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Biomedical subjects

J Susman

Publications and source records attributed to J Susman.

16 recordsLinked to original sources
PubMed1996

Do program directors and their chief residents view the role of chief resident similarly?

BACKGROUND: The chief resident plays an important role in family practice residencies and is positioned at the nexus of the relationship between the faculty and the residents. It is unknown if program directors and their respective chief residents view this position and the role of training and faculty development similarly. METHODS: Parallel surveys were sent to all family practice residency program directors and their respective chief residents to explore their perceptions of the importance of the tasks and roles of the chief resident and the effects that perceived training, feedback, and support have on the chief resident's satisfaction. RESULTS: Fifty-one percent of chief residents and their program directors returned surveys that could be analyzed in parallel. Program directors placed relatively greater importance on the administrative role of chiefs. Mentioned most frequently as problems were balancing administrative duties with other tasks, dealing with personnel issues, and working with the lack of a clear job description. Chiefs who participated in formal training programs and who perceived better burnout prevention were more satisfied with their position. CONCLUSIONS: A large number of chief residents perceived gaps in the preparation for their position, particularly with regard to administrative skills. These deficiencies are particularly ironic in light of program directors' perceptions that administrative duties are of the highest importance among the tasks assigned to chief residents. Faculty development strategies and a program of burnout prevention for chief residents should be incorporated into each residency.

Adult↗
PubMed1994

Disability, stigma and deviance.

An important contribution social science research makes to understanding the experiences of disabled individuals in the U.S. is to illuminate the influence of stigma and deviance on those experiences. Because perceptions of negative difference (deviance) and their evocation of adverse responses (stigma) have been and continue to be widespread, it is these with which alternate perceptions and responses vie in the construction of disability's symbolic and practical meanings. While some research demonstrates a regrettable imposition of stigma/deviance into the lives and minds of disabled people, some of it shows disabled people resisting stigma/deviance imputations; and some of it suggests that such imputations are losing force as new ways of thinking about the meaning of disability gain sway.

Attitude to Health↗
PubMed1994

Delivering services to the rural elderly: a study of policy implementation.

This article presents an analysis of two demonstration projects designed to improve delivery of services to elderly residents of rural Nebraska. One project employs a statewide system of care management focused on individual clients. In the other, local agencies in four communities coordinate services by using the local senior center as a focal point. This article uses established theory of policy implementation to illustrate problems encountered in starting new social programs that require state-local cooperation. Four guidelines are suggested for policymakers: (a) if local agencies are responsible for implementation, local managers must be involved in all the planning activities for new programs; (b) clear guidelines are needed to be sure that there is consensus concerning the details of implementation; (c) all health care providers should be involved in implementation when health care services are being coordinated; and (d) community coordinating councils can be effective.

Aged↗
PubMed1994

An overview of clinical policies with implications for clinical practice, medical education, and research.

Clinical policies, also known as practice parameters or practice guidelines, are gaining notoriety out of a desire to control escalating medical costs, lessen wide practice variations, and improve quality of care. The clinical policies are supposed to influence medical decision making by summarizing scientific data about a clinical problem in a format that is easily understood by patient and physician alike. Developing an evidence-based policy involves: a clearly defined clinical problem, a comprehensive literature review, a summary table of the data (known as an evidence table), a presentation of this data as outcome possibilities from alternative decisions (in the form of a balance sheet), and creation of clinical recommendations that incorporate both financial costs and patient preferences. Well-developed policies can be used by family physicians as guides in areas of clinical uncertainty and by medical educators as up-to-date literature syntheses for teaching critical appraisal and for outlining approaches to common problems. Explicit policy formulation also highlights the shortcomings of existing literature and can suggest more appropriate future research. The future of the clinical policy movement rests on its ability to reduce costs of care and improve patient outcomes. Explicit clinical policy formulation incurs significant development and implementation costs and the evidence on which many policies are based is lacking. Nevertheless, clinical policies in some form are likely to play an increasing role in medical care.

Curriculum↗
PubMed1992

Family medicine residency directors' perceptions of the position of chief resident.

This report describes a survey that explored the selection, training, duties, skills, and evaluation of chief residents as perceived by the program directors of the 381 family medicine residencies in the United States in 1989. A response rate of 79% (300 programs) was achieved. In 70% of the programs the chief resident received no formal training, and in 41% no formal evaluation. The program directors believed the most important duties and skills of a chief resident were acting as a liaison and advocate for residents, scheduling, and leadership. The directors thought that the most exciting aspects of being a chief resident included the development of leadership skills and the ability to influence curriculum; the aspects that caused the most concern included time pressures and demands that detract from clinical learning. The authors suggest that more attention should be directed to the nurturing and development of chief residents, who are the future leaders in academic medicine.

Administrative Personnel↗
PubMed1992

Perceived core procedural skills for Nebraska family physicians.

We conducted a mail survey of 287 practicing family physicians, 22 family practice faculty, and 60 family practice residents in both rural and urban Nebraska concerning their perceptions of "core" procedures in family medicine and their perceived competency in performing them. Final response rate was 45%. There was general agreement concerning what constituted the core procedures in family medicine, although several newer procedures, such as flexible sigmoidoscopy, provoked more controversy. Rural physicians were more likely to classify intrauterine device insertion, endometrial biopsy, and cervical biopsy as core procedures than their urban counterparts. As expected, whether a physician performed a procedure related directly to his reported competence in performing it. However, there were discrepancies between perceived training during residency and current practice for control of nasal hemorrhage, aspiration of breast mass, flexible sigmoidoscopy, endometrial biopsy, and joint aspiration. Faculty programs for teaching procedural skills, standards for documenting competence, and systems for ongoing quality assurance should be further developed.

Clinical Competence↗
PubMed1989

Arnold-Chiari malformation: a diagnostic challenge.

Arnold-Chiari malformation is a disorder of embryologic development. In Type I, there is cerebellar displacement into the spinal canal, but hydrocephalus and syringomyelia are variable. Type II usually is manifested by severe hydrocephalus and myelomeningocele in infancy. Type I malformations may pose diagnostic challenges because they often produce bizarre and vague symptoms. A careful history and physical examination, coupled with neurologic testing, especially magnetic resonance imaging, will lead to the correct diagnosis.

Adult↗
PubMed1988

Orthostatic hypotension.

Orthostatic hypotension is a potentially debilitating condition in the elderly. It may be associated with aging, drug therapy or underlying disease. Pathophysiologic mechanisms can be classified as vasovagal, sympathicotonic and asympathicotonic (autonomic nervous system disease). Only a detailed history will uncover the disorder in some patients. When conservative measures fail, fludrocortisone is a generally helpful drug that induces volume expansion.

Aged↗
PubMedDate not supplied

A rural-urban comparison of prehospital emergency medical services in Nebraska.

BACKGROUND: Provision of emergency medical services (EMS) in the rural United States presents a unique challenge. While rural and urban EMS outcomes have been compared, differing urban-rural population characteristics and roles for rural ambulance teams can confound such comparisons. METHODS: A year-long study of the prehospital EMS was conducted in rural Richardson County, Nebraska. Data were collected on the age, sex, and race of patients, response time, transport distance, medical problems encountered, and treatment rendered enroute. These data compared with those from an urban Lancaster County comparison group and statistical data from the Nebraska State Health Department. RESULTS: In the rural county, 70 percent of calls involved the elderly, whereas 38 percent of the urban calls and 36 percent of the Nebraska State calls involved the elderly. The rural ambulance service was more likely to provide for routine transfers, to involve patients with fractures and cardiorespiratory and neurologic problems, and twice as likely to result in hospital admission than was the urban ambulance service. The frequency with which advanced life support measures were applied in the rural area was similar to that in the urban area. The rural area response times were equivalent to the urban area response times after the rural area long-distance transfers were excluded. The location of service in the rural area was more likely to be the hospital or nursing home, whereas the urban location was more likely to be a home, on a highway, or in a public setting. CONCLUSIONS: Prehospital EMS in this rural location involved a predominantly elderly population with a large number of routine transfers linking the nursing home and community hospital. Further comparisons of rural and urban EMS outcomes should account for possible differences in type and severity of illness and type and location of service.

Adolescent↗
PubMedDate not supplied

Postural hypotension in elderly family practice patients.

Postural hypotension (PH) was investigated in 100 ambulatory patients aged 65 years or older, who were seen in a university family practice clinic. Thirty-one percent had a decrease in systolic blood pressure of 20 mmHg or more, while 16 percent had a diastolic drop of 10 mmHg or more. Twelve percent had a significant drop in both systolic and diastolic blood pressure upon standing. Patients with both systolic and diastolic PH were more likely to have had a fall during the year prior to evaluation and decreased functional ability compared with those without PH. The group with systolic PH was more likely to have symptoms on standing and a history of weakness, but dizziness and lightheadedness were not correlated with PH. Postural hypotension occurred in only 13 percent of patients without risk factors for PH and in 35 percent of patients with risk factors. However, this difference was not statistically significant. Demographics and functional ability were similar between the risk factor groups. Thus, PH occurred frequently in our patients, could not be reliably predicted on the basis of risk factors or symptoms, and was correlated with a history of a recent fall and decreased functional ability.

Accidental Falls↗
PubMedDate not supplied

Continuity of care and outcome in nursing home patients transferred to a community hospital.

This study prospectively investigated the effect of continuity of primary physician care on functional ability and outcome of nursing home patients transferred to a community hospital. Evaluated were 335 consecutive transfers with concurrent chart review and a standardized functional rating scale on admission and discharge from the hospital. Continuity of care by the primary physician was more likely with a greater length of stay. There was no association of continuity with age, sex, initial functional status or mental status of the patient, type of admission, or payment source. No significant relationship was found between outcome and continuity of care by the primary physician. Logistic regression analysis indicated that emergency admission to the hospital conferred an increased risk of mortality but that the level of primary physician continuity did not.

Aged↗