The physician and accidents. Legal and medical problems

German law requires that any physician at a place of accident is obliged to help according to his training and ability. As an emergency doctor on duty he works in a warrantee position. In cases with multiple accident victims triage may be necessary, corresponding to the priority of medical care. In criminal procedures against a physician due to omitted help, there is no probative charge against the accused. On the other hand, civil law sets up an objective standard: attention as required in communication. In giving initial medical assistance for unconscious patients or injured children, rules of "authorized management without commission" become valid. Basic first aid measures involve: securing, saving and rescue. Life-threatening situations such as severe bleeding, airway obstruction and cardiac arrest must be dealt with immediately. Following this, such measures as proper positioning, clearing of the respiratory tract, removal of dental prostheses, evaluation of multiple injuries, avoidance of hypothermia and initiating infusions are mandatory. The orientating examination of the accident victim is described, as is the "ABCD Rule" for treating respiratory insufficiency or circulatory arrest and shock, using heart massage and artificial respiration. Finally, medical first aid is described for special injuries, such as cerebral or thoracic trauma, fractures and burns. The psychological situation affecting the physician at the place of an accident is characterized.     

Study of major volatiles in wines and discriminant analysis applied to classification according to region

The major volatiles of eighty eight wines (white, rosè and red) from Madrid were studied. The samples came from the three districts forming the "Vinos de Madrid" DO (Denominación de Origen) region: Arganda, Navalcarnero and San Martín, and were analyzed by gas chromatography. The resulting data were treated by Stepwise Discriminant Analysis (SDA) in order to ascertain the efficacity of these compounds in classifying the wines according to their geographical origin. The results confirm that the above components were of little use in classifying the red and white wines and, although a correct classification percentage of 90.91% was obtained for the rosés when all the variables were used, this too was considered unsatisfactory.     

Forensic medical criteria of relationship according to the dermatoglyphic traits of the foot

Inheriting of 55 dermatoglyphic signs of the soles are analyzed using Cummins and Midlo's method (1962) in 100 families (father, mother, one or two children). For the first time in Russian forensic medicine quantitative criteria of familial similarity by the complex of dermatoglyphic signs of the soles have been defined. The inheritance of skin patterns on the toes is governed by the same regularities as on the hands and does not depend on the localization of patterns (right or left side), number of the toe, and sex. The authors detected and investigated the possibility of inheritance of skin patterns from a homologous toe or area of the sole of a parent by a child in whom this pattern occurs on the homologous toe or area of the sole (mirror symmetry) or on one of the adjacent toes or the same sole. The possibility of referring a child to a specific couple of parents on the basis of a single complex pattern formalized according to the devised method has been validated for the first time.     

The physician perspective of health psychologists in medical settings.

Examined physician attitudes and utilization of psychologists in medical settings by administering a 15-item questionnaire to 397 26–78 yr old physicians (84% male) practicing family/general practice, surgery, internal medicine, or miscellaneous clinical medicine. Although differences in attitudes were associated with age, sex, and specialty, generally favorable attitudes toward psychologists were found among Ss. Results show a recognition by the majority of Ss of the role that psychological factors play in medical disease and an appreciation of clinical psychological skills by a large majority. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of medical training factors on physician utilization behavior

The purpose of this study is to determine the influence of medical school, teaching hospital, and specialization on physicians' use of clinical and technical resources. The universe of the study consists of 34 internists practicing in the prepaid gorup practice setting of Kaiser in Portland, Oregon. The data reported here show that physicians trained in medical schools and hospitals with a scientific medical orientation generally use fewer such resources than other physicians. However, under conditions of uncertainty, that is, when diagnosis is unknown, they tend to use more services. In other words, these physicians are conservative in theri use of resourses when ambiguity is low, and liveral when ambiguity increases. Graduates of the more scientifically oriented institutions seem therefore more flexible in adjusting to the demands of the disease situation.     

Informed consent: an evolution from battery/medical negligence to potential invasion of physician privacy

The data on Marburg virus resistance to freeze-drying in the presence of protective media and on a decrease in the freeze-dried virus biological activity at positive and negative temperatures are presented. Using the results of the experiments, kinetic parameters of virus thermoinactivation were determined for long-term storage at 20 and 37 degrees C. The rate of Marburg virus inactivation was comparable to the rates reported in the literature for para-, mixo- and toga-viruses. The conclusion is made on feasibility of prolonged storage of Marburg virus under negative temperatures.     

Assessment of medical care by elderly people: general satisfaction and physician quality

OBJECTIVE: To identify personal characteristics and factors related to health and patterns of healthcare utilization associated with the elderly people's satisfaction with medical care. DATA SOURCES/STUDY SETTING: Data from the 1991 Medicare Current Beneficiary Survey (MCBS) on 8,859 persons age 65 and over living in the community. STUDY DESIGN: Items reflecting general satisfaction with care and views of physician quality are examined and, based on factor analysis, grouped in dimensions of two (global quality, access) and three (technical skills, interpersonal manner, information-giving), respectively. The relationship of high levels of satisfaction in each dimension to personal characteristics of elderly people, and to measures of access and utilization, is assessed using logistic regression. PRINCIPAL FINDINGS: While satisfaction is high, with over 90 percent surveyed expressing some satisfaction, there is substantial variation with less likelihood of high satisfaction among those 80 or older, with less education and income and in poorer health. Longer waiting time at visits and less frequent visits are factors in lower satisfaction as well. A favorable perception of physician quality, especially regarding technical skills, appears to play a significant role in satisfaction with global quality of care. CONCLUSIONS: Studies of patient satisfaction in elderly people are rare. Some factors expected to be related to positive assessment based on earlier studies, were, e.g., better health and shorter waiting time, while others were not, e.g., increasing age. Elderly people appear to place greater importance on physician technical skills, as opposed to interpersonal dimensions, in assessing global quality. These findings suggest the need for a better understanding of how elderly people evaluate care and what they value in interactions with the healthcare system.     

Psychologist–physician partnership in a medical specialty screening clinic.

Describes the development of a headache screening clinic in which psychologists participate with neurologists in the initial patient evaluation, using brief screening questionnaires and interviews. The majority of patients assessed in this clinic experienced clinically significant emotional distress, although only a minority of these patients felt a need for psychological intervention. By combining psychological screening with initial medical evaluation, emotionally disturbed individuals who present with physical complaints can be rapidly identified and their defensiveness about referral for psychological/psychiatric intervention can be minimized. Psychologists' psychometric screening instruments and their interviewing skills can contribute significantly to optimal utilization of health care services. Three case examples are given. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transurethral resection of partially obstructed ejaculatory ducts: seminal parameters and pregnancy outcomes according to the etiology of obstruction

PURPOSE: We determine how transurethral resection of the ejaculatory ducts performed for infertility affects seminal parameters and pregnancy outcomes in patients with partial ejaculatory duct obstruction due to a congenital or acquired etiological factor. MATERIALS AND METHODS: Based on history and physical examination, hormonal profiles, semen analyses, transrectal ultrasonography and vasography findings partial ejaculatory duct obstruction was diagnosed in 14 men a mean of 30 years old who presented for infertility evaluation. Patients were grouped according to congenital or acquired cause of obstruction. Transurethral resection of the ejaculatory ducts was performed using the standard resectoscope loop technique. Clinical outcome was assessed by postoperative analyses of seminal parameters and pregnancy reports. RESULTS: Transurethral resection of the ejaculatory ducts significantly improved semen quality (ejaculate volume and percentage of sperm motility) in all patients in the congenital group, while all but 1 (83%) had an improved sperm count. Pregnancy was achieved via sexual intercourse by 66% of the patients an average of 5.7 months postoperatively. Of the acquired etiological factor group 37.5% had improved semen quality after transurethral resection of ejaculatory duct and 12.5% achieved pregnancy via sexual intercourse. Postoperative complications occurred at a similar rate in each group (33%). However, complications in the congenital etiology group were minor, while 25% of the men in the acquired group had significant impairment of seminal parameters after transurethral resection of the ejaculatory ducts. CONCLUSIONS: Semen quality improvement and pregnancy outcome after transurethral resection of the ejaculatory ducts for partial ejaculatory duct obstruction differ significantly according to the main etiological cause of obstruction. An equivocal diagnosis of partial obstruction and technical problems during transurethral resection of the ejaculatory ducts may contribute to failure. However, in some cases the reason for failure remains unclear.     

Global physician budgets as common-property resources: some implications for physicians and medical associations

Since 1990 payment for physician services in the fee-for-service sector has shifted from an open-ended system to fixed global budgets. This shift has created a new economic context for practising medicine in Canada. A global cap creates a conflict between physicians' individual economic self-interest and their collective interest in constraining total billings within the capped budget. These types of incentive problems occur in managing what are known in economics as "common-property resources." Analysts studying common-property resources have documented several management principles associated with successful, long-run use of such resources in the face of these conflicting incentives. These management principles include early defining the boundaries of the common-property resource, explicitly specifying rules for using the resource, developing collective decision-making arrangements and monitoring mechanisms, and creating low-cost conflict-resolution mechanisms. The authors argue that global physician budgets can usefully be viewed as common-property-resources. They describe some of the key management principles and note some implications for physicians and the provincial and territorial medical associations as they adapt to global budgets.     

Coreceptor usage of primary human immunodeficiency virus type 1 isolates varies according to biological phenotype

The biological phenotype of primary human immunodeficiency virus type 1 (HIV-1) isolates varies according to the severity of the HIV infection. Here we show that the two previously described groups of rapid/high, syncytium-inducing (SI) and slow/low, non-syncytium-inducing (NSI) isolates are distinguished by their ability to utilize different chemokine receptors for entry into target cells. Recent studies have identified the C-X-C chemokine receptor CXCR4 (also named fusin or Lestr) and the C-C chemokine receptor CCR5 as the principal entry cofactors for T-cell-line-tropic and non-T-cell-line-tropic HIV-1, respectively. Using U87.CD4 glioma cell lines, stably expressing the chemokine receptor CCR1, CCR2b, CCR3, CCR5, or CXCR4, we have tested chemokine receptor specificity for a panel of genetically diverse envelope glycoprotein genes cloned from primary HIV-1 isolates and have found that receptor usage was closely associated with the biological phenotype of the virus isolate but not the genetic subtype. We have also analyzed a panel of 36 well-characterized primary HIV-1 isolates for syncytium induction and replication in the same series of cell lines. Infection by slow/low viruses was restricted to cells expressing CCR5, whereas rapid/high viruses could use a variety of chemokine receptors. In addition to the regular use of CXCR4, many rapid/high viruses used CCR5 and some also used CCR3 and CCR2b. Progressive HIV-1 infection is characterized by the emergence of viruses resistant to inhibition by beta-chemokines, which corresponded to changes in coreceptor usage. The broadening of the host range may even enable the use of uncharacterized coreceptors, in that two isolates from immunodeficient patients infected the parental U87.CD4 cell line lacking any engineered coreceptor. Two primary isolates with multiple coreceptor usage were shown to consist of mixed populations, one with a narrow host range using CCR5 only and the other with a broad host range using CCR3, CCR5, or CXCR4, similar to the original population. The results show that all 36 primary HIV-1 isolates induce syncytia, provided that target cells carry the particular coreceptor required by the virus.