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Biomedical subjects

D Bower

Publications and source records attributed to D Bower.

At least 19 recordsLinked to original sources
PubMed2001

Understanding the careers of physician educators in family medicine.

PURPOSE: Little is known about what contributes to the career decisions of physician educators in family medicine. This study sought to understand the variables that influence these decisions and to identify key sources of vitality for physician educators in family medicine. METHOD: A national sample of randomly selected physician educators in family medicine responded to a postcard survey regarding their contribution(s) to education and career satisfaction. A series of exclusion criteria were applied to 399 useable responses, yielding 24 physician educators who participated in a semi-structured telephone interview focusing on their careers. Using qualitative research methods, themes were identified and categorized from the transcribed interviews and investigators' field notes. RESULTS: The career decisions and actions of physician educators in family medicine emanated from an underlying set of values and beliefs associated with "making the world better." Participants sought challenging, diverse, and stimulating positions from which they could have an impact in ways that were consistent with their values. Three major sources of vitality (learners, colleagues, and patients) complemented the desire for challenging positions. Physician educators in family medicine, however, continually struggled to balance their personal and professional lives. CONCLUSION: The study results highlight the key variables that draw faculty into education and sustain their vitality, and the professional and personal challenges that can derail or support their careers. This information can be used to recruit, develop, and retain successful and productive physician educators in family medicine.

Adaptation, Psychological↗
PubMed2000

Coping with dementia: evaluation of four nonpharmacologic interventions.

To evaluate nonpharmacologic interventions, caregivers (65 women, 38 men) and their dementia-diagnosed spouses (patients) were randomized to one of four treatment programs (cognitive stimulation, dyadic counseling, dual supportive seminar, and early-stage day care) or to a wait-list control group. Assessments occurred initially and at postintervention (3 months). Patients were evaluated on memory, verbal fluency, and problem-solving ability, and caregivers were assessed on marital interaction, emotional status, and physical health, along with stress, coping, and social support. Caregivers also completed a program evaluation. Repeated measures procedures showed that patients in the cognitive stimulation group demonstrated more improvement over time in cognitive outcomes, and caregivers decreased in depressive symptoms. Early-stage day-care and dual supportive seminar group caregivers reported a decrease in hostility and a decrease in use of negative coping strategies, respectively. Although qualitatively derived benefits differed across groups, similarities in program content reduced the potential for quantitative differentiation among the groups.

Adaptation, Psychological↗
PubMed1998

Residents find clinical practice guidelines valuable as educational and clinical tools.

BACKGROUND AND OBJECTIVES: Information regarding clinical practice guideline (CPG) use in residency education is limited. We surveyed a regional population of family practice residents to determine use, attitudes, and curricular needs for practice guidelines. METHODS: A written survey was developed that measured residents' exposure to, frequency of use, attitudes, access, and knowledge about use of CPGs. The survey was mailed to 114 family practice residents. RESULTS: The response rate was 75%. The most frequently seen guidelines were immunization schedules, cancer screening, hyperlipidemia, and hypertension management. The residents reported positive attitudes toward CPGs; 75% thought CPGs were easy to use, 80% thought they improved their efficiency, 78% thought they improved their residency education, and 75% thought they improved patient care. Barriers to effective use of practice guidelines were also identified; 20% knew where to find guidelines in their clinic, 35% had faculty modeling, and 22% knew how to evaluate the validity of a guideline. Eighty-nine percent of respondents desired instruction on CPG use and interpretation. CONCLUSIONS: The surveyed family practice residents have similar usage rates for CPGs as the literature reports for practicing physicians, but residents report more positive attitudes. Barriers that prevent effective use of CPGs in training environments include lack of critical appraisal abilities and faculty role modeling.

Curriculum↗
PubMed1995

Supportive seminar groups: an intervention for early stage dementia patients.

A supportive seminar group was developed and conducted for individuals with early stage dementia and their caregivers. The eight sessions focused on pertinent topics, namely, coping with memory problems, daily living, self-esteem, relationships, health, legal, and financial concerns. Content analysis of the evaluative statements from nine men and six women patients revealed positive themes of feelings of purposefulness, gratification, belongingness, and survival, while other themes reflected the turmoil of the disease, namely, feelings of helplessness, devaluation, and unpredictability. These preliminary findings lend support to the feasibility of a group approach for early stage dementia patients.

Alzheimer Disease↗
PubMed1992

Level of cancer pain knowledge among baccalaureate student nurses.

Inadequate nursing education is a major impediment to effective pain relief for cancer patients throughout the world. This study was conducted to identify the level of cancer pain knowledge among baccalaureate student nurses and to determine whether specific activities affect this level of knowledge. Two questionnaires were administered to 82 baccalaureate student nurses in the final course of their program. Although the students displayed a realistic perspective about the severity and prevalence of cancer pain and psychological dependence, specific knowledge deficits and negative attitudes suggest the possibility of inadequate pain management. Specifically, the students believed that (a) maximal analgesic therapy should be delayed until the patient's prognosis was less than 12 months; (b) the proportion of patients whose pain can be controlled by appropriate therapy is less than is possible; (c) increasing pain is related to tolerance rather than to progression of the disease; (d) the preferred route of administration is intravenous rather than oral; and (e) the degree of respiratory depression, rather than constipation, does not decrease with repeated administration. Significant positive correlations (P < or = 0.05) were found between age and cancer pain knowledge and between attendance at seminars/workshops and time spent reading professional journal articles. Of the 30% of the participants who perceived a particular person to be a source for obtaining information about cancer pain management, 52% specified a practicing registered nurse. Seminars and workshops were chosen by 59% of the students as the most effective way for nurses to increase their knowledge.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

The safety and lack of efficacy of vinpocetine in Alzheimer's disease.

Fifteen Alzheimer patients were treated with increasing doses of vinpocetine (30, 45, and 60 mg per day) in an open-label pilot trial during a one-year period. Patients were assessed seven times both on and off drug with: the Buschke Selective Reminding Task, a letter fluency test, a category fluency test, the Boston Naming Test, a cognitive capacity screening examination, and a clinical global impression. Vinpocetine failed to improve cognition on psychometric testing or overall functioning, as measured by the clinical global impression, at any dose tested. Patients showed significant decline in most measures during the course of the study, at the same rate as a matched control group, consistent with progressive dementia. There were no significant side effects from drug therapy. We conclude that vinpocetine is ineffective in improving cognitive deficits and does not slow the rate of decline in individuals with Alzheimer's disease.

Aged↗
PubMed1979

Loudness discomfort level and acoustic reflex threshold for speech stimuli.

Loudness discomfort level (LDL) and acoustic reflex threshold (ART) measurements were obtained from subjects with normal hearing using several speech stimuli, as well as broad-band and speech-spectrum noise. The purpose of the investigation was to determine the LDL for a variety of representative speech samples, and to determine the relationship between the LDL and ART for selected speech and noise stimuli. For all stimuli, LDL measurements were relatively constant, but ART measurements decreased significantly for wide-band noise stimuli as compared with the speech stimuli. Mean differences between the two measures were consistent, but individual subject data were characterized by wide variability precluding accurate prediction of the LDL from ART measurements.

Acoustic Stimulation↗
PubMed1977

Use of performance-intensity functions for diagnosis.

Performance-intensity (PI) functions for phonetically balanced (PB) word lists were obtained for a group of normal listeners (27 ears), and for two groups of patients with cochlear (89 ears) and retrocochlear disorders (eight ears). Listeners with normal hearing or cochlear disorders exhibited mild to moderate reductions in discrimination score as the speech level was raised above the PB maximum. In contrast, patients with retrocochlear disorders showed a pronounced rollover phenomenon, characterized by a rapid decline in performance as the speech level was raised above the maximum discrimination score.

Audiometry↗