Positive and negative work characteristics associated with burnout among primary care pediatricians

Background: There is little research regarding specific work features that might cause chronic stress and burnout among primary care pediatricians. The aim of the present study was first, to assess specific negative and positive characteristics of the job that might be related to burnout; and second, to compare burnout levels and work characteristics among board-certified versus general pediatricians; and clinic directors versus non-directors.
Methods: Questionnaires were sent to 200 pediatricians employed full-time in pediatric primary care community centers in the largest Israeli Health Maintenance Organization (HMO). Respondents replied anonymously. The questionnaires assessed sociodemographic details, burnout levels, and negative and positive job characteristics.
Results: There were no differences in burnout levels between board-certified and general pediatricians. Positive job features had stronger associations with burnout than negative features. Compared with general pediatricians, board-certified pediatricians reported significantly higher levels of negative features (e.g. conflicts between the medical and administrative system in the HMO; parents disregarding instructions); but higher levels of autonomy and appreciation from patients. Compared with regular pediatricians, clinic directors had significantly higher levels of negative job features (e.g. less access to resources); and higher levels of positive work features.
Conclusions: The absence of positive job features (e.g. autonomy, recognition for one's work and utilization of skills) may be more important in causing burnout than the presence of negative characteristics (e.g. overload, demanding and noisy parents). It is consistent with recent suggestions that in the presence of positive features, employees can better tolerate stressful aspects of the job and still feel motivated and engaged.     

Clinical characteristics of myotonia congenita in China Literature analysis of the past 30 years

AIM:To understand the distinct,clinical features of myotonia congenita in China.METHODS:Case reports of myotonia congenita were retrieved from the Chinese Journal Full-text database,dating between 1980 and 2007,and analyzed for clinical characteristics of myotonia congenita. RESULTS:There were 35 published reports and 258 cases about myotonia congenita.Six reports(62 cases)were excluded due to lack of clinical data,imprecise diagnosis,or duplication.Finally,29 published reports and 196 cases(140 males and 56 females)were included in this analysis.About 78.6% of patients were diagnosed with myotonia congenita before the age of 20,and among these, 86.1% were classified as dominant inheritance.Lower and upper extremities were frequently affected with severe symptoms.Eyelids,mouth and lingual muscles,and trunk muscles and cervical muscles were less frequently involved.However,muscles for swallowing,sphincter muscles,and smoothmuscles were not involved.There were no reports of cataracts,cardiac conduction block,or dyscrinism. Myotonia congenita symptoms were induced or aggravated by cold temperatures in 71.9% of the patients and warming-up effect occurred in 95.6% of the patients.Muscle hypertrophy was observed in 69.6% and percussion of muscles in 76.5% of the patients.Myotonia potential or myotonia-likepotential was detected in all patients using electromyography.Muscle fiber swelling or hypertrophy was frequently detected through muscular biopsy.CONCLUSION:Myotonia congenita frequently occurs in males before the age of 20,in particular as the autosomal dominant form of myotonia congenita.Skeletal muscles throughout the body,especially the lower and upper extremities,are involved.However,muscles for swallowing,sphincter muscles, and smooth muscles are not involved.Warming-up effect is the main characteristic of myotonia congenita.     

神经外科医院感染的特点及病原菌耐药性分析

目的分析神经外科病房医院感染的特点及细菌耐药动态，为神经外科患者医院内感染的预防和治疗提供依据。方法回顾性分析2006年1月至2007年12月我院神经外科收治患者的临床资料，对其中发生医院感染病例的细菌种类、感染部位、耐药率等进行重点分析。结果神经外科的医院感染例次率是15.3％，明显高于全院同期发生感染的例次率（3．6％）（P〈0.05）；病原菌以G^-杆菌为主（59．8％），G^＋球菌为32．5％，真菌为7．6％；以下呼吸道感染居多（63．8％），其次为泌尿道感染（15．5％）和血液系统感染（8．2％）等。结论系统监测神经外科医院感染的特点及其细菌耐药动态，对临床合理使用抗生素具有重要的参考价值：降低神经外科医院感染率的重点是控制下呼吸道感染，其他综合性治疗措施也应予以重视。     

医学生应对方式与人格特征的相关分析

目的探讨医学生应对方式的特点及与其人格特征的关系。方法采用应对方式评定问卷和艾森克人格问卷(EPQ)对石河子大学医学院学生采取分层整群抽样的方法进行测试、分析。结果应对方式测试结果,女生求助因子得分高于男生,男生合理化因子得分高于女生。EPQ问卷评定,男生的P因子得分高于女生,女生的L因子得分高于男生。应对方式因子分与EPQ各维度存在不同程度的相关。结论建议高校管理者应了解学生的这些心理特点,有针对性地进行心理健康教育。     

Promoting leadership: the development of a nurse executive team in an acute hospital trust

Aim The purpose of this study was to evaluate how an executive nursing team, within an acute hospital trust in the south of England, developed their leadership characteristics through the use of a professional development programme. Background This paper offers an insight into how this team worked together to clarify their views of their new role and how the role would be enacted. Method A questionnaire using quantitative and qualitative measures was used to explore the group’s leadership style and evaluate the professional development programme. Findings The findings show how the development programme worked and what clarity it afforded the group in terms of their leadership style. Group work, building on the findings, helped them define their particular characteristics, skills and leadership ability and what further work was needed to demonstrate this. Conclusions The issues raised, such as team‐working, mutual purpose and personal development, are discussed in terms of their function within an integrated executive team with vision and goals. Implications for nursing management In ensuring that the nursing service has positive purpose, direction and goals, there needs to be a strategic approach to corporate development; otherwise, nursing will struggle to lead itself within a fast changing health care system.     

Seizures in patients with symptomatic cervical artery occlusion by dissection and by atherosclerosis

Background and purpose: The outcome of patients with occlusion by cervical dissection (OCD) is considered to be better than of those with atherosclerotic occlusion (ATO) of cervical arteries. The present observational retrospective study investigates whether there are also differences in the occurrence of seizures between OCD and ATO patients. Methods: The characteristics and the occurrence of seizures in 199 consecutive patients with a stroke due to a cervical artery occlusion are determined. Forty patients with OCD and 159 with ATO are compared. Results: Occlusion by cervical dissection patients are significantly younger and have less vascular risk factors than those with ATO. Stroke type, vascular territory, NIHS score and outcome are similar. Three (7.5%) OCD and 29 (18.2%) ATO patients developed seizures. However, this difference is not statistically significant (P = 0.146). On multiple logistic regression analysis, ageing and arterial hypertension are independent variables. Discussion: This study suggests a lower incidence of seizures in patients with OCD compared to those with ATO, although not statistically proven, due to the small sample size. Age and arterial hypertension can explain this difference.     

Quality control in blood cell analysis

In the literature various methods are described for quality control in the determination of haemometric and haemocytometric values. In most clinical laboratories, commercial blood cell control material is utilised in internal quality control. Although it is claimed that the materials do not change markedly within 4 to 6 weeks, variations may occur. The values assigned to the materials are determined by utilising various blood cell analysers in selected laboratories, and may vary according to the type of instrument. Since the analytical results should be the same for every type of instrument, one may deduce that, by using such materials, only the repeatability and reproducibility, i.e., the constancy of performance of the instrument is checked. Although the use of the materials has some advantages, it is clear that accuracy is not guaranteed where there is lack of a calibrator.In the National Institute of Public Health and Environmental Hygiene (RIVM) in the Netherlands, efforts were made to improve on the methods of quality control in haematology. After studying five methods mentioned in the literature for the preparation of stabilised erythrocytes, the method described by Benedek (1966) was found to be the best when taking into consideration the shapes of the cells, the suitability for counting, and the stability. In a contract with the Council of Europe the method was further developed.Thorough studies were also undertaken into the performance of cell counting instruments. In collaboration with nine clinical laboratories we succeeded, taking into account the basic anomalies of the various types of blood cell counting instruments, in determining the concentration of a suspension of stabilised cells (Stabicells) to a tolerance of less than 2%. As its lifetime is virtually unlimited, this suspension may be considered to be a calibrator.A comparable procedure was used to prepare a calibrator for the automated determination of haemoglobin concentration. The concentration could be shown not to deviate markedly within a period of 3 years.Using a combination of technical anomaly corrections with quality control by daily calibration, we set up a system independent of external control. Since in animal haematology, problems are greater than in human haematology, and external support is less available, application of the system is strongly recommended in animal haematology.     

Behavioral characteristics of epilepsy patients compared with normal controls

Using neuropsychological testing procedures, we measured the behavioral characteristics of patients with epilepsy unaffected by anticonvulsant drugs and compared these results with control subjects matched for age, sex, and education. In a nationwide VA Cooperative study, 622 patients with well-defined seizure types were given a selected battery of neuropsychological tests prior to and at 1 month after initiation of drug therapy. Seventy-four control subjects were administered the same test battery under standardized conditions at the same VA testing centers. All tests of controls were also repeated 1 month later. The patients with epilepsy scored significantly and consistently below the level of the control subjects on all but three behavioral measures. Differences reaching statistical significance were found on tests of motor function (Finger Tapping, Pegboard, Color Naming), cognitive-attention (Digit Symbol, Discriminative Reaction Time, Word Fluency), and subtests of the Profile of Mood Status (tension, depression, vigor, and confusion). These data provide a profile of behavioral characteristics of unmedicated patients with epilepsy.     

Segregation by modality of myelinated and unmyelinated fibers in human sensory nerve fascicles

Thin diameter concentric needle electrodes with a small recording surface were used to explore the characteristics of neighboring fibers in sensory median nerve fascicles. Fibers which were close neighbors in the fascicle, were not randomly distributed intraneurally. Instead there was an intrafascicular segregation by modality of both myelinated and unmyelinated fibers. In addition, evidence was obtained which suggested that the contents of different Schwann cells vary. Some Schwann cell systems envelop afferent C fibers whereas others hold efferent sympathetic C axons. The results imply a modality segregation amongst both A and C fibers in human peripheral sensory nerve fascicles.     

错(牙合)畸形对成年人人格倾向影响的多因素研究

目的:通过对成年人不同错(牙合)畸形的人格倾向研究,探讨不同错(牙合)畸形对成年人人格倾向的关系和影响.方法:采用艾森克个性量表(EPQ)对360例昆明地区正常(牙合)和患有不同类型错(牙合)畸形的汉族成年患者的人格倾向进行调查分析.结果:牙颌畸形各重度组与正常(牙合)组EPQ存在显著差异性.畸形程度、年龄与精神质特质成正相关性,文化程度与精神质特质成负相关性;畸形程度、性别与内外向性特质成负相关,文化程度内外向性特质成正相关;畸形程度、文化程度、年龄与神经质性特质成正相关,安氏Ⅲ类成人患者神经质性特质分值高于安氏Ⅰ、Ⅱ成人错(牙合)畸形患者.结论:牙颌畸形各重度组的人格倾向与正常(牙合)组存在显著差异性;性别、畸形程度、年龄、文化程度在对成年人人格倾向影响上起到不同的作用.