The Journal of family practice
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Comparative Study
Full clinical departments of family practice: their relationship to hospital privileges in university hospitals.
All 52 family practice residency programs that hospitalize patients at a university hospital were surveyed to determine how many have full clinical departments of family practice and what effect having a full clinical department has on hospital privileges. A full clinical department is defined as one in which all hospital privileges for family physicians are reviewed and recommended by the family practice department without need for review by other specialties, even when the requested privileges overlap with another specialty. Responses were received from 100 percent of the surveyed hospitals. ⋯ When these hospitals were compared with the 36 (69.2 percent) at which there is no full clinical department, it was found that in every area of patient care, hospital privileges for family physicians are more extensive at hospitals with full clinical departments. The American Academy of Family Physicians is currently promoting the formation of full clinical departments of family practice as a method for improving hospital privileges for its members. The results of this study suggest that promoting the formation of full clinical departments will be an effective intervention.
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The mentally incapacitated patient is frequently encountered in the general medical hospital. Incapacity is the clinical state in which a patient is unable to participate in a meaningful way in medical decisions. Mentally incapacitated patients relinquish the authority, that is the competent patient's right, to choose among professionally acceptable alternative treatments. ⋯ Questions of incapacity or the authority of surrogate decision-makers also arose with comatose, mentally retarded, mentally ill, and physically handicapped patients. While standards to determine capacity remain unclear, a practical approach is to demonstrate that a patient is able to describe the physician's view of the situation and to understand the physician's opinion as to the best intervention. When a patient is deemed to be incapacitated, the physician should turn to family members, whenever possible, to make decisions.
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Physician performance was assessed in cardiopulmonary resuscitation (CPR) by the number and type of errors committed. In simulated arrests, physicians previously certified in advanced life support made fewer errors (5.6 vs 14.3, P = .007) than those not certified. ⋯ Guidelines for successful completion of these simulations were developed. This study indicates the need for continued physician education in CPR.
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The predictive value positive of serum iron studies and erythrocyte indices in differentiating between iron deficiency anemia and the anemia of chronic disease (ACD) were determined in 82 hospitalized patients with an iron-binding saturation of 15 percent or less. Iron deficiency, determined by serum ferritin of 20 ng/mL or less, was present in only 31 percent of patients with a serum iron level of 10 micrograms/dL or less; 39 percent of patients with a transferrin saturation of 5 percent or less, and 54 percent of patients with a total iron-binding capacity (TIBC) of 350 micrograms/dL or greater; conversely, iron deficiency was present in only 3 percent of patients with a TIBC of 250 micrograms/dL or less. Iron deficiency was present in 83 percent of patients with a mean corpuscular volume (MCV) of 75 microns3 or less, but only 2 percent of patients with an MCV of 86 microns3 or greater. It is concluded that the MCV has strong predictive value positive (and negative) when below (or above) the values just cited, but that serum iron studies do not have sufficient predictive value to justify their use in the routine differentiation between iron deficiency anemia and the ACD in hospitalized patients when no other cause for anemia is likely.