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Practice parameters for the surgical treatment of ulcerative colitis. The American Society of Colon and Rectal Surgeons is dedicated to assuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Standards Committee is composed of Society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This committee was created to lead international efforts (...) in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by developing Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive, and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management
Patient-centered informed consent in surgical practice. To review the medical, ethical, and legal basis of the doctrine of informed consent for surgery and its complications, particularly for an incapacitated patient who requires a surrogate decision maker; to discuss the elasticity of the consent doctrine, whether surgical consent encompasses consent for surgical complications, and emphasize the importance of communication and shared decision making in the context of the patient-surgeon (...) relationship; and to discuss patient and surrogate refusal of treatment, standards of surrogate decision making, barriers to effective communication, the role of the hospital ethics committee in resolving disputes over treatment, and how to reconceptualize surgical consent in the context of patient-centered medicine.We reviewed PubMed citations for informed consent in surgery, patient-physician communication, shared decision making, patient-centered medicine, and consent guidelines published by specialty
Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised). The American Society of Colon and Rectal Surgeons is dedicated to assuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Standards Committee is composed of Society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This Committee was created to lead (...) international efforts in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by developing Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive, and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about
Practice parameters for the management of rectal cancer (revised). The American Society of Colon and Rectal Surgeons is dedicated to assuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Standards Committee is composed of Society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This Committee was created to lead international efforts (...) in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by developing Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive, and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management
, regionalization and integration into related health services would maximize equal accessibility and effectiveness of genetic actions. There is a need for harmonization of the rules involved in financial coverage of DNA tests in order to make these available to all Europeans. Clear guidelines for the bestpractice will ensure that the provision of genetic services develops in a way that is beneficial to its customers, be they health professionals or the public, especially since the coordination of clinical (...) Provision of genetic services in Europe: current practices and issues. This paper examines the professional and scientific views on the social, ethical and legal issues that impact on the provision of genetic services in Europe. Many aspects have been considered, such as the definition and the aims of genetic services, their organization, the quality assessment, public education, as well as the partnership with patients support groups and the multicultural aspects. The methods was primarily
Guidelines for safety and quality in anaesthesia practice in the European Union. Anaesthesia is a medical specialty that is particularly concerned with the safety of the patient who is undergoing a surgical procedure. This is a prerequisite in order to provide quality of care, which is based on good clinical practice, on a sound organization, on an agreement on bestpractice and on adequate communication with other healthcare workers involved. Providing a safe environment for those working (...) in healthcare is at least as important as other factors serving that objective. A working party on Safety and Quality in Anaesthesiological Practice in the Section and Board of Anaesthesiology of the European Union of Medical Specialists (EUMS/UEMS) has prepared guidelines that were amended and approved recently.
outcomes for mothers and infants, to assist practitioners to apply the best available research evidence to clinical decisions, and to promote the responsible use of health care resources. Additionally, gaps in the availabil- ity of evidence-based practice will be highlighted. Nurses working in specialty areas or with special needs infants/families (i.e., pre-term infants) will require further practice direction from clinical practice guidelines in their unique area of focus. Bestpractice guidelines (...) Breastfeeding BestPractice Guidelines for Nurses Breastfeeding BestPractice Guidelines for Nurses Nursing BestPractice Guideline Shaping the future of Nursing September 2003Greetings from Doris Grinspun Executive Director Registered Nurses Association of Ontario It is with great excitement that the Registered Nurses Association of Ontario (RNAO) disseminates this nursing bestpractice guideline to you. Evidence-based practice supports the excellence in service that nurses are committed
Relative costs of specialist services in a family practice population The frequency and cost of referrals to specialists in March 1984 for 8980 rostered patients attending a family practice clinic located in a teaching hospital were analysed. The patients made 1891 visits to specialists. In all age groups and for all specialties female patients were more likely to be seen. The total direct provider costs were higher for female patients than for male patients. However, costs per patient seen (...) were higher for male patients, except for psychiatry and medicine. Visits to surgeons had the highest total cost, while visits to psychiatrists had the highest cost per patient seen. Of the direct provider costs 61% was for specialist services. The family physician, in the "gatekeeper" role, has an opportunity to control some of the costs of the health care system by ensuring that the best and most efficient use is made of the referral network.
clearly useful for some important purposes. The large-scale medical practice survey seems particularly valuable in generating an understanding of differences among specialties in resources used in the delivery of care. Nevertheless, researchers and policymakers must understand the steps necessary to obtain reliable results and possible limitations in the accuracy of findings to make the best use of survey methodology as applied to medical practice. (...) Issues in survey data on medical practice: some empirical comparisons. In recent years, researchers and policymakers have used data from large-scale surveys of physicians to address important issues. A review of several of these surveys explores potential problems in this method of gathering data on physicians' services. To obtain a better grasp of the limitations such problems may pose, we examine several recent surveys, comparing response rates and survey findings, and in one survey
who attended one of the hospitals. Prevalence among male general practice patients ranged between 0.1% and 0.2%, while that for male patients attending surgical or surgically related specialties was 0.1%.The prevalence data indicate that HIV has not seeded from the high risk groups into the wider heterosexual population, and that the risk of a surgeon acquiring HIV occupationally is extremely low in a city which has an HIV prevalence similar to or greater than that seen in most other parts (...) Unlinked anonymous HIV study of hospital patients and general practice attenders in Glasgow, 1991â€“1997 To determine whether HIV is spreading from injecting drug users and homosexual/bisexual males into lower risk heterosexual populations in Glasgow, Scotland, and to pilot a method of monitoring HIV prevalence which involves testing routine biochemistry specimens.An unlinked anonymous HIV testing study of hospital patients and general practice attenders was conducted during January 1992
Competition through physician-managed care: the case for capitated multispecialty group practices. The dominant managed care model in the USA is the individual practice association (IPA), in which physicians in separate practices contract with a health plan. One alternative model, the capitated multispecialty group practice (CMGP), has some distinct advantages: (i) the best randomized trial comparing a health management organization (HMO) with indemnity insurance showed equivalent health (...) practices also lack the financial resources and expertise to develop information systems, continuous quality improvement programs, and other means of improving efficiency. Larger groups can integrate specialty and primary care, laboratory, pharmacy, information technology and other services, to improve quality and cost-effectiveness, while maintaining physician control of the process; (iv) in urban California, HMO enrollment in six large capitated groups increased by 91% from 1990 to 1994. Hospital
violated. Given the wide range of specifics in any health-care problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the Board of Trustees. Each has been extensively reviewed and revised by the Committee, other experts in the field, physicians who will use them (...) Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. Guidelines for clinical practice are intended to indicate preferred approaches to medical problems as established by scientifically valid research. Double-blind placebo-controlled studies are preferable, but compassionate use reports and expert review articles are utilized in a thorough review of the literature conducted through Medline with the National Library
Legal issues in the practice of critical care medicine: a practical approach. The intensive care unit is characterized by severely ill patients who frequently succumb to their disease, despite complex modern therapies and the best efforts of dedicated care teams. Although critical care is not historically characterized as a high-risk medical specialty with respect to litigation, the urgency, complexity, and invasive nature of intensive care unit care clearly increases legal risk exposure (...) . Physicians do not practice in a vacuum. Instead, the practice of medicine is increasingly affected by government regulation, societal pressures, and pubic expectations. Law governs the interactions among the government, institutions, and individuals. Therefore, at a time when the practice of medicine itself is becoming increasingly more complex, physicians and other healthcare providers also face increasing administrative and legal challenges. Therefore, it is imperative that physicians develop
Surgeon specialty and operative mortality with lung resection. We sought to examine the effect of subspecialty training on operative mortality following lung resection.While several different surgical subspecialists perform lung resection for cancer, many believe that this procedure is best performed by board-certified thoracic surgeons.Using the national Medicare database 1998 to 1999, we identified patients undergoing lung resection (lobectomy or pneumonectomy) for lung cancer. Operating (...) surgeons were identified by unique physician identifier codes contained in the discharge abstract. We used the American Board of Thoracic Surgery database, as well as physician practice patterns, to designate surgeons as general surgeons, cardiothoracic surgeons, or noncardiac thoracic surgeons. Using logistic regression models, we compared operative mortality across surgeon subspecialties, adjusting for patient, surgeon, and hospital characteristics.Overall, 25,545 Medicare patients underwent lung
included an option to prescribe them (p = .048). Among those practices with standard admission orders, there was greatest prescription for practices additionally having a specialty consultation service (p = .004). There was an inverse association between severity of illness and prescription of bestpractices (p = .001): Sicker patients were less likely to be prescribed best practices.There may be substantial variability in the acceptance and prescription of commonly recommended bestpractices (...) for critically ill patients. Standard order sets and focused specialty consultation may improve knowledge translation and prescription of bestpractice.
failed to adopt the amendment by the required two-thirds majority. Constitutional bylaws of both societies stress the importance of the goal of unification and representation of the specialty of dermatology. Continued rapprochement appears to be in the best interest of the AAD and AOCD and may well enhance our efforts to deal with the challenges that face dermatology and medical practice in the 21st century. (...) Osteopathic medicine and the practice of dermatology: history and current status. An overview of the American Osteopathic College of Dermatology, an affiliate specialty college of the American Osteopathic Association. As the unified training body for osteopathic physicians specializing in dermatology, the American Osteopathic College of Dermatology (AOCD) sponsors 18 dermatology residency programs that integrate academic training (focusing on the core of basic medical sciences) with clinical
analyses indicated that the predictors were useful, but classification table results indicated that at best two out of three cases could be correctly classified.Practicing specialties without prior graduate medical education in those specialties was related to sociodemographic characteristics and type of specialty training, but a fuller understanding of the circumstances affecting physician specialty changes will require querying physicians directly about their practice choices. (...) Predictors of young physicians practicingspecialties without prior graduate medical education. This study identifies predictors of young physicians practicingspecialties for which they did not report having graduate medical education.A secondary analysis was conducted using a nationally representative survey of young physicians, Practice Patterns of Young Physicians, 1987 (United States). Physicians were under 40 years of age and in uninterrupted practice more than one but fewer than six