Hiring preferences of diagnostic radiology groups: results of a 1994 survey

RATIONALE AND OBJECTIVES: We surveyed diagnostic radiology group preferences and considerations in hiring radiologists and compared these findings with those of a survey performed in 1990. We sought to identify changes in hiring practices that might have occurred because of socioeconomic changes. We also sought to identify features of job candidates that make them more attractive to hiring groups. METHODS: One hundred surveys were mailed to a stratified random sample of diagnostic radiology groups identified by the American College of Radiology. We solicited information on the importance of various attributes and the level of experience of a candidate, the fellowship training considered most desirable, and the effect of changes in the health care socioeconomic environment. The responses were weighted by group size and geographic location to estimate what results might have been obtained if we had surveyed all groups in the United States. RESULTS: Seventy-five groups returned the survey. The two most important factors in choosing a candidate were motivation and radiologic knowledge. The fellowships that groups that were hiring considered to be the most desirable were body imaging, neuroradiology, and angiography/interventional radiology. Groups overwhelmingly preferred recent training over long experience. CONCLUSION: Fellowship training increases a candidate's marketability, but the two factors that hiring groups consider the most important are motivation and radiologic knowledge.     

US national survey of physician practices for the secondary and tertiary prevention of ischemic stroke. Design, service availability, and common practices

BACKGROUND AND PURPOSE: Stroke is largely a preventable disease. However, there are little data available concerning the use of stroke prevention diagnostic and treatment modalities by practicing physicians. These data are critical for the rational allocation of resources and targeting of educational efforts. The purposes of this national survey were to gather information about physicians' stroke prevention practice patterns and their attitudes and beliefs regarding secondary and tertiary stroke prevention strategies. METHODS: We conducted a national survey of stroke prevention practices among a stratified random sample of 2000 physicians drawn from the American Medical Association's Physician Masterfile. The survey focused on the availability of services and the use of diagnostic and preventive strategies for patients at elevated risk of stroke. RESULTS: Sixty-seven percent (n = 1006) of eligible physicians completed the survey. Diagnostic studies considered readily available by at least 90% of physicians included carotid ultrasonography, transthoracic echocardiography, Holter monitoring, and brain CT and MRI scans. MR angiography was perceived as being readily available by 68% and transesophageal echocardiography by 74% of respondents. Twelve percent of physicians reported cerebral arteriography and 10% reported carotid endarterectomy as not being readily available. Multiple logistic regression analyses showed that the availability of services varied with physician specialty (noninternist primary care, internal medicine, neurology, surgery), practice setting (nonmetropolitan versus small metropolitan or large metropolitan areas), and for carotid endarterectomy, region of the country (South, Central, Northeast, and West). The odds of carotid endarterectomy being reported as readily available were approximately 2.5 to 3.5 times greater for physicians practicing in the central, northeastern, and western regions compared with those practicing in the South, independent of practice setting and specialty. With regard to stroke prevention practices, 61% of physicians reported prescribing 325 mg of aspirin for stroke prevention, while 33% recommend less than 325 mg and 4% use doses of 650 mg or more. Seventy-one percent of physicians using warfarin reported monitoring anticoagulation with international normalized ratios, and 78% reported monitoring anticoagulated patients at least once a month. Fewer than 20% of physicians reported knowing the perioperative carotid endarterectomy complication rates at the hospital where they perform the operation themselves or refer patients to have the procedure done. CONCLUSIONS: Although all routine and most specialized services for secondary and tertiary stroke prevention are readily available to most physicians, variation in availability exists. The use of international normalized ratios for monitoring warfarin therapy has not yet become universal. Physician knowledge of carotid endarterectomy complication rates is generally lacking. Depending on their causes, these problems may be addressed through targeted physician education efforts and systematic changes in the way in which services are provided.     

Teaching medical students in community-based practices: a national survey of generalist physicians

To study the role of Moraxella (subgenus Branhamella) catarrhalis (B. catarrhalis) adherence to airway cells in lower respiratory tract infections, the in vitro attachments of B. catarrhalis to upper airway (oropharyngeal) and lower airway (bronchial) epithelial cells were compared. The adherence of 4 strains (1 nonfimbriated and 3 fimbriated) of B. catarrhalis to respiratory tract epithelial cells collected from 11 patients with chronic pulmonary disease (CPD) and 11 healthy individuals was evaluated. Both the fimbriated and nonfimbriated strains showed increased attachment to oropharyngeal cells in the CPD patients (mean +/- SEM; 25.0 +/- 3.2/cell; P < 0.01) when compared to the control subjects (12.1 +/- 1.1/cell). On the average, the attachment to bronchial cells was 6.1 to 13.6 times greater per surface area (bacteria/micron2) than the attachment to oropharyngeal cells. The fimbriated strains tended to adhere in higher numbers to bronchial cells (19.0 +/- 1.8/cell) than the nonfimbriated strain (8.7 +/- 1.2/cell), although there was no difference between the CPD and control groups. In conclusion, the attachment of B. catarrhalis to oropharyngeal cells may be an enhancing factor for colonization in the upper respiratory tract in patients with CPD, and elevated adherence of the bacteria to bronchial cells may suggest pathogenic importance when mucociliary function is impaired.     

Psychotherapy supervision practices of academic faculty: A national survey.

A national sample of 300 American Psychological Association (APA) Division 12 members who hold academic appointments was surveyed about psychotherapy supervision practices. Of the 50.7% who returned questionnaires, results are reported for the 38.3% who described themselves as full-time faculty who regularly provide psychotherapy supervision. While there were substantial individual differences, the average academic supervisor devoted nearly seven hours per week to providing individual and group supervision and was responsible for an average of four graduate trainees, each of whom carried four cases. Despite the professional time commitment and attendant responsibilities and liabilities, 50% of faculty supervisors reported no additional compensation beyond their regular salaries. Also discussed are proportion of time allocated to various supervision modalities (e.g., live supervision) and gender differences in supervision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Systemic chemotherapy for psoriasis: a national survey

A questionnaire that was mailed to 510 randomly selected dermatologists in the United States surveyed their use of three systemic chemotherapeutic agents for the treatment of psoriasis during the two-year period of 1973 to 1974. Methotrexate was used by 52% of the surveyed dermatologists, while hydroxyurea and azaribine were used by 10% and 2%, respectively. Seventy-five percent of the dermatologists who used methotrexate treated ten or fewer psoriatic patients with this drug. Multiple dose therapy with methotrexate divided over a period of 36 hours each week was the preferred schedule of 66% of the dermatologists. Liver biopsy specimens and creatinine clearance tests were obtained for only 17% and 35% of patients, respectively, prior to initiating methotrexate therapy. The estimated number of dermatologist-treated psoriatics nationwide receiving methotrexate is 25,000.     

Israeli dentists: a survey of infection control office practices and care of medically compromised patients

A familial complex chromosomal rearrangement (CCR) was ascertained through a mentally retarded, dysmorphic individual. Carriers of the CCR have the karyotype 46,XX or XY, t(6;15)(q16;q21), ins(3;6)(q12;q14q16), and malsegregation of the CCR resulted in loss of the segment 6q14 to 6q16 in the proband, and in an additional copy of the same segment in three members of the extended family. The proband has features similar to other reported cases with deletion of 6q1. The individuals with duplication of 6q14 to 6q16 have moderate mental retardation, short stature, obesity, microcephaly, brachycephaly, a short smooth philtrum, central hair whorl, simian creases, 5th finger brachydactyly and skeletal disproportion. In the 4-generation family, CCR carriers have a 20% empiric risk of phenotypically abnormal livebirths.     

Diazoxide treatment for insulinoma: a national UK survey

A survey of UK patients receiving the drug diazoxide, revealed 40 patients with insulinoma on this treatment. Mean age (+/- SD) was 67 +/- 18 years, and 74% were female. Duration of treatment was 7 +/- 6 years (range 1-22). Most (55%) patients were treated with diazoxide because of tumour non-localisation (including failed previous surgery). Metastatic disease (20%) and poor surgical risk (10%) were other indications. Side-effects (notably fluid retention and hirsutism) were common (47%) but not troublesome. Treatment was highly effective--59% were symptom free and 38% had only occasional symptoms. Only one patient had frequent hypoglycaemia despite treatment. We conclude that diazoxide is effective in the management of insulinoma. Side-effects are common but not problematic. Treatment should be considered for all patients not cured by surgery, or unsuitable for surgical treatment.     

The role of the nurse manager in ambulatory care: results of a national survey

Increasing complexity in ambulatory care settings requires nurse managers who can function at higher levels. Little agreement currently exists regarding the role expectations and academic preparation needed for nurse managers in ambulatory care settings. The majority of surveyed ambulatory care nurse managers (40%) have an AD or diploma as their highest level of academic preparation, and have thus acquired the majority of their management skills in the practice setting. The authors express concern that there are pressures to employ non-nurses as managers in ambulatory health care settings and that ambulatory nurse managers are often seen as not needing advanced academic preparation. A wide variety of settings including university and community hospitals, outpatient departments, physician group practices and HMOs, currently employ nurse managers in their multidisciplinary ambulatory care sites. The majority of ambulatory care nurse managers describe their model of care as either the medical model or the functional model.     

Sedation of adult critically ill ventilated patients in intensive care units: a national survey

Pain management presents exciting opportunities for nurse anesthetists. Today there are thousands of pain clinics and pain services dedicated to the diagnosis and treatment of chronic and acute pain. By becoming familiar with the principles involved in the management of chronic and acute pain, the different treatment modalities available, and the organization of pain clinics and pain services, nurse anesthetists will be able to take advantage of the opportunities they provide.     

Questionnaire survey of urologists and primary care physicians' diagnostic and treatment practices for prostatitis

OBJECTIVES: To establish diagnostic and treatment practices for chronic prostatitis by survey of urologists in Wisconsin and primary care providers in Dane County, Wisconsin. METHODS: All Wisconsin urologists (n = 135) and primary care providers in Dane County, Wisconsin (n = 365) were surveyed by mail with a 10-item questionnaire used to establish diagnostic and treatment practices for prostatitis. RESULTS: Seventy-eight percent of primary caregivers consider prostatitis to be bacterial in nature, whereas 59% of urologists consider it to be noninfectious. Fewer than 50% of primary care providers consider pain to be other than perineal in the diagnosis. Fewer than 50% of urologists or primary caregivers evaluate expressed prostatic secretions and few primary care providers (11%) use nonantibiotic therapy. CONCLUSIONS: The diagnostic and treatment practices for prostatitis do not follow standard textbook algorithms.     

Graduate training for managed care: A national survey of psychology and social work programs.

Although there is much discussion within the professional literature about the training needs of graduate students in response to managed care, little empirical research exists that assesses the extent to which graduate programs provide training opportunities in this field. The present study surveyed graduate program training directors in clinical psychology, counseling psychology, and social work about the training opportunities available for their graduate students. Almost 60% of the respondents indicated that they provide some type of training related to managed care. Implications and applications of these results are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contemporary psychotherapists: A national survey of characteristics, practices, orientations, and attitudes.

Surveyed a representative sample of American psychologists engaged in psychotherapy concerning their characteristics, activities, affiliations, theories, and selected attitudes. 410 members (aged 24–79 yrs) of Division 29 (Psychotherapy) of the American Psychological Association responded to an 82-item questionnaire. Survey results are described and compared to the findings of a similar survey by J. C. Norcross and J. O. Prochaska (e.g., see record 1982-21987-001) of American clinical psychologists (Division 12 members). Among the most salient findings were that (1) over 80% of Ss have had personal therapy and highly value these experiences as preparation for providing therapy; (2) individual therapy is the most popular therapeutic modality, but over one-half of the Ss engage in marital and family therapy; (3) while therapists spend relatively small percentages of their time doing research, they do as a group publish and present papers; (4) private practice is the modal affiliation of the Ss and may be the most equitable employment setting; and (5) psychodynamic orientations have experienced renewed preference with eclecticism declining, suggesting a need for more integrative models of therapy. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Benefits of screening mammography: a review for the primary care physician

BACKGROUND: Screening mammography, particularly for women in their 40s, has become a confusing issue for many physicians. Recent scientific and political controversies regarding screening guidelines have added to this confusion. METHODS: Many randomized clinical trials have shown the benefits of mammographic screening for women over the age of 50, and recent studies show a statistically significant benefit for women in their 40s as well. Understanding the screening controversy requires an understanding of the principle of screening for disease, the epidemiology of breast cancer, and the results of the many randomized clinical trials, particularly recent data from the Swedish two-county trials. An appreciation of the improvements in mammographic quality in recent years, and in the education of the radiologists who interpret these studies, will also heighten clinical acceptance of this screening technique. RESULTS: Both the American Cancer Society and American College of Radiology endorse annual mammographic screening for women over age 40, and there is compelling evidence to support these recommendations. CONCLUSION: Radiologists, primary care providers, surgeons, and pathologists should work together to enhance the benefits of and access to screening mammography.     

Atypical mole syndrome: a brief overview for the primary care physician

Early detection of melanoma and identification of potential markers or precursor lesions can substantially improve survival. Several risk factors have been identified in the pathogenesis of this potentially lethal cancer. Numerous reports in the literature have confirmed a subset of persons with an increased risk of developing melanoma. These patients are identified by a distinctive clinical phenotype depicted by unusually appearing melanocytic nevi (moles) in association with an increased number of total body nevi. They may have a family history of atypical moles or melanoma. In order to facilitate the recognition of such individuals by the non-dermatologist, a brief overview and salient features of the atypical mole syndrome are presented.     

Resident training in nursing home care: survey of successful educational strategies

OBJECTIVE: To identify educational strategies for resident training in nursing home care deemed successful by a large number of programs. DESIGN: A mail survey with three follow-up mailings. PARTICIPANTS: Directors of accredited internal medicine and family practice residency programs. MEASUREMENTS: Open- and closed-ended questionnaire eliciting curricular content, instructional strategies, and evaluation techniques from programs offering a nursing home experience. Identification of barriers to implementation of a nursing home curriculum and recommendations for success were requested. MAIN RESULTS: Of the 814 surveys mailed, 537 were returned for a response rate of 66%. Nursing home experiences were required in 86% of family practice residency programs but in only 25% of internal medicine programs. Most geriatric medicine curricular content areas were taught in the nursing home; however, relatively little emphasis was given to rehabilitation, organization, and financing of health care, and coordination of care between acute and chronic settings. Direct patient care, bedside rounds, and lectures were the most common instructional strategies reported. Evaluation approaches included faculty observations, resident attendance, and chart reviews with written and skill-based examinations infrequent. Availability of faculty and conflict with other rotations were identified as the principal barriers to implementation of nursing home rotations. An organized nursing home curriculum supervised by enthusiastic faculty using a longitudinal rotation format with resident involvement in an interdisciplinary team was recommended. CONCLUSIONS: Educational strategies exist for successful implementation of a residency nursing home curriculum. Greater priority must be given to training residents in nursing home care and developing nursing home faculty to substantially increase the number and quality of physicians who practice in this setting.