The unit of analysis error in studies about physicians’ patient care behavior

Objective:To estimate the frequency with which patients are incorrectly used as the unit of analysis among statistical calculations in published studies of physicians’ patient care behavior. Design:Retrospective review of studies published during 1980–1990. Articles:54 articles retrieved by a computerized search using medical subject beadings for physicians and study characteristics. Article selection criteria included the requirement that the physician should have been the correct unit of analysis. Intervention:Presence of the error was determined by consensus using published criteria. Main results:The error was present in 38 articles (70%). The number of study physicians was reported in 35 articles (65%). The error was found in 57% of articles that reported the number of study physicians and in 95% of those that did not. The error rate was not lower among articles published more recently nor among those published in journals with higher rates of article citations in the medical literature. Conclusion:The unit of analysis error occurs frequently and can generate artificially low p values. Failure to report the number of study physicians can be a clue that this type of error has been made.     

The implementation of a Pain Monitoring Programme for nurses in daily clinical practice: results of a follow-up study in five hospitals

AIMS OF THE STUDY: To study the effects of the implementation of a Pain Monitoring Programme (PMP) for nurses in daily clinical practice. In addition, nurses' and physicians' pain knowledge and attitudes were studied, as well as change in nurses' pain knowledge after implementation of the programme. RATIONALE: The rationale for the study was that many hospitalized patients suffer from pain and treatment of pain is often inadequate. BACKGROUND: Reasons for inadequate treatment of pain are the failure of nurses to assess pain on a daily basis and insufficient knowledge about pain and pain management in both nurses and physicians. The PMP tried to overcome these barriers by implementing daily pain assessment and educating nurses about pain and pain management. RESEARCH METHODS: This follow-up study was conducted in five hospitals. In total, 277 nurses and 115 physicians participated. The implementation and long-term effects of the programme were measured with a pretest-post-test design without a control group. RESULTS: Results showed that nurses carried out daily pain assessment in at least 75% of patients during the first 5 months of the intervention period, but in the remaining 2 months professional compliance gradually decreased. Both nurses and physicians are positive about daily pain assessment and want to continue with it. The level of nurses' and physicians' knowledge about pain and pain management is moderate. The programme increased nurses' knowledge and satisfaction regarding the quality of pain treatment. DISCUSSION: Because professional compliance decreased after 5 months, incentives are needed to motivate nurses to continue with daily pain assessment. Continuous Quality Improvement may be a useful method to guide the implementation process. CONCLUSIONS: Based on these results it can be concluded that it is possible to implement the PMP in daily clinical practice. Moreover, the beneficial effects of our programme on nurses' knowledge and attitudes have been demonstrated. Therefore, participating hospitals were advised to continue and extend the programme and other hospitals are encouraged to implement it.     

开展医师医务管理轮训的实践与思考

为提升医师对医疗工作的整体认识水平,促进其熟悉医务管理工作和提高病历书写质量,加强医患沟通和管理部门与临床科室的交流,以及完善对医师医务管理知识的再教育工作,阜外心血管病医院针对高年资主治医师建立了医务管理轮训制度。经过近2年的实践和效果评价显示,适时地开展医务管理知识培训和实践十分重要而且必要,并对管理部门和临床医师双方而言都大有裨益。     

临床教学医院进修医师管理和培养模式的探索

目的本文通过多年来在进修医生的管理及培养过程中形成的模式进行分析,探索适合新时期形式下进修医生的管理和培养模式,以提高管理质量及教学水平。方法对我院2005～2009年进修医师的年龄、工龄、学历、专业职称进行统计分析。结果通过多年来的总结,摸索出了一整套较为规范的进修医师管理和培养模式：管理制度化、接收条件严格化、岗前培训系列化、教学方式多样化、教学手段现代化、病历书写规范化、奖惩措施具体化、教学管理双向化、管理体现人性化。结论用完善的制度进行管理,用规范的模式进行培养,从而使进修医师真正学到知识、提高水平,同时提高科室教学水平、扩大医院影响力,真正实现＂双赢＂目的 。     

Facilitators and barriers for GP�Cpatient communication in palliative care: a qualitative study among GPs, patients, and end-of-life consultants

Background

Effective communication is considered to be essential for the delivery of high-quality care. Communication in palliative care may be particularly difficult, and there is still no accepted set of communication skills for GPs in providing palliative care.

Aim

To obtain detailed information on facilitators and barriers for GP–patient communication in palliative care, with the aim to develop training programmes that enable GPs to improve their palliative care communication skills.

Design of study

Qualitative study with focus groups, interviews, and questionnaires.

Setting

GPs with patients receiving palliative care at home, and end-of-life consultants in the Netherlands.

Method

GP (n = 20) focus groups discussing facilitators and barriers, palliative care patient (n = 6) interviews regarding facilitators, and end-of-life consultant (n = 22) questionnaires concerning barriers.

Results

Facilitators reported by both GPs and patients were accessibility, taking time, commitment, and listening carefully. GPs emphasise respect, while patients want GPs to behave in a friendly way, and to take the initiative to discuss end-of-life issues. Barriers reported by both GPs and end-of-life consultants were: difficulty in dealing with former doctors'' delay and strong demands from patients'' relatives. GPs report difficulty in dealing with strong emotions and troublesome doctor–patient relationships, while consultants report insufficient clarification of patients'' problems, promises that could not be kept, helplessness, too close involvement, and insufficient anticipation of various scenarios.

Conclusion

The study findings suggest that the quality of GP–patient communication in palliative care in the Netherlands can be improved. It is recommended that specific communication training programmes for GPs should be developed and evaluated.     

名老中医临证能力模型研究

目的 探讨构成名老中医临证能力模型的各种要素,有效挖掘当代名老中医临证经验.方法 研究运用文献学、心理学、统计学的方法,确定名老中医临证经验,建构名老中医临证能力模型,并采用专家经验评定法来检验所建立模型的信度和效度.结果 42份病历中各项典型行为编码的一致性较高,根据典型行为确立了6个能力要素;建构名老中医临证能力模型,检验结果表明所建构的模型具有较高效度.结论 完整的名老中医临证能力模型包含临证沟通能力、临证信息收集能力、临证思维能力、患者取向能力、临证诊疗能力、研究与创新能力6种能力要素和每个能力要素规范的操作性定义,以及能反映能力要素的临证典型行为及其解释.     

Noncardiac Chest Pain—An Asia-Pacific Survey on the Views of Primary Care Physicians

Noncardiac chest pain (NCCP) is common and has a significant impact on health care. Primary care physicians (PCPs)’ attitudes, clinical approach, preference of diagnostic tests, referral patterns, and comfort in managing patients with NCCP in the Asia-Pacific region are not known. Consequently, we performed this survey in the Asia-Pacific region. The self-completed questionnaire was sent to PCPs in the Asia-Pacific region. A 28-item questionnaire contained questions on demographic information, characteristics of practice, preferences of diagnostic tests, referral patterns, treatment plans, and opinion on Helicobacter pylori and NCCP. A total of 108 (74%) PCPs returned the questionnaire. A mean of 18% of the patients were diagnosed with NCCP by PCPs in the past 6 months. Ninety-four percent of PCPs had treated NCCP patients in the last 6 months. Only 38% of the PCPs were comfortable in diagnosing NCCP but 85.2% believed that they should manage NCCP patients. PCPs in Malaysia and Philippines were more likely to refer patients to subspecialists. Fifty-seven and four-tenths percent of PCPs believed that H. pylori infection plays a role in the development of NCCP. The study demonstrates clearly that the understanding, diagnostic strategies, and treatment strategies of NCCP in the Asia-Pacific region are suboptimal and thus highlights the importance of educational and training programs tailored for PCPs in NCCP.     

Do physicians improve their communication skills between finishing medical school and completing internship? A nationwide prospective observational cohort study

Objective

To test whether young physicians improve their communication skills between graduating from medical school and completing clinical internship, and to explore contributing background and/or internship factors.

Methods

Norwegian medical students graduating June 2004 were invited to take part in a videotaped standardized patient interview February 2004. Of the 111 students who originally participated, 62 completed a second interview February 2006. Observed communication skills were assessed with the Arizona Communication Interview Rating Scale (ACIR).

Results

The level of communication skills increased significantly during the period for participants overall; and for females but not males. General social skills reached significantly higher levels than specific professional skills, both types of skill improving during the study. Independent predictors were working in local hospitals, learning atmosphere and low stress.At school completion, 50% reached a level defined as ‘advanced beginner’. Towards the end of the internship, 58% reached ‘capable’ and 27% ‘competent’ levels of communication skills.

Conclusions

Female physicians improved most in communication skills, the gender difference being multivariate mediated through low stress levels and learning atmosphere. The findings support the division of communication skills into general social and specific professional skills.

Practice implications

The relatively low proportion of young physicians, especially males, developing the capability to practise independently at internship completion indicates a need for more effective training in communication skills, during both medical school and internship.