Physician extenders may be a valuable asset to an outpatient otolaryngology practice. The adjunctive care provided by physician extenders appears to be cost effective and has the advantages of increasing patient education, promoting physician productivity, and improving management of chronic conditions. Practice types that may benefit from advanced practice providers include group or solo practices with high demand or who need improved efficiency. We discuss five different practice models for incorporation of advanced practice providers in an outpatient otolaryngology practice. These models include scribe, collaborative, limited independent, partial independent, and near complete independent practice and are based primarily on the autonomy level of the physician extender. In additon, we examine available literature discussing the cost effectiveness of physician extenders used in an outpatient setting.
89%), salivary function (59% vs 79%), subcutaneous fibrosis (97% vs 75%). Concerning long term dysphagia: some discomfort (22% vs 39%), soft diet required (42% vs 28%), fluids only and naso-gastric tube feeding (11% vs 4%); patients with severe dysphagia and taste impairment showed higher levels of anxiety (pϽ0.05): dysphagia influences the QoL, fatigue and physical-social functioning. Severe salivary function impairment is related only with troubles in social eating and contacts, without effects on QoL. MADRS depression was 56% vs 46%, HADS anxiety was 22% vs 21%. CONCLUSION: A different pattern of long term toxicity was observed in SϩRTvsCTϩRT. Anxiety rate is lower, depression is present in half of patients and is statistically related with dysphagia.
Chairman Lee Forrest Hill, M.D., Des Moines, Iowa: I should like to introduce our panel speakers. Dr. George M. Wheatley is 3rd Vice President, Metropolitan Life Insurance Company, and Chairman of the Academy's Committee on Rheumatic Fever, New York City. Next is Dr. T. N. Harris of Philadelphia. Dr. Harris is Assistant Research Professor of Pediatrics of the School of Medicine, University of Pennsylvania. He is chief of the Rheumatic Fever Clinic at the Philadelphia General Hospital. He is Assistant Consultant to the Outpatient Department of the Children's Hospital in Philadelphia. Dr. Hubbard is Assistant Professor of Pediatrics, School of Medicine, University of Pennsylvania. Dr. Robert L. Jackson is Associate Professor of Pediatrics, School of Medicine, State University of Iowa. Magnitude of the Problem Dr. Wheatley.—Because of the general acceptance of rheumatic fever as a major pediatric and public health problem, we find in an increasing number of localities both the medical profession and the public ready to support organized community efforts to find cases, to provide adequate treatment, and, in fact, willing to undertake most any logical measures which promise some control over this important cause of heart disease. For intelligent planning and evaluation at the community level or on a larger scale, facts showing the magnitude and relative importance of rheumatic fever are essential. Perhaps at this point you wonder what expressions such as "community level" and "planning and evaluation" have to do with the practicing pediatrician. As a clinician your primary concern is with the individual child. When you are at the bedside puzzled by a syndrome suggestive of rheumatic fever, it is of little help to know facts and figures on the incidence, prevalence and severity of this disease. The reason is that as a pediatrician you have a dual responsibility.
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