Computer use by family physicians in the United States

In March 1988 the American Academy of Family Physicians (AAFP) sampled approximately 4400 active members to ascertain their interest in office computers. After two mailings an overall response rate of 58.9% was achieved. Approximately 45% of active members currently use a computer in their office practices while 3% use a service bureau. There is a wide variation of use by US census region with approximately one in two family physicians in the West North Central census region using office computers compared to one in three in the Middle Atlantic. Accounts receivable and billing are the principal applications and are used by 86.9% of family physicians with computers in their offices. Very few are using a computer for medical records. Approximately two in five indicated that they have a personal or home computer. It is estimated that approximately 65% of AAFP active members have access to a computer either at home or at their office.     

Why flexible sigmoidoscopy instead of rigid sigmoidoscopy?

Representative outcome studies describing the procedures of rigid sigmoidoscopy and use of the 60-cm flexible sigmoidoscope are summarized. Subspecialist outcomes are compared with those obtained by family physicians. Family physicians consistently obtain similar insertion depths and diagnostic yields, although comparison is difficult because of referral bias and inconsistency regarding the reporting of hyperplastic polyps. No complications have been reported to date. Low physician and patient compliance with suggested guidelines for sigmoidoscopic examination may be partially responsible for unchanged five-year survival rates for colorectal cancer over the last 30 years. Preliminary studies indicate that the 60-cm flexible sigmoidoscope has improved compliance in at least one setting. Longitudinal cost-benefit studies should be performed in primary care settings.     

Use of vitamin-mineral supplements by female physicians in the United States

BACKGROUND: Rates of vitamin-mineral supplement use by US female physicians are unknown but are of particular interest for several epidemiologic and clinical reasons. OBJECTIVE: The objective was to determine rates of and variations in vitamin-mineral supplement use among US female physicians. DESIGN: We used data from the Women Physicians' Health Study, a large (n = 4501) national, randomly sampled mail survey of female physicians aged 30-70 y. RESULTS: Half of the physicians took a multivitamin-mineral supplement; 35.5% of these did so regularly. However, 相似文献   

Changes in supply and distribution of family physicians in the United States

From 1970 to 1980, the supply of family and general physicians in the United States increased by 4 percent. The overall increase was not felt uniformly among the states. Rather, the distribution reflected general regional trends in the United States. The analysis derives from a comparison of 1970 and 1980 American Medical Association and Bureau of the Census data. A study is made of changes in the supply of family and general physicians, in the number of residents in family practice programs, in the supply of general internists and pediatricians, in the population, and in the per capita income of each state. Regions with economic and population growth also benefited from immigration of family physicians and from new residency programs. They had fewer barriers to growth in the form of primary care competitors and elderly general practitioners requiring replacement. The dominance of market forces in channeling the effects of educational and manpower politics raises challenges for the specialty of family practice.     

Feasibility of 105-cm flexible sigmoidoscopy in family practice

The 105-cm flexible sigmoidoscope was studied for the feasibility of its use in a family practice setting in screening for colorectal cancers and polyps. A total of 49 examinations were performed. The average length of colon examined was 71 cm. Insertion to 105 cm was accomplished in 14 patients (29 percent) and exceeded 65 cm in 28 patients (57 percent). No complications of the procedure were encountered. The study indicated that some patients, with no special preparation or medications and no additional discomfort, might benefit by the more thorough screening afforded by 105-cm flexible sigmoidoscope. What is not yet known is the efficacy of large-scale screening for cancers and polyps utilizing the 105-cm flexible sigmoidoscope in the family practice setting.     

Norms for the rigid and flexible control over eating scales in a United States population

Westenhoefer [(1991). Dietary restraint and disinhibition: Is restraint a homogeneous construct? Appetite, 16, 45-55] argued that dietary restraint may not be a homogeneous construct but instead a combination of rigid control (RC) and flexible control (FC) over eating. These concepts hold promise for understanding some of the conflicting data in the restraint field. Scores on measures of RC and FC are often subjected to a median split, resulting in a less powerful and less informative dichotomous variable. It may, therefore, be useful to develop normative ranges of scores on these measures from very low to very high restraint. Such normative ranges have been developed in a German population but may not be applicable to men and women in the United States. To that end, the current study subjected the RC and FC scales to standardization in a college population.     

Continued assessment of flexible sigmoidoscopy in a family practice residency

The UCLA Family Practice Residency continues to use 60-cm flexible sigmoidoscopy in the care of patients. Between July 1980 and June 1983, 450 patients received an examination with the 60-cm flexible sigmoidoscope. One or more adenomatous polyps were detected in 21 patients. Adenocarcinoma was found in five patients. Four patients were found to have a villous adenoma, and four patients were determined to have inflammatory bowel disease. Of the 34 discrete lesions, 32 percent, 41 percent, and 27 percent were located between 0 and 20 cm, 21 and 35 cm, and 36 and 60 cm, respectively, from the anus. No complications were encountered. Sixty-four percent of the examinations were done by a family practice resident supervised by a full-time faculty member. The remaining 36 percent of the examinations were performed by full-time faculty. The overall detection rate for significant pathology was 8.0 percent. Most pathology by far was found in symptomatic patients. These results validate the safety and viability of 60-cm flexible sigmoidoscopy when performed by properly trained family physicians and family practice residents-in-training.     

Costs of flexible sigmoidoscopy screening for colorectal cancer in the United Kingdom

OBJECTIVES: Colorectal cancer is one of the most commonly occurring cancers in industrialized countries, yet appears to be amenable to screening. Amongst the many possible protocols is once-only screening by means of flexible sigmoidoscopy. This protocol is currently being investigated in a UK multicenter trial and the study provides estimates of the expected resource costs. METHODS: The direct health care costs of sigmoidoscopy and of all subsequent procedures were estimated from an audit of resource use of approximately 40,000 patients at thirteen centers. Patient-borne costs were estimated from the results of surveys conducted at twelve of these centers. RESULTS: The health service costs of a flexible sigmoidoscopy was estimated at pounds 56. The total costs of screening (including private costs) averaged pounds 82 per person screened, although costs varied by center. The total health service costs of screening and subsequent management averaged approximately pounds 91 per person screened, again with variations between centers. CONCLUSIONS: Even within a strict trial protocol, intercenter variation in costs can be detected, ascribable to variability in local management practices, local yield, and local patient-borne costs. Other recent estimates of flexible sigmoidoscopy costs vary widely. As these costs form the basis of technology assessment simulation models which, in turn, inform policy obtaining realistic cost estimates within the appropriate health care setting is of paramount importance.     

Media images of physicians and nurses in the United States

This paper analyzes images of physicians and nurses presented in advertisements in the medical and nursing journals JAMA (Journal of the American Medical Association) and AJN (American Journal of Nursing). Advertisements are viewed as hyper-ritualized displays of symbols and rituals associated with medical and nursing practice, both reflecting and reaffirming stereotypes and beliefs that are widely held in the society at large. Trends over the past few decades show that medical advertisements are dropping some traditional symbols (such as the white coat and stethoscope) in favor of depicting science-in-action and high technology. Nursing advertisements, however, are more frequently utilizing the symbols formerly reserved for physicians. Both physicians and nurses are depicted in their respective journals as existing largely independent of one another. While these advertisements clearly do not depict social reality, they present a fictionalized version which reflects and reproduces some of the expressed ideals in medical and nursing practice.     

Marketing hospitals to physicians in the United States.

This paper discusses the application of multidimensional scaling (MDS) in formulating the strategies for marketing a hospital to physicians. An extensive hospital factor survey was used to provide information for interpreting the MDS results, and to formulate specific strategies to: attract new physicians to the hospital; and, to make the hospital attractive to affiliated physicians for patient referrals. We conclude that MDS provides a unique approach for formulating strategies for similar non-conventional situations.     

Withdrawal from maternity care. A comparison of family physicians in Ontario, Canada, and the United States

To determine the relative importance of factors influencing the withdrawal of family physicians from maternity care, two studies, one done in Ontario, Canada, and the other done in the United States, were compared. The proportion of residency-trained family physicians who provide maternity care at the initiation of their careers and the proportion who have given up maternity care are nearly identical in the United States and Canada. Both studies found that about one half of the family physicians who currently provide maternity care were giving consideration to stopping. The reasons underlying this withdrawal were multifactorial. Malpractice issues were the predominant concern of United States family physicians, but the data from the studies indicate that other issues, such as interference with lifestyle and office practice and the effect of attitudes of obstetricians, should not be overlooked.     

Predictors of incomplete flexible sigmoidoscopy

OBJECTIVES: Flexible sigmoidoscopy (flex sig) is an easily administered method of screening for colorectal polyps and cancer. In some patients, the depth of insertion is incomplete, which may result in missed polyps and cancers. To address the question of prospective patient selection for this procedure, we analyzed the factors affecting depth of insertion of sigmoidoscopies performed in outpatients over a 3-year period. STUDY DESIGN: The study involved retrospective chart review of procedures performed by one endoscopist over a 3-year period. OUTCOMES MEASURED: Variables that might affect the extent of depth of insertion of the flexible sigmoidoscope. RESULTS: We developed separate logistic regression models of incomplete depth of insertion for women and men because sex was an effect modifier for many factors. For women, incomplete depth of insertion was related to inadequate preparation [odds ratio (OR) 3.59; 95% confidence interval (CI), 1.66 to 7.78]. Comparisons were made with the lowest risk group-women younger than 70 years with no hysterectomy. For women younger than 70 years, those with a hysterectomy were more likely to have an incomplete examination (OR 6.89; 95% CI, 2.68 to 17.73). For women 70 years and older, the odds ratio for women with a hysterectomy (OR 2.68; 95% CI, 0.96 to 7.46) was similar to that of women without a hysterectomy (OR 4.79; 95% CI, 2.27 to 10.12). For men, incomplete depth of insertion was related to age older than 75 years (OR 6.51; 95% CI, 1.72 to 30.40), history of abdominal surgery (OR 3.15; 95% CI, 0.95 to 10.41), and weight loss (OR 9.62; 95% CI, 1.98 to 46.67). CONCLUSIONS: Our study showed a relationship between incomplete examination and increasing age, female sex (more than 75% of the incomplete examinations were in women), poor bowel preparation (in women), hysterectomy, abdominal surgery (in men) and weight loss (in men). Further research is necessary to determine whether a predictive model can be developed that would be useful to select patients most appropriate for flex sig. In those patients in whom difficulty is anticipated, the choice can be made in to perform flex sig under sedation, analgesia, with the help of distraction techniques, or offer primary colonoscopy.