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PubMedDate not supplied

A case report: special needs of hospitalized elders.

A case report is used to discuss common problems and complications of hospitalized elders. The report also illustrates the need for proactive hospital staff who are knowledgeable about the special needs of the aging population if this group is to be cared for successfully. The geriatric resource nurse model involves informal unit-based education aimed at expanding staff nurses' geriatric knowledge and is one of several models sponsored by the Hartford Foundation to improve care of the hospitalized elderly. Teaching rounds between geriatric resource nurses and advanced practice nurses are a primary feature of this model.

Aged↗
PubMed2004

Palliative care education integrated into a geriatrics rotation for resident physicians.

The authors present the curricular elements of a palliative care experience for internal medicine residents at the Medical College of Wisconsin (MCW) and the Zablocki Veterans Affairs Medical Center (ZVAMC), Milwaukee, Wisconsin. To improve resident physicians' knowledge and skills in palliative care, a structured clinical/educational experience was integrated into an existing required geriatrics rotation for senior medicine residents. Each month, two residents rotate simultaneously in the palliative care and the geriatrics evaluation and management units at the ZVAMC. The curricular elements of palliative care include prognostication, assessment and management of pain and nonpain symptoms in end-of-life care. The geriatrics component emphasizes mechanisms of aging, pathophysiology of common geriatric diseases, clinical pharmacology and psychosocial aspects of geriatric care. Teaching methods include direct patient care, bedside teaching rounds, lectures, and multidisciplinary and family meetings. Rotation design avoided conflicting time demands on the residents. In a prerotation/postrotation knowledge self-assessment questionnaire, residents (n = 28) indicated significant knowledge improvement in all palliative care domains taught during the experience. The rotation was well integrated into the existing curricular elements in geriatrics and palliative medicine at MCW. This combined rotation can serve as a reference for educators interested in developing new or enhancing existing palliative care training programs.

Clinical Competence↗
PubMed1998

The clinical epidemiology ward round: can we teach public health medicine at the bedside?

BACKGROUND: The clinical epidemiology ward round (CEWR) is an educational tool for integrating the teaching of epidemiology with clinical paediatrics. It aims to facilitate the acquisition of the knowledge, skills and attitudes that promote the effective application of epidemiological insights into routine clinical practice. This paper describes experience of the CEWR in a UK medical school and initial student responses to it. METHODS: Since 1995, the CEWR has formed an integral part of the clinical teaching given to all final phase medical students during their eight-week child health course at the University of Glasgow. It took place in a general paediatric ward of the Royal Hospital for Sick Children, Glasgow. Groups of up to seven students were taught by a clinical epidemiologist with a strong research interest, as well as clinical experience, in child health. Each round lasted approximately 90 minutes and the teaching style was informal and interactive. At the end of the child health course, students were asked a series of questions relating to the CEWR's educational objectives. RESULTS: The evaluation indicated that the CEWR had been well received by students, 85 per cent of whom said it was an excellent or good idea in principle, and 71 per cent of whom said it worked well in practice. Most students seemed unconvinced about its role in reinforcing epidemiological knowledge or in clinical skill development. CONCLUSION: The CEWR requires further development but offers a potentially inexpensive, effective and enjoyable vehicle for integrating the teaching of two previously separate components of the curriculum.

Adult↗
PubMed1987

Levels and causes of stress among residents.

Medical and dental residents at the University of Rochester Medical Center were surveyed to measure stress and its causes. Their stress, as measured by the brief symptom inventory, showed levels slightly above those of an adult comparison group. The average levels of stress decreased with the residents' advancing levels of training. Comparison of the top quartile with the lowest quartile of scores of everyday stress showed significantly elevated stress for rotations in the emergency room, greater frequency of being on call, and lesser amount of sleep. The residents' reports showed that the bleakest three days of residency tended to occur in the first year and during intensive care rotations. Stress during these bleakest times was significantly higher than everyday levels. The residents described the major causes of distress during bleakest times as lack of sleep, inadequate support from senior professionals, large patient load, and competition from peers. "High quality" teaching rounds, a night-float system, and sick leave were felt by the residents to lessen stress. To cope with the stress, the residents reported they talked to others, tried to see humor in the situation, or slept.

Adaptation, Psychological↗
PubMed2006

Merging cultures: palliative care specialists in the medical intensive care unit.

We summarize the key interventions and general findings from a 3-yr project titled, "Merging Palliative and Critical Care Cultures in the Medical Intensive Care Unit." This multifaceted demonstration project was designed so palliative care and intensive care clinicians would share their expertise and develop projects that promote end-of-life care in a medical intensive care unit (ICU) setting. A variety of interventions are described, including collaborating with ICU leaders, training nurses as "palliative care champions," opening visiting hours, educating house officers and other staff about relevant palliative practices, establishing the presence of a palliative care specialist during work rounds, teaching about and promoting family meetings, introducing a "Get to Know Me" poster, staff support efforts, and modeling of interdisciplinary teamwork. Additional problems were noted but not well addressed, particularly routine communication with families and continuity of care for complex patients leaving the ICU.

Attitude of Health Personnel↗
PubMed2007

Physician-scientist, heal thyself . . .

Historically, physician-scientists have had dual roles in caring for patients and in performing investigative research that could potentially lead to new diagnostics and therapeutics. Physician-scientists conducted teaching rounds in the hospital, surrounded by eager house staff and medical students, and were often avidly pursued as the most important sources of new knowledge for trainees. But alas, times have changed. Now physician-scientists are rarely seen in the hospital; they are most often spotted at their desks tapping out yet another grant application. Most struggle to find the time to mentor students and clinical trainees, let alone to care for patients in the hospital, even though these interactions are often the motivating forces for scientific creativity.

Education, Medical↗
PubMedDate not supplied

A comparison of two methods for indexing and retrieval from a full-text medical database.

The objective of this study was to compare how well medical professionals are able to retrieve relevant literature references using two computerized literature searching systems that provide automated (non-human) indexing of content. The first program was SAPHIRE, which features concept-based indexing, free-text input of queries, and ranking of retrieved references for relevance. The second program was SWORD, which provides single-word searching using Boolean operators (AND, OR). Sixteen fourth-year medical students participated in the study. The database for searching was six volumes from the 1989 Yearbook series. The queries were ten questions generated on teaching rounds. All subjects searched half the queries with each program. After the searching, each subject was given a questionnaire about prior experience and preferences about the two programs. Recall (proportion of relevant articles retrieved from the database) and precision (proportion of relevant articles in the retrieved set) were measured for each search done by each participant. Mean recall was 57.6% with SAPHIRE; it was 58.6% with SWORD. Precision was 48.1% with SAPHIRE vs 57.6% with SWORD. Each program was rated easier to use than the other by half of the searchers, and preferences were associated with better searching performance for that program. Both systems achieved recall and precision comparable to existing systems and may represent effective alternatives to MEDLINE and other retrieval systems based on human indexing for searching medical literature.

Abstracting and Indexing↗
PubMed2000

Nutrition Services in Canadian Neonatal Intensive Care: The Role of the Dietitian.

Inclusion of registered dietitians/nutritionists (RDNs) on the neonatal intensive care team has been shown to improve nutrition and growth rates in high-risk infants, shortening their hospital stay. To determine the role of RDNs, 55 neonatal intensive care units (NICUs) and post-discharge services in Canada were surveyed. The response rate was 69%. RDNs were involved in 73% (8/11) of level II and 92% (24/26) of level III units. The average RDN time devoted to the NICU, in full-time equivalents, was 0.2 in level II and 0.5 in level III units. More than 90% of the RDNs develop, evaluate, and modify nutrition care plans, and then document interventions in the health record. Seventy-nine percent of the RDNs participate in teaching rounds and patient care conferences, and make referrals to the community. All of the RDNs instruct patient families. Seventy-one percent of respondents provide family follow-up care after hospital discharge. Forty-six percent work with families of NICU graduates with feeding difficulties. Eighty-two percent provide education to other health professionals. Sixty-eight percent participate in research projects, initiating the majority of these projects. These results provide pertinent information for clinical leaders seeking to establish a role for the clinical dietitian in neonatal intensive care. For those already working in NICUs, the results may provide some guidance on role definition and expansion.

Journal Article↗
PubMed1986

Sexual abuse in the family. Suggestions for medical curricula.

Awareness of the recent escalation of sexual abuse in the RSA has exposed inconsistencies in the intervention and treatment process and has implications for routine health care. Fifth-year medical students at the University of the Witwatersrand are involved with children in institutions as part of their community paediatric course. During 1985, 9 of the 50 students had to deal with children who had previously been sexually abused. The students recognized their limitations in dealing with the sexually abused child and became aware of their own feelings when confronted with this problem. This has implications for the teaching of the dynamics of sexual abuse to medical students. It is suggested that knowledge of sexual abuse and its ramifications be addressed at the medical school curriculum level and be taught in the various clinical departments and incorporated into ward teaching rounds and seminars.

Child↗