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Ambulance notes of a Bellevue Hospital intern: May 1938.

In 1938, as a New York University/Bellevue Hospital intern, I recorded notes on the 384 cases I saw during my 1-month ambulance duty. Although I intended to use them to follow up the clinical course of patients I admitted to Bellevue, the long hours and pressure of work made this ambitious goal unachievable. Sixty years later, after retirement from academic medicine and medical practice at New York University School of Medicine, I found the long-lost notes among my papers. They are of historic interest since they provide insight into aspects of primary and emergency medicine of the era when the therapeutic efficacy of the sulfanilamide class of agents was under investigation, a unique view of the life of an intern just before interns were replaced on ambulances by technicians, and a glimpse of the surprising character of several neighborhoods of pre-World War II Manhattan. The notes also provide the basis for a current analysis of case incidence and treatment by disease category. A description of the confluence of social, economic, and political forces that led to the establishment of the Bellevue Hospital Ambulance Service, the first such urban service in the world, is included.

Ambulances↗

Using methods that matter: the impact of reflection, dialogue, and voice.

In recent years, the field of community psychology has given considerable attention to how research and evaluation methods should be designed to support our goals of empowerment and social justice. Yet, as a field, we have given much less attention to whether the use of our methods actually achieves or supports our empowerment agenda. With the primary purpose of beginning to establish the norm of reporting on the impacts of our methods, this paper reports on the findings from interviews of 16 youth and adults who had participated in one participatory evaluation method (Photovoice). Two specific questions were examined: (1) What is the impact of participating in a Photovoice effort; and (2) How does the method of Photovoice foster these impacts? Overall, participants noted that they were significantly affected by their experiences as photographers and through their dialogue with neighbors during Photovoice group sessions. Impacts ranged from an increased sense of control over their own lives to the emergence of the kinds of awareness, relationships, and efficacy supportive of participants becoming community change agents. According to participants, Photovoice fostered these changes by (a) empowering them as experts on their lives and community, (b) fostering deep reflection, and (c) creating a context safe for exploring diverse perspectives. The implications of these findings for the science and practice of community psychology are discussed.

Adolescent↗

Negotiating risk: knowledge and use of HIV prevention by persons with serious mental illness living in supportive housing.

As a population, persons with serious mental illness (SMI) have an elevated risk for HIV infection. However, relatively little is known about how the risk of HIV has affected their lives, how persons with SMI evaluate their HIV risk, and what preventive measures they undertake. Furthermore, relatively little is known about community-based HIV prevention for persons with SMI as most interventions have been restricted to clinical settings. This report presents findings on the HIV-related experiences of persons with SMI living in supportive housing programs, one possible setting for implementing community-based HIV prevention with this population. The qualitative investigation interviewed 41 men and women living in five supportive housing programs. In-depth, qualitative interviews elicited discussion of research participants' (a) experiences with HIV, (b) knowledge about HIV and HIV prevention, (c) assessments of their own risk, (d) descriptions of how they apply their prevention knowledge, and (e) reports of barriers for HIV prevention. Research participants describe social networks that have substantial contact with persons affected by HIV. However, contrary to some expectations of persons with SMI, research participants report using HIV prevention knowledge in negotiating their risk of contracting HIV. The implications of these findings are discussed in terms of their relevance for implementing community-based HIV prevention for persons with SMI.

Acquired Immunodeficiency Syndrome↗

Story telling.

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Anecdotes as Topic↗

An evaluation of vignettes for predicting variation in the quality of preventive care.

OBJECTIVE: Clinical vignettes offer an inexpensive and convenient alternative to the benchmark method of chart audits for assessing quality of care. We examined whether vignettes accurately measure and predict variation in the quality of preventive care. DESIGN: We developed scoring criteria based on national guidelines for 11 prevention items, categorized as vaccine, vascular-related, cancer screening, and personal behaviors. Three measurement methods were used to ascertain the quality of care provided by clinicians seeing trained actors (standardized patients; SPs) presenting with common outpatient conditions: 1) the abstracted medical record from an SP visit; 2) SP reports of physician practice during those visits; and 3) physician responses to matching computerized case scenarios (clinical vignettes). SETTING: Three university-affiliated (including 2 VA) and one community general internal medicine clinics. PATIENTS/PARTICIPANTS: Seventy-one randomly selected physicians from among eligible general internal medicine residents and attending physicians. MEASUREMENTS AND MAIN RESULTS: Physicians saw 480 SPs (120 at each site) and completed 480 vignettes. We calculated the proportion of prevention items for each visit reported or recorded by the 3 measurement methods. We developed a multiple regression model to determine whether site, training level, or clinical condition predicted prevention performance for each measurement method. We found that overall prevention scores ranged from 57% (SP) to 54% (vignettes) to 46% (chart abstraction). Vignettes matched or exceeded SP scores for 3 prevention categories (vaccine, vascular-related, and personal behavior). Prevention quality varied by site (from 40% to 67%) and was predicted similarly by vignettes and SPs. CONCLUSIONS: Vignettes can measure and predict prevention performance. Vignettes may be a less costly way to assess prevention performance that also controls for patient case-mix.

Anecdotes as Topic↗

The maestro.

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Anecdotes as Topic↗

Without my ears.

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Anecdotes as Topic↗

Snake season.

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Anecdotes as Topic↗

Vocation.

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Anecdotes as Topic↗