Search PubMed⌕ Search

Biomedical subjects

David E Weissman

Publications and source records attributed to David E Weissman.

At least 37 records · Page 2Linked to original sources
PubMed2002

The assessment of discomfort in dementia protocol.

Many people with dementia are unable to clearly or consistently verbalize pain symptoms. The Assessment of Discomfort in Dementia (ADD) Protocol is a systematic tool that can be used by nurses to make a differential assessment and treatment plan for both physical pain and affective discomfort experienced by people with dementia. This ADD Protocol is based on the assumption that behaviors associated with dementia are symptoms of unmet physiologic and/or nonphysiologic needs. Steps of the process include a physical assessment, a review of the patient's history, an assessment of affective needs including environmental stress and sensoristasis, and the administration of analgesics. The ADD Protocol is unique in that it uses "as needed" analgesics as a part of the assessment process. The dualistic perspective, in which physical and affective needs are considered in tandem, is an essential and innovative feature of the ADD Protocol.

Clinical Protocols↗
PubMed2002

End-of-life care education in internal medicine residency programs: an interinstitutional study.

BACKGROUND: Integrating end-of-life care (EOL) education into medical residency programs requires knowledge of what programs currently teach and what residents learn. OBJECTIVE: Evaluate EOL teaching content and practices in internal medicine residency programs and the EOL knowledge of their faculty and residents. DESIGN: An interinstitutional pilot study. We examined patterns of EOL education, discerned from program directors' responses to structured surveys of institutional teaching and evaluation practices, and EOL knowledge, derived from the performance of faculty and residents on a 36-item knowledge examination. SUBJECTS: Program directors, faculty, and residents at 32 accredited U.S. internal medicine residency programs. RESULTS: Although all programs cited inclusion of some EOL education, expected EOL domains were not systematically taught or assessed. Pain assessment and treatment training was required in only 60% of programs. Even fewer programs required instruction on nonpain symptoms (<30%) or hospice and nonhospital care settings (22%). EOL assessment depends primarily on faculty's general ratings of residents' global competency; few programs use knowledge examinations or structured skill assessments. Directors identified barriers and support for improving education. On the knowledge examination, the mean score of residents increased across training levels (F = 21.7, p < .001), and the mean score of faculty was higher than residents' (57.6%: 48.9%, t = 51.6, p < .001). CONCLUSIONS: Existing internal medicine residency education lacks training in critical EOL care domains. Residency programs need additional training for residents and teaching faculty in EOL content and skills, with assessment practices that demonstrate competencies have been acquired. Program directors perceive institutional support for making these changes.

Analysis of Variance↗
PubMed2002

End-of-life curriculum reform: outcomes and impact in a follow-up study of internal medicine residency programs.

BACKGROUND: In 1998 we initiated a pilot project to evaluate the feasibility of recruiting and training internal medicine residency programs in methods designed to enhance and integrate end-of-life (EOL) instruction and assessment into their curriculum. OBJECTIVE: To evaluate participants' assessment of the training program and the 12-month impact of the training on the 32 residency programs' EOL teaching. DESIGN: Prospective multi-institutional study. MEASUREMENT AND RESULTS: After participating in training, all participants agreed/strongly agreed that the skills-related objectives of the training were met. Mean ratings of intention to continue with the program were consistent across trainees representing different academic ranks (F = 2.8, p = 0.07), levels of experience in EOL education (F = 1.3, p = 0.28), and involvement in other national EOL training programs (F = 1.5, p = 0.23). Twelve months after training, most programs (78%) continued with the project and had initiated EOL curriculum reform in seven key EOL domains.). CONCLUSIONS: The study suggests that focused training in EOL teaching methods and institutional change strategies can facilitate EOL curriculum reform.

Curriculum↗