Understanding patient preference for physician attire in ambulatory clinics: a cross-sectional observational study

ObjectivesWe explored patient perceptions regarding physician attire in different clinical contexts and resultant effects on the physician–patient relationship.SettingThe 900-bed University Hospital Zurich, Switzerland.ParticipantsA convenience sample of patients receiving care in dermatology, infectious diseases and neurology ambulatory clinics of the University Hospital Zurich participated in a paper-based survey.Primary and secondary outcome measuresThe survey instrument was randomised and showed photographs of male or female physicians wearing various forms of attire. On the basis of the respondents’ ratings of how the physician’s attire affected perceptions across five domains (knowledgeable, trustworthy, caring, approachable and comfort with the physician), a composite preference score for attire was calculated as the primary outcome. Secondary outcomes included variation in preferences by respondent characteristics and context in which care was provided.ResultsOf 834 patient respondents (140 in dermatology, 422 in infectious diseases and 272 in neurology), 298 (36%) agreed that physician attire was important. When compared with all available choices, the combination of white scrubs with white coat was rated highest while a business suit ranked lowest. Variation in preferences and opinions for attire were noted relative to respondent demographics and the clinical setting in which the survey was administered. For example, compared with younger patients, respondents ≥65 years of age more often reported that physician dress was both important to them and influenced how happy they were with their care (p=0.047 and p=0.001, respectively).ConclusionsOutpatients at a large Swiss University hospital prefer their physicians to be dressed in white scrubs with white coat. Substantial variation among respondents based on demographics, type of physician and clinical setting were observed. Healthcare systems should consider context of care when defining policies related to dress code.

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Work of Health Educators in a Clinical Setting

Californian Journal of Health Promotion ◽

10.32398/cjhp.v4i1.733 ◽

2006 ◽

Vol 4 (1) ◽

pp. 58-63

Author(s):

Lisa Smith ◽

James F. McKenzie

Keyword(s):

Health Education ◽

Clinical Setting ◽

Clinical Settings ◽

Health Educators ◽

Education Curriculum ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Convenience Sample ◽

Content Areas ◽

Survey Results

This study examined the task of health educators working in a clinical setting to better understand their roles. The study was designed as a descriptive, cross-sectional survey using a convenience sample of health educators who worked in clinical settings in Indiana and who had a college degree in health education. Forty health educators were contacted and 62% of the subjects participated in the survey. Results indicated most jobs were similar in nature and the health education curriculum studied helped them in the roles they were serving. However, many educators felt there were other content areas of study that would have been helpful to prepare them for working in the clinical setting. A majority of the respondents reported that having Certified Health Education Specialist (CHES) certification was helpful and necessary in their positions.

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Is an obesity simulation suit in an undergraduate medical communication class a valuable teaching tool? A cross-sectional proof of concept study

BMJ Open ◽

10.1136/bmjopen-2019-029738 ◽

2019 ◽

Vol 9 (8) ◽

pp. e029738

Author(s):

Anne Herrmann-Werner ◽

Teresa Loda ◽

Lisa M Wiesner ◽

Rebecca Sarah Erschens ◽

Florian Junne ◽

...

Keyword(s):

Medical Students ◽

Role Play ◽

Overweight And Obesity ◽

University Hospital ◽

Secondary Outcome ◽

Teaching Tool ◽

Proof Of Concept ◽

Cross Sectional ◽

Concept Study ◽

Advantages And Disadvantages

ObjectiveWith the growing prevalence of overweight and obesity, medical students should be prepared to engage in weight management and obesity-related communications in order to prevent patients from having stigmatising experiences. In addition, medical students should have training to reduce anti-fat prejudices.DesignCross-sectional proof of concept study.SettingUniversity Hospital Tuebingen, Germany.Participants246 participants (207 second-year medical students, 13 standardised patients (SPs) and 22 teachers) took part in the study.Primary and secondary outcome measuresThe primary outcome was the assessment of degree of reality of the encounter with the SP wearing an obesity simulation suit (OSS). The secondary outcome was the evaluation of students’ awareness and prejudice against patients with obesity in a simulated role play. Additionally, a description of the advantages and disadvantages when using such a teaching tool is delivered.ResultsThe OSS contributed to a realistic perception of the patient group depicted in a role play according to students, teachers and SPs. OSS body mass index estimation by students, teachers and SPs correctly was over 30 kg/m2—thus in the range of obesity. In a selected subscale of the Anti-Fat Attitudes Test, students showed significantly stronger anti-fat stigmatisation compared with teachers and SPs.ConclusionsAn OSS worn by an SP is a valuable teaching tool to raise awareness about patients with obesity. It gives a realistic picture of the encounter. Stigmatisation was low in general but was especially present in the students. Further research should include intervention studies to address this issue.

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Development and validation of Nurses’ Moral Courage Scale

Nursing Ethics ◽

10.1177/0969733018791325 ◽

2018 ◽

Vol 26 (7-8) ◽

pp. 2438-2455 ◽

Cited By ~ 2

Author(s):

Olivia Numminen ◽

Jouko Katajisto ◽

Helena Leino-Kilpi

Keyword(s):

Internal Consistency ◽

Reliability And Validity ◽

Principal Component ◽

Moral Courage ◽

Face Validity ◽

University Hospital ◽

Moral Competence ◽

Good Reliability ◽

Cross Sectional ◽

Convenience Sample

Background: Moral courage is required at all levels of nursing. However, there is a need for development of instruments to measure nurses’ moral courage. Objectives: The objective of this study is to develop a scale to measure nurses’ self-assessed moral courage, to evaluate the scale’s psychometric properties, and to briefly describe the current level of nurses’ self-assessed moral courage and associated socio-demographic factors. Research design: In this methodological study, non-experimental, cross-sectional exploratory design was applied. The data were collected using Nurses’ Moral Courage Scale and analysed statistically. Participants and research context: The data were collected from a convenience sample of 482 nurses from four different clinical fields in a major university hospital in Finland for the final testing of the scale. The pilot comprised a convenience sample of 129 nurses. Ethical considerations: The study followed good scientific inquiry guidelines. Ethical approval was obtained from the university ethics committee and permission to conduct the study from the participating hospital. Findings: Psychometric evaluation showed that the 4-sub-scale, 21-item Nurses’ Moral Courage Scale demonstrates good reliability and validity at its current state of development showing a good level of internal consistency for a new scale, the internal consistency values ranging from 0.73 to 0.82 for sub-scales and 0.93 for the total scale, thus well exceeding the recommended Cronbach’s alpha value of >0.7. Principal component analysis and confirmatory factor analysis supported the theoretical construct of Nurses’ Moral Courage Scale. Face validity and expert panel assessments markedly contributed to the relevance of items in establishing content validity. Discussion and conclusion: Nurses’ Moral Courage Scale provides a new generic instrument intended for measuring nurses’ self-assessed moral courage. Recognizing the importance of moral courage as a part of nurses’ moral competence and its assessment offers possibilities to develop interventions and educational programs for enhancement of moral courage. Research should focus on further validation measures of Nurses’ Moral Courage Scale in international contexts.

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Perspectives on simulation-based training from paediatric healthcare providers in Nigeria: a national survey

BMJ Open ◽

10.1136/bmjopen-2019-034029 ◽

2020 ◽

Vol 10 (2) ◽

pp. e034029

Author(s):

Rachel Umoren ◽

Veronica Chinyere Ezeaka ◽

Ireti B Fajolu ◽

Beatrice N Ezenwa ◽

Patricia Akintan ◽

...

Keyword(s):

Healthcare Workers ◽

Professional Training ◽

Tertiary Care ◽

Healthcare Providers ◽

Secondary Outcome ◽

Skills Acquisition ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Convenience Sample ◽

Simulation Based

ObjectivesThe objective of this study was to explore the access to, and perceived utility of, various simulation modalities by in-service healthcare providers in a resource-scarce setting.SettingPaediatric training workshops at a national paediatric conference in Nigeria.ParticipantsAll 200 healthcare workers who attended the workshop sessions were eligible to participate. A total of 161 surveys were completed (response rate 81%).Primary and secondary outcome measuresA paper-based 25-item cross-sectional survey on simulation-based training (SBT) was administered to a convenience sample of healthcare workers from secondary and tertiary healthcare facilities.ResultsRespondents were mostly 31–40 years of age (79, 49%) and women (127, 79%). Consultant physicians (26, 16%) and nurses (56, 35%) were in both general (98, 61%) and subspecialty (56, 35%) practice. Most had 5–10 years of experience (62, 37%) in a tertiary care setting (72, 43%). Exposure to SBT varied by profession with physicians more likely to be exposed to manikin-based (29, 30% physicians vs 12, 19% nurses, p<0.001) or online training (7, 7% physician vs 3, 5% nurses, p<0.05). Despite perceived barriers to SBT, respondents thought that SBT should be expanded for continuing education (84, 88% physician vs 39, 63% nurses, p<0.001), teaching (73, 76% physicians vs 16, 26% nurses, p<0.001) and research (65, 68% physicians vs 14, 23% nurses, p<0.001). If facilities were available, nearly all respondents (92, 98% physicians; 52, 96% nurses) would recommend the use of online simulation for their centre.ConclusionsThe access of healthcare workers to SBT is limited in resource-scarce settings. While acknowledging the challenges, respondents identified many areas in which SBT may be useful, including skills acquisition, skills practice and communication training. Healthcare workers were open to the use of online SBT and expressed the need to expand SBT beyond the current scope for health professional training in Nigeria.

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OPPORTUNISTIC INFECTIONS DIAGNOSED IN PATIENTS INFECTED WITH THE HUMAN IMMUNODEFICIENCY VIRUS (HIV) AT THE SERVICE OF INFECTIOUS DISEASES OF UHC (UNIVERSITY HOSPITAL CENTER) YALGADO OUÉDRAOGO, BURKINA FASO

10.36106/paripex/7006220 ◽

2021 ◽

pp. 1-2

Author(s):

Savadogo M ◽

Diallo I ◽

Sondo K A

Keyword(s):

Infectious Diseases ◽

Hiv Infection ◽

Opportunistic Infection ◽

Antiretroviral Treatment ◽

Opportunistic Infections ◽

Sub Saharan Africa ◽

University Hospital ◽

Cross Sectional ◽

Sub Saharan ◽

Living With Hiv

Introduction: Sub-Saharan Africa remains one of the regions most affected by HIV infection with severe lethality.Most deaths of patients living with HIV are caused by opportunistic infections. Objective: to determine the prevalence of opportunistic infections among patients living with HIV in hospital serving infectious diseases of UHC YO of Ouagadougou. Patients and Methods:This is a cross-sectional descriptive study covering a 14-month period from 1 January 2017 to 28 February 2018. Included were all HIV-positive patients, hospitalized at the service of Infectious Diseases, in which an opportunistic infection was diagnosed on the basis of clinical and/or para-clinical arguments. Results: During the study period a total of 55 patients living with HIV were hospitalized in the infectious disease unit,35 of whom had at least one opportunistic infection or 63.6% of the patients.The average age of patients was 37 years with extremes of 18 and 66 years.Twenty-two patients were female versus 13 male, a sex ratio = 0.59. HIV1 was involved in 97% of patients.The mean TCD4 lymphocyte rate was 156 cell/mm3 with extremes of 7 and 718 cell/mm3.Tuberculosis and digestive mycosis were the most frequently diagnosed opportunistic infections. Opportunistic infection was the circumstance for HIV testing in two patients.She revealed immune restoration syndrome in two other patients.Nineteen patients were already on antiretroviral treatment upon admission to the service.Half of the patients on treatment were in therapeutic failure.The evolution was marked by 26.5% lethality. Conclusion:The frequency of opportunistic infections is high in patients living with HIV.Their prevention requires early detection of HIV infection and antiretroviral treatment.

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Hormonal, metabolic and nutritional alterations in smokers: emergency for smoking abstinence

Jornal Brasileiro de Psiquiatria ◽

10.1590/s0047-20852013000400003 ◽

2013 ◽

Vol 62 (4) ◽

pp. 261-267 ◽

Cited By ~ 1

Author(s):

Gláucia Renata Souza Rodrigues ◽

Marcela Melquíades ◽

Maria Alvim Leite ◽

Maíra Barros Louro ◽

Carmen Perches ◽

...

Keyword(s):

Smoking Cessation ◽

Cross Sectional Study ◽

The Body ◽

University Hospital ◽

Anthropometric Parameters ◽

Cross Sectional ◽

Convenience Sample ◽

Fasting Glycemia ◽

Increased Risk ◽

The University

OBJECTIVE: To evaluate the biochemical and nutritional status of smokers in treatment for smoking cessation and its association with anthropometric parameters. METHODS: This is a cross-sectional study with convenience sample. Adult smokers were assessed at the start of treatment in the Interdisciplinary Center for Tobacco Research and Intervention of the University Hospital of the Federal University of Juiz de Fora (CIPIT/HU-UFJF). We evaluated the body mass index (BMI), conicity index (CI); waist circumference (WC), percentage of body fat (%BF), fasting glycemia, cortisol, insulin, total cholesterol (TC), LDL-c, HDL-c, triglycerides (TG) and metabolic syndrome (MS). RESULTS: Most participants (52.2%) had MS and high cardiovascular risk. The fasting glycemia was abnormal in 30.4%. There was a significant positive correlation between BMI and WC (r = 0.90; p = 0.0001), %BF (r = 0.79; p = 0.0001), CI (r = 0.65; p = 0.0001), glycemia (r = 0.42; p = 0.04) and TG (r = 0.47; p = 0.002). The CI presented positive correction with insulin (r = 0.60; p = 0.001), glycemia (r = 0.55; p = 0.007), TG (r = 0.54; p = 0.008) and %BF (r = 0.43; p = 0.004). Patients with longer duration of smoking had a higher risk of developing MS (OR = 9.6, p = 0.016). CONCLUSION: The smokers evaluated had increased risk for developing MS, especially those with longer duration of smoking, requiring urgent smoking cessation.

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Sacral anatomical interspace landmark for lumbar puncture in pregnancy

Neurology ◽

10.1212/wnl.0000000000008749 ◽

2019 ◽

Vol 94 (6) ◽

pp. e626-e634

Author(s):

Carlo Pancaro ◽

Baskar Rajala ◽

Christie Vahabzadeh ◽

Ruth Cassidy ◽

Thomas T. Klumpner ◽

...

Keyword(s):

Gestational Age ◽

Tertiary Care ◽

Lumbar Vertebra ◽

University Hospital ◽

Secondary Outcome ◽

Mechanical Trauma ◽

Office Visits ◽

Convenience Sample ◽

The Third ◽

In Pregnancy

ObjectiveTo determine whether the sacral anatomical interspace landmark (SAIL) technique is more accurate than the classic intercristal line (ICL) technique in pregnant patients and to assess the percentage of clinical determinations above the third lumbar vertebra.MethodsIn this prospective, randomized, open-label trial, there were 110 singleton pregnant patients with gestational age greater than 37 weeks included. Selection procedure was a convenience sample of pregnant patients who presented for office visits or vaginal or cesarean delivery between March 15 and July 31, 2018, at a single-center obstetric tertiary care university hospital. Both techniques were evaluated by 2 physicians independently assessing each method. Before data collection, we hypothesized that the SAIL technique would be more accurate than the ICL technique in determining the L4-L5 interspace, and that the SAIL technique would produce more estimations below the third lumbar vertebra than the ICL technique. Therefore, the primary outcome was accuracy in identifying the L4-L5 lumbar interspace with SAIL vs ICL. The secondary outcome was difference in clinical assessments above the third lumbar vertebra. Both outcomes were measured via ultrasonography.ResultsPatients were 31 ± 5 years of age (mean ± SD) and had body mass index of 31.8 ± 5.7 kg/m2 and gestational age of 38.8 ± 1.1 weeks. A total of 110 patients were analyzed. SAIL correctly identified the L4-L5 interspace 49% of the time vs 8% using ICL (p < 0.0001). Estimations above L3 were 1% for SAIL vs 31% for ICL (p < 0.0001).ConclusionsOur study shows improved accuracy in identifying intervertebral space using the SAIL technique; this may prevent direct mechanical trauma to the conus medullaris when lumbar punctures are performed in pregnancy.Clinicaltrials.gov identifierNCT03433612.

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Evaluation of quality of life, functionality and disability in patients with systemic sclerosis in a University Hospital

ABCS Health Sciences ◽

10.7322/abcshs.45.2020.1349 ◽

2020 ◽

Vol 45 ◽

pp. e020025

Author(s):

Amanda Maria da Silva ◽

Letticia Cristina Santos Cardozo Roque ◽

Rafaela Silva Guimarães Gonçalves ◽

Angela Luzia Branco Pinto Duarte ◽

Angélica da Silva Tenório ◽

...

Keyword(s):

Quality Of Life ◽

Systemic Sclerosis ◽

Short Form ◽

Hand Function ◽

Health Assessment ◽

University Hospital ◽

High Morbidity ◽

Cross Sectional ◽

Convenience Sample

Introduction: Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by progressive fibrosis of the skin and internal organs that promotes high morbidity and mortality. Objective: To evaluate the functionality, disability and quality of life of patients with systemic sclerosis and to compare the clinical forms of the disease. Methods: Cross-sectional, descriptive and analytical study performed at the Rheumatology Clinic of the Hospital das Clínicas of the Federal University of Pernambuco (HC-UFPE) from August 2018 to April 2019. The non-probabilistic, convenience sample consisted of 60 patients diagnosed with systemic sclerosis (SSc), followed at the Rheumatology outpatient clinic of the Hospital das Clínicas, Federal University of Pernambuco. To evaluate the outcomes, the following instruments were used: Cochin Hand Functional Scale (CHFS) for hand function; 12-Item Short-Form Health Survey (SF-12) for quality of life; and Scleroderma Health Assessment Questionnaire (SHAQ) for functionality and disability. Results: The mean results for CHFS, SHAQ, SF-12 Physical Component Summary and SF-12 Mental Component Summary were 14.5 (6.0-29.75), 1.01±0.56, 35.04±8.09, 40.94±10.56, respectively. There were no significant differences in CHFS outcomes between patients with diffuse and limited forms of SSc, SHAQ and the mental component of SF-12. However, in the physical component of SF-12, a better score was found in patients with the diffuse form of the disease (p=0.04). Conclusion: Patients with SSc present an important impairment of hand function, quality of life and functional capacity, and those with limited cutaneous form present worse scores of the physical component in the evaluation of quality of life.

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‘I decided not to go into surgery due to dress code’: a cross-sectional study within the UK investigating experiences of female Muslim medical health professionals on bare below the elbows (BBE) policy and wearing headscarves (hijabs) in theatre

BMJ Open ◽

10.1136/bmjopen-2017-019954 ◽

2019 ◽

Vol 9 (3) ◽

pp. e019954 ◽

Cited By ~ 3

Author(s):

Abida Malik ◽

Hafsah Qureshi ◽

Humayra Abdul-Razakq ◽

Zahra Yaqoob ◽

Fatima Zahra Javaid ◽

...

Keyword(s):

Hospital Medicine ◽

Cross Sectional Study ◽

Secondary Outcome ◽

Dress Code ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Operating Theatres ◽

Uniform Policy ◽

The Uk ◽

The Impact

ObjectivesThe objective of this study is to explore the impact of workplace dress code policies and guidance that may influence inclusivity and opportunities in the workplace.DesignQuantitative, self-completion cross-sectional survey.SettingBritish Islamic Medical Association conference.ParticipantsEighty-four female medical healthcare professionals with a range of ethnicities and wide geographical coverage.Primary and secondary outcome measuresThe study reports on the experiences of female Muslim healthcare professions wearing the headscarf in theatre and their views of the bare below the elbows (BBE) policy. Percentage of positive answers and their respective 95% CIs are calculated.ResultsThe majority of participants agreed that wearing the headscarf was important for themselves and their religious beliefs (94.1%), yet over half (51.5%) experienced problems trying to wear a headscarf in theatre; some women felt embarrassed (23.4%), anxious (37.1%) and bullied (36.5%). A variety of different methods in head covering in operating theatres were identified. The majority of respondents (56.3%) felt their religious requirement to cover their arms was not respected by their trust, with nearly three-quarters (74.1%) of respondents not happy with their trust’s BBE uniform policy alternative. Dissatisfaction with the current practice of headscarves in theatre and BBE policy was highlighted, with some respondents preferring to specialise as GPs rather than in hospital medicine because of dress code matters. The hijab prototype proposed by the research team also received a positive response (98.7%).ConclusionsOur study suggests that female Muslims working in the National Health Service (NHS) reported experiencing challenges when wearing the headscarf in theatre and with BBE policy. The NHS needs to make its position clear to avoid variations in individual trust interpretation of dress code policies. This illustrates a wider issue of how policies can be at odds with personal beliefs which may contribute to a reduction in workforce diversity.

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What is the value of fibre-endoscopic evaluation of swallowing (FEES) in neurological patients? A cross-sectional hospital-based registry study

BMJ Open ◽

10.1136/bmjopen-2017-019016 ◽

2018 ◽

Vol 8 (3) ◽

pp. e019016 ◽

Cited By ~ 4

Author(s):

Tobias Braun ◽

Martin Juenemann ◽

Maxime Viard ◽

Marco Meyer ◽

Sven Fuest ◽

...

Keyword(s):

Clinical Investigation ◽

Brain Lesions ◽

University Hospital ◽

Secondary Outcome ◽

Endoscopic Evaluation ◽

Cross Sectional ◽

Neurological Patients ◽

The Impact ◽

Oral Diet ◽

Structural Brain

ObjectivesFibre-endoscopic evaluation of swallowing (FEES) to detect dysphagia is gaining more and more importance as a diagnostic tool. Therefore, we have investigated the impact of FEES in neurological patients in a clinical setting.DesignCross-sectional hospital-based registry.SettingPrimary acute care in a neurological department of a German university hospital.Participants241patients with various neurological diseases who underwent FEES procedure.Primary and secondary outcome measuresDysphagia and related comorbidities.Results267 FEES were performed in 241 patients with various neurological diagnoses. Dysphagia was diagnosed in 68.9% of the patients. In only 33.1% of the patients, appropriate oral diet was chosen prior to FEES. A relevant dysphagia occurred more often in patients with structural brain lesions (83.1% vs 65.3%, P=0.001), patients with dysphagia had a longer hospitalisation (median 18 (IQR 12–30) vs 15 days (IQR 9.75–22.75), P=0.005) and had a higher mortality (8.4% vs 1.3%, P=0.041). When the oral diet was changed, we observed a lower pneumonia rate (36% vs 50%, P=0.051) and a lower mortality (3.7% vs 11.3%, P=0.043) in comparison to no change of oral diet. A restriction of oral diet was identified more often in older patients (median 75 years (IQR 66.3–82 years) vs median 72 years (IQR 60–79 years), P=0.01) and in patients with structural brain lesions (86.8% vs 73.1%, P=0.05).ConclusionOn clinical investigation, dysphagia was misjudged for the majority of the patients. FEES might help to compensate this drawback, revising the diet regime in nearly 70% of the patients.

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