Background: The rise in the total number of seniors will lead to a considerable increase in the prevalence of persons with dementia (PWD), the number of senior drivers and the amount of drivers with dementia. Understanding how this life event is experienced by PWD and their caregivers is paramount to policy development and planning. Methods: Descriptive qualitative study using secondary data. There were 25 participants over the age of 65, whose monthly phone call conversations were analyzed using analytic induction, to find links and create a theoretically based hypothesis regarding the experience of driving cessation. A standardized questionnaire was used to guide the telephone data collection. Results: PWD may experience emotions of anger when they don’t understand why they are no longer allowed to drive. When PWD understand why they are no longer allowed to drive, they seem to accept and self-regulate their driving cessation. Cognitive tests and physicians instructing PWD they have to cease driving, are not perceived to be helpful in this understanding. Public transportation and alternate means of personal transportation are potentially associated with the acceptance of driving cessation. Conclusions: PWD might not understand the link between cognitive assessments, their memory, and their driving performance. A systems level approach to improved access to transportation and on-road driving tests might make it easier for PWD to understand and accept the lifestyle changes that come with driving cessation.

Population health is concerned with analyzing the factors that determine the uneven distribution of health in a population and it also proposes interventions to narrow health inequalities. Kindig has proposed a population health management strategy that would engage the health and other sectors on population health improvement through a financial incentive linked to health outcomes. Proposed elements of a population health approach in health care at the patient encounter level include paying attention to health determinants for the patient and ensuring interprofessional collaboration; at the system level the approach includes developing and advocating for interventions that address health inequalities, such as delivering services to under-serviced areas and vulnerable populations. There has been virtually no research among frontline clinicians on the awareness and salience of a population health approach. In order to address this gap an exploratory study was conducted among family physicians in Primary Care Networks (PCNs) in Alberta, Canada. PCNs include capitation funding that is used to purchase services such as nursing, pharmacy and dietetics. The physicians were able to describe their patient populations in terms of a full range of social determinants and the health status inequalities they produce. They emphasized the importance of preventive screening and counseling in contributing to the health of their patients, and cited the key contributions of other team members to these activities, as well as the electronic medical record (EMR). They reported ambivalence toward the effectiveness of financial incentives for population health improvement, and while there was some collaboration with schools, inter-sectoral collaboration has yet to develop outside the health sector. This thesis has demonstrated the potential for primary care physicians to adopt a population health approach. However, there is a considerable distance to go in introducing an incentive approach for outcome-based population health management, as envisioned by Kindig.

This study examines the implications of, and health interest groups responses to federally developed national standards for physician licensure, contained in the proposed Health Security Act (HSA). The Act was introduced into the United States Congress in 1975 by Senator Kennedy and Congressman Corman. While the legislation was withdrawn from Congressional consideration in 1979, it was unique, offering a comprehensive range of health services to the public with significant implications for changes in the way health care would be delivered and paid for. The Act's physician licensure provisions were a significant attempt to divest states and health interest groups of their control over health manpower (e.g. determination of minimum competency levels, supply levels, and restrictions on services offered by other health professionals.) The study critiques the Act's physician licensure provisions in a number of ways: it reviews the past and current structures and processes for determining physician licensure; analyzes the interplay between medical interest groups in assuring quality medical care; details the Act's physician licensure provisions; surveys health interest groups concerning their perceptions on physician licensure and the Act's proposed licensure provisions; and, concludes with reasons why the Act failed as well as alternative approaches it could have taken. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

This study is a part of a three stage pursuit to examine and to comprehend the relationship between the resources available, the apparent utilization patterns of those resources by the population being served, and the selected characteristics of the populations utilizing and not utilizing the prevailing medical care system. The first stage of the research involves the examination of the existing patterns of medical care utilization by socioeconomic status groups. Cross-national Comparison of Physician Utilization by the Socioeconomic Status Groups is the pilot research for the first stage and both modifies and develops the methodology for this type of research and also examines the physician utilization patterns of a population in well defined basic measurements — in this case the socioeconomic status index, the diagnosed disease, and the number of physician contacts. The comparison of the physician utilization patterns of socioeconomic status groups in respect to the prevailing medical care delivery system necessarily involves cross-area studies at least at regional level, but most likely cross-national comparisons as well. This study used already collected data, nevertheless, primary data, which had been collected and partly analysed in the World Health Organization/International Collaborative Study of Medical Care Utilization. The data came from twelve geographical areas, altogether from seven countries, and provided documented research material on the surveyed respondents' social characteristics, standard diagnostic procedures, and standard definitions of the interactions between the users and the prevailing medical care delivery systems. The social characteristics were used separately, but in a standardized way, in order to derive socioeconomic status groups in each area; the diseases distributions were examined in relationship to the socioeconomic status groups, and the physician utilization patterns were related to the socioeconomic status groups while controlling for the distributions of selected diseases, after which the study areas were compared to each other in terms of the exhibited relationships between the physician utilization and the socioeconomic status groups. The physician utilization patterns were found to vary only little from one area to another, however, consistently, to warrant the use of derived information for the second stage of the research. Physician utilizations were very weakly correlated to the socioeconomic status and these correlations were not substantially effected by the selection of the controlling disease, i.e., they were consistent. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Forskning kring stressrelaterad ohälsa är vanligt förekommande idag, speciellt kring arbetsrelaterad stress och utmattning. Dock är forskning om återgång i arbete efter utmattning bland läkare tämligen begränsad. Syftet med studien är att undersöka hur läkare som har varit sjukskrivna i utmattning upplever återgången i arbetet, samt vilka faktorer som underlättat eller försvårat återgången. 12 läkare intervjuades med hjälp av en semistrukturerad intervjuguide. Den tematiska analysen av faktorer som underlättade återgången identifierade fem teman, vilka var rehabiliteringsplan från organisationen, socialt stöd från chefen, byte av arbetsplats, tydliga gränser och socialt stöd från anhöriga och kollegor. Den tematiska analysen av faktorer som försvårade återgången identifierade 4 teman, vilka var ansvarsförskjutning av rehabiliteringsplan, frånvarande chefskap, skam och skuld, och kollegialt utanförskap. Viktigast för en lyckad återgång var en anpassad rehabiliteringsplan med en närvarande närmaste chef.

The safe and successful performance of office procedures, surgical procedures, and emergency procedures as well as radiological imaging procedures demand a working and yet specific knowledge of anatomy. This study focuses on the competency to perform clinical procedures, especially the underlying anatomical knowledge base necessary to perform a safe and successful procedure. No study reports on the assessment of clinical anatomy as part of the competency of family physicians to perform clinical procedures. The aim of this study was to determine a) which clinical procedures are performed in hospital practices in South Africa; b) the frequency of performance; c) the importance rating of clinical procedures; d) the comfort of performance; e) difficulties and anatomically related complications encountered; f) the role of clinical anatomy competency in reducing difficulties and complications; g) the role of clinical anatomy in improving confidence of performance; h) a selection of 15 problem procedures; i) the relevant clinical anatomy necessary to perform these procedures and j) to develop a clinical anatomy training program for these procedures. A list of 57 procedures relevant to family practice in South Africa was compiled and a questionnaire completed by doctors at various hospitals, which were randomly selected in three provinces in South Africa. A total of 102 questionnaires were obtained and analyzed. The following procedures were selected which were performed often (>50%), ranked important, encountered most difficulties and complications, where more doctors were uncomfortable than comfortable and where the influence of clinical anatomy knowledge on the safe and successful performance of the procedure, was ranked highest: Central venous catheterization, cricothyroidotomy, pericardiocentesis, great saphenous vein cutdown, oro/naso tracheal intubation, lumbar puncture, appendectomy, cesarean section, reduction of uncomplicated forearm fractures, ectopic pregnancy surgery, epistaxis and nasal packing, rectal examination, proctoscopy and sigmoidoscopy, knee joint aspiration, wrist and digital nerve block and obstetric ultrasound. A referenced knowledge base was developed by an extensive literature search of the selected procedures under the following headings: Indications, contraindications/ precautions, step by step procedure, anatomical pitfalls and anatomically relevant complications. This was expanded to develop a Virtual Procedures Clinic, an interactive multimedia package. / Thesis (PhD)--University of Pretoria, 2009. / Anatomy / unrestricted

No description available.

Sexual health affects many aspects of patient health; however, it is often not addressed with patients, and research shows that sexual health is not emphasized in medical education. Primary care providers ought to be on the front lines of the integration of sexual health into patient centered care. In rural areas, this responsibility often falls to family medicine physicians as patients do not have access to Ob/Gyns (obstetrician and gynecologist). The objective of this study was to assess the types and prevalence of sexual health concerns among patients in rural Appalachia and also to assess the comfort level of family medicine physicians in addressing and managing sexual health concerns. Sexual health was defined to include sexual wellness, infections, contraception, and sexual dysfunction. Participants included East Tennessee State University (ETSU) family medicine attending physicians (faculty physicians) and resident physicians at three designated ETSU residency clinic sites. We designed and distributed an eighteen-question survey to residents and faculty physicians in order to evaluate how the recently emerging sexual health emphasis has translated to the practice of family medicine in East Tennessee. Of note in the data analysis, the majority of providers reported they feel at least moderately comfortable discussing sexual health with patients. However, when asked how frequency they address sexual health with patients, most providers reported that they do not frequently ask patients about sexual health concerns. Even though the American College of Obstetrics and Gynecology (ACOG) recommends long-acting reversible contraceptives (LARCs) as first-line contraceptives, less than half of providers recommend LARCs to patients. Additional exploration is needed to address why most family medicine physicians do not ask patients about sexual health as well as to determine if any regional barriers exist. This data also suggests that family medicine providers often do not have the means to recommend first-line contraception, likely due to lack of access and/or lack of knowledge regarding current recommendations. This study suggests that more emphasis should be placed on addressing sexual health and there is a need for additional training perhaps through educational workshops, or the distribution of educational brochures, or training in LARC placement.

Bombarded by constant and rapid change, healthcare organizations feel a sense of urgency to meet their needs for leaders. They rely on physicians to lead at all levels in their healthcare organizations. For them to successfully navigate today's healthcare environment, they require more than a medical education. To address this need, healthcare organizations are developing in-house leadership development programs.In this paper, I conduct a case study of physicians transitioning into leadership and their self-efficacy facilitated through an in-house leadership development program. Documentation, semi-structured interviews, and observations are examined to explore how physicians think about their leadership experiences following their participation in a six-month leadership development program.The study also explores at a high-level how these experiences influenced physician's self-efficacy as a first step in developing a theory of physician leadership and self-efficacy.

Objective: To evaluate the psychometric properties of the Spanish version of Jenkins Sleep Scale with 4 items (JSS-4) of the Peruvian health system's (PHS) nurses and physicians. Methods: We carried out a psychometric study based on secondary analysis in a sample from a nationally representative survey that used acomplex sampling design. The participants were physicians and nurses aged 18–65 years, working in PHS private and public facilities, who have fulfilled all JSS-4 items. We performed a confirmatory factor analysis. Reliability was evaluated via two estimates - classic alpha (α) and categorical omega (ω) coefficients. Also, we tested the invariance across groups of variables. The convergent validity was evaluated based on the relation between JSS-4 and PHQ-2 using Pearson's correlation coefficient and effect size (Cohen's d). Also, we designed normative values based on percentiles. Results: We included 2100 physicians and 2826 nurses in the analysis. We observed that the unidimensional model has adequate goodness-of-fit indices and values of α and ω coefficients. No measurement invariance was found between the groups of professionals and age groups; however, invariance was achieved between sex, monthly income, work-related illness, and chronic illness groups. Regarding the relation with other variables, the JSS-4 has a small correlation with PHQ-2. Also, profession and age-specific normative values were proposed. Conclusion: JSS-4 Spanish version has adequate psychometric properties in PHS nurses and physicians. / Revisión por pares