Diversion programs for impaired physicians.

Nine states have legislated impaired physician programs administered by state medical boards (2), by independent agencies (4), or by medical societies through contracts with medical boards (3). All other state programs are administered by medical societies. California''s diversion program has been in effect for more than 10 years. It was the first program for alcohol- and drug-addicted physicians in the country administered by the state agency that also disciplines physicians. Of the physicians who enrolled in this program, 72% have completed it successfully. A total of 618 physicians have been accepted into the program since its inception, with 247 physicians currently participating.     

Patterns of practice among older physicians in Ontario

BACKGROUND: Policy-makers interested in the supply of doctors in Canada have recently begun focusing attention on older physicians. This study informs the policy debate by analysing the practice patterns of Ontario physicians aged 65 years and over. METHODS: A cross-sectional and longitudinal analysis of physician claims data for fiscal years 1989/90 through 1995/96 was conducted. The number of full-time equivalent (FTE) physicians by age category, urban or rural status, and specialty was calculated by means of an established method, and differences between older physicians, established physicians and recent graduates (in practice for 5 years or less), in terms of the types of services provided and patients seen, were examined. RESULTS: The proportion of FTE physicians aged 65 or more increased from 5.3% to 7.0% during the study period, whereas the proportion of recent graduates decreased from 19.6% to 16.3%. Of the older physicians, 61.4% practised part time (less than 1 FTE). Half of the physicians aged 75 in 1989/90 were still in practice 6 years later. Older physicians were less likely than those under age 65 to practice obstetrics (4.6% v. 16.9%), provide emergency department services (1.1% v. 14.8%) or house calls (38.7% v. 60.4%), or perform many minor procedures (38.7% v. 62.3%) (p < or = 0.001 for all comparisons). Older physicians tended to be male and had older patients in their practices than did younger physicians. Rural regions had higher proportions of older specialists. INTERPRETATION: Ontario''s physician corps is aging. This may result in decreasing availability of obstetrics and emergency department coverage in the future. Encouraging retirement may create more openings for recent graduates, but if such policies are enacted, special attention should be paid to ensure that rural communities and older patients continue to be served.     

Future role of neurologists.

Clinical neurologists in the health care system of the future should have a multifaceted role. Advances in the basic understanding of the nervous system and therapeutics of neurologic disease have created, for the first time in human history, an ethical imperative to correctly diagnose neurologic disease. In many situations, the neurologists may function as a consultant and principal physician for patients with primary nervous system disorders including Parkinson''s disease, multiple sclerosis, Alzheimer''s disease, epilepsy, migraine, cerebrovascular disease, movement disorders, and neuromuscular disease. Other important roles for neurologists include the training of future physicians, both neurologists and primary care physicians, the application of cost-effective approaches to care, and the support of health care delivery research and academic programs that link basic research efforts to the development of new therapy. To be successful, future residency training programs should include joint certification opportunities in both neurology and general medicine, and training programs for clinical investigators should be expanded. Despite its threats to specialists, managed care should also provide opportunities for new alliances among neurologists, other specialists, and primary care physicians that will both improve patient care and increase efficiency and cost-effectiveness.     

FPs have vital role in ensuring success of breast cancer screening programs

SCREENING IS THE ONLY PROVEN STRATEGY for reducing breast cancer mortality in women older than 50. Over the last 9 years, 8 provinces and 2 (territories have established independent dedicated mammography programs. A recent workshop on screening programs was told that family physicians play a crucial role in the ultimate success of these programs because of their referral role.     

House Calls in Utah

To learn the criteria Utah physicians use in making or not making house calls and their specialty, age and frequency of calls, a random sample of half of Utah''s physicians in family practice, general practice and general medicine was surveyed. Of 225 respondents, 70% reported making house calls at an average rate of 2.6 per month. More family practitioners made house calls than did internists; older physicians made more house calls than their younger counterparts. An estimated 82% of the calls were for patients aged 65 years and older. The most frequently stated reasons for making house calls were that patients were homebound and to assess the family or home situation. Reasons given for not making house calls were inefficient use of time and lack of equipment or necessary facilities.     

Educational package on hypertension for primary care physicians.

The usefulness of an educational package on hypertension that provides clinically important, up-to-date medical information and office "aids" to primary care physicians was tested in a randomized controlled trial. Fifty-six physicians completed a pretest multiple-choice questionnaire and were allocated at random either to a group that received the educational package (the "study group") or to a control group. There was a highly significant correlation between the pretest scores and the number of years since graduation (r = -0.55, p less than 0.0001), which indicated that younger physicians are more likely than older physicians to have an up-to-date knowledge of the management of hypertension. The increase in knowledge in the study group (17.5%) was significantly greater than that in the control group (2.7%). Furthermore, although the post-test scores in the control group were still significantly correlated with the number of years since graduation, those in the study group were not. It was concluded that although the older physicians knew less than their younger colleagues about hypertension, the use of the educational package significantly increased knowledge, and the increase was not limited by the physician''s age.     

The Physician Profile System

The Physician Profile System is currently the most efficient and equitable mechanism of administering the payment to physicians under the usual and customary charge programs. Local peer review must be closely linked with the system to provide the assurance of reasonableness of charges, to resolve differences of opinion, and to scrutinize the utilization of health care resources.In actual practice, the Profile System permits for gradually increasing charges, both for the individual physician and for the medical community. It is equally capable of giving effect to lowered charges which sometimes follow technologic improvements.Usual and customary programs have not proved to be inflationary, and have developed conservative trend patterns which permit realistic prediction of future program costs. Experience has shown that physicians have not abused the usual and customary charge programs. Administrative and peer review devices provide an impressive array of checks and safeguards against abuses in the utilization of benefits and in the payment of physicians'' charges.     

Physician resource databank: numbers,distribution and activities of Canada's physicians

The physician resource databank, compiled and maintained by the Canadian Medical Association (CMA), contains functional information from 41 599 of Canada''s licensed physicians. The information was gathered from a 20-item questionnaire sent to 47 162 physicians. Of the total, 38 653 responses came from physicians who had completed their training and these were included in the analysis to produce a profile of the supply of physicians in Canada. The data from physicians younger than 35 years indicate some changes in the structure of the supply: 27% are women (compared with only about 9% of physicians older than 45 years).The implications of these statistics are not yet clear, but within the next decade the numbers in some specialties—surgery, anesthesia, obstetrics and gynecology, and radiology—may be too few to meet the demand as more than 20% of the current practitioners reach retirement age. Other findings are that [List: see text]     

Jehovah's Witnesses leading education drive as hospitals adjust to no blood requests.

Jehovah''s Witness representatives have visited more than 10 Canadian medical schools and 200 hospitals in an attempt to educate future and practising physicians about nonblood medicine. The trend is becoming more popular since the advent of HIV, and there are now about 100 bloodless medicine and surgery centres around the world, including 52 in the US. However, a Jehovah''s Witness spokesman says Canada is "conspicuously absent" from the list of countries that offer bloodless-medicine programs.     

Is deleting the digital rectal examination a good idea?

Although the supply of physicians in the United States has doubled during the past 20 years, there is still disagreement as to whether we currently have or should expect a significant surplus of physicians. The evidence suggests that despite the rapid expansion in the pool of available physicians, serious physician shortages persist for certain rural populations, ethnic and occupational groups, and other medically disadvantaged segments of the population. Medical students'' declining interest in rural practice and primary care specialties suggests that problems of geographic and specialty maldistribution may worsen despite a rising population of physicians. It is unlikely that a significant physician surplus will develop unless there is a conscious attempt to limit the proportion of national wealth expended on medical care. Pockets of shortage can be reduced by broadening the availability of health insurance, lessening large income disparities between different specialties, changing the way teaching institutions are reimbursed for their training costs, and supporting direct governmental service programs such as the National Health Service Corps.     

Impact of the Walton report on cervical cancer screening programs in Canada.

It is almost 4 years since the Walton report on cervical cancer screening programs was published. In an effort to assess the impact of this report on such programs across Canada the Department of National Health and Welfare carried out a survey using questionnaires. It appears from the evaluation that physicians, laboratories and provincial departments of health are giving thoughtful but cautious consideration to implementing the report''s recommendations. Stated areas of controversy include the recommended frequency of cervical smear examination, the establishment of province-wide cytology registries and the recommended size of laboratories. Perhaps the pace will quicken as additional knowledge and experience are gained. Perhaps, too, if a national mechanism to encourage provincial implementation were instituted hesitancy would decrease.     

Detecting and managing elder abuse: challenges in primary care

OBJECTIVE: To determine family physicians'' perceptions of barriers and strategies in the effective detection and appropriate management of abused elderly people. DESIGN: Questionnaire survey; the protocol included an advance notification letter and 3 follow-up mailings. SETTING: Regional Municipality of Hamilton-Wentworth, Ont. PARTICIPANTS: All active nonspecialist physicians who reported seeing elderly patients in their practices were eligible for inclusion. Fifty health service organization (HSO) physicians were randomly selected from among those listed with the HSO Mental Health Program, and 200 fee-for-service physicians were randomly selected from the Canadian Medical Directory. Of the 189 eligible physicians 122 returned completed questionnaires, a response rate of 65%. OUTCOME MEASURES: Physicians'' ratings of the importance of potential barriers in assisting older people experiencing abuse and of the usefulness of strategies for dealing with elder abuse. RESULTS: Physicians identified the following barriers as fairly or very important: denial of abuse, resistance to intervention, not knowing where to call for help, lack of protocols to assess and respond to abuse, lack of guidelines about confidentiality, fear of reprisal, and lack of knowledge of the prevalence and definition of elder abuse. Strategies deemed to be helpful included a single agency to call, a directory of services, a list of resource people, an educational package, guidelines for detection and management, reimbursement for time spent on legal matters, continuing education, revision of fee structure and a central library of resources on elder abuse. CONCLUSION: Although the physicians perceived numerous barriers to their detection and management of elder abuse, they identified many strategies that could be implemented at a local level. Preparation of an algorithm to help physicians is the next phase of this work.     

Cervical cancer screening: are the 1989 recommendations still valid? National Workshop on Screening for Cancer of the Cervix.

Although screening for cervical cancer has been shown to be effective in reducing the morbidity and mortality associated with this disease, and despite many attempts to encourage the development of provincial programs, as of 1995 no province had a comprehensive screening program for cervical cancer. Participants at the Interchange ''95 workshop, held in Ottawa in November 1995, reviewed the recommendations of the 1989 National Workshop on Screening for Cancer of the Cervix and identified factors that have impeded their implementation. Participants discussed the need for comprehensive information systems, quality control and strategies to increase recruitment of unscreened and underscreened women. They concluded that the formation of a Cervical Cancer Prevention Network involving key stakeholders will facilitate the development and implementation of provincial programs to ensure optimal screening. They agreed that, in the interim, recommendations for practising physicians should remain as they were following the 1989 workshop.     

Social Dancing and Incidence of Falls in Older Adults: A Cluster Randomised Controlled Trial

BackgroundThe prevention of falls among older people is a major public health challenge. Exercises that challenge balance are recognized as an efficacious fall prevention strategy. Given that small-scale trials have indicated that diverse dance styles can improve balance and gait of older adults, two of the strongest risk factors for falls in older people, this study aimed to determine whether social dance is effective in i) reducing the number of falls and ii) improving physical and cognitive fall-related risk factors.ConclusionsSocial dancing did not prevent falls or their associated risk factors among these retirement villages'' residents. Modified dance programmes that contain "training elements" to better approximate structured exercise programs, targeted at low and high-risk participants, warrant investigation.

Trial Registration

The Australian New Zealand Clinical Trials Registry ACTRN12612000889853     

Chelation therapy in workers with lead exposure.

Occupational lead overexposure remains a major problem. To evaluate the settings in which physicians appropriately prescribe chelation therapy for lead exposure, 7 cases were identified from physician phone calls and mandatory laboratory reporting of elevated blood lead levels to the California Department of Health Services. In the 2 workers with the highest blood lead levels (both of whom had severe symptoms), treatment was indicated. Physicians inappropriately prescribed chelating agents to workers with ongoing lead exposure as prophylaxis against rising blood lead levels and to treat atherosclerotic heart disease. Workers'' personal physicians identified lead overexposure in 5 of the 7 cases. Workplace lead medical surveillance programs mandated by the federal Occupational Safety and Health Administration were inadequate in all 5 of the workplaces where information was available.     

Physicians' and nurses' retention of knowledge and skill after training in cardiopulmonary resuscitation.

Physicians and nurses in a community hospital who successfully completed the standard 1-day training program in basic life support cardiopulmonary resuscitation (CPR) were retested 6 and 12 months after training. Their perceptions of their knowledge of and skill in CPR were recorded along with an account of the roles they had taken in CPR incidents. The physicians and nurses initially had the same level of knowledge of CPR, but the physicians learned significantly more and retained it longer. After training, the nurses participated much more in CPR incidents, limiting themselves to basic life support functions. The physicians'' participation, however, remained at about the same level and was limited to advanced life support functions. By 12 months after training the scores in both groups were similar to the pretraining scores, which suggests that practice with feedback is necessary during the 1-year period before retraining and recertification. It may be that the two groups require different training programs.     

Lifestyle interventions in the management of hypertension: a survey based on the opinion of 105 practitioners

Background Lifestyle interventions in the management of hypertension were beneficial in published studies. ObjectiveTo evaluate (1) which lifestyle recommendations are given by physicians and to what extent the possibility of drug-induced hypertension is addressed; (2) to study the characteristics of the physicians who more often perform lifestyle interventions. MethodsGeneral practitioners in the area of Dordrecht were asked whether or not they included lifestyle advice in the management of their patients' hypertension. ResultsOf the 176 physicians invited, 105 consented to take part. Measures to reduce body weight, stopping smoking, and physical exercise advice were given by 94, 92, and 92% of the physicians, respectively. Advice on psychological relaxation and reducing liquorice (Dutch: drop) intake was only given by 23 and 32%. Rural physicians were more active: they more often recommended quitting smoking (p<0.02), reducing weight (p<0.02), and participating in sporting activities (p<0.02). And so were older physicians: they more often recommended starting low-calorie diets (p<0.05), stopping liquorice consumption (p<0.04) and emphasised drug compliance (p<0.02). Increased blood pressure as a side effect of concomitant medications, other than nonsteroidal anti-inflammatory drugs and oral contraceptives, was virtually never addressed. Conclusions(1) Advice to reduce body weight, stop smoking, and increase physical exercise are the only lifestyle recommendations routinely given, (2) rural physicians and older physicians were more active in giving non-drug treatments, (3) increased blood pressure as a side effect of medications was virtually never addressed. (Neth Heart J 2009;17:9-12.)     

Características de los programas de entrenamiento de fuerza muscular en personas mayores con sarcopenia. Revisión de alcance

ObjectiveThe aim of this scoping review was to analyze the resistance training-based programs’ characteristics and outcomes of physical and psychological health and cognitive functions measured in older adults with sarcopenia.MethodThis scoping review was carried out following the criteria and flow diagram established in the PRISMA guidelines and included studies from 2011 until 2020 from electronic databases, including PubMed, Scopus, and Web of Science.ResultsA total of 13 randomized controlled trials were included. The sample's average age was 72.2 years, with an age range between 71 and 80 years, considering a total sample of 1029 older adults (57% women). Resistance training-based programs were carried out mainly in university facilities, presented high adherence (91.2%) and were able to induce increase in strength and muscle mass. The most frequent parameters used were 2-3 weekly, 50-90-min-long sessions for 3-9 months, using between 8 and 15 repetitions, in an intense training zone with 1-RM between 60% and 85%. The most measured physical health outcomes were muscle strength, muscle mass, and BMI. Cognitive impairment was frequently evaluated, and few studies evaluated mental health.ConclusionThis review characterized resistance training-based programs in older people with sarcopenia, highlighting the extension, frequency, duration, and intensity of these, as well the most frequently used outcome measures and instruments. These results could be useful for prescribing future resistance training-based programs in older adults with sarcopenia.