What can we learn from the experiences of consultants around the time of a child's death?

Aims To describe how paediatric consultants report dealing with child and neonatal deaths as part of their daily work. Background Paediatric consultants are involved with children and their families facing death through illness. This study focused on consultant's involvement around the time of death including: decision making and its associated difficulties, talking to parents and the use of coping strategies. Consultants with more than 5 years experience were asked what experience has taught them and consultants with less that 5 years experience were asked what they felt was the biggest change from being a registrar. Methods Following Multicentre Research Ethics Committee (MREC) approval a pre‐piloted self‐administered questionnaire (with one reminder) was sent to 100 of the paediatric consultants within the South West Region. Results There was a 61% response rate. Most consultants had experienced a variety of opinions when talking to parents about when to withdraw or withhold life sustaining treatment. Uncertainty (39%) and disagreement (44%) made decision making difficult. Discussion with colleagues (41%), ‘honesty and time with parents’ (28%) and planning or ‘stage managing’ talking with parents (38%) were well used strategies to deal with this. New consultants find responsibility and decision making the biggest change from being a registrar. Conclusions We can learn much from the experiences of consultants around the time of a child's death. Their approach during resuscitation and withdrawal or withholding life sustaining treatment describes many strategies that have been developed to ease the often complex decision‐making process. Although consultants have built up personal support networks and individual coping strategies many recognize that these are not all encompassing and some harbour unresolved feelings of grief. Enabling health professionals to genuinely care, ‘giving oneself totally yet preserving oneself totally’ remains a challenge.     

我国职业卫生与职业病学的发展史

目的论述对职业卫生与职业病学做出过贡献的人和事,划分职业卫生与职业病发展时段,方便学术研讨。方法结合职业卫生与职业病学学科演变、职业卫生工作进展等资讯进行分析并予以确定。结果职业卫生与职业病学可分为3个期和3个阶段,3个期为萌芽(雏形)期、成形(冠名)期、发展(深化)期;3个阶段是工业卫生阶段、劳动卫生阶段、职业卫生阶段。结论职业卫生与职业病学是预防医学的一个重要分支学科,它学术性强,专业理论博杂,要想在职业卫生与职业病学工作中有所建树,必须精通专业理论知识和相关学科理论知识。职业卫生与职业病学工作保障了工人的身体健康,遏制了职业病危害,促进了国民经济的有序发展。学习和掌握职业卫生与职业病学知识,了解和熟悉职业卫生与职业病学发展史,对职业病防治工作的开展及学术研讨有明显的帮助。     

A Curriculum in Agricultural Medicine for Medical Students

A variety of educational programs in occupational medicine are available for medical students. This paper describes a two-day program that emphasizes agricultural medicine for senior medical students during their rotation in the Department of Family Medicine at the Medical University of South Carolina. The program uses interactive case discussions and farm visits as tools for motivating students to pursue further experience in the field.     

The rise and fall of occupational medicine in the United States

Thirty years ago, occupational medicine was one of the smallest of all the medical specialties, ignored by most physicians and medical schools. Occupational physicians were more likely to have entered the field through career transition than by residency training. In 1970, governmental agencies sought to transform occupational medicine into a major clinical specialty. Influential groups projected a need for large numbers of physicians in the field. Residency training was expanded, as were other teaching programs. However, industry and its workers' compensation insurance partners were not widely included in these plans. For that reason, among others, many physicians entering the field met with disappointment. About half the corporate positions for occupational physicians have disappeared in the last decade. Private practice opportunities turned out to be much more limited than planners had anticipated. Attempts to bring occupational medicine into the curriculum of the medical schools failed. Many of the residency programs that had been created are now closing. The proposal that occupational medicine create a joint specialty with environmental medicine is not widely accepted by the rest of medicine. Because so few physicians obtain board certification, it appears that the specialty of occupational medicine is returning to its former obscurity.     

64家单位职业卫生与职业医学科学研究仪器设备配置情况的调查

目的 了解我国主要职业卫生与职业医学科学研究机构仪器设备在不同机构和不同地区的配置情况.方法 编制主要科研设施和仪器设备信息调查表并向各省、市主要从事职业病防治及科学研究的78家单位发放,由各机构填写后收回,统计仪器设备配置情况.结果 共收回64家单位调查表.主要职业卫生与职业医学科学研究机构仪器设备在不同机构和地区的设备配置情况各有特点,大学主要配备生物学实验设备,疾病控制机构在理化分析上有优势,职业病防治院配备了在临床检查相关研究设备.结论 建议同地区或邻近省市的职业卫生与职业医学科学研究机构间建立主要科研仪器设备优势互补和资源共享机制.     

情景模拟教学在职业卫生与职业医学综合性实验中的应用

目的在职业卫生与职业医学综合性实验中应用情景模拟教学。方法分析情景模拟教学在职业卫生与职业医学综合性实验中的应用模式,评价教学效果及局限性。结果情景模拟教学可以改善教学质量、提高学生综合素质,具有较好的趣味性和可塑性,但职业现场情景设计的局限性和师生关系的定位问题有待于改善。结论在职业卫生与职业医学综合性实验中应用情景模拟教学具有良好作用。     

Practice patterns of occupational medicine physicians in Canada

The objectives of this survey were to identify the practice patterns of Canadian physicians working in the field of occupational medicine and to determine whether the type of certification influences the nature of the work they perform in the field. An Internet-based survey was conducted in September 2015 of members of the Occupational and Environmental Medicine Association of Canada. Eighty-six Canadian-based occupational medicine physicians completed the survey (response rate 36%). These physicians performed a wide variety of tasks (12 ± 6), with few spending most of their time doing a single task. The most frequently performed tasks were fitness-to-work (78%) and return-to-work evaluations (78%). Specialty-trained physicians were more likely to be involved in teaching and research and less likely to be involved in a variety of ability-to-work evaluations.     

Exploring Lactation Consultant Views on Infant Safe Sleep

Objectives The purpose of this qualitative study was to explore the infant safe sleep beliefs and occupational practices of lactation consultants and to determine if lactation consultants give advice to clients that is consistent with the American Academy of Pediatrics’ recommendations on this topic. Methods Focus groups were conducted with certified lactation consultants in two cities in Ohio. Participants discussed the role of lactation consultants, the infant sleep advice they provide to women, their views on the American Academy of Pediatrics’ infant safe sleep recommendations and related policies, and perceived benefits and barriers associated with providing infant safe sleep education as part of their work. A member-checking session was held to ensure the credibility of the findings. Results Four focus groups were conducted with 22 certified lactation consultants between September and November 2015. Major themes that emerged included: lactation consultants’ beliefs regarding the importance of bedsharing for supporting breastfeeding success; their disagreement with the infant safe sleep recommendations of the American Academy of Pediatrics; their frustration with policies that restrict consultants’ ability to discuss bedsharing; and the impact of infant safe sleep policies on their work and the advice they provide. Conclusions for Practice Lactation consultants interact with mothers of newborns at a critical time for infant safe sleep decision-making and may influence a woman’s choices related to this topic. Women may not be receiving messages from lactation consultants that are consistent with the infant safe sleep recommendations of the American Academy of Pediatrics.     

检验实习生职业防护教学中存在的问题与对策

针对检验实习生职业防护教学中存在的对职业防护重要性和医院感染危险因素认识不到位，前期教学过程缺乏系统职业防护教育等问题，提出增强学员自我防护意识及防护能力，实施前期职业防护理论教学及加强岗前安全防护的培训，在教学实践中贯穿职业防护措施的应用，提高检验医学实习生的自我防护能力。     

Breast milk and labour support: lactation consultants’ and doulas’ strategies for navigating the medical context of maternity care

This article provides a comparison of two occupational groups working in maternity care: International Board Certified Lactation Consultants, who assist women with breastfeeding, and DONA International certified birth doulas, who provide physical, emotional and informational support to birthing women. Using interviews with 18 lactation consultants and 16 doulas working in the USA, I compare these two groups’ strategies for gaining entrance to the maternity care team and their abilities to create change in maternity care practices. Due to the organisation of occupational boundaries in maternity care and differences between the influence of the medicalisation of breastfeeding versus that of childbirth on those boundaries, lactation consultants are able to utilise a front‐door entrance to the medical maternity system, entering as lactation specialists and advocates, while doulas use a back‐door entrance, emphasising their care work and downplaying their advocacy. These different strategies result in different methods being available to each for effecting change. Lactation consultants create formal change, such as changing hospital policies and practices to be more pro‐breastfeeding. Doulas create change informally, ‘one birth at a time’, by creating space for natural birth to occur in the hospital, as well as exposing medical providers to non‐medical ways of giving birth.     

The three faces of Occupational Medicine: printed paper, problems in practice, and professional purpose

The 50-year run of the journal Occupational Medicine and its forbears demonstrates the ways in which UK occupational medical practice has developed and changed since 1950. This has been in response to changes in society, technology and medicine. The journal has played an important part in education and professional development. It has also been the voice for the aspirations and concerns of its readers. Two aspects stand out: the development of occupational medicine as a specialty, and the way in which a medical model for occupational health service provision has been championed. A distinguished line of journal editors has been central to the crystallization of ideas within occupational medicine and their editorials map out professional successes and challenges over the years.     

A survey of eye trauma and diseases at a teaching hospital: implications for training in occupational ophthalmology in Nigeria

This study explores the amount of occupational ophthalmology that it is possible to encounter within an existing teaching hospital system, as this offers the primary training facilities for resident doctors who expect to specialize in occupational medicine. The study was based on an analysis of ophthalmology patient records available at the University College Hospital, Ibadan, which is Nigeria's largest teaching hospital. One thousand, three hundred and thirty-four patients with eye disease were seen during the 1-year study. Of these, 1052 (78.9%) did not have their occupations recorded. Accidents were the only occupational diagnoses recorded, and this occurred in 75 (5.6%) of cases. The findings indicate that doctors who train in this specialty should gain experience in industries that have sizeable occupational health services, in addition to their formal ophthalmology training, in order to acquire experience in primary and occupational eye care. It is suggested that greater emphasis be placed on occupational ophthalmology in teaching hospitals and that there is a general improvement in completing patients' records: in particular, a patient's occupation should be recorded.     

关于中国环境与职业医学发展战略的若干建议——纪念《环境与职业医学》创办30周年

中国的环境与职业医学发展战略,对于加速中华民族伟大复兴有着重要意义。本文从可持续发展、人才引进、新技术开发,以及深化环境与职业医学体制改革,支持创新性和多学科领域合作课题研究,鼓励海外学者参与祖国环境与职业医学学科建设,加强国内外环境与职业医学科技团体的合作与交流等方面提出8点建议,以供政府相关部门参考。     

Application of P4 (Predictive,Preventive, Personalized,Participatory) Approach to Occupational Medicine

In recent years there has been a growth in the role of prevention in controlling the disease burden. Increasing efforts have been conveyed in the screening implementation and public health policies, and the spreading knowledge on risk factors reflects on major attention to health checks. Despite this, lifestyle changes are difficult to be adopted and the adherence to current public health services like screening and vaccinations remains suboptimal. Additionally, the prevalence and outcome of different chronic diseases and cancers is burdened by social disparities. P4 [predictive, preventive, personalized, participatory] medicine is the conceptualization of a new health care model, based on multidimensional data and machine-learning algorithms in order to develop public health intervention and monitoring the health status of the population with focus on wellbeing and healthy ageing. Each of the characteristics of P4 medicine is relevant to occupational medicine, and indeed the P4 approach appears to be particularly relevant to this discipline. In this review, we discuss the potential applications of P4 to occupational medicine, showing examples of its introduction on workplaces and hypothesizing its further implementation at the occupational level.     

The Occupational Therapist in the School System

The consequences of the passing of American Public Law 94–142 on the provision of occupational therapy services in the schools is contrasted with the present situation within the Australian educational system. The need for increased provision and documentation of occupational therapy services in Australian schools is discussed. Occupational therapy consultancy programmes are evaluated in terms of extending the availability of occupational therapy services in schools.     

Survey of perceived stress and work demands of consultant doctors.

OBJECTIVES: The objectives of this study were to assess the work demands as potential stressors of health service consultants, and to describe the development of tools for measuring stress experiences of consultants. METHODS: A stratified random sample of 500 NHS consultants in Scotland was targeted by a postal questionnaire and 375 (75%) returned a valid response. They completed questionnaires, including information on demographic factors, work demands, occupational stressors, and burnout. RESULTS: Principal components analysis showed that professional work demands of consultants fell into three categories: clinical, academic, and administrative. Their perceived stressors separated into four main factors: clinical responsibility, demands on time, organisational constraints, and personal confidence. These were assessed by 25 questions in the specialist doctors' stress inventory. Specific questions about perceived stressors which resulted in a high positive response included questions about demands on time, and organisational change in the NHS. CONCLUSION: These self reported data characterise and measure the consultants' work demands and their role as potential stressors. These measurements could form the basis for strategies to reduce occupational stress in these workers.     

Developments in education in occupational medicine in the United Kingdom

Postgraduate medical education in the United Kingdom has changed. Now, five years of undergraduate training merely prepare a doctor for postgraduate training, whatever his specialty will be. After undergraduate training (and a year in hospital) all doctors do three years General Professional Training followed by some four years Higher Specialist Training. Occupational physicians do the same General Professional Training as physicians or primary care general practitioners. Their Higher Specialist Training lasts four years and is based on supervised practical experience in the factory or other place of work. After the first two years of this they take an examination covering the broad field of occupational medicine (AFOM). After the next two years of supervised practical experience the doctor has to present evidence of special study and can then become a specialist (MFOM). In the U.K. about 70% of occupational physicians work part time. Their supervised practical experience is therefore spread over a longer period. Many stop at the AFOM. If, later in their career, they change to full time in occupational medicine, they can proceed to the specialist qualification (MFOM). Most part-timers do other work and therefore cannot go away to one of the few universities that provide courses for the AFOM. Those who live near one of the few universities can go on day release. A “distance teaching” project has been started to take teaching material on occupational medicine such as audio tapes, tape slides, and video tapes to these doctors. It will be supplemented by local seminars and short courses at universities.     

Out on a Limb A Novel Approach for Traditional Occupational Therapy Practice

In 1979 the authors presented a workshop in which the use of non-traditional approaches in occupational therapy was compared to the kind of risk one takes when going out on a limb of a tree. This article details that relationship. Similarities and differences among concepts associated with non-traditional practice are clarified and described and a comparison is made showing three occupational therapists who use a non-traditional approach. The article closes with several recommendations for anyone who is thinking about going ‘out on a limb’.     

A rude awakening: post-take ward round in the department of medicine for the elderly.

This paper describes the post-take ward round of a department of medicine for the elderly (DME), to portray the nature of the medical admissions and their immediate management. The data concern the patients seen by one consultant in 28 such ward rounds during the last four months of 1997, in a teaching hospital where the DME is separate from the department of general internal medicine. 254 patients were seen, 107 men and 147 women, with an average age of 82.4 years (range 73-102). The decisions taken included diagnosis, further investigations, treatment, referral, discharge, and resuscitation status. Very few admissions were judged inappropriate, particularly among the majority referred by general practitioners. 101 patients were thought suitable for transfer to the department of general internal medicine, 109 definitely unsuitable. These findings support the view that, if medical beds are to be freed, the initiative must come from facilitating discharge rather than curtailing admission. Generalists are needed to sort and manage these patients. In the UK, these will often be general internal medicine consultant geriatricians, while the younger patients are seen by consultants practising general internal medicine in addition to one of the specialties. Sizeable numbers of these consultants are needed if the post-take ward round is to be efficient and not conflict with their fixed commitments.