The diluting effect of medical work groups on feedback efficacy in changing physician's practice

Feedback intervention has been advocated as a successful method to modify the way that physicians practice medicine. However, most studies concerned with modifying physician profiles have focused on interns and residents. The results presented here concern regular staff and therefore provide a better basis for generalization. Over a 2.5-year period, we analyzed the use of clinical resoucces by physicians practicing in four medical specialties in two hospitals. Hierarchical multiple regression models were used to control case mix in order to identify the specific effects attributable to feedback. The information failed to modify the physicians' practice profiles. Our results suggest that this failure is related to the organization of inpatient medical practice as a group effort. This mode of practice has a negative effect on feedback efficacy. First, it weakens one of the main feedback mechanisms, that is personal identification with the data. Second, it probably generates mutual adjustment among physicians, thus eliminating practice variations at the source.     

银川地区213名正常人口服葡糖耐量试验结果

作者等在进行银川地区糖尿病患病率调查的同时,对213名正常成人进行口服葡糖耐量试验,发现该地区受试者各时限血糖均值较外地报道的数值为高,变异程度也大。造成这种结果的原因,经推测是由于本组受试者包括了一部分高龄人群,且受试者中66.7％为回民,他们的某些特殊饮食习惯(如嗜饮糖茶等)可能对糖耐量有所影响。     

Adaptation to Chronic Dialysis

While dialysis is a medical advance that enables people to live who would otherwise die, it is often experienced as an ordeal by those who must live with it. Patients and staff experience difficulties in their adaptation to chronic dialysis. A program that excepts all patients, regardless of motivation and stability, carries with it the responsibility of offering care in a way the patient can tolerate and of providing a regimen within the context of his personality structure and social adaptation.     

Perceived Benefits of Online Support Groups for Women with Metastatic Breast Cancer

Women with metastatic breast cancer (MBC), a life-threatening illness, stand to benefit a great deal from online support groups, but none have been studied specifically within this population. The present mixed-method study was carried out to determine which therapeutic factors occurred in online MBC support groups, and to see how such factors might have acted to benefit participants. Participants were 20 women with MBC who participated in online peer support groups. Most reported benefiting in some way from their groups. Six therapeutic factors theorized to be helpful in online support groups and cancer support groups were present in the groups studied: group cohesiveness, information exchange, universality, instillation of hope, catharsis, and altruism. However, although participants reported being able to discuss many other concerns freely, they had difficulty discussing death and dying, which are critical issues for this category of women with BC.     

Nonfinancial Barriers to Prenatal Care

No abstract available for this article.     

Potato processing in the central highlands of Peru

The processing of food products is an important economic activity of rural households in the Andean Highlands of Perú. Potatoes are processed into several dehydrated products the most common of which are chuño and papa seca. Chuño is a freezedried product made principally from bitter types of potatoes (Solarium juzepczukii and S. curtilobum) while papa seca is made from common varieties. This article describes how these and other products are made and their role within the Peruvian diet.     

In This Issue

No abstract available for this article.     

Looking ahead: planning for the first human intracortical visual prosthesis by using pilot data from focus groups of potential users

In planning for our research team's first human implant of a technologically advanced intracortical visual prosthesis we have conducted three focus groups with blind persons from a pool of likely participants. Guided by the principles of the Independent Living movement and Participatory Action Research (PAR), we asked the participants to share their thoughts and concerns about the procedure. The preliminary results reveal that achievement of the desired highest ethical of informed consent will require extensive pre-operative learning opportunities, such as those provided by these focus groups. Persons who are blind may be motivated to participate in research like this based on a need to know, understand, and explore ones environment, to leave a legacy, and to experience some restored perception.     

青年与老年直肠癌临床对比分析

目的探讨青年与老年直肠癌的临床、病理及预后差异。方法中国医学科学院肿瘤医院自1990年1月至2000年1月收治40岁以下直肠癌患者138例（青年组），65岁以上者163例（老年组），对这组患者的病例资料进行生存分析和预后的多因素分析。结果青年组Ⅲ期直肠癌患者比例（53．6％，74／138）明显高于老年组（34.3％，55／163）；P=0．001；青年组中黏液腺癌和低分化腺癌患者比例（28．2％，39／138）也高于老年组（10．4％，17／163）P〈0．001。青年组和老年组5年生存率分别为50．4％和64．1％．两组比较差异有统计学意义（P〈0．05）；而按照TNM分期进一步分析显示．同期别两组的生存率差异均无统计学意义（P〉0．05）。多因素分析结果显示，肿瘤T分期（P=-0．001）和淋巴结转移（P〈0．05）是影响两组患者预后的独立因素。结论与老年直肠癌相比，青年直肠癌患者的病期较晚、肿瘤分化程度较低，影响其预后；但相同病期者生存率相似。早期诊疗是提高直肠癌总体生存率的关键。