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Medical Association (medical + association)
Kinds of Medical Association Selected AbstractsTwo steps forward, one step back: advance care planning, Australian regulatory frameworks and the Australian Medical AssociationINTERNAL MEDICINE JOURNAL, Issue 9 2007M Parker Abstract The Australian Medical Association has recently adopted a policy position concerning advance care planning, which is generally supportive of extending patient self-determination beyond the loss of decision-making capacity. It calls for uniform national legislation for legally enforceable advance health directives (AHD), and statutory protection for practitioners who comply with valid AHD, or who do not comply on several grounds. Analysis of the grounds for non-compliance indicate that they undermine patient autonomy, and aspects of the policy are inconsistent with current common law and statutory regimes that allow an adult to complete a legally binding AHD. The policy therefore threatens the patient self-determination, which it endorses, and places doctors who participate in advance care planning at legal risk. [source] Prescription practices of public and private health care providers in Attock District of PakistanINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 1 2002S. Siddiqi Abstract The irrational use of drugs is a major problem of present day medical practice and its consequences include the development of resistance to antibiotics, ineffective treatment, adverse effects and an economic burden on the patient and society. A study from Attock District of Pakistan assessed this problem in the formal allopathic health sector and compared prescribing practices of health care providers in the public and private sector. WHO recommended drug use indicators were used to study prescription practices. Prescriptions were collected from 60 public and 48 private health facilities. The mean (±,SE) number of drugs per prescription was 4.1,±,0.06 for private and 2.7,±,0.04 for public providers (,p,<,0.0001). General practitioners (GPs) who represent the private sector prescribed at least one antibiotic in 62% of prescriptions compared with 54% for public sector providers. Over 48% of GP prescriptions had at least one injectable drug compared with 22.0% by public providers (,p,<,0.0001). Thirteen percent of GP prescriptions had two or more injections. More than 11% of GP prescriptions had an intravenous infusion compared with 1% for public providers (,p,<,0.001). GPs prescribed three or more oral drugs in 70% of prescriptions compared with 44% for public providers (,p,<,0.0001). Prescription practices were analysed for four health problems, acute respiratory infection (ARI), childhood diarrhoea (CD), fever in children and fever in adults. For these disorders, both groups prescribed antibiotics generously, however, GPs prescribed them more frequently in ARI, CD and fever in children (,p,<,0.01). GPs prescribed steroids more frequently, however, it was significantly higher in ARI cases (,p,<,0.001). For all the four health problems studied, GPs prescribed injections more frequently than public providers (,p,<,0.001). In CD cases GPs prescribed oral rehydration salt (ORS) less frequently (33.3%) than public providers (57.7%). GPs prescribed intravenous infusion in 12.3% cases of fever in adults compared with none by public providers (,p,<,0.001). A combination of non-regulatory and regulatory interventions, directed at providers as well as consumers, would need to be implemented to improve prescription practices of health care providers. Regulation alone would be ineffective unless it is supported by a well-established institutional mechanism which ensures effective implementation. The Federal Ministry of Health and the Provincial Departments of Health have to play a critical role in this respect, while the role of the Pakistan Medical Association in self-regulation of prescription practices can not be overemphasized. Improper prescription practices will not improve without consumer targeted interventions that educate and empower communities regarding the hazards of inappropriate drug use. Copyright © 2002 John Wiley & Sons, Ltd. [source] Interview with a Quality Leader: Paul Gluck, Immediate Past Chair, National Patient Safety FoundationJOURNAL FOR HEALTHCARE QUALITY, Issue 5 2009Pamela K. Scarrow Interviewer Abstract: Dr. Paul Gluck, MD, FACOG, has held many leadership positions. He served as the president/chair of the William A. Little OB/GYN Society, the Miami OB/GYN Society, the Florida OB/GYN Society, the Baptist Health Foundation, the Health Council of south Florida, the Florida Section of the American College of OB/GYN (ACOG), National Patient Safety Foundation, as well as the Dade County Medical Association. He is currently ACOG assistant secretary and serves on their Executive Committee. Dr. Gluck has an interest in access to healthcare. For his work in establishing a prenatal clinic in an area of critical need he received ACOG president's Service Award and Humanitarian of the Year Award from the South Florida Perinatal Network. He led the Florida initiative to promote depression screening and treatment in women recognized by the Wyeth National Section Award. He co-chaired the Governance Committee of the Mayor's Task Force charged with solving the problem of providing care for the over 450,000 uninsured residents of Miami-Dade County. [source] Clinical Utility of Office-Based Cognitive Predictors of Fitness to Drive in Persons with Dementia: A Systematic ReviewJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2006Frank J. Molnar MDCM OBJECTIVES: To perform a systematic review of evidence available regarding in-office cognitive tests that differentiate safe from unsafe drivers with dementia. DESIGN: A comprehensive literature search of multiple databases including Medline, CINAHL, PsychInfo, AARP Ageline, and Sociofile from 1984 to 2005 was performed. This was supplemented by a search of Current Contents and a review of the bibliographies of all relevant articles. SETTING: English prospective cohort, retrospective cohort, and case-control studies that used accepted diagnostic criteria for dementia or Alzheimer's disease and that employed one of the primary outcomes of crash, simulator assessment, or on-road assessment were included. PARTICIPANTS: Two reviewers. MEASUREMENTS: The reviewers independently assessed study design, main outcome of interest, cognitive tests, and population details and assigned a Newcastle-Ottawa quality assessment rating. RESULTS: Sixteen articles met the inclusion criteria. Tests recommended by guidelines (e.g., the American Medical Association (AMA) and Canadian Medical Association guidelines) for the assessment of fitness to drive did not demonstrate robustly positive findings (e.g., Mini-Mental State Examination, Trails B) or were not evaluated in any of the included studies (e.g., Clock Drawing). Fifteen studies did not report any cutoff scores. CONCLUSION: Without validated cutoff scores, it is impossible to employ tests in a standardized fashion in front-line clinical settings. This study identified a research gap that will prevent the development of evidence-based guidelines. Recommendations to address this gap are that driving researchers routinely perform cutoff score analyses and that stakeholder organizations (e.g., AMA, American Geriatrics Society) sponsor consensus fora to review driving research methodologies. [source] Screening for hepatitis B in chemotherapy patients: survey of current oncology practicesALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2010T. T. TRAN Summary Background, Hepatitis B virus (HBV) reactivation occurs in up to 78% of patients receiving cytotoxic chemotherapy for nonhepatic malignancies. Reactivation can lead to hepatic dysfunction, jaundice and fulminant hepatic failure. Current recommendations include screening patients at risk for HBV prior to immunosuppressive therapy and initiating antiviral prophylaxis in patients with chronic HBV. Aim, To investigate current practice among oncologists regarding HBV screening and antiviral prophylaxis in candidates for chemotherapy. Methods, A survey was sent to American Medical Association registered oncologists assessing demographics and HBV screening practices. Statistical analysis was performed using Fisher's exact test. Results, In all, 265 responses were received. Office-based physicians were less likely to screen for HBV prior to chemotherapy (P < 0.001). Years in practice varied: 51% with <5 years, 29% with 5,15 years and 18% with >15 years, with no difference in screening practices between groups (P = N.S.). Responders screen for HBV as follows: never , 20%, only in the presence of abnormal liver biochemistries , 30%, risk factors or history of hepatitis , 38%. In patients with known HBV, 75% of oncologists refer to specialists, 7% initiate therapy, while 15% do not refer or initiate therapy, most of whom are in an office setting (P = 0.02). Conclusions, Twenty per cent of oncologists never screen for HBV prior to initiating chemotherapy. Office-based physicians were less likely to screen, treat or refer to a specialist prior to chemotherapy. Greater education regarding risk of HBV reactivation is needed for clinicians treating patients with immunosuppressive therapies. Aliment Pharmacol Ther,31, 240,246 [source] The Emergence of Integrative Medicine in Australia: The Growing Interest of Biomedicine and Nursing in Complementary Medicine in a Southern Developed SocietyMEDICAL ANTHROPOLOGY QUARTERLY, Issue 1 2008Hans Baer In this article, I examine the process by which some biomedical physicians and nurses in Australia have come to adopt various alternative therapies in their regimens of practice, largely in response to (1) the growing interest on the part of many Australians in what is generally called "complementary medicine", and (2) a recognition that biomedicine is not particularly effective in treating an array of chronic ailments. Some Australian biomedical physicians and nurses have come to embrace "integrative medicine," which purports to blend the best of biomedicine and complementary medicine, and have even created an Australasian Integrative Medical Association and established integrative medical training programs and centers. I argue that the adoption of alternative therapies and the development of integrative medicine on the part of Australian biomedical physicians and nurses constitute another national manifestation of the co-option of complementary and alternative medicine. [source] The Knowles Affair: Nixon's Self-Inflicted WoundPRESIDENTIAL STUDIES QUARTERLY, Issue 3 2000DEAN J. KOTLOWSKI The Knowles affair, a forgotten chapter of the early Nixon presidency, caused quite a stir in 1969. The administration's five-month-long attempt to elevate John H. Knowles, a moderate Republican, to the post of assistant secretary of health, education, and welfare (HEW) for health and scientific affairs aroused opposition from the American Medical Association and Senate Minority Leader Everett McKinley Dirksen, a Republican of Illinois. The imbroglio revealed weaknesses in Nixon's decision-making and administrative style, drew considerable criticism in the press, and helped to undermine the position of HEW Secretary Robert H. Finch, until then a presidential favorite. For students of the modern presidency, the Knowles case showed how a minor dispute can become important when stoked by ego, ambition, bungling, and press leaks. [source] Suicide patterns and characteristics in Akita, JapanPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 3 2005MASAHITO FUSHIMI md Abstract, Akita Prefecture currently has the highest rate of suicide in Japan. Given this alarming statistic, investigation of the underlying causes of suicide and identification of strategies for suicide prevention are imperative. Members of the Akita Prefectural Medical Association (APMA) see most of the individuals who commit suicides in Akita Prefecture, so data from the APMA would prove advantageous in any investigation of suicides. In this study, members of the APMA who had attended to individuals who had committed suicide were asked to complete a questionnaire about the case to determine the factors underlying suicide in Akita Prefecture. From 1 July 2001 to 30 June 2002, a total of 138 cases (102 males, 36 females) of suicide were reported. Most suicide cases were of 50,69 year olds. Many cases involved relatively lethal methods (such as hanging). Most suicides were performed at home and at a time when the rest of the family was asleep or absent. The most ,common ,complaint ,appeared ,to ,be ,economic-related ,problems. ,Depressive ,disorder ,was the most common psychiatric disorder, and many cases displayed high depressive trait scores. The present results do not exclude the possibility that economic-related problems are playing a major role in recent increases in suicide numbers. However, strategies for dealing with depression as well as economic-related problems are considered important. [source] A new metric for continuing medical education creditTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 3 2004Dr. Nancy L. Davis PhD Director Abstract The two major continuing medical education (CME) credit systems for allopathic physicians in the United States are administered by the American Medical Association (AMA) and the American Academy of Family Physicians (AAFP). This article explores the history of AMA and AAFP CME credit and its value to physicians and the patients they serve. Historically, CME credit has been awarded as hours for participation, but this approach is inadequate as a measure of CME and its impact on improving physician practice. New credit systems are needed to measure a CME activity by its value in bettering the physician's knowledge base, competence, and performance in practice. [source] National Health Service Corps Staffing and the Growth of the Local Rural Non-NHSC Primary Care Physician WorkforceTHE JOURNAL OF RURAL HEALTH, Issue 4 2006Donald E. Pathman MD ABSTRACT:,Context: Beyond providing temporary staffing, National Health Service Corps (NHSC) clinicians are believed by some observers to contribute to the long-term growth of the non-NHSC physician workforce of the communities where they serve; others worry that NHSC clinicians compete with and impede the supply of other local physicians. Purpose: To assess long-term changes in the non-NHSC primary care physician workforce of rural underserved counties that have received NHSC staffing support relative to workforce changes in underserved counties without NHSC support. Methods: Using data from the American Medical Association and NHSC, we compared changes from 1981 to 2001 in non-NHSC primary care physician to population ratios in 2 subsets of rural whole-county health professional shortage areas: (1) 141 counties staffed by NHSC physicians, nurse practitioners, and/or physician assistants during the early 1980s and for many of the years since and (2) all 142 rural health professional shortage area counties that had no NHSC clinicians from 1979 through 2001. Findings: From 1981 to 2001, counties staffed by NHSC clinicians experienced a mean increase of 1.4 non-NHSC primary care physicians per 10,000 population, compared to a smaller, 0.57 mean increase in counties without NHSC clinicians. The finding of greater non-NHSC primary care physician to population mean ratio increase in NHSC-supported counties remained significant after adjusting for baseline county demographics and health care resources (P < .001). The estimated number of "extra" non-NHSC physicians in NHSC-supported counties in 2001 attributable to the NHSC was 294 additional physicians for the 141 supported counties, or 2 extra physicians, on average, for each NHSC-supported county. Over the 20 years, more NHSC-supported counties saw their non-NHSC primary care workforces grow to more than 1 physician per 3,500 persons, but no more NHSC-supported than nonsupported counties lost their health professional shortage area designations.Conclusions: These data suggest that the NHSC contributed positively to the non-NHSC primary care physician workforce in the rural underserved counties where its clinicians worked during the 1980s and 1990s. [source] Estimating HIV Incidence Based on Combined Prevalence TestingBIOMETRICS, Issue 1 2010Raji Balasubramanian Summary Knowledge of incidence rates of HIV and other infectious diseases is important in evaluating the state of an epidemic as well as for designing interventional studies. Estimation of disease incidence from longitudinal studies can be expensive and time consuming. Alternatively, Janssen et al. (1998,,Journal of the American Medical Association,280, 42,48) proposed the estimation of HIV incidence at a single point in time based on the combined use of a standard and "detuned" antibody assay. This article frames the problem from a longitudinal perspective, from which the maximum likelihood estimator of incidence is determined and compared with the Janssen estimator. The formulation also allows estimation for general situations, including different batteries of tests among subjects, inclusion of covariates, and a comparative evaluation of different test batteries to help guide study design. The methods are illustrated with data from an HIV interventional trial and a seroprevalence survey recently conducted in Botswana. [source] Guidelines for the use of recombinant activated factor VII (rFVIIa) in uncontrolled bleeding: a report by the Israeli Multidisciplinary rFVIIa Task ForceJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 4 2005U. MARTINOWITZ Summary.,Background:,Recombinant activated factor VII (rFVIIa) has been approved by the U.S. Food and Drug Administration (FDA) for almost a decade for hemophilic patients with inhibitors. Its off-label use as a hemostatic agent in massive bleeding caused by a wide array of clinical scenarios is rapidly expanding. While evidence-based guidelines exist for rFVIIa treatment in hemophilia, none are available for its off-label use. Objectives:,The aim of this study is to develop expert recommendations for the use of rFVIIa in patients suffering from uncontrolled bleeding (with special emphasis on trauma) until randomized, controlled trials allow for the introduction of more established evidence-based guidelines. Methods:,A multidisciplinary task force comprising representatives of the relevant National Medical Associations, experts from the Medical Corps of the Army, Ministry of Health and the Israel National Trauma Advisory Board was established in Israel. Recommendations were construed based on the analysis of the first 36 multi-trauma patients accumulated in the prospective national registry of the use of rFVIIa in trauma, and an extensive literature search consisting of published and prepublished controlled animal trials, case reports and series. The final consensus guidelines, together with the data of the first 36 trauma patients treated in Israel, are presented in this article. Results:,Results of the first 36 trauma patients: The prolonged clotting assays [prothrombin time (PT) and partial thromboplastin time (PTT)] shortened significantly within minutes following administration of rFVIIa. Cessation of bleeding was achieved in 26 of 36 (72%) patients. Acidosis diminished the hemostatic effect of the drug, while hypothermia did not affect it. The survival rate of 61% (22/36) seems to be favorable compared with published series of similar, or less severe, trauma patients (range 30%,57%). Conclusions:,As a result of the lack of controlled trials, our guidelines should be considered as suggestive rather than conclusive. However, they provide a valuable tool for physicians using rFVIIa for the expanding off-label clinical uses. [source] Physician peer assessments for compliance with methadone maintenance treatment guidelinesTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2007Carol Strike PhD Abstract Introduction: Medical associations and licensing bodies face pressure to implement quality assurance programs, but evidence-based models are lacking. To improve the quality of methadone maintenance treatment (MMT), the College of Physicians and Surgeons of Ontario, Canada, conducts an innovative quality assurance program on the basis of peer assessments. Using data from this program, we assessed physician compliance with MMT guidelines and determined whether physician factors (e.g., training, years of practice), practice type, practice location, and/or caseload is associated with MMT guideline adherence. Methods: Secondary analysis of methadone practice assessment data collected by the College of Physicians and Surgeons of Ontario, Canada. Assessment data from methadone prescribing physicians who completed their first year of methadone practice were analyzed. We calculated the mean percentage compliance per guideline per physician and global compliance across all guidelines per physician. Linear regression was used to assess factors associated with compliance. Results: Data from 149 physician practices and 1,326 patient charts were analyzed. Compliance across all charts was greater than 90% for most areas of care. Compliance was less than 90% for take-home medication procedures; urine toxicology screening; screening for hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), tuberculosis, other sexually transmitted infections, and completion of a psychosocial assessment. Mean global compliance across all charts and guidelines per physician was 94.3% (standard deviation = 7.4%) with a range of 70% to 100%. Linear regression analysis revealed that only year of medical school graduation was a significant predictor of physician compliance. Discussion: This is the first report of MMT peer assessments in Canada. Compliance is high. Few countries conduct similar assessment processes; none report physician-level results. We cannot quantify the contribution of peer assessment, training, or self-selection to the compliance rates, but compared to other areas of practice these rates suggest that peer assessment may exert a significant effect on compliance. A similar assessment process may in other areas of clinical practice improve physician compliance. [source] Ethical Implications of Physician Involvement in Lawsuits on Behalf of the Tobacco IndustryTHE JOURNAL OF LAW, MEDICINE & ETHICS, Issue 4 2007Jess Alderman The statements of physicians who serve as expert witnesses for the tobacco industry reveal subtle but significant problems. Some expert testimony obfuscates the important issues, and some initially reasonable statements later evolve into extreme positions during cross-examination. Such statements fall into a "gray area" of professional ethics, potentially misleading juries and adversely affecting professional integrity. Medical associations can and should strongly enforce professional standards that do not tolerate tobacco industry influence on physician expert witnesses. [source] Acceptance of Sentinel Lymph Node Biopsy of the Breast by All General Surgeons in KentuckyTHE BREAST JOURNAL, Issue 4 2005C. Adam Conn MD Abstract:, Sentinel lymph node biopsy (SLNB) for breast cancer is now performed routinely in many U.S. medical centers. The acceptance of SLNB in the community and in rural medical centers, however, has not been accurately defined. The purpose of this study was to assess how surgeons in Kentucky, a predominantly rural state, have incorporated SLNB into practice. General surgeons in the state of Kentucky were identified by registration with the state medical association. All general surgeons (n = 272) in the state were mailed the questionnaire, with 93% (n = 252) responding. Overall, 172 defined themselves as rural surgeons. Among the rural surgeons, 87% perform breast cancer operations and 54% perform SLNB. In comparison, 74% of nonrural surgeons perform breast cancer operations and 80% perform SLNB. A majority of nonrural surgeons (73%) have performed SLNB for more than 2 years when compared to rural surgeons (73% versus 37%, respectively; p < 0.0001). Planned backup axillary node dissection was stopped by both rural (26%) and community (39%) surgeons after 10 cases (14% rural, 19% nonrural) or 11,20 cases (12% rural, 20% nonrural). Surgeons reported using SLNB for the following diagnoses: invasive cancer (98%), ductal carcinoma in situ (DCIS) (43%), and lobular carcinoma in situ (LCIS) (11%). The majority of surgeons (87%) reported a greater than 90% SLN identification rate. SLNB has become widely accepted by surgeons in both rural and nonrural medical centers in Kentucky. However, there has been considerable variability in the number of training cases surgeons have performed prior to abandoning routine axillary dissection. This indicates a need for continuing educational efforts aimed at quality assurance. [source] Medical and legal considerations of brain deathACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2004T. T. Randell Brain death was first defined in 1968, and since then laws on determining death have been implemented in all countries with active organ transplantation programs. As a prerequisite, the aetiology of brain death has to be known, and all reversible causes of coma have to be excluded. The regulations for the diagnosis of brain death are most commonly given by the national medical associations, and they vary between countries. Thus, the guidelines given in the medical textbooks are not universally applicable. The diagnosis is based on clinical examination, but confirmatory tests, such as angiography or EEG, are allowed on most occasions. Brain death is followed by cardiovascular and hormonal changes, which have implications in the management of a potential organ donor. Spinal reflexes are preserved, and motor and haemodynamic responses are frequently observed in brain dead patients. [source] The annual scientific conference: what does the future hold?ANZ JOURNAL OF SURGERY, Issue 3 2009Michael Hollands It is now expected that medical practitioners around the world will engage in ongoing professional development. Many Colleges, medical associations and societies have made completion of appropriate continuing professional development (CPD) mandatory and medical registration in some jurisdictions is predicated on participation in a CPD programme. This commits doctors to a programme of lifelong learning. 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