Consultation-liaison psychiatry, which seeks to make a clinical and cultural contribution to medical problems, is the subject of considerable debate at a theoretical level. Moreover, at least in Italy, it is far removed from total actualization in practical terms. On the basis of a clinical experience, the authors underscore how ...

In a recent issue of The Medical Staff Counselor, Dr. Howard L. Lang portrayed hospitals as usurping the role of the medical staff by instituting actions for fiscal controls in response to outside pressures. This author believes that Dr. Lang's proposal to make the medical staff more independent reflects a ...

The paper compares the incidence of viral hepatitis, the frequency of occurrence of antigen HBs, as well as the clinical course of the disease in medical staff in relation to patients in the general population. The analysis has shown that the incidence rate in the Lublin district in the years ...

The psycho-behavioral troubles of patients with an Alzheimer's Disease (AD) are such that it is very difficult to keep those patients within the normal family environment, and that it therefore proves necessary to have them placed in a specially adapted residence manned by a highly specialised medical and para-medical staff. ...

Today's physicians are faced with conflicting pressures. As hospitals attempt to base staff privileges on the physician's ability to operate with economic restraint, physicians must struggle to maintain the medical staff autonomy vital to the provision of quality patient care. Dr. Lang urges medical staff unity against corporate influence over ...

This article originally was prepared for presentation at the 1988 Texas Health Law Conference, Nov 4, 1988, in Austin. It appears this month in Texas Medicine to emphasize the importance of state and federal laws that require reporting of certain peer review actions by hospitals, medical societies, and other organizations ...

Man is unable to control for the ever-present potential of disaster. In the past practices and procedures have been developed to minimize physical risk and maximize personal safety. However, there has been little awareness of, or attention to, the stress to those involved in the care-giving process to the victims. ...

Hospitals have recently begun to explore and adopt medical staff membership criteria that go beyond simply determining a practitioner's ability to practice medicine. Medical competence and expertise will always play a central role in medical staff membership decisions. However, the increasing competition among hospitals for patients with the attendant pressure ...

An inventory is described for assessing medical staffs' knowledge of behavioral methods with pediatric pain patients. It was adapted from a measure designed by Sanders and Webster (1982) for use with nurses treating adult chronic pain patients. The modified inventory was administered to three groups of medical staff: (a) pediatric ...

We conducted a survey of physicians-in-chief (PCs) and chief medical residents (CMRs) in training programs throughout Canada to determine their attitudes toward the need for and role of CMRs in Canada and to rate the importance of CMR duties and attributes. Forty-three hospitals with 5 to 126 house staff in ...

Intravenous drug abusers with endocarditis present difficult problems in both medical and psychiatric management. A retrospective chart survey revealed that eight of nine such patients with endocarditis signed out against medical advice before antibiotic therapy was completed. Reasons for premature discharge included the patient's underlying psychopathology as well as the ...

Infections resulting from contamination of medical equipment and medications with opportunistic mycobacteria are reviewed and the mode of spread discussed. The prevention of Mycobacterium tuberculosis in patients and staff, by the implementation of occupational health schemes, infection control policies and disinfection policies is also reviewed. The problems relating to immunocompromised ...

The facsimile transceiver (FAX) was trialed at Beverly Hospital, Beverly Massachusetts, on the Intensive Care Unit and the Pediatric Floor from March 13 to April 27, 1987. Beverly Hospital is a 233 bed non profit community hospital. The facsimile unit was used to transmit medication orders to the pharmacy over ...

Case notes of patients admitted to hospital or seen in the casualty department following an overdose were assessed in a standardized way. The medical records were deficient in several important areas, especially for those patients seen in casualty and not referred to a psychiatrist. If only selected patients were to ...

The medical staff is a self-governing, legally separate entity representing the collective professional responsibility of its members in the management and administration of medical care within the hospital. This article explores the essentials of medical staff self-governance: the development and adoption of medical staff bylaws, which may not be unilaterally ...

In today's hospital environment, a new group that may be termed "medical staff professionals" provides administrative and managerial support for both the clinical and non-clinical activities of today's medical staff. This article explains why hospitals and medical staffs recognize the need for such professionals, and discusses the areas that such ...

One of the six corollaries to high quality healthcare identified in a 1987 study indicated that a team approach is required, although it challenges the notion of the professional autonomy of the medical staff. There are both individual and delivery system barriers to formation of partnerships and resistance to the ...

While some courts have characterized medical staff bylaws as a contract, and such characterization is supported by the American Medical Association and the Joint Commission on Accreditation of Healthcare Organizations, the author argues that many implications of regarding medical staff bylaws as a contract have been ignored, and that the ...

In response to an awareness of the emotional needs of cancer patients and their families, a psychosocial oncology conference was begun at the Veterans Administration Medical Center in Houston, TX approximately 10 years ago. Its goal has been to educate medical staff about the mental health issues of cancer patients ...

Even though physicians need business organizations to help them compete for the limited health care dollars, such organizations should be separate from the hospital medical staff. This article points out that the risks in incorporating the medical staff--increased risk of liability for peer review, loss of antitrust defenses, increased risk ...

This article discusses ambulatory care joint ventures by hospitals and selected members of their medical staffs and emphasizes the resolution of problems in the early planning stages. Failure to follow an orderly and thoughtful planning process not only risks valuable resources of the venture partners, but also jeopardizes the working ...

Postmortem cornea retrieval rates are inadequate to meet transplantation demands. Comparison of annual deaths versus donations (1982 to 1985) between Eisenhower Army Medical Center and the Medical College of Georgia reveals that Eisenhower had lower rates of cornea donation. Attitudinal surveys showed that physicians omitting organ donation requests rarely found ...

Androgenetic alopecia (AGA) sometimes referred to as `male pattern baldness' (MPB) may affect up to 50% of males between the ages of 30 and 50 years. The authors of this article review the medical and surgical approaches currently available to treat AGA. Medications, such as topical minoxidil, which are currently ...

During 100 routine psychiatric hospital electroconvulsive treatments the medical staff administering treatment experienced little difficulty in deciding that a fit had occurred. The judgement was based on simple clinical observation of a succession of clonic bodily movements, and high inter-rater agreement was found for the measurement of fit duration. The ...

This study was designed to assess the use of the resuscitation room for trauma cases, the information being used to identify particular problem areas and put forward possible solutions. One hundred and fifty consecutive resuscitation room trauma patients were studied prospectively, with details being obtained both at the time of ...

In a climate in which medical staffs are being sued as a result of their decisions in peer review activities, hospitals' administrative and medical staffs are becoming more cautious in their approach to medical staff privileging. Medical staff bylaws that contain substantive and procedural requirements serve as guides to the ...

The cases of 83 boys who were admitted to hospital with acute testicular pain or swelling were studied. Twenty seven had torsion of the testis, and 15 (55%) of these lost a testis. The main reason for the poor results was delay by the patient or his parents in seeking ...

The heart of a hospital's credentialing responsibilities lies in its duties to evaluate, to monitor, and to discipline its medical staff. Some key elements of an effective credentialing system are the skills of the medical staff coordinator, the use of physician proctors to evaluate new applicants, careful investigation of applicants ...

The concept of grievance procedures, when applied to physicians, has a foreign ring to it. We ordinarily associate grievance procedures with unions and labor relations activities unrelated to professional conduct and behavior. As described in the preceding article, grievance procedures usually are extremely limited, having been created to resolve very ...

Using a needs assessment based on a consumer opinion study, a series of seminars on "The Art of Medicine" was set up for medical staff in a large health maintenance organization. Taught by fifteen staff physicians who underwent a facilitator training program, the seminars focused on physician-patient relationships, with participants ...

California courts have recognized that hospitals have a fiduciary duty when dealing with medical staff privileges. This article discusses the rationale for requiring this higher standard of conduct in privileging decisions, noting the importance to the physicians of medical staff privileges and the fact that medical services are a matter ...

Physician practices can be expanded through the formation of a hospital marketing committee for the medical staff. Such a committee could assist in establishing referral services, identifying locations for practices, assessing community needs, and assessing alternative delivery systems, as well as fulfilling other functions to increase medical staff visibility and ...

Neuropathological examination of post-mortem material in cases of mental handicap may give valuable clues to aetiology, natural history and the effects of long-term medication. The dating of neuropathological changes may have implications for treatment and parental counselling. A coordinated procedure to obtain such information in a routine manner is recommended. ...

The increasing complexities of hospitals and their relationships with their medical staffs require a complete examination of the environment to reveal ways to enhance hospital outcomes. A properly trained and empowered medical director can be the missing link that ensures the continuity and coordination necessary for the best possible outcomes ...

In this study, the authors determined how residents in internal medicine allotted their time during patient management rounds (work rounds). Fourteen house staff teams were observed for four days each, and the time spent on all activities was recorded. Of the 56 days studied, work rounds were not conducted on ...

To assist its medical staff in making appointments and reappointments to the medical staff, delineating clinical privileges, and maintaining quality assurance information, as well as to streamline clerical duties in the medical staff office, El Camino Hospital (a 460-bed acute care facility in Mountain View, California) developed a comprehensive, computerized ...

More board involvement is needed in the credentialing process, but what form should that involvement take? Some hospitals have restructured the medical staff credentials committee to include trustee representation. This article examines the antitrust and personal liability implications of that move, as well as the likely reaction of the medical ...

The challenge for hospital controllers in overseeing the prospective payment system (PPS) lies not in acquiring technical expertise but in working with the chief executive officer to coordinate organizational change. Specifically, the controller should assist in creating a prospective payment committee (PPC)--an interdisciplinary group of executives, middle managers, and medical ...

A recent survey shows that nearly two-thirds of all hospitals have or are considering a medical director position. Comparative data show that the average bed size of hospitals with a medical director continues to decline as more and more institutions add the position. The reasons for the growth, according to ...

The educational value of morning report should be enhanced by thorough evaluation of the medical literature. We added a clinical medical librarian (CML) program to our morning report 2 1/2 years ago to provide rapid, complete access to reference material relevant to topics discussed in morning report. MEDLINE searches and ...

For the five-year period 1980 through 1984, a total of 241 persons with measles in 30 states were identified as probably having acquired their infection in a medical facility. The proportion of all measles cases acquired in medical settings increased from 0.7% for 1980 through 1982 to 2.9% for 1983 ...

In today's health care environment, the hospital's relationship to its medical staff can mean the difference between success and failure. As opposed to the current system, the medical staff of the future must be organized and strong, yet flexible enough to undergo the changes necessary for "venturing." This article describes ...

The type and amount of medical services provided to 2,394 patients in methadone maintenance programs in three states was studied. Data were obtained from on-site confidential interviews with the entire treatment staff at seven programs. It was found that there were marked differences in the number and type of medical ...

Born in Scotland in 1807 of a well to do family, Farquhar McCrae received his medical training in Edinburgh and Paris. He was commissioned as Assistant Surgeon in the British Army and in 1839 migrated with his family to become a pioneer grazier, businessman and doctor in the settlement at ...

If hospitals are to succeed in their efforts in cost control, they must segregate the influence of efficiency and effectiveness and integrate the medical staff into the management structure. One management model that facilitates such integration is Clinical Matrix Management. Using such a model, the distinct responsibilities in patient care ...

These final regulations--(1) Broaden the scope of services for which a State must collect from third parties the cost of medical assistance furnished to Medicaid recipients, revise the methods of paying claims involving third party liability, and make conforming changes to incorporate a statutory provision that requires the assignment of ...

A significant portion of internal medicine residency training in the United States today occurs in general medicine sections of Veterans Administration hospitals. The authors studied the demographic, diagnostic, and prognostic characteristics of the patients treated by house staff members rotating through the general medical wards of the Houston, Texas, Veterans ...

This report serves to detail the progress, status, and funding of approved projects conducted under protocol by staff members, interns, and residents at William Beaumont Army Medical Center. The varying projects as reported are classified according to the service or department to which the principal investigator belongs. Research conducted at ...

The safety of an order for medication as needed depends on assumptions and knowledge that may or may not accompany that order. Physicians should consider carefully the need for prescribing potent medications on an as-needed basis for newly admitted patients, particularly if these patients have not been examined, their histories ...

First, fourth, and seventh graders completed a specially designed medical fears questionnaire. The effects of grade, gender, and previous hospitalization on the children's medical fears were analyzed. Gender was found to be significantly related to both the frequency and intensity of medical fears, with girls expressing more and stronger fears ...