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Incidental appendectomy during radical cystectomy: An interdepartmental survey and review of the literature

UROLOGY 2000年第2期56卷 241-244页

作者： Neulander, EZ Hawke, CK Soloway, MS Univ Miami Sch Med Dept Urol Miami FL 33101 USA

Objectives. To survey and review the incidence of appendectomy performed during radical cystectomy and urinary diversion. We were interested in the reasons behind the decision and if continent diversions have changed the policy. Methods. We performed a selective survey among urologists in academic centers throughout the United States regarding their practice of incidental appendectomy during radical cystectomy. We also reviewed the literature regarding the rationale for incidental appendectomy in general and during radical cystectomy in particular. Results. Among the 13 departments and 26 urologists replying to the survey, 9 (69%) departments and 20 (77%) individual clinicians are not performing routine incidental appendectomy. In 2 departments, it is considered a matter of choice, and, in 4 (31%) departments, appendectomy is performed routinely. Many believe that the low risk of subsequent appendicitis does not justify the procedure and that the appendix may be useful for future reconstruction. A review of the literature suggests that incidental appendectomy during radical cystectomy is not necessary. Conclusions. Incidental appendectomy during radical cystectomy is not necessary and is no longer being performed in many academic centers. The risk of subsequent appendicitis is extremely low. The decision may depend on the form of urinary diversion planned. UROLOGY 56: 241-244, 2000. (C) 2000, Elsevier Science Inc.

关键词：医学科学研究中心/统计学和数值数据阑尾切除术/统计学和数值数据阑尾炎/流行病学阑尾炎/预防和控制阑尾炎/外科学膀胱切除术/统计学和数值数据卫生保健调查发病率专业业务/统计学和数值数据美国/流行病学膀胱/外科学尿流改道术/统计学和数值数据泌尿科学/统计学和数值数据人类

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Should ophthalmology practices be online?

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JOURNAL OF CATARACT AND REFRACTIVE SURGERY 2000年第1期26卷 8-9页

作者： Prasad, S Sheffield United Kingdom

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Two decades of experience in the University of Washington Family Medicine Residency Network: Practice differences between graduates in rural and urban locations

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Journal of Rural Health 1995年第1期11卷 60-72页

作者： Baldwin, L.-M. Hart, L.G. West, P.A. Norris, T.E. Gore, E. Schneeweiss, R. Department of Family Medicine School of Medicine University of Washington Seattle WA 98195 United States

This study describes how graduates of the University of Washington Family Medicine Residency Network who practice in rural locations differ from their urban counter-parts in demographic characteristics, practice organization, practice content and scope of services, and satisfaction. Five hundred and three civilian medical graduates who completed their residencies between 1973 and 1990 responded to a 27-item questionnaire sent in 1992 (84% response rate). Graduates practicing outside the United States in a specialty other than family medicine or for fewer than 20 hours per week in direct patient care were excluded from the main study, leaving 116 rural and 278 urban graduates in the study. Thirty percent of graduates reported practicing in rural counties at the time of the survey. Rural graduates were more likely to be in private and solo practices than urban graduates. Rural graduates spent more time in patient care and on call, performed a broader range of procedures, and were more likely to practice obstetrics than urban graduates. Fewer graduates in rural practice were women. A greater proportion of rural graduates had been defendants in medical malpractice suits. The more independent and isolated private and solo practice settings of rural graduates require more practice management skills and support. Rural graduates' broader scope of practice requires training in a full range of procedures and inpatient care, as well as ambulatory care. Rural communities and hospitals also need to develop more flexible practice opportunities, including salaried and part-time positions, to facilitate recruitment and retention of physicians, especially women.

关键词：卡方分布卫生服务研究实习医师和住院医师职务医疗事故医师家庭/统计学和数值数据医师女/统计学和数值数据专业业务/统计学和数值数据专业场所/统计学和数值数据问卷调查农村卫生/统计学和数值数据城市卫生/统计学和数值数据华盛顿女(雌)性人类

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Clinician-specific episiotomy rates: Impact on perineal outcomes

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JOURNAL OF MIDWIFERY & WOMENS HEALTH 2000年第2期45卷 87-93页

作者： Low, LK Seng, JS Murtland, TL Oakley, D Univ Michigan Sch Nursing Ann Arbor MI 48109 USA Univ Michigan Womens Studies Program Ann Arbor MI 48109 USA Univ Iowa Coll Nursing Iowa City IA 52242 USA Univ Michigan Hlth Syst Triage Serv Ann Arbor MI 48109 USA Univ Michigan Ctr Nursing Res Sch Nursing Ann Arbor MI 48109 USA

Recent, large, randomized, controlled trials of the effects of episiotomy on perineal damage have confirmed that episiotomy is associated with an increased risk of damage to the perineum. Yet episiotomy remains the most common surgical procedure women undergo. This article examines if clinician experience, rather than scientific evidence, forms the basis for continuing this practice. Perineal outcome data are analyzed for 865 low-risk women who were attended at birth by the staff nurse-midwives or faculty obstetricians at a university-based, tertiary-care hospital. Data were collected under routine, non-experimental conditions such that the circumstances of the labor and the clinician's preferences were allowed to determine management decisions regarding the use of episiotomy or other techniques of perineal management. Multivariate findings indicate that in the absence of episiotomy, rates of perineal integrity were highest among clinicians who usually had the lowest rate of episiotomy use. When an episiotomy was done, rates of third- and fourth-degree extensions were highest among clinicians who used episiotomy most frequently. This finding challenges the idea that clinicians who were very experienced with the use of episiotomy would avoid complications such as extensions. Future research should explore the use of nonsurgical techniques such as those employed by midwives to promote perineal integrity. Then interdisciplinary research and evidence-based education regarding these techniques can occur to improve perineal outcomes for all women. (C) 2000 by the American College of Nurse-Midwives.

关键词：会阴切开术/统计学和数值数据 Logistic模型病案助产学/方法结果评价(卫生保健) 会阴/损伤专业业务/统计学和数值数据美国/流行病学女(雌)性人类妊娠

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Effects of state organizational structure and forensic examiner training on pretrial competence assessments

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JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH 1999年第2期26卷 140-150页

作者： Edens, JF Poythress, NG Nicholson, RA Otto, RK Sam Houston State Univ Dept Psychol Huntsville TX 77341 USA Univ S Florida Dept Mental Hlth Law & Policy Tampa FL USA Univ Tulsa Dept Psychol Tulsa OK 74104 USA

States differ widely in their delivery of pretrial forensic evaluation services, in terms of organizational structure and training requirements of forensic examiners. It was hypothesized that defendants adjudicated incompetent to proceed in stares using community-based, private-practitioner systems would show less impairment on a competence assessment measure, the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA), than defendants adjudicated incompetent in states using traditional, inpatient systems. It also was hypothesized that mean MacCAT-CA scores for incompetent defendants from states requiring forensic training/certification would be lower than for defendants from states lacking such requirements. Results indicated significant differences across the four types of service delivery systems examined. However;planned comparisons revealed no differences between a stare using a traditional, inpatient model and a stare employing a community-based, private-practitioner model. Analyses examining the effects of mandatory forensic training failed to support the hypothesis that training requirements result in the adoption of higher thresholds for determining incompetence.

关键词：方差分析卫生保健提供/组织和管理卫生保健提供/统计学和数值数据司法精神病学/教育司法精神病学/组织和管理司法精神病学/统计学和数值数据精神能力精神卫生服务/组织和管理精神卫生服务/统计学和数值数据私营部门专业业务/统计学和数值数据心理测定学/统计学和数值数据公营部门参考值州政府美国成年人女(雌)性人类男(雄)性中年人

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Do management tasks differ by field of practice?

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ADMINISTRATION IN SOCIAL WORK 1996年第1期20卷 17-&页

作者： Raymond, GT Teare, RJ Atherton, CR UNIV ALABAMA SCH SOCIAL WORKPOB 870314TUSCALOOSAAL 35487 USA

The authors examine the question:Do management tasks differ by field of practice? Marry social work Master's programs are organized on the principle of specialization by field of practice for both micro- and macro-practice students. Secondary analysis of task data suggests that managers and supervisors with MSW degrees perform the same tasks regardless of the field of practice. The study results suggest a need to examine assumptions of current MSW curriculum organization.

关键词：行政管理人员/教育行政管理人员/统计学和数值数据数据收集教育研究生专业业务/统计学和数值数据社会工作/教育社会工作/组织和管理社会工作/统计学和数值数据专门化作业完成和分析美国

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1994 air medical program survey

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Air Medical Journal 1994年第9期13卷 353-358页

作者： Cady, Geoffrey EmergencyCareInformationCenter.

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Scope of pharmacy.

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The Journal of pharmacy technology : jPT : official publication of the Association of Pharmacy Technicians 1994年第4期10卷 145-146页

作者： Whitney Jr., H.A.

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The Development of a State‐level Health Manpower Database Using an Employer‐based Survey: A Pilot Project

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The Journal of Rural Health 1994年第3期10卷 199-207页

作者： Bamberg, Richard Malvey, Donna Wainright, Major Charles Fottler, Myron D. Joiner, Charles L. University of Alabama-Birmingham Birmingham Alabama United States Administration-Health Services University of Alabama-Birmingham Birmingham Alabama United States Administration-Health Services School of Health Related Professions University of Alabama-Birmingham Birmingham Alabama United States School of Health University of Alabama-Birmingham Birmingham Alabama United States Board for Alabama's Health Professiosn Eduction Employment Council Niversity of Alabama-Birmingham Birmingham Alabama United States

State health care reform may provide a better approach to meeting the health care needs of rural communities than does federal reform because the planning is closer to the needs of local communities. However, state health reform requires a health manpower database (along with other data) that includes all health occupations and such databases are often nonexistent. This study reports on one element of such a database–a survey of a wide range of rural health care employers covering the full range of health occupations in Alabama. Information on current and future employment of the most significant health occupations is reported here. It was found that the greatest numbers of new health personnel employees needed in the future were, in descending order, nursing assistants, registered nurses, licensed practical nurses, radiological technicians, specialist physicians, nurse practitioners, physical therapists, primary care physicians, and respiratory care therapists. While an employer survey has limitations and should be supplemented by data on community needs and health status indicators, it does provide useful information for planning educational programs to prepare health personnel. Copyright © 1994, Wiley Blackwell. All rights reserved

关键词：亚拉巴马数据收集数据库事实型就业/统计学和数值数据卫生人力/统计学和数值数据卫生服务研究/方法院内诊疗/统计学和数值数据私人开业/统计学和数值数据专业业务/统计学和数值数据专业场所/统计学和数值数据农村卫生州卫生计划美国

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Physician practice characteristics and satisfaction: A rural-urban comparison of medical directors at US community and migrant health centers

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JOURNAL OF RURAL HEALTH 1998年第4期14卷 346-356页

作者： Shi, LY Samuels, ME Cochran, CR Glover, S Singh, DA Johns Hopkins Univ Sch Hyg & Publ Hlth Baltimore MD 21205 USA

For this study, the association between physician practice characteristics and satisfaction of medical directors at rural and urban Community and Migrant Health Centers (C/MHCs) was investigated. Data for this study came from a 1996 cross-sectional survey of C/MHCs' medical directors. A total of 411 centers (68.3 percent) responded to the survey including 240 rural (67.4 percent) and 271 urban (68.7 percent) C/MHCs. Factor analysis was used to synthesize physician practice characteristics related to overall satisfaction. The resulting factors were entered as new variables in a predictive logistic regression model of overall satisfaction Growing tip in an inner-city community was significantly associated with practicing in an urban center;whereas, growing up in a rural or frontier community was more likely to result in practicing in a rural center The majority of medical directors (82.3 percent) were either somewhat satisfied or very satisfied with their work. Satisfaction with work was most significantly associated with overall level of satisfaction, followed by satisfaction with administration, peers and patients. Recruitment efforts are more likely to succeed when they target individuals with prior exposure to underserved areas. Improving the working conditions and interactions with administrators would help sustain the high level of satisfaction experienced by medical directors at C/MHCs.

关键词：社区卫生中心/人力人口统计学因素分析统计学职业满意 Logistic模型缺医地区医生行政负责人/心理学医生行政负责人/统计学和数值数据专业业务/统计学和数值数据乡村卫生服务/人力暂居者和移居者美国市区卫生服务/人力女(雌)性人类男(雄)性

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