were worried about future job prospects with 91% exploring ways of extending their training. Only 36% would consider working away from their current location as a consultant, only 42% of those trained in acute medicine wish to take part in the acute take, 15% would consider a 'sub-consultant' post and only 60% were looking forward to becoming a consultant. The findings of this survey show that medical registrars are very concerned about their future. From their perspective, clinical medicine in England is in poor health.

  13. A physician's exposure to defamation. (United States)

    Mandell, W J


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

  14. [Sherlock Holmes as amateur physician]. (United States)

    Madsen, S


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

  15. 42 CFR 415.172 - Physician fee schedule payment for services of teaching physicians. (United States)


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

  16. Global health interdependence and the international physicians' movement. (United States)

    Gellert, G A


    International Physicians for the Prevention of Nuclear War has had an impressive public impact in the 1980s, helping to shatter the myths of surviving and medically responding to a nuclear attack. The 1990s present a new challenge for the medical community in a different social and international context characterized by increasing global interdependence. Another view of physician activism is presented to complement advocacy for nuclear disarmament in the promotion of peace. A framework for analysis is provided by "fateful visions"--accepted policy views of prospective superpower relations--drawn from practitioners of foreign policy, international relations, and security affairs. A perceptual gap may exist between physicians who wish to address underlying ethical and public health concerns on security issues and policy practitioners who are accustomed to discussion within existing policy frames of reference that can be pragmatically used. A strategy is proposed for physicians to use their specialized training and skills to evaluate trends in global health interdependence. The international physicians' movement may contribute substantively to the formulation of policy by expanding and interpreting an increasingly complex database on interdependence, and by creating a dialogue with policy formulators based on mutual recognition of the value and legitimacy of each professions' expertise and complementary contributions to international security policy.

  17. Global health interdependence and the international physicians' movement

    International Nuclear Information System (INIS)

    Gellert, G.A.


    International Physicians for the Prevention of Nuclear War has had an impressive public impact in the 1980s, helping to shatter the myths of surviving and medically responding to a nuclear attack. The 1990s present a new challenge for the medical community in a different social and international context characterized by increasing global interdependence. Another view of physician activism is presented to complement advocacy for nuclear disarmament in the promotion of peace. A framework for analysis is provided by fateful visions--accepted policy views of prospective superpower relations--drawn from practitioners of foreign policy, international relations, and security affairs. A perceptual gap may exist between physicians who wish to address underlying ethical and public health concerns on security issues and policy practitioners who are accustomed to discussion within existing policy frames of reference that can be pragmatically used. A strategy is proposed for physicians to use their specialized training and skills to evaluate trends in global health interdependence. The international physicians' movement may contribute substantively to the formulation of policy by expanding and interpreting an increasingly complex database on interdependence, and by creating a dialogue with policy formulators based on mutual recognition of the value and legitimacy of each professions' expertise and complementary contributions to international security policy

  18. International migration patterns of physicians to the United States: a cross-national panel analysis. (United States)

    Hussey, Peter S


    To analyze the dynamics of physician international migration patterns and identify the countries deviating most from expected migration rates. A negative binomial log-linear model of physician migration to the United States from every other country was constructed using a panel of country-level data for years 1994-2000. The model was used to identify factors associated with physician migration and to identify countries with higher or lower rates of physician migration than expected. Physician migration varied with a country's GDP per capita in an inverse-U pattern, with highest migration rates from middle-income countries. The absence of medical schools, immigrant networks in the United States, medical instruction in English, proximity to the United States, and the lack of political and civil liberties were also associated with higher migration rates. Countries with higher-than-predicted migration rates included Iceland, Albania, Armenia, Dominica, Lebanon, Syria, the United Arab Emirates, and Bulgaria. Countries with lower-than-predicted migration rates included Mexico, Japan, Brazil, Zimbabwe, Mauritania, Portugal, Senegal, and France. This analysis shows that many of the most powerful factors associated with physician migration are difficult or impossible for countries to change through public policy. GDP per capita and proximity to the U.S. are two of the most powerful predictors of physician migration. Networks of immigrants in the U.S. and fewer political and civil liberties also put countries at higher risk for physician emigration. Several other factors that were associated with physician migration might be more easily amenable to policy intervention. These factors include the absence of a medical school and medical instruction in English. Policies addressing these factors would involve making several difficult tradeoffs, however. Other examples of policies that are effective in minimizing physician migration might be found by examining countries with lower-than-expected

  19. The role of expectation in the therapeutic outcomes of alcohol and drug addiction treatments. (United States)

    Spagnolo, Primavera A; Colloca, Luana; Heilig, Markus


    Throughout history, patient-physician relationships have been acknowledged as an important component of the therapeutic effects of any pharmacological treatment. Here, we discuss the role of physicians' expectations in influencing the therapeutic outcomes of alcohol and drug addiction pharmacological treatments. As largely demonstrated, such expectations and attitudes may contribute to produce placebo and nocebo effects that in turn affect the course of the disease and the response to the therapy. This article is aimed at discussing the current insights into expectations, placebo and nocebo mechanisms and their impact on the therapeutic outcomes of alcohol and drug addiction treatments; with the goal of informing physicians and other health care providers about the potentially widespread implications for clinical practice and for a successful treatment regimen. Published by Oxford University Press on behalf of Medical Council on Alcohol 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  20. Broken Expectations: Violation of Expectancies, Not Novelty, Captures Auditory Attention (United States)

    Vachon, Francois; Hughes, Robert W.; Jones, Dylan M.


    The role of memory in behavioral distraction by auditory attentional capture was investigated: We examined whether capture is a product of the novelty of the capturing event (i.e., the absence of a recent memory for the event) or its violation of learned expectancies on the basis of a memory for an event structure. Attentional capture--indicated…

  1. The self-referred mammography patient

    International Nuclear Information System (INIS)

    Reynolds, H.E.; Jackson, V.P.


    This paper compares the demographics, knowledge, and attitudes of women who refer themselves for screening mammography with those who undergo mammography on the advice of their physicians. Four hundred eighty-five consecutive mammography patients (437 doctor preferred [DR], 48 self-referred [SR]) completed a survey during their mammography appointment. The sample population contained a wide range of socioeconomic groups. While similar in age, race, and employment status to DR patients, SR patients were significantly more likely to have a family income of more than 30,000 per year, be college graduates, and report that they were in good or excellent health

  2. Standard Reference Tables - (United States)

    Department of Transportation — The Standard Reference Tables (SRT) provide consistent reference data for the various applications that support Flight Standards Service (AFS) business processes and...

  3. 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.

  4. Citations to Web pages in scientific articles: the permanence of archived references. (United States)

    Thorp, Andrea W; Schriger, David L


    We validate the use of archiving Internet references by comparing the accessibility of published uniform resource locators (URLs) with corresponding archived URLs over time. We scanned the "Articles in Press" section in Annals of Emergency Medicine from March 2009 through June 2010 for Internet references in research articles. If an Internet reference produced the authors' expected content, the Web page was archived with WebCite ( Because the archived Web page does not change, we compared it with the original URL to determine whether the original Web page had changed. We attempted to access each original URL and archived Web site URL at 3-month intervals from the time of online publication during an 18-month study period. Once a URL no longer existed or failed to contain the original authors' expected content, it was excluded from further study. The number of original URLs and archived URLs that remained accessible over time was totaled and compared. A total of 121 articles were reviewed and 144 Internet references were found within 55 articles. Of the original URLs, 15% (21/144; 95% confidence interval [CI] 9% to 21%) were inaccessible at publication. During the 18-month observation period, there was no loss of archived URLs (apart from the 4% [5/123; 95% CI 2% to 9%] that could not be archived), whereas 35% (49/139) of the original URLs were lost (46% loss; 95% CI 33% to 61% by the Kaplan-Meier method; difference between curves PWeb page at publication can help preserve the authors' expected information. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  5. Hitler’s Jewish Physicians (United States)

    Weisz, George M.


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

  6. Physician-centered management guidelines. (United States)

    Pulde, M F


    The "Fortune 500 Most Admired" companies fully understand the irreverent premise "the customer comes second" and that there is a direct correlation between a satisfied work force and productivity, service quality, and, ultimately, organizational success. If health care organizations hope to recruit and retain the quality workforce upon which their core competency depends, they must develop a vision strategic plan, organizational structure, and managerial style that acknowledges the vital and central role of physicians in the delivery of care. This article outlines a conceptual framework for effective physician management, a "critical pathway," that will enable health care organizations to add their name to the list of "most admired." The nine principles described in this article are based on a more respectful and solicitous treatment of physicians and their more central directing role in organizational change. They would permit the transformation of health care into a system that both preserves the virtues of the physician-patient relationship and meets the demand for quality and cost-effectiveness.

  7. Introducing Physician Assistants to Ontario

    Directory of Open Access Journals (Sweden)

    Meredith Vanstone


    Full Text Available In 2006, the Ontario Ministry of Health and Long-Term Care (MOHLTC introduced Physician Assistants (PAs through the announcement of demonstration projects, education and training programs, and subsequent funding. PAs are directly supervised by physicians and act as physician extenders by performing acts as delegated to them by their supervising physicians. PAs were proposed as a potential solution to help improve access to health care and reduce wait times throughout the province. Prior to the 2006 Ministry announcement, there was little public discussion regarding the acceptance of the PA role or its sustainability. Opposition from nursing and other groups emerged in response to the 2006 announcement and flared again when stakeholder comments were solicited in 2012 as part of the PA application for status as regulated health professionals. As a health reform, the introduction of PAs has neither succeeded nor failed. In 2013, the majority of PA funding continues to be provided by the MOHLTC, and it is unknown whether the PA role will be sustainable when the MOHTLC withdraws salary funding and health system employers must decide whether or not to continue employing PAs at their own expense.

  8. Physician assistant education in Germany

    NARCIS (Netherlands)

    M. Dierks; L. Kuilman; C. Matthews


    The first physician assistant (PA) program in Germany began in 2005. As of 2013 there are three PA programs operational, with a fourth to be inaugurated in the fall of 2013. The programs have produced approximately 100 graduates, all with a nursing background. The PA model of shifting tasks from

  9. American College of Chest Physicians (United States)

    ... Foundation Participate in the e-Community Get Social Career Connection Publications CHEST Journal CHEST SEEK Guidelines & Consensus Statements CHEST Physician CHEST NewsBrief Coding for Chest Medicine Tobacco Dependence Toolkit (3rd Ed.) Mobile Websites and Apps CHEST Journal ...

  10. Hitler’s Jewish Physicians

    Directory of Open Access Journals (Sweden)

    George M. Weisz


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

  11. [The tragic fate of physicians]. (United States)

    Ohry, Avi


    Physicians and surgeons were always involved in revolutions, wars and political activities, as well as in various medical humanities. Tragic fate met these doctors, whether in the Russian prisons gulags, German labor or concentration camps, pogroms or at the hands of the Inquisition.

  12. The Mindful Physician and Pooh (United States)

    Winter, Robin O.


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

  13. Consumer's inflation expectations in Brazil

    Directory of Open Access Journals (Sweden)

    Fernando Ormonde Teixeira

    Full Text Available Abstract This paper investigates what are the main components of consumer's inflation expectations. We combine the FGV's Consumer Survey with the indices of inflation (IPCA and government regulated prices, professional forecasts disclosed in the Focus report, and media data which we crawl from one of the biggest and most important Brazilian newspapers, Folha de São Paulo, to determine what factors are responsible for and improve consumer's forecast accuracy. We found gender, age and city of residence as major elements when analyzing micro-data. Aggregate data shows the past inflation as an important trigger in the formation of consumers' expectations and professional forecasts as negligible. Moreover, the media plays a significant role, accounting not only for the expectations' formation but for a better understanding of actual inflation as well.

  14. Test expectancy affects metacomprehension accuracy. (United States)

    Thiede, Keith W; Wiley, Jennifer; Griffin, Thomas D


    Theory suggests that the accuracy of metacognitive monitoring is affected by the cues used to judge learning. Researchers have improved monitoring accuracy by directing attention to more appropriate cues; however, this is the first study to more directly point students to more appropriate cues using instructions regarding tests and practice tests. The purpose of the present study was to examine whether the accuracy metacognitive monitoring was affected by the nature of the test expected. Students (N= 59) were randomly assigned to one of two test expectancy groups (memory vs. inference). Then after reading texts, judging learning, completed both memory and inference tests. Test performance and monitoring accuracy were superior when students received the kind of test they had been led to expect rather than the unexpected test. Tests influence students' perceptions of what constitutes learning. Our findings suggest that this could affect how students prepare for tests and how they monitoring their own learning. ©2010 The British Psychological Society.

  15. Expectations for a scientific collaboratory

    DEFF Research Database (Denmark)

    Sonnenwald, Diane H.


    In the past decade, a number of scientific collaboratories have emerged, yet adoption of scientific collaboratories remains limited. Meeting expectations is one factor that influences adoption of innovations, including scientific collaboratories. This paper investigates expectations scientists have...... with respect to scientific collaboratories. Interviews were conducted with 17 scientists who work in a variety of settings and have a range of experience conducting and managing scientific research. Results indicate that scientists expect a collaboratory to: support their strategic plans; facilitate management...... of the scientific process; have a positive or neutral impact on scientific outcomes; provide advantages and disadvantages for scientific task execution; and provide personal conveniences when collaborating across distances. These results both confirm existing knowledge and raise new issues for the design...

  16. Sports medicine in The Netherlands: consultation with a sports physician without referral by a general practitioner (United States)

    de Bruijn, Matthijs C; Kollen, Boudewijn J; Baarveld, Frank


    Background In The Netherlands, sports medicine physicians are involved in the care of about 8% of all sports injuries that occur each year. Some patients consult a sports physician directly, without being referred by a general practitioner. This study aims to determine how many patients consult a sports physician directly, and to explore differences in the profiles of these patients compared with those who are referred. Methods This was an exploratory cross-sectional study in which all new patients presenting with an injury to a regional sports medical center during September 2010 were identified. The characteristics of patients who self-referred and those who were referred by other medical professionals were compared. Results A total of 234 patients were included (mean age 33.7 years, 59.1% male). Most of the injuries occurred during soccer and running, particularly injuries of the knee and ankle. In this cohort, 39.3% of patients consulted a sports physician directly. These patients were significantly more often involved in individual sports, consulted a sports physician relatively rapidly after the onset of injury, and had received significantly less care before this new event from medical professionals compared with patients who were referred. Conclusion In this study, 39.3% of patients with sports injuries consulted a sports physician directly without being referred by another medical professional. The profile of this group of patients differed from that of patients who were referred. The specific roles of general practitioners and sports physicians in medical sports care in The Netherlands needs to be defined further. PMID:24379706

  17. [Family physicians attitude towards quality indicator program]. (United States)

    Shani, Michal; Nakar, Sasson; Azuri, Yossi


    Quality indicator programs for primary care are implanted throughout the world improving quality in health care. In this study, we have assessed family physicians attitudes towards the quality indicators program in Israel. Questionnaires were distributed to family physicians in various continuing educational programs. The questionnaire addressed demographics, whether the physician dealt with quality indicators, time devoted by the physician to quality indicators, pressure placed on the physician related to quality indicators, and the working environment. A total of 140 questionnaires were distributed and 91 (65%) were completed. The average physician age was 49 years (range 33-65 years]; the average working experience as a family physician was 17.8 years (range 0.5-42); 58 physicians were family medicine specialist (65.9%). Quality indicators were part of the routine work of 94% of the physicians; 72% of the physicians noted the importance of quality indicators; 84% of the physicians noted that quality indicators demand better team work; 76% of the physicians noted that quality indicators have reduced their professional independence. Pressure to deal with quality indicators was noted by 72% of the family physicians. Pressure to deal with quality indicators was related to reduced loyalty to their employer (P = 0.001), reducing their interest to practice family medicine (p programs, without creating a heavy burden on the work of family physicians.

  18. [Expectations of hospital administrators about administrative functions of nurses]. (United States)

    Melo, M R; Fávero, N; Trevizan, M A; Hayashida, M


    The objective of the present study was to investigate hospital administrator's expectations about the administrative role played by nurses, utilizing functions proposed by the Neoclassical Theory of Administration: planning, organization, direction, and control as theoretical references. An instrument established in TREVIZAN (1989) was applied to 11 hospital administrators. The results showed they expect the four functions to be done by nurses. Therefore, the interaction between nurses and hospital administrators is critical to improve the patient's assistance.

  19. Physician career satisfaction within specialties

    Directory of Open Access Journals (Sweden)

    Kravitz Richard L


    Full Text Available Abstract Background Specialty-specific data on career satisfaction may be useful for understanding physician workforce trends and for counseling medical students about career options. Methods We analyzed cross-sectional data from 6,590 physicians (response rate, 53% in Round 4 (2004-2005 of the Community Tracking Study Physician Survey. The dependent variable ranged from +1 to -1 and measured satisfaction and dissatisfaction with career. Forty-two specialties were analyzed with survey-adjusted linear regressions Results After adjusting for physician, practice, and community characteristics, the following specialties had significantly higher satisfaction levels than family medicine: pediatric emergency medicine (regression coefficient = 0.349; geriatric medicine (0.323; other pediatric subspecialties (0.270; neonatal/prenatal medicine (0.266; internal medicine and pediatrics (combined practice (0.250; pediatrics (0.250; dermatology (0.249;and child and adolescent psychiatry (0.203. The following specialties had significantly lower satisfaction levels than family medicine: neurological surgery (-0.707; pulmonary critical care medicine (-0.273; nephrology (-0.206; and obstetrics and gynecology (-0.188. We also found satisfaction was significantly and positively related to income and employment in a medical school but negatively associated with more than 50 work-hours per-week, being a full-owner of the practice, greater reliance on managed care revenue, and uncontrollable lifestyle. We observed no statistically significant gender differences and no differences between African-Americans and whites. Conclusion Career satisfaction varied across specialties. A number of stakeholders will likely be interested in these findings including physicians in specialties that rank high and low and students contemplating specialty. Our findings regarding "less satisfied" specialties should elicit concern from residency directors and policy makers since they

  20. What to expect from Obamacare

    Directory of Open Access Journals (Sweden)

    Robbins RA


    Full Text Available Overall it appears that the ACA will have minimal impact on its goals of expanding care to the poor, reducing costs or improving care for the foreseeable future. It will likely continue to cost shift reimbursement away from physicians while costs continue to rise. Almost certainly it will be entangled in political bickering, eligibility challenges and lawsuits reducing many of the benefits of the law. However, we can probably be assured that CMS will continue to rely on inaccurately reported data, quickly declare their programs successful and stay their course, despite the programs doing little to nothing for patients. When their programs focus on outcomes such as mortality, morbidity, length of stay and readmission rates, real progress can be made in improving patient care rather than “spinning” dubious results.

  1. Career Expectations of Accounting Students (United States)

    Elam, Dennis; Mendez, Francis


    The demographic make-up of accounting students is dramatically changing. This study sets out to measure how well the profession is ready to accommodate what may be very different needs and expectations of this new generation of students. Non-traditional students are becoming more and more of a tradition in the current college classroom.…

  2. Primary expectations of secondary metabolites (United States)

    My program examines the plant secondary metabolites (i.e. phenolics) important for human health, and which impart the organoleptic properties that are quality indicators for fresh and processed foods. Consumer expectations such as appearance, taste, or texture influence their purchasing decisions; a...

  3. Expected utility with lower probabilities

    DEFF Research Database (Denmark)

    Hendon, Ebbe; Jacobsen, Hans Jørgen; Sloth, Birgitte


    An uncertain and not just risky situation may be modeled using so-called belief functions assigning lower probabilities to subsets of outcomes. In this article we extend the von Neumann-Morgenstern expected utility theory from probability measures to belief functions. We use this theory...

  4. Privacy Expectations in Online Contexts (United States)

    Pure, Rebekah Abigail


    Advances in digital networked communication technology over the last two decades have brought the issue of personal privacy into sharper focus within contemporary public discourse. In this dissertation, I explain the Fourth Amendment and the role that privacy expectations play in the constitutional protection of personal privacy generally, and…

  5. Gainsharing Strategies, Physician Champions, Getting Physician Buy In. (United States)

    Anoushiravani, Afshin A; Nunley, Ryan M


    As healthcare spending continues to outpace economic growth, legislators and healthcare economists have explored many processes aimed at improving efficiency and reducing waste. Gainsharing or the general concept that organizations and their employees can work together to continually improve outcomes at reduced expenditures in exchange for a portion of the savings has been shown to be effective within the healthcare system. Although gainsharing principles may be applicable to healthcare organizations and their physician partners, specific parameters should be followed when implementing these arrangements. This article will discuss 10 gainsharing strategies aimed at properly aligning healthcare organizations and physicians, which if followed will ensure the successful implementation of gainsharing initiatives. Copyright © 2017. Published by Elsevier Inc.

  6. A qualitative study of factors influencing different generations of Newfoundland and Saskatchewan trained physicians to leave a work location. (United States)

    Mathews, Maria; Seguin, Maureen; Chowdhury, Nurun; Card, Robert T


    Some studies have suggested that young physicians may have different expectations and practice behaviours than their older generational counterparts, including their reasons for wanting to remain or leave a community. This study examined the factors associated with a physician's decision to leave a work location. We compared different generations of physicians to assess whether these factors have changed over generations. We conducted semi-structured, qualitative interviews with 48 physicians who graduated from two Canadian medical schools. We asked each physician about the number and nature of work location changes and the factors related to their decisions to leave each location. Interview transcripts and notes were analysed using a thematic analysis approach. Dissatisfaction with the working environment was the most frequently cited reason for leaving a location for physicians of all generations. Elements which contributed to the quality of the work environment included the collaborative nature of the practice, the relationship with administrators, and access to resources and personnel. For younger physicians, the work environment had to meet their personal expectations for work-life balance. While remuneration level was given by some physicians as the key reason for leaving a location, for others it was the "last straw" if the work environment was poor. A small number of older generation physicians moved in response to political events and/or policies We documented generational differences in physicians' reasons for choosing a work location. We found that a poor work environment was universally the most important reason why a physician chose to leave a location. A few physicians who were unsatisfied with their work location identified level of remuneration as an additional reason for leaving. Some older generation physicians cited political climate as a reason for leaving a work location. While economic factors have largely been the focus of recruitment and

  7. The relationship between physician humility, physician-patient communication, and patient health. (United States)

    Ruberton, Peter M; Huynh, Ho P; Miller, Tricia A; Kruse, Elliott; Chancellor, Joseph; Lyubomirsky, Sonja


    Cultural portrayals of physicians suggest an unclear and even contradictory role for humility in the physician-patient relationship. Despite the social importance of humility, however, little empirical research has linked humility in physicians with patient outcomes or the characteristics of the doctor-patient visit. The present study investigated the relationship between physician humility, physician-patient communication, and patients' perceptions of their health during a planned medical visit. Primary care physician-patient interactions (297 patients across 100 physicians) were rated for the physician's humility and the effectiveness of the physician-patient communication. Additionally, patients reported their overall health and physicians and patients reported their satisfaction with the interaction. Within-physician fluctuations in physician humility and self-reported patient health positively predicted one another, and mean-level differences in physician humility predicted effective physician-patient communication, even when controlling for the patient's and physician's satisfaction with the visit and the physician's frustration with the patient. The results suggest that humble, rather than paternalistic or arrogant, physicians are most effective at working with their patients. Interventions to improve physician humility may promote better communication between health care providers and patients, and, in turn, better patient outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. Norms and nurse management of conflicts: keys to understanding nurse-physician collaboration. (United States)

    Keenan, G M; Cooke, R; Hillis, S L


    In this cross-sectional study, registered nurses from 36 emergency rooms completed an abridged version of the Organizational Culture Inventory (Cooke & Lafferty, 1989) and responded to nine hypothetical conflict vignettes. Stepwise regressions were performed with nurse conflict style intentions as dependent variables and 10 independent variable (three sets of norms, five measures of conflict styles expected to be used by the physician, gender, and education). Nurses' expectations for physicians to collaborate and strong constructive and aggressive norms were found to explain a moderate amount of variance (32%) in nurses' intentions to collaborate in conflicts conducive to nurse-physician collaboration. The findings of this study provide support for the proposed theoretical framework and can be used to design interventions that promote nurse-physician collaboration.

  9. Relation Between Physicians' Work Lives and Happiness. (United States)

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


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

  10. Work hours and turnover intention among hospital physicians in Taiwan: does income matter? (United States)

    Tsai, Yu-Hsuan; Huang, Nicole; Chien, Li-Yin; Chiang, Jen-Huai; Chiou, Shu-Ti


    Physician shortage has become an urgent and critical challenge to many countries. According to the workforce dynamic model, long work hours may be one major pressure point to the attrition of physicians. Financial incentive is a common tool to human power retention. Therefore, this large-scale physician study investigated how pay satisfaction may influence the relationship between work hours and hospital physician's turnover intention. Data were obtained from a nationwide survey of full-time hospital staff members working at 100 hospitals in Taiwan. The analysis sample comprised 2423 full-time physicians. Dependent variable was degree of the physicians' turnover intention to leave the current hospital. The pay satisfaction was assessed by physicians themselves. We employed ordinal logistic regression models to analyze the association between the number of work hours and turnover intention. To consider the cluster effect of hospitals, we used the "gllamm" command in the statistical software package Stata Version 12.1. The results show that 351 (14.5%) of surveyed physicians reported strong intention to leave current hospital. The average work hours per week among hospital physicians was 59.8 h. As expected, work hours exhibited an independent relationship with turnover intention. More importantly, pay satisfaction could not effectively moderate the positive relationship between work hours and intentions to leave current hospital. The findings show that overtime work is prevalent among hospital physicians in Taiwan. Both the Taiwanese government and hospitals must take action to address the emerging problem of physician high turnover rate. Furthermore, hospitals should not consider relying solely on financial incentives to solve the problem. This study encouraged tackling work hour problem, which would lead to the possibility of solving high turnover intention among hospital physicians in Taiwan.

  11. Physician consensus on preventability and predictability of readmissions based on standard case scenarios

    DEFF Research Database (Denmark)

    van Galen, L. S.; Cooksley, T; Merten, H


    Background: Policy makers struggle with unplanned readmissions as a quality indicator since integrating preventability in such indicators is difficult. Most studies on the preventability of readmissions questioned physicians whether they consider a given readmission to be preventable, from which...... conclusions on factors predicting preventable readmissions were derived. There is no literature on the interobserver agreement of physician judgement. Aim: To assess the degree of agreement among physicians regarding predictability and preventability of medical readmissions. Design: An online survey based...... on eight real-life case scenarios was distributed to European physicians. Methods: Physicians were requested to rate from the first four (index admission) scenarios whether they expected these patients to be readmitted within 30 days (the predictability). The remaining four cases, describing a readmission...

  12. When do doctors follow patients' orders? Organizational mechanisms of physician influence. (United States)

    Menchik, Daniel A; Jin, Lei


    Physicians, like other professionals, are expected to draw from specialized knowledge while remaining receptive to clients' requests. Using nationally representative U.S. survey data from the Community Tracking Study, this paper examines the degree to which physicians are influenced by patients' requests, and how physicians' workplaces may mediate acquiescence rates through three mechanisms: constraints, protection, and incentives. We find that, based on physicians' reports of their responses to patients' suggestions, patient influence is rare. This influence is least likely to be felt in large workplaces, such as large private practices, hospitals, and medical schools. We find that the protection and incentives mechanisms mediate the relationship between workplace types and physician acquiescence but more prescriptive measures such as guidelines and formularies do not affect acquiescence. We discuss these findings in light of the ongoing changes in the structure of medicine. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. A fuzzy-match search engine for physician directories. (United States)

    Rastegar-Mojarad, Majid; Kadolph, Christopher; Ye, Zhan; Wall, Daniel; Murali, Narayana; Lin, Simon


    A search engine to find physicians' information is a basic but crucial function of a health care provider's website. Inefficient search engines, which return no results or incorrect results, can lead to patient frustration and potential customer loss. A search engine that can handle misspellings and spelling variations of names is needed, as the United States (US) has culturally, racially, and ethnically diverse names. The Marshfield Clinic website provides a search engine for users to search for physicians' names. The current search engine provides an auto-completion function, but it requires an exact match. We observed that 26% of all searches yielded no results. The goal was to design a fuzzy-match algorithm to aid users in finding physicians easier and faster. Instead of an exact match search, we used a fuzzy algorithm to find similar matches for searched terms. In the algorithm, we solved three types of search engine failures: "Typographic", "Phonetic spelling variation", and "Nickname". To solve these mismatches, we used a customized Levenshtein distance calculation that incorporated Soundex coding and a lookup table of nicknames derived from US census data. Using the "Challenge Data Set of Marshfield Physician Names," we evaluated the accuracy of fuzzy-match engine-top ten (90%) and compared it with exact match (0%), Soundex (24%), Levenshtein distance (59%), and fuzzy-match engine-top one (71%). We designed, created a reference implementation, and evaluated a fuzzy-match search engine for physician directories. The open-source code is available at the codeplex website and a reference implementation is available for demonstration at the datamarsh website.

  14. Patient–physician communication regarding electronic cigarettes

    Directory of Open Access Journals (Sweden)

    Michael B. Steinberg


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

  15. Nigerian physicians' knowledge, attitude and practices regarding ...

    African Journals Online (AJOL)

    Nigerian physicians' knowledge, attitude and practices regarding diabetes ... conducted among physicians in four towns in four different States in Nigeria, ... Only 36.8% of the participants knew that children with diabetes should eat family diet.

  16. Medicares Physician Quality Reporting System (PQRS)... (United States)

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

  17. Physician Asthma Management Practices in Canada

    Directory of Open Access Journals (Sweden)

    Robert Jin


    Full Text Available OBJECTIVES: To establish national baseline information on asthma management practices of physicians, to compare the reported practices with the Canadian Consensus recommendations and to identify results potentially useful for interventions that improve physician asthma management practices.

  18. Medicare Provider Data - Physician and Other Supplier (United States)

    U.S. Department of Health & Human Services — The Physician and Other Supplier Public Use File (Physician and Other Supplier PUF) provides information on services and procedures provided to Medicare...

  19. Liver transplantation for nontransplant physicians

    Directory of Open Access Journals (Sweden)

    Amany AbdelMaqsod Sholkamy


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

  20. Physicians, radiologists, and quality control

    International Nuclear Information System (INIS)

    Payne, W.F.


    Factors involved in quality control in medical x-ray examinations to achieve the least possible exposure to the patient are discussed. It would be hoped that film quality will remain in the position of paramount importance that it must in order to achieve the greatest amount of diagnostic information on each radiographic examination. At the same time, it is hoped that this can be done by further reducing the exposure of the patient to ionizing radiation by the methods that have been discussed; namely, education of the physician, radiologist, and technologist, modern protective equipment and departmental construction, efficient collimation whether automatic or manual, calibration and output measurement of the radiographic and fluoroscopic units, ongoing programs of education within each department of radiographic facility, film badge monitoring, education of and cooperation with the nonradiologic physician, and hopefully, more intensive programs by the National and State Bureaus and Departments of Radiological Health in education and encouragement to the medical community. (U.S.)

  1. [Imhotep--builder, physician, god]. (United States)

    Mikić, Zelimir


    The medicine had been practiced in ancient Egypt since the earliest, prehistoric days, many millenia before Christ, and was quite developed in later periods. This is evident from the sceletal findings, surgical instruments found in tombs, wall printings, the reliefs and inscriptions, and most of all, from the sparse written material known as medical papyri. However, there were not many physicians from that time whose names had been recorded. The earliest physician in ancient Egypt known by name was Imhotep. WHO WAS IMHOTEP?: Imhotep lived and worked during the time of the 3rd Dynasty of Old Kingdom and served under the pharaoh Djoser (reigned 2667-2648 BC) as his vizier or chief minister, high priest, chief builder and carpenter. He obviously was an Egyptian polymath, a learned man and scribe and was credited with many inventions. As one of the highest officials of the pharaoh Djoser Imhotep is credited with designing and building of the famous Step Pyramid of Djoser at Saqqarah, near the old Egyptian capital of Memphis. Imhotep is also credited with inventing the method of stone-dressed building and using of columns in architecture and is considered to be the first architect in history known by name. It is believed that, as the high priest, Imhotel also served as the nation's chief physician in his time. As the builder of the Step Pyramid, and as a physician, he also had to take medical care of thousands of workers engaged in that great project. He is also credited with being the founder of Egyptian medicine and with being the author of the so-called Smith papirus containing a collection of 48 specimen clinical records with detailed accurate record of the features and treatment of various injuries. As such he emerges as the first physician of ancient Egypt known by name and, at the same time, as the first physician known by name in written history of the world. GOD: As Imhotep was considered by Egyptian people as the "inventor of healing", soon after the death, he

  2. Forecasting Spanish natural life expectancy. (United States)

    Guillen, Montserrat; Vidiella-i-Anguera, Antoni


    Knowledge of trends in life expectancy is of major importance for policy planning. It is also a key indicator for assessing future development of life insurance products, substantiality of existing retirement schemes, and long-term care for the elderly. This article examines the feasibility of decomposing age-gender-specific accidental and natural mortality rates. We study this decomposition by using the Lee and Carter model. In particular, we fit the Poisson log-bilinear version of this model proposed by Wilmoth and Brouhns et al. to historical (1975-1998) Spanish mortality rates. In addition, by using the model introduced by Wilmoth and Valkonen we analyze mortality-gender differentials for accidental and natural rates. We present aggregated life expectancy forecasts compared with those constructed using nondecomposed mortality rates.

  3. The construction of normal expectations

    DEFF Research Database (Denmark)

    Quitzau, Maj-Britt; Røpke, Inge


    The gradual upward changes of standards in normal everyday life have significant environmental implications, and it is therefore important to study how these changes come about. The intention of the article is to analyze the social construction of normal expectations through a case study. The case...... concerns the present boom in bathroom renovations in Denmark, which offers an excellent opportunity to study the interplay between a wide variety of consumption drivers and social changes pointing toward long-term changes of normal expectations regarding bathroom standards. The study is problemoriented...... and transdisciplinary and draws on a wide range of sociological, anthropological, and economic theories. The empirical basis comprises a combination of statistics, a review of magazine and media coverage, visits to exhibitions, and qualitative interviews. A variety of consumption drivers are identified. Among...

  4. Assessment of trust in physician: a systematic review of measures.

    Directory of Open Access Journals (Sweden)

    Evamaria Müller

    Full Text Available Over the last decades, trust in physician has gained in importance. Studies have shown that trust in physician is associated with positive health behaviors in patients. However, the validity of empirical findings fundamentally depends on the quality of the measures in use. Our aim was to provide an overview of trust in physician measures and to evaluate the methodological quality of the psychometric studies and the quality of psychometric properties of identified measures. We conducted an electronic search in three databases (Medline, EMBASE and PsycInfo. The secondary search strategy included reference and citation tracking of included full texts and consultation of experts in the field. Retrieved records were screened independently by two reviewers. Full texts that reported on testing of psychometric properties of trust in physician measures were included in the review. Study characteristics and psychometric properties were extracted. We evaluated the quality of design, methods and reporting of studies with the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN checklist. The quality of psychometric properties was assessed with Terwee's 2007 quality criteria. After screening 3284 records and assessing 169 full texts for eligibility, fourteen studies on seven trust in physician measures were included. Most of the studies were conducted in the USA and used English measures. All but one measure were generic. Sample sizes range from 25 to 1199 participants, recruited in very heterogeneous settings. Quality assessments revealed several flaws in the methodological quality of studies. COSMIN scores were mainly fair or poor. The overall quality of measures' psychometric properties was intermediate. Several trust in physician measures have been developed over the last years, but further psychometric evaluation of these measures is strongly recommended. The methodological quality of psychometric property studies

  5. Cystic fibrosis physicians' perspectives on the timing of referral for lung transplant evaluation: a survey of physicians in the United States. (United States)

    Ramos, Kathleen J; Somayaji, Ranjani; Lease, Erika D; Goss, Christopher H; Aitken, Moira L


    Prior studies reveal that a significant proportion of patients with cystic fibrosis (CF) and advanced lung disease are not referred for lung transplant (LTx) evaluation. We sought to assess expert CF physician perspectives on the timing of LTx referral and investigate their LTx knowledge. We developed an online anonymous survey that was distributed by the Cystic Fibrosis Foundation (CFF) to the medical directors of all CFF-accredited care centers in the United States in 2015. The survey addressed only adult patients (≥18 years old) and was sent to 119 adult CF physicians, 86 CFF-affiliated CF physicians (who see adults and children, but have smaller program sizes than adult or pediatric centers), and 127 pediatric CF physicians (who see some adults, but mostly children). The focus of the questions was on CFF-care center characteristics, physician experience and indications/contraindications to referral for LTx evaluation. There were 114/332 (34%) total responses to the survey. The response rates were: 57/119 (48%) adult physicians, 12/86 (14%) affiliate physicians and 43/127 (34%) pediatric physicians; 2 physicians did not include their CFF center type. Despite the poor ability of FEV 1  < 30% to predict death within 2 years, 94% of responding CF physicians said they would refer an adult patient for LTx evaluation if the patient's lung function fell to FEV 1  < 30% predicted. Only 54% of respondents report that pulmonary hypertension would trigger referral. Pulmonary hypertension is an internationally recommended indication to list a patient for LTx (not just for referral for evaluation). Very few physicians (N = 17, 15%) employed components of the lung allocation score (LAS) to determine the timing of referral for LTx evaluation. Interestingly, patient preference not to undergo LTx was "often" or "always" the primary patient-related reason to defer referral for LTx evaluation for 41% (47/114) of respondents. Some potential barriers to timely LTx

  6. Empowering Physicians with Financial Literacy. (United States)

    Bar-Or, Yuval


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

  7. Bhagavad gita for the physician

    Directory of Open Access Journals (Sweden)

    Sanjay Kalra


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



    Raissa Kaziyeva


    The purpose of the article is to provide a critical review of franchising development in Kazakhstan by focusing on the relationship between the franchisor and the franchisee. We have conducted extensive research and communicated with lots of potential and existing Kazakhstani franchisors and franchisees, operating since 2003. Our findings show that the process of signing franchising agreements is quite challenging in Kazakhstan.  Thorough investigation of the differences between expectations ...

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

    Energy Technology Data Exchange (ETDEWEB)

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


    by medium-volume family physicians more often than by low-volume family physicians (adjusted OR 1.437 [95% Cl 1.036-1.992]. Family physicians' delivery volumes were not associated with adverse outcomes for mothers or newborns, Low-volume family physicians referred patients and transferred deliveries to obstetricians more frequently than high-or medium-volume family physicians. Further research is needed to validate these findings in smaller facilities, both urban and rural. (author)

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

    International Nuclear Information System (INIS)

    Klein, M.C.; Spence, A.; Kaczorowski, J.; Kelly, A.; Grzybowski, S.


    by medium-volume family physicians more often than by low-volume family physicians (adjusted OR 1.437 [95% Cl 1.036-1.992]. Family physicians' delivery volumes were not associated with adverse outcomes for mothers or newborns, Low-volume family physicians referred patients and transferred deliveries to obstetricians more frequently than high-or medium-volume family physicians. Further research is needed to validate these findings in smaller facilities, both urban and rural. (author)

  11. Nurse-physician communication - An integrated review. (United States)

    Tan, Tit-Chai; Zhou, Huaqiong; Kelly, Michelle


    To present a comprehensive review of current evidence on the factors which impact on nurse-physician communication and interventions developed to improve nurse-physician communication. The challenges in nurse-physician communication persist since the term 'nurse-doctor game' was first used in 1967, leading to poor patient outcomes such as treatment delays and potential patient harm. Inconsistent evidence was found on the factors and interventions which foster or impair effective nurse-physician communication. An integrative review was conducted following a five-stage process: problem identification, literature search, data evaluation, data analysis and presentation. Five electronic databases were searched from 2005 to April 2016 using key search terms: "improve*," "nurse-physician," "nurse," "physician" and "communication" in five electronic databases including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PubMed, Science Direct and Scopus. A total of 22 studies were included in the review. Four themes emerged from the data synthesis, namely communication styles; factors that facilitate nurse-physician communication; barriers to effective nurse-physician communication; and interventions to improve nurse-physician communication. This integrative review suggests that nurse-physician communication still remains ineffective. Current interventions only address information needs of nurses and physicians in limited situations and specific settings but cannot adequately address the interprofessional communication skills that are lacking in practice. The disparate views of nurses and physicians on communication due to differing training backgrounds confound the effectiveness of current interventions or strategies. Cross-training and interprofessional educational from undergraduate to postgraduate programmes will better align the training of nurses and physicians to communicate effectively. Further research is needed to determine the

  12. Grade Expectations: Rationality and Overconfidence (United States)

    Magnus, Jan R.; Peresetsky, Anatoly A.


    Confidence and overconfidence are essential aspects of human nature, but measuring (over)confidence is not easy. Our approach is to consider students' forecasts of their exam grades. Part of a student's grade expectation is based on the student's previous academic achievements; what remains can be interpreted as (over)confidence. Our results are based on a sample of about 500 second-year undergraduate students enrolled in a statistics course in Moscow. The course contains three exams and each student produces a forecast for each of the three exams. Our models allow us to estimate overconfidence quantitatively. Using these models we find that students' expectations are not rational and that most students are overconfident, in agreement with the general literature. Less obvious is that overconfidence helps: given the same academic achievement students with larger confidence obtain higher exam grades. Female students are less overconfident than male students, their forecasts are more rational, and they are also faster learners in the sense that they adjust their expectations more rapidly. PMID:29375449

  13. Grade Expectations: Rationality and Overconfidence

    Directory of Open Access Journals (Sweden)

    Jan R. Magnus


    Full Text Available Confidence and overconfidence are essential aspects of human nature, but measuring (overconfidence is not easy. Our approach is to consider students' forecasts of their exam grades. Part of a student's grade expectation is based on the student's previous academic achievements; what remains can be interpreted as (overconfidence. Our results are based on a sample of about 500 second-year undergraduate students enrolled in a statistics course in Moscow. The course contains three exams and each student produces a forecast for each of the three exams. Our models allow us to estimate overconfidence quantitatively. Using these models we find that students' expectations are not rational and that most students are overconfident, in agreement with the general literature. Less obvious is that overconfidence helps: given the same academic achievement students with larger confidence obtain higher exam grades. Female students are less overconfident than male students, their forecasts are more rational, and they are also faster learners in the sense that they adjust their expectations more rapidly.

  14. Price expectations and petroleum development

    International Nuclear Information System (INIS)

    Pollio, G.; Marian, W.S.


    In the first section of this paper, the authors present a highly stylized model of the world oil market that explicitly incorporates both expectative and financial effects. The model generates the extremely interesting result that actual future price outcomes are inversely related to prevailing price expectations, owing to fluctuation in the level and timing of industry investment expenditure. Given the importance of price expectations, it is surprising that the topic has received such scant attention. The authors therefore present in the second section of selective survey of the various measures that have been proposed and used in the literature, as well as an assessment of the value of potentially new indices and market prices for existing hydrocarbon reserves, for example. In the final section of the paper, we discuss the extent to which financial innovation, in the form of commodity-linked products-such as swaps, caps, collars, and so forth-are transforming the oil market, enabling all market segments to manage price uncertainty far more effectively than was ever possible in the past

  15. Changing physician behavior: what works? (United States)

    Mostofian, Fargoi; Ruban, Cynthiya; Simunovic, Nicole; Bhandari, Mohit


    There are various interventions for guideline implementation in clinical practice, but the effects of these interventions are generally unclear. We conducted a systematic review to identify effective methods of implementing clinical research findings and clinical guidelines to change physician practice patterns, in surgical and general practice. Systematic review of reviews. We searched electronic databases (MEDLINE, EMBASE, and PubMed) for systematic reviews published in English that evaluated the effectiveness of different implementation methods. Two reviewers independently assessed eligibility for inclusion and methodological quality, and extracted relevant data. Fourteen reviews covering a wide range of interventions were identified. The intervention methods used include: audit and feedback, computerized decision support systems, continuing medical education, financial incentives, local opinion leaders, marketing, passive dissemination of information, patient-mediated interventions, reminders, and multifaceted interventions. Active approaches, such as academic detailing, led to greater effects than traditional passive approaches. According to the findings of 3 reviews, 71% of studies included in these reviews showed positive change in physician behavior when exposed to active educational methods and multifaceted interventions. Active forms of continuing medical education and multifaceted interventions were found to be the most effective methods for implementing guidelines into general practice. Additionally, active approaches to changing physician performance were shown to improve practice to a greater extent than traditional passive methods. Further primary research is necessary to evaluate the effectiveness of these methods in a surgical setting.

  16. 2002 reference document; Document de reference 2002

    Energy Technology Data Exchange (ETDEWEB)



    This 2002 reference document of the group Areva, provides information on the society. Organized in seven chapters, it presents the persons responsible for the reference document and for auditing the financial statements, information pertaining to the transaction, general information on the company and share capital, information on company operation, changes and future prospects, assets, financial position, financial performance, information on company management and executive board and supervisory board, recent developments and future prospects. (A.L.B.)

  17. Physician Perspectives on Decision Making for Treatment of Pediatric Sleep-Disordered Breathing. (United States)

    Boss, Emily F; Links, Anne R; Saxton, Ron; Cheng, Tina L; Beach, Mary Catherine


    Sleep-disordered breathing (SDB) is prevalent in children and most commonly treated by surgery with adenotonsillectomy. We aimed to learn physician perspectives of social and communication factors that influence decision making for treatment of pediatric SDB. Purposive sampling identified 10 physician key informants across disciplines and practice settings, who participated in semistructured interviews regarding SDB care experiences and communication with parents. Interviews were analyzed using directed qualitative content analysis. Physicians provided a variety of perspectives on decision making for treatment that fell into 3 overarching themes: approach to surgery and alternatives, communication and decision making with families, and sociocultural factors/barriers to care. Perspectives were moderately heterogeneous, suggesting that individual social and relational elements may significantly influence how physicians refer patients and recommend treatment, and how parents choose surgery for this prevalent condition. These findings will inform development of culturally competent communication strategies and support tools to enhance shared decision making for physicians treating children with SDB.

  18. 38 CFR 51.150 - Physician services. (United States)


    ... case of an emergency. (e) Physician delegation of tasks. (1) Except as specified in paragraph (e)(2) of... by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (d) Availability of physicians for emergency care. The facility management...

  19. 22 CFR 62.27 - Alien physicians. (United States)


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

  20. Effects of scanning and eliminating paper-based medical records on hospital physicians' clinical work practice. (United States)

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


    It is not automatically given that the paper-based medical record can be eliminated after the introduction of an electronic medical record (EMR) in a hospital. Many keep and update the paper-based counterpart, and this limits the use of the EMR system. The authors have evaluated the physicians' clinical work practices and attitudes toward a system in a hospital that has eliminated the paper-based counterpart using scanning technology. Combined open-ended interviews (8 physicians) and cross-sectional survey (70 physicians) were conducted and compared with reference data from a previous national survey (69 physicians from six hospitals). The hospitals in the reference group were using the same EMR system without the scanning module. The questionnaire (English translation available as an online data supplement at ) covered frequency of use of the EMR system for 19 defined tasks, ease of performing them, and user satisfaction. The interviews were open-ended. The physicians routinely used the system for nine of 11 tasks regarding retrieval of patient data, which the majority of the physicians found more easily performed than before. However, 22% to 25% of the physicians found retrieval of patient data more difficult, particularly among internists (33%). Overall, the physicians were equally satisfied with the part of the system handling the regular electronic data as that of the physicians in the reference group. They were, however, much less satisfied with the use of scanned document images than that of regular electronic data, using the former less frequently than the latter. Scanning and elimination of the paper-based medical record is feasible, but the scanned document images should be considered an intermediate stage toward fully electronic medical records. To our knowledge, this is the first assessment from a hospital in the process of completing such a scanning project.

  1. Great expectations: teaching ethics to medical students in South Africa. (United States)

    Behrens, Kevin Gary; Fellingham, Robyn


    Many academic philosophers and ethicists are appointed to teach ethics to medical students. We explore exactly what this task entails. In South Africa the Health Professions Council's curriculum for training medical practitioners requires not only that students be taught to apply ethical theory to issues and be made aware of the legal and regulatory requirements of their profession, it also expects moral formation and the inculcation of professional virtue in students. We explore whether such expectations are reasonable. We defend the claim that physicians ought to be persons of virtuous character, on the grounds of the social contract between society and the profession. We further argue that since the expectations of virtue of health care professionals are reasonable, it is also sound reasoning to expect ethics teachers to try to inculcate such virtues in their students, so far as this is possible. Furthermore, this requires of such teachers that they be suitable role models of ethical practice and virtue, themselves. We claim that this applies to ethics teachers who are themselves not members of the medical profession, too, even though they are not bound by the same social contract as doctors. We conclude that those who accept employment as teachers of ethics to medical students, where as part of their contractual obligation they are expected to inculcate moral values in their students, ought to be prepared to accept their responsibility to be professionally ethical, themselves. © 2013 John Wiley & Sons Ltd.

  2. Subjective Expected Utility: A Model of Decision-Making. (United States)

    Fischoff, Baruch; And Others


    Outlines a model of decision making known to researchers in the field of behavioral decision theory (BDT) as subjective expected utility (SEU). The descriptive and predictive validity of the SEU model, probability and values assessment using SEU, and decision contexts are examined, and a 54-item reference list is provided. (JL)

  3. Application of diagnostic reference levels in medical practice

    Energy Technology Data Exchange (ETDEWEB)

    Bourguignon, Michel [Faculty of Medicine of Paris, Deputy Director General, Nuclear Safety Authority (ASN), Paris (France)


    Diagnosis reference levels (D.R.L.) are defined in the Council Directive 97/43 EURATOM as 'Dose levels in medical radio diagnosis practices or in the case of radiopharmaceuticals, levels of activity, for typical examinations for groups of standards-sized patients or standards phantoms for broadly defined types of equipment. These levels are expected not to be exceeded for standard procedures when good and normal practice regarding diagnostic and technical performance is applied'. Thus D.R.L. apply only to diagnostic procedures and does not apply to radiotherapy. Radiation protection of patients is based on the application of 2 major radiation protection principles, justification and optimization. The justification principle must be respected first because the best way to protect the patient is not to carry a useless test. Radiation protection of the patient is a continuous process and local dose indicator values in the good range should not prevent the radiologist or nuclear medicine physician to continue to optimize their practice. (N.C.)

  4. Application of diagnostic reference levels in medical practice

    International Nuclear Information System (INIS)

    Bourguignon, Michel


    Diagnosis reference levels (D.R.L.) are defined in the Council Directive 97/43 EURATOM as 'Dose levels in medical radio diagnosis practices or in the case of radiopharmaceuticals, levels of activity, for typical examinations for groups of standards-sized patients or standards phantoms for broadly defined types of equipment. These levels are expected not to be exceeded for standard procedures when good and normal practice regarding diagnostic and technical performance is applied'. Thus D.R.L. apply only to diagnostic procedures and does not apply to radiotherapy. Radiation protection of patients is based on the application of 2 major radiation protection principles, justification and optimization. The justification principle must be respected first because the best way to protect the patient is not to carry a useless test. Radiation protection of the patient is a continuous process and local dose indicator values in the good range should not prevent the radiologist or nuclear medicine physician to continue to optimize their practice. (N.C.)

  5. The properties of inflation expectations: Evidence for India

    Directory of Open Access Journals (Sweden)

    Naresh Kumar Sharma


    Full Text Available Empirical inferences about particular forms of agents’ inflation expectations are crucial for the conduct of monetary policy. This paper is an attempt to explore the properties of the Reserve Bank of India’s survey data of households’ inflation expectations. The paper shows that survey respondents do not form expectations rationally, regardless of the reference measures of inflation used. Further, results indicate that inflation expectations are formed purely in backward-looking manner, suggesting that the Reserve Bank of India (RBI has a low degree of credibility within the survey respondents. The study then formulates a model to identify individual elements of the backward-looking expectations in the data. The results suggest that the respondents’ short term expectations for WPI inflation are purely naïve type of expectations, only influenced by respondents earlier period expectations. In the case of CPIIW inflation, the results however suggest that the short-term expectations are not purely naïve type, but also contain adaptive as well as a static forms of expectations. This means that respondents consider their previous forecast errors about CPIIW inflation and draw recent price developments in the CPIIW while forming their overall short-term inflation expectations. This finding provides some formal evidence that the CPI based inflation measure is better suited, than WPI inflation, as a nominal anchor in the RBI’s recent transition to inflation targeting regime. JEL classification: D84, E31, E52, E37, Keywords: Inflation, Inflation expectations, Survey data, Price index, Monetary policy, Forecasting

  6. Generational differences in factors influencing physicians to choose a work location. (United States)

    Mathews, M; Seguin, M; Chowdhury, N; Card, R T


    Canadian medical schools have increased enrolment and recruited more rural students in an effort to address general and rural physician shortages. The success of this approach depends on the recruitment of these newly trained physicians to under-serviced areas. Studies from North America suggest that the career expectations and practice patterns of younger, more recently graduated physicians differ from those of their older counterparts. This study explored the factors that influenced the work location choices of physicians of differing generations, who trained at universities in Saskatchewan, and Newfoundland and Labrador, two Canadian provinces with large rural populations and no community larger than 235 000 population. Semi-structured, qualitative interviews were conducted with physicians who graduated from either the Memorial University of Newfoundland or the University of Saskatchewan. Generation definitions were based on the graduation year. Early-career physicians graduated between 1995 and 1999; mid-career physician graduated between 1985 and 1989; late-career physicians graduated between 1975 and 1979; and end-career physicians graduated between 1965 and 1969. Each physician was asked questions about the number and nature of work location changes over the course of their careers and the factors related to their decision to choose each location. Interview transcripts and notes were analyzed using a thematic analysis approach. Although the study focus was on generational differences, similarities and differences between universities, sexes and specialties (family physicians/GPs vs specialists) were also examined. Recruitment to the provinces was focused on as a whole, because the largest communities in the provinces are small compared with most urban communities. Forty-eight physicians were interviewed, five to nine physicians who graduated in each decade and from each university. The desire to be near family and friends was cited as the primary

  7. Physicians report on patient encounters involving direct-to-consumer advertising. (United States)

    Weissman, Joel S; Blumenthal, David; Silk, Alvin J; Newman, Michael; Zapert, Kinga; Leitman, Robert; Feibelmann, Sandra


    We surveyed a national sample of 643 physicians on events associated with visits during which patients discussed an advertised drug. Physicians perceived improved communication and education but also thought that direct-to-consumer advertising (DTCA) led patients to seek unnecessary treatments. Physicians prescribed the advertised drug in 39 percent of DTCA visits but also recommended lifestyle changes and suggested other treatments. Referring to visits when the DTCA drug was prescribed, 46 percent said that it was the most effective drug, and 48 percent said that others were equally effective. Prescribing DTCA drugs when other effective drugs are available warrants further study.

  8. VBE reference framework

    NARCIS (Netherlands)

    Afsarmanesh, H.; Camarinha-Matos, L.M.; Ermilova, E.; Camarinha-Matos, L.M.; Afsarmanesh, H.; Ollus, M.


    Defining a comprehensive and generic "reference framework" for Virtual organizations Breeding Environments (VBEs), addressing all their features and characteristics, is challenging. While the definition and modeling of VBEs has become more formalized during the last five years, "reference models"

  9. CMS Statistics Reference Booklet (United States)

    U.S. Department of Health & Human Services — The annual CMS Statistics reference booklet provides a quick reference for summary information about health expenditures and the Medicare and Medicaid health...

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

    International Nuclear Information System (INIS)

    Mostafa A. Arafa


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

  11. Haemostatic reference intervals in pregnancy

    DEFF Research Database (Denmark)

    Szecsi, Pal Bela; Jørgensen, Maja; Klajnbard, Anna


    Haemostatic reference intervals are generally based on samples from non-pregnant women. Thus, they may not be relevant to pregnant women, a problem that may hinder accurate diagnosis and treatment of haemostatic disorders during pregnancy. In this study, we establish gestational age-specific refe......Haemostatic reference intervals are generally based on samples from non-pregnant women. Thus, they may not be relevant to pregnant women, a problem that may hinder accurate diagnosis and treatment of haemostatic disorders during pregnancy. In this study, we establish gestational age......-specific reference intervals for coagulation tests during normal pregnancy. Eight hundred one women with expected normal pregnancies were included in the study. Of these women, 391 had no complications during pregnancy, vaginal delivery, or postpartum period. Plasma samples were obtained at gestational weeks 13......-20, 21-28, 29-34, 35-42, at active labor, and on postpartum days 1 and 2. Reference intervals for each gestational period using only the uncomplicated pregnancies were calculated in all 391 women for activated partial thromboplastin time (aPTT), fibrinogen, fibrin D-dimer, antithrombin, free protein S...

  12. Attitudes of health care professionals, relatives of advanced cancer patients and public towards euthanasia and physician assisted suicide. (United States)

    Parpa, Efi; Mystakidou, Kyriaki; Tsilika, Eleni; Sakkas, Pavlos; Patiraki, Elisabeth; Pistevou-Gombaki, Kyriaki; Govina, Ourania; Panagiotou, Irene; Galanos, Antonis; Gouliamos, Athanasios


    Nowadays, euthanasia has the meaning of the direct administration of a lethal agent to the patient by another party with a merciful intent after patients' request. Physician assisted suicide refers to the patient intentionally and wilfully ending his or her own life with the assistance of a physician. The objectives of the manuscript were to investigate the opinions of Greek physicians, nurses, lay people and relatives of advanced cancer patients on euthanasia and physician assisted suicide. The final sample consisted of 215 physicians, 250 nurses, 218 relatives and 246 lay people. A survey questionnaire was used concerning issues such as euthanasia and physician assisted suicide. The survey instrument included 13 questions and described issues such as religious and spiritual beliefs, euthanasia, physician assisted suicide and decision-making situations. 43.3% physicians and 41.3% relatives would agree in advance that in case of heart and/or respiratory arrest there would not be an effort to revive a terminally ill cancer patient. 20.5% physicians had a request for euthanasia. Significant associations were found between physicians (9.3%), relatives (1.8%, p=0.001) and lay people (3.7%, p=0.020) on their opinions regarding withdrawing treatment. The majority of the participants were opposed to euthanasia and physician assisted suicide. However many would agree to the legalization of an advanced cancer patient's hastened death. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  13. Changing quantum reference frames


    Palmer, Matthew C.; Girelli, Florian; Bartlett, Stephen D.


    We consider the process of changing reference frames in the case where the reference frames are quantum systems. We find that, as part of this process, decoherence is necessarily induced on any quantum system described relative to these frames. We explore this process with examples involving reference frames for phase and orientation. Quantifying the effect of changing quantum reference frames serves as a first step in developing a relativity principle for theories in which all objects includ...

  14. Processes and experiences of Portugal's international recruitment scheme of Colombian physicians: Did it work? (United States)

    Masanet, Erika


    The Portuguese Ministry of Health performed five international recruitment rounds of Latin American physicians due to the need for physicians in certain geographic areas of the country and in some specialties, as a temporary solution to shortages. Among these recruitments is that of Colombian physicians in 2011 that was the largest of the five groups. This paper presents an evaluation of the international recruitment procedure of Colombian physicians based on the criteria of procedural outcomes and health system outcomes. The methodology used is qualitative, based on semi-structured interviews with key informants and Colombian physicians recruited in Portugal and also on documentary analysis of secondary sources. International recruitment of Colombian physicians coincided with a period of political change and severe economic crisis in Portugal that caused some problems in the course of this recruitment, mainly family reunification in the later group of Colombian physicians and non-compliance of the salary originally agreed upon. Furthermore, due to the continuous resignations of Colombian physicians throughout the 3-year contract, procedural outcomes and health system outcomes of this international recruitment were not fulfilled and therefore the expected results to meet the temporary needs for medical personnel in some areas of the country were not accomplished. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. 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.

  16. 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.


    Ecological assessments of aquatic ecosystems depend on the ability to compare current conditions against some expectation of how they could be in the absence of significant human disturbance. The concept of a ‘‘reference condition’’ is often used to describe the standard or benchmark against which current condition is compared. If assessments are to be conducted consistently, then a common understanding of the definitions and complications of reference condition is necessary. A 2006 paper (Stoddard et al., 2006, Ecological Applications 16:1267-1276) made an early attempt at codifying the reference condition concept; in this presentation we will revisit the points raised in that paper (and others) and examine how our thinking has changed in a little over 10 years.Among the issues to be discussed: (1) the “moving target” created when reference site data are used to set thresholds in large scale assessments; (2) natural vs. human disturbance and their effects on reference site distributions; (3) circularity and the use of biological data to assist in reference site identification; (4) using site-scale (in-stream or in-lake) measurements vs. landscape-level human activity to identify reference conditions. Ecological assessments of aquatic ecosystems depend on the ability to compare current conditions against some expectation of how they could be in the absence of significant human disturbance. The concept of a ‘‘reference condition’’ is often use

  18. 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

  19. Regulatory Expectations for Safety Culture

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Su Jin; Oh, Jang Jin; Choi, Young Sung [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)


    The oversight of licensee's safety culture becomes an important issue that attracts great public and political concerns recently in Korea. Beginning from the intended violation of rules, a series of corruptions, documents forgery and disclosure of wrong-doings made the public think that the whole mindset of nuclear workers has been inadequate. Thus, they are demanding that safety culture shall be improved and that regulatory body shall play more roles and responsibilities for the improvements and oversight for them. This paper introduces, as an effort of regulatory side, recent changes in the role of regulators in safety culture, regulatory expectations on the desired status of licensee's safety culture, the pilot inspection program for safety culture and research activity for the development of oversight system. After the Fukushima accident in Japan 2011, many critics has searched for cultural factors that caused the unacceptable negligence pervaded in Japan nuclear society and the renewed emphasis has been placed on rebuilding safety culture by operators, regulators, and relevant institutions globally. Significant progress has been made in how to approach safety culture and led to a new perspective different from the existing normative assessment method both in operators and regulatory side. Regulatory expectations and oversight of them are based on such a new holistic concept for human, organizational and cultural elements to maintain and strengthen the integrity of defense in depth and consequently nuclear safety.

  20. Expectation values in quantum gravity

    International Nuclear Information System (INIS)

    Jordan, R.D.


    The purpose of this dissertation is to develop new methods for calculating expectation values of field operators, in situations where particle creation is important. The goal is to apply these techniques to quantum gravity, to see if the initial singularity in the universe might be avoided in the quantum theory. Standard effective action theory is modified to produce effective field equations satisfied by the expectation value of the field in an in state, as opposed to the usual in-out amplitude. Diagrammatic rules are found for calculation of the new field equations, and are used to show that the equations are real and causal up to two loop order. The theory also provides a simple check of unitarity, which is carried out, again up to two loops. Just as the standard effective field equations can be derived by analytic continuation from a theory defined in Euclidean space, so can the modified equations be obtained from a modified contour rotation of the Euclidean theory. This result is used to prove a recent conjecture which yields a simple rule for finding the real, causal equations. The new formalism is applied to two gravitational systems. First, the stability of flat space time is studied by finding the equation satisfied by small perturbations of Minkowski space

  1. Regulatory Expectations for Safety Culture

    International Nuclear Information System (INIS)

    Jung, Su Jin; Oh, Jang Jin; Choi, Young Sung


    The oversight of licensee's safety culture becomes an important issue that attracts great public and political concerns recently in Korea. Beginning from the intended violation of rules, a series of corruptions, documents forgery and disclosure of wrong-doings made the public think that the whole mindset of nuclear workers has been inadequate. Thus, they are demanding that safety culture shall be improved and that regulatory body shall play more roles and responsibilities for the improvements and oversight for them. This paper introduces, as an effort of regulatory side, recent changes in the role of regulators in safety culture, regulatory expectations on the desired status of licensee's safety culture, the pilot inspection program for safety culture and research activity for the development of oversight system. After the Fukushima accident in Japan 2011, many critics has searched for cultural factors that caused the unacceptable negligence pervaded in Japan nuclear society and the renewed emphasis has been placed on rebuilding safety culture by operators, regulators, and relevant institutions globally. Significant progress has been made in how to approach safety culture and led to a new perspective different from the existing normative assessment method both in operators and regulatory side. Regulatory expectations and oversight of them are based on such a new holistic concept for human, organizational and cultural elements to maintain and strengthen the integrity of defense in depth and consequently nuclear safety

  2. Will generalist physician supply meet demands of an increasing and aging population? (United States)

    Colwill, Jack M; Cultice, James M; Kruse, Robin L


    We predict that population growth and aging will increase family physicians' and general internists' workloads by 29 percent between 2005 and 2025. We expect a 13 percent increased workload for care of children by pediatricians and family physicians. However, the supply of generalists for adult care, adjusted for age and sex, will increase 7 percent, or only 2 percent if the number of graduates continues to decline through 2008. We expect deficits of 35,000-44,000 adult care generalists, although the supply for care of children should be adequate. These forces threaten the nation's foundation of primary care for adults.

  3. The specialist physician's approach to rheumatoid arthritis in South Africa. (United States)

    Bester, Frederik C J; Bosch, Fredricka J; van Rensburg, Barend J Jansen


    Rheumatoid arthritis (RA) is expected to increase in Africa and South Africa. Due to the low numbers of rheumatologists in South Africa, specialist physicians also have to care for patients with RA. Furthermore several new developments have taken place in recent years which improved the management and outcome of RA. Classification criteria were updated, assessment follow-up tools were refined and above all, several new biological disease-modifying anti-rheumatic drugs were developed. Therefore it is imperative for specialist physicians to update themselves with the newest developments in the management of RA. This article provides an overview of the newest developments in the management of RA in the South African context. This approach may well apply to countries with similar specialist to patient ratios and disease profiles.

  4. Mutual expectation compacts: a means to link practice culture and vision. (United States)

    Drury, Ivo; Slomski, Carol


    We describe the development of a mutual expectation compact in an academic department of surgery as a means of reinforcing the department's vision document and promoting cultural change. The compact makes explicit those implicit agreements that exist between a physician and his or her practice. It strengthens the relationship by avoiding the misunderstandings that can arise when agreements are implicit.

  5. Older people who are 'weary of life': their expectations for the future and perceived hopelessness

    NARCIS (Netherlands)

    Rurup, M.L.; Pasman, H.R.W.; Kerkhof, A.J.F.M.; Deeg, D.J.H.; Onwuteaka-Philipsen, B.D.


    Older people who are 'weary of life': their expectations for the future and perceived hopelessness There has been a debate for over a decade in the Netherlands about whether physicians should be allowed to provide assistance with suicide to older people who are 'weary of life'. Actual knowledge

  6. Internship for physicians in Slovenia

    Directory of Open Access Journals (Sweden)

    Gaber Plavc


    Full Text Available Background: Well-educated and highly-trained physicians are an essential part of high-quality health care. Therefore, quality assurance in medical education must be one of the priorities of health systems. We researched and analysed responses from physicians after completion of internship (IS and their mentors to questions regarding preparedness to IS and IS itself.Methods: In this cross-sectional study electronic surveys were sent to 298 physicians, having completed the IS between February 2014 and February 2015, and to their 200 mentors. Ordinal reponses of two independent groups were compared by Mann-Whitney-U test, while Kruskal-Wallis test was used for comparing more than two groups. Frequency distributions of practical procedures that were completed by interns in required quantities were compared between institutions by χ²-test. The same test was used for comparing frequency distributions of binary responses between clinical departments.Results: Statistically significant differences were found in the following: in reported preparedness for IS between graduates of the two Slovenian medical faculties; in realisation of practical procedures in quantities as prescribed in the IS program between different health institutions; in agreement with statements about satisfaction between different clinical departments and different institutions; and in reported active participation in patient care between different clinical departments.Conclusions: In this study we identified differences in phisicians' preparedness for IS between the graduates of the two Slovenian medical faculties, as well as differences in realization of IS program between health institutions and clinical departments. Alongside presented descriptive statistics these data allow evaluation of the current quality of IS in Slovenia. Furthermore, the results of this study will permit assessment of quality improvement after realisation of planned IS program renovation.

  7. Physician gender and patient-centered communication: a critical review of empirical research. (United States)

    Roter, Debra L; Hall, Judith A


    Physician gender has stimulated a good deal of interest as a possible source of variation in the interpersonal aspects of medical practice, with speculation that female physicians are more patient-centered in their communication with patients. Our objective is to synthesize the results of two meta-analytic reviews the effects of physician gender on communication in medical visits within a communication framework that reflects patient-centeredness and the functions of the medical visit. We performed online database searches of English-language abstracts for the years 1967 to 2001 (MEDLINE, AIDSLINE, PsycINFO, and BIOETHICS), and a hand search was conducted of reprint files and the reference sections of review articles and other publications. Studies using a communication data source such as audiotape, videotape, or direct observation were identified through bibliographic and computerized searches. Medical visits with female physicians were, on average, two minutes (10%) longer than those of male physicians. During this time, female physicians engaged in significantly more communication that can be considered patient-centered. They engaged in more active partnership behaviors, positive talk, psychosocial counseling, psychosocial question asking, and emotionally focused talk. Moreover, the patients of female physicians spoke more overall, disclosed more biomedical and psychosocial information, and made more positive statements to their physicians than did the patients of male physicians. Obstetrics and gynecology may present a pattern different from that of primary care: Male physicians demonstrated higher levels of emotionally focused talk than their female colleagues. Female primary care physicians and their patients engaged in more communication that can be considered patient-centered and had longer visits than did their male colleagues. Limited studies exist outside of primary care, and gender-related practice patterns might differ in some subspecialties from

  8. The Lean Reference Collection: Improving Functionality through Selection and Weeding. (United States)

    Nolan, Christopher W.


    Discusses references collections in academic libraries and offers guidelines for placing materials in a reference collection that focus on their suitability for true reference functions and the expected frequency of use. Problems with poorly managed collections are discussed, and the importance of selection policies and weeding are emphasized. (37…

  9. Female Surgeons as Counter Stereotype: The Impact of Gender Perceptions on Trainee Evaluations of Physician Faculty. (United States)

    Fassiotto, Magali; Li, Jie; Maldonado, Yvonne; Kothary, Nishita


    Similar to women in Science, Technology, Engineering and Mathematics disciplines, women in medicine are subject to negative stereotyping when they do not adhere to their sex-role expectations. These biases may vary by specialty, largely dependent on the gender's representation in that specialty. Thus, females in male-dominated surgical specialties are especially at risk of stereotype threat. Herein, we present the role of gender expectations using trainee evaluations of physician faculty at a single academic center, over a 5-year period (2010-2014). Using Graduate Medical Education evaluation data of physician faculty from MedHub, we examined the differences in evaluation scores for male and female physicians within specialties that have traditionally had low female representation (e.g., surgical fields) compared to those with average or high female representation (e.g., pediatrics). Stanford Medicine residents and fellows' MedHub ratings of their physician faculty from 2010 to 2014. A total of 3648 evaluations across 1066 physician faculty. Overall, female physicians received lower median scores than their male counterparts across all specialties. When using regression analyses controlling for race, age, rank, and specialty-specific characteristics, the negative effect persists only for female physicians in specialties with low female representation. This finding suggests that female physicians in traditionally male-dominated specialties may face different criteria based on sex-role expectations when being evaluated by trainees. As trainee evaluations play an important role in career advancement decisions, dictate perceptions of quality within academic medical centers and affect overall job satisfaction, we propose that these differences in evaluations based merely on gender stereotypes could account, in part, for the narrowing pipeline of women promoted to higher ranks in academic medicine. Copyright © 2018 Association of Program Directors in Surgery. Published

  10. IAEA biological reference materials

    International Nuclear Information System (INIS)

    Parr, R.M.; Schelenz, R.; Ballestra, S.


    The Analytical Quality Control Services programme of the IAEA encompasses a wide variety of intercomparisons and reference materials. This paper reviews only those aspects of the subject having to do with biological reference materials. The 1988 programme foresees 13 new intercomparison exercises, one for major, minor and trace elements, five for radionuclides, and seven for stable isotopes. Twenty-two natural matrix biological reference materials are available: twelve for major, minor and trace elements, six for radionuclides, and four for chlorinated hydrocarbons. Seven new intercomparisons and reference materials are in preparation or under active consideration. Guidelines on the correct use of reference materials are being prepared for publication in 1989 in consultation with other major international producers and users of biological reference materials. The IAEA database on available reference materials is being updated and expanded in scope, and a new publication is planned for 1989. (orig.)

  11. Physician behaviour for antimicrobial prescribing for paediatric upper respiratory tract infections: a survey in general practice in Trinidad, West Indies

    Directory of Open Access Journals (Sweden)

    Ramdhanie Joseph


    Full Text Available Abstract Background Upper respiratory tract infections (URTIs are among the most frequent reasons for physician office visits in paediatrics. Despite their predominant viral aetiology, URTIs continue to be treated with antimicrobials. We explored general practitioners' (GPs prescribing behaviour for antimicrobials in children (≤ 16 years with URTIs in Trinidad, using the guidelines from the Centers for Disease Control and Prevention (CDC as a reference. Methods A cross-sectional study was conducted on 92 consenting GPs from the 109 contacted in Central and East Trinidad, between January to June 2003. Using a pilot-tested questionnaire, GPs identified the 5 most frequent URTIs they see in office and reported on their antimicrobial prescribing practices for these URTIs to trained research students. Results The 5 most frequent URTIs presenting in children in general practice, are the common cold, pharyngitis, tonsillitis, sinusitis and acute otitis media (AOM in rank order. GPs prescribe at least 25 different antibiotics for these URTIs with significant associations for amoxicillin, co-amoxiclav, cefaclor, cefuroxime, erythromycin, clarithromycin and azithromycin (p 30 years were more likely to prescribe antibiotics for the common cold (p = 0.014. Severity (95.7% and duration of illness (82.5% influenced doctors' prescribing and over prescribing in general practice was attributed to parent demands (75% and concern for secondary bacterial infections (70%. Physicians do not request laboratory investigations primarily because they are unnecessary (86% and the waiting time for results is too long (51%. Conclusions Antibiotics are over prescribed for paediatric URTIs in Trinidad and amoxicillin with co-amoxiclav were preferentially prescribed. Except for AOM, GPs' prescribing varied from the CDC guidelines for drug and duration. Physicians recognise antibiotics are overused and consider parents expecting antibiotics and a concern for secondary

  12. Reservation wages, expected wages and unemployment


    Brown, S; Taylor, K


    We model unemployment duration, reservation and expected wages simultaneously for individuals not in work, where wage expectations are identified via an exogenous policy shock. The policy shock increased expected wages, which were found to be positively associated with reservation wages.

  13. Teaching and Assessing Professionalism in Medical Learners and Practicing Physicians

    Directory of Open Access Journals (Sweden)

    Paul S. Mueller


    Full Text Available Professionalism is a core competency of physicians. Clinical knowledge and skills (and their maintenance and improvement, good communication skills, and sound understanding of ethics constitute the foundation of professionalism. Rising from this foundation are behaviors and attributes of professionalism: accountability, altruism, excellence, and humanism, the capstone of which is professionalism. Patients, medical societies, and accrediting organizations expect physicians to be professional. Furthermore, professionalism is associated with better clinical outcomes. Hence, medical learners and practicing physicians should be taught and assessed for professionalism. A number of methods can be used to teach professionalism (e.g. didactic lectures, web-based modules, role modeling, reflection, interactive methods, etc.. Because of the nature of professionalism, no single tool for assessing it among medical learners and practicing physicians exists. Instead, multiple assessment tools must be used (e.g. multi-source feedback using 360-degree reviews, patient feedback, critical incident reports, etc.. Data should be gathered continuously throughout an individual’s career. For the individual learner or practicing physician, data generated by these tools can be used to create a “professionalism portfolio,” the totality of which represents a picture of the individual’s professionalism. This portfolio in turn can be used for formative and summative feedback. Data from professionalism assessments can also be used for developing professionalism curricula and generating research hypotheses. Health care leaders should support teaching and assessing professionalism at all levels of learning and practice and promote learning environments and institutional cultures that are consistent with professionalism precepts.

  14. Clinical performance feedback and quality improvement opportunities for perioperative physicians

    Directory of Open Access Journals (Sweden)

    Kaye AD


    Full Text Available Alan David Kaye,1 Olutoyin J Okanlawon,2 Richard D Urman21Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, 2Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston MA, USAAbstract: Clinical performance feedback is an important component of the ongoing development and education of health care practitioners. For physicians, feedback about their clinical practice and outcomes is central to developing both confidence and competence at all stages of their medical careers. Cultural and financial infrastructures need to be in place, and the concept of feedback needs to be readily embraced and encouraged by clinical leadership and other stakeholders. The "buy-in" includes the expectation and view that feedback occurs on a routine basis, and those engaged in the process are both encouraged to participate and held accountable. Feedback must be part of an overarching quality improvement and physician education agenda; it is not meant to be an isolated, fragmented initiative that is typically undermined by lack of resources or systemic barriers to gaining improvement within programs. Effective feedback should be an integral part of clinical practice. Anesthesiologists and other perioperative physicians are identifying specialty-specific indicators that can be used when creating a broader quality improvement agenda. Placing a more immediate formal feedback strategy that focuses on goal-oriented behavior is rapidly becoming a mainstay. Physicians may use their individual feedback reports for reflection and designing personal development plans as lifelong learners and leaders in improving patient care.Keywords: physician education, outcomes measurement, performance improvement, anesthesiology

  15. When expectation confounds iconic memory. (United States)

    Bachmann, Talis; Aru, Jaan


    In response to the methodological criticism (Bachmann & Aru, 2015) of the interpretation of their earlier experimental results (Mack, Erol, & Clarke, 2015) Mack, Erol, Clarke, and Bert (2016) presented new results that they interpret again in favor of the stance that an attention-free phenomenal iconic store does not exist. Here we once more question their conclusions. When their subjects were unexpectedly asked to report the letters instead of the post-cued circles in the 101th trial where letters were actually absent, they likely failed to see the empty display area because prior experience with letters in the preceding trials produced expectancy based illusory experience of letter-like objects. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Great expectations: large wind turbines

    International Nuclear Information System (INIS)

    De Vries, E.


    This article focuses on wind turbine product development, and traces the background to wind turbines from the first generation 1.5 MW machines in 1995-6, plans for the second generation 3-5 MW class turbines to meet the expected boom in offshore wind projects, to the anticipated installation of a 4.5 MW turbine, and offshore wind projects planned for 2000-2002. The switch by the market leader Vestas to variable speed operation in 2000, the new product development and marketing strategy taken by the German Pro + Pro consultancy in their design of a 1.5 MW variable speed pitch control concept, the possible limiting of the size of turbines due to logistical difficulties, opportunities offered by air ships for large turbines, and the commissioning of offshore wind farms are discussed. Details of some 2-5 MW offshore wind turbine design specifications are tabulated

  17. Battling demons with medical authority: werewolves, physicians and rationalization. (United States)

    Metzger, Nadine


    Werewolves and physicians experienced their closest contact in the context of early modern witch and werewolf trials. For medical critics of the trials, melancholic diseases served as reference points for medical explanations of both individual cases and werewolf beliefs in general. This paper attempts to construct a conceptual history of werewolf beliefs and their respective medical responses. After differentiating the relevant terms, pre-modern werewolf concepts and medical lycanthropy are introduced. The early modern controversy between medical and demonological explanations forms the main part of this study. The history of werewolves and their medical explanations is then traced through to present times. An important point of discussion is to what extent the physicians' engagements with werewolves can be characterized as rationalization.

  18. Status of Women in Society and Life Expectancy at Birth

    Directory of Open Access Journals (Sweden)

    Anica Novak


    Full Text Available The purpose of this paper is to investigate the influence of the status of women in society over life expectancy at birth. Based on the data of some of the socio-economic variables for 187 countries worldwide, collected by the United Nations within United Nations Development Programme – Human Development Report, we developed a regression model of life expectancy factors. Through empirical testing of the three hypotheses which refer to different aspects of the status of women in society, we found that the employment ratio between women and men has a statistically significant negative impact on life expectancy at birth, which is, at least at first glance, unexpected. At the same time, the number of teenage births per 100 women aged 15–19 as well as gender inequality has a statistically significant negative impact on life expectancy at birth.

  19. Clinical Databases for Chest Physicians. (United States)

    Courtwright, Andrew M; Gabriel, Peter E


    A clinical database is a repository of patient medical and sociodemographic information focused on one or more specific health condition or exposure. Although clinical databases may be used for research purposes, their primary goal is to collect and track patient data for quality improvement, quality assurance, and/or actual clinical management. This article aims to provide an introduction and practical advice on the development of small-scale clinical databases for chest physicians and practice groups. Through example projects, we discuss the pros and cons of available technical platforms, including Microsoft Excel and Access, relational database management systems such as Oracle and PostgreSQL, and Research Electronic Data Capture. We consider approaches to deciding the base unit of data collection, creating consensus around variable definitions, and structuring routine clinical care to complement database aims. We conclude with an overview of regulatory and security considerations for clinical databases. Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  20. Difficult physician-patient relationships. (United States)

    Reifsteck, S W


    Changes in the delivery of health care services in the United States are proceeding so rapidly that many providers are asking how the working relationships between doctors and patients will be effected. Accelerated by cost containment, quality improvement and the growth of managed care, these changes have caused some critics to feel that shorter visits and gatekeeper systems will promote an adversarial relationship between physicians and patients. However, proponents of the changing system feel that better prevention, follow-up care and the attention to customer service these plans can offer will lead to increased patient satisfaction and improved doctor-patient communication. Dedicated to addressing these concerns, the Bayer Institute for Health Care Communication was established in 1987 as a continuing medical education program (CME) focusing on this topic. A half-day workshop on clinician-patient communication to enhance health outcomes was introduced in 1992 and a second workshop, "Difficult' Clinician-Patient Relationships," was developed two years later. The two courses discussed in this article are offered to all physicians, residents, medical students, mid-level providers and other interested staff within the Carle system.

  1. Childhood Bullying: Implications for Physicians. (United States)

    Stephens, Mary M; Cook-Fasano, Hazel T; Sibbaluca, Katherine


    Childhood bullying is common and can lead to serious adverse physical and mental health effects for both the victim and the bully. In teenagers, risk factors for becoming a victim of bullying include being lesbian, gay, bisexual, or transgender; having a disability or medical condition such as asthma, diabetes mellitus, a skin condition, or food allergy; or being an outlier in weight and stature. An estimated 20% of youth have been bullied on school property, and 16% have been bullied electronically in the past year. Bullying can result in emotional distress, depression, anxiety, social isolation, low self-esteem, school avoidance/refusal, and substance abuse for the victim and the bully. Preventive measures include encouraging patients to find enjoyable activities that promote confidence and self-esteem, modeling how to treat others with kindness and respect, and encouraging patients to seek positive friendships. For those who feel concern or guilt about sharing their experiences, it may be useful to explain that revealing the bullying may not only help end the cycle for them but for others as well. Once bullying has been identified, family physicians have an important role in screening for its harmful effects, such as depression and anxiety. A comprehensive, multitiered approach involving families, schools, and community resources can help combat bullying. Family physicians are integral in recognizing children and adolescents who are affected by bullying-as victims, bullies, or bully- victims-so they can benefit from the intervention process.

  2. [Burnout syndrome among family physicians]. (United States)

    Sánchez-Cruz, Juan; Mugártegui-Sánchez, Sharon


    burnout syndrome is a state of physical and emotional exhaustion that can occur among workers who interact directly with others. This could affect job performance. The objective was to determine the prevalence of this syndrome and its associated factors among family physicians. a cross-sectional survey applying the Maslach Burnout Inventory was conducted in a selected convenience non-probability sampling of family physicians. Central tendency and dispersion measures were used in determining the prevalence of burnout syndrome; the associated factors were analysed by χ(2) test. there were 59 cases of burnout syndrome, 36 had involvement in a single component, 15 in 2 and 8 were affected in 3 components; we observed that 35 % of positive cases reported doing an average of 10 extra shifts a month (p = 0.013). Having a second job was associated with positive cases of burnout syndrome. the results are consistent with similar studies. Working extra shifts or having a second job were the related factors most associated to this syndrome.

  3. Specifying the effects of physician's communication on patients' outcomes: A randomised controlled trial. (United States)

    van Osch, Mara; van Dulmen, Sandra; van Vliet, Liesbeth; Bensing, Jozien


    To experimentally test the effects of physician's affect-oriented communication and inducing expectations on outcomes in patients with menstrual pain. Using a 2×2 RCT design, four videotaped simulated medical consultations were used, depicting a physician and a patient with menstrual pain. In the videos, two elements of physician's communication were manipulated: (1) affect-oriented communication (positive: warm, emphatic; versus negative: cold, formal), and (2) outcome expectation induction (positive versus uncertain). Participants (293 women with menstrual pain), acting as analogue patients, viewed one of the four videos. Pre- and post video participants' outcomes (anxiety, mood, self-efficacy, outcome expectations, and satisfaction) were assessed. Positive affect-oriented communication reduced anxiety (pcommunication. Positive expectations increased feelings of self-efficacy (pcommunication and a positive expectation reduced anxiety (p=0.02), increased outcome expectancies (p=0.01) and satisfaction (p=0.001). Being empathic and inducing positive expectations have distinct and combined effects, demonstrating that both are needed to influence patients' outcomes for the best. Continued medical training is needed to harness placebo-effects of medical communication into practice. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Verbal Aggressiveness Among Physicians and Trainees. (United States)

    Lazarus, Jenny Lynn; Hosseini, Motahar; Kamangar, Farin; Levien, David H; Rowland, Pamela A; Kowdley, Gopal C; Cunningham, Steven C


    To better understand verbal aggressiveness among physicians and trainees, including specialty-specific differences. The Infante Verbal Aggressiveness Scale (IVAS) was administered as part of a survey to 48 medical students, 24 residents, and 257 attending physicians. The 72 trainees received the IVAS and demographic questions, whereas the attending physicians received additional questions regarding type of practice, career satisfaction, litigation, and personality type. The IVAS scores showed high reliability (Cronbach α = 0.83). Among all trainees, 56% were female with mean age 28 years, whereas among attending physicians, 63% were male with mean age 50 years. Average scores of trainees were higher than attending physicians with corresponding averages of 1.88 and 1.68, respectively. Among trainees, higher IVAS scores were significantly associated with male sex, non-US birthplace, choice of surgery, and a history of bullying. Among attending physicians, higher IVAS scores were significantly associated with male sex, younger age, self-reported low-quality of patient-physician relationships, and low enjoyment talking to patients. General surgery and general internal medicine physicians were significantly associated with higher IVAS scores than other specialties. General practitioners (surgeons and medical physicians) had higher IVAS scores than the specialists in their corresponding fields. No significant correlation was found between IVAS scores and threats of legal action against attending physicians, or most personality traits. Additional findings regarding bullying in medical school, physician-patient interactions, and having a method to deal with inappropriate behavior at work were observed. Individuals choosing general specialties display more aggressive verbal communication styles, general surgeons displaying the highest. The IVAS scoring system may identify subgroups of physicians with overly aggressive (problematic) communication skills and may provide a

  5. A public health physician named Walter Leser. (United States)

    Mello, Guilherme Arantes; Bonfim, José Ruben de Alcântara


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

  6. Ethics and responsibility of the physics physician

    International Nuclear Information System (INIS)

    Villasenor N, L. F.


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

  7. A report card on the physician work force: Israeli health care market--past experience and future prospects. (United States)

    Toker, Asaf; Shvarts, Shifra; Glick, Shimon; Reuveni, Haim


    The worldwide shortage of physicians is due not only to the lack of physicians, but also to complex social and economic factors that vary from country to country. To describe the results of physician workforce planning in a system with unintended policy, such as Israel, based on past experience and predicted future trends, between 1995 and 2020. A descriptive study of past (1995-2009) and future (through 2020) physician workforce trends in Israel. An actuarial equation was developed to project physician supply until 2020. In Israel a physician shortage is expected in the very near future. This finding is the result of global as well as local changes affecting the supply of physicians: change in immigration pattern, gender effect, population growth, and transparency of data on demand for physicians. These are universal factors affecting manpower planning in most industrial countries all over the world. We describe a health care market with an unintended physician workforce policy. Sharing decision makers' experience in similar health care systems will enable the development of better indices to analyze, by comparison, effective physician manpower planning processes, worldwide.

  8. Nature and determinants of customer expectations of service recovery in health care. (United States)

    Dasu, S; Rao, J


    Service recovery refers to the service provider's response to a dissatisfied customer. This article proposes a model of customer expectations of service recovery in health care services. The model discusses two types of service recovery expectations: will and should. An exploratory study indicates that industry reputation and personal experiences drive customers' "will-expectations" of service recovery while "should-expectations" can be explained via norm, fairness, social contract and hospitality theories.

  9. Indoor air: Reference bibliography

    International Nuclear Information System (INIS)

    Campbell, D.; Staves, D.; McDonald, S.


    The U. S. Environmental Protection Agency initially established the indoor air Reference Bibliography in 1987 as an appendix to the Indoor Air Quality Implementation Plan. The document was submitted to Congress as required under Title IV--Radon Gas and Indoor Air Quality Research of the Superfund Amendments and Reauthorization Act of 1986. The Reference Bibliography is an extensive bibliography of reference materials on indoor air pollution. The Bibliography contains over 4500 citations and continues to increase as new articles appear

  10. What to Expect During a Colonoscopy

    Medline Plus

    Full Text Available ... active and effective sponsor of educational programming for consumers and physicians alike. About the Institute Mission and ... clinical science. Whether you are working on a consumer health story, an article for healthcare providers or ...

  11. What to Expect During a Colonoscopy

    Medline Plus

    Full Text Available ... and physicians alike. About the Institute Mission and Leadership Institute Annual Reports Donation Form ACG Visiting Professor ... Media ACG Media Journalists access information on digestive health, including the latest ACG news and up-to- ...

  12. What to Expect During a Colonoscopy

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    Full Text Available ... Patient Website Patient Assistance Programs Practice Management Practice Management From articles to educational programs, ACG provides you ... and physicians alike. About the Institute Mission and Leadership Institute Annual Reports Donation Form ACG Visiting Professor ...

  13. Expectant versus aggressive management in severe preeclampsia remote from term. (United States)

    Sarsam, D S; Shamden, M; Al Wazan, R


    Our study aims to compare neonatal and maternal outcomes between expectant (or conservative) and aggressive (or immediate) management in cases with severe preclampsia remote from term. This is a comparative study conducted at Al-Batool Teaching Hospital in Mosul City, Iraq, from April 2003 to August 2004. A total of 74 singleton pregnancies complicated by severe preeclampsia with gestational age of 24-34 weeks were studied during this period. The criteria used for the diagnosis of severe preeclampsia were in accordance with the guidelines of the American College of Obstetricians and Gynaecologists. All the patients were counselled for expectant management. 39 patients were delivered immediately due to refusal of expectant management either by the patient or the attending physician. The other 35 patients were managed expectantly; this group was followed-up and carefully monitored for a period ranging from 72 hours to 18 days. Neonatal parameters, neonatal outcome and maternal outcome were compared between the two groups. The mean value of pregnancy prolongation was 9.2 days. Median gestational age for the first group was 29 weeks, and for the second group, it was 30 weeks. Regarding neonatal parameters, the expectantly-managed group had a higher Apgar score at one minute (3.56 +/- 1.72 vs. 5.05 +/- 1.77, p-value equals 0.001), lower mean days of hospitalisation in the neonatal intensive care unit (6.83 +/- 5.38 vs. 4.50 +/- 3.46, p-value equals 0.03), with a lower incidence of neonatal and maternal complications. Expectant management is recommended in patients with severe preeclampsia remote from term, after proper selection of patients and careful monitoring.

  14. Android quick APIs reference

    CERN Document Server

    Cinar, Onur


    The Android Quick APIs Reference is a condensed code and APIs reference for the new Google Android 5.0 SDK. It presents the essential Android APIs in a well-organized format that can be used as a handy reference. You won't find any technical jargon, bloated samples, drawn out history lessons, or witty stories in this book. What you will find is a software development kit and APIs reference that is concise, to the point and highly accessible. The book is packed with useful information and is a must-have for any mobile or Android app developer or programmer. In the Android Quick APIs Refe

  15. [History of occupational health physician and industrial safety and health law]. (United States)

    Horie, Seichi


    In Japan, an employer of a workplace with 50 or more employees is legally required to assign an occupational health physician. The assignment rate in 2010 was reported as 87.0%. This policy started with the provision of "factory physician"in the Factory Law in 1938, then the Labour Standard Law stipulated "physician hygienist" in 1947, and finally the Industrial Safety and Health Law defined "occupational health physician" in 1972. In 1996, a revision of the law then required those physicians to complete training courses in occupational medicine, as designated by an ordinance. Historically, an on-site physician was expected to cure injuries and to prevent communicable diseases of factory workers. The means of occupational hygienic management by working environment measurements, etc., and of health management by health examinations, etc., were developed. Localized exhaust ventilation and personal protection equipment became widely utilized. Qualification systems for non-medical experts in occupational hygiene were structured, and relationships between employers and occupational health physicians were stipulated in the legislative documents. Currently, the Japan Medical Association and the University of Occupational and Environmental Health, Japan educate and train occupational health physicians, and the Japan Society for Occupational Health maintains a specialized board certification system for these physicians. In the future, additional efforts should be made to strengthen the expertise of occupational health physicians, to define and recognize the roles of non-medical experts in occupational hygiene, to incorporate occupational health services in small enterprises, to promote occupational health risk assessment in the workplace, and to reorganize the current legislation, amended repeatedly over the decades.

  16. Work hours and turnover intention among hospital physicians in Taiwan: does income matter?

    Directory of Open Access Journals (Sweden)

    Yu-Hsuan Tsai


    Full Text Available Abstract Background Physician shortage has become an urgent and critical challenge to many countries. According to the workforce dynamic model, long work hours may be one major pressure point to the attrition of physicians. Financial incentive is a common tool to human power retention. Therefore, this large-scale physician study investigated how pay satisfaction may influence the relationship between work hours and hospital physician’s turnover intention. Methods Data were obtained from a nationwide survey of full-time hospital staff members working at 100 hospitals in Taiwan. The analysis sample comprised 2423 full-time physicians. Dependent variable was degree of the physicians’ turnover intention to leave the current hospital. The pay satisfaction was assessed by physicians themselves. We employed ordinal logistic regression models to analyze the association between the number of work hours and turnover intention. To consider the cluster effect of hospitals, we used the “gllamm” command in the statistical software package Stata Version 12.1. Results The results show that 351 (14.5% of surveyed physicians reported strong intention to leave current hospital. The average work hours per week among hospital physicians was 59.8 h. As expected, work hours exhibited an independent relationship with turnover intention. More importantly, pay satisfaction could not effectively moderate the positive relationship between work hours and intentions to leave current hospital. Conclusions The findings show that overtime work is prevalent among hospital physicians in Taiwan. Both the Taiwanese government and hospitals must take action to address the emerging problem of physician high turnover rate. Furthermore, hospitals should not consider relying solely on financial incentives to solve the problem. This study encouraged tackling work hour problem, which would lead to the possibility of solving high turnover intention among hospital physicians in

  17. Barriers to success for female physicians in academic medicine

    Directory of Open Access Journals (Sweden)

    Ashley C. Wietsma


    Full Text Available Despite the fact that women now comprise half of the medical student and resident populations, women remain underrepresented in prominent leadership positions in academia. Women are challenging themselves to live up to the expectations of their professional peers, society, and their patients in order to ‘have it all.’ These pressures are leading to professional and personal dissatisfaction. Is this a problem that will resolve itself as the younger generations of female physicians graduate into faculty positions, or does it require more attention from both male and female medical professionals?

  18. Barriers to success for female physicians in academic medicine. (United States)

    Wietsma, Ashley C


    Despite the fact that women now comprise half of the medical student and resident populations, women remain underrepresented in prominent leadership positions in academia. Women are challenging themselves to live up to the expectations of their professional peers, society, and their patients in order to 'have it all.' These pressures are leading to professional and personal dissatisfaction. Is this a problem that will resolve itself as the younger generations of female physicians graduate into faculty positions, or does it require more attention from both male and female medical professionals?

  19. Overview of physician-hospital ventures. (United States)

    Cohn, Kenneth H; Allyn, Thomas R; Rosenfield, Robert H; Schwartz, Richard


    An ongoing environment of reimbursement lagging behind escalating expenses has led physicians to explore new sources of revenue. The goal of physician-hospital ventures is to create a valuable entity that benefits patients, physicians, and the hospital. Physicians may choose to invest in healthcare facilities to improve patient care and obtain increased control over daily operations. If so, they should seek counsel to avoid violating Stark laws and anti-kickback laws. Modalities for investing in physician-hospital ventures are joint equity (stock) ventures, participating bond transactions (PBTs), and contractual integration, a new method to align the goals of specialists and hospital management without using joint equity ventures. Physicians and management should invest time in developing a shared vision of the future before beginning contract negotiations. Successful partnering requires transparency and stepwise building of trust. The greatest gain in joint ventures arises when both sides become active owners, rather than passive investors.

  20. [Addicted colleagues: a blind spot amongst physicians?]. (United States)

    Rode, Hans; de Rond, Marlies; Dam, Ingrid


    Physician impairment due to substance abuse or dependence is at least as prevalent as amongst non-physicians and is a real challenge. Not only for the impaired physicians themselves, but also for their colleagues, family members and patients. A 68-year-old physician describes her experiences of being an alcoholic as well as a patient with concomitant psychiatric disorders, including the hurdles she had to get over to deal with her disease and remain abstinent. Although colleagues knew what was going on, some of them took no action. The initial treatment by her general practitioner proved compromised. Addressing addiction amongst fellow physicians can be challenging and for this reason the Royal Dutch Medical Association (KNMG) has started the ABS Programme. On prompt and adequate intervention, treatment in specialised facilities has proved to be highly and durably effective. Addicted physicians who have been successfully treated should be monitored and supported, thus enabling their safe return to practice.

  1. 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.

  2. Educational Expectations and Media Cultures

    Directory of Open Access Journals (Sweden)

    Petra Missomelius


    Full Text Available This article investigates themedia-supported educational resources that arecurrently under discussion, such as OERs and MOOCs. Considering the discursive connection between these formats, which is couched in terms of educational freedom and openness, the article’sthesis is that these are expectations which are placed on the media technologies themselves, andthen transferred to learning scenarios. To this end, the article will pursue such questions as: What are the learners, learning materials and learning scenarios allegedly free from or free for? What obstructive configurations should be omitted? To what extent are these characteristics which are of a nature to guaranteelearning processes in the context of lifelong learning or can these characteristics better be attributed to the media technologies themselves and the ways in which they are used? What advantages or new accentuations are promised by proponents of theeducation supplied by media technology? Which discourses provide sustenance for such implied “post-typographic educational ideals” (Giesecke 2001 and Lemke 1998? The importance to learners, teachers and decision-makers at educational institutions of being well informed as far as media is concerned is becoming increasingly apparent.

  3. CMS: Beyond all possible expectations

    CERN Multimedia

    CERN Bulletin


    After having retraced the entire Standard Model up to the Top, the CMS collaboration is ready to go further and continue the success of what Guido Tonelli – its spokesperson – defines as a ‘magic year’. Things evolve fast at CMS, but scientists have taken up the challenge and are ready for the future.   ‘Enthusiasm’ is the word that best describes the feeling one gets when talking to Guido Tonelli. “In just a few months we have rediscovered the Standard Model and have gone even further by producing new results for cross-sections, placing new limits on the creation of heavy masses, making studies on the excited states of quarks, and seeking new resonances. We could not have expected so much such a short space of time. It’s fantastic”, he says. “We went through the learning phase very smoothly. Our detector was very quickly ready to do real physics and we were able to start to produce results almost ...

  4. Knowledge on Irradiation, Medical Imaging Prescriptions, and Clinical Imaging Referral Guidelines among Physicians in a Sub-Saharan African Country (Cameroon). (United States)

    Moifo, Boniface; Tene, Ulrich; Moulion Tapouh, Jean Roger; Samba Ngano, Odette; Tchemtchoua Youta, Justine; Simo, Augustin; Gonsu Fotsin, Joseph


    Clinical imaging guidelines (CIGs) are suitable tools to enhance justification of imaging procedures. To assess physicians' knowledge on irradiation, their self-perception of imaging prescriptions, and the use of CIGs. A questionnaire of 21 items was self-administered between July and August 2016 to 155 referring physicians working in seven university-affiliated hospitals in Yaoundé and Douala (Cameroon). This pretested questionnaire based on imaging referral practices, the use and the need of CIGs, knowledge on radiation doses of 11 specific radiologic procedures, and knowledge of injurious effects of radiation was completed in the presence of the investigator. Scores were allocated for each question. 155 questionnaires were completed out of 180 administered (86.1%). Participants were 90 (58%) females, 63 (40.64%) specialists, 53 (34.20%) residents/interns, and 39 (25.16%) general practitioners. The average professional experience was 7.4 years (1-25 years). The mean knowledge score was 11.5/59 with no influence of sex, years of experience, and professional category. CIGs users' score was better than nonusers (means 14.2 versus 10.6; p imaging exams. Seventy-eight (50.3%) participants have knowledge on CIGs and half of them made use of them. "Impact on diagnosis" was the highest justification criteria follow by "impact on treatment decision." Unjustified requests were mainly for "patient expectation or will" or for "research motivations." 96% of interviewees believed that making available national CIGs will improve justification. Most physicians did not have appropriate awareness about radiation doses for routine imaging procedures. A small number of physicians have knowledge on CIGs but they believe that making available CIGs will improve justification of imaging procedures. Continuous trainings on radiation protection and implementation of national CIGs are therefore recommended.

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

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


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

  6. Physician Assistant | Center for Cancer Research (United States)

    The Surgical Oncology section of the Thoracic & Gastrointestinal Oncology Branch is recruiting a Physician Assistant (PA) to support general surgery clinical activities of the Branch. Responsibilities: Complete in-depth documentation through written progress notes, dictation summaries, and communication with referring physicians according to medical record documentation requirements. Participate in clinical rounds and conferences. Administer and adjust trial medication under the guidance of a physician. Explain discharge instructions and medication regimens to patients and follow up with consulting service recommendations.  Order, perform and interpret basic laboratory diagnostic/treatment tests and procedures. Perform comprehensive health care assessments by obtaining health and family medical histories. Complete physical examinations. Perform clinical data recording and medical chart entries. Obtain informed consent. Perform minor surgeries (incisional and excisional biopsies). Maintain and complete medical records. Place orders for medications and tests. Perform retrievals from electronic medical information system. Distinguish between normal and abnormal findings and determine which findings need further evaluation and/or collaboration assessment. Develop and implement a plan for care, including appropriate patient/family counseling and education based on in-depth knowledge of the specific patient populations and/or protocols. Evaluate, modify and revise care plan at appropriate intervals. Assess acute and non-acute clinical problems and toxicities. Assess needs and/or problem areas and plan appropriate therapeutic measures. Assist in developing, implementing and evaluating medical services policies and practices. Ensure compliance with applicable licensure/certification requirements, healthcare standards, governmental laws and regulations, and policies, procedures, and philosophy in nature. Attend scheduled patient care rounds and didactic lecture sessions of

  7. 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 ...

  8. Still on physicians' attitude to medical marijuana


    Olukayode Abayomi; Emmanuel Babalola


    Desai and Patel highlighted in a recent review that and ldquo;there are several issues related to medical marijuana, which concern public health such as its medical use, harmful effects, laws and physicians role. and rdquo; Certainly, physician's perspectives and position on the relative harm and benefits of marijuana contribute to the growing controversy over its legalization in western countries. Interestingly, the seeming resistance of physicians in western countries to marijuana prescrip...

  9. Physician burnout: contributors, consequences and solutions. (United States)

    West, C P; Dyrbye, L N; Shanafelt, T D


    Physician burnout, a work-related syndrome involving emotional exhaustion, depersonalization and a sense of reduced personal accomplishment, is prevalent internationally. Rates of burnout symptoms that have been associated with adverse effects on patients, the healthcare workforce, costs and physician health exceed 50% in studies of both physicians-in-training and practicing physicians. This problem represents a public health crisis with negative impacts on individual physicians, patients and healthcare organizations and systems. Drivers of this epidemic are largely rooted within healthcare organizations and systems and include excessive workloads, inefficient work processes, clerical burdens, work-home conflicts, lack of input or control for physicians with respect to issues affecting their work lives, organizational support structures and leadership culture. Individual physician-level factors also play a role, with higher rates of burnout commonly reported in female and younger physicians. Effective solutions align with these drivers. For example, organizational efforts such as locally developed practice modifications and increased support for clinical work have demonstrated benefits in reducing burnout. Individually focused solutions such as mindfulness-based stress reduction and small-group programmes to promote community, connectedness and meaning have also been shown to be effective. Regardless of the specific approach taken, the problem of physician burnout is best addressed when viewed as a shared responsibility of both healthcare systems and individual physicians. Although our understanding of physician burnout has advanced considerably in recent years, many gaps in our knowledge remain. Longitudinal studies of burnout's effects and the impact of interventions on both burnout and its effects are needed, as are studies of effective solutions implemented in combination. For medicine to fulfil its mission for patients and for public health, all stakeholders

  10. Literary Library for Physicians (II

    Directory of Open Access Journals (Sweden)

    Fernando A. NAVARRO


    Full Text Available The adequate practice of medicine is a difficult job if some intimate and deep feelings of patients, such pain, loneliness, depression and helplessness facing an incurable disease or the fear of dying, are not fully understood. A good way to gain a satisfactory understanding of such feelings might be the reading of the great literary works of all times. In this “Medical library for physicians” an essential list of seventy literary works from the Modern to the Contemporary periods has been collected. Their plot is about the disease, the madness, the hospital, the professionalism and the historical and social images of the physicians. In the second part of the article, a brief review of the last thirty?five books is carried out. It considers from Sinuhe egyptiläinen (1945 by Mika Waltari to Nemesis (1943 by Philip Roth.

  11. Physician assistant education: five countries. (United States)

    Hooker, Roderick S; Kuilman, Luppo


    Physician assistant (PA) education has undergone substantial change since the late 1960s. After four decades of development, other countries have taken a page from the American experience and launched their own instructional initiatives. The diversity in how different countries approach education and produce a PA for their nation's needs provides an opportunity to make comparisons. The intent of this study was to document and describe PA programs in Australia, Canada, the United Kingdom, The Netherlands, and the United States. We reviewed the literature and contacted a network of academics in various institutions to obtain primary information. Each contact was asked a set of basic questions about the country, the PA program, and the deployment of graduates. Information on US PA programs was obtained from the Physician Assistant Education Association. At year's end 2010, the following was known about PA development: Australia, one program; Canada, four programs; United Kingdom, four programs; The Netherlands, five programs; the United States, 154 programs. Trends in program per capita growth remain the largest in the United States, followed by The Netherlands and Canada. The shortest program length was 24 months and the longest, 36 months. Outside the United States, almost all programs are situated in an academic health center ([AHC] defined as a medical university, a teaching hospital, and a nursing or allied health school), whereas only one-third of US PA programs are in AHCs. All non-US programs receive public/government funding whereas American programs are predominately private and depend on tuition to fund their programs. The PA movement is a global phenomenon. How PAs are being educated, trained, and deployed is known only on the basic level. We identify common characteristics, unique aspects, and trends in PA education across five nations, and set the stage for collaboration and analysis of optimal educational strategies. Additional information is needed on

  12. 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

  13. Career satisfaction and burnout among Ghanaian physicians. (United States)

    Opoku, Samuel T; Apenteng, Bettye A


    Thus far, there has been limited inquiry into the factors associated with physician career satisfaction and burnout in Ghana, although the two have been linked to the brain drain problem. The objective of this study was to assess career satisfaction and burnout among physicians practicing in a developing nation, Ghana. A 21-item instrument was used to assess career satisfaction among actively practicing Ghanaian physicians, using items adapted from the Physician Worklife Study survey. Burnout was assessed using the Abbreviated Maslach's Burnout Inventory. Two hundred physicians participated in the online survey from December 2012 to February 2013. Generally, physicians in Ghana expressed moderate overall career satisfaction. However, they were least satisfied with the availability of resources, their compensation and work-life balance. Overall, burnout was low in the study population; however physicians exhibited moderate levels of emotional exhaustion. Career satisfaction was negatively associated with the burnout dimensions of depersonalization, emotional exhaustion and low personal accomplishment. Health policy-makers in Ghana should address issues relating to resource adequacy, compensation and the work-life balance of physicians in order to improve the overall career satisfaction of an already dwindling physician workforce.

  14. Difficulties facing physician mothers in Japan. (United States)

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


    Despite recent increases in the number of female physicians graduating in Japan, their premature resignations after childbirth are contributing to the acute shortage of physicians. Previous Japanese studies have explored supportive measures in the workplace, but have rarely focused on the specific problems or concerns of physician-mothers. Therefore, this study explored the challenges facing Japanese physician-mothers in efforts to identify solutions for their retention. Open-ended questionnaires were mailed to 646 alumnae of Juntendo University School of Medicine. We asked subjects to describe their opinions about 'The challenges related to female physicians' resignations'. Comments gathered from alumnae who graduated between 6 and 30 years ago and have children were analyzed qualitatively. Overall, 249 physicians returned the questionnaire (response rate 38.5%), and 73 alumnae with children who graduated in the stated time period provided comments. The challenges facing physician-mothers mainly consisted of factors associated with Japanese society, family responsibilities, and work environment. Japanese society epitomized by traditional gender roles heightened stress related to family responsibilities and promoted gender discrimination at work environment. Additionally, changing Japanese society positively influenced working atmosphere and husband's support. Moreover, the introduction of educational curriculums that alleviated traditional gender role was proposed for pre- and post- medical students. Traditional gender roles encourage discrimination by male physicians or work-family conflicts. The problems facing female physicians involve more than just family responsibilities: diminishing the notion of gender role is key to helping retain them in the workforce. © 2011 Tohoku University Medical Press

  15. Physicians' preferences for asthma guidelines implementation. (United States)

    Kang, Min-Koo; Kim, Byung-Keun; Kim, Tae-Wan; Kim, Sae-Hoon; Kang, Hye-Ryun; Park, Heung-Woo; Chang, Yoon-Seok; Kim, Sun-Sin; Min, Kyung-Up; Kim, You-Young; Cho, Sang-Heon


    Patient care based on asthma guidelines is cost-effective and leads to improved treatment outcomes. However, ineffective implementation strategies interfere with the use of these recommendations in clinical practice. This study investigated physicians' preferences for asthma guidelines, including content, supporting evidence, learning strategies, format, and placement in the clinical workplace. We obtained information through a questionnaire survey. The questionnaire was distributed to physicians attending continuing medical education courses and sent to other physicians by airmail, e-mail, and facsimile. A total of 183 physicians responded (male to female ratio, 2.3:1; mean age, 40.4±9.9 years); 89.9% of respondents were internists or pediatricians, and 51.7% were primary care physicians. Physicians preferred information that described asthma medications, classified the disease according to severity and level of control, and provided methods of evaluation/treatment/monitoring and management of acute exacerbation. The most effective strategies for encouraging the use of the guidelines were through continuing medical education and discussions with colleagues. Physicians required supporting evidence in the form of randomized controlled trials and expert consensus. They preferred that the guidelines be presented as algorithms or flow charts/flow diagrams on plastic sheets, pocket cards, or in electronic medical records. This study identified the items of the asthma guidelines preferred by physicians in Korea. Asthma guidelines with physicians' preferences would encourage their implementation in clinical practice.

  16. Colorado family physicians' attitudes toward medical marijuana. (United States)

    Kondrad, Elin; Reid, Alfred


    Over the last decade, the use of medical marijuana has expanded dramatically; it is now permitted in 16 states and the District of Columbia. Our study of family physicians in Colorado is the first to gather information about physician attitudes toward this evolving practice. We distributed an anonymous web-based electronic survey to the 1727 members of the Colorado Academy of Family Physicians' listserv. Items included individual and practice characteristics as well as experience with and attitudes toward medical marijuana. Five hundred twenty family physicians responded (30% response rate). Of these, 46% did not support physicians recommending medical marijuana; only 19% thought that physicians should recommend it. A minority thought that marijuana conferred significant benefits to physical (27%) and mental (15%) health. Most agreed that marijuana poses serious mental (64%) and physical (61%) health risks. Eighty-one percent agreed that physicians should have formal training before recommending medical marijuana, and 92% agreed that continuing medical education about medical marijuana should be available to family physicians. Despite a high prevalence of use in Colorado, most family physicians are not convinced of marijuana's health benefits and believe its use carries risks. Nearly all agreed on the need for further medical education about medical marijuana.

  17. Patient-physician communication regarding electronic cigarettes. (United States)

    Steinberg, Michael B; Giovenco, Daniel P; Delnevo, Cristine D


    Smokers are likely asking their physicians about the safety of e-cigarettes and their potential role as a cessation tool; however, the research literature on this communication is scant. A pilot study of physicians in the United States was conducted to investigate physician-patient communication regarding e-cigarettes. A total of 158 physicians were recruited from a direct marketing e-mail list and completed a short, web-based survey between January and April 2014. The survey addressed demographics, physician specialty, patient-provider e-cigarette communication, and attitudes towards tobacco harm reduction. Nearly two-thirds (65%) of physicians reported being asked about e-cigarettes by their patients, and almost a third (30%) reported that they have recommended e-cigarettes as a smoking cessation tool. Male physicians were significantly more likely to endorse a harm reduction approach. Physician communication about e-cigarettes may shape patients' perceptions about the products. More research is needed to explore the type of information that physicians share with their patients regarding e-cigarettes and harm reduction.

  18. Developing a competency framework for academic physicians. (United States)

    Daouk-Öyry, Lina; Zaatari, Ghazi; Sahakian, Tina; Rahal Alameh, Boushra; Mansour, Nabil


    There is a mismatch between the requirements of the multifaceted role of academic physicians and their education. Medical institutions use faculty development initiatives to support their junior academic physicians, however, these rarely revolve around academic physician competencies. The aim of this study was to identify these academic physician competencies and develop a competency framework customized to an organizational context. The authors conducted semi-structured interviews and Critical Incident Technique with 25 academic physicians at a teaching medical center in the Middle East region inquiring about the behaviors of academic physicians in teaching, clinical, research, and administrative roles. Using content analysis, the authors identified 16 competencies: five "Supporting Competencies", common to all four roles of academic physicians, and 11 "Function-Specific Competencies", specific to the role being fulfilled. The developed framework shared similarities with frameworks reported in the literature but also had some distinctions. The framework developed represents a step towards closing the gap between the skills medical students are taught and the skills required of academic physicians. The model was customized to the context of the current organization and included a future orientation and addressed the literature calling for increasing focus on the administrative skills of academic physicians.

  19. Analysis of emergency physicians' Twitter accounts. (United States)

    Lulic, Ileana; Kovic, Ivor


    Twitter is one of the fastest growing social media networks for communication between users via short messages. Technology proficient physicians have demonstrated enthusiasm in adopting social media for their work. To identify and create the largest directory of emergency physicians on Twitter, analyse their user accounts and reveal details behind their connections. Several web search tools were used to identify emergency physicians on Twitter with biographies completely or partially written in English. NodeXL software was used to calculate emergency physicians' Twitter network metrics and create visualisation graphs. The authors found 672 Twitter accounts of self-identified emergency physicians. Protected accounts were excluded from the study, leaving 632 for further analysis. Most emergency physicians were located in USA (55.4%), had created their accounts in 2009 (43.4%), used their full personal name (77.5%) and provided a custom profile picture (92.2%). Based on at least one published tweet in the last 15 days, there were 345 (54.6%) active users on 31 December 2011. Active users mostly used mobile devices based on the Apple operating system to publish tweets (69.2%). Visualisation of emergency physicians' Twitter network revealed many users with no connections with their colleagues, and a small group of most influential users who were highly interconnected. Only a small proportion of registered emergency physicians use Twitter. Among them exists a smaller inner network of emergency physicians with strong social bonds that is using Twitter's full potentials for professional development.

  20. Physician buy-in for EMRs. (United States)

    Yackanicz, Lori; Kerr, Richard; Levick, Donald


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

  1. 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.

  2. Response Expectancy and the Placebo Effect. (United States)

    Kirsch, Irving


    In this chapter, I review basic tenets of response expectancy theory (Kirsch, 1985), beginning with the important distinction between response expectancies and stimulus expectancies. Although both can affect experience, the effects of response expectancies are stronger and more resistant to extinction than those of stimulus expectancies. Further, response expectancies are especially important to understanding placebo effects. The response expectancy framework is consistent with and has been amplified by the Bayesian model of predictive coding. Clinical implications of these phenomena are exemplified. © 2018 Elsevier Inc. All rights reserved.

  3. Obligation for transparency regarding treating physician credentials at academic health centres. (United States)

    Martin, Paul J; Skill, N James; Koniaris, Leonidas G


    Academic health centres have historically treated patients with the most complex of diseases, served as training grounds to teach the next generations of physicians and fostered an innovative environment for research and discovery. The physicians who hold faculty positions at these institutions have long understood how these key academic goals are critical to serve their patient community effectively. Recent healthcare reforms, however, have led many academic health centres to recruit physicians without these same academic expectations and to partner with non-faculty physicians at other health systems. There has been limited transparency in regard to the expertise among the physicians and the academic faculty within these larger entities. Such lack of transparency may lead to confusion among patients regarding the qualifications of who is actually treating them. This could threaten the ethical principles of patient autonomy, benevolence and non-maleficence as patients risk making uninformed decisions that might lead to poorer outcomes. Furthermore, this lack of transparency unjustly devalues the achievements of physician faculty members as well as potentially the university they represent. In this paper, it is suggested that academic health centres have an obligation to foster total transparency regarding what if any role a physician has at a university or medical school when university or other academic monikers are used at a hospital. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Building a Physician Culture for Healthcare Transformation: A Hospital's Leadership Challenge. (United States)

    Hemker, Robert A; Solomon, Leslie A


    Engaging and integrating physicians has become the veritable "brass ring" for many hospital systems: many attempts and few actual wins. This is especially true in California's managed care environment and for public entities such as Palomar Health in Escondido, California. Our commitment to engage and integrate physicians continues to be a vital element of a larger cultural shift toward delivery of care that puts the patients' needs first. A key determinant of success has been the ability to align a diverse medical staff culture with administrative priorities. This alignment involves a carefully executed strategy and a structure to build a collective identity among diverse players. Palomar Health is in the third year of the journey. Some of the critical milestones have been the implementation of a physician leadership development process, creation of a physician onboarding process to codify the desired physician culture, delineation of roles and expectations for physician leadership, and formalization of dyad and triad partnerships between physicians and their clinical and administrative partners.

  5. Marketing Reference Services. (United States)

    Norman, O. Gene


    Relates the marketing concept to library reference services. Highlights include a review of the literature and an overview of marketing, including research, the marketing mix, strategic plan, marketing plan, and marketing audit. Marketing principles are applied to reference services through the marketing mix elements of product, price, place, and…

  6. Reference class forecasting

    DEFF Research Database (Denmark)

    Flyvbjerg, Bent

    optimisme og misinformation. RCF bygger på teorier, som vandt Daniel Kahneman Nobelprisen i økonomi i 2002. RCF estimerer budgettet for et givet projekt på grundlag af de faktiske udfald for budgetterne i en reference-klasse af projekter. RCF udføres i tre trin: 1. Identifikation af en relevant reference...

  7. Physician and parent perceptions of prognosis and end-of-life experience in children with advanced heart disease. (United States)

    Balkin, Emily M; Wolfe, Joanne; Ziniel, Sonja I; Lang, Peter; Thiagarajan, Ravi; Dillis, Shay; Fynn-Thompson, Francis; Blume, Elizabeth D


    Little is known about how physician and parent perspectives compare regarding the prognosis and end-of-life (EOL) experience of children with advanced heart disease (AHD). The study's objective was to describe and compare parent and physician perceptions regarding prognosis and EOL experience in children with AHD. This was a cross-sectional survey study of cardiologists and bereaved parents. Study subjects were parents and cardiologists of children with primary cardiac diagnoses who died in a tertiary care pediatric hospital between January 2007 and December 2009. Inclusion required both physician and parent to have completed surveys respective to the same patient. A total of 31 parent/physician pairs formed the analytic sample. Perceptions were measured of cardiologists and bereaved parents regarding the EOL experience of children with AHD. Nearly half of parents and physicians felt that patients suffered 'a great deal,' 'a lot,' or 'somewhat' at EOL, but there was no agreement between them. At diagnosis, parents more often expected complete repair and normal lifespan while the majority of physicians expected shortened lifespan without normal quality of life. Parents who expected complete repair with normal life were more likely to report 'a lot' of suffering at EOL (p=0.002). In 43% of cases, physicians reported that the parents were prepared for the way in which their child died, while the parents reported feeling unprepared. Both parents and physicians perceive suffering at EOL in patients who die of AHD. Moreover, parent expectations at diagnosis may influence perceptions of suffering at EOL. Physicians overestimate the degree of parent preparedness for their child's death.

  8. Macroeconomic Expectations of Households and Professional Forecasters


    Christopher D Carroll


    Economists have long emphasized the importance of expectations in determining macroeconomic outcomes Yet there has been almost no recent effort to model actual empirical expectations data; instead macroeconomists usually simply assume expectations are rational This paper shows that while empirical household expectations are not rational in the usual sense expectational dynamics are well captured by a model in which households' views derive from news reports of the views of professional foreca...

  9. On heterotic vacua with fermionic expectation values

    Energy Technology Data Exchange (ETDEWEB)

    Minasian, Ruben [Institut de Physique Theorique, Universite Paris Saclay, CEA, CNRS, Gif-sur-Yvette (France); Petrini, Michela [Sorbonne Universites, CNRS, LPTHE, UPMC Paris 06, UMR 7589, Paris (France); Svanes, Eirik Eik [Sorbonne Universites, CNRS, LPTHE, UPMC Paris 06, UMR 7589, Paris (France); Sorbonne Universites, Institut Lagrange de Paris, Paris (France)


    We study heterotic backgrounds with non-trivial H-flux and non-vanishing expectation values of fermionic bilinears, often referred to as gaugino condensates. The gaugini appear in the low energy action via the gauge-invariant three-form bilinear Σ{sub MNP} = tr anti χΓ{sub MNP}χ. For Calabi-Yau compactifications to four dimensions, the gaugino condensate corresponds to an internal three-form Σ{sub mnp} that must be a singlet of the holonomy group. This condition does not hold anymore when an internal H-flux is turned on and O(α{sup '}) effects are included. In this paper we study flux compactifications to three and four-dimensions on G-structure manifolds. We derive the generic conditions for supersymmetric solutions. We use integrability conditions and Lichnerowicz type arguments to derive a set of constraints whose solution, together with supersymmetry, is sufficient for finding backgrounds with gaugino condensate. (copyright 2017 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

  10. Physician Acceptance of Pharmacist Recommendations about Medication Prescribing Errors in Iraqi Hospitals

    Directory of Open Access Journals (Sweden)



    Full Text Available The objectives of this study were to measure the incidence and types of medication prescribing errors (MPEs in Iraqi hospitals, to calculate for the first time the percentage of physician agreement with pharmacist medication regimen review (MRR recommendations regarding MPEs, and to identify the factors influencing the physician agreement rate with these recommendations. Methods: Fourteen pharmacists (10 females and 4 males reviewed each hand-written physician order for 1506 patients who were admitted to two public hospitals in Al-Najaf, Iraq during August 2015. The pharmacists identified medication prescribing errors using the Medscape WebMD, LCC phone application as a reference. The pharmacists contacted the physicians (2 females and 34 males in-person to address MPEs that were identified. Results: The pharmacists identified 78 physician orders containing 99 MPEs with an incidence of 6.57 percent of all the physician orders reviewed. The patients with MPEs were taking 4.8 medications on average. The MPEs included drug-drug interactions (65.7%, incorrect doses (16.2%, unnecessary medications (8.1%, contra-indications (7.1%, incorrect drug duration (2%, and untreated conditions (1%. The physicians implemented 37 (37.4% pharmacist recommendations. Three factors were significantly related to physician acceptance of pharmacist recommendations. These were physician specialty, pharmacist gender, and patient gender. Pediatricians were less likely (OR= 0.1 to accept pharmacist recommendations compared to internal medicine physicians. Male pharmacists received more positive responses from physicians (OR=7.11 than female pharmacists. Lastly, the recommendations were significantly more likely to be accepted (OR= 3.72 when the patients were females. Conclusions: The incidence of MPEs is higher in Iraqi hospitalized patients than in the U.S. and U.K, but lower than in Brazil, Ethiopia, India, and Croatia. Drug-drug interactions were the most common type of

  11. Core competencies for pharmaceutical physicians and drug development scientists (United States)

    Silva, Honorio; Stonier, Peter; Buhler, Fritz; Deslypere, Jean-Paul; Criscuolo, Domenico; Nell, Gerfried; Massud, Joao; Geary, Stewart; Schenk, Johanna; Kerpel-Fronius, Sandor; Koski, Greg; Clemens, Norbert; Klingmann, Ingrid; Kesselring, Gustavo; van Olden, Rudolf; Dubois, Dominique


    Professional groups, such as IFAPP (International Federation of Pharmaceutical Physicians and Pharmaceutical Medicine), are expected to produce the defined core competencies to orient the discipline and the academic programs for the development of future competent professionals and to advance the profession. On the other hand, PharmaTrain, an Innovative Medicines Initiative project, has become the largest public-private partnership in biomedicine in the European Continent and aims to provide postgraduate courses that are designed to meet the needs of professionals working in medicines development. A working group was formed within IFAPP including representatives from PharmaTrain, academic institutions and national member associations, with special interest and experience on Quality Improvement through education. The objectives were: to define a set of core competencies for pharmaceutical physicians and drug development scientists, to be summarized in a Statement of Competence and to benchmark and align these identified core competencies with the Learning Outcomes (LO) of the PharmaTrain Base Course. The objectives were successfully achieved. Seven domains and 60 core competencies were identified and aligned accordingly. The effective implementation of training programs using the competencies or the PharmaTrain LO anywhere in the world may transform the drug development process to an efficient and integrated process for better and safer medicines. The PharmaTrain Base Course might provide the cognitive framework to achieve the desired Statement of Competence for Pharmaceutical Physicians and Drug Development Scientists worldwide. PMID:23986704

  12. Core Competencies for Pharmaceutical Physicians and Drug Development Scientists

    Directory of Open Access Journals (Sweden)

    Honorio eSilva


    Full Text Available Professional groups, such as IFAPP (International Federation of Pharmaceutical Physicians and Pharmaceutical Medicine, are expected to produce the defined core competencies to orient the discipline and the academic programs for the development of future competent professionals and to advance the profession. On the other hand, PharmaTrain, an Innovative Medicines Initiative project, has become the largest public-private partnership in biomedicine in the European Continent and aims to provide postgraduate courses that are designed to meet the needs of professionals working in medicines development. A working group was formed within IFAPP including representatives from PharmaTrain, academic institutions and national member associations, with special interest and experience on Quality Improvement through education. The objectives were: to define a set of core competencies for pharmaceutical physicians and drug development scientists, to be summarized in a Statement of Competence and to benchmark and align these identified core competencies with the Learning Outcomes of the PharmaTrain Base Course. The objectives were successfully achieved. Seven domains and 60 core competencies were identified and aligned accordingly. The effective implementation of training programs using the competencies or the PharmaTrain Learning Outcomes anywhere in the world may transform the drug development process to an efficient and integrated process for better and safer medicines. The PharmaTrain Base Course might provide the cognitive framework to achieve the desired Statement of Competence for Pharmaceutical Physicians and Drug Development Scientists worldwide.

  13. Collaboration of Physician, Pharmacist and Director Model Toward the Improvement of Teamwork Effectiveness in Hospital

    Directory of Open Access Journals (Sweden)

    Widy S. Abdulkadir


    Full Text Available Collaboration of physicians and pharmacists is very important in providing treatment to patients. Collaboration includes an exchange of views or ideas that give perspective to all collaborators. In order to make collaborative relationship optimal, all members of the different professions should have a desire to cooperate. Pharmacists and physicians should plan and practice as colleagues, work interdependence within the limits of the scope of practice with a variety of values and knowledge. The role of director in cooperation between doctor and pharmacist takes decision-making which refers to treatment of patients to be decided together between health professionals (physician and pharmacist. The study was a quasi-experimental design with a pre-test-post-test control group design, using paired t-test analysis. The study was conducted from October 2012 until February 2013. The paired t-test results showed that the variable of teamwork effectiveness in M. M. Dunda Hospital increased significantly (p=0.038, which means that the three-party (physician-pharmacist-director collaboration model may increase teamwork effectiveness. Three-party collaboration model can improve physician-pharmacist relationship in the hospital. Leadership has a positive and significant effect on employees’ organizational commitment. Director can be an inspiration in the work and determine the direction and goals of the organization. Therefore, the three-party (physician-pharmacist-director collaboration model can improve the quality of the relationship between the two professions, physician and pharmacist.

  14. Physician and patient attitudes towards complementary and alternative medicine in obstetrics and gynecology

    Directory of Open Access Journals (Sweden)

    Sen Ananda


    Full Text Available Abstract Background In the U.S., complementary and alternative medicine (CAM use is most prevalent among reproductive age, educated women. We sought to determine general attitudes and approaches to CAM among obstetric and gynecology patients and physicians. Methods Obstetrician-gynecologist members of the American Medical Association in the state of Michigan and obstetric-gynecology patients at the University of Michigan were surveyed. Physician and patient attitudes and practices regarding CAM were characterized. Results Surveys were obtained from 401 physicians and 483 patients. Physicians appeared to have a more positive attitude towards CAM as compared to patients, and most reported routinely endorsing, providing or referring patients for at least one CAM modality. The most commonly used CAM interventions by patients were divergent from those rated highest among physicians, and most patients did not consult with a health care provider prior to starting CAM. Conclusion Although obstetrics/gynecology physicians and patients have a positive attitude towards CAM, physician and patients' view of the most effective CAM therapies were incongruent. Obstetrician/gynecologists should routinely ask their patients about their use of CAM with the goal of providing responsible, evidence-based advice to optimize patient care.

  15. [Family and career planning in young physicians]. (United States)

    Buddeberg-Fischer, Barbara; Stamm, Martina; Klaghofer, Richard


    The study investigates in what way physicians integrate their desire to have children into their career planning. Within the framework of a prospective cohort study of Swiss medical school graduates on career development of young physicians, beginning in 2001, 534 participants (285 women, 249 men) were assessed in January 2007, in terms of having children, planning to have children, the career aspired to and the work-family balance used or planned. Among the study participants, 19% (54) of the women and 24% (59) of the men have children. Of the others 88% plan to start a family in the future. Female physicians with children are less advanced in their careers than women without children; for male physicians no such difference can be observed. Of the female physicians with children or the desire for children 42% aspire to work in a practice, 28% to a clinical and only 4% to an academic career. Of the male physicians with children or the desire for children one third aspire to work in a practice, one third to a clinical and 14% to an academic career. The preferred model of work repartition of female physicians with children is father full time/mother part time or both parents part time; the preferred model of male physicians is father full time/mother part time or not working. Children are an important factor in the career and life planning of physicians, female physicians paying more attention to an even work-family balance than male physicians. Copyright 2008 S. Karger AG, Basel.

  16. Information Reception and Expectations Among Hospitalized Elderly Patients in Taiwan: A Pilot Study. (United States)

    Chen, Kai-Li; Chang, Chia-Ming; Chen, Ching-Huey; Huang, Mei-Chih


    Communicating with patients, especially geriatric patients, is a challenge for medical professionals. Medical message receiving and expectations among hospitalized elderly patients have not been studied. The aim of this study was to explore medical message receiving and expectations concerning medical information among hospitalized elderly patients in Taiwan. A descriptive study design was used. Convenience sampling was applied, and the research was conducted in a geriatric ward in a medical center in southern Taiwan. Patients were recruited who were 65 years or older and capable of verbal communication. Data were collected using a self-developed semistructured questionnaire. For each participant, data were collected in one regular ward round. The messages of the physician were recorded. During the first and fourth hours after the ward round, the researcher collected the medical messages that were conveyed by the physician in the ward round and that could be repeated by the patients. Open-ended questions were used to collect data about patient expectations of medical messages during the first hour after the ward round. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using content analysis. Thirty patients participated in this study. All of the participants remembered the visit of the physician. Seventeen participants (56.6%), however, could not repeat the messages, and the total message repetition rate was 17.8% at the first hour after the ward round. By the fourth hour, the message repetition rate fell to 8.9%. Furthermore, three participants (10%) reported messages incorrectly. Participants reported the importance and necessity of physicians conveying medical messages. "Desire to know the reasons for discomfort" and "discharge date" were the messages most expected by the participants. This study suggests that most hospitalized elderly patients cannot repeat medical messages that are conveyed by their physicians

  17. Evolving expectations from international organisations

    International Nuclear Information System (INIS)

    Ruiz Lopez, C.


    The author stated that implementation of the geological disposal concept requires a strategy that provides national decision makers with sufficient confidence in the level of long-term safety and protection ultimately achieved. The concept of protection against harm has a broader meaning than radiological protection in terms of risk and dose. It includes the protection of the environment and socio-economic interests of communities. She recognised that a number of countries have established regulatory criteria already, and others are now discussing what constitutes a proper regulatory test and suitable time frame for judging the safety of long-term disposal. Each regulatory programme seeks to define reasonable tests of repository performance, using protection criteria and safety approaches consistent with the culture, values and expectations of the citizens of the country concerned. This means that there are differences in how protection and safety are addressed in national approaches to regulation and in the bases used for that. However, as was recognised in the Cordoba Workshop, it would be important to reach a minimum level of consistency and be able to explain the differences. C. Ruiz-Lopez presented an overview of the development of international guidance from ICRP, IAEA and NEA from the Cordoba workshop up to now, and positions of independent National Advisory Bodies. The evolution of these guidelines over time demonstrates an evolving understanding of long-term implications, with the recognition that dose and risk constraints should not be seen as measures of detriment beyond a few hundred years, the emphasis on sound engineering practices, and the introduction of new concepts and approaches which take into account social and economical aspects (e.g. constrained optimisation, BAT, managerial principles). In its new recommendations, ICRP (draft 2006) recognizes. in particular, that decision making processes may depend on other societal concerns and considers

  18. Learning curves for ultrasound guided lung biopsy in the hands of respiratory physicians

    DEFF Research Database (Denmark)

    Laursen, Christian; Naur, Therese Maria Henriette; Bodtger, Uffe


    are depicted in figure 1. Six of the physicians had learning curves with a relatively downward or stable projection as a sign of developing competence. Three physicians, however, had learning curves with an upward projection indicating unacceptable competence in performing the procedure......Background: The aim of this study was to determine learning curves for ultrasound guided transthoracic needle biopsies (US-TTNB) performed by respiratory physicians after implementation at three different centers.Methods: During January 2012 to August 2014 patients were included if they had...... a registered US-TTNB procedure at any of the three centers. The US-TTNB was defined as being successful if the result was diagnostic and otherwise as being unsuccessful. Histology or cytology results and clinical follow-up were used as a reference tests. The learning curves for physicians having performed...

  19. Uranium reference materials

    International Nuclear Information System (INIS)

    Donivan, S.; Chessmore, R.


    The Technical Measurements Center has prepared uranium mill tailings reference materials for use by remedial action contractors and cognizant federal and state agencies. Four materials were prepared with varying concentrations of radionuclides, using three tailings materials and a river-bottom soil diluent. All materials were ground, dried, and blended thoroughly to ensure homogeneity. The analyses on which the recommended values for nuclides in the reference materials are based were performed, using independent methods, by the UNC Geotech (UNC) Chemistry Laboratory, Grand Junction, Colorado, and by C.W. Sill (Sill), Idaho National Engineering Laboratory, Idaho Falls, Idaho. Several statistical tests were performed on the analytical data to characterize the reference materials. Results of these tests reveal that the four reference materials are homogeneous and that no large systematic bias exists between the analytical methods used by Sill and those used by TMC. The average values for radionuclides of the two data sets, representing an unbiased estimate, were used as the recommended values for concentrations of nuclides in the reference materials. The recommended concentrations of radionuclides in the four reference materials are provided. Use of these reference materials will aid in providing uniform standardization among measurements made by remedial action contractors. 11 refs., 9 tabs

  20. Physician assisted suicide: the great Canadian euthanasia debate. (United States)

    Schafer, Arthur


    A substantial majority of Canadians favours a change to the Criminal Code which would make it legally permissible, subject to careful regulation, for patients suffering from incurable physical illness to opt for either physician assisted suicide (PAS) or voluntary active euthanasia (VAE). This discussion will focus primarily on the arguments for and against decriminalizing physician assisted suicide, with special reference to the British Columbia case of Lee Carter vs. Attorney General of Canada. The aim is to critique the arguments and at the same time to describe the contours of the current Canadian debate. Both ethical and legal issues raised by PAS are clarified. Empirical evidence available from jurisdictions which have followed the regulatory route is presented and its relevance to the slippery slope argument is considered. The arguments presented by both sides are critically assessed. The conclusion suggested is that evidence of harms to vulnerable individuals or to society, consequent upon legalization, is insufficient to support continued denial of freedom to those competent adults who seek physician assistance in hastening their death. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. STL pocket reference

    CERN Document Server

    Lischner, Ray


    The STL Pocket Reference describes the functions, classes, and templates in that part of the C++ standard library often referred to as the Standard Template Library (STL). The STL encompasses containers, iterators, algorithms, and function objects, which collectively represent one of the most important and widely used subsets of standard library functionality. The C++ standard library, even the subset known as the STL, is vast. It's next to impossible to work with the STL without some sort of reference at your side to remind you of template parameters, function invocations, return types--ind

  2. Handbook of reference electrodes

    CERN Document Server

    Inzelt, György; Scholz, Fritz


    Reference Electrodes are a crucial part of any electrochemical system, yet an up-to-date and comprehensive handbook is long overdue. Here, an experienced team of electrochemists provides an in-depth source of information and data for the proper choice and construction of reference electrodes. This includes all kinds of applications such as aqueous and non-aqueous solutions, ionic liquids, glass melts, solid electrolyte systems, and membrane electrodes. Advanced technologies such as miniaturized, conducting-polymer-based, screen-printed or disposable reference electrodes are also covered. Essen

  3. Regular Expression Pocket Reference

    CERN Document Server

    Stubblebine, Tony


    This handy little book offers programmers a complete overview of the syntax and semantics of regular expressions that are at the heart of every text-processing application. Ideal as a quick reference, Regular Expression Pocket Reference covers the regular expression APIs for Perl 5.8, Ruby (including some upcoming 1.9 features), Java, PHP, .NET and C#, Python, vi, JavaScript, and the PCRE regular expression libraries. This concise and easy-to-use reference puts a very powerful tool for manipulating text and data right at your fingertips. Composed of a mixture of symbols and text, regular exp

  4. Neptunium: a bibliographic reference

    International Nuclear Information System (INIS)

    Mosley, R.E.


    A comprehensive bibliograhy of the literature on the element neptunium published prior to January 1976 is presented. A short abstract is given for each listed reference, with a few exceptions. The references are divided into sections categorized as General, Man-Made Sources (Reactors), Man-Made Sources (Fuel Reprocessing), Chemistry (Solubility), Chemistry (Compounds), Chemistry (Isotopes), Analyses (Instrumental), Analyses (Chemical), Chemical (Animal), Biological (Effects), Biological (Animal-Metabolism-Retention), Biological (Air Movement), Biological (Human Inhalation), Measurement, and Dosimetry. The bibliography contains author and keyword indexes and was compiled to serve as a quick reference source for neptunium-related work. 184 citations

  5. CSS Pocket Reference

    CERN Document Server

    Meyer, Eric


    When you're working with CSS and need a quick answer, CSS Pocket Reference delivers. This handy, concise book provides all of the essential information you need to implement CSS on the fly. Ideal for intermediate to advanced web designers and developers, the 4th edition is revised and updated for CSS3, the latest version of the Cascading Style Sheet specification. Along with a complete alphabetical reference to CSS3 selectors and properties, you'll also find a short introduction to the key concepts of CSS. Based on Cascading Style Sheets: The Definitive Guide, this reference is an easy-to-us

  6. Biomedical Engineering Desk Reference

    CERN Document Server

    Ratner, Buddy D; Schoen, Frederick J; Lemons, Jack E; Dyro, Joseph; Martinsen, Orjan G; Kyle, Richard; Preim, Bernhard; Bartz, Dirk; Grimnes, Sverre; Vallero, Daniel; Semmlow, John; Murray, W Bosseau; Perez, Reinaldo; Bankman, Isaac; Dunn, Stanley; Ikada, Yoshito; Moghe, Prabhas V; Constantinides, Alkis


    A one-stop Desk Reference, for Biomedical Engineers involved in the ever expanding and very fast moving area; this is a book that will not gather dust on the shelf. It brings together the essential professional reference content from leading international contributors in the biomedical engineering field. Material covers a broad range of topics including: Biomechanics and Biomaterials; Tissue Engineering; and Biosignal Processing* A hard-working desk reference providing all the essential material needed by biomedical and clinical engineers on a day-to-day basis * Fundamentals, key techniques,

  7. LINQ Pocket Reference

    CERN Document Server

    Albahari, Joseph


    Ready to take advantage of LINQ with C# 3.0? This guide has the detail you need to grasp Microsoft's new querying technology, and concise explanations to help you learn it quickly. And once you begin to apply LINQ, the book serves as an on-the-job reference when you need immediate reminders. All the examples in the LINQ Pocket Reference are preloaded into LINQPad, the highly praised utility that lets you work with LINQ interactively. Created by the authors and free to download, LINQPad will not only help you learn LINQ, it will have you thinking in LINQ. This reference explains: LINQ's ke

  8. R quick syntax reference

    CERN Document Server

    Tollefson, Margot


    The R Quick Syntax Reference is a handy reference book detailing the intricacies of the R language. Not only is R a free, open-source tool, R is powerful, flexible, and has state of the art statistical techniques available. With the many details which must be correct when using any language, however, the R Quick Syntax Reference makes using R easier.Starting with the basic structure of R, the book takes you on a journey through the terminology used in R and the syntax required to make R work. You will find looking up the correct form for an expression quick and easy. With a copy of the R Quick


    Directory of Open Access Journals (Sweden)

    S. N. Vikram RAJ URS


    Full Text Available Education is intimately connected with ethics, because holistically speaking education is more than simply passing examinations and acquiring degrees. Education is character building and life long learning. Savants and philosophers throughout the history of humankind have borne testimony to this aspect of education. Today, there is a great deal of emphasis on continuous and life long learning which implies that education is a continual learning process and not merely relegated to certification. Our experience in the field of distance education indicates that the profile of distance learners varies, cutting across barriers of gender, class and caste. The distance learner may be suffering from a sense of isolation as he/she makes a return to study after a gap of time or while working. It is there that the distance educator makes a positive, ethical and interventionist role by helping the student to learn beyond the stereotypical classroom situation and can act effectively as the friend, philosopher and guide of the learner. Thus practicing what you preach is the moto of ethics in distance. Some of the more important ethical concerns associated with open and distance learning are not those that may be faced by learners. Instead, the challenges faced by those that design ODL or use it in their teaching can be seen as increasingly important. These challenges include globalization, which has emphasized instrumental rather than social aims of education, and the use of cognitive rather than affective pedagogies. For ODL designers and teachers, this has resulted in a concentration on cognitive tasks and market-driven aspects of open and distance learning at the expense of the social harmony that might otherwise be achieved. The overarching ethical concern for ODL practitioners should be to implement an appropriate pedagogy that will satisfy both instrumental and social aims. While this can be achieved, in part, through the use of the pedagogies outlined in this paper, the problem is seen as being associated with deeply interwoven social and cultural contexts. Consequently, there is a greater responsibility for all ODL practitioners to ensure that the choices that they make are ethical at all times, irrespective of the demands of any employer, institution or authority. This paper deals with ethics in general, its role in distance education and its significance to educational institutions.

  10. Relationship Marketing: Spoke of a Wheel Reference to Industrial Customers Expectations and contentment towards Identification Products


    Shrivastava, Roopal; Shrivastava, Dr.Sangya


    The future of business is social" -- Barry Libert,Author of Social Nation,CEO MzingaOrganizations, big or small, tries for customers satisfaction, delight and loyalty. The term relationship marketing was popularised in the 1980s when the focus of marketers started to switch from customer acquisition to customer retention. The tool kit for the marketers on which they can compete and survive are 4 pillars of marketing but the countries like India did not possess the knowledge of marketing till ...

  11. Physician Job Satisfaction across Six Major Specialties (United States)

    Duffy, Ryan D.; Richard, George V.


    A random sample of 763 physicians was surveyed to examine the relation of 18 critical work-related factors to job satisfaction. On the whole, physicians reported that they were satisfied with their careers and believed that caring for patients, sense of accomplishment, continuity of care, autonomy, and personal time were the five most important…

  12. Influence of pharmacists expertise on physicians prescription ...

    African Journals Online (AJOL)

    Purpose: To explore the influence of pharmacist factors on prescription decisions of physicians. Methods: A survey of literature was carried out across online databases and 12 relevant articles were identified. The influence of pharmacist factors on physician prescription decisions was identified in the articles. A conceptual ...

  13. Evaluation of Physicians' Requests for Autopsies. (United States)

    Kesler, Richard W.; And Others


    Chaplains and seminary students enrolled in the University of Virginia Medical Center's Clinical Pastoral Program were asked to judge physicians' performances while requesting autopsies by completing a confidential evaluation form. The results of the evaluations were correlated with the physicians' success in obtaining autopsies. (MLW)

  14. Physician Performance Assessment: Prevention of Cardiovascular Disease (United States)

    Lipner, Rebecca S.; Weng, Weifeng; Caverzagie, Kelly J.; Hess, Brian J.


    Given the rising burden of healthcare costs, both patients and healthcare purchasers are interested in discerning which physicians deliver quality care. We proposed a methodology to assess physician clinical performance in preventive cardiology care, and determined a benchmark for minimally acceptable performance. We used data on eight…

  15. Physician assisted death in psychiatric practice

    NARCIS (Netherlands)

    Groenewoud, J.H.; van der Maas, P.J.; van der Wal, G.; Hengeveld, M.W.; Tholen, A.J.; Schudel, W.J.; van der Heide, A.


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

  16. A Management Development Course for Physicians (United States)

    Plovnick, Mark S.; And Others


    Developed and tested by the Health Management Project at the MIT Sloan School of Management, this course was designed to provide a more accurate understanding of the relevance and usefulness of management education to physicians and to train physicians in some basic management skills. Its content and field tests are described. (LBH)

  17. Religious characteristics of US women physicians. (United States)

    Frank, E; Dell, M L; Chopp, R


    Physicians' religious attributes are unknown, and may affect patient care. The Women Physicians' Health Study (WPHS) is a random sample (n = 4501 respondents, 59% response rate) of US women physicians aged 30-70; the first large, national study of US women physicians. In this study US women physicians were less likely to be Christian than were other Americans (61.2% of women physicians versus 85.1% of the general population), but were more likely to be Jewish (13.2% vs 2.0%), Buddhist (1.4% vs 0.3%), Hindu (3.9% vs 0.4%), or atheist/agnostic (5.9% vs 0.6%). Protestantism (29.3% of the population) and Catholicism (24.9%) were the most commonly reported religious identities. The strongest religious identity was claimed by Mormons and Seventh Day Adventists. Thus, women physicians' religious beliefs differ from those of the general population in the US. This may be particularly important for physicians practicing with patient populations with different religious affiliations, and in addressing clinical questions with ethical or religious dimensions.

  18. Physicians cannot prepare for nuclear disaster

    International Nuclear Information System (INIS)

    Geiger, H.J.


    In this paper, the author argues that medical preparations for nuclear war are futile. Not only would few physicians survive a nuclear attack, but these physicians would have the impossible task of caring for hundreds of thousands of injured and dying victims

  19. 38 CFR 52.150 - Physician services. (United States)


    ... acute care when it is indicated. (d) Availability of physicians for emergency care. In case of an emergency, the program management must provide or arrange for the provision of physician services when the... assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section...

  20. [Suicide in female and male physicians

    NARCIS (Netherlands)

    Lagro-Janssen, A.L.M.; Luijks, H.D.P.


    OBJECTIVE: To determine whether there are gender differences in the incidence of suicide in physicians, and whether there are differences in the methods used by male and female physicians to commit suicide. DESIGN: Systematic literature search. METHOD: A literature search was performed in the

  1. Physicians' Mandatory Reporting of Elder Abuse. (United States)

    Daniels, R. Steven; And Others


    Evaluated physicians' responses to Alabama state elder abuse reporting statutes in Alabama Protective Services Act of 1976. Survey responses from over 100 Alabama physicians suggest that they have reservations about their ability to diagnose abuse, operation of the law, and their willingness to report abuse. (Author/NB)

  2. 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.

  3. Tailoring hospital marketing efforts to physicians' needs. (United States)

    Mackay, J M; Lamb, C W


    Marketing has become widely recognized as an important component of hospital management (Kotler and Clarke 1987; Ludke, Curry, and Saywell 1983). Physicians are becoming recognized as an important target market that warrants more marketing attention than it has received in the past (Super 1987; Wotruba, Haas, and Hartman 1982). Some experts predict that hospitals will begin focusing more marketing attention on physicians and less on consumers (Super 1986). Much of this attention is likely to take the form of practice management assistance, such as computer-based information system support or consulting services. The survey results reported here are illustrative only of how one hospital addressed the problem of physician need assessment. Other potential target markets include physicians who admit patients only to competitor hospitals and physicians who admit to multiple hospitals. The market might be segmented by individual versus group practice, area of specialization, or possibly even physician practice life cycle stage (Wotruba, Haas, and Hartman 1982). The questions included on the survey and the survey format are likely to be situation-specific. The key is the process, not the procedure. It is important for hospital marketers to recognize that practice management assistance needs will vary among markets (Jensen 1987). Therefore, hospitals must carefully identify their target physician market(s) and survey them about their specific needs before developing and implementing new physician marketing programs. Only then can they be reasonably confident that their marketing programs match their customers' needs.

  4. A Study of the Educationally Influential Physician. (United States)

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


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

  5. Construction of a Physician Skills Inventory (United States)

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


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

  6. Religious and Spiritual Beliefs of Physicians. (United States)

    Robinson, Kristin A; Cheng, Meng-Ru; Hansen, Patrick D; Gray, Richard J


    The aim of this study is to describe religious and spiritual beliefs of physicians and examine their influence on the decision to pursue medicine and daily medical practice. An anonymous survey was e-mailed to physicians at a large, multidisciplinary tertiary referral center with satellite clinics. Data were collected from January 2014 through February 2014. There were 2097 respondents (69.1 % men), and number of practicing years ranged from ≤1 to ≥30. Primary care physicians or medical specialists represented 74.1 %, 23.6 % were in surgical specialties, and 2.3 % were psychiatrists. The majority of physicians believe in God (65.2 %), and 51.2 % reported themselves as religious, 24.8 % spiritual, 12.4 % agnostic, and 11.6 % atheist. This self-designation was largely independent of specialty except for psychiatrists, who were more likely report agnosticism (P = 0.003). In total, 29.0 % reported that religious or spiritual beliefs influenced their decision to become a physician. Frequent prayer was reported by 44.7 % of physicians, but only 20.7 % reported having prayed with patients. Most physicians consider themselves religious or spiritual, but the rates of agnosticism and atheism are higher than the general population. Psychiatrists are the least religious group. Despite the influence of religion on physicians' lives and medical practice, the majority have not incorporated prayer into patient encounters.

  7. Peseshet--the first female physician? (United States)

    Harer, W B; el-Dawakhly, Z


    Excavation of the tomb of Akhet-Hetep at Giza revealed a monument dedicated to his mother Peseshet, who is identified by many important titles including "Overseer of Women Physicians." She is probably the world's earliest known woman physician. She practiced at the time of the building of the great pyramids in Egypt, about 2500 BC.

  8. Physician morality and perinatal decisions. (United States)

    Minkoff, Howard; Zafra, Katherine; Amrita, Sabharwal; Wilson, Tracey E; Homel, Peter


    Given the same set of "facts" (e.g. fetal prognosis) different physicians may not give the same advice to patients. Studies have shown that people differ in how they prioritize moral domains, but how those domains influence counseling and management has not been assessed among obstetricians. Our objective was to see if, given the same set of facts, obstetricians' counseling would vary depending on their prioritization of moral domains. Obstetricians completed questionnaires that included validated scales of moral domains (e.g. autonomy, community, divinity), demographic data, and hypothetical scenarios (e.g. how aggressively they would pursue the interests of a potentially compromised child, the degree of deference they gave to parents' choices, and their relative valuation of fetal rights and women's rights). Multivariate logistic regression using backwards conditional selection was used to explore how participants responded to the moral dilemma scenarios. Among the 249 participating obstetricians there was wide variation in counseling, much of which reflected differences in prioritization of moral domains. For example, requiring a higher likelihood of neonatal survival before recommending a cesarean section with cord prolapse was associated with Fairness/Reciprocity, an autonomy domain which emphasizes treating individuals equally (OR=1.42, 90% CI=1.06-1.89, p=0.05). Honoring parents' request to wait longer to suspend attempts to resuscitate an infant with no heart rate or pulse was associated with the community domains (involving concepts of loyalty and hierarchy) of In-Group/Loyalty; OR 1.30, 90% CI=1.04-1.62, p=0.05 and Authority/Respect (OR=1.34, 90% CI=1.06-1.34, p=0.045). Carrying out an unconsented cesarean section was associated with In-Group Loyalty (OR=1.26, 90% CI=1.01-1.56, p=0.08) and religiosity (OR=1.08, 90% CI=1.00-1.16, p=0.08). The advice that patients receive may vary widely depending on the underlying moral values of obstetricians. Physicians

  9. Multicultural Differences in Women's Expectations of Birth. (United States)

    Moore, Marianne F


    This review surveyed qualitative and quantitative studies to explore the expectations around birth that are held by women from different cultures. These studies are grouped according to expectations of personal control expectations of support from partner/others/family; expectations of carel behavior from providers such as nurses, doctors, and/or midwives; expectations about the health of the baby; and expectations about pain in childbirth. Discussed are the findings and the role that Western culture in medicine, power and privilege are noted in providing care to these women.

  10. Active and Passive Physician-Assisted Dying and the Terminal Disease Requirement. (United States)

    Varelius, Jukka


    The view that voluntary active euthanasia and physician-assisted suicide should be made available for terminal patients only is typically warranted by reference to the risks that the procedures are seen to involve. Though they would appear to involve similar risks, the commonly endorsed end-of-life practices referred to as passive euthanasia are available also for non-terminal patients. In this article, I assess whether there is good reason to believe that the risks in question would be bigger in the case of voluntary active euthanasia and physician-assisted suicide than in that of passive euthanasia. I propose that there is not. On that basis, I suggest that limiting access to voluntary active euthanasia and physician-assisted suicide to terminal patients only is not consistent with accepting the existing practices of passive euthanasia. © 2016 John Wiley & Sons Ltd.

  11. [Gender influence on health related quality of life among resident physicians working in an emergency department]. (United States)

    Fernández-Prada, María; González-Cabrera, Joaquín; Torres G, Francisco; Iribar-Ibabe, Concepción; María Peinado, José


    The high emotional burden of physicians working in emergency departments may affect their quality of life perception. To evaluate health related quality of life among resident physicians performing shifts at an emergency department. Seventy one physicians aged 26,3 ± 1,7 years (47 women), working as residents in an emergency department, answered the short version of the Short-Form Health Survey Questionnaire (SF-36®). This questionnaire analyses eight domains: physical function, body pain, general health, vitality, social function, emotional role and mental health. Women had a significantly worse perception than a reference population in four dimensions of the SF-36, especially mental health and social functioning. Men had scores similar to the reference population. Among women, vitality is the best predictor of mental health and social functioning. Women working as residents in an emergency department have a worse perception of their quality of life than men performing the same job.

  12. Physician assistants and their intent to retire. (United States)

    Coombs, Jennifer; Hooker, Roderick S; Brunisholz, Kim


    To determine predictors of physician assistants (PAs) to retire or to permanently leave clinical practice. The intent was to create a measure of retention and attrition for purposes of forecasting PA supply. All PAs 55 years or older who were nationally certified in 2011 were surveyed. Statistical analysis included descriptive measures utilizing means, standard deviations, range, and proportions for all survey questions. Univariable analysis using χ² test for the categorical variables determined gender differences in participants' intent to retire. A studentized t test analysis for continuous variables was used to compare differences across genders. The estimated time interval until retirement was calculated using reported values from participants and then subtracting their projected retirement age from current age. The same calculation was used for estimating PA career length from date of graduation to retirement. For all analyses, a P value surveyed online; 4767 responded (38%). The mean age was 60 years and the years in clinical practice was 25. When asked to predict a retirement date or age, the mean duration of working beyond age 55 years was 12 years (range 5 to 21). Most respondents reported being confident they were on track to retire with an adequate income. The significant differences that emerged were that men were more confident than women in preparing to retire, having enough money for medical expenses, and being able to live comfortably in retirement. Men more than women stated that, if forced to retire, they were more confident in the preparation to do so. PAs 55 years and older report they are likely to delay retirement from practice until age 67 years, on average. Women were less confident than men in retirement preparation. This age prediction expands career projections and refines forecasting models for the profession. Correlations based on expectation-action chain of events should be developed by periodically measuring how often intent and

  13. Can complexity science inform physician leadership development? (United States)

    Grady, Colleen Marie


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

  14. Useful but Different: Resident Physician Perceptions of Interprofessional Feedback. (United States)

    Vesel, Travis P; O'Brien, Bridget C; Henry, Duncan M; van Schaik, Sandrijn M


    Phenomenon: Based on recently formulated interprofessional core competencies, physicians are expected to incorporate feedback from other healthcare professionals. Based on social identity theory, physicians likely differentiate between feedback from members of their own profession and others. The current study examined residents' experiences with, and perceptions of, interprofessional feedback. In 2013, Anesthesia, Obstetrics-Gynecology, Pediatrics, and Psychiatry residents completed a survey including questions about frequency of feedback from different professionals and its perceived value (5-point scale). The authors performed an analysis of variance to examine interactions between residency program and profession of feedback provider. They conducted follow-up interviews with a subset of residents to explore reasons for residents' survey ratings. Fifty-two percent (131/254) of residents completed the survey, and 15 participated in interviews. Eighty percent of residents reported receiving written feedback from physicians, 26% from nurses, and less than 10% from other professions. There was a significant interaction between residency program and feedback provider profession, F(21, 847) = 3.82, p feedback provider profession, F(7, 847) = 73.7, p feedback from attending physicians higher than feedback from others, and anesthesia residents rated feedback from other professionals significantly lower than other residents. Ten major themes arose from qualitative data analysis, which revealed an overall positive attitude toward interprofessional feedback and clarified reasons behind residents' perceptions and identified barriers. Insights: Residents in our study reported limited exposure to interprofessional feedback and valued such feedback less than intraprofessional feedback. However, our data suggest opportunities exist for effective utilization of interprofessional feedback.

  15. Physicians' group seeks nuclear arms ban. (United States)

    Litwin, M S


    The history and recent activities of the International Physicians for the Prevention of Nuclear War (IPPNW) are reported. Founded in 1980 by cardiologists Bernard Lown of the United States and Eugene Chazov of the Soviet Union, the group has attracted well over 100,000 members from 51 countries. Following the organization's fifth congress in Budapest in June 1985, a four-city tour of the United States by three American and four Soviet physicians was co-sponsored by IPPNW, Physicians for Social Responsibility, and the Soviet Committee of Physicians for the Prevention of Nuclear War. Through separate lecture series aimed at physicians and laypersons, the doctors sought to persuade colleagues to take an active stand against nuclear war, and to increase public awareness of the medical realities of a nuclear attack. A similar tour of the Soviet Union is planned.

  16. Issues for the Traveling Team Physician. (United States)

    Kaeding, Christopher C; Borchers, James


    This article outlines the value of having the team physician traveling with athletes to away venues for competitions or training sessions. At present, this travel presents several issues for the team physician who crosses state lines for taking care of the athletes. In this article, these issues and their possible remedies are discussed. A concern for the travelling team physician is practicing medicine while caring for the team in a state where the physician is not licensed. Another issue can be the transportation of controlled substances in the course of providing optimal care for the team athletes. These two issues are regulatory and legislative issues at both the state and federal levels. On the practical side of being a team physician, the issues of emergency action plans, supplies, and when to transport injured or ill patients are also reviewed. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  17. Pharmaceutical marketing research and the prescribing physician. (United States)

    Greene, Jeremy A


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

  18. Dealing with ambiguity: Israeli physician's attitudes and practices regarding pre-exercise certificates: a questionnaire study. (United States)

    Hoffman, Robert D; Golan, Ron; Vinker, Shlomo


    modification of the law has made the need for standardization of the nature of what is expected of primary care physicians more urgent. A large portion of physicians exercise on a regular basis - and exercising physicians are more positive regarding pre-exercise certificates. Our study clearly shows a gap in knowledge transfer; and we call for a standardized approach to pre-exercise certificates utilizing computerized patient medical files.

  19. Selecting physician leaders for clinical service lines: critical success factors. (United States)

    Epstein, Andrew L; Bard, Marc A


    Clinical service lines and interdisciplinary centers have emerged as important strategic programs within academic health centers (AHCs). Effective physician leadership is significant to their success, but how these leaders are chosen has not been well studied. The authors conducted a study to identify current models for selecting the physician leaders of clinical service lines, determine critical success factors, and learn how the search process affected service line performance. In 2003 and 2004, the authors interviewed clinical and executive personnel involved in 14 programs to establish, or consider establishing, heart or cancer service lines, at 13 AHCs. The responses were coded to identify and analyze trends and themes. The key findings of the survey were (1) the goals and expectations that AHCs set for their service line leaders vary greatly, depending on both the strategic purpose of the service line in the AHC and the service line's stage of development, (2) the matrix organizational structure employed by most AHCs limits the leader's authority over necessary resources, and calls forth a variety of compensating strategies if the service line is to succeed, (3) the AHCs studied used relatively informal processes to identify, evaluate, and select service line leaders, and (4) the leader's job is vitally shaped by the AHC's strategic, structural, and political context, and selection criteria should be determined accordingly. Institutions should be explicit about the strategic purpose and stage of development of their clinical service lines and be clear about their expectations and requirements in hiring service line leaders.

  20. Optimal primitive reference frames

    International Nuclear Information System (INIS)

    Jennings, David


    We consider the smallest possible directional reference frames allowed and determine the best one can ever do in preserving quantum information in various scenarios. We find that for the preservation of a single spin state, two orthogonal spins are optimal primitive reference frames; and in a product state, they do approximately 22% as well as an infinite-sized classical frame. By adding a small amount of entanglement to the reference frame, this can be raised to 2(2/3) 5 =26%. Under the different criterion of entanglement preservation, a very similar optimal reference frame is found; however, this time it is for spins aligned at an optimal angle of 87 deg. In this case 24% of the negativity is preserved. The classical limit is considered numerically, and indicates under the criterion of entanglement preservation, that 90 deg. is selected out nonmonotonically, with a peak optimal angle of 96.5 deg. for L=3 spins.

  1. Reference Climatological Stations (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Reference Climatological Stations (RCS) network represents the first effort by NOAA to create and maintain a nationwide network of stations located only in areas...

  2. Toxicity Reference Database (United States)

    U.S. Environmental Protection Agency — The Toxicity Reference Database (ToxRefDB) contains approximately 30 years and $2 billion worth of animal studies. ToxRefDB allows scientists and the interested...

  3. Python essential reference

    CERN Document Server

    Beazley, David M


    Python Essential Reference is the definitive reference guide to the Python programming language — the one authoritative handbook that reliably untangles and explains both the core Python language and the most essential parts of the Python library. Designed for the professional programmer, the book is concise, to the point, and highly accessible. It also includes detailed information on the Python library and many advanced subjects that is not available in either the official Python documentation or any other single reference source. Thoroughly updated to reflect the significant new programming language features and library modules that have been introduced in Python 2.6 and Python 3, the fourth edition of Python Essential Reference is the definitive guide for programmers who need to modernize existing Python code or who are planning an eventual migration to Python 3. Programmers starting a new Python project will find detailed coverage of contemporary Python programming idioms.

  4. Collaborative networks: Reference modeling

    NARCIS (Netherlands)

    Camarinha-Matos, L.M.; Afsarmanesh, H.


    Collaborative Networks: Reference Modeling works to establish a theoretical foundation for Collaborative Networks. Particular emphasis is put on modeling multiple facets of collaborative networks and establishing a comprehensive modeling framework that captures and structures diverse perspectives of

  5. Ozone Standard Reference Photometer (United States)

    Federal Laboratory Consortium — The Standard Reference Photometer (SRP) Program began in the early 1980s as collaboration between NIST and the U.S. Environmental Protection Agency (EPA) to design,...

  6. Feasibility and acceptability of a workers' health surveillance program for hospital physicians. (United States)

    Ruitenburg, Martijn M; Plat, Marie-Christine J; Frings-Dresen, Monique H W; Sluiter, Judith K


    A Workers' Health Surveillance (WHS) program is an occupational health strategy used to detect and address the health of individual workers to improve their ability to work. This study aims to investigate the feasibility and acceptability of a new job-specific WHS for hospital physicians. All hospital physicians of the general surgery, radiotherapy and obstetrics and gynecology departments from 1 academic hospital were invited to participate in the WHS by the in-company occupational health service. An occupational physician and a medical assistant were trained to use the protocol. Feasibility was operationalized as the received and delivered dose, observed success factors and potential obstacles. Acceptability was assessed by asking whether the WHS was desirable and feasible for future use and by estimating the effects on health and work ability. Written questions and semi-structured interviews were conducted with the participating physicians, 5 department managers and the 2 occupational health professionals involved in the study. One-third of the hospital physicians (34%) participated in every part of the WHS. The delivered dose was 77/84 (92%). Almost all hospital physicians who received recommendations expected to adhere to this advice. The study participants appreciated the organization of the WHS. This WHS was positively graded (8 out of 10 max) in terms of acceptability. Positive effects of the WHS on health, work functioning and long-term work ability were perceived by 2/3 of the physicians. The new job-specific WHS for hospital physicians showed good feasibility and acceptability among participating hospital physicians, occupational health professionals and medical managers. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

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

    Directory of Open Access Journals (Sweden)

    Martijn M. Ruitenburg


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

  8. 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.

  9. Enterprise Reference Library (United States)

    Bickham, Grandin; Saile, Lynn; Havelka, Jacque; Fitts, Mary


    Introduction: Johnson Space Center (JSC) offers two extensive libraries that contain journals, research literature and electronic resources. Searching capabilities are available to those individuals residing onsite or through a librarian s search. Many individuals have rich collections of references, but no mechanisms to share reference libraries across researchers, projects, or directorates exist. Likewise, information regarding which references are provided to which individuals is not available, resulting in duplicate requests, redundant labor costs and associated copying fees. In addition, this tends to limit collaboration between colleagues and promotes the establishment of individual, unshared silos of information The Integrated Medical Model (IMM) team has utilized a centralized reference management tool during the development, test, and operational phases of this project. The Enterprise Reference Library project expands the capabilities developed for IMM to address the above issues and enhance collaboration across JSC. Method: After significant market analysis for a multi-user reference management tool, no available commercial tool was found to meet this need, so a software program was built around a commercial tool, Reference Manager 12 by The Thomson Corporation. A use case approach guided the requirements development phase. The premise of the design is that individuals use their own reference management software and export to SharePoint when their library is incorporated into the Enterprise Reference Library. This results in a searchable user-specific library application. An accompanying share folder will warehouse the electronic full-text articles, which allows the global user community to access full -text articles. Discussion: An enterprise reference library solution can provide a multidisciplinary collection of full text articles. This approach improves efficiency in obtaining and storing reference material while greatly reducing labor, purchasing and

  10. Physician training rotations in a large urban health department. (United States)

    Alkon, Ellen; Kim-Farley, Robert; Gunzenhauser, Jeffrey


    Hospitals are the normal setting for physician residency training within the United States. When a hospital cannot provide the specific training needed, a special rotation for that experience is arranged. Linkages between clinical and public health systems are vital to achieving improvements in overall health status in the United States. Nevertheless, most physicians in postgraduate residency programs receive neither training nor practical experience in the practice of public health. For many years, public health rotations have been available within the Los Angeles County Department of Public Health (and its antecedent organizations). Arrangements that existed with local medical schools for residents to rotate with Los Angeles County Department of Health hospitals were extended to include a public health rotation. A general model for the rotation ensured that each resident received education and training relevant to the clinician in practice. Some parts of the model for experience have changed over time while others have not. Also, the challenges and opportunities for both trainees and preceptors have evolved and varied over time. A logic model demonstrates the components and changes with the public health rotation. Changes included alterations in recruitment, expectations, evaluation, formal education, and concepts related to the experience. Changes in the rotation model occurred in the context of other major environmental changes such as new electronic technology, changing expectations for residents, and evolving health services and public health systems. Each impacted the public health rotation. The evaluation method developed included content tests, assessment of competencies by residents and preceptors, and satisfaction measures. Results from the evaluation showed increases in competency and a high level of satisfaction after a public health rotation. The article includes examples of challenges and benefits to a local health department in providing a public

  11. Comparability of reference values

    International Nuclear Information System (INIS)

    Rossbach, M.; Stoeppler, M.


    Harmonization of certified values in Reference Materials (RMs) can be carried out by applying nuclear analytical techniques to RMs of various matrix types and concentration levels. Although RMs generally should not be used as primary standards the cross evaluation of concentrations in RMs leads to better compatibility of reference values and thus to a greater agreement between analytical results from different laboratories using these RMs for instrument calibration and quality assurance. (orig.)

  12. Electronics engineer's reference book

    CERN Document Server

    Turner, L W


    Electronics Engineer's Reference Book, 4th Edition is a reference book for electronic engineers that reviews the knowledge and techniques in electronics engineering and covers topics ranging from basics to materials and components, devices, circuits, measurements, and applications. This edition is comprised of 27 chapters; the first of which presents general information on electronics engineering, including terminology, mathematical equations, mathematical signs and symbols, and Greek alphabet and symbols. Attention then turns to the history of electronics; electromagnetic and nuclear radiatio

  13. 2002 reference document

    International Nuclear Information System (INIS)


    This 2002 reference document of the group Areva, provides information on the society. Organized in seven chapters, it presents the persons responsible for the reference document and for auditing the financial statements, information pertaining to the transaction, general information on the company and share capital, information on company operation, changes and future prospects, assets, financial position, financial performance, information on company management and executive board and supervisory board, recent developments and future prospects. (A.L.B.)

  14. Reference Inflow Characterization for River Resource Reference Model (RM2)

    Energy Technology Data Exchange (ETDEWEB)

    Neary, Vincent S [ORNL


    Sandia National Laboratory (SNL) is leading an effort to develop reference models for marine and hydrokinetic technologies and wave and current energy resources. This effort will allow the refinement of technology design tools, accurate estimates of a baseline levelized cost of energy (LCoE), and the identification of the main cost drivers that need to be addressed to achieve a competitive LCoE. As part of this effort, Oak Ridge National Laboratory was charged with examining and reporting reference river inflow characteristics for reference model 2 (RM2). Published turbulent flow data from large rivers, a water supply canal and laboratory flumes, are reviewed to determine the range of velocities, turbulence intensities and turbulent stresses acting on hydrokinetic technologies, and also to evaluate the validity of classical models that describe the depth variation of the time-mean velocity and turbulent normal Reynolds stresses. The classical models are found to generally perform well in describing river inflow characteristics. A potential challenge in river inflow characterization, however, is the high variability of depth and flow over the design life of a hydrokinetic device. This variation can have significant effects on the inflow mean velocity and turbulence intensity experienced by stationary and bottom mounted hydrokinetic energy conversion devices, which requires further investigation, but are expected to have minimal effects on surface mounted devices like the vertical axis turbine device designed for RM2. A simple methodology for obtaining an approximate inflow characterization for surface deployed devices is developed using the relation umax=(7/6)V where V is the bulk velocity and umax is assumed to be the near-surface velocity. The application of this expression is recommended for deriving the local inflow velocity acting on the energy extraction planes of the RM2 vertical axis rotors, where V=Q/A can be calculated given a USGS gage flow time

  15. [Physician's professional retirement. Family dynamics]. (United States)

    Aguirre Gas, Héctor G


    Human beings have a natural resistance to think about their old age, both personally and professionally. Governments have targeted efforts to successfully prolong the life of the population, situation which already is a social and economic problem. “Old is a person with physical, intellectual and emotional limitations, who has a reduced autonomy and welfare, as a result of the years lived”. Not everyone ages at the same age; it will depend on health, habits, physical and intellectual activity, nutritional status, vices and attitude towards life. A physician may decide not to continue exercising medicine due to: health problems, because they do not want to, because they do not feel competent, because of the risk of having to deal with a complaint or a lawsuit, to have a new life project, or because they have no patients. The options available for a doctor at the time of retirement will depend on his/her age, health status, stage of the aging process: autonomy, dependency or old age; his/her physical and mental condition, professional development, economic situation and family environment. A doctor may remain independent, join another family or seek shelter in a retirement home.

  16. [Expectations and user experiences of older Roma women with health services in primary care]. (United States)

    Ramos-Morcillo, Antonio Jesús; Ruzafa-Martínez, María; Fernández-Salazar, Serafín; Del-Pino-Casado, Rafael


    To know the expectations and user experiences of older Roma women with health services in primary care (PC). Phenomenological qualitative study. Using focus groups (4-9 women/group) and semistructured interviews. Audio recorded from March to November 2011. Performed in Úbeda and Linares (Spain). Roma women over 50years. A purposive sample stratified by age and area of residence was carried out. Woman were recruited through community leaders. Process of qualitative content analysis: coding, triangulation, obtain and verify results. Supported whit the software Nvivo 8. Three focus groups and four interviews were conducted, including 23 women. The expectations for the PC are focus exclusively on their physician, being invisible other professionals. They look for a relationship with their physician based on trust. In their user experience with the PC coexist three types of user: who goes to their appointments, demands attention only in acute disease and does not attend appointments and reviews. There are socio-cultural factors related to accessibility. Older Roma women set their expectations and experiences with health service in PC around the binomial disease/physician. Expect attention based on trust and a high instrumentalization. A speech with signs of change directed towards a more active and demanding participation in PC services is observed. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  17. Helping Family Physicians Improve Their Cardiac Auscultation Skills with an Interactive CD-ROM. (United States)

    Roy, Douglas; Sargeant, Joan; Gray, Jean; Hoyt, Brian; Allen, Michael; Fleming, Michael


    Physicians (n=42) studied cardiac auscultation using a 15-hour CD-ROM program. Nine months later, 21 who completed a posttest showed significant improvement in identifying heart sounds. CDs were valued for opportunities to review material at an individual pace. Lack of computer skills hindered use. (Contains 26 references.) (SK)

  18. Expectations and perceptions of primary healthcare professionals regarding their own continuous education in Catalonia (Spain): a qualitative study. (United States)

    Mundet-Tuduri, Xavier; Crespo, Ramon; Fernandez-Coll, Ma Luisa; Saumell, Montserrat; Millan-Mata, Flor; Cardona, Àngels; Codern-Bové, Núria


    The planning and execution of continuous education in an organization that provides health services is a complex process. The objectives, learning sequences, and implementation strategies should all be oriented to improving the health of the population. The aim of this study was to analyse the expectations and perceptions of continuous educations by primary healthcare professionals (physicians and nurses) and identify aspects that hinder or encourage the process. A qualitative study with 5 focus groups made up of 25 primary healthcare professionals from the Catalan Health Institute, Barcelona (Catalonia, Spain). The focus groups were audio-recorded and the results transcribed. The analysis involved: a) Reading of the data looking for meanings b) Coding of the data by themes and extracting categories c) Reviewing and refining codes and categories d) Reconstruction of the data providing an explanatory framework for the meanings e) Discussion about the interpretations of the findings and f) Discussed with relevant professionals from PHC (physicians and nurses)"Data regarding thematic content were analyzed with the support of Atlasti 5.1 software. The health needs of the population were often at the core of the learning processes but the participants' views did not always spontaneously refer to improvements in these issues. Common themes that could hinder learning and where identified, including contextual aspects such as work constraints (timetables, places being covered during training) and funding policies. New learning strategies to improve the effectiveness of continuous education were proposed such as the exchange of knowledge, the activation of personal commitment to change, and the improvement of organizational aspects. The primary healthcare professionals in our study viewed continuous education as a professional necessity and would like to translate the knowledge acquired to improving the health of the population. Nevertheless, professional, structural, and

  19. Consumers' Attitudes and Their Inflation Expectations

    DEFF Research Database (Denmark)

    Ehrmann, Michael; Pfajfar, Damjan; Santoro, Emiliano


    situation, their purchasing attitudes, and their expectations about the macroeconomy. Respondents with current or expected financial difficulties and those with pessimistic attitudes about major purchases, income developments, or unemployment have a stronger upward bias than other households. However...

  20. Experiments on Expectations in Macroeconomics and Finance

    NARCIS (Netherlands)

    Assenza, Tiziana; Bao, Te; Hommes, Cars; Massaro, Domenico; Duffy, John

    Expectations play a crucial role in finance, macroeconomics, monetary economics, and fiscal policy. In the last decade a rapidly increasing number of laboratory experiments have been performed to study individual expectation formation, the interactions of individual forecasting rules, and the