American College of Physicians: Internal Medicine — Doctors for Adults ®

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Practice briefs

From the April 1995 ACP Observer, copyright 1995 by the American College of Physicians.

By Deborah Gesensway

Medicare publications now on tape

A set of free audiotape recordings of various Medicare publications can help patients who have trouble reading Medicare information handbooks and brochures because of visual or physical impairments.

Available on tape are these publications: Medicare Handbook, Medicare Coverage of Kidney Dialysis and Kidney Transplant Services, Guide to Health Insurance for People with Medicare, Medicare Q&A, Medicare Hospice Benefits, Medicare and Advanced Directives and Medicare Savings for Medicare Beneficiaries. Total listening time is about six hours.

The tapes are available by calling the Medicare hot line at 800-638-6833 or by contacting one of the 146 regional libraries associated with the Library of Congress National Library Service for the Blind and Physically Handicapped. For information about where to find these libraries, call 800-424-8567.

The tapes must be placed on special equipment available free to any U.S. citizen or resident who cannot hold a book or read standard print. To borrow equipment, contact any of the regional libraries or write to: Reference Section, National Library Service for the Blind and Physically Handicapped, Library of Congress, Washington, D.C. 20542.

Nurses warn of problems due to layoffs and cutbacks

A survey of more than 1,800 registered nurses nationwide concludes that hospital cutbacks are contributing to unsafe conditions for some patients and massive workloads for the RNs who remain employed.

According to the American Nurses Association, which surveyed its members last fall, more than two-thirds of the respondents said the number of RNs employed in their facilities had been reduced either by layoffs or attrition in the past year. Of these respondents, 78% said they thought quality of patient care has worsened, with 64% saying they felt that patient safety has been adversely affected.

More than half the nurses responding indicated they are taking care of more patients than before and that they have less time to provide patient care.

More than 17% of the respondents reported an increase in the number of errors committed by nursing and non-nursing staff, with medication errors topping the list. Also mentioned by the nurses were increases in patient falls, longer waits for routine care and lab draws and re-injuries resulting from inadequate patient education.

PDR available in electronic formats

Chances are you already received your complimentary copy of the 1995 Physicians' Desk Reference, but you may prefer to get the information on more than 2,800 drugs and diagnostics in a different form.

Medical Economics is offering its 1995 PDR, its guide to drug interactions and its non-prescription drugs companion volume in four different electronic versions. The 1995 Pocket PDR with data card costs $199.95. The Pocket PDR Desktop System, new for 1995, features a larger screen and keyboard than the pocket version and costs $245.95. The 1995 PDR Library on CD-ROM costs $595. The 1995 PDR drug interactions, side effects and indications diskettes cost $235, and free demo disks are available.

Information: 800-232-7379, fax 201-573-4956.

New guidelines on conducting lab tests

The National Committee for Clinical Laboratory Standards (NCCLS), a non-profit organization that develops voluntary consensus standards for use within the clinical lab testing community, has issued a series of new guidelines. A sampling appears below.

  • "Sweat Testing: Sample Collection and Quantitative Analysis" aims to help lab and clinical personnel collect, analyze, report and evaluate sweat test results for cystic fibrosis.
  • "Fine Needle Aspiration Biopsy Techniques" describes specific procedures for collecting, handling, fixing and staining biopsy specimens, as well as recommendations for obtaining patient consent.
  • "Specifications for Immunological Testing for Infectious Diseases" promotes a better understanding of the requirements, capabilities and limitations of immunodi-agnostic testing.
  • "Training Verification for Laboratory Personnel" recommends a structured approach for training and retraining lab employees, including assessment tools and forms for documentation and record keeping as part of a training verification program.

Guidelines cost $25 each (for member organizations) or $50 each (for non-members). Information: 610-525-2435.

Why patients sue their doctors

According to the nation's largest medical malpractice insurance company, the most common allegation cited in malpractice lawsuits settled last year involved postoperative complications of surgery, followed by failure to diagnose cancer, an inadvertent act during surgery, improper treatment relating to childbirth and failure to diagnose a fracture or dislocation.

The St. Paul Fire and Marine Insurance Co. also listed the most expensive claims it settled last year. Improper treatment during childbirth topped the list, followed by failures to diagnose hemorrhage, myocardial infarction, infection and cancer.

More hospitals hiring medical directors

Three-quarters of all hospitals now have a medical director or vice president of medical affairs on staff, up from 60% last year, according to a survey by the Physician Executive Management Center, a physician executive recruitment firm based in Tampa, Fla.

The average compensation for these positions is $171,615, representing an increase of 10% from last year. Salaries for senior medical managers in HMOs and group practices are also increasing, according to the survey.

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