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PubMed2003

Childbirth expectations of Chinese first-time pregnant women.

BACKGROUND: This topic had not been researched previously and the information gained could have implications for midwives working with Chinese women everywhere. AIMS: To explore the specific childbirth expectations of Hong Kong Chinese first-time pregnant women. METHODS: This was a cross-sectional descriptive survey study and a Chinese version of the Childbirth Expectations Questionnaire was used to collect data. The sample consisted of 186 first-time pregnant women who first attended the antenatal clinic at a large public hospital in a major geographical region of Hong Kong. RESULTS: Results showed that the Chinese pregnant women, the majority of who had not attended childbirth education classes, had high expectations of support from both their partners and midwives during labour and delivery. Conversely, expectations toward their own ability to cope with pain were relatively low. In addition, the pregnant women expressed concerns about the severity of labour pain and indicated low expectations about minimal use of medical interventions during labour. CONCLUSIONS: This study results add to the existing literature about childbirth expectations of first-time pregnant Hong Kong Chinese women. Midwife educators should incorporate the findings into childbirth education classes to help pregnant women develop realistic and positive expectations.

Adaptation, Psychological↗
PubMed2004

Nurses' perceptions of their pharmacology educational needs.

BACKGROUND: Pharmacology education in nursing has become increasingly important as nurses' roles in administering, prescribing and educating patients about their medications have grown. Some authors have expressed concern at the lack of science teaching in nurse education, and others have suggested that there is a theory-practice gap in this area of the curriculum. AIM: This paper reports a study to explore nurses' pharmacology education needs by identifying nursing roles that require pharmacology knowledge, and nurses' preparation for practice from preregistration pharmacology education. METHOD: A qualitative approach was used to collect data from a purposive sample of 10 qualified nurses from an emergency admissions unit in a city in the north of England. Semi-structured interviews were transcribed verbatim and categorized using Burnard's 14 stages. FINDINGS: This study revealed a limited understanding of the subject, and dissatisfaction with the teaching of pharmacology, with resulting anxiety on qualifying. Nursing roles identified as requiring pharmacology knowledge included drug administration, patient assessment, nurse prescribing, and patient medication education. CONCLUSION: The findings suggest that, although nurses have a limited understanding of pharmacology, they recognize the need for pharmacology knowledge in practice. Improved pharmacology teaching might increase nurses' confidence in performing drug administration, patient education, and nurse prescribing, and decrease anxieties related to these roles.

Attitude of Health Personnel↗
PubMed1999

Identification of early self-injurious behaviour in young children with intellectual disability.

Very little is known about the early stages of self-injurious behaviour (SIB) in young children with developmental disabilities, even though there has been a great deal of research into the prevalence, assessment and treatment of well-established SIB in older individuals. In the present initial study, teachers in special schools for children under II years of age with severe intellectual disability and/or autism were asked to identify children who were beginning to show early self-injury (the index group). These children were then matched to classroom controls (of the same ability level and mobility), and teachers were interviewed about the children's behaviours and skills. The index children showed significantly more potential SIB than the control group children, but there was overlap between the groups in terms of percentage duration of potential SIB, suggesting that teachers do not find it easy to identify children with 'early' SIB. The index children's skills and problem behaviours, their sensory impairments and degree of autism did not differ significantly from those of the control group. When all the children showing any potential SIB were pooled together, it transpired that developmental age and degree of mobility were significantly correlated with percentage duration of SIB, suggesting that these characteristics may be important risk markers. The index children were also observed at 3-month intervals at school over the following 18 months and self-injury clearly escalated for some of the index children, while it did not do so for others. Using regression analysis, increases in SIB were shown to be associated only with the degree of concern expressed about the child's behaviour at time I by the teacher, no other variables predicting increases in SIB.

Age Factors↗
PubMed2000

Response to criticisms of the US FDA parametric approach for withdrawal time estimation: rebuttal and comparison to the nonparametric method proposed by Concordet and Toutain.

The benefits and drawbacks of using nonparametric methods for estimating product withdrawal times have been debated for many years. This issue was recently revived by Concordet & Toutain (1997a, b) when they described a nonparametric method for withdrawal time estimation. The authors urged the international adoption of this approach, basing their recommendation on three fundamental concerns: (1) the lack of a consistent official procedure for determining a withdrawal time within the European Union (EU); (2) the need to identify a statistical method for improving the international harmonization of withdrawal times for new chemical entities; and (3) a lack of confidence in the robustness of the US Food and Drug Administration/Center for Veterinary Medicine (US FDA) procedure, particularly with respect to minor violations in the underlying parametric assumptions. Due to the critical nature of these issues, the US FDA considers it vital to respond to these concerns. This paper provides a description of the US FDA parametric procedure. We also examine the statistical concerns expressed by Concordet and Toutain, identifying the reasons for our confidence in the US FDA parametric approach. Finally, using their Monte Carlo simulation models, we generate additional datasets to explore the behaviour of their nonparametric procedure and evaluate its ability to support US FDA regulatory activities.

Animal Diseases↗
PubMed1999

Evaluating problem-based learning in a multilingual student population.

OBJECTIVES: The University of Natal Medical School in South Africa provides training for a student body composed of two groups: one with English as a first language and the other with an African language as a first language and English as the second. A new methodology was developed to evaluate an innovative course using modified problem-based learning techniques in this heterogeneous environment. DESIGN: The learning model proposed required achieving a balance of three components: content, enquiry/learning process and social interaction/group process. A multidimensional system, felt to be consistent with this educational philosophy, was developed using seven different quantitative and qualitative techniques. SETTING: The University of Natal Medical School. SUBJECTS: First-year multilingual medical students. RESULTS: The results revealed that social interaction was highly successful in reducing barriers between the student groups and between students and facilitators. However, the emphasis on group participation may have overshadowed the enquiry process, leading to superficial discussions of problems and feelings of repetitiveness. During the course students and facilitators expressed concern that the innovative assessments used did not assess the course content adequately. While the group presentations and projects were useful exercises for consolidation and group interaction, they did not enable facilitators to identify struggling students. CONCLUSIONS: The outcome of the evaluation stressed the need of achieving an appropriate balance both in the curriculum and assessments of the three components of the learning model, particularly in a setting where student backgrounds and language ability differ. Multidimensional methodology is needed for effective evaluation that promotes critical reflection.

Attitude of Health Personnel↗
PubMed2000

Consistency of teaching in parallel surgical firms: an audit of student experience at one medical school.

BACKGROUND: Traditional clinical clerkships have been based on the apprenticeship model of learning, with opportunistic teaching by doctors on presenting patients. Students at King's College School of Medicine, London had expressed concern that they were receiving inequitable experiences in different clerkships. This had become more apparent since the introduction of a school-wide end-of-year skills assessment. We decided to assess the consistency of delivery of the surgical syllabus. METHOD: A multistage questionnaire survey was undertaken with third-year (first clinical year) undergraduate medical students on surgical clerkships. The questionnaire required students to record topics about which they had been taught, and practical skills on which they had been supervised, from the surgical syllabus pertaining at the time. RESULTS: 194 (46.4%) questionnaires were returned. A low level of consistency was reported in the teaching of theoretical topics and practical skills across surgical clerkships in eight different locations. There were substantial differences, both in overall coverage of the syllabus and in the priority given to different topics. There were no overall differences between teaching hospital- and district general hospital-based clerkships. DISCUSSION: Students in so called 'parallel' clerkships did not receive comparable teaching. The traditional opportunistic nature of clinical teaching led, in effect, to individual curricula within each clerkship. The General Medical Council has called for a core curriculum to be delivered across different clinical sites within each medical school. To achieve this, medical schools may need to introduce guidelines to direct teaching in the same way that clinical protocols have been developed to achieve greater standardization in clinical practice.

Clinical Clerkship↗
PubMed2000

A review of a surgical ward round in a large paediatric hospital: does it achieve its aims?

The review which this paper outlines aimed to explore whether the ward round of the surgical team at Birmingham Children's Hospital achieved its objectives and to investigate the attitudes of medical and nursing staff, patients and their parents towards the round. Initial open-ended interviews generated themes from which questionnaires were constructed and administered to 16 members of the surgical team, 30 nurses, 14 patients and 24 parents. The surgical team generally felt that the round plays a valuable role whereas the nursing team expressed dissatisfaction with many aspects of the round. The majority of the surgical and nursing team thought that the round should change from its present form and a number of suggestions were made as to how changes in the round could improve the quality of the teaching experience and promote quality in patient care. Patients tended to express rather neutral feelings towards the round although a significant minority of parents expressed concerns over confidentiality and the level of anxiety felt by children. It is hoped that the results of this review will be used to inform changes in the way the round is carried out. A further review will be initiated in the future to evaluate the efficacy of any such changes.

Attitude of Health Personnel↗
PubMed2000

Practice-based learning: views on the development of a reflective learning tool.

CONTEXT: This study reports the first part of a funded project to develop a tool to improve and record learning, known as a Progress File. A Progress File typically contains an element of reflection and a means of recording achievement. AIM: The aim of the study was to collect and understand the attitudes and experiences of students and tutors with regard to reflection, and to determine their views on the development and implementation of a Progress File for one member of the dental team, the dental therapist. METHOD: A consultation exercise was undertaken in four institutions which train dental therapists. A total of 76 students and tutors were interviewed individually or in groups. Examples of reflective tools were used to prompt discussion and feedback. Emergent themes were derived from content analysis. RESULTS: Participants identified many uses for the Progress File within and beyond their courses. They also expressed concerns regarding the effectiveness and feasibility of Progress File learning within present educational environments. DISCUSSION AND CONCLUSION: Successful integration of the Progress File into courses of medical and dental education may depend upon institutional culture change and a move towards a system which facilitates and rewards reflection on learning. The results will inform development of the File.

Attitude of Health Personnel↗
PubMed2002

Learning preferences, computer attitudes, and student evaluation of computerised instruction.

OBJECTIVE: To explore the relationship between learning preferences, attitudes towards computers, and student evaluation of a computer-assisted instructional (CAI) program. CONTEXT: A third year required clerkship in surgery at the University of Nebraska Medical Center. METHODS: A mixed-methods design combining attitudinal measures and qualitative interviews was employed to assess student reactions to a CAI program on angiography completed during a required surgical clerkship. Between January 1998 and July 1999, 151 students completed the program. Prior to participating, students completed the Rezler Learning Preference Inventory (LPI) and a computer attitudes survey (CAS). The LPI characterizes learning preferences as being abstract or concrete, individual or interpersonal, and student-structured or teacher-structured. The CAS measures attitudes towards computers and their role in education. After using the CAI program, students evaluated the module by completing an 18 item questionnaire. Based on LPI and CAS scores, 31 students were invited to participate in an in-depth qualitative interview on their experiences and perceptions of the program. RESULTS: There was no relationship between learning preferences, computer attitudes, and evaluation of the CAI program. Students were very positive about the program's content, clarity, organization, and ease of use. They also rated it as efficient and effective. However, many still indicated a preference for lecture and text-based learning. Qualitative interviews suggest students worry computers will supplant student--teacher contact. CONCLUSIONS: Learning preferences and prior attitudes toward computers did not bias student reactions to the CAI program assessed in this study. However, students expressed concerns that CAI would interfere with the traditional student--teacher encounter and relationship.

Attitude to Computers↗
PubMed2002

The Pastoral Pool: an evaluation of a new system of pastoral care provision.

CONTEXT: Medical students experience significant stress and stress-related problems. The benefits of support during training are described in this paper. Recently, student support systems have become increasingly stretched as medical schools merge, courses become modular and staff face increasing clinical and research pressures. The pastoral support system at St Bartholomew's and the Royal London School of Medicine has been changed in response to an evaluation of the old system of personal tutors. Pastoral care is now provided by a group of willing staff members known to have an interest in student welfare. The group is known as the 'Pastoral Pool' (PP). METHODS: Students and staff PP members completed similar questionnaires addressing their expectations of the PP and identifying the need for support systems in general. Pastoral Pool activity was investigated using confidential record sheets stating the frequency, duration and content of each PP encounter. RESULTS: Students were aware of the PP and many would consider using it. Staff and students agreed over the functions of the PP. Students frequently expressed concerns over confidentiality within the system. Uptake was low, with only 3% of students approaching the PP and the majority of PP work performed by only two staff members. The content of meetings was often multifactorial and usually on a subject within the PP remit. CONCLUSIONS: The PP is beneficial because pastoral care is provided only by dedicated staff members with an interest in student welfare. Membership is small enough to enable staff training and development. However, the system relies on self-referral by students. Rather than preventing problems arising, it therefore provides secondary support to those students insightful enough to identify their problems and motivated enough to seek help.

Adaptation, Psychological↗
PubMed2002

Patients' opinions of the use of psychiatric case-finding questionnaires in general practice.

BACKGROUND: The common mental disorders of depression and anxiety often remain undetected in general practice. Psychiatric screening instruments have been recommended to assist detection. AIM: To assess patients' attitudes towards the use of psychiatric screening questionnaires for common mental disorders within general practice. DESIGN: Twenty focus groups comprising 127 patients were conducted in Wales, UK. The groups were distinguished by age, sex and locality. RESULTS: The majority of respondents felt that the use of a screening questionnaire was acceptable and would be willing to complete one within a general practice setting. However, a number of individuals expressed concern about the validity of the kinds of questions asked and the usefulness of the instrument in practice. Respondents also discussed their concerns relating to issues of confidentiality and the doctor's response to the assessment. CONCLUSION: The study indicates that lay beliefs towards mental illness, particularly relating to perceived stigma, will continue to pose problems for the routine use of psychiatric case-finding questionnaires within general practice.

Adolescent↗
PubMed2000

Improving basic surgical skills for final year medical students: the value of a rural weekend.

BACKGROUND: Hospitals employing medical graduates often express concern at the inexperience of new interns in basic surgical skills. In self assessment questionnaires, our senior medical students reported little clinical procedural experience. A practical skills workshop was staged in order to set learning goals for the final study year. This gave the students an opportunity to learn, revise and practice basic surgical techniques. METHOD: The Bruce Rock rural community sponsored a surgical camp at the beginning of the academic year. Ninety-five (80%) of the class registered at the workshop, which rotated them through teaching modules, with private study opportunities and the capacity to cater for varied skill levels. Eight teaching stations with multiple access points were provided, and ten mock trauma scenarios were staged to augment the learning process. RESULTS: The teaching weekend was rated by students on an evaluative entrance and exit questionnaire. Sixty-five (73%) students returned questionnaires. They recorded significant improvement (P < 0.05) in their ability to handle the teaching stations. All students had inserted intravenous lines in practice prior to the camp, so the rating change in intravenous line insertion ability was not statistically significant. CONCLUSIONS: The weekend retreat offers students a chance to focus on surgical skills, free from the pressures of a clinical setting or the classroom. The emphasis was on the value of practice and primary skills learning. Students endorsed the camp as relevant, practical and an enjoyable learning experience for basic surgical skills.

Cardiopulmonary Resuscitation↗
PubMed1999

Urinary incontinence after radical prostatectomy: a randomized controlled trial comparing pelvic muscle exercises with or without electrical stimulation.

OBJECTIVES: To assess the effectiveness of intensive conservative treatment on and the impact of urinary incontinence after radical retropubic prostatectomy. PATIENTS AND METHODS: Sixty-three men with urinary incontinence >/= 8 weeks after radical prostatectomy were randomized to one of three groups; group 1, standard treatment (control); group 2, intensive pelvic muscle exercises (PME); or group 3, PME plus electrical stimulation (PME+ES). Group 1 received verbal and written instructions about postoperative PME from their urologist and from the nurses at the pre-admission clinic. Groups 2 and 3 were treated by a physiotherapist for 30 min twice a week for 12 weeks and carried out home exercises three times a day on the days when they were not treated. Outcome was assessed using the 24-h pad test, two validated quality-of-life questionnaires and a urine symptom inventory, all obtained at baseline, 12, 16 and 24 weeks after enrolment. The final pad test was carried out approximately 8 months after surgery. RESULTS: Fifty-eight patients completed the study, 21 in group 1, 18 in group 2 and 19 in group 3; five discontinued, three with bladder neck contractures requiring dilatation, one with rectal pain when doing the exercises and one unable to complete therapy while on vacation. The mean (median) time elapsed from surgery to entry into the study was 19 (8) weeks. At 12 weeks from baseline, the mean overall urine loss had decreased from 463 g to 115 g but there were no differences among groups, nor were there significant differences in urine loss at 16 and 24 weeks (F=0. 16, P=0.69). There was a significant impact on quality of life during the early recovery. Despite preoperative instructions, many patients revealed little or no knowledge about catheter care, bladder spasms, rectal pain, incontinence and erectile dysfunction. Little of the preoperative education was retained because of the overwhelming nature of the diagnosis. CONCLUSIONS: From the initial assessment to the final pad-test at approximately 8 months after surgery, incontinence improved greatly in all three groups. This rapid improvement may have masked any treatment benefit. Further research should address incontinence in men whose urine loss has stabilized and who underwent surgery >8 months previously. Moreover, a telephone-based follow-up soon after discharge may alleviate many of the concerns expressed.

Aged↗
PubMed1999

Diabetes and driving: towards equitable, evidence-based decision-making.

In January 1998, the British government introduced new restrictions on licensing of people with insulin-treated diabetes mellitus to drive. These restrictions were based on the second EU driver licensing directive (91/4389) and looked to be costing insulin-treated diabetic individuals their entitlement to drive light goods and small passenger-carrying vehicles. In response to concerns expressed by the diabetes community in Britain, the British Diabetic Association commissioned a report examining and interpreting the available evidence of accident risk in insulin-treated diabetic patients, particularly that related to unexpected hypoglycaemia. The following article is drawn from that report.

Accidents, Traffic↗
PubMed1998

Postpartum early hospital discharge and follow-up practices in Canada and the United States.

BACKGROUND: Although official guidelines and recent legislation have addressed early postpartum hospital discharge and follow-up, little is known about the practices of obstetricians in Canada and the United States on this issue. METHODS: Questionnaires were mailed to two separate random samples of 2000 Fellows of the American College of Obstetricians and Gynecologists (ACOG) in the United States and all Canadian Fellows. Practices and perceptions were compared with those recommended in the literature, recent legislation, and guidelines of ACOG and American Academy of Pediatrics (AAP). RESULTS: In contrast to concerns expressed in the medical literature and official AAP/ACOG guidelines, many physicians considered potential psychosocial and demographic risk factors relatively unimportant in making early discharge decisions, preferring to emphasize aspects of the patient's medical condition, hospital course, and social support. Although the official guidelines encourage follow-up for all patients discharged early, additional visits are routinely advised by only 39 percent of obstetricians after vaginal delivery and by 68 percent after cesarean section. After vaginal delivery 39 percent of obstetricians used telephone follow-up and 37 percent after cesarean delivery. Moreover, although the official guidelines recommend follow-up within 48 hours of discharge, only one-half of the obstetricians surveyed advised follow-up at this time. In contrast to the guidelines, most obstetricians defined early discharge as that occurring within 24 hours after vaginal delivery and 72 hours after cesarean delivery; most defined optimal lengths of stay within the 48-hour (after vaginal delivery) and 96-hour (after cesarean delivery) periods considered short by the guidelines. CONCLUSIONS: Current postpartum early discharge and follow-up practices emphasize the physical health of the mother and place little emphasis on social risk. They appear to be influenced by perceptions of the appropriateness of the length of stay and are not in agreement with professional guidelines.

Aftercare↗
PubMedDate not supplied

Cancer self-help groups and family physicians.

PURPOSE: Despite the phenomenal growth during the past decade of cancer self-help groups for adult patients with cancer, little research has been conducted to document the interface between these groups and healthcare professionals, especially physicians. This study was initiated to provide information about family physician practices, awareness, and attitudes about self-help groups. DESCRIPTION: A survey questionnaire was mailed to a random sample of Ontario family physicians drawn from the College of Family Physicians of Canada's membership database. RESULTS: A total of 911 completed questionnaires were returned, for a response rate of 64%. A majority (56.8%) of respondents were aware of at least one cancer self-help group in their region; 26.8% of these spoke frequently with their cancer patients about such groups. Most family physicians indicated that they were positively inclined toward cancer self-help groups, giving especially high ratings of helpfulness to sharing common experiences, overcoming isolation, feeling understood, and sharing information. Ratings of potential harm were low, with the most concern expressed about the possible provision of misinformation and the promotion of unconventional therapies. Responses to an open-ended question showed that many family physicians qualify their support for cancer self-help groups, depending on patient need, group composition, and leadership. CLINICAL IMPLICATIONS: Family physicians and other members of the cancer care team should give increased attention to informing cancer patients about the potential benefits of self-help groups. Efforts need to be made to assist cancer self-help groups in developing informational brochures and to ensure that groups are listed in cancer resource directories. Educational initiatives about self-help groups would be useful for family physicians and other health professionals engaged in the care of cancer patients.

Adult↗
PubMed1999

Laser resurfacing: usual and unusual complications.

The use of the carbon dioxide laser for skin resurfacing was initially described in 1989. 1 Since that time, several reports have shown it to be highly effective in the treatment of photodamaged skin and acne scarring. 2,3,4,5 Advances in laser technology have simplified the procedure and minimized adverse sequelae. Laser skin resurfacing has become a very popular technique, and recently several patient series have been published on the use of different resurfacing lasers to treat photodamaged skin. 3,4 However, very little has been written about its complications. Adequate patient selection, sound medical judgement, proper training with experience and knowledge of skin physiology and wound care are important factors for successful outcomes. Interested physicians across a broad range of subspecialties have expressed concern about the rate of adverse outcomes and management of complications. We report seven representative cases of complications referred to our dermatology clinics from outside physicians, in the hope of educating clinicians regarding the usual and unusual side effects of this procedure.

Abscess↗
PubMed2002

A philosophy and strategy for surgical hair restoration: a 10-year experience.

BACKGROUND: Three principal strategies have evolved for surgical hair restoration: follicular grafting, scalp reduction, and flap rotation. OBJECTIVE: Although grafting techniques have assumed a preeminent rank as the cornerstone of modern hair-replacement therapy, scalp reduction and rotation methods should not be entirely dismissed. METHODS: Over the past 10 years of clinical experience, the authors have relied on all three methods of hair restoration, carefully tailoring the optimal surgical approach to the patient's expressed concerns and particular regional hair deficit. RESULTS: We have found that scalp reduction and rotation provides a considerable density of hair unmatched by any grafting technique for the vertex and frontotemporal regions, respectively. CONCLUSION: Also we have concluded that the former yields the most natural result for a patient with significant crown baldness who desires hair restoration in that area. However, micro- and minigrafting still represent the overwhelming majority of our operative cases. This article attempts to review the surgical methodology and philosophy that have guided our approach to hair restoration.

Alopecia↗