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作者： Rodriguez, JL Jacobs, DM Zera, RT Van Camp, JM Muehlstedt, SG West, MA Bubrick, MP Univ Minnesota Sch Med Hennepin Cty Med Ctr Dept Surg Minneapolis MN 55455 USA

Background. The mission of public academic health centers (puAHC) and their affiliated practice groups (APG) focuses on teaching, research, and the clinical care of at-risk populations. Resources to accomplish this mission, however, are becoming scarce. For puAHC to survive and remain competitive, innovative strategies will need to be developed by the APG. We hypothesized that the integration of a surgical academic practice of the APG with a nonacademic integrated health care delivery system (NAIDS) in a managed care environment would benefit all involved. Methods. A surgical academic practice was integrated with a NAIDS in a 95% managed care market. Faculty alone provided care the first year and third-year residents were added the following year. To assess outcome, we collected benefit and cost data for the 1-year period before integration and compared them with the two, 1-year periods after integration. Results. In the second year of integration 1-revenues from the NAIDS referrals to the puAHC and APG increased 89% and 150%, respectively. The NAIDS' general surgical and endoscopy caseload increased by 25%. Additionally, there was a 92% reduction in operating room technician cost with no increase in operating time per case. Finally, the third-year resident experienced a caseload increase of 163%. Conclusions. In an environment where resources are diminishing and managed care consists of many large NAIDS that drive referrals and revenue, the integration of a surgical academic practice with a NAIDS benefits all shareholders. Academic practice groups that develop strategies that leverage their competitive advantage will have the best chance of surviving in today's turbulent health care market.

关键词：医学科学研究中心/组织和管理卫生保健提供联合/组织和管理全体教工医学院校/组织和管理联合开业/组织和管理医院县/组织和管理实习医师和住院医师职务/组织和管理管理医疗规划/组织和管理卫生服务使用研究组织隶属关系结果评价(卫生保健) 外科学/组织和管理人类

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Emergency medicine in southern Brazil

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ANNALS OF EMERGENCY MEDICINE 2001年第2期37卷 223-228页

作者： Tannebaum, RD Arnold, JL De Negri, A Spadoni, VS Provena St Joseph Med Ctr Sect Emergency Med Joliet IL 60435 USA Univ Illinois Coll Med Dept Emergency Med Chicago IL USA Cedars Sinai Med Ctr Dept Emergency Med Los Angeles CA 90048 USA Univ Fed Rio Grande Sul Porto Alegre RS Brazil

Emergency medicine is developing rapidly in southern Brazil, where elements of both the France-German and the Anglo-American models of emergency care are in place, creating a uniquely Brazilian approach to emergency care. Although emergency medical services (EMS) in Brazil have been directly influenced by the French mobile EMS (SAMU) system, with physicians dispatched by ambulances to the scenes of medical emergencies, the first American-style emergency medicine residency training program in Brazil was recently established at the Hospital de Pronto Socorro (HPS) in Porto Alegre. Emergency trauma care appears to be particularly developed in southern Brazil, where advanced trauma life support is widely taught and SAMU delivers sophisticated trauma care en route to trauma centers designated by the state.

关键词：巴西卫生保健提供/组织和管理急救医疗服务/组织和管理急救医学/教育急救医学/组织和管理预测实习医师和住院医师职务/组织和管理生命支持疗法/组织和管理模型教育模型组织管理技术转让人类

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Estimating the impact of a competencies-based system of education and evaluation: The perspective of the American board of Emergency Medicine

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ACADEMIC EMERGENCY MEDICINE 2002年第11期9卷 1220-1221页

作者： Reinhart, MA Graff, JG Amer Board Emergency Med E Lansing MI USA

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Evaluating the performance of academic medical education administrators

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EVALUATION & THE HEALTH PROFESSIONS 1999年第4期22卷 484-496页

作者： Guyatt, G Cook, D King, D Nishikawa, J Brill-Edwards, P McMaster Univ Hlth Sci Ctr Hamilton ON L8N 3Z5 Canada Ontario Minist Hlth Toronto ON Canada

Educators have devoted little attention to formal evaluation of educational administrative personnel. The authors surveyed the educational administrators working in McMaster University's Department of Medicine residency program and found they felt they were receiving little useful feedback The authors also surveyed the colleagues, residents, and administrative staff with whom the administrators worked and found they felt they had inadequate input into the administrators' evaluation In response to these results, a measurement instrument was developed based on existing job descriptions and feedback was obtained on administrators' performance from relevant individuals. After three yearly evaluations, administrators and evaluators acknowledged much broader input into evaluation but saw little evaluation-related improvement in performance. Of the administrators, 85% felt the process should continue as did 91% of the evaluators. An evaluation process may nor alter perceived performance when it is already good but there may be other benefits to rigorous evaluation.

关键词：医务工作者的态度雇员能力评定/方法全体教工医学院校/标准随访研究实习医师和住院医师职务/组织和管理职务说明需求估价同侪集群医生行政负责人/标准专业能力/标准问卷调查人类

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The effects of consecutive night shifts on neuropsychological performance of interns in the emergency department: A pilot study

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ANNALS OF EMERGENCY MEDICINE 2003年第3期41卷 400-406页

作者： Rollinson, DC Rathlev, NK Moss, M Killiany, R Sassower, KC Auerbach, S Fish, SS Boston Univ Med Ctr Dept Emergency Med Boston MA 02215 USA Boston Univ Med Ctr Dept Neurol Boston MA 02215 USA Boston Univ Sch Med Dept Anat Boston MA 02118 USA Massachusetts Gen Hosp Sleep Disorders Unit Dept Neurol Boston MA 02114 USA Boston Univ Sch Publ Hlth Dept Biostat & Epidemiol Boston MA 02215 USA

Study objective: We obtain preliminary information on the neuropsychological performance of house officers at the beginning and end of a shift while they worked consecutive night shifts in the emergency department. Methods: We prospectively studied interns working 12-hour consecutive night shifts in an urban Level I trauma center ED. All consecutive non-emergency medicine interns rotating for 1 month were eligible except those older than 40 years and those with sleep disorders or depression (identified by using the Profile of Mood Scale, Sleep Diagnostic Questionnaire). We tested research subjects at the beginning of a day shift and at the beginning and end of night shifts 1 and 3 of 4 consecutive night shifts at times of estimated baseline wakefulness (10 Pm) and maximum fatigue (3 AM). We used 3 standardized neuropsychological tests: (1) Delayed Recognition Span Test (visual memory capacity);(2) Continuous Performance Test (attentional function, vigilance);and (3) Santa Ana Form Board Test (psychomotor speed, coordination). We analyzed data with mixed-model analysis, with research subject as a random effect. Results: Thirteen interns were eligible, and 1 declined. Twelve interns (6 men and 6 women;age range 25 to 35 years) were enrolled. The Delayed Recognition Span Test (number correct before first error) revealed significant deterioration from the beginning of the shift to the end of the shift (mean difference -2.2;95% confidence interval -3.1 to -1.3). This represents an 18.5% decrease in visual memory capacity. There were no significant differences found for the other tests. Conclusion: Interns working nights demonstrated a significant reduction in visual memory capacity across the night shift. Research involving neuropsychological performance during night shifts in the ED is important. It might provide valuable insights into ways to improve our performance during night shifts.

关键词：注意力波士顿急诊室医院/组织和管理实习医师和住院医师职务/组织和管理记忆神经心理学测验人员配备和时间安排试点项目前瞻性研究精神运动性行为工作安排忍受/心理学成年人女(雌)性人类男(雄)性

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Osteopathic physicians in emergency medicine

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ANNALS OF EMERGENCY MEDICINE 2003年第2期42卷 261-265页

作者： Pollard, JA Leveque, EA Lewin, MR Calif State Univ Fresno Dept Emergency Med Fresno CA 93702 USA Oklahoma State Univ Coll Osteopath Med Tulsa OK USA Calif State Univ Fresno Emergency Med Residency Program Fresno CA 93740 USA

[ Ann Emerg Med. 2003;42:261-265.]

关键词：聘任鉴定/组织和管理教育医学研究生/组织和管理急救医学/教育急救医学/组织和管理实习医师和住院医师职务/组织和管理骨病医学/教育骨病医学/组织和管理医师的作用院校医学/组织和管理学会医学/组织和管理美国人类

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Residency programs at the Canadian Memorial Chiropractic College

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JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS 2000年第7期23卷 503-511页

作者： Steiman, I Canadian Mem Chiropract Coll Toronto ON M4G 3E6 Canada

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STAFF COMMUNICATIONS AND CREDENTIALING IN A MULTISITE INSTITUTION

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ANNALS OF THE NEW YORK ACADEMY OF SCIENCES 1992年第1期670卷 211-214页

作者： BOOTH, FVM HASSETT, JM Department of Surgery School of Medicine and Biomedical Sciences State University of New York at Buffalo 100 High Street Buffalo New York 14203-1154

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