US Practitioners Research Articles

Reformation in Chinese healthcare: lessons to be learned from US best practices in consulting, education and development of health system change

Since the early 1990s there has been strong interest by the Chinese healthcare establishment to engage US healthcare leaders on a variety of educational and consultative services. This exchange has occurred on both sides of the Pacific, with Chinese delegations visiting US health systems, government agencies, and university programmes in health administration. US scholars and practitioners have also travelled to China for consultative and management services. Despite heavy dialogue between officials and industry experts from both countries, little is written on best practices for dealing with this work. This paper explores this question using the authors' experiences as consultants and educators with Chinese healthcare administrators and officials in the greater Shanghai area.

Changing gastric cancer treatment in the United States and the pursuit of quality

The low incidence of gastric cancer in the US presents various quality challenges. For most US practitioners, individual experience is inadequate. Accrual to clinical trials testing new treatments can be daunting. However, through the use of nationally available clinical trials sponsored by many trial groups working in concert, and the use of national registries for treatment and outcome surveillance, a path to increased gastric cancer survival has been charted. Moreover, systems for continuous quality improvement at the institutional level are in place. Quality assurance is an increasing concern of both private and governmental groups. In this article, we summarize recent national US clinical trial findings concerning gastric cancer treatment, highlight national assessment systems for cancer outcomes, and describe what these systems tell us about the current status of gastric cancer care in the US, highlighting challenges and areas for potential improvement.

Australian and US responses to electroconvulsive therapy dosage selection.

The practice of electroconvulsive therapy (ECT) varies considerably across sites with a lack of certainty as to what constitutes seizure adequacy. The aim of this study was to trial a method to explore decision making and to describe any differences between Australian and US practitioners. Two hundred and thirty-six consultant psychiatrists from Australia and US were asked what dosage of electrical energy they would prescribe after reading a standardized clinical vignette in which an unremarked upon change in seizure tracings followed the first two treatments. Considerable variability in the dosage was found with 17.3% decreasing, 46.8% maintaining and 30% increasing charge. Involvement in administration of ECT was unrelated to this decision. Standardized vignettes may be a useful method to assess clinicians' responses in dosage selection.

Acupuncture: The Historical Basis and Its US Practitioners

Acupuncture is a therapeutic technique that has been used in China for at least 4,500 years. Recently, it has gained rapid acceptance by the US public. During the past decade, scientific studies have been published in the Western medical literature that suggest a biological basis for the therapeutic effects of acupuncture. Published clinical studies also confirm the effectiveness of acupuncture in the treatment of many different illnesses. This article, the first of two about acupuncture, will explore the historical basis of this medical practice and describe the various types of acupuncturists in the United States

MED-ARB: New Coke or Swatch?

Mediation followed by arbitration is an alternate dispute resolution (ADR) method favoured by some US practitioners. Is it an idea whose time will come in Europe, or rather a peculiarly US institution? There has been increasing interest recently in Alternative Dispute Resolution (ADR) methods.1 Many of these methods owe their recent visibility and popularity to their apparently successful use in the US. Some methods even appear to have been invented, or at least perfected, in the US quite recently. One particular method that raises some controversy in Europe is MED-ARB, the practice of starting to resolve a dispute by a mediation process, and then switching to an arbitration process if the mediation fails. In some cases the mediator becomes the arbitrator; some practitioners view this version of MED-ARB with suspicion, for reasons that will be explored later. Is MED-ARB an accurate and inexpensive way of resolving conflicts, and therefore...

Physicians Who Have Lost Their Malpractice Insurance-Reply

In Reply.— Dr Howland incorrectly suggests that length of time in practice is the key determinant of whether a physician is likely to lose his or her malpractice insurance. In fact, insurance companies typically reach termination decisions without considering claims that occurred more than 5 (or at the most 10) years previously. Moreover, if tenure were the key to termination, one would expect to see older physicians in excess numbers in the surplus-lines pool. However, it is not older physicians but those in the 45- to 54-year age bracket who are overrepresented. As noted in our article, a physician's coverage is typically terminated in circumstances where he or she has a claims history that is substantially more adverse than others in the same specialty, or following an action by the state medical board. In the case of most physicianowned companies (which now insure about half of US practitioners), decisions are