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In April 2000, a new medical fee system for hospitals designated for specific functions was introduced into the remuneration of medical services. A basic concept of this system is to pay a supplementary fee for hospital treatment during the acute treatment. In this study, in order to clarify the effect of this new system on hospital management, we performed the case study of three hospitals (Kumamoto National Hospital, Saiseikai Kumamoto Hospital and Kumamoto Chuo Hospital) located in Kumamoto medical area. As a result, in this area, the basic qualitative aspects of medical care environment, such as the number of hospital beds and long-term facilities, was found to be well equipped. In addition, three hospitals differ in following points: 1) characteristics of clinical department, 2) management strategy. In conclusion, the case of the Kumamoto medical area was considered to provide an important model of collaboration and co-operation between medical facilities toward the new medical fee system.
OBJECTIVE: The objective of this study was to investigate whether the essential elements of the Association of Professors of Gynecology and Obstetrics (APGO) Medical Student Educational Objectives were adequately represented on the National Board of Medical Examiners (NBME) obstetrics and gynecology subject examination, and that the topics questioned on that examination were covered by the APGO objectives. STUDY DESIGN: The Undergraduate Medical Education Committee of APGO and the NBME staff separately reviewed the same 2 NBME obstetrics and gynecology subject examinations. The questions were mapped to the 15 essential elements of the APGO educational objectives and comparisons were made to check how well they matched. RESULTS: All the essential elements of the educational objectives were covered by the NBME subject examination. Of the questions on the examination, 99% were deemed appropriate for medical students with 70% of the questions mapping to "Priority 1" objectives. CONCLUSION: The NBME examination provides an appropriate assessment of mastery of what a medical student should learn, as represented by the APGO Medical Student Educational Objectives.
WFME has recently decided to extend its 'International Collaborative Programme for the Reorientation of Medical Education', aiming at the implementation of its educational policy at the institutional level. The first objective is to stimulate educational institutions to formulate their own plans for change and for quality improvement to align with international standards. The second objective is to establish a system to assure minimum quality standards for medical school programmes. Both objectives can be accomplished by publishing a World Register of Medical School, which will constitute an instrument of quality assurance in medical education. The Register should specify designation of a World Register Accreditation of medical schools, which fulfil internationally accepted and approved standards of medical education programmes. The accreditation could be differentiated in various categories.
A major obstacle to establishing a computer-stored medical record is the lack of "standards" that would permit government, care providers, insurance companies, and medical computer system developers to share patient data easily. In this position paper, the Board of Directors of the American Medical Informatics Association recommends specific approaches to standardization in the areas of patient, provider, and site of care identifiers; computerized health care message exchange; medical record content and structure, and medical codes and terminologies. The key concept developed in this position paper is that developers and users of computer-stored medical records must embrace existing and tested approaches, despite their imperfections, to progress quickly. This approach to standardization is being coordinated with the American National Standards Institute's Health Informatics Standards Planning Panel. The development of standards is a long-term process involving continued refinement. The proposed standards are an important step toward the goal of better and more efficient health care.
The most common prescription medications encountered and recorded in the normal course of a death investigation by a medical examiner's office in a moderate-sized jurisdiction in an urban city are tallied, based on data collected from 2233 deaths reported in 1998. Medication history was available for 775 of these deaths and is reviewed in this study. The 25 most common medications are each briefly discussed, particularly adverse effects and possible toxicity of concern in the investigation of death. Medications to treat cardiovascular disease are by far the most commonly encountered. The 10 most common medications regardless of category were furosemide, digoxin, nitroglycerin, potassium, lisinopril, warfarin, albuterol, nifedipine, codeine, and amlodipine.
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In the Federal Republic of Germany, the medical discretion is protected by criminal law section 203, by section 9 of the medical professional law, and by the state law regarding data protection. Patient's secret may only be revealed if the patient agrees, if a law demands or allows the revelation, or if a legal good of higher value facilitates the revelation. The employer may be informed about the fact of sickness of an employed and about the results of an occupational medical screening but not about diagnosis and therapy. Under specific circumstances, the health insurance companies have the right to demand revelation from the physician if this is legally permitted or if the patient agrees. Certified hospitals have to reveal certain data to the insurance companies. Medical services of health insurances have the right to demand certain data from the physician if a health insurance company has ordered an expert witness opinion or examination and if the revelation is necessary for this examination. If it is suspected that there is a mismanagement about the numbers of beds occupied by patients in a hospital, the medical service of a health insurance may examine all patient's records related to the health insurance of interest. There exists no legal rights or duties to reveal information to private health insurance companies. The revelation of patient's data to such companies is most commonly not allowed.
The use of computer technology in medicine is no longer the domain of only a few "gadget" happy high-tech aficionados. The rapid pace of medical progress and the increasing demands on physicians' time mandate that mechanisms be developed to deliver the tools of contemporary information management directly into the hands of all practicing physicians. It is with this intent that the Council on Long-range Planning and Development and the Council on Scientific Affairs of the American Medical Association have developed an informational report on Medical Informatics. The technology for producing information about medicine and patients is well into the information age. However, the technology for managing this information has not kept up, at least to the extent of being available in medical facilities where it is needed. Most users of medical information, physicians included, have not crossed the threshold into the electronic/computer era of information acquisition, distribution, and assimilation. The continuing development of the physician as computer user will create a more efficient work environment for the physician while at the same time improving patient care.
It was a cross sectional descriptive type of study carried out among the 3rd year, 4th year and 5th year medical students of Mymensingh Medical College (MMC) with the objective of finding out the various lecture style followed by medical teachers of MMC and other relevant information regarding teaching tools used related to lecturing. The sample size was 134 who were selected purposively. The study was conducted in the month of June 2004. One thirty four (134) respondents were interviewed by pre tested questionnaire. From the study it was revealed that majority (66%) of these respondents were male and 34% were female and 57%, 28.5% and 14.5% were 3rd, 4th and 5th year students respectively. A good number of students (82.5%) expressed their opinion that lecture time was sufficient for their learning. Among the medical teachers the lecture methods followed were VIG (81%) OP (54%) EP (47.2%) EL (25.5%) AT (23%). Eighty Seven percent of the students gave their opinion that the best style of lecture was EP. Seventy and half percent students disliked the AT style followed by OP, which was 85.5%. Seventy two percent of the students were not satisfied with the teaching aids used by the teachers. OHP (90%) was the most commonly used teaching material. Most of the respondents (97.5%) expressed their opinion that SGT was the most suitable way for imparting information.
STUDY OBJECTIVE: International guidelines for cardiopulmonary resuscitation (CPR) recommend determination of unconsciousness, breathlessness, and absence of pulse to diagnose cardiorespiratory arrest. Thus far, there have been no scientifically proven data available regarding the quality of assessing breathlessness. The study objective was to evaluate the effectiveness of checking for breathing in an emergency situation, to determine the necessary amount of time until diagnosis, and to document used techniques. METHODS: Four different populations were tested for their ability to assess breathlessness: emergency medical services (EMS) personnel, physicians, medical students, and laypersons. Each participant was asked to perform the diagnostic procedure twice, first with a breathing or not-breathing unresponsive test person and then with a modified megacode manikin (with the possibility of simulated respiratory function). The order of testing and the respiratory status were strictly randomized. Diagnostic accuracy, time interval to diagnosis, and used techniques were documented. RESULTS: A total of 261 persons were tested in 522 trials, with a median time interval of 12 seconds for obtaining a diagnosis. Regarding all participants, the correct diagnosis was achieved in 81.0% (EMS personnel, 89.7%; physicians, 84.5%; medical students, 78.4%; laypersons, 71.5%). Only 55.6% of all participants showed correct diagnostic skills (EMS personnel, 91.3%; physicians, 51.5%; medical students, 61.9%; laypersons, 18.5%). CONCLUSION: Checking for breathing was shown to be mostly inaccurate and unreliable. This diagnostic procedure takes more time than recommended in international guidelines. Therefore CPR training should focus more on the determination of breathlessness. Also, the guidelines for CPR should be revised.
A total of 330 preclinical and clinical medical students and house officers at St Mary's Hospital were surveyed by questionnaire to assess their knowledge and experience of inner city deprivation and health, and their opinions on the role of the doctor in responding to these problems. The response rate was 87%. Over 75% of the respondents had had no experience of inner city living conditions before coming to medical school, and they gained little experience during the medical course until well into the clinical years. Most preclinical students wanted more contact with the community early in the course; less than one-third of the clinical students wanted this. The differences in knowledge and attitudes between the year groups are discussed and possible reorientation in medical education is considered.
We assessed indebtedness of graduating physicians and dentists in the class of 1996, University of Medicine and Dentistry of New Jersey, and found the percentage of students with debt to average 80% (range, 77-84%) among the five schools of the university. Mean indebtedness was $73,000 per student. We then surveyed the graduates of one of the four medical schools in the university (New Jersey Medical School) regarding attitudes toward established programs for financial assistance to medical students and physicians and alleviation of educational indebtedness in return for military service. More than half (57%) of the students were unaware of any program that would repay part of their educational loans in return for military service. Of those who professed such knowledge, few could name the programs. A similar number of students (55% of the graduates) said that they would not consider serving in the military under any circumstances. Despite considerable indebtedness among today's medical students, most do not know about career opportunities offering financial assistance with tuition or educational loans in return for military service. Worse yet, they do not care.
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