Reading habits of physical medicine and rehabilitation resident physicians

OBJECTIVE: To investigate the focus and extent of the resident physician reading habits, to compare how these change over the years of their training, and to compare these habits with those of physiatrists in practice. DESIGN: A total of 1,076 surveys were sent to 80 physical medicine and rehabilitation residency programs accredited by the Accreditation Council for Graduate Medical Education. The questionnaire contained a list of 36 journals pertinent to the field of Physical Medicine and Rehabilitation. Resident physicians were asked to indicate which journals they read during the past year and how extensively they read them. Respondents were also asked whether they participated in a journal club and if they read as much as they would like. RESULTS: A total of 324 surveys (30.1%) were completed correctly. At least half of the surveyed resident physicians scanned or read six journals:Archives of Physical Medicine and Rehabilitation (85.2%), American Journal of Physical Medicine and Rehabilitation (80.6%), Journal of the American Medical Association (68.8%), New England Journal of Medicine (60.5%), American Journal of Sports Medicine (50.9%), and Rehab in Review (49.7%). Most resident physicians (93.9%) responded that they do not read as much as they would like, and 90.1% of resident physicians participate in some form of journal club. CONCLUSION: Most resident physicians in the field of physical medicine and rehabilitation tend to scan for important articles within one of six journals, with most of these physicians noting that they do not read as much as they would like. As the resident physicians advance in postgraduate-year level, the number of journals that they scan increases. The reading habits of the resident physicians were quite similar to those noted in our previous study of the reading habits of practicing physiatrists.     

The Connecticut survey of public attitudes toward chiropractic

This paper reports the results of a public opinion survey of attitudes toward chiropractic, commissioned by the Connecticut Chiropractic Association and carried out by the Institute for Social Inquiry at the University of Connecticut. Telephone interviews with 500 randomly selected households elicited responses from a representative sample of Connecticut residents. While 28% of the respondents stated they were not at all familiar with chiropractic, 21% (that is, 104 of the 500) had visited a chiropractor at least once. A total of 40% of the respondents or a member of their family had gone to a chiropractor. Of the respondents who went, 78% rated their treatment as effective, 89% were satisfied with the amount of personal attention they received, 72% were satisfied with the cost of their treatment, and 72% said they would go again for the same or similar problem. When those who are familiar with chiropractic were asked their overall opinion of it, 78% of those who expressed a definite opinion were favorable; however, only 61% of this group thought "most people in Connecticut" have a favorable opinion of chiropractic. When those familiar with chiropractors but who had never been to one were asked if they would go to one for a problem chiropractors treat, 59% said they would go and 68% of those who were familiar said they would encourage a friend to go. Respondents' factual information and attitudes about what chiropractors do were probed in depth.(ABSTRACT TRUNCATED AT 250 WORDS)     

Attitudes toward research among undergraduate nursing students

Attitudinal changes about research among undergraduate nursing students during their two years in a baccalaureate nursing program showed no significant improvements except for significant improvements in confidence about understanding research terminology methods and evaluating the adequacy of research studies. These improvements were apparent after the course and in the second year when the students were queried again. The overall research attitude score was essentially the same in the senior year as it had been on the pre-test when the students began the program. Although 52.9% of the students indicated they wanted to go on for a master's degree, 6.2% said they definitely wanted to take additional research courses. In the senior year, 31.9% of the students indicated they definitely wanted to go on to graduate school, while 60.4% said they were uncertain; 7.7% indicated they definitely did not want to return to graduate school.     

Is "sugar" the same as diabetes? A community-based study among rural African-Americans

OBJECTIVE: To determine if differing beliefs about high blood glucose exist and are associated with blood glucose control among rural African-Americans. RESEARCH DESIGN AND METHODS: A community-based sample of rural African-Americans completed a survey, and a subsample underwent a subsequent screening that included glucose and GHb measurement. Participants were asked if they thought they had diabetes or sugar-diabetes on the survey; "sugar" was added to the screening along with specific questions about this condition. RESULTS: A total of 1,031 people completed the survey, and 403 the screening exam. The total prevalence of diabetes was 13.6% for men and 15.5% for women. Among those who reported having one of the three conditions, 64% said they had diabetes, 7% sugar-diabetes, and 29% sugar. There was a discrepancy between the survey and screening in that 31% of subjects who answered "yes" to whether they had sugar at the screening had answered "no" to the survey question about diabetes. Subjects who believed they had sugar felt their condition was less serious and had higher glucose levels than those who said they had diabetes. CONCLUSIONS: Diabetes was very common in this population. Over one-fourth of those with diabetes believed they had the condition "sugar." Efforts are needed to improve control of diabetes in this population and should consider these disparate health beliefs.     

Patients' preferences concerning medical information and surrogacy: results of a prospective study in a French emergency department

Objective: To study the wishes of a sample of French patients about medical information and surrogacy, at a time when the French Ministry of Health is supporting increased patient autonomy.¶Design: A cohort of competent patients with non-critical illnesses or injuries completed an intention-to-act questionnaire on the amount of medical information they would want to receive should they be hospitalized or in a life-threatening situation. The percentage of patients who would want to have a surrogate if they were in a coma was determined, as well as the identity of the preferred surrogate. The subgroup of patients who were married or living with a partner was evaluated separately to determine how often the spouse/partner was the preferred surrogate. Associations were looked for between patients' wishes and age, sex, educational level, occupation, hierarchical order in the family, and level of confidence in medicine.¶Setting: The emergency room of a teaching hospital in the Paris area (France).¶Results: Of the 1089 patients included in the study, 5.5 % reported that they would not want any information, 25.3 % that they would want to participate actively in all decisions about their care, and 87.3 % that they would want to be fully informed if they were in a life-threatening situation. Slightly less than one-third of the patients (29.6 %) believed they would not want a surrogate if they developed a coma. Among the patients living with a spouse/partner, 40.6 % (229/561) indicated they would want their spouse/partner to be their surrogate. A significant correlation was observed between wanting more information and wanting a surrogate. Younger patients with a higher educational level were significantly more likely to predict a desire for information and for a surrogate than the other patients.¶Conclusion: Our patients expressed a strong desire to receive extensive information should they become seriously ill, and two-thirds of them reported they would want a surrogate. However, only 40.6 % of the patients living with a spouse/partner would want their spouse/partner to be their surrogate. These data suggest that the time has probably come to propose a nation-wide public hearing on medical information and surrogacy in France.     

Observation of Emergency Medicine Residents at the Bedside: How Often Does It Happen?

Objective: To determine how often trainees in emergency medicine (EM) are observed while performing a history, a physical examination, or specific procedures. Methods: The 26 members of the National Consensus Group on Clinical Skills in Emergency Medicine affiliated with an EM residency program were asked to circulate a survey to their residents during February and March 1994. Twenty-one programs participated. surveying a total of 514 residents. The residents were asked how many times they had been observed by an attending physician while they performed a history, a physical examination. endotracheal intubation. or central vein catheterization during training. The residents also were asked about observation of specific components of the physical examination. such as the heart. lung, and genitourinary systems. Results: Three hundred nineteen residents (62%) responded to the survey. Thirteen percent of the residents reported that they had never been observed taking a history during training. During their PGYI training, 19% of the residents reported that they had never been observed taking a history, 42% had been observed one to three times, 255% had been observed four to 12 times. and 13% had been observed >12 times. Six percent of the residents reported that they had never been observed doing a physical examination during training. During their PGYI training, 10% of the residents had never been observed performing a physical examination, 38% had been observed one to three times. 34% had been observed four to 12 times, and 18% had been observed >12 times. Conclusions: Many residents report that they are infrequently observed performing histories and physical examinations during their EM training. with a significant number of residents reporting that they were never observed performing basic bedside clinical skills. More direct observation with trained faculty observers may provide an opportunity for better evaluation and remediation of bedside clinical skills.     

Being an interviewer in a structured oral assessment process for selection of undergraduate nursing students: Motivations,expectations and reflections of the experience

There is a dearth of knowledge about individuals who interview candidates for nursing. Who are they and why do they volunteer to take part in an oral assessment process for selection of undergraduate nursing students? The aim of this study was to answer these questions, and to seek the perspectives of the assessors about the process. Academic staff of the Faculty of Health Sciences, staff members of the Discipline of Nursing and registered nurses working in affiliated hospitals nominated for roles as oral assessors. All assessors received training and no payment was made. Thirty‐nine of 45 (86.6%) oral assessors completed questionnaires on their experiences of being an assessor. The majority of assessors were female (69.2%) and from a clinical background (71.8% vs. 28.2% faculty‐based). The most commonly cited motivations included a desire to contribute to the development of the nursing profession (94.9% of responding); because they knew what was involved in a nursing career (79.5%); wanting to influence who becomes a nurse (76.9%); and because they understood the qualities needed to be a registered nurse (76.9%). Assessors spoke highly of the experience and in general found it enjoyable.     

How and what staff nurses learn about the medical devices they use in direct patient care

Registered nurses (N = 323) working in a 500-bed tertiary care hospital in a large midwestern city were surveyed to determine what and how they initially learned about the medical devices they use, and the consequences of their use. The most frequently identified methods of initial learning were trial and error (taught self) and reading the user instruction manual. At least 90% of respondents indicated that when they first learned about the device they learned how to operate it and its purpose and function. Medical device use causes more than 75% of staff nurses to feel stressed; 11% had used a medical device that had harmed a patient. ©1995 John Wiley & Sons, Inc.     

Support programs for new graduates in pediatric nursing

This study examined intent to stay and the relationship between work satisfaction and burnout in a sample of new registered nurse graduates hired at a freestanding children's hospital. The following research questions were addressed: (1) Two years after initial employment, what is the percentage of new graduates who intend to stay on the job? (2) Is there a relationship between work satisfaction and burnout? (3) What is the turnover rate after the implementation of a support group program for new registered nurses? Of a target group of 75 new graduate nurses, 33 (44%) completed a modified version of Aiken's Revised Nursing Work Index and the Maslach Burnout Inventory. A majority of the registered nurses intended to stay on the job, with 87.9% reporting that they were satisfied with their current position and 97.0% reporting that they were satisfied with being a nurse. The correlation between job satisfaction and burnout was as follows: r = -0.684, F(1,30) = -21.71; p < .001. Of the participants, 39% reported an increase in the amount of time they spent with patients over the year, 27% reported an increase in the amount of time they spent documenting patient care, and 24% reported that the "quality of care" they were providing was better than 1 year ago. Before the implementation of a support group program for new graduates in 2006, the turnover rate was 7.6%; in 2009, the turnover rate was 5.7%.     

Visual problems among people with mental retardation

Vision impairment can be a debilitating condition, affecting not only the social, emotional, mental and physical functioning of an individual, but also the individual's ability to perform basic and instrumental activities of daily living. Scant knowledge exists about visual impairment among people with mental retardation. The results of this prospective study were based on interviews and eye ophthalmologic screening of 106 adults with a moderate level of mental retardation, ranging in ages from 19 to 62 years. Findings show that only 3% of those interviewed recalled having had an eye examination, yet 24% reported that they had visual problems. In spite of the high probability of visual problems for this group, only 13% reported having glasses and 20% said they needed glasses; 92% reported watching television but 22% stated they had difficulty seeing the TV; 62% of the respondents reported that they cook for themselves but 17% reported that visual problems affected their ability to perform this activity. Medical eye screening of the participants found that 79% had ocular problems - 42% were in need of eyeglasses, 12% had a cataract problem requiring surgery and 25% needed outpatient care at the local hospital. The study findings are discussed in terms of policy implications and service provision, and recommendations are made for additional research.     

Physician-reported management of edema and destabilized blood pressure in cyclooxygenase-2-specific inhibitor users with osteoarthritis and treated hypertension

BACKGROUND: The addition of a nonsteroidal anti-inflammatory drug to the regimen of a patient with treated hypertension can cause a destabilization of blood pressure. OBJECTIVE: The aim of this study was to describe physician-reported management of clinically significant edema and/or destabilized blood pressure in patients with osteoarthritis (OA) and hypertension when initiating therapy with rofecoxib or celecoxib. METHODS: A cross-sectional survey was administered to physicians who attended one of several arthritis consultant programs sponsored by Pharmacia Corporation, with attendees selected by local sales representatives. Each program included a clinical presentation by a physician concerning the cardiorenal safety of celecoxib, followed by a consultative presentation and session led by a Pharmacia Clinical Education Manager. RESULTS: A total of 828 physicians in the following specialties completed the survey: family practice (33.0%), internal medicine (25.0%), orthopedics (15.2%), and rheumatology (11.4%). Responding physicians expected that the majority of patients who experienced edema would contact them (68.4%). They reported that they schedule follow-up visits for blood pressure monitoring 65.6% of the time after initiating a cyclooxygenase-2 (COX-2)-specific inhibitor, with family practitioners and internists most likely to indicate that they would do so and orthopedists least likely. Responding physicians indicated that the presence of edema and destabilized blood pressure generally led to discontinuation of the COX-2-specific inhibitor (58%-82% of the time). Internists and family practitioners were most likely to report that they treat edema by initiating or modifying diuretic therapy (33%-51% of the time). For destabilized blood pressure, an antihypertensive drug was reported to be initiated or modified 40% to 55% of the time by family practitioners and internists, whereas orthopedists indicated that they referred patients to the primary care provider. The COX-2-specific inhibitor prescribed resulted in management differences: physicians indicated that they were more likely to switch from rofecoxib to celecoxib in the event of edema or destabilized blood pressure, whereas they were more likely to adjust the celecoxib dose than the rofecoxib dose. Because the data were captured from convenience samples of physicians attending sponsored meetings, it is possible that respondents provided the answers they thought the sponsor would want. Because this was a cross-sectional survey, reported behavior was not compared with actual behavior. CONCLUSIONS: A significant percentage of physicians reported that they monitor patients with OA and hypertension for the occurrence of destabilized blood pressure and edema after initiation of a COX-2-specific inhibitor. Physicians indicated that they would nearly always intervene when either event is identified.     

护士对所需求工作环境认可度的调查分析

目的探讨护士对所需求工作环境认可度,为护理管理者制订管理方法提供依据。方法用盖洛普Q12调查表对400名护士进行调查,了解护士对所需求工作环境的认可程度。结果护士能明确对自己工作的要求,在单位有一位最要好的朋友,有做好工作所需要的材料和设备,认可度分别为97.0、87.5和80.8;对环境中管理人员和同事的认可度在50.5-74.0;个人潜能发展方面受到重视的认可度在40.8-45.8。结论护理管理者应为护士营造一个积极、高效的工作环境,提升护士自我价值实现的工作场所,建立良好的人际沟通环境,让护士各尽其能,发挥优势,从而塑造了一个优秀的护理团队。     

Physicians' own preferences to the limitation and withdrawal of life-sustaining therapy

While limiting and forgoing therapy at the end of life is now accepted on medical, ethical, moral and legal grounds, many Americans continue to die with heroic measures being taken to prevent their death. Recent studies have demonstrated that physicians frequently attend to their patients without knowledge of their preferences with regards to end-of-life issues. It is postulated that a physician's personal preferences with regard to the limitation and withdrawal of life support and active euthanasia would effect the discussion they had with their patients. The purpose of this study was to analyze end-of-life preferences of a diverse group of practicing physicians. The participants were active attending physicians at a community hospital, a rural referral center, a large tertiary care referral academic complex, and a specialized tertiary care referral center all within the United States. A questionnaire was developed which was mailed to attending physicians at the four participating medical centers. The respondents provided basic demographic data, do-not-resuscitate (DNR) preferences under various clinical circumstances as well as responses to a number of case vignettes. Six hundred and forty physicians responded to the survey. The mean age of the respondents was 46 years; 72% were male. In the event of a cardiac arrest less than 20% of respondents would want to undergo cardiopulmonary resuscitation in the setting of chronic end stage organ failure; the positive response rate was 5% for metastatic cancer and 2% for Alzheimer's disease. If death was imminent, 87% of physicians indicated they would want treatment withdrawn. Similarly, 95% of respondents indicated that they would want treatment withdrawn should they be in a persistent vegetative state. Only 1% of respondents believed that health care providers should never remove or withhold life-sustaining therapy. Should they have advanced motor neuron disease, 38% of physicians indicated they would request that their life be ended. The majority of physicians surveyed volunteered that they would want life-sustaining measures to be limited at the end of their life. A significant number were in favor of active euthanasia. This study suggests that it is unlikely that physicians' personal beliefs in regards to end-of-life care result in the failure to discuss these issues with their patients.     

Patients'' Understanding of the Roles of Interns, Residents, and Attending Physicians in the Emergency Department

OBJECTIVE: To assess patients' knowledge of the responsibilities and roles of physician training in the ED. METHODS: This was a prospective survey of a convenience sample of 345 adult patients and family members in an academic county ED. Thirty questions addressed the different roles, responsibilities, and hierarchies of physician levels of training. Four opinion-based questions assessed patients' willingness to have physicians-in-training care for them. RESULTS: 96.5% of the surveys were returned. Of the participants responding, 68% were Hispanic, 23% were non-Hispanic white, and 55% were women. Forty percent of the participants indicated that they had education greater than a high school diploma. Most participants answered fewer than 50% of the questions correctly, indicating that they did not understand the levels of physician training. Participants with higher education were more likely to know the correct answer. Seventy-nine percent of the participants believed that it is very important to know the level of training of their physicians. However, only 34% of the participants actually thought they knew the training level of their physicians when they were being treated. Twenty-nine percent of the participants did not want learning to take place on themselves by physicians-in-training. CONCLUSION: Participants believe that it is important to know their physicians' level of training, but they do not understand the roles and responsibilities of physicians-intraining in the medical training system in which they receive care. In particular, patients who have less than a high school education seem to know least about this system.     

Cancer patient expectations of and communication with oncologists and oncology nurses: the experience of an integrated oncology and palliative care service

The purpose of this study was to evaluate ambulatory cancer patients' knowledge of their diagnosis and stage, their expectations of medical and nursing staff, and issues related to communication with the professional staff. A structured interview was conducted with each of 103 consecutive cancer patients attending the Oncology Day Hospital of the Shaare Zedek Medical Center. There were 77 women and 26 men, and their median age was 56 (18-86) years. Their religious status was elicited: 48% described themselves as religious, 25% as traditional, and 27% as secular. According to their physicians, 41 were in remission, 11 had stable disease, 47 had progressive disease and in 4 the disease status was unknown. Patients tended to underestimate the status of their disease: among those with progressive disease, 36% stated that their disease was stable or in remission. Overwhelmingly, patients expected that their oncologists should be patient and skilled in diagnostic procedures (98%), tactful, considerate and therapeutically skilled (90-95%), and skilled in the management of pain and the psychosocial consequences of cancer (75-85%). When there is bad news to be transmitted, 92% of patients indicated that they would want disclosure, while 6% indicated that they would want the news withheld from them but passed on to their family members. Most patients were very satisfied with the clarity of the information they received about their disease (85%) and the sensitivity with which it was transmitted (90%). Although 88% of patients reported that they relied on their oncologist for therapeutic decision making, 45% indicated that they had sought a second opinion and 32% reported seeking the opinion of a rabbinical medical broker. Almost all, 97%, of patients indicated that they felt comfortable seeking advice from their oncologist, and the oncologist was the staff member most often sought out for both information (69%) and support (66%). The data indicate high patient expectations of nursing and medical oncology staff members' skills and behaviors. Despite expressing a high level of satisfaction, a substantial percentage of patients had an inaccurate understanding of their disease status.