The Journal of family practice
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Comparative Study Clinical Trial Controlled Clinical Trial
Should intrathecal narcotics be used as a sole labor analgesic? A prospective comparison of spinal opioids and epidural bupivacaine.
Intrathecal narcotics (ITNs) are being used in some settings as a sole labor analgesic. However, they have not been directly compared to epidural analgesia. ⋯ Within the limitations of a nonrandomized study, a single intrathecal injection of morphine and fentanyl has a shorter duration of action and provides less effective pain control than a continuous epidural infusion of bupivacaine and fentanyl. However, ITNs may have a role in settings with limited support from anesthesiologists or for women whose labors are progressing rapidly.
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We studied how physicians' relative satisfaction and/or dissatisfaction with 10 distinct aspects of their work protected against or promoted their plans for leaving their jobs. ⋯ To promote retention, these data suggest that physicians and their employers should avoid physician dissatisfaction in particular. Building particularly high levels of satisfaction generally is not helpful for this end. Avoiding relative dissatisfaction with pay and with community relationships appears broadly important.
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The chasm theory of marketing states that fundamental differences exist between early adopters of technology and the mainstream marketplace, making it difficult for technology to transition to the mainstream market. We investigated possible differences in attitudes and beliefs about electronic medical records (EMRs) between current EMR users (early market) and nonusers (mainstream market). ⋯ A chasm exists between EMR users and nonusers regarding issues that affect EMR implementation, including necessity, usefulness, data entry, cost, security and confidentiality. To reach full implementation of EMRs in family medicine, organizations should use these data to target their research, education, and marketing efforts.