Biomedical subjects
Publications and source records attributed to T J Marr.
As health care becomes more industrialized, more influenced by Wall Street, and more driven by internal needs instead of being patient-focused, patients and society lose faith, confidence, and trust in physicians and hospitals. In this paper, a new model of a health care system as a healing community--one that services a community--is presented. The proposed structure will foster service and support.
The authors conducted a national study to determine the factors associated with the success of physician leaders. They utilized the Leadership Practices Inventory (LPI) and a demographic survey followed by individual interviews with respondents. Data analysis revealed several implications for the selection, training, management, and career development of physician leaders. The results suggest that: Physician leadership training should have a strong focus on the "human side" of management, including negotiation, organizational "politics," conflict resolution, team building, and motivation. Data management and finance should be a focus represented in the curriculum. Mentoring relationships should be developed as an aspiring physician leader pursues a career shift. Self assessment, including an analysis of style, strengths, best potential organizational fit, and specific areas of strength and weakness should be an integral part of the development of an aspiring physician leader. Screening mechanisms to ascertain a physician's motivation to move toward a full-time leadership role should be developed to ensure appropriate intent. To facilitate this implication, more effective assessment tools need to be developed.
The purpose of this study was to investigate the use of the readily available and frequently used clinical test of total protein excretion as a correlative of hemoglobin A1C concentration and thus, as an indicator of strictness of control of type 1 diabetes. Subjects were 211 diabetic children being followed in a private practice. Twenty-four hour urine protein excretion and hemoglobin A1C were measured and data were compared using Pearson correlation procedures. The relationship between these two variables was not significant (p = .88). These findings indicate that total urinary protein does not correlate with hemoglobin A1C and is therefore not a useful clinical test to evaluate strictness of control in type 1 diabetes in children.
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Nodulocystic acne (NCA), a severe dermatologic facial condition, has previously been described in association with the XYY genotype. Presented herein is a severely retarded insulin-dependent diabetic with grade three hypospadias, fibrous testes, and severe NCA. Chromosomal analysis revealed his karyotype to be 46 XY+, (4 p+, 14q-). This case report demonstrates that NCA may occur with chromosomal abnormalities other than a 46 XYY genotype. The need to have karyotypic proof of a phenotypic diagnosis is emphasized.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
A fifteen year old female juvenile diabetic had severe ulceration of NLD lesions, which were treated by skin grafting. Twenty-four months postoperatively, she has an excellent cosmetic result.
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Testicular and scrotal hemorrhage is uncommon in the Schönlein-Henoch syndrome. The diagnosis of testicular torsion is difficult to make when it is complicated by vasculitis of the testis. Since both conditions can occur simultaneously, torsion of the testis must be considered and surgical exploration performed whenever acute testicular pain and swelling occur during the course of the Schönlein-Henoch syndrome. Two patients with this syndrome as well as scrotal and testicular involvement are described.
Urine samples from 1,003 pediatric patients were examined for bacteriuria with a culture-nitrite strip test, along with microscopic assessment of pyruia and conventional chemical analysis. The latter two methods proved of little value in reliably detecting or excluding substantial bacteriuria. An overall prevalence of 5.2% was shown. Using Microstix Reagent Strips, 92 urine samples with substantial colony counts were detected. Subculture from the strips disclosed that 52 of these involved single pathogens, interpreted as true bacteriuria. When Microstix growth results were compared with the calibrated loop method on 108 randomly selected specimens, the strip gave only two false negatives and one false positive. Bacteriuria screening should be done in high-risk groups and in asymptomatic children as part of the health evaluation. The index of suspicion should be higher in girls, and reliable interpretation of culture results requires attention to proper specimen collection.
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Six hundred fifteen children (310 with diabetes, 106 nondiabetic siblings, and 199 nonsibling controls) were examined for the presence of joint contractures. Forty children had contractures: 8.4 per cent of those with diabetes and 4.6 per cent of those without diabetes. Contractures were present, however, in 9.4 per cent of nondiabetic siblings, and only 2 per cent of nonsibling controls, suggesting a familial tendency to joint contractures. The older the patient, the more likely he was to have contractures. There was no correlation with sex, race, or age at onset of the disease.
This study examined the psychological adjustment of children with diabetes and their siblings. Data were collected for 41 diabetic children and their siblings between ages 6 and 11 yr who were followed in a large pediatric practice. The diabetic group was matched with 35 control children who were followed for routine pediatric care and their siblings. Diabetic families and the controls did not differ on divorce rate or level of marital adjustment. Behavior problems were measured through the use of the Achenbach Behavior Checklist for both sexes separately at the 6-11- and 12-16-yr-old age levels. Diabetic boys, aged 6-11 yr, were higher than nondiabetic boys on internalizing and externalizing symptom scales, particularly on measures of schizoid tendencies, obsessive compulsive symptoms, hyperactivity, and aggression. Neither female patients, male siblings, nor female siblings in the 6-11-yr-old age group differed from controls on emotional adjustment. Among the 12-16-yr-old males, diabetic patients were higher on internalizing symptoms than male siblings and their controls. Male siblings tended to be lower than diabetic patients and controls on school performance. Social class differences may have contributed to the differences at the 12-16-yr age levels. Female subjects in the 12-16-yr-old group did not differ on measures of adjustment. Level of control was unrelated to patients' or siblings' adjustment, but behavioral symptoms tended to increase for male diabetic patients with length of illness, and tended to decrease for male siblings. Results are interpreted according to social class effects and sex differences.
A needs assessment identified leadership, management, and interpersonal skills as training and development areas for hospital's physician executives. Training sessions were developed and occurred quarterly over a two-year period. Development strategies were designed to enhance transfer of learning from the classroom setting and incorporated personalized coaching sessions, development of a peer mentoring program, group redesign of the performance appraisal process, strategic planning, and performance feedback sessions. The comprehensiveness of the approaches taken in this program is critical to successful training and development efforts of physician executives.
Performance evaluation is often used as a tool to determine salary adjustment as well as an opportunity to improve job performance. When inappropriately applied, performance evaluations may be perceived as being unfair, wasteful, and demeaning. In some organizations, there has been a trend to break down job functions to their most detailed level, weight each activity, judge it, and then add up all the invalid numbers to achieve a more invalid judgment of a person's performance. This non-Gestalt evaluation is an inspection philosophy that has not served manufacturing or health care very effectively. Over the past four years, we have evolved a performance evaluation process at Minneapolis Children's Medical Center for physicians in both patient care and management roles. In this article, we will describe the evolution to the present system and discuss its dovetailing with customer service-driven continuous quality improvement efforts and our plans to improve the process.
Developing a network of physicians into a high-performing group requires a cultural transformation. The hallmarks, as well as the obstacles, to achieving this are reviewed by two experienced consultants. The requirements of highly successful physician organizations range from sharing a common mission, vision, and values to developing an effective infrastructure to having visionary leadership. Barriers to successful physician groups include a lack of clarity of purpose and goals, lack of quality standards, and an absence of shared learning. A blueprint on how to become a successful physician group is provided.