Physician attitudes regarding telephone medicine.

OBJECTIVE: To measure physicians' attitudes regarding telephone medicine and identify determinants of these attitudes. DESIGN: Cross-sectional survey. SETTING: Ten internal medicine residency programs in the United States. PARTICIPANTS: Graduates from 1988 through 1992. The response rate was 62% (n = 356). MEASUREMENTS AND MAIN RESULTS: Survey items were assigned to one of four types of variables: demographic, attitude, training, or system variables. We used factor analysis to consolidate information from the individual questions about attitudes. Six scales describing attitudes toward telephone medicine were identified. Cronbach's alpha was greater than 0.70 for all scales. One scale measured physicians' satisfaction and confidence with the management of patient calls. Other attitude scales measured the helpfulness of personal experience or informal education and the importance of formal training in telephone medicine. Three of the scales measured how comfortable the physician felt prescribing over the telephone. We used regression analysis to predict physician attitudes towards telephone medicine using the demographic, training, and system variables. Availability of the patient's chart, feeling prepared for telephone medicine by one's residency training, and being comfortable prescribing narcotics by telephone predicted satisfaction and confidence with the management of patient calls (R2 = .25). CONCLUSIONS: Several physician attitudes regarding telephone medicine can be measured reliably. Our findings suggest that improving systems for managing patient calls and improving telephone training for physicians will improve physician satisfaction and confidence with the practice of telephone medicine.

Melittin-induced changes in Na and Cl movements across the skin and cornea (in vitro) of the toad Bufo marinus.

Melittin, from bee venom, increases short-circuit current (Isc) across the skin and cornea of toads. In skin this reflects a rise in the influx of Na and is inhibited by meclofenamic acid (inhibits prostaglandin synthetase). In corneas with melittin on the inside the rise in Isc is inhibited by bumetanide (inhibits Cl transport) and meclofenamic acid. Melittin on the tear side of the cornea causes a biphasic change in Isc, and a rise in all undirectional fluxes of Na and Cl. This effect was not changed by bumetanide or meclofenamic acid. Melittin apparently has two types of effects, one mediated by prostaglandins while the other is more direct.