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PubMedDate not supplied

Sources of stress and satisfaction in emergency practice.

The purpose of this study was 1) to determine sources of satisfaction in the practice of emergency medicine, and 2) to identify specific stresses experienced by emergency physicians as well as factors that help them to cope successfully with these stresses. A cross-sectional study was done with a sample of 104 physicians employed in emergency departments in 24 private, public, and university-affiliated teaching hospitals in the greater Los Angeles area. An Emergency Physicians Questionnaire was used for data collection. Data revealed that the three greatest sources of satisfaction include 1) proficient use of skills, 2) variety and excitement, and 3) being a member of an effective team. Major stresses reported by emergency physicians were 1) patient load, 2) interaction with patients and families, and 3) lack of administrative support. A longitudinal study should be initiated to follow a sample of emergency physicians from the time of their internship throughout their careers as a means of identifying factors that lead to a satisfying practice of emergency medicine.

Emergency Medicine↗
PubMed2005

Coeliac disease: changing views.

A continuing flow of new scientific developments concerning coeliac disease in the last decade asks for the formulation of new concepts of pathophysiology and clinical considerations. Immunogenetic studies have shown a correlation of the disease to the HLA region on the short arm of chromosome 6, immunological research has led to the concept of a T-cell driven immunologic response of the small intestine, with the identification of highly sensitive and specific antibodies. The understanding of the histopathology of coeliac disease has changed dramatically, initiated by the proposition of a spectrum of gluten sensitive enteropathy by Marsh in 1992. Clinical studies report a significant change in patient characteristics and epidemiology. The incidence of the disease has shifted to a majority of adult coeliacs, the disease may present with less severe symptoms of malabsorption and the screening studies suggest an overall prevalence of up to 1 in 200-300. Histopathology has been standardized; lymphocytic enteritis (Marsh I), lymphocytic enteritis with crypthyperplasia (Marsh II), and villous atrophy, subdivided in partial, subtotal and total (Marsh IIIABC). Special attention is given to a subgroup of 'refractory coeliacs', including the identification of pre-malignant T-cells in the intestinal mucosa. The management of coeliacs primarely consists of monitoring for compliance and complications. Dietetic and medical associations need to establish protocols and offer additional training to undergraduetes, internships, general practitioners and other allied health professionals. It might be relevant to have a low threshold for intestinal biopsies. However, screening asymptomatics may be harmful for individuals. Research is needed to assess the benefits of mass-screening in the future. HLA analysis can contribute towards recognising populations at increased risk.

Celiac Disease↗
PubMed2004

A de novo model of rational pharmacotherapy training: the interns' perspective.

Background: Poor prescribing habits can lead to ineffective and unsafe treatment, exacerbation or prolongation of illness, distress and harm to the patient, and higher costs. Rational pharmacotherapy training is very important for reducing poor prescribing practices, especially in developing countries. The aim of this study was to evaluate interns' satisfaction with a rational pharmacotherapy training program at the Department of Internal Medicine of our university. Methods: Rational pharmacotherapy training, designed by the WHO Action Program on Essential Drug Advice, was the subject of the study. Interactive learning methods, such as small group discussions and role-playing, were used as training methods. All of the interns in the class of 2003 participated in the training during their internal medicine internship period. Perceptions of the interns were collected via a 15-item feedback questionnaire. A 5-point Likert scale was used for scoring, and mean values were calculated for every item. Results: Mean values of all items were higher than 4, except for the control item. Interns' satisfaction with the training differed significantly in the third week, which focused on the physician-patient relationship. Interns suggested that this training should be performed in other classes and apprenticeship periods. Conclusions: This was the first training program in Turkey. Rational pharmacotherapy training should be integrated into the medical curriculum and performed using a multidisciplinary approach.

Journal Article↗
PubMed2006

Needlestick injuries during medical training.

Medical students are at risk of acquiring infections caused by needlestick injuries, although it is unknown when needlestick injuries are most likely to occur during medical training. The aim of this study was to define high-risk periods over the course of medical training. A cross-sectional study was conducted among medical students in the first, third, fourth and fifth years of training at two medical schools in Munich. Overall, 1317 (85%) students returned a questionnaire on demographic data, vaccination status against hepatitis B, lifetime prevalence of needlestick injuries, level of knowledge about measures after such accidents, and transmission risks. Lifetime prevalence of needlestick injuries was 23%, ranging from 12% in first year students to 41% in fourth year students. These accidents happened most commonly during medical internships, especially during blood-taking practices; an activity that usually starts during the third year of training. The frequency of respondents not vaccinated against hepatitis B also varied between first (21%) and fourth (6.6%) year students. Needlestick injuries occur frequently and early on in medical training. In order to decrease the risk of preventable infections, complete coverage of vaccination against hepatitis B should be achieved early in medical training.

Adult↗
PubMed2006

Back to the beginnings: an autobiography.

After receiving BS and MS degrees from the University of Washington in Seattle, I entered its new medical school in 1947, receiving an MD degree in 1951. After internship and residency, I obtained a 2-year postdoctoral fellowship in hematology under the guidance of Dr Clement Finch. The last 6 months of the fellowship were spent in London, England, at Dr Patrick Mollison's Blood Transfusion Research Unit. There I met and worked with Marie Cutbush (later Crookston) who has been a long-term friend. On returning to Seattle, I joined the faculty of the medical school and became the associate director of the Puget Sound Blood Center. There, I supervised the blood typing and cross-matching laboratory, introducing methods I had learned in London and measuring the effectiveness of various cross-matching procedures. My own research was largely directed toward human genetic polymorphism, and I wrote a textbook published in 1969, describing the biochemical structure, function, inheritance, and geographic distribution of the genetic markers. Subsequently, I discovered that 2 forms of inherited immunodeficiency disease were due to deficiencies of the enzymes adenosine deaminase and purine nucleoside phosphorylase. In 1979, I became the director of the blood center and was shortly afterwards elected to the National Academy of Sciences. I retired in 1987 and have spent most of the intervening years relearning to play the violin and exploring the wonders of chamber music.

Blood Banks↗
PubMed2002

Nursing school curricula and hospital-based training programs.

Perioperative nursing is at the threshold of an unprecedented shortage that may affect the profession for years to come as the existing workforce ages and nursing schools continue to marginalize perioperative curricula. The purpose of this study is to investigate perioperative staffing issues, preceptorship training programs, and nursing school curricula in the metropolitan area surrounding the city of San Jose, Calif. Results show that 77% of the ORs surveyed had vacant positions and experienced moderate to severe difficulty in filling these vacancies. Results for the schools of nursing show that 83% do not offer preceptorships or clinical internships in the perioperative setting. Recommendations regarding the development of professional, community, and academic partnerships to help address the perioperative nursing shortage are presented.

California↗
PubMed2000

Model for multicultural nutrition counseling competencies.

A model for multicultural nutrition counseling competencies for registered dietitians was developed and tested. Six hundred four registered dietitians who were members of The American Dietetic Association Public Health Nutrition Practice Group or directors of dietetic internships and didactic programs in dietetics were selected by a stratified random sample method and were mailed a survey. Respondents rated each of 46 competencies using a Likert scale to delineate how essential each competency will be for entry-level dietitians in the next 10 years. Of the 60% who responded (n=363), 94.4% met the study selection criteria. Most were white (85.7%), spoke English as their primary language (96.8%), and had a master's degree (64.4%). Many (37.9%) worked in community/public health facilities or organizations, and 50.4% provided nutrition counseling or education to clients culturally different from themselves. Exploratory principal components analysis extracted 3 factors with 28 competencies loading on them: multicultural nutrition counseling skills, multicultural awareness, and multicultural food and nutrition knowledge. Subjects responded similarly whether or not they provided nutrition counseling to culturally different clients. Secondary analysis revealed no significant interaction or differences between how bilingual dietitians and those of color scored items in the 3 factors. The resulting model is a guideline that can be used by educators to enhance dietetics education and training and by public health nutritionists as a basis for self-evaluation and selection of continuing education opportunities to enhance their multicultural nutrition counseling competence.

Clinical Competence↗
PubMed1995

Eating disorders: current nutrition therapy and perceived needs in dietetics education and research.

OBJECTIVE: Research was conducted to obtain a profile of nutrition therapy currently in practice for patients with anorexia nervosa, bulimia nervosa, and anorexia/bulimia (mixed diagnosis) and to identify the areas of dietetics education and research regarding eating disorders that need more attention. DESIGN: A cross-sectional correlational survey was conducted by mailing a questionnaire composed of open- and closed-ended questions to US dietitians who work with patients who have eating disorders. SAMPLE: Of 199 dietitians selected from a list of 495 representing all geographic areas of the United States, 117 responded. The list was obtained from a national referral network for eating disorders. STATISTICAL ANALYSIS: chi 2 Analysis was completed on all closed-ended answers. Pearson's correlation coefficient with a value of P < .05 was considered significant. RESULTS: Nutrition therapy administered varied among dietitians treating inpatients, outpatients, and both. Three community groups were identified as most important to reach for prevention of eating disorders: junior high school students, coaches, and parents. Crucial areas of research were perceived by 94 dietitians to be comparative effectiveness of techniques of medical nutrition therapy (n = 55) and of techniques of prevention (n = 26) and increased understanding of etiology in relation to identification of high-risk groups and prevention (n = 21). Dietitians desired further information on multiple topics related to eating disorders. APPLICATION: Medical nutrition therapy for eating disorders is a specialization that requires education and training beyond the minimum required for dietetic registration. Some of the techniques required are unique to this specialization due, in part, to the psychological nature of the disorders. All dietitians, however, must be able to recognize and refer patients with eating disorders; these skills must be included in basic undergraduate programs and internships. This study supports the need for more research concerning the outcomes of nutrition therapy and the effectiveness of prevention programs.

Anorexia Nervosa↗
PubMed2003

Emergency nursing: historical, current, and future roles.

Building upon a historical context, the current and future roles of the clinical emergency nurse are reviewed. For several reasons, emergency nurse availability is expected to be insufficient to meet staffing demands in the near future. Emergency physicians can partner with emergency nurses and hospital administrators to pursue the following strategies for addressing the nursing shortage: (1) improve the workplace environment by improving nurse-to-patient ratios and avoiding the boarding of admitted patients in the emergency department (ED); (2) refocus the emergency nurse job description to patients and their families; (3) promote mutually supportive relationships and comradeship between emergency nurses and physicians; (4) create an environment that allows unique solutions to staff scheduling and accommodates shiftwork; (5) increase nursing wages, and recognize special contributions of emergency nurses with financial reward; (6) identify and promote the personnel of the hospital ED as members of an elite unit; (7) develop preceptorships and internships for nurses new to emergency nursing and invest in clinical specialists or nurse-mentors to assist in "on-the-job" instruction of nurses with previous experience; and (8) invest in nursing education. Taking these steps today will strengthen the ED health care safety net for decades to come.

Clinical Competence↗
PubMed2002

Medication- and illness-related factual knowledge, perceptions and behaviour in angina pectoris patients.

As part of a study in Danish internship pharmacies, 70 fourth-year pharmacy interns interviewed 123 angina pectoris patients. Information was collected about the patients' medication- and illness-related factual knowledge and perceptions as well as their medication use. The results obtained showed that patients' perceptions and factual knowledge about medications and illness varied greatly, and that they administered their medication in a variety of ways. Patients' factual knowledge on illness, illness prevention and the function of medication was generally low. The patients were grouped in different categories according to their perceptions of illness and medication. A quarter had actively and reflectively self-regulated their medication and the rest of the patients did not do any deliberate self-regulation in terms of their medication. Half of the patients occasionally forgot to take their medication. Health care personnel should incorporate the results of this study in their efforts to improve patient counselling on illness, medication and other health-related matters.

Aged↗
PubMed2002

Global veterinary leadership.

The public needs no reminder that deadly infectious diseases such as FMD could emerge in any country at any moment, or that national food security could be compromised by Salmonella or Listeria infections. Protections against these risks include the knowledge that appropriate and equivalent veterinary education will enable detection and characterization of emerging disease agents, as well as an appropriate response, wherever they occur. Global veterinary leadership is needed to reduce the global threat of infectious diseases of major food animal and public health importance. We believe that the co-curriculum is an excellent way to prepare and train veterinarians and future leaders who understand and can deal with global issues. The key to the success of the program is the veterinarian's understanding that there is a cultural basis to the practice of veterinary medicine in any country. The result will be a cadre of veterinarians, faculty, and other professionals who are better able (language and culture) to understand the effects of change brought about by free trade and the importance of interdisciplinary and institutional relationships to deal effectively with national and regional issues of food safety and security. New global veterinary leadership programs will build on interests, experience, ideas, and ambitions. A college that wishes to take advantage of this diversity must offer opportunities that interest veterinarians throughout their careers and that preferably connect academic study with intensive experiential training in another country. At its best, the global veterinary leadership program would include a partnership between veterinarians and several international learning centers, a responsiveness to the identified international outreach needs of the profession, and attention to critical thinking and reflection. The global veterinary leadership program we have described is intended to be a set of ideas meant to promote collaboration, coalitions, and discussion among veterinarians and veterinary educators who may be intrigued by the concept. The impact of the program can be summarized as follows: Outreach Programs: The global veterinary leadership program will establish new partnerships between veterinarians and veterinary college faculty as they supervise the international internships and see a relationship between their goals and the value of food safety to this country. Strategic Opportunity: The program will build on the critical role that US veterinarians and veterinary colleges already play in strengthening the safety of free trade in this hemisphere. Diversity in an Age of Specialization: The program will combine a global orientation, language ability, and access to comprehensive, research- and economic-related work/study opportunities to expose veterinarians to the expanding world market for veterinary expertise. New Linkages Through Corporate Partners: Through the success and high visibility of current research and education programs, most veterinary colleges are well positioned to engage industry, government, and university leaders in ways to use the proposed program to increase the flow of new ideas and talent into the world food enterprise. International Funding: A new partnership among veterinarians, industry, government, and university leaders can coordinate strong multilateral requests for funding from national and international sources. An Interdisciplinary Strategy that Benefits Veterinary Medicine: The program will combine the diverse veterinary research and education system with our strong national and international network of collaborators to provide globally competent veterinarians who will be needed for the corporate and public opportunities of the future.

Animal Diseases↗
PubMed1998

Health Initiatives for Youth: a model of youth/adult partnership approach to HIV/AIDS services.

Health Initiatives for Youth (HIFY) in San Francisco, California, is an innovative organization providing health-related services for and by young people funded in part by the Special Projects of National Significance (SPNS) Program. The HIFY Youth Health Initiative (YHI) is composed of eight youth staff and aims to bring about individual and systemic change, enhance the quality of life for human immunodeficiency virus (HIV)-positive and at-risk young people, and increase the responsiveness and youth sensitivity of organizational and community systems. Comprehensive services have been delivered to 136 young men under 25 years, 33.1% of whom are HIV positive, and 164 young women, of whom 12.2% are HIV positive. In addition, thousands of youth and young adults have received lower-intensity services through dozens of educational workshops and presentations. YHI services are implemented through a comprehensive collection of education, training, and support activities that benefit the youth staff who produce them, along with the participants who benefit from the services provided. These activities include a speaker's bureau, health and advocacy trainings, internships, return-to-work and life skills training, publications, and conferences. Regional and national findings suggest that many youth do not yet comprehend their risk for HIV infection or understand the impact of HIV on their community. In direct response to these needs, HIFY programs inform and encourage access to counseling and testing, and provide meaningful access to adolescent care, treatment, and services.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

First-job preferences and expectations of pharmacy students: intergender and interethnic comparisons.

OBJECTIVES: To identify and measure intergender and interethnic differences in preferences and expectations of pharmacy students. DESIGN: Two-part survey. One part addressed systematic variations in work-related expectations and preferences between the sexes and among ethnic minorities that may result from cumulative disadvantage or attitudinal traits; the other part focused on similarities and differences in expected sources of job satisfaction and dissatisfaction. SETTING: College of Pharmacy, Nova Southeastern University. PARTICIPANTS: 171 students enrolled in their final semester of didactic training (that is, immediately before rotations or internship). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Significance of intergender and interethnic disparities was determined using t tests. RESULTS: No significant intergender disparities were detected in income expectations, anticipated level of job satisfaction, estimated time from graduation to passing the Board exam or working, or in preferred or expected sector of first job. African American students expected to earn lower levels of income, experience less satisfaction in their first job as a pharmacist, and work longer hours. Hispanic and Asian American students exhibited less confidence in their ability to pass the Board exam and in the allocative function of the job market. Salary and ability to help patients were the two sources of job satisfaction anticipated most frequently, whereas work overload ranked first among the anticipated sources of job dissatisfaction. CONCLUSION: The rapidly changing gender composition of the profession has altered traditional integender differences in outlook and attitudinal traits, contributing to the disappearance of intergender disparities identified in previous research. However, significant interethnic differences in preferences and expectations suggest the presence of cumulative disadvantage among minorities.

Adult↗
PubMed2003

Whatever happened to Dorothy Reed?

Born in 1874, Dorothy Reed entered the fourth medical school class at Johns Hopkins Medical School. After internship, she spent a year as University Fellow in Pathology, during which time she wrote and illustrated her well-known paper, "On the Pathological Changes in Hodgkin's Disease, With Especial Reference to Its Relationship to Tuberculosis." She left pathology at Hopkins after 1 year because, as a woman, she was told she could not be appointed to the faculty and because of an unhappy love affair. She took training in pediatrics, married a long-time friend, and moved to Madison, WI. Her first two children died tragically; subsequently, she gave birth to two fine boys. She developed a new career as a pioneer in maternal and child health. She established infant welfare clinics in Madison, wrote pamphlets for the United States Children's Bureau, and taught college students child development and sexual hygiene. For the first time, the identity of her lover and his role in establishing her fame is revealed.

History, 19th Century↗
PubMedDate not supplied

[Evaluation of scientific and medical articles].

Quality assessment of publications article is now teached during medical studies and will soon be included into the program of the internship examination. The impact factor of medical journals is frequently used to evaluate the scientific quality of an article and consequently as an index of scientific productivity. Impact factor is an indicator of citation but not of the quality of an article and should not be used as a unique criterion for evaluating the quality of medical or scientific research works.

Curriculum↗
PubMed2003

Collaborative environment for clinical reasoning and distance learning sessions.

BACKGROUND: The medical curriculum has changed with the adoption of the student-centered learning paradigm. Clinical reasoning learning (CRL) is used in order to develop and improve students' clinical reasoning and problem-solving skills. PURPOSE: We have observed that, in complement to traditional CRL sessions, students commonly consult resources available on the internet. Based on this observation, our objective is to create computer tools to coordinate CRL sessions at distance, integrating these electronic resources at every step of the reasoning process. MATERIAL AND METHODS: In order to create the system, we elaborated an object-oriented model of a computer-supported collaborative learning environment. The proposed system includes a local web-server to store electronic resources and a relational database to store their electronic addresses (urls). JAVA was used as the programming language. RESULTS: We developed a set of cooperative platform-independent tools. This environment includes a communication tool. Multimedia data exchange is possible. Information is shared thanks to an electronic notepad and whiteboard tools. PERSPECTIVES: This learning environment will be integrated in the French Virtual Medical University project, and is intended to be used for undergraduate, internships, residency or continuing medical education.

Computers, Handheld↗
PubMed2005

International Master's Program in health technology assessment and management: assessment of the first edition (2001--2003).

BACKGROUND: Despite a clear call for greater input from health technology assessment (HTA) in the areas of clinical practice and policy making, there are currently very few formal training programs. The objectives of our Consortium were to (i) develop a master's level program in HTA, (ii) test its content with a group of Canadian and European students, and (iii) evaluate the Program's strengths and weaknesses. OBJECTIVES: This study presents the results of our evaluation of the first edition of the Master's Program (2001--2003). METHODS: The evaluation relied on (i) a self-administered student questionnaire for each course (n = 142), (ii) interviews with students (n = 10), and (iii) interviews with internship supervisors (n = 5). RESULTS: A vast majority of students were satisfied with the course content and particularly appreciated the exercises and materials presented in an intensive format. However, they needed more systematic feedback from faculty members and recommended increasing the methodology content. The six key characteristics of the program are (i) flexible format adapted to the needs of skilled professionals, (ii) continuous interaction between HTA users and producers, (iii) international academic and professional collaboration, (iv) partnership with HTA agencies, (v) global approach to evidence-based methods and practices, and (vi) multidisciplinary approach. CONCLUSIONS: Despite the numerous organizational barriers inherent to creating an international program and several areas for improvement in the Program itself, the Ulysses Project was successful in attaining its objectives. Because there is a growing need for human resources with special training in HTA, further efforts need to be devoted to strengthening the international research capacity in HTA.

Canada↗
PubMed1998

The ESMO programme of certification and training for medical oncology.

ESMO has designed a programme of certification and training in medical oncology. In this paper the background of these programmes is given, and the programme of graduate education is described in greater detail. The standard requirements are a total training period of six years, beginning with a common internship in internal medicine of at least two years, followed by a training programme in oncology for three to four years, which must include at least one year of full-time clinical training in the diagnosis and management of neoplastic diseases, accompanied by one year of experience in an ambulatory care setting.

Certification↗