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PubMed1998

Identification of communication apprehension in medical students starting a surgery rotation.

BACKGROUND: Most methods used to critically evaluate young surgeons for advancement or certification in surgery require oral communication skills, eg, case and research presentations, rounds, morbidity and mortality conferences, interviews, journal clubs and oral examinations. The irony, though, is that much of surgery training focuses on technical skill lists, and the rhetorical aspects are often neglected until the surgeon encounters failure in an oral examination or is sued for not "talking" appropriately. Early identification of those at risk for difficulty with oral skills would provide programs with time needed to arrange for the appropriate types of interventions. Therefore, the purpose of this study was to identify those medical students with high communication apprehension scores in dyadic, group, or public speaking situations before they encountered failure and caused problems, not only for themselves, but also for their programs and practices. METHODS: Two scales, Willingness to Communicate (WTC) and the Personal Report of Communication Apprehension (PRCA-24), were administered to medical students at two large university medical centers during new student orientation to the surgery rotation. The WTC is a 20-item probability-estimate scale designed to measure one's predisposition toward approaching or avoiding the initiation of communication. The PRCA-24 is a scale designed to measure one's fear associated with either real or anticipated communication in four different contexts. In addition to the 44 items, a lengthy list of demographic items was added for possible correlations. These items were based on the student's perception of the communication or language environment in which he was raised. Therefore, a student ranked past and future socioeconomic status (eg, blue collar or white collar) according to his or her own criteria. The chairman was provided with a list of individual scores. Those students who were below the group means on skills required during a surgery rotation were identified for immediate intervention. RESULTS: The published data show a norm mean of 65.6 for PRCA-24 and 65.2 for WTC for college students. The current study found medical students to be more willing to communicate (WTC) and less anxious about communication (PRCA-24) than college students (mean 70.7 versus 65.2, P = 0.003, and 61.6 versus 65.6, P = 0.01, respectively). This difference was accentuated for blue-collar medical students compared with college students and persisted when blue-collar medical students were compared with white-collar medical students (73.9 blue-collar versus 70.9 college students, P = 0.15 for WTC, and 58.5 blue-collar versus 63.6 white-collar, P = 0.002 for PRCA-24). Male medical students were found to be less anxious about communication than female medical students. CONCLUSIONS: These instruments are easily administered at orientation and produce simple class lists with individual scores. They can be used to identify students who are below the mean for specific forms of communication before they encounter failure.

Clinical Clerkship↗

PubMed1993

Use of goal attainment scaling in measuring clinically important change in the frail elderly.

The selection of appropriate outcome measures is important in evaluating specialized geriatric programs, but how the various measures compare, and which are most appropriate, are matters still largely unexplored. We compared several outcome measures, including goal attainment scaling, to assess their sensitivity to changes in the health status of frail elderly patients admitted to two geriatric medicine wards. GAS is a measurement approach which accommodates multiple individual patient goals, and has a scoring system which allows for comparisons between patients. Forty-five patients (mean age 81 years, 30 females) received comprehensive assessments. GAS yielded a mean 5 goals per patient. The mean gain in the GAS score was 22 points (SD = 7) which was compared with the change in the Barthel Index (r = 0.59), the Functional Independence Measure (r = 0.45), the Physical Self-Maintenance Scale (r = 0.54), the Katz Activities of Daily Living Index (r = 0.49) and the Spitzer Quality of Life Index (r = 0.38). The inter-rater reliability of scoring the GAS follow-up guides was 0.91. Using a relative efficiency statistic, GAS proved more efficient than any other measure. The effect size statistic also demonstrated an increased responsiveness to change of GAS compared with standard measures. GAS is an individualized measurement approach which shows promise as a responsive measure in frail elderly patients.

Activities of Daily Living↗

PubMed1991

AIDS in the workplace: implications for hospice programs.

AIDS presents health care providers with complex medical management issues as well as the need to confront their own fears and prejudices. Hospice programs provide specialized care to persons who are in the final stages of the disease. As the epidemic grows, they increasingly also must respond to HIV-infected staff. A comprehensive workplace program prepares the hospice provider for these challenges and ensures an appropriate response. The four essential elements of such a program are policy development, staff education, supervisory training, and compliance monitoring. Policies to consider include infection control, occupational exposure, confidentiality, and the response to HIV-infected patients and employees. Comprehensive education ensures quality care for AIDS patients. Particularly crucial is the education of managers and supervisors. After policy implementation and training, procedures must be instituted to monitor compliance and develop corrective action. A bibliography of additional resource materials is provided.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Physician health and wellness.

BACKGROUND: Impaired physician health can have a direct impact on patient health care and safety. In the past, problems of alcoholism and substance abuse among physicians have received more attention than other conditions-usually in the form of discipline. While patient safety is paramount, the medical profession may be more successful in achieving the required standards by fostering a culture committed to health and wellness as well as supporting impaired physicians. OBJECTIVE: To develop ethical guidelines regarding physician health and wellness. METHODS: The American Medical Association's (AMA's) Council on Ethical and Judicial Affairs developed recommendations based on the AMA's Code of Medical Ethics, an analysis of relevant Medline-indexed articles, and comments from experts. The report's recommendations were adopted as policy of the Association in December 2003. RESULTS: Individually, physicians can promote their personal health and wellness through healthy living habits, including having a personal physician. The medical profession can foster health and wellness if its members are taught to identify colleagues in need of assistance and initiate appropriate methods of intervention, including referrals to physician health programs. CONCLUSIONS: Physicians whose health or wellness is compromised should seek appropriate help and engage in honest self-assessment of their ability to practice. The medical profession should provide an environment that helps to maintain and restore health and wellness. Physicians need to ensure that impaired colleagues promptly modify or cease practice until they can resume professional patient care. In addition, physicians may be required to report impaired colleagues who continue to practice despite reasonable offers of assistance.

Ethics, Professional↗

PubMed2003

MD/MBA programs in the United States: evidence of a change in health care leadership.

PURPOSE: Managerial sciences are playing an increasingly prominent role in the organization and delivery of health care. Despite popular media reports that a rising number of physicians are acquiring a background in this discipline through MD/MBA (medical and master of business administration) programs, no recent study has verified this. This study measured changes in the number and nature of the affiliations between management and medicine in the form of MD/MBA programs in the United States. METHOD: Surveys of admission officers of 125 U.S. allopathic medical schools and of the overseers of each joint MD/MBA degree program were administered in May-October 2001. Main outcome measures included program growth, curriculum and degree requirements, application and admission requirements, and program leadership and organization. RESULTS: The number of MD/MBA programs grew from six to 33 between 1993 and 2001, and 17 more medical schools were considering establishing the joint-degree program. Ten, 15, and 20 programs produced 27, 42, and 61 graduates in 1999, 2000, and 2001, respectively, and over 100 students were expected to graduate per year when all 33 programs matured. Program structures and oversight indicate a spectrum of philosophies regarding the appropriate level of integration of the two degrees. MD/MBA programs apparently attempt to complement medical education with management education rather than the converse. CONCLUSIONS: The growth in the numbers of MD/MBA programs and participants indicates rising cooperation between medical and business schools and increasing interest in management education early in the careers of graduating physicians.

Career Choice↗

PubMed1993

Intensive case management for children and youth with serious emotional disturbance: an emergent role for nursing?

Since 1988 New York state's Children and Youth Intensive Case Management (CYICM) program has enrolled more than 1700 children. The program goal is to maintain children in the least restrictive environment appropriate to their needs. This linkage and advocacy focused program uses a small caseload (10) and flexible service money to meet its goal. This paper reviews the program model, describes the enrollees, and presents the outcomes related to hospitalization. It also presents a case study of an encounter between a nurse case manager and parents of one of her clients. Finally, it considers the role of case management as an emergent for nurses.

Adolescent↗

PubMedDate not supplied

Training for GMPs.

Training is a dynamic process to assure that personnel are capable of performing their assigned functions. CGMP regulations contain only general expectations, and no FDA guideline regarding training has been issued. Training programs are generally in place in pharmaceutical firms. However, training quality and effectiveness may be inadequate in a number of firms. A pharmaceutical firm should be able to show that its training program consistently meets its training goals as purported, and that each trainee completing an instructional module has acquired the competencies as purported. The proper application of sound principles of instructional design should help firms overcome GMP deficiencies regarding training and personnel qualification. For example, principles of mastery learning, competency-based instruction, performance objectives, a systems approach to instructional design, and the evaluation of instruction as well as the instructional program should help ensure meaningful, relevant training and appropriate, effective instruction. Review of training should be included in the firm's program for managing change. Firms should also ensure adequate training documentation, a positive attitude toward training, and that training is not used inappropriately to remedy performance deviations not resulting from skills deficiencies.

Drug Industry↗

PubMed1977

Programming for articularion modification.

Within the past decade, principles and techniques of programmed instruction have been applied to the procedures of articulation modification in a number of preconstructed programs. The analysis of nine of these programs reveals that the majority of them are characterized by precisely stated objectives, ordered sequences of materials and procedures, clearly established criteria and rigorously controlled methods of reinforcement and recording of responses. Evaluation of the preconstructed programs raises some questions about the appropriateness of certain aspects of the technology to the process of articulation modification.

Evaluation Studies as Topic↗

PubMed2004

Implementation of a new Central Intake system in community care.

This article identifies how the Central Intake process for the community healthcare programs within one Interior Health health services area was restructured to provide clinical screening for all referrals. The process involved complex project management to ensure the respective input from acute, residential and community care programs. The result was the development of a much more effective, clinically led intake system providing more appropriate referrals within and beyond the community programs.

Canada↗

PubMed2001

The health of youth in the juvenile justice systems.

A substantial number of adolescents are imprisoned each year in the United States. Many of them come to detention with significant medical and mental health problems which, in many cases, have been neglected. The time of detention provides an opportunity to address these problems, thereby benefiting both the juvenile and society. The medical department has a vital role in giving individual care and ensuring that the detention facility provides a safe, positive environment in which delinquents can be rehabilitated. There are substantial barriers impeding the care of detainees that can be overcome using a variety of collaborations in the local and national communities. Involving teaching institutions brings outside oversight as well as new ideas into these closed institutions. Research in areas that will benefit inmates can improve our ability to provide appropriate care. Adolescent medicine and pediatric training programs have a duty to expose physician trainees to detention medicine so that an adequate number of appropriately trained physicians are available to work in juvenile correctional facilities. Juvenile detention medicine should be fully integrated into mainstream medical care and seen as a valuable career.

Adolescent↗

PubMed1996

History of the Medical Library Association's credentialing program.

Since the Medical Library Association (MLA) adopted the Code for the Training and Certification of Medical Librarians in 1949, MLA members have reviewed and revised the program regularly. This paper traces the history of MLA's professional recognition program to illustrate how the program has changed over time and to identify the issues that have surrounded it. These issues include the value of the program to individual members, cost to MLA, appropriate entry requirements, certification examinations, and recertification requirements. The development and operation of MLA's current credentialing program, the Academy of Health Information Professionals, is described in detail.

Academies and Institutes↗

PubMed2003

Cardiac rehabilitation in patients with implantable defibrillators. Feasibility and complications.

OBJECTIVE: We examined patients with implantable cardioverter defibrillators (ICD) in order to demonstrate their safe participation in a standard rehabilitation program. DESIGN: Prospective cohort study of a consecutive series of patients after ICD implantation. Setting Inpatient rehabilitation center. PATIENTS AND METHODS: A total of 118 patients (73.7% male, mean age 60+/-11 years) took part for 23 +/- 4 days in a standard inpatient rehabilitation program including physical activity, psychological care, heart function seminars, and resuscitation exercises with family members. The following noninvasive tests were performed: symptomlimited exercise testing, two-dimensional echocardiography, Holter monitoring, telemetric ICD interrogation, optional fluoroscopy or X-ray examination of the thorax, and (in some patients) defibrillation threshold testing. RESULTS: Out of 118 patients 101 patients (85.6%) participated in regular ergometer training during which the initial workload of 23 +/- 11 Watts could be increased to 45 +/- 18 Watts. An individual conditioning program was assigned to 15% (n = 17) patients, thereby enabling the inclusion of all patients in the rehabilitation process. Under these conditions 12 patients (10%) experienced ICD malfunctions requiring therapy. As a consequence of all cardiac function tests, ICD reprogramming was necessary in 26 patients (22.1%). CONCLUSION: Following ICD implantation, patients may participate in a standard rehabilitation program without serious complications and with a significant increase in physical capacity. However, ICD malfunction occurs in approximately 10% of patients. Additional tests performed by skilled medical staff and appropriate technical equipment allows the ICD program to be optimized.

Aged↗

PubMed1999

Binge eating and substance use among male and female adolescents.

OBJECTIVE: This study examines the relationship between binge eating and substance use behaviors and attitudes in adolescents and explores gender differences and mental health correlates. METHOD: The data are derived from the 1997 Ontario Student Drug Use Survey of public and Catholic school students. A weighted sample of 1,031 girls and 888 boys was categorized as nonbingers, past bingers, and noncompensating or compensating binge eaters. RESULTS: Binge eaters, particularly those who compensated, were more likely to use all types of substances, particularly cannabis and drugs other than tobacco and alcohol. Binge eating was associated with more problematic and heavier substance use and with lowered self-esteem and more depression. Female bingers were more likely to report compensatory behaviors than male students but gender differences in the relationship between binge eating and substance use were few. DISCUSSION: Adolescent binge eaters who engage in compensatory behaviors may be an appropriate target group for preventive programs in high schools.

Adolescent↗

PubMed2005

Post myocardial infarction, left ventricular dysfunction, and the expanding role of cardiac implantable electrical devices.

In patients post myocardial infarction (MI) at risk for fatal ventricular arrhythmias, cardiac implantable devices offer a means of preventive therapy that complements optimal pharmacologic therapy. In patients with depressed ejection fractions, prophylactic implantable cardioverter defibrillators (ICDs) significantly improve survival. The efficacy of ICDs in the primary prevention of sudden cardiac death in patients post MI has been examined in a number of major primary prevention trials. These trials demonstrated as much benefit as some secondary prevention trials, which were conducted in high-risk patients who already had a spontaneous sustained ventricular tachyarrhythmia. In patients who are candidates for an ICD, best medical therapy for left ventricular dysfunction should be in place for some time before implanting. This waiting period could mean avoiding the implantation of a device in a patient who would heal sufficiently with pharmacologic therapy alone. In New York Heart Association (NYHA) class III and IV, patients with heart failure, and QRS intervals > or = 120 ms, cardiac resynchronization therapy (CRT) in combination with a defibrillator is a valuable addition to optimal pharmacologic therapy. Recent studies have demonstrated improved survival with CRT as well as improved quality of life. The high cost of cardiac implantable devices has led the Centers for Medicare and Medicaid Services to impose strict indications for use. However, it is likely that indications will be broadened for ICDs to include selected patients with left ventricular ejection fraction up to 40%, compared with the current indication of < or = 30%. Implanted devices must be followed up appropriately, with periodic interrogation and program adjustment to reduce the risk for pacing-induced desynchronization and to optimize hemodynamic benefit.

Arrhythmias, Cardiac↗

PubMed1986

Computer simulation of bend propagation by axoplasmic microtubules.

The generation of bending waves by microtubules in squid nerve axoplasm has been modelled using appropriately modified versions of computer programs developed previously for simulation of flagellar bending waves. The results confirm that a constant longitudinal force directed along the axis of the microtubule is sufficient to cause the generation of regular oscillations and propagated bending waves when the forward gliding movement of the microtubule is obstructed. No control mechanism is required to modulate the active force-generating system. In order to obtain bending waves similar to those observed experimentally, it was necessary to use a model for the force-generating system in which the active force decreases with increasing sliding velocity. If the elastic bending resistance of axoplasmic microtubules is similar to that of microtubules in sperm terminal filaments, the longitudinal force per unit length generated by the axoplasmic microtubules must be of the same order of magnitude as the force generated by dynein arms along the doublet microtubules of eukaryotic flagella.

Animals↗

PubMed1991

SESAM: a relational database for structure and sequence of macromolecules.

A system is described that provides ways of integrating data on protein structure, sequence, and survey results, with molecular graphics and molecular mechanics software. Its major component is the relational database SESAM, presently implemented under the commercial package SYBASE. By design, the database allows full integration--within the same data organization--of raw data on protein structure, sequence, ligands, and heterogroups, obtained from the Brookhaven Protein Databank, with pure sequence information available from other databanks such as SWISS-PROT. It contains in addition higher level descriptions of structural and topological properties, as well as survey results, obtained by executing specialized computer programs. Aside from the very useful attribute of closely combining structural and nonstructural information, other important features distinguish it from analogous systems developed elsewhere. It includes a molecular dictionary with complete description of geometric properties and energy parameters used in modeling and conformational energy calculations. Using this dictionary, structural data are validated by checking for localized inconsistencies in atomic coordinates, atomic symbols, chirality definitions, and flagging errors and incomplete entries. Because of both the dictionary and the validation procedures, SESAM can be readily interfaced with conventional molecular graphics and mechanics software packages, or with other specialized application programs. With the aid of appropriate interfaces, data access is sufficiently fast for SESAM to be interrogated interactively. Prototypes of user interfaces, as well as an interface with the molecular graphics package BRUGEL, are described and the power of the system is illustrated in applications such as homology-based protein modeling, computer-aided protein design, protein structure predictions, analysis of local structure motifs, and of relationships between protein sequence and structure.

Amino Acid Sequence↗

PubMed2004

Protecting, promoting, and supporting breastfeeding among women in the labor force.

The need to protect, promote, and support breastfeeding among women in the labor force is an important global issue that requires greater attention. An increasing proportion of women of child-bearing age are employed outside the home. Women who resume full-time work outside the home when their infants are young tend to have shorter durations of breastfeeding and less exclusive breastfeeding. However, evidence indicates that appropriate breastfeeding policy and support programs can help sustain breastfeeding among employed women. Effective strategies include delayed return to work, working part-time, improved conditions at work for breastfeeding, breastfeeding breaks during work hours, milk expression and storage, and access to breastfeeding counseling. In this chapter, we consider the special needs of women working outside the home; provide a brief overview of the literature; and address international policy regarding the protection, promotion, and support of breastfeeding among women who work outside the home.

Adult↗

PubMed1982

Structure and composition of the oral mucous membrane on the lips and cheeks of the monkey, Macaca fascicularis.

In seven monkeys (6 Macaca fascicularis, 1 M. mulatta; 2.4 +/- 0.6 kg in weight) the labial and buccal mucosae were studied morphologically and quantitatively. Following fixation by perfusion, the upper and lower lips and entire cheeks were dissected free and processed for light-, scanning and transmission electron microscopy. Established programs (HISTOMEP, MUMANA II) and appropriate morphometric techniques were used to estimate, at the light-microscopic level, the epithelial thickness, the width of the combined lamina propria/submucosa, and the volumetric composition of the gland-containing portions of lip and cheek mucosae. The cheek epithelium was more than twofold thicker than the lip epithelium, on the average 0.46 +/- 0.04 and 0.21 +/- 0.02 mm, respectively, with no differences related to sex or topographical sites. The combined lamina propria/submucosa was 1.32 +/- 0.19 and 1.50 +/- 0.26 mm in width in cheeks and lips, respectively. The main mucosal constituents at both sites were glandular and connective tissue, and lymph follicles associated with secretory ducts. In lips, the volume of plasma cells around gland acini correlated positively with the amount of lymphoid tissue present around topographically related ducts. It is suggested that the duct/lymph follicle assembly may serve as a local antigen-recognition system.

Animals↗