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Purpose: The purpose of the study was to determine if simply providing nursing facilities with comparative quality performance information and education about quality improvement would improve clinical practices and subsequently improve resident outcomes, or if a stronger intervention, expert clinical consultation with nursing facility staff, is needed., Design and Methods: Nursing facilities (n = 113) were randomly assigned to one of three groups: workshop and feedback reports only, workshop and feedback reports with clinical consultation, and control. Minimum Data Set (MDS) Quality Indicator (QI) feedback reports were prepared and sent quarterly to each facility in intervention groups for a year. Clinical consultation by a gerontological clinical nurse specialist (GCNS) was offered to those in the second group., Results: With the exception of MDS QI 27 (little or no activity), no significant differences in resident assessment measures were detected between the groups of facilities. However, outcomes of residents in nursing homes that actually took advantage of the clinical consultation of the GCNS demonstrated trends in improvements in QIs measuring falls, behavioral symptoms, little or no activity, and pressure ulcers (overall and for low-risk residents)., Implications: Simply providing comparative performance feedback is not enough to improve resident outcomes. It appears that only those nursing homes that sought the additional intensive support of the GCNS were able to effect enough change in clinical practice to improve resident outcomes significantly.

A survey designed to assess the number, type, and current practice patterns of all infectious disease (ID) physicians active in the United States in 1986 was carried out in early 1987. Of 4328 mailed questionnaires, 48.3% were returned. One-third of respondents were in private practice, one-third in academics, and the rest in industry or government. Women accounted for 12.4% of the total; they were younger and as a group spent a greater proportion of total effort in ID. Sixty-five percent of all respondents had greater than or equal to 2 years training in ID. Overall, private practitioners worked longer hours than academicians but spent slightly less effort devoted solely to ID. The proportion of total effort devoted to ID has increased among physicians newly entering practice. Seventy-five percent of all respondents held a teaching appointment. Older ID physicians worked less than 50 h/week and tended to have more administrative than patient care responsibilities. In 1986, there were the equivalent of 1792 full-time ID physicians in the United States or 1:134,000 population.

Infectious disease-trained internal medicine physicians responding to a questionnaire survey (n = 1802) reported minor differences in time spent in patient care versus laboratory-based research whether they subsequently became practitioners or academicians. Both practitioners and academicians ranked hospital epidemiology first, followed by knowledge of hospital antibiotic policies in order of importance for new trainees to be taught. Internists with greater than 12 months of training in infectious diseases were divided into private practice versus academically based groups, and their distribution of time spent in various professional activities was analyzed by 5-year intervals for each cohort. These studies confirmed an increasing proportion of time spent in infectious disease-related patient care for new practitioners. Over time, patient care activities decreased and administrative activities increased in all groups. These data are important for estimating future manpower needs.

The occurrence and distribution of the three dimensions of the burnout syndrome (emotional exhaustion, depersonalization, and lowered feelings of personal accomplishment) were studied among infectious diseases physicians. A written survey was mailed to the entire identified US population of infectious diseases physicians (n = 4328); a 46.3% response rate provided 1840 usable surveys. Statistical analyses of the data demonstrated that 43.5% of the physician sample reported high scores on emotional exhaustion, and 40.3% scored high on depersonalization. Personal accomplishment scores remained high, despite burnout levels, with 91.8% reporting high personal accomplishment. The highest percentage of burnout occurred among physicians in private practice settings (55%), followed by government settings (39%), and academia (37%). The high percentage of infectious diseases physicians experiencing burnout suggests the need for further research to establish trends, to determine if other types of physicians experience similar levels of burnout, to identify casual factors, and to develop avenues to reduce stress and facilitate coping.

In an effort to identify those human male sex accessory tissues that may be under the physiological influence of estrogen, cytosolic and nuclear estrogen receptors were measured with two ligand systems that used either [3H]R2858 [moxesterol(11 beta-methoxy-17-ethynyl-1,3,5,(10)-estratriene-3,17 beta-diol)] or [3H]estradiol plus 1 microM dihydrotestosterone with diethylstilbestrol to correct for nonspecific binding. In seminal vesicles, high affinity binding was identified in cytosol (6 of 7 determinations) and nuclear extract (4 of 7 determinations); in the epididymis, high affinity binding was also present in the cytosol (10 of 12 determinations) and nuclear extract (10 of 11 determinations). In contrast, no high affinity binding was demonstrated in cytosol from the testis (0 of 5 determinations) or genital skin (0 of 7 determinations), and only low levels of nuclear receptor (80 fmol/g tissue) were present in the testis (3 of 5 determinations) and genital skin (1 of 7 determinations). In nonhyperplastic prostatic tissue, high affinity binding was present [in the cytosol of periurethral zone tissue (3 of 7 determinations) and nuclear extract (1 of 7 determinations), in cytosol of peripheral zone tissue (7 of 8 determinations) and nuclear extract (4 of 7 determinations), and in prostatic carcinoma cytosol (5 of 12 determinations) and nuclear extract (10 of 13 determinations)]. In contrast, no high affinity binding was present in either cytosol or nuclear extract from benign hyperplastic prostatic tissue. The finding of estrogen receptors in the human epididymis, seminal vesicle, and prostatic carcinoma suggests that estrogen, in addition to androgen, may act in the physiological regulation of these organs. However, the direct role of estrogen in the induction and maintenance of benign prostatic hyperplasia remains to be defined.

As the health care industry continues to absorb an ever-larger portion of society's resources, increasing pressure is being placed on the industry to justify its decisions about the outcomes of the services it renders relative to their costs. Emphasis is being shifted from accessibility to and availability of health care to the cost-effective delivery of those services. This focus on cost effectiveness is creating intense pressure on the various segments of the industry to justify their existence as cost-effective providers of services. To demonstrate cost effectiveness, the various segments are searching for tools to assist them. In this article, an outline of a mechanism for evaluating the cost effectiveness of providing physical therapy services is presented.