Search PubMed⌕ Search

Biomedical subjects

E V Dunn

Publications and source records attributed to E V Dunn.

At least 37 records · Page 2Linked to original sources
PubMed1992

Measuring the ethical sensitivity of medical students: a study at the University of Toronto.

An instrument to assess 'ethical sensitivity' has been developed. The instrument presents four clinical vignettes and the respondent is asked to list the ethical issues related to each vignette. The responses are classified, post hoc, into the domains of autonomy, beneficence and justice. This instrument was used in 1990 to assess the ethical sensitivity of students in all four medical classes at the University of Toronto. Ethical sensitivity, as measured by this instrument, is not related to age or grade-point average. Sensitivity increases between the 1st and 2nd year and then decreases throughout the rest of undergraduate medical training, such that the 4th-year students identify fewer issues than those entering medical school. Students expressing a career choice of family medicine identify more issues than their peers. Several problems with the use of the instrument and the interpretation of the data were found. Nonetheless, these findings, if reproducible, are important and their meaning needs further discussion.

Beneficence↗
PubMed1990

Evaluating ethical sensitivity in medical students: using vignettes as an instrument.

As a preliminary step to beginning to assess the usefulness of clinical vignettes to measure ethical sensitivity in undergraduate medical students, five clinical vignettes with seven to nine ethical issues each were created. The ethical issues in the vignettes were discussed and outlined by an expert panel. One randomly selected vignette was presented to first, second and third year students at the University of Toronto as part of another examination. The students were asked to list the issues presented by the patient problem. Responses from 281 students were obtained. These students identified an average of 2.72 ethical issues per vignette. Each response was classified under the domains of autonomy, beneficence and justice. Comparisons were made between classes and between vignettes. There was considerable variation between classes and the responses to different vignettes seem to indicate that different vignettes measure the various domains in different ways. It does appear that the use of vignettes is one way to measure aspects of ethical sensitivity in medical students but more study is required to clarify exactly what is being measured.

Beneficence↗
PubMed1989

Quality of care in family practice: does residency training make a difference?

As the proportion of physicians who enter residency training in family practice steadily increases, so does the need to evaluate the impact of their training and postgraduate education on the quality of care in their practices. We audited the practices of 120 randomly selected family physicians in Ontario, who were separated into four groups: nonmembers of the College of Family Physicians of Canada (CFPC), members of the CFPC with no certification in family medicine, certificated members without residency training in family medicine and certificated members with residency training in family medicine. The practices were assessed according to predetermined criteria for charting, procedures in periodic health examination, quality of medical care and use of indicator drugs. Generally the scores were significantly higher for CFPC members with residency training in family medicine than for those in the other groups, nonmembers having the lowest scores. Patient questionnaires indicated no difference in satisfaction with specific aspects of care between the four groups. Self-selection into residency training and CFPC membership may account for some of the results; nevertheless, the findings support the contention that residency training in family medicine should be mandatory for family physicians.

Adult↗
PubMed1989

Recruiting family physicians as participants in research.

Obtaining the voluntary participation of family physicians in quality of care research is a major problem in family practice research. An innovative approach was therefore required to recruit 120 randomly selected family physicians in southern Ontario in a quality of care study by the College of Family Physicians of Canada. A network of physician recruiters oriented to the study was organized for each district. This recruitment method resulted in an 84.5% participation rate. The relationship of these physician recruiters to the candidate and the method of approach were important factors in the enrolment process: the highest participation rate (95%) was obtained when the recruiters were friends of the candidate and when a personal meeting was arranged (91%). Recruiters were given an information package to help them in the recruitment process and rated the most useful items as follows: a policy statement about confidentiality, a description of the study and reprints of a published feasibility study. These results illustrate that cooperation in research in family physicians' offices can become a reality.

Confidentiality↗
PubMed1988

Study of relation of continuing medical education to quality of family physicians' care.

A random sample of 120 physicians in Ontario was studied to assess quality of care in primary care and test an hypothesis that quality of care was related to continuing medical education (CME) activities. The quality-of-care scores were obtained by an in-office audit of a random selection of charts. The scores were global scores for charting, prevention, the use of 13 classes of drugs, and care of a two-year period for 182 different diagnoses. There were no relationships between global quality-of-care scores based on these randomly chosen charts and either the type or quantity of the physicians' CME activities. These activities were reading journals, attending rounds, attending scientific conferences, having informal consultations, using audio and video cassettes, and engaging in self-assessment. The implications of these findings are significant for future research in CME and for planners of present CME programs.

Certification↗
PubMed1986

Health problems encountered by three levels of providers in a remote setting.

A study conducted in the Sioux Lookout Health Zone in northwestern Ontario, Canada analyzed the diagnoses and managements for 139,618 patient visits to three levels of practitioners: physicians, nurse practitioners, and minimally trained health aides. There were major differences between providers in their diagnostic and management patterns. Some of these differences were the result of administrative policy (e.g., physicians and nurses do preventive medicine) but even when adjustment had been made for these differences there was still considerable variation. The minimally trained practitioners made many more signs and symptoms diagnoses and asked for help more frequently. The nurses did much of the preventive measures and made more diagnoses in the supplementary diagnostic class. Physicians diagnosed medically sophisticated conditions more frequently. The physicians did considerable reassuring, suggesting that many cases referred to them were adequately handled. They were also more likely to order investigations.

Communication↗
PubMed1986

Diagnosis clusters adapted for ICD-9-CM and ICHPPC-2.

An ad hoc committee of the North American Primary Care Research Group (NAPCRG) was appointed to adapt the diagnosis clusters instrument for use with the International Classification of Diseases (ICD-9-CM) and the International Classification of Health Problems in Primary Care (ICHPPC-2). This article describes the development and testing of the final roster of 110 diagnosis clusters for family physicians. Almost 90 percent of all diagnoses recorded by family physicians in a variety of settings were included in the clusters. The diagnosis clusters can be used in the analysis of large databases and facilitate comparisons between different providers and practices.

Ambulatory Care↗
PubMed1985

Relative costs of specialist services in a family practice population.

The frequency and cost of referrals to specialists in March 1984 for 8980 rostered patients attending a family practice clinic located in a teaching hospital were analysed. The patients made 1891 visits to specialists. In all age groups and for all specialties female patients were more likely to be seen. The total direct provider costs were higher for female patients than for male patients. However, costs per patient seen were higher for male patients, except for psychiatry and medicine. Visits to surgeons had the highest total cost, while visits to psychiatrists had the highest cost per patient seen. Of the direct provider costs 61% was for specialist services. The family physician, in the "gatekeeper" role, has an opportunity to control some of the costs of the health care system by ensuring that the best and most efficient use is made of the referral network.

Adult↗
PubMed1985

Snoring as a risk factor for disease: an epidemiological survey.

In a study conducted in four family practice units in Toronto, Canada, 2001 subjects reported on snoring and medical conditions in members of their households. For spouses the prevalence of snoring increased with age up to the seventh decade, with a higher prevalence of nearly 85% in husbands. For 11 medical problems an association existed between snoring, its frequency, and the presence of the condition. This association continued when the data were corrected for sex, age, and marital state. For hypertension both men and women who snored between the fifth and 10th decades had a twofold increase over non-snorers. The prevalence of heart disease and other conditions, except for diabetes and asthma, also increased in snorers in this age group. When corrected for smoking and obesity the association between snoring, hypertension, and heart disease persisted. These findings extend those of Lugaresi et al, and if they could be confirmed snoring as a risk factor for conditions other than sleep apnoea and sleep disorders might be considered. Methods of alleviating the acoustic annoyance of snoring may also provide direct medical benefits.

Adult↗
PubMed1985

The use of freeze frame (slow scan) video for health professional education.

Continuing education in the professions is receiving increased emphasis and the economic and effective delivery of programmes must be a priority for the future. Freeze frame video, one of the newer telecommunication technologies, is a promising method for delivering continuing medical education (CME) over distance for those who have difficulty in regularly attending educational update programmes, especially for those in rural and isolated areas. The system uses two telephone lines to transmit both voice and a still picture simultaneously to one or several sites. The video portion can be a view of the patient, text, 35-mm slides, microscopic slides, or any other still object. Five years' experience with a slow-scan system as used for education is outlined. Three types of programme formats were all presented with this technology; consultations; discussion/case presentations; and lectures. The best use of the system was for small groups, with discussion of their unique problems. The fully interactive nature of the slow-scan system assisted in the presentations and allowed all sites in multisite conferences to be fully involved. Because most teachers are not familiar with the technology in their everyday life it requires more orientation and experience to accomplish a skilled programme than with other telecommunication systems such as the telephone or television.

Community Health Workers↗
PubMed1984

Provider acceptance of telemedicine systems in remote areas of Ontario.

Telemedicine, the use of telecommunications technology to assist in the delivery of health care, is an increasingly popular solution to some of the problems faced by rural residents in obtaining health care. Since September 1, 1977, the Sioux Lookout Zone in northwestern Ontario has been experimenting with slow-scan video equipment as part of its health care delivery system. The attitudes of the providers who use the system were surveyed. The nurses were positive about slow-scan video as an aid in the delivery of health care; however, the physicians were less enthusiastic. This difference can be explained by physicians' having had more extensive training than the nurses, and therefore not feeling the same need for medical backup and support. Both nurses and physicians had more positive attitudes toward the system after experience with it.

Attitude of Health Personnel↗
PubMed1983

Snoring in adults: some epidemiologic aspects.

Although snoring is a common problem it has received little attention in the medical literature. Therefore, a study was undertaken to determine the prevalence and epidemiologic aspects of snoring. The results showed that it is much more common than previously thought--86% of the married men and 57% of the married women were reported to snore. Overall, snoring was found to be more frequent in adult men than women, and its prevalence in adults was not related to age. It was found that 15% of the husbands and 52% of the wives were bothered by their spouse's snoring. Physicians must be made more aware of this problem and its potential effects on patients.

Adult↗