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Alaska's physician shortage: is enough being done to avoid a crisis?

https://arctichealth.org/en/permalink/ahliterature152783
Source
Alaska Med. 2008 Sep;50:9-15
Publication Type
Article
Date
Sep-2008
Source
[Seattle, Wash. : WAMI Program, School of Medicine, University of Washington] v.
Publication Type
Journal
Date
-1981
Source
[Seattle, Wash. : WAMI Program, School of Medicine, University of Washington] v.
Date
-1981
Language
English
Geographic Location
U.S.
Publication Type
Journal
Physical Holding
University of Alaska Anchorage
Keywords
Medical education -- Washington (state) -- Periodicals
Medical education -- Alaska -- Periodicals
Medical education -- Montana -- Periodicals
Medical education -- Idaho -- Periodicals
Notes
ALASKA R746.A4A4 (1978-79)
Merged with Idaho state report, WAMI Program; Montana state report, WAMI Program; and Washington state report, WAMI Program; top form: Annual WAMI state report
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American Indian and Alaska Native Cancer Patients' Perceptions of a Culturally Specific Patient Navigator Program.

https://arctichealth.org/en/permalink/ahliterature289968
Source
J Prim Prev. 2017 Apr; 38(1-2):121-135
Publication Type
Journal Article
Date
Apr-2017
Author
Carol Grimes
Jenine Dankovchik
Megan Cahn
Victoria Warren-Mears
Author Affiliation
Northwest Portland Area Indian Health Board, 918 NE Rosa Parks Way, Portland, OR, 97211, USA.
Source
J Prim Prev. 2017 Apr; 38(1-2):121-135
Date
Apr-2017
Language
English
Publication Type
Journal Article
Keywords
Adult
Aged
Alaska Natives - psychology
Attitude to Health - ethnology
Cultural Competency
Female
Humans
Idaho
Indians, North American - psychology
Interviews as Topic
Male
Middle Aged
Models, organizational
Neoplasms - ethnology - psychology
Oregon
Patient Navigation - methods - organization & administration - standards
Patient Satisfaction - ethnology
Qualitative Research
Young Adult
Abstract
Lack of access to care, funding limitations, cultural, and social barriers are challenges specific to tribal communities that have led to adverse cancer outcomes among American Indians/Alaska Natives (AI/AN). While the cancer navigator model has been shown to be effective in other underserved communities, it has not been widely implemented in Indian Country. We conducted in-depth interviews with 40 AI/AN patients at tribal clinics in Idaho and Oregon. We developed the survey instrument in partnership with community members to ensure a culturally appropriate semi-structured questionnaire. Questions explored barriers to accessing care, perceptions of the navigator program, satisfaction, and recommendations. AI/AN cancer patients reported physical, emotional, financial, and transportation barriers to care, but most did not feel there were any cultural barriers to receiving care. Navigator services most commonly used included decision making, referrals, transportation, scheduling appointments, and communication. Satisfaction with the program was high. Our study provides a template to develop a culturally appropriate survey instrument for use with an AI/AN population, which could be adapted for use with other indigenous patient populations. Although our sample was small, our qualitative analysis facilitated a deeper understanding of the barriers faced by this population and how a navigator program may best address them. The results reveal the strengths and weakness of this program, and provide baseline patient satisfaction numbers which will allow future patient navigator programs to better create evaluation benchmarks.
Notes
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PubMed ID
27838858 View in PubMed
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An obstetric and gynecologic clerkship's influence on a medical community. The Washington, Alaska, Montana, and Idaho Anchorage obstetric and gynecologic clerkship.

https://arctichealth.org/en/permalink/ahliterature4545
Source
Am J Obstet Gynecol. 1997 Jun;176(6):1363-5; discussion 1366-7
Publication Type
Article
Date
Jun-1997
Author
H B Hanson
Author Affiliation
Department of Obstetrics and Gynecology, University of Washington Medical School, Anchorage, AK, USA.
Source
Am J Obstet Gynecol. 1997 Jun;176(6):1363-5; discussion 1366-7
Date
Jun-1997
Language
English
Publication Type
Article
Keywords
Alaska
Clinical Clerkship
Communication
Community Health Services - standards
Consultants
Education, Medical - standards
Female
Gynecology - education
Humans
Idaho
Montana
Obstetrics - education
Perception
Pregnancy
Program Evaluation
Questionnaires
Rural Health Services - standards
Washington
Abstract
OBJECTIVES: Our purpose was to explore the influences of an obstetric and gynecologic medical student clerkship on a remote medical community. Return of physicians to Alaska and faculty perceptions of their experience were central foci. STUDY DESIGN: Data were obtained on former clerks to determine choice of specialty and location of practice. Data regarding all physicians new to Alaska was correlated with the University of Washington Medical School graduate data. Additionally, a questionnaire with a Likert-type scale evaluated the 10 clinical faculty members participating in the clerkship. RESULTS: Between 1978 and 1991 we trained 266 clerks. A total of 77 of 374 (21%) new physicians in Alaska (1978 to 1991) were graduates of the University of Washington; 26 of those 77 (34%) were our former Anchorage obstetrics and gynecology clerks. The clinical faculty reported both positive and negative effects of their participation in the clerkship. CONCLUSION: The desired benefit, the return of new physicians to Alaska, seemed supported. Questionnaire results hinted at additional benefits for the supervising faculty physicians in this isolated community. The formal affiliation effected by the clerkship seemed to have a positive impact on patient care, communication, consultation, and shared action among the participating physicians.
PubMed ID
9215198 View in PubMed
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Atlantic salmon, Salmo salar L. are broadly susceptible to isolates representing the North American genogroups of infectious hematopoietic necrosis virus.

https://arctichealth.org/en/permalink/ahliterature278813
Source
J Fish Dis. 2016 Jan;39(1):55-67
Publication Type
Article
Date
Jan-2016
Author
G. Kurath
J R Winton
O B Dale
M K Purcell
K. Falk
R A Busch
Source
J Fish Dis. 2016 Jan;39(1):55-67
Date
Jan-2016
Language
English
Publication Type
Article
Keywords
Alaska - epidemiology
Animals
British Columbia - epidemiology
California - epidemiology
Female
Fish Diseases - epidemiology - mortality - virology
Fisheries
Genotype
Idaho - epidemiology
Immunohistochemistry - veterinary
Infectious hematopoietic necrosis virus - classification - genetics - pathogenicity
Intestines - pathology
Kidney - pathology
Kinetics
Necrosis
Pancreas, Exocrine - pathology
Phylogeny
Rhabdoviridae Infections - epidemiology - veterinary - virology
Salmo salar
Spleen - pathology
Survival Analysis
Virulence
Washington - epidemiology
Abstract
Beginning in 1992, three epidemic waves of infectious hematopoietic necrosis, often with high mortality, occurred in farmed Atlantic salmon Salmo salar L. on the west coast of North America. We compared the virulence of eleven strains of infectious hematopoietic necrosis virus (IHNV), representing the U, M and L genogroups, in experimental challenges of juvenile Atlantic salmon in freshwater. All strains caused mortality and there was wide variation within genogroups: cumulative mortality for five U-group strains ranged from 20 to 100%, four M-group strains ranged 30-63% and two L-group strains varied from 41 to 81%. Thus, unlike Pacific salmonids, there was no apparent correlation of virulence in a particular host species with virus genogroup. The mortality patterns indicated two different phenotypes in terms of kinetics of disease progression and final per cent mortality, with nine strains having moderate virulence and two strains (from the U and L genogroups) having high virulence. These phenotypes were investigated by histopathology and immunohistochemistry to describe the variation in the course of IHNV disease in Atlantic salmon. The results from this study demonstrate that IHNV may become a major threat to farmed Atlantic salmon in other regions of the world where the virus has been, or may be, introduced.
PubMed ID
25381936 View in PubMed
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Carboxyhemoglobin measurement by hospitals: implications for the diagnosis of carbon monoxide poisoning.

https://arctichealth.org/en/permalink/ahliterature168666
Source
J Emerg Med. 2006 Jul;31(1):13-6
Publication Type
Article
Date
Jul-2006
Author
Neil B Hampson
Karen L Scott
Jennette L Zmaeff
Author Affiliation
Section of Pulmonary and Critical Care Medicine, Center for Hyperbaric Medicine, Virginia Mason Medical Center, Seattle, Washington, USA.
Source
J Emerg Med. 2006 Jul;31(1):13-6
Date
Jul-2006
Language
English
Publication Type
Article
Keywords
Alaska
Carbon Monoxide Poisoning - blood - diagnosis - therapy
Carboxyhemoglobin - analysis
Humans
Hyperbaric Oxygenation
Idaho
Montana
Oximetry
Severity of Illness Index
Time Factors
Washington
Abstract
Most case definitions for carbon monoxide (CO) poisoning include demonstration of an elevated blood carboxyhemoglobin (COHb) concentration. Further, it is generally believed that treatment of CO poisoning is more effective when performed as soon as possible after the exposure. This suggests that a hospital's inability to measure blood COHb could lead to delayed or missed diagnosis or treatment. This study evaluated the ability of hospitals in the Pacific Northwest to measure COHb levels. The clinical laboratory of every acute care hospital in Washington, Idaho, Montana, and Alaska was surveyed regarding the ability to measure COHb levels, the method utilized and the time required. If they could not measure COHb, they were asked whether samples are sent elsewhere, the location of the referral laboratory, and time required. Results were then compared to the list of hospitals referring CO-poisoned patients to a regional center for hyperbaric oxygen therapy from 2003-2004. In the four states, only 44% of acute care hospitals have the capability to measure COHb. The remaining 56% send blood samples to other laboratories. The average time to get a result is 10 +/- 10 min in hospitals with co-oximetry and 904 +/- 1360 min in those without, a difference of 15 h (p
PubMed ID
16798147 View in PubMed
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Clinical laboratory test menu changes in the Pacific Northwest: 1994 to 1996.

https://arctichealth.org/en/permalink/ahliterature205914
Source
Clin Chem. 1998 Apr;44(4):833-8
Publication Type
Article
Date
Apr-1998
Author
K M LaBeau
M. Simon
S J Steindel
Author Affiliation
Office of Laboratory Quality Assurance, Washington State Department of Health, Seattle 98155, USA.
Source
Clin Chem. 1998 Apr;44(4):833-8
Date
Apr-1998
Language
English
Publication Type
Article
Keywords
Alaska
Family Practice - legislation & jurisprudence - statistics & numerical data
Health Care Sector
Humans
Idaho
Laboratories - legislation & jurisprudence - utilization
Oregon
Physicians' Offices
Questionnaires
Washington
Abstract
Laboratory testing services are presently undergoing dynamic changes in response to a wide range of external factors. Government regulations, reimbursement, and managed care are only a few of the influences affecting the availability of testing services and on-site testing capabilities in hospital, independent, and physician office laboratories. Medical practice changes, marketplace influences, test technologies, and costs also play a role in determining where testing is being performed. To better understand the factors influencing clinical laboratory test volumes and menus and to identify on-site testing deemed essential in physician office laboratories, we gathered information from a network of clinical laboratories in the Pacific Northwest. Questionnaires were sent to 257 Laboratory Medicine Sentinel Monitoring Network participants in March 1996. In the past 2 years, changes in on-site test volumes and test menus have been primarily due to medical practice changes and marketplace influences. When laboratories had a decrease in test volumes or test menu choices, the size of the patient workload and the volumes of test orders have had the greatest impact. Laboratory regulations and managed care contracts have played a role in shifting on-site testing to outside sources; however, these factors did not appear to be primary influences. Only 5% of physician office laboratories identified tests that they believed were essential for optimal patient care but did not perform on-site.
PubMed ID
9554496 View in PubMed
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Communications satellites in health education and health care provision. The WAMI experience.

https://arctichealth.org/en/permalink/ahliterature3054
Source
JAMA. 1983 Aug 5;250(5):636-9
Publication Type
Article
Date
Aug-5-1983
Author
M R Schwarz
D C Schaad
F W Evans
C W Dohner
Source
JAMA. 1983 Aug 5;250(5):636-9
Date
Aug-5-1983
Language
English
Publication Type
Article
Keywords
Alaska
Audiovisual Aids - utilization
Communication
Delivery of Health Care
Education, Medical, Undergraduate
Idaho
Montana
Regional Medical Programs
Research Support, U.S. Gov't, P.H.S.
Telecommunications - instrumentation - methods
Washington
Abstract
Since 1971, the University of Washington School of Medicine, Seattle, has operated a four-state, medical education program covering Washington, Alaska, Montana, and Idaho. This WAMI Program involves four universities without medical schools and 15 communities. To maintain this program, communication between the sites is imperative and mandates travel. The experiments described in this article were undertaken to determine whether full-duplex audio and color-video interactions via communications satellites could replace the travel requirements of the WAMI Program. Experiments involving the administration of the program, the presentation of the undergraduate medical education curriculum, the provision of health services, and the formation of public policies were conducted. The results suggest that satellite communication has broad applicability in medical education and health care provision.
PubMed ID
6191052 View in PubMed
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Community based studies of diabetes control: program development and preliminary analysis.

https://arctichealth.org/en/permalink/ahliterature3260
Source
J Fam Pract. 1982 Mar;14(3):459-67
Publication Type
Article
Date
Mar-1982
Author
C K Smith
T R Taylor
M J Gordon
Source
J Fam Pract. 1982 Mar;14(3):459-67
Date
Mar-1982
Language
English
Publication Type
Article
Keywords
Administration, Oral
Adolescent
Adult
Aged
Alaska
Ambulatory Care
Blood Glucose - analysis
Child
Child, Preschool
Comparative Study
Diabetes Mellitus - drug therapy - epidemiology - prevention & control
Evaluation Studies
Family Practice
Female
Humans
Hypoglycemic agents - therapeutic use
Idaho
Infant
Infant, Newborn
Insulin - therapeutic use
Male
Middle Aged
Montana
Outcome and Process Assessment (Health Care)
Prospective Studies
Research Support, Non-U.S. Gov't
Time Factors
Washington
Abstract
In this report are examined the patterns of control of diabetes mellitus achieved by practicing family physicians in small communities in the Pacific Northwest and Alaska. The diabetic patients under study appear to be broadly similar to patients in tertiary care settings, where most studies of diabetes care have been carried out. Motivated, competent family physicians, knowledgeable about tight control of diabetes, appear to have considerable difficulty in maintaining even modest levels of biochemical control. Goals in this study for fasting plasma glucose levels for patients with insulin-dependent diabetes mellitus (IDDM) averaged between 120 and 160 mg/100 ml. Glucose levels actually achieved ranged up to 360 mg/100 ml. A similar though lesser discrepancy was noted for patients with non-insulin-dependent diabetes mellitus (NIDDM), with achieved levels ranging up to 270 mg/100 ml fasting plasma glucose. There were wide individual differences among physicians in management styles and treatment policy, including wide discrepancies in emphasis on diet, use of oral hypoglycemic agents, and insulin use. This diversity is felt to merit further investigation. Collaborative studies of this type with community based physicians are feasible and academically rewarding. Significant research questions can be addressed and answered.U
PubMed ID
7038027 View in PubMed
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Effect of racial/ethnic misclassification of American Indians and Alaskan Natives on Washington State death certificates, 1989-1997

https://arctichealth.org/en/permalink/ahliterature6052
Source
American Journal of Public Health. 2002 Mar;92(3):443-444
Publication Type
Article
Date
Mar-2002
  1 website  
Author
Stehr-Green, P
Bettles, J
Robertson, LD
Author Affiliation
Northwest Tribal Epidemiology Center (The EpiCenter), Northwest Portland Area Indian Health Board, 527 SW Hall, Suite 300, Portland, OR 97201, USA.
Source
American Journal of Public Health. 2002 Mar;92(3):443-444
Date
Mar-2002
Language
English
Publication Type
Article
Keywords
Alaska - ethnology
Algorithms
Cost of Illness
Death Certificates
Documentation - standards
Female
Hematologic Tests - standards
Humans
Idaho - epidemiology
Indians, North American - classification
Male
Medical Record Linkage - standards
Oregon - epidemiology
Probability
Quality Control
Registries - standards
Reproducibility of Results
Washington - epidemiology
Abstract
OBJECTIVES: This study examined effects of racial/ethnic misclassification of American Indians and Alaskan Natives on Washington State death certificates. METHODS: Probabilistic record linkage were used to match the 1989-1997 state death files to the Northwest Tribal Registry. RESULTS: We identified matches for 2819 decedents, including 414 (14.7%) who had been misclassified as non-American Indians and Alaskan Natives on the death certificates. The likelihood of being correctly classified increased 3-fold for each higher level of American Indian and Alaskan Native ancestry (odds ratio = 2.88; 95% confidence interval [CI] = 2.51, 3.30) and decreased by 6.9% per calendar year (95% CI = 2.0, 11.5). CONCLUSIONS: Systematic biases on death certificates in Washington State persist. Methods to reduce misclassification can improve data quality and enhance efforts to measure and reduce racial/ethnic health disparities.
Notes
Comment In: American Journal of Public Health. 2002 Sep;92(9):138612197956
PubMed ID
11867327 View in PubMed
Online Resources
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31 records – page 1 of 4.