Medical Environment (medical + environment)

Distribution by Scientific Domains


Selected Abstracts


What aspects of the job have most effect on nurses?

HUMAN RESOURCE MANAGEMENT JOURNAL, Issue 1 2003
Abraham Sagie
The study reported here compared the influences of psychological constructs (job demands and scheduling control) and objective work characteristics (shiftwork, night-work and hospital department type) on job satisfaction, organisational commitment, burnout and withdrawal intentions. Our hypothesis was that psychological constructs have a higher influence on work-related attitudes than objective characteristics of work schedules. In addition to the main effects, we proposed an interactive hypothesis: poor attitudes would result from high demands and low control rather than from other combinations of both psychological variables. Using a sample of 153 hospital nurses in Israel, the hypotheses were generally supported. As night-work, shiftwork and working in intensive care units are unavoidable characteristics of the modern medical environment, these findings are meaningful for improving the personal adjustment of hospital nurses. [source]


Cost-effectiveness of the surveillance program of hepatocellular carcinoma depends on the medical circumstances

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 3 2008
Kazuhiro Nouso
Abstract Background and Aim:, The clinical features of hepatocellular carcinoma (HCC) and the medical environment are diverse in different geographic areas. The aim of this study is to evaluate the cost-effectiveness of the surveillance of HCC in different medical circumstances. Methods:, The Markov model focused on variables that differ from country to country and may change in the future, especially in regards to the proportion of small HCC detected incidentally. The target population was 45-year-old patients with Child-Pugh class A cirrhosis, and the intervention was surveillance with ultrasonography every 6 months. Results:, The additional cost of the surveillance was $US15 100, the gain in quality-adjusted life years (QALYs) was 0.50 years, and the incremental cost-effectiveness ratio (ICER) was $US29 900/QALY in a base-case analysis (annual incidence of HCC = 4%). If 40% of small HCC were detected incidentally without surveillance, the gain in QALY decreased to 0.15 and the ICER increased to $US47 900/QALY. The increase in the annual incidence of HCC to 8% resulted in the increase of QALYs to 0.81, and the decrease of the ICER to $US25 400/QALY. The adoption of liver transplantation increased the gain in QALYs and the ICER to 0.84 and $US59 900/QALY, respectively. Conclusions:, The gain in QALYs and the ICER due to the surveillance of HCC varies between different patient subgroups and it critically depends on the rate of small HCC detected incidentally without surveillance, as well as the annual incidence of HCC and the adoption of liver transplantation. [source]


Medical student attitudes toward the doctor,patient relationship

MEDICAL EDUCATION, Issue 6 2002
Paul Haidet
Context, Medical educators have emphasized the importance of teaching patient-centred care. Objectives, To describe and quantify the attitudes of medical students towards patient-centred care and to examine: (a) the differences in these attitudes between students in early and later years of medical school; and (b) factors associated with patient-centred attitudes. Methods, We surveyed 673 students in the first, third, and fourth years of medical school. Our survey utilized the Patient,Practitioner Orientation Scale (PPOS), a validated instrument designed to measure individual preferences towards various aspects of the doctor,patient relationship. Total PPOS scores can range from patient-centred (egalitarian, whole person oriented) to disease- or doctor-centred (paternalistic, less attuned to psychosocial issues). Additional demographic data including gender, age, ethnicity, undergraduate coursework, family medical background and specialty choice were collected from the fourth year class. Results, A total of 510 students (76%) completed data collection. Female gender (P < 0·001) and earlier year of medical school (P = 0·03) were significantly associated with patient-centred attitudes. Among fourth year students (n = 89), characteristics associated with more patient-centred attitudes included female gender, European-American ethnicity, and primary-care career choice (P < 0·05 for each comparison). Conclusion, Despite emphasis on the need for curricula that foster patient-centred attitudes among medical students, our data suggest that students in later years of medical school have attitudes that are more doctor-centred or paternalistic compared to students in earlier years. Given the emphasis placed on patient satisfaction and patient-centred care in the current medical environment, our results warrant further research and dialogue to explore the dynamics in medical education that may foster or inhibit student attitudes toward patient-centred care. [source]


Promoting mental health care in a rural paediatric unit through participatory action research

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2009
Brenda Happell
Abstract Objective:,To explore, advance and evaluate mental health practices in a rural general paediatric unit through participatory action research. Design:,A participatory action research approach guided this study, providing an opportunity for nursing staff to become actively involved in the design, direction and outcomes of the research. Setting:,A 16-bed paediatric unit of a rural general hospital. Participants:,A purposive convenience sample of all paediatric nursing staff (n = 20; of 24 nurses). Outcome measures:,In the first phase of this study, focus groups were conducted to explore the experiences of nurses. Results:,Participants considered mental health to be a specialist discipline area and the role of the mental health nurse to be complex. They felt that their lack of training and experience with mental health issues was detrimental to the delivery of optimal patient care. There was concern about differing approaches to treatment, relationships with other mental health services and the suitability of the ward environment for young people with a mental health problem. Participants called for training by qualified mental health staff and the development of policies and clinical guidelines to facilitate their delivery of care to patients with a mental health problem in an acute medical environment. Conclusions:,There is a clear need for nursing specialities to work together to ensure that optimal care is given to patients admitted to general hospital with a mental health issue. Given the absence of accessible specialist child mental health inpatient units in regional and remote areas, upskilling paediatric nurses must be a priority. [source]