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Biomedical subjects

K J Ferguson

Publications and source records attributed to K J Ferguson.

At least 19 recordsLinked to original sources
PubMed2001

Monitoring adherence to Standard Precautions.

BACKGROUND: Health care workers (HCWs) do not consistently follow Standard Precautions (SP). This is a serious problem because inadequate compliance is associated with increased blood exposure thus predisposing HCWs to bloodborne pathogen transmission. METHODS: The primary goal of this study was to identify institutional factors associated with adequacy of HCW training to monitor coworkers' adherence to SP. Surveys were sent to all community hospital infection control practitioners (ICPs) in Iowa and Virginia. ICPs indicated on a 5-point Likert scale, ranging from strongly disagree to strongly agree, their assessment of HCW training adequacy. Data from another statewide survey of HCWs in Iowa were assessed to validate this outcome measure. Multiple logistic regression models were developed to identify predictors of assessed training adequacy. Independent variables included methods of education, training, approaches to SP compliance assessment, provision of SP reinforcement by clinical leaders, and organizational data. RESULTS: A total of 149 institutions (62%) participated. Models of training program adequacy varied across occupations. Management commitment to SP training programs, leadership support, frequency of providing bloodborne pathogen information, and safety climate were important institutional predictors of assessed adequacy of training. The outcome was validated by demonstrating an association between the ICPs' assessment of HCW training and workers who reported having sufficient information to comply with SP (P <.05). CONCLUSIONS: Institutional safety climate, leadership support, and frequency of education play an important role in HCWs' training adequacy to monitor coworkers' adherence to SP. Occupational groups should be considered independently when strategies are developed to increase compliance. Interventions based on modifiable factors identified by this study may reduce bloodborne pathogen exposure among HCWs.

Blood-Borne Pathogens↗
PubMed2001

Hospital bloodborne pathogens programs: program characteristics and blood and body fluid exposure rates.

OBJECTIVE: To describe hospital practices and policies relating to bloodborne pathogens and current rates of occupational exposure among healthcare workers. PARTICIPANTS AND METHODS: Hospitals in Iowa and Virginia were surveyed in 1996 and 1997 about Standard Precautions training programs and compliance. The primary outcome measures were rates of percutaneous injuries and mucocutaneous exposures. RESULTS: 153 (64%) of 240 hospitals responded. New employee training was offered no more than twice per year by nearly one third. Most (79%-80%) facilities monitored compliance of nurses, housekeepers, and laboratory technicians; physicians rarely were trained or monitored. Implementation of needlestick prevention devices was the most common action taken to decrease sharps injuries. Over one half of hospitals used needleless intravenous systems; larger hospitals used these significantly more often. Protected devices for phlebotomy or intravenous placement were purchased by only one third. Most (89% of large and 80% of small) hospitals met the recommended infection control personnel-to-bed ratio of 1:250. Eleven percent did not have access to postexposure care during all working hours. Percutaneous injury surveillance relied on incident reports (99% of facilities) and employee health records (61%). The annual reported percutaneous injury incidence rate from 106 hospitals was 5.3 injuries per 100 personnel. Compared to single tertiary-referral institution rates determined more than 5 years previously, current injury rates remain elevated in community hospitals. CONCLUSIONS: Healthcare institutions need to commit sufficient resources to Standard Precautions training and monitoring and to infection control programs to meet the needs of all workers, including physicians. Healthcare workers clearly remain at risk for injury. Further effective interventions are needed for employee training, improving adherence, and providing needlestick prevention devices.

Blood-Borne Pathogens↗
PubMed2001

Examining the generalizability of ratings across clerkships using a clinical evaluation form.

It is necessary to average multiple clinical evaluation form (CEF) observations to obtain a reliable score. Combining CEF observations across clerkships will provide more observations per student, but it is unknown how an across-clerkship generalization affects reliability. The authors conducted generalizability studies on balanced stratified random samples to examine the impact of averaging across clerkships. The study detected a student by clerkship interaction. Although the interaction magnitude was small, it had a large negative impact on the reliability of the mean score. The authors conclude that averaging across clerkships for the purpose of evaluating global clinical skills will produce a less reliable measure for a fixed number of observations than averages calculated within a clerkship for evaluating clerkship specific skills. The content specificity of clinical skills as measured by the CEF may resemble that found using other measurement methods.

Clinical Clerkship↗
PubMed2000

Choice of spectroscopic lineshape model affects metabolite peak areas and area ratios.

The use of Lorentzian model lineshapes leads to systematic errors in the quantification of in vivo (1)H NMR spectra. Experimental lineshapes are better modeled by the Voigt (mixed Lorentzian-Gaussian) function, leading to more accurate fits (reduced chi(2)). In this work, results from a group of 41 subjects are presented. It is shown that not only are the estimated metabolite peak areas affected by the choice of lineshape model, but so too are the metabolite ratios. For example, the NAA/choline ratio was 1.92 +/- 0.06 (mean +/- standard error) using the Lorentzian lineshape model and 1.85 +/- 0.05 using the Voigt lineshape model. The corresponding figures for NAA/creatine were 2.32 +/- 0.06 and 2. 10 +/- 0.05 respectively, which are significantly different for the two lineshape models. An explanation of this previously unreported effect is given. This finding clearly has serious implications for the methodology and reporting of spectroscopic studies.

Aged↗
PubMed2000

Evaluation methods for prevention education.

The knowledge, skills, and attitudes associated with prevention cut across clinical disciplines. Thus, they are often subsets of disciplines not otherwise present in the traditional curriculum (e.g., epidemiology or statistics) or considered the province of many disciplines (e.g., risk reduction or cancer screening). Evaluation of elements of prevention education can often become lost in the myriad other outcomes that are assessed in students, or they are intermingled with other content and skills. This article highlights the value of assessing students' competence in prevention knowledge, skills, and attitudes, provides general guidance for programs interested in evaluating their prevention instructional efforts, and gives specific examples of possible methods for evaluating prevention education. While it is important to tailor assessment methods to local institutional objectives, it is possible to share assessment methods and materials regionally and nationally. Sharing problems, as well as successes, encountered in developing appropriate assessment methods will advance the field of evaluation of prevention curricula.

Attitude of Health Personnel↗
PubMed1998

Teaching physical examination of the adult liver with use of real-time sonography.

RATIONALE AND OBJECTIVES: The authors developed and evaluated an approach to teaching examination of the liver that incorporates real-time ultrasound (US) imaging as immediate feedback to improve diagnostic accuracy. MATERIALS AND METHODS: Second-year medical students participating in a course in physical examination were assigned to receive instruction in measuring liver span without (group 1) or with (group 2) real-time sonography. Students from each group attended a practice session given by one of two physicians who were board certified in radiology and internal medicine with special expertise in US. During the practice session for group 2, students were shown the boundaries of the liver of the practice patient with real-time US. Both groups of students then made three measurements each of the liver span of a healthy practice patient and a single healthy test patient without US. The vertical liver span reference standard was determined by one of the authors. RESULTS: Students in group 2 showed greater accuracy in measuring liver span during both the practice and the test sessions than did students in group 1. The differences were significant for the third practice measurement and all three test measurements (P < .05). CONCLUSION: The use of real-time US as an aid in teaching physical examination improves students' accuracy in measuring liver size.

Adult↗
PubMed1997

Lifelong self-directed learning using a computer database of clinical questions.

Physicians often have self-perceived knowledge gaps when they are seeing patients. Traditional continuing medical education is designed to meet the knowledge gaps of groups rather than individual physicians with specific patient problems. Physicians with clinical information needs are advised to critically evaluate high-quality original research in order to practice "evidence-based medicine." But this advice may be unrealistic for busy clinicians. We propose a system for documenting self-perceived information needs using a computer database. Concise answers to these needs are included in the database along with reference citations supporting the answers. The system tracks continuing education efforts, directs patient care decisions, and focuses lifelong learning on relevant topics. We emphasize the importance of being sensitive to personal information needs and the benefits of maintaining a record of these needs.

Clinical Medicine↗
PubMed1996

Intervention research in agriculture: examples from the swine confinement and respiratory health project.

The "Measurement and Analysis in Agricultural Interventions" workshop session of the "Intervention Research in Occupational Health and Safety: Science, Skills, Strategies" conference considered a variety of approaches to safety and health interventions in agriculture. The "Respiratory Health in Swine Confinement Project" in Iowa, an educational intervention to improve respiratory health and safety in swine confinement workers, was presented as a case study for the discussion. Results from the project were used to illustrate the advantages and disadvantages of a variety of research techniques in interventions and program evaluation, including specific issues related to measurement and analysis. The discussion reflects comments from workshop participants along with summary observations reported to conference attendees. Themes of the session include the complementary nature of quantitative and qualitative techniques, and the importance of developing interventions that are community based.

Air Pollution, Indoor↗
PubMed1996

Predictors of hepatitis B vaccine acceptance in health care workers.

This article examines the relative importance of occupational, epidemiologic, and attitudinal factors in hepatitis B vaccine acceptance. A stratified random sample of 1,018 health care workers at risk for occupational blood exposure at our university hospital were contacted in 1992 and 919 (90%) participated. Potential reasons for vaccine acceptance or refusal were evaluated with factor analysis. Logistic regression models were calibrated on a stratified random subsample to identify independent predictors of initiating and completing the series, then validated on the remaining subjects. Fifty-four percent (482 of 898) of previously nonimmune workers had completed the series, while 70% (626) had received one or more doses. Hepatitis B vaccine acceptance was related strongly to social influence (physicians, supervisors, role models, friends, and spouse) and knowledge of the disease and vaccine, whereas refusal was primarily related to concern about vaccine side effects and problems with vaccine access. Independent predictors of initiating the vaccine series included younger age (odds ratio [OR] 0.98 per year, 95% confidence interval [CI95] 0.96-0.997), occupation (housestaff: OR 2.9, CI95 1.1-7.9; nurses: OR 2.1, CI95 1.0-4.3 versus housekeepers), increased blood exposure frequency (OR 2.4, CI95 1.6-3.5 for 1-6 versus 0 exposures in past year), and increased frequency of recent influenza vaccination (OR 3.3, CI95 2.0-5.3 for 1 versus 0 doses in prior 3 years). Occupation (increased acceptance among housestaff, nurses, nursing assistants, laboratory technicians), increased frequency of blood exposure, and recent influenza vaccination also were predictors of series completion. Factors such as occupation, blood exposure frequency and acceptance of other preventive services may help identify health care worker groups with low vaccine acceptance most likely to benefit from targeted vaccine delivery. Hepatitis B vaccine should be offered routinely during evaluation for occupational blood exposure. Future vaccine implementation efforts should emphasize the involvement of physicians and supervisors and education about occupational disease risk, liability, and the safety of the vaccine.

Adult↗
PubMed1995

Motivation for hepatitis B vaccine acceptance among medical and physician assistant students.

PURPOSE: To evaluate the acceptance rate and motivation for acceptance of hepatitis B virus (HBV) vaccine among preclinical medical and physician assistant (PA) students in comparison with similar data obtained from resident and staff physicians. METHODS: A cross-sectional survey of all second-year medical and PA students (n = 170) at the University of Iowa College of Medicine was conducted in Spring 1992, requesting demographic data, preventive health measure use, and reasons for HBV vaccine acceptance. Responses were compared with data obtained from resident and staff physicians during a concurrent hospital-wide survey. Rates of vaccine acceptance and use of other preventive health measures were compared across the physician groups. Factor analysis was performed to examine reasons for vaccine acceptance among the students. RESULTS: The questionnaire was completed by 162 of the 170 students (95%). Nearly all (99%) of the eligible students had received at least one dose of the HBV vaccine. Vaccine acceptance rates were significantly higher among the students than among either the resident or the staff physicians (p = 0.003, p < 0.0001, respectively). Influenza vaccine acceptance and seat belt use were significantly higher among the resident and staff physicians than they were among the students. The students attributed their high HBV vaccine acceptance rate to the recommendations of authority figures. Threat of illness and issues of vaccine safety and efficacy were relatively unimportant among the students, though the residents and staff physicians reported threat of illness to be an important motivator for vaccination. CONCLUSIONS: Excellent HBV vaccine acceptance rates may be achieved among preclinical medical and PA students. Recommendations of authority figures are important motivators for HBV vaccine acceptance among students.

Adult↗
PubMed1995

Binge eating disorder in a community-based sample of successful and unsuccessful dieters.

This study examined binge eating and weight cycling in a community-based sample of successful (46 women, 44 men) and unsuccessful (29 women, 25 men) dieters. Successful dieters had lost at least 15% of body weight, kept the weight off for at least 1 year, and regained no more than 10 lb (average weight loss = 48 lb). Subjects completed a written questionnaire and were interviewed by phone several weeks later. Unsuccessful dieters were more obese when starting on a diet (average body mass index = 35.6 compared to 32.1) and were much more likely to have lost and regained 20 lb. Six-month prevalence of binge eating disorder (BED) was 19% for unsuccessful dieters and 6% for successful dieters; lifetime prevalence was 15% and 13%, respectively. Unsuccessful dieters were two to three times more likely to perceive a lack of control during an episode of overeating, to be disgusted with themselves for overeating, and to eat alone because they were embarrassed. Encouraging dieters to set realistic goals, identify potential relapse situations, and interpret lapses may help them succeed.

Adult↗
PubMed1994

Physician recommendation as the key factor in patients' decisions to participate in preoperative autologous blood donation programs: Preoperative Autologous Blood Donation Study Group.

To determine whether the physician or patient had initiated the discussion regarding preoperative autologous blood donation (PABD) and to assess the relative importance of the physician's recommendation in patients' decision to donate, responses were obtained from 254 of 409 patients (62%) who had donated preoperatively during the 3 study months. Nearly all (96%) strongly agreed they would donate again for themselves and nearly all (94%) strongly agreed they would recommend PABD to others. Patients initiated the discussion about PABD 23% of the time, while 71% indicated strong surgeon input. The remaining respondents said their surgeon had "mentioned it, but said it was up to me." The importance of avoiding transfusion reactions was rated significantly greater among those whose surgeons had initiated the discussion, as was the relative weight of the surgeon's recommendation. The desire to alleviate the blood shortage was rated much less important among patients who had initiated the discussion themselves.

Attitude to Health↗
PubMed1994

Surveying smokeless tobacco use, oral lesions and cessation among high school boys.

We surveyed 821 Iowa teenage boys to establish patterns of smokeless tobacco use, occurrence of oral lesions and the effect of lesions on attitudes about quitting, current use and plans for future use. Results suggest that young ST users who currently have a lesion or have experienced lesions may be particularly receptive to discussion of quitting options and other information about ST health effects. Dentists and other oral health professionals should initiate ST intervention when establishing a lesion history or on discovering a lesion at examination.

Adolescent↗
PubMed1991

Physicians' effectiveness in assessing risk for human immunodeficiency virus infection.

An American Medical Association committee recently recommended that physicians routinely screen patients for behaviors that put patients at risk for human immunodeficiency virus infection, yet there is evidence that this screening does not occur routinely. Faculty, fellows, and residents at a teaching hospital in a midwestern state with a low prevalence of acquired immunodeficiency syndrome were surveyed regarding their experience in screening for human immunodeficiency virus, their training related to substance abuse and human sexuality, and their confidence and ease in addressing such topics with their patients. Results indicated that only 11% routinely screened patients for high-risk behaviors. While most physicians had received training in human sexuality, most had not received training in substance abuse screening. Those trained felt more confident in addressing substance abuse and human sexuality and felt more comfortable in caring for patients known to be infected with human immunodeficiency virus. A concerted effort to encourage human immunodeficiency virus risk assessment by physicians is needed. This should include training opportunities in screening and counseling patients about sexual activities and substance abuse.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Effective use of patient education illustrations.

Effective illustrations can greatly enhance patient education materials, yet many illustrations do not aid instruction as much as they could. By following the above recommendations, patient education materials developers and illustrators can together accomplish their objectives.

Audiovisual Aids↗
PubMed1990

Surgeons' knowledge, attitude, and use of preoperative autologous blood donation.

Before a comprehensive educational program on preoperative autologous blood donation was begun, 118 surgeons from three different areas of the country were tested to assess their baseline knowledge and attitude about this practice. Test results were correlated with the percentage of eligible patients that the surgeons actually referred for preoperative donation during a period of observation. The purpose of this preliminary effort was to identify areas in the educational program that required emphasis. Overall, the surgeons' attitude toward preoperative donation was quite favorable, but their depth of knowledge varied. Misunderstandings may have led to diminished use of this service (eg, about 50% didn't realize that many patients with medical conditions or low hematocrits are permitted to donate). However, it is not clear that simply bolstering surgeons' knowledge will increase their appropriate use of preoperative donation. When all 118 surgeons were studied, their knowledge and attitude were unrelated to the percentage of eligible patients referred. However, when 44 surgeons who managed the largest number of eligible patients were analyzed separately, their use of preoperative donation was directly correlated with their knowledge and attitude. The local awareness of AIDS also significantly influenced the use of this service. It is proposed that knowledge of preoperative donation may be important for inducing surgeons to begin referring patients for this service. Once a pattern of successful participation is established, referral seems to increase with the acquisition of working knowledge.

Blood Transfusion, Autologous↗
PubMed1989

Estrogen replacement therapy. A survey of women's knowledge and attitudes.

Because the significant health risks related to postmenopausal osteoporosis can be reduced by estrogen replacement therapy (ERT), this study assessed women's attitudes toward ERT to assess factors that might increase its use. Results showed that women taking ERT were more likely to know that decreased estrogen levels lead to osteoporosis, to perceive that menopause is a medical condition, to believe that natural approaches to menopause are less preferable, to be seeing a gynecologist for care, and to believe that women should take ERT for hot flashes. The study suggests that a systematic educational approach could influence women's willingness to take ERT, especially if the recommended therapy does not cause withdrawal bleeding.

Adult↗