JAMA : the journal of the American Medical Association
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As described in the introduction, the data presented in this report can be viewed in both a historical and an environmental context. From a historical perspective, there has been change in many areas of medical education. The number of applicants to medical schools has risen sharply in the past few years, a result seemingly inconsistent with the dissatisfaction with medicine expressed by many physicians and with the uncertainties about the eventual outcomes of health system reform. ⋯ Therefore, a look at medical education as a whole in the historical context reveals many positive changes (for example, an increase in student diversity over time, the introduction of alternative instructional formats, and attempts to evaluate student clinical competence more reliably). Within the context of environmental expectations, however, many challenges still remain. Medical schools are experiencing pressure to solve perceived problems with the specialty distribution of their graduates and with the specialty distribution of the general physician population, even though factors outside the control of the medical school, such as reimbursement and the practice environment, also influence specialty choice.(ABSTRACT TRUNCATED AT 400 WORDS)
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To review new insights in the pathogenetic mechanisms involved in the development of disseminated intravascular coagulation (DIC) in septic patients, in order to develop new directions for therapeutic intervention. ⋯ The increased knowledge of the various pathogenetic mechanisms of coagulation activation and fibrinolysis in sepsis may have therapeutic implications; however, their efficacy needs to be assessed in appropriate clinical trials.
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Randomized Controlled Trial Multicenter Study Clinical Trial
A controlled trial of educational outreach to improve blood transfusion practice.
To determine whether brief, face-to-face educational outreach visits can improve the appropriateness of blood product utilization. ⋯ Brief, focused educational outreach visits by transfusion specialists can substantially improve the appropriateness and cost-effectiveness of blood product use in surgery. More data are needed regarding the durability of changes in practice patterns and the health and economic benefits of such interventions.