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PubMed2006

Baby Think It Over: evaluation of an infant simulation intervention for adolescent pregnancy prevention.

In an intervention aimed at showing students the amount of responsibility involved in caring for an infant, 353 predominantly ninth-grade and Latino students carried the Baby Think It Over simulation doll in an intervention and completed matched pre- and posttest measures. Statistically significant gains were found on the total score and the impact of having a baby on academics, social life, and other family members; emotional risks; understanding and handling an infant's crying; and apprehension of the amount of responsibility involved in infant care. On a posttest-only measure, 108 participants reported statistically significant differences before and after carrying the doll with regard to the age at which they wished to have a child, their career and education plans, and the perceived interference of an infant with those education and career plans and their social life.

Adolescent↗

PubMed2003

Current thinking in stentless valve surgery.

Aortic valve replacement for aortic stenosis represents a tremendous achievement in the management of cardiac disease. However, despite 4 decades of use, the ideal substitute for the diseased aortic valve is still not agreed upon. Stentless aortic valves represent the optimum in hemodynamic performance. This article reviews the current thinking in stentless aortic valve surgery.

Aortic Valve↗

PubMed1994

How medical students think about ethical issues.

BACKGROUND: Although bioethics has become an established part of medical school curricula, relatively little is known about how students apply didactic material to clinical problem-solving situations. METHOD: Each of 92 second-year students (54 men and 38 women) at the University of California, Irvine, College of Medicine in 1991-92 wrote a paper identifying and attempting to resolve a clinical ethical dilemma of his or her choice. The papers were then coded for content, use of ethical theories and principles, degree of resolution, and level of personal orientation (i.e., evidence of personal involvement in the dilemmas). Data were analyzed by student sex and age, using chi-square tests of significance and correlational analysis. RESULTS: The students had no difficulty in identifying a range of ethical dilemma. Most students appeared to have understood and become familiar with the major ethical theories and principles currently in use, and to have employed them correctly. A majority of the students were able to successfully resolve their ethical dilemmas. Differences between the men and the women students were found regarding choice of topic, ethical principles used (p = .03), and level of personal orientation (p < .01). CONCLUSION: The women tended to be interested in issues involving broad social perspectives; to favor arguments emphasizing the rights of patients and families; and to incorporate personal responses, as well as abstract theories, in their assays. The men tended to be interested in issues involving personal control, authority, and responsibility; to advocate utilitarian, cost-containment thinking, and to rely exclusively on abstract, logical arguments. Further research should determine whether these differences can be identified in actual clinical decision making, and whether the differences have implications for the nature or quality of clinical decisions.

Attitude↗

PubMed1999

What do family medicine patients think about medical students' participation in their health care?

PURPOSE: To find out what patients think about students' involvement in their health care. METHOD: After conducting semistructured interviews with 24 patients, the authors developed a questionnaire addressing patients' concerns about student involvement in health care. The questionnaire was administered to 735 patients in academic and community settings; 575 (78%) patients responded. RESULTS: Most responding patients (90%) were willing to have a student involved in their health care. Those who were unwilling commonly cited privacy concerns. A third of the patients reported that the student did at least part of the physical examination. Three fourths of the patients who saw a student, and half of those who did not, said they appreciated or would appreciate the attention they got from a medical student. Almost half the patients (39%) perceived that student involvement lengthened their visits. CONCLUSION: Most patients in family medicine are willing to allow students to be involved in their care, and most perceive it as beneficial.

Adolescent↗

PubMed2004

Do clerkship directors think medical students are prepared for the clerkship years?

PURPOSE: Educators have begun to question whether medical students are adequately prepared for the core clerkships. Inadequate preclerkship preparation may hinder learning and may be predictive of future achievement. This study assessed and compared the views of clerkship directors regarding student preparation for the core clinical clerkships in six key competencies. METHOD: In 2002, a national survey was conducted of 190 clerkship directors in internal medicine, family medicine, pediatrics, surgery, obstetrics/gynecology, and psychiatry from 32 U.S. medical schools. Clerkship directors were asked to report their views on the appropriate level of student preparation needed to begin the core clinical clerkships (none, minimal, intermediate, advanced), and the adequacy of that preparation (ranging from "much less" to "much more than necessary") in six key clinical competencies. RESULTS: A total of 140 clerkship directors responded (74%). The majority reported that students need at least intermediate ability in five of six competencies: communication (96%), professionalism (96%), interviewing/physical examination (78%), life-cycle stages (57%), epidemiology/probabilistic thinking (56%), and systems of care (27%). Thirty to fifty percent of clerkship directors felt students are less prepared than necessary in the six competencies. Views were similar across all specialties and generally did not differ by other clerkship director characteristics. CONCLUSIONS: Almost half of clerkship directors were concerned that students do not receive adequate preparation in key competencies before starting the core clinical clerkships. Many medical schools may need to give more attention to the preclerkship preparation of students in these high-priority areas.

Attitude of Health Personnel↗

PubMed1996

Critical thinking in clinical learning: a holistic perspective.

A dynamic clinical setting affords multiple opportunities for learning. The article describes undergraduate and graduate teaching/learning strategies that facilitate the development of critical thinking and holistic intervention competencies. Insights regarding outcome evaluation of these competencies and the use of data for curriculum changes are presented.

Clinical Competence↗

PubMed1984

Parental communication deviance and forms of thinking in male schizophrenic offspring.

In a step beyond earlier research on parental communication deviance (CD) and schizophrenia, more specific links between these phenomena were investigated. First, subtypes of schizophrenia were distinguished by amount of formal thought disorder, and two forms of parental CD--called the "disorganized" and the "evasive" types--were qualitatively distinguished. In a sample of young adult male patients, it was found that schizophrenics who manifested definite and severe formal thought disorder had parents with much CD in their speech (especially the disorganized type). In contrast, male paranoid schizophrenics with constricted forms of thinking had parents whose level of CD was lower (and was comparable to that of the parents of the nonschizophrenic controls). This suggests that parental CD may be better understood as specifically associated with cognitive disorganization in the offspring, rather than with overall DSM-III or DSM-II criteria for schizophrenia.

Adolescent↗

PubMed1993

Allusive thinking in parents of schizophrenics. Meta-analysis.

Romney (J. Nerv. Ment. Dis. 178:481-486, 1990) performed a meta-analysis of studies examining psychometrically assessed "thought disorder" in the relatives of schizophrenics. He concluded that thought disorder was more prevalent in the relatives of schizophrenics than control subjects. The present review focuses on only those studies that measured "allusive thinking" using the Lovibond-Rapaport Object Sorting Test in parents of schizophrenics. Even when the meta-analysis included this more limited number of studies, it demonstrated that the parents of schizophrenics were 2.42 times more likely to obtain high scores on the Object Sorting Test, confirming replication of the original McConaghy (J. Neurol. Neurosurg. Psychiatry 22:243-246, 1959) finding. This effect remained significant when the original study was excluded from the meta-analysis. The predictive strength of parental Object Sorting Test score as a familial risk factor for the development of schizophrenia is discussed.

Family↗

PubMedDate not supplied

Adolescent girls' personal experience with Baby Think It Over infant simulator.

PURPOSE: To explore adolescent girls' personal experience with an infant simulator that had to be cared for over a period of 1 to 2 weeks. STUDY DESIGN AND METHODS: This qualitative study employed the phenomenological approach and utilized Colaizzi's method of analysis. Participants were nine adolescent high school girls who were interviewed and audiotaped. Interview data were coded using NUD*IST 4 software. RESULTS: Three themes emerged from the data. They were (1) a parenting journey incorporating intellectual, emotive, and physical faculties; (2) recognizing the illusionary nature of previously held ideas about parenting an infant; and (3) offering counsel based on the BTIO experience. CLINICAL IMPLICATIONS: The new perspectives gained by the participants about parenting a newborn infant differed markedly from the romantic fantasies they held prior to the experience. The teens started thinking more seriously about the consequences of sexual activity. Used for 1 to 2 weeks, in conjunction with budgeting exercises and provocative small-group discussions, the BTIO shows promise as an effective tool in helping to modify unrealistic and idealized teen views of adolescent pregnancy and parenting.

Adolescent↗

PubMed2002

What do injured workers think about their medical care and outcomes after work injury?

Patient satisfaction is an important aspect of quality of care. Little information about injured workers' satisfaction is available. A survey instrument was developed to assess "What Do Injured Workers Think About Their Medical Care?" Survey domains included access, satisfaction, reports of physician behaviors, and outcomes after work injury. Descriptive analyses were performed on more than 800 responses. Approximately 25% of respondents reported dissatisfaction with care. Satisfaction with choice of provider, interpersonal care, claims handling, and outcomes were major predictors of overall satisfaction. Spanish-speakers were more likely to be dissatisfied with physician communications. Months after injury, many workers reported significant pain and impact on job ability and daily function. Routine evaluation of patient satisfaction with occupational medical care could facilitate quality improvement efforts and informed purchaser and worker choice of occupational health services.

Accidents, Occupational↗

PubMedDate not supplied

Using problem-based learning to promote critical thinking in an orientation program for novice nurses.

To assist novice nurses in making the transition into the acute care setting, a student-centered, small-group, problem-based program was developed and combined with a preceptorship program. Challenged to work through the problems, novice nurses met the program objectives while enjoying the program. Supervisors and clinical specialists working with the graduates noted increased critical thinking, increased interest and ability in seeking information, and increased problem-solving ability.

Adult↗

PubMedDate not supplied

Designing and implementing an RN refresher course for the acute care hospital: development of the nurses' critical thinking skills.

With today's nursing shortage, hospitals are seeking creative strategies to recruit nurses. The task of recruiting inactive nurses has been more difficult because of the challenges faced by hospital-based nurses in this era of managed care and increased acuity of patients. This article describes a unique 8-week course, which provides the nurses with an update of technical skills and emphasizes the development of the critical-thinking skills necessary to deliver safe, competent patient care.

Competency-Based Education↗

PubMedDate not supplied

Concept mapping as a critical thinking tool for nurse educators.

Nursing educators must use teaching strategies designed to develop critical thinkers. Concept mapping helps fulfill this goal. Staff development instructors should continue the development of new nurse critical thinking skills using concept maps in a variety of ways.

Clinical Competence↗

PubMed1997

Applying systems thinking to public health leadership.

A review of the public health literature reveals a dearth of research that focuses on applying management theories to public health work. This article applies systems thinking to public health practice. A sample of health officers and health department executives were asked to identify the key attributes of the most important problem they faced in their work in the last week. Problems involved an average of four other organizations, and most required two to six months to be resolved. Most decisions were expected to result in new problems. Several cases are presented as examples. Implications for future research, practice, and training are discussed.

Health Planning↗

PubMed1995

When you think a subordinate is after your job.

Many managers find themselves in a position where they think a subordinate is after their job. Guidelines are presented for the manager's response when it appears a subordinate is after the manager's job. Deciding on a plan of action, discussing the matter with the supervisor and subordinate, confronting the subordinate with lack of support, maintaining a positive self-image, avoiding actions that can be criticized, and setting limits on the employee's behavior can all be acceptable approaches for the manager to use.

Administrative Personnel↗

PubMedDate not supplied

Changes in subjective vs objective burn scar assessment over time: does the patient agree with what we think?

It is not known whether objective measurements of burn scar quality reflect, or even bear any relationship to, the patient's opinion of their scar. The purpose of this study was to determine whether any correlation exists between the rehabilitation therapist's rating of the scar using the Vancouver Scar Scale (VSS) and the patient's subjective opinion of their scar. A total of 37 scars in 20 adult patients (mean age, 34 +/- 13 years; 30% female; mean %TBSA burn, 16 +/- 11%) were evaluated at 3.1 +/- 1.9 months after injury (early assessment). Patients were asked to rate their own scar (question 1) and to rate how they perceive other people view the scar (question 2). A visual analog scale (VAS) was used to score the answers to both questions. A burn occupational therapist who was blinded to the VAS scores performed a VSS rating of the scar. These evaluations were repeated 1.5 years after injury (late assessment). At the early assessment, there was no correlation between the VSS score and VAS scores for question 1 (r =.291) or question 2 (r =.371). At the late assessment, there was significant improvement in the VSS score and the VAS score for question 2. Also, a significant correlation developed between the VSS score and the VAS score for question 1 (r =.646, P =.003) but not between the VSS score and VAS score for question 2 (r =.099). The VSS measurement of the scar bears no relationship to the patient's opinion of their scar early after a burn injury. As the scar improves over time, the patient's opinion of their scar appears to improve and shows better correlation with the VSS rating. Conversely, the patient's impression of what others think of the scar continues to bear no relationship to the VSS rating, suggesting that scar acceptance by the patient is incomplete despite objective improvement in the quality of the scar. Although the VSS was never intended to measure a patient's opinion of their scar, these preliminary findings emphasize the necessity of including a patient-centered subjective component to routine scar monitoring and assessment.

Adult↗

PubMed2004

Medicolegal and ethical issues of cloning: do we need to think again and again?

Research on the cloning of human cells holds the promise of medical benefits, but cloning humans is a far more complex and ethically disturbing issue. Some have argued strenuously that human cloning should be banned permanently. They have called it immoral, repugnant, and abhorrent. Most European countries have already banned it, and others are considering a proscription. While allowing fundamental research in the field to progress, we need a wide debate on human cloning. We need to think about what, if any, circumstances might warrant cloning, as well as the circumstances under which it should never be allowed.

Bioethical Issues↗

PubMed2001

A framework to guide thinking and analysis regarding climate change policies.

The potential impacts from climate change, and climate change policies, are massive. Careful thinking about what we want climate change policies to achieve is a crucial first step for analysts to help governments make wise policy choices to address these concerns. This article presents an adaptive framework to help guide comparative analysis of climate change policies. The framework recognizes the inability to forecast long-term impacts (due in part to path dependance) as a constraint on the use of standard policy analysis, and stresses learning over time as a fundamental concern. The framework focuses on the objectives relevant for climate change policy in North America over the near term (e.g., the next 20 years). For planning and evaluating current climate policy alternatives, a combination of fundamental objectives for the near term and proxy objectives for characterizing the state of the climate problem and the ability to address it at the end of that term is suggested. Broad uses of the framework are discussed, along with some concrete examples. The framework is intended to provide a basis for policy analysis that explicitly considers the benefits of learning over time to improve climate change policies.

Journal Article↗