scholarly journals The other office

2018 ◽  
Vol 26 (1) ◽  
pp. 71-75 ◽  
Author(s):  
Elizabeth T Toll
Keyword(s):  
Cognitive Complexity ◽  
Clinical Care ◽  
Medical Knowledge ◽  
Third Party ◽  
Human Relationships ◽  
The Past ◽  
Visual Metaphors ◽  
Practice Of Medicine ◽  
Healing Relationships ◽  
Regulatory Mandates

Abstract Across recent decades, profound changes in the practice of medicine have been accompanied by parallel developments in the daily mental efforts of medical professionals. Using visual metaphors and hand-drawn illustrations, the author explores the evolution of one physician’s brain over the past 25 years. At the completion of training, the patient-practitioner relationship, medical knowledge, and care decisions dominated clinician thought, time, and effort. During the 1990’s, the growing constraints of third-party payers and government regulations presented new challenges to delivering relationship-based care. Over the past decade, the electronic health record (EHR) has added further cognitive complexity, disrupted human relationships, and contributed significantly to the current epidemic of clinician burnout. Solutions to these challenges include rethinking education, documentation, professional standards, institutional barriers, and regulatory mandates. It is important to pursue all solutions with the underlying premise of protecting healing relationships as the foundation of clinical care.

A Macintosh Interface for the Cameca Camebax-Micro Electron Microprobe

1990 ◽  
Vol 48 (1) ◽  
pp. 438-439
Author(s):  
Carl E. Henderson
Keyword(s):  
Electron Microprobe ◽  
Processing Speed ◽  
Word Processing ◽  
State Of The Art ◽  
Computer Control ◽  
Third Party ◽  
Disk Storage ◽  
The Past ◽  
User Facility ◽  
Instrument Control

Over the past few years it has become apparent in our multi-user facility that the computer system and software supplied in 1985 with our CAMECA CAMEBAX-MICRO electron microprobe analyzer has the greatest potential for improvement and updating of any component of the instrument. While the standard CAMECA software running on a DEC PDP-11/23+ computer under the RSX-11M operating system can perform almost any task required of the instrument, the commands are not always intuitive and can be difficult to remember for the casual user (of which our laboratory has many). Given the widespread and growing use of other microcomputers (such as PC’s and Macintoshes) by users of the microprobe, the PDP has become the “oddball” and has also fallen behind the state-of-the-art in terms of processing speed and disk storage capabilities. Upgrade paths within products available from DEC are considered to be too expensive for the benefits received. After using a Macintosh for other tasks in the laboratory, such as instrument use and billing records, word processing, and graphics display, its unique and “friendly” user interface suggested an easier-to-use system for computer control of the electron microprobe automation. Specifically a Macintosh IIx was chosen for its capacity for third-party add-on cards used in instrument control.

Novel Drugs and Biologics of 2016: A Boom for Neurodrugs in the Pipelin

2017 ◽  
Vol 10 (5) ◽  
pp. 3809-3814
Author(s):  
D Samba Reddy
Keyword(s):  
Muscular Atrophy ◽  
Clinical Care ◽  
New Drugs ◽  
Essential Medicines ◽  
High Demand ◽  
The Past ◽  
Novel Drugs ◽  
Innovative Products ◽  
Cns Drugs ◽  
The U.S

This article provides a brief overview of novel drugs approved by the U.S. FDA in 2016.  It also focuses on the emerging boom in the development of neurodrugs for central nervous system (CNS) disorders. These new drugs are innovative products that often help advance clinical care worldwide, and in 2016, twenty-two such drugs were approved by the FDA. The list includes the first new drug for disorders such as spinal muscular atrophy, Duchenne muscular dystrophy or hallucinations and delusions of Parkinson’s disease, among several others. Notably, nine of twenty-two (40%) were novel CNS drugs, indicating the industry shifting to neurodrugs. Neurodrugs are the top selling pharmaceuticals worldwide, especially in America and Europe. Therapeutic neurodrugs have proven their significance many times in the past few decades, and the CNS drug portfolio represents some of the most valuable agents in the current pipeline. Many neuroproducts are vital or essential medicines in the current therapeutic armamentarium, including dozens of “blockbuster drugs” (drugs with $1 billion sales potential).  These drugs include antidepressants, antimigraine medications, and anti-epilepsy medications. The rise in neurodrugs’ sales is predominantly due to increased diagnoses of CNS conditions. The boom for neuromedicines is evident from the recent rise in investment, production, and introduction of new CNS drugs.  There are many promising neurodrugs still in the pipeline, which are developed based on the validated “mechanism-based” strategy. Overall, disease-modifying neurodrugs that can prevent or cure serious diseases, such as multiple sclerosis, epilepsy, and Alzheimer’s disease, are in high demand. 

Reputation and Gossip in Game Theory

2019 ◽  
pp. 213-229
Author(s):  
Charles Roddie
Keyword(s):  
Game Theory ◽  
Strategic Behavior ◽  
Third Party ◽  
The Past ◽  
Past Behavior ◽  
Future Behavior ◽  
The Game Theory ◽  
Shed Light

When interacting with others, it is often important for you to know what they have done in similar situations in the past: to know their reputation. One reason is that their past behavior may be a guide to their future behavior. A second reason is that their past behavior may have qualified them for reward and cooperation, or for punishment and revenge. The fact that you respond positively or negatively to the reputation of others then generates incentives for them to maintain good reputations. This article surveys the game theory literature which analyses the mechanisms and incentives involved in reputation. It also discusses how experiments have shed light on strategic behavior involved in maintaining reputations, and the adequacy of unreliable and third party information (gossip) for maintaining incentives for cooperation.

It’s Time to Talk to Prehospital Providers: Feedback Disparities among Ground-Based Emergency Medical Services Providers and its Impact on Job Satisfaction

2021 ◽  
pp. 1-9
Author(s):  
Sarayna S. McGuire ◽  
Anuradha Luke ◽  
Aaron B. Klassen ◽  
Lucas A. Myers ◽  
Aidan F. Mullan ◽  
...  
Keyword(s):  
Job Satisfaction ◽  
Patient Care ◽  
Emergency Medical Services ◽  
Performance Feedback ◽  
Life Support ◽  
Clinical Care ◽  
Medical Services ◽  
The Past ◽  
Emergency Medical ◽  
Overall Job Satisfaction

Abstract Objective: Performance feedback on clinical care and patient outcomes is a cornerstone of medical education, yet it remains lacking in the prehospital environment. Research seeking to establish the quantity of feedback provided to Emergency Medical Services (EMS) has been limited and studies focused on complimentary feedback or how feedback relates to EMS job satisfaction are lacking. The objectives of this study were to measure the frequency and nature of feedback received by EMS agencies and to identify the importance of receiving feedback as it relates to EMS job satisfaction. Methods: This was an anonymous, survey-based study of twenty-nine Basic Life Support (BLS) and fifteen Advanced Life Support (ALS) agencies located in Southeastern Minnesota (USA). Descriptive statistics and Fisher exact tests were used. The study was deemed exempt by the Mayo Clinic Institutional Review Board. Results: Ninety-four responses were included from nineteen different EMS agencies, including sixty-one (64.9%) paramedics and thirty-three (35.1%) emergency medical technicians (EMTs). One-half of all respondents reported that they had not received any type of feedback in the past 30 days, while another 43.6% of respondents indicated that they had only received feedback one to three times in the same time period. Twenty (60.6%) EMTs reported receiving no feedback in the past 30 days, compared with twenty-seven (44.3%) paramedics (P = .123). Of respondents receiving feedback, 65.9% reported never or rarely receiving positive reinforcing feedback and 60.6% reported never or rarely receiving constructive criticism or feedback regarding something that did not go well with patient care or transport. The majority of respondents were dissatisfied with the quantity (86.1%) and quality (73.4%) of feedback received. An overwhelming majority (93.6%) indicated that feedback on patient care or outcomes was important in influencing their overall job satisfaction. This high importance was maintained across all demographic groups. Conclusion: Within the cohort of survey respondents, a paucity of feedback received by EMS personnel is a source of dissatisfaction for EMS providers. Feedback on patient care strongly relates to overall job satisfaction. These findings suggest system-wide opportunities for structured feedback processes, focusing upon both quality and quantity of delivered feedback, to improve both patient care and staff satisfaction.

Death, taxes and uncertainty: Economic motivations in end-of-life decision making

2021 ◽  
pp. 147775092110114
Author(s):  
George Slade Mellgard ◽  
Jacob M Appel
Keyword(s):  
End Of Life ◽  
Ethical Issues ◽  
Conflicts Of Interest ◽  
Clinical Care ◽  
Third Party ◽  
Ethical Conflicts ◽  
Financial Interests ◽  
End Of Life Decision ◽  
Death Taxes

Economic motivations are key drivers of human behavior. Unfortunately, they are largely overlooked in literature related to medical decisionmaking, particularly with regard to end-of-life care. It is widely understood that the directions of a proxy acting in bad faith can be overridden. But what of cases in which the proxy or surrogate appears to be acting in good faith to effectuate the patient’s values, yet doing so directly serves the decision-maker’s financial interests? Such situations are not uncommon. Many patients care as deeply about economic wellbeing of their families as they do for their own lives and health. This brief work examines three scenarios that raise ethical issues regarding the role of pecuniary motives in making critical medical decisions. Each scenario presents a potential financial conflict of interest between an incapacitated patient and a third-party decision-maker and offers a framework for integrating ethical and legal concerns into clinical care. It is our hope that this work prepares physicians for unexpected ethical conflicts of interest and enables them to further the interests of his or her patients.

A view of the current state of hygiene, sanitation, and public medicine

1923 ◽  
Vol 19 (2) ◽  
pp. 90-92
Author(s):  
V. V. Miloslavsky
Keyword(s):  
Medical Knowledge ◽  
Total Loss ◽  
Present Moment ◽  
The Past ◽  
Premature Deaths ◽  
Current State

Hardly any other branch of medical knowledge has ever faced greater challenges, more pressing questions, than hygiene does at the present moment. The past war has uprooted about 6 million healthy, strong individuals - a direct sacrifice on the altar of Mars. To this should be added about 50 million premature deaths caused by an increase of mortality and those who were not born as a result of a decrease in the birthrate. For Russia, the total loss had already reached 21 million souls by the end of 1920, with 25 million disabled.

Sex Offenders and Cyproterone Acetate—A Review of Clinical Care

1986 ◽  
Vol 26 (4) ◽  
pp. 279-282 ◽  
Author(s):  
David Torpy ◽  
Arden Tomison
Keyword(s):  
Sex Offenders ◽  
Cyproterone Acetate ◽  
Clinical Care ◽  
The Past

The literature on the use of cyproterone acetate in the treatment of sex offenders is examined. Seven patients who had received this treatment in the past five years are reviewed in the light of these publications.

scholarly journals Practical Negotiation for Medical Professionals

2018 ◽  
Vol 32 (04) ◽  
pp. 166-171 ◽  
Author(s):  
Bradley Eisemann ◽  
Ryan Wagner ◽  
Edward Reece
Keyword(s):  
Clinical Medicine ◽  
Clinical Care ◽  
Medical Knowledge ◽  
Medical Innovation ◽  
Medical Field ◽  
Residency Programs ◽  
Clinical Patient ◽  
Negotiation Strategies ◽  
Business Acumen ◽  
Time And Energy

AbstractDespite incredible advances in medical innovation and education, many students finish medical school, and physicians finish residency, without sound business acumen regarding the financial realities of the modern profession. The curriculum in medical schools and residency programs too often neglects teaching the business of medicine. This overview addresses how physicians can utilize effective negotiation strategies to help develop a medical practice or add value to an existing practice or institution. The authors applied the six foundations of effective negotiating, detailed by Richard Shell in his Bargaining for Advantage, to the medical field to demonstrate the processes involved in effective negotiating. They then outlined a strategy for physicians to adopt when negotiating and showed how this strategy can be used to add value. The six foundations include: developing a personal bargaining style, setting realistic goals, determining authoritative standards, establishing relationships, exploring the other party's interests, and gaining leverage. As physicians complete training, the ability to solely focus on medical knowledge and clinical patient care disappears. It is crucial that physicians invest the time and energy into preparing for the business aspects of this profession in much the same way they prepare for the clinical care of patients. This overview seeks to define the basics of negotiation, characterize the application of negotiation principles toward clinical medicine, and lay the foundation for further discussion and investigation.

Reimbursement as a Legitimizing Strategy for Health Education

2009 ◽  
Vol 10 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Virginia J. Noland Dodd ◽  
Ying Li
Keyword(s):  
Health Education ◽  
Third Party ◽  
Current Status ◽  
The Past ◽  
Education Profession ◽  
Third Party Reimbursement

The health education profession has made significant advances throughout the past few decades. However, health education is still described as an emerging profession. This article suggests strategies to move health education from its status as an emerging profession into that of an acknowledged profession. The authors assert that actively seeking direct third-party reimbursement will advance health education's emergence as a profession as well as increase its legitimacy in the eyes of other professions. The benefits of direct third-party reimbursement, experiences of the nursing profession's pursuit of direct third-party reimbursement, and the current status of health education are discussed. The article concludes by offering strategies for pursuing direct third-party reimbursement.

scholarly journals A Mobile Medical Knowledge Dissemination Platform (HeadToToe): Mixed Methods Study

10.2196/17729 ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. e17729 ◽  
Author(s):  
Ido Zamberg ◽  
Olivier Windisch ◽  
Thomas Agoritsas ◽  
Mathieu Nendaz ◽  
Georges Savoldelli ◽  
...  
Keyword(s):  
Medical Students ◽  
User Experience ◽  
Clinical Skills ◽  
Medical Knowledge ◽  
Postgraduate Education ◽  
Third Party ◽  
University Hospital ◽  
Knowledge Dissemination ◽  
Easy Access ◽  
The University

Background Finding readily accessible, high-quality medical references can be a challenging task. HeadToToe is a mobile platform designed to allow easy and quick access to sound, up-to-date, and validated medical knowledge and guidance. It provides easy access to essential clinical medical content in the form of documents, videos, clinical scores, and other formats for the day-to-day access and use by medical students and physicians during their pre- and postgraduate education. Objective The aim of this paper is to describe the architecture, user interface, and potential strengths and limitations of an innovative knowledge dissemination platform developed at the University of Geneva, Switzerland. We also report preliminary results from a user-experience survey and usage statistics over a selected period. Methods The dissemination platform consists of a smartphone app. Through an administration interface, content is managed by senior university and hospital staff. The app includes the following sections: (1) main section of medical guidance, organized by clinical field; (2) checklists for history-taking and clinical examination, organized by body systems; (3) laboratory section with frequently used lab values; and (4) favorites section. Each content item is programmed to be available for a given duration as defined by the content’s author. Automatic notifications signal the author when the content is about to expire, hence, promoting its timely updating and reducing the risk of using obsolete content. In the background, a third-party statistical collecting tool records anonymous utilization statistics. Results We launched the final version of the platform in March 2019, both at the Faculty of Medicine at the University of Geneva and at the University Hospital of Geneva in Switzerland. A total of 622 students at the university and 613 health professionals at the hospital downloaded the app. Two-thirds of users at both institutions had an iOS device. During the practical examination period (ie, May 2019) there was a significant increase in the number of active users (P=.003), user activity (P<.001), and daily usage time (P<.001) among medical students. In addition, there were 1086 clinical skills video views during this period compared to a total of 484 in the preceding months (ie, a 108% increase). On a 10-point Likert scale, students and physicians rated the app with mean scores of 8.2 (SD 1.9) for user experience, 8.1 (SD 2.0) for usefulness, and 8.5 (SD 1.8) for relevance of content. In parallel, postgraduate trainees viewed more than 6000 documents during the first 3 months after the implementation in the Division of Neurology at our institution. Conclusions HeadToToe is an educator-driven, mobile dissemination platform, which provides rapid and user-friendly access to up-to-date medical content and guidance. The platform was given high ratings for user experience, usefulness, and content quality and was used more often during the exam period. This suggests that the platform could be used as tool for exam preparation.

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