Physician engagement: the Vancouver Medical Staff Association engagement charter

Engagement of physicians with their healthcare community or institution should be a central issue in healthcare because it can be translated into improved patient care, enhanced well-being for physicians as well as safer, more effective and less costly healthcare. To accomplish the mission/goal of meaningful physician engagement, we set about to establish a 'charter' for physician engagement. We defined our concept of meaningful physician engagement and customised the engagement spectrum construct for physician relationship with their healthcare community or institution. While recognising the importance of physician leaders within the hierarchical system for efficacy of organisational management, relying only on physicians in formal executive positions is insufficient for developing physician engagement. There is a need for widespread physician engagement across the organisation. The objective is both an improvement in patient care and in physician well-being.

beta2-Adrenergic receptor haplotypes in mild, moderate and fatal/near fatal asthma

Excess beta2-agonist use in asthmatics has been associated with increased mortality and morbidity. The mechanisms responsible for these observations are unknown. We hypothesized that polymorphisms of the beta2-adrenergic receptor (beta2AR) at amino acid positions 16, 27, and 164, which are known to alter receptor functions in vitro, may predispose asthmatics to fatal/near-fatal asthma and/or modify asthma severity. In preliminary studies we found significant differences in allele frequencies due to ethnic background: Caucasian, Black, Asian Gly16 = 0.61, 0.50, 0.40 and Gln27 = 0.57, 0. 73, 0.80, respectively. beta2AR genotyping was performed on DNA from Caucasians classified as nonasthmatic/nonatopic (n = 84), fatal/near-fatal asthmatics (n = 81) and mild/moderate asthmatics (n = 86). No polymorphism or haplotype was found to be associated with fatal/near-fatal asthma. However, the Gly16/Gln27 haplotype, which undergoes enhanced downregulation in vitro, was substantially more prevalent in moderate asthmatics than in mild asthmatics (p = 0.003, odds ratio = 3.1). We conclude that the beta2AR genotype is not a major determinant of fatal or near-fatal asthma. Furthermore, allele frequency variation among ethnic groups must be considered in clinical studies of beta2AR polymorphisms in asthma.

Duplex ultrasonography criteria for internal carotid stenosis of more than 70% diameter: angiographic correlation and receiver operating characteristic curve analysis

OBJECTIVE

To determine duplex ultrasonography criteria for detecting stenosis of 70% or more in the internal carotid artery, to be used as a means of selecting candidates suitable for endarterectomy (a procedure suggested by the North American Symptomatic Carotid Endarterectomy Trial as appropriate for symptomatic patients with 70% to 99% stenosis).

PATIENTS AND METHODS

Between Jan. 1, 1991, and Apr. 30, 1993, 120 patients underwent internal carotid angiography at a tertiary care hospital for transient ischemic attacks, asymptomatic bruits or preoperative assessment. Of these, 83 also underwent duplex ultrasonography within 31 days of angiography. The angiographic and sonographic studies for 145 vessels in 75 of the patients (50 men and 25 women) were suitable for further study. The sonographic criteria were selected on the basis of a receiver operating characteristic curve relating peak systolic velocity of the internal carotid artery to the degree of stenosis determined angiographically.

RESULTS

Angiography indicated that 33 of the vessels had stenosis of 70% or more and that 12 additional vessels were completely occluded. The combined sonographic criteria of peak systolic velocity of less than 40 cm/s or 175 cm/s or more yielded 91% sensitivity and 60% specificity for angiographically determined stenosis of 70% or more.

CONCLUSION

In this patient population the combined criteria of peak systolic velocity of less than 40 cm/s or 175 cm/s or more were highly sensitive and reasonably specific for internal carotid artery stenosis of 70% or more.