The experience of providing physical therapy in a changing health care environment. (25/676)

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)

Professional strategies of medical officers of health in the post-war period--1: 'innovative traditionalism': the case of Dr Ian MacQueen, MOH for Aberdeen 1952-1974, a 'bull-dog' with the 'hide of a rhinoceros'. (26/676)

Recent policies concerning the enhancement of preventive medicine and health improvement have raised important questions about leadership in public health and have emphasized the roles that can be played by local authorities. In this light, it is worth exploring the activities undertaken by local authority Medical Officers of Health (MOsH), until their posts were abolished in 1974. The process leading to 1974 has often been blamed, at least partly, on the complacency, lack of imagination and demoralization of MOsH. However, when John Welshman asked the question 'watchdog or lapdog?' of the MOH, in a paper published in 1997, he concluded there was little justification for the latter label. This paper considers the career of Ian MacQueen, Aberdeen's last MOH, who is well known for the criticisms of his handling of the Aberdeen typhoid outbreak in 1964, which appeared in the report of an official enquiry. He was deemed to have made excessive use of the media and to have turned the outbreak into an event approaching a national crisis. However, in the context of MacQueen's 32 year career in Aberdeen, his use of the media during the typhoid outbreak was no aberration. Rather, it was characteristic of his determination to maintain an important role for the MOH within the NHS-era health services. There is therefore continuity between MacQueen's strategy and the ambitions of many MOsH before the NHS, who hoped for a unified health service with themselves occupying a leading role. MacQueen's actions during the typhoid outbreak also reflected his innovative activities in the field of health education, and his interest in the media for that purpose. In conclusion, MacQueen provides an example of an MOH who cannot be charged with complacency and resignation to a declining role: rather, his strategy of 'innovative traditionalism' sought to protect and extend his department's services.  (+info)

Professional strategies of medical officers of health in the post-war period--2: 'progressive realism': the case of Dr R. J. Donaldson, MOH for Teesside, 1968-1974. (27/676)

This paper discusses the work of Raymond J. Donaldson, who served as Medical Officer of Health (MOH) on Teesside in the North-East of England, 1968-1974, and the professional strategy that he adopted during this period is characterized. It is shown that Donaldson effectively withdrew from areas where the local authority public health department and general practitioners offered the same services, and consciously sought the complete attachment of some grades of staff to general practice. This approach, which was based on the view that in the long term the local authority could not compete successfully with general practitioners, allowed him to develop other activities, notably in the area of action research. 'Progressive realism' will be suggested as a suitable description for Donaldson's professional strategy during his time in Teesside.  (+info)

Challenges to the pharmacist profession from escalating pharmaceutical demand. (28/676)

Unexpected growth in medication use has escalated demand for pharmacists that has outpaced supply. Responses to the pharmacist shortage include larger workloads and greater use of pharmacist extenders and technology. As the profession has moved from a product orientation (dispensing medications) to a patient focus, clinical training requirements have expanded. However, structural and process barriers, particularly in community and retail pharmacies, must be addressed to improve the medication-use process. These issues merit greater attention from health care leaders and policymakers.  (+info)

Issues in conducting randomized controlled trials of health services research interventions in nonacademic practice settings: the case of retail pharmacies. (29/676)

OBJECTIVE: To describe unexpected challenges and strategies to overcome them when conducting randomized controlled trials (RCT) of health services research interventions in retail pharmacies. STUDY SETTING: Thirty-six retail drug stores in Indianapolis. STUDY DESIGN: We conducted an RCT to evaluate the effectiveness of an intervention to increase pharmacists' involvement in caring for customers. We describe: (1) our RCT as originally designed, (2) unexpected challenges we faced; and (3) how we resolved those challenges. DATA COLLECTION/EXTRACTION METHODS: Randomized controlled trial. PRINCIPAL FINDINGS: Major modifications in research design were necessitated by factors such as corporate restructuring, heightened sensitivity to patient confidentiality, and difficulties altering employees' behavior. We overcame these barriers by conducting research that is consistent with corporate goals, involving appropriate corporate administrators and technical personnel early in the process, and being flexible. CONCLUSIONS: Health services researchers should conduct RCTs in a variety of non-academic practice settings to increase generalizability and better reflect the true impact of interventions. Pragmatic problems, although significant, can be successfully overcome.  (+info)

Understanding niacin formulations. (30/676)

Niacin is an important therapeutic option for the treatment of dyslipidemias and is the only agent currently available that favorably affects all components of the lipid profile to a significant degree. Niacin has consistently been shown to significantly reduce levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and lipoprotein (a), while having the greatest high-density lipoprotein (HDL) cholesterol-raising effects of all available agents. Niacin has also been shown to significantly reduce coronary events and total mortality. Niacin is available in 3 formulations: immediate-release (IR), sustained-release (SR), and a newer formulation, niacin extended-release (ER), all of which differ in their pharmacokinetic, efficacy, and safety profiles. Conventional niacin therapy has notable limitations that include flushing, most often seen with IR formulations, and hepatotoxicity, associated with SR formulations. These side effects are related to the absorption rate and subsequent metabolism of niacin as delivered from the different products. Niacin ER has a delivery system allowing absorption rates intermediate to that of niacin IR and SR. As a result, niacin ER achieves the efficacy of niacin IR with a reduced incidence of flushing and without the hepatic effects seen with niacin SR. The pharmacist should be familiar with the differences among and the advantages and disadvantages of each formulation to educate patients and help them achieve the optimal therapeutic benefit of niacin while minimizing adverse effects.  (+info)

Effectiveness of tobacco counseling in the dental office. (31/676)

This article describes the results of studies among dental care providers regarding tobacco cessation in the past two decades. In the early period, surveys described what dentists were doing in their own practices. The results suggested that they were not adequately communicating to their patients the importance of quitting. There is good evidence that brief interventions from health professionals can increase rates of smoking cessation. The outcome from a number of trials that examined the feasibility of conducting smoking cessation in dental practices is reviewed here. The pivotal role of a team approach is highlighted in many studies. Dentists who implement an effective smoking cessation program can expect to achieve quit rates up to 10-15 percent each year among their patients who smoke or use smokeless tobacco. The challenge is implementing effective treatment in one's practice or institution while using available primary care resources to provide additional benefit.  (+info)

Standards for hospital libraries 2002. (32/676)

The Medical Library Association's "Standards for Hospital Libraries 2002" have been developed as a guide for hospital administrators, librarians, and accrediting bodies to ensure that hospitals have the resources and services to effectively meet their needs for knowledge-based information. Specific requirements for knowledge-based information include that the library be a separate department with its own budget. Knowledge-based information in the library should be directed by a qualified librarian who functions as a department head and is a member of the Academy of Health Information Professionals. The standards define the role of the medical librarian and the links between knowledge-based information and other functions such as patient care, patient education, performance improvement, and education. In addition, the standards address the development and implementation of the knowledge-based information needs assessment and plans, the promotion and publicity of the knowledge-based information services, and the physical space and staffing requirements. The role, qualifications, and functions of a hospital library consultant are outlined. The health sciences library is positioned to play a key role in the hospital. The increasing use of the Internet and new information technologies by medical, nursing, and allied health staffs; patients; and the community require new strategies, strategic planning, allocation of adequate resources, and selection and evaluation of appropriate information resources and technologies. The Hospital Library Standards Committee has developed this document as a guideline to be used in facing these challenges.  (+info)