Self-reported health behaviors of osteopathic physicians

The degree to which osteopathic physicians (DOs) take care of their own health is of interest not only to the osteopathic medical community, but also to physicians' patients. The American Osteopathic Association (AOA) Committee on Physician Health asked attendees at the July 2001 AOA House of Delegates Annual Business Meeting in Chicago, Ill, to complete a one-page survey on their personal health practices. This survey comprised 22 questions on such items as vacation and personal time, exercise habits, weight control, tobacco and alcohol use, and regular physical examinations and medical screening. Two hundred ninety-nine attendees completed the survey during the 15 minutes immediately after the report of the Committee on Physician Health (response rate: approximately 75%). The results indicate that DOs are similar to the proverbial patient in terms of personal health practices. Although DOs follow some physicians' orders, they do not follow others. Most DOs take regular vacations and daily personal time, and they get some of their recommended physical examinations and medical screenings. The authors suggest that DOs pay greater attention to their exercise habits, weight control, and signs of substance abuse.     

Different methods for assessing quality in health sector

AN OBLIGATION: The "management" of quality is an integral part of "medical" management today. The health centers and professionals have to prove their value and know-how through distinct signs of recognition. A METHOD FOR ASSESSING QUALITY: This paper defines the method of assessment of quality and specifies the typology of the persons, organisms, supervisors and clients of the French health system who have a personal or collective interest in judging the quality of health services. DIFFERENT POSSIBILITIES: Numerous existing methods for assessing quality are presented together with their use, implementation and the use made by the actors and consumers of the health system. Some of these assessment methods are formal, others informal, some are mandatory, others optional; some concern the general population, others the professionals. Although know-how is essential in health, making it known is strategic today.     

Famous discoveries by medical students

Heparin, insulin, the sinoatrial node and ether anaesthesia are just some of the major discoveries made by medical students, all of which have had a huge impact on the practice of surgery. This paper explores the breadth and depth of some of these talented individuals and their extraordinary contributions to medicine. While some continued to enjoy brilliant careers, others became embroiled in damaging disputes about priority or were overtaken by illness or personal problems. Regardless of their fate, their contributions are a potent reminder of what can be achieved by gifted and determined medical students undertaking a period of basic scientific or clinical research.     

Influences on the quality of student learning--implications for medical education.

This paper reviews recent research into the ways in which departments influence the quality of student learning. A substantial literature has developed which describes differences in the ways in which students learn and study in higher education. These differences emphasise the distinction between seeking personal understanding and reproducing information or procedures. The research indicates that certain departments, and some lecturers, are much better than others in encouraging students to look for deep levels of meaning. The quality of teaching and the methods of assessment are particularly influential, but so is the extent to which students are helped to develop effective studying and learning strategies. Some students have been shown to have major problems in the way they perceive and utilise the opportunities for learning provided by departments. While much of the research is not drawn directly from medical faculties, the relevance to medical education is pointed up and supported by specific examples of relevant research.     

Minimally invasive surgery of the hip: a review of the literature

Summary: For several years, special attention has been paid to minimally invasive prosthetic surgery by surgeons, prosthetic implant manufacturers, the media and patients, especially in English-speaking countries. On Google, the literature regarding this subject is abundant but few articles (barely twenty) are referenced in medical literature. Attempts to reduce surgical access by reducing the size of the incision exist with all types of access. Publications on the subject mix retrospective and prospective studies and personal experiments. They remain insufficient and the results are too variable to allow a clear and objective point of view. Minimally invasive surgery of the hip is optimized bysome authors and still criticized by others. Nevertheless, it raises a positive debate on the differences between surgical accesses and the improvement of postoperative surgical, medical or functional outcomes of hip arthroplasty. Also it clearly appears that it must be performed with adequate control of the position of implants, which is necessary in terms of longlasting and normal functioning of the prosthesis.     

Behandlungsabbruch und Behandlungspflicht am Ende des Lebens

Social developments and medical progress in the last decades have led to a significant change of values in medicine, which spans from the cornerstone of the patient's autonomy to the increasingly difficult decision-making process related to available medical treatments. This conflict exaggerates with end-of-life situations, where a purely palliative approach to the therapy is applied, or in cases of reduced ability for patient's consent. From a legal point of view, many uncertainties have been clarified in recent years. The patient's autonomy has been strengthened, however, the law requires the doctor to review and carefully balance the treatment options so that a new and modified patient-doctor relationship is often necessary in this difficult decision-making process. The doctor should no longer retreat into the classical role of a neutral advisor and leave the complete responsibility of medical decisions to the patient. Instead, in order for the patient to be able to make a balanced and individually tailored autonomous decision, the doctor needs to bring in his medical expertise along with his own personal experiences and personal opinions, as long as he clearly differentiates between personal and professional views. This way the patient will be empowered to make complex medical decisions, considering his personal situation and previous experiences as well as his own set of values. For complex situations medical practitioners can find support from reflection within the treatment team, or through an external ethical advisory panel. Algorithms can be helpful to illustrate the steps in a decision-making process and thus support medical staff in situations of difficult medical decisions.     

Transactions in a Support Group Meeting: A Case Study

Following bariatric surgery,the inclusion of a support group as part of the treatment plan makes after-care easier and more efficient for the patients,as well as for the physicians.The following is presented for the education of the medical community. It represents one exemplary session which incorporates the elements necessary for effective after-care: 1. Encouragement for compliance and praise for success. 2. Education about life-after-surgery, including nutrition, exercise and dieting techniques. 3. Identification of problems. 4. Identification and development of new kinds of self-nurturing. 5. Participation in a forum where others really "understand" the challenges and difficulties associated with "change,"even when the change is for the better. 6. Creation of a "safe harbor" where patients can bring spouses, parents and significant others so that they may also understand, encourage continuing success, and recognize their own personal issues related to the major changes that they are also experiencing with their loved one. 7. Opportunity for curious potential patients in the community to come and learn from the "experts" in an atmosphere of true caring and concern.     

A Career in Surgical Oncology: Finding Meaning,Balance, and Personal Satisfaction

The practice of surgical oncology provides opportunities for both personal distress as well as personal satisfaction. While many surgical oncologists experience career burnout, others derive great meaning and satisfaction from their work. In this article, we review the literature on surgeon burnout, discuss potential personal and professional consequences, and consider steps individual surgeons can take to promote personal and professional satisfaction.     

Clinico-diagnostic considerations on lymphocytic thyroiditis. Presentation of clinical cases

Personal experience with autoimmune lymphocyte thyroiditis, represented by 11 cases observed between 1972 and today, is reported. After some brief aetiopathogenetic notes on the lesions in question, the problems of diagnosing the nature of the thyropathy are stressed. After reviewing the examinations that have been proposed in the literature, it is noted that the preoperative recognition of a thyroiditis with autoimmune genesis is still problematical. The institution of a diagnostic protocol based on the systematic search for antibodies, the perchlorate test, the thyrostimulation test, ESR study, the search for alpha2 and gamma-globulins, scintigraphy with positive indicators and needle biopsy as well as on scintigraphy and thyrometabolic tests (T3-T4-TSH-TRH test) is proposed. Even when such a protocol is adopted, however, it should be mentioned that only in 18% of the personal cases was it possible to diagnose thyroiditis, in the other subjects this being merely an occasional post-operative finding. In confirming the personal therapeutic approach, which at least initially is medical, for recognized forms, it is pointed out that surgical treatment is to be preferred in certain cases because of the presence of compressive phenomena, and in others it appears capable of relieving, in follow-up, the thyroiditic process, probably as a result of the removal of the antigenic tissue.     

The influence of Sir Andrew Clark (1826-93) on William Osler (1849-1919)

Three lines of evidence suggest that Sir Andrew Clark had a significant influence on William Osler's postgraduate training: (1) numerous references to Clark in Osler's textbook of medicine; (2) the similarity of Clark's and Osler's aphoristic messages for students; and (3) personal encounters, including Clark's reminiscence that he 'had striven ten years for bread, ten years for bread and butter, and twenty years for cakes and ale'. Clark's meticulous approach to clinical problems, his work ethic and his enthusiasm for bedside teaching may have fostered or reinforced these same attributes in Osler. Osler honoured Clark's memory by helping Sir John MacAlister and others realize Clark's ambition to unite various London medical societies into a single organization, which, in 1907, became the Royal Society of Medicine.     

对医学生如何提高自学能力的认识

随着医学科学的全面发展,作为一名医学生,要将自己培养成适应社会的全面发展型人才,只靠课堂上的学习是不够的.对医学生来说,除扎扎实实地掌握书本知识外,还要重视各种能力的培养,这就要求医学生自身要具备自学能力,自主学习能力是医学生适应不断进步发展的时代所必需的,因此本文就如何提高自学能力结合自身经验谈谈个人看法.     

Should New South Wales hospital disaster teams be sent to major incident sites?

BACKGROUND: The aim of the present review was to assess the suitability of hospital disaster medical teams' training, personal safety and medical equipment for site casualty work at multiple casualty incidents (MCI), and to compare this with retrieval teams who routinely provide pre-hospital trauma care. The options for the provision of a site medical response based upon international and Australian disaster planning guidelines are also reviewed. METHODS: A questionnaire was mailed to all doctors dispatched to the 1997 Thredbo disaster as part of trauma service (TS) hospital medical teams, medical commanders or Helicopter Emergency Medical Service (HEMS) crew. Doctors with Sydney retrieval services (SRS) experience were compared with those without SRS experience in regard to the reported level of relevant training and experience as defined by current Australian guidelines and the Education and Training in Disaster Medicine Curriculum, Scientific Committee of the International Society of Disaster Medicine. Familiarity with medical equipment was assessed, as was level of compliance with Australian guidelines for personal protective clothing and equipment. RESULTS: Responses were obtained from all 25 doctors. Nine had SRS experience. None of the 16 doctors without SRS experience met the criteria of the Education and Training Curriculum, compared with four of nine doctors with SRS experience (44%). All six SRS doctors using SRS equipment had personally used or checked their equipment within 2 weeks prior to dispatch to Thredbo, compared with none of the 19 doctors using hospital equipment. Of the 11 areas of personal safety equipment and clothing assessed, all SRS doctors using SRS equipment complied with the guidelines in five areas (45%). There was no area assessed in which all the doctors using hospital equipment complied. CONCLUSION: Hospital medical teams suffer from the same problems of inadequate training, experience and personal safety equipment that are identified in previous reports from disasters overseas. The continued focus on hospital medical teams in counter-disaster planning as the primary source of on-site medical services is inappropriate because, with the exception of retrieval doctors who routinely provide pre-hospital trauma care, appropriately trained and experienced doctors are unlikely to be available from within the hospital system.     

SHOULD NEW SOUTH WALES HOSPITAL DISASTER TEAMS BE SENT TO MAJOR INCIDENT SITES?

Background : The aim of the present review was to assess the suitability of hospital disaster medical teams’ training, personal safety and medical equipment for site casualty work at multiple casualty incidents (MCI), and to compare this with retrieval teams who routinely provide pre-hospital trauma care. The options for the provision of a site medical response based upon international and Australian disaster planning guidelines are also reviewed. Methods : A questionnaire was mailed to all doctors dispatched to the 1997 Thredbo disaster as part of trauma service (TS) hospital medical teams, medical commanders or Helicopter Emergency Medical Service (HEMS) crew. Doctors with Sydney retrieval services (SRS) experience were compared with those without SRS experience in regard to the reported level of relevant training and experience as defined by current Australian guidelines and the Education and Training in Disaster Medicine Curriculum, Scientific Committee of the International Society of Disaster Medicine. Familiarity with medical equipment was assessed, as was level of compliance with Australian guidelines for personal protective clothing and equipment. Results : Responses were obtained from all 25 doctors. Nine had SRS experience. None of the 16 doctors without SRS experience met the criteria of the Education and Training Curriculum, compared with four of nine doctors with SRS experience (44%). All six SRS doctors using SRS equipment had personally used or checked their equipment within 2 weeks prior to dispatch to Thredbo, compared with none of the 19 doctors using hospital equipment. Of the 11 areas of personal safety equipment and clothing assessed, all SRS doctors using SRS equipment complied with the guidelines in five areas (45%). There was no area assessed in which all the doctors using hospital equipment complied. Conclusion : Hospital medical teams suffer from the same problems of inadequate training, experience and personal safety equipment that are identified in previous reports from disasters overseas. The continued focus on hospital medical teams in counter-disaster planning as the primary source of on-site medical services is inappropriate because, with the exception of retrieval doctors who routinely provide pre-hospital trauma care, appropriately trained and experienced doctors are unlikely to be available from within the hospital system.     

Xenotransplantation from the ethical viewpoint. An outline]

The duty to save and to preserve lives on one hand, and the scarcity of human donor organs on the other hand call for a search for new organ sources, including xenogenic ones. Xenotransplantation, however, is not only in need of medical research, but also of ethical analysis. The latter is not to be considered a substitute for moral intuition, but rather a foundation of it by way of a critical evaluation of the ethical principles and reasons involved. This basically demands an analysis of the legitimacy of the aims and of the acceptability of the means for xenotransplantation. It includes safeguarding informed consent; risk assessment and the protection of not only the recipient, but also others; the question of limitation of personal rights; allocation problems; and last but not least animal protection. The aim is to clarify the ethical status of xenotransplantation in general and the question of a moratorium regarding clinical trials due to unsolved problems of infectivity and immunosuppression in particular by way of an integrative approach to both scientific developments and ethical analysis.     

Medical ethics in surgery

Medical ethics have been developed over the long term to foster the necessary basic attitude of physicians who are responsible for the lives of others. As medical science continues to advance, physicians have an obligation to acquire up-to-date knowledge and skill levels to offer the best medical care. Since the clinical practice of surgeons is based on cooperation with physicians in other specialties, it is necessary for surgeons to supervise their own ethics strictly and receive objective assessments from others.     

Endoskopische Diagnostik und Therapie der gastrointestinalen Blutung

Gastrointestinal bleeding is still one of the most frequent medical emergencies. Despite improvements in endoscopic diagnosis and therapy, mortality from bleeding is still high (15%). Since conclusive trials are lacking, the endoscopist often has to rely on personal experience in the selection of therapeutic options. Therefore this article gives an overview of new publications in this field and recommendations based on personal experience.     

护理本科生个人职业生涯规划现状调查

目的了解护理本科生个人职业生涯规划现状,为高等护理教育开展职业生涯规划教育提供参考。方法采用自制个人职业生涯规划调查问卷对广州市3所高等医学院校的365名护理本科生进行调查。结果护理本科生的个人职业生涯规划均分为3．41;5个维度的平均得分由高到低依次为职业生涯定向、自我认识、职业认识、就业信心、自我规划。18．63％护理本科生认为很有必要进行个人职业生涯规划,仅3．01％和2．19％护理本科生非常清楚个人职业生涯规划的内容和非常清楚如何进行个人职业生涯规划。不同年级护理本科生的职业认识、自我规划和总分比较,差异有统计学意义（P〈0．05,P〈0．01）。结论护理本科生对个人职业生涯规划呈中等满意程度;护理教育者应重视护理本科生个人职业生涯规划,并根据年级需求给予相应的职业生涯规划指导和教育。     

Feeling the Burnout: Perceptions of Burnout,Anxiety, Depression,and Personal Achievement in US Podiatric Medical Students

Medical student burnout is a significant problem, which has led to the introduction of institutional intervention initiatives to combat the phenomenon. However, the incidence of burnout among podiatric medical students has not been previously assessed. The purpose of this cross-sectional study was to determine the perceptions of burnout, anxiety, depression, and personal achievement among podiatric medical students. A 50-question anonymous survey containing the Maslach Burnout Inventory-Human Services Survey and the Hospital Anxiety and Depression Scale was distributed to all students of eight US podiatric medical schools. Demographic and personal information regarding the student's free time, study time, family support, class or exam failures, loan debt, and previous work experience were recorded. Four hundred and eighty students completed the survey, and 479 responses were eligible for inclusion (response rate of 22.2%). Overall, 65.1% reported moderate or high self-perceived rates of burnout, a rate comparable to allopathic and osteopathic medical students. Respondents also reported high levels of emotional exhaustion and anxiety, but low levels of personal achievement. A predisposition for burnout was identified for third-year students between the ages of 26 to 35 years with borderline or abnormal levels of reported anxiety. The present study contributes to the growing body of literature regarding burnout with respect to the podiatric profession. Despite inherent limitations, the findings suggest institutional interventions for the promotion and development of protective factors may be warranted.     

Delegation ärztlicher Tätigkeiten in der Akutschmerztherapie

Acute pain management is an interprofessional and interdisciplinary task and requires a good and trustful cooperation between stakeholders. Despite provisions in Germany according to which medical treatment can only be rendered by a formally qualified physician (“Arztvorbehalt”), a physician does not have to carry out every medical activity in person. Under certain conditions, some medical activities can be delegated to medical auxiliary personnel but they need to be (1) instructed, (2) supervised and (3) checked by the physician himself; however, medical history, diagnostic assessment and evaluation, indications, therapy planning (e.g. selection, dosage), therapeutic decisions (e.?g. modification or termination of therapy) and obtaining informed consent cannot be delegated. With respect to drug therapy, monitoring of the therapy remains the personal responsibility of the physician, while the actual application of medication can be delegated. From a legal perspective, the current practice needs to be stressed about what is within the mandatory requirements and what is not when medical activities are delegated to non-medical staff. The use of standards of care improves treatment quality but like any medical treatment it must be based on the physician’s individual assessment and indications for each patient and requires personal contact between physician and patient. Delegation on the ward and in acute pain therapy requires the authorization of the delegator to give instructions in the respective setting. The transfer of non-delegable duties to non-medical personnel is regarded as medical malpractice.     

Return to work of road accident victims claiming compensation for personal injury.

Road accidents resulting in personal injury are an increasing cost to society. This study is based on 609 accident victims (of whom 521 survived injury) who were in employment when injured and whose claims for personal injury were settled for 5000 pounds or more by one insurance company over 2 years. It examines survivors' residual disablement, return to work and involvement with rehabilitation services. Data on a representative sample of 101 cases are analysed in more detail to identify possible 'predictors' of return to work. Both univariate and stepwise logistic regression analysis suggest that return to work is less associated with clinical variables, on which much medical advice on return to work is based, than with such other variables as time off work, absence of psychological problems and younger age. Very low rates of referral to rehabilitation may indicate that a rehabilitative approach to cost containment is underutilized in comparison with the traditional emphasis on preventive measures and enhanced medical treatment. More effective rehabilitation, however, may require new approaches to clinical case management, especially in orthopaedic departments where most personal injury claimants are treated.