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PubMed2006

A randomised controlled trial of clinical outreach education to rationalise antibiotic prescribing for acute dental pain in the primary care setting.

OBJECTIVE: To assess the effect of educational outreach visits on antibiotic prescribing for acute dental pain in primary care. STUDY DESIGN: RCT. SETTING: General dental practices in four health authority areas in Wales. SUBJECTS AND METHODS: General dental practitioners were recruited to the study and randomly allocated to one of the three study groups (control group, guideline group or intervention group). Following the intervention, practitioners completed a standardised questionnaire for each patient that presented with acute dental pain. INTERVENTIONS: The control group received no intervention. The guideline group received educational material by post. The intervention group received educational material by post and an academic detailing visit by a trained pharmacist. The educational material included evidence-based guidelines on prescribing for acute dental pain and patient information leaflets. MAIN OUTCOME MEASURES: The number of antibiotic prescriptions issued to patients presenting with dental pain and the number of 'inappropriate' antibiotic prescriptions. Antibiotics were considered to be inappropriate if the patient did not have symptoms indicative of spreading infection. RESULTS: A total of 1,497 completed questionnaires were received from 23, 20 and 27 general dental practitioners in the control, guideline and intervention group respectively. Patients in the intervention group received significantly fewer antibiotic prescriptions than patients in the control group (OR (95% CI) 0.63 (0.41, 0.95)) and significantly fewer inappropriate antibiotic prescriptions (OR (95% CI) 0.33 (0.21, 0.54)). However, antibiotic and inappropriate antibiotic prescribing were not significantly different in the guideline group compared to the control group (OR (95% CI) 0.83 (0.55, 1.21) and OR (95% CI) 0.82 (0.53, 1.29) respectively). CONCLUSIONS: Strategies based upon educational outreach visits may be successfully employed to rationalise antibiotic prescribing by dental practitioners.

Adult↗
PubMed2000

Did Project 2000 nurse training change recruitment patterns or career expectations?

In the UK, Project 2000 nurse education, introduced over the last eight years, aimed to increase the professional status of nurses and enhance skills, focusing on wider community care. This paper reports some of the results from a research project conducted between 1994 and 1996, funded by the Department of Health (Project 2000 Fitness for Purpose 1996). It was hypothesized that the changes in Project 2000 training might attract those more academically qualified and lead to more rapid career progression. The results found in this study did not support either of these hypotheses and suggestions are made about the reasons for the negative findings.

Adult↗
PubMed1989

Oncology nursing: five decades of growth.

Oncology nursing has evolved as a specialty over the past five decades. The focus of this article is the evolution of oncology nursing discussed within the context of historical changes in the definition of nursing, regulation of the profession, and educational preparation. The specialty has had an orderly progression from on-the-job training to continuing education to academic preparation. The practical and progressive ways in which the professional organizations, oncology nurse educators, and oncology nurse researchers have responded to the needs of cancer patients and families are discussed. Oncology specialty organizations now have a combined membership of approximately 15,000, which attests to the viability of the specialty.

Forecasting↗
PubMed2003

Listening to music: the case for its use in teaching medical humanism.

Listening to music has rarely been used by educators as a tool to teach humanism to medical students and residents. The authors present the argument that music embodies the characteristics of medical humanism (i.e., caring, empathy, human dignity, compassion, and the fostering of relationships) and that listening to music is ideally suited for inclusion in a humanism curriculum. The authors also describe an eight-session "music and medicine" course for residents given at their institution as part of an ongoing humanism-in-medicine initiative. The results of a post-course survey given to the participants showed that residents valued the course as an academically valid approach to humanism training.

Curriculum↗
PubMed2002

Nurses' attitudes toward truthful communication with patients with cancer. A Greek study.

The purpose of this study was to examine Greek nurses' attitudes toward truth-telling practices when working with cancer patients and their psychological status regarding the difficulties they face in their day-to-day communication with these patients. A self-administered questionnaire composed of 19 questions, including both multi-item scales and single-item measures, was designed for the study. For this study, 200 nurses were asked to participate, of whom 148 (74%) completed and returned the questionnaire. The questionnaire is self-administered, formulated after a thorough review of the relevant literature. The pretesting was carried out using the alpha model of reliability and the Cochran Chi Square test (Q-test), which was 545.46 (P < .0001) and showed a Cronbach alpha coefficient of 0.7148. A large percentage of the respondents (75.7%) believe that only some patients with cancer should be told the truth of their diagnosis and prognosis, although a larger percentage (89.1%) believe that the truth should be told to the relatives. Most of the respondents (66.2%) reported that is difficult to engage in open communication with the patients, because their academic education did not sufficiently train them in communication skills. Although 83.78% of the nurse respondents do not reveal that the disease is incurable, 86 (58.1%) believe that only the patient's physician should reveal the truth. These results indicate that although many Greek nurses believe that the patients should be informed and know their condition, lack of training in communication skills is a major obstacle to achieving this. Finally, this self-assessment questionnaire may provide acceptable and valid assessment of Greek nurses' perceptions and attitudes on truth telling.

Adult↗
PubMed1990

The mini-fellowship in teaching. A senior resident elective.

The residency program at the University of Pennsylvania offers a 1-month fellowship for senior residents in medical student education. Instructional philosophy, methods, and content are discussed, observed, practiced, and evaluated. Close supervision and immediate feedback provide training particularly needed by future academic radiologists, and strengthen consultative skills for clinical practice.

Fellowships and Scholarships↗
PubMed2000

Importance of comorbidity in head and neck cancer.

OBJECTIVES/HYPOTHESIS: Patients with head and neck cancer are staged according to the morphology of the tumor with little or no attention given to the importance of the other diseases, illnesses, or conditions. These other conditions are generally referred to as comorbidities. Although not a feature of the cancer itself, comorbidity is an important attribute of the patient with cancer. Comorbidity has direct impact on the care of patients, selection of initial treatment, and evaluation of treatment effectiveness. The objective of this thesis is to demonstrate the importance of comorbidity in head and neck cancer. Specifically, the aims are 1) to demonstrate the burden of comorbidity among head and neck cancer patients by comparing the incidence of none, mild, moderate, and severe comorbidity among patients with head and neck cancer to patients with cancers of the colorectum, lung, breast, gynecological sites, or prostate, 2) to demonstrate the independent impact of comorbidity on overall survival, and 3) to demonstrate the importance of comorbidity in the assessment of initial treatment effectiveness. STUDY DESIGN: This was a prospective cohort study of the impact of comorbidity on head and neck cancer patients presenting for treatment between January 1995 and December 1996. METHODS: In 1994, the author trained cancer registrars at an academic teaching hospital to code comorbidity from the medical record of new patients using a standard comorbidity index. Standard statistical techniques, including multivariable analysis, were used to compare and contrast the burden of comorbidity for patients with different cancers. Life survival techniques and multivariable logistic regression analysis were used to assess the independent prognostic impact of comorbidity. Further, the technique of conjunctive consolidation was used to augment the TNM system with comorbidity information, to more completely assess the impact of different initial treatments for patients with head and neck cancers. RESULTS: The cohort consisted of 3,378 patients with cancers of the head and neck (341), colorectum (307), lung (655), breast (483), gynecological sites (482), and prostate (1,110). The percentage of head and neck cancer patients with moderate to severe comorbidity was 21%; this degree of comorbidity burden was second only to patients with lung (40%) and colorectal (25%) cancer. There was a significant relationship between severity of comorbidity and overall survival (log-rank test, chi2 = 15.75; P < .0013). For cancers of the head and neck, lung, breast, and prostate the prognostic significance of comorbidity remained even after controlling for other factors, such as age and TNM stage. CONCLUSIONS: The results of this study show that comorbidity is an important feature of patients with head and neck cancer. Valid instruments exist to measure and classify the overall severity of comorbidity. The scientific evaluation of treatment and the care of patients are impeded by a rigid adherence to a staging system based solely on morphological descriptions of the cancer while ignoring suitable descriptions of the patient. The author believes that the addition of comorbidity information will improve the value of cancer statistics and the care of cancer patients.

Adult↗
PubMed1995

Financial strategies and outcomes management in trauma care: current status and predictions for the future.

In the competitive health care market of the 1990s, trauma centers face a multitude of fiscal challenges that threaten their survival. Trauma centers are confronted with the tremendous task of balancing the cost of caring for the patient with multiple trauma who requires resource-intensive care with the most fiscally responsible outcomes. Academic medical centers and residency training programs are faced with an even greater burden associated with controlling cost while providing learning experiences for physicians and nurses. Outcomes management represents the future strategy that trauma centers nationwide must embrace. Outcomes management gives trauma centers the opportunity to demonstrate their contribution to the community and society through improved patient and systems outcomes.

Financial Management, Hospital↗
PubMed2004

Pain, position, and stylet styles: infant lumbar puncture practices of pediatric emergency attending physicians.

OBJECTIVES: Lumbar punctures (LPs) are common emergency department (ED) procedures. Few pediatric studies exist to define training, guide practice, or indicate preferred methods for infants. While pain control is recommended, no recent studies indicate prevalence of analgesic use since the advent of topical anesthetics. We surveyed academic pediatric ED physicians to assess training and technique preferences and to highlight pain control usage. METHODS: A total of 398 physicians were randomly selected from the 621 e-mail accessible members of the AAP Section on Pediatric Emergency Medicine. Questions concerning physician training, analgesia, and technique were either sent by regular mail or via e-mail link to a Web-based survey. RESULTS: Of 359 deliverable surveys, there were 188 physician responses (52.4%) with differential response rates by survey format [58 e-mail (36%) and 130 regular mail responses (66%); P < 0.05]. Almost a third will advance the needle without the stylet in place. Two-thirds of physicians do not routinely use analgesia for neonatal LPs. Those using pain control were trained more recently (median 12 years vs. 15 years postresidency; P = 0.04). Analgesia use was the most common practice changed since residency. CONCLUSIONS: Analgesia is underused for infant LPs. Advancing the needle without a stylet is not uncommon. Response rate to regular mail surveys was much higher.

Adult↗
PubMed1997

Medicine and management: a conflict facing general practice?

Partners and practice managers are beginning to understand implications of management issues raised by recent reforms. Practices involved in this study agree the need for improvement, but partners and managers were often unable to define improvements needed. Demonstrates that effective management structure is vital to future success for general practice. To achieve this involves understanding new managerial challenges practices must meet and different organizational competences required. To change requires a radical restructure of many practice roles and several options are considered. Regardless of the chosen option the question of training remains. There is a need to involve consultants, managers, and doctors already advancing the boundaries of practice development, in a dialogue with institutions providing management training, to design suitable programmes. Academic institutions too often produce management programmes geared towards the old environment, whereas managerial skills which changes in the NHS demand from future practice managers are now required.

Budgets↗
PubMed1989

What 'makes' a good doctor?

The relation between gender, personality, school scores, grades at medical school and eventual achievement as a medical practitioner 8 years after qualifying has been explored by path analysis in a cohort of medical students. Factor analysis of data derived from a questionnaire identified a significant factor accounting for 75% of the common variance of the professional achievement scores. Standardized path coefficients were computed to indicate the relative importance of the causal factors to postgraduate achievement. Gender played an important role at many levels. For example it was apparent that many of our women graduates were seriously disadvantaged in their professional careers. Of the school subjects, chemistry was a surprising long-term predictor of postgraduate achievement. Academic achievement during medical school training, particularly in the final year, was a significant predictor, while personality attributes made their contribution to one or other aspect of achievement at earlier stages in training but made little additional direct contribution to postgraduate performance.

Achievement↗
PubMed1994

Improvement of neonatal care in Zhejiang Province, China through a self-instructional continuing education programme.

Major upheavals have taken place in medical education in the last three decades in China. This has meant that at every level there are personnel with a wide range of training backgrounds. Continuing education programmes to ameliorate the situation have been seen as a priority of the Ministry of Public Health (MOPH). However, many of the training courses offered are too academic in approach and do little to raise standards of clinical care. The shortcomings in neonatal education are particularly acute and this is reflected in the relatively high neonatal mortality rate. At the request of Zhejiang Provincial Bureau of Public Health (BOPH), Project HOPE, an American non-governmental organization (NGO), collaborated with Zhejiang Medical University (ZMU) on the development of a neonatal outreach programme. The programme was self-instructional in approach with individual hospitals having autonomy in the mode of implementation of the programme. There were 225 participants in four county level hospitals. Cognitive knowledge test scores improved by an average of 56%. Observation of clinical practices showed that 54% improved following the programme, with 34% meeting the criteria set by the modules. An inventory of facilities showed that of a list of essential items an average of 38% were present before the programme compared with 76% after completion of the programme. As a result of the success of the programme it is being expanded into a comprehensive teaching and evaluation package for use throughout Zhejiang Province and Eastern China.

China↗
PubMed1989

Diffusion of cancer education into schools.

Though implementing health education in schools has numerous advantages, many barriers impede adoption of effective curricula. Diffusion theory provides a framework for understanding why some school systems do not implement comprehensive, sequential, and behaviorally oriented curricula. Reasons for failure to provide optimal health education include competition for time, unawareness of resources and research results, political considerations, long-range planning difficulties, lack of teacher training, lack of testing, other academic priorities, uncertainty about responsibility for health education, and costs. Health educators can overcome such difficulties by working within existing curricular agendas, political interests, and budgets, and by organizing interventions through school health councils, while recognizing local programs, conditions, and resources.

Adolescent↗
PubMed2006

Perspectives on dental education in mainland China.

The Chinese dental education system has undergone major changes over the past three decades. Although a number of approaches have been adopted for the modification of the dental curriculum, the greatest challenge remains as to how to develop enough qualified dentists to meet the dental care needs of China's 1.3 billon population. In many areas the limited funds have been mainly used for the enhancement of academic status while the clinical training programmes for the improvement of practical skills of the clinicians has been greatly neglected. In addition, the discrepancies in the distribution of dental resources have been increasingly alarming and have the tendency toward becoming even more serious in the future. The aim of this review is to describe dental education in China in the hope that more favourable changes could take place and the system itself could be further optimised.

China↗
PubMed1996

New training guidelines: what are the implications for cardiological research?

The recognition of the importance of research experience is welcomed; committed research supervisors should be identified for each trainee and research planning should start as early as possible in the traineeship. It would be welcome if employing authorities and postgraduate deans were to provide personal support for up to one year and modest research expenses for trainees undertaking research. In the absence of such support, application would need to be made to grant-giving bodies well in advance. Certain posts may need to be earmarked for the training of future clinical scientists. Academic units should regard themselves as challenged, but not necessarily threatened, by the new proposals. With appropriate consultation and involvement, and a modest allocation of funding, the overall result should enhance the quality of both service and academic communities.

Academic Medical Centers↗
PubMed1996

On the making of a clinical nutritionist.

Clinical nutrition may be defined as the application of the principles of nutrition science and medical practice to the diagnosis, treatment, and prevention of human disease caused by the deficiency, excess, or metabolic imbalance of nutrients. At present, many physicans do not appreciate the great traditions established by their forebears in this field (Hippocrates, Lind, Eijkman, Glisson, Casal, Livingstone, Hopkins, and Goldberger). They have tended to avoid nutritional problems, plead ignorance of nutrition principles, and delegate the nutritional care of their patients to paramedical personnel. Only by changing this situation can members of the medical profession offer adequate care to their patients. In this chapter, I have attempted to present the duties and responsibilities of a clinical nutritionist in an academic environment. A well-trained academician in such a position can improve the education of medical students in nutrition, attract well-motivated graduates into nutrition training programs, and establish clinical nutrition as a bona fide subspecialty of medicine.

Animals↗
PubMed1981

Beyond the old state hospital: new opportunities ahead.

Despite criticism from many quarters, the state hospitals continue to perform important roles in patient care, evidenced by increasing admissions in recent years. The hospitals serve as back-up facilities for patients who cannot be treated in community settings, and, because of their size, they are able to offer specialized services that community-based programs cannot provide. In addition, smaller patient populations and stricter rules about adequacy of staff and treatment programs have opened up new opportunities for hospitals to move into other important areas involving affiliation with academic centers, such as professional training and clinical research. Because of the state hospital's central role in a growing number of legal and public policy issues, professionals in such facilities must become active participants in the decision-making processes that shape mental health policy and determine the quality of patient care.

Commitment of Persons with Psychiatric Disorders↗
PubMedDate not supplied

Mammographers' perception of women's breast cancer risk.

OBJECTIVE: To understand mammographers' perception of individual women's breast cancer risk. MATERIALS AND METHODS: Radiologists interpreting screening mammography examinations completed a mailed survey consisting of questions pertaining to demographic and clinical practice characteristics, as well as 2 vignettes describing different risk profiles of women. Respondents were asked to estimate the probability of a breast cancer diagnosis in the next 5 years for each vignette. Vignette responses were plotted against mean recall rates in actual clinical practice. RESULTS: The survey was returned by 77% of eligible radiologists. Ninety-three percent of radiologists overestimated risk in the vignette involving a 70-year-old woman; 96% overestimated risk in the vignette involving a 41-year-old woman. Radiologists who more accurately estimated breast cancer risk were younger, worked full-time, were affiliated with an academic medical center, had fellowship training, had fewer than 10 years experience interpreting mammograms, and worked more than 40% of the time in breast imaging. However, only age was statistically significant. No association was found between radiologists' risk estimate and their recall rate. CONCLUSION: U.S. radiologists have a heightened perception of breast cancer risk.

Adult↗