During the 1990s, internal medicine will change. Whether that change will be in directions desired by internists will depend on whether effective leadership of the discipline is accepted by the academic department chairs. Individually, and as a group, they are the only ones with sufficient authority to take control and ...

Strategic business planning is a two-step process--(1) formulation and (2) implementation. While much effort has been placed on how to formulate strategies that are consistent with internal and external environmental pressures, the key lies in making strategies work. Management cannot stop with formulation but must concern itself equally with the ...

Major changes have occurred in the practice of pharmacy and the practice opportunities for pharmacists during the past 20-25 years. As a consequence, the advances in pharmacy practice have necessitated significant changes in pharmaceutical education and the basic courses which constitute the curriculum. The recent changes which have occurred in ...

Exchangeable Al in subsoils of Ultisols in the southeastern USA can restrict rooting depth. Downward movement of basic cations (Ca, Mg, and K), applied as lime and fertilizer, may diminish that restriction over time. Materials from the argillic horizon were collected from three paired sites, having managed (long-term cropping) and ...

Dantrolene is effective in the management of malignant hyperpyrexia. Due to the similarities of malignant hyperpyrexia and heat stroke, we have investigated the effect of dantrolene on heat stroke in sheep. Our study indicates that dantrolene pretreatment decreases the extent of heat stroke signs and some of the induced changes ...

Over 10 months 5,000 practice information leaflets were distributed in a practice in Glasgow. The leaflet was principally evaluated by assessing patients' attitudes to and use of leaflets and changes in their knowledge about the practice. Changes in the pattern of consultation with the practice nurse and the timing of ...

As Hales (1986) has observed, the problem of much of the managerial research to date has been the reluctance to ask why managers behave in the way they do. The behaviour of general managers in tackling organisational change in the NHS needs to be viewed not only with respect to ...

Frequently the organisation change literature is stronger on theory than it is on practical information for the line manager. This action research project which involved the computerisation of the supply system in a small public hospital provided an example of the type of change activities which face the practising manager. ...

This paper describes how the NHS in the United Kingdom needs to continue to adapt and evolve in response to six major pressures, and how the corresponding challenge facing managers in the NHS is how to cope, adapt and tackle those pressures. The foundation was laid in 1984 with the ...

The concept of dairy production medicine has matured. The programs are probably essential for our profession to remain relevant to the dairy industry. Yet delivery of the services has lagged far behind the concept. Delivery lags because it is not simply the addition of some new techniques to an old ...

The needs of dairy farmers for veterinary assistance have changed and are still changing. It appears that many future opportunities in dairy practice will involve active consultation on herd management factors. The ability to evaluate herd records will be crucial to this effort. This article discusses organizing and then utilizing ...

Starting a dairy veterinary practice is a challenging and rewarding experience. A considerable amount of time spent in planning is required before attempting to actually start a new practice. Changing or expanding an existing practice also demands planning and foresight. The natural progression is similar for starting a new practice ...

Physical restraint is commonly used in the management of elderly people in North American hospitals and nursing homes. Between December 1981 and March 1982 the Department of Geriatric Medicine, St. Boniface General Hospital, Winnipeg, changed its practice regarding the use of such restraints. In the fiscal year 1980-81 the rate ...

Nutrition in the older person is complex because of changing physiology, changes caused by multiple chronic diseases, changes induced by pharmacologic agents, and commonly, failing protein/caloric intake. This article is designed to explain the mechanisms of these processes and to suggest pragmatic and practical responses in the management of the ...

Over the last several decades the context of the medicine residency has changed. These changes are described and attributed in considerable degree to bureaucratic impositions. I consider it paradoxic that there is finally a move afoot to reverse the changing nature of medicine residencies, yet this effort appears in the ...

Views from three general managers focus respectively on the impact of the Griffiths changes after five years; how 'success' in general management may be evaluated; and the changing nature of central-local relationships. At district level, the job of DGM has changed much more than was expected and the demands have ...

Doctors and receptionists in a group practice completed a questionnaire about the image of the practice and reactions to recurrent stressful situations. The results were shared among the participants in a way that preserved anonymity. A year later a further questionnaire was completed which showed that respondents perceived that beneficial ...

If health care organizations are to meet future challenges, greater attention needs to be given to the role and function of middle management. Middle management traditionally has tended to suffer from benign neglect vis-à-vis attention given to top executives in the management of strategic change. This article explores some of ...

This paper examines the views of members of the veterinary profession towards the change in orientation of professional practice that is occurring. It contrasts the values of veterinarians with those of doctors, dentists, lawyers and accountants. Particular attention is given to the areas of business efficiency, competition and advertising. Data ...

Recent changes in the American medical care system, such as new forms of practice used by physicians and hospitals, have presented new and uncertain legal issues. This Article discusses these changes and how older legal doctrines, such as the corporate practice of medicine, have become outdated and are in need ...

The role of low level (Le Fort I) osteotomy of the maxilla alone, or combined with a mandibular procedure, is discussed for the management of maxillary hypoplasia at the supra-apical level which is commonly associated with repaired cleft lip and palate. Osteotomy at this level influences the soft tissue contours ...

In a study of doctors who qualified from British medical schools in 1974 and 1977, which was carried out five to 11 years after graduation, frequent changes of career choice were found. Most of these changes occurred at a relatively early stage. There was a shift of choices towards general ...

Data on the annual expenditure on medicines and medical supplies have been collected and used to provide the expenditure on medicines only, by the main purchasing sectors for each of the fiscal years from 1975/76 to 1984/85 inclusive. During the decade total expenditure at constant prices increased by 145% with ...

To survive in today's competitive environment, hospitals must prepare themselves to effectively manage organizational changes such as downsizing or mergers. By analyzing the change process and understanding key roles, managers will be likely to ensure a smooth and successful transition. And a smooth and well-managed change will produce positive results ...

In the present study, we have analysed changes from 1979 to 1983 in the use of phenoxymethyl penicillin and broad spectrum penicillin in the treatment of sinusitis in general practice. The changes are related to the doctors' seniority and to their practice conditions. All GPs in five counties were invited ...

This article reflects long-term observations of a clinician in private practice. Significant changes have occurred in periodontology in the past 50 years, while basic principles of periodontics have remained firm. State of the art and predictions of the future of periodontal practice are based on experience gained in both a ...

Private voluntary social welfare organizations (PVSOs) are operating under increasingly competitive conditions. "Strategic Planning" (SP) is a management tool designed to meet those conditions. In an exploratory study of 154 PVSOs the authors examined management's reasons for adopting strategic planning, the attention given to external analysis, and the degree of ...

Between the years 1875 and 1889, extraordinary changes occurred in the practice of medicine and surgery. This article reviews these changes and attempts to understand something of the science of surgery as well as its place in American medicine during these years. The essay uses the two paintings by Thomas ...

Several variables could have influenced the results of resuscitation after two and one-half decades--selection of resuscitation candidates, resuscitation mechanics, pharmacologic interventions, and post-resuscitation management. However, the outcome of CPR remains consistently poor. It appears that only dramatic changes in candidacy or technique will change the likelihood of survival following in-house ...

We treated a patient who intentionally overdosed with theophylline complicated by metabolic disturbances. Management of the patient's hypokalemia with moderate doses of potassium chloride resulted in hyperkalemia with associated electrocardiographic changes. The rapid clearance of theophylline due to the administration of oral activated charcoal was believed to be a contributing ...

In summary, this is an exciting time in which materiel management, in conjunction with fiscal affairs, will be involved in just about all decisions affecting product use, cost, and management. It will be a period of many changes, and materiel managers must be willing to accept this and move forward ...

There is a gold mine of potential inventory reductions, expense reductions, and revenue increases in most hospitals that can be tapped by more intensive materiel management. The first step is incorporating the necessary ingredients for a strong materiel management effort--the right people and a state-of-the-art computer program. Reorganization may be ...

This article reviews changes in technology, the economics of reimbursement, and the health care delivery system and describes the cumulative impact of these trends on pathologists, pathologists-in-training, and pathology laboratories. While an increase in the number of pathologists-in-training is not anticipated, their training will be influenced by the new biology ...

An analysis of 18,940 deliveries between 1981 and 1984 in a large British obstetric unit showed marked changes in the management of the second stage of labour. These changes included an increase in the length of the second stage (especially among primiparous women), a rise in the rate of spontaneous ...

In New Zealand, the effect of resource constraint operates at two levels. In the macrocosm of national politics, there is a tectonic collision between two plates--social equity and a fiscal constraint on government expenditure. In the hospital, these forces are reflected in the frustration of the staff who cannot deliver ...

The results of active management and the findings of repeated audits of epilepsy care over the period 1978-86 in a general practice are described. It was found that about one-fifth of epileptic patients continued to have frequent seizures, usually complex partial, about half had few seizures, and many with mild ...

Organizations invite unions by poor management. The arrival of a union is a statement that significant organizational change is needed. Managing after the union comes should focus on seizing the initiative for organizational change and enlarging management control. Nonunionized agencies should evaluate their susceptibility to unionization and take preventive action.

Hemorrhoids are a common medical problem that usually can be managed conservatively with dietary changes, stool softeners, and local hydrocortisone creams. Acutely thrombosed external hemorrhoids require excision of the entire hemorrhoidal mass and the overlying skin. Persistently bleeding or painful internal hemorrhoids are best managed by the technique of band ...

Gradual morphologic and physiological changes in mucosa, bone and salivary glands in and about the oral cavity and pharynx bring about certain pathologic conditions occurring with greater frequency in the elderly than in the general population. The paper's intent is to summarize these changes and where possible provide some guidance ...

This paper describes and analyzes the social history of chiropractic in Canada to partially test a thesis regarding changes in the dominance of the medical profession. We earlier sketched the rise of medicine to dominance by World War I, its consolidation until after World War II, and signs of the ...

The practicalities of fabricating earmoulds for young babies (under the age of 3 months) have been investigated. The results indicate that earmoulds can be satisfactorily fabricated provided there are changes in approach in the fabrication procedure. This applies in both the ear impression taking and in the format of the ...

Downsizing of the workforce is now a reality in the rapidly changing healthcare environment. The effective manager must understand this complex subject and the able to identify its cause and effect relationship on the radiology department. The result of implementation can be new opportunities that will allow the manager to ...

Management of the problems associated with pregnancies that extend beyond 294 days of amenorrhea has become increasingly important in obstetrics. This article outlines some of the methods that minimize the risks to the mother, fetus, and neonate in postdate pregnancy. A brief description of the definitions, incidence, and impact of ...

Relatively unknown but, at the same time, of some significance to the aviation medicine historian, is the story of Colonel Levy Millspaugh Hathaway. An experienced military surgeon and a decorated veteran of World War I, Hathaway became the third Chief of the Medical Section, Office of the Chief of the ...

This article is about change; particularly the prospect for change in veterinary research during the last decade and a half of the 20th century. The title encapsulates the idea that veterinary medicine, if it is to be effective, periodically has to change its approach to solving animal health problems; that ...

The role of positive postingestional effects in the acquisition of liking for tastes was explored. The purpose of the first study was to ask whether changes in liking are associated with the repeated ingestion in a medicinal context of a drug which produces positive consequences and which has a distinctive ...

The effect of both environmental and management related stressors on fertility is discussed. While environmental heat as a stressor is significant in disrupting normal reproductive cyclicity, management induced stress is becoming more important when related to the requirements of modern production methods. Deviations in hormonal patterns are noted, and the ...

New principals in general practice who were appointed from 1981 to 1983 by two family practitioner committees, one in an inner city and one in a combination of an inner city and suburban area, were surveyed to find out if they were making improvements to primary medical care in their ...

One hundred young adults with acute pneumonia were prospectively studied to determine the impact of the transtracheal aspiration (TTA) Gram stain on immediate management. Sputum and TTA interpretations by staff and housestaff were compared. After a management plan was elected based on sputum Gram stain interpretation, the TTA was evaluated ...

Blue Cross of California--a nonprofit corporation--is refocusing itself strategically to become competitive in the rapidly changing health field. It must improve its ability to manage the transition for several years to come. Sustained effort's to ensure continuity will involve generating commitment to the vision of the "new" Blue Cross of ...