Geriatric medicine and geriatric psychiatry clinical services affiliated with U.S. academic medical centers

U.S. academic medical centers are providing many geriatric medicine (GM) and geriatric psychiatry (GP) clinical services at Veterans Health Administration (VHA) and non-VHA sites. This article describes the distribution and scope of GM and GP clinical services being provided. Academic GM leaders of the 146 U.S. allopathic and osteopathic medical schools were surveyed online in the spring of 2004. One hundred four program directors (71.2%) responded. These medical schools provided 1,325 GM and 376 GP clinical services, which included 654 VHA and 1,014 non-VHA GM and GP services, affiliation with 21 Programs of All-Inclusive Care for the Elderly, and 12 other specialized services. The mean number+/-standard deviation of distinct clinical services at each medical center was 16.4+/-8.2. More geriatrics faculty full-time equivalents, more time spent on training fellows, and designation as a GM Center of Excellence were associated with providing a wider range of geriatric clinical services. Using data from the survey, the first directory of GM and GP clinical services at academic medical centers was created (http://www.ADGAPSTUDY.uc.edu).     

Commentary: Multicultural aspects of aging in the U.S.: Implications for health and human services

This is a synthesis of the papers presented in this volume. This collection provides health and human service providers with useful concepts for developing culturally relevant services for ethnic elders.     

Health and health care among housestaff in four U.S. internal medicine residency programs

BACKGROUND: Although there have been many studies of the health care services that resident physicians provide, little is known about the health care services they receive. OBJECTIVE: To describe residents’ perceptions of the health care they receive. DESIGN: Anonymous mailed survey. SUBJECTS: All 389 residents in four U.S. categorical internal medicine training programs. MAIN RESULTS: Three hundred sixteen residents responded (83%). In aggregate, 116 (37%) reported having no primary care physician, and 36 (12%) reported that they are their own primary care physician. These figures varied substantially across the four programs. Most residents reported receiving basic screening and preventive services; however, their attitudes toward their health and health care differed across postgraduate level, gender, and program. Many residents reported that their long and unpredictable hours interfered with their ability to schedule clinician visits, that their health had declined because of residency, that programs and other residents were unsupportive of residents’ health care needs, and that residency raised special issues of privacy that limited access to health care. CONCLUSIONS: Despite high rates of receipt of preventive services, these internal medicine residents identified several barriers that limited their access to health care. Program directors should explore these barriers and, at the same time, reevaluate the messages being sent to resident physicians about maintaining their health and health care. This work was supported in part by SmithKline Beecham and the Greenwall Foundation. Dr. Asch is a Department of Veterans Affairs Health Services Research and Development Senior Research Associate.     

传染病医院中药新药研发的管理

中药研发利于传染病医院自身发展,是降低医疗成本的需要.中药新药的研发流程包括:处方发掘、研发立项、临床前研究、临床试验和注册申报.应设立专门机构组织管理中药新药研发,并创新合作方式及筹措资金.应积极申报科研成果,完成成果转化.