Promoting the maintenance of satisfactory communication: strategies used by caregivers and medical staff with people suffering from Alzheimer's disease

The goal of this literature review was to determine communication strategies that foster interactions between individuals with Alzheimer's disease (AD) and caregivers or medical staff. A search of PubMed and PsycINFO databases was conducted using combinations of the following terms: Alzheimer, family, caregiver, communication, language, treatment, intervention, therapy, communication strategies, functional communication and daily living activities. Studies were chosen based on the original language of the text, year of publication, peer-review status and specificity of the results regarding communication strategies in AD. This review covers 14 articles published between 1994 and 2014. The in-depth analysis of these studies shows that various communication strategies used by caregivers and medical staff are effective to promote interactions with people with AD at different stages of the disease. For caregivers, these strategies include producing short and syntactically simple sentences, relying on semantic memory rather than on episodic memory, providing more information and reformulate, removing potential distractions from the environment, specifying the topic of the conversation, using precise terms to identify communication breakdowns. Other strategies also appeared to be effective for medical staff, such as asking close-ended questions, providing response choices, verbalizing the actions performed during medical care and activities, paying attention to the needs expressed through verbal and non-verbal messages, adopting a supportive way of speaking. Furthermore, other communication strategies rather appear to be harmful to functional communication. These harmful strategies involve insisting that the person produce a specific word, asking him/her to repeat or tune out in case of communication breakdown. Finally, contradictory outcomes are reported for some strategies such as speaking slowly, repeating or rephrase questions and information. This article provides some useful avenues to better interact with people with AD. Further studies are needed to confirm and refine some results, in particular as regards the effectiveness of communication strategies at the different stages of the disease through longitudinal research design.

Placebo and nocebo effects and their significance in clinical practice

Most people have heard of the placebo effect, while relatively few have heard of nocebo, even within the circles of medical staff. Placebo effect means positive results by treatment via pharmacological inert substances. In contrast to placebo, by nocebo effect, due to negative beliefs and expectations, opposite results are achieved. Said in a more formal manner, what a sick person expects, unfortunately, he/she most often gets. It is a fact that a high number of medical staff is still uninterested in placebo and nocebo effects, although they would benefit from them. Maybe this is because the treatment would not seem "scientific enough". However, the newest scientific evidence undoubtedly shows that placebo and nocebo effects arise out of very active neurobiological processes intervened by psychological mechanisms such as expectations and conditions. Regardless of whether or not the doctor or the patient are aware of this, placebo and nocebo effects are extremely powerful and represent a significant part of the treatment process, in treatment by methods of ancient cultures, as well as in modern medicine. Of course medicines hold their role, but understanding how the human mind processes information is also very important.

Psychosocial Care Provided by Physicians and Nurses in Palliative Care: A Mixed Methods Study

CONTEXT

Psychosocial care is an important component of palliative care, which is also provided by physicians and nurses.

OBJECTIVE

The aim of this study was to explore the experiences of physicians and nurses in palliative care regarding the process of psychosocial care, the difficulties, and the support needs from "psychosocial care professionals."

METHODS

A two-phase mixed methods study was conducted. In the first phase, 16 physicians and nurses with palliative care experience were recruited. A semi-structured interview was used to collect data about their experience of providing psychosocial care, and these were analyzed using thematic analysis. In the second phase, 88 physicians and nurses completed an online survey that was developed from the qualitative results.

RESULTS

Qualitative results revealed three themes: 1) the contents of psychosocial care included not only disease-related events but also emotional and family support, 2) providing psychosocial care was a dynamic process including assessment, interventions, and evaluation, and 3) there were difficulties from the participants themselves, patients and families, and the system. Participants also reflected on what they did and the influences of providing care on themselves. Quantitative results showed that the most common psychosocial care was discussion about the progress of the disease and future care plan; the difficulty was the long-term problems in families; and the psychosocial care professionals most needed were social workers and clinical/counseling psychologists.

CONCLUSIONS

Understanding the process of psychosocial care and integrating it with specialized mental health care in a team could improve the quality of psychosocial care in palliative care.

[The way the quality of health services is perceived and treated by the managerial personnel of public hospitals]

BACKGROUND

Managerial knowledge and skills as well as profound understanding of goals and objectives of management determine the effectiveness and efficiency in all areas of managerial activities. In particular, this applies to the quality of healthcare services, perceived as a compliance between the effects (of medical treatment) and the assumed relevant objectives (defined/desired health condition). The aim of the research was to distinguish and define the way the health service quality is perceived by the hospital managerial personnel.

MATERIAL AND METHODS

The questionnaire was mailed to 836 members of the managerial personnel of public hospitals in the Łódź province. Of this number 122 questionnaires were returned.

RESULTS

Only 22 (18.49%) of respondents presented the definition of quality. Attempts to meet patients' expectations and to satisfy them were found to be the prevailing perception of the healthcare quality and 96.64% of respondents considered competences of medical staff contributory. Almost 64% of respondents disagree with the opinion that the number of medical staff does not affect the service quality. According to the respondents, a 46% increase in financial resources on average could significantly improve the quality of healthcare services. More than half (66.76%) of respondents claim that healthcare services that are available cover 82% of patients' needs. Almost 57% (56.52%) of respondents consider that the subordinate- superior relationship influences their work involvement. According to 42.61% of respondents, the offered incentives encourage actions for the quality improvement.

CONCLUSIONS

The results of the research indicate the need to develop a clear cut definition of the health service quality by the managerial personnel of public hospitals and to change their understanding, perception and treatment of the discussed issue, which provides a basis for the effective and efficient hospital management. Med Pr 2016;67(3):365-373.

Workplace violence and its effect on burnout and turnover attempt among Chinese medical staff

The present study was to evaluate workplace violence and examine its effect on job burnout and turnover attempt among medical staff in China. A total of 2,020 medical employees were selected from Fujian province by using stratified cluster sampling method. The Chinese version of the Workplace Violence Scale and the Maslach Burnout Inventory-General Survey were used to measure the workplace violence and job burnout, respectively. Other potential influencing factors for job burnout and turnover attempt were collected using a structured questionnaire. The incidence of workplace violence among medical staff was 48.0%. Workplace violence had a positive correlation with emotional exhaustion and cynicism and a negative correlation with professional efficacy. Workplace violence, marital status, employment type, working time (≥ 10 h/day), performance recognition, and life satisfaction were significant predictors for turnover attempt among Chinese medical staff.

Cervical Cancer Prevention Knowledge and Attitudes among Female University Students and Hospital Staff in Iran

Background:

Cervical cancer is a major preventable cancers. The, current study aimed to assess relevant knowledge and attitude of female students and hospital staff in Iran.

Method:

This cross-sectional study was conducted in Medical and Nursing faculties and hospitals of East-Azerbaijan Province of Iran. Participants were medical and paramedical female students and female staff in hospitals selected by stratified random sampling techniques. Tools for data collection were questionnaires for which validity and reliability had been verified (α=0.8). Descriptive and inferential statistics were used to analyze data with SPSS.16.

Result:

Response rates were 71 % (426 from 600) and 63.5% (254 from 400) for students and staff, respectively. Some 29.1% admitted that they had no information about cervical cancer, only 70 (10.3%) thinking their knowledge as high, 360 (52.9%) as intermediate, and 237 (34.9%) as low. While 93% of participants considered cervical cancer as a severe health problem, the only statistically significant relationships with knowledge were for education (p<.001) and occupation (p<.001) variables.

Conclusion:

Given the importance of the roles of medical students and personnel as information sources and leaders in health and preventive behavior, increasing and improving their scientific understanding seems vital. Comprehensive and appropriate education of all people and especially students and personnel of medical sciences and improving attitudes towards cervical cancer and its monitoring are to be recommended.

Assistive technology using integrated flexible sensor and virtual alarm unit for blood leakage detection during dialysis therapy

Blood leakages and blood loss are both serious complications during dialysis therapies. According to dialysis survey reports, these events are life-threatening issues for nephrology nurses, medical staff, and patients. When venous needle dislodgement occurs, it takes only <2.5 min of reaction time for blood loss in an adult patient, resulting in mortality. As an early-warning design, a wireless assistive technology using an integrated flexible sensor and virtual alarm unit was developed to detect blood leakage during dialysis therapies. The flexible sensor was designed using a screen print technique with printing electronic circuits on a plastic substrate. A self-organising algorithm was used to design a virtual alarm unit, consisting of a virtual direct current grid and a virtual alarm driver. In other words, this warning device was employed to identify the blood leakage levels via wireless fidelity wireless network in cloud computing. The feasibility was verified, and commercialisation designs can also be implemented in an embedded system.

Radiation awareness among dentists, radiographers and students

OBJECTIVES

The aim of this study was to assess radiation awareness among dentists, radiographers, dentistry students and radiography students from the Medical University of Warsaw.

METHODS

A questionnaire containing 13 multiple-choice questions was administered to 200 dentists, 200 radiographers, 100 dentistry students and 100 radiography students. Participants were asked about basic knowledge concerning dental radiological examinations.

RESULTS

In total, 301 (50.2%) questionnaires were returned. The mean score of correct answers was 8.13 out of 13 for all responders; 8.36 for dentists, 8.11 for radiographers, 8.19 for dentistry students and 7.46 for radiography students. Range of correct answers varied from 3 to 12. Differences between the four main groups were not statistically significant. Dentists who had completed radiation protection training had significantly higher number of correct answers than untrained dentists. For radiographers, the level of education had no connection with the results. Correlation between year of the study and results was not visible in the dentistry student group. Within the radiography student group, students in the third year of the study had significantly higher number of correct answers than those in the first and second years of the study.

CONCLUSIONS

Our survey shows that radiation awareness among dentists, radiographers and students is inadequate, without significant differences in the main groups. Dentists who had completed radiation protection training had better awareness than those without such training. Greater emphasis should be put on the dental radiology course in both dentistry and radiography programmes at universities.

Assessing a doctor you've rarely worked with: The use of workplace-based assessments in a busy inner city emergency department

OBJECTIVE

Historically, end-of-term assessments for Junior Medical Officers in our ED have been completed by nominated Consultants based on varying amounts of observation in addition to feedback from other health professionals. Our hypothesis is that this system of assessment is both inconsistent and unreliable. Our objective was to increase the validity of our assessment process using workplace-based assessments linked specifically to the domains set out in the Australian Medical Council intern assessment form.

METHODS

Current practice was established using an online survey. Workplace-based assessments were then performed on each junior doctor throughout the course of a term. A repeat survey at the end of term was used to audit the use of the workplace-based assessments and their effect on the adequacy of the assessments.

RESULTS

Almost three quarters of our Consultants used workplace-based assessments as part of their end-of-term assessment. Overall, 80% of Consultants agreed that the Junior Medical Officers assessment process was improved when using workplace-based assessments as an adjunct.

CONCLUSION

Workplace-based assessments improve the validity of end-of-term assessments for junior doctors in an ED as perceived by those performing the assessment.

The Mediating Role of Organizational Learning in the Relationship of Organizational Intelligence and Organizational Agility

Objectives

Organizational learning is defined as creating, absorbing, retaining, transferring, and application of knowledge within an organization. This article aims to examine the mediating role of organizational learning in the relationship of organizational intelligence and organizational agility.

Methods

This analytical and cross-sectional study was conducted in 2015 at four teaching hospitals of Yazd city, Iran. A total of 370 administrative and medical staff contributed to the study. We used stratified-random method for sampling. Required data were gathered using three valid questionnaires including Alberkht (2003) organizational intelligence, Neefe (2001) organizational learning, and Sharifi and Zhang (1999) organizational agility questionnaires. Data analysis was done through R and SPSS 18 statistical software.

Results

The results showed that organizational learning acts as a mediator in the relationship of organizational intelligence and organizational agility (path coefficient = 0.943). Also, organizational learning has a statistical relationship with organizational agility (path coefficient = 0.382).

Conclusion

Our findings suggest that the improvement of organizational learning abilities can affect an organization's agility which is crucial for its survival.

ICU Attending Handoff Practices: Results From a National Survey of Academic Intensivists

OBJECTIVES

To characterize intensivist handoff practices and expectations and to explore perceptions of the patient safety implications of attending handoffs.

DESIGN

Cross-sectional electronic survey administered in 2014.

SETTING

One hundred sixty-nine U.S. hospitals with critical care training programs accredited by the Accreditation Council for Graduate Medical Education.

SUBJECTS

Academic intensivists were recruited via e-mail invitation from a database of 1,712 eligible academic intensivists.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Six hundred sixty-one intensivists completed the survey (completion rate, 38.6%). Responses were received from at least one individual at 147 of 169 unique hospitals (87.0%) represented in the study database. Five hundred seventy-three (87%) respondents reported participating in handoffs at the end of each ICU rotation. A variety of communication methods were used for end-of-rotation handoffs, including in-person discussion (92.9%), telephone calls (83.9%), e-mail messages (69.0%), computer-generated documents (64.6%), and text messages (23.6%). Mean satisfaction with current handoff process was rated as 68.4 on a scale from 0 to 100 (SD, 22.6). Respondents (55.4%) said that attending handoffs should be standardized, but only 13.3% (76/572) of those participating in end-of-rotation handoffs reported using a standardized process. Specific handoff topics, including active clinical issues and resuscitation status, were reportedly discussed less frequently than would be ideal (p < 0.001 for the difference between reported frequency and ideal frequency). In free-text comments, 76 respondents (11.5%) expressed skepticism that attending handoffs were necessary given the presence of residents and fellows and given a lack of agreement about necessary content. Two hundred respondents (30.8%) reported knowing of an adverse event (inappropriate treatment, cardiac arrest, and death) attributable to inadequate attending handoffs.

CONCLUSIONS

ICU attending handoffs in the United States exhibit marked heterogeneity, and intensivists do not agree about the value of attending handoffs. In addition, some intensivists perceive a link between suboptimal attending handoffs, inappropriate treatment, and serious adverse events that warrants further study.

The employee's productivity in the health care sector in Poland and their impact on the treatment process of patients undergoing elective laparoscopic cholecystectomy

BACKGROUND

Increasing the engagement of employees in the treatment process of patients may benefit a hospital and employee productivity and may result in better patient care and satisfaction with medical services. Given this, the first step in improving the quality of patient care is better availability of doctors for patients in a hospital ward.

METHODS

The research for this paper was conducted in six health care units in the Kuyavian-Pomeranian province in Poland. The research assessed how the elements relating to employees' behavior and things characteristic to medical service influence patients' willingness to recommend a hospital.

RESULTS

Patients' perception of services is linked with the behavior of medical employees and their engagement in the treatment process.

CONCLUSION

Our research indicates that individual employee recognition and collective recognition of hospital employees as a whole were identified as the most important factors in employee engagement in the treatment process (employee productivity) and patients' satisfaction with medical service.

Confidence level in venipuncture and knowledge on causes of in vitro hemolysis among healthcare professionals

INTRODUCTION

This study aimed to assess confidence level of healthcare professionals in venipuncture and their knowledge on the possible causes of in vitro hemolysis.

MATERIALS AND METHODS

A sample of 94 healthcare professionals (nurses and laboratory technicians) participated in this survey study. A four-section questionnaire was used as a research instrument comprising general information for research participants, knowledge on possible causes of in vitro hemolysis due to type of material used and venipuncture technique and specimen handling, as well as assessment of healthcare professionals' confidence level in their own ability to perform first and last venipuncture.

RESULTS

The average score on the knowledge test was higher in nurses' than in laboratory technicians (8.11±1.7, and 7.4±1.5, respectively). The difference in average scores was statistically significant (P=0.035) and Cohen's d in the range of 0.4 indicates that there is a moderate difference on the knowledge test among the health care workers. Only 11/94 of healthcare professionals recognized that blood sample collection from cannula and evacuated tube is method which contributes most to the occurrence of in vitro hemolysis, whereas most risk factors affecting occurrence of in vitro hemolysis during venipuncture were recognized. There were no significant differences in mean score on the knowledge test in relation to the confidence level in venipuncture (P=0.551).

CONCLUSION

Confidence level at last venipuncture among both profiles of healthcare staff was very high, but they showed insufficient knowledge about possible factors affecting hemolysis due to materials used in venipuncture compared with factors due to venipuncture technique and handling of blood sample.

Impact of increasing overnight intensive care unit registrar staffing on duration of intubation of elective cardiac surgery patients

It is unclear whether increases to overnight junior medical staffing levels can improve ICU patient outcomes. We conducted a retrospective cohort study before and after the introduction of a third overnight ICU registrar at a 24-bed metropolitan ICU in February 2012. We hypothesised that this change would be associated with decreased intubation time for elective cardiac surgery patients and an increase in the proportion of these patients being extubated during the overnight period. All elective cardiac surgery patients were included from two temporally matched six-month periods (May to October) in 2011 and 2012. The primary outcome was median duration of intubation, and the secondary outcome was proportion of patients extubated during the 'overnight' period (2200 to 0700). A total of 142 and 188 patients were included in the control and intervention cohorts, respectively. Median (IQR) intubation time was 8.7 (6.6 to 14.5) hours in the control cohort and 8.2 (6.0 to 13.4) hours in the intervention cohort, with no significant difference between groups (P=0.40). The proportion of elective cardiac surgery patients extubated during the overnight period was similar, 54.2% in the control group compared to 50.0% in intervention group (P=0.45). In our unit, increasing overnight ICU registrar staffing levels was not associated with a significant reduction in duration of intubation for elective cardiac surgery patients or a reduction in the proportion of these patients extubated overnight. This is likely due to factors other than medical staffing levels influencing timing of extubation of these patients.

Exploring the Patient and Staff Experience With the Process of Primary Care

PURPOSE

Previous studies suggest that the highest-risk patients value accessible, coordinated primary care that they perceive to be of high technical quality. We have limited understanding, however, of how low-income, chronically ill patients and the staff who care for them experience each individual step in the primary care process.

METHODS

We conducted qualitative interviews with uninsured or Medicaid patients with chronic illnesses, as well as with primary care staff. We interviewed 21 patients and 30 staff members with a variety of job titles from 3 primary care practices (1 federally qualified health center and 2 academically affiliated clinics).]

RESULTS

The interviews revealed 3 major issues that were present at all stages of a primary care episode: (1) information flow throughout an episode of care is a frequent challenge, despite systems that are intended to improve communication; (2) misaligned goals and expectations among patients, clinicians, and staff members are often an impediment to providing and obtaining care; and (3) personal relationships are highly valued by both patients and staff.

CONCLUSIONS

Vulnerable populations and the primary care staff who work with them perceive some of the same challenges throughout the primary care process. Improving information flow, aligning goals and expectations, and developing personal relationships may improve the experience of both patients and staff.

Women in medicine: historical perspectives and recent trends

INTRODUCTION

Women now outnumber men in British medical schools. This paper charts the history of women in medicine and provides current demographic trends.

SOURCES OF DATA

A historical literature review and routinely collected data from Department of Health and the Health and Social Care Information Centre.

AREAS OF AGREEMENT

Clear gender differences are apparent in working practices, including greater likelihood of working part time and specializing in certain areas of medicine.

AREAS OF CONTROVERSY

The increasing need to increase activity among the existing medical workforce is timely amidst a changing workforce demographic.

GROWING POINTS

Workforce planners, policymakers and Royal Colleges should continue to develop interventions that may reduce disparities in career choices, as well as considering ways to increase participation and activity.

AREAS TIMELY FOR DEVELOPING RESEARCH

Further research is needed to explore the cost-effectiveness of existing and future interventions in this field.

What is the job satisfaction and active participation of medical staff in public hospital reform: a study in Hubei province of China

BACKGROUND

In China, public hospital reform has been underway for almost 5 years, and 311 pilot county hospitals are the current focus. This study aimed to assess the job satisfaction and active participation of medical staff in the reform. A total of 2268 medical staff members in pilot and non-pilot county hospitals in Hubei, China, were surveyed.

METHODS

Questionnaires were used to collect data. The Pearson chi-square statistical method was used to assess the differences between pilot and non-pilot county hospitals and identify the factors related to job satisfaction as well as the understanding and perception of the reform. Binary logistic regression was performed to determine the significant factors that influence the job satisfaction of medical staff in pilot county hospitals.

RESULTS

Medical staff members in pilot county hospitals expressed higher satisfaction on current working situation, performance appraisal system, concern showed by leaders, hospital management, and compensation packages (P < 0.05). They were exposed to work-related stress at a higher extent (P < 0.05) and half of them worked overtime. Within pilot county hospitals, less than half of the medical staff members were satisfied with current job and they have evidently less satisfaction on compensation packages and learning and training opportunities. The working hours and work stress were negatively related to the job satisfaction (P < 0.05). Satisfaction on the performance appraisal system, hospital management, compensation packages, and learning and training opportunities were positively related to job satisfaction (P < 0.05). Medical staff in pilot county hospitals exhibited better understanding of and more positive attitude towards the reform (P < 0.05).

CONCLUSIONS

Pilot county hospitals have implemented some measures through the reform, but there still are deficiencies. The government officials and hospital administrators should pay attention to influencing factors of job satisfaction and focus on the reasonable demands of medical staff. In addition, the medical staff in pilot county hospitals exhibited a better understanding of the public hospital reform programme and showed more firm confidence, but there still were some medical staff members who hold negative attitude. The publicity and education of the public hospital reform still need improvement.

Health-care professionals' attitudes across different hospital departments regarding alcohol-related presentations

INTRODUCTION AND AIMS

Attitudes to individuals presenting with alcohol-related issues are important in developing therapeutic relationships and applying alcohol-related interventions. This study explores staff attitudes to these individuals across a range of roles and departments.

DESIGN AND METHODS

Data were gathered from 204 staff in the Southern Health and Social Care Trust in Northern Ireland. Regression models were used to predict attitudes as measured by the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ).

RESULTS

Two hundred and four people participated in the study. The sample comprised doctors, nurses, allied health professionals and other staff who had face-to-face contact with patients. Staff worked in accident and emergency (A&E), medical, surgical, addiction or psychiatry departments. Staff working in addiction and psychiatry departments had significantly higher levels of role adequacy compared with those in A&E. Staff in addictions also demonstrated higher levels of role legitimacy, motivation and role satisfaction than those in A&E. Doctors had higher role adequacy and role legitimacy than nursing staff.

DISCUSSION AND CONCLUSIONS

There are critical differences in staff attitudes to patients presenting with alcohol-related issues in a range of hospital settings; training and working in a specialist setting have a significant positive influence on staff attitudes. This suggests that further training and support would positively enhance the attitudes of staff in a variety of professional roles and across a range of hospital settings in the management of patients presenting with alcohol-related difficulties. [Iqbal N, McCambridge O, Edgar L, Young C, Shorter GW. Health-care professionals' attitudes across different hospital departments regarding alcohol-related presentations. Drug Alcohol Rev 2015;34:487-94].

Systemic mistakes in hand hygiene practice in Ukraine: detection, consequences and ways of elimination

Aim: Every year, millions of people around the world suffer from different infectious diseases, considerable part of which are hospital-acquired infections. WHO considers hand hygiene as a priority measure aimed to reduce the level of infection. We evaluated various aspects related to the situational behavior and prioritization regarding hand hygiene measures among the healthcare workers of Ukraine.

Method: Identification of system mistakes in hand hygiene was carried out first of all by direct and indirect observation of the activities of medical and pharmaceutical personnel in their everyday practice as well as during their participation in trainings on routine hand hygiene. Questionnaires also were used to estimate the level of hand hygiene compliance of participants of the study. During this period 112 training courses, 315 master-classes and presentations on proper hand hygiene were realized. The target audience included health care workers of medical centers, clinics, maternity hospitals, health care organizations and staff of pharmacies and pharmaceutical manufacturing enterprises in all regions of Ukraine. 638 respondents took part in anonymous survey on hand hygiene practice.

Results: The most common mistakes were to regard hand washing and hand disinfection equally, to wash hands before doing a hand disinfection, to neglect the five moments for hand hygiene and to ignore hand hygiene before and after wearing protective gloves. Practitioners, medical attendants, pharmacy and pharmaceutical industry workers highlighted the need for practical and understandable instructions of various hand hygiene procedures, including the clarification of the possible technical mistakes. This became a ground for us to create individual master classes on hand hygiene for each cluster of healthcare workers.

Conclusions: Changing hand hygiene behavior and attitude is possible by beginning to observe clinical practice and by involving healthcare workers in teaching and training.

VOLUNTAD ANTICIPADA. UNA INVESTIGACIÓN A PROFESIONALES DE LA SALUD

The aim of this paper is to obtain the knowledge and attitudes in front of the advanced directives of the health staff of the Medical Center "Lic. Adolfo Lopez Mateos" of Toluca, state of Mexico. The sample consisted in 80 health professionals, who agreed to participate in the questionnaire complementing the previous instruction (Herreros, 2012). Which consisted of 11 closed questions. Being the first four of the last seven knowledge and attitudes. The results showed that there is little knowledge about the living will, and that you think the doctor is the social worker who must inform the patient on it. But a high percentage think it would be important to be held although also agrees that it should be performed in patients with terminal illness. It concludes that, although the reserve sample size, there is little knowledge on the subject, however the positive attitude tends to be performed so that the measures and diffusion, the living will become a acceptance document at least on the side of health professionals.

The sense of coherence and styles of success in the medical career: a longitudinal study

BACKGROUND

Sense of coherence is related to well-being, stress and life satisfaction among medical students and physicians. The purpose of the study was to investigate relation between sense of coherence during medical education and styles of success in the medical career.

METHODS

The participants were first examined when they applied to medical school in 1999. Questionnaires were given to these students each academic year from 2000 to 2005. Also, 54 medical doctors who had participated in the first phase of the study completed a questionnaire in 2009, four years after graduation. The baseline questionnaire measured the sense of coherence. The follow-up questionnaire included measures of quality of life, work stress and burnout, satisfaction with medicine as a career, and professional competency.

RESULTS

Medical students with the highest sense of coherence later have the highest quality of life and income, and are the least overwhelmed by work stress, but they also show the least satisfaction with medicine as a career and a low level of professional competence.

CONCLUSIONS

Antonovsky's SOC-29 questionnaire can be used to identify specific tendencies in the development of the medical career. Our results may be useful to medical school admissions officers and resident selection committees, in order to identify candidates at risk for failure.

Views of senior UK doctors about working in medicine: questionnaire survey

OBJECTIVES

We surveyed the UK medical qualifiers of 1993. We asked closed questions about their careers; and invited them to give us comments, if they wished, about any aspect of their work. Our aim in this paper is to report on the topics that this senior cohort of UK-trained doctors who work in UK medicine raised with us.

DESIGN

Questionnaire survey.

PARTICIPANTS

3479 contactable UK-trained medical graduates of 1993.

SETTING

UK.

MAIN OUTCOME MEASURES

Comments made by doctors about their work, and their views about medical careers and training in the UK.

METHOD

Postal and email questionnaires.

RESULTS

Response rate was 72% (2507); 2252 were working in UK medicine, 816 (36%) of whom provided comments. Positive comments outweighed negative in the areas of their own job satisfaction and satisfaction with their training. However, 23% of doctors who commented expressed dissatisfaction with aspects of junior doctors' training, the impact of working time regulations, and with the requirement for doctors to make earlier career decisions than in the past about their choice of specialty. Some doctors were concerned about government health service policy; others were dissatisfied with the availability of family-friendly/part-time work, and we are concerned about attitudes to gender and work-life balance.

CONCLUSIONS

Though satisfied with their own training and their current position, many senior doctors felt that changes to working hours and postgraduate training had reduced the level of experience gained by newer graduates. They were also concerned about government policy interventions.

Mobile technologies: expectancy, usage, and acceptance of clinical staff and patients at a university medical center

BACKGROUND

Despite their increasing popularity, little is known about how users perceive mobile devices such as smartphones and tablet PCs in medical contexts. Available studies are often restricted to evaluating the success of specific interventions and do not adequately cover the users' basic attitudes, for example, their expectations or concerns toward using mobile devices in medical settings.

OBJECTIVE

The objective of the study was to obtain a comprehensive picture, both from the perspective of the patients, as well as the doctors, regarding the use and acceptance of mobile devices within medical contexts in general well as the perceived challenges when introducing the technology.

METHODS

Doctors working at Hannover Medical School (206/1151, response 17.90%), as well as patients being admitted to this facility (213/279, utilization 76.3%) were surveyed about their acceptance and use of mobile devices in medical settings. Regarding demographics, both samples were representative of the respective study population. GNU R (version 3.1.1) was used for statistical testing. Fisher's exact test, two-sided, alpha=.05 with Monte Carlo approximation, 2000 replicates, was applied to determine dependencies between two variables.

RESULTS

The majority of participants already own mobile devices (doctors, 168/206, 81.6%; patients, 110/213, 51.6%). For doctors, use in a professional context does not depend on age (P=.66), professional experience (P=.80), or function (P=.34); gender was a factor (P=.009), and use was more common among male (61/135, 45.2%) than female doctors (17/67, 25%). A correlation between use of mobile devices and age (P=.001) as well as education (P=.002) was seen for patients. Minor differences regarding how mobile devices are perceived in sensitive medical contexts mostly relate to data security, patients are more critical of the devices being used for storing and processing patient data; every fifth patient opposed this, but nevertheless, 4.8% of doctors (10/206) use their devices for this purpose. Both groups voiced only minor concerns about the credibility of the provided content or the technical reliability of the devices. While 8.3% of the doctors (17/206) avoided use during patient contact because they thought patients might be unfamiliar with the devices, (25/213) 11.7% of patients expressed concerns about the technology being too complicated to be used in a health context.

CONCLUSIONS

Differences in how patients and doctors perceive the use of mobile devices can be attributed to age and level of education; these factors are often mentioned as contributors of the problems with (mobile) technologies. To fully realize the potential of mobile technologies in a health care context, the needs of both the elderly as well as those who are educationally disadvantaged need to be carefully addressed in all strategies relating to mobile technology in a health context.

Embedding research in clinical practice: differences in attitudes to research participation among clinicians in a tertiary teaching hospital

Despite a drive to increase research in healthcare settings, clinician participation in research remains infrequent. This paper describes an online survey comparing attitudes with research participation among clinicians (doctors, nurses and allied health professionals) at an Australian tertiary children's hospital. Differences between professional groups support the existence of different professional cultures surrounding research, suggesting that multiple strategies are required to improve participation in research.

Fatigue in Air Medical Clinicians Undertaking High-acuity Patient Transports

Abstract Background. Fatigue is likely to be a significant issue for air medical transport clinicians due to the challenging nature of their work, but there is little published evidence for this. Objective. To prospectively assess the levels and patterns of fatigue in air medical transport teams and determine whether specific mission factors influenced clinician fatigue. Methods. Physicians and flight nurses from two intensive care interhospital transport teams routinely completed fatigue report forms before and after patient transport missions over a 4-month period. Data collected included subjective ratings of fatigue (Samn-Perelli and visual analog scale), mission difficulty and performance. Multivariate hierarchical logistic and linear models were used to evaluate the influence of various mission characteristics on post-mission fatigue. Results. Clinicians returned 403 fully complete fatigue report forms at an estimated overall return rate of 73%. Fatigue increased significantly over the course of missions, and on 1 of every 12 fatigue reports returned clinicians reported severe post-mission fatigue (that is, levels of 6 or 7 on the Samn-Perelli scale). Factors that impacted significantly on clinician fatigue were the pre-mission fatigue level of the clinician, night work, mission duration, and mission difficulty. Poorer self-rated performance was significantly associated with higher levels of fatigue (r = -0.4, 95% CI -0.5 to -0.3), and for the 6-month period leading up to the study clinicians reported a total of 22 occasions on which they should have declined a mission due to fatigue. Conclusions. These results suggest that clinicians undertaking interhospital transports of even moderate duration experience high levels of fatigue on a relatively frequent basis. In the unique and challenging environment of air medical transport, prior fatigue, long or difficult missions, and the disadvantageous effect of night work on normal circadian rhythms are a combination where there are minimal safety margins for clinicians' performance capacity. Fatigue prevention or fatigue resistance measures could positively affect air medical clinicians in this context.