Biomedical subjects
D H Cordes
Publications and source records attributed to D H Cordes.
Training the clinician-manager. Assessing the reality.
Occupational medicine residents at the University of Arizona have been introduced to administrative skills and issues as part of residency training since 1983. A questionnaire survey of 17 program graduates was conducted to assess effectiveness of training and applicability of skills to present job position. Seventeen of the graduates surveyed (100%) returned a completed questionnaire. Graduates rated the extent to which certain training activities improved administrative skills, such as community-based rotations, a 1-month administration rotation, chief resident responsibilities, committee work, program or clinic administration, and residency training overall. Although ratings overall were low, we believe this stems from the need for training that residents discover on the job. The survey emphasized the importance of administrative training during the residency years and underscored the need for renewed training efforts on our part.
Work site risk assessment.
Awareness of the connection between work and health can be reinforced by primary care practitioners through visits to community workplaces. Physicians can use observation skills to increase understanding of work processes, hazardous exposures, potential adverse health effects, and preventive principles and control measures during inspection of work sites. They can also use site visits to augment the office occupational history and to obtain a community industrial profile. Adequate advance planning is imperative to ensure successful visits. The use of site visits by physicians is one method of realizing the goal of increased physician awareness of the work-relatedness of disease.
Workplace visits: an important place in family practice.
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Residency rotations to foster careers in rural health care.
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Teaching students about occupational health issues through worksite visits.
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Worker health and safety: the occupational medicine training factor.
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Introducing management skills and issues in preventive medicine residency programs: a survey.
A questionnaire survey of 60 accredited preventive medicine residency programs was conducted to determine the percentage of programs in which management training is undertaken and to identify the nature of such training. Forty eight of the 60 programs (80%) returned a completed questionnaire. Forty three of the 48 programs responding (90%) state that the teaching of management skills is a defined goal of their program. Ninety percent introduce management skills in the practicum year in an administration rotation or by providing opportunities to practice management skills in other rotations. Thirty five (73%) of responding programs present didactic sessions containing a focus on management issues, and academic year courses contain a focus on management skills or issues in 46 (96%). Considering the need for management training in preventive medicine careers, we are encouraged by these figures. However, although this survey determined the extent to which management training is undertaken and the reported content thereof, it did not attempt to evaluate the depth or effectiveness of this training. Therefore, we must continue to emphasize a longitudinal and multidimensional approach to management training during the residency years.
Prevention and treatment of travel-related illness.
Traveler's diarrhea, malaria, acquired immunodeficiency syndrome and jet lag are among the issues for the traveler preparing for a trip to or returning from developing countries. With appropriate measures, most travel-related diseases can be prevented. Diarrheal diseases, schistosomiasis, sexually transmitted diseases and AIDS can be prevented with proper avoidance behavior. Diseases such as hepatitis, rabies, yellow fever and meningitis can be prevented with immunization. Chemoprophylaxis can prevent malaria, altitude sickness and sinus barotrauma. Diagnosing an illness in a returning traveler requires a high index of suspicion regarding diseases that might have been acquired during travel. Resources for accessing up-to-date information concerning prophylaxis, diagnosis and treatment of travel-related illnesses are available.
Parasitic diseases. International travel. Preparing your patient.
Patients who travel to developing nations are those most likely to encounter parasitic diseases. Using a risk assessment approach and the resources introduced in this article, the primary care physician can prepare them for travel and continue their care on return. Immunizations and patient education are the major modes of prevention, coupled with chemoprophylaxis for malaria and traveler's diarrhea. Traveling pregnant women and young children need special precautions. A large body of preventive and therapeutic knowledge, including parasitology, is at the core of emporiatrics, the science of travel medicine.
A program of management training for residents.
To help prepare residents in preventive medicine and occupational medicine for their future management roles, the University of Arizona College of Medicine incorporated administrative training into many aspects of its residency programs, beginning in 1983. Training focuses on seven skill areas seen as needed to meet the management demands of the physicians' future specialties. The authors discuss the career choices of University of Arizona graduates and advocate long-term administrative training for all specialties.
Resident training in international occupational health: toward a new perspective.
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Mexico, maquiladoras, and occupational medicine training.
Industrialization and its concomitant social and environmental effects in developing countries are considered in this paper. Mexico offers one example of economic progress achieved through the promotion of industrial growth. Recognising the need for trained experts with global experience in occupational health, the University of Arizona (UA) has begun a programme to train occupational and preventive medicine residents in international aspects of occupational health in the nearby industrialized border regions of Mexico. By using the maquiladora (assembly plant) industries and the resources of the Instituto Mexicano del Seguro Social with the State of Sonora, residents observe existing problems in occupational safety and health in addition to adding to their understanding of the need for worldwide cooperation for research and reform in this field.
A travelers' clinic in an academic setting.
The Department of Family and Community Medicine at the University of Arizona has operated a travelers' clinic since 1983, staffed primarily by faculty and residents from the sections of preventive medicine, occupational medicine, and family medicine. We describe the clinic experience in providing preventive medical services to international travelers. Summer months are the busiest. Destinations of the travelers show a clear predominance of travel to less-developed countries, and this is reflected in the immunizations and prescriptions provided. After their trips, travelers reported a low incidence of diarrhea of generally low severity. The travelers' clinic is also a positive experience for resident physicians who help staff it, particularly those specializing in general preventive medicine.
Transdermal clonidine therapy and nicotine withdrawal.
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Management roles for physicians: training residents for the reality.
The University of Arizona has incorporated administrative training into general preventive medicine residency and occupational medicine residency training programs to provide preparation at the most appropriate time for future management roles for physicians. Training parallels future specialty choices and focuses on computer skills, fiscal control, budgeting, personnel management, political or regulatory process, program development, and planning and organization. Throughout the 2-year training period, residents are in a position to acquire management skills through course work, selected rotations, special projects, and a concentrated 1-month rotation in administration. Practical application is exercised in management settings within the department and in the community. A longitudinal training approach is advocated for similar programs and for other specialties to ensure successful management of health care with physicians as an integral component.
Health hazards of farming.
The U.S. farm work force numbers approximately 6.5 million. The health risks connected with their farm tasks are many and varied. Accidents and illnesses are caused by tractors, specialized farming equipment, chemicals, zoonoses, fungi, sensitizers, and the environment of confinement buildings. The scattered nature of the work force makes preventive measures difficult to implement.
Practice mode of occupational medicine graduates.
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