This thesis was undertaken to provide practice relevant information for educational planning within Family Medicine in Indiana. The basic aim was to determine the current practice patterns in family medicine and to develop profiles for selected career patterns. All All Indiana doctors with a career choice in family medicine comprised the population for this statewide study. The data were collected through the use of a validated questionnaire. The data were statistically analyzed by computer and reported in narrative and tabular form.Ball State UniversityMuncie, IN 47306

Self-regulation capacity allows individuals to manage their thoughts, feelings, and actions to attain personal goals (e.g., well-being and performance), as well as adjust to their changing social and physical environment (Zimmerman, 2000). Self-regulation as a positive adaptive skill and process has not been examined in relation to well-being in the context of medicine. The purpose of the current study was to examine self-regulation with 37 medical students and 25 supervising physicians to determine whether or not it may enhance well-being and performance, and reduce stress and burnout. A mixed-methods design was used to collect and analyze the data, and findings from the quantitative and qualitative phases were presented in two separate articles. Self-regulation capacity appears to be an important skill that may help both physicians and medical students to meet the demands of the medical profession and maintain an adequate level of well-being and performance in their work and daily life.

Several factors inform health professionals decisions to migrate from developing to developed countries to practice their profession. This study explores the Push and Pull factors that informed African-trained physicians decisions to migrate to the province of Saskatchewan, how well they integrated into their new working environments upon arrival and how that might contribute to future migration and retention in Saskatchewan. Based on questionnaire surveys and face-to-face interviews, this study identified differences in the relative importance of precipitating factors for physicans from South, North and Other African nations. Although the majority of African-trained physicians for the study indicated that profession-related push factors were the precipitating factors for their migration, a smaller number did not cite these as important. Most respondents for the study integrated well into the health care system and have remained at their current location of practice because of the support they received from colleagues at their work places.

Many patients with end-stage renal disease come to rely on catheters as their only means of hemodialysis when other options are no longer viable. These patients have a very poor quality of life due to their chronic illness as well as many long-term complications related to the use of tunneled catheters. Many prior attempts have been made to understand these catheter-related problems. Yet, they continue to be a major cause of morbidity and mortality in chronic catheter-reliant patients. We hope to examine the rate as well as long term time course of these complications such that in future, we may decrease their occurrence. We predict that over time, chronic catheter use decreases the mean indwell time for each catheterization and increases the incidence of complications. To study this, we conducted a retrospective study looking at all patients who had three or more tunneled catheter exchanges between July 2003 and July 2008. We collected information from Yale IDX database on the patients age and gender, the type of catheter used, the indwell time of the catheter, the vessel used as access, the indication for catheter removal, whether the procedure was performed by a medical doctor (M.D.) or physicians assistant (P.A.) and whether it was a de novo insertion or over-the-wire exchange. We collected a total of 764 data points on 191 patients (89 males and 102 females). They ranged from 8 to 87 years old with a median age of 56 years. Infection was the number one indication for catheter removal at 37%. The rate of infection was 3.34 per 1,000 catheter days. There was no difference in the rate of complications by the side of vessel accessed nor by type of catheter. However, right-sided catheters had a longer indwell time of 117 + 159 days compared to left-sided catheters, 87 + 124 days (p =0.008). There was no significant difference in the indwell duration of first catheter in comparison to all subsequent placements. There was also no difference in complications whether the catheter was exchanged over the wire or placed de novo. Nor were complication rates different among M.D. versus P.A. conducted procedures. We conclude that our rates of infection are similar to other institutions and the vessels located on the right-side of the neck are preferable to left-sided vessels to increase catheter longevity. Future research is needed to better assess how rates and incidences of complications change with long standing catheter-reliance.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

Thesis (Ph. D.)--Rand Graduate School, 2002. / Title from web page (viewed Aug. 27, 2003). Includes bibliographical references.

This Report examines the “paradox” of physician privacy: while physician privacy has been explicitly or implicitly invoked over the last century to defend physicians against greater transparency, proposals that might cause them economic harm, or interference by government or corporate entities, there has been little comprehensive work done to examine the substance and source of any privacy rights physicians may actually enjoy. This Report attempts to make three primary contributions with respect to physician privacy. First, the Report examines the current state of physician privacy and the legal framework that governs it. Second, the Report argues that physician “privacy” is not, and should not be considered, a unitary concept encompassing a singular meaning. Rather it is a broad umbrella term that encompasses not only a variety of legal protections for privacy, but guards against a variety of very different perceived harms. As a result, this Report argues that in evaluating policy initiatives, discussions about “privacy” implications can be counterproductive because the term obscures the real values, concerns, and policy judgments at play. To address this, the Report’s third aim is the proposal of an analytical framework that policymakers and others may use to consider the impact of various initiatives on the values and concerns that physician “privacy” actually protects: professional autonomy; economic considerations; personal dignity; and practical difficulties. / text

A philosophical and scientific eclectic, Dr. Friedrich Hoffmann (1660-1742) brought together the wisdom of ancient writers with the new science and philosophy of his day. In the Medicus Politicus (The Politic Physician) (1738) he applied his concepts to medicine and medical ethics. The Medicus Politicus contains the lecture notes of Hoffmann as first professor of medicine at the University of Halle. The work is divided into three parts: the personal characteristics required by the new politic physician; the physician's relationship with other members of the medical community (often competitors); and the patient-physician relationship. This dissertation provides the first comprehensive English-language philosophical analysis and commentary on this work. It addresses two issues found in the Medicus Politicus: Hoffmann's model for the new physician and the medical ethics required in the patient-physician relationship. The political, intellectual and religious upheavals of the Long Eighteenth Century inform the work of Hoffmann. Physicians were not yet considered professionals and competed with the untrained. The new Hoffmannian physician would change that and would develop the personal qualities that were found in the professions of theology and law. Specifically, the Hoffmannian physician would be moral, rational and clinically competent. Hoffmann provided two independent but harmonious foundations to justify these requirements: one theological and one rational. Specifically, Hoffmann was an enthusiastic Pietist, a Natural Law theorist and an evidence-based scientist. His applied ethics is one of the most complete systems ever found in the medical clinical setting as it addresses each stage of the healing process. The focus of the patient-physician relationship is trust and trustworthiness. The physician is trustworthy when he is compassionate and competent. Patient and physician work together towards a mutual goal of the patient's healing. The judgments of both patient and physician are directed by prudence--seeking that which preserves society and individuals. This very mature concept of the ethics of the patient-physician relationship founded on trust and trustworthiness is the basis of modern concepts of patient, fiduciary trust, medical ethics and medicine as a profession. / text

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences