A study of longitudinal curvature effects on the hypersonic laminar boundary layer

Imperial Users onl

Introduction

Since the awakening of the public and the medical educational establishment to the growing deficit of appropriately trained physicians to deliver primary care in the community, attention is now turned to the provision of educational programs appropriate for such physicians at the graduate and continuing educational levels. In the past, the inability to measure outcomes of patient care systems (that is, to use the scientific method in community settings) has hampered the union of the educational system with that of patient care. Many studies now are showing that outcomes are profoundly affected by communication and compliance between physician and patient. A partnership of the expertise of the medical center with the laboratory of the practice in the community equipped to measure the process of delivery, as well as outcomes, appears essential

Tri-Committee Draft Proposal for Health Care Reform

The Tri-Committee draft legislation takes a significant step towards establishing a health care workforce which will sustain a high-quality, cost-effective, fully accessible health care system. Moves to establish an Advisory Committee on Health Workforce Evaluation and Assessment, re-invest in the National Health Service Corps and Title VII of the Public Health Service Act, redistribute unused Medicare GME positions to primary care programs and establish teaching health centers, and address payment and practice challenges to primary care through the medical home and accountable care organization pilot programs are all positive moves towards a sustainable health care workforce. However, to fully achieve workforce reform, the following are recommended: Promoting the Advisory Committee on Health Workforce Evaluation and Assessment to a National Commission on the Health Workforce, providing it with an authorization and clarifying its role in reporting to Congress, including addressing Medicare GME payments. Fully supporting the Teaching Health Centers program, converting it to at minimum a pilot program rather than a demonstration project and creating a Teaching Health Centers Development Grant within Title VII. Further increasing National Health Service Corps authorization for appropriations to maximize the program\u27s full potential to provide health care in the most underserved areas. Increasing primary care bonus payments and SGR target growth rate to ensure effective maintenance and incentives for primary care. Invest in a primary care extension program to provide technical assistance and training programs for strengthening primary care practice

Health Care Workforce Issues and Access to Care: Assessing the Present and Preparing for the Future

Summary of Testimony Fitzhugh Mullan, M.D. Before the House Energy and Commerce Subcommittee on Health, March 24, 2009 Improving access to health care in the United States will require modifications in the structure of the U.S. physician workforce, the foremost of which will be the construction of a strong primary care delivery base. There are over 800,000 practicing physicians today or 280 physicians per 100,000 people. This represents a greater physician density than Canada (210) and the United Kingdom (250) but a density less than France (340) and Germany (350). The distribution of physicians in the U.S. heavily favors urban areas. Metropolitan areas have 2-5 times as many physicians as non-metropolitan areas. Economically disadvantaged areas have significant physician access problems. Two-thirds of the U.S. physician workforce practice as specialists. The number of young physicians indicating an interest in primary care is declining. Approximately 100,000 nurse practitioners (NPs) and 70,000 physician assistants (PAs) are practicing in the United States today. This represents an important asset for service delivery. Today\u27s physician-to-population ratio is in the zone of adequacy and should be maintained with appropriate growth in the number of physicians trained to parallel growth in the population. Increased requirements for patient care due to the aging of the population or the inclusion of more Americans in a universal care plan should be met by more strategic distribution of physicians, both geographically and across the primary care – specialty spectrum, and the expanded use of physician assistants and nurse practitioners. The role of PAs and NPs should be in both the generalist and specialist sectors of the care delivery system. Medical schools – The current expansion of medical schools is welcome but Title VII legislation needs to be reinvigorated and up-funded to augment primary care training in medical schools. Graduate Medical Education – The current number of Medicare funded slots is sufficient to maintain workforce numbers. However, reforms need to be made in current legislation to prioritize and incentivize community-based and ambulatory training. Beyond that, serious consideration needs to be given to aligning Medicare GME with the workforce needs of the country. This would entail designing a new GME allocation system. Medical Practice – Primary care payment reform, support for new practice organizations such as primary care medical homes, and investment in health information technology are all important reforms that will help to promote a strong primary care practice base in the country. Data and leadership in the field of U.S. health workforce development is insufficient. A National Center for Health Workforce Studies and a National Health Workforce Commission would both be important assets at the federal level in managing health care workforce reform

Affirmative action, Cuban style

Twenty-five percent of the U.S. population is black, Hispanic, or Native American, whereas only 6.1 percent of the nation’s physicians come from these backgrounds. Students from these minority groups simply don’t get into medical school as often as their majority peers, which results in a scarcity of minority physicians. This inequity translates into suffering and death, as documented by the Institute of Medicine. Poorer health outcomes in minority populations have been linked to lack of access to care, lower rates of therapeutic procedures, and language barriers. Since physicians from minority groups practice disproportionately in minority communities, they are an important part of the solution to the health-disparities quandary

Coping Strategies Associated with High Quality of Life in People Diagnosed with Multiple Sclerosis: An Intagrative Literature Review

Background: People suffering from Multiple Sclerosis (MS) face many challenges including physical disability, financial strain, and cognitive changes. While the coping mechanisms used to address these stressors can greatly impact one’s quality of life, limited studies are conducted to understand positive coping strategies used by this population. Objectives: The purpose of this integrative literature review was to examine the types of coping strategies that have a positive impact on quality of life in individuals diagnosed with Multiple Sclerosis. Methods: An integrative literature review was conducted. The keywords “coping, coping strategies, quality of life, multiple sclerosis, and MS” were used to search the literature between 1998 and 2016. Results: Emotion focused coping and problem focused coping positively affected quality of life. Successful emotion focused strategies included obtaining social support, stopping unpleasant emotions, maintaining a positive attitude, acceptance, and emotional release. Successful problem focused strategies included changing the situation or source of stress in some way, flexible goal adjustment, and goal pursuit Conclusions: This study discovered which coping mechanisms lead to high quality of life in people diagnosed with MS. Learning these positive coping strategies can help individuals effectively manage the stressors that accompany the diseas