John Noble

Occupational Hazards to Hospital Personnel

Hospital personnel are subject to various occupational hazards. Awareness of these risks, compliance with basic preventive measures, and adequate resources for interventions are essential components of an occupational health program. Physical, chemical, and radiation hazards; important infectious risks; and psychosocial problems prevalent in hospital workers are reviewed. A rational approach to managing and preventing these problems is offered.

Career Differences between Primary Care and Traditional Trainees in Internal Medicine and Pediatrics

OBJECTIVE To assess the relation of Primary Care Residency Training to career choice, board certification, and practice location of internists and pediatricians. DESIGN Cohort study with up to 8 years of follow-up. SETTING The United States. PARTICIPANTS The 17,933 residents trained in all internal medicine (13,750) and pediatrics (4,183) residency programs between 1977 and 1982 were studied using information from the National Resident Matching Program, the AMA Physician Masterfile, the Area Resource File, and a telephone survey. MEASUREMENTS Career choice, board certification, and practice location were studied in relation to five explanatory variables: type of residency (primary care or traditional track), gender, year of medical school graduation, educational orientation of the teaching hospital, and medical school prestige. MAIN RESULTS Graduates of primary care residency training programs chose careers in generalist primary care significantly more often than did graduates of traditional tracks in both internal medicine (72% compared with 54%) and pediatrics (88% and 81%, respectively; P less than 0.001 for both values). Board certification rates in internal medicine were statistically higher for graduates of primary care training programs (80%) than for graduates of traditional programs (76%, P = 0.002) but were not statistically significant for both groups of pediatric graduates. Graduates of primary care programs in pediatrics and internal medicine practiced in medically less served communities more often than did graduates of traditional programs. CONCLUSION Graduates of primary care residency training programs in internal medicine and pediatrics differ from graduates of traditional residency programs in career choices, board certification rates, and practice locations.

Primary Care Internal Medicine: A Challenging Career Choice for the 1990s

A career in primary care internal medicine can be challenging and rewarding, yet during the last decade fewer medical students have selected training in internal medicine. We wish to inform medical students, their advisors, and other physicians about the field of primary care internal medicine. We define the discipline, compare it with traditional internal medicine and with family practice, and describe features of strong primary care internal medicine training programs. We discuss common misconceptions and concerns about training programs and the career and give examples of career paths chosen by graduates of primary care programs. We encourage students to consider the option of primary care internal medicine when making career decisions and provide faculty advisors unfamiliar with primary care internal medicine training programs with a reference resource.

The Codman Competition: Rewarding Excellence in Performance Measurement, 1997–2006

BACKGROUND Since 1997 the Ernest Amory Codman Award, the only health care award that recognizes excellence in performance measurement, has honored organizations and individuals for their use of process and outcomes measures to improve organization performance and quality of care. INDIVIDUAL AWARD WINNERS The individual Codman award winners have advanced measurement of systems performance, health outcomes, and customer satisfaction. ORGANIZATION AWARD WINNERS Forty-two organizations have been selected as winners. The work for which these organizations were recognized was categorized as improvements in direct patient care services, improved effectiveness of care through better teamwork, interdisciplinary planning, improvement of administrative processes, and improved quality of care in large regions or health care systems. Case studies from four organizations that have won the Codman award each represents a lesson or theme that may be instructive for other health care organizations--(1) the need for catalysts or agents of change, (2) evidence-based clinical pathways are essential for delivering optimal care to patients in large organizations, (3) quality assessment and improvement methods from other industries can be successfully applied to health care, (4) as health care is increasingly delivered by large networks and systems, quality takes on regional and even national relevance. CONCLUSION The scope of Codmans endeavors is reflected in the array of quality improvement projects selected as Codman award winners.

Managing multiple risk factors: A call to action

With the exception of obesity, risk factors for cardiovascular disease rarely occur as single conditions. Because these multiple factors often act synergistically, causing a geometric increase in overall cardiovascular risk, it is essential that their recognition and management be a goal of comprehensive preventive care. Physicians must make every effort to implement strategies to maximize risk reduction, including modification of an individuals lifestyle, appropriate pharmacologic treatment when indicated, involvement of the family, the community, and the media, patient education, and ready access to support and health services.