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The authors sought to explore the implications of the Patient Protection and Affordable Care Act's establishment of Accountable Care Organizations (ACO). Summit participants, who discussed best practices and issues to be addressed when designing and implementing ACOs. Healthcare leaders from across the country in charge of running, developing, and/or implementing ACOs for health systems. Participants were asked to consider the challenges, benefits, and strategies to ACO implementation. [ABSTRACT FROM AUTHOR]

This paper reviews the use of psychotherapeutic approaches to treat individuals who have committed sex crimes and/or have problematic sexual interests (PSI); including types of psychotherapy used, descriptions of preventive and reintegration programmes, and highlighting specific theoretical controversies. In the second part, experts from Canada, the Czech Republic, Russia, the United Kingdom, and the United States, who participated in an International Consensus Meeting held in Prague (2017), summarize treatment programmes in their countries. The comparison revealed some general findings: each country has variability between its own programmes; most countries have different programmes for people who are in custody and who are in the community; the state-directed treatment programmes are primarily focused on criminal individuals, while non-criminal individuals are treated in preventive programmes and/or in special clinics or are untreated; the presence of PSI in patients is acknowledged in most programmes, although specific programmes exclusively for individuals with PSI rarely exist. Studies on effectiveness are difficult to compare due to methodologic, political, and cultural differences. Further communication between more countries to share knowledge about successful treatments and preventive approaches is needed, especially enhanced international collaboration between researchers and clinicians to verify the effectiveness of current clinical and experimental program, rs. [ABSTRACT FROM AUTHOR]

Background: Electronic health records (EHRs) are structured, distributed documentation systems that differ from paper charts. These systems require skills not traditionally used to navigate a paper chart and to produce a written clinic note. Despite these differences, little attention has been given to physicians' electronic health record (EHR)-writing and -reading competence. Purposes: This study aims to investigate physicians' self-assessed competence to document and to read EHR notes; writing and reading preferences in an EHR; and demographic characteristics associated with their perceived EHR ability and preference. Methods: Fourteen 5-point Likert scale items, based on EHR system characteristics and a literature review, were developed to measure EHR-writing and -reading competence and preference. Physicians in the midwest region of the United States were invited via e-mail to complete the survey online from February to April 2011. Factor analysis and reliability testing were conducted to provide validity and reliability of the instrument. Correlation and regression analysis were conducted to pursue answers to the research questions. Results: Ninety-one physicians (12.5%), from general and specialty fields, working in inpatient and outpatient settings, participated in the survey. Despite over 3 years of EHR experience, respondents perceived themselves to be incompetent in EHR writing and reading (Mean=2.74, SD=0.76). They preferred to read succinct, narrative notes in EHR systems. However, physicians with higher perceived EHR-writing and -reading competence had less preference toward reading succinct (r=-0.33, p<0.001) and narrative (r=-0.36, p<0.001) EHR notes than physicians with lower perceived EHR competence. Physicians' perceived EHRwriting and - reading competence was strongly related to their EHR navigation skills (r=0.55, p<0.0001). Conclusions: Writing and reading EHR documentation is different for physicians. Maximizing navigation skills can optimize non-linear EHR writing and reading. Pedagogical questions remain related to how physicians and medical students are able to retrieve correct information effectively and to understand thought patterns in collectively lengthier and sometimes fragmented EHR chart notes. [ABSTRACT FROM AUTHOR]

This paper examines the feasibility of achieving U.S. health care reform and prognosis for success. In order to accomplish the task, this paper provides a check list of major problems which emerge continually in the field. In compiling a list of major problems, a tentative list of eight are presented. These problems include the following: unnecessary administrative costs; other major industrial countries can provide adequate health care at a lower rate of the national budget than does the U.S.; increase in malpractice insurance; shortage of primary care physicians in the rural and inner city areas; failure of health insurance; abundance of technology; distribution of care; and increase in health care costs. According to the author, these eight major problems give some indication to the complexity of the issues involved in the health care reform. These problems should be viewed in the context of the five major participant groups in health care: consumers, politicians, physicians and other health care providers, employers, and insurance companies. This paper briefly discusses the affected participants. It also provides a brief review of the proposed solutions to the problem of health care reform.

This article presents emerging findings from the first year of a two-year study, which employed ethnographic methods to explore the culture of interprofessional collaboration (IPC) and family member involvement in eight North American intensive care units (ICUs). The study utilized a comparative ethnographic approach - gathering observation, interview and documentary data relating to the behaviors and attitudes of healthcare providers and family members across several sites. In total, 504 hours of ICU-based observational data were gathered over a 12-month period in four ICUs based in two US cities. In addition, 56 semi-structured interviews were undertaken with a range of ICU staff (e.g. nurses, doctors and pharmacists) and family members. Documentary data (e.g. clinical guidelines and unit policies) were also collected to help develop an insight into how the different sites engaged organizationally with IPC and family member involvement. Directed content analysis enabled the identification and categorization of major themes within the data. An interprofessional conceptual framework was utilized to help frame the coding for the analysis. The preliminary findings presented in this paper illuminate a number of issues related to the nature of IPC and family member involvement within an ICU context. These findings are discussed in relation to the wider interprofessional and health services literature. [ABSTRACT FROM AUTHOR]

To promote clinical and patient oriented research, as part of the Second International ALS Conference in Tarrytown, NY, USA, seven pairs of clinicians and scientists were asked to lead discussions with meeting attendees on six major topics (one of which was discussed by two groups); each one the focus of a 90-min Breakout Session. Approximately 25 meeting attendees participated in each session. The Breakout Sessions considered six major themes: 1) Approaches to encourage clinicians to engage in more clinical research to discover the pathogenesis and cause of ALS; 2) Exploring avenues to build more effective partnerships between basic scientists and ALS physicians; 3) Increasing patient interest and commitment to participating in non-trial clinical research; 4) Brainstorming about factors that are most critical to the discovery of the pathogenesis and cause of ALS; 5) Finding ways to incorporate clinical research projects into clinical trials; and 6) Developing state-of-the-art epidemiological studies to solve the mystery of ALS. In this paper, we present the reports from each of the Breakout Sessions; and we provide a wrap-up of the entire conference. [ABSTRACT FROM AUTHOR]

Disparities in access to health care also extend to the end-of-life care. Despite the general principle that palliative care is equitably available for all in need, it remains underutilised by certain groups in the community. Ethnic minorities, older people and patients with non-cancer diseases are found to be at a greatest risk for underutilisation of palliative care. Barriers to access palliative care by these groups in the community are complex and often overlapping. To overcome these barriers, there is a need to take action on many fronts. This paper discusses these barriers and provides an overview of the strategies that have been implemented to address these issues. [ABSTRACT FROM AUTHOR]

Prescription drug abuse is a major worldwide problem and its incidence is on the rise, resulting in a huge societal cost. Prescription drug monitoring programs (PDMPs) are electronic databases that collect data on controlled substances so that health care providers can access the data and deter abuse, doctor shopping, and diversion. Currently only a few countries, including the United States and France, have operational PDMPs. The purpose of this paper is to review the literature on prescription drug monitoring programs. There is a paucity of research articles in this area; only 11 articles were published on this topic and relevant in the last ten years. Four themes were identified, (1) the effect of PDMPs on prescribing practices and the effect of PDMPs on the public, (2) the effect of PDMPs on prescribing practices and multiple provider episodes, (3) the effect of PDMPs on prescribing practices and characteristics of patients, and (4) health care professionals' perspectives on PDMPs. Studies have shown that PDMPs decrease diversion and doctor shopping. Despite implementation of PDMPs, prescription drug rates for controlled substances and abuse rates have risen. There is an urgent need for understanding and research on this topic so that action can be taken. [ABSTRACT FROM AUTHOR]

Information about several papers discussed at a symposium held in May 20, 2011, sponsored by Southern Illinois University School of Law in Carbondale, Illinois, on health law and policy of the U.S. is presented. Topics include provider data reporting, provider accountability and health care quality is presented. The symposium featured several nationally noted speakers including David C. Pate, Mark Rust and Kristin Madison.

This case study was designed to identify possible independent variables in relation to communication patterns within a constant set of cultural values. The convenience sample included 53 physicians with a 100 percent response rate. Cultural values were identified using the Hofstede cultural dimensions and through self report data. Individual level differences were measured using a series of pen and paper assessments. These included locus of control, self-monitoring, and an emotional intelligence (EI) assessment. The physicians recently completed the Meyers Briggs Type Indicator® instrument. Participants viewed a videoclip and were asked to answer four questions relating to communication patterns within the clip. These results were then analyzed with the individual level differences, along with the gender and age data using correlational analysis. The results were used to develop a Values-Based EI Behavioral Model (VEB) in which EI plays a key role. [ABSTRACT FROM AUTHOR]

Background: Global shortages of healthcare workers in both developed and developing countries are of great concern. Research on physician migration typically focuses on medical school graduates, most often those seeking postgraduate training opportunities elsewhere. Description: An overview of medical school migration patterns is presented in this paper. To put this phenomenon into the broader context of global physician migration, data is also presented on the distribution of medical schools, physician density, the flow of international medical graduates to the US, and the present composition of the US physician workforce. Results: Results of the study indicate that many individuals leave their home country for undergraduate medical education. Conclusions: Given the movement of students and physicians, both for medical school and for advanced training opportunities, it is evident that some medical schools in the world are training doctors for their home country as well as for the international labor market. Overall, given the internationalization of medical education, collaborative efforts will be needed to develop an adequate, balanced, and well-trained global physician workforce. [ABSTRACT FROM AUTHOR]

Although the physician assistant profession has historically been male-dominated, women now comprise over sixty percent of physician assistants (PAs) in the U.S. This paper explores the reason for the increase of women into the physician assistant profession in recent decades and whether gender differences exist in how PAs are utilized. Twenty-one qualitative interviews with male and female physician assistants and key informants were conducted to assess the reasons for the influx of women. In addition, data from the American Academy of Physician Assistants Census Survey (n = 16,569) were analyzed to assess current gender differences in employment characteristics of PAs. In the interviews, female PAs reported entering the profession because it allowed them to practice within the medical model without having the high expense and demanding schedule of medical school. In fact, they claimed that the profession was quite compatible with family life. Significant gender differences were found in work characteristics, primary employer type, and practice specialty. Although women tend to concentrate in practice areas of women and children's health, evidence suggests that they are moving beyond these traditional roles into areas such as internal medicine and surgery. [ABSTRACT FROM AUTHOR]

One of the earliest papers describing a case of what came to be known as myasthenia gravis was written in 1892 in the German language by an American, Herman Hoppe, who at the time was an assistant in the Berlin polyclinic of the prominent German neurologist, Hermann Oppenheim's instigation, Hoppe published the pathology of a case that Oppenheim had diagnosed during life; he collected all the reported similar cases and tried to establish a symptom-complex, for which he was given crdit in Oppenheim's great neurology textbook of 1894. Upon his return to Cincinnati, Ohio, Hoppe's European experience qualified him as a specialist in nervous and mental diseases. His private practice of "neuropsychiatry" was his main occupation, but he also volunteered to teach as Professor of Nervous and Mental Diseases at the University of Cincinnati. In 1901 Oppenheim published the first monograph about what he called " Die Myasthenische Paralyse (Bulbarparalyse ohne anatomischen Befund)", summarizing 60 cases described in the medical literature up to that time. Hoppe, on the other hand, wrote on myasthenia gravis only ones again, a review article in 1914 in a Cincinnati weekly, giving Oppenheim credit for the establishment of the disease as a clinical entity. [ABSTRACT FROM AUTHOR]

America's physicians are ill-prepared for the surge of geriatric patients that will overwhelm the medical system in the near future. The combination of inadequate undergraduate medical training in geriatrics, insufficient numbers of geriatric faculty to serve as mentors, and lack of incentives for medical students considering geriatrics as a field have resulted in graduate geriatric positions going unfilled. This paper discusses the growing need for comprehensive geriatric training and presents geriatric training initiatives that have been funded at the federal and state level, in addition to programs being funded by private foundations. Recommendations focus on enhancing the attractiveness of geriatrics, expanding geriatric curriculum in undergraduate medical education, increasing clinical exposure to elderly patients in graduate medical education, expanding career development opportunities for faculty in geriatrics, expanding funding for training and research, and reformingMedicare's payment system. [ABSTRACT FROM PUBLISHER]

Health care consumers often need information about the quality of health services provided by specific facilities and health professionals. A growing number of Web sites are meeting consumers' needs for quality-related information. These sites offer a wide array of information, ranging from traditional directory information to comparative data and records of personal experiences. This paper provides a selective review of Web sites that offer information on the quality of health services delivered by specific physicians and facilities in the United States. [ABSTRACT FROM PUBLISHER]

Benson's taxonomy of alexia and agraphia is presented. Clinical characterization of the di erent alexias is reviewed. It is pointed out that Benson rightfully insisted on the following facts: A past history of developmental dyslexia may have a strong impact on the clinical manifestations of acquired dyslexia and dysgraphia; clinical evidence can also vary from one writing system to another; and recovery of acquired reading and writing disorders is in certain cases related to a takeover of the right hemisphere. An attempt at reconciliating neurosciences and cognitive sciences is introduced in the second section of the paper. A model for reading aloud and a model for writing to dictation are presented. It is proposed that there are three manners of reading and writing related to occipital frontal interactions for reading aloud and retrorolandic frontal interactions for writing. Finally, occipital alexia, parietal-temporal alexia, frontal alexia and agraphia are examined from both the neuroscience point of view and from the cognitive sciences perspective. [ABSTRACT FROM AUTHOR]

This paper examines the struggle for power in the U.S. hospital industry as occurring among three dominant forces: the physician group, the federal government as exerted through their hospital reimbursement mechanism and the hospital industry as exerted through the hospital administrative control mechanisms. Dependency is the obverse of power and an organization has power relative to an element of its task environment in relation to its ability to satisfy those needs. Physicians claim authority through skill in performing an intangible service and also by the capacity to judge the needs of the patient on an abstract basis. Factors in the external environment account for physicians' control and power in hospital organizations. There has been a hierarchy of health care workers in which parallels the social hierarchies of the time through the ages. In the last part of the nineteenth century, the medical profession in the U.S. also faced a lack of public confidence in the effectiveness of their services. The passage in 1947 of the Hill-Burton Act which provided for hospital construction and modernization marked the entrance of state and federal governments as principal powers in the medical care system. Physicians play a major role in analyzing which practice patterns in their hospitals are inefficient.