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The future of adult cardiology. Council on Long Range Planning and Development in cooperation with the American College of Cardiology.

During the past several years, the American Medical Association's Council on Long Range Planning and Development has identified trends in the environment of medicine that are likely to affect physicians, their practices, and the provision of medical care in the future. In the course of its environmental analysis studies, the Council has recognized that each medical specialty is uniquely subject to anticipated changes in the environment of medicine. As part of an ongoing series of analyses prepared by the Council, this report focuses on environmental trends that are likely to influence the practice of adult cardiology. The report outlines the current state of cardiology, the forces for change in the environment, and the implications regarding the changes.

Cardiology

The future of pediatrics. Implications of the changing environment of medicine. Council on Long Range Planning and Development in cooperation with the American Academy of Pediatrics.

We present the results of an environmental analysis by the American Medical Association Council on Long Range Planning and Development to determine the key factors that are likely to affect the pediatric specialty in the future. Three factors were identified that are particularly salient to future pediatric practice: demographic trends, decisions by third-party payers, and public attitudes toward services for children. Less than half as many children per pediatrician is predicted for the year 2000 compared with 1970. Pediatricians are likely to face future constraints on reimbursement, particularly for cognitive services and for providing care to the growing number of children in poverty. One moderating effect may be laws enacted at the state or federal level mandating basic insurance coverage for child health supervision services. The public interest in children's services will influence future access to pediatric care for children and the compensation that pediatricians receive for children in poverty. In light of these issues, organized medicine may seek means to adjust to and also to shape the environment in which pediatric practice is to occur in the future.

American Medical Association

[Significance of urban climatologic expert assessment for urban planning and development].

Aspects of urban climatology relevant to urban planning are given in respect of quality of the atmosphere and urban climate modification. This paper deals with the spatial evaluation of emission and incidence of air pollution, local conditions of air flow and diffusion, climatic effects of different surface types and conditions of urban ventilation.

Air Movements

The future of general internal medicine. Council on Long Range Planning and Development in Cooperation with the American College of Physicians, the American Society of Internal Medicine, and the Society of General Internal Medicine.

The American Medical Association Council on Long Range Planning and Development has been publishing a series of reports that assess trends in the environment of medicine and their impact on physicians and health care provision. The Council believes that each specialty in medicine has unique characteristics and will respond differently to changes in the health care arena. This report, developed in cooperation with the American College of Physicians, the American Society of Internal Medicine, and the Society of General Internal Medicine, provides an overview and environmental analysis of the specialty of general internal medicine. The Council first reviews socioeconomic data pertinent to general internal medicine. This is followed by a review of key issues pertinent to internists that relate to such topics as graduate medical education, reimbursement, scope of practice, manpower, and competition. In the conclusions, the Council suggests activities for the medical profession to pursue in response to the identified environmental trends.

Adult

Developing strategic plans for academic general internal medicine.

There is an increasing need to train more primary care physicians. Therefore, it would be advantageous for academic general internal medicine (GIM) to develop strategies to meet these demands. Our GIM division developed a strategic planning process with the participant groups being the division faculty, a pertinent literature review (the surrogate expert), and selected medical administrators. The IDEALS systems design provided the conceptual framework for the strategic planning process. This process used the Delphi technique to develop the theoretically ideal work system based on the division's vision for its future role, and the Nominal Group Process Technique to create the recommended work system, using the Delphi results. The strategic planning process was economical and division faculty agreed that it was useful.

Delphi Technique

Medical informatics: an emerging medical discipline. Council on Scientific Affairs and Council on Long Range Planning and Development of the American Medical Association.

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.

Databases, Bibliographic

Chronic undernutrition and the young.

The problem of chronic undernutrition and its direct and indirect effects, especially in Africa are multi-faceted and integrated, and have roots in socio-economic, cultural, environmental, political, technological and other factors. In this scenario, the immediate victims are children, especially those under 5 years of age. There seems to be a vicious cycle of maternal malnutrition, infant death and high fertility as well as malnutrition, ill-health and low agricultural productivity in Africa. These make the situation serious and chronic. It means that the structures which bring about this problem need critical re-evaluation, particularly in terms of increased agricultural productivity, both in quantity and quality, and normal nutritional status. Increased production of staple and supplementary foods is now a widespread need in the African continent, as is population control. Experience has shown that nutrition is a complex and interacting phenomenon which is very much influenced by policies that affect socio-economic structures. Since the problem of hunger and malnutrition is a structural problem, nutrition may be regarded as an integral part of development planning. Higher priority may be given, therefore, to food and nutrition planning and their subsequent integration into national development plans, especially by taking into consideration the vulnerable groups which are the children in the population (Idusogie, 1977).

Africa

Career planning and development for emergency medicine faculty.

In this article, we propose a methodology to be used by emergency medicine faculty members who are interested in career planning and faculty development on an individual basis. The basic competencies needed by faculty and methods of setting goals are described. Educational courses, workshops, seminars, and self-study strategies that can be used to provide the basic competencies and meet defined goals are described, including the advantages and disadvantages of each method, the time commitment, and needed resources. The advantage of this methodology is the ability to customize a program to meet individual needs and fit into the constraints of available time and monetary resources.

Career Mobility

Steps in planning and developing health communication campaigns: a comment on CDC's framework for health communication.

This reviews the efforts of the Centers for Disease Control and Prevention to integrate effective health communication into its programs that are designed to change behaviors. Although the 10-step framework for developing and implementing the Centers' health communication programs is both practical and comprehensive, it is suggested that a reversal of steps 2 and 3 is a more logical sequence, is more consistent with the literature and, more importantly, could avoid misapplications of the framework by less experienced practitioners. Comment is also made on the dynamic nature of health communication planning and development, a point not made explicit in the Centers' framework.

Centers for Disease Control and Prevention, U.S.