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Biomedical subjects

J Garrard

Publications and source records attributed to J Garrard.

At least 37 records · Page 2Linked to original sources

A comparison of response rate, data quality, and cost in the collection of data on sexual history and personal behaviors. Mail survey approaches and in-person interview.

The authors examined differences in rate of response, data quality, and cost between mail approaches and in-person interview in the collection of data on sexual history and personal behaviors. A sample of women from a midwestern United States university (n = 342) was identified from health service medical records as having been seen for a sexually transmitted disease (cases) or a contraceptive visit (controls) during the latter half of 1985. The women were randomly assigned to one of three data collection strategies. A total of 268 subjects (78%) participated. Results indicated no differences in validity by method of data collection or by case-control status but there were significant differences in completeness, cost, and response rates. In-person interviews resulted in more complete data than mail approaches, although all instruments had low proportions of missing data (0.001-0.006). Response rate differences were not found when data collection methodologies were compared (75-82%) but were found in case-control analyses. Cases were consistently less likely to participate and significantly less likely to respond by mail (p less than 0.05). The cost of the in-person interview was approximately four times that of the mail survey for the data collection. Implications of the case-control response rate difference suggest that mail methodologies, although low in cost, may introduce sampling bias in studies of sexually transmitted diseases.

Adolescent↗

Effects of a geriatric nurse practitioner on process and outcome of nursing home care.

We compared measures of quality of care and health services utilization in 30 nursing homes employing geriatric nurse practitioners with those in 30 matched control homes. Information for this analysis came from reviews of samples of patient records drawn at comparable periods before and after the geriatric NPs were employed. The measures of geriatric nurse practitioner impact were based on comparisons of changes from pre-NP to post-NP periods. Separate analyses were done for newly admitted and long-stay residents; a subgroup of homes judged to be best case examples was analyzed separately as well as the whole sample. Favorable changes were seen in two out of eight activity of daily living (ADL) measures: five of 18 nursing therapies; two of six drug therapies; six of eight tracers. There was some reduction in hospital admissions and total days in geriatric NP homes. Overall measures of medical attention showed a mixed pattern with some evidence of geriatric NP care substituted for physician care. These findings suggest that the geriatric NP has a useful role in nursing home care.

Activities of Daily Living↗

Epidemiology of human bites to children in a day-care center.

The purpose of this study was to examine the epidemiology of human bites to children in a day-care center over a one-year period. This was a cohort study based on the injury log maintained on a daily basis by staff of the day-care center, as required by state II-censure law. A total of 224 children was enrolled in the center during the study period: 29 infants (ages 0 to 16 months), 62 toddlers (16.1 to 30 months), and 133 preschoolers (30.1 to 72 months). One hundred four children were bitten one or more times by other children in the center, with a total of 347 bites. The bite rates (defined as number of bites per 100 child days of enrollment in the center) varied significantly by age group but not by gender for initial or first-time bites, with toddlers having the highest rate and preschoolers the lowest (infants, 0.7129; toddlers, 1.3672; preschoolers, 0.4193). Total bite rates (which took into account multiple bites per child over the 12-month study period) varied significantly by age group, with toddlers having the highest rate per 100 days of enrollment and preschoolers the lowest (infants, 2.1931; toddlers, 3.1300; preschoolers, 0.5611). Males and females differed significantly in total bite rates per 100 enrollment days within the toddler age group (males, 3.6683; females, 2.3096) but not within the other two age groups. None of the demographic characteristics available in this study distinguished between children who were bitten compared with those who were not bitten with the exception of number of days of enrollment. The circumstances surrounding the biting events were examined with respect to the activity of the child when bitten, the victim's location when bitten, body part bitten, and treatment by staff. The results of this study raise policy questions about treatment protocols for human bites of children in group child-care settings, the routine recording of biting events, and the ethics and practice of reporting such events to parents.

Bites and Stings↗

Educational priorities in mental health professions: do educators and consumers agree?

Empirical comparisons of priorities of consumers and educators in university-based programmes in psychiatry, psychiatric nursing and social work are described. Data resulted from a Q-sort of 200 objectives for mental health education. The results of the tests of validity and reliability of the instrument are described, followed by a discussion of the similarities and differences among the four samples of subjects: consumers and educators in the three mental health professions. Suggestions for applications of this methodology by inter- and intradisciplinary service providers are described.

Attitude of Health Personnel↗

National culture vs professional culture: a comparative study of psychiatric educators in two countries.

A survey of the literature in medicine and in comparative education finds virtually no reports of systematic studies of professional education across national boundaries. This paper describes the use of the Priority Sort of Educational Objectives in Mental Health with samples of psychiatric and psychiatric nurse educators in the United States and South Korea. The data suggests a somewhat different pattern of cultural influences in professional education priorities between these disciplines in the two countries. The relative impact of the culture of a profession and of national culture are examined through the data generated on these populations of educators in two culturally dissimilar countries. Despite these differences of culture there has been a great impact of professional education from one country to the other. The resulting data suggest a stronger impact of professional culture with one profession, psychiatry, and a greater impact of national culture with the psychiatric nurse educators.

Cross-Cultural Comparison↗

Comparison of psychiatric-mental health nursing education objectives: consumers, educators, and practitioners.

This consumer-nurse study was part of a larger project, Research in Mental Health Education, which compared the priorities of educators and practitioners within and between three core mental health professions and between the professionals and consumers. In the consumer-nurse portion of the study, the objectives for graduate education in psychiatric-mental health nursing were validated by psychiatric-mental health nursing educators (N=20) based in four university programs in the East, West, and Midwest. Another sample of nurse educators and practitioners in this specialty area, drawn from nine states, prioritized these objectives. A separate deck of objectives for mental health professionals was generated and prioritized by consumers (N=15) who were members of the Mental Health Association of Minnesota. Standardized procedures for generating and validating the objectives for nurses and consumers and the same task, the Priority Sort, were used by all subjects, nurses, and consumers, to prioritize the objectives. Similarities and differences between nurses and consumers are discussed. Differences between nurse educators and practitioners, which are statistically significant, also are described. Implications for consumer and practitioner input into curricular decisions are discussed as well as interdisciplinary courses that could conserve faculty time and budgetary resources.

Community Participation↗

Psychosocial support in residency training programs.

A representative sample (n = 481) of residency training programs in six medical specialties (family practice, obstetrics/gynecology, pediatrics, psychiatry, internal medicine, and surgery) was surveyed to examine the frequency and kinds of psychosocial support offered to residents. Residency programs in family practice and psychiatry were generally more likely than programs in the other specialties surveyed to offer to residents the 10 types of support covered by the survey. In addition, the survey revealed residency programs were less likely to offer support related to personal or family problems as opposed to medical/professional issues.

Adult↗

Effect of variations in sequencing of clinical tutorials.

The sequence in which different specialties are presented to medical students may influence their impact. However, the subjects has been rarely examined. In the present study a variety of educational outcomes were evaluated for a second-year medical school class. They followed a series of eight clinical tutorials but did so in four different sequences. The outcomes assessed were: (1) student achievement during their tutorial year and in several major clinical courses taken in the third medical school year; (2) student perceptions of the tutorial experiences and the impact of the tutorials on subsequent clinical training; and (3) student choices of clinical courses and programmes in their third and fourth years. The results indicated that the sequence of the eight tutorials had no adverse effect upon the educational outcomes examined.

Achievement↗

Psychosocial support of residents in family practice programs.

Family practice residency programs (N = 347) were surveyed to examine the frequency of 11 kinds of psychosocial support available to residents through their programs. Family practice programs offer a considerable number of support elements to residents, with programs showing much homogeneity in the kinds of support offered. The size of a program does influence the kinds of support available, with small programs less likely than medium or large programs to offer the formal kinds of support examined in this study. Four patterns of support emerge from the data, each reflecting a specific orientation: (1) the psychological orientation, (2) the "bare bones" of support, (3) the support group orientation, and (4) the family orientation. In general, the kinds of support that address the residents' family needs are least likely to be available. Because time away from work helps to relieve the pressures of residency training, length of vacation and frequency of night call were also examined. On the average, first year residents cover night call every 3.64 nights and have 2.4 weeks of vacation.

Counseling↗

Physicians' concordance with consultants' recommendations for psychotropic medication.

Physicians' concordance with the recommendations of psychiatric consultants regarding the use of psychotropic medications in a general hospital was retrospectively examined in an outcome study. Using medical records in a series of 200 consecutive consultations, the authors found 68% of all psychotropic recommendations resulted in physician responses rated concordant and 24% nonconcordant. Resultant concordance ratings are presented according to category of recommendation (that is, start, adjust, continue, or discontinue) and drug groupings. The data suggest that drug group is not a critical variable in physician concordance. Responses did differ by category of recommendation. Further study of physician concordance is desirable. The work suggests both the potential of and need for outcome studies in consultation work.

Humans↗

Characteristics of graduating medical students who were matched and unmatched to hospital training posts.

The purpose of this paper is to examine similarities and differences between graduating medical students who do and do not match through the National Internship and Resident Matching Programme (NIRMP). Data from graduates of 3- and 4-year undergraduate curricula were examined separately. A two way analysis of variance was used; the two independent variables were (1) whether the student was a 3- or 4-year medical graduate, and (2) the students' matched vs unmatched status. The dependent variables used in this study were in the following five categories: (1) demographic and academic performance upon entrance to medical school, (2) academic performance during medical school, (3) future practice preferences projected during medical school, (4) internship/residency choices, and (5) clinical performance during internship/residency. On the basis of the data presented, it is clear that there are few differences between matched and unmatched students that could be detected in over seventy-five measures examined. Within the unmatched group, however, the 3-year graduates differ in some respects from their 4-year colleagues. It is likely, therefore, that a different constellation of factors appears to be operating in these two unmatched groups but not within the matched groups.

Decision Making↗