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At least 145 records · Page 8Linked to original sources

PubMed2005

Death rounds: end-of-life discussions among medical residents in the intensive care unit.

PURPOSE: We introduced "Death Rounds," a monthly discussion of the issues and emotions surrounding the care of dying patients, into the intensive care unit (ICU) rotations for medical house staff. We surveyed participating residents to evaluate their satisfaction with these discussions. SUBJECTS AND METHODS: Death Rounds occurred at university-based teaching hospitals in Seattle, Washington and Salt Lake City, Utah, between October 2000 and March 2002. Residents who had attended Death Rounds were surveyed in April 2002. RESULTS: A 10-item survey was distributed by e-mail to 116 residents in Utah and Washington. Of 116 residents, 97 (84%) responded to the survey; 50 of these 97 had attended at least one Death Rounds. Of these 50, the majority reported that Death Rounds were worthwhile (76%) and that sessions should be incorporated into all ICU rotations (76%). CONCLUSIONS: Death Rounds provide a unique opportunity for residents to discuss the issues raised in caring for dying patients. This conference can be easily incorporated into the ICU curriculum. Most residents who participated in the survey indicated that they valued Death Rounds and believed that it should be included in all ICU rotations.

Adult↗

PubMedDate not supplied

Predicting fruit consumption: cognitions, intention, and habits.

OBJECTIVE: To study predictors of fruit intake in a sample of 627 adults. DESIGN: Potential predictors of fruit intake were assessed at baseline, and fruit intake was assessed at two-week follow-up with self-administered questionnaires distributed by e-mail. SETTING: The study was conducted among Dutch adult members of an Internet research panel. PARTICIPANTS: A random sample of 627 adults aged 18-78. VARIABLES MEASURED: Attitudes, subjective norms, self-efficacy, expected pros and cons, habit strength, intention, and fruit intake. Fruit intake was assessed with a validated food-frequency questionnaire. ANALYSIS: Hierarchical linear and logistic regression analyses. Alpha < .05 was considered statistically significant. RESULTS: Sex, attitudes, subjective norms, perceived pros, different self-efficacy expectations, and habit strength were significantly associated with the intention to eat two or more servings of fruit per day. Age, intentions, and habit strength were significant predictors of consumption of two or more servings of fruit per day. CONCLUSIONS AND IMPLICATIONS: The results confirm that Theory of Planned Behavior constructs predict fruit intake, and that habit strength and different self-efficacy expectations may be additional determinants relevant to fruit intake. Because habitual behavior is considered to be triggered by environmental cues, fruit promotion interventions should further explore environmental change strategies.

Adolescent↗

PubMed2006

Medical and nursing students' attitudes toward cardiopulmonary resuscitation and current practice guidelines.

PURPOSE OF THE STUDY: Every member of a healthcare organisation should be able to perform cardiopulmonary resuscitation and defibrillation (CPR-D). The purpose of this cohort study was to examine medical and nursing student's beliefs and attitudes toward CPR-D and current practice guidelines. MATERIALS AND METHODS: A pilot questionnaire concerning beliefs and attitudes toward CPR-D was distributed to 120 fourth year medical students. After statistical analyses (Cronbach's alpha), the questionnaire was modified to increase its reliability. The second version was distributed via e-mail to 100 final sixth year medical students and to 120 final fourth year nursing students. The students had 2 weeks to answer the questionnaire. A reminder was sent via e-mail after 1 week. RESULTS: The questionnaire was answered by 71 of 120 fourth year students (59.1%), 56 of 100 (56.0%) sixth year medical students and 76 of 120 (63.3%) nursing students. Seventy percent of the fourth year, 85.8% of the final (sixth) year medical students and 70.0% of the final (fourth) year nursing students felt confident about their ability to perform basic life support (p<0.01) and 24.0% of the fourth year, 84.0% of the final year medical students and 22.7% of the nursing students about defibrillation (p<0.001). The perceived ability to defibrillate correlated significantly with a positive attitude toward nurse-performed defibrillation (p<0.01) and negatively with fear of damaging the patient's heart by defibrillation (p<0.01). Negative attitude toward defibrillation correlated with perceived organisational attitudes toward practise guidelines (p<0.01). CONCLUSIONS: Medical students' attitudes mature as hoped for, but the nursing students need encouragement. More information is needed to diminish anxiety concerning defibrillation. Negative beliefs and attitudes toward defibrillation affect the students' attitudes toward practice guidelines.

Adult↗

PubMed2005

Ventilator dependence and expressions of need: a study of patients with amyotrophic lateral sclerosis in Japan.

This research examined the experience of Amyotrophic Lateral Sclerosis (ALS) patients who depend on an invasive mechanical ventilator in Japan. We investigated their difficulties in expressing their needs, their desires and wishes, and their sources of support and happiness. We examined the relationship between these factors and patient demographics, and hope as an indicator of successful adaptation to the illness experience (assessed by the Herth Hope Index). Interview results guided the formation of an anonymous questionnaire distributed to patients by mail. We interviewed 27 patients and their families and surveyed 157 respondents with a questionnaire. Most patients experienced multiple categories of difficulties, which correlated with reduced hope. More severe physical symptoms correlated with more emotional and social difficulties. Notable findings included a high prevalence of unalleviated pain, fear or experience of ventilator difficulties, and fear of burdening others. Having more sources of psychosocial support and happiness was associated with greater hope. Living at home was associated with fewer social difficulties. No patients claimed additional sources of support without claiming family or professional caregiver support, suggesting their mediation may be crucial in maintaining other social connections. Users of computer communication reported more sources of support and happiness and less frustration from difficulty expressing themselves. The most common reported desires, following a cure for ALS, related to the happiness of the patients' families, and a desire not to burden them. We also found that invasive mechanical ventilation (IMV) had been initiated emergently in 30.1% of patients without patient or family consent. Our results provide an insight into the world of this challenged population, elucidating the difficulties they face, and clarifying the role of support and other factors in maintaining hope. We identify concrete areas to which increased attention should be directed in patient care.

Adult↗

PubMed2004

The view from two sides: a qualitative study of community and medical perspectives on screening for colorectal cancer using FOBT.

BACKGROUND: Population-wide screening for people at average risk of colorectal cancer (CRC) by faecal occult blood test (FOBT) is under consideration in Australia. METHODS: Qualitative methods were used to examine the views of community members who did (n = 18) or did not (n = 12) participate in a pilot program of FOBT screening. In addition, views were obtained from general practitioners (GPs) and specialist gastroenterologists directly involved in the implementation of the program. Two focus group sessions were conducted with screening participants and interviews were conducted with nonparticipants, GPs and gastroenterologists. RESULTS: The findings suggest that CRC screening by FOBT distributed to households by mail was well accepted by the community and by the medical practitioners involved in its implementation. The trial had little negative effect on general practice. Both medical practitioners and consumers raised concerns about the efficacy of FOBT screening. Medical practitioners were also concerned about the potential burden mass screening could place on the public (government-funded) health care sector. CONCLUSIONS: It would seem that CRC screening using FOBT will not enjoy unqualified support from the community or from medical practitioners involved in the continuum of screening. Information about the objectives of screening programs, in general, and the efficacy of FOBT screening in particular, needs to be provided to the community to ensure informed individual choice.

Aged↗

PubMed1997

HIV testing history among gay/bisexual men recruited in Barcelona: evidence of high levels of risk behavior among self-reported HIV + men.

As part of the first quantitative study of men who have sex with men (MSM) and HIV/ AIDS in Spain, anonymous, self-administered questionnaires were distributed via gay/lesbian organization mailings, bathhouses, and sex shops in Barcelona. We analyzed 547 gay/bisexual men along self-reported HIV testing history-i.e. untested, previously tested HIV-, and previously tested HIV +. Eleven variables discriminated significantly between the three groups in multivariable analysis. HIV- men were over-represented in the mailing subsample. While untested men exhibited potentially protective behaviors (e.g. least likely to have had stable and casual sex partners with HIV/AIDS and to practice anal intercourse), they were also least likely to be out with their homosexuality and most likely to never use condoms when they practiced anal intercourse. HIV + men were most likely to report insertive and receptive anal intercourse with a condom and least likely to practice insertive anal intercourse without a condom in the past month, yet they were also most likely to report the highest interpersonal barriers to safer sex, recent cocaine use with sex, meeting sex partners in public restrooms, and recent episodes of STD. A potentially volatile combination of higher sexual activity (e.g. more sex partners and casual sex activity) coupled with the presence of safer sex barriers (e.g. poor scores on indices measuring safer sex disposition, elevated drug use accompanying sex) was evidenced among HIV + men. There were no statistically significant differences between the three groups for anal intercourse without a condom, but with 37.5% of this collective reporting one such episode in the past month, all groups can be considered equally risky. Against the backdrop of a 20.5% self-reported HIV prevalence, there is considerable need for enhanced prevention efforts among gay/bisexual men in general and targeted strategies among HIV + men in particular.

AIDS Serodiagnosis↗

PubMed1999

New approach to the medical information system for quality management in patient care: development of Problem Mapping System.

A new type of medical information system named Problem Mapping System (P-Map) has been developed, which aids physicians with solving patients' problems. With this system, physicians can define the problems of in-patients, monitor their progress clearly, and share information efficiently. In P-map, a list of problems, such as disease names, can be set for each inpatient easily. The progress of each problem is clearly shown using progress lines on a time axis. Physicians can save the Subjective Objective Assessment Plan (SOAP) notes which are linked to each problem. At the final stage of patient care, a discharge summary can be made easily. With the aid of this system, the quality of patient care is improved due to the following: (1) physicians can make the best decision; (2) medical staff in the same team can provide the best medical treatment; (3) evaluation of each medical treatment is easy; (4) saved data can be used effectively for education and research; (5) the system can improve cooperation with other medical institutes by providing discharge summary information which can be distributed using e-mail; and (6) the system can improve patients' understanding for the purpose of informed consent by providing clear and well organized information to patients.

Computer Systems↗

PubMed2006

Are newborns receiving premedication before elective intubation?

AIMS: To determine the extent and type of premedication used for elective endotracheal intubation in neonatal intensive care units (NICUs). METHODS: A pretested questionnaire was distributed via e-mail to the program directors of the neonatology divisions with accredited fellowship programs in Neonatal-Perinatal Medicine in the United States. RESULTS: Of the 100 individuals contacted, 78 (78%) participated in the survey. Only 34 of the 78 respondents (43.6%) always use any premedication for elective intubation. Nineteen respondents (24.4%) reported to have a written policy regarding premedication. Morphine or fentanyl was used most commonly (57.1%), with a combination of opioids and midazolam or other benzodiazepines used less frequently. Fourteen respondents (25%) also use muscle relaxants with sedation for premedication, but only nine respondents combined paralysis with atropine and sedation. CONCLUSION: Most neonatology fellowship program directors do not report always using premedication for newborns before elective endotracheal intubation despite strong evidence of physiologic and practical benefits. Only a minority of the NICUs has written guidelines for sedation, which may preclude effective auditing of this practice. Educational interventions may be necessary to ensure changes in clinical practice.

Analgesics, Opioid↗

PubMed2003

Occupational stress among Canadian orthodontists.

The occupational stress associated with many professions, including general dentistry, has been well researched. An anonymous, self-administered, mail-out survey was distributed to Canadian orthodontists. The survey included 67 potential stressors, an overall occupational stress score, an overall job satisfaction scale, and items addressing various characteristics of the respondents. The response rate was 51.2% (335/654). Pronounced differences were found between the respondents in the evaluation of potential stressors and the overall occupational stress score. The category of stressors with the highest mean severity of stress scores was time-related stressors. The stressors with high mean severity scores and high mean frequency scores were as follows: falling behind schedule, trying to keep to a schedule, constant time pressures, patients with broken appliances, and motivating patients with poor OH and/or decalcification. Stepwise multiple regression determined a model, involving overall job satisfaction, age, participation in a study group, hours worked per week, part-time academics, days of continuing education per year, and participation in stress management, to account for 35.9% of the variation in overall occupational stress scores. The results indicate the importance of time-management skills in reducing occupational stress, but other factors seem to have more effect on reported occupational stress than do the characteristics addressed by this survey.

Age Factors↗

PubMed2002

A comparison of practice outcomes of graduates from traditional and non-traditional medical schools in Australia.

AIM: The primary aim of the study was to compare the practice outcomes of doctors who graduated from a non-traditional, problem-based medical school (University of Newcastle) with those of graduates from a traditional programme (University of Sydney), matched randomly on the background characteristics of graduation year, age, gender, and rural primary and secondary school education. Our secondary aim was to differentiate admission from curricular influences by comparing the outcomes of Newcastle and Sydney graduates who entered medical school under similar admission criteria ('traditional academic' entry). DESIGN: Nested case-control analysis in a retrospective cohort study. METHODS: A validated mail-out survey was distributed to all Newcastle and Sydney graduates registered to practise in the state of New South Wales, Australia. OUTCOME MEASURES: Current main occupation (clinician or other), clinical career choice (family medicine and psychiatry or other specialties), practice location (urban or rural) and employment sector (public or private). RESULTS: A total of 513 Newcastle respondents (68% of the original, eligible Newcastle sample) were each matched randomly with a Sydney respondent according to the four background characteristics. Medical school background was not related to main occupation; over 90% of all graduates were employed in clinician positions. A greater proportion of Newcastle than Sydney graduates were either training or qualified in family medicine or psychiatry rather than in other specialties. The school of graduation was not related to practice environment; fewer than 20% of all graduates were working in rural locations and around 25% were employed in the public sector. There were no differences in outcome between Newcastle and Sydney graduates who had entered medical school under similar academic criteria. CONCLUSION: Our study suggests that initial selection procedures of medical school candidates with particular background characteristics and attributes may influence practice outcomes. Further research is required to confirm these findings.

Adolescent↗

PubMed1999

Smoking: rates and attitudes among nursing staff in central Sydney.

The objectives of this study were to determine the prevalence and predictors of smoking and attitudes to smoking-related issues among nurses employed by the Central Sydney Area Health Service in Sydney, Australia. A self-administered questionnaire, was distributed via the internal mail system of the Central Sydney Area Health Service in November 1997 to 610 randomly selected nursing staff. Twenty-one per cent (n = 127) of respondents smoked. Smokers were significantly younger than non-smokers and were more likely to speak mainly English at home. There were clear differences between smokers and non-smokers in response to all attitude statements. Interventions specifically directed at nurses who smoke to assist them to stop and maintain cessation are indicated. Future health service workplace tobacco control programmes should address deficits in knowledge about the health effects of passive smoking, should raise awareness among nurses who smoke about their potential to affect the behaviours of others through modelling, and should provide all nurses with the skills required to be smoking educators and advocates for tobacco control.

Adult↗

PubMed2005

Academic administrators' attitudes towards interprofessional education in Canadian schools of health professional education.

Interprofessional education is an approach to educating and training students and practitioners from different health professions to work in a collaborative manner in providing client and/or patient-centred care. The introduction and successful implementation of this educational approach is dependent on a variety of factors, including the attitudes of students, faculty, senior academic administrators (e.g., deans and directors) and practitioners. The purpose of this study was to examine attitudes towards interprofessional teamwork and interprofessional education amongst academic administrators of post-secondary health professional education programs in Canada. A web-based questionnaire in English and French was distributed via e-mail messaging during January 2004 to academic administrators in Canada representing medicine, nursing, pharmacy, social work, occupational therapy and physiotherapy post-secondary educational programs. Responses were sought on attitudes towards interprofessional teamwork and interprofessional education, as well as opinions regarding barriers to interprofessional education and subject areas that lend themselves to interprofessional education. In general, academic administrators responding to the survey hold overall positive attitudes towards interprofessional teamwork and interprofessional education practices, and the results indicate there were no significant differences between professions in relation to these attitudinal perspectives. The main barriers to interprofessional education were problems with scheduling/calendar, rigid curriculum, turf battles and lack of perceived value. The main pre-clinical subject areas which respondents believed would lend themselves to interprofessional education included community health/prevention, ethics, communications, critical appraisal, and epidemiology. The results of this study suggest that a favourable perception of both interprofessional teamwork and interprofessional education exists amongst academic administrators of Canadian health professional education programs. If this is the case, the post-secondary system in Canada is primed for the introduction of interprofessional education initiatives which support the development of client and patient-centred collaborative practice competencies.

Administrative Personnel↗

PubMed2004

Nutritional supplements and complementary/alternative medicine in Tourette syndrome.

OBJECTIVE: Tourette syndrome (TS) is a neuropsychiatric disorder associated with motor and vocal tics. Some people with TS have reported using alternative or complementary medicine (CAM), including nutritional supplements to control their tics. In a recent national survey, approximately 40% of people reported having used CAM in the prior year. We attempted to explore the use of supplements and other CAM among TS patients. METHOD: We developed a survey instrument based on anecdotal accounts of CAM use and distributed it to the mailing list of the New York Chapter of the Tourette Syndrome Association (n=500) and the subscription list of Latitudes, a newsletter exploring CAM treatments for neurological conditions (n=750). Responses were entered in a database and analyzed using SPSS version 10. RESULTS: Of 115 respondents, 87.8% reported using 1 or more of 29 nutritional supplements to control symptoms. Many also reported using other CAM. Most supplement users reported an improvement in tics. CONCLUSIONS: Although these results are not generalizable, they provide no evidence that use of supplements and other CAM is rarer among TS patients than in the general population. Given that most of our respondents were also using conventional medication, further study of the use of supplements and other CAM therapies by people with TS, the safety and efficacy of such therapies in this population, and possible interactions of such therapies with conventional treatment seems warranted.

Adolescent↗

PubMed2004

Targeting recovery: priorities of the spinal cord-injured population.

In the United States alone, there are more than 200,000 individuals living with a chronic spinal cord injury (SCI). Healthcare for these individuals creates a significant economic burden for the country, not to mention the physiological, psychological, and social suffering these people endure everyday. Regaining partial function can lead to greater independence, thereby improving quality of life. To ascertain what functions are most important to the SCI population, in regard to enhancing quality of life, a novel survey was performed in which subjects were asked to rank seven functions in order of importance to their quality of life. The survey was distributed via email, postal mail, the internet, interview, and word of mouth to the SCI community at large. A total of 681 responses were completed. Regaining arm and hand function was most important to quadriplegics, while regaining sexual function was the highest priority for paraplegics. Improving bladder and bowel function was of shared importance to both injury groups. A longitudinal analysis revealed only slight differences between individuals injured <3 years compared to those injured >3 years. The majority of participants indicated that exercise was important to functional recovery, yet more than half either did not have access to exercise or did not have access to a trained therapist to oversee that exercise. In order to improve the relevance of research in this area, the concerns of the SCI population must be better known and taken into account. This approach is consistent with and emphasized by the new NIH roadmap to discovery.

Activities of Daily Living↗

PubMed1989

An examination of loneliness among elderly Canadian seasonal residents in Florida.

As part of a larger study focusing on different facets of the lives of 2,731 older Canadians who seasonally reside in Florida, we investigated primarily the extent of family and friendship contacts and the loneliness expressed by these older Canadians. The data were collected using a questionnaire that was distributed and returned by mail. The sample was taken from the subscription list of a newspaper in Florida that was a subsidiary of a large Canadian newspaper. The results show a population that was relatively young, married, in generally good health, and with rather extensive contacts with family and friends while residing in Florida. Nevertheless, more than a fifth indicated they were at least somewhat lonely. Results, using discriminate function analysis, showed that those more lonely were younger, female, less educated, not married, in poorer physical health, had fewer Florida friends, and had more children who lived near them in Canada, but fewer children who lived near them in the United States. Implications of the results are discussed.

Age Factors↗

PubMed1999

REBASE-restriction enzymes and methylases.

REBASE is a comprehensive database of information about restriction enzymes and their associated methylases, including their recognition and cleavage sites and their commercial availability. Also included is a listing of homing endonucleases. Information from REBASE is distributed via monthly electronic mailings as well as through anonymous ftp and the World Wide Web. The REBASE web site (http://www.neb.com/rebase) contains a web page for every enzyme, reference and supplier. Additionally, there is a search facility, help and NEWS pages, and a complete description of our various services. Specialized files are available that can be used directly by many software packages.

Base Sequence↗

PubMed1980

Research in physical therapy: philosophy, barriers to involvement, and use among California physical therapists.

This study was designed to 1) determine the importance of research in physical therapy to professional physical therapists; 2) assess the factors impeding their involvement in research; and 3) examine the extent to which therapists use published research. The study was conducted in two parts, a series of personal interviews and a questionnaire developed from the results of the interviews. The sample for the interviews was drawn from the population of Santa Clara County, California, and the questionnaires were mailed to a random distribution of 300 physical therapists throughout the State of California. Lack of time and funding as well as unfamiliarity with both the research process and the use of statistics were cited as the main barriers to research involvement. Collaboration with other health professionals involved in research and an apprenticeships were listed as desirable methods to gain additional research skills; however, these were believed to largely unavailable. A large percentage of therapists used research information published in professional journals other than PHYSICAL THERAPY.

Adult↗

PubMed1999

Sleep habits of Long Island Rail Road commuters.

STUDY OBJECTIVES: We addressed the issue of how commuting affects sleep habits, and its association with general health and potential sleep disorders in individuals on a large, U.S. commuter rail system. DESIGN: Postage-paid mail back questionnaires were distributed to commuters over 6 consecutive weekdays. The questionnaire incorporated previously validated questions regarding sleep habits. SETTING: Questionnaires were dispensed at 15 different rail stations. PARTICIPANTS: 21,000 commuters accepted the questionnaire. MEASUREMENTS AND RESULTS: Data was analyzed by total group and length of commute. A total of 4715 (22%) questionnaires were returned. Over 50% of the sample reported difficulty with sleep and wakefulness while only 3% sought professional help. Sleep apnea was suspected in 4.2% of male and 1% of female respondents and was associated with increased reports of excessive daytime sleepiness, and history of hypertension, diabetes and obesity. Total nocturnal sleep time was significantly less in those subjects with long commutes. Seventy percent of respondents reported napping during the commute. Length of commute was associated with hypertension. CONCLUSION: Commuting long distances negatively impacts one's ability to capture adequate sleep. Data suggests that there may be significant numbers of respondents with unrecognized sleep disorders which further impact on general health.

Adult↗