RESUMEN
The aim of this study is to describe religious and spiritual beliefs of physicians and examine their influence on the decision to pursue medicine and daily medical practice. An anonymous survey was e-mailed to physicians at a large, multidisciplinary tertiary referral center with satellite clinics. Data were collected from January 2014 through February 2014. There were 2097 respondents (69.1 % men), and number of practicing years ranged from ≤1 to ≥30. Primary care physicians or medical specialists represented 74.1 %, 23.6 % were in surgical specialties, and 2.3 % were psychiatrists. The majority of physicians believe in God (65.2 %), and 51.2 % reported themselves as religious, 24.8 % spiritual, 12.4 % agnostic, and 11.6 % atheist. This self-designation was largely independent of specialty except for psychiatrists, who were more likely report agnosticism (P = 0.003). In total, 29.0 % reported that religious or spiritual beliefs influenced their decision to become a physician. Frequent prayer was reported by 44.7 % of physicians, but only 20.7 % reported having prayed with patients. Most physicians consider themselves religious or spiritual, but the rates of agnosticism and atheism are higher than the general population. Psychiatrists are the least religious group. Despite the influence of religion on physicians' lives and medical practice, the majority have not incorporated prayer into patient encounters.
Asunto(s)
Actitud del Personal de Salud , Médicos/psicología , Religión y Medicina , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Médicos/estadística & datos numéricos , Espiritualidad , Adulto JovenRESUMEN
OBJECTIVE: To evaluate interactive effects of pulmonary coccidioidomycosis and asthma. METHODS: We identified three groups of 33 age- and sex-matched patients: Group 1 (both asthma and coccidioidomycosis), Group 2 (asthma only), and Group 3 (pulmonary coccidioidomycosis only). Predetermined end points included: rate of disseminated coccidioidomycosis, duration of symptoms and antifungal therapy, hospitalization, death, and escalation of asthma therapies. RESULTS: Baseline characteristics were similar across groups. Group 1 patients had worsening asthma outcomes (except forced expiratory volume in 1 s) with coccidioidomycosis. They required more asthma medications (median, 2.0 vs 0.0; p < 0.001), more corticosteroids (mean [SD], 0.9 [4.2] vs 0.3 [0.6]; p < 0.001), and more healthcare visits (mean [SD], 0.2 [0.4] vs 0.1 [0.3]; p = 0.03). Groups 1 and 3 had no differences in coccidioidal end points, including rates of dissemination (1 vs 0; p > 0.99), symptom duration (mean, 15.2 vs 23.6 weeks; p = 0.24), antifungal treatment (n = 21 [63.6%] vs n = 24 [72.7%]; p = 0.60), and treatment duration (median, 26.5 vs 11 weeks; p = 0.09). Ten patients in Group 1 versus none in Group 3 required systemic corticosteroids for coccidioidomycosis (p < 0.001). CONCLUSIONS: Active pulmonary coccidioidomycosis significantly worsens asthma outcomes. Asthma (or its treatment) does not worsen coccidioidal outcomes, despite increasing the likelihood of treatment with systemic corticosteroids.
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Asma/epidemiología , Coccidioidomicosis/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ruidos Respiratorios , Adulto JovenRESUMEN
INTRODUCTION: Analyzing hospital naloxone use may assist in identification of areas for quality and safety improvement. Our primary objective is to quantitate the incidence of hospital naloxone use and to assess certain patient populations at risk. METHODS: During the years 2008 to 2011, each clinical scenario where naloxone was administered on an in-patient care ward was reviewed. The events were assessed to separate situations where naloxone rescue was effective in reversing opioid-induced intoxication vs. others. Further analysis was conducted to stratify patient populations at greatest risk. RESULTS: Naloxone was administered for well-defined opioid-induced respiratory depression and oversedation 61% of the time, the remainder used for patient deterioration of other etiology. Surgical populations are at risk with an incidence of 3.8/1,000 hospitalized patients, and this is the greatest within 24 hours of surgery. General surgical patients represent the highest surgical patient risk at 5.5/1,000. Medical patients represent lower risk at 2.0/1,000. Patients with patient-controlled analgesia and epidural opioid infusion are high risk at 12.1 and 13.1/1,000 patients, respectively. Many quality and safety interventions were gradually implemented in response to this data and are summarized. These include nursing and provider education, electronic medical record modification, and more stringent patient monitoring practices. CONCLUSION: Examination of naloxone use can assist in the identification and stratification of patients at risk for opioid-induced respiratory depression and oversedation and can serve as a driver for improvements in hospital patient safety. This information can also guide other institutions interested in similar improvements.
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Naloxona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Adulto , Anciano , Analgesia Epidural , Analgesia Controlada por el Paciente , Analgésicos Opioides/antagonistas & inhibidores , Analgésicos Opioides/envenenamiento , Bases de Datos Factuales , Femenino , Humanos , Hipnóticos y Sedantes/efectos adversos , Hipnóticos y Sedantes/antagonistas & inhibidores , Incidencia , Masculino , Persona de Mediana Edad , Naloxona/efectos adversos , Antagonistas de Narcóticos/efectos adversos , Educación del Paciente como Asunto , Seguridad del Paciente , Insuficiencia Respiratoria/inducido químicamente , Insuficiencia Respiratoria/tratamiento farmacológico , Medición de Riesgo , Centros de Atención TerciariaRESUMEN
UNLABELLED: This study analyzed patient adoption of secure messaging to update medication list in an ambulatory care setting. The objective was to establish demographic differences between users and non-users of secure messaging for medications list update. Efficiency of secure messaging for the updates was compared to fax and telephone based updates. METHODS: The study used a retrospective, cross-sectional study of patient medical records and pharmacy call logs at Mayo Clinic, Arizona from December 2012 to May 2013, approximately one year after organizing a pharmacy call center for medication updates. A subgroup analysis during a 2-week period was used to measure time to complete update. MAIN MEASURES: Main dependent variable is the frequency of medication list updates over the study duration. Technician time required for the update was also utilized. RESULTS: A total of 22,495 outpatient visits were drawn and 18,702 unique patients were included in the primary analysis. A total of 402 unique patients were included in sub-group analysis. Secure message response rate (49.5%) was statistically significantly lower than that for phone calls (54.8%, p<0.001). Time to complete the update was significantly higher for faxed medication lists (Wilcoxon rank-sum tests, p<0.001) when compared to those for secure message or phone. CONCLUSIONS: Around 50% of the patients respond to medication update requests before office visit when contacted using phone calls and secure messages. Given the demographic differences between users and non-users of patient portal, mixed mode communication with patients is likely to be the norm for the foreseeable future in outpatient settings.
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Atención Ambulatoria/estadística & datos numéricos , Confidencialidad , Registros Electrónicos de Salud/estadística & datos numéricos , Sistemas de Entrada de Órdenes Médicas/estadística & datos numéricos , Cumplimiento de la Medicación/estadística & datos numéricos , Conciliación de Medicamentos/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Arizona/epidemiología , Humanos , Conciliación de Medicamentos/métodos , Persona de Mediana Edad , Participación del Paciente/estadística & datos numéricos , Distribución por Sexo , Adulto JovenRESUMEN
OBJECTIVE: Perioperative hydroxy-3-methyl glutaryl coenzyme A reductase inhibitors (statins) have been shown to decrease morbidity and mortality after noncardiac surgery. The objective of this study was to assess patient understanding of the potential benefits of perioperative statins in a select population already on chronic therapy. A secondary aim was to determine the frequency with which patients recalled having a discussion with their provider regarding perioperative statins. DESIGN: Survey. SETTING: Teaching hospital. PARTICIPANTS: Patients taking daily statins presenting to a preoperative medical evaluation clinic were offered a 12-question survey that assessed their understanding of the potential benefit of taking the medication in the perioperative period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: One hundred thirty-two patients completed the questionnaire. The mean age was 68.3 years (standard deviation, 9.0); 42% were female. The most frequent surgical referral to the clinic was orthopedics, at 36%. The most common statin prescribed was atorvastatin, in 35% of patients. Twenty-seven percent of patients (n = 36) recognized that perioperative statins are beneficial; 44% of these patients (n = 14) cited decreased cholesterol during the procedure as the reason, representing 12% of the total sampled population. Twenty-two percent (n = 8) of those recognizing the benefit of perioperative statins identified a decrease in the risk of heart attack or death as the reason. This represented only 6% of the total sample. One percent of surgeons mentioned statins in relation to the planned surgery; 2% of primary or prescribing physicians mentioned the medication in relation to surgery. CONCLUSIONS: This study suggested low patient understanding of the potential importance and reasons for perioperative statins. In addition, this study also suggested that the information regarding the importance of perioperative statins is not being relayed to the patient at the level of the surgeon or primary care physician. All physicians involved in perioperative care can offer improved patient education to promote compliance with statin therapy in hopes of a favorable impact on perioperative outcomes.
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Comprensión , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Cumplimiento de la Medicación , Participación del Paciente/métodos , Atención Perioperativa/métodos , Complicaciones Posoperatorias/prevención & control , Anciano , Atorvastatina/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Encuestas y CuestionariosRESUMEN
Mammography use has increased over the past 20 years, yet more than 30% of women remain inadequately screened. Structural barriers can deter individuals from screening, however, cognitive, emotional, and communication barriers may also prevent mammography use. This study sought to identify the impact of number and type of barriers on mammography screening status, and to examine whether number and type of barriers are different for never-screened and off-schedule women. A total of 182 women aged 40 years or older completed a computer kiosk facilitated survey as part of a larger patient navigator intervention. Logistic regression analysis indicated that breast cancer knowledge predicted whether a woman had ever had a mammogram (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.02-1.06, p = .0003), while the number of emotional, structural, and communication barriers predicted whether a woman was on-schedule for mammograms (OR = 0.79, 95% CI = 0.65-0.95, p = .0127). The results suggest that to increase the use of mammography at recommended regular intervals, interventions should be tailored toward current screening status.
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Conocimientos, Actitudes y Práctica en Salud , Mamografía/psicología , Mamografía/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/diagnóstico , Estudios Transversales , Detección Precoz del Cáncer , Femenino , Conductas Relacionadas con la Salud , Accesibilidad a los Servicios de Salud , Humanos , Modelos Logísticos , Persona de Mediana Edad , Missouri , Cooperación del Paciente , Servicio Social , Interfaz Usuario-ComputadorRESUMEN
BACKGROUND: With the advent of limits to resident duty hours and the size of teaching services, many academic institutions have introduced nonteaching services, often triaging perceived better teaching cases to the resident services. OBJECTIVE: To compare resident versus faculty perceptions of ideal cases for teaching services and compare these perceptions with actual triage decisions made by faculty who assigned patients to either teaching or nonteaching services. DESIGN: Residents and hospitalist faculty were surveyed about their perceptions of ideal and actual teaching admissions, first with qualitative, open-ended questions and then with quantitative, specific questions generated from responses to the first survey. Characteristics of patients admitted to teaching and nonteaching services were analyzed retrospectively and compared with resident and faculty perceptions. RESULTS: Residents and faculty agreed that rare cases, patients with unique physical findings, and a variety of pathology were ideal for teaching services and that social admissions, benefactors, and patients with chronic or functional pain were not. Residents believed that traditional ("bread and butter") medicine cases were under-represented on the teaching services. Although residents perceived that they received a disproportionate number of older patients, outside transfers, patients with chronic pain, and patients with cancer, the only statistically significant difference was in patient age, with the teaching service actually receiving younger patients (66.7 vs 69.3 years; P=0.008). CONCLUSIONS: Residents and faculty have similar views about ideal teaching cases, but a triage system based on perceived educational merit creates the possibility of resident misperceptions about their case mix, even if patients are distributed relatively equitably.
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Toma de Decisiones en la Organización , Educación Médica Continua/métodos , Médicos Hospitalarios/educación , Hospitales de Enseñanza , Internado y Residencia/métodos , Admisión del Paciente/normas , Médicos/normas , Grupos Diagnósticos Relacionados , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
In Arizona, USA, primary pulmonary coccidioidomycosis accounts for 15%-29% of community-acquired pneumonia. To determine the evolution of symptoms and changes in laboratory values for patients with mild to moderate coccidioidomycosis during 2010-2012, we conducted a prospective 24-week study of patients with primary pulmonary coccidioidomycosis. Of the 36 patients, 16 (44%) were men and 33 (92%) were White. Median age was 53 years, and 20 (56%) had received antifungal treatment at baseline. Symptom scores were higher for patients who received treatment than for those who did not. Median times from symptom onset to 50% reduction and to complete resolution for patients in treatment and nontreatment groups were 9.9 and 9.1 weeks, and 18.7 and 17.8 weeks, respectively. Median times to full return to work were 8.4 and 5.7 weeks, respectively. One patient who received treatment experienced disseminated infection. For otherwise healthy adults with acute coccidioidomycosis, convalescence was prolonged, regardless of whether they received antifungal treatment.
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Coccidioides/patogenicidad , Coccidioidomicosis/fisiopatología , Convalecencia , Enfermedades Pulmonares Fúngicas/fisiopatología , Neumonía/fisiopatología , Adulto , Anciano , Antifúngicos/uso terapéutico , Arizona/epidemiología , Coccidioides/efectos de los fármacos , Coccidioides/crecimiento & desarrollo , Coccidioidomicosis/tratamiento farmacológico , Coccidioidomicosis/epidemiología , Coccidioidomicosis/microbiología , Infecciones Comunitarias Adquiridas , Femenino , Humanos , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/epidemiología , Enfermedades Pulmonares Fúngicas/microbiología , Masculino , Persona de Mediana Edad , Neumonía/tratamiento farmacológico , Neumonía/epidemiología , Neumonía/microbiología , Estudios Prospectivos , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVES: Analyze the effect of ipsilateral submandibular gland preservation on patients undergoing concurrent neck dissection and transoral surgery for oropharyngeal squamous cell carcinoma. Evaluate for (1) intraoperative and postoperative communications between the oropharynx and neck and (2) oncologic outcomes. STUDY DESIGN: Retrospective chart review of prospectively collected data. SETTING: Tertiary academic referral center. METHODS AND SUBJECTS: Retrospective chart review of patients undergoing transoral laser resection of oropharyngeal squamous cell carcinoma with simultaneous neck dissection(s) for primary, persistent, recurrent, and second primary disease between January 1999 and February 2013. Data analyzed for operative technique, pathologic diagnosis, postoperative course, complications, and oncologic outcomes. RESULTS: Overall 253 patients were identified. Of these, 96 patients underwent ipsilateral submandibular gland preservation and 157 underwent ipsilateral submandibular gland removal at the time of neck dissection. The prevalence of intraoperative communication between the neck and oropharynx was significantly lower in cases with submandibular gland preservation (2/96, 2.08%) compared to those with submandibular gland removal (22/157, 14.13%). No postoperative leaks occurred in the gland preservation group (0/96, 0%) compared to a leak prevalence of 8.92% (14/157) when the gland was removed (P = .0041). There was no difference in local, regional, or distant disease recurrence between submandibular gland preservation and gland removal. Similarly, Kaplan-Meier analysis showed no difference in disease free survival, disease specific survival, or overall survival. CONCLUSIONS: Submandibular gland preservation during neck dissection in patients undergoing transoral surgery for oropharyngeal squamous cell carcinoma significantly reduces the risk of intraoperative and postoperative salivary leaks without compromising oncologic outcomes.
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Carcinoma de Células Escamosas/cirugía , Boca/cirugía , Disección del Cuello/métodos , Tratamientos Conservadores del Órgano/métodos , Neoplasias Orofaríngeas/cirugía , Glándula Submandibular , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Boca/patología , Disección del Cuello/mortalidad , Preservación de Órganos , Neoplasias Orofaríngeas/mortalidad , Neoplasias Orofaríngeas/patología , Seguridad del Paciente , Estudios Retrospectivos , Medición de Riesgo , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
OBJECTIVE: The study's objective was to determine the impact of care directed by a specialty-trained nurse practitioner (NP) or physician assistant (PA) on use of basal-bolus insulin therapy and glycemic control in a population of noncritically ill patients with diabetes. METHODS: A retrospective review of diabetes patients evaluated between July 1, 2011 and December 31, 2011 was conducted. Patients cotreated by a specialty-trained NP/PA were compared with patients who did not receive such care. RESULTS: In total, 171 patients with 222 hospitalizations were cotreated by an NP/PA and 543 patients with 665 hospitalizations were not. Patients with NP/PA involvement were younger, and had more frequent hyperglycemia, and had greater corticosteroid use than patients without NP/PA involvement (P<.01 for all). Basal-bolus insulin therapy was administered to 80% of patients with NP/PA involvement and 34% of patients without it (P<.01). After adjustment for age, sex, hyperglycemia measures, and corticosteroid use, the odds of basal-bolus insulin therapy being administered were increased significantly through NP/PA care (odds ratio, 3.66; 95% confidence interval, 2.36-5.67; P<.01). After adjustment for these variables and insulin regimen, NP/PA care was significantly correlated with lower mean point-of-care glucose levels at 24 hours before discharge (P = .042). CONCLUSION: Diabetes care assisted by an NP/PA trained in inpatient diabetes management results in greater use of recommended basal-bolus insulin therapy and is correlated with lower mean glucose levels before discharge. Adapting this model for use outside an endocrinology consult service needs to be explored so that the expertise can be brought to a broader inpatient population with diabetes.
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Diabetes Mellitus/tratamiento farmacológico , Enfermeras Practicantes , Asistentes Médicos , Anciano , Femenino , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Sistemas de Atención de Punto , Estudios RetrospectivosRESUMEN
There is no consensus on how best to assess the health literacy demands of health information materials. Comprehensive, reliable, and valid assessment tools are needed. The authors report on the development, refinement, and testing of Health Literacy INDEX, a new tool reflecting empirical evidence and best practices. INDEX is comprised of 63 indicators organized into 10 criteria: plain language, clear purpose, supporting graphics, user involvement, skill-based learning, audience appropriateness, user instruction, development details, evaluation methods, and strength of evidence. In a sample of 100 materials, intercoder agreement was high: 90% or better for 52% of indicators, and above 80% for nearly all others. Overall scores generated by INDEX were highly correlated with average ratings from 12 health literacy experts (r = 0.89, p < .0001). Additional research is warranted to examine the association between evaluation ratings generated by INDEX and individual understanding, behaviors, and improved health. Health Literacy INDEX is a comprehensive tool with evidence for reliability and validity that can be used to evaluate the health literacy demands of health information materials. Although improvement in health information materials is just one aspect of mitigating the effects of limited health literacy on health outcomes, it is an essential step toward a more health literate public.