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Dr. Robert C. Smith MD Jennifer A. Mettler MA Bertram E. Stöffelmayr PhD Judith S. Lyles MA Alicia A. Marshall PhD Lawrence F. Van Egeren PhD Gerald G. Osborn DO Valerie Shebroe PhD 《Journal of general internal medicine》1995,10(6):315-320
OBJECTIVE: To evaluate an intensive training program’s effects on residents’ confidence in their ability in, anticipation of positive
outcomes from, and personal commitment to psychosocial behaviors.
DESIGN: Controlled randomized study.
SETTING: A university- and community-based primary care residency training program.
PARTICIPANTS: 26 first-year residents in internal medicine and family practice.
INTERVENTION: The residents were randomly assigned to a control group or to one-month intensive training centered on psychosocial skills
needed in primary care.
MEASUREMENTS: Questionnaires measuring knowledge of psychosocial medicine, and self-confidence in, anticipation of positive outcomes from,
and personal commitment to five skill areas: psychological sensitivity, emotional sensitivity, management of somatization,
and directive and nondirective facilitation of patient communication.
RESULTS: The trained residents expressed higher self-confidence in all five areas of psychosocial skill (p<0.03 for all tests), anticipated
more positive outcomes for emotional sensitivity (p=0.05), managing somatization (p=0.03), and nondirectively facilitating
patient communication (p=0.02), and were more strongly committed to being emotionally sensitive (p=0.055) and managing somatization
(p=0.056), compared with the untrained residents. The trained residents also evidenced more knowledge of psychosocial medicine
than did the untrained residents (p<0.001).
CONCLUSIONS: Intensive psychosocial training improves residents’ self-confidence in their ability regarding key psychosocial behaviors
and increases their knowledge of psychosocial medicine. Training also increases anticipation of positive outcomes from and
personal commitment to some, but not all, psychosocial skills.
Presented at the annual meeting of the Society of General Internal Medicine, Washington, DC, April 27–29, 1994.
Supported by the Fetzer Institute in Kalamazoo, MI. 相似文献
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Successful hematopoietic cell transplantation in a patient with X‐linked agammaglobulinemia and acute myeloid leukemia
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86.
Protocolized Laboratory Screening for the Medical Clearance of Psychiatric Patients in the Emergency Department: A Systematic Review
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Alyssa Conigliaro MA Roshanak Benabbas MD Eric Schnitzer DO Maria‐Pamela Janairo MD Richard Sinert DO 《Academic emergency medicine》2018,25(5):566-576
Objective
Emergency department (ED) patients with psychiatric chief complaints undergo medical screening to rule out underlying or comorbid medical illnesses prior to transfer to a psychiatric facility. This systematic review attempts to determine the clinical utility of protocolized laboratory screening for the streamlined medical clearance of ED psychiatric patients by determining the clinical significance of individual laboratory results.Methods
We searched PubMed, Embase, and Scopus using the search terms “emergency department, psychiatry, diagnostic tests, laboratories, studies, testing, screening, and clearance” up to June 2017 for studies on adult psychiatric patients. This systematic review follows the recommendations of Meta‐analysis of Observational Studies in Epidemiology (MOOSE) statement. The quality of each study was rated according to the Newcastle‐Ottawa quality assessment scale.Results
Four independent reviewers identified 2,847 publications. We extracted data from three studies (n = 629 patients). Included studies defined an abnormal test result as any laboratory result that falls out of the normal range. A laboratory test result was deemed as “clinically significant” only when patient disposition or treatment plan was changed because of that test result. Across the three studies the prevalence of clinically significant results were low (0.0%–0.4%).Conclusions
The prevalence of clinically significant laboratory test results were low, suggesting that according to the available literature, routine laboratory testing does not significantly change patient disposition. Due to the paucity of available research on this subject, we could not determine the clinical utility of protocolized laboratory screening tests for medical clearance of psychiatric patients in the ED. Future research on the utility of routine laboratory testing is important in a move toward shared decision making and patient‐centered health care.87.
88.
Patient‐level Factors and the Quality of Care Delivered in Pediatric Emergency Departments
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James P. Marcin MD MPH Patrick S. Romano MD MPH Parul Dayal MS Madan Dharmar MBBS PhD James M. Chamberlain MD Nanette Dudley MD Charles G. Macias MD MPH Lise E. Nigrovic MD MPH Elizabeth C. Powell MD MPH Alexander J. Rogers MD Meridith Sonnett MD Leah Tzimenatos MD Elizabeth R. Alpern MD MSCE Rebecca Andrews‐Dickert MD Dominic A. Borgialli DO MPH Erika Sidney MD T. Charles Casper PhD J. Michael Dean MD Nathan Kuppermann MD MPH for the Pediatric Emergency Care Applied Research Network 《Academic emergency medicine》2018,25(3):301-309
Objective
Quality of care delivered to adult patients in the emergency department (ED) is often associated with demographic and clinical factors such as a patient's race/ethnicity and insurance status. We sought to determine whether the quality of care delivered to children in the ED was associated with a variety of patient‐level factors.Methods
This was a retrospective, observational cohort study. Pediatric patients (<18 years) who received care between January 2011 and December 2011 at one of 12 EDs participating in the Pediatric Emergency Care Applied Research Network (PECARN) were included. We analyzed demographic factors (including age, sex, and payment source) and clinical factors (including triage, chief complaint, and severity of illness). We measured quality of care using a previously validated implicit review instrument using chart review with a summary score that ranged from 5 to 35. We examined associations between demographic and clinical factors and quality of care using a hierarchical multivariable linear regression model with hospital site as a random effect.Results
In the multivariable model, among the 620 ED encounters reviewed, we did not find any association between patient age, sex, race/ethnicity, and payment source and the quality of care delivered. However, we did find that some chief complaint categories were significantly associated with lower than average quality of care, including fever (–0.65 points in quality, 95% confidence interval [CI] = –1.24 to –0.06) and upper respiratory symptoms (–0.68 points in quality, 95% CI = –1.30 to –0.07).Conclusion
We found that quality of ED care delivered to children among a cohort of 12 EDs participating in the PECARN was high and did not differ by patient age, sex, race/ethnicity, and payment source, but did vary by the presenting chief complaint.89.
Improved Survival for Rural Trauma Patients Transported by Helicopter to a Verified Trauma Center: A Propensity Score Analysis
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Thein Hlaing Zhu MBBS FACE FRCP Lisa Hollister RN MSN Dazar Opoku MPH Samuel M. Galvagno DO PhD MS FCCM Jr. 《Academic emergency medicine》2018,25(1):44-53
Objectives
Recent studies using advanced statistical methods to control for confounders have demonstrated an association between helicopter transport (HT) versus ground ambulance transport (GT) in terms of improved survival for adult trauma patients. The aim of this study was to apply a methodologically vigorous approach to determine if HT is associated with a survival benefit for when trauma patients are transported to a verified trauma center in a rural setting.Methods
The ascertainment of trauma patients age ≥ 15 years (n = 469 cases) by HT and (n = 580 cases) by GT between 1999 and 2012 was restricted to the scene of injury in a rural area of 10 to 35 miles from the trauma center. The propensity score (PS) was determined using data including demographics, prehospital physiology, intubation, total prehospital time, and injury severity. The PS matching was performed with different calipers to select a higher percentage of matches of HT compared to GT patients. The outcome of interest was survival to discharge from hospital. Identical logistic regression analysis was done taking into account for each matched design to select an appropriate effect estimate and confidence interval (CI) controlling for initial vital signs in the emergency department, the need for urgent surgery, intensive care unit admission, and mechanical ventilation.Results
Unadjusted mortalities for HT compared to GT were 7.7 and 5.3%, respectively (p > 0.05). The adjusted rates were 4.0% for HT and 7.6% for GT (p < 0.05). In a PS well‐matched data set, HT was associated with a 2.69‐fold increase in odds of survival compared to GT patients (adjusted odds ratio = 2.69; 95% CI = 1.21–5.97).Conclusions
In a rural setting, we demonstrated improved survival associated with HT compared to GT for scene transportation of adult trauma patients to a verified Level II trauma center using an advanced methodologic approach, which included adjustment for transport distance. The implication of survival benefit to rural population is discussed. We recommend larger studies with multiple trauma systems need to be repeated using similar study methodology to substantiate our findings. 相似文献90.
Morgan R. Bobb Azeemuddin Ahmed MD MBA Paul Van Heukelom MD Rachel Tranter MPAS PA‐C Karisa K. Harland PhD MPH Brady M. Firth PhD MA Randy Fry MBA Katherine Schneider MSN RN CEN Kathryn K. Dierks DO Sarah L. Miller MD Nicholas M. Mohr MD MS 《Academic emergency medicine》2018,25(7):795-803