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PubMed2006

Medication barriers and anti-hypertensive medication adherence: the moderating role of locus of control.

Locus of control as a moderator of the relationship between medication barriers (e.g., side-effects, forgetting to take medication, and keeping track of pills) and anti-hypertensive medication adherence was examined. Baseline data were obtained from 588 hypertensive veterans. In general, fewer medication barriers, higher internal locus of control and lower external locus of control was associated with better hypertensive medication adherence. Furthermore, internal locus of control served as a moderator (beta = -.74, p < .01) for the relationship between medication barriers and medication adherence; effect size was large. Decomposition of the interaction revealed that the relationship between medication barriers and medication adherence was strongest when internal control was high (b = -.24, p < .01). Higher internal locus of control was beneficial when barriers to medication adherence are low, but at high perceived barriers, locus of control plays less of a role in medication adherence. Future efforts to improve medication adherence should consider the patient's perceived level of medication barriers in conjunction with their locus of control.

Antihypertensive Agents↗

PubMed1986

Medical and psychiatric determinants of outpatient medical utilization.

Ninety-two general medical outpatients were surveyed with an interview, questionnaires, and a medical record review to investigate the relationships among psychiatric disorder (depression and hypochondriasis), somatic symptoms, medical morbidity, and the utilization of ambulatory medical services. Medical utilization correlated with the number of somatic symptoms reported (r = 0.49, P = 0.0001), depressive symptoms (r = 0.34, P = 0.001), and the number of medical diagnoses in the medical record. Somatic symptoms were not significantly correlated with the number of medical diagnoses, but were related to hypochondriacal attitudes (r = 0.52, P = 0.0001) and depression (r = 0.51, P = 0.0001). In stepwise multiple regressions, the number of medical diagnoses accounted for 33% of the variance in medical utilization. Somatic symptoms were the second most powerful predictor, increasing R2 to 0.469. The next best predictors were two hypochondriacal attitudes and the presence of a major psychiatric diagnosis in the medical record. This five-step model explained 56% of the variance. Somatic symptoms are thus powerful determinants of medical utilization, even after controlling for medical morbidity. Depression, disease fear, and bodily preoccupation are also important predictors of utilization. Somatic symptoms are a final common pathway through which emotional disturbance, psychiatric disorder, and organ pathology all express themselves, and which prompt patients to visit doctors.

Adult↗

PubMed1998

[Geographical distribution of medical expenditure for the aged insured by National Health Insurance in secondary medical care areas in Japan].

PURPOSES: To determine what factors affect medical expenditure for the aged insured by the National Health Insurance among secondary medical care areas. METHOD: The original data of municipalities were combined and converted into the data of secondary medical areas. The original data included medical expenditure of the aged in 1994, medical supply factors per 100,000 population (numbers of doctors, numbers of general beds in hospitals, numbers of clinics, etc.) and socio-economic factors (income, proportion of employees for three sectors of industries, population density, average size of family, etc.). Medical expenditures for inpatients and outpatients were used separately as independent variables. The medical supply and socio-economic factors have been used as dependent variables. Multiple regression models were applied to clarify the differences in the contributing factors between inpatient and outpatient. RESULTS: 1. The maximum inpatient and outpatient medical expenditures for the aged are respectively 4 times and 2.6 times more expensive than minimum expenditures among secondary medical care areas. 2. The numbers of beds, income per capita, numbers of doctor, average size of family, proportion of employees for third level industry and income accounted for 57.4% of variance in inpatient medical expenditure of the aged. 3. The proportion of employees for first level industry, the numbers of beds and average members of family accounted for 21.4% of variance in outpatient medical expenditure of the aged. 4. Medical expenditure for inpatients related with medical supply and socioeconomic factors differently from that of outpatients.

Aged↗

PubMed2006

From vagueness in medical thought to the foundations of fuzzy reasoning in medical diagnosis.

OBJECTIVE: This article delineates a relatively unknown path in the history of medical philosophy and medical diagnosis. It is concerned with the phenomenon of vagueness in the physician's "style of thinking" and with the use of fuzzy sets, systems, and relations with a view to create a model of such reasoning when physicians make a diagnosis. It represents specific features of medical ways of thinking that were mentioned by the Polish physician and philosopher Ludwik Fleck in 1926. The paper links Lotfi Zadeh's work on system theory before the age of fuzzy sets with system-theory concepts in medical philosophy that were introduced by the philosopher Mario Bunge, and with the fuzzy-theoretical analysis of the notions of health, illness, and disease by the Iranian-German physician and philosopher Kazem Sadegh-Zadeh. MATERIAL: Some proposals to apply fuzzy sets in medicine were based on a suggestion made by Zadeh: symptoms and diseases are fuzzy in nature and fuzzy sets are feasible to represent these entity classes of medical knowledge. Yet other attempts to use fuzzy sets in medicine were self-contained. The use of this approach contributed to medical decision-making and the development of computer-assisted diagnosis in medicine. CONCLUSION: With regard to medical philosophy, decision-making, and diagnosis; the framework of fuzzy sets, systems, and relations is very useful to deal with the absence of sharp boundaries of the sets of symptoms, diagnoses, and phenomena of diseases. The foundations of reasoning and computer assistance in medicine were the result of a rapid accumulation of data from medical research. This explosion of knowledge in medicine gave rise to the speculation that computers could be used for the medical diagnosis. Medicine became, to a certain extent, a quantitative science. In the second half of the 20th century medical knowledge started to be stored in computer systems. To assist physicians in medical decision-making and patient care, medical expert systems using the theory of fuzzy sets and relations (such as the Viennese "fuzzy version" of the Computer-Assisted Diagnostic System, CADIAG, which was developed at the end of the 1970s) were constructed. The development of fuzzy relations in medicine and their application in computer-assisted diagnosis show that this fuzzy approach is a framework to deal with the "fuzzy mode of thinking" in medicine.

Diagnosis↗

PubMed2000

What do medical students read and why? A survey of medical students in Newcastle-upon-Tyne, England.

OBJECTIVES: There is increasing interest in the role of medical humanities within the undergraduate curriculum, but we know little about medical students' views on this or about their reading habits. Our study explored the reading habits of medical students, and their attitudes towards literature and the introduction of humanities into the curriculum. DESIGN: Self-completion questionnaire survey. SETTING: Newcastle University and Medical School. SUBJECTS: All first-, second- and third-year undergraduate medical students (384), biology students (151) and a random sample of law students (137) were sent a self-completion questionnaire to assess reading levels, attitudes towards literature and the medical humanities (medical students) and the perceived benefits of reading. RESULTS: Medical students read widely beyond their course and articulate a range of benefits from this, including: increasing awareness of life outside their experience; introspection or inspiration; emotional responses; and stimulation of an interest in reading or literature. Of the medical students, 40% (103/258) read one or more fiction books per month, but 75% (193) read fewer non-curricular books since starting university, largely because of time pressures, work, study or academic pressures and restricted access to books. A total of 77% (194) thought that medical humanities should definitely or possibly be offered in the curriculum, but of these 73% (141) thought it should be optional and 89% (172) that it should not be examined. CONCLUSIONS: Medical students read literature for a variety of very positive and valued reasons, but have found leisure reading harder to maintain since starting university. They support inclusion of the humanities in medical education, but have mixed views on how this should be done.

Attitude↗

PubMed2003

A systematic review of the effect of different models of after-hours primary medical care services on clinical outcome, medical workload, and patient and GP satisfaction.

BACKGROUND: The organization of after-hours primary medical care services is changing in many countries. Increasing demand, economic considerations and changes in doctors' attitudes are fueling these changes. Information for policy makers in this field is needed. However, a comprehensive review of the international literature that compares the effects of one model of after-hours care with another is lacking. OBJECTIVE: The aim of this study was to carry out a systematic review of the international literature to determine what evidence exists about the effect of different models of out-of-hours primary medical care service on outcome. METHODS: Original studies and systematic reviews written since 1976 on the subject of 'after-hours primary medical care services' were identified. Databases searched were Medline/Premedline, CINAHL, HealthSTAR, Current Contents, Cochrane Reviews, DARE, EBM Reviews and EconLit. For each paper where the optimal design would have been an interventional study, the 'level' of evidence was assessed as described in the National Health and Medical Research Council Handbook. 'Comparative' studies (levels I, II, III and IV pre-/post-test studies) were included in this review. RESULTS: Six main models of after-hours primary care services (not mutually exclusive) were identified: practice-based services, deputizing services, emergency departments, co-operatives, primary care centres, and telephone triage and advice services. Outcomes were divided into the following categories: clinical outcomes, medical workload, and patient and GP satisfaction. The results indicate that the introduction of a telephone triage and advice service for after-hours primary medical care may reduce the immediate medical workload. Deputizing services increase immediate medical workload because of the low use of telephone advice and the high home visiting rate. Co-operatives, which use telephone triage and primary care centres and have a low home visiting rate, reduce immediate medical workload. There is little evidence on the effect of different service models on subsequent medical workload apart from the finding that GPs working in emergency departments may reduce the subsequent medical workload. There was very little evidence about the advantages of one service model compared with another in relation to clinical outcome. Studies consistently showed patient dissatisfaction with telephone consultations. CONCLUSIONS: The rapid growth in telephone triage and advice services appears to have the advantage of reducing immediate medical workload through the substitution of telephone consultations for in-person consultations, and this has the potential to reduce costs. However, this has to be balanced with the finding of reduced patient satisfaction when in-person consultations are replaced by telephone consultations. These findings should be borne in mind by policy makers deciding on the shape of future services.

After-Hours Care↗

PubMed1998

Institutional sources of medical school faculty and patterns of personnel flow among medical schools.

PURPOSE: To describe patterns of interaction among U.S. medical schools related to faculty production and faculty hiring. METHOD: The medical school origins of MD faculty earning degrees between 1980 and 1989 and holding full-time positions in 1995 were used to gauge organizations' tendencies to interact and to identify institutional participants and their roles in reciprocal interactions. Additional data on medical school characteristics were used to characterize faculty suppliers, employers, and interacting organizations. Included in the present study were 19,381 individuals who were active, full-time members in 1995 and who held MD degrees earned between 1980 and 1989 from one of the 125 accredited U.S. medical schools. RESULTS: Major research-oriented medical schools were the most active suppliers of faculty to other medical schools. Foremost among these "research" schools was Harvard Medical School, which had nearly 20% of its 1980-1989 graduates widely dispersed among all the medical schools in 1995. Data on reciprocal interactions involving nine or more faculty were used to form empirically based groups of three geographically proximate dyads in North Carolina, Michigan, and Puerto Rico, and one complex cluster of 17 schools. CONCLUSION: The findings suggest that medical schools can be grouped and characterized by looking at institutional-level data on faculty production and employment. Research-oriented medical schools have been the major producers of medical school faculty. Recent emphasis on generalist careers may have the unintended consequence of further diminishing the variety of institutional sources of medical school faculty.

Academic Medical Centers↗

PubMed1987

The influence of medical school programs on physicians' attitudes toward universal access to medical care.

The extent to which medical education influences physicians' attitudes toward the issue of universal access to medical care was studied. Data were obtained from a survey of graduates from three medical schools with differing orientations. The first school could be described as traditional and highly research-oriented; the second as also traditional but more middle-of-the-road in its curriculum content; and the third as more social and primary care-oriented. Our results indicated that graduates from the more socially-oriented medical school were significantly more positive in their attitudes about the universality of the medical care issue than were graduates of the more traditional medical schools. The medical school effect vanished completely, however, when differences in personal characteristics among the three groups of graduates, namely, sex and interest in social sciences, were taken into account. Such findings support the hypothesis that the medical school effect can be explained to a greater extent by differences in medical student recruitment than by differences in medical school curricula. They also limit the expectations of those who advocate changes in medical curricula as a mean of inducing more favorable attitudes toward progressive medical care approaches in tomorrow's physicians.

Attitude of Health Personnel↗

PubMed2007

The predictive validity of the MCAT for medical school performance and medical board licensing examinations: a meta-analysis of the published research.

PURPOSE: To conduct a meta-analysis of published studies to determine the predictive validity of the MCAT on medical school performance and medical board licensing examinations. METHOD: The authors included all peer-reviewed published studies reporting empirical data on the relationship between MCAT scores and medical school performance or medical board licensing exam measures. Moderator variables, participant characteristics, and medical school performance/medical board licensing exam measures were extracted and reviewed separately by three reviewers using a standardized protocol. RESULTS: Medical school performance measures from 11 studies and medical board licensing examinations from 18 studies, for a total of 23 studies, were selected. A random-effects model meta-analysis of weighted effects sizes (r) resulted in (1) a predictive validity coefficient for the MCAT in the preclinical years of r = 0.39 (95% confidence interval [CI], 0.21-0.54) and on the USMLE Step 1 of r = 0.60 (95% CI, 0.50-0.67); and (2) the biological sciences subtest as the best predictor of medical school performance in the preclinical years (r = 0.32 95% CI, 0.21-0.42) and on the USMLE Step 1 (r = 0.48 95% CI, 0.41-0.54). CONCLUSIONS: The predictive validity of the MCAT ranges from small to medium for both medical school performance and medical board licensing exam measures. The medical profession is challenged to develop screening and selection criteria with improved validity that can supplement the MCAT as an important criterion for admission to medical schools.

Achievement↗

PubMed1999

Relationship between conditional early acceptance into medical school and medical school leadership and academic performance: the Conley Scholar experience at the University of Missouri-Columbia.

UNLABELLED: The Conley Scholars Program at the University of Missouri-Columbia was created in 1987 to guarantee top flight students entrance to medical school without the frantic competition well known in undergraduate pre-med programs. The program provides greater freedom as undergraduates than most combined baccalaureate-MD programs. It is not known how this freedom and avoidance of the "pre-med syndrome" affects medical school performance and relative leadership qualities compared to traditional medical students. The goals of this study are to: a) compare relative composition and performance of Conley medical students to traditional medical students; b) assess the role of Conleys in leadership positions within medical school organizations. METHODS: Using the medical school computer data files and AMCAS application files, composition, academic, and leadership data were collected regarding all medical school classes containing Conleys. Statistical analysis was performed on all data. RESULTS: The results suggest that: a) Conley Scholars averaged significantly higher undergraduate GPAs than other medical students; b) Conley Scholars averaged higher GPAs throughout medical school; c) Conley Scholars are more likely to hold medical school leadership roles than traditional medical students. CONCLUSIONS: The results confirm the value of the Conley Scholar Program. Benefits extend beyond academic achievement to encompass the development of leadership skills recognized by faculty and peers.

Chi-Square Distribution↗

PubMed2005

Validity of the Medical College Admission Test for predicting medical school performance.

PURPOSE: Since the introduction of the revised Medical College Admission Test (MCAT(R)) in 1991, the Association of American Medical Colleges has been investigating the extent to which MCAT scores supplement the power of undergraduate grade point averages (uGPAs) to predict success in medical school. This report is a comprehensive summary of the relationships between MCAT scores and (1) medical school grades, (2) United States Medical Licensing Examination (USMLE) Step scores, and (3) academic distinction or difficulty. METHOD: This study followed two cohorts from entrance to medical school through residency. Students from 14 medical schools' 1992 and 1993 entering classes provided data for predicting medical school grades and academic difficulty/distinction, while their peers from all of the U.S. medical schools were used to predict performance on USMLE Steps 1, 2, and 3. Regression analyses assessed the predictive power of combinations of uGPAs, MCAT scores, and undergraduate-institution selectivity. RESULTS: Grades were best predicted by a combination of MCAT scores and uGPAs, with MCAT scores providing a substantial increment over uGPAs. MCAT scores were better predictors of USMLE Step scores than were uGPAs, and the combination did little better than MCAT scores alone. The probability of experiencing academic difficulty or distinction tended to vary with MCAT scores. MCAT scores were strong predictors of scores for all three Step examinations, particularly Step 1. CONCLUSIONS: MCAT scores almost double the proportion of variance in medical school grades explained by uGPAs, and essentially replace the need for uGPAs in their impressive prediction of Step scores. The MCAT performs well as an indicator of academic preparation for medical school, independent of the school-specific handicaps of uGPAs.

Clinical Competence↗

PubMed1960