Community hospital and medical school cooperation in continuing medical education.

PURPOSE: To determine the extent and trends of cooperation in continuing medical education (CME) between community teaching hospitals and medical schools in the United States. METHOD: A questionnaire was sent in September 1992 to the directors of CME at 276 teaching hospital members of the Association for Hospital Medical Education (AHME). The survey was designed to answer two questions: (1) What is the extent of cooperation between hospital CME providers and medical schools? (2) In the next three years will community hospitals seek competitive or collaborative relationships in CME with medical schools? RESULTS: By late April 1993, 216 (78%) of the questionnaires had been returned. Of these, 177 (64% of the sample) were analyzed. Of the responding hospitals, 91 (52%) cooperated with 92 medical schools in CME; 75 (45%) of the hospitals planned to increase cooperation. Only ten (11%) of the hospitals described their current CME relationship with a medical school as "competitive in most areas"; 23 (14%) expected to increase competition in the next three years. Forty-one (24%) of the respondents were part of a community hospital CME consortium; only 20 (16%) of the other institutions expected to participate in a consortium in the next three years. Hospital size and membership in the Association of American Medical Colleges' Council of Teaching Hospitals were generally correlated with current and future competition in CME with a medical school and likely participation in a community CME consortium. CONCLUSION: The majority of teaching hospital members of the AHME perceived that they would have cooperative relationships in CME with affiliated medical schools in the three years following the survey. These collaborative relationships should provide an important basis for the further planning and development of medical education consortia.

Determining the effectiveness of a clinical-practice intervention in improving the control of pain in outpatients with cancer.

PURPOSE: To determine the effectiveness of a clinical-practice intervention in improving the control of pain in outpatients with cancer. METHOD: Between July 5 and September 30, 1995, a randomized, controlled trial of 510 cancer outpatients and 13 oncologists was conducted at 23 clinics in Indiana. All the patients completed assessments of their pain, their pain regimens, and the degrees of relief received; they were surveyed again by mail four weeks after their clinic visits. The intervention group's clinical charts contained a summary of the completed pain scales; the oncologists who treated these patients were instructed to review the summary sheet prior to an evaluation. This summary was not available for the oncologists treating the patients in the control group. Each patient's pain management index (PMI) was calculated: the patient's pain medication level was rated on a scale of 0 to 3; the patients's pain level was rated on a scale of 0 to 3 and then subtracted from the first rating. A negative PMI was interpreted as representing insufficient treatment. Data were analyzed with several statistical tests. RESULTS: In all, only 320 patients who reported cancer-related pain were used in the analysis: 160 to 260 in the control group and 160 of 250 in the intervention group. The groups were similar with respect to demographics, cancer sites, and performance status. A significant difference (p = .0162) in the physicians' prescription patterns was found. In the control group, prescriptions for 86% of the patients did not change, with no decrease in analgesic prescriptions; for 14% of the patients analgesic prescriptions increased. In the intervention group, analgesic prescriptions changed for 25% of the patients, decreasing for 5% and increasing for 20%. A decrease in the incidence of pain described as more than life's usual aches and pains was found for the intervention group (p = .05). No significant difference was found between the groups for the patients undertreated for pain, as measured by PMIs. CONCLUSION: Although analgesic regimens were altered significantly when the physicians understood more about the patient's pain, cancer pain management remains a complex problem. Future studies should focus on the long-term systematic incorporation of simple pain-assessment tools into daily outpatient oncology practices as well as on innovative ways to address other aspects of managing cancer pain.

Continuing medical education: a survey of practitioners' needs and interests.

A number of factors, including legislated recertification or relicensure, have engendered a tremendous increase in the number and type of continuing medical education (CME) programs being offered. There is very sparse documentation of the involvement of the intended recipient or practitioner in the conceptualization, development and conduct of CME programs. In order to more accurately ascertain the factors or circumstances that influence attendance or nonattendance at a CME program, a five-page questionnaire was developed that asked a randomly sampled population of 313 practicing obstetricians ane gynecologists to indicate their preference for CME programs.

Ingestion of isobutyl nitrite, a recreational chemical of abuse, causing fatal methemoglobinemia.

Isobutyl nitrite is widely abused as a sexual stimulant and enhancer of discotheque dancing. Though the usual route of administration by inhalation has not resulted in any toxicologically verified deaths, there may be fatal toxic methemoglobinemia if the chemical is orally ingested. A second case of death following ingestion is discussed.

Are international patients the answer to American hospitals' problems?

American hospitals hoping to capitalize on the lucrative market for international patients may be in for some surprises. Not only is this market limited, but also the drawbacks may outweigh the potential benefits for hospitals seeking to enter this business.