Emergency Medicine Residents and Statistics: What is the Confidence?

The objective of this study was to assess whether residents have the essential tools and a sense of competency when evaluating published studies, especially the statistics. Questionnaires were mailed to emergency medicine (EM) residency programs in the United States querying residents' demographics and training in statistics as well as their impressions and use of statistics in the current literature; a five-question statistical quiz was also included. Possible responses of—almost always, more than ½ time, ½ time, less than ½ time, almost never—were tallied individually as well as compared in groups of polarized answers: over 1/2 time (almost always + more than ½ time) vs. under ½ time (less than ½ time + almost never). There were 495 questionnaires returned from 42 centers. No significant difference was found when comparing quiz performance with participants' self-reported statistical knowledge. There were considerable differences in the polarized answers (Over vs. Under), whether statistics: were used appropriately (40% vs. 15%, respectively); were used to enhance weak data (54% vs. 13%, respectively); enhanced their understanding of information (38% vs. 24%, respectively); simplified complex data (26% vs. 41%, respectively); were understood by them (23% vs. 38%, respectively); confused them (37% vs. 24%, respectively); were skipped (52% vs. 23%, respectively). Participants felt there should be more statistical training (49% vs. 22%, Over vs. Under, respectively). There was no difference in respondents who did or did not read the statistics (39% vs. 34%, Over vs. Under, respectively). Many EM residents surveyed do not trust, read, or understand statistics presented in current journal articles. Residency programs may want to consider enhanced training in statistics.     

Medicine and the individual: is phenomenology the answer?

The issue of how to incorporate the individual's first‐hand experience of illness into broader medical understanding is a major question in medical theory and practice. In a philosophical context, phenomenology, with its emphasis on the subject's perception of phenomena as the basis for knowledge and its questioning of naturalism, seems an obvious candidate for addressing these issues. This is a review of current phenomenological approaches to medicine, looking at what has motivated this philosophical approach, the main problems it faces and suggesting how it might become a useful philosophical tool within medicine, with its own individual, but interrelated, contribution to make to current medical debates. After the general background, there is a brief summary of phenomenological ideas and their current usage in a medical context. Next is a critique of four key claims within current phenomenological medical works, concerning both the role phenomenology plays and the supposedly clear divide between phenomenology and other approaches. There are significant problems within these claims, largely because they overlook the complexity of the questions they consider. Finally, there is some more in‐depth examination of phenomenology itself and the true complexity of phenomenological debate concerning subjectivity. The aim is to show that it will be both more productive and truer to phenomenology itself, if we use phenomenology as a philosophical method for explicating and gaining deeper understanding of complex and fundamental problems, which are central to medicine, rather than as providing simple, but flawed solutions.     

Competency Education and Validation in the United States: What Should Nurses Know?

This article provides an overview of the progress in the past decade toward effectively documenting the initial and continuing competence of registered nurses.     

Integrative Medicine in the Oncology Setting,What Does the Research Show?

Most oncology patients are using some form of complementary alternative medicine (CAM). These can include acupuncture, massage, yoga, homeopathy, energy work, spiritual healers, vitamins and supplements, mind-body interventions, diets, and many other modalities. Although many of these interventions are safe and beneficial, some of them can be harmful. Unfortunately, because of time constraints, knowledge deficits, and the acuity of our patients, assessment of the use of CAM is often overlooked. As nurse practitioners, we must educate ourselves about the evidence for safety and efficacy of these interventions.     

Sepsis,Pneumonia, and Meningitis: What Is the Difference?

Sepsis, pneumonia, and meningitis are types of infections seen frequently in the neonate. The signs of sepsis can be an overwhelming, systematic response, or the signs can be localized to the place of infection, whether lungs, spinal fluid, or bones. It is important for nurses to understand how the source of infection and progression of the disease can cause changes in the signs of infection. Infection can invade the bloodstream, produce an inflammatory reaction, and cause shock with resulting multiple-organ dysfunction. A conceptual model of the progression of sepsis in the neonate will be presented. The importance of understanding the progression in the disease process will assist the nurse to facilitate prompt and effective treatment for the infant with sepsis.