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Biomedical subjects

Michael D Fetters

Publications and source records attributed to Michael D Fetters.

At least 19 recordsLinked to original sources
PubMed2006

Pre-exercise stretching and sports related injuries: knowledge, attitudes and practices.

OBJECTIVE: Pre-exercise stretching (PES) has been common practice prior to participation in athletic events. Despite evidence for lack of benefit, many coaches continue to routinely instruct and prescribe stretching. This study assesses the knowledge, attitudes and practices of high school coaches regarding PES. DESIGN: A cross-sectional survey. SETTING: Multiple high schools in a Southeast Michigan county. PARTICIPANTS: Head coaches (n = 71) at ten county high schools completed the survey. MAIN OUTCOME MEASURES: Knowledge, attitudes and practices of high school coaches regarding PES. RESULTS: The survey was completed by coaches at 10 of 11 public high schools with an overall response rate of 46%. Coaches stretch athletes for an average of 13 minutes prior to practice or competition. Almost 95% of coaches feel stretching is beneficial, specifically in decreasing injury risk. Nearly 73% believe that there are no drawbacks to stretching. The most significant reason cited for stretching is decreased injury risk. Coaches stated that personal experience and scientific evidence are the two factors that would most likely influence their future recommendations regarding PES. There are statistically significant differences in stretching practices between male and female coaches and experienced and inexperienced coaches. CONCLUSIONS: Despite the lack of evidence, nearly all coaches believe that PES prevents a wide array of injuries. Although coaches value personal experience in determining their PES practices, they are open to new scientific evidence, which should encourage the medical community to deliver current research.

Adult↗
PubMed2006

Residency education through the family medicine morbidity and mortality conference.

BACKGROUND AND OBJECTIVES: The value of the morbidity and mortality conference (M&MC) has received little examination in the primary care literature. We sought to understand the educational content of M&MCs by examining data from a family medicine training program. METHODS: Archived morbidity and mortality conference data (July 2001-July 2003) were retrieved from two University of Michigan family medicine adult inpatient services (one community based and one university based). We used chi-square and t test to compare demographic variables and adverse events between hospital sites. We qualitatively analyzed written comments about adverse events. RESULTS: Both family medicine services shared similar diagnoses, patient volume, length of stay, and gender distribution of patients, but the community hospital had an older average patient age (67.9 years versus 52.9 years) and a higher outpatient complication rate. Analysis of the qualitative data revealed patterns of adverse events, such as an association between avoidable admissions and inadequate pain control, that could be improved through educational intervention. CONCLUSIONS: Although family medicine residents' experiences in university and community hospitals were comparable, there were differences in patient populations and case complexity. Modifying the M&MC format could enhance its effectiveness as an educational tool about adverse events.

Congresses as Topic↗
PubMed2005

Lessons learned in developing family medicine residency training programs in Japan.

BACKGROUND: While family medicine is not well established as a discipline in Japan, a growing number of Japanese medical schools and training hospitals have recently started sougoushinryoubu (general medicine departments). Some of these departments are incorporating a family medicine approach to residency training. We sought to learn from family medicine pioneers of these programs lessons for developing residency training. METHODS: This qualitative project utilized a long interview research design. Questions focused on four topics: 1) circumstances when becoming chair/faculty member; 2) approach to starting the program; 3) how Western ideas of family medicine were incorporated; and 4) future directions. We analyzed the data using immersion/crystallization to identify recurring themes. From the transcribed data, we selected representative quotations to illustrate them. We verified the findings by emailing the participants and obtaining feedback. RESULTS: Participants included: five chairpersons, two program directors, and three faculty members. We identified five lessons: 1) few people understand the basic concepts of family medicine; 2) developing a core curriculum is difficult; 3) start with undergraduates; 4) emphasize clinical skills; and 5) train in the community. CONCLUSION: While organizational change is difficult, the identified lessons suggest issues that merit consideration when developing a family medicine training program. Lessons from complexity science could inform application of these insights in other countries and settings newly developing residency training.

Academic Medical Centers↗
PubMed2005

Preconception care by family physicians and general practitioners in Japan.

BACKGROUND: Preconception care provided by family physicians/general practitioners (FP/GPs) can provide predictable benefits to mothers and infants. The objective of this study was to elucidate knowledge of, attitudes about, and practices of preconception care by FP/GPs in Japan. METHODS: A survey was distributed to physician members of the Japanese Academy of Family Medicine. The questionnaire addressed experiences of preconception education in medical school and residency, frequency of preconception care in clinical practice, attitudes about providing preconception care, and perceived need for preconception education to medical students and residents. RESULTS: Two hundred and sixty-eight of 347 (77%) eligible physicians responded. The most common education they reported receiving was about smoking cessation (71%), and the least was about folic acid supplementation (12%). Many participants reported providing smoking cessation in their practice (60%), though only about one third of respondents advise restricting alcohol intake. Few reported advising calcium supplementation (10%) or folic acid supplementation (4%). About 70% reported their willingness to provide preconception care. Almost all participants believe medical students and residents should have education about preconception care. CONCLUSION: FP/GPs in Japan report little training in preconception care and few currently provide it. With training, most participants are willing to provide preconception care themselves and think medical students and residents should receive this education.

Adult↗
PubMed2005

Herb and vitamin supplementation use among a general ophthalmology practice population.

PURPOSE: To survey comprehensive ophthalmology patients about their use of vitamins and herbal supplements. DESIGN: Cross-sectional survey. METHODS: A survey instrument was developed and distributed to 397 patients presenting to a main campus university-based comprehensive ophthalmology clinic and to an off-site comprehensive ophthalmology clinic. Information gathered included demographics, use of prescription medications, use of vitamin and herbal supplements, the reasons for using these supplements, perceived benefits of these products, where the information regarding them was gathered, and with whom patients had discussed their use. RESULTS: Fifty-eight percent of patients reported nearly daily use of vitamins. Multivitamins were the most common vitamin and were used by 46% of the patients. Eight percent of patients used herbal products on a daily basis. Twenty-six percent learned about vitamins from their primary care physician (PCP), and just 2% from their ophthalmologists, while 35% discussed their actual use with a PCP, and 5% with their ophthalmologists. Just 2% of these patients learned of herbs from a PCP, and <1% from an ophthalmologist. Older patients used multivitamins and other vitamins most frequently, while gender and education were not predictive of vitamin or herbal use. Mean monthly spending on vitamins by users was 15.74 dollars, while herbal users spent a monthly mean of 15.35 dollars. CONCLUSIONS: Vitamins and herbs are used by a significant number of patients in a comprehensive ophthalmology setting. Given the prevalence of vitamin and herbal use, ophthalmologists should systematically inquire about their use.

Adolescent↗
PubMed2005

Opening cultural doors: providing culturally sensitive healthcare to Arab American and American Muslim patients.

Differences in the social and religious cultures of Arab Americans and American Muslims raise challenges to healthcare access and delivery. These challenges go far beyond language to encompass entire world views, concepts of health, illness, and recovery and even death. Medical professionals need a more informed understanding and consideration of the rich and diverse array of beliefs, expectations, preferences, and behavioral make up of the social cultures of these patients to ensure that they are providing the best and most comprehensive care possible. Improved understanding will enhance a provider's ability to offer quality healthcare and to build trusting relationships with patients. Here, we provide a broad overview of Arab culture and Islamic religious beliefs that will assist providers in delivering culturally sensitive healthcare to these groups. We offer insight into the behaviors, requirements, and preferences of Arab American and American Muslim patients, especially as they apply to women's health.

Arabs↗
PubMed2004

Contraceptive care by family physicians and general practitioners in Japan: attitudes and practices.

BACKGROUND AND OBJECTIVES: Japan has one of the highest rates of unintended pregnancies among developed countries. Family physicians and general practitioners (FPs/GPs) have unique opportunities to provide family planning. The purpose of this research was to elucidate the attitudes and practices about contraceptive care by FPs/GPs in Japan. METHODS: In this cross-sectional study, we distributed to physician members of the Japanese Academy of Family Medicine a survey that addressed their educational experiences with contraceptive care, frequency of contraceptive care in their practices, attitudes toward providing it, and attitudes toward providing medical students and residents with contraception education. RESULTS: A total of 265 physicians responded (response rate 77.2%). Many physicians reported receiving limited education about contraception, and 75% reported offering no contraceptive care in practice. While 60% of participants reported a desire to provide information about contraception, one of four physicians reported no interest. About 90% of the physicians indicated that medical students should have contraception education. Eighty percent reported that residents should receive such education. CONCLUSIONS: Most FPs/GPs in Japan have received limited education about contraception. Few provide it currently, but 60% are willing to do so. Further investigation is needed to fully understand barriers to Japanese FPs/GPs providing contraceptive care.

Adult↗
PubMed2004

Emergency contraception: knowledge and attitudes of family medicine providers.

BACKGROUND AND OBJECTIVES: Emergency contraception (EC) is an underutilized method of preventing unplanned pregnancy. This study assessed family physicians' and nurse providers' knowledge, attitudes, and beliefs about EC. METHODS: A cross-sectional survey was distributed to faculty, residents, and clinic nurses in a Midwestern department of family medicine. Data were analyzed using Statistical Package for the Social Sciences. Statistical significance was tested by chi-square test, Student's t test, and Mann-Whitney U test where appropriate. RESULTS: Seventy-eight providers participated (response rate 81%). Seventy-four percent of physicians have prescribed EC in the past, with an average of 3.2 (range 0-10) times in the last year. The majority of providers reported that they were familiar with indications (96%) and protocols (78%) for prescribing EC, yet knowledge inaccuracies were identified. Overall attitudes regarding EC were positive. CONCLUSIONS: Although the majority of participating providers were willing to prescribe EC and had generally favorable attitudes toward it, rates of providing this therapy were low. There was a discrepancy between providers' perceived and actual knowledge about EC. Interventions targeting misunderstandings might help reduce missed opportunities to provide EC.

Attitude of Health Personnel↗
PubMed2004

Developing a Web site in primary care.

BACKGROUND AND OBJECTIVES: While content, navigability, and usability are essential qualities of effective Web sites, the health care literature contains limited discussion of these issues. This article describes how knowledge gained through focus groups, Web site searches, and individual interviews were used to develop and improve a health-related Web site. METHODS: We conducted 10 focus groups and searches of existing Web sites in preparation for developing a Web site about colorectal cancer (CRC) screening. We conducted 30 in-depth interviews to assess content, navigation, and usability of a new CRC Web site, using participants recruited from Michigan communities with a low incidence of CRC testing. Targeted participants were 50-70 years of age, had no prior experience with CRC testing, and had variable comfort levels with Internet use. RESULTS: Existing CRC screening Web sites uniformly use user-directed navigation and have little variation in content. Our study participants stimulated revisions in content, navigation, and usability. Revised content factors included comprehension, utility, and appeal. Navigation changes focused on logical transition between sections. Usability changes included user focus and clarity of graphics/ text. CONCLUSIONS: We found focus groups, Web site searches, and individual interviews useful in developing and testing content, navigation, and usability of a CRC screening Web site. These steps provide methodological procedures for developing and revising health-related Web sites.

Aged↗
PubMed2003

Doctor-patient communication: a comparison of the USA and Japan.

BACKGROUND: Little is known about the differences and similarities between doctor-patient communication patterns in different cultures. OBJECTIVES: The aim of this study was to examine communication patterns of doctor-patient consultations in two different cultures, namely the USA and Japan, and to elucidate linguistic differences and similarities in communication. METHODS: This cross-sectional study used quantitative discourse analysis from linguistics to compare 40 doctor-patient consultations: 20 out-patient consultations of five physicians in the USA and 20 out-patient consultations of four physicians in Japan. The main outcomes measured were time spent in each phase of the encounter, number of categorized speech acts, distribution of question types and frequencies of back-channel responses and interruptions. RESULTS: The average length of doctor-patient encounters was 668.7 s in the USA and 505 s in Japan. US physicians spent relatively more time on treatment and follow-up talk (31%) and social talk (12%), whereas the Japanese had longer physical examinations (28%) and diagnosis or consideration talk (15%). Japanese doctor-patient conversations included more silence (30%) than those in the USA (8.2%). The doctor-patient ratios of total speech acts were similar (USA 55% versus 45%; Japan 59% versus 41%). Physicians in both countries controlled communication during encounters by asking more questions than the patients (75% in the USA; 78% in Japan). The Japanese physicians and patients used back-channel responses and interruptions more often than those in the USA. CONCLUSIONS: While doctor-patient communication differed between the USA and Japan in the proportion of time spent in each phase of the encounter, length of pauses and the use of back-channel responses and interruptions, physician versus patient ratios of questions and other speech acts were similar. The variations may reflect cultural differences, whereas the similarities may reflect professional specificity stemming from the shared needs to fill the information gap between physician and patient. Adequate awareness of these differences and similarities could be used to educate clinicians about the best approaches to patients from particular cultural backgrounds.

Adult↗
PubMed2003

Cost-effectiveness of pap smear screening for vaginal cancer after total hysterectomy for benign disease.

OBJECTIVE: To examine the cost effectiveness of Papanicolaou screening for cancer after total hysterectomy for benign disease. MATERIALS AND METHODS: Decision analysis including Markov modeling applied to women aged 40 or older with a history of total hysterectomy for benign disease. We derived expected discounted costs and life expectancy. RESULTS: Maximum gain in life expectancy between no screening and any screening strategy was approximately 3 weeks. Cost effectiveness in dollars per life-year gained was > or =$143,875 more than no screening for strategies starting at age 50, and over $12 million for aged 40 or more screening strategy. None of the sensitivity analyses caused the incremental cost effectiveness of any strategy to come to less than $100,000 per life year gained compared with no screening. CONCLUSIONS: Despite significant costs for any strategy, Pap smear screening after total hysterectomy for benign disease provides essentially no gain in life expectancy. In absence of risks for genital cancer, such screening is not cost effective.

Journal Article↗
PubMed2003

Japanese women's perspectives on pelvic examinations in the United States. Looking behind a cultural curtain.

OBJECTIVE: To elucidate overseas Japanese women's preferences on whether to use a curtain to separate themselves from the provider during pelvic examinations in the United States, as practiced in Japan. STUDY DESIGN: We qualitatively interviewed 19 overseas Japanese women who presented to a clinic serving Japanese people living in southeastern Michigan. We synthesized this interview data into a cohesive overview of the content and used illustrative quotes generated by the participants to provide a context. RESULTS: Most participants (n = 12) approved of the U.S. style of examination, including the use of private rooms and a sheet to cover the perineum. A minority of women (n = 4) said they were neutral to the approach, 2 preferred the Japanese examination style, and 1 did not like pelvic examinations. Some participants strongly disliked the use of the curtain and the structure of examination rooms in Japan. CONCLUSION: Most participating women did not support using a curtain during pelvic examinations in the U.S., as practiced in Japan, and some were critical of the Japanese practice. Clinicians may help place their Japanese patients at ease by acknowledging nonuse of a curtain in the U.S., and explaining the intentional use of a private room and sheet to protect patient privacy.

Adult↗
PubMed2002

Responsibility and cancer disclosure in Japan.

In Japan, as in many countries around the world, cancer patients are often not told the truth about their illness. Despite polls showing a majority of those surveyed wish to be told, surveys of physicians indicate only a small percentage will tell, especially when the cancer is advanced or terminal. We interviewed physicians from various specialties with experience managing advanced or terminal cancer patients to investigate their approaches to cancer disclosure. Our analysis reveals physicians divide into two groups: those who usually do not tell (non-tellers) such patients and those who usually do tell (tellers). Non-tellers reported the shock of disclosure inhibits telling patients, families' wishes for non-disclosure cannot be ignored, and most patients themselves do not wish to be told. Tellers asserted disclosure is unavoidable and patients want to be told, few problems result when they tell, and telling has many advantages such as not having to lie to the patient. Despite the experience of non-tellers, most physicians continue to follow the traditional approach, for advanced or terminal cancers. Physicians, as well as families and patients, display an aversion to taking responsibility for the potential risks of disclosure, and this may perpetuate the status quo.

Adult↗
PubMed2002

[Individual interviews with elderly in a rural area: expectations for medical care services].

INTRODUCTION: As intensive health care users, the elderly contribute significantly to rising health care cost in Japan. This research sought to elucidate the decision making processes elderly use when seeking medical care and their expectations of medical facilities and physicians. METHODS: We conducted qualitative individual interviews with rural elderly, over 65 years old, who had access to private physician offices, community, regional, and university hospitals. Interview questions elicited participants' experiences in seeking medical care; their most memorable experiences in hospitals; and their expectations for medical services. After the individual interviews, we surveyed the participants to verify the results. RESULTS: A total of 19 individuals participated in these interviews. These 19 individuals and an additional five individuals who met eligibility criteria were surveyed by mail after the interviews and verified the results. The participants identified "a feeling of intimacy" and "receiving kind-hearted treatment" as the most important attributes of medical facilities. Other important factors included: accommodating patients' preferences; being close to home; earning the patient trust; and having a well organized infrastructure. Comparatively important element were: "technology and skill", "opinion and reputation of third person", "length in the latency", "continued medical treatment by the same doctor", "actual feeling of improvement", "introduction to a higher order medical facility", "multiple medical departments", and "medical judgement by multiple doctors". These factors fall into three categories: emotional expectations; expectations of the health system; and convenience in daily life. The survey data confirmed these findings. DISCUSSION: These results suggested that elderly expect "supportive" and "accommodating" health care services in which the medical activity does not cause problems for daily life. However, these vague expectations for the medical system need translated into practical steps. Still, it is important for health care providers to consider these expectations and the relationships among them. These findings corroborate the results of a previous investigation that used focus group interviews.

Aged↗
PubMedDate not supplied

Designing a mixed methods study in primary care.

BACKGROUND: Mixed methods or multimethod research holds potential for rigorous, methodologically sound investigations in primary care. The objective of this study was to use criteria from the literature to evaluate 5 mixed methods studies in primary care and to advance 3 models useful for designing such investigations. METHODS: We first identified criteria from the social and behavioral sciences to analyze mixed methods studies in primary care research. We then used the criteria to evaluate 5 mixed methods investigations published in primary care research journals. RESULTS: Of the 5 studies analyzed, 3 included a rationale for mixing based on the need to develop a quantitative instrument from qualitative data or to converge information to best understand the research topic. Quantitative data collection involved structured interviews, observational checklists, and chart audits that were analyzed using descriptive and inferential statistical procedures. Qualitative data consisted of semistructured interviews and field observations that were analyzed using coding to develop themes and categories. The studies showed diverse forms of priority: equal priority, qualitative priority, and quantitative priority. Data collection involved quantitative and qualitative data gathered both concurrently and sequentially. The integration of the quantitative and qualitative data in these studies occurred between data analysis from one phase and data collection from a subsequent phase, while analyzing the data, and when reporting the results. DISCUSSION: We recommend instrument-building, triangulation, and data transformation models for mixed methods designs as useful frameworks to add rigor to investigations in primary care. We also discuss the limitations of our study and the need for future research.

Health Services Research↗
PubMedDate not supplied

Opening the black box: cognitive strategies in family practice.

PURPOSE: We wanted to describe the cognitive strategies used by family physicians when structuring the decision-making tasks of an outpatient visit. METHODS: This qualitative study used cognitive task analysis, a structured interview method in which a trained interviewer works individually with expert decision makers to capture their stages and elements of information processing. RESULTS: Eighteen family physicians of varying levels of experience participated. Three dominant themes emerged: time pressure, a high degree of variation in task structuring, and varying degrees of task automatization. Based on these data and previous research from the cognitive sciences, we developed a model of novice and expert approaches to decision making in primary care. The model illustrates differences in responses to unexpected opportunity in practice, particularly the expert's use of attentional surplus (reserve capacity to handle problems) vs the novice's choice between taking more time or displacing another task. CONCLUSIONS: Family physicians have specific, highly individualized cognitive task-structuring approaches and show the decision behavior features typical of expert decision makers in other fields. This finding places constraints on and suggests useful approaches for improving practice.

Adult↗
PubMedDate not supplied

The experiences of Japanese generalist physicians in overseas faculty development programs.

BACKGROUND AND OBJECTIVES: While many resources have been invested in sending Japanese physicians for advanced training in family medicine abroad, no known research examines the nature of their experiences. The purpose of this research was to investigate the impact of family medicine faculty development training abroad on participating Japanese physicians. METHODS: We distributed a self-administered, semi-structured questionnaire to physicians identified as having completed a faculty development program abroad. RESULTS: Sixteen (response rate 94%) physicians participated. The participants' a priori goals included learning about family medicine and developing teaching skills. From observing precepting and small-group discussions, they learned new teaching approaches. Most reported their fellowship training as influencing current teaching, clinical, and research activities and as particularly enhancing their interest in clinical skills, learner-oriented teaching, and the doctor-patient relationship. They also reported formulating new ideas regarding teaching activities, department structure, and clinical care during their fellowships, though they have encountered barriers to implementing such reforms after returning to Japan. CONCLUSIONS: Faculty development training abroad contributes to all major aspects of physicians' professional lives after returning to Japan, although many report difficulties implementing new teaching ideas after their return.

Adult↗