Do perinatal guidelines have an impact on obstetric practices?

BackgroundThe publication of several sets of French guidelines was unfortunately not accompanied by planned assessment of their impact on practices. The goal of this study was to assess the impact of eight French perinatal guidelines on actual obstetric practices.MethodsHistorical cohort setting in France: the Audipog database of 299,412 pregnancies from 1994 to 2006, from which we extracted a sub-sample by randomLy selecting from each participating maternity ward all births occurring during a single month of each year (n = 107,450 pregnancies). The main outcome measure was the incidence of pertinent perinatal indicators related to these guidelines. These included site of delivery for low-birth-weight infants (1998), caesarean delivery (2000), preterm delivery (2002), breastfeeding (2002), smoking and pregnancy (2004), immediate postpartum hemorrhages (2004), early discharge after delivery (2004) and episiotomies (2005). Standardised rates, before and after the year of each guideline, were compared using a Chi² test.ResultsThe percentage of children weighing less than 1500 g at birth born in Level III hospitals increased through 1999 but dropped subsequently, without ever returning to the 1994 level (P < 0.0001). The overall caesarean rate climbed slowly but regularly from 1994 through 2006 (P < 0.0001). Use of antenatal corticosteroids for women hospitalised for threatened preterm labour and in children born before 33 weeks has fluctuated since the release of the guideline (P > 0.05). Exclusive breastfeeding at discharge from the maternity ward has increased slowly (P < 0.0001). The percentage of deliveries with active management of the third stage of labour rose notably from 1999 to 2006 (P < 0.0001), and smoking cessation during pregnancy rose slightly in 2006 (P < 0.0001). Since 1994, early discharges have become slowly, slightly, but regularly more frequent for all women (P < 0.0001). The guideline on episiotomies has had a slight positive effect in the short term (P < 0.0001).ConclusionsGlobally, the impact on actual practices of clinical practice guidelines, except the guideline concerning the active management of the third stage of labour, was low. Most of the changes observed in practices began before the pertinent guideline was published.     

Does sickness presenteeism have an impact on future general health?

Purpose  

The primary aim of this prospective study was to investigate whether working despite illness, so called “sickness presenteeism”, has an impact on the future general health of two different working populations during a follow-up period of 3 years.     

What impact do students have on clinical educators and the way they practise?

The clinical education setting plays an important part in teaching students about the real world of clinical practice. Traditionally the educational relationship between student and clinical educator has been considered one-way, with students being the ones that benefit. This review focuses on the areas of clinician practice and behaviour that students are reported to influence through clinical placements and as such, determine the overall impact students can have on supervising clinicians. Electronic searches were conducted across MEDLINE, EMBASE, PsychINFO and CINAHL in July 2016. Retrieved articles were filtered to find those which presented data relating to students in the clinical setting. Data was extracted and analysed independently by two authors through thematic analysis. Twenty-eight studies met the inclusion criteria. Results showed that practitioners enjoy the act of teaching. Clinical student presence encourages clinicians to solidify their knowledge base, stimulates learning and causes them to re-evaluate their practice. Practitioner skills were further developed as a results of students. Clinical educator workload and time spent at work increased when a student was present with time management being the predominant challenge practitioners faced. Studies demonstrated that clinicians feel they benefit by students periodically becoming the teacher. Student placements in clinical practice cause an increase in practitioner workload and lengthen their work day. These perceived limitations are outweighed by the many benefits described by supervising clinicians. Providing clinical education can enrich both the practice, and the practitioner, and the aforementioned advantages should be highlighted when offering or considering the expansion of clinical placements.     

What impact will the ‘conversion’ of two district general hospitals into teaching hospitals have? Views from the field

AIM: To gather opinions from a variety of healthcare professionals in Birmingham and the Black Country as to the potential impact of 'converting' 2 district general hospitals into teaching hospitals. METHODS: Thirty-three semi-structured interviews were conducted with healthcare professionals including Directors of Public Health, Community Health Council Chief Officers, Trust Chief Executives, medical directors, trust managerial and consultant staff, junior doctors and nurses. Interviewees were asked to outline what they felt the major impacts of the 'conversion' to teaching status were likely to be. RESULTS: Five main thematic areas were identified from the interviews. Three of these related to the medical students receiving their clinical training in the new teaching hospitals, the teachers undertaking new or additional teaching duties and the patients being treated in the new teaching settings. Interviewees also identified several organisational effects relating to the new, established and non-teaching hospitals in the locality and discussed potential impacts outside of health care settings. CONCLUSIONS: The majority of views expressed by participants were positive citing potential benefits from developments in teaching provision. Areas of concern generally related to the need for successful implementation of the changes within clinically focused environments rather than to the effects of teaching per se. The impacts consequent to the reconfiguration of district general hospitals to teaching hospitals should be evaluated by appropriately designed longitudinal studies.     

Towards gender balance: but will women physicians have an impact on medicine?

The increasing numbers of women in medicine in western societies has raised the issue about their impact on medical practice. As a way of addressing the issue, this paper explores women's position in medicine in the Nordic countries, where the medical profession will soon be gender-balanced. Support for both a ghettoization and a vanguard argument for women physicians can be documented. The final section offers three sociological perspectives--the socialization theory, the neo-Weberian, and the social constructionist--as theoretical explanations for the gender segregation of medicine and as diagnostic paradigms and potential heuristic devices to aid women's empowerment as medical providers.     

The mechanism of impact of summative assessment on medical students’ learning

It has become axiomatic that assessment impacts powerfully on student learning, but there is a surprising dearth of research on how. This study explored the mechanism of impact of summative assessment on the process of learning of theory in higher education. Individual, in-depth interviews were conducted with medical students and analyzed qualitatively. The impact of assessment on learning was mediated through various determinants of action. Respondents’ learning behaviour was influenced by: appraising the impact of assessment; appraising their learning response; their perceptions of agency; and contextual factors. This study adds to scant extant evidence and proposes a mechanism to explain this impact. It should help enhance the use of assessment as a tool to augment learning.     

Do patients have an obligation to participate in student teaching?

Context  Patients may participate in teaching in many ways, in different settings and with different degrees of expert supervision. The majority of patients are generally very willing to participate in teaching. At times, however, patients may decline to see students because they are too sick, wish to maintain their privacy, prefer to have more expert care, or simply wish to have no involvement with students. This raises the question as to whether patients have any obligation to participate in education.
Methods  A number of arguments are advanced to justify the claim that patients have an obligation to participate in student teaching. These include: that patients should participate in training for the benefit of others if they wish to benefit from the care of those who have learnt from others; that, without patient participation in teaching, the entire health system would collapse; that participation in education provides a benefit over and above the provision of individual care; that, as we all benefit from the presence of a functioning health system, we should all be prepared to contribute to it, and that patients should 'pay' for free public health care by participating in teaching.
Conclusions  None of the arguments that patients have an obligation to participate in medical education are convincing. We believe that patients participate in training largely out of altruism rather than obligation. Where possible, sick patients should be substituted for by healthy patients or simulations.     

What do medical students read and why? A survey of medical students in Newcastle‐upon‐Tyne,England

OBJECTIVES: There is increasing interest in the role of medical humanities within the undergraduate curriculum, but we know little about medical students' views on this or about their reading habits. Our study explored the reading habits of medical students, and their attitudes towards literature and the introduction of humanities into the curriculum. DESIGN: Self-completion questionnaire survey. SETTING: Newcastle University and Medical School. SUBJECTS: All first-, second- and third-year undergraduate medical students (384), biology students (151) and a random sample of law students (137) were sent a self-completion questionnaire to assess reading levels, attitudes towards literature and the medical humanities (medical students) and the perceived benefits of reading. RESULTS: Medical students read widely beyond their course and articulate a range of benefits from this, including: increasing awareness of life outside their experience; introspection or inspiration; emotional responses; and stimulation of an interest in reading or literature. Of the medical students, 40% (103/258) read one or more fiction books per month, but 75% (193) read fewer non-curricular books since starting university, largely because of time pressures, work, study or academic pressures and restricted access to books. A total of 77% (194) thought that medical humanities should definitely or possibly be offered in the curriculum, but of these 73% (141) thought it should be optional and 89% (172) that it should not be examined. CONCLUSIONS: Medical students read literature for a variety of very positive and valued reasons, but have found leisure reading harder to maintain since starting university. They support inclusion of the humanities in medical education, but have mixed views on how this should be done.     

Does overweight in childhood have an impact on adult health?

The consequences of overweight in childhood, including persistence into adulthood and as a risk factor for adverse health consequences, are of substantial concern given the recent upward trend in prevalence. A recent report on an historic cohort--a British 1947 birth cohort--is largely consistent with previous estimates of persistence of overweight. Long-term health consequences of obesity were not demonstrable in this study, likely owing to the small numbers of subjects who were overweight during post-World War II Britain.     

What happens to medical students who complete an honours year in public health and epidemiology?

BACKGROUND: Around one-third of medical students in the UK take an intercalated honours degree in addition to their basic undergraduate course. The honours year has been reported to have a major influence on subsequent career choice; honours students show greater interest in research and laboratory medicine careers and less in general practice and public health.1,2 AIMS: To examine the career choice of Nottingham medical students who completed an honours year in public health and epidemiology (including general practice). METHODS: Postal questionnaire and telephone follow-up of a cohort of 266 students who entered the honours year in Public Health and Epidemiology between 1973 and 1993. RESULTS: Career information was available on 203 students; 78% (195) of those are currently employed in medicine. 44% were working in general practice (expected 40-45%) and 8% in public health medicine (expected 2%). Overall 19% (expected 4-11%) had chosen academic careers including nine of the 15 choosing an academic career in public health. The majority (60%) reported that the honours year had influenced their career choice, while 55% reported that the year had increased their likelihood of choosing an academic career. CONCLUSIONS: The honours year does encourage entry into academic and research careers in general and the type of honours year department strongly influences the subsequent choice of specialty.     

Does the presence of medical students affect quality in general practice consultations?

Context  Previous studies have suggested that the patient's experience of a consultation with a doctor is not affected by the presence of medical students. However, no study has looked at the effect of student presence on conventional UK general practice consultations.
Objectives  This study aimed to measure the quality of the consultation as experienced by patients when students are present, to explore patients' attitudes to the presence of medical students, and to look at the relationships between these factors.
Methods  We conducted a cross-sectional questionnaire study in general practices in north-east England. General practitioners (GPs) from practices teaching fourth and final year students administered questionnaires to patients who were seen in either teaching or non-teaching consultations. The questionnaire comprised previously validated measures of empathy and enablement as measures of quality, attitudinal statements regarding the presence of students, a scale rating pertaining to the patient's degree of acquaintance with the doctor, and items on demographic data.
Results  Results showed no significant differences in enablement scores between the 2 groups. Consultations with student presence last longer. Empathy scores were significantly lower in the 'student present' group, but the size of the difference was small. Attitudinal statements regarding the presence of students showed a high proportion of positive responses, and some groupings of negative ones. Further analysis demonstrated some significant links between attitudinal statements and enablement and empathy scores.
Conclusions  The quality of general practice consultations was not adversely affected by medical student presence. However, significant numbers of patients who agreed to be seen with a student present were resistant to the student's presence.     

Can an intervention on clinical inertia have an impact on the perception of pain,functionality and quality of life in patients with hip and/or knee osteoarthritis? Results from a cluster randomised trial

ObjectivesEvaluate whether an intervention applied to general practitioners to prevent clinical inertia had an impact on pain, functionality, and health-related quality of life (HRQoL) of patients with hip and/or knee osteoarthritis.DesignThis was a cluster-based, multicentre, prospective, randomized, parallel-group study. Clusters of physicians working were assigned to one of two study groups. Physicians in Group 1 received a training session while those in Group 2 did not.SettingPrimary Care Health centers representative of the entire Spanish territory.Participants329 general practitioners of primary healthcare centre.InterventionsThe intervention consists of a motivational session to propose a proactive care, based on current recommendations.MeasurementsVisual analogue scale (VAS); functionality (WOMAC scale) and global perception of health by SF-12. Effects were measured in two visits six months apart.ResultsA total of 1361 physicians, and 4076 patients participated in the study. No significant differences were observed in the clinical benefit obtained between patients assigned to Group 1 and Group 2. Nevertheless, a significant improvement was observed in the combined population (Groups 1 + 2) in the VAS (p < 0.001), WOMAC (p < 0.0001) and SF-12v2 (p < 0.001) questionnaires in Visit 2 compared to Visit 1.ConclusionsThe results indicate that, although this specific intervention carried out on physicians did not provide an additional clinical benefit to patients with knee and/or hip osteoarthritis, an increased awareness of the patient's disease through the use of functionality indexes, as well as the mere fact of being observed, seem to improve patient-reported pain, functionality and HRQoL.     

What benefits will choice bring to patients? Literature review and assessment of implications

OBJECTIVES: To assess the demand for, and likely impact of, increasing patient choice in health care. The study examined whether patients would like to exercise choice of hospital, primary care provider and treatment, and investigated the likely impact of policies designed to increase choice on equity of access, and on the efficiency and quality of service delivery. METHOD: Theory-based literature review including an analysis of the intended and unintended impact of choice-related policies in health care in the UK, European Union and USA. Selected papers focused not only on offering choice to individual patients but also evidence of the impact of choice by patients' agents such as GPs, and on the impact of introducing choice in education and social services. RESULTS: Choosing between hospitals or primary care providers is not currently a high priority for the public, except where local services are poor, e.g. they have long waiting times and where individual patients' circumstances do not limit their ability to travel. When patients become ill, they are increasingly likely to wish to rely on a trusted health practitioner to choose their treatment. Better educated populations make greater use of information and are more likely to exercise choice in health care. The increase in inequality which this could produce might be reduced by specific provision of information and help, enabling less advantaged populations to make choices about health care. There was little evidence in the literature that providing greater choice will in itself improve efficiency or quality of care. CONCLUSION: Although patients may themselves make limited use of choices, the existence of choice may, in theory, stimulate providers to improve quality of care. Patients do, however, want to be more involved in individual decisions about their own treatment, and generally participate much less in these decisions than they would wish.     

Restructuring Canada's Blood System: What will be the impact on hospitals?

With the amount of publicity given to the Commission of Inquiry on the Blood System in Canada (Krever Commission), hospitals will be pressured to change policies and procedures regarding transfusions and the use of drug alternatives to surgical blood transfusions. Over the next year, hospital administrators will be forced to implement changes regarding allocation of resources, upgrades to information systems and revised patient care practices for patients requiring transfusions or blood alternatives. At a series of focus groups organized by the Canadian College of Health Service Executives and Janssen-Ortho Inc. in early 1996, 57 health care administrators from across Canada discussed their vision of how the Krever Commission has and will affect hospital policies and procedures over the next few years. This article summarizes the groups' findings relating to the changes that hospital administrators are likely to implement across Canada in the next two to three years as a result of the Commission's activities.