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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]

As the United States Navy transitions from Operation Iraqi Freedom/Operation Enduring Freedom to preparing for a near-peer competition, an increasing focus of wartime strategy relies upon a network of distributed naval assets for total sea control, known as Distributed Maritime Operations (DMO). Historically, embedded medical personnel have provided care at sea in times of war. Recent reviews of shipboard and evacuated mass casualty incidents have alluded to weaknesses in the existing Navy Medicine approach that will require advances in care provision to sustain high-quality care that would benefit from industry and civilian academic collaboration. To gain input from civilian prehospital expertise and insight, the current DMO and Navy En-Route Care (ERC) systems must be plainly described for non-Navy military and civilian leaders, clinicians, and researchers to understand. N/A In this review, we translate US Navy structure and vernacular into common civilian and non-Navy language, describe the maritime role-tiered ERC system, elucidate the medical assets on each naval warship, and discuss clinician levels and capabilities while deployed to help communicate the inherent challenges of US Navy maritime medical care during routine operations, casualty treatment, stabilization, and evacuation. We describe the roles of care, clinician levels, and medical assets within the Navy ERC system for researchers and military leaders who aim to mitigate the inherent challenges of future maritime trauma care in the age of Distributed Maritime Operations. This paper lays the framework of the Navy deployed medical system to enable research in maritime en-route care, and prompt inclusion of identified solutions into common use in the US Navy. [ABSTRACT FROM AUTHOR]

More than 60% of physicians in the U.S. practice as small healthcare providers. The realm of small healthcare providers includes dental offices, orthodontists, chiropractors, massage therapists, optometrists, long-term care facilities and other small, independent clinics that typically have 1 –30 employees. While studies have reported variable levels of Health Insurance Portability and Accountability Act (HIPAA) information security (InfoSec) compliance among hospitals and large medical facilities (Anthony DL, Appari A, Johnson ME. Institutionalizing HIPAA compliance: Organizations and competing logics in U.S. health care. J Health Soc Behav 2014;55(1):108–24; Brady, JW. Securing health care: Assessing factors that affect HIPAA security compliance in academic medical centers. Proceedings of the 2011 44th Hawaii International Conference on System Sciences, Manoa, Hawaii; 2011.), small healthcare providers face even more challenges in their effort to be HIPAA compliant. This paper will use a case study to examine factors that affect the small healthcare providers’ effort in meeting HIPAA InfoSec compliance. The paper also discusses services and technologies available to them to become compliant and how they can maintain continued compliance once they become compliant. Both a process model and an action compass are proposed to guide small healthcare providers. This case study provides support to existing compliance theories. The proposed guidance is useful for not only small healthcare providers but also mid-sized and large businesses in general. [ABSTRACT FROM PUBLISHER]

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]

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 considers global diversity management in relation to migration from Africa, specifically Nigeria, of doctors to the UK and the USA. It seeks to demonstrate the importance of global diversity strategies for African countries, often driven by ethnic tensions. It argues that these tensions play their part in the decisions to migrate. It also brings in the triadic relationships to global diversity analysis and demonstrates that diasporic professional groups play often hidden roles in the diversity structures of the destination country and provide important means of connecting with their country of origin. [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]

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]

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]

Over the past 10 years, European pharmaceutical regulators (especially the European Medicines Agency [EMA]) have enacted a wave of transparency policies. Since 2010, the overwhelming majority have focused on releasing more scientific medicines information online and providing open access to regulatory data. Amongst other benefits, EMA expects its policies to build public trust and provide outsiders with a better understanding of regulatory decision-making. Yet, few studies have empirically examined the EMA’s transparency policies, especially on the end users of ‘transparent’ information (e.g. medical doctors or patients). This paper presents standout findings from a November 2014 survey conducted in Spain, Germany, France and the United Kingdom with a sample of 1005 general practitioners and medical specialists treating either multiple sclerosis, rheumatoid arthritis, osteoporosis, idiopathic pulmonary fibrosis or HIV/AIDS. The study found that 76% of respondents think it is a bad idea to release information into the public domain before possible safety issues have been investigated by the regulators and (relevant) pharmaceutical company. The results also suggested that medical doctors in Europe have a poor understanding of pharmaceutical regulatory activities. In particular, the majority were largely unaware of the current activities of the EMA, did not have good knowledge of how the regulators assess the safety of medicines (e.g. only 17% said they had good knowledge of how EMA assess the safety of medicines) and were unfamiliar with regulatory documents frequently used by regulators and industry to discuss the safety of medicines (e.g. in approving a medicine). [ABSTRACT FROM PUBLISHER]

With the rise of clinical management, new skills of medical doctors stand out, including leadership skills. Medical doctors organize medical work and improve patient care. The training of frontline leadership skills, however, is weakly developed in residency programmes. Medical professional cultures tend to resist organizational techniques and values. This paper analyses cultural interventions in health-care organizations, aimed at overcoming ‘clashes’ between professional and organizational logics in frontline domains. These interventions do not work against, but ‘use’ professional traditions, styles and customs as cultural resources. We use one particular project to illustrate this, a project in which internal medicine residents are invited to join quality improvement sessions, during which they identify critical (organizational) experiences with care provision and realize change. We show how residents feel enabled to establish results and cooperate with other professionals. We also show how this project links organizational responsibilities and medical professionalism – how complementarity (instead of conflict) is established. This is done in practical ways, which commit instead of alienate medical professionals. [ABSTRACT FROM PUBLISHER]

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]

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]

The purpose of this paper is to review the billing methodology of physicians that participate in fee-for-service plans, and, using a data set of billing charges, determine the significance of the variation in fees by providers of certain kind of procedures. Providers use cost-plus pricing and take into account the medical aspects of the services and market forces. Using the Current Procedural Terminologies (CPT) established by the American Medical Association, the providers define the medical services by the six digit CPT code, and bill accordingly. The statistical evidence shows that there is some evidence that fees of providers who bill under the 'medicine' codes tend to exhibit more variation in charges than other procedures. [ABSTRACT FROM AUTHOR]

The prescribing of pharmaceuticals by health care providers is influenced by many factors. The significance of these factors is an important consideration to public health advocates and government agencies, health insurance companies, pharmaceutical firms, physician and provider associations, medical ethics researchers, patient consumers, and other stakeholders in health care. Better understanding the factors that motivate physician prescribing can bring about more efficient use of health care resources through the improved dissemination of information and more informed decision making. This paper attempts to provide a sound and inclusive review of the influences upon physician prescribing patterns in the extant literature. This review identifies several factors as being highly influential upon physician prescribing: peer influence, financial and managed care considerations, pharmaceutical representatives and drug samples, and direct-to-consumer advertising. To date, several key areas have not been well researched; these include the perceived price of a drug, the role of new technology, and the impact of physician experience. Based upon the literature review, a theoretical model of individual physician prescribing in the outpatient setting is proposed. Further research might be directed toward determining the influence of each factor upon physician prescribing and testing the overall model and interactions among its individual components. [ABSTRACT FROM PUBLISHER]

Comments on a study by R. M. Werner and colleagues, which examined issues relating to the use of deception by physicians to get an insurance company to pay for a medical procedure. Percentage of physicians in the U.S. who had supported misrepresentation of facts given to insurance companies; Ethical implications of the deceptive approach to health insurance; Arguments concerning the health care system in the U.S.

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]

The #DoctorsSpeakUp hashtag, which was designed by physicians to collectively promote vaccines on Twitter in Spring of 2020, was hijacked by anti-vaccine advocates. Through the lens of counterpublic sphere theory, thematic analysis revealed that the hashtag hijacking by a scientific counterpublic was successful, and the majority of #DoctorsSpeakUp tweets were oriented against vaccines. Five overarching themes emerged in anti-vaccine hijacked tweets, including: personal experience with vaccine injury, profits over people, lack of liability, perception that doctors are uninformed, and 'We are the Herd.' In contrast, fewer than 17% of tweets originated from pro-vaccine doctors who openly identified themselves as such in their tweets or profiles. Thus, using the #DoctorsSpeakUp hashtag, anti-vaccine advocates dominated the discourse, which speaks to the communication dynamics afforded within the information ecosystem of a social network. Hashtag activism can connect individuals and promote grassroots movements but may also backfire, allowing a vocal minority of individuals to shout the loudest through the digital megaphone. [ABSTRACT FROM AUTHOR]

Background: Little is known about the experiences of transgender and gender non-binary (TNB) physicians in medical residency training programs. Aim: To identify the self-reported experiences and needs of TNB individuals during medical residency in United States training programs. Methods: An online, anonymous survey of TNB current residents and recent graduates was designed. Results: A total of 26 respondents completed the survey. The most common reported gender identity was non-binary or gender queer (n = 11, 42.3%) and male or transgender man (n = 7, 26.9%). About half of participants (n = 14, 53.8%) had undergone gender affirming interventions prior to residency. Most participants (n = 19, 73.1%) did not know all the gender affirming healthcare benefits offered by their program. The majority (n = 21, 80.8%) also reported 2 hours or less of transgender-related didactics in residency. Respondents were most likely to disclose their gender identity to other residents (n = 19, 73.1%) and faculty (n = 19, 73.1%) and were least likely to disclose their identity to patients (n = 6, 23.1%). Most respondents (n = 15, 57.7%) stated that program faculty and staff communicated support for their gender identity. Most participants (n = 16, 61.5%) reported that they perceived transgender residents to be treated similarly to their non-transgender peers in their training program, while the remainder (n = 7, 26.9%) disagreed or strongly disagreed. Nevertheless, approximately three-quarters of trainees (n = 22, 84.6%) self-reported microaggressions during their training program and non-binary and transfeminine trainees were more likely to report these experiences than transmasculine people. Nearly a quarter of transfeminine and non-binary participants reported macroaggressions, with none of the transmasculine respondents reporting these negative experiences. Most macroaggressions were from program faculty. Discussion: This study highlights that while most physicians in residency report support from their program for their TNB identity, TNB physicians still experience significant barriers and prejudices throughout training and more action is needed among program faculty for support of TNB trainees. [ABSTRACT FROM AUTHOR]

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 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.

Unlike recent studies that arc based on international cross-sectional series, this paper attempts to quantify the role of the determinants of aggregate health care expenditure per capita, using time-series data for the period of 1960-87 for the United States The paper applies the relatively new procedures of unit root testing, cointegration and error-correction modeling The evidence supports cointegration Although, the results indicate that per capita income, age of the population, number of practising physicians, and public financing of health care are important determinants, the age structure of the population and number of practising physicians emerge as the major determinants of aggregate health care expenditure in the United States [ABSTRACT FROM AUTHOR]

This paper examines the impact of the 1965 liberalization of immigration restrictions on the market for physician services in the United States. Estimates of the effect of physician migration on consumer surplus and physician earnings are calculated for the period beginning in 1966 and ending in 1971. A conservative estimate is that the dollar value of the benefits to consumers from unrestricted migration over the six-year period had reached 2.9 billion dollars (in 1967 dollars) by 1971. Measured as a percentage of total expenditures on physician services, the gain to consumers ranges from near 1% in 1966 to over 12% by 1971. A conservative estimate is that physician earnings would have been 11% higher by 1971 had there been no change in migration restrictions in 1965. As an empirical contribution to the debate over physician migration, the estimates presented in this paper give a rough idea of the magnitude of the dollar values involved when migration restrictions are liberalized during a period of rapid growth in demand. [ABSTRACT FROM AUTHOR]

This study offers an example of how a specific quantifiable proposition can be derived from the labeling perspective. The paper examines the usefulness of labeling theory in explaining the relationship between the distribution of medical manpower and rates of "blindness." If, as labeling theory suggests, deviance is in the "eye of the beholder," it is reasonable to expect that rates of deviance will depend, in part, on the number of official "beholders" in the community. In New York State, all physicians and optometrists are required, by law, to report the names of blind patients to the state Department of Social Services. The results of a multivariate analysis indicate that rates of medical manpower have a small, but statistically significant effect on county rates of blindness. Rates of medical manpower, however, do not have a similar effect on most other measures of county mortality and morbidity. This suggests that the relationship between blindness and manpower rates is better explained by a labeling perspective than by the traditional medical manpower model. [ABSTRACT FROM AUTHOR]

Contemporary state-of-the-art healthcare facilities are incorporating technology into their building design to improve communication and patient care. However, technological innovations may also have unintended consequences. This study seeks to better understand how technology influences interprofessional communication within a hospital setting based in the United States. Nine focus groups were conducted including a range of healthcare professions. The focus groups explored practitioners’ experiences working on two floors of a newly designed hospital and included questions about the ways in which technology shaped communication with other healthcare professionals. All focus groups were recorded, transcribed, and coded to identify themes. Participant responses focused on the electronic medical record, and while some benefits of the electronic medical record were discussed, participants indicated use of the electronic medical record has resulted in a reduction of in-person communication. Different charting approaches resulted in barriers to communication between specialties and reduced confidence that other practitioners had received one’s notes. Limitations in technology—including limited computer availability, documentation complexity, and sluggish sign-in processes—also were identified as barriers to effective and timely communication between practitioners. Given the ways in which technology shapes interprofessional communication, future research should explore how to create standardised electronic medical record use across professions at the optimal level to support communication and patient care. [ABSTRACT FROM PUBLISHER]

An online survey of 691 clinicians who use hypnosis was conducted in 31 countries to gain a broad real-world picture of current practices, views, and experiences in clinical hypnosis. Among 36 common clinical uses, stress reduction, wellbeing and self-esteem-enhancement, surgery preparations, anxiety interventions, mindfulness facilitation, and labor and childbirth applications were the most frequently rated as highly effective (each by ≥70% of raters) in the clinicians' own experience. Adverse hypnosis-associated effects had been encountered by 55% of clinicians but were generally short-lived and very rarely judged as serious. The most common hypnosis approaches used were Ericksonian (71%), hypnotic relaxation therapy (55%), and traditional hypnosis (50%). Almost all respondents reported regularly using other therapeutic modalities alongside hypnosis. Among a range of client variables potentially affecting therapy, most clinicians rated hypnotist-client rapport (88%) and client motivation (75%) as very or extremely important factors for successful hypnotherapy. The majority of respondents had conducted hypnosis treatment via teletherapy, and 54% of those estimated it to be as effective as in-person treatment. [ABSTRACT FROM AUTHOR]

The authors comment on the article "Slowing the Slide Down th Slippery Slope of Medical Assistance in Dying: Mutual Learnings for Canada and the US" by Daryl Pullman which uses a rhetorical device to immediately bias readers toward perceiving the increasing sanctioning of medical assistance in dying (MAiD) in Canada as descent into immoral nether regions. Topics include the MAiD legislation in the U.S. and their agreement with Pullman that decisions concerning MAiD are complicated.

We analyze gender and racial disparities in academic otolaryngology from 2007 to 2018 in the United States (US). A cross-sectional retrospective analysis was done using data from the American Association of Medical Colleges. The distribution of gender and race, academic ranks, tenure tracks, and degrees was reported. The total number of otolaryngologists increased from 1,490 to 2,239, where 53 percent were females. All races experienced an increase; however, Whites and Asians had a greater increase compared to Black and Hispanics. Regarding percentages at different ranks, White were the majority (>50 percent) in every category. As for tenure, the general trend was a decrease in the total number of tenured physicians from 327 in 2007 to 318 in 2018, where Black, Hispanic, and Asian tenured physicians increased, while White tenured physicians decreased. White male otolaryngologists were the majority for every subgroup (>60 percent), whereas Black faculty made up less than 1 percent of tenured category. Female representation gradually increased for all levels of tenure. As for all degrees, Whites were the majority for all levels of education (>60 percent). There were some improvements in the representations for the females in all and Asians on the tenure track. However, progress for the URM remains an elusive dream. [ABSTRACT FROM AUTHOR]

Issue: As U.S. healthcare systems plan for future physician workforce needs, the systemic impacts of climate change, a worldwide environmental and health crisis, have not been factored in. The current focus on increasing the number of trained physicians and optimizing efficiencies in healthcare delivery may be insufficient. Graduate medical education (GME) priorities and training should be considered in order to prepare a climate-educated physician workforce. Evidence: We used a holistic lens to explore the available literature regarding the intersection of future physician workforce needs, GME program priorities, and resident education within the larger context of climate change. Our interinstitutional, transdisciplinary team brought perspectives from their own fields, including climate science, climate and health research, and medical education to provide recommendations for building a climate-educated physician workforce. Implications: Acknowledging and preparing for the effects of climate change on the physician workforce will require identification of workforce gaps, changes to GME program priorities, and education of trainees on the health and societal impacts of climate change. Alignment of GME training with workforce considerations and climate action and adaptation initiatives will be critical in ensuring the U.S. has a climate-educated physician workforce capable of addressing health and healthcare system challenges. This article offers a number of recommendations for physician workforce priorities, resident education, and system-level changes to better prepare for the health and health system impacts of climate change. [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.

Most of the estimated 4.5 million Americans who currently suffer from Alzheimer's disease are cared for by primary care physicians rather than geriatric or other specialists. Although clinical practice guidelines provide evidence-based recommendations for diagnosing and managing dementia, a number of barriers prevent their implementation in the primary care setting. These barriers include the nature of dementing illness which make its symptoms difficult to recognize and respond to, time and other constraints in the primary care setting, and physician attitudes. As well as presenting sound evidence-based knowledge, effective medical education programs must use effective educational approaches and must seek strategies to overcome these barriers. [ABSTRACT FROM AUTHOR]

Language and ethnicity are parts of the interpersonal process that converge during psychiatric diagnosis, affecting diagnostic accuracy and concordance among clinicians. In this feasibility study, the authors videotaped two Hispanic psychiatrists conducting typical diagnostic interviews with first-time Hispanic patients (N = 10) in a community mental health clinic. Then, two non-Hispanic psychiatrists viewed the videotapes with translator assistance. All psychiatrists rendered DSM-IV diagnoses on the patients they interviewed or whose tapes they watched. On Axis 1, psychiatrists did not differ, diagnosing mostly mood disorders. On Axis II, non-Hispanic psychiatrists diagnosed personality disorders more often. On Axis IV, Hispanic psychiatrists identified more psychosocial stressors, especially family-related ones. On Axis V, Hispanic psychiatrists rated patients more functionally impaired. Although limited, the findings raise several interesting questions that can he useful to clinicians and researchers diagnosing patients from their own or a different culture. Are Axis I diagnoses less subject to cultural biases than Axis II personality disorders? Does cultural proximity between patient and clinician add sensitivity to psychosocial stressors while holding patients to higher functional standards? [ABSTRACT FROM AUTHOR]

A challenging obstacle to primary health care in the United States (US) is patient no-shows or missed appointments. The no-show rate can vary from 5.5% to 50%. A no-show may contribute to increased health risks, poor continuity of care, and loss of revenue. In this study, we develop and test a predictive model of patient visits. Retrospective regression analyzed patient visits in 2014 and 2015. Dependent variables were month, day, age, gender, race, ethnicity, insurance type, visit type, and the number of previous no-shows. A threshold for classifying no-shows was determined. The model was prospectively tested on patient visits in 2016. Significant variables included age, visit type, insurance, and number of previous no-shows. The model performed at 47% sensitivity and 79% specificity. The receiver operating characteristic (ROC) area under curve (AUC) was 0.72 (95% CI, 0.69–0.76) for the model and 0.70 (95% CI, 0.65–0.74) for prospective analysis. Simulated overbooking with the model resulted in 3.67 vs. 6.87 unused appointments, P < 0.000 (mean diff 3.2, 95% CI, 2.9–3.5). It is feasible to develop and implement a predictive model for single physician practices and implementation may improve practice efficiency. [ABSTRACT FROM AUTHOR]

Patients with end-stage liver disease (ESLD) have impaired physical, psychological, and social functions, which can diminish patient quality of life, burden family caregivers, and increase health-care utilization. For those with a life expectancy of less than six months, these impairments and their downstream effects can be addressed effectively through high-quality hospice care, delivered by multidisciplinary teams and focused on the physical, emotional, social, and spiritual wellbeing of patients and caregivers, with a goal of improving quality of life. In this review, we examine the evidence supporting hospice for ESLD, we compare this evidence to that supporting hospice more broadly, and we identify potential criteria that may be useful in determining hospice appropriateness. Despite the potential for hospice to improve care for those at the end of life, it is underutilized for patients with ESLD. Increasing the appropriate utilization of hospice for ESLD requires a better understanding of patient eligibility, which can be based on predictors of high short-term mortality and liver transplant ineligibility. Such hospice criteria should be data-driven and should accommodate the uncertainty faced by patients and physicians. [ABSTRACT FROM AUTHOR]

Phenomenon: Point-of-care ultrasound is fast becoming standard clinical bedside practice for diverse specialties. Medical schools are responding by adding ultrasound education, though the majority use it to supplement the learning of basic sciences. Point-of-care ultrasound practice-based clinical skills education is rare. There also is a lack of standardization across curricula, leading to much variability in the ultrasound skills that medical students from different schools bring to residency. To best inform a point-of-care ultrasound curriculum for our Transition-to Residency program, we investigated literature on 1) how medical students are being prepared for use of point-of-care ultrasound in clinical practice, 2) what skills are being taught, 3) what point-of-care ultrasound skills residency programs expect from incoming residents. Approach: We reviewed literature to identify curricula in U.S. medical schools that teach the concepts, knowledge, and skills related to point-of-care ultrasound. We also mapped point-of-care ultrasound expectations set forth by the Entrustable Professional Activities for undergraduate medical education to the specialty-specific milestones identified by the Accreditation Council for Graduate Medical Education. Additionally, we reviewed specialty-specific professional organizations for position statements and guidelines describing the point-of-care ultrasound skills expected for practicing physicians in their respective specialties. The goal was to identify any needs and gaps in education regarding point-of-care ultrasound across the undergraduate to graduate medical education continuum to practice. Findings: We found seven published point-of-care ultrasound curricula for medical students. There was wide variability in these curricula regarding what point-of-care ultrasound content is being taught, as well as when and how this skill is taught. No Entrustable Professional Activity listed point-of-care ultrasound as a skill requirement for graduating medical students. For graduate medical education, there was wide variability across specialties in residency milestones related to point-of-care ultrasound; some (e.g., emergency medicine) listed extensive milestones while others (e.g., internal medicine) listed none. However, we found that many specialty-specific professional organizations do list detailed point-of-care ultrasound expectations for their practicing physicians. Insights: As point-of-care ultrasound is fast becoming common practice across many specialties, standardization of education and related competencies—similar to other clinical skills training—is necessary across medical schools. Mapping point-of-care ultrasound expectations to current teaching across the continuum from undergraduate to graduate medical education may allow schools to tailor point-of-care ultrasound training for Transition-to-Residency programs. We provide a sample pilot point-of-care ultrasound curriculum that we designed for our Transition-to-Residency course. [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.

This paper presents a method for determining shadow prices for a physician's services on the basis of actual prices charged. The Ramsey rule is used as the shadow-pricing formula. This is combined with the physician's profit-maximizing condition to produce an expression for the social prices in terms of the price elasticities of demand for the third parties paying for the services. On the basis of implicit estimates of the elasticities for a hospital plastic surgeon in the USA, it was found that roughly half (between 42 and 59 cents of every dollar charged) was not relevant for social-valuation purposes. [ABSTRACT FROM AUTHOR]

In the US, disagreement over the biological basis of "chronic Lyme disease" has resulted in the institutionalization of two standards of care: "mainstream" and "Lyme-literate." For mainstream physicians, chronic Lyme disease is a "medically unexplained illness" that presents with an abundance of "symptoms" in the absence of diagnostic "signs." For Lyme-literate physicians, and complementary and alternative medicine practitioners more generally, symptoms alone provide sufficient evidence for medical explanation. Drawing upon ethnographic research among mainstream and Lyme-literate physicians, I suggest that medically unexplained illness is not a biomedical anomaly but an intrinsic feature of biomedicine. [ABSTRACT FROM AUTHOR]

Background: Opioid overdose is a national health priority and curbing inappropriate prescribing is critical. In 2016, the Centers for Disease Control and Prevention (CDC) issued appropriate prescribing guidelines. Objectives: Examine associations between care networks defined by shared patients and problematic opioid prescribing. Methods: Analysis was at the provider-year level. Social network analysis (SNA) applied to the Medicaid MarketScan® Research Database for the years 2010–2015 identified care communities, each community's level of integration (centralization), and each provider's integration (centrality). Nested multivariable logistic regressions controlling for patient mix and provider specialty simultaneously examined the risk of any (incident) and repeated (prevalent) inappropriate prescribing. Outcomes: Four behaviors defined by the CDC guidelines were examined: (1) more than 90 days continuous supply of high-dose opioid analgesics for chronic pain, (2) overlapping opioid supplies, (3) overlapping opioid and benzodiazepine prescriptions, and (4) prescribing an extended release opioid for an acute pain diagnosis. Results: Provider centrality was associated with reduced incidence of outcome (2) (OR: 0.95) and decreased prevalence of outcomes (1), (2), and (3). However, higher incidence (OR: 1.32) and prevalence (OR: 1.027) of outcome (4) were observed. Conversely, centralization associated with decreased incidence of (1) and (2) and lower prevalence of (1), (2), and (3). Conclusions: Greater provider integration is associated with a lower risk of a provider's patients repeatedly having potentially inappropriate prescription fills; however, the association with a provider having any potentially problematic prescription is more ambiguous. [ABSTRACT FROM AUTHOR]

Previous literature has demonstrated a gap between what health care consumers say they want to know about their physicians and the publicly available information the health care industry provides. This systematic analysis of Yelp reviews from the 25 most populous U.S. metropolitan areas is predicated on the assumptions that patients who post online physician reviews include information they would find useful when choosing a physician, and that this information represents an ecologically valid sample for making inferences regarding patients' decision making process. Obstetrician gynecologists are twice as likely to be reviewed as other physicians, but this is, to our knowledge, the first study examining online reviews of obstetrician-gynecologists specifically. This study contributes to the literature on medical decision making, demonstrating that the physician choice decision is made using a heuristic tallying model, in which only two, nearly equally weighted parameters are meaningful: patient (which, within the reviews, incorporates physician interpersonal manner and physician knowledge and skills) and office management. Yelp reviews of obstetrician-gynecologists follow patterns previously established in scholarship: ratings are bimodal, and approximately two-thirds are positive. In the absence of objective, user-friendly physician-level information, patients will turn to review sites like Yelp when choosing physicians. Rather than resisting this trend, physicians and hospital systems would be better served by working with review sites, or creating their own, to emphasize aspects of the experience patients are qualified to evaluate: the physician's interpersonal manner and office management. [ABSTRACT FROM AUTHOR]

The article presents a study on physicians' education under the Physician Payments Sunshine Act (PPSA) as well as its significance on the improvement of patient trust in the U.S. Discussed are issues on conflicts of interest (COI) in medical journals and studies on transparency at the medical care sector. Challenges on medical policy under the PPSA are explored.

An editorial is presented on arguments for physician aid-in-dying (PAD) for psychiatric disorders. Topics discussed include permitting PPAD would not have negative policy and practice implications serious enough to outweigh the intended merits; conflicts with the practice of involuntary commitment in psychiatry; and parity argument has the following form: If PAD for terminal physical illness is justified on the basis of suffering.

Objective: The aims of this study were: 1) to determine the short-term impact of the SleepTrackTXT2 intervention on air-medical clinician fatigue during work shifts and 2) determine the longer-term impact on sleep quality over 120 days. Methods: We used a multi-site randomized controlled trial study design with a targeted enrollment of 100 (ClinicalTrials.gov NCT02783027). The intervention was behavioral (non-pharmacological) and participation was scheduled for 120 days. Participation was voluntary. All consented participants answered baseline as well as follow-up surveys. All participants answered text message queries, which assessed self-rated fatigue, sleepiness, concentration, recovery, and hours of sleep. Intervention participants received additional text messages with recommendations for behaviors that can mitigate fatigue. Intervention participants received weekly text messages that promoted sleep. Our analysis was guided by the intent-to-treat principle. For the long-term outcome of interest (sleep quality at 120 days), we used a two-sample t-test on the change in sleep quality to determine the intervention effect. Results: Eighty-three individuals were randomized and 2,828 shifts documented (median shifts per participant =37, IQR 23–49). Seventy-one percent of individuals randomized (n = 59) participated up to the 120-day study period and 52% (n = 43) completed the follow-up survey. Of the 69,530 text messages distributed, participants responded to 61,571 (88.6%). Mean sleep quality at 120 days did not differ from baseline for intervention (p > 0.05) or control group participants (p > 0.05), and did not differ between groups (p > 0.05). There was no change from baseline to 120 days in the proportion with poor sleep quality in either group. Intra-shift fatigue increased (worsened) over the course of 12-hour shifts for participants in both study arms. Fatigue at the end of 12-hour shifts was higher among control group participants than participants in the intervention group (p < 0.05). Pre-shift hours of sleep were often less than 7 hours and did not differ between the groups over time. Conclusions: The SleepTrackTXT2 behavioral intervention showed a positive short-term impact on self-rated fatigue during 12-hour shifts, but did not impact longer duration shifts or have a longer-term impact on sleep quality among air-medical EMS clinicians. [ABSTRACT FROM AUTHOR]

Purpose: Physician review portals are becoming increasingly popular among patients and often serve as a primary advisory tool during the search for a doctor. However, it has not been established whether these platforms favor leaders of the field; i.e., physicians with high academic rank. Here, we assessed online ratings of US ophthalmologists, selected for their outstanding scientific performance.Methods: This cross-sectional, Internet-based study was performed in September 2016. First, we selected US ophthalmologists who published at least one manuscript or conference abstract that reached at least 100 citations from 2006 to 2016. Second, academic impact of preselected physicians, measured by overall number of citations or Hirsch index, was correlated with their ratings on two physician review portals: healthgrades.com and zocdoc.com.Results: We selected 105 ophthalmologists who met established criteria. A total of 78 were rated on healthgrades.com, but only two were rated on zocdoc.com. The average rating on healthgrades.com was 4.2 +/-0.9, similar to the previously reported US mean for a physician (∼4). The rating did not correlate with the number of citations or with Hirsh index.Conclusions: Highly cited ophthalmologist are not rated proportionately to their scientific achievements. Their reviews are positive, but do not stand out in comparison to other physicians. Additionally, we found that this group of ophthalmologists might be significantly underrepresented on particular review websites. [ABSTRACT FROM AUTHOR]

The inappropriate use of opioids in the United States has increased markedly and has resulted in a tragic loss of lives. To combat this problem, prescription drug monitoring programs (PDMPs) have been instituted in most states. Use of the programs is voluntary for prescribers in some states, whereas in other states it is mandatory. The current study used a self-report survey instrument that was administered to 223 participant physicians. The goal of the study was to compare awareness and use of the PDMP in a state that mandates use (Ohio) with one that does not (North Carolina). Although awareness was not significantly different between respondents from the two states, self-reported use was significantly higher in the state mandating use (Ohio post-mandate vs. Ohio pre-mandate: 64% vs. 51%; χ2 = 15.66, P <.0001; and Ohio post-mandate vs. North Carolina: 64% vs. 42%; χ2 = 12.76, P <.0001). Based on these results, mandating use may be an effective method to increase PDMP utilization. [ABSTRACT FROM AUTHOR]

Models of care for people living with HIV (PLWH) have varied over time due to long term survival, development of HIV-associated non-AIDS conditions, and HIV specific primary care guidelines that differ from those of the general population. The objectives of this study are to assess how often infectious disease (ID) physicians provide primary care for PLWH, assess their practice patterns and barriers in the provision of primary care. We used a 6-item survey electronically distributed to ID physician members of Emerging Infections Network (EIN). Of the 1248 active EIN members, 644 (52%) responded to the survey. Among the 644 respondents, 431 (67%) treated PLWH. Of these 431 responders, 326 (75%) acted as their primary care physicians. Responders who reported always/mostly performing a screening assessment as recommended per guidelines were: (1) Screening specific to HIV (tuberculosis 95%, genital chlamydia/gonorrhoea 77%, hepatitis C 67%, extra genital chlamydia/gonorrhoea 47%, baseline anal PAP smear for women 36% and men 34%); (2) Primary care related screening (fasting lipids 95%, colonoscopy 95%, mammogram 90%, cervical PAP smears 88%, depression 57%, osteoporosis in postmenopausal women 55% and men >50 yrs 33%). Respondents who worked in university hospitals, had <5 years of ID experience, and those who cared for more PLWH were most likely to provide primary care to all or most of their patients. Common barriers reported include: refusal by patient (72%), non-adherence to HIV medications (43%), other health priorities (44%), time constraints during clinic visit (43%) and financial/insurance limitations (40%). Most ID physicians act as primary care providers for their HIV infected patients especially if they are recent ID graduates and work in university hospitals. Current screening rates are suboptimal. Interventions to increase screening practices and to decrease barriers are urgently needed to address the needs of the aging HIV population in the United States. [ABSTRACT FROM AUTHOR]