Biomedical subjects
Publications and source records attributed to L S Zun.
Panic disorder is a newly recognized psychiatric illness involving unexpected, unprovoked attacks of anxiety. Patients with panic disorder commonly seek treatment in the ED. It is important for the emergency physician to properly recognize and categorize this disorder to initiate appropriate treatment. Illness description and treatment guidelines of this disorder are discussed in this article.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Emergency physicians (EPs), like other specialists in medicine, can be terminated from their positions. Little has been written about the process of physician termination. It is important that this process be well thought-out and performed in a professional manner to ensure that there is no undue damage to the physician or to the institution. The institution must be aware of the effects of terminations on its ability to recruit and retain EPs. To properly terminate a physician employee, the physician manager must use the appropriate termination rationale, ensure appropriate performance evaluations, provide for remediation, understand the psychology of termination, and address the alternatives to termination prior to the termination. Indeed, the hiring process itself must address the grounds on which termination may occur. Successful terminations are performed by planning the process, reviewing the file and the contract, arranging the meeting, examining the termination process, and considering the legal implications and due process issues.
Few managers have the training or the expertise to terminate a physician. Some managers are uncomfortable with this process and may even subvert, delegate, or fumble the process. A properly performed termination will leave the physician with understanding of the termination and may assist in his or her development. A poor termination can cause ill effects not only with the involved physician, but also with the organization terminating the physician. Many physicians are leery of working for an organization that has the reputation of unfairly terminating physicians. They are also concerned with their job security. Potential legal ramifications make the process even more difficult.
Explore the source record for details and available documents.
In the 1990s, many hospitals will continue to be confronted with financial, regulatory, and medical staff issues that threaten their survival. Inadequate reimbursement, HCFA certification problems, and aging medical staffs are just a few examples of the many difficult issues health care institutions face today and that have contributed to the phenomenal number of failing hospitals. Failing hospitals must consider all their options, such as turnaround process, modification of service mix, change to a specialty hospital, transfer to a new owner, or closure. Selection of the most appropriate option hinges on the hospital's goals and mission, its need in the community, and its owner's and sponsor's desire or ability to continue in the health care business. This article will discuss the transfer of ownership option.
More and more hospitals in this country are being threatened by the removal of their Health Care Financing Authority (HCFA) Medicare Certification. A perception of competitiveness among HCFA, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and other organizations has heightened this concern. This unpleasant situation has provoked many hospitals to prevent any type of regulator decertification. One of the practical methods of prevention is the use of a HCFA-type survey. These surveys prepare institutions for unexpected, unarmored review by regulators and should be part of the quality improvement (QI) process even in institutions with limited resources. This article discusses the means to accomplish the HCFA-type survey. The development of the survey process involves institutional commitment, hospital policy and procedures, a department review schedule, selection of review personnel, preparation of review personnel, record keeping, and department education.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Acute visual loss is not an infrequent presenting complaint to the Emergency Department. The history of visual loss, physical examination of the eye, and indicated laboratory evaluation are keys to making the diagnosis. The etiology of nontraumatic visual loss is diverse, involving vascular, anatomic, infectious, autoimmune, toxicologic, and psychogenic causes. Appropriate treatment, as well as the need for timeliness of ophthalmologic consultation, is described.
This brief article presents in table form the most commonly used ophthalmologic agents. Other information pertinent to these agents is included, such as how the medication is supplied, what are the adverse effects, the usual dosages, and the most probable use for each agent.