Wait times, patient satisfaction scores, and the perception of care.

OBJECTIVES: To analyze the impact of waiting time on patient satisfaction scores; not only of satisfaction with the provider in general, but also with the specific perception of the quality of care and physician abilities. STUDY DESIGN: Using surveys regarding patient satisfaction with provider care, data was collected from a sample of 11,352 survey responses returned by patients over the course of 1 year across all 44 ambulatory clinics within a large academic medical center. While a small minority of patients volunteered identification, the surveys were made anonymously. METHODS: A questionnaire with Health Consumer Assessment of Healthcare Providers and Systems patient satisfaction and waiting time queries was administered via mail to all clinic patients-roughly 49,000-with a response rate of 23%. Employing a standard statistical approach, results were tabulated and stratified according to provider scores and wait time experience, and then analyzed using statistical modeling techniques. RESULTS: While it is well established that longer wait times are negatively associated with clinical provider scores of patient satisfaction, results indicated that every aspect of patient experience-specifically confidence in the care provider and perceived quality of care-correlated negatively with longer wait times. CONCLUSIONS: The clinical ambulatory patient experience is heavily influenced by time spent waiting for provider care. Not only are metrics regarding the likelihood to recommend and the overall satisfaction with the experience negatively impacted by longer wait times, but increased wait times also affect perceptions of information, instructions, and the overall treatment provided by physicians and other caregivers.

Mercury from chlor-alkali plants: measured concentrations in food product sugar.

Mercury cell chlor-alkali products are used to produce thousands of other products including food ingredients such as citric acid, sodium benzoate, and high fructose corn syrup. High fructose corn syrup is used in food products to enhance shelf life. A pilot study was conducted to determine if high fructose corn syrup contains mercury, a toxic metal historically used as an anti-microbial. High fructose corn syrup samples were collected from three different manufacturers and analyzed for total mercury. The samples were found to contain levels of mercury ranging from below a detection limit of 0.005 to 0.570 micrograms mercury per gram of high fructose corn syrup. Average daily consumption of high fructose corn syrup is about 50 grams per person in the United States. With respect to total mercury exposure, it may be necessary to account for this source of mercury in the diet of children and sensitive populations.

The forgotten faculty: challenges for Ph.D.s in clinical medical school departments.

The data and discussion contained in this invited paper are based on the opening plenary by the first author whose paper titled "The Status of Ph.D.s in US Medical Schools" was presented at the 3rd national conference of the Association of Psychologists in Academic Health Centers, Minneapolis, MN, May 2007. The significant growth of the number of Ph.D.s in clinical departments is described, as is their distribution. The roles they play; the barriers they face in terms of leadership opportunities, promotion and tenure; and the concerns they voice that are specific to this population are also discussed. Salary differentials between Ph.D.s on main and medical school campuses are provided. Recommendations for future investigation of disparate treatment and for faculty development opportunities specifically aimed at this group are found at the conclusion of the paper.

The challenge for excellence at the University of Louisville: implementation and outcomes of research resource investments between 1996 and 2006.

In the decade beginning in 1996, the National Institutes of Health (NIH) budget doubled, whereas NIH funding at the University of Louisville School of Medicine increased nearly sevenfold. The schools of nursing and dentistry, the other Health Science Center schools at Louisville, experienced comparable growth. The University of Louisville was thus one of the fastest growing research enterprises in the country during this period. While there was an infusion of state funds, the authors believe that the magnitude of the research growth depended more critically on development of an effective strategic plan with closely monitored outcomes. This process included first the identification of programs of distinction deserving of investment and then the reallocation of resources from units that were not research-intensive to those that were. The strategy focused on (1) the recruitment of endowed chairs and their teams (thus the popular name for the program "Bucks for Brains"), (2) the implementation of new promotion and tenure standards, (3) the creation of research-productivity linked salary incentives, (4) the implementation of posttenure review, and (5) an effort to improve research infrastructure, including core facilities, and physical plant. The authors describe how the investment by the Commonwealth of Kentucky was structured and how accountability to the state facilitated this growth. This description of how postsecondary education reform and the infusion of modest resources through the Research Challenge Trust Fund were leveraged into a substantial return-on-investment at Louisville could serve as a guide to schools during this time of NIH budgetary constraint.

Post-tenure review at the University Of Louisville School Of Medicine: a faculty development and revitalization tool.

In 1994, the University of Louisville board of trustees mandated that each school develop a methodology for post-tenure review. Ten years after implementation, this article provides an update on the process and its outcomes. In the case of an unsatisfactory evaluation, a faculty member is re-reviewed two years later. Failed reviews trigger the creation of a faculty development plan. The plan includes specific and measurable requirements to be met within one year, with an additional year to demonstrate success. The plan must clearly state objective goals related to the area of deficiency, development activities that the faculty member will engage in, and resources the institution will provide for the faculty member to achieve the stated goals. Soon after implementation, an increase in retirement rates was observed. Since then, more than 250 post-tenure reviews have been completed in the school of medicine, and over 95% of faculty reviewed received ratings of satisfactory. Outcomes for faculty receiving ratings of unsatisfactory vary. Overall, results suggest that post-tenure review at the University of Louisville School of Medicine has facilitated faculty revitalization not only for those who failed, but also for others as they prepare for the evaluation process. The key to the success of this program is its nonpunitive nature. The focus on faculty development and the resulting reinvigoration of the careers of faculty put a positive spin on what otherwise would have been perceived as a top-down measure to increase faculty accountability.

Morphology of neurons cultured from subdivisions of the mouse cochlear nucleus.

This study was designed to characterize the dendritic organization of cochlear nucleus (CN) cells grown in primary cell culture and to assess differences among cultures grown from different regions of CN. Cultures were prepared from postnatal mice and processed using microtubule-associated protein 2 (MAP2) or gamma-aminobutyric acid (GABA) immunohistochemistry. CN neurons were successfully cultured from preparations grown from either the anteroventral subdivision of the nucleus (AVCN), the posterior region [posteroventral (PVCN) and dorsal (DCN) subnuclei], or the whole CN, although the cultured neurons did not exhibit complex dendritic patterns characteristic of CN neurons in vivo. Neurons cultured from the entire nucleus exhibited an increased rate of survival compared to those cultured from either the anterior or posterior regions, although similar types of cells were observed in all preparations. The majority of cultured CN neurons were GABA-positive and had soma areas that were similar to the areas of immature GABAergic neurons measured in CN sections. Small cells (soma areas or=120 microm(2)) were also present in significant numbers. Overall, CN cultures consisted of a heterogeneous population of neurons that had less elaborate dendritic organizations than cells of corresponding size that have been described in adult animals in vivo.

Subcellular localization of GABA receptors in the central nervous system using post-embedding immunohistochemistry.

The following detailed protocol can be applied to demonstrate the localization of GABA receptors in CNS neurons at the ultrastructural level. While others have investigated receptors at the electron microscopic level using immunocytochemical techniques, the appearance of the tissue is usually poor and analyses of the distribution of receptors is limited. The methodology described in this paper allows for optimal preservation of the tissue while retaining immunogenicity. It does this, in part, by utilizing a balanced salt solution washout in conjunction with fixation. When the ionic composition of a fixative solution differs from extracellular fluids, like in most fixation protocols for electron microscopy, ultrastructural changes may occur in the tissue. Balanced salt solutions, like the Tyrode solution used here, helps maintain the normal extracellular environment allowing the fixing agent to reach sufficient concentration to bring about permanent and more optimal fixation even when reduced amounts of glutaraldehyde are required to preserve antigenicity. Therefore, unlike many protocols for post-embedding immunoelectronmicroscopy, this method allows for superior preservation of tissue ultrastructure compared to results previously published by others.