bluuebunny/crossref_metadata_2025 huggingface dataset:
Medindflydelse i virksomheden
Authors: Redaktionen -
Published: October 2018

I studier af medindflydelse på arbejdspladsen skelnes der ofte mellem de ansattes direkte og indirekte indflydelse. Den direkte medindflydelse udøves af den enkelte ansatte eller grupper af ansatte og relaterer sig primært til det operative niveau, dvs. beslutninger omkring selve arbejdets udførelse. En del af dette felt blev behandlet i tidsskriftets nr. 1, 2005, hvor temaet var Team-organisering af arbejdet. Til forskel herfra er det med dette og det kommende nummer af Tidsskrift for Arbejdsliv hensigten at fokusere på former for medindflydelse, som rækker ud over det operationelle niveau, og som især er af typen indirekte indflydelse. Den indirekte indflydelse udøves via de ansattes valgte repræsentanter og retter sig i højere grad mod beslutninger på det taktiske og strategiske niveau, dvs. de mere overordnede beslutninger, der har at gøre med virksomhedens teknologi, arbejdsorganisation, forretningsområde, investeringer mv. En oplagt indgang til begrebet medindflydelse er at placere det i forhold til ledelsesretten. Her i landet har arbejdsgiverne siden storkonflikten og September-forliget i 1899 utvetydigt haft retten til at lede og fordele arbejdet. Men ledelsesretten er ikke uindskrænket. Den begrænses af såvel af de kollektive overenskomster som af en række institutioner, der giver de ansattes repræsentanter mulighed for at øve indflydelse på ledelsesbeslutninger: ¥ tillidsrepræsentanten, hvis opgaver, pligter og rettigheder er fastlagt i overenskomsterne ¥ samarbejdsudvalget, som fungerer på grundlag af kollektive aftaler på det private og offentlige område ¥ sikkerhedsrepræsentanten og sikkerhedsudvalget, hvis roller er beskrevet i arbejdsmiljølovgivningen ¥ lønmodtageres repræsentation i selskabsbestyrelser som fastlagt i selskabslovgivningen. Det er disse institutioner, der først og fremmest er kanaler for de ansattes kollektive, repræsentative indflydelse på virksomheder og i offentlige institutioner. Dertil kommer, at de ansattes repræsentanter kan øve indflydelse i mere uformelle eller konkret definerede sammenhænge, fx gennem repræsentation i udviklings- eller projektgrupper, der planlægger forandringer på virksomheden. Endelig er der den betydning for forholdet mellem ledelsesret og medindflydelse/medbestemmelse, som lovgivningen-og i de senere år EU-direktiver-udgør. Indflydelsen er indirekte, men ikke desto mindre kan den være af stor betydning, fordi det sætter de rammer, som parterne skal arbejde under-og som de kun selv har stærkt begrænset indflydelse på. Medindflydelse over for ledelsesret kan ses i et magtperspektiv. Medindflydelse kan tolkes som et instrument til at øge de ansattes magt på bekostning af ledelsens magt. Denne tolkning giver dog kun begrænset mening. For det første er den magt, der tildeles de ansatte gennem reglerne om medindflydelse, grundlæggende ikke en magt, de får på ledelsens bekostning. På bestyrelsesniveau er der tale om mindretalsrepræsentation, og i samarbejdsudvalgene er der almindeligvis
Social- og sundhedshjælperelevers omsorgsorientering og hjælperarbejdets modsætningsfyldte krav
Authors: Liveng Anne , Liveng Anne
Published: October 2018

Denne artikel handler om social- og sundhedshjælperelevers orientering mod omsorgsarbejdet og om, hvordan arbejdets indhold og rammer på en gang forudsætter og negligerer denne 'omsorgsorientering'. Gennem analysen af et livshistorisk interview med Lotte, der er sosu-hjælperelev, viser jeg, hvordan omsorgsorienteringen er en del af en livshistorisk socialisation for Lotte, hvordan den farver hendes uddannnelses- og jobvalg, og hvordan omsorgsorienteringen projiceres ud i hendes fremtidsdrømme. Klip fra observationer med Lotte i uddannelsens praktikperiode il lustrerer de modsætningsfyldte krav til Lotte, når hun er på arbejde i hjemmeplejen.
Ungdom-selvidentitet eller krise?
Authors: Gudmundsson Gestur
Published: October 2018

Siden 1993 har det i Danmark været en politisk målsætning at give 95% af hver årgang en ungdomsuddannelse, men i realiteten er denne andel forlængst stagneret omkring 80%. Reformerne af ungdomsuddannelserne i denne periode har i høj grad været styret af andre modstridende målsætninger, og har kun i lille grad baggrund i forskningsbaseret viden. Denne artikel er baseret på observationer og opfølgning i 12 pædagogiske institutioner, som arbejder med unge, som ikke gennemfører en ungdomsuddannelse på ordinære vilkår. Ved også at inddrage ungdomsteori og anden relevant forskning udvikles den analyse, at reproduktionen af klasseuligheder i Danmark i stigende grad foregår igennem en smadring af identitetsudviklingen blandt et betydeligt mindretal af ungdommen, mens både reformarbejde og forskning har opereret med alt for snævre forståelser af såvel problemer som reformmuligheder.
Mellem drømme og realiteter — tre historier om at uddanne sig til møbelsnedker
Authors: Juul Ida
Published: October 2018

I denne artikel undersøges den rolle, erhvervsuddannelserne fra uddannelsesplanlæggernes side blev tiltænkt i efterkrigstiden. Disse forestillinger perspektiveres af tre forskellige fortællinger om, hvordan et uddannelsesforløb indenfor møbelsnedkerfaget kunne opleves i henholdsvis 1960'erne, 1980'erne og i 2006. Ideen med at anvende livshistoriske interview er, at gøre det personlige og subjektive til et historisk studieobjekt og dermed undersøge et væsentligt aspekt, som hidtil har været relativt underprioriteret i studier af efterkrigstidens uddannelseshistorie.
Lange og skæve arbejdstider — kan øget indflydelse bedre balancen?
Authors: Albertsen Karen , Kristensen Tage Søndergaard , Pejtersen Jan
Published: October 2018

arbejdstidens tilrettelæggelse er et af de forhold i arbejdslivet, som har størst indfl ydelse på privatlivet. Artiklen undersøger, hvilken rolle arbejdstidens længde og placering samt graden af indflydelse på placeringen af arbejdstiden spiller for oplevelsen af balance mellem arbejde og privatliv. Desuden undersøges, hvordan oplevelsen af balance mellem arbejde og privatliv ser ud i forskellige familie-typer og for ansatte i stillinger med potentielt grænseløst arbejde sammenlignet med ansatte i andre stillinger. Artiklen konkluderer, at øget indflydelse på placeringen af arbejdstiden har en positiv, men ret begrænset virkning, og ikke ser ud til at kunne mindske de negative konsekvenser af lange og uregelmæssige arbejdstider. Hvis balancen mellem arbejde og privatliv for alvor skal bedres, er det derfor nødvendigt at mindske arbejdstiden for de mest belastede grupper og at reducere arbejdet på 'skæve' tidspunkter mest muligt.
arbejdsrelateret stress — fra symptomer til et komplekst samspil
Authors: Andersen Lars Peter , Andersen Lars Peter
Published: October 2018

Et stigende antal mennesker giver udtryk for, at de i deres dagligdag føler sig stressede, og et stigende antal mennesker sygemeldes på grund af stresssymptomer. Det er dog ikke klart, hvad det vil sige at føle sig stresset endsige klinisk defineret, hvornår en person er syg på grund af stress. Artiklen redegør for, hvorledes det måtte opleves at være stresset på baggrund af eksisterende litteratur. Resultaterne viser, at stresssymptomer dækker over en bred vifte af symptomer fra milde symptomer til mere alvorlige symptomer, der kan være så belastende, at det kan sidestilles med en psykiatrisk diagnose.
Selvledelse under IT-understøttede ledelsessystemer
Authors: Andersen Vibeke , Nielsen Flemming
Published: October 2018

I dag ser vi, at det moderne arbejdsliv i stigende grad er karakteriseret ved at en ræk ke nye former for medarbejdermålinger, moniteringer og evalueringer indføres-ofte som led i indførelsen af nye ledelseskoncepter.
Vikarer mellem fl eksibilitet og sikkerhed
Authors: Andersen Søren Kaj
Published: October 2018

Flexicurity dukkede først op i Holland, og her var der fra start af fokus på ansatte i 'atypisk' beskæftigelse-det vil sige vikarer, tidsbegrænset ansatte og deltidsansatte. Spørgsmålet blev, i hvilket omfang disse fleksible ansættelsesforhold blev fulgt af en høj sikkerhed i forhold til løn- og ansættelsesvilkår. Det er en markant forskellighed i forhold til den danske fl exicurity diskussion, hvor der har været fokus på, hvordan den 'normale' ansættelsesforhold både er fl eksibelt på grund af liberale ansættelses- og afskedigelsesregler og sikkert på grund af en relativt høj understøttelse ved ledighed og den aktive arbejdsmarkedspolitik. Inspireret af den hollandske tilgang til flexicurity vil det i denne artikel blive diskuteret, om vikarer på det danske arbejdsmarked er omfattet af flexicurity. Yderligere vil det blive diskuteret, hvorfor andelen af vikarer på det danske arbejdsmarked vokser markant i disse år, når vi nu har en meget fl eksibel regulering af ansættelser og afskedigelser.
Videoendoscopia em equinos ao alcance todos: os recursos do smartphone
Authors: Winter Gustavo Henrique Zimmermann , Passos Luis Felipe Pelinson , Souza Andreza Morais de
Published: October 2018

O diagnóstico por imagem é ferramenta importante no dia a dia da clínica de equinos. Os equipamentos, no entanto, requerem um alto capital imobilizado. O presente trabalho idealiza e apresenta uma alternativa de baixo custo e alta praticidade para a realização de videoendoscopia em equinos através do uso de mini câmeras acopladas ao smartphone. A partir de um dispositivo Android® (tablet ou smartphone), uma sonda flexível e um boroscópio (câmera USB) é possível montar um videoendoscópio para uso no campo. O presente artigo ensina como montar o videoendoscópio, suas vantagens e desvantagens, e apresenta exemplos das imagens visualizadas. Nos exames realizados em equinos foi posível visualizar as vias aéreas, parte do sistema digestivo e parte do útero nas éguas. Entende-se que a videoendoscopia aqui apresentada é um interessante recurso de triagem diagnóstica ao médico veterinário de campo, bem como em uso na educação do acadêmico em medicina veterinária ou cursos de educação continuada.
Comportamento ingestivo de éguas e potros da raça Crioula em campo nativo melhorado
Authors: Pereira João Danilo Biffi , Vilanova Marcele Sousa , Andelieri Caroline Braga , Giacomet Cátia Dal Bello , Perin Willian
Published: October 2018

O objetivo deste trabalho foi avaliar o comportamento ingestivo de éguas da raça Crioula, prenhas e com potro ao pé, em pastagem de campo nativo melhorado, durante os turnos da manhã, meio-dia e tarde. O experimento foi realizado na Cabanha Tamboré, localizada no município de São Francisco de Paula, no estado do Rio Grande do Sul. Foram selecionadas oito éguas com idade média de 9 anos, prenhas, com potros ao pé. Os animais foram alocados em um potreiro de 8 ha, composto por pastagem nativa, melhorada com trevo branco, trevo vermelho e cornichão. Foram avaliados três tratamentos: turno da manhã, turno do meio-dia e turno da tarde, durante o período das 8h às 18h, compreendendo dez horas totais de avaliação. A coleta dos dados foi realizada em três dias consecutivos. Foram anotadas as frequências dos comportamentos ingestivos e a interação entre os animais égua/égua, égua/potro e potro/potro. O método de avaliação utilizado foi o do etograma, técnica de amostragem do animal focal, com intervalos de 10 em 10 minutos entre as observações. O delineamento experimental foi inteiramente casualizado, com 24 repetições de cada tratamento (para potros e para éguas, distintamente). Os resultados obtidos foram submetidos à análise de variância e as médias comparadas pelo teste t a 5% de probabilidade. Os três principais comportamentos realizados pelos potros, durante as 10 hs de avaliação, foram dormir, ficar em ócio e pastejar, enquanto as éguas apresentaram como maior frequência os comportamentos de descanso e pastejo. O conhecimento das variáveis comportamentais em potros e éguas em pastoreio permite ao criador uma ferramenta para melhor manejar seus animais.
Cavalo Campeiro: Passado, Presente e Futuro do Marchador das Araucárias
Authors: Souza Anderson Fernando de , Fonteque Joandes Henrique , Costa Dirceu
Published: October 2018

O Brasil é dotado de um número considerável de raças naturalizadas de animais de produção e equinos que, em grande, parte não são conhecidas ou reconhecidas pelos produtores/população, os quais voltam a atenção às raças exóticas devido ao marketing massivo existente. A formação destas raças não foi fruto de uma estratégia ou planejamento, mas sim oriunda da adversidade e de acontecimentos históricos sucessivos, aliada à dedicação e visão futurista de pessoas que se esforçaram e ainda se esforçam para sua conservação e melhoramento. Com o cavalo Campeiro, que tem origem nos animais trazidos durante as expedições espanholas de 1541, não é diferente. Trata-se de um grupamento genético de grande valor, mas pouco lapidado, em que não há na literatura um resgate histórico sólido e uma análise de sua situação atual. Sendo assim, esse artigo tem por objetivo apresentar uma revisão literária sobre os equinos da raça Campeiro, abordando aspectos históricos, de formação, condições atuais e perspectivas futuras, além de uma matriz SWOT da raça para servir como ferramenta de promoção e fomento a estratégias para a conservação da raça.
Tratamento de úlcera indolente em equino
Authors: Melo João Cardoso de , Fagundes Bruno , Melo Vera Cardoso de
Published: October 2018

O presente estudo objetiva relatar o tratamento de uma úlcera corneana indolente em equino, através do emprego associado de debridamento do tecido epitelial necrótico com broca de diamante e medicação tópica. Os sinais clínicos foram confirmados pelo exame com fluoresceína em strips. No dia 0, o cavalo foi anestesiado topicamente por cloridrato de proximetacaína 0,5% (Anestalcon®) e foi realizado o debridamento com uma broca de diamante manual (Algerbrush II®) de cabeça média. O tratamento medicamentoso envolveu a administração de soro autólogo refrigerado e colírios à base de moxifloxacino (Vigamox®) e de ácido hialurônico (Hyabak®), ambos de 4 em 4 horas, por 14 dias, com revisões nos dias 7 e 14, mantendo-se o animal confinado para evitar a ocorrência de possíveis traumas e complicações. Nas revisões, observou-se o progresso efetivo do tratamento, com avanço favorável da reepitelização da córnea como esperado no dia 7. No dia 14 a córnea já se encontrava completamente reepitelizada, possibilitando que se reputasse o tratamento como totalmente bem sucedido. Concluiu-se que a abordagem de tratamento empregada se demonstrou eficaz para a completa cicatrização da córnea e o fez de forma rápida, um objetivo a ser buscado particularmente quando o caso em questão envolve animais utilizados no desempenho de atividades laborais.
Hemoperitoneo por linfoma em raiz mesentérica em equino
Authors: Cicolo da Silva Sofia , Volpato Maria Eduarda Moreira , Spagnolo Julio David , Torres Luciana Neves , Ríspoli Vivian Fratti Penna , Castro Paulo Henrique dos Santos , Barros Aline De Matos Curvelo , Belli Carla Bargi
Published: October 2018

Hemoperitoneo é o acúmulo de sangue na cavidade peritoneal, uma condição pouco relatada na espécie equina. Relata-se aqui o caso de um equino, Quarto de Milha, macho, 6 anos de idade, com queixa de edema recorrente em bolsa escrotal, distensão abdominal e alterações em auscultação pulmonar. O exame físico revelou baixo escore corporal, taquicardia, mucosas congestas e distensão abdominal. Realizou-se abdominocentese, onde foi observado líquido peritoneal sanguinolento, com 5% de hematócrito, proteína 2 g/dL, 24.900 de células nucleadas e lactato 18,6 mmol/L. No ultrassom abdominal, notou-se grande quantidade de líquido com presença de fibrina e baço com superfície irregular, de tamanho reduzido e afastado da parede abdominal. Indicou-se uma laparotomia exploratória, onde, além de grande quantidade de líquido sanguinolento, observou-se a presença de formação tumoral em porção distal do jejuno, estendendo-se desde a raiz mesentérica até a junção com a alça intestinal. Devido à impossibilidade de remoção cirúrgica, indicou-se a eutanásia. Durante a necropsia, além da tumoração, havia também aumento de linfonodos mediastinais. O exame histopatológico indicou linfoma na forma multicêntrica. O incomum do caso é o acometimento da raiz mesentérica e o desenvolvimento de distensão abdominal e hemoperitoneo. O diagnóstico definitivo com o animal vivo é difícil, porém neste caso foi possível devido à laparotomia exploratória. Conclui-se que o linfoma deve ser considerado como diagnóstico diferencial em cavalos com hemoperitoneo.
Avulsão parcial de casco em equino com crescimento laminar em aparente fluxo ascendente
Authors: Reis Luiza De Siqueira Almeida , Campebell Rita de Cássia , Câmara Antônio Carlos Lopes , Neto Antônio Raphael Teixeira , De Castro Márcio Botelho , Wilson Tais Meziara , Moreira Igor Louzada
Published: October 2018

Avulsão do casco é descrita com uma laceração aguda ou ocasionada por lesões crônicas por traumas repetitivos, podendo ser completa, com perda total dos tecidos, ou incompleta, na qual uma borda do casco permanece intacta. A parede do casco, região coronária, sola, falange distal, lâminas e a articulação interfalangeana distal podem estar envolvidas. Neste trabalho, relata-se o caso de um equino, SRD, macho, adulto, de aproximadamente 15 anos e com 285 kg, encaminhado ao hospital veterinário apresentando ferida com secreção purulenta, tecido necrosado e avulsão na porção dorsal da pele e região coronária do membro pélvico direito, além de edema distal da articulação metatarso-falangeana e claudicação. Na avaliação física, observou-se extensiva lesão traumática no casco do membro pélvico direito, com perda de parte da muralha no aspecto dorsal, tecido ulcerativo e necrótico, com incrustações compactas e de odor fétido, presença de miíase na sola e claudicação de grau 5. A terapêutica aplicada associada à abordagem cirúrgica promoveu evolução satisfatória da ferida podal, com progressiva eclosão do estojo córneo em direção oposta ao que é comumente observado, isto é, a cicatrização adquiriu uma oclusão advinda da região distal, próxima à pinça do casco em direção à coroa, adquirindo fornecimento constante de novas células na região lamelar, gerando um aparente fluxo laminar ascendente e considerável diminuição de secreção e redução da claudicação para grau 3.
Healthcare reform and practice choices: A survey of osteopathic medical students
Authors: Ross-Lee Barbara , Shubrook Jay H. , Solomon Jeff A.
Published: October 2018

Medical students are major stakeholders in the changing world of healthcare. Initiatives to change the specialty makeup and geographic distribution of the physician workforce, changes in the organization of healthcare delivery systems, and financing systems for healthcare will profoundly alter their practice environment while they are in school and just beginning to make career decisions. The decisions of osteopathic medical students, who currently make up 300/0 of the profession, will shape the profession's response to the new initiatives and determine its place in emerging healthcare systems. The authors surveyed first and second-year osteopathic medical students to ascertain their perceived knowledge, opinions, and intentions as they relate to healthcare reform. They discovered that increasing numbers of students intend to practice in primary care fields. The student respondents support some of the major changes proposed by reformers in greater numbers than physicians as a whole, and have different priorities that they would like to see addressed in reform. This study reveals links between respondents' intentions to practice primary care and support for specific reform items, but the results show no link between anticipated indebtedness and respondents' intentions to enter primary care or specialty fields. The authors conclude that healthcare reform, although still in debate, has already exerted an influence on the decision-making processes of medical students.
Atrophy of suboccipital muscles in patients with chronic pain: A pilot study
Authors: Greenman Philip E. , Hallgren Richard C. , Rechtien James J.
Published: October 2018

Magnetic resonance imaging studies were performed in six patients with chronic head and neck pain and in five control subjects to determine whether irreversible atrophic changes resulting in destruction of muscle fibers have a role in patients with chronic pain specific to the cervical spine. Both groups of subjects had medical history obtained and underwent physical examination and proton density-weighted (PD-weighted) magnetic resonance imaging. Subjects with chronic pain had substantial restriction of motion. Axial proton density-weighted images of the rectus capitis major and minor muscles were examined. In the subjects with chronic pain, the muscles had high signal intensity, indicating replacement of dead suboccipital skeletal muscle with fatty tissue. This infiltration was not observed in the control subjects who were free of significant motion restrictions and had no history of recurring neck and head pain. Analysis of pixel intensity values confirmed this finding. The reduction in proprioceptive afferent activity in affected muscles may cause increased facilitation of neural activity that is perceived as pain. A least mean squares algorithm was used to define a linear estimating equation for each subject. linear regression analysis, using an alpha level <.005, was used to determine how well each subject's data fit the estimating equation. This preliminary work indicates substantial infiltration of fatty tissue into suboccipital muscles of some subjects being treated for chronic head and neck pain.
Medical liability, product liability, and the question of tort reform
Authors: Ross-Lee Barbara , Kiss Lois E. , Weiser Michael A.
Published: October 2018

Physicians have identified malpractice reform as their first priority during the recent flurry of national reform initiatives. Their focus on malpractice, however, tends to obscure the relationship between malpractice and the systemic problems wracking our healthcare delivery system. Because malpractice has an impact on all three foci of comprehensive reform-quality, cost, and access-it is reasonable to expect healthcare reform to include some manner of tort reform. However, it is important to realize the tangential nature of the relationship and keep the focus of reform on the underlying issues of system reform. The authors define the areas of physician liability under tort law (both malpractice and product liability), point out the misperceptions that inform physician behavior, and review the individual reforms proposed. They identify the stakeholders and their positions on each proposal, while imploring a cooperative, systemwide approach to tort reform.
Performances of candidates with osteopathic compared with allopathic subspecialty training on the American Osteopathic Board of Internal Medicine subspecialty certifying examinations 1984 to 1992
Authors: Slick Gary L. , Dolan Sandra
Published: October 2018

The American Osteopathic Board of Internal Medicine has been examining various factors that may affect candidate performance on subspecialty certifying examinations. To see whether taking subspecialty training in an osteopathic compared with an allopathic institution could predict better performance on the certifying examinations, the authors analyzed examination performance for all candidates from 1984 through 1992. There was no significant difference between the mean scores for the two groups for any of the nine subspecialty certifying examinations. When the results from all nine examinations were pooled, the mean first-time examination takers' score for candidates in allopathic subspecialty programs (n=201) was 78.3 and for those in osteopathic subspecialty programs (n= 153), 77.4 (P> O.2). On the basis of these results, we cannot conclude that osteopathic subspecialty training is a factor that predicts better performance on the subspecialty certifying examination.
Planning a medical relief mission
Authors: Lesho CPT Emil P.
Published: October 2018

Surveillance of drug consumption and disease incidence from medical relief missions in two locations (southeast Asia and eastern Africa) revealed close similarities. Analgesics, antibiotics, antimalarials, antihistamine or decongestant preparations (or both), bronchodilators, and scabicides were the 10 most commonly used drugs. Orthopedic, respiratory, gastrointestinal, dermatologic, and ophthalmic conditions, malaria, sexually transmitted diseases, and parasitic infestations were encountered most frequently. Recognition and early treatment of xerophthalmia, trachoma, and onchocerciasis, which are rare in more developed countries but common at tropical latitudes, can prevent the blindness that results from untreated disease progression. Pulsetemperature relationships and fever patterns may offer diagnostic clues to physicians deprived of laboratory support. Important logistic considerations, disease incidences, and selected topics and idiosyncrasies of humanitarian aid missions to tropical communities are discussed in hopes of aiding providers who are planning future relief missions.
Bicarbonate therapy in the treatment of lactic acidosis: Medicine or toxin?
Authors: Sing Ronald F. , Branas Charles A. , Sing Robert F.
Published: October 2018

The metabolic acidosis resulting from poor tissue perfusion is considered to have several significant hemodynamic effects. Correction of the acidosis with sodium bicarbonate seems to be a rational approach to this problem. However, the current medical literature shows little clinical benefit to this tactic. In fact, indiscriminate bicarbonate administration may, itself, have deleterious effects. Concurring with the absence of a consistent therapeutic advantage to the use of sodium bicarbonate in the treatment of lactic acidosis due to inadequate tissue perfusion, the American Heart Association removed the routine use of sodium bicarbonate from the treatment of cardiac arrest in the algorithms of the Advanced Cardiac Life Support course. Although the debate continues, a detailed review of the medical literature does not support the use of sodium bicarbonate in this setting.
Female enrollment in colleges of osteopathic medicine: Five years and five percentage points behind
Authors: Baker Helen H.
Published: October 2018

An estimated one fifth of graduates of the colleges of osteopathic medicine (COMs) before 1910 were women. However, the proportion of women declined after 1900, so that by 1969, less than 3% of osteopathic medical students were women. Dramatic gains have been made in the past 25 years: for the 1993-1994 academic year, women made up 35% of all osteopathic medical students. Although these gains seem impressive, allopathic medical school enrollment comprised 400/0 women during the same academic year (5 percentage points higher than in osteopathic medical schools). Allopathic medical schools have had significantly more women enrolled every year between academic years 1969-1970 and 1993-1994. In. academic year 1985-1989, allopathic medical schools already had an enrollment that consisted of 35% female students, a percentage that COMs would first reach 5 years later. Based on these findings, enrollment of women in COMs is 5 years and 5 percentage points behind that of allopathic medical schools.
Twenty-year experience with the Mentor bladder pacemaker
Authors: Finkelstein Leonard H. , Coffman Leland M.
Published: October 2018

Twenty years after placement of a Mentor bladder pacemaker, a 38-year-old woman with spina bifida cystica still has controlled detrusor contraction and complete bladder emptying. The varied treatment modalities for this difficult group of patients has included electronic bladder stimulation. Although no longer commonly used, electronic bladder stimulation has shown long-term efficiency in this patient.
Reexamination of the paradigm of HIV risk reduction in adolescents
Authors: Karl Daniel Thad
Published: October 2018

Infection with the human immunodeficiency virus (HIV) in the adolescent/young adult population of the United States is a serious, growing problem. The current HIV risk reduction strategies for adolescents have been less than effective in stemming the tide of infection. This ineffectiveness can be linked to failure of making developmentally appropriate risk-reduction informational material and reliance on condom-based interventions, which have an unacceptably high failure rate. A critical analysis of current models of HIV-risk reduction should be undertaken to create more developmentally appropriate and effective methods.
Challenges and opportunities in occupational medicine
Authors: McCunney Robert J.
Published: October 2018

Recent position papers of the American College of Physicians and the Institute of Medicine have emphasized the role of primary care physicians in occupational medicine. Although opportunities for physicians to become certified in occupational medicine have expanded, shortages in the specialty are likely to persist throughout the 1990s. To help acquaint osteopathic physicians with some of the challenges facing the specialty of occupational medicine, this article addresses the extent of occupational illnesses, health-related policies in the workplace, the delivery of occupational medical services, and graduate medical education.
Does Sjogren's syndrome predispose surgical patients to acquired hemophilia?
Authors: Dachman Adam F. , Margolis Harold , Aboulafia Elie
Published: October 2018

The authors report the first American case of a factor VIII inhibitor found in a patient with Sjogren's syndrome. The inhibitor was isolated from a patient with no known hematologic disorder who was seen with a compartment syndrome of the left thigh after sustaining a fall from bed. The Sjogren's syndrome had been previously diagnosed via lower lip biopsy. After fasciotomy, signs and symptoms of intra-abdominal hemorrhage developed, and the patient was taken to laparotomy, where no hemorrhage was found. A coagulopathy developed, and the patient's hemoglobin continued to fall. A complete factor analysis revealed a factor VIII inhibitor that was quantified at 40 Bethesda units. After vigorous therapy-which included factor concentrates, immunoglobulins, steroids, antifibrinolytic agents, and blood replacement-the patient's bleeding stopped and she continued to convalesce under hospital care until her ultimate death from respiratory problems. Acquired hemophilia with a factor VIII inhibitor may be associated with Sjogren's syndrome.
The amobarbital sodium interview in conversion disorders: Use of video feedback in therapy
Authors: Bradley Ronald H. , Zonia Carolynn L. , Caputo Sam J.
Published: October 2018

The prognosis in treating acute conversion disorder is good, but it demands considerable time in the form of an intensive, and often extensive, hospital stay. With the increasing trend to limiting hospital stays, the family practitioner working with a psychiatrist in the hospital setting is pressured to find new approaches in order to limit the use of inpatient units. The authors describe a case of classic conversion disorder and outline a successful approach that uses a video recording of the interview, during which the patient is under the influence of amobarbital sodium. The videotape then provides valuable feedback during future therapy sessions in the treatment of this persistent disorder.
Interexaminer agreement on palpatory diagnosis and patient self-assessment of disability: A pilot study
Authors: Patriquin David A. , Beal Myron C.
Published: October 2018

To evaluate interexaminer agreement on palpatory diagnostic findings, we compared interexaminer results, patient disability self-evaluations, and assessment of patients' progress by referring physicians. Three examiners (two clinicians and a third-year osteopathic medical student fellow) monitored patients' progress using negotiated examination procedures. The patients were examined independently by each examiner at each of eight weekly visits. Patients completed a disability assessment form at each visit, and the referring physicians recorded changes in their patients' condition. The patients' disability self-rating and examiner test results did not show clear correlation. There was a 62.2% agreement between the two physician examiners when the general descriptors ''improvement,'' ''no change," or "aggravation" were used. The student examiner's agreement with the clinician examiners was 60.2% and 51.8%. Interexaminer agreement of findings from osteopathic testing procedures appears to depend on general clinical experience and specific experience with the testing procedures.
Cranial findings and iatrogenesis from craniosacral manipulation in patients with traumatic brain syndrome.
Authors: Greenman Philip E. , McPartland John M.
Published: October 2018

Craniosacral findings were recorded for all patients with traumatic brain injury entering an outpatient rehabilitation program between 1978 and 1992. The average cranial rhythmic impulse was low in all 55 patients (average, 7.2 c/min). At least one cranial strain pattern was exhibited by 95%, and 87% had one or more bony motion restrictions. Sacral findings were similar to those in patients with low back pain. Although craniosacral manipulation has been found empirically useful in patients with traumatic brain injury, three cases of iatrogenesis occurred. The incidence rate is low (5%), but the practitioner must be prepared to deal with the possibility of adverse reactions.
Topical metronidazole for arterial insufficiency ulcers
Authors: PharmD Barbara Kaplan, , Gibson Leo B.
Published: October 2018

The use of topical metronidazole has been limited to the treatment of acne rosacea, infected foot ulcers associated with diabetes mellitus, varicose veins, postirradiation ulcers, and dental conditions since the Food and Drug Administration approved the drug in 1988. Because of this agent's apparent effectiveness in treating anaerobic bacterial infections in such ulcers, the authors believed that treatment of arterial insufficiency ulcers with a solution of topical metronidazole would be a rational approach. They describe a 30-year-old man in whom bilateral lower extremity cellulitis developed as a result of arterial insufficiency. The patient's ulcers were unresponsive to intravenously administered antibiotics and whirlpool therapy. However, when a topical solution of metronidazole was administered, the ulcers began to heal and epithelialization at the ulcer sites occurred. The authors review others' studies concerning clinical use of topical metronidazole and suggest that further study is warranted. To the authors' knowledge, topical metronidazole solution for the treatment of arterial insufficiency and venous stasis ulcers has not been previously reported.
Fatal venous air embolism after removal of a central venous catheter
Authors: Sing Ronald F. , Steffe Thomas J. , Branas Charles C.
Published: October 2018

Venous air embolism is an infrequent, but potentially disastrous, occurrence after the insertion or removal of central venous catheters. The authors describe fatal venous air embolism after removal of a central venous catheter in a 43-year old man recovering from coronary artery bypass surgery. They discuss the pathophysiology, diagnosis, treatment, and prevention. Several practical considerations are necessary to prevent this complication of central venous catheterization, a procedure commonly delegated to junior house officers.
Changes in presence of a segmental dysfunction pattern associated with hypertension: Part 1: A short-term longitudinal study
Authors: Johnston William L. , Kelso Albert F. , Babock Howard B.
Published: October 2018

A statistically significant pattern of segmental components of somatic dysfunction associated with a history of high blood pressure was investigated for change after an interval of 4 to 8 months. The volunteer subjects, from an inner-city ambulatory clinic, included normotensive, borderline hypertensive, and hypertensive persons. A standardized palpatory examination determined whether there were specific motion asymmetries centered at spinal segments C6, T2, and T6 and confirmed by mirror-image motion asymmetries in adjacent segments. Blood pressure measurements and diagnosis of hypertension followed American Heart Association standards. The repeated presence of the pattern in subjects with a history of hypertension was statistically significant. Presence of the pattern in normotensive subjects, however, appeared to be random. The subjects' histories during the study period revealed no influence of antihypertensive medications, major accidents, or illness on the patterns' continuing presence in subjects requiring medical control of their hypertension.
Making sense of federal GME reforms: The impact on osteopathic medicine
Authors: Meyer Christopher T.
Published: October 2018

Physician workforce issues, particularly the generalist/specialist mix, surfaced as a major component of the healthcare reform debate in the last Congress. Both of the major bills before the Congress at the end of the session would have legislated reforms in graduate medical education designed to control the cost, mix, and supply of physician manpower. This article examines the graduate medical education reform measures proposed in the Gephardt (House) and Mitchell (Senate) bills and identifies elements of agreement. Discussion focuses on the potential for reforms that could be enacted in the new Congress, with a look at the implications for the osteopathic medical profession. A second article, to appear in next month's issue, will focus on recommendations for secondary reforms to prepare osteopathic medical institutions for the changing graduate medical education environment. Such a changing environment requires comprehensive reevaluation in all of the institutions of osteopathic medicine-the colleges, the hospitals, and the American Osteopathic Association.
Emphasizing a preventive medicine orientation during primary care/family practice residency training
Authors: Winters Frank D. , Inwald Samson A.
Published: October 2018

In the wake of managed care, primary care physicians are expected to be gatekeepers in the overall healthcare system. As such, preventive medicine, rather than disease-oriented medicine, will play a key role in keeping medical costs in line. To that end, the authors review the current preventive medicine practices and guidelines and suggest ways in which these practices can be implemented in the training of primary care/family practice residents.
'But doctor, someone has to do something': Resolving interpersonal conflicts in the workplace
Authors: Robinett Jane , Cruser des Anges , Podawiltz Alan Lee
Published: October 2018

Physicians are often called on to address interpersonal conflicts among office staff and colleagues. Because such strife can interfere with patient care, physicians should learn to diffuse these situations as adeptly and quickly as possible. The authors outline one approach, which they developed while working at the Oklahoma Department of Mental Health. Designated by the mnemonic LIFT (Listen, Inquire, ask for Feedback, Test), this approach has been used successfully to resolve interpersonal conflict in small groups.
Systemic Malassezia furfur infection in an adult receiving total parenteral nutrition
Authors: Shparago CPT Neal I. , Bruno LTC Philip P.
Published: October 2018

Malassezia furfur sepsis developed in a woman with hyperemesis gravidarum while she was receiving total parenteral nutrition supplemented with lipids. Fever, chills, dyspnea, pleuritic chest pain, and multiple bilateral pulmonary nodular infiltrates were the primary clinical manifestations. Lysis-centrifugation fungal blood cultures supplemented with olive oil grew M furfur. Treatment included removal of the central venous catheter line, discontinuation of the lipid emulsion, and antifungal chemotherapy. Malassezia furfur sepsis complicating total parenteral nutrition may be more common in adults than once suspected. A high index of suspicion is required to diagnose this infection, and the addition of olive oil to the fungal culture medium will provide the necessary growth factors to isolate this fungus.
Accidental epinephrine auto-injector-induced digital ischemia reversed by phentolamine digital block
Authors: Hardy Stephen J. , Agostini Dennis E.
Published: October 2018

The use of epinephrine-containing auto-injectors as a prescription medication for treating routine to severe anaphylactic reactions is now widely accepted. Associated with this trend is an increasing number of accidental injections of epinephrine into digits, causing severe vasoconstriction and the risk of ischemic necrosis. When epinephrine is accidentally discharged into a digit, ischemic skin necrosis resulting from the aadrenergic blocking effects of this agent can lead to the need for multiple operations, wound infection, and even loss of the digit. The a-adrenergic blocking characteristics of phentolamine administered by a variety of methods have proved effective in reversing the effects of epinephrine in these cases. The authors urge that the described treatment protocol become more widely disseminated 'among primary care and emergency physicians.
A standardized form for DSM-IV review of symptoms and mental status examination for students and residents
Authors: Reeves Roy R. , Bullen John A.
Published: October 2018

A common error by medical students and residents is the inadvertent omission of some part of the mental status examination or failure to screen for a psychiatric diagnosis that is not evident on the patient's presentation. The authors introduce a structured questionnaire and standardized form to guide psychiatric and generalist medical trainees through the mental status examination. Based on criteria from the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV), the questionnaire and form are intended to facilitate a psychiatric review of patients without missing key points.
First-pass radionuclide cineangiography in diagnosis of coronary artery disease in patients older than 75 years: Evaluation of sensitivity
Authors: Sacher Howard L. , Sacher Michael L. , Landau Stuart W. , Kersten Roger S. , Dooley Frances , Cnmt Allen Chien, , Dietrich Kathleen A. , Sacher Amy , Sacher Mandy
Published: October 2018

The sensitivity of first-pass radionuclide cineangiography in the detection of coronary artery disease was evaluated in 60 patients subdivided equally according to age younger than or older than 75 years. The mean age of group 1 (age > 75 years) was 80.2 years ±5.3, and the mean age in group 2 (age < 75 years) was 62.0 years ±6.4. Disease prevalence in group 1 was 87% versus 80% in group 2. Group 1 had higher prevalence of hypertension (67% vs 33%) and lower prevalence of typical angina pectoris (23% vs 55%). Overall sensitivity of first-pass radionuclide cineangiography in group 1 was 93% versus 97% in group 2. Older patients had significantly lower maximal heart rates, workloads, and exercise durations, and age correlations were significant for exercise heart rate, workload, and exercise duration. Failure to achieve an adequate exercise endpoint had significant effect on testing sensitivity only in the younger subjects (98% vs 60%), indicating that sensitivity of first-pass radionuclide cineangiography is age independent.
Phenobarbital-induced fibromyalgia as the cause of bilateral shoulder pain
Authors: Goldman Stephen J. , ATC Michelle S. Krings
Published: October 2018

A female swimming instructor was seen with chronic bilateral shoulder pain and loss of range of motion. Intensive physical therapy significantly improved the range of motion but did not alleviate the pain. Osteopathic manipulative treatment produced no further improvement in pain or function. Results of laboratory tests were all within normal limits. Four months after the initial consultation, the patient, who was taking medication for tonic/clonic seizures, recalled that her symptoms began after her anticonvulsant medication was switched from hydantoin sodium to phenobarbital. Therefore, phenobarbital-induced fibromyalgia was diagnosed. In 4 months, pain had completely disappeared. The authors discuss several theories regarding the cause of fibromyalgia and the mechanism of action of phenobarbital, including its relationship to sleep disturbance, a probable contributor to pain and dysfunction in the patient described.
Hospital guidelines for diagnosis-related groups/osteopathic manipulative treatment
Authors: Feely Richard A.
Published: October 2018

The DRG/OMT [Diagnosis-Related Groups/Osteopathic Manipulative Treatment] Master Matrix is a tabulated guideline for helping osteopathic physicians and hospitals document their unique form of healthcare. The DRG/OMT Master Matrix is a quality management tool designed for osteopathic physician care of hospitalized patients. It furnishes a mechanism for relating various diagnostic entities to probable areas of somatic dysfunction. This matrix and the accompanying patient record aid the physician in recording diagnosis and treatment, thus providing the hospital with documentation of osteopathic patient care's competitive advantage. In a hospital record review, OMT use increased from 5% to 15% of patients after the DRG/OMT Master Matrix was introduced.
Cluster headache: A review
Authors: Connors Marilyn J.
Published: October 2018

Cluster headache is a debilitating neuronal headache with secondary vascular changes and is often accompanied by other characteristic signs and symptoms, such as unilateral rhinorrhea, lacrimation, and conjunctival injection. It primarily affects men, and in many cases, patients have distinguishing facial, body, and psychologic features. Several factors may precipitate cluster headaches, including histamine, nitroglycerin, alcohol, transition from rapid eye movement (REM) to non-REM sleep, circadian periodicity, environmental alterations, and change in the level of physical, emotional, or mental activity. The pathophysiologic features have not been completely elucidated, but the realms of neurobiology, intracranial hemodynamics, endocrinology, and immunology are included. Therapy is prophylactic or abortive (or both). Treatment, possibly with combination regimens, should be tailored to the needs of the individual patient.
Use of astemizole in a large group practice
Authors: Craig Timothy J. , Greenwald Mark , Kauffmann Vanessa , Craig Jill
Published: October 2018

Astemizole was released in 1988. In late 1992, a new warning label was added in response to reports of syncope and death from arrhythmia. Records of patients given new prescriptions for astemizole were reviewed to assess compliance with the warnings in a large multispecialty practice. The indication was appropriate in 89% of cases. Excessive doses were used in 4% of cases. Two percent of prescriptions were given to patients with contraindications. Only two complications were documented. Despite carrying a drug warning, astemizole continues to be used inappropriately and is a medicolegal concern. Education and drug evaluations can be used to enhance compliance and decrease the risk associated with the use of astemizole.
ERISA: Pillar of pension reform, roadblock to healthcare reform
Authors: Ross-Lee Barbara , Kiss Lois E. , Weiser Michael A.
Published: October 2018

With Republicans and Democrats agreeing to strategies that move the resources and responsibilities for healthcare reform to the states, the Employee Retirement Income Security Act of 1974 (ERISA) presents even greater barriers than surfaced in federal planning. The single most formidable obstacle to state healthcare reforms, ERISA's preemption clause supersedes all state laws that ''relate to" employee benefit plans. The authors trace the history of pension legislation that led to the strong ERISA protections and explain the interpretations of the law which affect healthcare. They explain the history of the Hawaii plan's waiver; the continual refinement of the law through legislation; and the growing body of case law that interprets ERISA's application through the "relate to" requirement, the "savings" clause, and the "deemer" clause. Finally, they point out that the political solutions being acted out in Congress are leading to poor healthcare policy. Overriding or waiving ERISA would not lead to national health policy solutions and could endanger millions of workers' pension and benefit plans. Meanwhile, the only relief for states comes in slow and incremental steps through the court system.