Physician performance

Poisonous substances described by Dioscorides include conium, strychnia, colchicum, aconitum, the poppy, hellebore, and the mandragora. From the last named, a wine is made which produces so heavy, long continued and unconscious a sleep that physicians perform difficult operations by its use. Pliny also says that it is given before incisions or punctures are made in the body, in order to ensure insensibility to pain. 

Smith-Coggins R, Rosekind MR, Hurd S, Buccino KR. Relationship of day versus night sleep to physician performance and mood. Ann Emerg Med 1994 24 928-934. 

Parker JB. The effects of fatigue on physician performance—an underestimated cause of physician impairment and increased patient risk. Can J Anaesth 1987 34 489 195. 

During all valvuloplasty interventions antibiotics (e.g., cefuroxime, I, 5 g, i.v.) are administered. Patients allergic to penicillin should receive vancomycin I g intravenously. Most physicians perform transcatheter valvuloplasty in the fasting state under mild sedation, Substances that are frequently used are meperidine, promethazine, and chlorpromazine, given intramuscularly or intermittent doses of midazolam (0.05 to 0.1 mg/kg, i.v.) and/or fentanyl (0.5 to 1.0 Lig/kg, i.v.). Some operators also apply ketamine or general anesthesia for all interventional cases. 

Non-physicians performing laser procedures should be properly trained, licensed, and insured... 

We have acquired our own experience with 318 outpatient biopsies, included in our total number of 4,124 biopsies - we observed no complications whatsoever in these 318 patients, (s. tab. 7.7) Evaluation of the publications quoted and our own experience show that the frequency of complications tends to be even lower than in hospitalized patients. This is probably due to the fact that only very experienced physicians perform outpatient biopsies and that indications and contraindications are heeded with greater stringency. 

Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance. A systematic review... 

Since the civilizations before Christ there has been a division between the physicians who diagnosed and prescribed drugs and those who discovered and compounded them, with the grey area in betweeen in which certain physicians performed equally well. We have then what could be termed two worlds of medicine, worlds which fortunately revolve in the same direction and with amazing synchronization. 

D.A. Davis, M.A. Thomson, A.D. Oxman et al.. Changing physician performance a systematic review of the effect of continuing medical education strategies, JAMA 274 (1995), 700-705. 

A more detailed medical evaluation may be required. Communication between the physician performing the preplacement evaluation and the worker s private physician may be appropriate and is encouraged. 

Two other possibilities exist, of course. One is that researchers who examine physicians performance and find it to be exemplary may not write and then submit manuscripts, and so the only manuscripts that are eligible for publication are those reporting poor performance. The other possibility (and one that is considerably more disconcerting) is that every study that has been conducted has found poor performance. We do not presume to have the answers to these questions we simply raise them for readers consideration. 

Robotics is an interdisciplinary scientific field concerned with the design, development, operation, and assessment of electromechanical devices used to perform tasks that would otherwise require human action. Robotics applications can be found in almost every arena of modern life. Robots, for example, are widely used in industrial assembly lines to perform repetitive tasks. They have also been developed to help physicians perform difficult surgeries and are essential to the operation of many advanced military vehicles. Among the most promising robot technologies are those that draw on biological models to solve problems, such as robots whose limbs and joints are designed to mimic those of insects and other animals. 

Percutaneous vertebroplasty (PV) is a safe and efficient therapeutic option for patients suffering from otherwise untreatable pain and disability caused by osteoporotic fracture or tumoral involvement of a vertebra. Vertebroplasty provides nearly immediate pain relief and stabilization, leading to a high rate of successful treatments with low morbidity, no or only short hospitalization, and rare adverse events. In addition, PV contributes to spinal stabilization and can be successfully combined with chemotherapy, radiation therapy, tumor ablation, and posterior laminectomy. Therefore, the number of procedures performed has continuously increased over the last few yccus. However, indications and contraindications, technical aspects, and possible complications of PV always have to be taken into account by the interventional radiologist. The success rate strongly depends - besides on the experience of the physician performing the procedure - on the visualization equipment used, such as CT fluoroscopy. 

Rijssen, van Antonius, JM Johannes, R A de Wout, EL van Allard, J, 2011. Systematic development of a communication skills training course for physicians performing work disability assessments from evidence to practice. BMC medical education, 11,28. 

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