Family physicians' involvement in two hospitals. Two different models of inpatient care.

OBJECTIVE: To describe the roles of family physicians in two hospitals with different models of inpatient care. DESIGN: Cross-sectional descriptive study of a random sample of 11528 patients admitted to two hospitals between 1985 and 1988. SETTING: Two acute-care community hospitals in suburban Montreal, Que. SUBJECTS: Family physicians providing inpatient care at the two hospitals. MAIN OUTCOME MEASURE: How often family physicians were attending physicians (attending responsibility); what percentage of patients were visited by at least one family physician (case load); and what percentage of bedside visits were made by family physicians (workload). RESULTS: In one hospital, where family physicians were actively promoted as primary care providers, they were frequently attending physicians, had heavier case loads, and made more patient visits. Also, they collaborated more often with specialists. In the other hospital, family physicians tended to care for specific populations of patients. CONCLUSION: When hospitals promote different organizational models of medical care, family physicians' roles are affected.

A statewide institute to deliver professional development programs to school health personnel in Massachusetts.

Schoolchildren suffer from health problems ranging from chronic medical and developmental problems to new morbidities related to drugs, violence, and sexual behavior. To help administrators, teachers, and health personnel meet the new challenges in schools, nursing educators from the University of Massachusetts and Simmons College developed the UMass-Simmons School Health Institute. The Institute delivers a series of professional development programs in all regions of the commonwealth to: 1) devise innovative strategies to remove health barriers to learning and to promote the health of children and adolescents, and 2) enhance the design, implementation, integration, and management of comprehensive school health programs, including those mandated and regulated by the Commonwealth of Massachusetts. This article describes a statewide model to prepare school health personnel for delivery of comprehensive school health services.

Using Gilligan's framework to analyze nurses' stories of moral choices.

The manner in which nurses address and eventually solve ethical and moral questions and institutional problems is not yet well explained. This is a qualitative descriptive study examining the moral decision-making processes used by 24 nurses. The work of Carol Gilligan provides the framework for this study. The perspectives of the nurses was explored and a determination was made as to whether the justice or caring orientation prevailed in the situation. The method described by the Gilligan group is explained. Three stories are presented to serve as exemplars of the various orientations and of institutional forces that were active in the nurses' stories. The caring orientation was clearly present, as was the justice orientation to a lesser degree. Other issues such as power and financial security also were apparent.

Portal and systemic effects of selective infusion of vasopressin into the superior mesenteric artery in cirrhotic patients.

Selective infusion of vasopressin (0.2 U per min) was performed in 8 cirrhotic patients with portal hypertension who underwent umbilicoportal catheterization. There was a significantly decreased (9.6%) of the free portal venous pressure from 27.0 plus or minus 1.4 mm Hg to 24.4 plus or minus 1.4 mm Hg. In all patients, the portal PO2 significantly decreased with a mean fall of 18.8%. However, in all patients, significant systemic effects were noted: an increase in arterial blood pressure and a decrease in the arterial PO2. In 3 patients, a marked fall of the cardiac output (greater than 2.0 liters per min) was recorded during the selective infusion of vasopressin. It is concluded that if selective infusion of vasopressin into the superior mesenteric artery is efficacious in the control of bleeding varices, the therapeutic effect cannot be totally explained by the lowering of the portal venous pressure in cirrhotic patients with portal hypertension. The risk of vascular thrombosis, the decreased portal PO2, and the systemic effects have to be considered when this approach is used in cirrhotic patients with ruptured esophageal and/or gastric varices.