Patient suicide often results in profound personal and professional crises for the treating clinicians. Residency training in psychiatry represents a critical time for experiencing the death of patients by suicide. While residents often treat some of the most acutely ill, high-risk patients, during a uniquely vulnerable phase of professional development, ...

OBJECTIVE: To identify barriers to first-responder automated external defibrillator (AED) use by determining firefighter attitudes, opinions, and concerns about their AED program. METHODS: An anonymous survey was mailed to all firefighters in a municipal department that had had first-responder defibrillation for more than two years. A follow-up survey was mailed ...

BACKGROUND: Physician adherence to practice guidelines has been poor. Exposure to such guidelines is not a routine part of medical school curricula. PURPOSE: This study was designed to determine whether standardized patients could be used to teach preclinical students the skills to manage a patient with newly diagnosed diabetes mellitus. ...

OBJECTIVE: Although there is a literature discussing and describing medical students providing psychotherapy, there has been little written about students doing crisis therapy with an emergency department patient population. At the University of Toronto, third-year clinical clerks can do a rotation in the Clerk Crisis Clinic where they are assigned ...

PURPOSE: The primary objective of this descriptive study was to assess if and when dental hygiene curricula provide practice opportunities to students in teaching patient/client oral health self-care techniques and whether that experience was prior to their first clinical experience. METHODS: Data were collected through the use of descriptive research ...

BACKGROUND: The ways that GPs treat depressed patients have been criticized in a number of studies. OBJECTIVE: To explore factors that shape how GPs work with depressed patients. METHODS: Seventeen GPs from the county of Orebro, Sweden participated in a qualitative semi-structured interview study. GPs' conceptions of factors shaping their ...

OBJECTIVE: The primary objective was to determine the effect of a hydroxymethylglutaryl- CoA reductase inhibitor (HMG) tablet-splitting program on laboratory outcomes (lipid panel and liver enzyme tests). Other objectives were to assess patient compliance and satisfaction with splitting tablets and to measure the reduction in drug acquisition costs. METHODS: Patients ...

The present study explored the similarities and differences in patterns of psychological distress, coping strategies and social support of 41 cancer patients who dropped out of a psychosocial therapy program and 20 patients who completed the program as agreed. The findings indicated that only depression, out of nine brief symptom ...

OBJECTIVES: The purpose of this project was to teach students how to work effectively with patients in the area of health-behavior change. As part of the patient-doctor course, first-year medical students worked with diabetic patients who were selected by their primary physicians. In preparation for their patient interactions, students were ...

A training program of "limited goal-oriented abdominal sonography" for general practitioners (GPs) was planned, set up and tested. After 1 month of intensive training (about 100 examinations), four test subjects succeeded in technically performing examinations in four patients out of five patients, and were able to rule out or exclude ...

OBJECTIVE: To develop and evaluate the Patient Care Project (PCP), an integrated patient-centred, community-based learning activity, implemented at the University of Hong Kong since 1992. DESIGN: The PCP, a required course in the first 2 preclinical years, is structured into four learning cycles over 9 months. Each cycle consists of ...

BACKGROUND: Standardized patient training involves an experiential approach to clinical training, using laypeople acting as patients to provide skills-building opportunities for health care providers. METHOD: Standardized patient training was used for 2 years in combination with a computer-based continuing education program or traditional inservice program to teach two important communication ...

Previous research has shown that physicians experience incompetence and difficulty in dealing with patients' feelings after they have broken bad news to them. During the past 10 years, we have implemented a longitudinal training program targeting these issues. The present article describes this training and discusses its contribution to doctors' ...

A pilot study was conducted to develop and test a nursing intervention to facilitate the management of fatigue in patients receiving chemotherapy. The intervention, named the "Beating Fatigue" program, has 4 elements: assessment/monitoring, education, coaching in the management of fatigue, and provision of emotional support. Beating Fatigue was implemented with ...

BACKGROUND: Medical education uses the cognitive apprenticeship model of student learning extensively. Students rotate among different hospitals and out- patient clinics where they are exposed to a range of professionally relevant contexts. Here they learn to think and act in different domains under the supervision of experts. Previous research has ...

For a variety of reasons, end-stage renal disease disproportionately affects minority populations. Factors such as socioeconomic status, cultural differences, and genetic variations, are all involved. In addition, there are often real and perceived barriers for these patient groups in fully accessing the healthcare system. Thus, there is a real need ...

OBJECTIVE: To describe how centers of amputee care in Canada evaluate program and patient outcome. DESIGN: National postal survey. SETTING: Amputee rehabilitation centers across Canada. PARTICIPANTS: Forty-four medical directors. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Type and frequency of use of program evaluation, formal and informal patient outcome measures data, ...

Given the high number of patients who fail to take their medicines as directed, there is a strong case to be made that pharmacists could play a much stronger role in DM efforts. Now, Costa Mesa, CA-based Prescription Solutions is testing that theory out with two new programs that target ...

We describe a new cognitive-behavioral systems-based group treatment for persons with borderline personality disorder (BPD). The program is called STEPPS, an acronym for Systems Training for Emotional Predictability and Problem Solving. Briefly, the program combines cognitive-behavioral techniques and skills training with a systems component. The latter involves patients with BPD ...

BACKGROUND: Teledermatology has become more widely used, but its impact has not been clearly elucidated. We developed a teledermatology program in response to clinical need, based on the store-and-forward approach. OBJECTIVE AND METHODS: Our purpose was to evaluate the satisfaction of patient and referring physician by using telephone interview. RESULTS: ...

BACKGROUND: Because the prevalence of end-stage renal disease (ESRD) has progressively increased in both the United States and Canada, patients with ESRD are likely to constitute progressively larger proportions of nephrology practices. METHODS: We mailed a questionnaire to US and Canadian nephrology program directors to determine methods used in dialysis ...

PURPOSE: To support students' developing professionalism, it is necessary to understand the professional challenges and dilemmas they perceive in the clinical setting. This study systematically documented and catalogued students' reports of professional lapses. METHOD: Six focus groups were conducted with senior medical students (n = 29) at three universities. Using ...

BACKGROUND: When empathy was presented in a lecture, medical students did not appreciate the topic or have opportunities to practice empathic techniques. The Patient Navigator Project was designed to foster understanding of a patient's experiences and encourage empathic communication. METHODS: The project uses experiential learning in an outpatient setting in ...

Lifestyle behaviors contribute significantly to the onset and course of numerous diseases and affect well-being in general. Patient education is the principal strategy nurses use to modify individuals' knowledge, attitudes, and beliefs about their health behaviors. However, current approaches are failing to induce the behavior changes necessary to reduce the ...

That is the prescription of at least one expert who contends that common practitioner behaviors actually build up resistance to change in their chronically ill patients. To combat these behaviors, he contends that many practitioners need to learn new skills to help them better guide patients along the continuum of ...

OBJECTIVES: To identify factors limiting the effectiveness of communication between Aboriginal patients with end-stage renal disease and healthcare workers, and to identify strategies for improving communication. DESIGN: Qualitative study, gathering data through (a) videotaped interactions between patients and staff, and (b) in-depth interviews with all participants, in their first language, ...

There is a growing population of adults with cystic fibrosis (CF) and a need for development of adult CF programs. Recommendations for transfer of patients from pediatric care to an adult program include a transition program. The purpose of this study was to survey adult CF patients to assess their ...

A local Personal Computer (PC) network program has been designed to improve training and patient care in Family and Community Medicine set-up. The software was designed to cope with the different clinical, preventive, promotive and statistical programs of the teaching set-up. This system serves multiple levels of patient priority, assigning ...

An interactive team exercise based in the dual topic areas of social and abnormal psychology is described that employs videotaped case studies to sensitize students to the processes by which they form first impressions of other people, and to various issues regarding assessments of mental disorders. Each of three case ...

Ventricular assist devices (VADs) have made it possible for patients with end-stage heart failure to survive until a donor heart is available. In addition to serving as a bridge to transplantation, evolving indications for VADs include bridge to recovery and destination therapy. There are many VAD programs, but in the ...

PURPOSE/OBJECTIVES: To describe the process of developing a cancer-related patient and family education CD-ROM program and initial evaluation results. DATA SOURCES: Published research, theory, practice, and personal experience. DATA SYNTHESIS: CD-ROM programs can be far more comprehensive than the booklets and videotapes used more commonly in patient education. Developing CD-ROM ...

A medication education program for ambulatory care patients implemented in a church setting was studied. The program at each of 20 churches in Ohio consisted of a one-hour orientation for pharmacists/interns, a 20-minute presentation on medications and health, a question-and-answer session led by a pharmacist and a nurse, a one-on-one ...

The transport of critically ill patients is hazardous, yet necessary. In these conditions monitoring may be challenging, and the ability to intervene when problems arise is often limited. Conducting safe transport of these patients has been shown to be possible when experienced personnel apply their knowledge appropriately. It is a ...

A good recall system can improve the efficiency of any dental office. The majority of patients do not respond to the standard reminder postcard used in the passive recall system. An active prebooking system is far more productive. This article will outline an effective recall program and include discussion of ...

This descriptive article highlights a 42-month project in which a comprehensive program revision was implemented in a psychiatric hospital that included numerous alternative strategies to the use of patient restraint and seclusion. The results of this project include a 94% reduction in the rate of restraint and seclusion, development of ...

Major national and international critiques of the medical curriculum in the 1980s noted the following significant flaws: (1) over-reliance on learning by rote memory, (2) insufficient exercise in analysis and synthesis/conceptualization, and (3) failure to connect the basic and clinical aspects of training. It was argued that the invention of ...

We describe a step-wise role playing approach to bedside teaching during the clinical training of medical students. The objective of this approach is to teach them the skills which are required to practice patient-centered medicine. "Patient-centered medicine" refers to a style of practice which relates to patients' needs rather than ...

AIM: To determine students opinions about diagnosis disclosure to the patient and other interested parties. METHODS: During 2000/2001 academic year, an anonymous survey was conducted among the first-year (200 questionnaires) and sixth-year medical students (200 questionnaires) at the Zagreb University School of Medicine. Students were asked what they would say ...

The triadic match is the author's term for the interaction among analytic candidate, supervisor, and patient. Overlapping or diverging characteristics of candidate and supervisor may influence the candidate's learning for good or ill depending on the way patient's and candidate's character and conflicts interact. Four candidates who had found their ...

The objective of this study was to evaluate a computer based interactive diabetes education program designed to train patients with diabetes to correctly estimate the energy or carbohydrate contents of foods. The acceptance and the operator convenience of the program were evaluated with an integrated program and written questionnaires. The ...

Over the past two decades, considerable evidence has accrued that heart failure patients benefit from aerobic exercise training programs. Improvements in peak oxygen consumption and its components as well as increases in ventilatory threshold and submaximal endurance have been documented from such programs. Despite the fact that heart failure predominates ...

This paper discusses the critical issues that surround the development of an orofacial pain program in a dental school and suggests strategies to address them. Since the University of Minnesota has an established orofacial pain program involved in both predoctoral and postdoctoral teaching, clinical and basic research, and interdisciplinary patient ...

BACKGROUND: Delivering bad news is a difficult task that is important to address in medical education. PURPOSE: This study evaluated the impact of an experiential educational intervention using multiple standardized patient scenarios on medical students' comfort with delivering difficult news. METHODS: In small groups, 3rd-year medical students practiced communicating bad ...

OBJECTIVES: Home hemodialysis (HHD) has been used only in a minority of patients over past years although it may offer significant advantages over the other renal replacement therapies. This study describes the systems for and the initial results of starting a HHD program. MATERIAL AND METHODS: A program for HHD ...

The Healthy Start Clinic is a multidisciplinary program that provides education and appropriate clinical interventions for patients with chronic renal insufficiency. The overall goals of the program are to delay the progression of kidney disease and improve the quality of care at the initiation of renal replacement therapy. This report ...

The major challenge of contemporary dental education is teaching students to transfer their acquired knowledge from one setting to another. New technology-based educational tools such as IMPACT, Interactive Multimedia Patient Case Tutor, developed at the Virginia Commonwealth University School of Dentistry, can assist in this educational paradigm shift by teaching ...

BACKGROUND AND OBJECTIVE: We describe an approach for the resolution of difficulties that some preclinical medical students appeared to have when acquiring patient interviewing skills. SETTING: Two medical schools in Israel. TYPE OF STUDY: Descriptive. OBSERVATIONS: Students' difficulties were related to the inconsistency between the patient-centered approach that was emphasized ...

The leading cause of death in the United States is heart disease. Because an elevated serum cholesterol level is an independent risk factor for development of coronary heart disease (CHD), individuals older than 20 years of age are advised to have their cholesterol level checked every 5 years. Walk-in screening ...

INTRODUCTION: In patients with myocardial infarction, platelet aggregation inhibition with glycoprotein IIb/IIIa antagonists helps restore and maintain coronary blood flow when administered alone, with fibrinolytics, or with angioplasty. This article evaluates whether an adequate number of patients transported by an air medical program could benefit from flight team administration of ...

OBJECTIVE: To test a training procedure designed to enable severely paralyzed patients to communicate by means of self-regulation of slow cortical potentials. DESIGN: Application of the Thought Translation Device to evaluate the procedure in patients with late-stage amyotrophic lateral sclerosis (ALS). SETTING: Training sessions in the patients' homes. PARTICIPANTS: Two ...