The experience of providing physical therapy in a changing health care environment.
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BACKGROUND AND PURPOSE: The changes in the health care environment during the last decade have had an impact on the roles and responsibilities of all health care professionals. The purpose of this phenomenological study was to describe the experience of staff physical therapists during a time of systemic change within a large urban academic medical center. SUBJECTS AND METHODS: Participants were 5 physical therapists working in various clinical settings within the medical center. The participants were interviewed and asked the question "Over the past 4 years, there have been major changes in your work environment. What has it been like for you working as a clinician during this time of change?" Interviews were recorded, transcribed, and analyzed to find thematic patterns of responses. RESULTS: Four common themes emerged in which participants described experiencing loss of control, stress, discontent, and disheartenment. A fifth theme showed that despite these negative feelings, participants were able to "find the silver lining" in their daily work lives (ie, they were able to find positive aspects of their professional lives despite the perceived unpleasant changes with which they had to cope). DISCUSSION AND CONCLUSION: This study provides insight into the experiences of a group of staff physical therapists during a time of systemic change in their work environment. Although the themes reflect largely unsettling and negative experiences, there seems to be an underlying ability to find affirmative aspects of work. (+info)
Incidence and risk factors for microbial keratitis in Hong Kong: comparison with Europe and North America.
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PURPOSE: To establish the incidence, etiology and risk factors for microbial keratitis (MK) in Hong Kong. METHODS: Two hundred and twenty-three new cases of presumed MK were recruited over a period of 17 months and comprehensive microbiologic studies performed. A nested case-control study was pursued for patients wearing contact lenses (CLW) to determine risk factors for MK with regards to types of CLW and hygiene practice. RESULTS: Of the 223 patients recruited, 59 (26%) wore contact lenses. Corneal scrapes yielded positive cultures from 77 patients (35% overall, 56 non-CLW, 21 CLW). Two hundred and six CLW volunteers were recruited to participate in the case-control study, of whom 135 were matched with 45 CLW patients. The annual incidence of MK was 0.63 per 10,000 population and 3.4 per 10,000 CLW with rates for daily, extended and rigid lens wear of 3.09, 9.30 and 0.44 per 10,000 CLW respectively. Pseudomonas aeruginosa was the dominant bacterial pathogen. Six cases of Acanthamoeba keratitis occurred, five in CLW (incidence 0.33 per 10,000 CLW) and one following corneal abrasion. Non-CLW developed MK at a peak age of 73, which is 10 years younger than expected for Scotland and USA. CONCLUSIONS: Previous ocular surface disease and trauma were the main risk factors for MK in Hong Kong. CLW appears at least as safe as that found in Scotland and the USA. Acanthamoeba keratitis was detected but with an incidence rate five times lower than Scotland. Factors predisposing hydrogel CLWs to MK, that were statistically significant, included overnight wear, poor hygiene and smoking. (+info)
Sampling private wells at past homes to estimate arsenic exposure: a methodologic study in New England.
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We are conducting a collaborative, population-based case-control study in Maine, New Hampshire, and Vermont to investigate the reasons for the elevated bladder cancer mortality in northern New England. Arsenic in drinking water is one of the primary exposures under investigation. To estimate subjects' lifetime exposure to waterborne arsenic, it will be necessary to obtain water samples from private wells that subjects used in the past. We conducted a methodologic study to assess the feasibility of locating and sampling from private wells at subjects' past residences. Ninety-eight New Hampshire residents (mean age 67 years) completed a questionnaire requesting the complete address, dates of occupancy, and drinking water sources for each home lived in since birth. An interviewer then asked subjects for more detailed information about each home to assist in a field search of past homes in the three-state study area of Maine, New Hampshire, and Vermont. Fifty-eight of the 98 subjects indicated that they had used a total of 103 private wells in 95 previous homes located in these three states. We conducted a field search to locate these 95 homes, visited town offices to find the properties on tax maps and obtain the current owners' names and addresses, attempted to obtain permission from the current owners to sample the wells, and collected water samples. In all, 48 (47%) of the 103 past wells in the study area were sampled successfully. The remaining wells were not sampled because the homes were not located (22%) or had been demolished (2%), permission to sample the wells was not obtained (17%), the wells had been destroyed (7%) or could not be found on the grounds of the residence (3%), or for other reasons (2%). Various approaches for improving the success rates for sampling water from private wells are discussed, as is the use of predictive modeling to impute exposures when sampling is not feasible. (+info)
Will volume-based referral strategies reduce costs or just save lives?
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Although recent policy initiatives aimed at concentrating selected surgical procedures in high-volume hospitals may reduce mortality, their economic implications have not been considered fully. From the hospital perspective, the primary effect of these policies will be to redistribute surgical profits to bigger centers. From the payer perspective, prices paid for procedures will likely increase in some geographic areas. From the societal perspective, how these policies will affect the true cost of providing surgical care is uncertain, but use of discretionary procedures will likely increase. For these reasons, the primary argument for volume-based referral strategies should be improving quality, not reducing costs. (+info)
A capacity mapping approach to public health training resources.
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The capacity mapping approach can be used to identify existing community resources. As part of this approach, inventories are used to provide information for a capacity map. The authors describe the development of two inventories and a capacity map for public health workforce development. For the first inventory, the authors contacted 754 institutions to determine available public health training resources; 191 institutions reported resources, including 126 directly providing distance learning technologies and courses or modules addressing important competency domains. Distance learning technologies included video conferencing facilities (61%) and satellite download facilities (50%). For the second inventory, the authors obtained information on 129 distance-accessible public health training modules. The workforce development capacity map produced from these two inventories revealed substantial resources available for use by individuals or agencies wishing to improve training in public health competencies. (+info)
Racial and ethnic identification practices in public health data systems in New England.
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OBJECTIVE: Efforts are underway to standardize "racial" and "ethnic" identification in public health data systems under the Revised Minimum Standards for the Classification of Federal Data on Race and Ethnicity issued in 1997. This study analyzed the racial and ethnic constructs and labels used in public health data systems maintained by the six New England states in light of these standards. METHODS: The authors surveyed public health officials responsible for ongoing individual-level data systems and reviewed relevant documents. RESULTS: Information was obtained on 169 of 170 identified data systems. Ninety-one systems (54%) conformed to the federal standard in having separate "race" and "ethnicity" fields, yet many of these did not conform to the standard in other respects. Fifty-five systems had only a race field; of these, 20 included no identifiers corresponding to Hispanic and/or Latino ethnicity. Three systems used only an ethnicity field. The systems used various lists of racial and/or ethnic categories, and overlapping but not fully comparable labels. Few systems allowed for identification of ancestry groups not included in the revised federal guidelines but with large populations in New England, such as Brazilians. Some definitions and coding instructions seemed inconsistent with social and geographic reality. CONCLUSIONS: These public health data systems used inconsistent methods for classifying people by race and ethnicity. Standardization according to federal standards would improve comparability, but would limit options for defining and including some ethnic groups while forcing other groups to be aggregated in single race categories, perhaps inappropriately. Fundamental reconsideration of racial and ethnic categorization is called for. (+info)
Outbreak of listeriosis--northeastern United States, 2002.
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A multistate outbreak of Listeria monocytogenes infections with 46 culture-confirmed cases, seven deaths, and three stillbirths or miscarriages in eight states has been linked to eating sliceable turkey deli meat. Cases have been reported from Pennsylvania (14 cases), New York (11 in New York City and seven in other locations), New Jersey (five), Delaware (four), Maryland (two), Connecticut (one), Massachusetts (one), and Michigan (one). Culture dates ranged from July 18 to September 30, 2002; case-finding is ongoing. Outbreak isolates share a relatively uncommon pulsed-field gel electrophoresis (PFGE) pattern. (+info)
Gender-related changes in the practice and outcomes of percutaneous coronary interventions in Northern New England from 1994 to 1999.
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OBJECTIVES: We sought to determine whether the changing practice of interventional cardiology has been associated with improved outcomes for women, and how these outcomes compare with those for men. BACKGROUND: Previous work from the early 1990s suggested women are at a higher risk than men for adverse outcomes after percutaneous coronary interventions (PCIs). From 1994 to 1999 data were collected on 33,666 consecutive hospital admissions for a PCI in Northern New England. Multivariate models were used to adjust for differences in case-mix across year of procedure when comparing outcomes. Direct standardization was used to calculate adjusted rates. RESULTS: From 1994 to 1999, the case-mix worsened for both women and men, although women had more co-morbidities than did men throughout the period. Stent use increased over time (>75% in 1999). Concomitantly, the need for emergency coronary artery bypass graft surgery (CABG) decreased significantly (p(trend) < or = 0.001; in 1999: 0.06% for women, 0.05% for men). Although the emergency CABG rates were higher for women at the beginning of the study, by the end, they were comparable (adjusted odds ratio 1.34, 95% confidence interval 0.76 to 2.38, p = 0.315). The myocardial infarction (MI) rates decreased over time for both women (by 29.7%, p(trend) = 0.378) and men (by 37.6%, p(trend) = 0.009) and did not differ by gender. The mortality rates did not decrease significantly over time and were not significantly different between the genders (mean 1.21% for women, 1.06% for men; p = 0.096). CONCLUSIONS: Concurrent with the changing practice of PCI, and despite treating sicker patients, there have been important improvements in post-PCI CABG and MI rates for women, as well as for men. Unlike in earlier years, there are no longer significant differences in outcomes by gender. (+info)