Sociopsychological characteristics of resident psychiatrists and their use of drug therapy.
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Humans↗
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Professional career characteristics of residency trained emergency physicians.
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Emergency Medicine↗
The Ontario Family Medicine Residents Cohort Study: factors affecting residents' decisions to practise obstetrics.
BACKGROUND: The number of family physicians practising obstetrics in Canada is declining. On the assumption that factors related to the obstetrics training of family medicine residents may be influencing this trend, we conducted a cohort study of residents' stated intentions with regard to practising obstetrics, their educational experiences and their subsequent obstetric practice. METHODS: We followed a cohort consisting of all residents who enrolled in family medicine residency programs in Ontario in 1994 and 1995. The data, collected by mail-in survey at entry to, during and 2 years after completion of the 2-year training programs, consisted of residents' characteristics, stated plans during residency to practise obstetrics, obstetric experiences during training, attitudes and opinions related to obstetrics, and actual practice 2 years after completion of residency. We used logistic regression to determine the factors influencing whether a family physician practises obstetrics after graduation. RESULTS: Of the 498 residents who started programs in 1994 and 1995, 480 were eligible for inclusion, although not all of those eligible responded to the various surveys. At entry into the residency programs, 216 (52%; 95% confidence interval [CI] 47-57%) of the 411 respondents expressed an intention to practise obstetrics. By the end of residency, the proportion intending to practise obstetrics had fallen to 17% (95% CI 13-22%; 46 of 274 respondents), and only 16% (95% CI 12% to 20%) were actually practising intrapartum obstetrics (i.e., delivering babies) 2 years later. The proportions of residents in the 7 Ontario family medicine programs who were actually practising obstetrics 2 years later ranged from 2% of those from the University of Western Ontario to 38% of those from Thunder Bay. Three factors were independently associated with practising intrapartum obstetrics 2 years after completing residency: intention at the end of residency to practise intrapartum obstetrics (odds ratio [OR] 11.7, 95% CI 3.1-44.7, p = 0.001), not having the opinion that intrapartum care is too disruptive of personal life (OR 9.1, 95% CI 1.5-55.5, p = 0.02) and practising in a community of 15 000 or fewer people (OR 6.0, 95% CI 1.8-19.4, p = 0.003). INTERPRETATION: Residents who have positive attitudes toward obstetrics at the end of their training and who intend at that time to perform deliveries are more likely to be doing so 2 years later, especially if they practise in communities of 15,000 or fewer people.
Career Choice↗
[Biochemical polymorphic systems and psychological characteristics in residents of the Soviet North-East].
15 biochemical polymorphic systems (AcP, PGM, GPT, GLO-1, EsD, PGP, Pp, AK, Gc, Hp, Tf, BO, MN, Le, P) were comparatively studied which possess psychodiagnostic features investigated by means of all-round personality study and 16-factors Kettle personality inventory in 340 healthy residents of Magadan. With the aid of computer cluster analysis, psychodiagnostic features were revealed which authentically differentiate clusters consisting of 5 combined polymorphic systems, three of them being different. Frequency of particular loci participation in differentiation of persons for psychodiagnostic tests is well-coordinated with a degree of their participation in genotype differentiation in those who left and remained in the region. Interrelations between psychological personality features and individual heterozygosis for 12 loci with codominant inheritance are determined. Authentic differences between low- and highly-heterozygous individuals are revealed using the same psychodiagnostic parameters as those in the cluster analysis.
Adaptation, Physiological↗
[Health institution for the elderly--quality of service and characteristics of residents].
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Aged↗
Characteristics of long-term-care facility residents associated with receipt of influenza and pneumococcal vaccinations.
BACKGROUND: Studies have found residency in long-term-care facilities (LTCFs) a risk factor for influenza and pneumonia and have demonstrated that vaccinations against these diseases reduce the risk of disease. However, rates are below Healthy People 2010 goals of 90% for LTCFs. During 1999-2002, a multi-state demonstration project was conducted in LTCFs to implement standing orders programs for immunizations. OBJECTIVE: Identify nursing home resident-specific characteristics associated with vaccination coverage at baseline. METHODS: Facility-level data were collected from self-reported surveys of selected nursing homes in 14 states and from the On-line Survey and Certification Reporting System. Resident-level data, including demographics and physical functioning, were obtained from the Centers for Medicare & Medicaid Services' Minimum Data Set; 2000-2001 vaccination status was obtained by chart review. Influenza vaccination status reflected a single season, whereas pneumococcal vaccination status reflected vaccination in the past. Multilevel analysis was used to control for facility-level variation. RESULTS: Of 22,188 residents sampled in 249 LTCFs, complete data were obtained for 20,516 (92%). The average coverage for immunizations was 58.5% +/- 0.7% for influenza and 34.6% +/- 0.3% for pneumococcal. On bivariate analyses, residents with cognitive, psychiatric, or neurologic problems were more likely to be vaccinated; those with accidental injuries, unstable conditions, or cancer were less likely to receive either vaccine. On multilevel analysis, the strongest resident characteristics associated with receipt of immunizations, controlling facility variation, were cognitive deficits and psychiatric illness. CONCLUSION: The variation in baseline vaccination coverage associated with LTCF resident characteristics supports the need for strategies to increase vaccination coverage in LTCFs.
Aged↗
Picking behaviour in cognitively impaired residents in geriatric settings: prevalence of the behaviour and characteristics of the residents.
This paper presents the findings of a point prevalence study performed at all geriatric settings within a county in Northern Sweden. The aims of the study were twofold: to investigate the prevalence of picking behaviour in cognitively impaired residents in various kinds of geriatric care settings and describe the characteristics of the residents, and to investigate how the residents who exhibit picking behaviour are experienced by their care providers. The study comprises 1928 cognitively impaired residents. The prevalence of picking behaviour was found to be 17%. Multivariate analyses showed that behavioural and psychiatric symptoms such as 'often stands at the outer door and wants to go out', 'wanders alone or with other patients back and forth', 'aggressive threats to patients and staff' and being 'manic' and 'fearful' were associated with picking behaviour. Other factors associated with picking behaviour were 'taking part in daily tasks', 'can walk without assistance' and imposing a high psychological workload. Furthermore, residents who exhibited picking behaviour were experienced by care providers as more uncertain and unhappier than residents who did not behave in this way.
Activities of Daily Living↗
Risk factors that predict staff failure to release nursing home residents from restraints.
This study identifies resident characteristics related to nursing staff failure to provide consistent release from physical restraints as required by regulation. The lengths of intervals during which residents were restrained were measured and correlated with the staff's perception of degree of care burden and resident behavioural characteristics in order to identify risk factors related to the absence of consistent release. Staff perceptions of residents' verbal aggressiveness (multiple R = -.30, p < .01), physical aggressiveness (multiple R = -.25, p < .03) and unpleasantness (multiple R = -.25, p < .03) are the three characteristics most predictive of the length of time residents continuously remain restrained.
Aged↗
Recognition of depression by internal medicine residents.
We studied the ability of internal medicine residents to recognize depressive symptoms in a population of lower socio-economic primary care patients. Four hundred twenty patients completed the short form of the Beck Depression Inventory (BDI). Simultaneously, the resident caring for the patient estimated the degree of depression for each patient. One-fourth of the patients scored at or above the moderately depressed level on the BDI and the residents rated 23 percent of their patients as at least moderately depressed. However, the accuracy of the residents' assessment of his or her individual patient was poor (correlation = 0.42, sensitivity = 0.46, specificity = 0.84). Patients with a prior history of psychiatric disorder scored higher on the BDI and were given higher ratings of depression. No other pre-existing medical condition was significantly associated with a higher or lower BDI score. The amount of alcohol consumed and the amount smoked, were both associated with higher BDI scores. Residents varied in their sensitivity to their patients' BDI scores. Some showed high agreement with BDI scores, others low. There were no specific resident characteristics (e.g. year of training, resident gender) that could explain this variability. Patients with a history of depression were given lower resident ratings compared to other patients and patients with a history of depression were given lower resident ratings than predicted by their BDI scores. Residents' ability to accurately diagnose and treat depression in the underprivileged primary care patient can be facilitated by the institution of depression screening in the ambulatory clinic.
Adolescent↗
[[Coresidence with parents and marriage in modern Japan]].
Marriage trends and parental coresidence in Japan are analyzed using data on 9,000 couples from the 1987 Ninth National Fertility Survey. Consideration is given to age at marriage, residence characteristics, birth order, family size, and intergenerational transfers related to birth order. The author finds that "the percentage of children coresiding with parents at marriage has hardly changed and continued to be about 30 percent...since [the] 1960s." Comments on these findings by Kiyomi Morioka, Nobuyoshi Toshitani, and Makoto Atoh are included in Japanese (pp. 71-3). (SUMMARY IN ENG)
Asia↗
Case mix adjustment in nursing systems research: the case of resident outcomes in nursing homes.
Case mix indicates, for a resident population, the degree of risk for developing favorable or unfavorable outcomes. In a study of 164 nursing homes, we explored two methods for combining resident assessment data into a case mix index (CMI). We compared a facility-level, composite CMI to a prevalence-based CMI comprised of 22 separate resident characteristics for their adequacy in explaining resident outcomes. The prevalence-based CMI consistently explained more variance in outcomes than the facility level, composite CMI. This study indicates a reasonable method for using administrative databases containing resident assessment data to adjust for the influence of case mix on nursing home resident outcomes.
Fractures, Bone↗
Mealtimes as active processes in long-term care facilities.
Mealtimes are central to the nutritional care of residents in long-term care facilities. There has been little Canadian research to guide interdisciplinary practice around mealtimes. This study included a grounded theory approach to explore mealtime experiences of 20 people with dementia living in two long-term care facilities, and the meal-related care they received from registered nurses, health care aides, and dietitians. Theoretical sampling directed the collection and analysis of data from mealtime observations in special care units and key informant interviews with care providers. The constant comparison method was used to analyze and conceptualize the data. A substantive theory emerged with three key themes: 1. Each mealtime is a unique process embedded within a long-term care facility's environment. 2. Residents are central to the process through their actions (i.e., arriving, eating, waiting, socializing, leaving, and miscellaneous distracted activities). 3. Internal (i.e., residents' characteristics) and external (i.e., co-resident, direct caregiving, indirect caregiving, administrative, and government activities) influences affect residents' actions at mealtimes. The theory suggests that optimal mealtime experiences for residents require individualized care that reflects interdisciplinary, multi-level interventions.
Aged↗
Case mix for nursing home payment: resource utilization groups, version II.
A study of 3,427 nursing home residents in New York State, measuring both resources used and resident characteristics, was used to develop a resident classification system for payment purposes. The system balances clinical, statistical, and administrative criteria, making it useful both for the New York State Medicaid payment system and for quality of care and facility management.
Activities of Daily Living↗
Variations in the outcomes of care provided in Pennsylvania nursing homes. Facility and environmental correlates.
This research study utilizes indicators from federal and state surveys to evaluate variation in outcomes in 438 Medicare certified skilled nursing care facilities in Pennsylvania. First, a standardization function adjusting for patient characteristics known to influence outcomes was developed and estimated. The relationships between organizational and environmental characteristics and the chosen outcome indicators (i.e., differences between the actual and expected rate of mortality, pressure ulcers, urethral catheterization and physical restraints) were then analyzed by weighted least squares regression. Results suggest considerable interfacility variation in rates for these outcome indicators. A portion of this variation is significantly attributable to resident characteristics (P < or = 0.05). However, variation in outcomes in Pennsylvania facilities is also associated with facility characteristics (e.g., size and for-profit status), and environmental characteristics (e.g., per capita income and bed supply). Implications for nursing home management and policy are considered.
Aged↗
The effect of training on the provision of elective abortion: a survey of five residency programs.
OBJECTIVE: We investigated the correlation of residency abortion training and other variables with abortion provision. STUDY DESIGN: We surveyed obstetrician-gynecologists who graduated from five residency programs. Subjects were asked about demographic characteristics, residency abortion training, and abortion provision. We used a logistic regression model that included all variables that were correlated significantly with abortion provision in univariate analyses. RESULTS: Of 161 physicians (61%) who responded, 131 physicians (83%) participated in abortion training. Seventy-six physicians (47%) provided abortions currently, and 95 physicians (58%) had provided abortions at some time since residency. Three variables were independently, positively correlated with abortion provision: the number of abortions that were performed during residency, the gestational age limit of abortion training, and urban practice. Negatively correlated with provision were membership in a restrictive practice and training outside the teaching hospital. CONCLUSION: Variables that were indicative of more extensive residency abortion training were associated positively with the current provision of abortion.
Abortion, Induced↗
The quality of the quality indicator of pain derived from the minimum data set.
OBJECTIVE: To examine facility variation in data quality of the level of pain documented in the minimum data set (MDS) as a function of level of hospice enrollment in nursing homes (NHs). DATA SOURCE: Clinical assessments on 3,469 nonhospice residents from 178 NHs were merged with On-line Survey Certification and Reporting data of 2000, Medicare Claims data of 2000 and the MDS of 2000-2002. STUDY DESIGN: Using the same assessment protocol, NH staff and study nurses independently assessed 3,469 nonhospice residents. Study nurses' assessments being gold standard, we quantified and compared quality of NH staff's pain rating across NHs with high, medium, or low hospice use. Multilevel models were built to assess the effect of NH hospice use levels on the occurrence of false positive (FP) and false negative (FN) errors in NH-rated "severe pain." PRINCIPAL FINDINGS: Of 178 NHs, 25 had medium and 41 high hospice use. NHs with higher hospice use had lower sensitivities. In multilevel analysis, we found a significant facility-level variation in the probability of FP and FN errors in facility-rated "severe pain." Resident characteristics only explained 4 and 0 percent of the facility variation in FP and FN, respectively; characteristics and locations (state) of NHs further explained 53 and 52 percent of the variance. After controlling for resident and NH characteristics, staff in NHs with medium or high hospice use were less likely to have FP or FN errors in their MDS documentation of pain than were staff in NHs with low or no hospice use. CONCLUSIONS: The examination of data quality of pooled MDS data from multiple NHs is insufficient. Multilevel analysis is needed to elucidate sources of heterogeneity in the quality of MDS data across NHs. Facility characteristics, e.g., hospice use or NH location, are systematically associated with overrated/underrated pain and may bias pain quality indicator (QI) comparisons. To ensure the integrity of QI comparison in the NH setting, the government may need to institute regular audits of MDS data quality.
Aged↗
Perceived safety of area of residence and exercise: a pan-European study.
The authors examined the association between perceived safety of neighborhood and likelihood of exercise among adult residents of eight European cities. Data were collected by a survey of neighborhood, housing, and health conducted by the World Health Organization in 2002 and 2003. Baseline category logistic regression models were fit to estimate the association between perceived safety and exercise, accounting for demographic and place-of-residence characteristics. Among women, perception of safety was associated with a 22% (95% confidence interval: 1.00, 1.54) and a 40% (95% confidence interval: 1.03, 1.91) elevation in the odds of occasional and frequent exercise, respectively. Among men, perception of safety was associated with a 39% elevation in the odds of occasional exercise, but there was no association with frequent exercise. If these findings were replicated, they would suggest that health promotion efforts could target residential areas without the need to identify specific persons.
Adolescent↗
Description of the National Pressure Ulcer Long-Term Care Study.
OBJECTIVES: To describe and provide baseline data from The National Pressure Ulcer Long-Term Care Study (NPULS). DESIGN: Retrospective cohort study of detailed resident characteristics, treatments, and outcomes using convenience sampling. SETTING: One hundred nine long-term care facilities throughout the United States. PARTICIPANTS: Two thousand four hundred twenty adult residents aged 18 and older, with a length of stay of 14 days or longer and who were at risk of developing a pressure ulcer, as defined by a Braden Scale for Predicting Pressure Sore Risk MEASUREMENTS: More than 500 characteristics were obtained for each resident over a 12-week period. This paper describes the NPULS database with respect to the resident (sex, age, diagnoses, severity of illness scores, Braden Scale score, activities of daily living, cognitive ability, mobility, bowel or bladder incontinence, laboratory values, nutritional assessment, and pressure ulcer assessment documentation), treatment (nutritional interventions, pressure relieving devices, incontinence interventions, protective devices, turning schedules, and pressure ulcer treatments), and outcome variables (pressure ulcer development and healing, pressure ulcer and systemic infection, changes in nutritional status, and discharge disposition) associated with pressure ulcers. Descriptive statistics and bivariate associations were used for preliminary analyses of resident, treatment, and outcome characteristics. RESULTS: The average age +/- standard deviation was 79.7 +/- 14.2; 70% of the residents were female. Fifty-three percent of residents (n = 1,293) were at risk of developing a pressure ulcer but never developed one during the study (Group 1), 19% developed a new pressure ulcer during the study (n = 457) (Group 2), 22% had an existing pressure ulcer (n = 534) (Group 3), and 6% had an existing pressure ulcer and developed a new ulcer during the study (n = 136) (Group 4). Residents who developed a new pressure ulcer (Group 2) were more likely to be female, older, cognitively impaired, and immobile than residents who had an existing pressure ulcer (Group 3). CONCLUSIONS: This baseline study describes the NPULS database with respect to the resident, treatment, and outcome variables associated with pressure ulcers. Future studies will focus on multivariate analyses for risk factor prediction of pressure ulcer development and pressure ulcer healing. Research-based pressure ulcer prevention and treatment protocols can then be developed.
Adolescent↗