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PubMedDate not supplied

Selling yourself in a tough health care market.

Physician executives are vying for top positions in health care organizations. With so many qualified candidates in the marketplace, how can you differentiate yourself as a strong contender? Recruiters search through hundreds of résumés, not the ten or 20 that many hospital and HMO CEOs have seen. Recruiters--the people who actually find specific candidates--were interviewed to find out what they are looking for. Here are the top items on their checklists: Articulated focus, documented results, competitive intelligence, professional growth, good references, appearance and social skills, responsive and timely, and technical skills.

Career Mobility↗
PubMedDate not supplied

Reinventing my medical career.

The author found himself in a surprising situation in the Fall of 1998. For the first time in his life, he was looking for a job. Kent Bottles, MD, shares his experience of reinventing himself from academic chairman in an integrated delivery system to health care consultant. He stresses that physician executives need to package their experiences in terms of transferable skills that are easily understood by potential employers. He also emphasizes that acquaintances are more important than friends in obtaining employment; one needs to network with acquaintances and rely on the sympathy of relative strangers. A lot of hard work, networking, and "selling" his reinvented self resulted in a CEO hiring him. With all the changes brought on by the global economy and the uncertainties of the health care marketplace, other physician executives may be faced with the need to reinvent themselves.

Career Mobility↗
PubMedDate not supplied

[The effectiveness and safety of botulinum toxin in the treatment of chronic primary headaches].

INTRODUCTION: Primary headaches (PH), which are highly prevalent pathologies, are linked to high morbidity and disability rates and high costs for the health care system. Due to the partial effectiveness of prophylactic treatments, especially in chronic headaches, or the existence of contraindications that make them unsuitable for prescription, the use of botulinum toxin (BTX) arises as a promising preventive therapy. AIMS: The purpose of this study was to determine the usefulness and the mechanism of action of BTX in PH through a review of the literature. DEVELOPMENT: Recent results of BTX use in PH are contradictory and, although controlled studies with placebos are scarce, it has been suggested that it could have a grade II-III evidence level of effectiveness and safety, with greater benefits in refractory chronic migraine and chronic tension-type headache, together with the absence of analgesic abuse and psychiatric illness. The probable mechanism of action in PH is through a peripheral antinociceptive effect related to a decreased release of neuropeptides and to the transmission of impulses with indirect inhibition of nociceptive centres in the brain stem, which is an effect that is apparently intensified with repeated applications. A correlation has been claimed between the use of BTX and a reduction in the intensity, severity, number of headaches per month, diminished use of analgesics per month and lowered total management costs. Side effects of the treatment are infrequent (< 1%) and transient. CONCLUSIONS: Despite findings that have proved BTX to be effective and safe as prophylactic therapy in PH, it is still not considered to be the first choice preventive treatment. Further studies are needed to establish sites, doses and application schemas (fixed vs. mobile), as well as a subtype of patients who can benefit from its use.

Botulinum Toxins↗
PubMed2004

Synchronized time-motion study in the emergency department using a handheld computer application.

Emergency departments present a challenging environment for workflow evaluation and measurement of the effect of information system interventions. This paper describes a time-motion data collection tool built as a handheld computer application. The tool allows mobility of the observer and the intuitive inter-face supports rapid selection of tasks and frequent changes in tasks. It also allows documentation of overlapping tasks, a common occurrence in the emergency department. Synchronized data collection across the different providers of care in the emergency department is demonstrated, resulting in a data set from which task/event sequences can be built, documenting the ED care of individual patients. This technique should provide a very useful tool in measuring the effect of process changes in this difficult-to-assess environment, particularly changes in the information system.

Computers, Handheld↗
PubMedDate not supplied

Comparison of clofezone and diclofenac in the treatment of out-patients suffering from activated (painful) osteoarthrosis.

The effectiveness and acceptability of clofezone (Perclusone) were compared with those of diclofenac in a placebo-controlled, double-blind, cross-over trial on a group of 29 out-patients suffering from osteoarthrosis of the knee or hip. Clofezone was given at a daily dosage of 1200 mg during the first week and 600 mg during the second week; the corresponding dosages of diclofenac were 150 mg and 75 mg. The duration of the trial was 6 weeks. In order to wash out previous medication, a placebo was given for one week before and after each medication period. Eight of the patients stopped taking their drug after 1--3 weeks, namely 5 in the clofezone group and 3 in the diclofenac group, while one patient stopped taking the placebo. The principal reason for these stoppages was gastrointestinal intolerance. These 9 patients were disregarded in the evaluation of the trial results. This evaluation on the remaining 20 patients showed that clofezone brought about a significant improvement in respect of pain (both at rest and during movement), inflammation and mobility after two weeks' application. In the diclofenac group the only significant improvement after the same period was in respect of pain during movement. Statistical comparison of the two groups showed that the reduction in pain during movement and in inflammation was significantly greater under clofezone than under diclofenac and that clofezone had the longer-lasting action. These findings are discussed in the light of the kinetic characteristics of the two drugs and of the mild antidepressant properties of clofezone. There was no significant difference between the two drugs as regards tolerance.

Adult↗
PubMed2005

VEMH - Virtual Euro-Mediterranean Hospital for Global Healthcare.

The Virtual Euro-Mediterranean Hospital (VEMH) aims to facilitate the interconnection of various medical services through real integration. VEMH will provide an integrated satellite-terrestrial platform and realize telemedical services such as e-learning, real-time telemedicine and medical assistance and offer individual grants to young medical doctors. The methodologies of the VEMH are medical-need-oriented instead of technology-oriented. VEMH will provide for medical professionals in the whole Euro-Mediterranean area access to the required quality of medical service. For the successful deployment of the services of the VEMH GRID technologies have to be implemented especially for evidence-based medicine. A Metagrid Service Engine implements an additional software layer between proprietary GRID engines and the different applications. The use of mobile code is envisioned in future GRIDs which allows service creation and deployment on arbitrary nodes of a GRID. Dynamic Grid structures become an important point for the use of mobile code.

Computer Systems↗
PubMed2005

[Generalised joint hypermobility and benign joint hypermobility syndrome. I: reproducibility and validity of tests and criteria].

The clinician's evaluation of the presence of joint hypermobility is most often performed through application of a joint mobility scoring system. Several systems are available, all of them based on tests of selected joints or movements. In most cases, a positive test is based on a range of motion at or above the mean range of motion +3 SD. The tests' reproducibility is good when performed by an experienced rheumatologist; however, their validity is unknown as there are no gold standards. The British Society of Rheumatology has recommended Beighton's scoring system and the level > or =4 positive tests out of 9 as the criterion for general hypermobility. The reproducibility of the criterion has been examined only once, and only with the cut level of > or =6/9 tests. At this level, the intra- and interobserver variability was 0.75 and 0.78, respectively. In another study it was demonstrated that the Beighton scoring system correlates well with a global joint mobility index and shows good agreement with two other scoring systems. The diagnostic specificity is poor with regard to the criteria for benign joint hypermobility syndrome.

Arthritis, Rheumatoid↗
PubMed1989

Effect of mixed ligand complex therapy on the retention of 95Nb and 144Ce in mice.

We have examined in mice the effects of mixed ligand treatments with desferrioxamine B (DFOA), Na3Ca-diethylenetriamine pentaacetic acid (DTPA), and DL-penicillamine (PA) on the retention of a mixture of 95Nb and 144Ce. The results show that 95Nb + 144Ce could be mobilized effectively by simultaneous application of specific agents (i.e., DFOA, DTPA) with no decrease in their efficiencies.

Animals↗
PubMed1980

[A technique for continent feeding jejunostomy (author's transl)].

Nutrition is the main problem with inoperable gastroesophageal tumors. In 15 mongrel dogs the topmost jejunal loop was disconnected in a 'y' shape after Roux and diverted outwards, the small intestine anastomosed end-to-side. A sphincter plastic made of autologous small intestine muscles after the Würzburg method was wrapped as a sleeve around the thigh diverted to the epigastrium. The jejunostomy was absolutely continent; the dogs could be fed an elementary diet by means of a probe without their loss of weight or malaise. The mobility and the uncomplicated application signify improvement on the gastric fistula and parenteral feeding.

Animals↗
PubMed1996

Peripheral blood stem cells: a historical perspective.

Peripheral blood stem cells (PBSC) are rapidly becoming the primary rescue modality for autologous transplantation and are now actively being investigated in the allogeneic transplant setting. Many investigators and clinical researchers believe that PBSC are likely to replace bone marrow stem cells entirely, for use in clinical transplantation in the not too distant future (1). In order to better understand the rapidly changing developments in this field, it would be helpful to understand the historical development of this technology. The purpose of this article is to build for the reader a strong historical foundation with the intent to integrate the history of peripheral blood stem cells with their subsequent isolation, mobilization, collection, and clinical applications.

Animals↗
PubMedDate not supplied

[Combined surgical and physical treatment in traumatic painful syndromes of the cervical spine].

Clinical observations suggest the need for changing therapeutic management to a more active one in cases of cervical spine injury with damage to the spinal cord and nerve roots or brachial plexus. In 248 patients with these injuries treated initially conservatively the incidence of cervicobrachial pain was analysed. Neuralgic pains were present in 31.5% of cases, causalgic pains in 2.4% and sympathalgic pains in 2%. Conservative treatment conducted in these patients (89 cases) during many months after trauma had no effect on return of mobility. Long-term application of physioterapy prevented only temporarily the development of trophic changes and only partially relieved pains. Only surgical decompression of the spinal cord or spinal nerves with stabilization of damaged vertebrae caused disappearance of painful syndromes and improvement in the motor activity of the extremities. These observations show that early surgical intervention for decompression of the spinal cord, roots or brachial plexus should be advocated in these cases.

Cervical Vertebrae↗
PubMed2001

Size-exclusion electrochromatography with controlled pore flow.

In size-exclusion electrochromatography (SEEC) there exists an optimum in pore-to-interstitial flow ratio with respect to the resolution. Two methods for finding and controlling the optimal pore-to-interstitial flow ratio in SEEC have been studied: (i) varying the ionic strength of the mobile phase and (ii) the application of a hydrodynamic flow in addition to the electrco-driven flow. Both methodologies have been evaluated in terms of efficiency and applicability with columns packed with silica particles containing pores of either 10 or 50 nm in diameter, and with different ionic strength mobile phases. Using the first method with the 10-nm pore particles, the flow ratio could be adjusted within an appropriate range. However, with the wide-pore (50 nm) particles it appeared that the pore-to-interstitial flow ratio was too high at all conditions tested to obtain proper selectivity. In the second approach, the desired pore flow was generated by the electric field and the pore-to-interstitial flow ratio could then be adjusted by an applied pressure over the column. This method was applicable with both particle types studied. The application of a (low) voltage gradient in addition to a pressure-driven flow resulted in a sharply improved separation efficiency as a result of a strongly improved mass transfer due to intra-particle electroosmotic flow. When optimized, pressurized SEEC generates identical separation efficiencies for polystyrene standards as are obtained with pure SEEC, while the reduction in selectivity, in comparison to pressure-driven SEC, is kept minimal.

Chromatography, Gel↗