Twenty Advanced Trauma Life Support (ATLS) courses were conducted at the University of Manitoba between 1982 and 1987. There were 302 registrants, 95 of whom were from rural communities. Twelve registrants failed the course. The impact of the program was assessed by questionnaire (68.8% response overall). The response from department heads of surgery in urban hospitals was 87.5% and from surgeons in rural areas 50%. Fifty-eight percent of rural surgeons, 62.5% of urban surgeons and 75% of urban emergency-department directors claimed they could identify those who had attended an ATLS course by the increased confidence demonstrated and the use of more timely and appropriate consultation and treatment. Thirty percent of rural surgeons, 37% of urban surgeons and 42% of emergency-department directors claimed that mortality and morbidity were decreased when care was provided by ATLS-trained physicians. The remainder were undecided because of lack of information. Ninety-three percent of respondents indicated that the course increased their confidence, trauma capability and ability to communicate with consultant trauma surgeons. Fifty-two percent thought the course should be mandatory for all physicians, and 100% thought it should be mandatory for all emergency-department physicians. The data suggest that although most physicians treat fewer trauma patients 5 years after their ATLS training, the course is still highly recommended, and it has improved trauma care. Although the ATLS program was intended primarily for rural physicians, more urban-based physicians registered for it.
To describe the prevalence of various psychiatric and behavioral symptoms among patients with dementia in nursing homes and acute geriatric wards and to investigate the administration of psychotropic medications to these patients.
425 consecutive patients (>70 years) in six acute geriatric wards in two city hospitals and seven nursing homes in Helsinki, Finland, were assessed with an extensive interview, cognitive tests, and attention tests. Of these, 255 were judged to have dementia according to the following information: previous dementia diagnoses and their adequacy, results of CT scans, Mini-mental State Examination (MMSE) tests, Clinical Dementia Scale (CDR) tests, and DSM-IV criteria. Psychiatric and behavioral symptoms were recorded over two weeks for each patient.
Psychiatric and behavioral symptoms were very common among patients with dementia in both settings. In all, 48% presented with psychotic symptoms (delusions, visual or auditory hallucinations, misidentifications or paranoid symptoms), 43% with depression, 26% agitation, and 26% apathy. Use of psychotropic drugs was also common: 87% were on at least one psychotropic drug, 66% took at least two, 36% at least three, and 11% four or more psychotropic drugs. Of the patients with dementia, 42% were on conventional antipsychotics, and 34% on anxiolytics despite their known side-effects. Only 13% were on atypical antipsychotics and 3% on cholinesterase inhibitors. The use of selective serotonin reuptake inhibitors (SSRIs) was common (31%) among the patients. A surprising finding was that drugs with anticholinergic effects were also frequently (20%) used.
Both behavioural symptoms and use of psychotropic drugs are very common among dementia patients in institutional settings. The frequent use of potentially harmful drugs implies a need for education among physicians taking care of these patients.
This study has two objectives. First, to predict the outcomes of a public sector downsizing; second to measure effects of downsizing at organizational and inter-organizational levels. Primary data to assess the organizational level effects was collected through interviews with senior executives at two of Metro-Toronto's hospitals. Secondary data, to assess the inter-organizational effects, was collected from government documents and media reports. Due to the exploratory nature of the study's objectives a case study method was employed. Most institutional downsizing practices aligned with successful outcomes. Procedures involved at the inter-organizational level aligned with unsuccessful outcomes and negated organizational initiatives. This resulted in an overall alignment with unsuccessful procedures. The implication, based on private sector downsizings, is that the post-downsized hospital system was more costly and less effective.
PURPOSE: The purpose of this study is to evaluate whether dialogue groups for physicians can improve their psychosocial work environment. DESIGN/METHODOLOGY/APPROACH: The study assessed the impact of eight dialogue groups, which involved 60 physicians at a children's clinic in one of the main hospitals in Stockholm. Psychosocial work environment measures were collected through a validated instrument sent to all physicians (n = 68) in 1999, 2001 and 2003. Follow-up data were collected after the termination of the groups. FINDINGS: The overall score of organizational and staff wellbeing, as assessed by the physicians at the clinic, deteriorated from 1999 until 2003 and then improved 2004. This shift in the trend coincided with the intervention. No other factors which might explain this shift could be identified. RESEARCH LIMITATIONS/IMPLICATIONS: In a naturalistic study of this kind it is not possible to prove any causal relationships. A controlled survey of management programmes concerning the work environment among physicians would be of interest for further research. PRACTICAL IMPLICATIONS: The results suggest that dialogue groups may be one way to improve the psychosocial work environment for physicians. ORIGINALITY/VALUE: There is a lack of intervention studies regarding the efficacy of management programmes directed toward physicians, concerning the effects on professional and personal wellbeing. This is the first time dialogue groups have been studied within a health care setting.
Becoming critically ill and in need of ventilator treatment is a considerable burden. Fear and anxiety are natural reactions and it is not uncommon for patients to experience hopelessness, withdrawal and depression. In situations like these the possession of inner strength can be of vital importance.
To gain knowledge on what factors contribute to inner strength in critically ill patients cared for in an intensive care unit. The depth interviews were conducted with six former ventilator-treated patients aged 60-72years.
The informants were recruited through the ICU at an urban hospital in Norway.
The study has an exploratory and descriptive design. A hermeneutic approach was used to interpret the data, in which Kvale's self-perception, critical common sense and theoretical levels were applied.
The study clearly demonstrates that there are certain factors that promote the inner strength of patients undergoing ventilator treatment. These are: "To have the support of next of kin", "The wish to go on living", "To be seen" and "Signs of progress". Amongst these patients it appears that the presence of one's next of kin has prime significance in promoting inner strength.
To survey Fellows of the Australasian College for Emergency Medicine (FACEM) on how a range of factors influenced their decision to accept their most recent position. To compare this information between rural and metropolitan FACEM.
Analytical cross-sectional survey of FACEM. Sections included baseline demographics and a range of questions regarding the presence, absence and influence of 14 professional and 12 personal/external factors on the decision to accept their current position.
Questionnaires were returned by 498 (61.9%) of 805 FACEM. Eighty-seven (18.4%) were currently employed in rural areas. Rural FACEM were more likely to be male (odds ratio 2.0 [95% CI 1.1-3.9]) and to have worked for >12 months as a registrar in a rural hospital (odds ratio 4.5 [95% CI 2.2-9.1]). Negative influences for FACEM accepting rural positions included lack of access to continuing education, less acceptable on-call arrangements, fewer employment opportunities for their partner and less educational opportunities for their children. Positive influences included acceptable remuneration, desirable lifestyle, a higher indigenous caseload and more affordable housing.
The influence of different types of factors appears to differ between rural and metropolitan FACEM and this information might assist in the formulation of strategies aimed at increasing the rural workforce.
To assess the timing, legibility, and completeness of handwritten, faxed hospital discharge summaries as judged by family physicians and to obtain their opinion on the information categories on a standardized discharge summary form.
Fax survey of physicians for consecutive patients discharged from hospital over 8 weeks.
Three wards in a tertiary care teaching hospital.
One hundred two family physicians and general practitioners practising in Hamilton, Ont.
Proportions of summaries that were received, received within 48 hours of discharge, legible, and complete; types of information missing from incomplete summaries; proportion of physicians satisfied with the information categories.
Of 271 consecutive patient discharges, 195 (72%) were eligible for study. Among those ineligible, 22 patients (8%) did not have a family doctor identified on their hospital records. Among records that did have a family physician identified, fax numbers were unavailable or unknown for 54 physicians (20%). One hundred two physicians completed 166 discharge summary assessments for a response rate of 85% (166/195). By 3 weeks after discharge, 138 discharge summaries (83%) had been received by patients' family doctors. Among those received, 86% were received within 48 hours of discharge; 92% were legible; and 88% were complete. Hospital doctors' signatures, patients' diagnoses, and follow-up plans were most frequently missing. Ninety-five percent of physicians were satisfied with the information categories included on the standardized form.
Handwritten, faxed hospital discharge summaries were acceptable to family physicians for most patients. Criteria are needed for determining which patients require both handwritten and dictated discharge summaries.
Cites: J Gen Intern Med. 1989 Sep-Oct;4(5):453-62795267
The purpose of this study was to compare the domestic violence (DV) rate identified with simple direct questioning to a historical cohort of patients receiving routine emergency department (ED) care. One thousand ED charts of female patients were retrospectively reviewed. Each patient in the prospective cohort was asked five DV specific questions. The historical cohort revealed a DV prevalence rate of 0.4%. The prospective study group of 302 patients identified 11 (3.6%) patients who admitted to acute DV on direct questioning. Ten of these patients accepted help. Twenty (6.6%) were identified as probable DV and 12 (4%) admitted to past violence. The total number of victims of DV, past, present, and probable was 43 (14.2%). This increase in detection from 0.4% (4/1000) to 14.2% (43/302) is significant at p
Although many options exist for ligament reconstruction in knee dislocations, the optimal treatment remains controversial. Allografts and autografts have both been used to reconstruct the cruciate ligaments. We present the results of reconstruction using artificial ligaments at Hôpital du Sacré-Coeur in Montréal.
We reviewed the treatment of all patients with knee dislocations seen between June 1996 and October 1999. The Lysholm score, ACL-quality of life (QoL) questionnaire, physical examination and Telos instrumented laxity measurement were used to evaluate the results.
Twenty patients (21 knees) participated in the study. The mean (and standard deviation [SD]) Lysholm score was 71.7 (18). Results from the ACL-QoL questionnaire showed a global impairment in QoL. Mean (and SD) range of motion and flexion were 118 degrees (10.9 degrees) and 2 degrees (2.9 degrees) respectively. Mean (and SD) radiologic laxity evaluated with Telos for the anterior and posterior cruciate ligaments were 6.1 (5.7) mm and 7.3 (4.5) mm respectively.
Knee reconstruction with artificial ligaments shows promise, but further studies are necessary before it can be recommended for widespread use. This is the first study to show specifically a severe impairment in QoL in this patient population.
Heart disease and stroke are leading causes of death in North America. Nevertheless, in 2003, the Heart and Stroke Foundation of Canada reported that nearly two-thirds of Canadians have misconceptions regarding heart disease and stroke, echoing the results of similar American studies. Good knowledge of these conditions is imperative for cardiac patients who are at greater risk than the general population and should, therefore, be better educated. The present study evaluated the awareness of heart disease and stroke among cardiac patients to assess the efficacy of current education efforts.
Two hundred fifty-one cardiac inpatients and outpatients at St Michael's Hospital (Toronto, Ontario) were surveyed in July and August 2004. An unaided questionnaire assessed respondents' knowledge of cardiovascular risk factors, symptoms of heart attack and stroke, and actions in the event of cardiovascular emergency. Demographic data and relevant medical history were also obtained.
Cardiac patients demonstrated relatively adequate knowledge of heart attack warning symptoms. These patients also demonstrated adequate awareness of proper actions during cardiovascular emergencies. However, respondents were not aware of the most important risk factors for cardiovascular disease. Knowledge of stroke symptoms was also extremely poor. Socioeconomic status, and personal history of heart attack and stroke were positively correlated with good knowledge.
Future patient education efforts should address the awareness of the important cardiovascular risk factors and knowledge of cardiovascular warning symptoms (especially for stroke), as well as inform patients of appropriate actions during a cardiovascular emergency. Emphasis should be placed on primary and secondary prevention, and interventions should be directed toward low-income cardiac patients.
Cites: CMAJ. 2000;162(9 Suppl):S5-1110813022
Cites: J Community Health. 2000 Feb;25(1):47-6510706209