Resident attrition from family practice residencies: United States versus international medical graduates

BACKGROUND: Attrition of residents from family practice residency programs may cause significant problems for faculty, residents, and patients. The objective of this study was to determine international medical graduates' attrition rate from family practice residencies, compared with US medical school graduates. METHODS: Surveys were sent to all family practice residency program directors asking them to calculate their attrition rate for a 10-year period. RESULTS: The overall response rate was 56.6%, but interpretable responses were received from 45% of all civilian, continental US family practice residencies. Responding programs did not differ from all family practice programs with respect to program overall. Of those residents leaving, 63% did so to enter other specialties. The attrition rate was 18.5% for international graduates, compared with 7.8% for US graduates (P < .0001). International graduates enrolled outside of the National Resident Matching Program (NRMP) were most likely to leave programs before completion. CONCLUSIONS: Attrition rates from family practice residency programs are higher for international medical graduates than for US graduates. International graduates enrolled outside of the NRMP were most likely to leave a program.     

U. S. medical graduates versus foreign medical graduates. Are there performance differences in practice?

This study has attempted to determine the relationship between physicians' medical education and their performances (technical quality and utilization of medical care resources) in offices and hospitals. The sample consisted of 506 physicians of Hawaii, involving 18 specialty categories. The study finds little evidence of the influence of the type of medical schools on physicians' technical quality and utilization of medical resources in practice. The mean differences between the categories of medical schools were not statistically significant (except for the quality when specialists practiced within their own areas of specialization). There is no evidence that all categories of U.S. medical graduates provided a higher quality care and better utilization than all categories of foreign medical graduates. There was no consistent pattern of performances within the categories of U.S. medical schools and of foreign medical schools in these dimensions of performances.     

Psychology in United States medical schools: 1983.

Compared results from a survey of 108 chief psychologists at medical schools to the results of a previous survey by the 2nd author and colleagues (see record 1978-32394-001). The current survey revealed considerable progress in changing the bylaws of university-affiliated hospitals to enable psychologists to be members of the active medical staff. Some progress has also been made achieving departmental status for psychology. These developments are discussed in the context of the maturation of psychology in medical schools. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Respiratory questionnaire responses: how they change with time

AIM: Responses to respiratory questionnaires are often used to identify individuals with asthma symptoms and may also be used to identify asymptomatic individuals. This study investigates the repeat responses over four years to such a questionnaire in a population of adult New Zealanders. METHODS: Seven hundred and twenty three asthmatics were sent two almost identical questionnaires in three areas of New Zealand, separated by approximately four years. All of them had answered yes to at least one of the three questions under study in the first survey. RESULTS: Following the second asthma questionnaire only 487 (67.4%) answered yes to at least one of the survey questions. Similarly, 51.1% of those who had reported having nocturnal shortness of breath in the first survey did so in the second survey, 69.9% of those who reported having had an asthma attack in the first survey did so in the second survey, and finally 74.8% of those who reported using asthma medication in the first survey did so in the second survey. CONCLUSION: Even in a previously identified symptomatic asthmatic group, a large proportion did not report respiratory symptoms and asthma medication use four years later. This implies that the true prevalence pool of susceptibles is likely to be far greater than is identified in surveys of the 12-month period prevalence of asthma symptoms. This has implications not only for the design of epidemiological studies (e.g., it poses problems for the selection of a control group of non-asthmatics in prevalence case-control studies), but also for the planning of health services and educational programmes for people with asthma.     

Enculturation of foreign nurse graduates: an integrated model

Graduates of foreign nursing schools are a unique and valuable resource of the U.S. health care delivery system. Due to inadequate communication skills and a lack of cultural enculturation of many foreign nurse graduates (FNGs), some may not reach their full potential as a professional nurse. Agencies who employ FNGs can greatly improve their integration by providing continuing education to enhance communication and cultural enculturation. This model of a communications skills course addresses all aspects of communication: therapeutic, verbal and non-verbal, while integrating a cultural component. Thus, the implementation of this model can enhance foreign nurse graduates' ability to practice in the U.S. health care system.     

Mental disorders and access to medical care in the United States

OBJECTIVE: The authors examined the barriers to receipt of medical services among people reporting mental disorders in a representative sample of U.S. adults. METHOD: The sample was drawn from adults who responded to the 1994 National Health Interview Survey (N=77,183). The authors studied the association between report of a mental disorder and 1) access to health insurance and a primary provider, and 2) actual receipt of medical care. Multivariate techniques were used to model problems with access as a function of mental disorders, controlling for demographic, insurance, and health variables. RESULTS: While people who reported mental disorders showed no difference from those without mental disorders in likelihood of being uninsured or of having a primary care provider, they were twice as likely to report having been denied insurance because of a preexisting condition or having stayed in their job for fear of losing their health benefits. Among respondents with insurance, those who reported mental illness were no less likely to have a primary care provider but were about two times more likely to report having delayed seeking needed medical care because of cost or having been unable to obtain needed medical care. CONCLUSIONS: People who reported mental disorders experienced significant barriers to receipt of medical care. Efforts to measure and improve access to health care for this population may need to go beyond simply providing insurance benefits or access to general medical providers.     

Direct medical costs of coronary artery disease in the United States

To generate current incidence-based estimates of the direct medical costs of coronary artery disease (CAD) in the United States, a Markov model of the economic costs of CAD-related medical care was developed. Risks of initial and subsequent CAD events (sudden CAD death, fatal/nonfatal acute myocardial infarction [AMI], unstable angina, and stable angina) were estimated using new Framingham Heart Study risk equations and population risk profiles derived from national survey data. Costs were assumed to be those related to treatment of initial and subsequent CAD events ("event-related") and follow-up care ("nonevent-related"), respectively. Cost estimates were derived primarily from national public-use databases. First-year direct medical costs of treating CAD events are estimated to be $17,532 for fatal AMI, $15,540 for nonfatal AMI, $2,569 for stable angina, $12,058 for unstable angina, and $713 for sudden CAD death. Nonevent-related direct costs of CAD treatment are estimated to be $1,051 annually. The annual incidence of CAD in the United States is estimated at 616,900 cases, with first-year costs of treatment totaling $5.54 billion. Five- and 10-year cumulative costs in 1995 dollars for patients who are initially free of CAD are estimated at $9.2 billion and $16.5 billion, respectively; for all patients with CAD, these costs are estimated to be $71.5 billion and $126.6 billion, respectively. The direct medical costs of CAD create a large economic burden for the United States health-care system.     

Female patients with congestive heart failure: how they conceive their life situation

Congestive heart failure (CHF) is a significant health problem for women, particularly elderly women. The risk factors for heart failure appear to be different in women than in men, with hypertension and diabetes playing a greater role in women and ischaemic heart disease a greater role in men. The aim of this study was to describe, from a nurse's perspective, how female patients with CHF conceive their life situation. Interview questions were designed with a focus on five dimensions: biophysical, socio-cultural, emotional, intellectual and spiritual-existential. A qualitative method was used with a phenomenographic approach, as this approach examines aspects of the surroundings as they are conceived. Five categories emerged in the results: feeling content, feeling a sense of support, feeling a sense of limitation, feeling anxiety and feeling powerless. A sense of limitation regarding working capacity and being able to support those in their surroundings causes patients with CHF to experience anxiety due to feeling insecure about themselves and in relation to their surroundings. This may result in feelings of worthlessness in women with CHF, both concerning their own capacity and the fact that they feel they are a burden to those around them. Through nursing intervention, these patients can receive help to break this vicious circle of feeling limited and powerless. This can be done by encouraging them to verbalize their feelings and set realistic goals and expectations, and by increasing their knowledge and that of their families concerning CHF and its symptoms, with a focus on self-care and existing possibilities. These measures will make it easier for women with CHF to maintain a hopeful perspective and a sense of control, competence, and self-esteem.     

Workforce projections for emergency medicine: how many emergency physicians does the United States need?

Recent work in our lab has shown that the chemoprotective fatty acid, conjugated linoleic acid (CLA), inhibits phorbol ester skin tumor promotion in mice. Because little is known about the deposition of CLA into tissues as well as its biological activity, this study compared the incorporation and biological activity of CLA to linoleic acid (LA; 18:2, c9,c12) and arachidonic acid (AA; 20:4 c5,c8,c11,c14) in cultured keratinocytes. When keratinocytes (HEL-30) were grown in media containing 14C-CLA for various periods, more than 50% of the 14C-CLA was incorporated into cellular lipids by 9 h. The distribution of CLA in phospholipid classes was similar to LA, Approximately 50% of 14C-LA and 14C-CLA were incorporated into phosphatidylcholine (PC), while the remainder was taken up by phosphatidylethanolamine (PE) and phosphatidylserine/phosphatidylinositol (PS/PI). In contrast, 14C-AA was more equitably distributed into PC, PE, or PS/PI (27, 30, or 38%, respectively). When keratinocytes were prelabeled with radiolabeled fatty acids, phorbol ester-induced release of 14C-CLA was 1.5 times higher than 14C-LA and 14C-AA. However, 14C-prostaglandin E (PGE) release in 14C-CLA prelabeled cultures was 6 and 13 times lower than cultures treated with 14C-LA and 14C-AA, respectively. Moreover, the ability of non-radiolabeled CLA to support ornithine decarboxylase activity, a hallmark event of tumor promotion, was significantly lower than in LA- and AA-treated cultures. These studies suggest that CLA inhibits skin tumor promotion, in part, through a PGE-dependent mechanism.     

Diarrhea associated with Vibrio fluvialis in the United States

We report the isolation in the United States of Vibrio fluvialis from the stools of a patient who had severe watery diarrhea without fever and who subsequently died. V. fluvialis, a known enteric pathogen in other parts of the world, should be suspected in patients with watery diarrhea, especially in coastal areas.     

Health service indicators for radiology departments: how meaningful are they?

The Health Service Indicator (HSI) for Radiology Services in the UK is represented by a cost per case figure based on annual expenditure and workloads in individual departments. These show significant variations betweeen departments for a number of predictable reasons. Detailed analysis shows good correlation between population-based radiology costs and workloads and that departments with low cost per case values have above average workloads. The usefulness of the HSI cost per case is limited to identification of departments with unduly high or low values, thus allowing such departments to critically appraise their staffing and workload levels. Taken at face value, they can easily be misinterpreted as a measure of cost-effectiveness.     

Experimental studies on immunosuppression: how do they predict for man?

The aim of this study is to assess in human vein endothelial cells cultures the variations related to aging in: number of cells, glucose, triglycerides, thiobarbituric acid reactive substances (TBARS), calcium, phosphorus, cholesterol, total protein and urea and to analyze the relation of these parameters between themselves. Eight parallel flasks were subjected to the natural aging process, one of them without cells, analyzed at eight chronological stages. The determinations of biochemical parameters were performed in culture medium when it was changed. The number of cells, glucose, triglycerides and TBARS show significant variations during the aging process (P < 0.001). The glucose uptake per cell is maintained relatively constant in time (0.9 ng/cell day). A high linear correlation between glucose and the number of cells (r=0.935), triglycerides and the number of cells (r=0.505), triglycerides and decrease in number of cells (r=0.805) is observed. The measurement of glucose uptake seems to be an excellent method for the assessment of energetic cellular metabolism and, in certain conditions, can be used to estimate the number of cells. In the latest stages of aged cells a slight increase in glucose uptake has been observed. There is an increase of triglycerides and thiobarbituric acid reactive substances release during aging process.     

Urinary tract infections in children: why they occur and how to prevent them

Urinary tract infections (UTIs) usually occur as a consequence of colonization of the periurethral area by a virulent organism that subsequently gains access to the bladder. During the first few months of life, uncircumcised male infants are at increased risk for UTIs, but thereafter UTIs predominate in females. An important risk factor for UTIs in girls is antibiotic therapy, which disrupts the normal periurethral flora and fosters the growth of uropathogenic bacteria. Another risk factor is voiding dysfunction. Currently, the most effective intervention for preventing recurrent UTIs in children is the identification and treatment of voiding dysfunction. Imaging evaluation of the urinary tract following a UTI should be individualized, based on the child's clinical presentation and on clinical judgment. Both bladder and upper urinary tract imaging with ultrasonography and a voiding cystourethrogram should be obtained in an infant or child with acute pyelonephritis. Imaging studies may not be required, however, in older children with cystitis who respond promptly to treatment.