Creating a professional practice environment on a shoestring

Did you ever think, “If we just had a little money we could…”? The current health care environment is wrought with financial stressors that can be overwhelming and take up most of our time. Such stress can limit the development of a professional practice environment if you let it. How do you not only survive but thrive in this financial climate?     

Development and testing of a decision tree for blunt trauma

The aim of the present study was to examine the essential problems in a retrospective study of 381 organ injuries in 260 patients, to identify problems, to define criteria, to describe decision rules, and to organize these rules into branch-chain decision trees or clinical algorithms. The basic hypothesis of this study is that criteria organized into a prioritized decision tree can provide objective standards to evaluate the quality of trauma care and to compare alternative approaches. The algorithm was designed to provide prompt therapy for the most life-threatening problems: respiratory and cardiac arrest, shock, head injury, tamponade, lacerations of the great vessels, cardiac contusion, ruptured parenchymal organs, lacerated viscera, and injury to other intraperitoneal organs. Resuscitation from shock, correction of circulatory problems, and monitoring of physiologic variables were prioritized to evaluate the presence of circulatory deficits and the adequacy of specific therapy to correct them. Concomitantly, diagnosis of the underlying problems was approached using peritoneal lavage, abdominal and chest x-rays, iv urograms, cystograms, endoscopy, upper and lower GI barium or hypaque studies, ultrasound, scintograms, and CT scans. In emergency conditions these are limited to a large extent by time factors. The diagnostic accuracy, priorities, and limitations of each of these were evaluated in emergency conditions. The algorithm was used to track management decisions in a prospective series; the mortality of 51 patients with satisfactory compliance was 4% and 44% in nine patients with major deviations from the algorithm.     

Evaluation of the occult blood test in screening for colorectal neoplasms. A prospective study using flexible endoscopy

Survival rates from colorectal cancer will rise only when polyps and cancers are found at an earlier, curable stage. Consequently, the purpose of the present study was to compare the yield of colonic neoplasms from flexible sigmoidoscopy and colonoscopy with that from occult blood testing. Results from 474 flexible sigmoidoscopies and 1,115 colonoscopies were prospectively recorded during a four-year study period. Colorectal polyps were found in 111 (23.4%) patients undergoing flexible sigmoidoscopy and 325 (29.1%) patients undergoing colonoscopy. Among the 436 patients with polyps, the occult blood test was negative in 282 (64.7%). Among the 51 patients with colorectal cancers, the occult blood test was negative in 20 (39.1%). Thus, testing for occult blood missed the majority of polyps and a large percentage of the carcinomas. These data indicate that lower gastrointestinal endoscopy is superior to occult blood testing as a screening test for detecting colorectal polyps or cancers. Furthermore, given the high incidence of neoplasia in this patient population, the authors suggest that colonoscopy become the screening test of choice for colorectal cancer.     

Family physicians' perceptions of academic detailing: a quantitative and qualitative study

Background  

The efficacy of academic detailing in changing physicians' knowledge and practice has been the subject of many primary research publications and systematic reviews. However, there is little written about the features of academic detailing that physicians find valuable or that affect their use of it. The goal of our project was to explore family physicians' (FPs) perceptions of academic detailing and the factors that affect their use of it.     

The radiology of sarcomas and sarcomatoid carcinomas of the kidney

Tumours of the kidney with sarcomatoid elements are uncommon. The radiological findings in 11 patients with such lesions are presented. It is important to separate pure sarcomas from lesions with sarcomatous and carcinomatous elements since they have different radiological appearances and prognosis. These tumours often show calcification on radiographs and on angiography appear predominantly avascular with a blood supply from capsular vessels. Because of their rarity and the overlap of radiographic findings with more common tumours the diagnosis cannot be made by current imaging methods alone.     

Factors influencing maternal responsiveness in humans: usefulness of an animal model

In this article we review some of the hormonal, sensory and experiential factors that regulate the onset and early maintenance of maternal responsiveness in rat and human mothers. We discuss data suggesting that, in humans, pregnancy is associated with changes in feelings and attitudes that may bear on adjustment to motherhood postpartum. Preliminary studies indicate that these changes are probably not hormonally mediated but are associated with a variety of psychosocial factors. Once women give birth, there is some suggestion that they undergo a period of elevated "responsiveness" which may be influenced by puerperal hormones and during which experiences with the newborn take on a special salience. Following the early postpartum period, a variety of factors influence maternal responsiveness, including the mother's affective state, her social relationships, and experiences caring for young. We discuss the relative contributions of psychological and physiological influences to maternal responsiveness at different stages of the maternity cycle.