Recognizing and helping the suicidal patient in chiropractic practice

The assessment of a patient's suicide risk is often difficult for the busy practitioner. The present article examined chiropractic interns' and doctors' ability to recognize suicide lethality factors in their patients. On a suicide lethality scale, chiropractic interns and doctors scored significantly lower than a sample of physicians and psychologists and did not score significantly differently than ministers and college students. There was no significant difference between the scores of chiropractic interns and doctors. The article discusses important factors in assessing patient's suicide risk, such as: current mood; suicide plan; and present life circumstances. Suggestions for helping the suicidal patient in co-operation with a psychiatrist or psychologist are presented.     

不同授课形式在临床护理带教中的应用情况分析

目的分析3种基本教学形式在临床带教工作中的应用,探讨更好的临床授课形式。方法选择2004年7月-2005年6月在本院急诊科实习的护生90名,按学历层次随机分为3组,分别以讲授法、讨论法、演示法3种不同形式进行心肺复苏(CPR)的理论及操作授课,比较授课前后护生理论及操作考核成绩。发放调查问卷,分析护生对于不同授课形式的意见反馈。结果单一使用讲授法授课的效果欠理想;加强护生自我学习能力是保证讨论法教学效果的前提;演示法在临床授课中最受护生欢迎,是提高学生动手能力和实践操作技巧的较好方式。结论在完善理论教学的前提下,演示法可以充分调动护生学习的积极性,强化动手操作能力,从而取得更好的临床教学效果。     

护理专业实习生评判性思维能力及影响因素调查分析

目的了解护理专业实习生评判性思维能力现状,分析存在的问题及其影响因素,为临床护理教学改革提供依据。方法采用一般资料调查表及加利福尼亚评判性思维问卷中文版对厦门大学附属第一医院105名护理实习生进行调查。结果护理实习生评判性思维总分为(284.66±12.59)分,总体上具有正性批判性思维,各维度得分由高到低分别是求知欲、分析能力、自信心、开放思想、系统化能力、认知成熟度、寻找真相;不同学历的实习生评判性思维得分差异具有统计学意义(P<0.05);人际关系及实习满意度不同的护理实习生评判性思维能力差异具有统计学意义(P<0.05)。结论护理专业实习生具有正性评判性思维倾向,但评判性思维能力不强,有待于进一步提高;其评判性思维能力与学历、人际关系、实习满意度等因素有关。     

Health care quality assurance: tracer analysis in quality assessment of ambulatory care provided by two out patient teaching clinics

Population-based assessment of medical care provides information on the quality of care generated by a health care facility over a range of services. Patient chart review was undertaken via "tracer analysis" at two ambulatory care teaching clinics to obtain a measure of the clinical services provided by chiropractic interns for a range of diagnoses. The assessment indicated that chiropractic interns perform best when rendering care for spinal conditions. However, a greater emphasis on development of clinical problem-solving skills versus the use of routine standardized examination procedures would improve the quality of care across a broader spectrum of conditions encountered within the patient base of the clinics. Improved documentation of concurrent medical care or medical referral is warranted in instances of systemic comorbidity.     

临床护理实习生心肺复苏知识、技能与实施意愿调查

目的：了解临床护理实习生心肺复苏( cardiopulmonary resuscitation,CPR)理论知识和技能掌握情况以及院外实施心肺复苏意愿,为开展心肺复苏培训提供参考依据。方法采用“临床护理实习生心肺复苏调查问卷”与“单人徒手心肺复苏行为操作考核评分表”对某三甲医院176名护理实习生进行心肺复苏知识、技能掌握与现场实施心肺复苏意愿调查。结果临床护理实习生总体对CPR基础知识掌握较好,CPR技能掌握有待提高,不同学历护理实习生对CPR理论知识和技能掌握差异有统计学意义( P<0.05),护理实习生对陌生人和亲近人实施CPR意愿差异有统计学意义( P<0.05),对同一对象实施人工呼吸与胸外心脏按压意愿差异有统计学意义( P<0.05)。结论护理实习生CPR技能有待提高,学校和医院需进一步加强对护理实习生CPR培训与复训,找出现场施救的障碍因素,提高护理实习生院外实施CPR的意愿。     

Manual therapies for pain control: chiropractic and massage

OBJECTIVES: To evaluate the effectiveness of chiropractic and massage therapy for the reduction of any type of pain. METHODS: Systematic reviews of chiropractic and massage as a means of pain control were located and evaluated. RESULTS: Six systematic reviews were found, 4 of chiropractic and 2 of massage therapy. Promising evidence emerged from some of these reviews but neither for chiropractic nor for massage was there fully convincing evidence for effectiveness in controlling musculoskeletal or other pain. DISCUSSION: The notion that chiropractic or massage are effective interventions for pain control has not been demonstrated convincingly through rigorous clinical trials.     

Emphasis on various subtopics in the anatomy curriculum for chiropractic training: An international survey of chiropractors and anatomists

Objective

The aim of this study was to conduct an international survey of the perceived optimal level of anatomy teaching from anatomy academics and practicing chiropractors. We hypothesized that the optimum level of anatomical understanding for chiropractic students does not differ between the anatomists teaching the students and practicing chiropractors.

Methods

The opinion of anatomists teaching in a chiropractic course (n = 16) was compared to practicing chiropractors (n = 589). The students'' level of understanding was based on the revised Bloom''s taxonomy for 16 different curriculum areas. Anatomists were recruited by contacting the accredited chiropractic courses worldwide. Snowball sampling was used for the practicing chiropractors. Independent-samples Mann-Whitney U tests were used to compare the results of anatomists and chiropractors.

Results

Opinions differed between anatomists and chiropractors on 9 out of the 16 questions. Where opinions differed, chiropractors recommended a higher standard of anatomical knowledge. The level suggested by chiropractors for these curriculum areas is equal to the “evaluating” level where chiropractic students can remember, understand, apply, and analyze anatomical knowledge to be able to justify a clinical decision.

Conclusion

Compared to anatomists working in chiropractic programs, chiropractors suggest a higher standard of anatomy be taught to undergraduates. Collaboration between chiropractors and anatomists would likely be beneficial in creating or modifying anatomy curricula for chiropractic students.Key Indexing Terms: Anatomy, Chiropractic, Curriculum, Education     

A prospective study of 2,000 patients attending a chiropractic college teaching clinic

A prospective study was undertaken to characterize 2,000 patients attending a chiropractic teaching clinic and the effectiveness of the care they received. Fifty-two percent of the patients were between 21 and 34 years old; 41% categorized their occupation as professional and 14% as skilled blue collar; 79% presented with musculoskeletal complaints; 44% had low back pain; 41% had complaints less than 1 month; 83% had no work time loss. Eighty-one percent of musculoskeletal diagnoses were reported as strain, with less than 1% intervertebral disc syndrome. The primary treatment approach was manipulation in 90% of cases. As a group, both patients and interns had similar expectations about the likelihood of improvement following treatment and similar assessments of the degree of improvement actually attained. Eighty-two percent of patients improved during their course of treatment. An average 4.4 patient visits were encountered per episode of care, with an average total charge of $66.00.     

Prevalence of nonmusculoskeletal versus musculoskeletal cases in a chiropractic student clinic

Objective

We sought to identify the percentage of nonmusculoskeletal and musculoskeletal conditions treated by interns in the National University of Health Sciences (NUHS) Student Clinic compared to chiropractic and allopathic health care professionals.

Methods

The information gathered was taken from the charts of patients treated in the fall trimester, dated September 12, 2011 through December 9, 2011. The data collected included ICD-9 codes for the conditions treated, the number of patient visits, age, and gender, and was evaluated using Microsoft Excel.

Results

Over half of the 113 eligible patients were women with a mean patient age of 28 years, an average of three treated diagnoses, and a mean of seven treatments. Those treated only for musculoskeletal conditions totaled 52% of the patients; 48% of the patients were treated for nonmusculoskeletal conditions, or musculoskeletal plus nonmusculoskeletal conditions.

Conclusion

The NUHS Student Clinic interns are treating a greater percentage of nonmusculoskeletal conditions and a lesser percentage of musculoskeletal conditions than practicing chiropractic physicians. The student interns also treat a lesser percentage of nonmusculoskeletal and a greater percentage of musculoskeletal conditions than allopathic practitioners. This comparison would suggest that NUHS is nearing its institutional goal of training its student interns as primary care practitioners.Key Indexing Terms: Chiropractic, Manipulation, Chiropractic, Physicians, Primary Care, Primary Health Care     

临床教学专题系列微课的建设及在实习护生教学中的应用

目的 探讨护理专业临床实践教学专题式系列微课的建设及在实习护生教学中的应用效果。方法 成立微课教学专题小组,根据要求筛选出17个技能和知识点作为微课主题,进行微课资源的开发建设。整体选取2017年6月到广州医科大学附属第一医院实习的90名实习护生作为对照组,采用传统教学法;整体选取2018年6月到医院实习的93名实习护生作为观察组,在传统教学的基础上进行微课教学及教学效果评价。2组实习护生在实习结束前均参加理论及操作考核。结果 观察组实习护生理论知识、基础护理操作及专科护理操作成绩均高于对照组,差异有统计学意义（P<0.05）;实习护生对微课教学利用度和满意度高。结论 微课教学有助于激发实习护生学习热情,提高教学效果,可推广到临床教学中进行应用。     

护理实习生对玻璃体温计破损导致汞污染的认知状况

目的了解护理实习生对玻璃体温计破损时的处理方法及破损后导致汞污染的认知水平。方法应用自编的玻璃体温计破损情况及一般知识调查表和玻璃体温计破损后处理方法及危害认识调查表,对135名护理实习生进行调查。结果 103名(76.30%)护理实习生实习过的科室有玻璃体温计打碎的情况。"有机汞(甲基汞)进入人体的主要途径"的回答正确率最低,为28.89%。"体温计破损后如何处理""体温计破损后如何清扫""汞泄漏清理过程中如何处理""汞蒸气与甲基汞进入体内后主要损害"4题,大专生回答正确率高于中专生(P<0.05)。"清理工作完毕后如何做",大专生回答正确率低于中专生(P<0.05)。结论护理实习生对玻璃体温计破损具有一定的处理能力,并对汞污染有一定认识,但有欠缺,特别是中专实习生。学校应加强相关知识的教育,特别是在中等卫生专业学校。     

Intentions of Chiropractic Interns Regarding use of Health Promotion in Practice: Applying Theory of Reasoned Action to Identify Attitudes,Beliefs, and Influencing Factors

Purpose:

The theory of reasoned action is a health behavioral theory that has been used to predict personal health behaviors and intentions as well as those of providers delivering health care. The purpose of this study was to determine interns'' future practices regarding the use of health promotion using this model to develop survey questions and to determine attitudes and perceived influences on their prospective behaviors in general, toward the use of health promotion once in practice.

Methods:

Across the course of one year, all graduating interns at a chiropractic college were queried with a 20 question survey designed using the theory of reasoned action. Frequencies and inferential statistics were performed including prediction modeling using logistic regression.

Results:

A majority (>85%) of interns indicated they would use health promotion in practice. Differences were noted based on perceived skill levels, perception of educational emphasis, various normative beliefs, and gender.

Conclusion:

Most interns will use some form of health promotion in practice. Normative influences including those seen as key influencers are as powerful a predictor as perceived education or skill levels on future practice of health promotion.Key Indexing Terms: Chiropractic, Health Promotion, Public Health Practice, Health Behavior     

护理专业实习生评教评学调查问卷分析与对策

目的 对护理专业实习生进行评教评学调查,评估护生实习带教质量,为改进及提高实习质量提供依据。方法 对临床护理实习带教老师的带教情况及护生学习情况,采用自制评教评学问卷调查法对63名护生进行调查。结果 带教老师能经常结合病例给护生讲解专科疾病知识与护理占32％;讲解及示范专科及基础护理操作分别占32％、37％;清楚明确回答护生问题占43％;对护生做到放手不放眼占63％;操作正规占57％。护生有不懂的问题时能经常通过看书、请教带教老师、与同学讨论解决的分别占38％、48％、33％;经常翻阅病历了解病情占37％。结论 要提高实习质量,应使带教老师及护生明确实习带教的目标,提高带教老师的自身素质,培养护生的临床能力及独立思考、主动学习的意识,纠正护生重技术操作轻基础护理认识上的偏差,同时要加强带教防止差错事故的发生。     

The role of experience in clinical accuracy

A randomized controlled trial was performed to study the effect of various teaching techniques on students performing sacroiliac motion palpation tests. This trial assessed the interexaminer reliability of interns in their final year at a chiropractic college, and compared their results prior to and following 1 year of clinical experience. The study also compared the intra- and interexaminer reliability of experienced clinicians. The results were analyzed via the Kappa coefficient. Kappa values for interns ranged from 0.00 to 0.30, with no significant differences noted at the end of 1 year of clinical experience. The interexaminer reliability of experienced clinicians was 0.00 to 0.167, whereas their intraexaminer reliability ranged from 0.15 to 1.00. These results question the role of experience in improving clinical accuracy between examiners performing sacroiliac motion palpation. Results analyzed for intraexaminer agreement were moderate to almost perfect. We conclude that experience does not play a significant role in the diagnostic test analyzed, but rather that clinicians may establish their own criteria by which to determine the standards of a given test.     

Use of radiographic imaging protocols by canadian memorial chiropractic college interns

Objectives:

The purpose of this study was to determine if 4th-year interns plan to x-ray their patients, once they are in private practice, in accordance with the principles taught throughout their radiology program and with the evidence-based imaging guidelines outlined in the literature.

Methods:

Questionnaires were provided to all 4th-year interns. Each questionnaire consisted of 10 case scenarios representing possible chiropractic patients. Each intern was asked if he or she would radiograph the patient and, if so, which views would be taken. A “gold standard” was established by two chiropractic radiologists using evidence-based guidelines. Intern answers were compared with the gold standard using percent agreement.

Results:

Sixty-eight interns completed the questionnaire. Agreement between the interns and the gold standards for the question of whether or not they would take x-rays ranged from 63.2% to 100%. The percent agreement for the correct radiographic views chosen ranged from 32.6% to 48.4%.

Conclusion:

Interns are generally aware of and plan to apply the radiographic guidelines for determining whether or not radiographs are indicated, as outlined in the current literature. However, interns are inconsistent in choosing the correct views.Key Indexing Terms: chiropractic, education, radiation, ionizing, radiography, x-ray guidelines, x-rays     

A Longitudinal Study of Emergency Medicine Residents' Malpractice Fear and Defensive Medicine

Objectives: To determine the baseline level and evolution of defensive medicine and malpractice concern (MC) of emergency medicine (EM) residents.
Methods: Using a validated instrument consisting of case scenarios and Likert-type scale questions, the authors performed a prospective, longitudinal (June 2001 to June 2005) study of EM residents at five 4-year California residency programs.
Results: All 51 EM interns of these residencies were evaluated; four residents left their programs and one took medical leave, resulting in 46 graduating residents evaluated. MC did not affect the residency choice of interns. Although perceived likelihood of serious disease increased in case scenarios over time, defensive medicine decreased in 27% of cases and increased in 20%. On a scale with 1 representing extremely influential and 5 representing not at all influential, the mean (±SD) influence of MC on interns' and graduates' case evaluation and management was 2.5 (±1.1) and 2.7 (±1.0), respectively. Comparing interns and graduates, there was no significant difference in the percentages of respondents who declared MC (mean difference in proportions, 3.3%; 95% CI =−8.4% to 15%) or refused procedures because of MC (11.5%; 95% CI =−1.3% to 24.3%). More interns, however, declared substantial loss of enjoyment of medicine than graduates (48%; 95% CI = 30.3% to 65.5%).
Conclusions: Physicians enter four-year EM residencies in California with moderate MC and defensive medicine, which do not change significantly over time and do not markedly impact their decisions to perform emergency department procedures. Malpractice fear markedly decreases interns' enjoyment of medicine, but this effect decreases by residency completion.     

A critical study of the student interns' practice activities in a chiropractic college teaching clinic

The diagnoses and treatment provided for 2000 patients attending a chiropractic college teaching clinic are described. The relationship between presenting complaint and the diagnostic and treatment procedures used is examined. Inconsistencies were noted with regard to interns' practice activities. Certain therapeutic modalities were clearly underutilized. Interns rarely sought advice or help in diagnosis or treatment, and they were generally unable to successfully predict the number of treatments that would be required. Support is given that links these findings to the fact that patients are not truly representative of patients seen by chiropractors in the field; they are relatively young, with mild complaints. The study concludes that students' clinical training and experience may not reach the level at which they will be tested by patient problems in active practice after graduation. Three alternatives to the current clinical teaching model are presented.