Psychological androgyny and preference for intubation in a hypothetical case of end-stage lung disease

What determines immediate use of invasive ventilation in patients with COPD?

BACKGROUND

The choice between non-invasive ventilation (NIV) and invasive ventilation in patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may be irrational. The aim of this study was to examine those patient characteristics, and circumstances deemed important in the choice made between NIV and invasive ventilation in the intensive care unit (ICU).

METHODS

We first examined 95 admissions of AECOPD patients on nine ICUs and identified variables associated with invasive ventilation. Thereafter, a questionnaire was sent to ICU personnel to study the relative importance of different factors with a possible influence on the decision to use invasive ventilation at once.

RESULTS

Univariable analysis showed that increasing age [odds ratio (OR) 1.06 per year] and increasing body mass index (BMI) (OR 1.11 per kg/m(2) ) were associated with immediate invasive ventilation, while there was no such association with arterial blood gases or breath rate. BMI was the only factor that remained associated with immediate invasive ventilation in the multivariable analysis [OR 1.12 (95% confidence interval 1.03-1.23) kg/m(2) ]. Ranking of responses to the questionnaire showed that consciousness, respiratory symptoms and blood gases were powerful factors determining invasive ventilation, whereas high BMI and age were ranked low. Non-patient-related factors were also deemed important (physician in charge, presence of guidelines, ICU workload).

CONCLUSION

Factors other than those deemed most important in guidelines appear to have an inappropriate influence on the choice between NIV and immediate intubation in AECOPD in the ICU. These factors must be identified to further increase the appropriate use of NIV.

Comparison of Masculine and Feminine Traits in a National Sample of Male and Female Nursing Students

The stereotype that male nurses are less masculine has existed for generations and spans all age groups. Several studies have investigated masculinity and femininity in nurses using the Bem Sex-Role Inventory, but the results are conflicting and inconclusive. Therefore, a nationwide survey was conducted across the United States that examined the sex-role identity of individuals who chose nursing as a career path. Twenty-eight males and 81 females from 37 states completed the survey. The males and females in the study both had higher mean scores on masculinity and femininity scales when compared with previous studies. The greatest percentage of participants were classified as androgynous, as opposed to masculine, feminine, or undifferentiated, with half of the males and nearly half of the females falling into this category.

Predicting patient satisfaction: a study of two emergency departments

To identify perceptions that predict overall patient (dis)satisfaction with Emergency Department (ED) care, we studied responses to a survey mailed to all discharged patients over a 6-month period (Academic Hospital), and to a telephone interview of a random sample of discharged patients over a 1-year period (Community Hospital). The survey and interview both assessed overall satisfaction, as well as satisfaction with perceived waiting times, information delivery, and expressive quality of physicians, nurses, and staff. Data for 1176 patients (training sample) and 1101 patients (holdout sample) who rated overall satisfaction as either "very good" or "very poor" (Academic Hospital), and for 856 patients (training sample) and 431 patients (holdout sample) who rated overall satisfaction as either "excellent" or "poor" (Community Hospital), were retained for analysis. For both hospitals, nonlinear tree models efficiently achieved overall classification accuracy exceeding 98% in training analysis and 95% in holdout analysis (all p < .0001). The findings suggest that overall patient (dis)satisfaction with care received in the ED is nearly perfectly predictable on the basis of patient-rated expressive qualities of ED staff, particularly physicians and nurses. Interventions designed to reinforce positive (and extinguish negative) expressive health-care provider behaviors may cut the number of extremely dissatisfied patients in half.

Psychological androgyny and preference in loss-framed gambles of medical students: possible implications for resource utilization

Physician decisions concerning allocation of health care resources to patients are highly variable and poorly understood. Psychological androgyny theory (PAT) has been employed as a model of the interpersonal and task activities required of physicians for care of their patients. Several studies have successfully predicted physician resource utilization using measures derived from PAT. Using a sample of 97 first-year medical students, the authors explored the relationship between PAT and risk preference in loss-framed gambles in order to elucidate the process whereby variables derived from PAT predict resource utilization. As hypothesized, students selecting the certain loss had significantly higher mean androgyny scores than did students selecting uncertainty. Research involving these constructs is integrated in the context of a theoretical "causal model," which highlights issues deserving of future research.