Active Participation Of Physicians Research Articles

The Association Between Linguistic Characteristics of Physicians' Communication and Their Economic Returns: Mixed Method Study.

Web-based health care has the potential to improve health care access and convenience for patients with limited mobility, but its success depends on active physician participation. The economic returns of internet-based health care initiatives are an important factor that can motivate physicians to continue their participation. Although several studies have examined the communication patterns and influences of web-based health consultations, the correlation between physicians' communication characteristics and their economic returns remains unexplored. This study aims to investigate how the linguistic features of 2 modes of physician-patient communication, instrumental and affective, determine the physician's economic returns, measured by the honorarium their patients agree to pay per consultation. We also examined the moderating effects of communication media (web-based text messages and voice messages) and the compounding effects of different communication features on economic returns. We collected 40,563 web-based consultations from 528 physicians across 4 disease specialties on a large, web-based health care platform in China. Communication features were extracted using linguistic inquiry and word count, and we used multivariable linear regression and K-means clustering to analyze the data. We found that the use of cognitive processing language (ie, words related to insight, causation, tentativeness, and certainty) in instrumental communication and positive emotion-related words in affective communication were positively associated with the economic returns of physicians. However, the extensive use of discrepancy-related words could generate adverse effects. We also found that the use of voice messages for service delivery magnified the effects of cognitive processing language but did not moderate the effects of affective processing language. The highest economic returns were associated with consultations in which the physicians used few expressions related to negative emotion; used more terms associated with positive emotions; and later, used instrumental communication language. Our study provides empirical evidence about the relationship between physicians' communication characteristics and their economic returns. It contributes to a better understanding of patient-physician interactions from a professional-client perspective and has practical implications for physicians and web-based health care platform executives.

Increasing Engagement for Breast Cancer Screening and Treatment: The "ICANTREAT" Community of Expertise Initiative.

Background: Incidence of breast cancer and associated mortality are on the rise globally. Breast cancer incidence in India is on the rise and also accounts for a staggering 50% mortality rate among women. Health illiteracy, socio-economic and cultural barriers in addition to lack of an organized nationwide screening and prevention programme contribute to poor patient outcomes. Thus, it is imperative to strengthen the existing screening and treatment facilities to address the increasing cancer burden. In this regard, we conducted a workshop to investigate the scope of a multi- stakeholder engagement in breast cancer screening and treatment. Methods: A stakeholder workshop grounded in an established co-design methodology was convened in a semi-urban coastal district in South India with active participation of physicians, surgeons, occupational therapists, community leaders, programme officers, public health professionals and breast cancer survivors. Shiffman and Smith’s framework was adapted to highlight barriers to screening and role of stakeholders in the co-design of solutions. Results: Deliberate and active discussions marked the workshop proceedings resulting in the identification of individual and systems level barriers, facilitators and implementation strategies. Social stigma and non-existent standard protocols for screening and referral were recognised as critical barriers, while community engagement and a dedicated patient advocate were the proposed facilitators.Conclusion: This workshop was an important step in bringing together key stakeholders and marked the beginning of the ICANTREAT initiative and a Community of Expertise. The outcomes highlight the importance of stakeholder involvement in the cancer- care pathway for breast cancer screening, diagnosis and treatment.

The Scottish Enlightenment. Links Between Philosophy and Medicine in the Activities of Philosophical Societies

What is analysed in this paper is the connection between philosophical thinking and medicine based on activity of institutional bodies such as societies, clubs or voluntary institutions. Special emphasis will be placed on cooperation between philosophers and physicians of Aberdeen, Edinburgh and Glasgow societies. Some activities of the Glasgow Philosophical Society, the Aberdeen Philosophical Society – the Wise Club, and the Philosophical Society of Edinburgh will be presented, including the active participation of physicians in those societies with a description of related topics discussed at meetings and, as a result, some linked publications. A brief analysis performed here allows us to show how the philosophical knowledge and rational thinking became the background for medicine diagnoses and, at the same time, how developing medical science influenced philosophical thinking of those days, and created a new philosophical paradigm. The interaction between the men of science in Scotland, the scientists who very often knew each other, led to that incredible development in 18th-century Scotland.

Doctors and Canadian Medicare: Improving System Performance Requires System Change.

Many of the issues raised and insights provided by Marchildon and Sherar (2018) in their essay on doctors and Canadian medicare are on target. The inadequacy of available data on physician payment, however, calls into question the robustness of some interprovincial comparisons, and when it comes to compensation, comparisons to US physicians would be most relevant. In contrast to their assertion of a steadily increasing growth rate in physician expenditure, a more recent and longer view shows historically low growth in the past few years. Furthermore, the blame assigned to physicians and their medical associations needs to be shared with governments and most of all could be attributed to the lack of system structures and supports for improvement. New governance arrangements at the group or regional levels are needed but are insufficient in themselves. The additional features embodied in the Patient's Medical Home are essential for advancing primary care. Going even further, full population registration, greater availability of alternate payment arrangements, active participation of physicians in healthcare administration and support for meaningful measurement and feedback loops are among the changes required to transform Canadian medicare.

Indian physicians’ perception of clinical trials

<p>The successful completion of clinical trials depends largely on the active participation of physicians. Tharyan, P (2007) has discussed at length, the opportunities, obligations, challenges, and solutions of conducting clinical trials in India (2-4). In this regard, an online survey was conducted on Docplexus to measure the physician awareness, understanding, and inclination towards the involvement in conducting clinical trials in India.</p><p>Docplexus conducted a survey on 463 doctors specializing in Pharmacology/Clinical Pharmacology, General Medicine, Cardiology, Orthopedics, Neurology and Urology to understand their inclinations and concerns regarding clinical trials in India. A total of 53 doctors completed the survey. The data obtained from the survey was collected and analyzed to evaluate the parameters involved in inclination or aversion of physician participation and deduce perception.</p>

Impact of Medicaid Expansion on Medicaid-covered Utilization of Buprenorphine for Opioid Use Disorder Treatment.

Buprenorphine has been proven effective in treating opioid use disorder. However, the high cost of buprenorphine and the limited prescribing capacity may restrict access to this effective medication-assisted treatment for opioid use disorder. To examine whether Medicaid expansion and physician prescribing capacity may have impacted buprenorphine utilization covered by Medicaid. We used a quasi experimental difference-in-differences design to compare the pre-post changes in Medicaid-covered buprenorphine prescriptions and buprenorphine spending between the 26 states that implemented Medicaid expansions under the Affordable Care Act in 2014 and those that did not. All Medicaid enrollees in the expansion states and the nonexpansion and late-expansion states. Quarterly Medicaid prescriptions for buprenorphine and spending on buprenorphine from the Centers for Medicare and Medicaid Services Medicaid Drug Utilization files 2011 to 2014. State implementation of Medicaid expansions in 2014 was associated with a 70% increase (P<0.05) in Medicaid-covered buprenorphine prescriptions and a 50% increase (P<0.05) in buprenorphine spending. Physician prescribing capacity was also associated with increased buprenorphine utilization. Medicaid expansion has the potential to reduce the financial barriers to buprenorphine utilization and improve access to medication-assisted treatment of opioid use disorder. Active physician participation in the provision of buprenorphine is needed for ensuring that Medicaid expansion achieves its full potential in improving treatment access.

Withdrawal from bariatric treatment - an analysis under various demographic conditions.

Documentation of 115 subsequent patients diagnosed with grade 3 obesity, considered eligible for surgical treatment, was analysed since 2015. A subgroup of 68 patients was selected from this group and the included patients who decided to cancel their treatment at various stages. Their history since presentation at the obesity treatment centre, BMI with its history, age, education and place of residence were analysed, followed by a telephone survey. 42 patients were finally contacted. Special attention was placed on the analysis of patients taking into account their place of residence. Patients were divided into inhabitants of rural and urban areas. In the study group of 68 patients, 19 (27.9%) were inhabitants of rural areas and 49 (72.1%) of urban areas. Women accounted for 67.6%, and men for 32.4%. The mean age of patients when they presented for treatment was 43 years. On average, men presented 5 years later compared to women. The mean BMI on qualification for treatment of obesity was 47.6 kg/m2. The mean BMI max - 49.6 kg/m2. There were no differences regarding education in both populations. Despite the lack of differences regarding changes in the BMI since withdrawal from treatment, as many as 63% of patients from rural areas reached the BMI max in this time. There were demographic differences between the degree of obesity observed among patients receiving bariatric treatment, and inhabitants of urban areas were favoured. Patients from rural areas who withdrew from bariatric treatment and were left without medical care significantly more often achieved their maximum body weight, when compared to those living in urban areas. The active participation of physicians, both specialists and general practitioners, in the life of obese patients is imperative.

Increased Polyp Detection by Active Physician Participation on CRC Screening Campaign in Internal Medicine Residency Primary Care Clinic

Purpose: In our primary care clinic, the preliminary data revealed that active physician participation increased the number of patients willing to pursue CRC screening. However, clinical significance on the disease detection with positive screening tests from this active campaign is not yet determined. Methods: This is a follow-up study. All patients visiting primary care clinic from July 1, 2011 to May 31, 2012 between the ages 50-75 years old were enrolled in the study. Each internal medicine resident retrospectively reviewed charts to categorize patients into either patients who were appropriately screened vs. those who were not. Residents were then educated on CRC screening and its options (fecal occult blood test [FOBT], flexible sigmoidoscopy, colonoscopy etc.). Active intervention was performed by calling or deliberating with the patients who particularly had not received updated CRC screening. The results of each CRC screening test on selected patients were re-evaluated in 6-month period for data collection. Cross tabulation was used for result and data analysis. Results: From a total of 162 eligible patients for the follow up study, 49 (30.2%) patients agreed to receive one of CRC screening options. After 6-month follow-up, 31 (63.3%) patients underwent appropriate CRC screening (Table). Eleven (35.5%) patients received fecal occult blood tests; 19 (61.3%) received colonoscopy; one (3.2%) received flexible sigmoidoscopy. From 20 patients who received either colonoscopy or sigmoidoscopy, six (30.0%) patients had adenomatous polyp, three (15.0%) patients had hyperplastic polyp; three (15.0) patients had poor bowel preparation, and eight (40.0%) patients had normal colonoscpy. Eleven patients (100%) had negative FOBT.Table: Table. The percentage of patients with each method of CRC screening after an active campaignConclusion: Our study demonstrated that the CRC screening rate could be increased via active physician participation. It also underscores that a practical intervention could lead to an increase in polyp detection, identify at risk patients for closer surveillance, and eventually prevent development of CRC. Larger study with longer follow-up period is required to demonstrate the impact of this intervention on long-term clinical outcomes, and the overall cost of health care.

Changing management of acute MI – perspectives from India

Management of acute myocardial infarction (AMI) in India essentially rests on the established reperfusion strategies with unique adaptations compelled by the socioeconomic structure of the country. Due to limited availability of trained interventionists coupled with financial limitations, thrombolysis remains the most utilised reperfusion therapy for AMI. Patient education through the active participation of physicians concerning the early detection of symptoms suggestive of AMI can enhance the impact of thrombolysis on the outcomes by narrowing the door-to-needle time. This article discusses some of these unique issues and possible solutions in the emerging economies to optimise outcomes in AMI.

A Brief Overview of Academic Detailing in Canada: Another Role for Pharmacists

Medications are the second largest and fastest growing health care cost in Canada.1 In 2010, there were 499.6 million prescriptions dispensed across Canada, representing a total of $23.3 billion. 2 While medications often produce extensive improvements in patient health and well-being, they have also been associated with many preventable adverse events.3,4 In practice, medications are often used at different dosages, with other medications or for patients or conditions that were not included in clinical trials. These factors reflect the complexity of real-world practice and can result in suboptimal medication use that contributes to drug-related morbidity and mortality.5 In 2000, the cost of drug-related morbidity and mortality resulting from drug-related problems exceeded $177.4 billion US in the United States.6 According to a Canadian study completed in 2000, adverse drug reactions occur frequently (7.5 per 100 hospital admissions),7 are preventable (36.9%)7 and prolong hospital stay by an average of 3.6 days.8 Key points Academic detailing has been shown to improve patient health outcomes. Academic detailing is currently available province-wide in British Columbia, Saskatchewan and Nova Scotia. The role of the pharmacist can include academic detailer, evidence reviewer for topics, developer of key messages and content/supporting tools, developer of the evaluation framework and trainer of other academic detailers. Points cles Il a ete demontre que la visite academique ameliore les resultats pour la sante des patients. La visite academique est actuellement offerte dans l'ensemble de la Colombie-Britannique, de la Saskatchewan et de la Nouvelle-Ecosse. Le role du pharmacien peut varier de celui de formateur en pharmacotherapie a celui d'examinateur des donnees probantes ou de developpeur de messages cles, de contenu ou d'outils de soutien ou encore de cadres d'evaluation des agents de formation des formateurs en pharmacotherapie. There have been a number of strategies evaluated to improve medication prescribing and use. An overview of 41 systematic reviews of interventions to change provider behaviour9 found that passive approaches were unlikely to affect changes in provider behaviour, while academic detailing (AD or educational outreach) was considered to be a promising approach, even when delivered as a single intervention.9 AD is a method of continuing education in which a trained health care professional meets with a prescriber (e.g., family physician or nurse practitioner) in their practice setting to provide one-on-one evidence-based information.10 The information given may include feedback about their performance or may be based on overcoming obstacles to change practice. Academic detailing is frequently provided in multifaceted interventions with written materials, continuing education and feedback. One of the main components of academic detailing is that detailers (mostly pharmacists, sometimes nurses or other physicians) provide well-balanced, objective information; this can be accomplished because they are not employed by the pharmaceutical industry and the academic detailing programs do not have any financial links to the pharmaceutical industry. AD has been employed to effect changes in prescribing practices based on the best available evidence to improve patient health outcomes. Some improvements in the appropriate prescribing by physicians for antibiotics,11–13 benzodiazepines,14–16 NSAIDs,17,18 acid-peptic disease management19 and diuretics for hypertension20 have been observed. AD has also been employed to target behaviours related to the provision of preventive services or the general management of conditions commonly seen in general practice, such as the management of patients with diabetes,21 patients with osteoporosis,22 the provision of smoking cessation advice23 or cancer screening.24,25 A Health Council of Canada report26 corroborated these findings as part of a review of interventions to target suboptimal prescribing. AD was among one of the more highly effective interventions discussed, with some studies showing improvements ranging from 1% to 2%, to improvements as large as 24% to 45%.26 The reason for the large variance is unknown, but factors such as physicians' baseline knowledge of the evidence, number of physicians per AD visit, clinic location, complexity of behaviour change and the make-up of the academic detailing visit have all been considered.27,28 In a Cochrane review, 69 studies showed that academic detailing consistently provided small changes in prescribing that could lead to significant changes, with hundreds of patients being affected.27 Soumerai and Avorn recommend that the following principles of educational outreach be incorporated into academic detailing to improve clinical decision-making:29 Conduct interviews with target audience to investigate baseline knowledge and motivations for current prescribing and practice patterns. Focus programs on specific groups of prescribers and opinion leaders. Define clear educational and behavioural objectives. Establish credibility through a respected organizational identity, referencing authoritative and unbiased sources of information and presenting both sides of controversial issues. Stimulate active physician participation in educational interactions. Use concise graphic educational materials. Highlight and repeat the essential messages. Provide positive reinforcement of improved prescribing practices during follow-up visits. The objectives of this article are to provide a brief overview of academic detailing activity in Canada and describe the role of pharmacists as academic detailers.

Allhoff, Fritz. ed. 2008. Physicians at war: The dual-loyalties challenge

Physicians at war: The dual-loyalties challenge is a collection of essays which provide philosophical, political, and legal perspectives on many of the conflicting obligations which physicians may face during times of armed conflict. “Armed conflict” is best understood here as broadly construed. While some aspects of the book focus specifically on military physicians and/or the actions of physicians in traditional wars, the majority of the articles deal with issues relating to physician participation in activities in support of national security and/or national defense more generally. In the introduction to this volume Fritz Allhoff grounds the discussion by first identifying what he understands to be the dual-loyalties challenge in the context of armed conflict. The challenge is that there may be a conflict between one’s medical obligations to those under one’s care: for example, in the case battlefield triage or interrogation/torture; or to those who would suffer from one’s actions, as in the case of weapons development; and in one’s non-medical obligations to one’s commander, one’s nation, or those who would suffer as a result of one’s failure to act. Once he has explained the problem Allhoff discusses ways that the challenge is addressed in this book. The first way is to acknowledge the existence of the conflicting obligations, and then to determine which obligation carries the greatest weight. This might take the form of a utilitarian analysis weighing the harms against the benefits of a proposed action. The second option is to deny the force of one of the obligations. The most common form of this would be to deny that extramedical considerations carry any weight in medical considerations. The final option is to deny that there are dual-loyalties at all. This entails the claim that medical obligations apply only to physicians qua physician. That is, only those individuals acting in the role of physician garner medical obligations. In this light a distinction would be made between a person working in the role of physician and a person with medically training working in the role of an interrogator.

Collaboration in research protocol design: A case study exploring knowledge creation for the pharmaceutical industry and prescribing physicians

The pharmaceutical industry is under increasing pressure to bring innovative products to market in a timely manner. Without access to information from people outside the industry, this task is more difficult. Because physicians may have a greater understanding of specific product benefits in a clinical setting, knowledge creation within the pharmaceutical industry can be facilitated through active physician participation in clinical trial design, thereby delivering more effective use of medicines. Ultimately, knowledge creation efforts may enhance the use of evidence-based decision making and improve professional practice, which in turn will promote innovation in service and product development. The study aims to examine the potential for knowledge creation through collaboration between physicians and industry representatives. Eight physicians specialising in a specific disease agreed to meet with three industry representatives who organise clinical trials. The primary endpoint for this study was to design a phase IV clinical trial with collaborating physicians that specifically addressed a medical need within a highly specialised area of medicine. After meeting with industry representatives, the physicians concluded that company-sponsored studies were not appropriate, and any potential research should be conducted on a small scale (pilot and exploratory) within a clinical setting. The collaboration formed in this study failed to produce the intended result of a phase IV research protocol. Physicians were, however, able to steer the industry representatives towards research sponsorship that would – in their opinion – best serve the interests of improved patient outcomes. These findings support the importance of knowledge creation through collaboration between physicians and pharmaceutical companies.

Active Physician Participation Key to Smooth MOE/MAR Rollout

Fundamental to the project's success was acceptance of MOE/MAR by UHN's physicians, yet many physicians questioned whether MOE/MAR would impede their ability to care for their patients. To ensure physician adoption, UHN presented MOE/MAR as a patient safety initiative from the beginning.

Treatment considerations for head and neck cancer in the elderly

As life expectancy increases, surgeons can expect an increasing number of geriatric patients. In turn, the number of elderly patients presenting with head and neck cancer is likely to increase. Management of this subpopulation has become a source of debate because there is a paucity of randomized data regarding the effect of age on treatment response and morbidity associated with the treatment of head and neck cancer. The management of head and neck cancer in the elderly depends on the patient's age and general condition, the stage of disease, the effects of treatment on quality of life (such as speech and swallowing), patient and family wishes, and active physician participation in continued care. Elderly patient's comorbid conditions need appropriate attention especially if surgery is to be undertaken. The aim of this review is to examine the current literature in an attempt to develop an approach to the treatment of the elderly patient with head and neck cancer and to define the pertinent issues that require further study.

Prevalence and determinants of physician participation in conducting pharmaceutical-sponsored clinical trials and lectures

The relationship between physicians and the pharmaceutical industry is controversial because of the potential for conflicts of interest. However, little empirical evidence exists on the extent of physician participation in activities sponsored by pharmaceutical companies. To determine the prevalence of participation of internal medicine physicians in clinical trials and lectures sponsored by pharmaceutical companies and to describe factors that are associated with such participation. We conducted a cross-sectional regional survey of 1,000 Maryland internal medicine physicians between February 2000 and January 2001 in order to measure the prevalence of physician participation in pharmaceutical-sponsored clinical trials and lectures. We also collected economic and demographic information to examine potential associations between physician characteristics and engagement in such activities. Of 835 eligible physicians 444 (53%) responded, of whom 37% reported engaging in pharmaceutical-sponsored clinical trials and/or lectures to supplement their incomes. In our multivariable analysis, subspecialists versus generalist physicians (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.14 to 2.99), physicians in private group-single specialty and academic practice versus physicians in solo practice (OR, 2.30; 95% CI, 1.19 to 4.44 and OR, 2.56; 95% CI, 1.17 to 5.61, respectively), and physicians with higher versus lower annual incomes (OR, 1.22; 95% CI, 1.04 to 1.44) had a greater odds of participation in these activities. Additionally, physicians dissatisfied with their income had a 140% greater odds of participation (OR, 2.36; 95% CI, 1.45 to 3.83) than those who were satisfied with their income. A substantial number of internists engage in pharmaceutical industry-sponsored clinical trials and/or lectures in an effort to supplement their incomes. Physician dissatisfaction with income appears to partially explain such participation.

Critical pathways : a review. Committee on Acute Cardiac Care, Council on Clinical Cardiology, American Heart Association.

Critical pathways, also known as critical paths, clinical pathways, or care paths, are management plans that display goals for patients and provide the sequence and timing of actions necessary to achieve these goals with optimal efficiency.1 As competition in the healthcare industry has increased, managers have embraced critical pathways as a method to reduce variation in care, decrease resource utilization, and potentially improve healthcare quality. Cardiovascular medicine in particular is an area in which critical pathways have been embraced. This is due in part to the high volume and high cost associated with cardiovascular diseases and procedures. In addition, the relatively mature guideline process has also contributed to the growth in use of critical pathways in cardiology. Although anchored in clinical guidelines, the critical pathway is a distinct tool that details processes of care and highlights inefficiencies regardless of whether there is evidence to warrant changes in those processes. Clinical guidelines, on the other hand, are consensus statements that are systematically developed to assist practitioners in making patient management decisions related to specific clinical circumstances.2 Although clinical guidelines can and should be used in pathway development, the majority of processes included in a pathway have not been rigorously tested and are generally not addressed in guidelines. Another term that should also be distinguished from critical pathways is clinical protocols. Protocols are treatment recommendations that are often based on guidelines. Like the critical pathway, the goal of the clinical protocol may be to decrease treatment variation. However, protocols are most often focused on guideline compliance rather than the identification of rate-limiting steps in the patient care process. In further contrast to critical pathways, protocols may or may not include a continuous monitoring and data-evaluation component. Critical pathway techniques were first developed for use in industry as a tool to …

Changing Physician Prescribing Patterns: Evaluation of an Educational Strategy for Acute Diarrhea in Mexico City

This paper presents the results of an intervention strategy designed to decrease drug prescription and increase the use of oral rehydration therapy (ORT) in the treatment of acute diarrhea aimed at family medicine practitioners in two primary health care units of the Mexican Social Security Institute. The intervention consisted of six successive stages: 1) Baseline study of prescribing practices by all 69 physicians in both clinics; 2) Training workshop attended by 36 physicians, including a critical analysis of relevant up-to-date literature, review of results of stage I, discussion of a previously designed treatment algorithm for acute diarrhea, and modification of it according to participant's experience; 3) Post-workshop evaluation; 4) Establishment of a peer review committee to discuss the treatment behavior of participating physicians; 5) Mid-term evaluation for 2 months after the committee stopped functioning; 6) Long-term evaluation at 6, 12 and 18 months, of 20 physicians who received the complete intervention (study group) and 20 physicians who received none (control group). The treatment behaviors of the study and control groups were similar on baseline, but differed significantly (P < 0.01) in the post-workshop evaluation. The study group showed a reduction in the use of antibiotics (from 78.8% to 39.3%) and restrictive diets (47.3% to 12.4%), and increased the use of ORT (31.4% to 58.4%) for children younger than 5 years old with acute diarrhea. In the mid-term evaluation, the use of antibiotics by the study group decreased to 27.6%, prescription of restrictive diets decreased to 6.4%, and use of ORT increased to 73.8% (P < 0.01, in all cases). In the long-term evaluation, persistent positive prescribing behavior was still present in the study group, with a significant difference (P < 0.05) compared to the control group, where no modification was found in the prescribing behavior throughout the study. The average proportion of cases treated according to the algorithm by the study group increased in 29.2% (31.3 to 60.5%) after the workshop, and 45.2% (31.3 to 76.5%) after peer review committee. This behavior was maintained during 18 months after the intervention (74%). The control group showed no significant modification in the average proportion of cases treated according to the algorithm during the study (2 years 7 months). The active participation of physicians in the workshop and in the peer review committee was identified as the key to the short and long-term success of the educational strategy.

Doctors and execution in Turkey

EDITOR, - As Tessa Richards points out, the considerable problems besetting the World Medical Association should not mislead us into underestimating the importance of its ethical declarations.1 One of its more important resolutions was that passed in 1981 prohibiting the active participation of physicians in capital punishment other than to certify death. This resolution was in effect adopted in 1992 as one of the recommendations of the BMA's working party on the participation of doctors in abuses of …

Continuing Medical Education

EVENTS in 1991 and 1992 reflected continuing widespread debate about the form continuing medical education (CME) should take, who should provide it, the role commercial companies should play in paying for it, and how successful completion of specific CME activities should be documented. The American Medical Association (AMA) House of Delegates reviewed the Physician's Recognition Award (PRA) certification requirements and referred questions concerning the requirements to the AMA Board of Trustees for decision. A number of CME organizations joined to develop voluntary standards for industry funding of CME and rules for disclosure of conflict of interest by CME faculty. The Food and Drug Administration (FDA) took an interest in industry relationships to CME—the first time the federal government has taken a major interest in CME management. The AMA and the American Hospital Association developed a form that CME providers can use to document physician participation in activities directed toward expanding

The clinical process and the quality process

Quality management methods in health care organizations require the active participation of physicians. Many organizations are successfully using a variety of methods to support this involvement, building on the underlying intellectual similarity between clinical practice to improve the health of individuals and quality management to improve processes of work. Important similarities include the scientific combination of theory and fact, the avoidance of blaming, the systematic analysis of variation, the use of experiments, the refinement and use of measurement, and the development of an extended professional community.