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PubMed2002

Sex differences in cobalamin vitamin B12 opinions of Swedish physicians.

The aim of the study was to elucidate possible sex differences in knowledge, competence and attitudes behind decision-making on cobalamin-associated problems (vitamin B(12)). The study was conducted by postal questionnaires to Swedish physicians in 1996-98. The participants were recruited by random sampling of general practitioners (1996, 1998), and a total sampling of geriatricians (1998). The overall response rate was 71%. The study group comprised 480 female physicians and 526 male physicians. The responses to 24 statements in the questionnaire were measured by means of visual analogue scales. Group differences were evaluated by medians and shapes of distributions. The female doctors appeared to value patient-related symptoms and signs more than male doctors. Conversely, male doctors relied on laboratory tests more than female doctors. As reflected by questionnaire answers, female doctors appeared to be more informed than male doctors on cobalamin-associated clinical problems. Group differences between the sexes were marginal from a numerical point of view. It is suggested that the statistical differences observed should be regarded as negligible until confirmed by further studies.

Clinical Competence↗
PubMed2004

Ethical decision-making for extremely preterm deliveries: results of a qualitative survey among obstetricians and midwives.

OBJECTIVE: To explore the practices, attitudes and feelings of obstetricians and midwives in cases of extreme prematurity. METHODS: A qualitative study was conducted as part of a European Concerted Action (EUROBS) in three tertiary-care maternity units, located in three cities in the northern, southern and central areas of France. Semi-structured interviews lasted an average of 60 min and were tape-recorded. They were independently analyzed by two different researchers using a content analysis. All full-time obstetricians and half of the full-time midwives were eligible for the study. Overall, 17 obstetricians and 30 midwives participated. RESULTS: Both obstetricians and midwives considered that decision-making in case of very preterm births raised ethical problems concerning the mother and the fetus. Despite some birth weight and gestational age criteria defined in advance, management around delivery appeared to be decided on a case-by-case basis. At birth, the neonatologists made the decisions. They were perceived as being more inclined than the obstetric team to initiate intensive care. If the child was born alive, intensive care was started, in the knowledge that it could be withdrawn later, if appropriate. Parents were sometimes involved in decision-making during pregnancy, in particular when there was no emergency situation. Compared with obstetricians, midwives tended to have a less favorable perception of the neonatologists' practices, and to report less parental involvement in decision-making. CONCLUSIONS: Decisions about the obstetric management and resuscitation of extremely preterm infants are usually made on a case-by-case basis. Parents are sometimes involved in decision-making. Midwives express serious concerns about the current practices.

Attitude of Health Personnel↗
PubMed2000

Findings of the 1998 Infectious Diseases Society of America membership survey.

The Infectious Diseases Society of America (IDSA) conducted a survey in 1998 to characterize its membership and to determine their needs. The response rate was 39%. Although only 23% of the respondents spent most of their time in the field of teaching and research, 62% of the respondents listed an academic institution as their primary employer. According to survey results, 17% of respondents indicated that care of HIV-infected patients comprised one-half or more of their practices. Respondents noted shortcomings in their training as a result of recent changes in the clinical practice arena and the health care system; more than one-fourth of the respondents identified deficits in their preparation for administration, infection control, pharmacoeconomics, quality assurance, transplantation, and outcomes research. This survey discloses that the IDSA membership perceives a need for changes in IDSA-sponsored fellowship training programs and graduate educational activities.

Adult↗
PubMed2003

Do resident physicians use antibiotics appropriately in treating upper respiratory infections? A survey of 11 programs.

We surveyed resident physicians of 11 primary care programs regarding the management of upper respiratory infections and antibiotic resistance. Although they viewed excess antibiotic use as the most important factor increasing resistance, they had little knowledge regarding antimicrobial resistance and were willing to prescribe antibiotics for common viral illnesses.

Data Collection↗
PubMed2004

Survey of physician diagnostic practices for patients with acute diarrhea: clinical and public health implications.

To understand physician practices regarding the diagnosis of acute diarrheal diseases, we conducted a survey, in 1996, of 2839 physicians in Connecticut, Georgia, Minnesota, Oregon, and California. Bacterial stool culture was requested for samples from the last patient seen for acute diarrhea by 784 (44%; 95% confidence interval, 42%-46%) of 1783 physicians. Physicians were more likely to request a culture for persons with acquired immune deficiency syndrome, bloody stools, travel to a developing country, diarrhea for >3 days, intravenous rehydration, or fever. Substantial geographic and specialty differences in culture-request practices were observed. Twenty-eight percent of physicians did not know whether stool culture included testing for Escherichia coli O157:H7; 40% did not know whether Yersinia or Vibrio species were included. These variabilities suggest a need for clinical diagnostic guidelines for diarrhea. Many physicians could benefit from education to improve their knowledge about tests included in routine stool examinations.

Acute Disease↗
PubMed2003

Oregon physicians' perceptions of patients who request assisted suicide and their families.

In 1997, the Oregon Death with Dignity Act was enacted, allowing a physician to prescribe a lethal dose of medication for a competent, terminally ill patient who requests one. In 2000, we conducted single, semistructured, in-depth, face-to-face interviews with 35 Oregon physicians who received a request for a lethal prescription. The interviews focused on physicians' perceptions of patients who requested assisted suicide, the reasons for the request, and the reactions of their families. The interviews were audiotaped, transcribed, and analyzed using qualitative techniques. Physicians described requesting patients as having strong and vivid personalities characterized by determination and inflexibility. These individuals wanted to control the timing and manner of death and to avoid dependence on others. These preferences reflected long-standing coping and personality traits. Physicians perceived that these patients viewed living as purposeless and too effortful, and that they were ready for death. The requests, which were forceful and persistent, could occur at any point after diagnosis of the terminal illness, and were paralleled by refusal of medical interventions including palliative treatments. Many family members were reluctant to support these requests until they recognized the strength of the preference.

Attitude of Health Personnel↗
PubMed1997

Use of acupuncture by American physicians.

OBJECTIVES: Little is known about the characteristics of American physicians who currently practice acupuncture. We asked: (1) Do the demographics of physicians practicing acupuncture differ from the general physician population? (2) Do these physicians use or endorse other alternative therapies? (3) For which conditions is acupuncture most commonly used? (4) For which conditions is acupuncture perceived to be most efficacious? DESIGN: Mailed survey of physicians who incorporate acupuncture into their practice. PARTICIPANTS: Membership of the American Academy of Medical Acupuncture (AAMA). OUTCOME MEASURES: Demographic information regarding physicians and practice characteristics; specific illnesses treated, and perceived efficacy; use of other complementary modalities; personal reasons for practicing acupuncture. RESULTS: Compared with national data, respondents were more likely to be nonspecialists, in private practice, and age 35 to 54. There was an equal proportion of men and women. Most had been doing acupuncture for < 5 years; most use it on < 25% of their patients. Endorsement or use of other complementary methods (spinal manipulation, herbal medicine, supplements, homeopathy) was common. Acupuncture was more commonly used for pain conditions than general medical problems or addiction management. Reasons for use included: efficacy of the technique, an alternative in cases of inadequacy of standard medical approach, and a multidimensional approach to health care. CONCLUSIONS: Physicians surveyed in this study who incorporate acupuncture into their practice do so mainly to treat pain problems. They are more likely to be in the 35 to 54 age group, nonspecialists, and in private practice when compared with national averages. These physicians are also more likely to use or endorse other complementary modalities.

Acupuncture Therapy↗
PubMed2005

Knowledge, attitudes, and practices among physicians on HIV/AIDS in Quang Ninh, Vietnam.

Health care providers in Vietnam have been facing an increase in the number of HIV patients. However, little is known about physicians' knowledge, attitudes, and practices about HIV/AIDS and their correlates. A cross-sectional survey was conducted in 2003 with 151 physicians who had some contact with HIV-infected people. Anonymous data was collected by physicians' self-administration of the questionnaires. SAS version 8 (SAS, Cary, NC) was used for all descriptive and multivariate statistical analyses. We found that there were misconceptions on some transmission modes: 39.9% thought that good nutrition could protect from HIV/AIDS infection; 12.1% thought sharing the toilet with people living with HIV/AIDS (PLWHA) could transmit HIV infection. Only 41.6% of physicians knew that there was more than one type of HIV. Younger physicians or those with high patient volumes tended to be better informed. The one third of participants who reported positive attitudes regarding their interaction with HIV/AIDS patients were less likely to support mandatory testing or to exclude HIV/AIDS patients from their practices. Older physicians were more likely to have positive attitudes than the younger physicians. Approximately one fourth of the physicians prescribed antiretroviral medications but misuse was common. Among those prescribing antiretroviral medications, physicians working at provincial health care services were 3.1 times more likely to use antiretroviral medications than physicians working in district and commune health care services. In conclusion, even though Vietnamese physicians are providing health care for HIV/AIDS patients, the level of knowledge, attitudes, and practices regarding HIV/AIDS treatment suggest that further training is needed to improve their ability to deliver appropriate treatment to HIV/AIDS patients.

Adult↗
PubMedDate not supplied

Are doctors elastic?

Explore the source record for details and available documents.

Child Psychiatry↗
PubMed1998

The role of physician preferences in the choice of amniocentesis or chorionic villus sampling for prenatal genetic testing.

Our objective was to determine the effect of physician preferences, as well as physician demographic, obstetric, and practice-related factors, on the choice of prenatal test made by their patients. We studied preferences for prenatal outcomes for 372 pregnant women who either chose amniocentesis (AMN) (n = 288) or chorionic villus sampling (CVS) (n = 84) for the indication of maternal age. We also studied preferences for these outcomes for the 92 physicians that referred them for testing. Preferences were assessed using written scenarios and were measured on linear rating scales. According to patients, the choice of prenatal test was made entirely or mostly by the physician in 14% of cases and was shared equally between patient and physician in 37% of cases. After adjustment for patient preferences, physician concern about spontaneous abortion of a normal fetus after CVS (odds ratio 0.71; CI, 0.48-1.05; p = 0.08), and a limb reduction (LRD) birth after CVS (odds ratio 0.85; CI, 0.68-1.05; p = 0.12), tended to decrease their patients' odds of choosing CVS, but the results were not statistically significant. No other physician preference, and no physician demographic, obstetric, or practice-related factor, influenced patient test choice. We conclude that after taking patient preferences into account, physician preferences and practice-related factors did not emerge as significant determinants of the choice of prenatal test made by their patients. It remains possible, however, that physician concern about spontaneous abortion and about LRD increase the likelihood of their patients choosing AMN over CVS.

Abortion, Spontaneous↗
PubMed2005

Physician-identified barriers to intimate partner violence screening.

BACKGROUND: Intimate partner violence (IPV) causes approximately 2 million injuries and 1300 deaths each year. Despite the high frequency of IPV among women seeking healthcare, only a small proportion report being asked by healthcare professionals about abuse. This study examined perceived barriers to IPV screening among obstetricians/gynecologists, family physicians, and internists, so that protocols for IPV training can be tailored to those particular areas of difficulty. METHODS: A cross-sectional survey of 143 obstetricians and gynecologists, family practice physicians, and internists in a medium-sized upstate New York city was conducted. Factor analysis was performed. Two IPV barrier domains emerged and were examined using a multivariate analysis to determine associations between the domains and physician characteristics. RESULTS: For general knowledge, there were greater perceived barriers if the respondent was male but fewer perceived barriers if the respondent was an obstetrician/gynecologist and fewer perceived barriers if the respondent had 5-10 years in practice. For practice policy, there were greater perceived barriers if the physician was in a private practice setting and fewer perceived barriers if the physician was an obstetrician/gynecologist. CONCLUSIONS: These findings provide direction for training in IPV recognition. They support a need for continued training throughout the physician's career. More importantly, the findings support a need for better practice systems to encourage routine screening for IPV by healthcare providers.

Adult↗
PubMed1993

A national survey of attitudes and practices of primary-care physicians relating to nutrition: strategies for enhancing the use of clinical nutrition in medical practice.

A nationwide mail survey was used to determine the degree to which primary-care physicians indicated that they practice the "core competencies" in clinical nutrition identified by Young et al (Am J Clin Nutr 1983;38:800-10). We also surveyed the nutrition-related attitudes of these physicians. Although the 3416 physicians who responded to the survey tended to report favorable attitudes toward using nutrition in their practice, these favorable attitudes were not consistent with their own reports of clinical performance. Neither the positive- or negative-attitude score correlated highly with the reported behavior-practice score. The clinical practices reported by those surveyed are well below the minimum level defined by the Young et al essential core competencies in clinical nutrition. The attitudes, practices, and demographic characteristics associated with the clinical performance variables suggest educational strategies for improving the competence of primary-care physicians and medical students in clinical nutrition.

Adult↗