Board certification of medical doctors and medical technologists in transfusion medicine in Japan.

The Japan Society of Blood Transfusion (JSBT) organized a Board for certification of medical doctors in Transfusion Medicine (Board certified medical doctors by the JSBT) and a Board for certification of medical technologists for transfusion medicine (qualified medical technologists in Transfusion Medicine). For certified medical doctors the JSBT co-ordinated with the Japanese Association of Medical Science and with the Japan Medical Association, and for qualified medical technologists the JSBT co-organized with the Japanese Society of Laboratory Medicine, the Japanese Association of Medical Technologist and the College of Clinical Pathology of Japan. By May 2001, 259 of the certified medical doctors and 875 of the qualified medical technologists have been certified and are participating actively to increase the level of transfusion practice at individual facilities.     

Stigmatization of schizophrenia as perceived by nurses, medical doctors, medical students and patients

Stigmatization of schizophrenia is widespread and its genetic explanation may potentially increase the stigma. The present study investigated whether seeing schizophrenia as a genetic or environmental disorder might influence perceived beliefs towards people with schizophrenia and whether social stigmatizing attitudes were differently perceived the 202 subjects who were recruited. Perceived social stigmatizing attitudes were compared among participants who read two vignettes depicting a person with schizophrenia. Then, the Standardized Stigmatization Questionnaire (SSQ) was administered. A genetic explanation of schizophrenia was more frequently associated with stigmatizing attitudes. Also, there were higher levels of perceived stigmatization in medical students and medical doctors than in other groups based on their social experience or background. However, the sample size was small and this was a non-experimental design; also the SSQ would benefit from more cross-validation. About half of the participants perceived stigmatizing social attitudes. Finally, considering schizophrenia as a genetic disorder influenced participants perception of other people's beliefs about dangerousness and unpredictability and people's desire for social distance.     

Overnight sedation with midazolam or propofol in the ICU: Effects on sleep quality,anxiety and depression

Objective To assess and compare the impact of overnight sedation with midazolam or propofol on anxiety and depression levels, as well as sleep quality, in non-intubated patients in intensive care.Design Open, comparative, prospective, randomised study.Setting Surgical intensive care unit (ICU) in a university hospital.Patients 40 conscious patients expected to stay in the ICU for at least 5 days who were admitted following trauma or elective orthopaedic, thopaedic, thoracic or abdominal surgery.Measurements and results Evaluation of a self-assessment scale (Hospital Anxiety and Depression Scale, HAD) on the day following the 1st, 3rd and 5th night of sedation with either midazolam or propofol. Heart rate, pulse oximetry and blood gases were monitored. Eight patients were excluded from the analysis. The level of anxiety was severe (HAD>10) in 31% of the patients receiving midazolam and in 26% (p=0.1) receiving propofol after the first night of sedation, with no significant improvement over the next few days. The levels of depression remained high (>10) in 54% of patients receiving midazolam, and in 16% of the patients receiving propofol (p=0.15). Sleep quality tended to improve during the study in the two groups.Conclusions These data show that half of the patients in the ICU experienced high levels of anxiety and depression during the first 5 postoperative or post-trauma days in the ICU. The beneficial effects of sedation on sleep quality were comparable for midazolam and propofol, regardless of a lack of improvement in anxiety and depression. However, an improved quality of sleep could help to re-establish a physiological night and day rhythm.     

Quality of sleep in the medical department.

The quality of sleep in 134 patients admitted to two medical departments and an intensive coronary care unit was studied by comparing pre- and post-admission sleeping scores. Four aspects of sleep have been evaluated: duration of sleep; number of awakenings; personal assessment of quality of sleep; and the need for using sleeping pills. Results were expressed in scores ranging from 1 (worst) to 4 (best). A significant reduction in the mean quality of sleep for the entire group was found for all scores employed (P < 0.01-P < 0.001). Of the 134 patients, 51% had a reduction in post-admission total sleep score (23 +/- 3%, mean +/- SE); 31% had no change or mixed trends in the various scores, with a change in total sleep score not exceeding 3 +/- 3%; and 18% had an improved total sleep score (16 +/- 2%). Of the individual scores, a deterioration was found in the following order of frequency: number of awakenings (37%); personal assessment of quality of sleep (32%); duration of sleep (31%); and the need for using sleeping pills (26%). Of the reasons specified for impaired quality of sleep, the most important were noise made by other patients or by the medical staff (47%), and the patient's own disease (30%). Significant differences in the quality of sleep between the two medical departments located in different hospitals have been encountered (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Dimensions of patient attitudes regarding doctors and medical care services.

The factor analytic development and validation of numerous index scores to measure patient attitudes regarding characteristics of doctors and medical care services is described. Index scores meeting factor analytic criteria and found to be reliable were used to study the nature and number of attitudinal dimensions underlying patient satisfaction. The use of index scores which have met logical and empirical criteria is in contrast to the common practice of using individual questionnaire items as the unit of analysis. Four major dimensions of patient attitudes were identified and described, including attitudes toward doctor conduct (humanness and quality) and such enabling components as availability of services, continuity/convenience of care and access mechanisms (cost, payment mechanisms, and ease of emergency care). Measures of attitudes toward caring (humanness) and curing (quality/competence) aspects of doctor conduct appear to reflect the same underlying attitudinal dimension. Findings are discussed in relation to concepts and measures mentioned in the published literature and suggestions are offered for future research.     

Attitudes of oncologists, family doctors, medical students and lawyers to euthanasia

The purpose of this survey was to define attitudes and opinions of two types of physicians, medical students and lawyers in the area of euthanasia and related issues and problems. A questionnaire was used as the source of data. There were four groups of test persons: oncologists, home care physicians (family doctors), third-year medical students and lawyers. The questionnaire included 22 questions, 4 of which concerned general characteristics of tested persons (including religious belief), while 18 referred to the problems of euthanasia. The total number of tested persons was 123, 55 men and 68 women with a median age of 38 ±11 years (±SD). There were 30 test persons in the group of oncologists, 31 in the group of family doctors, 31 in the group of third-year students, and 31 in the group of lawyers. Between 97% and 100% of individuals gave scored responses to most items. More than half of the individuals (57%) were against euthanasia, and 61% are against the legalization of euthanasia. The views of doctors and medical students were similar (2/3 against) and significantly different from the view of lawyers (2/3 for, P<0.01). The legalization of euthanasia is favored by 61% of lawyers, in contrast to 43%, 30% and 23% of oncologists, family doctors and medical students, respectively. Overall, 31% sais they would apply euthanasia if they were asked for it, and 36% that would if it had been legalized. Lawyers are twice as willing to perform euthanasia as students or physicians. The least ready to apply euthanasia are physicians working as oncologists (only 1 in 5). Compared with oncologists, one-third of home-care physicians would perform euthanasia anyway, whether legalized or not. Most of the test persons were of the opinion that euthanasia should be performed in the case of children born with a severe anomaly. None of the tested groups considered invalidity or being a burden to the family important reasons for the termination of somebody's life. Approximately 40% of responders believed that the decision for euthanasia should be made by the patient alone. Only lawyers were of the opinion that the misuse of euthanasia could be controlled. Our study shows that it is probably more important to determine factors associated with behavior pertaining to euthanasia in physicians working closely with suffering patients. Reducing suffering and launching a hospice movement and palliative care services might be the most appropriate way to deal with the problem of euthanasia.     

The effect of mandibular advancement appliances on awake upper airway and masticatory muscle activity in patients with obstructive sleep apnoea

BACKGROUND: There is little understanding of how dental appliances, designed to posture the mandible forwards, act on pharyngeal airway dilatory and masticatory muscles in patients with obstructive sleep apnoea (OSA). This study evaluates, in a prospective cohort design, the effect of mandibular advancement splints (MAS) on awake genioglossus (GG), geniohyoid (GH) and masseter (M) muscle activity. METHODS: Fifty OSA patients received a custom-made removable Herbst MAS appliance, adjusted for maximum therapeutic benefit, as judged by subjective improvement. Awake electromyographic (EMG) activity was recorded at baseline and with the MAS in situ, by using bipolar surface electrodes in patients seated upright and in the natural head position. The lower splint was modified to facilitate the placement of the intra-oral bipolar surface electrodes used to record GG EMG activity. RESULTS: Significant increases in GG (P = 0.041), GH (P<0.001) and M (P<0.001) muscle activity accompanied placement of the MAS. CONCLUSIONS: These findings support the contention of a physiological role, which may act to augment the anatomical action of MAS.     

The relationship between sleep/awake rhythm development and caregiving activities

Ensuring proper central nerve system (CNS) development is the core issue in premature infant care. Because an infant's sleep pattern (or sleep state) manifests his or her CNS integration, recognizing infant sleep patterns is essential for caregivers involved with developmental care. This article aims to explore the development of biological rhythms and infant sleep/awake states, factors influencing sleep states, and the effectiveness of various interventions to promote infant sleep. Five major factors that influence infant sleep states include noise, light, environmental temperature, physical contact with caregivers, and body position. Accordingly, we propose interventions to improve infant sleep quality to facilitate the growth of premature infants.     

Numbers of doctors and medical training:the situation in a medical school in Algeria

In 1962, at the Independence, there were in Algeria about 500 medical doctors to take care of a population of 10 million. The situation has slowly improved later on. Nowadays, there are 45,000 medical doctors in the country (26,700 in the public sector and 18,300 in the private sector) i.e. more than 1 medical doctor per 1,000 population. However, the improvement has been more apparent than effective. The geographic distribution of physicians evidences a profound shortage in the rural areas and small cities. An opinion survey conducted on the medical students at the medical school of Oran shows a deep gap between the contents of their training and the real needs of the population.     

Nurses, doctors and the body of the patient: medical dominance revisited

Medical dominance is one of the most obvious features of the health care system and is particularly apparent in the relationship between doctors and nurses. Reasons given for the subordination of nurses to doctors have included matters of gender, class and state patronage of medicine. This paper, through an examination of university curricula and journal content, explores the notion that control over the model of the body is a major way in which medicine preserves its dominance over nursing. One reason for medicine maintaining its superior position is that nursing is not challenging this model of the body.     

医学生睡眠健康、睡眠行为及二者的相关性研究

目的 充足良好的睡眠对于身心健康至关重要,本研究旨在检验医学生睡眠健康（包括睡眠时间和失眠症状）、睡眠行为（包括睡眠卫生和睡眠拖延）及二者间的相关性,进而为改善其睡眠健康提供依据。方法 采用相关性研究设计,通过方便抽样法抽取上海市某医学院校576名医学生。采用一般情况调查表、失眠严重指数量表、睡眠卫生量表和睡眠拖延行为量表分别对一般资料和睡眠时间、失眠症状、睡眠卫生和睡眠拖延进行评估。采用Pearson和分层回归进行数据分析。结果 研究对象平均年龄为21.6岁,67%为女性。其平均睡眠时间为7.2小时,51.2%存在睡眠不足（小于7小时）;24.8%存在显著失眠症状。根据分层回归分析,在排除了潜在混杂因素的影响下,睡眠拖延（β= -0.30,P <0.001）是睡眠时间的显著影响因素;睡眠拖延（β=0.19,P<0.001）和睡眠卫生（β=0.28,P=0.001）均是失眠症状的显著影响因素。结论 医学生中,睡眠不足和失眠症状较常见。睡眠行为（包括睡眠卫生和睡眠拖延）是预测其睡眠健康的重要因素。今后的实践中,高校医疗保健人员应关注医学生的睡眠状况,并考虑将睡眠相关健康教育和科普宣传纳入校园文化建设中。     

医疗纠纷中医患心理因素分析

心理因素是产生医疗纠纷的主要原因,包括社会影响因素、病人和医疗双方的心理影响因素。分析容易导致发生医疗纠纷的医患双方的心理特点以及各自的心理状况,并探讨了处理医患双方存在的心理问题的方法。     

医疗纠纷中医患心理因素分析

心理因素是产生医疗纠纷的主要原因，包括社会影响因素、病人和医疗双方的心理影响因素。分析容易导致发生医疗纠纷的医患双方的心理特点以及各自的心理状况，并探讨了处理医患双方存在的心理问题的方法。