No description available.

Objective: To determine the association between perceived stress and the presence of musculoskeletal disorders in physicians at La Caleta de Chimbote Hospital and Eleazar Guzmán Barrón Regional Hospital in Ancash, Peru. Methods. An exploratory cross-sectional analytical study was conducted in 116 physicians. The Nordic Questionnaire was used to determine the areas of musculoskeletal pain and the Perceived Stress Scale (PSS-10) to assess the level of stress. The sociodemographic and occupational characteristics of the population were evaluated from the measurement of proportions and measures of central tendency and dispersion. For the bivariate analysis, Fisher's exact test and Chi2 were used. Finally, the multivariate analysis, based on a Logistics Regression model, was calculated with the crude and adjusted Odd Ratio (OR) [95% Confidence Intervals (CI)]. Results: The responses of 71 evaluations from a group of people between ages 34 to 59 (median 48) with a higher predominance of males (72%) were analyzed. No statistically significant association was found between the presence of non-specific musculoskeletal disorders and the perception of stress (p = 0.066); However, cervical, lumbar, hip / leg and ankle / foot pain specifically did show a significant association (p = 0.009; p = 0.033; p = 0.033 and p = 0.034, respectively). Finally, the cervical area maintained its association when performing the crude analysis and adjusted to physical activity (ORc = 7.29; 95% CI = 1.51-35.21 / ORa = 7.29 95% CI = 1.25-42.37). Anatomical areas such as lumbar, hip / leg and ankle / foot showed a non-significant association when performing the multivariate analysis. / Objetivo: Determinar la asociación entre el nivel de estrés percibido y la presencia de trastornos musculoesqueléticos en médicos del hospital La Caleta de Chimbote y Hospital Regional Eleazar Guzmán Barrón en Ancash, Perú. Métodos. Se realizó un estudio exploratorio de tipo transversal analítico en 116 médicos. Se utilizó el cuestionario nórdico para determinar las zonas de dolor musculoesqueléticos y la Escala de Estrés Percibido (EEP-10) para valorar el nivel de estrés. Se evaluaron las características sociodemográficas y ocupacionales de la población a partir de la medición de proporciones y medidas de tendencia central y dispersión. Para la realización del análisis bivariado se utilizó la prueba exacta de Fisher, Chi2. Finalmente, el análisis multivariado, a partir de un modelo de Regresión de Logística, se calculó con el Odd Ratio (OR) crudo y ajustado [Intervalos de Confianza (IC) al 95%]. Resultados: Se analizaron las respuestas de 71 evaluaciones de un grupo de personas de entre 34 a 59 años (mediana 48) con mayor predominio del sexo masculino (72%). No se encontró asociación estadísticamente significativa entre la presencia de trastornos musculoesqueléticos de manera inespecífica y la percepción de estrés (p=0.066); sin embargo, el dolor cervical, lumbar, cadera/pierna y tobillo/pie específicamente sí mostraron asociación significativa (p=0,009; p=0.033; p=0.033 y p=0.034, respectivamente). Finalmente, la zona cervical mantuvo su asociación al realizar el análisis crudo y ajustado a la actividad física (ORc=7.29; IC95%=1.51-35.21 / ORa=7.29 IC95%=1.25-42.37). Zonas anatómicas como lumbar, cadera/pierna y tobillo/pie mostraron asociación no significativa al realizar el análisis multivariado. / Tesis

Les troubles douloureux de l’épaule (TDE) affectent jusqu’à 55% de la population générale et sont souvent difficiles à traiter. L’objectif de cette thèse était de développer une intervention de mobilisation des connaissances permettant d’implanter les recommandations de guides de pratique clinique (GPC) couvrant la prise en charge des TDE. Pour ce faire, un processus basé sur le cadre conceptuel Knowledge-to-Action a été utilisé. D’abord, une revue systématique des recommandations des GPC à implanter pour améliorer la prise en charge des TDE a été effectuée. Puis, les écarts dans la pratique des cliniciens ont été identifiés à l’aide d’un sondage documentant la prise en charge des TDE ainsi qu’une étude évaluant la concordance entre les physiothérapeutes et les orthopédistes au niveau du diagnostic et de la prise en charge des TDE. Ensuite, les déterminants à l’implantation des recommandations des GPC ont été identifiés en procédant à deux études qualitatives ciblant les expériences et les attentes des patients vivant avec un TDE, puis les barrières et facilitateurs à l’implantation des recommandations des GPC identifiés par les cliniciens. Enfin, l’utilisation du Behaviour Change Wheel et des déterminants ont permis d’identifier des stratégies visant à implanter les recommandations de GPC sur la prise en charge des TDE en première ligne de soins. La revue systématique des GPC a permis de déterminer qu’initialement, les TDE ne requièrent généralement pas d’imagerie médicale et de référence à un médecin spécialiste, mais qu’un programme de réadaptation actif est requis. Selon les résultats du sondage, les médecins de famille (n=76) ont recommandé plus d’imagerie que les physiothérapeutes (n=175). Jusqu’à deux physiothérapeutes sur trois ont sélectionné des traitements non recommandés par les GPC. Les résultats de l’étude de concordance démontrent que l’accord entre physiothérapeutes et orthopédistes était bon au niveau du diagnostic et modéré au niveau du triage des candidats chirurgicaux. Les patients souffrant de TDE interrogés (n=13) ont mentionné, dans la première étude qualitative, avoir attendu que leur douleur soit incapacitante avant de consulter un professionnel. Ces participants s’attendaient alors à recevoir un diagnostic clair et à être référés pour des tests d’imagerie. Finalement, ils espéraient recevoir des explications complètes et se voir proposer des options pertinentes de traitements. Les 19 physiothérapeutes et 16 médecins de famille interrogés dans la deuxième étude qualitative ont indiqué comme barrières à l’utilisation des recommandations des GPC : le manque de connaissances, le manque d’habileté à réaliser une évaluation clinique de l’épaule et la crainte de ne pas détecter une pathologie grave, si présente, sans un test d’imagerie. Le temps insuffisant de consultation avec les patients, leurs attentes et le manque d’accès à certains soins ont aussi été indiqués comme des barrières. Les principales stratégies identifiées suivant ces études incluent donc des interventions éducatives, la préparation de champions cliniques et la création d’équipes cliniques interdisciplinaires. À l’aide de ces stratégies, l’implantation pilote de l’intervention sera réalisée dans des groupes de médecine familiale. L’impact potentiellement bénéfique de cette implantation pourrait, à terme, améliorer la prise en charge des patients atteints de TDE. / Shoulder pain is a common and difficult to manage condition that can affect up to 55% of the general population. To optimize shoulder pain management in primary care, the main objective of this thesis was to develop a knowledge mobilization intervention to implement the recommendations from clinical practice guidelines (CPGs) covering the management of different shoulder disorders. A knowledge mobilization process based on four steps of the Knowledge-to-Action framework was used in this thesis. First, a systematic review of CPGs was performed to identify recommendations to be implemented for improving shoulder pain management in primary care. Then, the evidence-practice gaps were assessed using a survey documenting family physicians and physiotherapists shoulder pain management as well as in a study evaluating the concordance between physiotherapists and orthopedists for shoulder pain diagnosis and management. The determinants influencing CPGs recommendations’ implementation were identified by conducting two qualitative studies. The first study explored the experiences and expectations of patients living with shoulder pain and the second aimed to interview clinicians for identifying barriers and facilitators to the implementation of CPGs recommendations. Finally, based on the identified determinants and using the Behaviour Change Wheel method, we identified strategies for implementing CPGs recommendations covering the management of shoulder pain in primary care. Based on the systematic review of shoulder CPGs, we identified that shoulder pain generally does not initially require diagnostic imaging and referral to a medical musculoskeletal specialist, but that an active rehabilitation program is required. According to the survey results, family physicians (n=76) recommended more imaging than physiotherapists (n=175) for rotator cuff tendinopathy and adhesive capsulitis, although this is not indicated. Up to two out of three physiotherapists selected treatments not recommended by CPGs in the management of shoulder pain. The results of the concordance study showed that the agreement between physiotherapists and orthopedists was good in terms of diagnosis and moderate in terms of triage of surgical candidates. Patients (n=13) interviewed in the first qualitative study reported waiting until their shoulder pain was disabling before seeing a family physician or a physiotherapist. Participants expected a clear diagnosis and imaging tests to explain their shoulder pain. They also wished to receive clear and thorough explanations and relevant treatment options. The 19 physiotherapists and 16 family physicians that participated in focus groups indicated as barriers to the use of CPGs recommendations: lack of knowledge, poor skills in performing a clinical evaluation and fear of not identifying a serious pathology without medical imaging. Patients’ expectations, insufficient consultation time with patients and lack of patients’ access to certain care, such as rehabilitation treatments were also identified as barriers. The main strategies identified following these studies therefore include educational interventions, the preparation of clinical champions and the creation of interdisciplinary clinical teams. Using these strategies, pilot implementation of the intervention will be carried out in family medicine groups. The potentially beneficial impact of this implantation could ultimately improve the management of patients with shoulder pain in primary care.

No description available.

Research has focused heavily on the study of Clinical Decision Support Systems. However, CDS systems have generally had little impact on clinical practice. One of the most important reasons is the lack of human-computer interaction (HCI) considerations in designing these systems. Although physicians play an essential role in healthcare decision-making, there is little literature describing physicians' expectations and preferences prior to the development of these systems, which is an essential phase in user-centered design.This study aims to answer the following research question: What do physicians expect of interacting with future clinical decision support systems? An exploratory qualitative study was conducted, and data were collected by interviewing 9 physicians practicing in Sweden. A thematic analysis was used for data analysis, and the findings are four themes: 1) physicians' Expectations related to clinical practice; 2) physicians' expectations related to physician-patient relationship; 3) physicians' expectations related to the physician's role 4) physicians' expectations related to CDS governance.The research findings contribute to the knowledge of Anticipated UX in the context of healthcare and CDS systems. The empirical findings on potential user expectations are valuable for understanding the diversity of user experience and user expectations as phenomena in the specific domain of CDS systems. Service designers can utilize and build on the empirical findings to develop positive user experiences of future CDS systems

<p><strong>Introduction:</strong> In Ontario alone, an estimated 6,700 people (3,000 women; 3,700 men) will die of lung cancer in 2011 (Canadian Cancer Society, 2011). A diagnosis of cancer is associated with complex decisions; the array of choices of cancer treatments brings about hope, but also anxiety over which treatment is best suited for the individual patient (Blank, Graves, Sepucha et al., 2006). The overall cancer experience depends on the quality of this decision (Blank et al., 2006). Clinical practice guidelines are knowledge translation tools to facilitate treatment decision-making. In Ontario, guidelines have been developed and disseminated with the purpose to inform clinical decisions, improve evidence based practice, and to reduce unwanted practice variation in the province. But has this been achieved? To study this issue, the purpose of the current study was to gain an in-depth understanding and develop a theoretical framework of how Ontario physicians are making treatment decisions with their non-small cell lung cancer patients. The following research questions guided the study: (a) How do physicians make treatment decisions with their stage II, stage IIIA and stage IIIB non-small cell lung cancer patients in Ontario? (b) How do knowledge translation tools, such as Cancer Care Ontario guidelines, influence the decision-making process?</p> <p><strong>Methods:</strong> A qualitative approach of grounded theory, following a social constructivist paradigm outlined by Kathy Charmaz (2006), was used in this study. 21 semi-structured interviews were conducted; 16 interviews with physicians and 5 with health care administrators. The method of analysis integrated grounded theory philosophy to identify the treatment decision-making process in non-small cell lung cancer, from the physician perspective.</p> <p><strong>Findings:</strong> The theory depicts the treatment decision-making process to involve five key “guides” (or factors) to inform the treatment-decision making process: the unique patient, the unique physician, the family, the clinical team, and the clinical evidence.</p> <p><strong>Conclusion:</strong> Decision-making roles in lung cancer are complex and nuanced. The use of evidence, such as, clinical practice guidelines, is one of many considerations. Information from a large number of sources and a wide array of factors, people, emotions, preferences, clinical expertise, experiences, and clinical evidence informs the dynamic process of treatment decision-making. This theory of the treatment decision-making process (from the physician perspective) has implications relevant to treatment decision-making research, theory development, and guideline development for non-small cell lung cancer.</p> / Master of Science (MSc)

儒醫是宋以後經過醫學文本訓練的，男性醫者的，文化認同/角色/定位。道醫、巫醫和女性醫者等其他醫者漸成為邊緣他者。儒醫宣稱比其他醫療實踐者更加深諳醫學經典、更加理性。儒醫攀附儒自居，模仿理學門戶互相攻訐，有學派之分。元代婺州朱震亨，「丹溪學派」的創始者，是明代儒醫的典範。本文將以朱震亨和「丹溪學派」為個案，一方面探討儒醫如何建構醫學身體、疾病觀念及其實踐，另一方面探討「丹溪學派」的思想和社會史。 / 第一、二、三章分別從三個角度探討元明儒醫的身體觀。首先，在強烈的「南人」認同之下，元代江浙的士人強調「南/北」身體的差異，「北醫」的療法不適合「南人」的身體，朱震亨被塑造為「南醫」的典範。其次，自劉完素以後，「火」不是日常生活中的火熱之氣，也不是推算運氣的術語，成為元明醫家對身體疾病的想像。據此，朱震亨提出「陽有餘而陰不足」的身體觀，是明代「丹溪學派」遵守的教條。第三，鬼神病因漸漸從儒醫的身體觀中淡出。道教醫學中的「傳尸勞瘵」，混雜了鬼邪和血氣病因，宋元儒醫卻劃分血氣「虛勞」和鬼邪「勞瘵」的界線。朱震亨將「勞瘵」解釋為「陰不足」病。追隨丹溪之後，虞摶病人見鬼實際上是「心神不寧」，清醫吳瑭認為「祝由科」是巫術，儒醫無法容忍鬼邪病因和儀式療法。 / 第四、五章討論儒醫多樣化的實踐。在臨床實踐中如何治療「陰不足」病，「丹溪學派」並不一致，王綸提倡的「補陰丸」在明代江浙醫者的實踐中廣受歡迎，但來自學派內部嚴厲的批評聲同時存在。明代醫家認為唐宋方書治「勞瘵」的天靈蓋「殘忍」，但紫河車卻是明代常用的治療「勞瘵」藥物。儒醫反對儀式療法，但某些驅除鬼邪的針灸療法，改頭換面依然留存在醫學實踐中，比如「秦承祖灸鬼法」。 / 第六、七章指出，從朱震亨到「丹溪學派」，是元代婺州地方士人建設宗族組織、講習理學、建構地方認同背景之下的社會史，也是蘇州城市醫者專業化、組織化的結果。元明政權更迭之後，「丹溪」弟子進入太醫院，依靠政治權威提升「丹溪」的醫學地位。1450年代以後「丹溪」成為商業書坊的暢銷本，注重師承關係的學派逐漸消解，「丹溪」成為大眾通俗的醫學入門文本作者。清代，考據醫學「丹溪」為通俗庸醫，「丹溪」不再是醫者撰寫醫書、醫療實踐的必引權威。 / This thesis aims to explain how Confucian physicians (儒醫) constructed the medical thoughts and practice. A Confucian physician is supposed to be a well-educated gentleman (儒) and a master of the medical classics. From the 12th century on, Confucian physicians gradually became a new identity of the orthodox doctors, while the Taoists, shamans, midwives and surgical practitioners all became the “others. At the same time, among the Confucian Physicians, different schools appeared. The Danxi School (丹溪學派) was a group of disciples following Zhu Zhenheng (朱震亨1282-1358) from the 14th to 15th centuries in Jiangnan (江南) . Zhu was a gentleman from Wuzhou, who was treated as an ideal model of “Confucian physicians through the whole Ming dynasty. / The first three chapters focus on the medical thoughts of Confucian phycians. Chapter One studies on the body of the “Southerners (南人). People living in the territory of Southern Song identified themselves as the “Southerners. This identity was strengthened by the unequal racial policy under the Mongol reign. It motivated the Jiangnan literati to appeal for a medical knowledge body specifically for the “Southerners, which would focus on treating the ailments caused by the “southern environment and dietary habits. Chapter Two explores the concept of “fire. In the Song dynasty, “fire is an element of the prevalent cosmological theory of “the five circulatory phases and the six seasonal influences (五運六氣) . However, in Liu Wansu (劉完素1132-1208) ’s innovative interpretation, the concept of “fire was internalized into the body structure. Zhu Zhenheng inherited this concept of bodily “fire and developed the theory of “yang is always in excess, yin is always deficient (陽有餘而陰不足) , which was later strictly followed by the Danxi School. Chapter Three investigates the disease of “laozhai (勞瘵) . According to the Taoist interpretation, the disease of “laozhai was due to the ancestor’s sin. However, Confucian physicians developed a new meaning in the context of Danxi’s “yin is deficient body. Demons were gradually excluded from the etiology of the Danxi School. / Chapter Four and Five study on the practice of Confucian physicians. The Danxi School didn’t have consensus on how to treat the “yin is deficient disease. Therefore, the therapy of “nourishing yin (滋陰) was quite differential in individual practices. However, it is certain that Confucian physicians tended to use herbs to treat patients who declared themselves suffering from demons. Religious rituals of expelling demons were excluded from their clinical practice. However, Confucian physicians didn’t refuse to use some unusual herbal remedies such as the placenta, or moxibustion that might function as Taoist rituals of expelling demons. / Chapter Six and Seven analyze the rise and fall of the Danxi School. The reason why Zhu became a powerful medical master lies not only in his medical thoughts or skills but in his social activities. He was very active in the lineage organization and local administration. In the local society, Zhu gained the power and fame as an authoritative Confucian gentleman, though he had never received any governmental position. After the death of Zhu, his disciples achieved successful careers as professional doctors in Suzhou (蘇州) . Later when the Ming Empire was established in Nanjing, most of Danxi’s disciples went into the Imperial Medical Service (太醫院) . After the 1450s, Zhu Zhenheng became a best-selling author and a symbol of the popular medicine. The popularity of his works eventually destroyed the structure of the master-disciple relationship in the Danxi School. The Danxi School gradually disappeared. In the end, because the mid-Qing physicians preferred ancient masters such as Zhang Zhongjing (張仲景 fl. 168-196) to the modern, vulgar Danxi, the Danxi School and their medical master faded away from the mainstream medicine. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / 張學謙. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 197-217). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / Zhang Xueqian. / 導論 --- p.1 / Chapter 一、 --- 儒醫：宋元明清醫者的身份認同 --- p.2 / Chapter 二、 --- 儒醫的理性與實踐 --- p.6 / Chapter 三、 --- 丹溪學派：醫學思想的社會史 --- p.11 / Chapter 四、 --- 研究說明 --- p.16 / Chapter 第一章 --- 元代醫學的「南/北」身體觀 --- p.18 / Chapter 一、 --- 南宋和元：「南人」認同的多層含義 --- p.18 / Chapter 二、 --- 「南/北」身體觀論述 --- p.24 / Chapter 三、 --- 製造「南醫」/「北醫」 --- p.32 / Chapter 四、 --- 結論 --- p.38 / Chapter 第二章 --- 丹溪學派的口號：「陽有餘而陰不足」的身體觀 --- p.40 / Chapter 一、 --- 五運六氣與宋人的身體觀 --- p.40 / Chapter 二、 --- 內丹對醫學身體觀的影響 --- p.46 / Chapter 三、 --- 朱震亨的相火論 --- p.50 / Chapter 四、 --- 結論 --- p.59 / Chapter 第三章 --- 宋明儒醫的「理性化」：以「勞瘵」為中心 --- p.60 / Chapter 一、 --- 《道藏》文本中「勞瘵」的界定 --- p.62 / Chapter 二、 --- 儒醫文本中「勞瘵」的界定 --- p.68 / Chapter 三、 --- 儒醫「勞瘵」與明代社會身體 --- p.73 / Chapter 四、 --- 明代儒醫對「祝由」的困惑 --- p.77 / Chapter 五、 --- 結論 --- p.85 / Chapter 第四章 --- 「陰虛」病與療法 --- p.87 / Chapter 一、 --- 丹溪「陰虛」病及療法 --- p.87 / Chapter 二、 --- 補陰丸與人參之爭 --- p.93 / Chapter 三、 --- 薛己、趙獻可：從補陰血到補陰精 --- p.99 / Chapter 四、 --- 結論 --- p.103 / Chapter 第五章 --- 儒醫的實踐 --- p.105 / Chapter 一、 --- 道醫「追蟲」儀式 --- p.105 / Chapter 二、 --- 儒醫勞瘵療法 --- p.108 / Chapter 三、 --- 天靈蓋與紫河車在明代醫學中的不同遭遇 --- p.113 / Chapter 四、 --- 從「秦承祖灸鬼法」到「灸鬼哭穴」 --- p.121 / Chapter 五、 --- 結論 --- p.125 / Chapter 第六章 --- 從朱震亨到「丹溪學派」的社會史 --- p.126 / Chapter 一、 --- 朱震亨的出身與赤岸朱氏宗族的建構 --- p.129 / Chapter 二、 --- 「儒醫」朱震亨與地方社會 --- p.136 / Chapter （一） --- 朱震亨之行醫 --- p.137 / Chapter （二） --- 朱震亨之醫療產業 --- p.140 / Chapter （三） --- 朱震亨在地方社會的角色 --- p.142 / Chapter 三、 --- 元代婺州的「丹溪」門徒 --- p.147 / Chapter （一） --- 地方醫療資源與組織 --- p.147 / Chapter （二） --- 婺州地方士族的網絡 --- p.151 / Chapter 四、 --- 元末蘇州的「丹溪」門徒 --- p.155 / Chapter 五、 --- 明代太醫院的「丹溪」門徒（1368-1450） --- p.162 / Chapter 六、 --- 結論： --- p.166 / Chapter 第七章 --- 「丹溪」的大眾化與清代醫學的轉折 --- p.167 / Chapter 一、 --- 「丹溪」文本的製造與流傳 --- p.168 / Chapter （一） --- 「丹溪」文本的製造 --- p.168 / Chapter （二） --- 「丹溪」文本的印刷與晚明私人的商業書坊 --- p.178 / Chapter 二、 --- 「丹溪」權威的下降 --- p.183 / Chapter （一） --- 明清醫者對「南/北」身體觀、療法的不同意見 --- p.184 / Chapter （二） --- 「陰不足」到「命門火衰」 --- p.186 / Chapter （三） --- 考據醫學之批評「丹溪」 --- p.188 / Chapter 三、 --- 結論 --- p.192 / 結論 --- p.193 / 參考書目 --- p.197 / Chapter 一、 --- 一手文獻 --- p.197 / Chapter (一) --- 醫書 --- p.197 / Chapter (二) --- 正史 --- p.200 / Chapter (三) --- 文集 --- p.201 / Chapter (四) --- 地方志和家譜 --- p.203 / Chapter (五) --- 筆記和其他： --- p.204 / Chapter 二、 --- 工具書： --- p.206 / Chapter 三、 --- 近人研究： --- p.207 / Chapter (一) --- 中文專書 --- p.207 / Chapter (二) --- 英文專書 --- p.209 / Chapter (三) --- 中文論文 --- p.212 / Chapter (四) --- 英文論文 --- p.214

Indiana University-Purdue University Indianapolis (IUPUI) / Reducing medical error remains in the forefront of healthcare reform. The use of health information technology, specifically the electronic health record (EHR) is one attempt to improve patient safety. The implementation of the EHR in the Emergency Department changes physician workflow, which can have negative, unintended consequences for patient safety. Inaccuracies in clinical documentation can contribute, for example, to medical error during transitions of care. In this quasi-experimental comparison study, we sought to determine whether there is a difference in document quality, error rate, error type, cognitive load and time when Emergency Medicine (EM) residents use paper charts versus the EHR to complete physician documentation of clinical encounters. Simulated patient encounters provided a unique and innovative environment to evaluate EM physician documentation. Analysis focused on examining documentation quality and real-time observation of the simulated encounter. Results demonstrate no change in document quality, no change in cognitive load, and no change in error rate between electronic and paper charts. There was a 46% increase in the time required to complete the charting task when using the EHR. Physician workflow changes from partial documentation during the patient encounter with paper charts to complete documentation after the encounter with electronic charts. Documentation quality overall was poor with an average of 36% of required elements missing which did not improve during residency training. The extra time required for the charting task using the EHR potentially increases patient waiting times as well as clinician dissatisfaction and burnout, yet it has little impact on the quality of physician documentation. Better strategies and support for documentation are needed as providers adopt and use EHR systems to change the practice of medicine.

The exponential growth in medical pharmaceuticals and related clinical trials have created a need to better understand the decision-making factors in the processes for developing hospital medication formularies. The purpose of the study was to identify, rank, and compare major factors impacting hospital formulary decision-making among three prescriber groups serving on a hospital's pharmacy and therapeutics (P&T) committee. Prescribers were selected from the University of Texas, MD Anderson Cancer Center which is a large, multi-facility, academic oncology hospital. Specifically, the prescriber groups studied were comprised of physicians, midlevel providers, and pharmacists. A self-administered online survey was disseminated to participants. Seven major hospital formulary decision-making factors were identified in the scientific literature. Study participants were asked to respond to questions about each of the hospital formulary decision-making factors and to rank the various formulary decision-making factors from the factor deemed most important to the factor deemed least important. There are five major conclusions drawn from the study including three similarities and two significant differences among the prescriber groups and factors. Similarities include: (1) the factor "pharmacy staff's evaluation of medical evidence including formulary recommendations" was ranked highest for all three prescriber groups; (2) "evaluation of medications by expert physicians" was ranked second for physicians and midlevel providers while pharmacists ranked it third; and (3) the factor, "financial impact of the treatment to the patient" was fifth in terms of hospital formulary decision-making statement and ranking by all three prescriber groups. Two significant differences include: (1) for the hospital-formulary decision making statement, "I consider the number of patients affected by adding, removing, or modifying a drug on the formulary when making hospital medication formulary decisions," midlevel providers considered this factor of significantly greater importance than did physicians; and (2) for the ranked hospital formulary decision-making factor, "financial impact of treatment to the institution," pharmacists ranked this factor significantly higher than did physicians. This study contributes to a greater understanding of the three prescriber groups serving on a P&T committee. Also, the study contributes to the body of literature regarding decision-making processes in medicine and specifically factors impacting hospital formulary decision-making. Furthermore, this study has the potential to impact the operational guidelines for the P&T committee at the University of Texas, MD Anderson Cancer Center as well as other hospitals.

This study, quantitative determinants of need and demand for primary health care in the District of Columbia (DCPC), analysed data over a twenty-year period from 1985 to 2004, on need and demand for primary care using standard and epidemiologically innovative statistical measures for physician distributions and socio-demographic characteristics in the District of Columbia (DC). The study attempted to answer the question: Using U.S census-based small area aggregations, Census Tract Groupings (CTGs), that are not zip-code areas or legislative/political boundaries, can a multivariate predictive model be developed using physician distributions, primary care service index (PCSI) and composite need scores (CNS) to explain variations in primary care visits shortages? Primary care visits shortages and priority scores (PCPS) were calculated, analysed and presented for CTGs in the District of Columbia from 1985 to 2004. Results indicated that the abundant supply of DC-based physicians – indicated by decreasing population per physician ratios of 239 (1985) to 146 (2004) – appear to be a long-term trend. As raw physician counts increased, the ratio of satisfied visits to demand decreased, from 2.62 (1985) to 1.80 (in 2004). This result appears to indicate that, due to inequities in distribution of primary care physicians in DC’s small areas, the increasing numbers of primary care physicians were by themselves, not sufficient to address the city’s overall primary care visits need. Epidemiological profiles and physician distribution analytical methods appear to be useful for small area analysis of urban primary care shortage areas and for setting priorities. Physician rates per 1,000 pop may be a necessary but not sufficient statistic for estimating urban primary health care needs / Health Studies / D. Litt. et Phil. (Health Studies)