scholarly journals Triggers of defensive medical behaviours: a cross-sectional study among physicians in the Netherlands

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e025108 ◽  
Author(s):  
Erik Renkema ◽  
Kees Ahaus ◽  
Manda Broekhuis ◽  
Maria Tims
Keyword(s):  
Primary Outcome ◽  
Response Rate ◽  
Cross Sectional Study ◽  
Avoidance Behaviour ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Self Blame ◽  
Prescribe Medicine ◽  
Risk Patients ◽  
Defensive Behaviours

ObjectivesThis study investigated whether the attitudes of physicians towards justified and unjustified litigation, and their perception of patient pressure in demanding care, influence their use of defensive medical behaviours.DesignCross-sectional survey using exploratory factor analysis was conducted to determine litigation attitude and perceived patient pressure factors. Regression analyses were used to regress these factors on to the ordering of extra tests or procedures (defensive assurance behaviour) or the avoidance of high-risk patients or procedures (defensive avoidance behaviour).SettingData were collected from eight Dutch hospitals.ParticipantsRespondents were 160 physicians and 54 residents (response rate 25%) of the hospital departments of (1) anaesthesiology, (2) colon, stomach and liver diseases, (3) gynaecology, (4) internal medicine, (5) neurology and (6) surgery.Primary outcome measuresRespondents’ application of defensive assurance and avoidance behaviours.Results‘Disapproval of justified litigation’ and ‘Concerns about unjustified litigation’ were positively related to both assurance (β=0.21, p<0.01, and β=0.28, p<0.001, respectively) and avoidance (β=0.16, p<0.05, and β=0.18, p<0.05, respectively) behaviours. ‘Self-blame for justified litigation’ was not significantly related to both defensive behaviours. Perceived patient pressures to refer (β=0.18, p<0.05) and to prescribe medicine (β=0.23, p<0.01) had direct positive relationships with assurance behaviour, whereas perceived patient pressure to prescribe medicine was also positively related to avoidance behaviour (β=0.14, p<0.05). No difference was found between physicians and residents in their defensive medical behaviour.ConclusionsPhysicians adopted more defensive medical behaviours if they had stronger thoughts and emotions towards (un)justified litigation. Further, physicians should be aware that perceived patient pressure for care can lead to them adopting defensive behaviours that negatively affects the quality and safety of patient care.

scholarly journals Professional Commitment and Career Maturity of Full-Time Nursing Postgraduates in China: A Cross-Sectional Study

2020 ◽  
Author(s):  
kejimu sunzi ◽  
cheng lei ◽  
jun pan ◽  
mei ju
Keyword(s):  
Response Rate ◽  
Career Planning ◽  
Survey Design ◽  
Career Maturity ◽  
Cross Sectional Study ◽  
Professional Commitment ◽  
Full Time ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
The Status

Abstract Background: Nursing is becoming ever more demanding, and is regarded as a stressful occupation because of manpower shortages and various other challenges associated with nursing practice.This article describes the students’ professional commitment and career maturity, and students establish their career objectives during the early stages of their graduate study. Methods: A cross sectional，survey design was conducted at universities in China. A sample of 184 students was selected using the professional commitment scale and career maturity scale to investigate the status quo of professional commitment and career maturity of full-time nursing postgraduates. Data was collected using self-designed demographic characteristics of the student, professional commitment scale, career maturity scale in 2019.Data was analyzed using correlation coefficient test(α < 0.05 ).Results: Participants returned 184 surveys (response rate, 100%) . Career maturity (105.12±11.13), Specialty commitment(90.0 ±12.09),Career maturity was positively correlated with Professional Commitment (r=0.20).Conclusions: The career maturity and professional commitments of full-time nursing postgraduates were of an average level. Career planning courses could be useful to strengthen the vocational education of the post-graduate students.

Students’ Self-assessed Competence Levels during Nursing Education Continuum – A Cross-sectional Survey

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Satu Kajander-Unkuri ◽  
Riitta Meretoja ◽  
Jouko Katajisto ◽  
Helena Leino-Kilpi ◽  
Arja Suikkala
Keyword(s):  
Nursing Education ◽  
Clinical Practice ◽  
Nursing Students ◽  
Response Rate ◽  
Cross Sectional Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Competence Scale ◽  
The Relationship ◽  
Education Nursing

AbstractDuring nursing education, nursing students are required to develop their competence to be able to fulfill their duties safely as Registered Nurses. The aims of this study were to explore 1) nursing students’ self-assessed competence levels during education 2) the relationship with competence and frequency at which competencies are utilized in clinical practice, and 3) factors related to competence levels. 841 (response rate 67.6 %) nursing students responded to the Nurse Competence Scale in a cross-sectional study. The self-assessed overall competence levels were improving during the education continuum (VAS-means 1st 56.6; 2nd 58.3; 3rd 59.8 and 3.5th -year students 68.4). Every group revealed a significant positive correlation with competence and frequency at which competencies are utilized in clinical practice in clinical placement. Risk factors for low competence were also identified. Systematic multimethod competence evaluations with longitudinal designs are needed to monitor outcomes of nursing education.

scholarly journals Cross-Sectional Survey of Students and Instructors on Virtual Dermatology Teaching in a Competency-based Format

2021 ◽  
Vol 5 (6) ◽  
pp. 680-684
Author(s):  
Shara Chopra ◽  
Ankita Sinharoy ◽  
Alexandra Flamm
Keyword(s):  
Response Rate ◽  
Core Competencies ◽  
Medical Student Education ◽  
Cross Sectional Study ◽  
Learning Objectives ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Qualitative Feedback ◽  
University Support ◽  
Instructor Satisfaction

Background Due to the COVID-19 pandemic in the Spring of 2020, the dermatology rotation at the Penn State College of Medicine was converted into a 4-week virtual format. Given these rapid changes, we aimed to assess student and instructor satisfaction to the virtual course and if the course fulfilled the six ACGME core-competencies for medical student education required in a traditional teaching format.   Methods We conducted a cross-sectional study to assess PSCOM student and instructor satisfaction to the elective. Surveys specifically inquired about course learning objectives, interaction, and teaching in the virtual setting based on a 5-point Likert scale and asked to provide qualitative feedback.   Results Medical students (n=15, response rate=52%) were satisfied with learning objectives geared towards the ACGME core competencies in five of the six competencies. Instructors (n=7, response rate=58%) reported satisfaction with convenience, university support, and technical training, but less with student-to-student interaction, gauging comprehension, and fostering critical thinking. Qualitative feedback reflected these results.   Conclusions From our survey data, students and instructors were generally satisfied with the virtual rotation’s dermatology teaching during the uncertain times of the COVID-19 pandemic and holds potential to expand dermatology education, with a future focus on improving student engagement in a virtual format.

scholarly journals Virtual obstetrics and gynecology fellowship interviews during the coronavirus disease 2019 (COVID-19) pandemic: a survey study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Alexandra Peyser ◽  
Moti Gulersen ◽  
Michael Nimaroff ◽  
Christine Mullin ◽  
Randi H. Goldman
Keyword(s):  
Primary Outcome ◽  
Response Rate ◽  
Survey Study ◽  
Future Application ◽  
Obstetrics And Gynecology ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Interview Process ◽  
And Performance ◽  
Attending Physicians

Abstract Background Due to the coronavirus disease 2019 (COVID-19) pandemic, all Obstetrics and Gynecology fellowship interviews were held virtually for the 2020 fellowship match cycle. The aim of this study was to describe our initial experience with virtual Obstetrics and Gynecology fellowship interviews and evaluate its effectiveness in assessing candidates. Methods This was a cross-sectional survey study that included all interviewing attending physicians and fellows from five Obstetrics and Gynecology subspecialties at a single academic institution following the 2020–2021 fellowship interview season. The survey consisted of 19 questions aimed to evaluate each subspecialty’s virtual interview process, including its feasibility and performance in evaluating applicants. The primary outcome was the subjective utility of virtual interviews. Secondary outcomes included a comparison of responses from fellows and attending physicians. Results Thirty-six attendings and fellows completed the survey (36/53, 68% response rate). Interviewers felt applicants were able to convey themselves adequately during the virtual interview (92%) and the majority (70%) agreed that virtual interviews should be offered in future years. Attending physicians were more likely than fellows to state that the virtual interview process adequately assessed the candidates (Likert Scale Mean: 4.4 vs. 3.8, respectively, p = 0.02). Respondents highlighted decreased cost, time saved, and increased flexibility as benefits to the virtual interview process. Conclusion The use of virtual interviews provides a favorable method for conducting fellowship interviews and should be considered for use in future application cycles. Most respondents were satisfied with the virtual interview process and found they were an effective tool for evaluating applicants.

scholarly journals Cross-sectional study of nutritional intake among patients undergoing tuberculosis treatment along the Myanmar–Thailand border

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e052981
Author(s):  
Karim Damji ◽  
Ahmar H Hashmi ◽  
Lin Lin Kyi ◽  
Michele Vincenti-Delmas ◽  
Win Pa Pa Htun ◽  
...  
Keyword(s):  
Weight Gain ◽  
Primary Outcome ◽  
Cross Sectional Study ◽  
Nutritional Intake ◽  
Secondary Outcome ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Tb Treatment ◽  
Micronutrient Intake ◽  
Caloric Requirements

ObjectiveThis study summarises nutritional intake among patients with tuberculosis (TB) along the Myanmar–Thailand border according to the local diet.SettingTB clinic along the Myanmar–Thailand border.ParticipantsCross-sectional surveys of 24-hour food recall were conducted with participants receiving anti-TB treatment. Participants were purposively selected to reflect proportion of age, sex and HIV co-infection based on historical patient records. Out of a total of 28 participants, 20 (71.4%) were men and 5 (17.9%) were co-infected with HIV.Primary and secondary outcome measuresThe primary outcome compared actual recorded intake to recommended intake. Secondary outcomes compared weight gain and body mass index (BMI) from diagnosis to time of survey.ResultsThere were no significant differences in macronutrient or micronutrient intake by sex or for patients supplementing their rations. Mean treatment length at time of survey was 20.7 weeks (95% CI: 16.5 to 24.8). A significantly higher proportion of women (8/8, 100%) met caloric requirements compared with men (9/20, 45.0%, p=0.010), but few participants met other macronutrient or micronutrient requirements, with no significant differences by sex or for patients supplementing their rations. From diagnosis to the time of the survey, participants averaged significant weight gain of 6.48 kg (95% CI: 3.87 to 9.10) and increased BMI of 2.47 kg/m2 (95% CI: 1.45 to 3.49; p=0.0001 for both). However, 50% (14/28) still had mild or more severe forms of malnutrition.ConclusionsThis cross-sectional survey of nutritional intake in patients undergoing TB treatment in a sanatorium setting demonstrates the difficulty in sufficiently meeting nutritional demands, even when providing nutritional support.

scholarly journals Factors associated with the timely initiation of antenatal care: findings from a cross-sectional study in Northern Bangladesh

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052886
Author(s):  
Bidhan Krishna Sarker ◽  
Tawhidur Rahman ◽  
Tanjina Rahman ◽  
Musfikur Rahman
Keyword(s):  
Antenatal Care ◽  
Rural Women ◽  
Primary Outcome ◽  
Educational Status ◽  
Sociodemographic Factors ◽  
Cross Sectional Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Timely Initiation ◽  
To Receive

ObjectiveThis paper explored the factors that influence the timely initiation of antenatal care (ANC) in Bangladesh.DesignThis was a cross-sectional survey.SettingThis study conducted in two rural subdistricts and one urban area from three Northern districts of Bangladesh from August to November 2016.ParticipantsWomen who had a live birth in the last 1 year prior to data collection were enrolled for this study. In each study area, around 900 women were interviewed, and finally, we completed 2731 interviews.Primary outcome measuresThe primary outcome was timely first ANC from a Medically Trained Provider (MTP).ResultsAbout 43% of pregnancies were detected at their earliest time. The majority of participants (82%) received at least one ANC from an MTP. Only 11% received timely first ANC from an MTP as per the WHO FANC model. The women who detected pregnancy earlier were more likely (adj.OR 1.99, 95% CI 1.31 to 3.01) to receive the timely first ANC. The urban women were more likely (adj.OR 1.78, 95% CI 1.13 to 2.80) to receive the timely first ANC from an MTP than those of the rural women. Besides, their husbands’ educational status (adj.OR 1.61, 95% CI 1.0 to 2.60) was significantly associated with the timely first ANC.ConclusionApart from sociodemographic factors, early pregnancy detection was strongly associated with the timely first ANC visit. Timely initiation of ANC is an opportunity to adhere to all the WHO recommended timely ANC visits for a pregnant woman. The findings suggest maternal, neonatal, and child health programmes to focus on the early detection of pregnancy to ensure universal ANC coverage and its timeliness.

scholarly journals Experiences of relatives with outpatient palliative care: a cross-sectional study

2020 ◽  
Vol 26 (5) ◽  
pp. 230-237
Author(s):  
André Fringer ◽  
Sabrina Stängle ◽  
Iren Bischofberger ◽  
Daniel Büche ◽  
Renate Praxmarer ◽  
...  
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Response Rate ◽  
Cross Sectional Study ◽  
Descriptive Statistics ◽  
Sectional Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Dying At Home ◽  
At Home

Aim: The authors aimed to evaluate the experiences of the relatives of dying people, both in regard to benefits and special needs, when supported by a mobile palliative care bridging service (MPCBS), which exists to enable dying people to stay at home and to support patients' relatives. Design: A cross-sectional survey. Methods: A standardised survey was performed, asking 106 relatives of dying people about their experiences with the MPCBS (response rate=47.3%). Descriptive statistics were analysed using SPSS 23. Findings: Many relatives (62.5%) reported that their dying relations when discharged from a facility to stay at home were not symptom-free. The MPCBS helped relatives maintain home care, and this was reported to be helpful. Support provided by the MPCBS made it easier for 77.6% of relatives to adjust care as soon as situations changed, and helped ensure that symptoms could be better controlled, at least for 68.2% of relatives. Younger relatives felt more encouraged by the MPCBS to care for their relatives dying at home.

Abstract 13883: The Presence of Coronary Calcifications on the Chest CT Scan Performed to Diagnose Covid-19 is Associated With a Worse Prognosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jean Guillaume DILLINGER ◽  
Fatima Azzahra Benmessaoud ◽  
Theo Pezel ◽  
Sebastian Voicu ◽  
Georgios Sideris ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Metabolic Diseases ◽  
Invasive Mechanical Ventilation ◽  
Cross Sectional Study ◽  
Chest Ct ◽  
Cross Sectional ◽  
Risk Patients ◽  
Cv Disease ◽  
Worse Prognosis ◽  
Chest Ct Scan

Introduction: With the coronavirus disease (COVID-19) outbreak, early identification of the most severely impacted patients is essential. Previous cardiovascular (CV) and metabolic diseases affect the COVID-19 prognosis. In high CV risk patients, coronary artery calcification (CAC) is associated with a higher incidence of CV outcomes. Hypothesis: To assess the association between the presence of CAC on the chest CT performed to diagnose COVID-19 and the occurrence of severe COVID-19 outcomes. Methods: Cross-sectional study on consecutive patients from 40 to 80 years of age, hospitalized for COVID-19 infection, with a chest CT without contrast injection performed on the day of admission. Patients with CV disease history were excluded. CAC was defined as any area ≥1mm2 with a density >130 Hounsfield units on the known coronary track. The primary outcome was the rate of patients with severe progression, defined as a score of 5 to 7 on the WHO Blueprint expert group scale (noninvasive or invasive mechanical ventilation, extracorporeal membrane oxygenation, death) within 8 days following hospital admission. Results: 134 consecutive patients (60±8 years) were included. CAC was detected in 61 patients (46%). The primary outcome occurred in 29 (48%) of those 61 patients with CAC compared to 15 (21%) without CAC (HR 2.9; 95% CI [1.6 - 5.3]; p=0.0008). In patients ≤60 years (n=69), CAC was detected in 28% and the primary outcome occurred in 58% of patients with CAC compared to 16% without CAC (p=0.0006). In patients >60 years (n=65), CAC was detected in 63% of patients. In this population, the primary outcome occurred in 43% of patients with CAC compared to 30% without CAC without significant interaction. Multivariate analysis showed that CAC was independently associated with poor prognosis (HR 3.4; 95% CI [1.5 - 7.8]; p= 0.004). Conclusions: The evidence of CAC on initial chest CT performed in patients with COVID-19 is associated with a worse prognosis.

scholarly journals Sex differences in prevalence and determinants of hypertension among adults: a cross-sectional survey of one rural village in Bangladesh

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037546
Author(s):  
Jessica Yasmine Islam ◽  
M Mostafa Zaman ◽  
Jasim Uddin Ahmed ◽  
Sohel Reza Choudhury ◽  
Hasanuzzaman Khan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sex Differences ◽  
Primary Outcome ◽  
Cross Sectional Study ◽  
Lifestyle Changes ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Hypertension Prevalence ◽  
Health History ◽  
Physical Measurements

ObjectivePrevention of mortality due to cardiovascular disease (CVD) through control of hypertension is a public health priority in Bangladesh. Our objective was to assess sex differences in prevalence and determinants of hypertension among adults in one rural area of Bangladesh.Study designCross-sectional.Setting and participantsFrom January 2014 to December 2015, we conducted a cross-sectional study of 2600 men and women aged ≥18 years located in one rural district of Bangladesh. We collected data on demographics, behavioural factors, physical measurements and health history.Primary outcome measuresOur primary outcome was hypertension (systolic blood pressure ≥140 or diastolic blood pressure ≥90 mm Hg).ResultsThe average age of participants was 41.6 years and 53.7% were women. Hypertension prevalence was 6.9% (95% CI 5.9 to 7.9), and was significantly higher among women (8.9%) than men (4.5%). The highest prevalence of hypertension was observed among women aged ≥60 years at 21.3% (95% CI 16.6 to 26.7). A higher proportion of men with hypertension were aware of their condition (72.2%) compared with women (52.4%). Determinants of hypertension included older age, higher education, current tobacco use, increasing body mass index, and hyperglycaemia.ConclusionOur research suggests that hypertension prevalence is higher among women than men in rural Bangladesh. Sex-specific interventions should be developed to inform adults of the necessary lifestyle changes that may reduce the risk of hypertension and subsequent CVDs.

Coping Style as a Mediator of the Relationship Between Depressive Symptoms and Deliberate Self-Harm

Crisis ◽  
2011 ◽  
Vol 32 (5) ◽  
pp. 272-279 ◽  
Author(s):  
Allison S. Christian ◽  
Kristen M. McCabe
Keyword(s):  
Depressive Symptoms ◽  
Undergraduate Students ◽  
Cross Sectional Study ◽  
Self Report ◽  
Hierarchical Regression ◽  
Cross Sectional ◽  
Deliberate Self Harm ◽  
Self Blame ◽  
Self Harm ◽  
The Relationship

Background: Deliberate self-harm (DSH) occurs with high frequency among clinical and nonclinical youth populations. Although depression has been consistently linked with the behavior, not all depressed individuals engage in DSH. Aims: The current study examined maladaptive coping strategies (i.e., self-blame, distancing, and self-isolation) as mediators between depression and DSH among undergraduate students. Methods: 202 students from undergraduate psychology courses at a private university in Southern California (77.7% women) completed anonymous self-report measures. Results: A hierarchical regression model found no differences in DSH history across demographic variables. Among coping variables, self-isolation alone was significantly related to DSH. A full meditational model was supported: Depressive symptoms were significantly related to DSH, but adding self-isolation to the model rendered the relationship nonsignificant. Limitations: The cross-sectional study design prevents determination of whether a casual relation exists between self-isolation and DSH, and obscures the direction of that relationship. Conclusions: Results suggest targeting self-isolation as a means of DSH prevention and intervention among nonclinical, youth populations.

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