Primary care specialty career choice among Canadian medical students: Understanding the factors that influence their decisions.

PubMed

Osborn, Heather Ann; Glicksman, Jordan T; Brandt, Michael G; Doyle, Philip C; Fung, Kevin

2017-02-01

To identify which factors influence medical students' decision to choose a career in family medicine and pediatrics, and which factors influence their decision to choose careers in non-front-line specialties. Survey that was created based on a comprehensive literature review to determine which factors are considered important when choosing practice specialty. Ontario medical school. An open cohort of medical students in the graduating classes of 2008 to 2011 (inclusive). The main factors that influenced participants' decision to choose a career in primary care or pediatrics, and the main factors that influenced participants' decision to choose a career in a non-front-line specialty. A total of 323 participants were included in this study. Factors that significantly influenced participants' career choice in family medicine or pediatrics involved work-life balance (acceptable hours of practice [ P = .005], acceptable on-call demands [ P = .012], and lifestyle flexibility [ P = .006]); a robust physician-patient relationship (ability to promote individual health promotion [ P = .014] and the opportunity to form long-term relationships [ P  < .001], provide comprehensive care [ P = .001], and treat patients and their families [ P = .006]); and duration of residency program ( P = .001). The career-related factors that significantly influenced participants' decision to choose a non-front-line specialty were as follows: becoming an expert ( P  < .001), maintaining a focused scope of practice ( P  < .001), having a procedure-focused practice ( P = .001), seeing immediate results from one's actions ( P  < .001), potentially earning a high income ( P  < .001), and having a perceived status among colleagues ( P  < .001). In this study, 8 factors were found to positively influence medical students' career choice in family medicine and pediatrics, and 6 factors influenced the decision to choose a career in a non-front-line specialty. Medical students can be

Factors influencing the choice of specialty of Australian medical graduates.

PubMed

Harris, Mary G; Gavel, Paul H; Young, Jeannette R

2005-09-19

To identify the relative importance of extrinsic determinants of doctors' choice of specialty. A self-administered postal questionnaire. Australian vocational training programs. 4259 Australian medical graduates registered in September 2002 with one of 16 Australian clinical colleges providing vocational training programs. Choice of specialist vocational training program; extrinsic factors influencing choice of program, and variation by sex, age, marital status and country of birth. In total, 79% of respondents rated "appraisal of own skills and aptitudes" as influential in their choice of specialty followed by "intellectual content of the specialty" (75%). Extrinsic factors rated as most influential were "work culture" (72%), "flexibility of working arrangements" (56%) and "hours of work" (54%). We observed variation across training programs in the importance ascribed to factors influencing choice of specialty, and by sex, age and marital status. Factors of particular importance to women, compared with men, were "appraisal of domestic circumstances" (odds ratio [OR], 1.9), "hours of work" (OR, 1.8) and "opportunity to work flexible hours" (OR, 2.6). Partnered doctors, compared with single doctors, rated "hours of work" and "opportunity to work flexible hours" as more important (OR, 1.3), while "domestic circumstances" was more important to doctors with children than those without children (OR, 1.7). In total, 80% of doctors had chosen their specialty by the end of the third year after graduation. Experience with discipline-based work cultures and working conditions occurs throughout medical school and the early postgraduate years, and most doctors choose their specialty during these years. It follows that interventions to influence doctors' choice of specialty need to target these critical years.

The Stability of Factors Influencing the Choice of Medical Specialty Among Medical Students and Postgraduate Radiology Trainees.

PubMed

Yen, Adam J; Webb, Emily M; Jordan, Eric J; Kallianos, Kimberly; Naeger, David M

2018-06-01

To investigate whether general psychological motivating factors that guide career selection of a medical specialty differ over the course of medical school and to compare differences in motivating factors among students choosing "controllable" lifestyle specialties, students choosing "uncontrollable" lifestyle specialties, and a cohort of radiology residents. An anonymous survey was distributed to first- through fourth-year medical students and radiology residents at a single institution. Participants were asked to select their top three of seven factors that most influenced their choice of medical specialty. Fourth-year students were asked to designate the specialty to which they had applied. The survey was distributed to 259 students and 47 radiology residents with a response rate of 93.8% (243 of 259) and 95.7% (45 of 47), respectively. The top three factors indicated by medical students were finding the daily work fulfilling, work-life balance, and interest in the subject. These top three factors were common to all medical student classes and did not differ between students choosing "controllable" versus "uncontrollable" fields. The factors uncommonly selected were similar personality to others in the field, attending income, competitiveness or prestige, and job market conditions. For radiology residents, the top three motivating factors were the same as for medical students. Three out of seven motivating factors were universally important to trainees, regardless of their stage of medical training or their selection of a controllable versus uncontrollable lifestyle specialty. These data suggest the variety of career choices made by students may not derive from differing underlying values. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Factors potentially influencing academic performance among medical students.

PubMed

Al Shawwa, Lana; Abulaban, Ahmad A; Abulaban, Abdulrhman A; Merdad, Anas; Baghlaf, Sara; Algethami, Ahmed; Abu-Shanab, Joullanar; Balkhoyor, Abdulrahman

2015-01-01

Studies are needed to examine predictors of success in medical school. The aim of this work is to explore factors that potentially influence excellence of medical students. The study was conducted in the Medical Faculty of King Abdulaziz University during October 2012. A self-administered questionnaire was used. Medical students with a grade point average (GPA) ≥4.5 (out of 5) were included and compared to randomly selected medical students with a GPA <4.5, who were available at the time of the study. A total of 359 undergraduate students participated in the study. 50.4% of the sample was students with a GPA ≥4.5. No statistically significant difference regarding the time spent on outings and social events was found. However, 60.7% of high GPA students spend less than 2 hours on social networking per day as compared to 42.6% of the lower GPA students (P<0.01). In addition, 79% of high GPA students prefer to study alone (P=0.02), 68.0% required silence and no interruptions during studying time (P=0.013), and 47% revise their material at least once before an exam (P=0.02). Excellent medical students have many different characteristics. For example, they do not use social networking for prolonged periods of time, and they have strong motivation and study enjoyment. Further studies are needed to examine whether these differences have a real impact on GPA or not.

Factors Influencing Choice of Medical Specialty of Preresidency Medical Graduates in Southeastern Nigeria

PubMed Central

Eze, Boniface Ikenna; Okoye, Onochie Ike; Maduka-Okafor, Ferdinand Chinedu; Aguwa, Emmanuel Nwabueze

2011-01-01

Background This study examined the determinants of specialty choice of preresidency medical graduates in southeastern Nigeria. Methods We used a comparative cross-sectional survey of preresidency medical graduates who took the Basic Sciences Examination of the Postgraduate Medical College in Enugu, southeastern Nigeria, in March 2007. Data on participants' demographics and specialty selected, the timing of the decision, and factors in specialty selection were collected using a questionnaire. Data were examined using descriptive and analytical statistics. P < .05 was considered significant. Results The survey response rate was 90.8% (287 of 316). The sample included 219 men and 68 women, ranging in age from 24 to 53 years and with a mean age of 33.5 ± 1.1 (SD) years. Career choice was more frequently influenced by personal interest (66.6%), career prospects (9.1%), and appraisal of own skills/aptitudes (5.6%), and it was least affected by altruistic motives (1.7%) and influence of parents/relations (1.7%). The respondents selected specialties at different rates: obstetrics and gynecology (22.6%), surgery (19.6%), pediatrics (16.0%), anesthesiology (3.1%), psychiatry (0.3%), and dentistry (0.0%). Most (97.2%) participants had decided on specialty choice by the end of their fifth (of a total 16 years) postgraduate year. The participants significantly more frequently preferred surgery and pediatrics to other disciplines (P < .002, after Bonferroni correction for multiple comparisons). Conclusions Preresidency medical graduates in southeastern Nigeria were influenced by personal interest, career prospects, and personal skills/aptitude in deciding which specialty training to pursue. The most frequently chosen specialties were surgery and pediatrics. These findings have implications for Nigeria's education and health care policy makers. PMID:22942964

Social and Cultural Factors Influence African American Men's Medical Help Seeking

ERIC Educational Resources Information Center

Griffith, Derek M.; Allen, Julie Ober; Gunter, Katie

2011-01-01

Objective: To examine the factors that influenced African American men's medical help seeking. Method: Thematic analysis of 14 focus groups with 105 older, urban African American men. Results: African American men described normative expectations that they did not go to the doctor and that they were afraid to go, with little explanation. When they…

Exploring Factors that Influence Informal Caregiving in Medication Management for Home Hospice Patients

PubMed Central

Berman, Rebecca; Halpern, Leslie; Pickard, A. Simon; Schrauf, Robert; Witt, Whitney

2010-01-01

Abstract Objective To explore factors that influence how informal caregivers manage medications as part of caring for hospice patients. Methods : Semistructured, open-ended interviews were conducted with 23 informal caregivers and 22 hospice providers from 4 hospice programs in the Chicago metropolitan areas. Qualitative analysis was conducted consistent with the grounded theory approach. Results : In general, informal caregivers and hospice providers identified similar key factors that facilitated or impeded caregivers' process in managing medications. Caregivers' life experience and self-confidence were considered assets that facilitated medication management. Limitations impeding the process included caregivers' negative emotional states, cognitive and physical impairments, low literacy, other competing responsibilities, as well as patients' negative emotional states and complex medication needs. Furthermore, the social context of medication management emerged as a salient theme: caregivers' good interpersonal relations with patients facilitated medication management, whereas poor communication/relations among caregivers within a support network impeded the process. While both study groups discussed the positive attributes of good caregiver–patient relations and support from multiple caregivers, hospice providers were cautious about the potential adverse influence of close relations with patients on caregivers' decision making about medications and discussed poor communication/relations among informal and privately hired caregivers that often resulted from family conflicts and/or a lack of long-standing leadership. Conclusion Our findings suggest additional intervention points, beyond knowledge and skill building, that could be addressed to support caregivers in executing medication responsibilities at home for hospice patients. PMID:20836633

Multi-level modelling of the factors that influence the participation of disabled rural individuals in social medical insurance in China

PubMed Central

2013-01-01

Background The Second China National Sample Survey on Disability in 2006 showed that the participation rate of disabled Chinese rural individuals in social medical insurance participation was less than 30%. However, there has been limited number of studies on the influencing factors, especially contextual factors, affecting their participation in social medical insurance. Therefore, this study aimed to analyze the factors influencing the participation of disabled rural individuals in social medical insurance, including contextual factors. Methods Based on data derived from the Second China National Sample Survey on Disability, chi-square test and two-level logistic regression model were used to analyze the influencing factors. Results The results showed that the disabled rural individuals in the New Rural Cooperative Medical System pilot counties who lived in communities with rehabilitation stations or with higher per capita income of villagers were more likely to participate in the social medical insurance. Meanwhile, those employed, with less severe disability degree or with less severe barriers in participation in society were more likely to participate in the social medical insurance. Conclusions Contextual factors including economic and policy contexts were important factors influencing their participation in social medical insurance before 2006 in China. Unemployment, severer disability degree and social isolation might also prevent them from gaining equal access to social medical insurance. PMID:23402275

Non-medical influences on medical decision-making.

PubMed

McKinlay, J B; Potter, D A; Feldman, H A

1996-03-01

The influence of non-medical factors on physicians' decision-making has been documented in many observational studies, but rarely in an experimental setting capable of demonstrating cause and effect. We conducted a controlled factorial experiment to assess the influence of non-medical factors on the diagnostic and treatment decisions made by practitioners of internal medicine in two common medical situations. One hundred and ninety-two white male internists individually viewed professionally produced video scenarios in which the actor-patient, presenting with either chest pain or dyspnea, possessed various balanced combinations of sex, race, age, socioeconomic status, and health insurance coverage. Physician subjects were randomly drawn from lists of internists in private practice, hospital-based practice, and HMO's, at two levels of experience. The most frequent diagnoses for both chest pain and dyspnea were psychogenic origin and cardiac problems. Smoking cessation was the most frequent treatment recommendation for both conditions. Younger patients (all other factors being the same) were significantly more likely to receive the psychogenic diagnosis. Older patients were more likely to receive the cardiac diagnosis for chest pain, particularly if they were insured. HMO-based physicians were more likely to recommend a follow-up visit for chest pain. Several interactions of patient and physician factors were significant in addition to the main effects. The variability in decision-making evidenced by physicians in this experiment was not entirely accounted for by strictly rational Bayesian inference (the common prescriptive model for medical decision-making), in-as-much as non-medical factors significantly affected the decisions that they made. There is a need to supplement idealized medical schemata with considerations of social behavior in any comprehensive theory of medical decision-making.

Influence of physician factors on the effectiveness of a continuing medical education intervention.

PubMed

Flores, Sergio; Reyes, Hortensia; Perez-Cuevas, Ricardo

2006-01-01

Continuing medical education (CME) is essential for improving the quality of care in primary health care settings. This study's objective was to determine how the characteristics of family physicians influenced the effectiveness of a multifaceted CME intervention to improve the management of acute respiratory infection (ARI) or type 2 diabetes (DM2). A secondary analysis was conducted based on data from 121 family physicians, who participated in the educational intervention study. The outcome variable was positive change in physician's performance for treatment of ARI or DM2. The exposure variable was multifaceted CME intervention. Independent variables were professional physicians and organizational characteristics. Analysis included log binomial regression modeling. Factors influencing positive change included, for ARI, participation in the CME intervention and medical director interested in that condition and for DM2, participation in the CME intervention, medical director interested in DM2, and being a teacher. Physicians' characteristics and organizational environment influence the effectiveness of educational intervention and are therefore relevant to the implementation of CME strategies.

Factors influencing medical students' motivation to practise in rural areas in low-income and middle-income countries: a systematic review

PubMed Central

Zwanikken, Prisca A C; Pokharel, Paras K; Scherpbier, Albert J

2017-01-01

Objectives There is a shortage of doctors working in rural areas all over the world, especially in low-income and middle-income countries. The choice to practise medicine in a rural area is influenced by many factors. Motivation developed as a medical student is one key determinant of this choice. This study explores influences on medical students' motivation to practise in rural areas of low-income and middle-income countries following graduation. Design A systematic review was conducted to identify influences on medical students' motivation to work in rural areas in low-income and middle-income countries. Papers reporting influences on motivation were included, and content analysis was conducted to select the articles. Articles not published in English were excluded from this review. Results A rural background (ie, being brought up in a rural area), training in rural areas with a community-based curriculum, early exposure to the community during medical training and rural location of medical school motivate medical students to work in rural areas. Perceived lack of infrastructure, high workload, poor hospital management and isolation are among the health facility factors that demotivate medical students for medical practice in rural areas. Conclusions Medical school selection criteria focusing on a rural background factor and medical education curriculum focusing on rural area are more relevant factors in low-income and middle-income countries. The factors identified in this review may assist the planners, medical educators and policymakers in low-income and middle-income countries in designing relevant interventions to positively influence rural choices where the shortage of rural physicians is an ongoing and increasing concern. PMID:28232465

Factors that influence career choice in primary care among medical students starting social service in Honduras.

PubMed

Puertas, E Benjamín; Rivera, Tamara Y

2016-11-01

To 1) describe patterns of specialty choice; 2) investigate relationships between career selection and selected demographic indicators; and 3) identify salary perception, factors that influence career choice in primary care, and factors that influence desired location of future medical practice. The study used a mixed-methods approach that included a cross-sectional questionnaire survey applied to 234 last-year medical students in Honduras (September 2014), and semi-structured interviews with eight key informants (October 2014). Statistical analysis included chi-square and factor analysis. An alpha level of 0.05 was used to determine significance. In the qualitative analysis, several codes were associated with each other, and five major themes emerged. Primary care careers were the preferred choice for 8.1% of students, who preferred urban settings for future practice location. The perceived salary of specialties other than primary care was significantly higher than those of general practitioners, family practitioners, and pediatricians (P < 0.001). Participants considered "making a difference," income, teaching, prestige, and challenging work the most important factors influencing career choice. Practice in ambulatory settings was significantly associated with a preference for primary care specialties (P = < 0.05). Logistic regression analysis found that factors related to patient-based care were statistically significant for selecting primary care (P = 0.006). The qualitative analysis further endorsed the survey findings, identifying additional factors that influence career choice (future work option; availability of residency positions; and social factors, including violence). Rationales behind preference of a specialty appeared to be based on a combination of ambition and prestige, and on personal and altruistic considerations. Most factors that influence primary care career choice are similar to those found in the literature. There are several factors

Factors influencing the current practice of self-medication consultations in Eastern Indonesian community pharmacies: a qualitative study.

PubMed

Brata, Cecilia; Fisher, Colleen; Marjadi, Brahmaputra; Schneider, Carl R; Clifford, Rhonda M

2016-05-13

Research has shown that the current practice of pharmacy staff when providing self-medication consultations in Indonesia is suboptimal. To improve the performance of pharmacy staff when providing self-medication consultations in community pharmacies, the factors that influence current practice need to be understood. The aim of this study is to identify the factors that influence current practice of pharmacy staff when handling self-medication consultations in Eastern Indonesian community pharmacies. Fifteen in-depth interviews were conducted with pharmacists, pharmacy technicians, pharmacy owners, and counter attendants. Thematic analysis was used to generate findings. The current practice of pharmacy staff when handling self-medication consultations is directly influenced by the professionalism of pharmacy staff and patient responses to the consultations. These factors are in turn affected by the organisational context of the pharmacy and the external pharmacy environment. The organisational context of the pharmacy includes staffing, staff affordability, and the availability of time and facilities in which to provide consultations. The external pharmacy environment includes the number of trained pharmacy staff in the research setting, the relevance of pharmacy education to the needs of pharmacy practice, the support offered by the Indonesian Pharmacists Association, a competitive business environment, and the policy environment. Complex and inter-related factors influence the current practice of pharmacy staff when providing self-medication consultations in community pharmacies in this research setting. Multiple strategies will be required to improve consultation practices.

Factors influencing medical students' motivation to practise in rural areas in low-income and middle-income countries: a systematic review.

PubMed

Budhathoki, Shyam Sundar; Zwanikken, Prisca A C; Pokharel, Paras K; Scherpbier, Albert J

2017-02-22

There is a shortage of doctors working in rural areas all over the world, especially in low-income and middle-income countries. The choice to practise medicine in a rural area is influenced by many factors. Motivation developed as a medical student is one key determinant of this choice. This study explores influences on medical students' motivation to practise in rural areas of low-income and middle-income countries following graduation. A systematic review was conducted to identify influences on medical students' motivation to work in rural areas in low-income and middle-income countries. Papers reporting influences on motivation were included, and content analysis was conducted to select the articles. Articles not published in English were excluded from this review. A rural background (ie, being brought up in a rural area), training in rural areas with a community-based curriculum, early exposure to the community during medical training and rural location of medical school motivate medical students to work in rural areas. Perceived lack of infrastructure, high workload, poor hospital management and isolation are among the health facility factors that demotivate medical students for medical practice in rural areas. Medical school selection criteria focusing on a rural background factor and medical education curriculum focusing on rural area are more relevant factors in low-income and middle-income countries. The factors identified in this review may assist the planners, medical educators and policymakers in low-income and middle-income countries in designing relevant interventions to positively influence rural choices where the shortage of rural physicians is an ongoing and increasing concern. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Workplace violence and influencing factors among medical professionals in China.

PubMed

Wu, Siying; Zhu, Wei; Li, Huangyuan; Lin, Shaowei; Chai, Wenli; Wang, Xiaorong

2012-11-01

Workplace violence has attracted increasing public attention over the past few decades in China. This study was conducted to evaluate the frequency of workplace violence in healthcare settings by various job titles and hospital departments, and to explore the related risk factors among Chinese medical professionals. A total of 2,464 medical professionals in 12 hospitals of two provinces were surveyed by using a stratified cluster sampling method. The Chinese version of the Workplace Violence Scale was used to measure the frequencies of workplace violence, classified as physical assault, emotional abuse, threat of assault, verbal sexual harassment and sexual assault experienced by the subjects over the previous 12 months. A structured questionnaire was administered to collect information on potentially influencing factors for workplace violence. Multivariate analysis was applied to determine the risk factors for workplace violence. About 50% of study subjects reported at least one type of workplace violence. The rates of experiencing two episodes or more of physical assault, emotional abuse, threat of assault, verbal sexual harassment, and sexual assault were 11%, 26%, 12%, 3%, and 1%, respectively. Identified risk factors for workplace violence included working in the departments of psychiatry, emergency, pediatrics and surgery, male gender, divorce/widowed status, long working hours (≥10 hr/day), and night shift. The study suggested that workplace violence occurs commonly in Chinese healthcare settings. Effective intervention strategies targeting workplace violence should be formulated in terms of major risk factors. Copyright © 2012 Wiley Periodicals, Inc.

Factors influencing a nurse's decision to question medication administration in a neonatal clinical care unit.

PubMed

Aydon, Laurene; Hauck, Yvonne; Zimmer, Margo; Murdoch, Jamee

2016-09-01

The aim of this study was to identify factors that influence nurse's decisions to question concerning aspects of medication administration within the context of a neonatal clinical care unit. Medication error in the neonatal setting can be high with this particularly vulnerable population. As the care giver responsible for medication administration, nurses are deemed accountable for most errors. However, they are recognised as the forefront of prevention. Minimal evidence is available around reasoning, decision making and questioning around medication administration. Therefore, this study focuses upon addressing the gap in knowledge around what nurses believe influences their decision to question. A critical incident design was employed where nurses were asked to describe clinical incidents around their decision to question a medication issue. Nurses were recruited from a neonatal clinical care unit and participated in an individual digitally recorded interview. One hundred and three nurses participated between December 2013-August 2014. Use of the constant comparative method revealed commonalities within transcripts. Thirty-six categories were grouped into three major themes: 'Working environment', 'Doing the right thing' and 'Knowledge about medications'. Findings highlight factors that influence nurses' decision to question issues around medication administration. Nurses feel it is their responsibility to do the right thing and speak up for their vulnerable patients to enhance patient safety. Negative dimensions within the themes will inform planning of educational strategies to improve patient safety, whereas positive dimensions must be reinforced within the multidisciplinary team. The working environment must support nurses to question and ultimately provide safe patient care. Clear and up to date policies, formal and informal education, role modelling by senior nurses, effective use of communication skills and a team approach can facilitate nurses to

Factors influencing French medical students towards a career in psychiatry.

PubMed

Andlauer, Olivier; Guicherd, William; Haffen, Emmanuel; Sechter, Daniel; Bonin, Bernard; Seed, Kitty; Lydall, Gregory; Malik, Amit; Bhugra, Dinesh; Howard, Rob

2012-09-01

There is a need to increase the recruitment to psychiatry in France. Our aim in this study was to compare factors influencing career choice between French medical students considering and not considering psychiatry as a specialty. Quantitative cross-sectional online survey on 145 French students in their last year of medical school. 22.7% of our sample considered choosing a career in psychiatry. A preference for a career in psychiatry was associated with more frequent history of personal/familial mental illness, higher ratings of psychiatric teaching, more weeks of compulsory psychiatry teaching and placement, during which students had more often met patients in recovery and been asked their opinion on patients. Students considering psychiatry as a career also emphasized more the need for a good work-life balance, and presented better attitudes toward psychiatry. Improving opportunities of interactions between students and psychiatrists or psychiatric patients might help to improve recruitment in psychiatry.

Factors Influencing Medical School Graduates Toward a Career in Psychiatry: Analysis from the 2011-2013 Association of American Medical Colleges Graduation Questionnaire.

PubMed

Wilbanks, Lindsey; Spollen, John; Messias, Erick

2016-04-01

Various factors influence choice of medical specialty. Previous research grouped specialties into controllable lifestyle, primary care, and surgical. This study compared factors influencing individuals to choose psychiatry versus other specialties. Data came from the 2011-2013 Association of American Medical Colleges Graduation Questionnaire. The authors grouped responses, ranging from no influence to minor, moderate, and strong influence, into psychiatry and controllable lifestyle, primary care, and surgical specialties and analyzed the data using one-way analysis of variance. The analyses included 29,227 students, of which 1329 (4.5%) elected psychiatry; 10,998 (37.6%), controllable lifestyle specialties; 12,320 (42.2%), primary care specialties; and 4580 (15.7%), surgical specialties. Students choosing psychiatry reported less influence of competitiveness, student debt, and salary expectations than those choosing controllable lifestyle and surgical specialties (p < 0.0001) and more influence of work/life balance than those choosing primary care and surgical specialties (p < 0.0001). They reported less influence of family expectations than those choosing controllable lifestyle specialties (p < 0.0001). They reported more influence of fit with personality than controllable lifestyle, primary care, and surgical specialties (p < 0.004). Students entering psychiatry do not fit the traditional categories of controllable lifestyle, primary care, and surgical profiles, but fall between controllable lifestyle and primary care specialties. Recruitment efforts may need to address this different pattern of influences.

Factors influencing the results of faculty evaluation in Isfahan University of Medical Sciences.

PubMed

Kamali, Farahnaz; Yamani, Nikoo; Changiz, Tahereh; Zoubin, Fatemeh

2018-01-01

This study aimed to explore factors influencing the results of faculty member evaluation from the viewpoints of faculty members affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. This qualitative study was done using a conventional content analysis method. Participants were faculty members of Isfahan University of Medical Sciences who, considering maximum variation in sampling, were chosen with a purposive sampling method. Semi-structured interviews were held with 11 faculty members until data saturation was reached. The interviews were transcribed verbatim and analyzed with conventional content analysis method for theme development. Further, the MAXQDA software was used for data management. The data analysis led to the development of two main themes, namely, "characteristics of the educational system" and "characteristics of the faculty member evaluation system." The first main theme consists of three categories, i.e. "characteristics of influential people in evaluation," "features of the courses," and "background characteristics." The other theme has the following as its categories: "evaluation methods," "evaluation tools," "evaluation process," and "application of evaluation results." Each category will have its subcategories. Many factors affect the evaluation of faculty members that should be taken into account by educational policymakers for improving the quality of the educational process. In addition to the factors that directly influence the educational system, methodological problems in the evaluation system need special attention.

[Job burnout and related influencing factors in community medical staff in Nanchong, China].

PubMed

Zhu, T; Zhang, S S; Chen, D Y; Yang, H; Zheng, T; Zheng, L M; Li, J

2016-12-20

Objective: To investigate job burnout and related influencing factors in community medical staff in Nanchong, China. Methods: From June to July, 2015, cluster random sampling was performed to select 181 medical staff members in Nanchong Community Health Service Center as study subjects. The Chinese Maslach Burnout Inventory (CMBI) was used to measure the level of job burnout. Results: The overall detection rate of job burnout in community medical staff in Nanchong was 95.0%, and among these staff members with job burnout, 119 (65.7%) had mild job burnout, 44 (24.3%) had moderate job burnout, and 9 (5.0%) had severe job burnout. There were significant differences in the scores of emotional exhaustion and reduced sense of personal accomplishmentbetween the medical staff members with different ages ( F =5.820 and 3.180, both P <0.05) . There was a significant difference in the score of emotional exhaustion between the medical staff members with different working years ( F =2.909, P <0.05) . There was also a significant difference in the score of reduced sense of personal accomplishment between the medical staff members with different types of work ( F =5.797, P <0.05) , and the nurses had the lowest score. Conclusion: The medical staff members in Nanchong have a high incidence rate of job burnout, with the feature of reduced sense of personal accomplishment. An old age, long working years, and nursing occupation are major risk factors for job burnout.

Factors influencing the suicide intervention skills of emergency medical services providers.

PubMed

Lygnugaryte-Griksiene, Aidana; Leskauskas, Darius; Jasinskas, Nedas; Masiukiene, Agne

2017-01-01

Lithuania currently has the highest suicide rate in Europe and the fifth highest worldwide. To identify the factors that influence the suicide intervention skills of emergency medical services (EMS) providers (doctors, nurses, paramedics). Two hundred and sixty-eight EMS providers participated in the research. The EMS providers were surveyed both prior to their training in suicide intervention and six months later. The questionnaire used for the survey assessed their socio-demographic characteristics, suicide intervention skills, attitudes towards suicide prevention, general mental health, strategies for coping with stress, and likelihood of burnout. Better suicide intervention skills were more prevalent among EMS providers with a higher level of education, heavier workload, more positive attitudes towards suicide prevention, better methods of coping with stress, and those of a younger age. Six months after the non-continuous training in suicide intervention, the providers' ability to assess suicide risk factors had improved, although there was no change in their suicide intervention skills. In order to improve the suicide intervention skills of EMS providers, particular attention should be paid to attitudes towards suicide prevention, skills for coping with stress, and continuous training in suicide intervention. EMS: Emergency medical services; SIRI: Suicide intervention response inventory.

Factors influencing the results of faculty evaluation in Isfahan University of Medical Sciences

PubMed Central

Kamali, Farahnaz; Yamani, Nikoo; Changiz, Tahereh; Zoubin, Fatemeh

2018-01-01

OBJECTIVE: This study aimed to explore factors influencing the results of faculty member evaluation from the viewpoints of faculty members affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. MATERIALS AND METHODS: This qualitative study was done using a conventional content analysis method. Participants were faculty members of Isfahan University of Medical Sciences who, considering maximum variation in sampling, were chosen with a purposive sampling method. Semi-structured interviews were held with 11 faculty members until data saturation was reached. The interviews were transcribed verbatim and analyzed with conventional content analysis method for theme development. Further, the MAXQDA software was used for data management. RESULTS: The data analysis led to the development of two main themes, namely, “characteristics of the educational system” and “characteristics of the faculty member evaluation system.” The first main theme consists of three categories, i.e. “characteristics of influential people in evaluation,” “features of the courses,” and “background characteristics.” The other theme has the following as its categories: “evaluation methods,” “evaluation tools,” “evaluation process,” and “application of evaluation results.” Each category will have its subcategories. CONCLUSIONS: Many factors affect the evaluation of faculty members that should be taken into account by educational policymakers for improving the quality of the educational process. In addition to the factors that directly influence the educational system, methodological problems in the evaluation system need special attention. PMID:29417073

Prevalence of and factors influencing smoking among medical and non-medical students in Tbilisi, Georgia*

PubMed Central

Chkhaidze, Ivane; Maglakelidze, Nino; Maglakelidze, Tamaz; Khaltaev, Nikolai

2013-01-01

OBJECTIVE: Smoking is a serious problem that has a devastating impact on health. The objective of this study was to describe the prevalence of and factors influencing smoking among medical and non-medical students in Tbilisi, Georgia, as well as to determine whether medical education has an impact on smoking. METHODS: A cross-sectional study was carried out at Tbilisi State Medical University and Tbilisi State University, both of which are located in Tbilisi, Georgia. A total of 400 4th-year students (200 students at each university) were asked to complete standardized questionnaires. RESULTS: Of the sample as a whole, 48.75% were identified as smokers and 51.25% were identified as nonsmokers. The mean age was 20.24 years among smokers and 20.26 years among nonsmokers. Of the medical students, 49.5% were smokers, as were 48.0% of the non-medical students. The male-to-female ratio in the study population was 0.9:1.1. Smoking was found to have a strong relationship with gender, males accounting for 65% of all smokers. Of the smokers, 56.9% stated that they would like to quit smoking (for health or financial reasons). Of the medical students, 59.5% expressed a willingness to quit smoking, as did 54.2% of the non-medical students. CONCLUSIONS: There is a need to improve smoking education for undergraduate students. Special attention should be given to the inclusion of anti-smoking education in undergraduate curricula, as well as to the implementation of smoking prevention campaigns at institutions of higher education. However, such measures will be effective only if tobacco control policies are strictly enforced on the national level as well. PMID:24310631

Factors influencing nurses' decisions to activate medical emergency teams.

PubMed

Pantazopoulos, Ioannis; Tsoni, Aikaterini; Kouskouni, Evangelia; Papadimitriou, Lila; Johnson, Elizabeth O; Xanthos, Theodoros

2012-09-01

To evaluate the relationship between nurse demographics and correct identification of clinical situations warranting specific nursing actions, including activation of the medical emergency team. If abnormal physiology is left untreated, the patient may develop cardiac arrest. Nurses in general wards are those who perceive any clinical deterioration in patients. A descriptive, quantitative design was selected. An anonymous survey with 13 multiple choice questions was distributed to 150 randomly selected nurses working in general medical and surgical wards of a large tertiary hospital in Athens, Greece. After explanation of the purposes of the study, 94 nurses (response ratio: 62%) agreed to respond to the questionnaire. Categories with the greatest nursing concern were patients with heart rate<40/minute, an atypical thoracic pain, foreign body airway obstruction and bronchial secretions, respiratory rate<5/minute and heart rate=100/minute. However, almost 50% of nurses were able to accurately identify the critical nursing action for patients with respiratory rate<4/minute, 72% for patients with airway obstruction and 73% for patients with chest pain. Nurses who had graduated from a four-year educational programme identified clinical situations that necessitated medical emergency team activation in a significantly higher rate and also scored significantly higher in questions concerning clinical evaluation than nurses who had graduated from a two-year educational programme. Activation of the medical emergency team is influenced by factors such as level of education and cardiopulmonary resuscitation courses attendance. Graduating from a four-year educational programme helps nurses identify emergencies. However, irrespective of the educational programme they have followed, undertaking a basic life support or advanced life support provider course is critical as it helps them identify cardiac or respiratory emergencies. © 2012 Blackwell Publishing Ltd.

A Case Study of Career Emegency Medical Technicians: Factors That Influenced Their Decision to Stay

ERIC Educational Resources Information Center

Miller, Denine V.

2013-01-01

This case study (Stake, 1995) examined the perceptions of long-term Emergency Medical Technicians (EMTs) to identify factors influencing their decision to remain employed as EMTs for the duration of a career. EMT retention plans frequently utilize data from either employee exit interviews or workers with intent to leave, and since privacy law…

Factors Influencing the Application of a Biopsychosocial Perspective in Clinical Judgement of Chronic Pain: Interactive Management with Medical Students.

PubMed

Dwyer, Christopher P; McKenna-Plumley, Phoebe E; Durand, Hannah; Gormley, Emer M; Slattery, Brian W; Harney, Owen M; MacNeela, Padraig; McGuire, Brian E

2017-09-01

Though there is wide support for the application of biopsychosocial perspectives in clinical judgement of chronic pain cases, such perspectives are often overlooked due to either inadequate training or attitudes favoring a biomedical approach. Recent research has indicated that despite such explanations, both established general practitioners (GP) and medical students account for some psychosocial factors when making clinical judgements regarding chronic pain cases, but report not being likely to apply these in real-world, clinical settings due to numerous factors, including available time with patients. Thus, it is evident that a greater understanding of clinical judgement-making processes and the factors that affect application of these processes is required, particularly regarding chronic pain. The aims of the current study were to investigate medical students' conceptualizations of the factors that influence application of a biopsychosocial approach to clinical judgement-making in cases of chronic pain using interactive management (IM), model the relationships among these factors, and make recommendations to chronic pain treatment policy in light of the findings. The current study used IM to identify and model factors that influence the application of a biopsychosocial approach to clinical judgement-making in cases of chronic pain, based on medical students' conceptualizations of these factors. Two university classrooms. IM is a systems thinking and action mapping strategy used to aid groups in developing outcomes regarding complex issues, through integrating contributions from individuals with diverse views, backgrounds, and perspectives. IM commonly utilizes the nominal group technique and interpretive structural modeling, which in this context were employed to help medical students identify, clarify, and model influences on the application of biopsychosocial perspectives in treating chronic pain patients. Results of IM group work revealed 7 core

Factors influencing the suicide intervention skills of emergency medical services providers

PubMed Central

Lygnugaryte-Griksiene, Aidana; Leskauskas, Darius; Jasinskas, Nedas; Masiukiene, Agne

2017-01-01

ABSTRACT Background: Lithuania currently has the highest suicide rate in Europe and the fifth highest worldwide. Aims: To identify the factors that influence the suicide intervention skills of emergency medical services (EMS) providers (doctors, nurses, paramedics). Method: Two hundred and sixty-eight EMS providers participated in the research. The EMS providers were surveyed both prior to their training in suicide intervention and six months later. The questionnaire used for the survey assessed their socio-demographic characteristics, suicide intervention skills, attitudes towards suicide prevention, general mental health, strategies for coping with stress, and likelihood of burnout. Results: Better suicide intervention skills were more prevalent among EMS providers with a higher level of education, heavier workload, more positive attitudes towards suicide prevention, better methods of coping with stress, and those of a younger age. Six months after the non-continuous training in suicide intervention, the providers’ ability to assess suicide risk factors had improved, although there was no change in their suicide intervention skills. Conclusions: In order to improve the suicide intervention skills of EMS providers, particular attention should be paid to attitudes towards suicide prevention, skills for coping with stress, and continuous training in suicide intervention. Abbreviations: EMS: Emergency medical services; SIRI: Suicide intervention response inventory PMID:28235388

Factors that influence a career choice in primary care among medical students from high-, middle-, and low-income countries: a systematic review.

PubMed

Puertas, E Benjamín; Arósquipa, Carlos; Gutiérrez, Daniela

2013-11-01

To determine which factors influence a medical student's decision to choose a career in primary care; and to establish if these factors are similar or different among students in high-, middle- and low-income countries. An extensive search was done of PubMed, Google Scholar, and Virtual Library of Health for articles on primary care careers published in 2003-2013 in English, Spanish, and/or Portuguese. Initially, 600 records were identified; 74 full-text articles were assessed for eligibility and 55 were selected (42 from high-income countries; 13 from middle- and low-income). These were assessed to identify intrinsic and extrinsic factors that influence career choice among medical students from high-, middle-, and low-income countries. A comparison framework with common and specific factors that influence career choice in primary care among medical students from high-, middle- and low-income was developed. Factors were classified as extrinsic or intrinsic, and as facilitators or barriers. Several factors common to all countries were identified: facilitators were exposure to rural location, role models, working conditions; barriers were low income, prestige, and medical school environment. Some factors specific to middle- and low-income countries were: understanding of rural needs and intellectual challenge. Other factors specific to high-income countries were: attitude towards social problems, voluntary work, influence of family, and length of residency. Further studies on the subject are needed, especially in low- and middle-income countries. Identifying factors as barriers or facilitators for career choice will promote a better understanding of the reasons behind the shortage of primary care professionals and will contribute to policy building, improved training, and recruitment and retention of these professionals.

Factors influencing nurse and pharmacist willingness to take or not take responsibility for non-medical prescribing.

PubMed

Maddox, C; Halsall, D; Hall, J; Tully, M P

2016-01-01

In the UK, the majority of non-medical prescribers (NMPs) are nurses or pharmacists working in community or primary care. However, little is known about what influences their decisions to prescribe, unlike with medical prescribing. It is also unclear whether the medical findings can be extrapolated, given their very different prescribing training. To explore the factors influencing whether nurse and pharmacist NMPs in community and primary care settings take responsibility for prescribing. Initially, 20 NMPs (15 nurses and 5 pharmacists) were purposively selected and interviewed using the critical incident technique about situations where they felt it was inappropriate for them to take responsibility for prescribing or where they were uneasy about doing so. In addition, more general factors influencing their decision to take or not take prescribing responsibility were discussed. Subsequently, the themes from the interview analysis were validated in three focus groups with a total of 10 nurse NMPs. All data were analyzed using a constant comparison approach. Fifty-two critical incidents were recorded--12 from pharmacist NMPs and 40 from nurse NMPs. Participants experienced situations where they were reluctant to accept responsibility for prescribing. Perceptions of competency, role and risk influenced their decision to prescribe. Workarounds such as delaying the prescribing decision or refer the patient to a doctor were used. For NMPs to feel more confident about taking responsibility for prescribing, these issues of competency, role and perceived risk need to be addressed. Roles of NMPs must be clear to colleagues, doctors and patients. Training and support must be provided to enable professional development and increasing competence of NMPs. Copyright © 2016 Elsevier Inc. All rights reserved.

Sources of influence on medical practice

PubMed Central

Fernandez, L. A.; Martin, J. M.; del Castillo, J. d. D. L.; Gaspar, O. S.; Millan, J. I.; Lozano, M. J.; Keenoy, E. D.

2000-01-01

OBJECTIVES—To explore the opinion of general practitioners on the importance and legitimacy of sources of influence on medical practice.
METHODS—General practitioners (n=723) assigned to Primary Care Teams (PCTs) in two Spanish regions were randomly selected to participate in this study. A self administered questionnaire was sent by mail and collected by hand. The dependent variable collected the opinion on different sources that exert influence on medical practice. Importance was measured with a 9 item scale while legitimacy was evaluated with 16 items measured with a 1 to 7 point Likert scale.
RESULTS—The most important and legitimate sources of influence according to general practitioners were: training courses and scientific articles, designing self developed protocols and discussing with colleagues. The worst evaluated were: financial incentives and the role played by the pharmaceutical industry.
CONCLUSIONS—The development of medical practice is determined by many factors, grouped around three big areas: organisational setting, professional system and social setting. The medical professional system is the one considered as being the most important and legitimate by general practitioners. Other strategies of influence, considered to be very important by the predominant management culture (financial incentives), are not considered to be so by general practitioners. These results, however, are not completely reliable as regards the real network of influences existing in medical practice, which reflect instead different "value systems".


Keywords: primary health care; physicians' practice patterns; medical practice management; physicians' incentive plans PMID:10890875

Factors influencing the adoption of E-learning in Tabriz University of Medical Sciences.

PubMed

Abdekhoda, Mohammadhiwa; Dehnad, Afsaneh; Ghazi Mirsaeed, Sayd Javad; Zarea Gavgani, Vahideh

2016-01-01

Background: Electronic Learning (E-learning), is the use of electronic technology in education via computer and the internet. Despite its slow adoption by faculty members, e-learning provides several benefits to individuals and organizations. This study was conducted to determine the factors influencing the adoption of e-learning by faculty members in Tabriz University of Medical Sciences. Methods: This was a cross- sectional study, in which a sample of 190 faculty members of Tabriz University of Medical Sciences was randomly selected, using stratified sampling. A Conceptual Path Model of Unified Theory of Acceptance and Use of Technology (UTAUT) was applied to assess the faculty members' attitude towards e-learning. The collected data were analyzed by SPSS16, using descriptive statistics and regression analysis. The model was tested by structural equation modeling (SEM) and was finally represented by Analysis of Moment Structures. Results: The results evidenced that UTAUT model explains about 56% of the variance for adoption of elearning. The findings also revealed that performance expectancy, effort expectancy, social influences and behavior indentation had direct and significant effects on faculty members' behavior towards the use of e-learning. However, facilitated condition had no significant effects on the use of e-learning. Conclusion: The authorized model provides considerable insight for perception and anticipation of faculty members' behaviors in adopting e-learning. The survey clearly identified significant and non-significant factors that may affect the adoption of e-learning. The results of this study could help the policy makers when successful adoption of e-learning is in their agenda.

Factors influencing the adoption of E-learning in Tabriz University of Medical Sciences

PubMed Central

Abdekhoda, Mohammadhiwa; Dehnad, Afsaneh; Ghazi Mirsaeed, Sayd Javad; Zarea Gavgani, Vahideh

2016-01-01

Background: Electronic Learning (E-learning), is the use of electronic technology in education via computer and the internet. Despite its slow adoption by faculty members, e-learning provides several benefits to individuals and organizations. This study was conducted to determine the factors influencing the adoption of e-learning by faculty members in Tabriz University of Medical Sciences. Methods: This was a cross- sectional study, in which a sample of 190 faculty members of Tabriz University of Medical Sciences was randomly selected, using stratified sampling. A Conceptual Path Model of Unified Theory of Acceptance and Use of Technology (UTAUT) was applied to assess the faculty members’ attitude towards e-learning. The collected data were analyzed by SPSS16, using descriptive statistics and regression analysis. The model was tested by structural equation modeling (SEM) and was finally represented by Analysis of Moment Structures. Results: The results evidenced that UTAUT model explains about 56% of the variance for adoption of elearning. The findings also revealed that performance expectancy, effort expectancy, social influences and behavior indentation had direct and significant effects on faculty members’ behavior towards the use of e-learning. However, facilitated condition had no significant effects on the use of e-learning. Conclusion: The authorized model provides considerable insight for perception and anticipation of faculty members’ behaviors in adopting e-learning. The survey clearly identified significant and non-significant factors that may affect the adoption of e-learning. The results of this study could help the policy makers when successful adoption of e-learning is in their agenda. PMID:28491832

Disclosure of Medical Errors: What Factors Influence How Patients Respond?

PubMed Central

Mazor, Kathleen M; Reed, George W; Yood, Robert A; Fischer, Melissa A; Baril, Joann; Gurwitz, Jerry H

2006-01-01

BACKGROUND Disclosure of medical errors is encouraged, but research on how patients respond to specific practices is limited. OBJECTIVE This study sought to determine whether full disclosure, an existing positive physician-patient relationship, an offer to waive associated costs, and the severity of the clinical outcome influenced patients' responses to medical errors. PARTICIPANTS Four hundred and seven health plan members participated in a randomized experiment in which they viewed video depictions of medical error and disclosure. DESIGN Subjects were randomly assigned to experimental condition. Conditions varied in type of medication error, level of disclosure, reference to a prior positive physician-patient relationship, an offer to waive costs, and clinical outcome. MEASURES Self-reported likelihood of changing physicians and of seeking legal advice; satisfaction, trust, and emotional response. RESULTS Nondisclosure increased the likelihood of changing physicians, and reduced satisfaction and trust in both error conditions. Nondisclosure increased the likelihood of seeking legal advice and was associated with a more negative emotional response in the missed allergy error condition, but did not have a statistically significant impact on seeking legal advice or emotional response in the monitoring error condition. Neither the existence of a positive relationship nor an offer to waive costs had a statistically significant impact. CONCLUSIONS This study provides evidence that full disclosure is likely to have a positive effect or no effect on how patients respond to medical errors. The clinical outcome also influences patients' responses. The impact of an existing positive physician-patient relationship, or of waiving costs associated with the error remains uncertain. PMID:16808770

Factors that influence the recognition, reporting and resolution of incidents related to medical devices and other healthcare technologies: a systematic review.

PubMed

Polisena, Julie; Gagliardi, Anna; Urbach, David; Clifford, Tammy; Fiander, Michelle

2015-03-29

Medical devices have improved the treatment of many medical conditions. Despite their benefit, the use of devices can lead to unintended incidents, potentially resulting in unnecessary harm, injury or complications to the patient, a complaint, loss or damage. Devices are used in hospitals on a routine basis. Research to date, however, has been primarily limited to describing incidents rates, so the optimal design of a hospital-based surveillance system remains unclear. Our research objectives were twofold: i) to explore factors that influence device-related incident recognition, reporting and resolution and ii) to investigate interventions or strategies to improve the recognition, reporting and resolution of medical device-related incidents. We searched the bibliographic databases: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and PsycINFO database. Grey literature (literature that is not commercially available) was searched for studies on factors that influence incident recognition, reporting and resolution published and interventions or strategies for their improvement from 2003 to 2014. Although we focused on medical devices, other health technologies were eligible for inclusion. Thirty studies were included in our systematic review, but most studies were concentrated on other health technologies. The study findings indicate that fear of punishment, uncertainty of what should be reported and how incident reports will be used and time constraints to incident reporting are common barriers to incident recognition and reporting. Relevant studies on the resolution of medical errors were not found. Strategies to improve error reporting include the use of an electronic error reporting system, increased training and feedback to frontline clinicians about the reported error. The available evidence on factors influencing medical device-related incident recognition, reporting and resolution by healthcare professionals can inform data collection and

Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review

PubMed Central

Medic, Goran; Littlewood, Kavi J.; Diez, Teresa; Granström, Ola; De Hert, Marc

2013-01-01

Background: Nonadherence to medication is a recognized problem and may be the most challenging aspect of treatment. Methods: We performed a systematic review of factors that influence adherence and the consequences of nonadherence to the patient, healthcare system and society, in patients with schizophrenia. Particular attention was given to the effect of nonadherence on hospitalization rates, as a key driver of increased costs of care. A qualitative systematic literature review was conducted using a broad search strategy using disease and adherence terms. Due to the large number of abstracts identified, article selection was based on studies with larger sample sizes published after 2001. Thirty-seven full papers were included: 15 studies on drivers and 22 on consequences, of which 12 assessed the link between nonadherence and hospitalization. Results: Key drivers of nonadherence included lack of insight, medication beliefs and substance abuse. Key consequences of nonadherence included greater risk of relapse, hospitalization and suicide. Factors positively related to adherence were a good therapeutic relationship with physician and perception of benefits of medication. The most frequently reported driver and consequence were lack of insight and greater risk of hospitalization respectively. Conclusions: Improving adherence in schizophrenia may have a considerable positive impact on patients and society. This can be achieved by focusing on the identified multitude of factors driving nonadherence. PMID:24167693

Factors influencing teamwork and collaboration within a tertiary medical center

PubMed Central

Chien, Shu Feng; Wan, Thomas TH; Chen, Yu-Chih

2012-01-01

AIM: To understand how work climate and related factors influence teamwork and collaboration in a large medical center. METHODS: A survey of 3462 employees was conducted to generate responses to Sexton’s Safety Attitudes Questionnaire (SAQ) to assess perceptions of work environment via a series of five-point, Likert-scaled questions. Path analysis was performed, using teamwork (TW) and collaboration (CO) as endogenous variables. The exogenous variables are effective communication (EC), safety culture (SC), job satisfaction (JS), work pressure (PR), and work climate (WC). The measurement instruments for the variables or summated subscales are presented. Reliability of each sub-scale are calculated. Alpha Cronbach coefficients are relatively strong: TW (0.81), CO (0.76), EC (0.70), SC (0.83), JS (0.91), WP (0.85), and WC (0.78). Confirmatory factor analysis was performed for each of these constructs. RESULTS: Path analysis enables to identify statistically significant predictors of two endogenous variables, teamwork and intra-organizational collaboration. Significant amounts of variance in perceived teamwork (R2 = 0.59) and in collaboration (R2 = 0.75) are accounted for by the predictor variables. In the initial model, safety culture is the most important predictor of perceived teamwork, with a β weight of 0.51, and work climate is the most significant predictor of collaboration, with a β weight of 0.84. After eliminating statistically insignificant causal paths and allowing correlated predictors1, the revised model shows that work climate is the only predictor positively influencing both teamwork (β = 0.26) and collaboration (β = 0.88). A relatively weak positive (β = 0.14) but statistically significant relationship exists between teamwork and collaboration when the effects of other predictors are simultaneously controlled. CONCLUSION: Hospital executives who are interested in improving collaboration should assess the work climate to ensure that employees are

Factors Influencing Adoption of Hospital-Acquired Pressure Ulcer Prevention Programs in US Academic Medical Centers.

PubMed

Padula, William V; Valuck, Robert J; Makic, Mary Beth F; Wald, Heidi L

2015-01-01

Recent data show a decrease in hospital-acquired pressure ulcers (PUs) throughout US hospitals; these changes may be associated with increased success in implementing evidence-based practices for PU prevention. The purpose of this study was to identify wound care nurse perceptions of the primary factors that influenced the overall reduction of PUs. Cross-sectional descriptive survey. Surveys were sent to wound care nurses at 98 University HealthSystem Consortium (UHC) hospitals. The UHC consists of more than 120 academic medical centers and affiliated facilities across the United States. Responses solicited from this survey represented a geographically diverse set of hospitals from less than 200 beds to more than 1000 beds. The survey questionnaire used a framework of 7 internal and 5 external influential factors for implementing evidence-based practices for PU prevention. Internal influential factors queried included availability of nurse specialists, high nursing job turnover, high PU rates, and prevention campaigns. External influential factors included data sharing, Medicare nonpayment policy, and applications for Magnet recognition. Hospital-acquired PU prevention experts at UHC hospitals were contacted through the Wound, Ostomy and Continence Nurses Society membership directory to complete the questionnaire. Consenting participants were e-mailed a disclosure and online questionnaire; they were also sent monthly reminders until they either responded to the survey or declined participation. Fifty-five respondents (59% response rate) indicated several internal factors that influenced evidence-based practice: hospital prevention campaigns; the availability of nursing specialists; and the level of preventive knowledge among hospital staff. External influential factors included financial concerns; application for Magnet recognition; data sharing among peer institutions; and regulatory issues. These findings suggest that the Centers for Medicare & Medicaid Services

Factors influencing adherence to psychopharmacological medications in psychiatric patients: a structural equation modeling approach.

PubMed

De Las Cuevas, Carlos; de Leon, Jose; Peñate, Wenceslao; Betancort, Moisés

2017-01-01

To evaluate pathways through which sociodemographic, clinical, attitudinal, and perceived health control variables impact psychiatric patients' adherence to psychopharmacological medications. A sample of 966 consecutive psychiatric outpatients was studied. The variables were sociodemographic (age, gender, and education), clinical (diagnoses, drug treatment, and treatment duration), attitudinal (attitudes toward psychopharmacological medication and preferences regarding participation in decision-making), perception of control over health (health locus of control, self-efficacy, and psychological reactance), and level of adherence to psychopharmacological medications. Structural equation modeling was applied to examine the nonstraightforward relationships and the interactive effects among the analyzed variables. Structural equation modeling demonstrated that psychiatric patients' treatment adherence was associated: 1) negatively with cognitive psychological reactance (adherence decreased as cognitive psychological reactance increased), 2) positively with patients' trust in their psychiatrists (doctors' subscale), 3) negatively with patients' belief that they are in control of their mental health and that their mental health depends on their own actions (internal subscale), and 4) positively (although weakly) with age. Self-efficacy indirectly influenced treatment adherence through internal health locus of control. This study provides support for the hypothesis that perceived health control variables play a relevant role in psychiatric patients' adherence to psychopharmacological medications. The findings highlight the importance of considering prospective studies of patients' psychological reactance and health locus of control as they may be clinically relevant factors contributing to adherence to psychopharmacological medications.

Influence of risk factors on development of chronic obstructive pulmonary disease and legislative foundations for copd medical care in Ukraine.

PubMed

Mykhalchuk, Vasyl M; Vasyliev, Averian G

2018-01-01

Introduction: Out of all respiratory diseases COPD is the leading cause of death and is characterized with diffuse non-reversible airway obstruction. Many various components play role in development and progression of this disease, while COPD risk factors play the most prominent role. Further progress in healthcare system development around COPD in Ukraine requires analysis of legislation, regulating pulmonological medical service in Ukraine. The aim: To analyze the influence of major risk factors on the development of chronic obstructive pulmonary disease and to determine key legislative aspects of the organization of medical care for COPD patients in Ukraine. Materials and methods: 50 medical literature sources were systematically reviewed as the material for the research of COPD risk factors and their impact on studies disease. Also, an analysis of existing legislative acts regulating the pulmonological medical care in Ukraine, specifically, in patients with COPD, was conducted. Conclusions: There is a need to develop and implement a set of organizational and medical measures aiming at addressing the priorities of public healthcare, and specifically improvement of the quality of medical care for patients with chronic obstructive pulmonary disease in Ukraine.

Factors that influence the choice to work in rural township health centers among 4,669 clinical medical students from five medical universities in Guangxi, China.

PubMed

Qing, Yunbo; Hu, Guijie; Chen, Qingyun; Peng, Hailun; Li, Kailan; Wei, Jinling; Yi, Yanhua

2015-01-01

To produce competent undergraduate-level medical doctors for rural township health centers (THCs), the Chinese government mandated that medical colleges in Central and Western China recruit rural-oriented, tuition-waived medical students (RTMSs) starting in 2010. This study aimed to identify and assess factors that influence the choice to work in rural township health centers among both RTMSs and other students from five medical universities in Guangxi, China. An internet-based self-administered questionnaire survey was conducted with medical students in Guangxi province. Multinomial logistic regression was used to identify factors related to the attitudes toward work in a rural township health center. Among 4,669 medical students, 1,523 (33%) had a positive attitude and 2,574 (55%) had a neutral attitude toward working in THCs. Demographic characteristics, personal job concerns, and knowledge of THCs were associated with the choice of a career in THCs. The factors related to a positive attitude included the following: three-year program, a rural-oriented medical program, being male, an expectation of working in a county or township, a focus on medical career development, some perceived difficulty of getting a job, having family support, sufficient knowledge of THCs, optimism toward THC development, seeking lower working pressure, and a lower expected monthly salary. Male students in a three-year program or a rural-oriented tuition-waived medical education program were more likely to work in THCs. Selecting medical students through interviews to identify their family support and intentions to work in THCs would increase recruitment and retention. Establishing favorable policies and financial incentives to improve living conditions and the social status of rural physicians is necessary.

Influence of the medication environment on the unsafe medication behavior of nurses: A path analysis.

PubMed

Yu, Xi; Li, Ce; Gao, Xueqin; Liu, Furong; Lin, Ping

2018-04-20

To explore the relationship between the medication environment and the unsafe medication behavior of nurses and to analyze its influence path. Unsafe medication behavior is the direct cause of medication error. The organizational environment is the foundation of and plays a guiding role in work behavior. Whether the medication environment correlates with the unsafe medication behavior of nurses remains unclear. This study used a correlative design with self-administered questionnaires, and the SHEL model, an acronym of its elements of software, hardware, environment, and liveware, was used as the framework for the medication environment. A survey was conducted among 1012 clinical nurses from five tertiary hospitals in China using the nurse unsafe medication behavior scale (NUMBS) and the nurses' perceptions of the medication environment scale (NPMES). Data were collected from January to February 2017. Path analyses were used to examine the hypothesized model. The medication environment correlated negatively with unsafe medication behavior (r=-0.48, p<0.001). The path analysis showed that software, liveware and nurses' personal factors directly affected unsafe medication behavior. Software, hardware and the environment indirectly influenced unsafe medication behavior, and nurses' personal factors played a mediating role in the relationships of unsafe medication behavior with software, hardware, and the environment. The unsafe medication behavior of nurses should be further improved. The medication environment was a predictor of unsafe medication behavior. Care managers should actively improve the medication environment to reduce the incidence of unsafe medication behaviors. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Specialty preferences and motivating factors: A national survey on medical students from five uae medical schools.

PubMed

Abdulrahman, Mahera; Makki, Maryam; Shaaban, Sami; Al Shamsi, Maryam; Venkatramana, Manda; Sulaiman, Nabil; Sami, Manal M; Abdelmannan, Dima K; Salih, AbdulJabbar M A; AlShaer, Laila

2016-01-01

Workforce planning is critical for being able to deliver appropriate health service and thus is relevant to medical education. It is, therefore, important to understand medical students' future specialty choices and the factors that influence them. This study was conducted to identify, explore, and analyze the factors influencing specialty preferences among medical students of the United Arab Emirates (UAE). A multiyear, multicenter survey of medical student career choice was conducted with all five UAE medical schools. The questionnaire consisted of five sections. Chi-squared tests, regression analysis, and stepwise logistic regression were performed. The overall response rate was 46% (956/2079). Factors that students reported to be extremely important when considering their future career preferences were intellectual satisfaction (87%), work-life balance (71%), having the required talent (70%), and having a stable and secure future (69%). The majority of students (60%) preferred internal medicine, surgery, emergency medicine, or family Medicine. The most common reason given for choosing a particular specialty was personal interest (21%), followed by flexibility of working hours (17%). The data show that a variety of factors inspires medical students in the UAE in their choice of a future medical specialty. These factors can be used by health policymakers, university mentors, and directors of residency training programs to motivate students to choose specialties that are scarce in the UAE and therefore better serve the health-care system and the national community.

Factors Influencing Medical Students to Choose Primary Care or Non-primary Care Specialties.

ERIC Educational Resources Information Center

Rogers, Laura Q.; And Others

1990-01-01

A questionnaire was administered to 339 graduating senior medical students at the Medical College of Georgia to determine different potential sources of influence on career choice. Indebtedness may be associated with the choice of a non-primary care specialty with greater remuneration than primary care specialty. (MLW)

The influence factors of medical professionalism: A stratified-random sampling study based on the physicians and patients in ambulatory care clinics of Chengdu, China.

PubMed

Lin, Yifei; Yin, Senlin; Lai, Sike; Tang, Ji; Huang, Jin; Du, Liang

2016-10-01

As the relationship between physicians and patients deteriorated in China recently, medical conflicts occurred more frequently now. Physicians, to a certain extent, also take some responsibilities. Awareness of medical professionalism and its influence factors can be helpful to take targeted measures and alleviate the contradiction. Through a combination of physicians' self-assessment and patients' assessment in ambulatory care clinics in Chengdu, this research aims to evaluate the importance of medical professionalism in hospitals and explore the influence factors, hoping to provide decision-making references to improve this grim situation. From February to March, 2013, a cross-sectional study was conducted in 2 tier 3 hospitals, 5 tier 2 hospitals, and 10 community hospitals through a stratified-random sampling method on physicians and patients, at a ratio of 1/5. Questionnaires are adopted from a pilot study. A total of 382 physicians and 1910 patients were matched and surveyed. Regarding the medical professionalism, the scores of the self-assessment for physicians were 85.18 ± 7.267 out of 100 and the scores of patient-assessment were 57.66 ± 7.043 out of 70. The influence factors of self-assessment were physicians' working years (P = 0.003) and patients' complaints (P = 0.006), whereas the influence factors of patient-assessment were patients' ages (P = 0.001) and their physicians' working years (P < 0.01) and satisfaction on the payment mode (P = 0.006). Higher self-assessment on the medical professionalism was in accordance with physicians of more working years and no complaint history. Higher patient-assessment was in line with elder patients, the physicians' more working years, and higher satisfaction on the payment mode. Elder patients, encountering with physicians who worked more years in health care services or with higher satisfaction on the payment mode, contribute to higher scores in patient assessment part. The government should

Factors influencing return to work after illness in France.

PubMed

Pélissier, C; Fontana, L; Chauvin, F

2014-01-01

Few studies have been published about the factors influencing return to work after sickness absence. To identify medical and occupational factors influencing the type of fitness certificate given by occupational physicians before employees return to work after sickness absence. A cross-sectional study was undertaken over 3 months in several health services in France. Workers undergoing a medical examination before returning to work after a period of sickness absence of at least 3 weeks were included. Medical and occupational factors were collected using a questionnaire. The relationship between different factors and certification of fitness was assessed by univariate and multivariate analyses. Among the 402 workers included, 64% were considered fit to return to work. Being older, strenuous work, prolonged sick leave and fear of returning to work appeared to be negative factors influencing the return to a previous job. In contrast, having an education level higher than secondary school, being satisfied at work, perception of very good health and benefitting from satisfactory professional relationships appeared to favour return to work. We developed a predictive score of not being fit to return to work after illness. Our study highlighted the relationship between medical and occupational factors with problems returning to work. The predictive score may be used by occupational physicians as a screening tool to identify those who are likely to have difficulties returning to work after illness, so that their working conditions can be modified to take this into consideration.

Critical factors in career decision making for women medical graduates.

PubMed

Lawrence, Joanna; Poole, Phillippa; Diener, Scott

2003-04-01

Within the next 30 years there will be equal numbers of women and men in the medical workforce. Indications are that women are increasing their participation in specialties other than general practice, although at a slower rate than their participation in the workforce as a whole. To inform those involved in training and employment of medical women, this study investigated the influencing factors in career decision making for female medical graduates. A total of 305 women medical graduates from the University of Auckland responded to a mail survey (73% response rate) which examined influences on decision making, in both qualitative and quantitative ways, as part of a larger survey. Most women were satisfied with their careers. The principal component analysis of the influencing factors identified four distinct factors important in career choice - interest, flexibility, women friendliness and job security, although the first two of these were rated more highly than the others. Barriers to full participation by medical women in training and employment need to be systematically examined and removed. This is not only to allow women themselves to reach their full potential, but for workforce and socio-economic reasons. Initiatives that allow and value more flexible training and work practices, particularly through the years of child raising, are necessary for women and the health care workforce at large.

Mental Health of the Prison Medical Workers (PMWs) and Influencing Factors in Jiangxi, China.

PubMed

Liu, Xiaojun; Jiang, Dongdong; Hou, Zhaoxun; He, Meikun; Lu, Yuanan; Mao, Zongfu

2017-11-26

Prison medical workers (PMWs) are critically important, but they are also vulnerable to psychological problems. Currently, there is no study on examining PMWs' mental health conditions and possible influencing factors in China. Hence, we conducted this cross-sectional survey, aiming to understand the mental health status of the PMWs and related impact factors in Jiangxi province of China. We employed the Chinese version of the Symptom Checklist-90-R (SCL-90-R) to assess the mental disorders and psychological health conditions of PMWs in Jiangxi. The t tests were used to compare the differences for the average score of SCL-90-R between the Chinese general population and targeted PMWs of this study. Multivariable logistic regression analyses were conducted to identify the main factors associated with overall detection rate of PMWs' psychological health conditions. The scores of four dimensions (somatization, obsessive-compulsive symptoms, anxiety, and paranoid ideation) were significantly higher than the Chinese national norm, and the total positive rate was 49.09% among the PMWs. Gender, marital status, age, and length of employment are identified to be the most significant predictors to affect PMWs' mental health. Positive correlations between each of the nine dimensions of the SCL-90-R have been verified. This study demonstrated for the first time that PMWs are facing mental health risk and suffering serious psychological problems with psychopathology symptoms, which has become a growing concern in China. Our current findings suggest a need for more in-depth studies on this subject going forward to validate our conclusions and also to identify more impact factors, since such studies and knowledge of PMWs' mental health and influencing factors are very limited in China.

The influence of factors of work environment and burnout syndrome on self-efficacy of medical staff.

PubMed

Nowakowska, Iwona; Rasińska, Renata; Głowacka, Maria Danuta

2016-06-02

Conditions of a healthy, friendly and safe work environment and proper work organisation increase self-efficacy and decrease or eliminate the factors causing the occurrence of burnout symptoms, all of which have a decisive impact on increasing the quality of work. The aim of the study was to analyse and assess the influence of factors of work environment and burnout syndrome on the self-efficacy of medical staff. The study comprised randomly selected professionally-active nurses working on hospital wards (N=405) on the area of two provinces in Poland. The study used the Generalized Self-Efficacy Scale, Copenhagen Burnout Inventory and a questionnaire concerning the factors that influence the process of work organisation at nursing positions in hospitals. Lower scores for self-efficacy resulted in a worse assessment of development opportunities and promotion prospects (r=-0.11), participation in the decision-making process (r=-0.11) and teamwork (r=-0.10). Lower self-efficacy contributed to the occurrence of burnout symptoms r∈[-0.19 - -0.17]. Properly shaped and used organisational factors are stimulating for professional efficiency and effectiveness, and consequently, for the quality of nursing work. Negative assessment of the factors in the work environment contributes to the occurrence of burnout symptoms and decrease in self-efficacy. Nurses with lower self-efficacy more often experienced symptoms of burnout.

[Influence of World War II on high medical school education in the US].

PubMed

Zhang, Yan-Rong

2005-01-01

Modern medical education was gradually established in the US since Flexner's report was published in 1910. Medical education had developed rapidly before World War II. The outbreak of World War II had become an important factor influencing the development of medical education in history. By analyzing the influence of World War II in medical education and analyzing and summarizing the American medical education before and after this War, we hope that it can offer some useful experiences to the development of medical education in our country.

[Influencing factors on depression among medical staff in Hunan province under ordinal regression analysis].

PubMed

Liu, Zhi-yu; Zhong, Meng; Hai, Yan; Du, Qi-yun; Wang, Ai-hua; Xie, Dong-hua

2012-11-01

To understand the situation of depression and its related influencing factors among medical staff in Hunan province. Data were collected through random sampling with multi-stage stratified cluster. Wilcoxon rank sum test, Kruskal-Wallis H test and Ordinal regression analysis were used for data analysis by SPSS 17.0 software. This survey was including 16,000 medical personnel with 14, 988 valid questionnaires and the effective rate was 93.68%. from the single factor analysis showed that factors as: level of the hospital grading, gender, education background, age, occupation, title, departments, the number of continue education, income, working overtime every week, the frequency of night work, the number of patients treated in the emergency room etc., had statistical significances (P < 0.05). Data from ordinal regression showed that the probabilities related to depression that clinicians and nurses suffering from were 1.58 times more than the pharmacists (OR = 1.58, 95%CI: 1.30 - 1.92). The probability among those whose income was less than 2000 Yuan/month was 2.19 times of the ones whose earned more than 3000 Yuan/month (OR = 2.19, 95%CI: 2.05 - 2.35). The higher the numbers of days with working overtime every week, the frequencies of night work, and the numbers of patients being treated at the emergency room, with more probabilities of the people with depression seen in our study. Depression seemed to be common among doctors and nurses. We suggested that the government need to increase the monthly income and to reduce the workload and intensity, lessen the overworking time, etc.

Integrative Approach to Quality Assessment of Medical Journals Using Impact Factor, Eigenfactor, and Article Influence Scores

PubMed Central

Rizkallah, Jacques; Sin, Don D.

2010-01-01

Background Impact factor (IF) is a commonly used surrogate for assessing the scientific quality of journals and articles. There is growing discontent in the medical community with the use of this quality assessment tool because of its many inherent limitations. To help address such concerns, Eigenfactor (ES) and Article Influence scores (AIS) have been devised to assess scientific impact of journals. The principal aim was to compare the temporal trends in IF, ES, and AIS on the rank order of leading medical journals over time. Methods The 2001 to 2008 IF, ES, AIS, and number of citable items (CI) of 35 leading medical journals were collected from the Institute of Scientific Information (ISI) and the http://www.eigenfactor.org databases. The journals were ranked based on the published 2008 ES, AIS, and IF scores. Temporal score trends and variations were analyzed. Results In general, the AIS and IF values provided similar rank orders. Using ES values resulted in large changes in the rank orders with higher ranking being assigned to journals that publish a large volume of articles. Since 2001, the IF and AIS of most journals increased significantly; however the ES increased in only 51% of the journals in the analysis. Conversely, 26% of journals experienced a downward trend in their ES, while the rest experienced no significant changes (23%). This discordance between temporal trends in IF and ES was largely driven by temporal changes in the number of CI published by the journals. Conclusion The rank order of medical journals changes depending on whether IF, AIS or ES is used. All of these metrics are sensitive to the number of citable items published by journals. Consumers should thus consider all of these metrics rather than just IF alone in assessing the influence and importance of medical journals in their respective disciplines. PMID:20419115

Influences on final year medical students' attitudes to general practice as a career.

PubMed

Parker, Johanna E; Hudson, Ben; Wilkinson, Tim J

2014-03-01

General practice is under-represented in student career choices. This study aimed to identify and explore factors that influence the attitudes of final year medical students to general practice as a career. This qualitative study used semi-structured interviews of focus groups of final year undergraduate medical students at the University of Otago, Christchurch, New Zealand. Thematic analysis and grounded theory were used to interpret the data. General practitioners (GPs) play a key role in influencing medical students' attitudes to general practice as a career. Students identified their general practice placement during medical school training and personal contact with their own GP as principal factors. The media portrayal of general practice and the attitudes of friends and family were also influential. Students were positively influenced when they were made to feel part of the team, involved with consultations, allowed to carry out practical procedures under supervision, and witnessed what they perceived as good medical practice during clinical placements. Positive experiences often occurred later in training, when students felt more confident of their clinical abilities. While students reported occasional negative comments about general practice by some hospital doctors, these had a lesser role in influencing their perceptions of general practice compared with their own experiences, both as students and patients. GPs have a strong influence, positively and negatively, on the attitudes of medical students to general practice as a career. Effective influences include being made to feel welcome, involved, valued, and given legitimate roles during clinical placements.

Factors effective on medication errors: A nursing view.

PubMed

Shahrokhi, Akram; Ebrahimpour, Fatemeh; Ghodousi, Arash

2013-01-01

Medication errors are the most common medical errors, which may result in some complications for patients. This study was carried out to investigate what influence medication errors by nurses from their viewpoint. In this descriptive study, 150 nurses who were working in Qazvin Medical University teaching hospitals were selected by proportional random sampling, and data were collected by means of a researcher-made questionnaire including demographic attributes (age, gender, working experience,…), and contributing factors in medication errors (in three categories including nurse-related, management-related, and environment-related factors). The mean age of the participant nurses was 30.7 ± 6.5 years. Most of them (87.1%) were female with a Bachelor of Sciences degree (86.7%) in nursing. The mean of their overtime working was 64.8 ± 38 h/month. The results showed that the nurse-related factors are the most effective factors (55.44 ± 9.14) while the factors related to the management system (52.84 ± 11.24) and the ward environment (44.0 ± 10.89) are respectively less effective. The difference between these three groups was significant (P = 0.000). In each aforementioned category, the most effective factor on medication error (ranked from the most effective to the least effective) were as follow: The nurse's inadequate attention (98.7%), the errors occurring in the transfer of medication orders from the patient's file to kardex (96.6%) and the ward's heavy workload (86.7%). In this study nurse-related factors were the most effective factors on medication errors, but nurses are one of the members of health-care providing team, so their performance must be considered in the context of the health-care system like work force condition, rules and regulations, drug manufacturing that might impact nurses performance, so it could not be possible to prevent medication errors without paying attention to our health-care system in a holistic approach.

Factors effective on medication errors: A nursing view

PubMed Central

Shahrokhi, Akram; Ebrahimpour, Fatemeh; Ghodousi, Arash

2013-01-01

Objective: Medication errors are the most common medical errors, which may result in some complications for patients. This study was carried out to investigate what influence medication errors by nurses from their viewpoint. Methods: In this descriptive study, 150 nurses who were working in Qazvin Medical University teaching hospitals were selected by proportional random sampling, and data were collected by means of a researcher-made questionnaire including demographic attributes (age, gender, working experience,…), and contributing factors in medication errors (in three categories including nurse-related, management-related, and environment-related factors). Findings: The mean age of the participant nurses was 30.7 ± 6.5 years. Most of them (87.1%) were female with a Bachelor of Sciences degree (86.7%) in nursing. The mean of their overtime working was 64.8 ± 38 h/month. The results showed that the nurse-related factors are the most effective factors (55.44 ± 9.14) while the factors related to the management system (52.84 ± 11.24) and the ward environment (44.0 ± 10.89) are respectively less effective. The difference between these three groups was significant (P = 0.000). In each aforementioned category, the most effective factor on medication error (ranked from the most effective to the least effective) were as follow: The nurse's inadequate attention (98.7%), the errors occurring in the transfer of medication orders from the patient's file to kardex (96.6%) and the ward's heavy workload (86.7%). Conclusion: In this study nurse-related factors were the most effective factors on medication errors, but nurses are one of the members of health-care providing team, so their performance must be considered in the context of the health-care system like work force condition, rules and regulations, drug manufacturing that might impact nurses performance, so it could not be possible to prevent medication errors without paying attention to our health-care system in a

Intrinsic factors influencing help-seeking behaviour in an acute stroke situation.

PubMed

Zock, Elles; Kerkhoff, Henk; Kleyweg, Ruud Peter; van de Beek, Diederik

2016-09-01

The proportion of stroke patients eligible for intravenous or intra-arterial treatment is still limited because many patients do not seek medical help immediately after stroke onset. The aim of our study was to explore which intrinsic factors and considerations influence help-seeking behaviour of relatively healthy participants, confronted with stroke situations. Semi-structured interviews were conducted with 25 non-stroke participants aged 50 years or older. We presented 5 clinical stroke situations as if experienced by the participants themselves. Recognition and interpretation of symptoms were evaluated and various factors influencing help-seeking behaviour were explored in-depth. We used the thematic synthesis method for data analysis. Five themes influencing help-seeking behaviour in a stroke situation were identified: influence of knowledge, views about seriousness, ideas about illness and health, attitudes towards others and beliefs about the emergency medical system. A correct recognition of stroke symptoms or a correct interpretation of the stroke situations did not automatically result in seeking medical help. Interestingly, similar factors could lead to different types of actions between participants. Many intrinsic, as well as social and environmental factors are of influence on help-seeking behaviour in an acute stroke situation. All these factors seem to play a complex role in help-seeking behaviour with considerable inter-individual variations. Accomplishing more patients eligible for acute stroke treatment, future research should focus on better understanding of all factors at various levels grounded in a theory of help-seeking behaviour.

Age or health status: which influences medical insurance enrollment greater?

PubMed Central

Xu, Wei; Cai, Gong–Jie; Li, Guan–Nan; Cao, Jing–Jing; Shi, Qiong–Hua; Bai, Jie

2016-01-01

Background The New Cooperative Medical Scheme (NCMS) for peasantries implemented in 2003 and the Urban Resident Basic Medical Insurance (URBMI) for the urban unemployed implemented in 2007 have many similarities. They both apply the financing mode of individual premiums plus government’s subsidies, and the voluntary enrollment. The Chinese government plans to integrate these two systems and build a unified basic medical insurance system for the unemployed in order to achieve the medical equity and increase the general health level. Thus, to analyze the main influencing factors of the enrollment of the urban unemployed and rural residents is very important for improving the system and securing the stability of the system during the transition. Methods The study uses data from the China Health and Nutrition Survey (CHNS) and adopts logistic regression models to test which factors influence the enrollment of the URBMI and the NCMS under the background of rather high enrollment rate of Chinese basic medical insurances and strong fiscal support of the Chinese government, especially whether health status or age influences enrollment of these two insurances greater. Results There is indeed some adverse selection in the URBMI and the NCMS. Whether the individual has chronic diseases have significant influence on enrollments of both the urban unemployed and rural residents, while whether the individual got ill in last four weeks just influences enrollments of the urban unemployed. Age influences enrollment greater than health status. The older the insured are, the larger the enrollment rates are. Conclusion Because of the active support for basic medical insurances of the Chinese government, the enrollment performance of the urban unemployed and rural residents has already changed. When implementing the new policy, the government should pay attention to the willingness to enroll in and the change of enrollment performance of the insured. Therefore, under the policy of

What factors influence the choice of urban or rural location for future practice of Nepalese medical students? A cross-sectional descriptive study.

PubMed

Sapkota, Bhim Prasad; Amatya, Archana

2015-11-10

Nepal is experiencing a public health issue similar to the rest of the world, i.e., the geographical maldistribution of physicians. Although there is some documentation about the reasons physicians elect to leave Nepal to work abroad, very little is known about the salient factors that influence the choice of an urban versus rural practice setting for those physicians who do not migrate. In recent years, around 1000 medical students became doctors within Nepal, but their distribution in rural locations is not adequate. The purpose of this study was to explore what factors influence the choice of urban or rural location for the future clinical practice of Nepalese medical students in the final year of their program A cross-sectional descriptive study design was used for this study involving Nepalese medical students in their final year of study and currently doing an internship in a medical college. The sample consisted of 393 medical students from four medical colleges in Nepal that were selected randomly. An anonymous self-administered questionnaire was used for data collection. To determine the association with rural location choice for their future practice setting, a comparison was done that involved demographic, socio-economic, and educational factors. Data were entered in EpiData and analyzed by using SPSS version 16. Among the 393 respondents, two thirds were male (66.9%) and more than half were below 25 years of age. Almost all (93%) respondents were single and about two thirds (63.4%) were of Brahmin and Chhetri ethnic origin. About two thirds (64.1%) of the respondents were born in a rural setting, and 58.8% and 53.3% had a place of rearing and permanent address in a rural location, respectively. The predictors of future rural location choice for their clinical practice (based on the bivariate analysis) included: (a) Rural (versus urban) place of birth, place of rearing, and permanent address (b) Source of family income (service, business, and agriculture

Practice location factors influencing South Dakota School of Medicine graduates (1977-85).

PubMed

Jarratt, L G; Leonardson, G R; Nord, W J

1989-12-01

Physician numbers and placement continue to be major health delivery concerns in the rural state of South Dakota. This study of four-year graduates (1977-1985) of the South Dakota School of Medicine looks at current factors affecting physician placement and compares placement and location selection factors to a previous study of graduates of the medical school when it was a two-year program (1969-1973). Factors influencing physicians locating in South Dakota were: closeness to their home town and or spouses' home town, residency training in small towns, payment of educational loans, medical school clerkships, time of decision, etc. Factors influencing physicians locating in rural communities (less than 5,000) were: growing up in small communities, residency training in small communities, early location decisions, payment of loans, and high medical need.

Factors Influencing Enrollment in the Medication Therapy Management Clinic at an Academic Ambulatory Care Clinic.

PubMed

Shah, Mansi; Tilton, Jessica; Kim, Shiyun

2016-04-01

In 2001, the University of Illinois Hospital and Health Sciences System (UI Health) established a pharmacist-run, referral-based medication therapy management clinic (MTMC). Referrals are obtained from any UI Health provider or by self-referral. Although there is a high volume of referrals, a large percentage of patients do not enroll. This study was designed to determine the various factors that influence patient enrollment in the MTMC. This study was a retrospective chart review of demographic and patient variable data during years 2010 and 2011. Disabilities, distance from MTMC, mode of transportation, past medical history, and appointment dates were extracted from the medical records. Results were analyzed using descriptive statistics and logistic regression analysis. A total of 103 referrals were made; however, only 17% of patients remain enrolled in MTMC. The baseline demographics included a mean age of 63 years, 68% female, 70% African American, and 81% English speaking. Patients lived an average of 8 miles from MTMC; most utilized public or government-supplemented transport services; 24% of patients reported some type of disability, most commonly utilizing a walker or a wheelchair. On average, patients were prescribed 13 medications with hypertension (70%), diabetes (56%), and hyperlipidemia (48%) being the most common chronic disease states. The reason for referral included medication management, education, medication reconciliation, and disease state management. Five patients were unable to be contacted to schedule an initial appointment. Additionally, 18 patients failed their scheduled initial appointment and did not reschedule. Logistic regression analysis demonstrated distance traveled for clinic visit, age, and history of hypertension affected the probability of patients showing for their appointments (chi-square = 19.7, P < .001). This study demonstrated that distance from MTMC is the most common barrier in patient enrollment; therefore, strategies

Exploring critical factors influencing physicians' acceptance of mobile electronic medical records based on the dual-factor model: a validation in Taiwan.

PubMed

Liu, Chung-Feng; Cheng, Tain-Junn

2015-02-07

With respect to information management, most of the previous studies on the acceptance of healthcare information technologies were analyzed from "positive" perspectives. However, such acceptance is always influenced by both positive and negative factors and it is necessary to validate both in order to get a complete understanding. This study aims to explore physicians' acceptance of mobile electronic medical records based on the dual-factor model, which is comprised of inhibitors and enablers, to explain an individual's technology usage. Following an earlier healthcare study in the USA, the researchers conducted a similar survey for an Eastern country (Taiwan) to validate whether perceived threat to professional autonomy acts as a critical inhibitor. In addition, perceived mobility, which is regarded as a critical feature of mobile services, was also evaluated as a common antecedent variable in the model. Physicians from three branch hospitals of a medical group were invited to participate and complete questionnaires. Partial least squares, a structural equation modeling technique, was used to evaluate the proposed model for explanatory power and hypotheses testing. 158 valid questionnaires were collected, yielding a response rate of 33.40%. As expected, the inhibitor of perceived threat has a significant impact on the physicians' perceptions of usefulness as well as their intention to use. The enablers of perceived ease of use and perceived usefulness were also significant. In addition, as expected, perceived mobility was confirmed to have a significant impact on perceived ease of use, perceived usefulness and perceived threat. It was confirmed that the dual-factor model is a comprehensive method for exploring the acceptance of healthcare information technologies, both in Western and Eastern countries. Furthermore, perceived mobility was proven to be an effective antecedent variable in the model. The researchers believe that the results of this study will

Understanding the factors that influence the adoption and meaningful use of social media by physicians to share medical information.

PubMed

McGowan, Brian S; Wasko, Molly; Vartabedian, Bryan Steven; Miller, Robert S; Freiherr, Desirae D; Abdolrasulnia, Maziar

2012-09-24

Within the medical community there is persistent debate as to whether the information available through social media is trustworthy and valid, and whether physicians are ready to adopt these technologies and ultimately embrace them as a format for professional development and lifelong learning. To identify how physicians are using social media to share and exchange medical information with other physicians, and to identify the factors that influence physicians' use of social media as a component of their lifelong learning and continuing professional development. We developed a survey instrument based on the Technology Acceptance Model, hypothesizing that technology usage is best predicted by a physician's attitudes toward the technology, perceptions about the technology's usefulness and ease of use, and individual factors such as personal innovativeness. The survey was distributed via email to a random sample of 1695 practicing oncologists and primary care physicians in the United States in March 2011. Responses from 485 physicians were analyzed (response rate 28.61%). Overall, 117 of 485 (24.1%) of respondents used social media daily or many times daily to scan or explore medical information, whereas 69 of 485 (14.2%) contributed new information via social media on a daily basis. On a weekly basis or more, 296 of 485 (61.0%) scanned and 223 of 485 (46.0%) contributed. In terms of attitudes toward the use of social media, 279 of 485 respondents (57.5%) perceived social media to be beneficial, engaging, and a good way to get current, high-quality information. In terms of usefulness, 281 of 485 (57.9%) of respondents stated that social media enabled them to care for patients more effectively, and 291 of 485 (60.0%) stated it improved the quality of patient care they delivered. The main factors influencing a physician's usage of social media to share medical knowledge with other physicians were perceived ease of use and usefulness. Respondents who had positive

Factors influencing the perception of medical staff and outpatients of dual practice in Shanghai, People's Republic of China.

PubMed

Chen, Haiping; Li, Meina; Dai, Zhixin; Deng, Qiangyu; Zhang, Lulu

2016-01-01

Dual practice is defined as a physician's performance of medical activities in different health care institutions (two or more) simultaneously. This study aimed to examine the perception and acceptance of medical staff and outpatients of dual practice and explore the possible factors affecting people's perception. A cross-sectional study was conducted in 13 public hospitals in Shanghai. Participants included medical staff and outpatients. We distributed 1,000 questionnaires to each participant group, and the response rates were 66.7% and 69.4%, respectively. Statistical differences in variables were tested, and multinomial logistic regression methods were employed for statistical analysis. The study included two parts: medical staff survey and outpatient survey. The results of medical staff survey showed that 63.0% of the respondents supported dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the publicity activities of dual practice and hospitals' human resource management system were important factors affecting the willingness of the medical staff. The results of outpatient survey showed that 44.5% of respondents believed that dual practice could reduce difficulty in consulting a doctor. Regarding the perceived benefits of dual practice, the proportion of outpatients who believed that dual practice could meet the demand for health convenience, minor illness, and chronic disease were 45.4%, 42.4%, and 53.7%, respectively. Additionally, demographic characteristics significantly influenced the perception of outpatients. This study confirmed that both medical staff and outpatients generally held positive attitudes toward dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the existence of publicity activities and more flexible

Factors associated with self-medication in Spain: a cross-sectional study in different age groups.

PubMed

Niclós, Gracia; Olivar, Teresa; Rodilla, Vicent

2018-06-01

The identification of factors which may influence a patient's decision to self-medicate. Descriptive, cross-sectional study of the adult population (at least 16 years old), using data from the 2009 European Health Interview Survey in Spain, which included 22 188 subjects. Logistic regression models enabled us to estimate the effect of each analysed variable on self-medication. In total, 14 863 (67%) individuals reported using medication (prescribed and non-prescribed) and 3274 (22.0%) of them self-medicated. Using logistic regression and stratifying by age, four different models have been constructed. Our results include different variables in each of the models to explain self-medication, but the one that appears on all four models is education level. Age is the other important factor which influences self-medication. Self-medication is strongly associated with factors related to socio-demographic, such as sex, educational level or age, as well as several health factors such as long-standing illness or physical activity. When our data are compared to those from previous Spanish surveys carried out in 2003 and 2006, we can conclude that self-medication is increasing in Spain. © 2017 Royal Pharmaceutical Society.

How to introduce medical ethics at the bedside - Factors influencing the implementation of an ethical decision-making model.

PubMed

Meyer-Zehnder, Barbara; Albisser Schleger, Heidi; Tanner, Sabine; Schnurrer, Valentin; Vogt, Deborah R; Reiter-Theil, Stella; Pargger, Hans

2017-02-23

As the implementation of new approaches and procedures of medical ethics is as complex and resource-consuming as in other fields, strategies and activities must be carefully planned to use the available means and funds responsibly. Which facilitators and barriers influence the implementation of a medical ethics decision-making model in daily routine? Up to now, there has been little examination of these factors in this field. A medical ethics decision-making model called METAP was introduced on three intensive care units and two geriatric wards. An evaluation study was performed from 7 months after deployment of the project until two and a half years. Quantitative and qualitative methods including a questionnaire, semi-structured face-to-face and group-interviews were used. Sixty-three participants from different professional groups took part in 33 face-to-face and 9 group interviews, and 122 questionnaires could be analysed. The facilitating factors most frequently mentioned were: acceptance and presence of the model, support given by the medical and nursing management, an existing or developing (explicit) ethics culture, perception of a need for a medical ethics decision-making model, and engaged staff members. Lack of presence and acceptance, insufficient time resources and staff, poor inter-professional collaboration, absence of ethical competence, and not recognizing ethical problems were identified as inhibiting the implementation of the METAP model. However, the results of the questionnaire as well as of explicit inquiry showed that the respondents stated to have had enough time and staff available to use METAP if necessary. Facilitators and barriers of the implementation of a medical ethics decision-making model are quite similar to that of medical guidelines. The planning for implementing an ethics model or guideline can, therefore, benefit from the extensive literature and experience concerning the implementation of medical guidelines. Lack of time and

Factors influencing parental decision making about stimulant treatment for attention-deficit/hyperactivity disorder.

PubMed

Ahmed, Rana; McCaffery, Kirsten J; Aslani, Parisa

2013-04-01

Attention-deficit/hyperactivity disorder (ADHD) is a pediatric psychological condition commonly treated with stimulant medications. Negative media reports and stigmatizing societal attitudes surrounding the use of these medications make it difficult for parents of affected children to accept stimulant treatment, despite it being first line therapy. The purpose of this study was to identify factors that influence parental decision making regarding stimulant treatment for ADHD. A systematic review of the literature was conducted to identify studies: 1) that employed qualitative methodology, 2) that highlighted treatment decision(s) about stimulant medication, 3) in which the decision(s) were made by the parent of a child with an official ADHD diagnosis, and 4) that examined the factors affecting the decision(s) made. Individual factors influencing parental treatment decision making, and the major themes encompassing these factors, were identified and followed by a thematic analysis. Eleven studies reporting on the experiences of 335 parents of children with ADHD were included. Four major themes encompassing influences on parents' decisions were derived from the thematic analysis performed: confronting the diagnosis, external influences, apprehension regarding therapy, and experience with the healthcare system. The findings of this systematic review reveal that there are multiple factors that influence parents' decisions about stimulant therapy. This information can assist clinicians in enhancing information delivery to parents of children with ADHD, and help reduce parental ambivalence surrounding stimulant medication use. Future work needs to address parental concerns about stimulants, and increase their involvement in shared decision making with clinicians to empower them to make the most appropriate treatment decision for their child.

Exploring the factors influencing clinical students' self-regulated learning.

PubMed

Berkhout, Joris J; Helmich, Esther; Teunissen, Pim W; van den Berg, Joost W; van der Vleuten, Cees P M; Jaarsma, A Debbie C

2015-06-01

The importance of self-regulated learning (SRL) has been broadly recognised by medical education institutions and regulatory bodies. Supporting the development of SRL skills has proven difficult because self-regulation is a complex interactive process and we know relatively little about the factors influencing this process in real practice settings. The aim of our study was therefore to identify factors that support or hamper medical students' SRL in a clinical context. We conducted a constructivist grounded theory study using semi-structured interviews with 17 medical students from two universities enrolled in clerkships. Participants were purposively sampled to ensure variety in age, gender, experience and current clerkship. The Day Reconstruction Method was used to help participants remember their activities of the previous day. The interviews were transcribed verbatim and analysed iteratively using constant comparison and open, axial and interpretive coding. Self-regulated learning by students in the clinical environment was influenced by the specific goals perceived by students, the autonomy they experienced, the learning opportunities they were given or created themselves, and the anticipated outcomes of an activity. All of these factors were affected by personal, contextual and social attributes. Self-regulated learning of medical students in the clinical environment is different for every individual. The factors influencing this process are affected by personal, social and contextual attributes. Some of these are similar to those known from previous research in classroom settings, but others are unique to the clinical environment and include the facilities available, the role of patients, and social relationships pertaining to peers and other hospital staff. To better support students' SRL, we believe it is important to increase students' metacognitive awareness and to offer students more tailored learning opportunities. © 2015 John Wiley & Sons Ltd.

Brain Drain: Post Graduation Migration Intentions and the influencing factors among Medical Graduates from Lahore, Pakistan.

PubMed

Imran, Nazish; Azeem, Zahra; Haider, Imran I; Amjad, Naeem; Bhatti, Muhammad R

2011-10-17

The increasing migration of health professionals to affluent countries is not a recent phenomenon and has been addressed in literature. However the various facets of physician migration from Pakistan, the third leading source of International medical graduates has not been rigorously evaluated. The objective of the current study was to survey final year students and recent medical graduates in Lahore, Pakistan about their intentions to train abroad, their post training plans as well as to identify the factors responsible for their motivation for international migration. A self administered structured questionnaire was developed to collect respondents' demographic and educational characteristics, intention to train abroad, their preferred destination & post training intentions of returning to Pakistan. Various influencing factors which impact on medical graduate's motivation to train abroad or stay in Pakistan were explored using a 10 point scale. SPSS software was used for data entry and analysis. Of the 400 eligible respondents, 275 responded (response rate 68.7%). One hundred and sixty six respondents (60.4%) intended to train abroad either for a specialty (54.9%) or a subspecialty (5.5%) The United States and United Kingdom were the most preferred destination. While 14.2% intended to return to Pakistan immediately after training, a significant percentage (10%) never intended to return to Pakistan or wished to stay abroad temporarily (37%). Professional excellence and establishing quickly in the competitive market were the most important goal to be achieved by the respondents for intention for postgraduate training abroad. The most common reasons cited for training abroad were the impact of residency training on future career (mean score 8.20 ± 2.3), financial conditions of doctors (mean score 7.97 ± 2.37) and job opportunities (mean score7.90 ± 2.34). An alarming percentage of medical graduates from Lahore, Pakistan intend to migrate for post graduate

Brain Drain: Post Graduation Migration Intentions and the influencing factors among Medical Graduates from Lahore, Pakistan

PubMed Central

2011-01-01

Background The increasing migration of health professionals to affluent countries is not a recent phenomenon and has been addressed in literature. However the various facets of physician migration from Pakistan, the third leading source of International medical graduates has not been rigorously evaluated. The objective of the current study was to survey final year students and recent medical graduates in Lahore, Pakistan about their intentions to train abroad, their post training plans as well as to identify the factors responsible for their motivation for international migration. Method A self administered structured questionnaire was developed to collect respondents' demographic and educational characteristics, intention to train abroad, their preferred destination & post training intentions of returning to Pakistan. Various influencing factors which impact on medical graduate's motivation to train abroad or stay in Pakistan were explored using a 10 point scale. SPSS software was used for data entry and analysis. Results Of the 400 eligible respondents, 275 responded (response rate 68.7%). One hundred and sixty six respondents (60.4%) intended to train abroad either for a specialty (54.9%) or a subspecialty (5.5%) The United States and United Kingdom were the most preferred destination. While 14.2% intended to return to Pakistan immediately after training, a significant percentage (10%) never intended to return to Pakistan or wished to stay abroad temporarily (37%). Professional excellence and establishing quickly in the competitive market were the most important goal to be achieved by the respondents for intention for postgraduate training abroad. The most common reasons cited for training abroad were the impact of residency training on future career (mean score 8.20 ± 2.3), financial conditions of doctors (mean score 7.97 ± 2.37) and job opportunities (mean score7.90 ± 2.34). Conclusion An alarming percentage of medical graduates from Lahore, Pakistan intend

[German influences on Romanian medical terminology].

PubMed

Răcilă, R G; Răileanu, Irena; Rusu, V

2008-01-01

The medical terminology plays a key part both in the study of medicine as well as in its practice. Moreover, understanding the medical terms is important not only for the doctor but also for the patients who want to learn more about their condition. For these reasons we believe that the study of medical terminology is one of great interest. The aim of our paper was to evaluate the German linguistic and medical influences on the evolution of the Romanian medical terminology. Since the Romanian-German cultural contacts date back to the 12th century we had reasons to believe that the number of German medical words in Romanian would be significant. To our surprise, the Romanian language has very few German words and even less medical terms of German origin. However, when we searched the list of diseases coined after famous medical personalities, we found out that 26 % of them bore the names of German doctors and scientists. Taken together this proves that the German medical school played an important role on the evolution of Romanian medicine despite the fact that the Romanian vocabulary was slightly influenced by the German language. We explain this fact on the structural differences between the Romanian and German languages, which make it hard for German loans to be integrated in the Romanian lexis. In conclusion we state that the German influence on the Romanian medical terminology is weak despite the important contribution of the German medical school to the development of medical education and healthcare in Romania. Key

Factors influencing the perception of medical staff and outpatients of dual practice in Shanghai, People’s Republic of China

PubMed Central

Chen, Haiping; Li, Meina; Dai, Zhixin; Deng, Qiangyu; Zhang, Lulu

2016-01-01

Objective Dual practice is defined as a physician’s performance of medical activities in different health care institutions (two or more) simultaneously. This study aimed to examine the perception and acceptance of medical staff and outpatients of dual practice and explore the possible factors affecting people’s perception. Methods A cross-sectional study was conducted in 13 public hospitals in Shanghai. Participants included medical staff and outpatients. We distributed 1,000 questionnaires to each participant group, and the response rates were 66.7% and 69.4%, respectively. Statistical differences in variables were tested, and multinomial logistic regression methods were employed for statistical analysis. Results The study included two parts: medical staff survey and outpatient survey. The results of medical staff survey showed that 63.0% of the respondents supported dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the publicity activities of dual practice and hospitals’ human resource management system were important factors affecting the willingness of the medical staff. The results of outpatient survey showed that 44.5% of respondents believed that dual practice could reduce difficulty in consulting a doctor. Regarding the perceived benefits of dual practice, the proportion of outpatients who believed that dual practice could meet the demand for health convenience, minor illness, and chronic disease were 45.4%, 42.4%, and 53.7%, respectively. Additionally, demographic characteristics significantly influenced the perception of outpatients. Conclusion This study confirmed that both medical staff and outpatients generally held positive attitudes toward dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the existence of

Multivariate analysis of factors influencing medical costs of acute pancreatitis hospitalizations based on a national administrative database.

PubMed

Murata, Atsuhiko; Matsuda, Shinya; Mayumi, Toshihiko; Okamoto, Kohji; Kuwabara, Kazuaki; Ichimiya, Yukako; Fujino, Yoshihisa; Kubo, Tatsuhiko; Fujimori, Kenji; Horiguchi, Hiromasa

2012-02-01

Little information is available on the analysis of medical costs of acute pancreatitis hospitalizations. This study aimed to determine the factors affecting medical costs of patients with acute pancreatitis during hospitalization using a Japanese administrative database. A total of 7193 patients with acute pancreatitis were referred to 776 hospitals. We defined "patients with high medical costs" as patients whose medical costs exceeded the 90th percentile in medical costs during hospitalization and identified the independent factors for patients with high medical costs with and without controlling for length of stay. Multiple logistic regression analysis demonstrated that necrosectomy was the most significant factor for medical costs of acute pancreatitis during hospitalization. The odds ratio of necrosectomy was 33.64 (95% confidence interval, 14.14-80.03; p<0.001). Use of an intensive care unit was the most significant factor for medical costs after controlling for LOS. The OR of an ICU was 6.44 (95% CI, 4.72-8.81; p<0.001). This study demonstrated that necrosectomy and use of an ICU significantly affected the medical costs of acute pancreatitis hospitalization. These results highlight the need for health care implementations to reduce medical costs whilst maintaining the quality of patient care, and targeting patients with severe acute pancreatitis. Copyright © 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Medical Specialty Choice and Related Factors of Brazilian Medical Students and Recent Doctors.

PubMed

Correia Lima de Souza, Ligia; Mendonça, Vitor R R; Garcia, Gabriela B C; Brandão, Ediele C; Barral-Netto, Manoel

2015-01-01

Choosing a medical specialty is an important, complex, and not fully understood process. The present study investigated the factors that are related to choosing and rejecting medical specialties in a group of students and recent medical doctors. A cross-sectional survey of 1,223 medical students and doctors was performed in Brazil in 2012. A standardized literature-based questionnaire was applied that gathered preferable or rejected specialties, and asked questions about extracurricular experiences and the influence of 14 factors on a Likert-type scale from 0 to 4. Specialties were grouped according to lifestyle categories: controllable and uncontrollable, which were subdivided into primary care, internal medicine, and surgical specialties. Notably, the time period of rejection was usually earlier than the time period of intended choice (p < 0.0001, χ(2) = 107.2). The choice mainly occurred during the internship period in medical school (n = 466; 38.7%). An overall large frequency of participation in extracurricular activities was observed (n = 1,184; 95.8%), which were highly associated with the respective medical area. Orthopedic surgery had the highest correlation with participation in specialty-specific organized groups (OR = 59.9, 95% CI = 21.6-166.3) and psychiatry was correlated with participation in research groups (OR = 18.0, 95% CI = 9.0-36.2). With regard to influential factors in controllable lifestyle specialties, "financial reason" (mean score ± standard deviation: 2.8 ± 1.0; median = 3) and "personal time" (3.1 ± 1.3; median = 4) were important factors. In primary care, these factors were less important (1.7 ± 1.3 and 1.7 ± 1.5, respectively; median = 2 for both), and higher scores were observed for "curricular internship" (3.2 ± 1.1, median = 4) and "social commitment" (2.6 ± 1.3, median = 3). The present findings provide important insights into developing strategies to stimulate interest in specialties based on the needs of the Brazilian

Medical Specialty Choice and Related Factors of Brazilian Medical Students and Recent Doctors

PubMed Central

Correia Lima de Souza, Ligia; Mendonça, Vitor R. R.; Garcia, Gabriela B. C.; Brandão, Ediele C.; Barral-Netto, Manoel

2015-01-01

Background Choosing a medical specialty is an important, complex, and not fully understood process. The present study investigated the factors that are related to choosing and rejecting medical specialties in a group of students and recent medical doctors. Methodology and Findings A cross-sectional survey of 1,223 medical students and doctors was performed in Brazil in 2012. A standardized literature-based questionnaire was applied that gathered preferable or rejected specialties, and asked questions about extracurricular experiences and the influence of 14 factors on a Likert-type scale from 0 to 4. Specialties were grouped according to lifestyle categories: controllable and uncontrollable, which were subdivided into primary care, internal medicine, and surgical specialties. Notably, the time period of rejection was usually earlier than the time period of intended choice (p < 0.0001, χ2 = 107.2). The choice mainly occurred during the internship period in medical school (n = 466; 38.7%). An overall large frequency of participation in extracurricular activities was observed (n = 1,184; 95.8%), which were highly associated with the respective medical area. Orthopedic surgery had the highest correlation with participation in specialty-specific organized groups (OR = 59.9, 95% CI = 21.6-166.3) and psychiatry was correlated with participation in research groups (OR = 18.0, 95% CI = 9.0-36.2). With regard to influential factors in controllable lifestyle specialties, “financial reason” (mean score ± standard deviation: 2.8 ± 1.0; median = 3) and “personal time” (3.1 ± 1.3; median = 4) were important factors. In primary care, these factors were less important (1.7 ± 1.3 and 1.7 ± 1.5, respectively; median = 2 for both), and higher scores were observed for “curricular internship” (3.2 ± 1.1, median = 4) and “social commitment” (2.6 ± 1.3, median = 3). Conclusion The present findings provide important insights into developing strategies to stimulate

Factors influencing medical students' choice of future specialization in medical sciences: a cross-sectional questionnaire survey from medical schools in china, malaysia and regions of South asian association for regional cooperation.

PubMed

Kumar, Arun; Mitra, Kasturi; Nagarajan, Sangeetha; Poudel, Bibek

2014-03-01

In future, increase in the number of healthcare professionals is dependent on the career interest among present undergraduate medical students. Based on their interest to pursue their specialty, the availability of medical doctors in each specialty could be done. This study was to find out future career interest and factors that influence undergraduate medical students to choose their future specialization. The study was carried out among first-year medical students from five countries. The students were asked to complete an 8-item questionnaire. Two thousand one hundred fifty three participants were enrolled in the study. Data were analyzed in Microsoft-Excel and Statistical Package for the Social Sciences. Of the 2153 participants, only 1470 responded. Among the 1470 participants, 169 participants were excluded due to the ambiguity in responses, finally making it to 1301participants. Among them, Anatomy (49.3%) followed by Biochemistry (26.7%) and Physiology (24%) were the most preferred subjects. Anatomy was the most preferred basic science subject among the other subjects and the students were interested to pursuing surgery in future. Furthermore, the most preferred future specialties were surgery, internal medicine and pediatrics with gender variations; males preferring surgery and females in obstetrics and gynecology.

Factors contributing to registered nurse medication administration error: a narrative review.

PubMed

Parry, Angela M; Barriball, K Louise; While, Alison E

2015-01-01

To explore the factors contributing to Registered Nurse medication administration error behaviour. A narrative review. Electronic databases (Cochrane, CINAHL, MEDLINE, BNI, EmBase, and PsycINFO) were searched from 1 January 1999 to 31 December 2012 in the English language. 1127 papers were identified and 26 papers were included in the review. Data were extracted by one reviewer and checked by a second reviewer. A thematic analysis and narrative synthesis of the factors contributing to Registered Nurses' medication administration behaviour. Bandura's (1986) theory of reciprocal determinism was used as an organising framework. This theory proposes that there is a reciprocal interplay between the environment, the person and their behaviour. Medication administration error is an outcome of RN behaviour. The 26 papers reported studies conducted in 4 continents across 11 countries predominantly in North America and Europe, with one multi-national study incorporating 27 countries. Within both the environment and person domain of the reciprocal determinism framework, a number of factors emerged as influencing Registered Nurse medication administration error behaviour. Within the environment domain, two key themes of clinical workload and work setting emerged, and within the person domain the Registered Nurses' characteristics and their lived experience of work emerged as themes. Overall, greater attention has been given to the contribution of the environment domain rather than the person domain as contributing to error, with the literature viewing an error as an event rather than the outcome of behaviour. The interplay between factors that influence behaviour were poorly accounted for within the selected studies. It is proposed that a shift away from error as an event to a focus on the relationships between the person, the environment and Registered Nurse medication administration behaviour is needed to better understand medication administration error. Copyright © 2014

Why neurology? Factors which influence career choice in neurology.

PubMed

Albert, Dara V; Hoyle, Chad; Yin, Han; McCoyd, Matthew; Lukas, Rimas V

2016-01-01

To evaluate the factors which influence the decision to pursue a career in neurology. An anonymous survey was developed using a Likert scale to rate responses. The survey was sent to adult and child neurology faculty, residents and fellows, as well as medical students applying for neurology. Descriptive statistics were used to analyse the factors of influence. Respondents were subsequently categorized into pre-neurology trainees, neurology trainees, child neurologists and adult neurologists, and differences between the groups were analysed using Pearson's chi-square test. One hundred and thirty-three anonymous responses were received. The respondents were neurologists across all levels of training and practice. Across all respondents, the most common factor of high importance was intellectual content of specialty, challenging diagnostic problems, type of patient encountered and interest in helping people. Responses were similar across the groups; however, the earliest trainees cited interest in helping people as most important, while those in neurology training and beyond cite intellectual content of the specialty as most important. As trainees transition from their earliest levels of clinical experience into working as residents and faculty, there is a shift in the cited important factors. Lifestyle and financial factors seem to be the least motivating across all groups. Encouragement from peers, mentors, faculty and practicing physicians is considered high influences in a smaller number of neurologists. This may present an opportunity for practicing neurologists to make connections with medical students early in their education in an effort to encourage and mentor candidates.

Concern beliefs in medications: changes over time and medication use factors related to a change in beliefs.

PubMed

Shiyanbola, Olayinka O; Farris, Karen B; Chrischilles, Elizabeth

2013-01-01

Concern belief in medication is a construct that may characterize patients' attitude toward managing medicines, and this could change with time. Understanding the factors that would impact a change in concern beliefs would be helpful in interventions that could reframe patients' perceptions about their medicines. To examine if patient concern beliefs in medications change over time, assess the characteristics of individuals whose beliefs change, and determine what factors might impact a change in patient beliefs. Secondary data analysis using 2 longitudinal studies. The first study was an Internet-based survey of Medicare enrollees pre-post Medicare Part D. The second study was a randomized controlled trial evaluating a medication management intervention among adults with physical limitations. Respondents were classified as those whose beliefs remained stable and those whose beliefs increased and decreased over 2 separate periods. Chi-square analysis examined significant differences across the groups. Multiple linear regressions examined factors that influence changes in patient beliefs. Among older adults, there were differences in perceived health status (χ(2)=26.05, P=.001), number of pharmacies used (χ(2)=17.41, P=.008), and number of medicines used after the start of Medicare Part D. There were no significant differences among adults with physical limitations. Among older adults, having an increased number of medicines over time and reporting a self-reported adverse effect to a physician were positively associated with an increase in concern beliefs in medication. Having an increase in adherence was associated with a decrease in concern beliefs over time. Concern beliefs in medications may contribute independent information about individuals' response to drug programs and policies. Outcomes of medication use may influence patient anxieties about medicines. The instability of patient concerns in medications that occurs with prescription drug coverage changes

Factors potentially influencing aminoglycoside use and expenditure

DOE Office of Scientific and Technical Information (OSTI.GOV)

DiPiro, J.T.; Kilsdonk, G.F.; Amerson, A.B.

1982-07-01

Factors that may have influenced aminoglycoside use and expenditure in one hospital were examined. Factors that were evaluated as to their influence on aminoglycoside-use patterns were: (1) formulary status; (2) bacterial susceptibility patterns; (3) identified or perceived differences in toxicity; (4) changes in patient population; (5) price paid by the hospital for aminoglycosides; (6) distribution of newsletters or memoranda; (7) advertising and detailing; and (8) pharmacy policies. For FY 1976-77 to 1979-80, the largest proportion of aminoglycoside expense was for gentamicin. During FY 1980-81, the expenditure for gentamicin decreased and tobramycin accounted for the largest proportion of total expenditure. Monthlymore » gentamicin use decreased 20% during FY 1980-81 from the previous year. Tobramycin use increased from January 1979 to November 1980 and decreased from December 1980 to June 1981. Kanamycin use and amikacin use were fairly constant during the study period. Based on temporal relationships, the following factors appeared to influence aminoglycoside use and expenditure: (1) a study conducted at the institution from June 1977 to June 1979 comparing gentamicin and tobramycin nephrotoxicity; (2) a comparative nephrotoxicity study published in a widely circulated medical journal in May 1980; and (3) an intramural newsletter and memorandum distributed in March 1981 encouraging selective aminoglycoside use. The identification of factors that potentially influenced aminoglycoside use can be used to anticipate the future impact of similar events and to devise strategies to influence antimicrobial use.« less

Conflicts of interest at medical journals: the influence of industry-supported randomised trials on journal impact factors and revenue - cohort study.

PubMed

Lundh, Andreas; Barbateskovic, Marija; Hróbjartsson, Asbjørn; Gøtzsche, Peter C

2010-10-26

transparency in reporting of conflict of interest is an increasingly important aspect of publication in medical journals. Publication of large industry-supported trials may generate many citations and journal income through reprint sales and thereby be a source of conflicts of interest for journals. We investigated industry-supported trials' influence on journal impact factors and revenue. we sampled six major medical journals (Annals of Internal Medicine, Archives of Internal Medicine, BMJ, JAMA, The Lancet, and New England Journal of Medicine [NEJM]). For each journal, we identified randomised trials published in 1996-1997 and 2005-2006 using PubMed, and categorized the type of financial support. Using Web of Science, we investigated citations of industry-supported trials and the influence on journal impact factors over a ten-year period. We contacted journal editors and retrieved tax information on income from industry sources. The proportion of trials with sole industry support varied between journals, from 7% in BMJ to 32% in NEJM in 2005-2006. Industry-supported trials were more frequently cited than trials with other types of support, and omitting them from the impact factor calculation decreased journal impact factors. The decrease varied considerably between journals, with 1% for BMJ to 15% for NEJM in 2007. For the two journals disclosing data, income from the sales of reprints contributed to 3% and 41% of the total income for BMJ and The Lancet in 2005-2006. publication of industry-supported trials was associated with an increase in journal impact factors. Sales of reprints may provide a substantial income. We suggest that journals disclose financial information in the same way that they require them from their authors, so that readers can assess the potential effect of different types of papers on journals' revenue and impact.

Factors affecting choice of sponsoring institution for residency among medical students in Singapore.

PubMed

Ng, Chew Lip; Liu, Xuan Dao; Murali Govind, Renuka; Tan, Jonathan Wei Jian; Ooi, Shirley Beng Suat; Archuleta, Sophia

2018-03-16

Postgraduate medical education in Singapore underwent major transition recently, from a British-style system and accreditation to a competency-based residency programme modelled after the American system. We aimed to identify the relative importance of factors influencing the choice of residency sponsoring institutions (SIs) among medical students during this transition period. A questionnaire-based cross-sectional study of Singaporean undergraduate medical students across all years of study was performed in 2011. Participants rated 45 factors (including research, academia and education, marketing, reputation of faculty, working conditions, posting experience and influence by peers/seniors) for degree of importance to their choice of SIs on a five-point Likert scale. Differences with respect to gender and seniority were compared. 705 of 1,274 students completed the survey (response rate 55.3%). The top five influencing factors were guidance by mentor (4.48 ± 0.74), reputation for good teaching (4.46 ± 0.76), personal overall experience in SIs (4.41 ± 0.88), quality of mentorship and supervision (4.41 ± 0.75), and quality and quantity of teaching (4.37 ± 0.78). The five lowest-rated factors were social networking (2.91 ± 1.00), SI security (3.01 ± 1.07), open house impact (3.15 ± 0.96), advertising paraphernalia (3.17 ± 0.95) and research publications (3.21 ± 1.00). Female students attributed more importance to security and positive work environment. Preclinical students rated research and marketing aspects more highly while clinical students valued positive work environment more. Quality of education, mentorship, experiences during clerkship and positive working environment were the most important factors influencing the choice of SIs.

Factors affecting medication adherence in elderly people

PubMed Central

Jin, Hyekyung; Kim, Yeonhee; Rhie, Sandy Jeong

2016-01-01

Background Little is known about the functional health literacy (FHL) associated with medication adherence in elderly patients. The aim of this study was to examine the FHL among older adults and identify influencing factors that can predict medication adherence. Methods This was a cross-sectional survey. Participants (n=160) aged 65 years and older were selected from outpatient clinics of 3 tertiary care hospitals, 6 community pharmacies, and 2 senior centers between November 1 and 30, 2014. The participants’ FHL was measured using the Korean Functional Health Literacy Test, which consists of 15 items including 8 numeracy and 7 reading comprehension items. Medication adherence was measured by the Adherence to Refills and Medication Scale. Descriptive statistics, chi-square or Fisher’s exact test, and multiple regression analyses were used to analyze the data. Results The mean score of the total FHL was 7.72±3.51 (range 0–15). The percentage of the total number of correct answers for the reading comprehension subtest and numeracy subtest were 48.1% and 54.4%, respectively. Among 160 participants, 52.5% showed low adherence to medication. The factors affecting medication adherence included the patient’s degree of satisfaction with the service (β=−0.215, P=0.022), sufficient explanation of medication counseling (β=−0.335, P=0.000), education level (β=−0.153, P=0.045), health-related problems (β=−0.239, P=0.004), and dosing frequency (β=0.189, P=0.018). Conclusion In this study, we found medication adherence of elderly patients was associated with education level, health-related problems, dosing frequency, satisfaction with patient counseling, and explanation of medication, but no association was found with FHL. Pharmacists should consider elderly patients’ individual characteristics such as educational background and specific patient-related health problems, provide sufficient information and explanation of medication, and ensure patient

The influence of experiential learning on medical equipment adoption in general practices.

PubMed

Bourke, Jane; Roper, Stephen

2014-10-01

The benefits of the availability and use of medical equipment for medical outcomes are understood by physicians and policymakers alike. However, there is limited understanding of the decision-making processes involved in adopting and using new technologies in health care organisations. Our study focuses on the adoption of medical equipment in Irish general practices which are marked by considerable autonomy in terms of commercial practice and the range of medical services they provide. We examine the adoption of six items of medical equipment taking into account commercial, informational and experiential stimuli. Our analysis is based on primary survey data collected from a sample of 601 general practices in Ireland on practice characteristics and medical equipment use. We use a multivariate Probit to identify commonalities in the determinants of the adoption. Many factors, such as GP and practice characteristics, influence medical equipment adoption. In addition, we find significant and consistent evidence of the influence of learning-by-using effects on the adoption of medical equipment in a general practice setting. Knowledge generated by experiential or applied learning can have commercial, organisational and health care provision benefits in small health care organisations. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Market factors and electronic medical record adoption in medical practices.

PubMed

Menachemi, Nir; Mazurenko, Olena; Kazley, Abby Swanson; Diana, Mark L; Ford, Eric W

2012-01-01

Previous studies identified individual or practice factors that influence practice-based physicians' electronic medical record (EMR) adoption. Less is known about the market factors that influence physicians' EMR adoption. The aim of this study was to explore the relationship between environmental market characteristics and physicians' EMR adoption. The Health Tracking Physician Survey 2008 and Area Resource File (2008) were combined and analyzed. Binary logistic regression was used to examine the relationship between three dimensions of the market environment (munificence, dynamism, and complexity) and EMR adoption controlling for several physician and practice characteristics. In a nationally representative sample of 4,720 physicians, measures of market dynamism including increases in unemployment, odds ratio (OR) = 0.95, 95% confidence interval (CI) [0.91, 0.99], or poverty rates, OR = 0.93, 95% CI [0.89, 0.96], were negatively associated with EMR adoption. Health maintenance organization penetration, OR = 3.01, 95% CI [1.49, 6.05], another measure of dynamism, was positively associated with EMR adoption. Physicians practicing in areas with a malpractice crisis, OR = 0.82, 95% CI [0.71, 0.94], representing environmental complexity, had lower EMR adoption rates. Understanding how market factors relate to practice-based physicians' EMR adoption can assist policymakers to better target limited resources as they work to realize the national goal of universal EMR adoption and meaningful use.

Factors that influence the acceptance of telemetry by emergency medical technicians in ambulances: an application of the extended technology acceptance model.

PubMed

Hwang, Ji Young; Kim, Ki Young; Lee, Kang Hyun

2014-12-01

The aim of the study was to verify the effects of patient factors perceived by emergency medical technicians (EMTs) as well as their social and organizational factors on prehospital telemetry use intention based on the technology use intention and elaboration likelihood models. This is a retrospective empirical study. Questionnaires were developed on the basis of clinical factors of 72,907 patients assessed by prehospital telemetry from January 1, 2009 to April 30, 2012 by reviewing their prehospital medical care records and in-hospital medical records. Questionnaires regarding the social and organizational factors of EMTs were created on the basis of a literature review. To verify which factors affect the utilization of telemetry, we developed a partial least-squares route model on the basis of each characteristic. In total, 136 EMTs who had experience in using prehospital telemetry were surveyed from April 1 to April 7, 2013. Reliability, validity, hypotheses, and the model goodness of fit of the study tools were tested. The clinical factors of the patients (path coefficient=-0.12; t=2.38), subjective norm (path coefficient=0.18; t=2.63), and job fit (path coefficient=0.45; t=5.29) positively affected the perceived usefulness (p<0.010). Meanwhile, the clinical factors of the patients (path coefficients=-0.19; t=4.46), subjective norm (path coefficient=0.08; t=1.97), loyalty incentives (path coefficient=-0.17; t=3.83), job fit (path coefficient=-0.32; t=7.06), organizational facilitations (path coefficient=0.08; t=1.99), and technical factors (i.e., usefulness and ease of use) positively affected attitudes (path coefficient=0.10, 0.58; t=2.62, 5.81; p<0.010). Attitudes and perceived usefulness significantly positively affected use intention. Factors that influence the use of telemetry by EMTs in ambulances included patients' clinical factors, as well as complex organizational and environmental factors surrounding the EMTs' occupational environments. This suggests

Factors influencing the occupational trajectory of patients with systemic sclerosis: a qualitative study.

PubMed

Decuman, Saskia; Smith, Vanessa; Grypdonck, Maria; De Keyser, Filip; Verhaeghe, Sofie

2015-01-01

To describe, from the patient's point of view, the factors influencing the occupational trajectory of patients with systemic sclerosis (SSc). This was a qualitative study designed using grounded theory with constant comparison. Data were collected through semi-structured interviews with 14 patients who fulfilled the American College of Rheumatology or Leroy-Medsger criteria for SSc. Based on our interviews, we found that the occupational trajectory of patients with SSc is influenced by the continuous interplay between four groups of factors. The first group concerns the values patients attribute to work, including identity, normality, financial value, social contact, and structure. The meaning of these values and how they relate to each other underlies the desire to work. A second group of factors is those influencing the balance between daily life, work participation, and medical condition (e.g. job content, flexibility in organising work, and the willingness to ask for accommodations at work). The occupational trajectory is also influenced by external factors, including availability of support, know-ledge of the disease, pressure to work, contact with medical professionals, and existing regulations and the patient's knowledge about them. Finally, the occupational trajectory is influenced by personal factors, including socio-demographics, psychological assets, and disease- and work-related personal factors. The decisions patients with SSc take concerning work depend on an interplay between many factors and, especially, on the patients' personal interpretation of these factors. These need to be taken into account when helping patients with SSc determine their occupational trajectory.

Individual and hospital-specific factors influencing medical graduates' time to medical specialization.

PubMed

Johannessen, Karl-Arne; Hagen, Terje P

2013-11-01

Previous studies of gender differences in relation to medical specialization have focused more on social variables than hospital-specific factors. In a multivariate analysis with extended Cox regression, we used register data for socio-demographic variables (gender, family and having a child born during the study period) together with hospital-specific variables (the amount of supervision available, efficiency pressure and the type of teaching hospital) to study the concurrent effect of these variables on specialty qualification among all 2474 Norwegian residents who began specialization in 1999-2001. We followed the residents until 2010. A lower proportion of women qualified for a specialty in the study period (67.9% compared with 78.7% of men, p < 0.001), and they took on average six months longer than men did to complete the specialization qualification (p < 0.01). Fewer women than men entered specialties providing emergency services and those with longer working hours, and women worked shorter hours than men in all specialties. Hospital factors were significant predictors for the timely attainment of specialization: working at university hospitals (regional) or central hospitals was associated with a reduction in the time taken to complete the specialization, whereas an increased patient load and less supervision had the opposite effect. Multivariate analysis showed that the smaller proportion of women who qualified for a specialty was explained principally by childbirth and by the number of children aged under 18 years. Copyright © 2013 Elsevier Ltd. All rights reserved.

Factors influencing the hospitalization costs of patients with type 2 diabetes.

PubMed

Cao, Ping; Wang, Kaixiu; Zhang, Hua; Zhao, Rongzhi; Li, Chenglong

2015-03-01

This study aims to research the factors influencing the hospitalization costs of patients with type 2 diabetes, so as to provide some references for reducing their economic burden. Based on the Hospital Information System of a 3A grade hospital in China, we analyzed 2970 cases with type 2 diabetes during 2005-2012. Both the number of inpatients and the hospitalization costs had increased in the study period. Using multiple linear regression analysis, we found that patients in Urban Employee Basic Medical Insurance had higher costs than those in New Rural Cooperative Medical Scheme. We also found hospitalization costs to be higher in male patients and older patients, patients who stayed more days at hospital and who had surgeries, patients who had at least 1 complication, and patients whose admission status was emergency. After standardizing the regression coefficients, we found that the hospital stay, the forms of payment, and presence of complications were the first 3 factors influencing hospitalization costs in our study. In conclusion, the hospitalization costs of patients with type 2 diabetes could be influenced by age, gender, forms of payment, hospital stay, admission status, complications, and surgery. Medical workers in the studied region should take actions to reduce the duration of hospital stay for diabetic patients and prevent relevant complications. What is more, medical insurance needs further improvement. © 2015 APJPH.

Factors Influencing Cecal Intubation Time during Retrograde Approach Single-Balloon Enteroscopy

PubMed Central

Chen, Peng-Jen; Shih, Yu-Lueng; Huang, Hsin-Hung; Hsieh, Tsai-Yuan

2014-01-01

Background and Aim. The predisposing factors for prolonged cecal intubation time (CIT) during colonoscopy have been well identified. However, the factors influencing CIT during retrograde SBE have not been addressed. The aim of this study was to determine the factors influencing CIT during retrograde SBE. Methods. We investigated patients who underwent retrograde SBE at a medical center from January 2011 to March 2014. The medical charts and SBE reports were reviewed. The patients' characteristics and procedure-associated data were recorded. These data were analyzed with univariate analysis as well as multivariate logistic regression analysis to identify the possible predisposing factors. Results. We enrolled 66 patients into this study. The median CIT was 17.4 minutes. With univariate analysis, there was no statistical difference in age, sex, BMI, or history of abdominal surgery, except for bowel preparation (P = 0.021). Multivariate logistic regression analysis showed that inadequate bowel preparation (odds ratio 30.2, 95% confidence interval 4.63–196.54; P < 0.001) was the independent predisposing factors for prolonged CIT during retrograde SBE. Conclusions. For experienced endoscopist, inadequate bowel preparation was the independent predisposing factor for prolonged CIT during retrograde SBE. PMID:25505904

Factors influencing deprescribing habits among geriatricians.

PubMed

Ní Chróinín, Danielle; Ní Chróinín, Chantelle; Beveridge, Alexander

2015-07-01

deprescribing habits among physicians managing older, frailer, cognitively impaired patients have not been well investigated. an anonymised electronic survey was disseminated to all members of an international geriatric society/local advanced trainee network (N = 930). This comprised a Likert-scale analysis of factors influencing desprescribing, and five case vignettes, detailing a patient with progressive cognitive impairment and dependency, on a background of ischaemic heart disease and hypertension. among 134 respondents (response rate 14.4%), 47.4% were female, 48.9% aged 36-50 years and 84.1% specialists (15.9% trainees). Respondents commonly rated limited life expectancy (96.2%) and cognitive impairment (84.1%) as very/extremely important to deprescribing practices. On multivariable analysis, older respondents less commonly rated functional dependency (odds ratio [OR] 0.22 per change in age category; P < 0.001) and limited life expectancy (OR 0.09, P = 0.04) important when deprescribing, while female participants (OR 3.03, P < 0.001) and trainees (versus specialists OR 14.29, P < 0.001) more often rated adherence to evidence-based guidelines important. As vignettes described increasing dependency and cognitive impairment, physicians were more likely to stop donepezil, aspirin, atorvastatin and antihypertensives (all P < 0.001 for trend). Aspirin (93.6%) and ramipril (94.1%) were most commonly deprescribed. Commonest reasons cited for deprescribing medications were 'dementia severity', followed by pill burden. in this exploratory analysis, geriatricians rated limited life expectancy and cognitive impairment very important in driving deprescribing practices. Geriatricians more often deprescribed multiple medications in the setting of advancing dependency and cognitive impairment, driven by dementia severity and pill burden concerns. Physician characteristics also influence deprescribing practices. Further exploration of factors influencing deprescribing

[Study on restriction factors and countermeasures of influence of China medical devices competitiveness].

PubMed

Zhang, Zhijun

2012-07-01

Recent years, China medical devices industry has been a sunrise industry with widely-ranged products, high-tech innovation, and booming market demands. But with the globalization of market economy, China industry is still in the inferior position of competition. How to promote the industrial structure transition, increase scientific and technological level, speed up the updating of products, enhance the international competitiveness is one of the major tasks to maintain the healthy development of industry. This article makes a study on current situation of China medical devices industry, analyses the new opportunities, challenges and restriction factors, provides the countermeasures of strengthening industry competitiveness as well.

Factors influencing registered nurses perception of their overall job satisfaction: a qualitative study.

PubMed

Atefi, N; Abdullah, K L; Wong, L P; Mazlom, R

2014-09-01

The purpose of this qualitative descriptive study was to explore factors related to critical care and medical-surgical nurses' job satisfaction as well as dissatisfaction in Iran. Job satisfaction is an important factor in healthcare settings. Strong empirical evidence supports a causal relationship between job satisfaction, patient safety and quality of care. A convenient sample of 85 nurses from surgical, medical and critical care wards of a large hospital was recruited. Ten focus group discussions using a semi-structured interview guide were conducted. Interviews were audio-recorded, transcribed verbatim and analysed using a thematic approach. The study identified three main themes that influenced nurses' job satisfaction and dissatisfaction: (1) spiritual feeling, (2) work environment factors, and (3) motivation. Helping and involvement in patient care contributed to the spiritual feeling reported to influence nurses' job satisfaction. For work environment factors, team cohesion, benefit and rewards, working conditions, lack of medical resources, unclear nurses' responsibilities, patient and doctor perceptions, poor leadership skills and discrimination at work played an important role in nurses' job dissatisfaction. For motivation factors, task requirement, professional development and lack of clinical autonomy contributed to nurses' job satisfaction. Nurse managers should ensure a flexible practice environment with adequate staffing and resources with opportunities for nurses to participate in hospital's policies and governance. Policy makers should consider nurses' professional development needs, and implement initiatives to improve nurses' rewards and other benefits as they influence job satisfaction. © 2014 International Council of Nurses.

Factors affecting residency rank-listing: a Maxdiff survey of graduating Canadian medical students.

PubMed

Wang, Tao; Wong, Benson; Huang, Alexander; Khatri, Prateek; Ng, Carly; Forgie, Melissa; Lanphear, Joel H; O'Neill, Peter J

2011-08-25

In Canada, graduating medical students consider many factors, including geographic, social, and academic, when ranking residency programs through the Canadian Residency Matching Service (CaRMS). The relative significance of these factors is poorly studied in Canada. It is also unknown how students differentiate between their top program choices. This survey study addresses the influence of various factors on applicant decision making. Graduating medical students from all six Ontario medical schools were invited to participate in an online survey available for three weeks prior to the CaRMS match day in 2010. Max-Diff discrete choice scaling, multiple choice, and drop-list style questions were employed. The Max-Diff data was analyzed using a scaled simple count method. Data for how students distinguish between top programs was analyzed as percentages. Comparisons were made between male and female applicants as well as between family medicine and specialist applicants; statistical significance was determined by the Mann-Whitney test. In total, 339 of 819 (41.4%) eligible students responded. The variety of clinical experiences and resident morale were weighed heavily in choosing a residency program; whereas financial incentives and parental leave attitudes had low influence. Major reasons that applicants selected their first choice program over their second choice included the distance to relatives and desirability of the city. Both genders had similar priorities when selecting programs. Family medicine applicants rated the variety of clinical experiences more importantly; whereas specialty applicants emphasized academic factors more. Graduating medical students consider program characteristics such as the variety of clinical experiences and resident morale heavily in terms of overall priority. However, differentiation between their top two choice programs is often dependent on social/geographic factors. The results of this survey will contribute to a better

Factors influencing social distance toward people with mental illness.

PubMed

Lauber, Christoph; Nordt, Carlos; Falcato, Luis; Rössler, Wulf

2004-06-01

When identifying ways to reduce stigmatization because of mental illness it is crucial to understand contributing factors. Social distance-the willingness to engage in relationships of varying intimacy with a person--is an indicator of public attitudes toward persons with mental illness. Multiple linear regression analysis of the results of a vignette-based opinion survey conducted on a representative population sample in Switzerland (n = 594). The level of social distance increases if situations imply 'social closeness.' The vignette describing a person with schizophrenia, attitudes to general aspects of mental health (lay helping, community psychiatry), emotions toward those affected, and the attitude toward consequences of mental illness (medical treatment, medication side effects, negative sanctions, e.g. withdrawal of the driver license) were found to predict social distance. Demographic factors such as age, gender, and the cultural background influence social distance. The explained variance (R2) is 44.8%. Social distance is a multifaceted concept influenced by, e.g., socio-economic and cultural factors, but also by the respondent's general attitude toward (mental) health issues. These results suggest that more knowledge about mental illnesses, especially schizophrenia, may increase social distance. The findings presented here may help to focus anti-stigma campaigns not only on transmission of knowledge, but on integrating different approaches.

Factors influencing family physicians' drug prescribing behaviour in asthma management in primary care.

PubMed

Tan, N C; Tay, I H; Ngoh, A; Tan, M

2009-03-01

Little is known about the decision pathway that family physicians (FP) take in considering drug therapy for their asthma patients. This study aimed to explore the factors that influence FPs' decisions in prescribing medications for their asthma patients. A qualitative method using focus group discussions (FGD) was used to gather qualitative data based on a semi-structured topic guide from FPs of different training backgrounds and practices. 29 Singapore FPs working as private general practitioners (GP), polyclinic doctors and locums were recruited into five FGDs. The FPs' asthma drug prescription decisions were related to the FPs' medical training and acquisition of asthma-related information and updates. Uncertainty of disease diagnosis, patients' beliefs and their perceptions of the disease and treatment, as well as the FPs' concerns about drug side effects, were significant considerations for the participants. Costs related to differential subsidies in the consultation fees and drugs between public polyclinics and GP clinics in the local primary healthcare system, was a key factor in influencing the FPs' asthma drug treatment decisions. FPs' asthma drug prescribing behaviour is influenced by their medical training, disease definition, patient factors and drug costs in the context of the local primary healthcare system and policy.

Factors influencing medical informatics examination grade--can biorhythm, astrological sign, seasonal aspect, or bad statistics predict outcome?

PubMed

Petrovecki, Mladen; Rahelić, Dario; Bilić-Zulle, Lidija; Jelec, Vjekoslav

2003-02-01

To investigate whether and to what extent various parameters, such as individual characteristics, computer habits, situational factors, and pseudoscientific variables, influence Medical Informatics examination grade, and how inadequate statistical analysis can lead to wrong conclusions. The study included a total of 382 second-year undergraduate students at the Rijeka University School of Medicine in the period from 1996/97 to 2000/01 academic year. After passing the Medical Informatics exam, students filled out an anonymous questionnaire about their attitude toward learning medical informatics. They were asked to grade the course organization and curriculum content, and provide their date of birth; sex; study year; high school grades; Medical Informatics examination grade, type, and term; and describe their computer habits. From these data, we determined their zodiac signs and biorhythm. Data were compared by the use of t-test, one-way ANOVA with Tukey's honest significance difference test, and randomized complete block design ANOVA. Out of 21 variables analyzed, only 10 correlated with the average grade. Students taking Medical Informatics examination in the 1998/99 academic year earned lower average grade than any other generation. Significantly higher Medical Informatics exam grade was earned by students who finished a grammar high school; owned and regularly used a computer, Internet, and e-mail (p< or =0.002 for all items); passed an oral exam without taking a written test (p=0.004), or did not repeat the exam (p<0.001). Better high-school students and students with better grades from high-school informatics course also scored significantly better (p=0.032 and p<0.001, respectively). Grade in high-school mathematics, student's sex, and time of year when the examination was taken were not related to the grade, and neither were pseudoscientific parameters, such as student zodiac sign, zodiac sign quality, or biorhythm cycles, except when intentionally

Medical School Factors That Prepare Students to Become Leaders in Medicine.

PubMed

Arnold, Louise; Cuddy, Paul G; Hathaway, Susan B; Quaintance, Jennifer L; Kanter, Steven L

2018-02-01

To identify medical school factors graduates in major leadership positions perceive as contributing to their leadership development. Using a phenomenological, qualitative approach, in August-November 2015 the authors conducted semistructured interviews with 48 medical leaders who were 1976-1999 baccalaureate-MD graduates of the University of Missouri-Kansas City School of Medicine (UMKC). At UMKC, they participated in longitudinal learning communities, the centerpiece for learning professional values and behaviors plus clinical skills, knowledge, and judgment, but received no formal leadership instruction. The authors subjected interview comments to directed, largely qualitative content analysis with iterative coding cycles. Most graduates said their experiences and the people at UMKC positively influenced their leadership growth. Medical school factors that emerged as contributing to that growth were the longitudinal learning communities including docents, junior-senior partners, and team experiences; expectations set for students to achieve; a clinically oriented but integrated curriculum; admission policies seeking students with academic and nonacademic qualifications; supportive student-student and student-faculty relationships; and a positive overall learning environment. Graduates viewed a combination of factors as best preparing them for leadership and excellence in clinical medicine; together these factors enabled them to assume leadership opportunities after graduation. This study adds medical leaders' perspective to the leadership development literature and offers guidance from theory and practice for medical schools to consider in shaping leadership education: Namely, informal leadership preparation coupled with extensive longitudinal clinical education in a nurturing, authentic environment can develop students effectively for leadership in medicine.

Review on Factors Influencing Physician Guideline Adherence in Cardiology.

PubMed

Hoorn, C J G M; Crijns, H J G M; Dierick-van Daele, A T M; Dekker, L R C

2018-04-09

Cardiovascular disease is the most common cause of death in Western countries. Physician adherence to guidelines is often suboptimal, resulting in impaired patient outcome and prognosis. Multiple studies have been conducted to evaluate patterns and the influencing factors of patient adherence, but little is known about factors influencing physician guideline adherence. This review aims to identify factors influencing physician guideline adherence relevant to cardiology and to provide insights and suggestions for future improvement. Physician adherence was measured as adherence to standard local medical practice and applicable guidelines. Female gender and older age had a negative effect on physician guideline adherence. In addition, independent of the type of heart disease, physicians without cardiologic specialization were linked to physician noncompliance. Also, guideline adherence in primary care centers was at a lower level compared to secondary or tertiary care centers. The importance of guideline adherence increases as patients age, and complex diseases and comorbidity arise. Appropriate resources and interventions, taking important factors for nonadherence in account, are necessary to improve guideline adoption and adherence in every level of the chain. This in turn should improve patient outcome.

Factors associated with high-severity disciplinary action by a state medical board: a Texas study of medical license revocation.

PubMed

Cardarelli, Roberto; Licciardone, John C

2006-03-01

There has been an increase in research evaluating factors associated with disciplinary action of physicians by state medical boards. However, factors related to the severity of disciplinary action are lacking. By investigating these factors while controlling for the type of violation, the authors sought to determine whether physician characteristics influenced the process of disciplinary action by state medical boards. Physicians disciplined by the Texas Medical Board between January 1, 1989, and December 31, 1998, were included in this case-controlled study (N=1129). Multivariate logistic regression analysis was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with license revocation, the most severe disciplinary action, compared with all other forms of disciplinary action combined. Anesthesiologists (OR, 2.45; 95% CI, 1.05-5.74), general practitioners (OR, 1.80; 95% CI, 1.01-3.19), and psychiatrists (OR, 2.68; 95% CI, 1.41-5.13), as well as those with multiple disciplinary actions (OR, 1.91; 95% CI, 1.29-2.83) were most susceptible to license revocation. The more years a disciplined physician was in practice, the greater risk he or she had of license revocation (OR, 1.05; 95% CI, 1.04-1.07). Factors associated with a greater likelihood of license revocation for physicians are: primary medical specialty, number of years in practice, and a history of multiple disciplinary actions.

Choosing a Career in Psychiatry: Influential Factors within a Medical School Program

ERIC Educational Resources Information Center

Manassis, Katharina; Katz, Mark; Lofchy, Jodi; Wiesenthal, Stephanie

2006-01-01

Objective: To examine the influence of initial interest, pre-clerkship experiences, clerkship experiences, and enrichment activities on choosing a career in psychiatry. Method: Residents in psychiatry at the authors' medical school completed a survey that examined each of these factors in relation to career choice. Results: Thirty participants…

Conflicts of Interest at Medical Journals: The Influence of Industry-Supported Randomised Trials on Journal Impact Factors and Revenue – Cohort Study

PubMed Central

Lundh, Andreas; Barbateskovic, Marija; Hróbjartsson, Asbjørn; Gøtzsche, Peter C.

2010-01-01

Background Transparency in reporting of conflict of interest is an increasingly important aspect of publication in medical journals. Publication of large industry-supported trials may generate many citations and journal income through reprint sales and thereby be a source of conflicts of interest for journals. We investigated industry-supported trials' influence on journal impact factors and revenue. Methods and Findings We sampled six major medical journals (Annals of Internal Medicine, Archives of Internal Medicine, BMJ, JAMA, The Lancet, and New England Journal of Medicine [NEJM]). For each journal, we identified randomised trials published in 1996–1997 and 2005–2006 using PubMed, and categorized the type of financial support. Using Web of Science, we investigated citations of industry-supported trials and the influence on journal impact factors over a ten-year period. We contacted journal editors and retrieved tax information on income from industry sources. The proportion of trials with sole industry support varied between journals, from 7% in BMJ to 32% in NEJM in 2005–2006. Industry-supported trials were more frequently cited than trials with other types of support, and omitting them from the impact factor calculation decreased journal impact factors. The decrease varied considerably between journals, with 1% for BMJ to 15% for NEJM in 2007. For the two journals disclosing data, income from the sales of reprints contributed to 3% and 41% of the total income for BMJ and The Lancet in 2005–2006. Conclusions Publication of industry-supported trials was associated with an increase in journal impact factors. Sales of reprints may provide a substantial income. We suggest that journals disclose financial information in the same way that they require them from their authors, so that readers can assess the potential effect of different types of papers on journals' revenue and impact. Please see later in the article for the Editors' Summary PMID:21048986

Stability of and Factors Related to Medical Student Specialty Choice of Psychiatry.

PubMed

Goldenberg, Matthew N; Williams, D Keith; Spollen, John J

2017-09-01

Targeted efforts are needed to increase the number of medical students choosing psychiatry, but little is known about when students decide on their specialty or what factors influence their choice. The authors examined the timing and stability of student career choice of psychiatry compared with other specialties and determined what pre- and intra-medical school factors were associated with choosing a career in psychiatry. Using survey data from students who graduated from U.S. allopathic medical schools in 2013 and 2014 (N=29,713), the authors computed rates of psychiatry specialty choice at the beginning and end of medical school and assessed the stability of that choice. A multivariate-adjusted logistic regression and recursive partitioning were used to determine the association of 29 factors with psychiatry specialty choice. Choice of psychiatry increased from 1.6% at the start of medical school to 4.1% at graduation. The stability of psychiatry specialty choice from matriculation to graduation, at just over 50%, was greater than for any other specialty. However, almost 80% of future psychiatrists did not indicate an inclination toward the specialty at matriculation. A rating of "excellent" for the psychiatry clerkship (odds ratio=2.66), a major in psychology in college (odds ratio=2.58), and valuing work-life balance (odds ratio=2.25) were the factors most strongly associated with psychiatry career choice. Students who enter medical school planning to become psychiatrists are likely to do so, but the vast majority of students who choose psychiatry do so during medical school. Increasing the percentage of medical students with undergraduate psychology majors and providing an exemplary psychiatry clerkship are modifiable factors that may increase the rate of psychiatry specialty choice.

Factors influencing endometrial thickness in postmenopausal women.

PubMed

Hebbar, S; Chaya, V; Rai, L; Ramachandran, A

2014-07-01

Cut-off values for endometrial thickness (ET) in asymptomatic postmenopausal woman have been standardized. However, there are no comprehensive studies to document how various factors can influence the ET after the age of menopause. To study the various factors influencing the ET in postmenopausal women. This was a prospective observational study. A total of 110 postmenopausal women underwent detailed history taking, clinical examination, and transvaginal scan for uterine volume and ovarian volume. The volumes were calculated by using ellipsoid formula: Width × thickness × height × 0.523. The variation in ET with respect to the influencing factors such as age, duration of menopause, parity, body mass index (BMI), medical illness like diabetes/hypertension, drugs like tamoxifen, presence of myoma, uterine volume, ovarian volume, and serum estradiol (in selected patients) were measured. Descriptive analysis was performed using SPSS software (version 16, Chicago II, USA) to obtain mean, standard deviation (SD), 95% confidence intervals (CIs) and inter quartile ranges. Comparison of means was carried out using analysis of variance. The mean (SD) age of the patients was 55.4 (6.91) years (95% CI, 54.1, 56.7). The mean (SD) age at menopause was 47.95 (3.90) years (95% CI, 47.2, 48.7) and the mean (SD) duration of menopause was 7.27 (6.65) years (95% CI, 6.01, 8.53). The mean (SD) ET was 3.8 (2.3) mm (95% CI, 3.36, 4.23). Medical illness like diabetes and hypertension did not alter the ET. ET increased as BMI increased and it was statistically significant. The presence of myoma increased uterine volume significantly and was associated with thick endometrial stripe. Similarly, whenever the ovaries were visualized and as the ovarian volume increased, there was an increase in ET. When ET was > 4 mm (n = 37), they were offered endocel, of which 16 agreed to undergo the procedure. None were found to have endometrial cancer. This study suggests that parity, BMI, presence of

What influences medical students' choice of surgical careers.

PubMed

Erzurum, V Z; Obermeyer, R J; Fecher, A; Thyagarajan, P; Tan, P; Koler, A K; Hirko, M K; Rubin, J R

2000-08-01

Recent emphasis in medical education has been to encourage students to pursue primary care careers. This could have a negative impact on applications to surgical residencies. To determine what factors are most influential for a student to pursue a surgical career in spite of this environment, third- and fourth-year medical students were surveyed with a 40-item questionnaire. The response rate was 37% (76/205). Those students considering a career in surgery were more likely than their counterparts to be motivated by role models (P <.006), career opportunities (P <.006), and academic opportunities (P <.013) in surgery. They were less likely than their counterparts to be discouraged from surgery on the basis of lifestyle (P <.001), time commitment (P <.001), call schedules (P <.001), or residency length (P <.028). No differences regarding financial rewards, research opportunities, or intellectual challenges were seen between the groups. Neither race nor sex had a significant role in the selection of surgery as a career. The data suggests that students are more likely to be influenced to pursue surgical careers by offering early exposure to positive role models and career and academic opportunities in surgery. Knowledge of these influences on student career choices should help surgical educators attract and maintain student interest in surgical careers.

Increasing educational indebtedness influences medical students to pursue specialization: a military recruitment potential?

PubMed

Bale, Asha G; Coutinho, Karl; Swan, Kenneth G; Heinrich, George F

2013-02-01

Cost of medical education and student indebtedness has increased dramatically. This study surveyed medical students on educational debt, educational costs, and whether indebtedness influenced career choice. Responses should impact (1) Department of Defense (DoD) recruitment of physicians and (2) future of primary care. The authors surveyed 188 incoming medical students (University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Class of 2012) concerning educational indebtedness, perceptions about educational costs, and plans regarding loan repayment. Data were analyzed and expressed as mean +/- standard error. Students with loans anticipated their medical educational costs to be $155,993. 62% felt costs were "exorbitant," and 28% "appropriate." 64% planned to specialize, whereas only 9% chose primary care. 28% of students planning specialization said income potential influenced their decision. 70% of students said cost was a factor in choosing New Jersey Medical School over a more expensive school. Students anticipated taking about 10 years to repay loans. As medical educational costs and student indebtedness rise, students are choosing less costly education and career paths with higher potential future earnings. These trends will negatively impact health care availability, accessibility, and cost. DoD programs to provide financial assistance in exchange for military service are not well publicized. These findings should increase DoD recruitment opportunities.

Factors influencing warfarin control in Australia and Singapore.

PubMed

Bernaitis, Nijole; Ching, Chi Keong; Teo, Siew Chong; Chen, Liping; Badrick, Tony; Davey, Andrew K; Crilly, Julia; Anoopkumar-Dukie, Shailendra

2017-09-01

Warfarin is widely used for patients with non-valvular atrial fibrillation (NVAF). Variations in warfarin control, as measured by time in therapeutic range (TTR), have been reported across different regions and ethnicities, particularly between Western and Asian countries. However, there is limited data on comparative factors influencing warfarin control in Caucasian and Asian patients. Therefore, the aim of this study was to determine warfarin control and potential factors influencing this in patients with NVAF in Australia and Singapore. Retrospective data was collected for patients receiving warfarin for January to June 2014 in Australia and Singapore. TTR was calculated for individuals with mean patient TTR used for analysis. Possible influential factors on TTR were analysed including age, gender, concurrent co-morbidities, and concurrent medication. The mean TTR was significantly higher in Australia (82%) than Singapore (58%). At both sites, chronic kidney disease significantly lowered this TTR. Further factors influencing control were anaemia and age<60years in Australia, and vascular disease, CHA 2 DS 2 -VASc score of 6, and concurrent platelet inhibitor therapy in Singapore. Warfarin control was significantly higher in Australia compared to Singapore, however chronic kidney disease reduced control at both sites. The different levels of control in these two countries, together with patient factors further reducing control may impact on anticoagulant choice in these countries with better outcomes from warfarin in Australia compared to Singapore. Copyright © 2017 Elsevier Ltd. All rights reserved.

Institutional factors affecting participation in national faculty development programs: a nation-wide investigation of medical schools.

PubMed

Kim, Do-Hwan; Hwang, Jinyoung; Lee, Seunghee; Shin, Jwa-Seop

2017-02-28

Medical schools have used faculty development programs as an essential means to improve the instruction of faculty members. Thus far, however, participating in such programs has been largely voluntary for individuals even though a certain degree of participation is required to achieve practical effectiveness. In addition, the learning behaviors of faculty members are known to be influenced by organizational contexts such as a hidden curriculum. Therefore, this study explored the organizational characteristics of medical schools affecting attendance at faculty development programs. Forty medical schools in South Korea were included in this study. In total, 1,667 faculty members attended the faculty development programs at the National Teacher Training Center for Health Personnel between 2007 and 2015. For independent variables, information on the basic characteristics and the educational states was collected from all the medical schools. Themes were identified from their educational goals and objectives by inductive content analysis. The number of nine-year cumulative attendees from medical schools ranged from 8 to 104. The basic characteristics of the medical schools had little influence on faculty development program attendance, while several themes in the educational goals and objectives, including "cooperation", "serving various societies", and "dealing with a changing future" showed a significant difference in participation. The number of full-time faculty showed a significant positive correlation when it was smaller than the median, and the proportion of alumni faculty showed a significant negative correlation when it was higher than 50%. This study adds to existing knowledge on factors affecting attendance at faculty development programs by identifying related institutional factors that influence attendance. While the variations depending on the basic characteristics were minimal, the organizational environment surrounding medical education significantly

Factors Influencing Mini-CEX Rater Judgments and Their Practical Implications: A Systematic Literature Review.

PubMed

Lee, Victor; Brain, Keira; Martin, Jenepher

2017-06-01

At present, little is known about how mini-clinical evaluation exercise (mini-CEX) raters translate their observations into judgments and ratings. The authors of this systematic literature review aim both to identify the factors influencing mini-CEX rater judgments in the medical education setting and to translate these findings into practical implications for clinician assessors. The authors searched for internal and external factors influencing mini-CEX rater judgments in the medical education setting from 1980 to 2015 using the Ovid MEDLINE, PsycINFO, ERIC, PubMed, and Scopus databases. They extracted the following information from each study: country of origin, educational level, study design and setting, type of observation, occurrence of rater training, provision of feedback to the trainee, research question, and identified factors influencing rater judgments. The authors also conducted a quality assessment for each study. Seventeen articles met the inclusion criteria. The authors identified both internal and external factors that influence mini-CEX rater judgments. They subcategorized the internal factors into intrinsic rater factors, judgment-making factors (conceptualization, interpretation, attention, and impressions), and scoring factors (scoring integration and domain differentiation). The current theories of rater-based judgment have not helped clinicians resolve the issues of rater idiosyncrasy, bias, gestalt, and conflicting contextual factors; therefore, the authors believe the most important solution is to increase the justification of rater judgments through the use of specific narrative and contextual comments, which are more informative for trainees. Finally, more real-world research is required to bridge the gap between the theory and practice of rater cognition.

Determinate factors of mental health status in Chinese medical staff

PubMed Central

Zhou, Chenyu; Shi, Lei; Gao, Lei; Liu, Wenhui; Chen, Zhenkang; Tong, Xinfa; Xu, Wen; Peng, Boshi; Zhao, Yan; Fan, Lihua

2018-01-01

Abstract Numerous previous studies have investigated the mental health status of medical staff in China and explored its associated determinate factors; however, scope and methods associated with these have introduced uncertainty regarding the results. The aim of this study was to perform a comprehensive examination of the mental health status of Chinese medical staff and its relative risk factors based on a cross-sectional survey. We conducted a broad area, cross-sectional, questionnaire-based survey of Chinese medical workers. Participants were randomly selected from 27 hospitals in the Heilongjiang province. The questionnaire that was distributed consisted of 5 parts: the demographic characteristics of the participant; questions related to the relative risk factors of psychological health; the posttraumatic stress disorder (PTSD) Checklist-Civilian Version (PCL-C); the Self-rating Depression Scale (SDS); and the Self-rating Anxiety Scale (SAS). The last 3 components were used to evaluate the mental health status of the target population. Logistic and linear regression were used to analyze the determinate factors of the mental health status of Chinese medical staff. Of the 1679 questionnaires distributed, 1557 medical workers responded (response rate: 92.73%; male: 24.1%; female 75.9%). The results of mental health status self-assessments indicated that 32.3% of participants were considered to have some degree of PTSD (based on the PCL-C). The SDS index was 0.67 and the mean score from SAS was 55.26; a result higher than found in the general population. Multivariate logistic regression analysis revealed that being female, dissatisfaction or average satisfaction with income, and good or very good self-perceived psychological endurance when faced with an emergency were associated with a reduction of PTSD symptoms. A frequency of verbal abuse incidents greater than 4 was associated with an increase in PTSD symptoms. The mental health status of Chinese medical staff

Factors which influence necropsy requests: a psychological approach.

PubMed Central

Start, R. D.; Hector-Taylor, M. J.; Cotton, D. W.; Startup, M.; Parsons, M. A.; Kennedy, A.

1992-01-01

AIMS: To determine which factors influence a clinician's decision to request a necropsy. METHODS: Patient age, confidence in premortem diagnosis, relatives' attitudes, and conditions of necropsy practice were combined factorially (two levels each) in separate medical and surgical questionnaires based on clinical case histories. The interactions between the factors were measured by a repeated measures factorial analysis of variance for each of the two clinical groups. The influence of the clinician's interest in necropsies on these interactions was also examined by a similar method. RESULTS: Necropsies were more likely to be requested on young patients, when diagnostic confidence was low, and when relatives' attitudes were favourable. Conditions of necropsy practice did not affect the likelihood of a request and there was no apparent overall difference in necropsy requests between the two groups of clinicians. The "patient age" and "relatives" factors had less influence on the decision of the surgical group to request necropsy. This was attributed to the opportunity to "see for themselves" at operation and was supported by the finding that surgeons were very likely to request necropsies in the absence of surgical intervention. Clinicians from both groups with a high pre-existing interest in the necropsy were consistently more likely to request necropsies. CONCLUSIONS: The "case history" based questionnaires successfully measured the relative influence of multiple factors in relation to the decision of clinicians to request a necropsy. These findings suggest that any attempt to reverse the decline in necropsy rates should focus on changing the clinician's perception of the value of the modern necropsy. PMID:1556237

Factors influencing health professions students' use of computers for data analysis at three Ugandan public medical schools: a cross-sectional survey.

PubMed

Munabi, Ian G; Buwembo, William; Bajunirwe, Francis; Kitara, David Lagoro; Joseph, Ruberwa; Peter, Kawungezi; Obua, Celestino; Quinn, John; Mwaka, Erisa S

2015-02-25

Effective utilization of computers and their applications in medical education and research is of paramount importance to students. The objective of this study was to determine the association between owning a computer and use of computers for research data analysis and the other factors influencing health professions students' computer use for data analysis. We conducted a cross sectional study among undergraduate health professions students at three public universities in Uganda using a self-administered questionnaire. The questionnaire was composed of questions on participant demographics, students' participation in research, computer ownership, and use of computers for data analysis. Descriptive and inferential statistics (uni-variable and multi- level logistic regression analysis) were used to analyse data. The level of significance was set at 0.05. Six hundred (600) of 668 questionnaires were completed and returned (response rate 89.8%). A majority of respondents were male (68.8%) and 75.3% reported owning computers. Overall, 63.7% of respondents reported that they had ever done computer based data analysis. The following factors were significant predictors of having ever done computer based data analysis: ownership of a computer (adj. OR 1.80, p = 0.02), recently completed course in statistics (Adj. OR 1.48, p =0.04), and participation in research (Adj. OR 2.64, p <0.01). Owning a computer, participation in research and undertaking courses in research methods influence undergraduate students' use of computers for research data analysis. Students are increasingly participating in research, and thus need to have competencies for the successful conduct of research. Medical training institutions should encourage both curricular and extra-curricular efforts to enhance research capacity in line with the modern theories of adult learning.

Health care professionals' reactions to patient pain: impact of knowledge about medical evidence and psychosocial influences.

PubMed

De Ruddere, Lies; Goubert, Liesbet; Stevens, Michaël André Louis; Deveugele, Myriam; Craig, Kenneth Denton; Crombez, Geert

2014-03-01

This study examined the impact of evidence concerning the presence of 1) a biomedical basis for pain and 2) psychosocial influences on practitioner appraisals of patient pain experiences. Furthermore, the potential moderating role of patient pain behavior was examined. In an online study, 52 general practitioners and 46 physiotherapists viewed video sequences of 4 patients manifesting pain, with accompanying vignettes describing presence or absence of medical evidence and psychosocial influences. Participants estimated pain intensity, daily interference, sympathy felt, effectiveness of pain medication, self-efficacy, their likability, and suspicions of deception. Primary findings indicated lower perceived pain and daily interference, less sympathy, lower expectations of medication impact, and less self-efficacy when medical evidence was absent. The same results were found when psychosocial influences were present, but only when the patient displayed higher levels of pain behavior. Furthermore, absence of medical evidence was related to less positive evaluations of the patients and to higher beliefs in deception in both professions. The presence of psychosocial influences was related to less positive evaluations and higher beliefs in deception in both professions. In sum, a range of contextual factors influence health care practitioner responses to patient pain. Implications for caregiving behavior are discussed. The present study indicates that in the absence of clear medical evidence and in the presence of psychosocial influences, patient pain might be taken less seriously by health care practitioners. These findings are important to further understand the difficulties that relate to the clinical encounter between pain patients and health care practitioners. Copyright © 2014 American Pain Society. All rights reserved.

Factors of interpersonal communication and behavioral health on medication self-efficacy and medication adherence.

PubMed

Archiopoli, Ashley; Ginossar, Tamar; Wilcox, Bryan; Avila, Magdalena; Hill, Ricky; Oetzel, John

2016-12-01

Despite devastating effects on health outcomes and disease progression, many people living with HIV (PLWH) are non-adherent to their medications. Medication self-efficacy is a pivotal factor in medication adherence, yet its formation and relationship with other factors are understudied. This study examines a model that considers the role of three communicative factors (patient-provider communication, social support, and social undermining) and two behavioral health factors (depression and alcohol abuse) and medication self-efficacy impacting medication adherence. Methods included a cross-sectional design using a survey questionnaire of 344 PLWH. Findings indicated that 25% of variance in medication adherence can be explained by a mediation model where depression (B = -.18) and provider-patient communication (B = .21) affect medication self-efficacy, which in turn impacts medication adherence (B = .64). Other variables, including demographics, did not add any explanatory power. These findings demonstrate the complex nature of medication adherence and the formation of medication self-efficacy.

Factors considered by undergraduate medical students when selecting specialty of their future careers.

PubMed

Alawad, Awad Ali Mohamed Ahmed; Khan, Waleed Shabeer; Abdelrazig, Yousif Mohammed; Elzain, Yamin Ibrahim; Khalil, Hassan Osman; Ahmed, Omer Bakri Elsayed; Adam, Omeralfaroug Ahmed Ibrahim

2015-01-01

Medical students are the source of a country's physicians. Determining how medical students select their areas of specialization is the key to achieve a balanced distribution of doctors among all specialties. The objective is to identify the number of medical students who have decided their postgraduate specialty career, their career specialties preference, and factors that may influence their decision to select a particular specialty. A facility based cross-sectional study was conducted in September 2013 at Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan. A self-administered semi-structured questionnaire comprising demographic data and questions about future specialties preferences and factors influencing those preferences was distributed to 887 male and female students, (from first to fifth academic years) recruited in the study. Response rate was 73% with 647 questionnaires collected, out of 887 eligible medical students. Of the returned questionnaires, 604 were valid. The majority of students (541, 89.6%) have chosen a specialty. Surgery, medicine, paediatrics and obstetrics and gynecology were the most selected specialties. The least selected specialty was anaesthesiology. A significant association was found between gender and specialty choice using Chi-square test (p = 0.00). There was no association between undergraduate level and specialty choice (p = 0.633). The most common reason for choosing a specific specialty was "Personal Interest" (215, 39.7%) followed by being "Helpful to the community" (144, 26.6%). Surgery, medicine, paediatrics and obstetrics and gynecology were the most selected specialties.

Factors Influencing Quality of Pain Management in a Physician Staffed Helicopter Emergency Medical Service.

PubMed

Oberholzer, Nicole; Kaserer, Alexander; Albrecht, Roland; Seifert, Burkhardt; Tissi, Mario; Spahn, Donat R; Maurer, Konrad; Stein, Philipp

2017-07-01

Pain is frequently encountered in the prehospital setting and needs to be treated quickly and sufficiently. However, incidences of insufficient analgesia after prehospital treatment by emergency medical services are reported to be as high as 43%. The purpose of this analysis was to identify modifiable factors in a specific emergency patient cohort that influence the pain suffered by patients when admitted to the hospital. For that purpose, this retrospective observational study included all patients with significant pain treated by a Swiss physician-staffed helicopter emergency service between April and October 2011 with the following characteristics to limit selection bias: Age > 15 years, numerical rating scale (NRS) for pain documented at the scene and at hospital admission, NRS > 3 at the scene, initial Glasgow coma scale > 12, and National Advisory Committee for Aeronautics score < VI. Univariate and multivariable logistic regression analyses were performed to evaluate patient and mission characteristics of helicopter emergency service associated with insufficient pain management. A total of 778 patients were included in the analysis. Insufficient pain management (NRS > 3 at hospital admission) was identified in 298 patients (38%). Factors associated with insufficient pain management were higher National Advisory Committee for Aeronautics scores, high NRS at the scene, nontrauma patients, no analgesic administration, and treatment by a female physician. In 16% (128 patients), despite ongoing pain, no analgesics were administered. Factors associated with this untreated persisting pain were short time at the scene (below 10 minutes), secondary missions of helicopter emergency service, moderate pain at the scene, and nontrauma patients. Sufficient management of severe pain is significantly better if ketamine is combined with an opioid (65%), compared to a ketamine or opioid monotherapy (46%, P = .007). In the studied specific Swiss cohort, nontrauma patients

Sleep disorder status of nurses in general hospitals and its influencing factors.

PubMed

Han, Yanjie; Yuan, Yingzi; Zhang, Li; Fu, Yanru

2016-06-01

This study aimed to evaluate the current sleep disorder status of nurses in general hospitals and analyze its influencing factors. A total of 2,033 nurses who have worked for 6 months in 3 general hospitals, namely, The First Affiliated Hospital of Harbin Medical University, The Second Affiliated Hospital of Harbin Medical University, and The Third Affiliated Hospital of Harbin Medical University, were selected by random sampling from April 2015 to November 2015 and investigated. The Effort-Reward Imbalance Questionnaire (ERI) and Job Content Questionnaire (JCQ) were applied to evaluate occupational stress. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep disorder status of the research subjects. Logistic regression analysis was adopted to determine the influencing factors of nurses' sleep disorders. The average PSQI score of 2,003 research subjects is 7.26±3.56, including 860 subjects with PSQI ≥8, accounting for 42.9%. The female research subjects in the department of gynecology and obstetrics, emergency department, and ICU show high risks of sleep disorders (i.e., many years of working; job title: registered nurse; many times of night shift per month; no frequent exercise; many efforts and few rewards; high decision-making autonomy). Educational background and marital status did not exhibit statistical relevance with sleep disorders. The sleep disorder status of nurses in general hospitals is closely related to occupational stress. As such, nurse managers should focus more attention to the influencing factors of nurses' sleep disorders and relieve their occupational stress to reduce the occurrence rate of sleep disorders.

Experience of psychiatry teaching at medical school influences Croatian medical students' attitudes towards choosing psychiatry as a career.

PubMed

Kuzman, Martina Rojnic; Lovrec, Petra; Smoljan, Mia; Kuzman, Tomislav; Farooq, Kitty; Lydall, Greg; Malik, Amit; Bhugra, Dinesh

2013-06-01

Reports indicate that the number of students interested in choosing psychiatry as their future profession is constantly decreasing in the last decades. Our aim was to determine the proportion of medical students intending to pursue a career in psychiatry and to define undergraduate education-related factors influencing that choice. We report the preliminary findings of a cross sectional quantitative survey of final year Croatian medical students as part of the International Survey Of Student Career Choice In Psychiatry (ISOSCCIP). We surveyed medical students attending their final year at Zagreb School of Medicine in the academic year 2009/2010, using a structured questionnaire examining demographics, students' preferences on future career choice and their evaluations of undergraduate psychiatry teaching. The overall student evaluation of the compulsory psychiatry curriculum was "average". Significantly higher ratings were reported by students who felt more involved in the teaching of the subject. The possibility of psychiatry as a career choice correlated significantly with better evaluation grades of psychiatry lectures. Furthermore, poor evaluation grades predicted a higher likelihood that medical students completely ruled out choosing a career in psychiatry. This is the first survey of this kind in Croatia. Student ratings of medical school psychiatric education and perceived involvement in teaching appears to influence the likelihood of a stated career in psychiatry. Addressing these issues may increase the number of students motivated to pursue psychiatry as their future career choice.

Factors influencing knowledge about childhood autism among final year undergraduate Medical, Nursing and Psychology students of University of Nigeria, Enugu State, Nigeria.

PubMed

Igwe, Monday N; Bakare, Muideen O; Agomoh, Ahamefule O; Onyeama, Gabriel M; Okonkwo, Kevin O

2010-06-13

Knowledge and awareness about childhood autism is low among health care workers and the general populace in Nigeria. Poor knowledge about childhood autism among final year medical, nursing and psychology students who would form tomorrow's child health care professionals can compromise early recognition and interventions that are known to improve prognosis in childhood autism. Educational factors that could be influencing knowledge about childhood autism among these future health care professionals are unknown. This study assessed knowledge about childhood autism among final year undergraduate medical, nursing and psychology students in south-eastern Nigeria and determined the factors that could be influencing such knowledge. One hundred final year undergraduate students were randomly selected from each of the Departments of Medicine, Nursing Science and Psychology respectively of University of Nigeria, Enugu State, Nigeria making a sample size of three hundred. A socio-demographic questionnaire and knowledge about childhood autism among health workers (KCAHW) questionnaire were administered to the students. The total mean score for the three groups of students on the KCAHW questionnaire was 10.67+/-3.73 out of a possible total score of 19, with medical, nursing and psychology students having total mean scores of 12.24+/-3.24, 10.76+/-3.50 and 9.01+/-3.76 respectively. The mean scores for the three groups showed statistically significant difference for domain 1 (p=0.000), domain 3 (p=0.029), domain 4 (p=0.000) and total score (p=0.000), with medical students more likely to recognise symptoms and signs of autism compared to nursing and psychology students. The mean score in domain 2 did not show statistically significant difference among the three groups (p=0.769). The total score on the KCAHW questionnaire is positively correlated with the number of weeks of posting in psychiatry (r=0.319, p=0.000) and the number of weeks of posting in paediatrics (r=0.372, p=0

TEMPORAL TRENDS AND FACTORS ASSOCIATED WITH MEDICATION PRESCRIPTION PATTERNS IN PERITONEAL DIALYSIS PATIENTS.

PubMed

Campos, Ludimila G; Bragg-Gresham, Jennifer; Han, Yun; Moraes, Thyago P; Figueiredo, Ana E; Barretti, Pasqual; Balkrishnan, Rajesh; Saran, Rajiv; Pecoits-Filho, Roberto

2018-06-06

Patients on peritoneal dialysis (PD) suffer from a high burden of comorbidities, which are managed with multiple medications. Determinants of prescription patterns are largely unknown in this population. This study assesses temporal changes and factors associated with medication prescription in a nationally representative population of patients on PD under the universal coverage healthcare system in Brazil. Incident patients recruited in the Brazilian Peritoneal Dialysis Study (BRAZPD) from December 2004 to January 2011, stratified by prior hemodialysis (HD) treatment, were included in the analysis. Multivariable logistic regression was used to assess the association between medication prescription and socioeconomic factors. Yearly prevalent cross-sections were calculated to estimate prescription over time. Medication prescription was in general higher among patients who had previously received HD, compared with those who started renal replacement therapy (RRT) directly on PD. Prescription increased from baseline to 6 months of PD therapy, particularly in those who did not previously receive HD. After accounting for patient characteristics, significant associations were found between socioeconomic factors, geographic region, and medication prescription patterns. Finally, the prescription of all cardioprotective and anemia medications and phosphate binders increased significantly over time. In a PD population under universal coverage in a developing country, there was an increase in drug prescription during the first 6 months on PD, and a trend toward more liberal prescription of medications in later years. Independent from patient characteristics and comorbidities, socioeconomic factors influenced drug prescriptions that likely impact patient outcome, calling for public health action to decrease potential inequities in management of comorbidities in PD patients.

Frequency, character and predisposing factor of headache among students of medical college of Karachi.

PubMed

Noor, Tooba; Sajjad, Ali; Asma, Anoosha

2016-02-01

To evaluate the frequency, predisposing factors and symptomatology of headache among medical students. The cross-sectional study was conducted from September to December 2013 and comprised students of two medical colleges of Karachi. International Classification of Headache Disorder-II criterion was used to diagnose and classify headache. SPSS 17 was used for statistical analysis. Of the 413 medical students studies, 326(79%) had tension type headache, and 87 (21%) had migraine. Headache was more frequent among females than males, with a ratio of 6.5:1. Both types of headache were significantly associated with self-reported disturbed sleep pattern, stress and various triggering factors (p<0.05 each). Both types greatly influenced individual's daily life with significant association with avoiding academics, extra-curricular activities, family and friends (p<0.05 each). High self-medication rate of 400(96.9%) was observed. The prevalence of headache among medical students was high with female predominance. Infrequent consultation needs to be addressed through awareness programmes.

Factors Influencing the Choice of Anesthesia as a Career by Undergraduates of the University of Rwanda.

PubMed

Chan, Denise M; Wong, Rex; Runnels, Sean; Muhizi, Epaphrodite; McClain, Craig D

2016-08-01

Rwanda currently faces a severe shortage of trained medical personnel, including physician anesthesiologists. The recruitment of residents into the anesthesia program has been consistently low. This study aimed at determining the factors that influence undergraduates' decision to pursue anesthesia as a career choice. A questionnaire was created and administered to final year undergraduate medical students at the University of Rwanda. The questionnaire was created based on factors identified from literature review and key informant interviews. The questionnaire was translated, field-tested, and refined. The final survey questionnaire contains 27 4-point Likert scale items and 4 free-text questions. Seventy-nine final year undergraduate medical students responded to the survey. Only 2 students (2.5%) chose anesthesia as their top choice for postgraduate training. The most frequently named factors for not choosing anesthesiology were long work hours and high stress level, insufficient mentorship, and low job opportunity. The issues identified by our survey must be considered when making efforts toward increasing anesthesia recruitment in Rwanda. Factors such as lack of material resources and high workload will not be easily addressed. Others can be addressed through changes in medical student anesthesiology rotations and better mentorship by anesthesiologists during formative years. Focusing on factors that can be changed now may increase enrollment into anesthesiology. Future studies will include broadening the survey population and further investigating the influencing factors elucidated by this study.

Factors influencing surgical career choices and advancement in Ireland and Britain.

PubMed

Corrigan, Mark A; Shields, Conor J; Redmond, Henry P

2007-10-01

The aim of this study was to analyze the factors that influence the advancement and the career choices of doctors and medical students. Using the combined databases of the iformix and surgent websites, 450 doctors and medical students were invited to complete an internet-based survey. Surgent (http://www.surgent.ie) and iformix (http://www.iformix.com) are two free internet services administered by the authors. Surgent is a medical educational website, while iformix facilitates the online submission of abstracts to surgical and medical conferences across Britain and Ireland. The combined database of these two websites is approximately 4500 entries. Four hundred and fifty users represented a 10% sample based on an expected 40%-45% response rate. This was anticipated to yield between 180 and 202 respondents, statistically sufficient to analyze the data. A detailed Likert scale assessed the importance of "academic," "clinical," and "lifestyle" factors in determining career choice and progression. Analysis included descriptive statistics and inferential testing. Fifty percent (N = 222) of surveys were returned; 142 men and 78 women. Thirty-seven percent of respondents were Irish, 28% British, and 35% non-European. Fifteen percent were undergraduates, 4% interns, 12% had 2-4 years of clinical experience, while 69% had completed more than 4 years. Fifty-six percent had decided upon a career in general surgery. Overall, the most important factors for career choice were intellectual challenge (95%), academic opportunities (61%), and research opportunities(54%). Doctors with more than 4 years of experience deemed duration of training (p = 0.002), lifestyle during training (p = 0.02), and stress (0.005) as less important factors when considering career choice. Correlation analyses demonstrated that prestige (p = 0.002), patient relationships (p = 0.006), and advice from friends or family (p = 0.01) were more important influencing factors for interns. In terms of career

[Development, factor-analytical control and psychometric evaluation of a questionnaire on specialty choices among medical students].

PubMed

Hermann, K; Buchholz, A; Loh, A; Kiolbassa, K; Miksch, A; Joos, S; Götz, K

2012-07-01

A questionnaire was developed and validated which assesses factors influencing career choices of medical students and their perception of possibilities in general practice. The first questionnaire version, which was developed based on a systematic literature review, was checked for comprehensibility and redundancy using concurrent think aloud. The revised version was filled out by a pilot sample of medical students and the factor structure was assessed using principal component analysis (PCA). The final version was filled out in an online survey by medical students of all 5 Medical Faculties in the federal state of Baden-Wuerttemberg. The factor structure was validated with a confirmatory factor analysis (CFA). Reliability was assessed as internal consistency using Cronbach's α. The questionnaire comprises 2 parts: ratings of (A) the individual importance and of (B) the possibilities in general practice on 5-point scales. The first version comprising 118 items was shortened to 63 items after conducting interviews using concurrent think aloud. A further 3 items giving no information were removed after piloting the questionnaire on 179 students. The 27 items of part A were structured in 7 factors (PCA): image, personal ambition, patient orientation, work-life balance, future perspectives, job-related ambition, and variety in job. This structure had a critical fit in the CFA applied to the final version filled out by 1 299 students. Internal consistency of the factors was satisfactory to very good (Cronbach's α=0.55-0.81). The questionnaire showed good psychometric properties. Further, not assessed factors influence career choice resulting in unexplained variance in our dataset and the critical fit of the model. © Georg Thieme Verlag KG Stuttgart · New York.

Medications Adherence and Associated Factors among Patients with Type 2 Diabetes Mellitus in the Gaza Strip, Palestine.

PubMed

Elsous, Aymen; Radwan, Mahmoud; Al-Sharif, Hasnaa; Abu Mustafa, Ayman

2017-01-01

The aim of this study was to evaluate the adherence to anti-diabetic medications among patients with type 2 diabetes mellitus (DM) seeking medical care in the Gaza Strip, Palestine. A cross-sectional study was conducted among 369 primary care patients with type 2 DM from October to December 2016. Adherence to medications was measured using the Morisky Medication Adherence Scale (MMAS-4). Socio-demographic and clinical variables, provider-patient relationship, health literacy, and health belief were examined for each patient. Univariate, binary logistic regression and multiple linear regression were applied to determine the independent factors influencing adherence to anti-diabetic medications using SPSS version 22. Of all the respondents, 214 (58%), 146 (39.5%), and nine (2.5%) had high (MMAS score = 0), medium (MMAS score = 1 + 2), and low (MMAS score ≥ 3) adherence to anti-diabetic medications, respectively. Factors that were independently associated with adherence to anti-diabetic medications were as follows: female gender [odds ratio (OR): 1.657, 95% confidence interval (CI): 1.065-2.578] and perception of disease's severity (OR: 1.510, 95% CI: 0.410-5.560). Elderly ( t  = 1.345) and longer duration of DM ( t  = 0.899) were also predictors of adherence but showed no statistical significance ( p  > 0.05). The level of complete adherence to anti-diabetic medications was sub-optimal. New strategies that aim to improve patients' adherence to their therapies are necessary taking into consideration the influencing factors and the importance of having diabetes educators in the primary care centers.

Factors considered by undergraduate medical students when selecting specialty of their future careers

PubMed Central

Alawad, Awad Ali Mohamed Ahmed; Khan, Waleed Shabeer; Abdelrazig, Yousif Mohammed; Elzain, Yamin Ibrahim; khalil, Hassan Osman; Ahmed, Omer Bakri Elsayed; Adam, Omeralfaroug Ahmed Ibrahim

2015-01-01

Introduction Medical students are the source of a country's physicians. Determining how medical students select their areas of specialization is the key to achieve a balanced distribution of doctors among all specialties. The objective is to identify the number of medical students who have decided their postgraduate specialty career, their career specialties preference, and factors that may influence their decision to select a particular specialty. Methods A facility based cross-sectional study was conducted in September 2013 at Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan. A self-administered semi-structured questionnaire comprising demographic data and questions about future specialties preferences and factors influencing those preferences was distributed to 887 male and female students, (from first to fifth academic years) recruited in the study. Results Response rate was 73% with 647 questionnaires collected, out of 887 eligible medical students. Of the returned questionnaires, 604 were valid. The majority of students (541, 89.6%) have chosen a specialty. Surgery, medicine, paediatrics and obstetrics and gynecology were the most selected specialties. The least selected specialty was anaesthesiology. A significant association was found between gender and specialty choice using Chi-square test (p = 0.00). There was no association between undergraduate level and specialty choice (p = 0.633). The most common reason for choosing a specific specialty was “Personal Interest” (215, 39.7%) followed by being “Helpful to the community” (144, 26.6%). Conclusion Surgery, medicine, paediatrics and obstetrics and gynecology were the most selected specialties. PMID:26090050

Factors Influencing American Plastic Surgery Residents Toward an Academic Career.

PubMed

Chetta, Matthew D; Sugg, Kristoffer B; Diaz-Garcia, Rafael J; Kasten, Steven J

2018-02-01

Plastic surgery residency program directors have an interest in recruiting applicants who show an interest in an academic practice. Medical school achievements (ie, United States Medical Licensing Examination® scores, publications, and Alpha Omega Alpha status) are metrics assessed to grade applicants but may not correlate with ultimately choosing an academic career. This study was designed to investigate factors influencing residents' choices for or against academic careers. A 25-item online questionnaire was designed to measure baseline interest in academic plastic surgery and factors that influence decisions to continue on or abandon that career path. This questionnaire was disseminated to the integrated/combined plastic surgery residents during the 2013 to 2014 academic year. One hundred twenty-five respondents indicated that they were currently interested in pursuing academic practice (n = 78) or had lost interest in academic practice (n = 47). Among all respondents, 92.8% (n = 116) stated they were interested in academic careers at the time of residency application, but one-third (n = 41) subsequently lost interest. Those residents who retained interest in academic careers indicated resident/medical student educational opportunities (57%) and complexity of patients (52%) as reasons. Those who lost interest cited a lack of autonomy (43%), publishing requirements (32%), and income discrepancy (26%) as reasons. Many residents report losing interest in academics during residency. Traditional metrics valued in the recruitment process may not serve as positive predictors of an academic career path. Reasons why residents lose interest are not easily correctable, but mentorship, adequate career counseling, and research opportunities during training remain factors that can be addressed across all residency programs.

Medical and nonmedical factors influencing utilization of delayed pushing in the second stage.

PubMed

Frey, Heather A; Tuuli, Methodius G; Cortez, Sarah; Odibo, Anthony O; Roehl, Kimberly A; Shanks, Anthony L; Macones, George A; Cahill, Alison G

2013-08-01

To evaluate factors impacting selection to delayed pushing in the second stage of labor. This case-control study was a secondary analysis of a large retrospective cohort study. Cases included women who delayed pushing for 60 minutes or more in the second stage of labor. Controls began pushing prior to 60 minutes from the time of diagnosis of complete dilation. Demographic, labor, and nonmedical factors were compared among cases and controls. Logistic regression modeling was used to identify factors independently associated with delayed pushing. We identified 471 women who delayed pushing and 4819 controls. Nulliparity, maternal body mass index > 25, high fetal station at complete dilation, regional anesthesia use, and start of second stage during staffing shift change were independent factors associated with increased use of delayed pushing. On the other hand, black race and second-stage management during night shift were associated with lower odds of employing delayed pushing. Delayed pushing was more commonly employed in nulliparous women, but 38.9% of multiparous women also delayed pushing. We identified multiple factors associated with use of delayed pushing. This study helps to define current patterns of second-stage labor management. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Factors influencing patient compliance with therapeutic regimens in chronic heart failure: A critical incident technique analysis.

PubMed

Strömberg, A; Broström, A; Dahlström, U; Fridlund, B

1999-01-01

The aim of this study was to identify factors influencing compliance with prescribed treatment in patients with chronic heart failure. A qualitative design with a critical incident technique was used. Incidents were collected through interviews with 25 patients with heart failure strategically selected from a primary health care clinic, a medical ward, and a specialist clinic. Two hundred sixty critical incidents were identified in the interviews and 2 main areas emerged in the analysis: inward factors and outward factors. The inward factors described how compliance was influenced by the personality of the patient, the disease, and the treatment. The outward factors described how compliance was influenced by social activities, social relationships, and health care professionals. By identifying the inward and outward factors influencing patients with chronic heart failure, health care professionals can assess whether intervention is needed to increase compliance.

Factors associated with physical activity promotion by allied and other non-medical health professionals: A systematic review.

PubMed

Crisford, Paul; Winzenberg, Tania; Venn, Alison; Schultz, Martin; Aitken, Dawn; Cleland, Verity

2018-05-21

To identify factors associated with non-medical health professionals' engagement in physical activity (PA) promotion. Five electronic databases were searched for studies including practising health professionals (excluding medical doctors), a PA promotion practice measure, a test of association between potential influencing factors and PA promotion practice, and written in English. Two researchers independently screened studies and extracted data. Extracted data were synthesized in a tabular format with a narrative summary (thematic analysis). Thirty studies involving 7734 non-medical health professionals were included. Self-efficacy in PA promotion, positive beliefs in the benefits of PA, assessing patients' PA, and PA promotion training were the main factors associated with engaging in PA promotion. Lack of remuneration was not associated. Common study limitations included a lack of information on non-responders, data collection by survey only and limited reliability or validity testing of measurements. There are common factors influencing PA promotion, but the absence of studies from some health professions, limitations related to study measures, and the lack of randomised controlled intervention trials highlights the need for further research. The factors identified may prove useful for guiding the development of strategies to encourage greater engagement in PA promotion by health professionals. Copyright © 2018 Elsevier B.V. All rights reserved.

Analysis of Factors Influencing Inpatient and Outpatient Satisfaction with the Chinese Military Health Service.

PubMed

Lv, Yipeng; Xue, Chen; Ge, Yang; Ye, Feng; Liu, Xu; Liu, Yuan; Zhang, Lulu

2016-01-01

Relatively few articles have focused on exploring factors influencing soldiers' overall satisfaction and differences between inpatients' and outpatients' satisfaction, particularly in the Chinese army. Elucidating factors influencing military inpatient and outpatient care separately and analyzing their differences may provide more information for the health system. The Revised China National Health Service Survey questionnaire was used in the survey. The questionnaire included 5 sections and 32 items concerning demographic, inpatient, and outpatient characteristics and perception variables for both inpatients and outpatients. Bivariate and multivariate techniques were used to reveal relationships between satisfaction and the variables assessed. Outpatients' and inpatients' overall satisfaction rates were 19.0% and 18.5%, respectively. The strongest determinant of outpatients' satisfaction was satisfaction with doctor's communication regarding therapeutic regimen followed by length of military service, level of trust in medical staff, and disease severity. Determinants of inpatients' satisfaction included staff categories, satisfaction with environment, and satisfaction with medical quality. The factors influencing military outpatients' satisfaction differed from those of inpatients. Exploring the causes of satisfaction and dissatisfaction with military health institutions is important in their fulfillment of their responsibility to maintain soldiers' health.

Predictive Modeling of Physician-Patient Dynamics That Influence Sleep Medication Prescriptions and Clinical Decision-Making

NASA Astrophysics Data System (ADS)

Beam, Andrew L.; Kartoun, Uri; Pai, Jennifer K.; Chatterjee, Arnaub K.; Fitzgerald, Timothy P.; Shaw, Stanley Y.; Kohane, Isaac S.

2017-02-01

Insomnia remains under-diagnosed and poorly treated despite its high economic and social costs. Though previous work has examined how patient characteristics affect sleep medication prescriptions, the role of physician characteristics that influence this clinical decision remains unclear. We sought to understand patient and physician factors that influence sleep medication prescribing patterns by analyzing Electronic Medical Records (EMRs) including the narrative clinical notes as well as codified data. Zolpidem and trazodone were the most widely prescribed initial sleep medication in a cohort of 1,105 patients. Some providers showed a historical preference for one medication, which was highly predictive of their future prescribing behavior. Using a predictive model (AUC = 0.77), physician preference largely determined which medication a patient received (OR = 3.13 p = 3 × 10-37). In addition to the dominant effect of empirically determined physician preference, discussion of depression in a patient’s note was found to have a statistically significant association with receiving a prescription for trazodone (OR = 1.38, p = 0.04). EMR data can yield insights into physician prescribing behavior based on real-world physician-patient interactions.

How a Lumbar Diskectomy Influenced Medical Malpractice and the Landscape of Health Care.

PubMed

Yang, Brian W; Bi, Wenya Linda; Smith, Timothy R; Brewster, Ryan; Gormley, William B; Dunn, Ian F; Laws, Edward R

2016-02-01

Jeff Chandler was one of Hollywood's top leading men in the 1950s and 1960s. In 1961, at the peak of his career, Chandler died of complications following an aortic-iliac injury during a routine lumbar diskectomy. The subsequent public outcry and malpractice suit resulted in an unprecedented settlement award. Chandler's lawsuit marked a pivotal time in the evolution of medical malpractice and monetary awards. Before 1960, malpractice legal claims were rare, with little impact on the practice of medicine. Chandler's award, however, dwarfed the average malpractice verdict for its time and would influence the relationship between medicine and the legal world. This case helped issue a radical increase in total expenditure on medical liability insurance, frequency of successful claims, average numbers of neurosurgical malpractice suits, and financial award sizes. The trend ensuing from this time has continued to the contemporary era. To link Chandler's case to the current malpractice climate, we highlight the relationship of the case with 3 factors comprising the legal argument for the perpetuation of medical malpractice: 1) contingency fees, 2) citizen juries, and 3) the nature of tort law. This case illustrates an inflection point in American medical malpractice expenditure increases beginning in the 1960s to a current estimated $55.6 billion. As we investigate ways to provide value in health care, it is important to consider the historical factors that have influenced the status quo when seeking strategies to reform the malpractice system on both sides of the value equation: quality and cost. Copyright © 2016 Elsevier Inc. All rights reserved.

Sources influencing patients in their HIV medication decisions.

PubMed

Meredith, K L; Jeffe, D B; Mundy, L M; Fraser, V J

2001-02-01

The authors surveyed 202 patients (54.5% male; 62.4% African American) enrolled at St. Louis HIV clinics to identify the importance of various sources of influence in their HIV medication decisions. Physicians were the most important source for 122 (60.4%) respondents, whereas prayer was most important for 24 respondents (11.9%). In multivariate tests controlling for CD4 counts, Caucasian men were more likely than Caucasian women and African Americans of both genders to select a physician as the most important source. African Americans were more likely than Caucasians to mention prayer as the most important source. Caucasians and those rating physicians as the most important source were more likely to be using antiretroviral medications. Respondents identified multiple important influences-hence the potential for conflicting messages about HIV medications. These findings have implications for health education practices and behavioral research in the medical setting.

Becoming a general practitioner - Which factors have most impact on career choice of medical students?

PubMed Central

2011-01-01

Background In Germany, there is a shortage of young physicians in several specialties, the situation of general practitioners (GP) being especially precarious. The factors influencing the career choice of German medical students are poorly understood. This study aims to identify factors influencing medical students' specialty choice laying a special focus on general practice. Methods The study was designed as a cross-sectional survey. In 2010, students at the five medical schools in the federal state of Baden-Wuerttemberg (Germany) filled out an online-questionnaire. On 27 items with 5-point Likert scales, the students rated the importance of specified individual and occupational aspects. Furthermore, students were asked to assign their intended medical specialty. Results 1,299 students participated in the survey. Thereof, 1,114 students stated a current choice for a specialty, with 708 students choosing a career in one of the following 6 specialties: internal medicine, surgery, gynaecology and obstetrics, paediatrics, anaesthetics and general practice. Overall, individual aspects ('Personal ambition', 'Future perspective', 'Work-life balance') were rated as more important than occupational aspects (i.e. 'Variety in job', 'Job-related ambition') for career choice. For students favouring a career as a GP individual aspects and the factor 'Patient orientation' among the occupational aspects were significantly more important and 'Job-related ambition' less important compared to students with other specialty choices. Conclusions This study confirms that future GPs differ from students intending to choose other specialties particularly in terms of patient-orientation and individual aspects such as personal ambition, future perspective and work-life balance. Improving job-conditions in terms of family compatibility and work-life balance could help to increase the attractiveness of general practice. Due to the shortage of GPs those factors should be made explicit at an

Becoming a general practitioner--which factors have most impact on career choice of medical students?

PubMed

Kiolbassa, Kathrin; Miksch, Antje; Hermann, Katja; Loh, Andreas; Szecsenyi, Joachim; Joos, Stefanie; Goetz, Katja

2011-05-09

In Germany, there is a shortage of young physicians in several specialties, the situation of general practitioners (GP) being especially precarious. The factors influencing the career choice of German medical students are poorly understood. This study aims to identify factors influencing medical students' specialty choice laying a special focus on general practice. The study was designed as a cross-sectional survey. In 2010, students at the five medical schools in the federal state of Baden-Wuerttemberg (Germany) filled out an online-questionnaire. On 27 items with 5-point Likert scales, the students rated the importance of specified individual and occupational aspects. Furthermore, students were asked to assign their intended medical specialty. 1,299 students participated in the survey. Thereof, 1,114 students stated a current choice for a specialty, with 708 students choosing a career in one of the following 6 specialties: internal medicine, surgery, gynaecology and obstetrics, paediatrics, anaesthetics and general practice. Overall, individual aspects ('Personal ambition', 'Future perspective', 'Work-life balance') were rated as more important than occupational aspects (i.e. 'Variety in job', 'Job-related ambition') for career choice. For students favouring a career as a GP individual aspects and the factor 'Patient orientation' among the occupational aspects were significantly more important and 'Job-related ambition' less important compared to students with other specialty choices. This study confirms that future GPs differ from students intending to choose other specialties particularly in terms of patient-orientation and individual aspects such as personal ambition, future perspective and work-life balance. Improving job-conditions in terms of family compatibility and work-life balance could help to increase the attractiveness of general practice. Due to the shortage of GPs those factors should be made explicit at an early stage at medical school to increase

Factors Affecting Applicants' Acceptance or Decline of Offers to Enroll in a Medical School.

ERIC Educational Resources Information Center

Cleave-Hogg, Doreen; And Others

1994-01-01

A University of Toronto (Canada) study of medical school applicants accepting (n=784) and declining (n=255) admission identified influential factors. Some (living cost, location) cannot be affected by the institution. The institution has limited control of others (faculty size, school environment) but can influence applicant perceptions. One…

Influence of medical training on self-medication by students.

PubMed

James, H; Handu, S S; Khaja, K A J Al; Sequeira, R P

2008-01-01

To examine the influence of medical training on the knowledge, attitude and practice of self-medication by medical students. This was a cross-sectional, descriptive study. A self-developed, pre-validated questionnaire containing open-ended and close-ended items was used for data collection. Medical students in the 2nd and 4th year of the medical course at the Arabian Gulf University Bahrain filled in the questionnaire anonymously. Data were analyzed using SPSS and results expressed as counts and percentages. 2-tailed Chi2-test was applied and p < 0.05 was considered significant. The respondents (n = 141) had a mean age of 19.94 A+/- 1.21 years. Overall, they had a fair knowledge about appropriate self-medication but knowledge of the benefits and risks of self-medication was adequate. Self-medication was perceived to be time-saving, providing quick relief in common illnesses, a learning experience, economical, and convenient. Among the perceived disadvantages were adverse drug reactions, inappropriate drug use, and the risk of making a wrong diagnosis. Majority of the respondents had a positive attitude favoring self-medication and read the package insert. The practice of self-medication was common and often inappropriate. The commonest indications for self-medication were cough, cold and sore throat (63.2% in Year 2) and headache (78.3% in Year 4). Mild illness, previous experience, and lack of time were the most frequent reasons for resorting to self-medication. Analgesics were the commonest drugs used, and drugs were mostly obtained from private pharmacies. Students of Year 4 had better knowledge about appropriate self-medication (58.7% versus 35.8%, p = 0.02), had greater awareness of the risks of self-medication and would discourage others from practicing self-medication (58.7% versus 40.4%, p = 0.04). They had a more confident attitude (54.3% versus 35.1%, p = 0.03) and a smaller number of them would seek a prescription (34.8% versus 54.3%, p = 0.03). They

Factors influencing knowledge about childhood autism among final year undergraduate Medical, Nursing and Psychology students of University of Nigeria, Enugu State, Nigeria

PubMed Central

2010-01-01

Background Knowledge and awareness about childhood autism is low among health care workers and the general populace in Nigeria. Poor knowledge about childhood autism among final year medical, nursing and psychology students who would form tomorrow's child health care professionals can compromise early recognition and interventions that are known to improve prognosis in childhood autism. Educational factors that could be influencing knowledge about childhood autism among these future health care professionals are unknown. This study assessed knowledge about childhood autism among final year undergraduate medical, nursing and psychology students in south-eastern Nigeria and determined the factors that could be influencing such knowledge. Methods One hundred final year undergraduate students were randomly selected from each of the Departments of Medicine, Nursing Science and Psychology respectively of University of Nigeria, Enugu State, Nigeria making a sample size of three hundred. A socio-demographic questionnaire and knowledge about childhood autism among health workers (KCAHW) questionnaire were administered to the students. Results The total mean score for the three groups of students on the KCAHW questionnaire was 10.67 ± 3.73 out of a possible total score of 19, with medical, nursing and psychology students having total mean scores of 12.24 ± 3.24, 10.76 ± 3.50 and 9.01 ± 3.76 respectively. The mean scores for the three groups showed statistically significant difference for domain 1 (p = 0.000), domain 3 (p = 0.029), domain 4 (p = 0.000) and total score (p = 0.000), with medical students more likely to recognise symptoms and signs of autism compared to nursing and psychology students. The mean score in domain 2 did not show statistically significant difference among the three groups (p = 0.769). The total score on the KCAHW questionnaire is positively correlated with the number of weeks of posting in psychiatry (r = 0.319, p = 0.000) and the number of weeks

Factors affecting UK medical students' decision to train in urology: a national survey.

PubMed

Jayakumar, Nithish; Ahmed, Kamran; Challacombe, Ben

2016-10-01

Our aim was to understand the specific factors which influence medical students' choice to train in urology, in order to attract the best and the brightest into the specialty during a challenging time for surgical training in the United Kingdom A cross-sectional web-based survey was generated to evaluate: 1) perceptions of urology; 2) attitudes about urology as a career; 3) exposure to urology at medical school; and 4) proficiency in common urological procedures. The survey was sent to all 33 medical schools in the UK and advertised to all medical students. The survey received 488 responses were received from 14 medical schools; 59.8% of respondents did not consider a career in urology. Factors affecting a career choice in urology included: 1) year of study; 2) male gender; 3) favorable perceptions of urology; 4) favorable attitudes about urology as a career; 5) more hours of urology teaching in preclinical years; 6) attendance at urology theatre sessions; 7) confidence in performing urological procedures; and 8) more attempts at male catheterization. The commonest reason for not considering urology was inadequate exposure to urology. Students in Year 3 were more likely to consider urology than final-year students, due to multifactorial reasons. Year of study is a novel factor affecting students' consideration of urology as a career. This paper clearly shows that early and sustained exposure to urology positively correlated with considering a career in urology. Urologists must be more active in promoting the specialty to medical students.

Are medical students influenced by preceptors in making career choices, and if so how? A systematic review.

PubMed

Stagg, P; Prideaux, D; Greenhill, J; Sweet, L

2012-01-01

Increasingly medical students undertake clinical training in distributed learning environments. The driving factor for this is predominantly to address medical workforce shortages. In these environments students are often taught by private practitioners, residents, house staff and registrars, as well as faculty. Through a mix of short- and long-term preceptorships, clerkships and rotations, medical students are exposed to a wider range of preceptors, mentors and role models than has traditionally been the case. The aim of this systematic review was to understand if and how medical students' career choices are influenced by their interactions with preceptors. A search of Ovid Medline, Scopus, ISI Web of Science, PubMed, Eric and CIHNAL was undertaken. The search was structured around the key terms: Medical Student, Career Choice and Preceptor, and variants of these terms. Search limits were set to English-language publications between 1995 and 2010. A total of 36 articles met the selection criteria from the 533 citations sourced from the search. Required preceptorships as short as 3 weeks' duration influence the career choice of students when they rate the preceptor as a high quality teacher. Preceptors who are judged (by students) as high quality teachers have the greatest influence on student career choice by up to four-fold. When students judged a preceptor as being a negative role model, a poor teacher or lacking discipline specific knowledge they will turn away from that field. The positive influence of relationships between preceptors and students on career choice is strongest where there is continuity of preceptors, continuity of care, and continuity of patient interactions. The longer the duration of the preceptorship the greater the influence on student career choice, particularly in primary cares environments. This review adds to the literature by identifying how differing components and combinations of components of a preceptorship influence medical

Tool for Predicting Medical Student Burnout From Sustained Stress Levels: Factor Analysis of the Medical Education Hassles Scale-R.

PubMed

Johnson, Jane C; Degenhardt, Brian F; Smith, Carol K; Wolf, Thomas M; Peterson, D Fred

2018-03-01

Acute stress during medical school affects the health of students and is associated with burnout. The Medical Education Hassles Scale-R (MEHS-R) is designed to measure acute stress among medical students. Researchers using the MEHS-R primarily report overall hassles scores, which are unable to discriminate between different categories of hassles encountered. The present study examined the factor structure of the MEHS-R to identify subscales that would be useful to categorize hassles for research and assessment purposes. Longitudinal, observational study. Two osteopathic medical schools. Five hundred six first-year medical students. The MEHS-R was administered at orientation and 9 to 10 times throughout the first year, classified into examination, vacation, and routine medical school activity periods. Students rated the 101 items on a 4-point scale (0=none to 3=a great deal) to indicate how much of a hassle each item had been during the previous week. Demographic subgroups were males, females, married students, single students, whites, and ethnic minorities. Exploratory factor analysis was conducted on data collected at the first school during orientation. Seven subscales were identified: Academic and Time Pressures, Financial, Social, External Influences, Day-to-Day Functioning, Relationships With Immediate Family, and Health. Cronbach α were ≥0.75. Stability of these subscales was examined using confirmatory factor analysis. Both of the fit indices used indicated the 7-subscale model for the MEHS-R adequately fit the data obtained during examination and routine medical school activity periods, one fit index indicated adequate fit for the vacation period, and neither indicated adequate fit for the data from the second school. Of the 7 subscales, 5 had a strong correspondence with categories identified by the scale developers. Fit indices also indicated the 7-subscale model was adequately generalizable to the demographic subgroups with the exception of the ethnic

Influencing Factors on Choosing Psychiatry as a Career: An Exploration in Chinese University Students.

PubMed

Zhong, Jiawei; Zheng, Luna; Chen, Xiaoling; Gao, Qianqian; Zhang, Bingren; Wang, Wei

2016-12-01

There is a consistent need of psychiatric professionals in the world including China, and a consistent challenge to recruit more medical students into the psychiatric careers. We aimed to look for factors which have an impact on career-choosing of psychiatry in Chinese university students. We invited 508 non-medical students (NM), 304 medical students without (MO) and 123 medical students with clinical internship experience (MW), to answer a matrix of 43 questions regarding factors influencing career-choosing of psychiatry. Answers to these questions were analyzed through exploratory and confirmatory factor analyses, once the latent factors were identified and structurally-validated, their mean scores in three groups of students were calculated. Five factors with five items each were identified, namely social status inferiority, career importance, practice reward, career preference, and practice stress. NM scored lower than MO and MW did on Social Status Inferiority; NM group scored higher than MO and MW groups did on Career Importance; MW scored lower than NM and MO did on Practice Reward and on Career Preference; Regarding Practice Stress, NM scored higher than MO did, who then in turn, scored higher than MW did. In addition, Practice Stress was positively correlated with advice of the medical educators; and Social Status Inferiority and Career Preference were positively correlated with the psychiatry teaching of the medical educators. Raising career rewards, improving social status, and reinforcing psychiatric education might help to recruit more medical students to specialize in psychiatry practicing.

Factors that influence the choice of psychiatry as a career by medical students at the School of Medicine, College of Health Sciences, University of Nairobi.

PubMed

Ndetei, David M; Ngumi, Zipporah W; Mutiso, Victoria N; Musyimi, Christine W; Kamau, Lucy W

2013-08-01

The aim of this paper is to assess the particular factors facilitating and those hampering the choice of psychiatry as a career by medical students at the University of Nairobi in a cross-sectional population study of medical students at the University of Nairobi, College of Health Sciences, School of Medicine using self-administered questionnaires. A total of 31 students (13%) said they would like to be psychiatrists while 44 (18%) were neutral and 170 (69%) did not want to become psychiatrists. The factors that made psychiatry interesting for the students included the view that the problems presented by psychiatric patients were often particularly interesting and challenging and the fact that mental illness presented the field of medicine with one of the greatest challenges. Discouraging factors articulated by the students included views that psychiatry was a vague and speculative speciality, psychiatry was not an important part of the curriculum in medical schools, and psychiatric patients tend to make more emotional demands on their doctors than other patients. There was a negative view of psychiatric patients who most of the students thought were strange, dangerous and incurable, although they were curious to know more about them. Most of the negative influence in psychiatry is due to the misconceptions that students have about its prestige and scope, the rewards it offers in terms of job satisfaction and opportunities and the negative views towards psychiatric patients. Integration of psychiatry into the curriculum may address these misunderstandings.

Factors associated with stress among medical students.

PubMed

Qamar, Khadija; Khan, Najamus Saqib; Bashir Kiani, Muhammad Rizwan

2015-07-01

To determine the probable factors responsible for stress among undergraduate medical students. The qualitative descriptive study was conducted at a public-sector medical college in Islamabad, Pakistan, from January to April 2014. Self-administered open-ended questionnaires were used to collect data from first year medical students in order to study the factors associated with the new environment. There were 115 students in the study with a mean age of 19±6.76 years. Overall, 35(30.4%) students had mild to moderate physical problems, 20(17.4%) had severe physical problems and 60(52.2%) did not have any physical problem. Average stress score was 19.6±6.76. Major elements responsible for stress identified were environmental factors, new college environment, student abuse, tough study routines and personal factors. Majority of undergraduate students experienced stress due to both academic and emotional factors.

Factors influencing the career interest of medical graduates in obstetrics and gynaecology in Hong Kong: a cross-sectional questionnaire survey.

PubMed

Lam, Christy Y Y; Cheung, Charleen S Y; Hui, Annie S Y

2016-04-01

The trend of declining interest of medical graduates in pursuing obstetrics and gynaecology as a career has been observed in many overseas studies. This study aimed to evaluate the career interest of the most recent medical graduates in Hong Kong, especially their level of interest in obstetrics and gynaecology, and to identify key influential factors for career choice and career interest in obstetrics and gynaecology. All medical graduates from the Chinese University of Hong Kong and the University of Hong Kong who attended the pre-internship lectures in June 2015 were invited to participate in this cross-sectional questionnaire survey. The main outcome measures were the level of career interest in obstetrics and gynaecology, the first three choices of specialty as a career, key influential factors for career choice, and key influential factors for career interest in obstetrics and gynaecology. Overall, 73.7% of 323 new medical graduates participated in the study and 233 questionnaires were analysed. The median score (out of 10) for the level of career interest in obstetrics and gynaecology was 3. There were 37 (16.2%) participants in whom obstetrics and gynaecology was among their first three choices, of whom 29 (78.4%) were female. Obstetrics and gynaecology ranked as the eighth most popular career choice. By factor analysis, the strongest key influential factor for career interest in obstetrics and gynaecology was clerkship experience (variance explained 28.9%) and the strongest key influential factor for career choice was working style (variance explained 26.4%). The study confirmed a low level of career interest in obstetrics and gynaecology among medical graduates and a decreasing popularity of the specialty as a career choice. The three key influential factors for career interest in obstetrics and gynaecology and career choice were working style, clerkship experience, and career prospects.

Factors that Influence Physicians to Practice in Rural Locations: A Review and Commentary

ERIC Educational Resources Information Center

Ballance, Darra; Kornegay, Denise; Evans, Paul

2009-01-01

Rural populations remain underserved by physicians, despite various efforts by medical schools and other institutions/organizations to correct this disparity. We examined the literature on factors that influence rural practice location decisions by physicians to determine what opportunities exist along the entire educational pipeline to entice…

Are new medical students' specialty preferences gendered? Related motivational factors at a Dutch medical school.

PubMed

van Tongeren-Alers, Margret; van Esch, Maartje; Verdonk, Petra; Johansson, Eva; Hamberg, Katarina; Lagro-Janssen, Toine

2011-01-01

Female students currently outnumber male students in most medical schools. Some medical specialties are highly gender segregated. Therefore, it is interesting to know whether medical students have early specialization preferences based on their gender. Consequently, we like to know importance stipulated to motivational factors. Our study investigates new medical students' early specialization preferences and motivational factors. New students at a Dutch medical school (n = 657) filled in a questionnaire about specialty preferences (response rate = 94%; 69.5% female, 30.5% male). The students chose out of internal medicine, psychiatry, neurology, pediatrics, surgery, gynecology and family medicine, "other" or "I don't know." Finally, they valued ten motivational factors. Forty percent of the medical students reported no specialty preference yet. Taken together, female medical students preferred pediatrics and wished to combine work and care, whereas male students opted for surgery and valued career opportunities. Gender-driven professional preferences in new medical students should be noticed in order to use competencies. Changes in specialty preferences and motivational factors in pre- and post graduates should further assess the role of medical education.

Factors associated to chronic migraine with medication overuse: A cross-sectional study.

PubMed

Viana, Michele; Bottiroli, Sara; Sances, Grazia; Ghiotto, Natascia; Allena, Marta; Guaschino, Elena; Nappi, Giuseppe; Tassorelli, Cristina

2018-01-01

several aspects that may be involved in the development of chronic migraine and medication overuse. A multivariate analysis identified 10 factors belonging to five different areas, to suggest that chronic migraine and medication overuse onset is likely influenced by a complex mixture of factors. This information is useful when planning strategies to prevent and manage chronic migraine and medication overuse.

Factors Influencing Successful Prescribing by Intern Doctors: A Qualitative Systematic Review

PubMed Central

R. Hansen, Christina; Bradley, Colin P.; Sahm, Laura J.

2016-01-01

As the majority of prescribing in hospital is undertaken by intern doctors, the aims of this systematic review were to compile the evidence of the qualitative literature on the views and experiences of intern doctors and to examine the role of the pharmacist in assisting in prescribing by interns. A systematic review of the qualitative literature was done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The findings were synthesized using thematic analysis. Seven publications were included. Factors influencing prescribing behaviour were related to the environment; collaboration in medical teams; hierarchical structures; and patient and individual factors. This review confirmed that interns’ prescribing behaviour is influenced by multiple factors, and further highlighted the need for an educational intervention that supports the intern completing the prescribing task in a complex environment, and not just addresses the presumed knowledge gap(s). PMID:28970397

Factors Influencing Successful Prescribing by Intern Doctors: A Qualitative Systematic Review.

PubMed

R Hansen, Christina; Bradley, Colin P; Sahm, Laura J

2016-08-24

As the majority of prescribing in hospital is undertaken by intern doctors, the aims of this systematic review were to compile the evidence of the qualitative literature on the views and experiences of intern doctors and to examine the role of the pharmacist in assisting in prescribing by interns. A systematic review of the qualitative literature was done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The findings were synthesized using thematic analysis. Seven publications were included. Factors influencing prescribing behaviour were related to the environment; collaboration in medical teams; hierarchical structures; and patient and individual factors. This review confirmed that interns' prescribing behaviour is influenced by multiple factors, and further highlighted the need for an educational intervention that supports the intern completing the prescribing task in a complex environment, and not just addresses the presumed knowledge gap(s).

Influencing Factors for Adopting Technology Enhanced Learning in the Medical Schools of Punjab, Pakistan

ERIC Educational Resources Information Center

Iqbal, Shazia; Ahmad, Shahzad; Willis, Ian

2017-01-01

As the successful establishment of technology supported educational systems requires wide investment in terms of finances and faculty time, this study explores the influencing factors in the adoption of Technology Enhanced Learning (TEL) and the main barriers encountered during the use of TEL in Punjab, Pakistan. Semi-structured interviews were…

Factors predicting desired autonomy in medical decisions: Risk-taking and gambling behaviors

PubMed Central

Fortune, Erica E; Shotwell, Jessica J; Buccellato, Kiara; Moran, Erin

2016-01-01

This study investigated factors that influence patients’ desired level of autonomy in medical decisions. Analyses included previously supported demographic variables in addition to risk-taking and gambling behaviors, which exhibit a strong relationship with overall health and decision-making, but have not been investigated in conjunction with medical autonomy. Participants (N = 203) completed measures on Amazon’s Mechanical Turk, including two measures of autonomy. Two hierarchical regressions revealed that the predictors explained a significant amount of variance for both measures, but the contribution of predictor variables was incongruent between models. Possible causes for this incongruence and implications for patient–physician interactions are discussed. PMID:28070406

Factors that affect general practice as a choice of medical speciality: implications for policy development.

PubMed

Vohra, Amit; Ladyshewsky, Richard; Trumble, Stephen

2017-11-28

Objective This article critically appraises the range of personal, professional and social factors that affect the choice of speciality across medical students, prevocational doctors, general practice registrars and general practitioners. Methods This qualitative study applied constructs from the fields of decision theory and career theory to better understand the complex nature of choosing a speciality. In all, 47 in-depth interviews were conducted with participants at different stages of their career cycle. The data was codified and analysed using NVivo to identify key factors that influenced speciality choice. Results The research identified 77 individual findings influencing general practice as a choice of medical speciality. These were distilled into a matrix to show that factors such as money, prestige and peer interaction did not have a compelling effect, whereas clinical and academic role models, flexibility, work-life balance, scope of practice, connection with patients, training environment and practical opportunities did. Conclusion The findings indicate that the decision in relation to the choice of medical speciality is a complex cognitive process that is undertaken within a personal, social and professional context particular to each individual. What is known about the topic? Current literature aims to quantify changes in attitudes towards choice of speciality or the effect of particular variables in isolation while ignoring the complexity of this decision process and how the numerous variables compare with each other. What does this paper add? The present study is the first intergenerational research on this topic in the Australian context and the paper dismisses the role of prestige and remuneration as key drivers of choice in picking general practice as a speciality, noting that money is merely a 'hygiene factor'. What are the implications for policy makers? A policy framework outlining 10 key principles is presented to assist policy makers seeking

Nurses' reported influence on the prescription and use of medication.

PubMed

Jutel, A; Menkes, D B

2010-03-01

To identify the activities senior nurses report undertaking that may influence the prescription and use of medicines. While much attention has focused on the role of nurse prescribing, little is known about the extent to which non-prescribing nurses influence medication decision making. The pharmaceutical industry recognizes this influence in its marketing strategies, and courts nurses by provision of promotional material and sponsorship of nursing professional development. We undertook parallel web- and paper-based surveys of 100 senior registered nurses employed by government-funded health boards in two distinct New Zealand regions. Only 2/96 (2%) of nurses had prescribing rights, yet 74/94 (79%) reported recommending treatments to the prescribing doctor, 74/95 (79%) stated they provided advice to patients about over-the-counter medications and 71/92 (77%) participated in the development of guidelines or policies that include the use of medications. All nurses in this sample reported influencing the prescription of medicines in one way or another. From actually writing prescriptions to providing feedback on treatment outcomes, there are many opportunities for nurses to influence the decision making of medical and other prescribers, which open nurses to exploitation from commercial forces. Policy and education regarding prescriber relationships with the pharmaceutical industry should also recognize the role of non-prescribing nurses.

Exploring the factors that influence medication rating Web sites value to older adults: A cross-sectional study.

PubMed

AlRuthia, Yazed Sulaiman H; Hong, Song Hee; Graff, Carolyn; Kocak, Mehmet; Solomon, David; Nolly, Robert

2016-01-01

In this cross-sectional study, we evaluated factors that affected the perceived value of medication rating Web sites to 284 people aged ≥ 60 years who were taking prescription medications. The Patient Reviews of Medication Experience (PROMEX) questionnaire score, which assessed participant opinions about the value of online reviews of medications, was positively associated with preference to share health care decision making with the health care provider and negatively associated with the Physical Component Summary (PCS-12) and Mental Component Summary scores of the Short Form 12 health survey. The Primary Care Assessment Survey Communication score, which measured participant satisfaction with the communication from the health care provider, was positively associated with PCS-12 and health literacy. In summary, older adults who had poor physical and mental health-related quality of life were more likely to believe that medication rating Web sites were useful and helpful in facilitating communication with health care providers. Copyright © 2016 Elsevier Inc. All rights reserved.

Academic season does not influence cardiac surgical outcomes at US Academic Medical Centers.

PubMed

Lapar, Damien J; Bhamidipati, Castigliano M; Mery, Carlos M; Stukenborg, George J; Lau, Christine L; Kron, Irving L; Ailawadi, Gorav

2011-06-01

Previous studies have demonstrated the influence of academic season on outcomes in select surgical populations. However, the influence of academic season has not been evaluated nationwide in cardiac surgery. We hypothesized that cardiac surgical outcomes were not significantly influenced by time of year at both cardiothoracic teaching hospitals and non-cardiothoracic teaching hospitals nationwide. From 2003 to 2007, a weighted 1,614,394 cardiac operations were evaluated using the Nationwide Inpatient Sample database. Patients undergoing cardiac operations at cardiothoracic teaching and non-cardiothoracic teaching hospitals were identified using the Association of American Medical College's Graduate Medical Education Tracking System. Hierarchic multivariable logistic regression analyses were used to estimate the effect of academic quarter on risk-adjusted outcomes. Mean patient age was 65.9 ± 10.9 years. Women accounted for 32.8% of patients. Isolated coronary artery bypass grafting was the most common operation performed (64.7%), followed by isolated valve replacement (19.3%). The overall incidence of operative mortality and composite postoperative complication rate were 2.9% and 27.9%, respectively. After accounting for potentially confounding risk factors, timing of operation by academic quarter did not independently increase risk-adjusted mortality (p = 0.12) or morbidity (p = 0.24) at academic medical centers. Risk-adjusted mortality and morbidity for cardiac operations were not associated with time of year in the US at teaching and nonteaching hospitals. Patients should be reassured of the safety of performance of cardiac operations at academic medical centers throughout a given academic year. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Factors affecting the results of comprehensive pre-internship exam among medical students of Kermanshah University of Medical Sciences.

PubMed

Khazaei, Mohammad Rasool; Zarin, Afshin; Rezaei, Mansuor; Khazaei, Mozafar

2018-06-01

This study was aimed to evaluate the factors affecting the results of comprehensive pre-internship exam (CPIE) among medicals students of Kermanshah University of Medical Sciences. In this descriptive-analytical study, all students (n=240) participating in CPIE over a 3-year period (2012-2014) were selected. Data were gathered by a questionnaire, including the CPIE results and educational and demographic data. Spearman correlation coefficient, Mann-Whitney U-test, and analysis of variance were used to analyze the association of students' success with study variables. Also, regression analysis was applied to determine the role of independent variables in students' success. The frequency of the failed units in apprenticeship course was one of the most important risk factors associated with failure in CPIE. Average scores of pre-internship course were the most important factors of success in CPIE. The CPIE score had the highest direct relationship with grade point average (GPA) of apprenticeship course, total GPA of all three courses, GPAs of physiopathology and basic sciences courses, and score of comprehensive basic sciences examination, respectively. CPIE showed the highest inverse correlation with the number of failed units in apprenticeship course. The most important factors influencing this exam were failure in apprenticeship course and GPA of previous educational stages.

An Investigation of Factors Influencing Nurses' Clinical Decision-Making Skills.

PubMed

Wu, Min; Yang, Jinqiu; Liu, Lingying; Ye, Benlan

2016-08-01

This study aims to investigate the influencing factors on nurses' clinical decision-making (CDM) skills. A cross-sectional nonexperimental research design was conducted in the medical, surgical, and emergency departments of two university hospitals, between May and June 2014. We used a quantile regression method to identify the influencing factors across different quantiles of the CDM skills distribution and compared the results with the corresponding ordinary least squares (OLS) estimates. Our findings revealed that nurses were best at the skills of managing oneself. Educational level, experience, and the total structural empowerment had significant positive impacts on nurses' CDM skills, while the nurse-patient relationship, patient care and interaction, formal empowerment, and information empowerment were negatively correlated with nurses' CDM skills. These variables explained no more than 30% of the variance in nurses' CDM skills and mainly explained the lower quantiles of nurses' CDM skills distribution. © The Author(s) 2016.

[Influence of contractual medical association on inpatient service performance].

PubMed

Wu, Zhi-jun; Jian, Wei-yan

2015-06-18

To study the influence of contractual medical association on inpatient service performance. The data came from "Database of Inpatient Record" administered by Department of Medical Insurance. Using diagnosis related groups (DRG) as the tool of risk-adjustment, the third-tier general hospitals and second-tier general hospitals in medical alliance as the intervention group, and the average level of the same grade local hospitals as the control group, the influence of medical alliance on inpatient service performance was evaluated. The difference in difference (DID) method was used for the data analysis. The assessing indicators included the number of DRG group, case mix index (CMI), the total weight, cost efficiency index and time efficiency index. After the establishment of medical association, compared with the average level of the same grade local hospitals, in the third-tier general hospitals of medical alliance, the growth rate of the total weight had declined, and cost efficiency index had increased, while in the second-tier general hospitals of medical alliance, the CMI value had declined, and the cost efficiency index had increased. Contractual medical association played a role of triage patients, and improved the service levels and management efficiency of the second-tier general hospitals.

How psychosocial factors affect well-being of practice assistants at work in general medical care?--a questionnaire survey.

PubMed

Goetz, Katja; Berger, Sarah; Gavartina, Amina; Zaroti, Stavria; Szecsenyi, Joachim

2015-11-11

Well-being at work is an important aspect of a workforce strategy. The aim of the study was to explore and evaluate psychosocial factors and health and work-related outcomes of practices assistants depending on their employment status in general medical practices. This observational study was based on a questionnaire survey to evaluate psychosocial aspects at work in general medical practices. A standardized questionnaire was used, the Copenhagen Psychosocial Questionnaire (COPSOQ). Beside descriptive analyses linear regression analyses were performed for each health and work-related outcome scale of the COPSOQ. 586 practice assistants out of 794 respondents (73.8 %) from 234 general medical practices completed the questionnaire. Practice assistants reported the highest scores for the psychosocial factor 'sense of community' (mean = 85.9) and the lower score for 'influence at work' (mean = 41.2). Moreover, practice assistants who worked part-time rated their psychosocial factors at work and health-related outcomes more positively than full-time employees. Furthermore, the two scales of health related outcomes 'burnout' and 'job satisfaction' showed strong associations between different psychosocial factors and socio-demographic variables. Psychosocial factors at work influence well-being at work and could be strong risk factors for poor health and work-related outcomes. Effective management of these issues could have an impact on the retention and recruitment of health care staff.

Factors Modifying Burnout in Osteopathic Medical Students.

PubMed

Lapinski, Jessica; Yost, Morgan; Sexton, Patricia; LaBaere, Richard J

2016-02-01

The purposes of the current study are to examine factors modifying burnout and identify which of these factors place osteopathic medical students at risk for developing burnout. The current study used a cross-sectional study design and an anonymous, web-based survey to assess burnout and depression in osteopathic medical students. The survey included Maslach Burnout Inventory, the Patient Health Questionnaire, the Stressors and their impact scale, students' sleeping and studying habits, and students' extracurricular involvement. In total, 1294 osteopathic medical students completed the survey. Burnout was present in 516 (39.9%) osteopathic medical students, and 1006 (77.0%) met criteria for depression. Females were 1.5 times more likely to be burned out in comparison to males. For the burnout subscales, males had lower emotional exhaustion, slightly higher depersonalization, and lower personal accomplishment. Lesbian/gay/bisexual/asexual students were 2.62 times more likely to be burned out compared with heterosexual students. Depression and academic, personal, and family stressors were all strongly linked to overall burnout. Finally, for modifiable factors, average hours of sleep, average hours spent studying, and club involvement appeared to be linked to burnout. The current study suggested that a variety of factors, including non-modifiable, situational, and modifiable, impact burnout in osteopathic medical students. Future research is necessary since burnout in physicians affects the quality of care provided to patients.

Factors Affecting the Attractiveness of Medical Tourism Destination: An Empirical Study on India- Review Article

PubMed Central

SULTANA, Seyama; HAQUE, Ahasanul; MOMEN, Abdul; YASMIN, Farzana

2014-01-01

Abstract Background In this edge, medical tourism is not a new idea. Medical treatment is one of the essential demands of human beings and it requires high quality and intensive care. Beside western world, few developing countries are playing key roles as medical tourism destinations. India is one of the leading names among these countries. The purpose of the paper is to find the factors influencing the attractiveness of India as a health tourism destination. Methods The study has found the major contributing factors and their relative importance in the attractiveness of the health tourism destination that is India from consumers’ perspectives by conducting survey with an application of structural equation modelling approach. Results In Indian context, medical tourists consider service quality and cost mostly to select any medical destination. In addition they also give value to the destination competitiveness but tourist attitude is less important in comparison with other factors affecting their destination choice. Since the study has used structural equation modelling approach to test the hypothesis and figure out the relative importance of the factors, the fundamental indices such as Normed Chi square(less than 3), RMSEA (less than 0.08) and CFI (more than 0.90) values show the overall model fit of the proposed model. Conclusion In order to transform a country such as India as an attractive and competitive medical tourist destination in this time of globalization, a step should be taken to control cost ensuring the quality of services. PMID:25909055

Factors affecting the attractiveness of medical tourism destination: an empirical study on India- review article.

PubMed

Sultana, Seyama; Haque, Ahasanul; Momen, Abdul; Yasmin, Farzana

2014-07-01

In this edge, medical tourism is not a new idea. Medical treatment is one of the essential demands of human beings and it requires high quality and intensive care. Beside western world, few developing countries are playing key roles as medical tourism destinations. India is one of the leading names among these countries. The purpose of the paper is to find the factors influencing the attractiveness of India as a health tourism destination. The study has found the major contributing factors and their relative importance in the attractiveness of the health tourism destination that is India from consumers' perspectives by conducting survey with an application of structural equation modelling approach. In Indian context, medical tourists consider service quality and cost mostly to select any medical destination. In addition they also give value to the destination competitiveness but tourist attitude is less important in comparison with other factors affecting their destination choice. Since the study has used structural equation modelling approach to test the hypothesis and figure out the relative importance of the factors, the fundamental indices such as Normed Chi square(less than 3), RMSEA (less than 0.08) and CFI (more than 0.90) values show the overall model fit of the proposed model. In order to transform a country such as India as an attractive and competitive medical tourist destination in this time of globalization, a step should be taken to control cost ensuring the quality of services.

Influence of anti-asthmatic medications on dental caries in children in Slovenia.

PubMed

Samec, Tomi; Amaechi, Bennett Tochukwu; Battelino, Tadej; Krivec, Uroš; Jan, Janja

2013-05-01

OBJECTIVE.  The study investigated the influence of exposure to anti-asthmatic medications and of various factors on the caries prevalence in children in Slovenia. METHODS.  The study population consisted of children aged 2 to 17 years (n = 220) under treatment for asthma, who had used anti-asthmatic medications for at least 1 year; 220 controls were matched for age. Caries status was determined by the number of decayed, missing, and filled surfaces through clinical examination by two calibrated dentists using the International Caries Detection and Assessment System-II scoring criteria. Questionnaires completed by parents and data from the patients' medical records provided information on various confounding factors. RESULTS.  Asthmatic children had significantly higher (P ≤ 0.01) prevalence of caries on primary and permanent teeth in all age groups, and the proportion of caries-free children was significantly smaller (P ≤ 0.05). In multivariate regression analysis, asthma diagnosis, child's age, daily use of inhaled glucocorticoids, length and frequency of medicine application, spacer use, mouth rinsing with water after medicine application, parents' education, frequent food and drink consumption, and frequency of toothbrushing were associated with caries experience of asthmatic children. CONCLUSION.  Children with asthma who had used anti-asthmatic medications had higher caries experience in primary and permanent teeth. © 2012 John Wiley & Sons Ltd, BSPD and IAPD.

Patient and medication factors associated with preventable medication waste and possibilities for redispensing.

PubMed

Bekker, C L; van den Bemt, B J F; Egberts, A C G; Bouvy, M L; Gardarsdottir, H

2018-05-02

Background Knowledge on factors related to preventable medication waste and waste-reducing interventions, including redispensing unused medications, is needed to maximise effectiveness. Objective To assess patient and medication factors associated with preventable medication waste and possibilities for redispensing unused medications. Setting Dutch community pharmacies. Methods In this cross-sectional study, pharmacy-staff registered patient and medication characteristics of prescription medications returned to 41 Dutch community pharmacies during 1 week in 2014. Medications were classified as preventable waste if the remaining amount could have been prevented and as theoretically eligible for redispensing if the package was unopened, undamaged and ≥ 6 months until the expiry date. Associations were analysed using multivariate logistic regression. Main outcome measures Proportion of medications classified as preventable waste and as eligible for redispensing, including factors associated with these medications. Results Overall, 279 persons returned 759 (low-cost) medications, and 39.3% was classified as preventable waste. These medications were more frequently used by men than women (OR; 1.7[1.2-2.3]) and by older (> 65 years) than younger patients (OR; 1.4[1.0-2.0]). Medications dispensed for longer periods were more often unnecessary wasted (1-3 months OR; 1.8[1.1-3.0], > 3 months 3.2[1.5-6.9]). Of all returned medications, 19.1% was eligible for redispensing. These medications were more frequently used by men than women (OR; 1.9[1.3-2.9]). Medications chronically used were more frequently eligible for redispensing than acute use (OR; 2.1[1.0-4.3]), and used for longer periods (1-3 months OR; 4.6[2.3-8.9], > 3 months 7.8[3.3-18.5]). Conclusions Over one-third of waste due to medications returned to community pharmacies can be prevented. One-fifth of returned medications can be redispensed, but this seems less interesting from an economic

Design of admission medication reconciliation technology: a human factors approach to requirements and prototyping.

PubMed

Lesselroth, Blake J; Adams, Kathleen; Tallett, Stephanie; Wood, Scott D; Keeling, Amy; Cheng, Karen; Church, Victoria L; Felder, Robert; Tran, Hanna

2013-01-01

Our objectives were to (1) develop an in-depth understanding of the workflow and information flow in medication reconciliation, and (2) design medication reconciliation support technology using a combination of rapid-cycle prototyping and human-centered design. Although medication reconciliation is a national patient safety goal, limitations both of physical environment and in workflow can make it challenging to implement durable systems. We used several human factors techniques to gather requirements and develop a new process to collect a medication history at hospital admission. We completed an ethnography and time and motion analysis of pharmacists in order to illustrate the processes used to reconcile medications. We then used the requirements to design prototype multimedia software for collecting a bedside medication history. We observed how pharmacists incorporated the technology into their physical environment and documented usability issues. Admissions occurred in three phases: (1) list compilation, (2) order processing, and (3) team coordination. Current medication reconciliation processes at the hospital average 19 minutes to complete and do not include a bedside interview. Use of our technology during a bedside interview required an average of 29 minutes. The software represents a viable proof-of-concept to automate parts of history collection and enhance patient communication. However, we discovered several usability issues that require attention. We designed a patient-centered technology to enhance how clinicians collect a patient's medication history. By using multiple human factors methods, our research team identified system themes and design constraints that influence the quality of the medication reconciliation process and implementation effectiveness of new technology. Evidence-based design, human factors, patient-centered care, safety, technology.

Factors influencing medication knowledge and beliefs on warfarin adherence among patients with atrial fibrillation in China.

PubMed

Zhao, Shujuan; Zhao, Hongwei; Wang, Xianpei; Gao, Chuanyu; Qin, Yuhua; Cai, Haixia; Chen, Boya; Cao, Jingjing

2017-01-01

Warfarin is often used for ischemic stroke prevention in patients with atrial fibrillation (AF), but the factors affecting patient adherence to warfarin therapy have not been fully understood. A cross-sectional survey was conducted in AF patients undergoing warfarin therapy at least 6 months prior to the study. The clinical data collected using questionnaires by phone interviews included the following: 1) self-reported adherence measured by the Morisky Medication Adherence Scale-8 © ; 2) beliefs about medicines surveyed by Beliefs about Medicines Questionnaire (BMQ); and 3) drug knowledge as measured by the Warfarin Related Knowledge Test (WRKT). Demographic and clinical factors associated with warfarin adherence were identified using a logistic regression model. Two hundred eighty-eight patients completed the survey and 93 (32.3%) of them were classified as nonadherent (Morisky Medication Adherence Scale-8 score <6). Major factors predicting warfarin adherence included age, cardiovascular disorders, WRKT, and BMQ; WRKT and BMQ were independently correlated with adherence to warfarin therapy by multivariate logistic regression analysis. Adherents were more likely to have greater knowledge scores and stronger beliefs in the necessity of their specific medications ([odds ratio {OR} =1.81, 95% confidence interval {CI} =1.51-2.15] and [OR =1.17, 95% CI =1.06-1.29], respectively). Patients with greater concerns about adverse reactions and more negative views of general harm were more likely to be nonadherent ([OR =0.76, 95% CI =0.69-0.84] and [OR =0.82, 95% CI =0.73-0.92], respectively). BMK and WRKT are related with patient behavior toward warfarin adherence. BMQ can be applied to identify patients at increased risk of nonadherence.

Influence of Course in Medical Ethics and Law on Career Plans of Medical Students

ERIC Educational Resources Information Center

Cheng, Shi-Yann; Lin, Lih-Hwa; Kao, Chung-Han; Chan, Tzu-Min

2015-01-01

Background: The significant increase in medical disputes and lawsuits in recent years in Taiwan has severely affected behavior and ecology in medical practice. For this reason, we designed integrated courses on ethics and law and conducted a questionnaire-based career plan study to understand whether these issues influence their specialty…

Treatment decision-making by men with localized prostate cancer: the influence of personal factors.

PubMed

Berry, Donna L; Ellis, William J; Woods, Nancy Fugate; Schwien, Christina; Mullen, Kristin H; Yang, Claire

2003-01-01

For many men with localized prostate cancer, there is no definite answer or unequivocal choice regarding treatment modality. This high-stakes treatment decision is made in the context of great uncertainty. The purpose of this study is to systematically document meaningful and relevant aspects of treatment decision-making reported by men with localized prostate cancer. Focus groups and individual interviews were conducted with 44 men who were within 6 months of a diagnosis of localized prostate cancer. Using content analysis and grounded theory analytic techniques, major aspects and processes of men's treatment decision making are identified and described. The participants reported their experiences beginning with influential personal history factors, followed by detailed descriptions of information gathering and the important influence of expected treatment outcomes and other individuals' cancer histories and/or shared opinions. Twenty of the 44 (45%) participants relied heavily on the influence of another's opinion or history to finalize a decision, yet only 10 of the 44 (22.7%) reported this individual to be their physician. A common process, "making the best choice for me" was explicated. Clinicians assume that men are making rational treatment decisions based on reliable information, yet this study documents a different reality. Patient education about medical therapies and the patients' own medical factors is not enough. A clinic visit dialogue that brings personal factors to the conversation along with medical factors can guide a man to making his "best choice" for localized prostate cancer.

[Natural factors influencing sleep].

PubMed

Jurkowski, Marek K; Bobek-Billewicz, Barbara

2007-01-01

Sleep is a universal phenomenon of human and animal lives, although the importance of sleep for homeo-stasis is still unknown. Sleep disturbances influence many behavioral and physiologic processes, leading to health complications including death. On the other hand, sleep improvement can beneficially influence the course of healing of many disorders and can be a prognostic of health recovery. The factors influencing sleep have different biological and chemical origins. They are classical hormones, hypothalamic releasing and inhibitory hormones, neuropeptides, peptides and others as cytokines, prostaglandins, oleamid, adenosine, nitric oxide. These factors regulate most physiologic processes and are likely elements integrating sleep with physiology and physiology with sleep in health and disorders.

[Case-control study on influence factors of birth defects].

PubMed

Xiu, Xin-hong; Yuan, Li; Wang, Xiao-ming; Chen, Yu-hua; Wan, Ai-hua; Fu, Ping

2011-07-01

To investigate the influence factors of birth defects. The congenital malformational fetuses born from 13 week of gestation to 7 days after birth were selected as the study group between April 1st, 2009 and March 31st, 2010. The health born fetuses were set as control in the same period. Case-control and the three-level of monitor network of birth defects were used in the study in the participating 75 hospitals (Qingdao Women and Children's Medical Center, Affiliated Hospital of Medical College Qingdao University, Qingdao Municipal Hospital, etc.). The study and control group's parents were interviewed by an uniformed questionnaire which was designed specially with influence factors of birth defects. (1) There are 466 congenital malformational fetuses in the total of 77 231 fetuses collected in 75 hospitals. The congenital malformational rate accounts for about 6.034‰. The top six defect diseases were congenital heart disease (112 cases), total harelip (cleft lip; cleft lip with palate: 85 cases), polydactyly (53 cases), neural tube defects (38 cases), congenital hydrocephalus (37 cases) and limb reduction defect (27 cases) in turn, which amounts to 353 cases (54.48%, 353/648). (2) Their mother education level in the birth-defect group (25.6%) were significantly lower than that in control group (30.0%, P<0.05). (3) The rate of passive smoking, drinking, raising pets of the parents in birth-defect group were significantly higher than that in control group (P<0.05). (4) The rate of exposure to harmful chemical and physical factors of mothers in birth defects group (13.9% and 20.5%, respectively) was higher than that in control group (1.1% and 11.7%, respectively), the difference between which were significant (P<0.01). The rate of disease (34.3%), fever (13.1%), taking drugs (33.8%) in pregnancy period in birth defect group were higher than that in control group (13.5%, 1.5% and 9.9%, respectively), the difference between which were significant (P<0.01). The rate

A cross-sectional study of sociodemographic factors and their influence on quality of life in medical students at Sao Paulo, Brazil.

PubMed

Serinolli, Mario Ivo; Novaretti, Marcia Cristina Zago

2017-01-01

Various sociodemographic factors can affect the quality of life of medical students and interfere in their ability to study. A deeper understanding of these factors may facilitate improvements in learning and retention of medical students. We conducted a cross-sectional study of 405 medical students, representing 65.3% of the total student body (years 1-6), at a private medical school in São Paulo, Brazil. Among the entire study group, 177 students (43.7%) were male, and 228 (56.3%) were female. The mean age was 23.55 years (SD = 3.98 years, range: 18-40). The World Health Organization Quality of Life-Biomedical Research and Education Facility (WHOQOL-BREF) scale was used to evaluate the following sociodemographic factors: age, sex, academic year, daily traveling time, housing conditions, smoking, weight, height, participant's and his/her parents' education background, students who had a degree or not and religious beliefs. The reliability of the WHOQOL-BREF was evaluated using Cronbach's analysis, and the association of sociodemographic factors with quality of life was examined using multivariate regression analysis. Quality of life was significantly higher in medical students with religious beliefs (β 0.14 for psychological domain; β 0.11 for environmental domain) when compared with that in those with no religious beliefs. BMI was negative associated with QOL in medical students (β -0.11 for physical domain; β -18.9 for the psychological domain). In both male and female students, longer daily traveling time was negative related to QOL (β -0.11 for environmental domain). Having at least one parent who was a doctor was associated with a better quality of life (β 0.17 for environmental domain). Male students presented with significantly higher mean scores for three of the four domains evaluated (β 0.20 for physical domain; β 0.25 for psychological domain; β 0.14 for social domain). This study has provided novel insights into the effects of sociodemographic

Factors Motivating Medical Students in Selecting a Career Specialty: Relevance for a Robust Orthopaedic Pipeline.

PubMed

Rao, Raj D; Khatib, Omar N; Agarwal, Arnav

2017-07-01

Selection of a career specialty by medical students is a complex and individualized decision. Our goals were to understand the factors that influenced medical students in selecting their career specialty, identify the stage at which this decision was made, and understand the role of demographics, mentors, and curricula in this process. Medical students from 10 institutions participated in a web-based survey. Results were stratified by sex, race/ethnicity, and level of interest in orthopaedic surgery. A total of 657 students responded to the survey. Specialty content (mean rating, 8.4/10) and quality of life/lifestyle/stress level (7.5/10) were the primary motivating factors in selecting a specialty. Interest in orthopaedic surgery was lower in women than in men (2.7 versus 3.9; P < 0.01) and was equivalent among race/ethnicity groups. Although 27% of students reported moderate or extensive medical school curriculum exposure to orthopaedics, this education did not sway them toward the specialty. Levels of interest in orthopaedics among medical students may be lower than generally assumed. Increasing the attractiveness of the specialty will require a multifaceted approach, including recognition of lifestyle factors, adjustments in the orthopaedic clerkship to make the specialty more appealing, mentorship by orthopaedic faculty, and conversion of high levels of interest in the specialty among minority medical students into successful residency applications. IV.

Finding the Perfect Match: Factors That Influence Family Medicine Residency Selection.

PubMed

Wright, Katherine M; Ryan, Elizabeth R; Gatta, John L; Anderson, Lauren; Clements, Deborah S

2016-04-01

Residency program selection is a significant experience for emerging physicians, yet there is limited information about how applicants narrow their list of potential programs. This study examines factors that influence residency program selection among medical students interested in family medicine at the time of application. Medical students with an expressed interest in family medicine were invited to participate in a 37-item, online survey. Students were asked to rate factors that may impact residency selection on a 6-point Likert scale in addition to three open-ended qualitative questions. Mean values were calculated for each survey item and were used to determine a rank order for selection criteria. Logistic regression analysis was performed to identify factors that predict a strong interest in urban, suburban, and rural residency programs. Logistic regression was also used to identify factors that predict a strong interest in academic health center-based residencies, community-based residencies, and community-based residencies with an academic affiliation. A total of 705 medical students from 32 states across the country completed the survey. Location, work/life balance, and program structure (curriculum, schedule) were rated the most important factors for residency selection. Logistic regression analysis was used to refine our understanding of how each factor relates to specific types of residencies. These findings have implications for how to best advise students in selecting a residency, as well as marketing residencies to the right candidates. Refining the recruitment process will ensure a better fit between applicants and potential programs. Limited recruitment resources may be better utilized by focusing on targeted dissemination strategies.

A survey-based study of factors that motivate nurses to protect the privacy of electronic medical records.

PubMed

Ma, Chen-Chung; Kuo, Kuang-Ming; Alexander, Judith W

2016-02-02

The purpose of this study is to investigate factors that motivate nurses to protect privacy in electronic medical records, based on the Decomposed Theory of Planned Behavior. This cross-sectional study used questionnaires to collect data from nurses in a large tertiary care military hospital in Taiwan. The three hundred two (302) valid questionnaires returned resulted in a response rate of 63.7 %. Structural equation modeling identified that the factors of attitude, subjective norm, and perceived behavioral control of the nurses significantly predicted the nurses' intention to protect the privacy of electronic medical records. Further, perceived usefulness and compatibility, peer and superior influence, self-efficacy and facilitating conditions, respectively predicted these three factors. The results of our study may provide valuable information for education and practice in predicting nurses' intention to protect privacy of electronic medical records.

The role of audience characteristics and external factors in continuing medical education and physician change: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.

PubMed

Lowe, Mary Martin; Bennett, Nancy; Aparicio, Alejandro

2009-03-01

The Agency for Healthcare Research and Quality (AHRQ) Evidence Report identified and assessed audience characteristics (internal factors) and external factors that influence the effectiveness of continuing medical education (CME) in changing physician behavior. Thirteen studies examined a series of CME audience characteristics (internal factors), and six studies looked at external factors to reinforce the effects of CME in changing behavior. With regard to CME audience characteristics, the 13 studies examined age, gender, practice setting, years in practice, specialty, foreign vs US medical graduate, country of practice, personal motivation, nonmonetary rewards and motivations, learning satisfaction, and knowledge enhancement. With regard to the external characteristics, the six studies looked at the role of regulation, state licensing boards, professional boards, hospital credentialing, external audits, monetary and financial rewards, academic advancement, provision of tools, public demand and expectations, and CME credit. No consistent findings were identified. The AHRQ Evidence Report provides no conclusions about the ways that internal or external factors influence CME effectiveness in changing physician behavior. However, given what is known about how individuals approach learning, it is likely that internal factors play an important role in the design of effective CME. Regulatory and professional organizations are providing new structures, mandates, and recommendations for CME activities that influence the way CME providers design and present activities, supporting a role that is not yet clear for external factors. More research is needed to understand the impact of these factors in enhancing the effectiveness of CME.

Medication-related risk factors associated with health-related quality of life among community-dwelling elderly in China.

PubMed

Zhang, Sha; Meng, Long; Qiu, Feng; Yang, Jia-Dan; Sun, Shusen

2018-01-01

Previous studies have demonstrated that medication adherence has an impact on health-related quality of life (HRQoL). However, other medication-related factors that may influence HRQoL have not been extensively studied, especially factors based on the Medication-Risk Questionnaire (MRQ), and such studies are mostly done in Western countries. Our objective was to explore risk factors associated with HRQoL among community-dwelling elderly with chronic diseases in mainland China, especially the medication-related risk factors regarding MRQ. The study was conducted in a community health service center through surveys to eligible patients. The main outcomes of HRQoL were assessed by the EuroQol-5D (EQ-5D) scale and EQ-visual analog scale (EQ-VAS). Medication-related risk factors according to MRQ associated with HRQoL were identified using a multiple linear regression. A total of 311 patients were analyzed, averaging 71.19±5.33 years, and 68.8% were female. The mean EQ-5D index was 0.72±0.09, and the mean EQ-VAS score was 71.37±11.97. The most prevalent problem was pain/discomfort, and 90.0% believed that they could take care of themselves without any problems. Sex, age, educational level, frailty, function status, and certain medication-related factors regarding MRQ were found to be significant factors impacting the HRQoL. A multivariate analysis showed that MRQ factors of polypharmacy, multimorbidity, feeling difficultly with taking medicines as prescribed, and taking medicines with narrow therapeutic index had negative impacts on the quality of life. Patient's internal characteristics and medication-related risk factors according to MRQ were associated with quality of life. The results of the MRQ is an indicator of quality of life that can identify patients who need interventions.

Short report: factors that affect specialty choice and career plans of Wisconsin's medical students.

PubMed

Knox, Kjersti E; Getzin, Anne; Bergum, Alison; McBride, Patrick; Rieselbach, Richard; Friedsam, Donna

2008-12-01

To identify factors that influence specialty choice among Wisconsin medical students and provide insight into approaches to encourage more students to pursue careers in primary care. The importance of several factors in medical student career choice was surveyed using a Web survey convenience sample of all Wisconsin medical students. Students intending to pursue a career in primary care and in other specialties were compared. Respondents, regardless of specialty choice or gender, identified a similar group of factors as highly influential, and similar group of factors as non-influential in their decision-making. However, significantly more primary care students than other specialty students considered interest in underserved populations, relationships with patients, scope of practice, and role models important in their career choice. Significantly more primary care students than other specialty students responded that salary and competitiveness were "not at all" important. A greater number of other specialty students than primary care students stated that interest in scope of practice, role models, and training years were "not at all" important. Debt-related factors were reported as "not at all" important by nearly one-third of respondents. Although primary care and other specialty students report making their career plans based on the impact of similar factors, significant differences between primary care and other specialty students were reported in key areas. These results validate many previously reported factors, and indicate that salary and years of training may have been overemphasized in understanding student career choice. The results of this survey may be useful for Wisconsin medical schools in order to sustain, support, and foster student interest in primary care.

Factors influencing medication knowledge and beliefs on warfarin adherence among patients with atrial fibrillation in China

PubMed Central

Zhao, Shujuan; Zhao, Hongwei; Wang, Xianpei; Gao, Chuanyu; Qin, Yuhua; Cai, Haixia; Chen, Boya; Cao, Jingjing

2017-01-01

Objectives Warfarin is often used for ischemic stroke prevention in patients with atrial fibrillation (AF), but the factors affecting patient adherence to warfarin therapy have not been fully understood. Methods A cross-sectional survey was conducted in AF patients undergoing warfarin therapy at least 6 months prior to the study. The clinical data collected using questionnaires by phone interviews included the following: 1) self-reported adherence measured by the Morisky Medication Adherence Scale-8©; 2) beliefs about medicines surveyed by Beliefs about Medicines Questionnaire (BMQ); and 3) drug knowledge as measured by the Warfarin Related Knowledge Test (WRKT). Demographic and clinical factors associated with warfarin adherence were identified using a logistic regression model. Results Two hundred eighty-eight patients completed the survey and 93 (32.3%) of them were classified as nonadherent (Morisky Medication Adherence Scale-8 score <6). Major factors predicting warfarin adherence included age, cardiovascular disorders, WRKT, and BMQ; WRKT and BMQ were independently correlated with adherence to warfarin therapy by multivariate logistic regression analysis. Adherents were more likely to have greater knowledge scores and stronger beliefs in the necessity of their specific medications ([odds ratio {OR} =1.81, 95% confidence interval {CI} =1.51–2.15] and [OR =1.17, 95% CI =1.06–1.29], respectively). Patients with greater concerns about adverse reactions and more negative views of general harm were more likely to be nonadherent ([OR =0.76, 95% CI =0.69–0.84] and [OR =0.82, 95% CI =0.73–0.92], respectively). Conclusion BMK and WRKT are related with patient behavior toward warfarin adherence. BMQ can be applied to identify patients at increased risk of nonadherence. PMID:28223782

The influence of non-clinical patient factors on medical oncologists' decisions to recommend breast cancer adjuvant chemotherapy.

PubMed

Pini, T May; Hawley, Sarah T; Li, Yun; Katz, Steven J; Griggs, Jennifer J

2012-07-01

The extent to which medical oncologists consider non-clinical patient factors when deciding to recommend adjuvant chemotherapy is unknown. Medical oncologists who treated a population-based sample of early stage breast cancer patients reported to the Los Angeles and Detroit Surveillance, Epidemiology, and End Results registries 2005-2007 were asked how strongly they consider a patient's ability to follow instructions, level of social support, and level of work support/flexibility in decisions to recommend adjuvant chemotherapy. Responses of 4 (Quite strongly) or 5 (Very strongly) on a five-point Likert scale defined strong consideration. Associations between oncologist/practice characteristics and strong consideration of each non-clinical factor were examined. 134 oncologists (66 %) reported strong consideration of one or more factor. Ability to follow instructions was strongly considered by 120 oncologists (59 %), social support by 78 (38 %), and work support/flexibility by 73 (36 %). Larger percent of practice devoted to breast cancer was associated with lower likelihood of strongly considering ability to follow instructions [odds ratio (OR) 0.98, 95 % confidence interval (CI) 0.97-0.99; P = 0.04]. Increased years in practice was associated with lower likelihood of strongly considering social support (OR 0.96, CI 0.93-0.99; P = 0.011), while non-white race (OR 2.1, CI 1.03-4.26; P = 0.041) and tumor board access (OR 2.04, CI 1.01-4.12; P = 0.048) were associated with higher likelihood. Non-white race was associated with strongly considering work support/flexibility (OR 2.44, CI 1.21-4.92; P = 0.013). Tumor board access (OR 2, CI 1.00-4.02; P = 0.051) was borderline significant. Non-clinical patient factors play a role in medical oncologist decision-making for breast cancer adjuvant chemotherapy recommendations.

Opting for rural practice: the influence of medical student origin, intention and immersion experience.

PubMed

Playford, Denese; Ngo, Hanh; Gupta, Surabhi; Puddey, Ian B

2017-08-21

To compare the influence of rural background, rural intent at medical school entry, and Rural Clinical School (RCS) participation on the likelihood of later participation in rural practice. Analysis of linked data from the Medical School Outcomes Database Commencing Medical Students Questionnaire (CMSQ), routinely collected demographic information, and the Australian Health Practitioner Regulation Agency database on practice location. University of Western Australia medical students who completed the CMSQ during 2006-2010 and were practising medicine in 2016. Medical practice in rural areas (ASGC-RAs 2-5) during postgraduate years 2-5. Full data were available for 508 eligible medical graduates. Rural background (OR, 3.91; 95% CI, 2.12-7.21; P < 0.001) and experience in an RCS (OR, 1.93; 95% CI, 1.05-3.54; P = 0.034) were significant predictors of rural practice in the multivariate analysis of all potential factors. When interactions between intention, origin, and RCS experience were included, RCS participation significantly increased the likelihood of graduates with an initial rural intention practising in a rural location (OR, 3.57; 95% CI, 1.25-10.2; P = 0.017). The effect of RCS participation was not significant if there was no pre-existing intention to practise rurally (OR, 1.38; 95% CI, 0.61-3.16; P = 0.44). For students who entered medical school with the intention to later work in a rural location, RCS experience was the deciding factor for realising this intention. Background, intent and RCS participation should all be considered if medical schools are to increase the proportion of graduates working rurally.

How does patient-provider communication influence adherence to asthma medications?

PubMed

Young, Henry N; Len-Rios, Maria E; Brown, Roger; Moreno, Megan M; Cox, Elizabeth

2017-04-01

To assess hypothesized pathways through which patient-provider communication impacts asthma medication adherence. A national sample of 452 adults with asthma reported assessments of patient-provider communication, proximal outcomes (understanding of asthma self-management, patient-provider agreement, trust in the clinician, involvement in care, motivation), and adherence to asthma medications. Structural equation modeling was used to examine hypothesized pathways. Significantly positive direct pathways were found between patient-provider communication and all proximal outcomes. Only positive indirect pathways, operating through trust and motivation, were found between patient-provider communication and medication adherence. Patient-provider communication influences many desirable proximal outcomes, but only influences adherence through trust and motivation. To promote better adherence to asthma medication regimens and, ultimately positive asthma outcomes, healthcare providers can focus on implementing communication strategies that strengthen patients' trust and increase patient motivation to use asthma medications. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Career motivation and burnout among medical students in Hungary - could altruism be a protection factor?

PubMed

Győrffy, Zsuzsa; Birkás, Emma; Sándor, Imola

2016-07-18

Burnout is a major issue among medical students. Its general characteristics are loss of interest in study and lack of motivation. A study of the phenomenon must extend beyond the university environment and personality factors to consider whether career choice has a role in the occurrence of burnout. Quantitative, national survey (n = 733) among medical students, using a 12-item career motivation list compiled from published research results and a pilot study. We measured burnout by the validated Hungarian version of MBI-SS. The most significant career choice factor was altruistic motivation, followed by extrinsic motivations: gaining a degree, finding a job, accessing career opportunities. Lack of altruism was found to be a major risk factor, in addition to the traditional risk factors, for cynicism and reduced academic efficacy. Our study confirmed the influence of gender differences on both career choice motivations and burnout. The structure of career motivation is a major issue in the transformation of the medical profession. Since altruism is a prominent motivation for many women studying medicine, their entry into the profession in increasing numbers may reinforce its traditional character and act against the present trend of deprofessionalization.

Medical students' attitudes towards general practice and factors affecting career choice: a questionnaire study

PubMed Central

Garnham, Laura

2014-01-01

Background The current issue of general practice recruitment is a significant challenge and concern. In order to address this, it is vital to understand medical students' attitudes towards general practice and what influences their choice of intended career. Method We used a questionnaire study to examine these attitudes across all years at Imperial College Medical School and to understand what a group of London medical students' current intended career choices were. Results We found that only 13% of students ranked general practice as their first choice career despite having a generally realistic and positive attitude towards the speciality. They highlighted that the main influence on future career choice was interest in the specific speciality and that lifestyle factors did not seem to be so important. Conclusion Exposure to general practice, primary care research and student GP societies might play some part in increasing interest, but more work is needed to understand why students are rejecting general practice and what we can do collectively to attract students into choosing a career in primary care. PMID:25949732

Determinate factors of mental health status in Chinese medical staff: A cross-sectional study.

PubMed

Zhou, Chenyu; Shi, Lei; Gao, Lei; Liu, Wenhui; Chen, Zhenkang; Tong, Xinfa; Xu, Wen; Peng, Boshi; Zhao, Yan; Fan, Lihua

2018-03-01

Numerous previous studies have investigated the mental health status of medical staff in China and explored its associated determinate factors; however, scope and methods associated with these have introduced uncertainty regarding the results. The aim of this study was to perform a comprehensive examination of the mental health status of Chinese medical staff and its relative risk factors based on a cross-sectional survey.We conducted a broad area, cross-sectional, questionnaire-based survey of Chinese medical workers. Participants were randomly selected from 27 hospitals in the Heilongjiang province. The questionnaire that was distributed consisted of 5 parts: the demographic characteristics of the participant; questions related to the relative risk factors of psychological health; the posttraumatic stress disorder (PTSD) Checklist-Civilian Version (PCL-C); the Self-rating Depression Scale (SDS); and the Self-rating Anxiety Scale (SAS). The last 3 components were used to evaluate the mental health status of the target population. Logistic and linear regression were used to analyze the determinate factors of the mental health status of Chinese medical staff.Of the 1679 questionnaires distributed, 1557 medical workers responded (response rate: 92.73%; male: 24.1%; female 75.9%). The results of mental health status self-assessments indicated that 32.3% of participants were considered to have some degree of PTSD (based on the PCL-C). The SDS index was 0.67 and the mean score from SAS was 55.26; a result higher than found in the general population. Multivariate logistic regression analysis revealed that being female, dissatisfaction or average satisfaction with income, and good or very good self-perceived psychological endurance when faced with an emergency were associated with a reduction of PTSD symptoms. A frequency of verbal abuse incidents greater than 4 was associated with an increase in PTSD symptoms.The mental health status of Chinese medical staff is poor

A cross-sectional study of sociodemographic factors and their influence on quality of life in medical students at Sao Paulo, Brazil

PubMed Central

2017-01-01

Background Various sociodemographic factors can affect the quality of life of medical students and interfere in their ability to study. A deeper understanding of these factors may facilitate improvements in learning and retention of medical students. Methods We conducted a cross-sectional study of 405 medical students, representing 65.3% of the total student body (years 1–6), at a private medical school in São Paulo, Brazil. Among the entire study group, 177 students (43.7%) were male, and 228 (56.3%) were female. The mean age was 23.55 years (SD = 3.98 years, range: 18–40). The World Health Organization Quality of Life-Biomedical Research and Education Facility (WHOQOL-BREF) scale was used to evaluate the following sociodemographic factors: age, sex, academic year, daily traveling time, housing conditions, smoking, weight, height, participant’s and his/her parents’ education background, students who had a degree or not and religious beliefs. The reliability of the WHOQOL-BREF was evaluated using Cronbach’s analysis, and the association of sociodemographic factors with quality of life was examined using multivariate regression analysis. Main Results Quality of life was significantly higher in medical students with religious beliefs (β 0.14 for psychological domain; β 0.11 for environmental domain) when compared with that in those with no religious beliefs. BMI was negative associated with QOL in medical students (β -0.11 for physical domain; β -18.9 for the psychological domain). In both male and female students, longer daily traveling time was negative related to QOL (β -0.11 for environmental domain). Having at least one parent who was a doctor was associated with a better quality of life (β 0.17 for environmental domain). Male students presented with significantly higher mean scores for three of the four domains evaluated (β 0.20 for physical domain; β 0.25 for psychological domain; β 0.14 for social domain). Conclusion This study has

Factors associated with the choice of general medicine as a career among Japanese medical students

PubMed Central

Kawamoto, Ryuichi; Ninomiya, Daisuke; Kasai, Yoshihisa; Kusunoki, Tomo; Ohtsuka, Nobuyuki; Kumagi, Teru; Abe, Masanori

2016-01-01

Background In Japan, there is a shortage of young physicians in various specialties; the present situation of general medicine or family medicine (GM/FM) in particular is risky. The factors influencing the career choice of Japanese medical students are poorly understood. This study aims to identify factors related to choosing GM/FM as a career. Methods The study was designed as a cross-sectional survey. Students at one medical school in Japan filled out a questionnaire. Students were asked to state their intended medical specialty, and they rated the importance of specific individual and occupational aspects using a 4-point likert scale. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbach‘s alpha coefficients; biserial correlations between the factors and career choices were calculated. Furthermore, multiple linear regression analysis was performed using career choice (GM/FM vs. others) as the criterion variable and the factors plus demographic characteristics as confounding variables. Results Factor analysis produced six factors that explained future career plans. Medical students in this study had a positive and realistic idea about GM/FM, but only 18.8% of them chose GM/FM first as a career. The significant variables associated with choosing GM/FM first as a career were: ‘Admission from hometown’ (β=0.189, P=0.001), ‘Student preparing for the entrance exam’ (β=0.172; P=0.001), ‘Intent for rural practice’ (β=0.123, P=0.016), and ‘Work–life balance’ (β=0.126, P=0.013). While significant variables that were negatively associated with choosing GM/FM were ‘Presence of medical relatives’ (β=−0.107, P=0.037) and ‘Scientific orientation’ (β=−0.125, P=0.013). Conclusions Strategies have been suggested, such as recruiting medical students with significant variables that were associated with choosing GM/FM first as a career. By engaging students early in their choice of career

Factors associated with the choice of general medicine as a career among Japanese medical students.

PubMed

Kawamoto, Ryuichi; Ninomiya, Daisuke; Kasai, Yoshihisa; Kusunoki, Tomo; Ohtsuka, Nobuyuki; Kumagi, Teru; Abe, Masanori

2016-01-01

Background In Japan, there is a shortage of young physicians in various specialties; the present situation of general medicine or family medicine (GM/FM) in particular is risky. The factors influencing the career choice of Japanese medical students are poorly understood. This study aims to identify factors related to choosing GM/FM as a career. Methods The study was designed as a cross-sectional survey. Students at one medical school in Japan filled out a questionnaire. Students were asked to state their intended medical specialty, and they rated the importance of specific individual and occupational aspects using a 4-point likert scale. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbach's alpha coefficients; biserial correlations between the factors and career choices were calculated. Furthermore, multiple linear regression analysis was performed using career choice (GM/FM vs. others) as the criterion variable and the factors plus demographic characteristics as confounding variables. Results Factor analysis produced six factors that explained future career plans. Medical students in this study had a positive and realistic idea about GM/FM, but only 18.8% of them chose GM/FM first as a career. The significant variables associated with choosing GM/FM first as a career were: 'Admission from hometown' (β=0.189, P=0.001), 'Student preparing for the entrance exam' (β=0.172; P=0.001), 'Intent for rural practice' (β=0.123, P=0.016), and 'Work-life balance' (β=0.126, P=0.013). While significant variables that were negatively associated with choosing GM/FM were 'Presence of medical relatives' (β=-0.107, P=0.037) and 'Scientific orientation' (β=-0.125, P=0.013). Conclusions Strategies have been suggested, such as recruiting medical students with significant variables that were associated with choosing GM/FM first as a career. By engaging students early in their choice of career, we may be able to increase

Factors associated with the choice of general medicine as a career among Japanese medical students.

PubMed

Kawamoto, Ryuichi; Ninomiya, Daisuke; Kasai, Yoshihisa; Kusunoki, Tomo; Ohtsuka, Nobuyuki; Kumagi, Teru; Abe, Masanori

2016-01-01

In Japan, there is a shortage of young physicians in various specialties; the present situation of general medicine or family medicine (GM/FM) in particular is risky. The factors influencing the career choice of Japanese medical students are poorly understood. This study aims to identify factors related to choosing GM/FM as a career. The study was designed as a cross-sectional survey. Students at one medical school in Japan filled out a questionnaire. Students were asked to state their intended medical specialty, and they rated the importance of specific individual and occupational aspects using a 4-point likert scale. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbach's alpha coefficients; biserial correlations between the factors and career choices were calculated. Furthermore, multiple linear regression analysis was performed using career choice (GM/FM vs. others) as the criterion variable and the factors plus demographic characteristics as confounding variables. Factor analysis produced six factors that explained future career plans. Medical students in this study had a positive and realistic idea about GM/FM, but only 18.8% of them chose GM/FM first as a career. The significant variables associated with choosing GM/FM first as a career were: 'Admission from hometown' (β=0.189, P=0.001), 'Student preparing for the entrance exam' (β=0.172; P=0.001), 'Intent for rural practice' (β=0.123, P=0.016), and 'Work-life balance' (β=0.126, P=0.013). While significant variables that were negatively associated with choosing GM/FM were 'Presence of medical relatives' (β=-0.107, P=0.037) and 'Scientific orientation' (β=-0.125, P=0.013). Strategies have been suggested, such as recruiting medical students with significant variables that were associated with choosing GM/FM first as a career. By engaging students early in their choice of career, we may be able to increase enthusiasm for this specialty.

Influences on medical student career choice: gender or generation?

PubMed

Sanfey, Hilary A; Saalwachter-Schulman, Alison R; Nyhof-Young, Joyce M; Eidelson, Ben; Mann, Barry D

2006-11-01

We hypothesized that increased enrollment of female medical students and different priorities of the current generation of students would be important influences on the declining interest in surgical careers. Students scored statements on surgical careers on 5-point Likert scales regarding agreement and whether these statements encouraged them to pursue a career in surgery. Data were analyzed using the Mann-Whitney U test. Qualitative comments were iteratively coded using a constant comparative method. Nine US medical schools. A Web-based survey on the Association for Surgical Education server was e-mailed to medical students. A total of 1300 of the 1365 respondents stated their sex. The survey asked questions pertaining to surgical life, surgical residency, surgeons as influence, equity, family, and other influences. A total of 680 (52%) of the 1300 respondents were male. Men and women disagreed about whether surgeons lead well-balanced lives (68% and 77%, respectively) and saw this as a deterrent. A total of 35% of women (3% men; P<.001) were discouraged by a lack of female role models. Compared with students unlikely to study surgery, lower percentages of male (74% vs 65%) and female students (85% vs 58%) likely to study surgery agreed that career choice was influenced by their decision to have a family (P=.01 for men, P<.001 for women). Of medical students who agreed that their skill sets were compatible with surgical careers, similar percentages were likely (30% men vs 24% women) and unlikely (49% men vs 54% women) to study surgery. All differences between men and women were less apparent when students likely to study surgery were compared with students unlikely to study surgery. The decision to have a family was a more significant influence for women than men, but family and lifestyle priorities were also important to male students, supporting our hypothesis that generation and gender are both important influences on career choices.

Premenstrual dysphoric disorder in medical students residing in hostel and its association with lifestyle factors

PubMed Central

Mishra, Amrita; Banwari, Girish; Yadav, Priyanka

2015-01-01

Context: There is scant research on premenstrual syndrome (PMS) and its more severe counterpart, premenstrual dysphoric disorder (PMDD) in Indian females. This study aimed to evaluate symptoms of PMS in medical students and to find the association of sociodemographic variables and lifestyle factors with PMDD. Subjects and Methods: A total of 179 medical students residing in the hostel of an Indian medical college and its affiliated teaching hospital were approached, of which 100 (55.8%) returned the completed questionnaires. Data related to lifestyle factors was collected. Self-screening quiz for Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision PMDD and Shortened Premenstrual Assessment Form were used for diagnosis of PMDD and detection of symptomatology, respectively. Results: PMDD was present in 37% of the respondents. It was found at a higher rate in older and postgraduate students. PMDD was significantly associated with lifestyle factors, namely, sleep, physical activity, total tea/coffee intake, and change in tea/coffee and food intake under stress. The most common physical and psychological symptoms were body ache/joint pain and feeling depressed/blue, respectively. Conclusions: PMDD is fairly common in Indian medical students residing in hostel although cultural factors may influence symptom expression. This study suggests that PMDD is associated with lifestyle factors in young, professional, urban women. Modification in lifestyle may thus be an important approach for management of PMS/PMDD. Prospective studies with larger representative samples are needed to validate these findings. PMID:27212819

Premenstrual dysphoric disorder in medical students residing in hostel and its association with lifestyle factors.

PubMed

Mishra, Amrita; Banwari, Girish; Yadav, Priyanka

2015-01-01

There is scant research on premenstrual syndrome (PMS) and its more severe counterpart, premenstrual dysphoric disorder (PMDD) in Indian females. This study aimed to evaluate symptoms of PMS in medical students and to find the association of sociodemographic variables and lifestyle factors with PMDD. A total of 179 medical students residing in the hostel of an Indian medical college and its affiliated teaching hospital were approached, of which 100 (55.8%) returned the completed questionnaires. Data related to lifestyle factors was collected. Self-screening quiz for Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision PMDD and Shortened Premenstrual Assessment Form were used for diagnosis of PMDD and detection of symptomatology, respectively. PMDD was present in 37% of the respondents. It was found at a higher rate in older and postgraduate students. PMDD was significantly associated with lifestyle factors, namely, sleep, physical activity, total tea/coffee intake, and change in tea/coffee and food intake under stress. The most common physical and psychological symptoms were body ache/joint pain and feeling depressed/blue, respectively. PMDD is fairly common in Indian medical students residing in hostel although cultural factors may influence symptom expression. This study suggests that PMDD is associated with lifestyle factors in young, professional, urban women. Modification in lifestyle may thus be an important approach for management of PMS/PMDD. Prospective studies with larger representative samples are needed to validate these findings.

Factors Influencing the Location of Rural General Practitioners

PubMed Central

Cordes, Sam M.

1978-01-01

Data on (1) personal background, (2) place of medical education and training, (3) reasons for selecting the present place of practice and (4) previous practice location were gathered and analyzed from 41 general practitioners in rural Washington state. The analysis was done to isolate factors influencing the choice of location by physicians. Results show that most of the physicians had spent at least some of their preadulthood years in small communities and that most had some exposure to the state of Washington before establishing their practices in the state. In addition to the apparent importance of previous exposure to small communities and Washington state, the physicians were also influenced in their locational choice by (1) the professional advantages or appeal of the community, (2) recruitment efforts by persons within the community and (3) economic reasons. The physicians were rather immobile. Most had never practiced in another community and only two of the 41 physicians planned to move to another community. PMID:625975

[Burnout-engagement and personality factors in medical students at a public university].

PubMed

Hansen, Gladys V; D'Urso Villar, Marcela; Fracchia, Liliana N

2016-09-01

Medical students can develop burnout syndrome, characterized by exhaustion, cynical attitude towards study and negative consequences on wellbeing and academic performance. Engagement, theoretically syndrome "opposite" to burnout, shows a positive influence on personal and academic performance. To study the association of syndromes burnout and engagement with personality factors in medical students, a longitudinal observational, descriptive study of a cohort follow-up was performed. Three questionnaires were used: reduced inventory NEO Five-Factor (NEO FFI) administered at the beginning of the sixth year; the Maslach Burnout Inventory-Student Survey and Utrecht Work Engagement Scale, applied at the end of the seventh year. 120 students participated. The chance of presenting burnout was 3 times higher when the student had 0.26 times higher neuroticism and high extraversion lower when presented. The chance to present engagement was 10 times higher in students who had high extraversion (Multilevel logistic regression model, p<0.05). It would be important to further research into the mechanisms underlying personality factors could favor the onset of burnout and engagement syndromes, and carry out strategies to prevent the consequences of academic stress on the most vulnerable students.

Factors influencing junior doctors' choices of future specialty: trends over time and demographics based on results from UK national surveys.

PubMed

Smith, Fay; Lambert, Trevor W; Goldacre, Michael J

2015-10-01

To study trends in factors influencing junior doctors' choice of future specialty. Respondents were asked whether each of 15 factors had a great deal of influence on their career choice, a little influence or no influence on it. Percentages are reported of those who specified that a factor had a great deal of influence on their career choice. UK. A total of 15,765 UK-trained doctors who graduated between 1999 and 2012. Questions about career choices and factors which may have influenced those choices, in particular comparing doctors who qualified in 2008-2012 with those who qualified in 1999-2002. Enthusiasm for and commitment to the specialty was a greater influence on career choice in the 2008-2012 qualifiers (81%) than those of 1999-2002 (64%), as was consideration of their domestic circumstances (43% compared with 20%). Prospects for promotion were less important to recent cohorts (16%) than older cohorts (21%), as were financial prospects (respectively, 10% and 14%). Domestic circumstances and working hours were considered more important, and financial prospects less important, by women than men. Inclination before medical school was rated as important by 41% of doctors who were over 30 years old, compared with 13% of doctors who were under 21, at the time of starting medical school. The increasing importance of both domestic circumstances and enthusiasm for their specialty choice in recent cohorts suggest that today's young doctors prize both work-life balance and personal fulfilment at work more highly than did their predecessors. The differences in motivations of older and younger generations of doctors, men and women, and doctors who start medical school relatively late are worthy of note. © The Royal Society of Medicine.

Medical practice in rural Saskatchewan: factors in physician recruitment and retention.

PubMed

Wasko, Kevin; Jenkins, Jacqueline; Meili, Ryan

2014-01-01

The recruitment and retention of physicians in rural communities is a challenge throughout Canada and across the globe. In 1976, a group of medical students profiled rural communities with medical practices and produced a summary report entitled Medical Practice in Saskatchewan. Our objective was to repeat the 1976 study and to identify factors that motivate physicians to select rural locations for practice. Physicians practising in rural Saskatchewan were interviewed in 2011 and 2012. Through qualitative, inductive analysis, we identified themes that drove the recruitment and retention of physicians. Sixty-two physicians were interviewed and 105 communities profiled. Of the physicians interviewed, 21 noted that the ability to practise full-scope family medicine and having the freedom to practise as they desire was important for recruitment, and 43 reported that these factors influenced their decision to remain in a community. Attraction to a rural lifestyle (cited by 17 physicians), having a rural background (13) and having ties to a specific community (12) were important for recruitment. Feeling appreciated by patients (45), one's spouse and/or family enjoying the community (41), and integration into the community (38) were important factors for retention. The decision to practise in a rural location correlates with a desire for a broad and varied scope of practice, being attracted to a rural lifestyle and having rural roots. Once physicians establish a rural practice, they are more likely to stay if they can continue a broad scope of practice, if they feel appreciated by their patients, and if their spouses and family are happy in the community.

Influence of patient-related and surgery-related risk factors on cognitive performance, emotional state, and convalescence after cardiac surgery.

PubMed

Ille, Rottraut; Lahousen, Theresa; Schweiger, Stefan; Hofmann, Peter; Kapfhammer, Hans-Peter

2007-01-01

Cardiac surgery may account for complications such as cognitive impairment, depression, and delay of convalescence. This study investigated the influence of different risk factors on cognitive performance, emotional state, and convalescence. We included 83 patients undergoing cardiac surgery who had no indication of postoperative delirium. Psychometric testing was performed 1 day before and 7 days after surgery. Neuron-specific enolase (NSE) levels were measured 1 day before and 36 h after surgery. Depression score increased after surgery, but patients showed no clinically significant depression. Postoperative cognitive performance correlated with postoperative depression level and preoperative cognitive performance. Forty-three percent of patients showed postoperative decline. Older patients exhibited a higher postoperative increase in NSE concentrations. Patients undergoing coronary artery bypass grafts or combined procedures exhibited more medical risk factors than those undergoing valve surgery alone. The number of bypass grafts was associated with time of hospitalization, and the number of patient-related risk factors correlated with stay in intensive care unit. For elderly patients undergoing cardiac surgery, older age, total preexisting medical risk factors, and surgery duration seem to be the most important factors influencing cognitive outcome and convalescence. Results show that, also for patients without postoperative delirium, medical risk factors and intraoperative parameters can result in delay of convalescence.

Factors affecting registered nurses' use of medication administration technology in acute care settings: A systematic review.

PubMed

San, Tay Hui; Lin, Serena Koh Siew; Fai, Chan Moon

review using a standardised data extraction tool developed by the JBI. Findings were presented in narrative summary due to heterogeneity of the study designs. Six descriptive studies were included in this review. Nurses' use of the technology can be influenced by a combination of complex and inter-related factors, such as organisational factors, and user and system characteristics. In order to successfully implement medication administration technology, system, user and organisational factors have to be collaborated concurrently.Users' needs should be accommodated when designing the system features. Prior to system implementation, institutions should consider the users' demographical characteristics and provide adequate preparations and training. A supportive culture from the institution and colleagues is also important.There is a significant need for further research in this field. Further research to discover potential factors in different settings, locations and countries are suggested. Studies to evaluate nurses' use of the technology at regular intervals are also required.

A unifying framework of the demand for transnational medical travel.

PubMed

Osterle, August; Johnson, Tricia; Delgado, Jose

2013-01-01

Transnational medical travel has gained attention recently as a strategy for patients to obtain care that is higher quality, costs less, or offers improved access relative to care provided within their home countries. This article examines institutional environments in the European Union and United States that influence transnational medical travel, describes the conceptual model of demand for medical travel, and illustrates individual dimensions in the conceptual model of medical travel using a series of case studies. The conceptual model of medical travel is predicated on Andersen's behavioral model of health services. Transnational medical travel is a heterogeneous phenomenon that is influenced by a number of patient-related factors and by the institutional environment in which the patient resides. While cost, access, and quality are commonly cited factors that influence a patient's decision regarding where to seek care, multiple factors may simultaneously influence the decision about the destination for care, including culture, social factors, and the institutional environment. The conceptual framework addresses the patient-related factors that influence where a patient seeks care. This framework can help researchers and regulatory bodies to evaluate the opportunities and the risks of transnational medical travel and help providers and governments to develop international patient programs.

Factors Associated with Undertreatment of Medical Student Depression.

ERIC Educational Resources Information Center

Tjia, Jennifer; Givens, Jane L.; Shea, Judy A.

2005-01-01

The authors measured factors associated with undertreatment of medical students' depression. They administered a cross-sectional Beck Depression Inventory and sociodemographic questionnaire to students at 1 medical school, defining their outcome measure as the use of counseling services or antidepressant medication. Of an estimated 450 available…

Drug consumption among medical students in São Paulo, Brazil: influences of gender and academic year.

PubMed

Oliveira, Lucio Garcia de; Barroso, Lucia Pereira; Wagner, Gabriela Arantes; Ponce, Julio de Carvalho; Malbergier, André; Stempliuk, Vladimir de Andrade; Andrade, Arthur Guerra de

2009-09-01

To analyze alcohol, tobacco and other drug use among medical students. Over a five-year period (1996-2001), we evaluated 457 students at the Universidade de São Paulo School of Medicine, located in São Paulo, Brazil. The students participated by filling out an anonymous questionnaire on drug use (lifetime, previous 12 months and previous 30 days). The influence that gender and academic year have on drug use was also analyzed. During the study period, there was an increase in the use of illicit drugs, especially inhalants and amphetamines, among the medical students evaluated. Drug use (except that of marijuana and inhalants) was comparable between the genders, and academic year was an important influencing factor. Increased inhalant use was observed among the medical students, especially among males and students in the early undergraduate years. This is suggestive of a specific behavioral pattern among medical students. Our findings corroborate those of previous studies. Inhalant use is on the rise among medical students at the Universidade de São Paulo School of Medicine. Because of the negative health effects of illicit drug use, further studies are needed in order to deepen the understanding of this phenomenon and to facilitate the development of preventive measures.

Factors influencing twins and zygosity.

PubMed

Hankins, Gary V D; Saade, George R

2005-01-01

Zygosity is influenced by many factors. Monozygotic twins occur spontaneously in approximately 1 in 250 births and are felt to increase twofold with ovulation induction techniques. Monozygotic twinning also increases in proportion to the number of blastocysts transferred during in vitro fertilisation. In contrast, dizygotic twinning appears to be influenced by race, genetic factors, maternal age, fertility enhancing drugs, folic acid supplementation, and maternal nutritional status.

42 CFR 412.322 - Indirect medical education adjustment factor.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Capital-Related Costs § 412.322 Indirect medical education adjustment factor. (a) Basic data. CMS...] Determination of Transition Period Payment Rates for Capital-Related Costs ... 42 Public Health 2 2010-10-01 2010-10-01 false Indirect medical education adjustment factor. 412...

Human factors and the FDA's goals: improved medical device design.

PubMed

Burlington, D B

1996-01-01

The Food and Drug Administration's new human factors design requirements for medical devices were previewed by the director of the FDA's Center for Devices and Radiological Health (CDRH) at AAMI/FDA's Human Factors in Medical Devices Conference held in September 1995. Director Bruce Burlington, MD, said the FDA plans to take a closer look at how new medical devices are designed to ensure proper attention has been paid to human error prevention. As a medical practitioner who has witnessed use-related deaths and injuries, Burlington stressed the importance of the medical community's reporting use errors as they occur and manufacturers' creating easy-to-use labeling and packaging. He also called for simplicity and quality of design in medical products, and asked for a consolidated effort of all professionals involved in human factors issues to help implement and further the FDA's new human factors program. An edited version of his presentation appears here.

[Associations between dormitory environment/other factors and sleep quality of medical students].

PubMed

Zheng, Bang; Wang, Kailu; Pan, Ziqi; Li, Man; Pan, Yuting; Liu, Ting; Xu, Dan; Lyu, Jun

2016-03-01

To investigate the sleep quality and related factors among medical students in China, understand the association between dormitory environment and sleep quality, and provide evidence and recommendations for sleep hygiene intervention. A total of 555 undergraduate students were selected from a medical school of an university in Beijing through stratified-cluster random-sampling to conduct a questionnaire survey by using Chinese version of Pittsburgh Sleep Quality Index (PSQI) and self-designed questionnaire. Analyses were performed by using multiple logistic regression model as well as multilevel linear regression model. The prevalence of sleep disorder was 29.1%(149/512), and 39.1%(200/512) of the students reported that the sleep quality was influenced by dormitory environment. PSQI score was negatively correlated with self-reported rating of dormitory environment (γs=-0.310, P<0.001). Logistic regression analysis showed the related factors of sleep disorder included grade, sleep regularity, self-rated health status, pressures of school work and employment, as well as dormitory environment. RESULTS of multilevel regression analysis also indicated that perception on dormitory environment (individual level) was associated with sleep quality with the dormitory level random effects under control (b=-0.619, P<0.001). The prevalence of sleep disorder was high in medical students, which was associated with multiple factors. Dormitory environment should be taken into consideration when the interventions are taken to improve the sleep quality of students.

Impact of cardiovascular risk factors on medical expenditure: evidence from epidemiological studies analysing data on health checkups and medical insurance.

PubMed

Nakamura, Koshi

2014-01-01

Concerns have increasingly been raised about the medical economic burden in Japan, of which approximately 20% is attributable to cardiovascular disease, including coronary heart disease and stroke. Because the management of risk factors is essential for the prevention of cardiovascular disease, it is important to understand the relationship between cardiovascular risk factors and medical expenditure in the Japanese population. However, only a few Japanese epidemiological studies analysing data on health checkups and medical insurance have provided evidence on this topic. Patients with cardiovascular risk factors, including obesity, hypertension, and diabetes, may incur medical expenditures through treatment of the risk factors themselves and through procedures for associated diseases that usually require hospitalization and sometimes result in death. Untreated risk factors may cause medical expenditure surges, mainly due to long-term hospitalization, more often than risk factors preventively treated by medication. On an individual patient level, medical expenditures increase with the number of concomitant cardiovascular risk factors. For single risk factors, personal medical expenditure may increase with the severity of that factor. However, on a population level, the medical economic burden attributable to cardiovascular risk factors results largely from a single, particularly prevalent risk factor, especially from mildly-to-moderately abnormal levels of the factor. Therefore, cardiovascular risk factors require management on the basis of both a cost-effective strategy of treating high-risk patients and a population strategy for reducing both the ill health and medical economic burdens that result from cardiovascular disease.

Identification of factors involved in medication compliance: incorrect inhaler technique of asthma treatment leads to poor compliance

PubMed Central

Darbà, Josep; Ramírez, Gabriela; Sicras, Antoni; García-Bujalance, Laura; Torvinen, Saku; Sánchez-de la Rosa, Rainel

2016-01-01

Objective To identify the impact of delivery device of inhaled corticosteroids and long-acting β2-agonist (ICS/LABA) on asthma medication compliance, and investigate other factors associated with compliance. Materials and methods We conducted a retrospective and multicenter study based on a review of medical registries of asthmatic patients treated with ICS/LABA combinations (n=2,213) whose medical devices were either dry powder inhalers (DPIs, such as Accuhaler®, Turbuhaler®, and NEXThaler®) or pressurized metered-dose inhalers (pMDI). Medication compliance included persistence outcomes through 18 months and medication possession ratios. Data on potential confounders of treatment compliance such as asthma exacerbations, comorbidities, demographic characteristics, and health care resource utilization were also explored. Results The probability of asthma medication compliance in case of DPIs was lower compared to pMDIs, which suggests that inhaler devices influence inhalation therapies. There were additional confounding factors that were considered as explanatory variables of compliance. A worse measure of airflow obstruction (forced expiration volume in 1 second), comorbidities and general practitioner (GP) consultations more than once per month decreased the probability of compliance. Within comorbidities, alcoholism was positively associated with compliance. Patients of 29–39, 40–50, and 51–61 age groups or suffering from more than two exacerbations during the study period were more likely to comply with their medication regime. The effects of DPIs toward compliance varied with the different DPIs. For instance, Accuhaler® had a greater negative effect on compliance compared to Turbuhaler® and Nexthaler® in cases of patients who suffered exacerbations. We found that GP consultations reduced the probability of medication compliance for patients treated with formoterol/budesonide combination. For retired patients, visiting the GP increased the

Factors that impact medical student and house-staff career interest in brain related specialties.

PubMed

Kamour, Abdulbaset H; Han, Dong Y; Mannino, David M; Hessler, Amy B; Kedar, Sachin

2016-10-15

There is a national shortage of physicians in brain related specialties (neurology, neurosurgery and psychiatry), with fewer students training in these specialties. This study explored socio-economic and experiential factors that determined medical trainees' interest in brain related specialties. Medical students and house-staff at a state university medical school completed a 46-item questionnaire sent as an anonymous email survey. Survey response rate was 22% (n=258). Eighty-eight (34.1%) trainees were interested in brain related specialties. Prior neuroscience experience (29.6%) and effective medical school neuroscience courses (23.9%) were identified as important by those interested in brain related specialties, while "neurophobia" was reported by 30% of those not interested. Multivariate regression model showed that effective college neuroscience course increased the likelihood for interest in brain related specialties (OR=2.28, 95% CI 1.22, 4.28). Factors which decreased the likelihood included parent's possessing professional degree (OR=0.37, 95% CI 0.17, 0.80), personal annual income>$50,000 (OR=0.40, 0.18, 0.87) and current debt level≥$100,000 (OR=0.33, 0.17, 0.64). The proportion of trainees interested in brain related specialties decreased from 51.7% (1st year medical students) to 27% (4th year students) and 25.3% among house-staff (χ(2) test of trend p=0.001). Socioeconomic (current personal debt and annual income) and experiential factors (college neuroscience course) influence a medical trainee's interest in brain related specialties. Career guidance and improved, better and early exposure to neurosciences may help mitigate trend for decreased interest in brain related specialties. Copyright © 2016 Elsevier B.V. All rights reserved.

Ireland's medical brain drain: migration intentions of Irish medical students.

PubMed

Gouda, Pishoy; Kitt, Kevin; Evans, David S; Goggin, Deirdre; McGrath, Deirdre; Last, Jason; Hennessy, Martina; Arnett, Richard; O'Flynn, Siun; Dunne, Fidelma; O'Donovan, Diarmuid

2015-03-12

To provide the optimum level of healthcare, it is important that the supply of well-trained doctors meets the demand. However, despite many initiatives, Ireland continues to have a shortfall of physicians, which has been projected to persist. Our study aimed to investigate the migration intentions of Irish medical students and identify the factors that influence their decisions in order to design appropriate interventions to sustain the supply of trained doctors in order to maintain a viable medical system. An online cross-sectional survey was undertaken of all Irish medical students studying in the Republic of Ireland. The survey included nominal, ordinal, and scale items to determine migration intentions, factors influencing their decisions, and understanding of the Irish healthcare system. A total of 2 273 medical students responded (37% response rate), of whom 1 519 were classified as Irish medical students (having completed secondary school in Ireland). Of these, 88% indicated they were either definitely migrating or contemplating migrating following graduation or completion of the pre-registration intern year. Forty percent expressed an intention of returning to Ireland within 5 years. The factors most influencing their decision to leave were career opportunities (85%), working conditions (83%), and lifestyle (80%). The migration intentions expressed in this study predict an immediate and severe threat to the sustainability of the Irish healthcare service. Urgent interventions such as providing information about career options and specialty training pathways are required. These must begin in the undergraduate phase and continue in postgraduate training and are needed to retain medical school graduates.

Human Factors in Training: Space Medical Proficiency Training

NASA Technical Reports Server (NTRS)

Byrne, Vicky E.; Barshi, I.; Arsintescu, L.; Connell, E.

2010-01-01

The early Constellation space missions are expected to have medical capabilities very similar to those currently on the Space Shuttle and the International Space Station (ISS). For Crew Exploration Vehicle (CEV) missions to the ISS, medical equipment will be located on the ISS, and carried into CEV in the event of an emergency. Flight surgeons (FS) on the ground in Mission Control will be expected to direct the crew medical officer (CMO) during medical situations. If there is a loss of signal and the crew is unable to communicate with the ground, a CMO would be expected to carry out medical procedures without the aid of a FS. In these situations, performance support tools can be used to reduce errors and time to perform emergency medical tasks. The space medical training work is part of the Human Factors in Training Directed Research Project (DRP) of the Space Human Factors Engineering (SHFE) Project under the Space Human Factors and Habitability (SHFH) Element of the Human Research Program (HRP). This is a joint project consisting of human factors team from the Ames Research Center (ARC) with Immanuel Barshi as Principal Investigator and the Johnson Space Center (JSC). Human factors researchers at JSC have recently investigated medical performance support tools for CMOs on-orbit, and FSs on the ground, and researchers at the Ames Research Center performed a literature review on medical errors. Work on medical training has been conducted in collaboration with the Medical Training Group at the Johnson Space Center (JSC) and with Wyle Laboratories that provides medical training to crew members, biomedical engineers (BMEs), and to flight surgeons under the Bioastronautics contract. One area of research building on activities from FY08, involved the feasibility of just-in-time (JIT) training techniques and concepts for real-time medical procedures. A second area of research involves FS performance support tools. Information needed by the FS during the ISS mission

Medication monitoring attitudes and perceived determinants to offering medication adherence advice to older hypertensive adults: a factorial survey of community pharmacy interns.

PubMed

Dillon, Paul; Smith, Susan M; Gallagher, Paul; Cousins, Gráinne

2018-06-13

Community pharmacy is an ideal setting to monitor medication adherence, however, barriers to pharmacist-led interventions exist. Preparing future pharmacists for enhanced roles may overcome such barriers. Our objective was to identify medication monitoring attitudes and contextual factors that influence adherence monitoring by pharmacy interns to inform educational activities on medication adherence. An online factorial survey of all pharmacy interns (N = 123) in the Republic of Ireland, completing advanced community pharmacy experiential learning in May 2016 was undertaken to evaluate attitudes to medication monitoring and to identify respondent characteristics and contextual factors which influence adherence monitoring of older hypertensive adults during repeat dispensing. The medication monitoring attitude measure (MMAM) was used to evaluate interns' attitudes, and factorial vignette analysis was performed to identify factors influencing behavioural intention to offer adherence advice. There were 121 completed online surveys. Half of interns reported they felt uncomfortable and confrontational discussing adherence with patients. In factorial vignette analysis, higher medication monitoring attitudes resulted in higher likelihood to offer adherence advice; experiential-learning characteristics such as pharmacy ownership-type (nonchain store) and contextual factors including patients being treated for longer and time-pressures had a significant negative influence on pharmacy interns' likelihood to offer adherence advice. Medication monitoring attitudes and contextual factors influenced responses to offer adherence advice in hypothetical scenarios. Ensuring pharmacy students are educated on patterns of adherence and appropriate skills to address nonadherence, and engage in structured programmes to facilitate patient interactions during experiential learning, may improve medication monitoring attitudes and adherence monitoring. © 2018 Royal Pharmaceutical Society.

[Concomitant influence of occupational and social risk factors on health of workers engaged into powder metallurgy].

PubMed

Shur, P Z; Zaĭtseva, N V; Kostarev, V G; Lebedeva-Nesevria, N A; Shliapnikov, D M

2012-01-01

Results of health risk evaluation in workers engaged into powder metallurgy, using complex of hygienic, medical, epidemiologic and sociologic studies, enable to define priority occupational and social risk factors, to assess degree of their influence on the workers' health and to identify occupationally induced diseases.

The Quality of Life of Hemodialysis Patients Is Affected Not Only by Medical but also Psychosocial Factors: a Canonical Correlation Study.

PubMed

Kim, Kyungmin; Kang, Gun Woo; Woo, Jungmin

2018-04-02

The quality of life (QoL) of patients with end-stage renal disease (ESRD) is very poor, plausibly due to both psychosocial and medical factors. This study aimed to determine the relationship among psychosocial factors, medical factors, and QoL in patients with ESRD undergoing hemodialysis (HD). In total, 55 male and 47 female patients were evaluated (mean age, 57.1 ± 12.0 years). The QoL was evaluated using the Korean version of World Health Organization Quality of Life Scale-Abbreviated Version. The psychosocial factors were evaluated using the Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social Support, Montreal Cognitive Assessment, Pittsburgh Sleep Quality Index, and Zarit Burden Interview. The medical factors were assessed using laboratory examinations. Correlation and canonical correlation analyses were performed to investigate the association patterns. The QoL was significantly correlated with the psychosocial factors, and to a lesser extent with the medical factors. The medical and psychosocial factors were also correlated. The canonical correlation analysis indicated a correlation between QoL and psychosocial factors (1st canonical correlation = 0.696, P < 0.001; 2nd canonical correlation = 0.421, P = 0.191), but not medical factors (1st canonical correlation = 0.478, P = 0.475; 2nd canonical correlation = 0.419, P = 0.751). The medical and psychosocial factors were also correlated (1st canonical correlation = 0.689, P < 0.001; 2nd canonical correlation = 0.603, P = 0.009). Psychosocial factors influence QoL in patients with ESRD, and should thus be carefully considered when caring for these patients in clinical practice. © 2018 The Korean Academy of Medical Sciences.

Influence of medications and diagnoses on fall risk in psychiatric inpatients.

PubMed

Lavsa, Stacey M; Fabian, Tanya J; Saul, Melissa I; Corman, Shelby L; Coley, Kim C

2010-08-01

The influence of medications and diagnoses on fall risk in psychiatric inpatients was evaluated. In this retrospective case-control study, psychiatric inpatients age 18 years or older with a documented fall that was reported served as study cases. These patients were matched to control patients from the same hospital (1:1) by admission year, sex, and age. Psychiatric diagnoses evaluated included major depressive disorder, schizophrenia or schizoaffective disorder, bipolar disorder, Alzheimer's disease and dementia, anxiety or neurosis, delirium, personality disorder, and obsessive-compulsive disorder. Medications assessed as independent variables were conventional antipsychotics, atypical antipsychotics, selective serotonin-reuptake inhibitors, tricyclic antidepressants, atypical antidepressants, monoamine oxidase inhibitors, lithium, anticonvulsants, benzodiazepines, nonbenzodiazepine sleep aids, Alzheimer's disease medications, antihistamines, antiarrhythmics, antihypertensives, benign prostatic hyperplasia medications, oral hypoglycemic agents, histamine H(2)-receptor blockers, laxatives and stool softeners, muscle relaxants, nonsteroidal antiinflammatory drugs, opioids, Parkinson's disease medications, and overactive bladder medications. Univariate logistic regression models were developed for each risk factor to determine its impact on fall risk. A total of 774 patient cases were matched with controls. Most falls occurred on the second day of hospitalization. Medications associated with a higher risk of falls were alpha-blockers, nonbenzodiazepine sleep aids, benzodiazepines, H(2)-blockers, lithium, antipsychotics, atypical antidepressants, anticonvulsants, and laxatives and stool softeners. Patients with a diagnosis of dementia and Alzheimer's disease also had an increased risk of falling. Alpha-blockers, nonbenzodiazepine sleep aids, benzodiazepines, H(2)-blockers, lithium, atypical antipsychotics, atypical antidepressants, anticonvulsants and mood

Audit in general practice: factors influencing participation.

PubMed Central

Baker, R.; Robertson, N.; Farooqi, A.

1995-01-01

OBJECTIVE--To identify the factors influencing participation in a single topic audit initiated by a medical audit advisory group. DESIGN--Interview and questionnaire survey of general practitioners who had been invited to take part in an audit of vitamin B-12. SETTING--All 147 general practices in Leicestershire. MAIN OUTCOME MEASURES--Aspects of structure, attitude, and behaviour that influenced participation or non-participation. RESULTS--75 practices completed the audit, 49 withdrew after initial agreement, and 23 refused to take part at the outset. Participants were more likely than those who refused to view the advisory group as useful or a threat and to have positive thoughts about audit but less likely to have previously undertaken audit entailing implementation of change. Participants were more likely than those who withdrew to have positive thoughts about audit and to have discussed whether to take part within the practice but were less likely to view the advisory group as useful. The most common reason given for withdrawal was lack of time. CONCLUSIONS--Participation was influenced by attitudes towards audit in general and the advisory group in particular and by aspects of behaviour such as communication within the practice. Practical support and resources may help some practices undertake audit, but advisory groups must also deal with attitudes and unsatisfactory communication in practice teams. PMID:7613323

Factors influencing stethoscope cleanliness among clinical medical students.

PubMed

Saunders, C; Hryhorskyj, L; Skinner, J

2013-07-01

This study aims to identify current stethoscope hygiene habits and attitudes in a UK medical school setting. Students completed a questionnaire using Likert-scale questions and free-text answers. A total of 308 questionnaires were completed from a potential 750 students (41%); 22.4% of respondents had never cleaned their stethoscope and only 3.9% cleaned their stethoscope after every patient. Significant correlations were identified between cleaning frequency and: others acting as role models (P = 0.001), students having confidence in how to clean stethoscopes (P = 0.001), and students thinking cleaning was important (P = 0.01), thereby highlighting inadequate education and role models as potential problems. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Impact of medical and nonmedical factors on physician decision making for HIV/AIDS antiretroviral treatment.

PubMed

Bogart, L M; Kelly, J A; Catz, S L; Sosman, J M

2000-04-15

To examine influences of medical factors (e.g., viral load) and nonmedical factors (e.g., patient characteristics) on treatment decisions for highly active antiretroviral therapy (HAART), we sent a survey to a random sample of 995 infectious disease physicians who treat patients with HIV/AIDS in the United States in August, 1998. The response rate was 53%. Respondents were asked to report their current practices with respect to antiretroviral treatment and the extent to which each of three medical and 17 nonmedical factors would influence them for or against prescribing HAART to a hypothetical HIV-positive patient. Most reported initiating HAART with findings of low CD4+ cell counts and high viral loads, and weighing CD4+ cell counts, viral load, and opportunistic infection heavily in their decisions to prescribe HAART. Patients' prior history of poor adherence was weighed very much against initiating HAART. Patient homelessness, heavy alcohol use, injection drug use, and prior psychiatric hospitalization were cited by most physicians as weighing against HAART initiation. Thus, most physicians in this sample follow guidelines for the use of HAART, and nonmedical factors related to patients' life situations are weighed as heavily as disease severity in treatment decisions. As HIV increasingly becomes a disease associated with economic disadvantage and other social health problems, it will be essential to develop interventions and care support systems to enable patients experiencing these problems to benefit from HIV treatment advances.

Medication errors of nurses and factors in refusal to report medication errors among nurses in a teaching medical center of iran in 2012.

PubMed

Mostafaei, Davoud; Barati Marnani, Ahmad; Mosavi Esfahani, Haleh; Estebsari, Fatemeh; Shahzaidi, Shiva; Jamshidi, Ensiyeh; Aghamiri, Seyed Samad

2014-10-01

About one third of unwanted reported medication consequences are due to medication errors, resulting in one-fifth of hospital injuries. The aim of this study was determined formal and informal medication errors of nurses and the level of importance of factors in refusal to report medication errors among nurses. The cross-sectional study was done on the nursing staff of Shohada Tajrish Hospital, Tehran, Iran in 2012. The data was gathered through a questionnaire, made by the researchers. The questionnaires' face and content validity was confirmed by experts and for measuring its reliability test-retest was used. The data was analyzed by descriptive statistics. We used SPSS for related statistical analyses. The most important factors in refusal to report medication errors respectively were: lack of medication error recording and reporting system in the hospital (3.3%), non-significant error reporting to hospital authorities and lack of appropriate feedback (3.1%), and lack of a clear definition for a medication error (3%). There were both formal and informal reporting of medication errors in this study. Factors pertaining to management in hospitals as well as the fear of the consequences of reporting are two broad fields among the factors that make nurses not report their medication errors. In this regard, providing enough education to nurses, boosting the job security for nurses, management support and revising related processes and definitions are some factors that can help decreasing medication errors and increasing their report in case of occurrence.

Demographic, medical, and psychiatric factors in work and marital status after mild head injury.

PubMed

Vanderploeg, Rodney D; Curtiss, Glenn; Duchnick, Jennifer J; Luis, Cheryl A

2003-01-01

To explore factors associated with long-term outcomes of work and marital status in individuals who had experienced a mild head injury (MHI), as well as those who had not. Population-based study using logistical regression analyses to investigate the impact of preinjury characteristics on work and marital status. Two groups of Vietnam-era Army veterans: 626 who had experienced a MHI an average of 8 years before examination, and 3,896 who had not. Demographic characteristics, concurrent medical conditions, early life psychiatric problems, loss of consciousness (LOC), and interactions among these variables were used to predict current work and marital status. Multiple variables were associated with work and marital status in the sample with MHI, accounting for approximately 23% and 17% of the variance in these two outcome variables, respectively. In contrast, the same factors accounted for significantly less variance in outcome in the sample without a head injury-13.3% and 9.4% for work and marital status, respectively. These findings suggest a more potent role for and increased vulnerability to the influence of demographic, medical, and psychiatric factors on outcomes after a MHI. That is, MHI itself moderates the influence of preinjury characteristics on work and marital status. In addition, in those who had a MHI, moderator relationships were found between education and LOC for both work and marital status. Similarly, complex moderator relationships among race, region of residence, and LOC were found for both work and marital status outcomes.

General analysis of factors influencing cataract surgery practice in Shanghai residents.

PubMed

Xu, Yi; He, Jiangnan; Lin, Senlin; Zhang, Bo; Zhu, Jianfeng; Resnikoff, Serge; Lu, Lina; Zou, Haidong

2018-04-18

It was reported that lack of knowledge, less confidence of medical services, commute difficulties, and poor economic conditions would be the main barriers for cataract surgery practice. The influencing factors could have changed in cities with high developing speed. Shanghai is one of the biggest cities in China and the world. The purpose of the study was to explore the factors influencing cataract surgery practice in Shanghai. This was a population-based, cross-sectional study. A total of 2342 cataract patients older than 50 years old with cataract-induced visual impairment or who had undergone cataract surgery were recruited from rural and urban areas of Shanghai. Participants accepted a face-to-face structured questionnaire. Data were collected on patient demographics, education, work, income, health insurance, awareness about cataracts disease, treatment and related medical resources and deration policy, transportation and degree of satisfaction with hospitals. There were 417 patients who had received cataract surgery, 404 of them supplied complete information in the questionnaire. More female subjects (64.6%) than male subjects (35.4%) accepted cataract surgery among the 404 patients. Of the patients with cataract history, 36.4% of surgery patients were equal or older than 80. More people with urban medical insurance received surgery (p = 0.036). Patients who received surgery were more satisfied with local medical service (p = 0.032). In urban area, Lower income and difficulties with commutes were related to a higher rate of surgery. Cataract patients with the following features were more inclined to receive surgery: female, old age, better awareness. In urban areas low income and difficult commutes did not represent barriers for cataract surgery, probably because of appropriate cataract surgery promotion policies recent years in Shanghai. In rural areas, better healthcare reimbursement policies would likely lead to a higher uptake of cataract surgery

Factors influencing risky decision-making in patients with cerebral infarction.

PubMed

Gong, Jingjing; Zhang, Yan; Wu, Bing; Feng, Jun; Zhang, Weiwei; Wang, Shijie; Huang, Yonghua; Wu, Xinhuai

2015-01-01

Numerous studies have found that the framing effect is common in medical scenarios, but few studies have examined the influence of the framing effect upon thrombolytic therapy for cerebral infarction. In this study, 1040 inpatients and outpatients in the department of neurology were recruited to explore whether there is a framing effect in decision-making within thrombolytic therapy, and if so, which factors influence that effect. The findings from Study 1 indicate that the framing effect occurred in patients both with and without cerebral infarction (χ(2) = 7.90, p = .005; χ(2) = 5.16, p = .023, respectively), with both groups displaying risk-seeking behavior (thrombolytic therapy) in the positive frame and no risk aversion or risk seeking in the negative frame. The results of Study 2 show that the patients preferred risk seeking in both collaborative and individual decision-making. In the collaborative decision-making group, the patients in the senior group showed the framing effect (χ(2) = 5.35, p < .05), with the patients in the positive frame (G) showing more significant risk seeking than both those in the negative frame (H) and those in the other positive frame (A, C, and E). In summary, decision-making about thrombolytic therapy in patients with cerebral infarction is influenced by the framing effect, and some influencing factors should be attended in clinical practice. Further research is necessary to guide the treatment of cerebral infarction.

Medical residents' job satisfaction and their related factors.

PubMed

Chung, Eun-Kyung; Han, Eui-Ryoung; Woo, Young-Jong

2013-03-01

This study was conducted to investigate medical residents' job satisfaction and their related factors to improve the quality of residency program. The study subjects were 159 medical residents being trained at Chonnam National University Hospital, South Korea, in 2011. The participants were asked to complete a short form Minnesota satisfaction questionnaire (MSQ). The mean score for 20 items on the short form MSQ varied between 2.91 and 3.64 on a 5-point Likert scale. The assessment of related factors with job satisfaction revealed that medical residents had higher levels for job satisfaction, particularly those who were women (beta=0.200, p=0.022), and those who had mentorship experience (beta=0.219, p=0.008). This study results indicate that we should expand and support the mentorship program during medical residency to promote job satisfaction.

Medical student researchers in Colombia and associated factors with publication: a cross-sectional study.

PubMed

Bonilla-Escobar, Francisco Javier; Bonilla-Velez, Juliana; Tobón-García, Daniel; Ángel-Isaza, Ana María

2017-12-15

Gaps between evidence-based research and clinical-public health practice have been evident for decades. One of the aims of medical student research is to close this gap. Accordingly, evaluating individual and environmental factors that influence participation of medical students in research are needed to understand and identify potential targets for action. This study aims to identify characteristics of medical student researchers in Colombia and the associated factors with scientific publications. A cross-sectional study of Colombian medical students involved in research using a validated, self-administered, online survey. The survey was distributed through the Colombian Association of Medical Students' Associations (ASCEMCOL). Data sets were analyzed using descriptive and summary statistics. Bivariate analysis and a multiple logistic regression model were conducted to identify predictors of scientific publications. A total of 133 responses were analyzed from students at 12 Colombian cities and 20 higher-education institutions. Although 94% of responders had at least one research proposal, only 57% had completed a project, and 17% had published their findings. Barriers for undertaking research included time restrictions and a lack of mentorship. Motivational factors included opportunity to publish findings and good mentorship. Students planning to do a specialization (OR = 3.25; 95% Confidence interval [CI] = 1.27-8.30), innovators (OR = 3.52; 95%CI = 1.30-9.52) and committed (OR = 3.39; 95%CI = 1.02-11.29), those who had previously published their findings (OR 9.13 IC95% 2.57-32.48), and were further in their medical education (OR 2.26 IC95% 1.01-5.07), were more likely to publish scientific papers. Our findings describe medical students understanding of the process of conducting research in Colombia. Although there appears to be motivation to participate in research, very few students achieve publication. Barriers such as time constraints

Factors associated with adherence to medication among depressed patients from Saudi Arabia: a cross-sectional study

PubMed Central

Al Jumah, Khalaf; Hassali, Mohamed Azmi; Al Qhatani, Dalal; El Tahir, Kamal

2014-01-01

Background Several studies have investigated the factors associated with adherence to antidepressants, with inconsistent conclusions. However, no similar study has investigated this issue among patients diagnosed with major depressive disorder in Saudi Arabia. The aim of this study is to explore patients’ adherence to antidepressant medications, and the factors associated with adherence. Methods A non-experimental cross-sectional design was used to measure adherence to antidepressants among major depressive disorder patients, and the factors associated with adherence. The patients were recruited from the outpatient clinic at the Al-Amal Complex for Mental Health in Riyadh, Saudi Arabia, between August 2013 and January 2014. Eligible participants met with one of the research coordinators for assessment of their adherence. Adherence was investigated indirectly by use of the Morisky Medication Adherence Scale, and patients’ beliefs were assessed through the Beliefs about Medicine Questionnaire. Information about the severity of their depression, demographics, and other study variables were collected. Results A total of 403 patients met the inclusion criteria and participated in the study. Of those, 203 (50.37%) were females, while the remaining 200 (49.6%) were males. There was an average age of 39 years (standard deviation, ±11 years). Half of the patients (52.9%) reported low adherence to their antidepressant medication, with statistically significant differences between the low adherence and high adherence scores relating to sex, age, and duration of illness. Conclusion Low medication adherence is a common problem among major depressive disorder patients in Saudi Arabia. Medication-taking behavior among depressed patients is influenced by several factors, mainly patients’ beliefs regarding antidepressants. This study has improved the understanding of the factors associated with adherence to antidepressants. PMID:25378929

Influence of training changes on the stability of specialty choices of UK medical graduates: surveys of the graduates of 2002 and 2008.

PubMed

Svirko, Elena; Lambert, Trevor W; Goldacre, Michael J

2015-01-01

To explore the impact of Modernising Medical Careers (MMC) training on the stability of medical career choices in the UK. Graduates of 2002 and 2008 from all UK medical schools, 1 and 3 years postgraduation. Questionnaire surveys were conducted of 2002 and 2008 graduates from all UK medical schools 1 and 3 years post graduation. Doctors gave their specialty choice(s) and rated the influence of each of 11 factors on their career choice. 2008 graduates were a little more likely than graduates of 2002 to retain their year 1 choice in year 3 (77.3% vs. 73.3%; p = 0.002). Among 2008 graduates, the percentage retaining their year 1 choice varied between 42% (clinical oncology) and 79% (general practice). Enthusiasm for a specialty, student experience and inclinations before medical school were associated with choice retention; consideration of domestic circumstances and hours/working conditions were associated with changes of choice. 2008 graduates were more likely than 2002s to be influenced by enthusiasm for a specialty, self-appraisal of their skills, working hours and their domestic circumstances; and less likely to be influenced by their experience of jobs, a particular teacher/department or eventual financial prospects. Post-MMC, graduates were less likely to change their career choice and more likely to be motivated by personal factors and self-assessment of their suitability to a particular area of work. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Sociotechnical factors influencing unsafe use of hospital information systems: A qualitative study in Malaysian government hospitals.

PubMed

Salahuddin, Lizawati; Ismail, Zuraini; Hashim, Ummi Rabaah; Raja Ikram, Raja Rina; Ismail, Nor Haslinda; Naim Mohayat, Mohd Hariz

2018-03-01

The objective of this study is to identify factors influencing unsafe use of hospital information systems in Malaysian government hospitals. Semi-structured interviews with 31 medical doctors in three Malaysian government hospitals implementing total hospital information systems were conducted between March and May 2015. A thematic qualitative analysis was performed on the resultant data to deduce the relevant themes. A total of five themes emerged as the factors influencing unsafe use of a hospital information system: (1) knowledge, (2) system quality, (3) task stressor, (4) organization resources, and (5) teamwork. These qualitative findings highlight that factors influencing unsafe use of a hospital information system originate from multidimensional sociotechnical aspects. Unsafe use of a hospital information system could possibly lead to the incidence of errors and thus raises safety risks to the patients. Hence, multiple interventions (e.g. technology systems and teamwork) are required in shaping high-quality hospital information system use.

Factors influencing consumer purchasing patterns of generic versus brand name over-the-counter drugs.

PubMed

Kohli, Erol; Buller, Allison

2013-02-01

US consumers spend more than $20 billion/year on over-the-counter (OTC) drugs. Although generic and brand name OTC drugs share the same active ingredients and undergo the same rigorous Food and Drug Administration approval process, brand name formulations continue to lead the OTC drug market with a higher market share. There is a limited amount of publicly available information regarding consumer perceptions and awareness about generic and brand name OTC drugs. The main objective of this research was to understand what factors influence US consumers to purchase generic versus brand name OTC drugs. The researchers used a 20-question, self-administered, multiple-choice survey to collect data on the factors influencing consumers' preferences for generic versus brand name OTC drugs. Results revealed that the single most influential factor for participants when purchasing OTC drugs was lower cost. Although economic factors play an important role in influencing consumers to choose generic formulations, a variety of other factors including advertisements, duration of the OTC effectiveness, severity of sickness, preferable form of OTC medication, safety of the OTC, relief of multiple symptoms, and preferred company will persuade others to pay more for brand name drugs. Ultimately, increased awareness and use of generic OTC drugs may result in substantial cost savings for consumers.

Medication effects on sleep and breathing.

PubMed

Seda, Gilbert; Tsai, Sheila; Lee-Chiong, Teofilo

2014-09-01

Sleep respiration is regulated by circadian, endocrine, mechanical and chemical factors, and characterized by diminished ventilatory drive and changes in Pao2 and Paco2 thresholds. Hypoxemia and hypercapnia are more pronounced during rapid eye movement. Breathing is influenced by sleep stage and airway muscle tone. Patient factors include medical comorbidities and body habitus. Medications partially improve obstructive sleep apnea and stabilize periodic breathing at altitude. Potential adverse consequences of medications include precipitation or worsening of disorders. Risk factors for adverse medication effects include aging, medical disorders, and use of multiple medications that affect respiration. Published by Elsevier Inc.

Absence of neonatal intensive care units in secondary medical care zones is an independent risk factor of high perinatal mortality in Japan.

PubMed

Matsumoto, Yoko; Nakai, Akihito; Nishijima, Yasuhiro; Kishita, Eisaku; Hakuno, Haruhiko; Sakoi, Masami; Kusuda, Satoshi; Unno, Nobuya; Tamura, Masanori; Fujii, Tomoyuki

2016-10-01

National medical projects are carried out according to medical care plans directed by the Medical Care Act of Japan. In order to improve Japanese perinatal medical care, it is necessary to determine the factors that might influence perinatal outcome. Statistical data of births and perinatal deaths were obtained for all municipalities in Japan from 2008 to 2012 from the Portal Site of Official Statistics of Japan (e-Stat). The perinatal mortality of all 349 Japanese secondary medical care zones was calculated. The number of neonatal intensive care units (NICUs), maternal-fetal intensive care units (MFICUs), pediatricians and obstetricians in 2011 were also obtained from e-Stat. Nine secondary medical care zones in two prefectures, Fukushima (7) and Miyagi (2) were excluded to eliminate the influence of the 2011 Great East Japan Earthquake. The 340 secondary medical care zones were divided into three groups according to population size and density: metropolis, provincial city, and depopulation. The number of secondary medical care zones in each group were 52, 168, and 120, respectively. The secondary medical care zones in the depopulation group had fewer pediatricians and significantly fewer NICUs and MFICUs than the metropolis group, but there was no significant difference in perinatal mortality. The only independent risk factor for high perinatal mortality, determined by multivariable analysis, was the absence of an NICU (P = 0.011). To consider directions in perinatal medical care, planned arrangement and appropriate access to NICUs is indispensable. © 2016 Japan Society of Obstetrics and Gynecology.

Factors influencing health care workers’ implementation of tuberculosis contact tracing in Kweneng, Botswana

PubMed Central

Tlale, Lebapotswe; Frasso, Rosemary; Kgosiesele, Onalenna; Selemogo, Mpho; Mothei, Quirk; Habte, Dereje; Steenhoff, Andrew

2016-01-01

Introduction TB contact tracing rates remain low in high burden settings and reasons for this are not well known. We describe factors that influence health care workers' (HCW) implementation of TB contact tracing (CT) in a high TB burden district of Botswana. Methods Data were collected using questionnaires and in-depth interviews in 31 of the 52 health facilities in Kweneng East Health District. Responses were summarized using summary statistics and comparisons between HCW groups were done using parametric or non-parametric tests as per normality of the data distribution. Results One hundred and four HCWs completed questionnaires. Factors that influenced HCW TB contact tracing were their knowledge, attitudes and practices as well as personal factors including decreased motivation and lack of commitment. Patient factors included living further away from the clinic, unknown residential address and high rates of migration and mobility. Administrative factors included staff shortages, lack of transport, poor reporting of TB cases and poor medical infrastructure e.g. suboptimal laboratory services. A national HCW strike and a restructuring of the health system emerged as additional factors during in-depth interviews of TB coordinators. Conclusion Multiple factors lead to poor TB contact tracing in this district. Interventions to increase TB contact tracing will be informed by these findings. PMID:27800084

Factors influencing health care workers' implementation of tuberculosis contact tracing in Kweneng, Botswana.

PubMed

Tlale, Lebapotswe; Frasso, Rosemary; Kgosiesele, Onalenna; Selemogo, Mpho; Mothei, Quirk; Habte, Dereje; Steenhoff, Andrew

2016-01-01

TB contact tracing rates remain low in high burden settings and reasons for this are not well known. We describe factors that influence health care workers' (HCW) implementation of TB contact tracing (CT) in a high TB burden district of Botswana. Data were collected using questionnaires and in-depth interviews in 31 of the 52 health facilities in Kweneng East Health District. Responses were summarized using summary statistics and comparisons between HCW groups were done using parametric or non-parametric tests as per normality of the data distribution. One hundred and four HCWs completed questionnaires. Factors that influenced HCW TB contact tracing were their knowledge, attitudes and practices as well as personal factors including decreased motivation and lack of commitment. Patient factors included living further away from the clinic, unknown residential address and high rates of migration and mobility. Administrative factors included staff shortages, lack of transport, poor reporting of TB cases and poor medical infrastructure e.g. suboptimal laboratory services. A national HCW strike and a restructuring of the health system emerged as additional factors during in-depth interviews of TB coordinators. Multiple factors lead to poor TB contact tracing in this district. Interventions to increase TB contact tracing will be informed by these findings.

Factors Influencing Suicidal Tendencies of Patients with Diagnosis of Attempted Suicide in Medical History and Potential Prevention of Relapse Prevention.

PubMed

Kotrbová, Kvetoslava; Dóci, Ivan; Hamplová, Lidmila; Dvořák, Vít; Selingerová, Šárka; Růžičková, Veronika; Chmelařová, Šárka

2017-12-01

The authors researched the incidence of suicidal thoughts and related factors in 123 patients of the psychiatric ward of the Hospital of České Budějovice with diagnosed attempted suicide in their medical history for the period from January 2013 – June 2015. The research was carried out in two stages. At the beginning of the hospitalization, quantitative data collection was implemented using a semi-structured questionnaire, followed by qualitative research conducted with semi-structured phone conversation, based on previous patient's written consent. The research data were statistically processed to obtain information about the character of relations among individual characteristics. To quantify them, the Bayesian Network (BN) was constructed, and to identify relations among individual characteristics, the Hill-Climbing algorithm was used. Before deriving the network, variables were discretized. The network parameters were set based on a data matrix using the maximal plausibility method. The results of analysed set show that the probability of suicidal thoughts is high, achieving a value of 0.750 (0.781 for women and 0.724 for men). If the patient visits a contact centre for drug-addicted persons, the probability of suicidal thoughts decreases to 0.683. If the patient visits a psychotherapist, the values of 0.736 are achieved. If a daily care centre is visited, the estimated risk rises to 0.832 and the probability of the patient repetitively attempting suicide is 0.606. If the interviewed person regularly consumes alcohol, the probable relapse amounts to 0.616. But if the person consumes alcohol from time to time, the probability rises to 0.701. In case of abstinence, the probable relapse decreases to 0.565. The incidence of suicidal thoughts in observed patients was high, and the amount of risk was influenced by gender, by visiting follow-up care facilities, psychotherapy, and particularly by the frequency of alcohol consumption. Intermittent alcohol

Phonological Awareness: Factors of Influence

ERIC Educational Resources Information Center

Frohlich, Linda Paulina; Petermann, Franz; Metz, Dorothee

2013-01-01

Early child development is influenced by various genetic and environmental factors. This study aims to identify factors that affect the phonological awareness of preschool and first grade children. Based on a sample of 330 German-speaking children (mean age = 6.2 years) the following domains were evaluated: Parent factors, birth and pregnancy,…

Factors influencing the delivery of abortion services in Ontario: a descriptive study.

PubMed

Ferris, L E; McMain-Klein, M; Iron, K

1998-01-01

Although Canadian women have had the right to obtain legal induced abortions for the past decade, access to the procedure is still limited and controversial in many areas. Chiefs of obstetrics and gynecology, chiefs of staff, directors of nursing and other health professionals at 163 general hospitals in Ontario, Canada, were asked to provide information on issues concerning the availability of abortion services of their facility. The hospital participation rate was 97% and the individual response rate was 75%. Nearly one-half (48%) of hospitals perform abortions. Approximately 36% of these hospitals do so up to a maximum gestational age of 12 weeks, 23% to a maximum of 13-16 weeks, 37% to a maximum of 17-20 weeks and 4% at greater than 20 weeks. Hospital factors, including resources and policies, did not significantly influence whether abortions are provided. However, these factors did affect the number performed, whether there were gestational limitations and the choice of procedure. About 13% of provider hospitals indicated that staff training contributes to the existence of gestational age limits, and 24% said that it directly influences procedure choice. Only 18% of hospitals reported that their physicians have received additional training outside of their medical school or medical residency education to learn abortion techniques or to gain new skills. Forty-five percent of hospitals that provide abortions had experienced harassment within the past two years, and 15% reported that this harassment has directly affected their staff members' willingness to provide abortions. Based upon the provision of obstetric care, many hospitals in Ontario that are capable of offering abortion services do not. Some of the reasons for this failure are related to the procedure itself, while others may be related to resource issues that affect the delivery of other medical services as well. Variation in the availability of abortions is due to a shortage of clinicians performing

Standardized assessment of psychosocial factors and their influence on medically confirmed health outcomes in workers: a systematic review.

PubMed

Rosário, Susel; Fonseca, João A; Nienhaus, Albert; da Costa, José Torres

2016-01-01

Previous studies of psychosocial work factors have indicated their importance for workers' health. However, to what extent health problems can be attributed to the nature of the work environment or other psychosocial factors is not clear. No previous systematic review has used inclusion criteria based on specific medical evaluation of work-related health outcomes and the use of validated instruments for the assessment of the psychosocial (work) environment. The aim of this systematic review is to summarize the evidence assessing the relationship between the psychosocial work environment and workers' health based on studies that used standardized and validated instruments to assess the psychosocial work environment and that focused on medically confirmed health outcomes. A systematic review of the literature was carried out by searching the databases PubMed, B-ON, Science Direct, Psycarticles, Psychology and Behavioral Sciences Collection and the search engine (Google Scholar) using appropriate words for studies published from 2004 to 2014. This review follows the recommendations of the Statement for Reporting Systematic Reviews (PRISMA). Studies were included in the review if data on psychosocial validated assessment method(s) for the study population and specific medical evaluation of health-related work outcome(s) were presented. In total, the search strategy yielded 10,623 references, of which 10 studies (seven prospective cohort and three cross-sectional) met the inclusion criteria. Most studies (7/10) observed an adverse effect of poor psychosocial work factors on workers' health: 3 on sickness absence, 4 on cardiovascular diseases. The other 3 studies reported detrimental effects on sleep and on disease-associated biomarkers. A more consistent effect was observed in studies of higher methodological quality that used a prospective design jointly with the use of validated instruments for the assessment of the psychosocial (work) environment and clinical

Clinical efficacy analysis of Ahmed glaucoma valve implantation in neovascular glaucoma and influencing factors

PubMed Central

He, Ye; Tian, Ying; Song, Weitao; Su, Ting; Jiang, Haibo; Xia, Xiaobo

2017-01-01

Abstract This study aimed to evaluate the efficacy of Ahmed glaucoma valve (AGV) implantation in treating neovascular glaucoma (NVG) and to analyze the factors influencing the surgical success rate. This is a retrospective review of 40 eyes of 40 NVG patients who underwent AGV implantation at Xiangya Hospital of Central South University, China, between January 2014 and December 2016. Pre- and postoperative intraocular pressure (IOP), visual acuity, surgical success rate, medications, and complications were observed. Surgical success criteria were defined as IOP ≤21 and >6 mm Hg with or without additional medications. Kaplan–Meier survival curves and Multivariate cox regression analysis were used to examine success rates and risk factors for surgical outcomes. The mean follow-up period was 8.88 ± 3.12 months (range: 3–17). IOP declined at each visit postoperatively and it was statistically significant (P < .001). An average of 3.55 ± 0.86 drugs was applied preoperatively, while an average of 0.64 ± 0.90 drugs was used postoperatively, with the difference being of statistical significance (P < .05). The complete surgical success rate of 3, 6, and 12 months after the operation was 85%, 75%, and 65%, respectively. Meanwhile, the qualified success rate of 3, 6, and 12 months after the operation was 85%, 80%, and 77.5%, respectively. The multivariate cox regression analysis showed that age (hazard ratio: 3.717, 7.246; 95% confidence interval: 1.149–12.048, 1.349–38.461; P = .028, .021) was influencing factors for complete success rate and qualified success rate among all NVG patients. Gender, previous operation history, primary disease, and preoperative IOP were found to be not significant. AGV implantation is an effective and safe surgical method to treat NVG. Age is an important factor influencing the surgical success rate. PMID:29049253

[The influence of the advertising in the medication use in a group of elderly attended in a primary health care unit in Aracaju (Sergipe, Brasil)].

PubMed

de Lyra, Divaldo Pereira; Neves, Aline Souza; Cerqueira, Karine Santos; Marcellini, Paulo Sergio; Marques, Tatiane Cristina; de Barros, José Augusto Cabral

2010-11-01

The growth of the Brazilian elderly people has led to a trend to an increase in the medication use. The inadequate use of drugs can be induced by some factors, like advertisement, with the risk of damaging the user's health. The objective of the study was to evaluate the advertisement influence in medication use in a group of elderly patients in a primary health care unit in Aracaju, Sergipe, Brazil. 230 elderly aging over 60 years with both genders had been interviewed from April to June of 2007. The majority of the interviewees (73%) has at least a chronic health condition and 73.9% consumed regularly at least one medication. 17.8% of the sample informed to use medication motivated by publicity influence; 2.2% had considered that the medication never cause damages and 6.5% believed that always it makes well. In this study, correlations have been made and demonstrated that those who presented a higher level of consumption influenced by advertising also think that drugs used are always beneficial and vice versa (p= 0.04). The data showed that part of elderly suffered influence of advertisement to medication use, and are not conscious of risks involved.

The influences of patient's trust in medical service and attitude towards health policy on patient's overall satisfaction with medical service and sub satisfaction in China.

PubMed

Tang, Liyang

2011-06-15

It is widely accepted that patient generates overall satisfaction with medical service and sub satisfaction on the basis of response to patient's trust in medical service and response to patient's attitude towards health policy in China. This study aimed to investigate the correlations between patient's trust in medical service/patient's attitude towards health policy and patient's overall satisfaction with medical service/sub satisfaction in current medical experience and find inspiration for future reform of China's health delivery system on improving patient's overall satisfaction with medical service and sub satisfaction in considering patient's trust in medical service and patient's attitude towards health policy. This study collaborated with the National Bureau of Statistics to collect a sample of 3,424 residents from 17 provinces and municipalities in a 2008 China household survey on patient's trust in medical service, patient's attitude towards health policy, patient's overall satisfaction and sub satisfaction in current medical experience. Patient's overall satisfaction with medical service and most kinds of sub satisfaction in current medical experience were significantly influenced by both patient's trust in medical service and patient's attitude towards health policy; among all kinds of sub satisfaction in current medical experience, patient's trust in medical service/patient's attitude towards health policy had the largest influence on patient's satisfaction with medical costs, the influences of patient's trust in medical service/patient's attitude towards health policy on patient's satisfaction with doctor-patient interaction and satisfaction with treatment process were at medium-level, patient's trust in medical service/patient's attitude towards health policy had the smallest influence on patient's satisfaction with medical facilities and hospital environment, while patient's satisfaction with waiting time in hospital was not influenced by patient

Lifelong learning of Chinese rural physicians: preliminary psychometrics and influencing factors.

PubMed

Li, Honghe; Wang, Ziwei; Jiang, Nan; Liu, Yang; Wen, Deliang

2015-10-30

There are more than 4.9 million rural health workers undertaking the health care need of rural population of over 629 million in China. The lifelong learning of physicians is vital in maintaining up-to-date and qualified health care, but rural physicians in many developing countries lack adequate medical professional developments. There has also been no empirical research focused on the lifelong learning of rural physician populations. The purpose of this study was to investigate the primary levels of lifelong learning of the rural physicians and to analyze group differences. We conducted a cross-sectional study on 1197 rural physicians using the Jefferson Scale of Physician Lifelong Learning (JSPLL). Cronbach's α coefficient, exploratory factor analysis, independent sample t-test, and one-way ANOVA followed by Student-Newman-Keuls test were performed to analyze the data. For Chinese rural physicians, the JSPLL was reliable (Cronbach's α coefficient = 0.872) and valid, with exploratory factor analysis fitting a 3-factor model and accounting for a total of 60.46 % of the variance. The mean lifelong learning score was 45.56. Rural physicians generally performed worse in the technical skills in seeking information domain. Rural physicians with 21-30 working years have a lower score of lifelong learning (P < 0.05) than other phases of working years. Career satisfaction and professional titles had a significantly positive influence on physicians' orientation towards lifelong learning (P < 0.05). The overall lifelong learning scores of physicians who received more training after completion of medical school were higher than those with less additional post-medical school training (P <0.05). The JSPLL is effective for the Chinese rural physician population. In order to cope with impacting factors on rural physicians' lifelong learning, the results of the study reinforced the importance of continuing medical education and career satisfaction for lifelong

[Impact factor of the Spanish medical journals].

PubMed

Aleixandre Benavent, Rafael; Valderrama Zurián, Juan Carlos; Castellano Gómez, Miguel; Simó Meléndez, Raquel; Navarro Molina, Carolina

2004-11-20

The 2001 edition of the Journal Citation Reports (JCR) includes only 13 Spanish medical journals. The impact factor (IF) of the rest of Spanish medical journals is unknown. The aim of this study is to determine the IF of the main Spanish medical journals, taking also into account the references from journals not covered by the SCI. A set of 87 Spanish medical journals was selected from the national database IME and other international databases. All citable articles published in these journals in 2001 were analyzed, extracting their bibliographic references to articles published in 1999, 2000 and 2001. The indicators obtained for each journal were the number of cites, the IF and the immediacy index. Among the 87 source journals, 74 were not included in the JCR. From them, 5,388 bibliographic references were examined, identifying the journals cited. Final indicators were obtained adding these results to the ones obtained by using the Science Citation Index. The most cited journal was Medicina Clinica (768 cites), and the highest IF were attained by Histology and Histopathology (IF = 1.866), International Journal of Developmental Biology (IF = 1.654) and Medicina Clinica (IF = 1.125). This work has permitted to obtain the IF of 87 Spanish medical journals. Already detected in previous works, the leadership of the journal Medicina Clinica in Spanish medicine is confirmed. Spanish medical journals published in English have received a small number of cites from the ones published in Spanish. A low impact factor is not necessarily related to lack of quality, merit or relevance.

Factors influencing students' borrowing that may affect their specialty choices and other after-graduation behaviors.

PubMed

Cooter, R; Bross, T M; Erdmann, J B

1998-01-01

To assess the factors that influence medical students' borrowing and how these factors may affect access to the profession, specialty choice, and medical graduates' repayment behaviors. The borrowing patterns of the 3,495 indebted students enrolled at Jefferson Medical College of Thomas Jefferson University between 1989-90 and 1994-95 were analyzed. (Debt included both subsidized and unsubsidized debt.) These borrowing patterns were assessed in relation to changes in the cost of education, family (i.e., parents') income, availability of grant funding, legislative changes to loan-eligibility criteria (specifically, the Higher Education Amendments of 1992), and average interest rates on federal unsubsidized loans. The annual changes in average debt levels suggest that while cost of education, family resources, and availability of grant funding may be significant factors, changes in loan eligibility and prevailing interest rates on unsubsidized loan source also influence medical students' borrowing. A comparison of the borrowing patterns for three income groups (low, middle, high) further demonstrated that while overall fluctuations for low-income group mirrored changes in the cost and resource variables, annual borrowing fluctuations for the middle- and high-income groups were more reflective of the expansion of loan eligibility and reduced interest rates on unsubsidized loans. From 1989-90 to 1994-95 the average cost of education increased by $2,368. Average unsubsidized debt increased by $1,544 for the low-income group, $3,960 for the middle-income group, and $4,439 for the high-income group. The percentage of unsubsidized funding included in the borrowers' financing packages increased by just under 6% for the low-income group but almost 10% and 11% for the middle- and high-income groups, respectively. The results suggest that medical students borrow for a variety of reasons, ranging from financial need to personal financing or lifestyle choices. These reasons

Factors Affecting Adherence to Osteoporosis Medications: A Focus Group Approach Examining Viewpoints of Patients and Providers

PubMed Central

Iversen, Maura D; Vora, Ruchita R; Servi, Amber; Solomon, Daniel H

2011-01-01

This is a qualitative study using a focus group approach, conducted to determine factors influencing adherence to osteoporosis medications among older adults. Thirty-two patients aged 65 to 85 years from the greater Boston area who were prescribed an osteoporosis medication, 11 general medicine physicians and 1 nurse practitioner were recruited from Boston based hospitals affiliated with a large healthcare system. Focus groups consisting of 6 to 8 subjects including males and females were held separately for providers and patients and conducted until thematic saturation was reached. Responses were obtained from patients and providers during the focus group interviews conducted by a trained focus group moderator. All interviews were audio taped and transcribed by a medical transcriptionist. According to patients, factors affecting adherence to osteoporosis drugs included lack of knowledge about osteoporosis, dissatisfaction with their doctor visits, side effects, and difficulty or failure to remember instructions for taking medications. Physicians reported lack of patient knowledge, structural barriers, medication side effects, and the inability to track patients’ adherence to their medications as barriers to adherence. This study identifies the extent of and reasons for non-adherence as perceived by patients and providers, and provides insights into strategies to modify treatment plans to address non-adherence. The results from this study were used to develop a RCT to conduct and evaluate patient and physician targeted interventions to improve adherence to osteoporosis medications and to examine cost effectiveness of alternative strategies. PMID:21937896

Are there future psychiatrists among medical students in Croatia? The role of premedical and medical factors on career choice in psychiatry.

PubMed

Rojnic Kuzman, Martina; Smoljan, Mia; Lovrec, Petra; Jovanovic, Nikolina; Lydall, Greg; Farooq, Kitty; Malik, Amit; Bhugra, Dinesh

2013-08-01

Despite the high prevalence of mental disorders, a worldwide shortage of psychiatrists exists. Moreover, the number of students interested in choosing psychiatry as their future profession is low and psychiatry is frequently regarded as one of the least wanted medical specializations. We report the findings of a cross-sectional quantitative survey of final year Croatian medical students as part of the International Survey of Student Career Choice in Psychiatry (ISoSCCiP). The questionnaire consisted of three sections: socio-demographic factors, psychiatric education during medical school, and attitudes and personality characteristics. Out of 200 students, 122 completed the questionnaire (response rate 61%). The overall student evaluation of the compulsory psychiatry curriculum was 'average'. Significantly higher ratings were reported by students who attended special psychiatry teaching modules, or felt more involved in the teaching of the subject. Poor evaluation of medical school psychiatric education significantly increased the likelihood of not choosing psychiatry as a future career. The choice of psychiatry was also predicted by attitudes towards psychiatry and by personal characteristics. In conclusion, student ratings of medical school psychiatric education and involvement in teaching appear to influence choice towards psychiatry. Addressing these issues may increase the number of students motivated to pursue psychiatry as their future career choice.

Self-reported medical, medication and laboratory error in eight countries: risk factors for chronically ill adults.

PubMed

Scobie, Andrea

2011-04-01

To identify risk factors associated with self-reported medical, medication and laboratory error in eight countries. The Commonwealth Fund's 2008 International Health Policy Survey of chronically ill patients in eight countries. None. A multi-country telephone survey was conducted between 3 March and 30 May 2008 with patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, the UK and the USA who self-reported being chronically ill. A bivariate analysis was performed to determine significant explanatory variables of medical, medication and laboratory error (P < 0.01) for inclusion in a binary logistic regression model. The final regression model included eight risk factors for self-reported error: age 65 and under, education level of some college or less, presence of two or more chronic conditions, high prescription drug use (four+ drugs), four or more doctors seen within 2 years, a care coordination problem, poor doctor-patient communication and use of an emergency department. Risk factors with the greatest ability to predict experiencing an error encompassed issues with coordination of care and provider knowledge of a patient's medical history. The identification of these risk factors could help policymakers and organizations to proactively reduce the likelihood of error through greater examination of system- and organization-level practices.

Medical School Factors Associated with Changes in Implicit and Explicit Bias Against Gay and Lesbian People among 3492 Graduating Medical Students.

PubMed

Phelan, Sean M; Burke, Sara E; Hardeman, Rachel R; White, Richard O; Przedworski, Julia; Dovidio, John F; Perry, Sylvia P; Plankey, Michael; A Cunningham, Brooke; Finstad, Deborah; W Yeazel, Mark; van Ryn, Michelle

2017-11-01

Implicit and explicit bias among providers can influence the quality of healthcare. Efforts to address sexual orientation bias in new physicians are hampered by a lack of knowledge of school factors that influence bias among students. To determine whether medical school curriculum, role modeling, diversity climate, and contact with sexual minorities predict bias among graduating students against gay and lesbian people. Prospective cohort study. A sample of 4732 first-year medical students was recruited from a stratified random sample of 49 US medical schools in the fall of 2010 (81% response; 55% of eligible), of which 94.5% (4473) identified as heterosexual. Seventy-eight percent of baseline respondents (3492) completed a follow-up survey in their final semester (spring 2014). Medical school predictors included formal curriculum, role modeling, diversity climate, and contact with sexual minorities. Outcomes were year 4 implicit and explicit bias against gay men and lesbian women, adjusted for bias at year 1. In multivariate models, lower explicit bias against gay men and lesbian women was associated with more favorable contact with LGBT faculty, residents, students, and patients, and perceived skill and preparedness for providing care to LGBT patients. Greater explicit bias against lesbian women was associated with discrimination reported by sexual minority students (b = 1.43 [0.16, 2.71]; p = 0.03). Lower implicit sexual orientation bias was associated with more frequent contact with LGBT faculty, residents, students, and patients (b = -0.04 [-0.07, -0.01); p = 0.008). Greater implicit bias was associated with more faculty role modeling of discriminatory behavior (b = 0.34 [0.11, 0.57); p = 0.004). Medical schools may reduce bias against sexual minority patients by reducing negative role modeling, improving the diversity climate, and improving student preparedness to care for this population.

Analysis of Factors that Predict Clinical Performance in Medical School

ERIC Educational Resources Information Center

White, Casey B.; Dey, Eric L.; Fantone, Joseph C.

2009-01-01

Academic achievement indices including GPAs and MCAT scores are used to predict the spectrum of medical student academic performance types. However, use of these measures ignores two changes influencing medical school admissions: student diversity and affirmative action, and an increased focus on communication skills. To determine if GPA and MCAT…

Why a Medical Career? "What Makes Sudanese Students to Join a Medical College and Pursue a Medical Career"?

ERIC Educational Resources Information Center

Mutwali, Ismat Mohammed; Omer, Aisha Ibrahim A.; Abdalhalim, Sadigh Mohammed

2015-01-01

Introduction: Career selection and decision to pursue a medical career is a multi factorial process. It is influenced by the personal capabilities and the available resources as well as the social, educational, economical and cultural factors. Sudan is one of the African countries with a high number of medical colleges and an increasing number of…

[Factors that influence the sexuality of the elderly: an integrative review].

PubMed

Alencar, Danielle Lopes de; Marques, Ana Paula de Oliveira; Leal, Márcia Carréra Campos; Vieira, Júlia de Cássia Miguel

2014-08-01

The scope of this article is to analyze the scientific evidence addressing the factors that influence the sexuality of the elderly. It involved an online search carried out in pairs, including original articles published between 2006 and October 2011 in Portuguese, English or Spanish, which fulfilled the requirements of the study. The MEDLINE, LILACS, CidSaúde and BDENF databases were used with the key words: sexualidade e idoso / sexuality and elderly / sexualidad y anciano. The articles selected were assessed for methodological quality using two instruments, namely CASP and the Hierarchical Classification of Evidence. After analysis, 15 articles were included in the review, which discuss the culture of asexuality of the elderly, whereby the experience of sexuality only prevails among younger people. The absence of the partner due to widowhood, attributing value to beauty standards of the young, the occurrence of disease, use of medication, and changes in sexual physiology were identified as important factors that influence the sexuality of the elderly. The conclusion drawn is that social and cultural factors, changes in body physiology, and the occurrence of disease interfere with the sexuality of the elderly, making it necessary for nursing professionals to be proactive in debunking myths and providing orientation.

Migration intentions of Ghanaian medical students: the influence of existing funding mechanisms of medical education ("the fee factor").

PubMed

Eliason, S; Tuoyire, D A; Awusi-Nti, C; Bockarie, A S

2014-06-01

To explore the effects of fee paying status on migration intentions of Ghanaian medical students. Cross sectional questionnaire based survey. All established Ghanaian medical schools with students in their clinical years. Fee-paying and non-fee-paying Ghanaian medical students in their clinical years. None. Migration intentions of Ghanaian medical students after graduation, Allegiance to Government of Ghana. Approximately half (49%) of the medical students surveyed had intentions of migrating after school. Over 48% of those with migration intentions plan on doing so immediately after completing their house job, while 44% plan to migrate at least one year after their house job. The most popular destination chosen by the potential migrant doctors was North America (38%). Fee-paying students were significantly more likely (OR=2.11, CI=1.32, 3.38) than non-fee-paying students to have intentions of migrating after their training. Secondly, fee-paying students were more likely (OR=9.66, CI=4.42, 21.12) than non-fee paying students to feel they owe no allegiance to the Government of Ghana because of their fee-paying status. Medical Students' fee-paying status affects their intentions to migrate and their allegiance to the country after completion of their training.

Primary care specialty career choice among Canadian medical students

PubMed Central

Osborn, Heather Ann; Glicksman, Jordan T.; Brandt, Michael G.; Doyle, Philip C.; Fung, Kevin

2017-01-01

Abstract Objective To identify which factors influence medical students’ decision to choose a career in family medicine and pediatrics, and which factors influence their decision to choose careers in non–front-line specialties. Design Survey that was created based on a comprehensive literature review to determine which factors are considered important when choosing practice specialty. Setting Ontario medical school. Participants An open cohort of medical students in the graduating classes of 2008 to 2011 (inclusive). Main outcome measures The main factors that influenced participants’ decision to choose a career in primary care or pediatrics, and the main factors that influenced participants’ decision to choose a career in a non–front-line specialty. Results A total of 323 participants were included in this study. Factors that significantly influenced participants’ career choice in family medicine or pediatrics involved work-life balance (acceptable hours of practice [P = .005], acceptable on-call demands [P = .012], and lifestyle flexibility [P = .006]); a robust physician-patient relationship (ability to promote individual health promotion [P = .014] and the opportunity to form long-term relationships [P < .001], provide comprehensive care [P = .001], and treat patients and their families [P = .006]); and duration of residency program (P = .001). The career-related factors that significantly influenced participants’ decision to choose a non–front-line specialty were as follows: becoming an expert (P < .001), maintaining a focused scope of practice (P < .001), having a procedure-focused practice (P = .001), seeing immediate results from one’s actions (P < .001), potentially earning a high income (P < .001), and having a perceived status among colleagues (P < .001). Conclusion In this study, 8 factors were found to positively influence medical students’ career choice in family medicine and pediatrics, and 6 factors influenced the

Social, cultural and economic factors associated with self-medication.

PubMed

Machado-Alba, Jorge E; Echeverri-Cataño, Luis Felipe; Londoño-Builes, Manuel José; Moreno-Gutiérrez, Paula Andrea; Ochoa-Orozco, Sergio Andrés; Ruiz-Villa, Joaquín Octavio

2014-01-01

Self-medication is an increasingly frequent phenomenon worldwide; some studies suggest that there is a relationship with socio-economic and cultural factors. To determine the prevalence of self-medication and its related factors in a Colombian city. Cross-sectional descriptive study, in Pereira, Colombia. We selected 414 adults using simple randomization sampling with houses used as the observational unit. The IRIS-AM instrument was used to collect the information required. Four hundred and fourteen (414) people were interviewed, 62.6% were females, and mean age was 44 years; 77.5% of the sample had self-medicated at least once in their life and 31.9% during the last month. The most commonly used medications were: analgesics and antipyretics (44.3%), non-steroidal anti-inflammatory drugs and anti-rheumatic medication (36.4%), and anti-histamine medication (8.5%). The most commonly self-medicated symptoms were: headache (55.7%), cold (16.2%) and muscular pain (13.2%). Multivariate analysis revealed an association between self-medication throughout life and storing medications at home, and between a high level of education and having a favorable opinion of self-medication. Storing medications at home and recommending them to others were associated with self-medication during the previous 30 days. Self-medication rates were found to be similar to those reported globally, but there is not an established pattern for this practice. Associations were found between social and demographic variables and self-medication, which require further characterization. Intention to self-medicate has not been well-described in other studies, and may be an important indicator which will contribute to future understanding of this phenomenon.

Recruiting medical students to rural practice: perspectives of medical students and rural recruiters.

PubMed

Jutzi, Leah; Vogt, Kelly; Drever, Erin; Nisker, Jeff

2009-01-01

To explore the strategies used by rural recruitment programs and their perceived influence on medical students. Two original questionnaires delivered electronically, one to medical students and the other to recruiters in rural Ontario communities. Ontario, Canada. All 525 medical students enrolled in the Schulich School of Medicine & Dentistry at the University of Western Ontario in London and physician recruiters in 71 rural communities in Ontario were invited to participate in the study. The factors that influence medical students to consider rural practice, strategies used by recruiters, and student perceptions of the ethical appropriateness of both. The questionnaire was completed by 42.1% of medical students. Lifestyle considerations were an important influence for 93.1% of students. Themes from the qualitative analysis included the ethical appropriateness of financial considerations, economic forces, perceived disadvantages of rural practice, competition between communities, and lack of altruism. Responses were received from recruiters in 43.7% of communities; of those, 92.9% offered financial incentives to attract prospective physicians. Financial and lifestyle considerations are important influences on medical students' choice to practise in rural communities. Most medical students felt incentive programs offered by rural communities were ethically appropriate.

Nurse-physician collaboration in an academic medical centre: The influence of organisational and individual factors.

PubMed

Bowles, Darci; McIntosh, Georgia; Hemrajani, Reena; Yen, Miao-Shan; Phillips, Allison; Schwartz, Nathan; Tu, Shin-Ping; Dow, Alan W

2016-09-01

Ineffective physician-nurse collaboration has been recognised to adversely impact patient and organisational outcomes, and some studies suggest an underlying factor may be that nurses and physicians have different perceptions of interprofessional collaboration (IPC). The objectives of this study were to evaluate for a difference in the perception of IPC between physicians and nurses and to explore potential contributing factors at the individual and organisational levels to any observed difference. Data including measures of perceptions of IPC were collected from a convenience sample of resident physicians (n = 47), attending physicians (n = 18), and nurses (n = 54) providing care for internal medicine patients in a large tertiary care academic medical centre. Regression analysis revealed significantly lower perceptions of IPC scores for nurses in comparison to the scores of both the resident and attending physician groups (p = .0001 for both). Although demographic and workload factors also differed by profession, only profession and workload remained significant in regression analysis. Given the known relationships between effective physician-nurse collaboration and superior patient and organisational outcomes, better defining the individual and organisational predictors of IPC scores may support development of more effective interventions targeting improvements in IPC.

Factors that Influence Participation in Online Learning

ERIC Educational Resources Information Center

Vonderwell, Selma; Zachariah, Sajit

2005-01-01

This study explored what factors influenced learner participation in two sections of a graduate online course at a Midwestern university. Findings indicated that online learner participation and patterns of participation are influenced by the following factors: technology and interface characteristics, content area experience, student roles and…

The influences of patient's trust in medical service and attitude towards health policy on patient's overall satisfaction with medical service and sub satisfaction in China

PubMed Central

2011-01-01

Background It is widely accepted that patient generates overall satisfaction with medical service and sub satisfaction on the basis of response to patient's trust in medical service and response to patient's attitude towards health policy in China. This study aimed to investigate the correlations between patient's trust in medical service/patient's attitude towards health policy and patient's overall satisfaction with medical service/sub satisfaction in current medical experience and find inspiration for future reform of China's health delivery system on improving patient's overall satisfaction with medical service and sub satisfaction in considering patient's trust in medical service and patient's attitude towards health policy. Methods This study collaborated with the National Bureau of Statistics to collect a sample of 3,424 residents from 17 provinces and municipalities in a 2008 China household survey on patient's trust in medical service, patient's attitude towards health policy, patient's overall satisfaction and sub satisfaction in current medical experience. Results Patient's overall satisfaction with medical service and most kinds of sub satisfaction in current medical experience were significantly influenced by both patient's trust in medical service and patient's attitude towards health policy; among all kinds of sub satisfaction in current medical experience, patient's trust in medical service/patient's attitude towards health policy had the largest influence on patient's satisfaction with medical costs, the influences of patient's trust in medical service/patient's attitude towards health policy on patient's satisfaction with doctor-patient interaction and satisfaction with treatment process were at medium-level, patient's trust in medical service/patient's attitude towards health policy had the smallest influence on patient's satisfaction with medical facilities and hospital environment, while patient's satisfaction with waiting time in hospital was

The influence of the structure and culture of medical group practices on prescription drug errors.

PubMed

Kralewski, John E; Dowd, Bryan E; Heaton, Alan; Kaissi, Amer

2005-08-01

it provides insights into the relationships of the structure and culture of medical group practices and prescription drug errors and provides direction for future research. Research focused on the factors influencing the high error rates in rural areas and how the interaction of practice structural and cultural attributes influence error rates would add important insights into our findings. For medical practice directors, our data show that they should focus on patient care coordination to reduce errors.

Factors influencing palliative care. Qualitative study of family physicians' practices.

PubMed Central

Brown, J. B.; Sangster, M.; Swift, J.

1998-01-01

OBJECTIVE: To examine factors that influence family physicians' decisions to practise palliative care. DESIGN: Qualitative method of in-depth interviews. SETTING: Southwestern Ontario. PARTICIPANTS: Family physicians who practise palliative care on a full-time basis, who practise on a part-time basis, or who have retired from active involvement in palliative care. METHOD: Eleven in-depth interviews were conducted to explore factors that influence family physicians' decisions to practise palliative care and factors that sustain their interest in palliative care. All interviews were audiotaped and transcribed verbatim. The analysis strategy used a phenomenological approach and occurred concurrently rather than sequentially. All interview transcriptions were read independently by the researchers, who then compared and combined their analyses. Final analysis involved examining all interviews collectively, thus permitting relationships between and among central themes to emerge. MAIN OUTCOME FINDINGS: The overriding theme was a common philosophy of palliative care focusing on acceptance of death, whole person care, compassion, communication, and teamwork. Participants' philosophies were shaped by their education and by professional and personal experiences. In addition, participants articulated personal and systemic factors currently affecting their practice of palliative care. CONCLUSIONS: Participants observed that primary care physicians should be responsible for their patients' palliative care within the context of interdisciplinary teams. For medical students to be knowledgeable and sensitive to the needs of dying patients, palliative care should be given higher priority in the curriculum. Finally, participants argued compellingly for transferring the philosophy of palliative care to the overall practice of medicine. PMID:9612588

Exploring the Influence of Context on Feedback at Medical School: A Video-Ethnography Study

ERIC Educational Resources Information Center

Urquhart, L. M.; Ker, J. S.; Rees, C. E.

2018-01-01

Feedback in medical education is complicated by the multiple contexts within which learning occurs. However, feedback research in medical education has typically focused on information provided by tutors to students with limited exploration of the influence of context. This research seeks to address this gap by exploring the influence of multiple…

How do physicians become medical experts? A test of three competing theories: distinct domains, independent influence and encapsulation models.

PubMed

Violato, Claudio; Gao, Hong; O'Brien, Mary Claire; Grier, David; Shen, E

2018-05-01

The distinction between basic sciences and clinical knowledge which has led to a theoretical debate on how medical expertise is developed has implications for medical school and lifelong medical education. This longitudinal, population based observational study was conducted to test the fit of three theories-knowledge encapsulation, independent influence, distinct domains-of the development of medical expertise employing structural equation modelling. Data were collected from 548 physicians (292 men-53.3%; 256 women-46.7%; mean age = 24.2 years on admission) who had graduated from medical school 2009-2014. They included (1) Admissions data of undergraduate grade point average and Medical College Admission Test sub-test scores, (2) Course performance data from years 1, 2, and 3 of medical school, and (3) Performance on the NBME exams (i.e., Step 1, Step 2 CK, and Step 3). Statistical fit indices (Goodness of Fit Index-GFI; standardized root mean squared residual-SRMR; root mean squared error of approximation-RSMEA) and comparative fit [Formula: see text] of three theories of cognitive development of medical expertise were used to assess model fit. There is support for the knowledge encapsulation three factor model of clinical competency (GFI = 0.973, SRMR = 0.043, RSMEA = 0.063) which had superior fit indices to both the independent influence and distinct domains theories ([Formula: see text] vs [Formula: see text] [[Formula: see text

Factors influencing microbial colonies in the air of operating rooms.

PubMed

Fu Shaw, Ling; Chen, Ian Horng; Chen, Chii Shya; Wu, Hui Hsin; Lai, Li Shing; Chen, Yin Yin; Wang, Fu Der

2018-01-02

The operating room (OR) of the hospital is a special unit that requires a relatively clean environment. The microbial concentration of an indoor OR extrinsically influences surgical site infection rates. The aim of this study was to use active sampling methods to assess microbial colony counts in working ORs and to determine the factors affecting air contamination in a tertiary referral medical center. This study was conducted in 28 operating rooms located in a 3000-bed medical center in northern Taiwan. The microbiologic air counts were measured using an impactor air sampler from May to August 2015. Information about the procedure-related operative characteristics and surgical environment (environmental- and personnel-related factors) characteristics was collected. A total of 250 air samples were collected during surgical procedures. The overall mean number of bacterial colonies in the ORs was 78 ± 47 cfu/m 3 . The mean number of colonies was the highest for transplant surgery (123 ± 60 cfu/m 3 ), followed by pediatric surgery (115 ± 30.3 cfu/m 3 ). A total of 25 samples (10%) contained pathogens; Coagulase-negative staphylococcus (n = 12, 4.8%) was the most common pathogen. After controlling for potentially confounding factors by a multiple regression analysis, the surgical stage had the significantly highest correlation with bacterial counts (r = 0.346, p < 0.001). Otherwise, independent factors influencing bacterial counts were the type of surgery (29.85 cfu/m 3 , 95% CI 1.28-58.42, p = 0.041), site of procedure (20.19 cfu/m 3 , 95% CI 8.24-32.14, p = 0.001), number of indoor staff (4.93 cfu/m 3 , 95% CI 1.47-8.38, p = 0.005), surgical staging (36.5 cfu/m 3 , 95% CI 24.76-48.25, p < 0.001), and indoor air temperature (9.4 cfu/m 3 , 95% CI 1.61-17.18, p = 0.018). Under the well-controlled ventilation system, the mean microbial colony counts obtained by active sampling in different working ORs were low. The

Factors of the medical career choice within the context of ukrainian healthcare reforms.

PubMed

Lymar, Lesia; Omelchuk, Sergii

2018-01-01

Introduction: The article is dedicated to the motives of medical career choice studied by Ukrainian and foreign scientists, and by the authors themselves. The authors define the main motives, grouped into the pragmatic, social, scientific and professional ones, paying particular attention to the proposed reforms of the Healthcare of Ukraine "Health 2020". The aim: The study has been aimed at detection of the medical career choice factor groups and their possible correction during the medical training, defining possible influence of the Ukrainian Healthcare reformation onto alterations of the medical career choice. Materials and methods: This article is based on bibliosemantic, dialectical, comparative, analytic, synthetic and comprehensive research methods. Review and conclusion: The authors have analyzed medical career motives according to the A. Maslow hierarchy of needs, comparing the present motives with the motives to be changed after reforming the Ukrainian healthcare. The authors conclude that according to the Maslow's hierarchy of needs, the medical career choice corresponding to the first, second and third needs level would be directly related to the pragmatic, social and scientific motives, further disappointment in career, low professional performance and professional "burnout". The career choice corresponding to the last levels of the needs hierarchy is related to the professional motives and self-actualization, but, due to the applicants' age and financial status of medical specialists in Ukraine, is not likely to occur. Positive changes in medical specialists' salary rise, social protection offered by the State and state support of the profession will provide for correction of motives onto the higher level, in this way, benefiting the patients.

Beliefs regarding medication and side effects influence treatment adherence in adolescents with attention deficit hyperactivity disorder.

PubMed

Emilsson, Maria; Gustafsson, Per A; Öhnström, Gisela; Marteinsdottir, Ina

2017-05-01

Adherence to attention deficit hyperactivity disorder (ADHD) treatment is important because, when untreated, it may have serious consequences with lifelong effects. In the case of adolescents on long-term medicine prescription, more knowledge is needed regarding adherence and factors influencing adherence, which was the purpose of this study. Adolescents (n = 101) on ADHD medication ≥6 months were administrated questionnaires at a monitoring appointment: Medication Adherence Report Scale (MARS), beliefs about medicines (BMQ) and the Brief Illness Perception Questionnaire (B-IPQ). Adherence was high, the mean value was 88% of the maximum MARS score, and correlated positively with the "BMQ-necessity-concerns differential" but negatively with "BMQ-concerns" and "BMQ-side effects". Adolescents with more belief in the necessity of the medication, less concerns and less experience of side effects tended to be more adherent to medication prescription ("intentional non-adherence"), while "unintentional non-adherence" (forgetfulness) was associated with how much they perceived that their ADHD affected their lives. In a multiple regression model, the variance of MARS total (R 2  = 0.21) and "intentional non-adherence" (R 2  = 0.24) was explained by the "BMQ-necessity-concern differential" and "BMQ-experienced side effects". The variance of "unintentional non-adherence" (R 2  = 0.12) was explained by the "BMQ-necessity-concern differential" and "B-IPQ-consequences of ADHD". In conclusion, adolescents on long-term medication reported good adherence, mainly influenced by more beliefs in the necessity versus concerns of the medications, less experienced side effects and more perceived consequences of ADHD. BMQ could be useful to identify risks of low adherence, which should be counteracted by partially gender-specific interventions.

[Frequent attendance: the primary care professional's perceptions on the influence of social factors and health care system organisation].

PubMed

Sandín-Vázquez, M; Conde-Espejo, P

2011-01-01

FREQUENT ATTENDANCE: The primary care professional's perceptions on the influence of social factors and health care system organisation. To find out the primary care (PC) professional's perceptions on the social factors and healthcare system organisation that influence frequent attendance. A qualitative study using semi-structured interviews in Primary Care Centres of six Health Areas in the Community of Madrid. Eighteen interviews were conducted, three per area (two physicians and one nurse). Structural sampling was carried out with regards to the variables that could influence the discourse: health area, occupation, sex and number of years worked. The transcriptions were analysed by two investigators and an agreement of interpretation was reached. Among the social factors, health professionals perceived as determining factors: the influence of the media and the medicalization of society, lack of health education and self-care abilities of the population and contextual factors of the patient (social, work and family). Among the health care organisation factors that could influence frequent attendance were, system saturation, appointment on demand, fear of potential lawsuits by the patient, chronic patients protocols, administrative consultations, professional behaviour, and poor coordination with specialised care. According to PC professionals, there are multiple environmental factors, both social and healthcare system organisational factors that encourage frequent attendance. Within the scope of health care system, organisational actions (such as teamwork and coordination with specialists) would help to manage demand. Copyright © 2010 SECA. Published by Elsevier Espana. All rights reserved.

Factors considered by medical students when formulating their specialty preferences in Japan: findings from a qualitative study

PubMed Central

Saigal, Priya; Takemura, Yousuke; Nishiue, Takashi; Fetters, Michael D

2007-01-01

Background Little research addresses how medical students develop their choice of specialty training in Japan. The purpose of this research was to elucidate factors considered by Japanese medical students when formulating their specialty choice. Methods We conducted qualitative interviews with 25 Japanese medical students regarding factors influencing specialty preference and their views on roles of primary versus specialty care. We qualitatively analyzed the data to identify factors students consider when developing specialty preferences, to understand their views about primary and subspecialty care, and to construct models depicting the pathways to specialization. Results Students mention factors such as illness in self or close others, respect for family member in the profession, preclinical experiences in the curriculum such as labs and dissection, and aspects of patient care such as the clinical atmosphere, charismatic role models, and doctor-patient communication as influential on their specialty preferences. Participating students could generally distinguish between subspecialty care and primary care, but not primary care and family medicine. Our analysis yields a "Two Career" model depicting how medical graduates can first train for hospital-based specialty practice, and then switch to mixed primary/specialty care outpatient practice years later without any requirement for systematic training in principles of primary care practice. Conclusion Preclinical and clinical experiences as well as role models are reported by Japanese students as influential factors when formulating their specialty preferences. Student understanding of family medicine as a discipline is low in Japan. Students with ultimate aspirations to practice outpatient primary care medicine do not need to commit to systematic primary care training after graduation. The Two Career model of specialization leaves the door open for medical graduates to enter primary care practice at anytime

A Qualitative Study on Factors that Influence Turkish Medical Students' Decisions to Become Family Physicians After the Health Transformation Programme.

PubMed

Tanriover, Ozlem; Hidiroglu, Seyhan; Akan, Hulya; Ay, Pinar; Erdogan, Yalcin; Karavus, Melda; Vitrinel, Ayca; Hayran, Osman

2014-06-01

In Turkey, general practitioners were authorized to work as family physicians without specialization, within the scope of the Health Transformation Programme, due to inadequate number of family medicine specialists since 2004. With this new implementation Family Medicine specialty became a less preferable option for medical students. The study was to investigate the perspectives of medical students and understand the issues to choose Family Medicine specialty as a career option. This qualitative study was performed with 48 final year medical students using a convenience sample from two medical universities. Three main categories emerged from the data viewing Family Medicine 'as a specialty', 'as an employment', and finally 'as a system'. Very few students stated that Family Medicine would be their choice for specialty. Family Medicine does not seem to be an attractive option in career planning by medical students. Several factors that may constrain students from choosing Family Medicine include: not perceiving Family Medicine as a field of expertise, and the adverse conditions at work which may originate from duality in the system.

Factors That Influence Language Growth.

ERIC Educational Resources Information Center

McCarthy, Dorothea, Ed.; And Others

This booklet contains four articles that discuss factors influencing language growth. The first, "The Child's Equipment for Language Growth" by Charlotte Wells, examines what the child needs for language learning, how the child uses his equipment for language growth, and what school factors facilitate the child's use of his equipment for language…

Factors Associated With Medical and Nursing Students' Willingness to Donate Organs.

PubMed

Tumin, Makmor; Tafran, Khaled; Tang, Li Yoong; Chong, Mei Chan; Mohd Jaafar, Noor Ismawati; Mohd Satar, NurulHuda; Abdullah, Nurhidayah

2016-03-01

Malaysia suffers from a chronic shortage of human organs for transplantation. Medical and nursing students (MaNS) are future health professionals and thus their attitude toward organ donation is vital for driving national donation rates. This study investigates MaNS' willingness to donate organs upon death and the factors influencing their willingness. A cross-sectional design was used with a sample of 500 students (264 medical and 236 nursing) at the University of Malaya. A self-administrated questionnaire was used. The responses were analyzed by using descriptive statistics and multiple logistic regression. Of all respondents, 278 (55.6%) were willing to donate organs upon death, while the remaining 222 (44.4%) were unwilling to donate. Only 44 (8.8%) had donor cards. The multiple logistic regression revealed that the minorities ethnic group was more willing to donate organs than Malay respondents (adjusted odds ratio [aOR] = 1.98, P = 0.010). In addition, medical students were more willing to donate than nursing students (aOR = 2.53, P = 0.000). Respondents who have a family member with a donor card were more willing to donate than respondents who do not (aOR = 3.48, P = 0.006). MaNS who believed that their religion permits deceased donation were more willing to donate than their counterparts (aOR = 4.96, P = 0.000). Household income and sex were not significant predictors of MaNS' willingness to donate organs upon death. MaNS have moderate willingness, but low commitment toward deceased organ donation. Strategies for improving MaNS' attitude should better educate them on organ donation, targeting the most the Malay and nursing students, and should consider the influence of family attitude and religious permissibility on MaNS' willingness.

Factors Associated With Medical and Nursing Students’ Willingness to Donate Organs

PubMed Central

Tumin, Makmor; Tafran, Khaled; Tang, Li Yoong; Chong, Mei Chan; Mohd Jaafar, Noor Ismawati; Mohd Satar, NurulHuda; Abdullah, Nurhidayah

2016-01-01

Abstract Malaysia suffers from a chronic shortage of human organs for transplantation. Medical and nursing students (MaNS) are future health professionals and thus their attitude toward organ donation is vital for driving national donation rates. This study investigates MaNS’ willingness to donate organs upon death and the factors influencing their willingness. A cross-sectional design was used with a sample of 500 students (264 medical and 236 nursing) at the University of Malaya. A self-administrated questionnaire was used. The responses were analyzed by using descriptive statistics and multiple logistic regression. Of all respondents, 278 (55.6%) were willing to donate organs upon death, while the remaining 222 (44.4%) were unwilling to donate. Only 44 (8.8%) had donor cards. The multiple logistic regression revealed that the minorities ethnic group was more willing to donate organs than Malay respondents (adjusted odds ratio [aOR] = 1.98, P = 0.010). In addition, medical students were more willing to donate than nursing students (aOR = 2.53, P = 0.000). Respondents who have a family member with a donor card were more willing to donate than respondents who do not (aOR = 3.48, P = 0.006). MaNS who believed that their religion permits deceased donation were more willing to donate than their counterparts (aOR = 4.96, P = 0.000). Household income and sex were not significant predictors of MaNS’ willingness to donate organs upon death. MaNS have moderate willingness, but low commitment toward deceased organ donation. Strategies for improving MaNS’ attitude should better educate them on organ donation, targeting the most the Malay and nursing students, and should consider the influence of family attitude and religious permissibility on MaNS’ willingness. PMID:27015207

Identifying potential engaging leaders within medical education: The role of positive influence on peers.

PubMed

Michalec, Barret; Veloski, J Jon; Hojat, Mohammadreza; Tykocinski, Mark L

2014-08-26

Abstract Background: Previous research has paid little to no attention towards exploring methods of identifying existing medical student leaders. Aim: Focusing on the role of influence and employing the tenets of the engaging leadership model, this study examines demographic and academic performance-related differences of positive influencers and if students who have been peer-identified as positive influencers also demonstrate high levels of genuine concern for others. Methods: Three separate fourth-year classes were asked to designate classmates that had significant positive influences on their professional and personal development. The top 10% of those students receiving positive influence nominations were compared with the other students on demographics, academic performance, and genuine concern for others. Results: Besides age, no demographic differences were found between positive influencers and other students. High positive influencers were not found to have higher standardized exam scores but did receive significantly higher clinical clerkship ratings. High positive influencers were found to possess a higher degree of genuine concern for others. Conclusion: The findings lend support to (a) utilizing the engaging model to explore leaders and leadership within medical education, (b) this particular method of identifying existing medical student leaders, and (c) return the focus of leadership research to the power of influence.

Factors influencing children's food choice.

PubMed

Koivisto Hursti, U K

1999-04-01

Although food habits are not stable and unchanging during a person's lifetime, a base for healthy food habits can be created in early childhood. Children's food habits can be assumed to be influenced by their parents' food habits and choices. The aim of this article is to review factors influencing food choice in children as well as in adults. The results demonstrate that the development of children's food habits is influenced by a multitude of factors. Parents play an important role in the formation of food habits and preferences of young children. They can influence their children's food choice by making specific foods available, by acting as models for their children and by their behaviour in specific situations. Children tend to be afraid of new foods and do not readily accept them. However, experience is known to enhance preference, and earlier experiences of a particular food are the major determinants of the development of children's food acceptance patterns. Thus, parents should be encouraged to make healthy foods easily available to the child and serve these foods in positive mealtime situations in order to help their child to develop healthy food habits.

Factors influencing children's food choice.

PubMed

Hursti, Ulla-Kaisa Koivisto

1999-01-01

Although food habits arc not stable and unchanging during a person's lifetime, a base for healthy food habits can be created in early childhood. Children's food habits can be assumed to be influenced by their parents' food habits and choices. The aim of this article is to review factors influencing food choice in children as well as in adults. The results demonstrate that the development of children's food habits is influenced by a multitude of factors. Parents play an important role in the formation of food habits and preferences of young children. They can influence their children's food choice by making specific foods available, by acting as models for their children and by their behaviour in specific situations. Children tend to be afraid of new foods and do not readily accept them. However, experience is known to enhance preference, and earlier experiences of a particular food are the major determinants of the development of children's food acceptance patterns. Thus, parents should be encouraged to make healthy foods easily available to the child and serve these foods in positive mealtime situations in order to help their child to develop healthy food habits.

Factors affecting smartphone adoption for accessing information in medical settings.

PubMed

Tahamtan, Iman; Pajouhanfar, Sara; Sedghi, Shahram; Azad, Mohsen; Roudbari, Masoud

2017-06-01

This study aimed to acquire knowledge about the factors affecting smartphone adoption for accessing information in medical settings in Iranian Hospitals. A qualitative and quantitative approach was used to conduct this study. Semi-structured interviews were conducted with 21 medical residents and interns in 2013 to identify determinant factors for smartphone adoption. Afterwards, nine relationships were hypothesised. We developed a questionnaire to test these hypotheses and to evaluate the importance of each factor. Structural equation modelling was used to analyse the causal relations between model parameters and to accurately identify determinant factors. Eight factors were identified in the qualitative phase of the study, including perceived usefulness, perceived ease of use, training, internal environment, personal experience, social impacts, observability and job related characteristics. Among the studied factors, perceived usefulness, personal experience and job related characteristics were significantly associated with attitude to use a smartphone which accounted for 64% of the variance in attitude. Perceived usefulness had the strongest impact on attitude to use a smartphone. The factors that emerged from interviews were consistent with the Technology Acceptance Model (TAM) and some previous studies. TAM is a reliable model for understanding the factors of smartphone acceptance in medical settings. © 2017 Health Libraries Group.

Factors influencing humanitarian care and the treatment of local patients within the deployed military medical system: casualty referral limitations.

PubMed

Causey, Marlin; Rush, Robert M; Kjorstad, Randy J; Sebesta, James A

2012-05-01

Humanitarian medical care is an essential task of the deployed military health care system. The purpose of this study was to analyze referral acceptance in treating injured local national patients during Operation Enduring Freedom. A prospective observation study of local nationals who were referred for humanitarian trauma care in Afghanistan from March through August 2009. Sixty-six patients were referred for evacuation for suspected non-coalition-caused injuries. The bed status at the receiving hospital was defined as green (able to accept patients), amber (nearing capacity), and red (at capacity). The only factor associated with acceptance was the accepting hospital bed status (odds ratio = 1.57%, 95% confidence interval, 1.11-2.22; P = .009). Factors not significant were age, the province of origin, the type of referring facility, a prior operation before the request, patient status/affiliation, or the mechanism of injury. Humanitarian medical care is directly related to the capacity for high-acuity care because bed availability is the predominate reason for acceptance or rejection. Published by Elsevier Inc.

MD/MBA Students: An Analysis of Medical Student Career Choice.

PubMed

Sherrill, Windsor Westbrook

2004-12-01

An increasing number of medical schools are offering dual degree MD/MBA programs. Career choices and factors influencing students to enter these programs provide an indicator of the roles in which dual degree students will serve in health care as well as the future of dual degree programs. Using career choice theory as a conceptual framework, career goals and factors influencing decisions to enter dual degree programs were assessed among dual degree medical students. Students enrolled at dual degree programs at six medical schools were surveyed and interviewed. A control group of traditional medical students was also surveyed. Factors influencing students to seek both medical and business training are varied but are often related to a desire for leadership opportunities, concerns about change in medicine and job security and personal career goals. Most students expect to combine clinical and administrative roles. Students entering these programs do so for a variety of reasons and plan diverse careers. These findings can provide guidance for program development and recruitment for dual degree medical education programs.

Parents' Perspectives About Factors Influencing Adherence to Pharmacotherapy for ADHD.

PubMed

Ahmed, Rana; Borst, Jacqueline; Wei, Yong C; Aslani, Parisa

2017-01-01

The aim of the present study was to explore factors influencing parents' decisions to adhere and persist with ADHD pharmacotherapy in children. Focus groups ( n = 3) were conducted with 16 parents recruited from metropolitan Sydney. Group discussions explored factors impacting on treatment initiation, continuation, and cessation. Focus groups were audio-recorded, transcribed verbatim, and thematically content analyzed. Parents commenced and continued pharmacotherapy due to its positive impact on their child's behavior. Improvements in the child's academic performance and social interactions encouraged persistence with therapy. Parents elected to cease therapy after their children experienced side effects including appetite suppression, weight loss, and sleep disturbances. Concerns about long-term effects of ADHD medication use including potential for addiction and growth stunting, in addition to the stigma surrounding ADHD also contributed to parents ceasing treatment. The findings highlight a need for the provision of accurate information about ADHD and its treatments to parents to empower their treatment decisions and promote adherence.

[Factors influencing activity of oral anticoagulants. Interactions with drugs and food].

PubMed

Sawicka-Powierza, Jolanta; Rogowska-Szadkowska, Dorota; Ołtarzewska, Alicja Małgorzata; Chlabicz, Sławomir

2008-05-01

Oral anticoagulants (OAC) are commonly used as a life-long therapy in prevention of systemic embolism in patients with atrial fibrillation, valvular heart disease and prosthetic hart valves and in the primary and secondary prevention of venous thromboembolism. They are also used for the prevention of thromboembolic events in patients with acute myocardial infarction and with angina pectoris, in patients with biological hart valves and after some types of orthopaedics surgery. The International Normalized Ratio (INR) is used to evaluate the efficacy of anti-coagulant therapy. The risk of thromboembolic and haemorrhagic complications increases when the INR is out of the therapeutic range. The aim of this study was to present information about the factors influencing activity of oral anticoagulants and interactions between oral anticoagulants and drugs or food. The effect of oral anticoagulants is influenced by genetic and environmental factors such as: medicines, food, diseases and pre-existing conditions. A common mutation in the gene coding for the cytochrome P450 (CYP2C9), with one or more combinations of its polymorphisms, is responsible for the reduced warfarin requirements or for the resistance to warfarin. A mutation in the factor IX is responsible for the risk of bleeding during OAC therapy without excessive prolongation of the prothrombin time (PT). Drugs, herbs and multivitamin supplements can alter the absorption, pharmacokinetics or pharmakodynamics of OAC. Nonsteroid anti-inflammatory drugs and paracetamol in combination with OAC seem to be the most dangerous because they are available without prescription and are used without medical consultation. Patients on OAC therapy are sensitive to changing dietary intake of vitamin K, which is supplied from phylloquinones in plants or from vitamin K-containing medicines. The effect of OAC can be influenced by other existing factors like: fever, diarrhoea, alcohol abuse or physical hyperactivity. Some malignancies

An exploration of the dynamics and influences upon second medical opinion consultations in cancer care.

PubMed

Philip, Jennifer; Gold, Michelle; Schwarz, Max; Komesaroff, Paul

2011-03-01

The aim of this study was to explore the dynamics within second medical opinion consultations in patients with cancer. Semi-structured interviews were held with four oncologists and were subjected to a thematic analysis to define the broad issues. These formed the basis of a survey distributed to Australian medical oncologists. Overall 65 surveys were returned representing an overall response rate of 30% (10% and 63% electronic and hardcopy response rates, respectively). The dynamics in giving second medical opinions are influenced by the collegiate relationships of the doctors. Nearly two-thirds of oncologists believed that the first doctors' treatment and recommendations influenced the outcome of the second opinion, more than one-third believed the outcome was influenced by the relationship between the two doctors, and 41% believed the public nature of a second opinion was influential. In each case, these figures were more than double their assessments of patients' beliefs of these influences. Care was taken not to criticise the primary doctor. Second medical opinions provide an opportunity for oncologists to review medical care and engage in enhanced communication with patients who have additional needs. These consultations do not, however, occur in a vacuum but are influenced by the need to attend to relationships between the patient and their primary doctor and between the doctors themselves. The second medical opinion is embedded within a network of relationships and within the illness journey. © 2010 Blackwell Publishing Asia Pty Ltd.

A Qualitative Study on Factors that Influence Turkish Medical Students’ Decisions to Become Family Physicians After the Health Transformation Programme

PubMed Central

Tanriover, Ozlem; Hidiroglu, Seyhan; Akan, Hulya; Ay, Pinar; Erdogan, Yalcin; Karavus, Melda; Vitrinel, Ayca; Hayran, Osman

2014-01-01

Background: In Turkey, general practitioners were authorized to work as family physicians without specialization, within the scope of the Health Transformation Programme, due to inadequate number of family medicine specialists since 2004. With this new implementation Family Medicine specialty became a less preferable option for medical students. Aims: The study was to investigate the perspectives of medical students and understand the issues to choose Family Medicine specialty as a career option. Materials and Methods: This qualitative study was performed with 48 final year medical students using a convenience sample from two medical universities. Results: Three main categories emerged from the data viewing Family Medicine ‘as a specialty’, ‘as an employment’, and finally ‘as a system’. Very few students stated that Family Medicine would be their choice for specialty. Conclusions: Family Medicine does not seem to be an attractive option in career planning by medical students. Several factors that may constrain students from choosing Family Medicine include: not perceiving Family Medicine as a field of expertise, and the adverse conditions at work which may originate from duality in the system. PMID:25006564

[Degree of dry mouth and factors influencing oral health-related quality of life for community-dwelling elders].

PubMed

Park, Myung Sook; Ryu, Se Ang

2010-10-01

This study was conducted to investigate the degree of dry mouth and oral health-related quality of life and to identify factors contributing to oral health-related quality of life for community-dwelling elders. A descriptive correlational study design was used. Participants were 156 older adults from two senior welfare centers. Data were collected on February 21, 22 and 29, 30, 2009 using structured questionnaires. Enter type multiple regression analysis was used to identify factors influencing oral health-related quality of life according to general and oral health characteristics. There were significant differences in oral health-related quality of life according to living arrangement, insurance, smoking, number of natural teeth, and denture type. The oral health-related quality of life had significant correlations with the number of chronic disease, number of medications, and dry mouth. Factors influencing oral health-related quality of life for community-dwelling older adults were dry mouth, number of chronic disease, and medical aid, which explained about 47.9% of total variance. These results indicate that in order to promote oral health-related quality of life for older adults, prevention or management of chronic diseases as well as oral health and dry mouth are needed for this population, and especially economically poor elders.

[Investigation on level and influencing factors of first aid knowledge among dentists in Sichuan province].

PubMed

Qiu, Yu; Li, Yuan-Yuan; Li, Tian-Guo; Chen, Yi-Ge; Kong, Jing-Jun; Pan, Jian

2018-04-01

The study aims to investigate the cognition degree and influencing factors of first aid knowledge among dentists in Sichuan province, and to provide suggestions for the training of oral clinician. A questionnaire was designed for this study. It included the basic situation of population, first aid knowledge level, emergency situation often encountered in stomatology clinic, first aid training situation, learning approach and attitude of first aid knowledge, etc. This questionnaire was used to investigate the dentists of medical institutions in various cities in Sichuan province. The survey results was statistical analyzed. There were 245 valid questionnaires. 1) The level of first aid knowledge of dentists was generally lower in Sichuan province. Work department and other departments work experience were the influencing factors of knowledge level of first aid knowledge among dentists. 2) 87.3% of dentists believed that it was very necessary to master the knowledge of first aid, but in the event of an emergency situation, 73.5% of dentists only can find other doctors to guide themselves to help. 3) The most common way to learn first aid knowledge was through work experience and medical school's first aid course. Dentists should strengthen the learning and training to improve the first aid skill.

Identification of variables influencing pharmaceutical interventions to improve medication review efficiency.

PubMed

Cornuault, Lauriane; Mouchel, Victorine; Phan Thi, Thuy-Tan; Beaussier, Hélène; Bézie, Yvonnick; Corny, Jennifer

2018-06-02

Background Clinical pharmacists' involvement has improved patients' care, by suggesting therapeutic optimizations. However, budget restrictions require a prioritization of these activities to focus resources on patients more at risk of medication errors. Objective The aim of our study was to identify variables influencing the formulation of pharmaceutical to improve medication review efficiency. Setting This study was conducted in medical wards of a 643-acute beds hospital in Paris, France. Methods All hospital medical prescriptions of all patients admitted within four medical wards (cardiology, rheumatology, neurology, vascular medicine) were analyzed. The study was conducted in each ward for 2 weeks, during 4 weeks. For each patient, variables prospectively collected were: age, gender, weight, emergency admission, number of high-alert medications and of total drugs prescribed, care unit, serum creatinine. Number of pharmaceutical interventions (PIs) and their type were reported. Main outcome measures Variables influencing the number of pharmaceutical interventions during medication review were identified using simple and multiple linear regressions. Results A total of 2328 drug prescriptions (303 patients, mean age 70.6 years-old) were analyzed. Mean number of hospital drug prescriptions was 7.9. A total of 318 PIs were formulated. Most frequent PIs were drug omission (n = 88, 27.7%), overdosing (n = 69, 21.7%), and underdosing (n = 51, 16.0%). Among variables studied, age, serum creatinine level, number of high-alert medications prescribed and total number of drugs prescribed were significantly associated with the formulation of pharmaceutical interventions (adjusted R 2  = 0.34). Conclusions This study identified variables (age, serum creatinine level, number of high-alert medication, number of prescribed drugs) that may help institutions/pharmacists target their reviews towards patients most likely to require pharmacist interventions.

Factors Influencing Effective Writing.

ERIC Educational Resources Information Center

Muccino, Mary Ann; And Others

Focusing on procedures and strategies suitable for teaching writing to students in grades 4, 6, and 8, this paper examines the factors that have been shown through research to influence effective writing. The paper divides the research examined into the categories of metacognition; socially-based writing strategies; theory-tested approaches to…

Medical and Non-Medical Factors Influencing Utilization of Delayed Pushing in the Second Stage

PubMed Central

FREY, Heather A.; TUULI, Methodius G.; CORTEZ, Sarah; ODIBO, Anthony O.; ROEHL, Kimberly A.; SHANKS, Anthony L.; MACONES, George A.; CAHILL, Alison G.

2014-01-01

Objective To evaluate factors impacting selection to delayed pushing in the second stage of labor. Study design This case-control study was a secondary analysis of a large retrospective cohort study. Cases included women who delayed pushing for 60 minutes or more in the second stage of labor. Controls began pushing prior to 60 minutes from the time of diagnosis of complete dilation. Demographic, labor, and nonmedical factors were compared among cases and controls. Logistic regression modelling was used to identify factors independently associated with delayed pushing. Results We identified 471 women who delayed pushing and 4,819 controls. Nulliparity, maternal body mass index > 25, high fetal station at complete dilation, regional anesthesia use, and start of second stage during staffing shift change were independent factors associated with increased use of delayed pushing. On the other hand, black race and second stage management during night shift were associated with lower odds of employing delayed pushing. Delayed pushing was more commonly employed in nulliparous women, but 38.9% of multiparous women also delayed pushing. Conclusion We identified multiple factors associated with use of delayed pushing. This study helps to define current patterns of second stage labor management. PMID:23208765

Minimizing medical litigation, Part 1.

PubMed

Harold, Tan Keng Boon

2006-01-01

The global rise in medical litigation has led to defensive medical practices and rising malpractice insurance premiums. There is a need to review all possible factors influencing litigiousness of the society and to develop strategies to control such factors. Some of the contributory causes of rising litigiousness include higher patients' expectations, poor provider-patient communication, and adversarial legalism of the society. A good combination of system, professional, and legislative strategies may keep medical litigation in check. Part 2 of this article will address the development of a dispute resolution framework.

Factors affecting self-regulated learning in medical students: a qualitative study

PubMed Central

Jouhari, Zahra; Haghani, Fariba; Changiz, Tahereh

2015-01-01

Introduction Clinical courses are required of all medical students and means that they must develop the key skill of self-regulation during learning. The ability to self-regulate learning strategies is affected by different factors. This study determined the views of medical students on the factors affecting self-regulated learning (SRL). Method This study uses a qualitative approach and the content analysis method. Nineteen medical students in their fourth, fifth, and sixth years of study at Isfahan University of Medical Science participated in semi-structured, in-depth interviews. The students were selected using purposive sampling based on their overall grade point average (GPA). Results Five main themes were found to affect SRL. These themes included family with the two subthemes of family supervisory and supportive roles; peers with the two subthemes of facilitating and inhibiting roles; instructors with the two subthemes of personal and educational instructor's characteristics; educational environment with the two subthemes of facilitator and inhibitor roles; and student with the two subthemes of facilitating and inhibiting personal factors. Conclusion The outcomes of student understanding of the factors affecting self-regulation indicate that facilitating factors should be used on an individual basis to reduce the effect of inhibiting factors to improve self-regulation in students. PMID:26549046

Factors affecting self-regulated learning in medical students: a qualitative study.

PubMed

Jouhari, Zahra; Haghani, Fariba; Changiz, Tahereh

2015-01-01

Introduction Clinical courses are required of all medical students and means that they must develop the key skill of self-regulation during learning. The ability to self-regulate learning strategies is affected by different factors. This study determined the views of medical students on the factors affecting self-regulated learning (SRL). Method This study uses a qualitative approach and the content analysis method. Nineteen medical students in their fourth, fifth, and sixth years of study at Isfahan University of Medical Science participated in semi-structured, in-depth interviews. The students were selected using purposive sampling based on their overall grade point average (GPA). Results Five main themes were found to affect SRL. These themes included family with the two subthemes of family supervisory and supportive roles; peers with the two subthemes of facilitating and inhibiting roles; instructors with the two subthemes of personal and educational instructor's characteristics; educational environment with the two subthemes of facilitator and inhibitor roles; and student with the two subthemes of facilitating and inhibiting personal factors. Conclusion The outcomes of student understanding of the factors affecting self-regulation indicate that facilitating factors should be used on an individual basis to reduce the effect of inhibiting factors to improve self-regulation in students.

Factors affecting self-regulated learning in medical students: a qualitative study.

PubMed

Jouhari, Zahra; Haghani, Fariba; Changiz, Tahereh

2015-01-01

Clinical courses are required of all medical students and means that they must develop the key skill of self-regulation during learning. The ability to self-regulate learning strategies is affected by different factors. This study determined the views of medical students on the factors affecting self-regulated learning (SRL). This study uses a qualitative approach and the content analysis method. Nineteen medical students in their fourth, fifth, and sixth years of study at Isfahan University of Medical Science participated in semi-structured, in-depth interviews. The students were selected using purposive sampling based on their overall grade point average (GPA). Five main themes were found to affect SRL. These themes included family with the two subthemes of family supervisory and supportive roles; peers with the two subthemes of facilitating and inhibiting roles; instructors with the two subthemes of personal and educational instructor's characteristics; educational environment with the two subthemes of facilitator and inhibitor roles; and student with the two subthemes of facilitating and inhibiting personal factors. The outcomes of student understanding of the factors affecting self-regulation indicate that facilitating factors should be used on an individual basis to reduce the effect of inhibiting factors to improve self-regulation in students.

Factors influencing perceived angular velocity.

PubMed

Kaiser, M K; Calderone, J B

1991-11-01

The assumption that humans are able to perceive and process angular kinematics is critical to many structure-from-motion and optical flow models. The current studies investigate this sensitivity, and examine several factors likely to influence angular velocity perception. In particular, three factors are considered: (1) the extent to which perceived angular velocity is determined by edge transitions of surface elements, (2) the extent to which angular velocity estimates are influenced by instantaneous linear velocities of surface elements, and (3) whether element-velocity effects are related to three-dimensional (3-D) tangential velocities or to two-dimensional (2-D) image velocities. Edge-transition rate biased angular velocity estimates only when edges were highly salient. Element velocities influenced perceived angular velocity; this bias was related to 2-D image velocity rather than 3-D tangential velocity. Despite these biases, however, judgments were most strongly determined by the true angular velocity. Sensitivity to this higher order motion parameter was surprisingly good, for rotations both in depth (y-axis) and parallel to the line of sight (z-axis).

Factors Influencing Curricular Reform; An Irish Perspective

ERIC Educational Resources Information Center

Ferris, Helena; Joyce, Pauline

2015-01-01

There are various influences and obstacles when planning an educational curriculum. The imprint of globalisation on the landscape of Irish medicine highlights the importance of delivering a diverse curriculum with international dimensions so that knowledge and skills can transfer across borders. It is also clear that medical emigration has a…

Patient, physician, pharmacy, and pharmacy benefit design factors related to generic medication use.

PubMed

Shrank, William H; Stedman, Margaret; Ettner, Susan L; DeLapp, Dee; Dirstine, June; Brookhart, M Alan; Fischer, Michael A; Avorn, Jerry; Asch, Steven M

2007-09-01

Increased use of generic medications conserves insurer and patient financial resources and may increase patient adherence. The objective of the study is to evaluate whether physician, patient, pharmacy benefit design, or pharmacy characteristics influence the likelihood that patients will use generic drugs Observational analysis of 2001-2003 pharmacy claims from a large health plan in the Western United States. We evaluated claims for 5,399 patients who filled a new prescription in at least 1 of 5 classes of chronic medications with generic alternatives. We identified patients initiated on generic drugs and those started on branded medications who switched to generic drugs in the subsequent year. We used generalized estimating equations to perform separate analyses assessing the relationship between independent variables and the probability that patients were initiated on or switched to generic drugs. Of the 5,399 new prescriptions filled, 1,262 (23.4%) were generics. Of those initiated on branded medications, 606 (14.9%) switched to a generic drug in the same class in the subsequent year. After regression adjustment, patients residing in high-income zip codes were more likely to initiate treatment with a generic than patients in low-income regions (RR = 1.29; 95% C.I. 1.04-1.60); medical subspecialists (RR = 0.82; 0.69-0.95) and obstetrician/gynecologists (RR = 0.81; 0.69-0.98) were less likely than generalist physicians to initiate generics. Pharmacy benefit design and pharmacy type were not associated with initiation of generic medications. However, patients were over 2.5 times more likely to switch from branded to generic medications if they were enrolled in 3-tier pharmacy plans (95% C.I. 1.12-6.09), and patients who used mail-order pharmacies were 60% more likely to switch to a generic (95% C.I. 1.18-2.30) after initiating treatment with a branded drug. Physician and patient factors have an important influence on generic drug initiation, with the patients who

Medication Errors in Vietnamese Hospitals: Prevalence, Potential Outcome and Associated Factors

PubMed Central

Nguyen, Huong-Thao; Nguyen, Tuan-Dung; van den Heuvel, Edwin R.; Haaijer-Ruskamp, Flora M.; Taxis, Katja

2015-01-01

Background Evidence from developed countries showed that medication errors are common and harmful. Little is known about medication errors in resource-restricted settings, including Vietnam. Objectives To determine the prevalence and potential clinical outcome of medication preparation and administration errors, and to identify factors associated with errors. Methods This was a prospective study conducted on six wards in two urban public hospitals in Vietnam. Data of preparation and administration errors of oral and intravenous medications was collected by direct observation, 12 hours per day on 7 consecutive days, on each ward. Multivariable logistic regression was applied to identify factors contributing to errors. Results In total, 2060 out of 5271 doses had at least one error. The error rate was 39.1% (95% confidence interval 37.8%- 40.4%). Experts judged potential clinical outcomes as minor, moderate, and severe in 72 (1.4%), 1806 (34.2%) and 182 (3.5%) doses. Factors associated with errors were drug characteristics (administration route, complexity of preparation, drug class; all p values < 0.001), and administration time (drug round, p = 0.023; day of the week, p = 0.024). Several interactions between these factors were also significant. Nurse experience was not significant. Higher error rates were observed for intravenous medications involving complex preparation procedures and for anti-infective drugs. Slightly lower medication error rates were observed during afternoon rounds compared to other rounds. Conclusions Potentially clinically relevant errors occurred in more than a third of all medications in this large study conducted in a resource-restricted setting. Educational interventions, focusing on intravenous medications with complex preparation procedure, particularly antibiotics, are likely to improve patient safety. PMID:26383873

How Numeracy Influences Risk Comprehension and Medical Decision Making

PubMed Central

Reyna, Valerie F.; Nelson, Wendy L.; Han, Paul K.; Dieckmann, Nathan F.

2009-01-01

We review the growing literature on health numeracy, the ability to understand and use numerical information, and its relation to cognition, health behaviors, and medical outcomes. Despite the surfeit of health information from commercial and noncommercial sources, national and international surveys show that many people lack basic numerical skills that are essential to maintain their health and make informed medical decisions. Low numeracy distorts perceptions of risks and benefits of screening, reduces medication compliance, impedes access to treatments, impairs risk communication (limiting prevention efforts among the most vulnerable), and, based on the scant research conducted on outcomes, appears to adversely affect medical outcomes. Low numeracy is also associated with greater susceptibility to extraneous factors (i.e., factors that do not change the objective numerical information). That is, low numeracy increases susceptibility to effects of mood or how information is presented (e.g., as frequencies vs. percentages) and to biases in judgment and decision making (e.g., framing and ratio bias effects). Much of this research is not grounded in empirically supported theories of numeracy or mathematical cognition, which are crucial for designing evidence-based policies and interventions that are effective in reducing risk and improving medical decision making. To address this gap, we outline four theoretical approaches (psychophysical, computational, standard dual-process, and fuzzy trace theory), review their implications for numeracy, and point to avenues for future research. PMID:19883143

Prevalence of self-medication in Brazil and associated factors

PubMed Central

Arrais, Paulo Sérgio Dourado; Fernandes, Maria Eneida Porto; Pizzol, Tatiane da Silva Dal; Ramos, Luiz Roberto; Mengue, Sotero Serrate; Luiza, Vera Lucia; Tavares, Noemia Urruth Leão; Farias, Mareni Rocha; Oliveira, Maria Auxiliadora; Bertoldi, Andréa Dâmaso

2016-01-01

ABSTRACT OBJECTIVE To analyze the prevalence and associated factors regarding the use of medicines by self-medication in Brazil. METHODS This cross-sectional population-based study was conducted using data from the PNAUM (National Survey on Access, Use and Promotion of Rational Use of Medicines), collected between September 2013 and February 2014 by interviews at the homes of the respondents. All people who reported using any medicines not prescribed by a doctor or dentist were classified as self-medication practitioners. Crude and adjusted prevalence ratios (Poisson regression) and their respective 95% confidence intervals were calculated in order to investigate the factors associated with the use of self-medication by medicines. The independent variables were: sociodemographic characteristics, health conditions and access to and use of health services. In addition, the most commonly consumed medicines by self-medication were individually identified. RESULTS The self-medication prevalence in Brazil was 16.1% (95%CI 15.0–17.5), with it being highest in the Northeast region (23.8%; 95%CI 21.6–26.2). Following the adjusted analysis, self-medication was observed to be associated with females, inhabitants from the North, Northeast and Midwest regions and individuals that have had one, or two or more chronic diseases. Analgesics and muscle relaxants were the therapeutic groups most used for self-medication, with dipyrone being the most consumed medicines. In general, most of the medicines used for self-medication were classified as non-prescriptive (65.5%). CONCLUSIONS Self-medication is common practice in Brazil and mainly involves the use of non-prescription medicines; therefore, the users of such should be made aware of the possible risks. PMID:27982373

Aversion to Ambiguity Regarding Medical Tests and Treatments: Measurement, Prevalence, and Relationship to Sociodemographic Factors

PubMed Central

HAN, PAUL K. J.; REEVE, BRYCE B.; MOSER, RICHARD P.; KLEIN, WILLIAM M. P.

2014-01-01

Aversion to “ambiguity”—uncertainty about the reliability, credibility, or adequacy of risk-related information—is an important problem that may influence judgments and decisions about medical interventions. Ambiguity aversion (AA) varies among individuals, however, and has been understudied in the health domain. To explore this phenomenon further, we developed a new theory-based measure of aversion to ambiguity regarding medical tests and treatments, and examined the prevalence and association of AA with sociodemographic factors. The “AA-Med” scale was developed using a large survey sample of the U.S. public (n = 4,398), and scale psychometric properties and the population distribution of AA were evaluated. The scale demonstrated acceptable reliability (α = .73) and validity as ascertained by association with respondents’ interest in a hypothetical ambiguous cancer screening test. Ambiguity aversion (AA) was associated with older age, non-White race, lower education and income, and female sex. The AA-Med scale is a promising new measure, and AA is associated with several sociodemographic factors. We discuss implications of these findings and potential applications of the scale for future research. PMID:19731127

What Influences Mental Illness? Discrepancies Between Medical Education and Conception.

PubMed

Einstein, Evan Hy; Klepacz, Lidia

2017-01-01

This preliminary study examined the differences between what was taught during a formal medical education and medical students' and psychiatry residents' conceptions of notions regarding the causes and determinants of mental illness. The authors surveyed 74 medical students and 11 residents via convenience sampling. The survey contained 18 statements which were rated twice based on truthfulness in terms of a participant's formal education and conception, respectively. Descriptive statistics and a Wilcoxon signed rank test determined differences between education and conception. Results showed that students were less likely to perceive a neurotransmitter imbalance to cause mental illness, as opposed to what was emphasized during a formal medical education. Students and residents also understood the importance of factors such as systemic racism and socioeconomic status in the development of mental illness, which were factors that did not receive heavy emphasis during medical education. Furthermore, students and residents believed that not only did mental illnesses have nonuniform pathologies, but that the Diagnostic and Statistical Manual of Mental Disorders also had the propensity to sometimes arbitrarily categorize individuals with potentially negative consequences. If these notions are therefore part of students' and residents' conceptions, as well as documented in the literature, then it seems appropriate for medical education to be further developed to emphasize these ideas.

Key Factors for Providing Appropriate Medical Care in Secondary School Athletics: Athletic Training Services and Budget

PubMed Central

Wham, George S.; Saunders, Ruth; Mensch, James

2010-01-01

Abstract Context: Research suggests that appropriate medical care for interscholastic athletes is frequently lacking. However, few investigators have examined factors related to care. Objective: To examine medical care provided by interscholastic athletics programs and to identify factors associated with variations in provision of care. Design: Cross-sectional study. Setting: Mailed and e-mailed survey. Patients or Other Participants: One hundred sixty-six South Carolina high schools. Intervention(s): The 132-item Appropriate Medical Care Assessment Tool (AMCAT) was developed and pilot tested. It included 119 items assessing medical care based on the Appropriate Medical Care for Secondary School-Age Athletes (AMCSSAA) Consensus Statement and Monograph (test-retest reliability: r  =  0.89). Also included were items assessing potential influences on medical care. Presence, source, and number of athletic trainers; school size; distance to nearest medical center; public or private status; sports medicine supply budget; and varsity football regional championships served as explanatory variables, whereas the school setting, region of state, and rate of free or reduced lunch qualifiers served as control variables. Main Outcome Measure(s): The Appropriate Care Index (ACI) score from the AMCAT provided a quantitative measure of medical care and served as the response variable. The ACI score was determined based on a school's response to items relating to AMCSSAA guidelines. Results: Regression analysis revealed associations with ACI score for athletic training services and sports medicine supply budget (both P < .001) when controlling for the setting, region, and rate of free or reduced lunch qualifiers. These 2 variables accounted for 30% of the variance in ACI score (R2  =  0.302). Post hoc analysis showed differences between ACI score based on the source of the athletic trainer and the size of the sports medicine supply budget. Conclusions: The AMCAT offers an

Social Factors Influencing Child Health in Ghana

PubMed Central

Quansah, Emmanuel; Ohene, Lilian Akorfa; Norman, Linda; Mireku, Michael Osei; Karikari, Thomas K.

2016-01-01

Objectives Social factors have profound effects on health. Children are especially vulnerable to social influences, particularly in their early years. Adverse social exposures in childhood can lead to chronic disorders later in life. Here, we sought to identify and evaluate the impact of social factors on child health in Ghana. As Ghana is unlikely to achieve the Millennium Development Goals’ target of reducing child mortality by two-thirds between 1990 and 2015, we deemed it necessary to identify social determinants that might have contributed to the non-realisation of this goal. Methods ScienceDirect, PubMed, MEDLINE via EBSCO and Google Scholar were searched for published articles reporting on the influence of social factors on child health in Ghana. After screening the 98 articles identified, 34 of them that met our inclusion criteria were selected for qualitative review. Results Major social factors influencing child health in the country include maternal education, rural-urban disparities (place of residence), family income (wealth/poverty) and high dependency (multiparousity). These factors are associated with child mortality, nutritional status of children, completion of immunisation programmes, health-seeking behaviour and hygiene practices. Conclusions Several social factors influence child health outcomes in Ghana. Developing more effective responses to these social determinants would require sustainable efforts from all stakeholders including the Government, healthcare providers and families. We recommend the development of interventions that would support families through direct social support initiatives aimed at alleviating poverty and inequality, and indirect approaches targeted at eliminating the dependence of poor health outcomes on social factors. Importantly, the expansion of quality free education interventions to improve would-be-mother’s health knowledge is emphasised. PMID:26745277

Social Factors Influencing Child Health in Ghana.

PubMed

Quansah, Emmanuel; Ohene, Lilian Akorfa; Norman, Linda; Mireku, Michael Osei; Karikari, Thomas K

2016-01-01

Social factors have profound effects on health. Children are especially vulnerable to social influences, particularly in their early years. Adverse social exposures in childhood can lead to chronic disorders later in life. Here, we sought to identify and evaluate the impact of social factors on child health in Ghana. As Ghana is unlikely to achieve the Millennium Development Goals' target of reducing child mortality by two-thirds between 1990 and 2015, we deemed it necessary to identify social determinants that might have contributed to the non-realisation of this goal. ScienceDirect, PubMed, MEDLINE via EBSCO and Google Scholar were searched for published articles reporting on the influence of social factors on child health in Ghana. After screening the 98 articles identified, 34 of them that met our inclusion criteria were selected for qualitative review. Major social factors influencing child health in the country include maternal education, rural-urban disparities (place of residence), family income (wealth/poverty) and high dependency (multiparousity). These factors are associated with child mortality, nutritional status of children, completion of immunisation programmes, health-seeking behaviour and hygiene practices. Several social factors influence child health outcomes in Ghana. Developing more effective responses to these social determinants would require sustainable efforts from all stakeholders including the Government, healthcare providers and families. We recommend the development of interventions that would support families through direct social support initiatives aimed at alleviating poverty and inequality, and indirect approaches targeted at eliminating the dependence of poor health outcomes on social factors. Importantly, the expansion of quality free education interventions to improve would-be-mother's health knowledge is emphasised.

The effective factors on library anxiety of students in Isfahan University of Medical Sciences and Shiraz University of Medical Sciences.

PubMed

Ashrafi-Rizi, Hasan; Sajad, Maryam Sadat; Rahmani, Sedigheh; Bahrami, Susan; Papi, Ahmad

2014-01-01

The efficient use of libraries can be an important factor in determining the educational quality of Universities. Therefore, investigation and identification of factors affecting library anxiety becomes increasingly necessary. The purpose of this research is to determine the factors effecting library anxiety of students in Isfahan University of Medical Sciences and Shiraz University of Medical Sciences. This was an applied survey research using Bostick's Library Anxiety questionnaire as data gathering tool. The statistical population consisted of all students of Isfahan University of Medical Sciences and Shiraz University of Medical Sciences (15011 students) with the sample size of 375 using stratified random sampling. The validity of data gathering tool was confirmed by experts in the library and information science and its reliability was determined by Cronbach's alpha (r = 0.92). Descriptive statistics (frequency, percentage, mean and standard deviation) and inferential statistics (t-test and ANOVA) were used for data analysis using SPSS 18 software. Findings showed that the mean of library anxiety score was 2.68 and 2.66 for students of Isfahan University of Medical Sciences and Shiraz University of Medical Sciences respectively which is above average (2.5). Furthermore, age and gender had no meaningful effect on the library anxiety of students of Isfahan University of Medical Sciences, but gender had a meaningful effect on library anxiety of students of Shiraz University of Medical Sciences while age had no such effect. The results showed that the mean of factors effecting library anxiety in students of Isfahan University of Medical Sciences and students of Shiraz University of Medical Sciences is higher than average and therefore not satisfactory and only factors relating to feeling comfortable in the library is lower than average and somewhat satisfactory.

The effective factors on library anxiety of students in Isfahan University of Medical Sciences and Shiraz University of Medical Sciences

PubMed Central

Ashrafi-rizi, Hasan; Sajad, Maryam Sadat; Rahmani, Sedigheh; Bahrami, Susan; Papi, Ahmad

2014-01-01

Introduction: The efficient use of libraries can be an important factor in determining the educational quality of Universities. Therefore, investigation and identification of factors affecting library anxiety becomes increasingly necessary. The purpose of this research is to determine the factors effecting library anxiety of students in Isfahan University of Medical Sciences and Shiraz University of Medical Sciences. Materials and Methods: This was an applied survey research using Bostick's Library Anxiety questionnaire as data gathering tool. The statistical population consisted of all students of Isfahan University of Medical Sciences and Shiraz University of Medical Sciences (15011 students) with the sample size of 375 using stratified random sampling. The validity of data gathering tool was confirmed by experts in the library and information science and its reliability was determined by Cronbach's alpha (r = 0.92). Descriptive statistics (frequency, percentage, mean and standard deviation) and inferential statistics (t-test and ANOVA) were used for data analysis using SPSS 18 software. Results: Findings showed that the mean of library anxiety score was 2.68 and 2.66 for students of Isfahan University of Medical Sciences and Shiraz University of Medical Sciences respectively which is above average (2.5). Furthermore, age and gender had no meaningful effect on the library anxiety of students of Isfahan University of Medical Sciences, but gender had a meaningful effect on library anxiety of students of Shiraz University of Medical Sciences while age had no such effect. Conclusion: The results showed that the mean of factors effecting library anxiety in students of Isfahan University of Medical Sciences and students of Shiraz University of Medical Sciences is higher than average and therefore not satisfactory and only factors relating to feeling comfortable in the library is lower than average and somewhat satisfactory. PMID:25250358

Medication-related factors affecting discharge to home.

PubMed

Hashimoto, Masako; Matsuzaki, Yu; Kawahara, Kumiko; Matsuda, Hiroshi; Nishimura, Genichi; Hatae, Takashi; Kimura, Yoshiaki; Arai, Kunizo

2014-01-01

To assess the reasons for barriers to home discharge by determining whether they were predicted by medication, clinical variables, and patient characteristics, the retrospective cohort study of 282 patients discharged from Kanazawa Red Cross Hospital in Kanazawa, Japan from January 2011 to December 2012 was performed. The percentage of patients discharged was 67.4%. By multivariate logistic analysis, significant differences in home discharge destination were determined by six factors: the duration of hospitalization before discharge (odds ratio (OR) 0.993; 95% 95% confidence interval (CI) 0.988-0.999), the presence of excretion assistance (OR 0.115; 95% CI 0.043-0.308), individual payment of medical expense (OR 0.344; 95% CI 0.146-0.811), the degree of independent living for the demented elderly (OR4.570; 95% CI 1.969-10.604), presence of the primary caregiver (OR 8.638; 95% CI 3.121-23.906), and admission to a hospital from home (OR 5.483; 95% CI 2.589-11.613). This study suggests that necessity of excretion assistance, long duration of hospitalization, and high individual payment of medical expense were barriers to home discharge. In contrast, three factors i.e., admission to a hospital form home, low degree of independent living for the demented elderly, and presence of the primary caregiver, favored home discharge. The relation between a patient's status (cognitive status and incontinence) and a caregiver has an important effect on the home discharge. However, medication characteristics appeared to have little effect on recuperation destination.

Factors influencing the decisions of senior UK doctors to retire or remain in medicine: national surveys of the UK-trained medical graduates of 1974 and 1977

PubMed Central

Smith, Fay; Lachish, Shelly; Goldacre, Michael J

2017-01-01

Objective To report attitudes to retirement of late-career doctors. Design Questionnaires sent in 2014 to all UK medical graduates of 1974 and 1977. Setting United Kingdom. Participants 3695 medical graduates. Main outcome measures Factors which influenced doctors’ decisions to retire and factors which encouraged doctors to remain in work. Results The response rate was 85% (3695/4369). 55% of respondents overall were still working in medicine (whether they had not retired or had retired and returned; 61% of men, 43% of women). Of the retirees, 67% retired when they had originally planned to, and 28% had changed their retirement plans. Fifty per cent of retired doctors cited ‘increased time for leisure/other interests’ as a reason; 43% cited ‘pressure of work’. Women (21%) were more likely than men (11%) to retire for family reasons. Women (27%) were more likely than men (9%) to retire because of the retirement of their spouse. General practitioners (GPs) were more likely than doctors in other specialties to cite ‘pressure of work’. Anaesthetists and GPs were more likely than doctors in other specialties to cite the ‘possibility of deteriorating skill/competence’. Radiologists, surgeons, obstetricians and gynaecologists, and anaesthetists were most likely to cite ‘not wanting to do out-of-hours work’. Doctors who were still working were asked what would encourage them to stay in medicine for longer. Factors cited most frequently were ‘reduced impact of work-related bureaucracy’ (cited by 45%) and ‘workload reduction/shorter hours’ (42%). Men (30%) were more motivated than women (20%) by ‘financial incentivisation’. Surgeons were most motivated by ‘reduction of on-call or emergency commitments’. Conclusions Retention policy should address ways of optimising the clinical contribution of senior doctors while offering reduced workloads in the areas of bureaucracy and working hours, particularly in respect of emergency commitments

[The role of malnutrition and other medical factors in the evolution of patients with hip fracture].

PubMed

García Lázaro, M; Montero Pérez-Barquero, M; Carpintero Benítez, P

2004-11-01

As the population progressively ages, hip fractures have become increasingly common and are associated with high morbidity and mortality and a pronounced decline in functional status. Hip fractures frequently occur in elderly patients with a high rate of comorbidity and polymedication. Patients hospitalised with hip fractures often display signs of protein malnutrition and may develop medical complications requiring intrahospital care. These factors, more than simply surgical ones, unfavourably influence the vital status and functional outcome of these patients. For this reason, it is necessary to improve the management of pre-existing conditions during hospitalisation, assess and treat malnutrition and prevent medical complications to achieve optimal outcomes for these patients. With this objective, we believe that care should be provided by multidisciplinary teams in close partnership with internists.

Influence of organizational factors on safety

DOE Office of Scientific and Technical Information (OSTI.GOV)

Haber, S.B.; Metlay, D.S.; Crouch, D.A.

There is a need for a better understanding of exactly how organizational management factors at a nuclear power plant (NPP) affect plant safety performance, either directly or indirectly, and how these factors might be observed, measured, and evaluated. The purpose of this research project is to respond to that need by developing a general methodology for characterizing these organizational and management factors, systematically collecting information on their status and integrating that information into various types of evaluative activities. Research to date has included the development of the Nuclear Organization and Management Analysis Concept (NOMAC) of a NPP, the identification ofmore » key organizational and management factors, and the identification of the methods for systematically measuring and analyzing the influence of these factors on performance. Most recently, two field studies, one at a fossil fuel plant and the other at a NPP, were conducted using the developed methodology. Results are presented from both studies highlighting the acceptability, practicality, and usefulness of the methods used to assess the influence of various organizational and management factors including culture, communication, decision-making, standardization, and oversight. 6 refs., 3 figs., 1 tab.« less

Exploring intentions of physician-scientist trainees: factors influencing MD and MD/PhD interest in research careers.

PubMed

Kwan, Jennifer M; Daye, Dania; Schmidt, Mary Lou; Conlon, Claudia Morrissey; Kim, Hajwa; Gaonkar, Bilwaj; Payne, Aimee S; Riddle, Megan; Madera, Sharline; Adami, Alexander J; Winter, Kate Quinn

2017-07-11

Prior studies have described the career paths of physician-scientist candidates after graduation, but the factors that influence career choices at the candidate stage remain unclear. Additionally, previous work has focused on MD/PhDs, despite many physician-scientists being MDs. This study sought to identify career sector intentions, important factors in career selection, and experienced and predicted obstacles to career success that influence the career choices of MD candidates, MD candidates with research-intense career intentions (MD-RI), and MD/PhD candidates. A 70-question survey was administered to students at 5 academic medical centers with Medical Scientist Training Programs (MSTPs) and Clinical and Translational Science Awards (CTSA) from the NIH. Data were analyzed using bivariate or multivariate analyses. More MD/PhD and MD-RI candidates anticipated or had experienced obstacles related to balancing academic and family responsibilities and to balancing clinical, research, and education responsibilities, whereas more MD candidates indicated experienced and predicted obstacles related to loan repayment. MD/PhD candidates expressed higher interest in basic and translational research compared to MD-RI candidates, who indicated more interest in clinical research. Overall, MD-RI candidates displayed a profile distinct from both MD/PhD and MD candidates. MD/PhD and MD-RI candidates experience obstacles that influence their intentions to pursue academic medical careers from the earliest training stage, obstacles which differ from those of their MD peers. The differences between the aspirations of and challenges facing MD, MD-RI and MD/PhD candidates present opportunities for training programs to target curricula and support services to ensure the career development of successful physician-scientists.

[Factors influencing the decision to establish a primary care practice: results from a postal survey of young physicians in Germany].

PubMed

Roick, C; Heider, D; Günther, O H; Kürstein, B; Riedel-Heller, S G; König, H H

2012-01-01

Although the estimated need for primary health care is covered to 108% in Germany, a primary care physician shortage is emerging in some regions. Moreover, the number of young physicians completing a specialist medical training for general medicine is decreasing. Therefore the present study aimed to investigate factors influencing young physicians to aspire to such a specialist training as well as aspects considered as important for practice establishment by these physicians. 14 939 young physicians aged under 40 years without completed specialist medical training were contacted by mail using databases of five state chambers of physicians (Lower Saxony, Westfalen-Lippe, Saxony, Saxony-Anhalt, Mecklenburg-Western Pomerania). The physicians were asked to answer questions regarding socio-demographic characteristics, the aspired medical speciality, their purpose to establish a practice as well as a questionnaire regarding factors which could be important for the latter decision. The questionnaire had been developed based on qualitative interviews with young physicians and an additional literature search. The answers of 5 053 respondents were eligible for data analysis. The questionnaire regarding factors influencing practice establishment was evaluated using a principal component analysis. Variables predicting the decision for a general medicine specialist training and the weighting of different factors for practice establishment were analysed using logistic or linear regression models. A general medicine specialist training was rather aspired by women, physicians who grew up in rural areas, living with a partner/spouse and having children. No differences were found between physicians living in the Old or New Federal States. Principal component analysis revealed 6 relevant factors for practice establishment. Of these, surrounding conditions for family as well as professional duties (e. g., on-call duty) were most important for the physicians. Opportunities for

Factors Influencing Resident Choice of Prosthodontic Residency Program.

PubMed

Wojnarwsky, Pandora Keala Lee; Wang, Yan; Shah, Kumar; Koka, Sreenivas

2017-06-01

The decision by prosthodontic residency program directors to employ the Match process highlights the need to understand applicant priorities that influence their choice of which programs to rank highly. The purpose of this study is to determine the factors that were most important to residents when choosing from among nonmilitary based prosthodontics dental residency programs in the United States. Following completion of a pilot study, all currently enrolled prosthodontic residents at nonmilitary residency programs were invited to participate via the internet. The study consisted of a survey instrument asking residents to rank 26 possible factors that might impact an applicant's choice of residency program. In addition, the instrument collected other possible influencing variables including gender and debt load. Mean rank scores were compared to determine the most and least important factors. Kruskal-Wallis test was used to compare specific factors between the possible influencing variables. Two hundred and thirty residents completed the survey instrument, representing a 54.1% response rate of possible participants. With regard to factors influencing program choice, reputation of the residency program was the factor ranked the highest by participants, followed in descending order by the program director's personality, curriculum content, access to use of the latest digital technology, and opportunities for dental implant placement. Quality of schools for children, community outreach opportunities, and the ability to moonlight were ranked as the least important factors. Male and female residents ranked factors such as tuition/stipend, curriculum content, and community outreach opportunities significantly differently. Depending on debt load, residents ranked the factors tuition/stipend, ability to moonlight, curriculum content, and safety of the area where the program is differently. Current prosthodontic residents valued the reputation of the program as the most

Effective factors in expansion of medical tourism in Iran.

PubMed

Rezaee, Reza; Mohammadzadeh, Mehdi

2016-01-01

Medical tourism (MT) refers to circumstances in which people travel for medical treatments. The present study focuses on determining factors affecting MT in Iran. The study uses a mixed method approach. Initially, through a qualitative study, 12 experts were interviewed deeply; then, 22 participants in three equal focus groups expressed their ideas about growth and development of MT in Iran. Based on the expressed ideas, 120 factors were identified and accordingly a structured questionnaire was developed. Some members from the focus groups confirmed the questionnaire's face and content validity. The reliability of pertinent items was confirmed using Cronbach's alpha=0.8. Afterwards, 61 eligible subjects filled out this questionnaire. The findings showed that "healthcare quality" and "high level of expertise" are two most attractive factors in MT. However, other factors such as "healthcare costs", and "visa facilities" are among key factors as well. Also, the role of "the healthcare providers" was found to be more prominent than the roles of "the government" and "the general tourist services". Although some attractive MT factors are present currently, MT expansion to a desirable level in Iran requires a comprehensive plan of which its factors were discussed in this paper.

42 CFR 413.80 - Direct GME payments: Determination of weighting factors for foreign medical graduates.

Code of Federal Regulations, 2011 CFR

2011-10-01

... factors for foreign medical graduates. 413.80 Section 413.80 Public Health CENTERS FOR MEDICARE & MEDICAID... weighting factors for foreign medical graduates. (a) The weighting factor for a foreign medical graduate is determined under the provisions of § 413.79 if the foreign medical graduate— (1) Has passed FMGEMS; or (2...

42 CFR 413.80 - Direct GME payments: Determination of weighting factors for foreign medical graduates.

Code of Federal Regulations, 2014 CFR

2014-10-01

... factors for foreign medical graduates. 413.80 Section 413.80 Public Health CENTERS FOR MEDICARE & MEDICAID... weighting factors for foreign medical graduates. (a) The weighting factor for a foreign medical graduate is determined under the provisions of § 413.79 if the foreign medical graduate— (1) Has passed FMGEMS; or (2...

42 CFR 413.80 - Direct GME payments: Determination of weighting factors for foreign medical graduates.

Code of Federal Regulations, 2013 CFR

2013-10-01

... factors for foreign medical graduates. 413.80 Section 413.80 Public Health CENTERS FOR MEDICARE & MEDICAID... weighting factors for foreign medical graduates. (a) The weighting factor for a foreign medical graduate is determined under the provisions of § 413.79 if the foreign medical graduate— (1) Has passed FMGEMS; or (2...

42 CFR 413.80 - Direct GME payments: Determination of weighting factors for foreign medical graduates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... factors for foreign medical graduates. 413.80 Section 413.80 Public Health CENTERS FOR MEDICARE & MEDICAID... weighting factors for foreign medical graduates. (a) The weighting factor for a foreign medical graduate is determined under the provisions of § 413.79 if the foreign medical graduate— (1) Has passed FMGEMS; or (2...

42 CFR 413.80 - Direct GME payments: Determination of weighting factors for foreign medical graduates.

Code of Federal Regulations, 2012 CFR

2012-10-01

... factors for foreign medical graduates. 413.80 Section 413.80 Public Health CENTERS FOR MEDICARE & MEDICAID... weighting factors for foreign medical graduates. (a) The weighting factor for a foreign medical graduate is determined under the provisions of § 413.79 if the foreign medical graduate— (1) Has passed FMGEMS; or (2...

Exploring Factors Affecting Emergency Medical Services Staffs' Decision about Transporting Medical Patients to Medical Facilities.

PubMed

Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza

2014-01-01

Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs' decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: "degree of perceived risk in EMS staffs and their patients." This theme consisted of two main categories: (1) patient's condition' and (2) the context of the EMS mission'. The patent's condition category emerged from "physical health statuses," "socioeconomic statuses," and "cultural background" subcategories. The context of the EMS mission also emerged from two subcategories of "characteristics of the mission" and EMS staffs characteristics'. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients' needs for transportation in a prehospital situation.

Investigating the effect of sociodemographic factors on 30-day hospital readmission among medical patients in Toronto, Canada: a prospective cohort study

PubMed Central

Kuluski, Kerry; Costa, Andrew P; Sinha, Samir K; Glazier, Richard H; Forster, Alan; Jeffs, Lianne

2017-01-01

Objective To examine the influence of patient-level sociodemographic factors on the incidence of hospital readmission within 30 days among medical patients in a large Canadian metropolitan city. Design Prospective cohort study. Setting and participants Patients admitted to the General Internal Medicine service of an urban teaching hospital in Toronto, Canada participated in a survey of sociodemographic information. Patients were not surveyed if deemed medically unstable, receiving care in medical/surgical step-down beds or were isolated for infection control. Included in the final analysis was a diverse cohort of 1427 adult, non-palliative, patients who were discharged home. Measures Thirteen patient-level sociodemographic variables were examined in relation to time to unplanned all-cause readmission within 30 days. Illness level was accounted for by the following covariates: self-perceived health status, previous hospital utilisation, primary diagnosis case mix group, Charlson Comorbidity Index score and inpatient length of stay. Results Approximately, 14.4% (n=205) of patients experienced readmission within 30 days. Sociodemographic factors were not significantly associated with time to readmission in unadjusted and adjusted analyses. Indicators of illness level, namely, previous hospitalisations, were the strongest risk factors for readmission within this cohort. One previous admission (adjusted HR 1.78; 95% CI 1.22 to 2.59, P<0.01) and at least four previous emergency department visits (adjusted HR 2.33; 95% CI 1.46 to 4.43, P<0.01) were associated with increased hazard of readmission within 30 days. Conclusions Patient-level sociodemographic factors did not influence the incidence of unplanned all-cause readmission within 30 days. Further research is needed to understand the generalisability of our findings and investigate whether contextual factors, such as access to universal health insurance coverage, attenuate the effects of sociodemographic factors

Medical student career intentions at the Christchurch School of Medicine. The New Zealand Wellbeing, Intentions, Debt and Experiences (WIDE) survey of medical students pilot study. Results part II.

PubMed

Gill, D; Palmer, C; Mulder, R; Wilkinson, T

2001-10-26

To record career preferences for medical students at the Christchurch School of Medicine and Health Sciences and investigate factors, including student debt, that might influence career decisions. A questionnaire, The New Zealand Wellbeing, Intentions, Debt, and Experiences (WIDE) Survey of Medical Students, was developed and administered to all 204 medical students at the Christchurch School of Medicine and Health Sciences. The survey included questions relating to preferred career intentions and factors influencing career decisions, including the decision to leave New Zealand to practise medicine. The response rate was 88%. 80% intend to practise medicine in New Zealand immediately after graduation, however 82% indicated that they would leave within two years of graduation. Financial opportunities overseas and level of debt were the strongest motivating factors to leave. Repayments towards student loans and increased salaries were factors that might retain people in New Zealand. Medical and surgical specialities were the most popular career choices. Personal interest was the strongest motivator for career choice. Practising in a rural community was not popular. Debt is one of a number of important factors influencing medical student career decisions including the decision to leave New Zealand. Initiatives addressing debt may be useful in retaining medical graduates in this country.

Identification of factors that affect the adoption of an ergonomic intervention among Emergency Medical Service workers.

PubMed

Weiler, Monica R; Lavender, Steven A; Crawford, J Mac; Reichelt, Paul A; Conrad, Karen M; Browne, Michael W

2012-01-01

This study explored factors contributing to intervention adoption decisions among Emergency Medical Service (EMS) workers. Emergency Medical Service workers (n = 190), from six different organisations, participated in a two-month longitudinal study following the introduction of a patient transfer-board (also known as slide-board) designed to ease lateral transfers of patients to and from ambulance cots. Surveys administered at baseline, after one month and after two months sampled factors potentially influencing the EMS providers' decision process. 'Ergonomics Advantage' and 'Patient Advantage' entered into a stepwise regression model predicting 'intention to use' at the end of month one (R (2 )= 0.78). After the second month, the stepwise regression indicated only two factors were predictive of intention to use: 'Ergonomics Advantage,' and 'Endorsed by Champions' (R (2 )= 0.58). Actual use was predicted by: 'Ergonomics Advantage' and 'Previous Tool Experience.' These results relate to key concepts identified in the diffusion of innovation literature and have the potential to further ergonomics intervention adoption efforts. Practitioner Summary. This study explored factors that potentially facilitate the adoption of voluntarily used ergonomics interventions. EMS workers were provided with foldable transfer-boards (slideboards) designed to reduce the physical demands when laterally transferring patients. Factors predictive of adoption measures included perceived ergonomics advantage, the endorsement by champions, and prior tool experience.

Influence of Dopaminergic Medication on Conditioned Pain Modulation in Parkinson's Disease Patients

PubMed Central

Buhmann, Carsten; Forkmann, Katarina; Diedrich, Sabrina; Wesemann, Katharina; Bingel, Ulrike

2015-01-01

Background Pain is highly prevalent in patients with Parkinson’s disease (PD), but little is known about the underlying pathophysiological mechanisms. The susceptibility to pain is known to depend on ascending and descending pathways. Because parts of the descending pain inhibitory system involve dopaminergic pathways, dysregulations in dopaminergic transmission might contribute to altered pain processing in PD. Deficits in endogenous pain inhibition can be assessed using conditioned pain modulation (CPM) paradigms. Methods Applying such a paradigm, we investigated i) whether CPM responses differ between PD patients and healthy controls, ii) whether they are influenced by dopaminergic medication and iii) whether there are effects of disease-specific factors. 25 patients with idiopathic PD and 30 healthy age- and gender-matched controls underwent an established CPM paradigm combining heat pain test stimuli at the forearm and the cold pressor task on the contralateral foot as the conditioning stimulus. PD patients were tested under dopaminergic medication and after at least 12 hours of medication withdrawal. Results No significant differences between CPM responses of PD patients and healthy controls or between PD patients “on” and “off” medication were found. These findings suggest (i) that CPM is insensitive to dopaminergic modulations and (ii) that PD is not related to general deficits in descending pain inhibition beyond the known age-related decline. However, at a trend level, we found differences between PD subtypes (akinetic-rigid, tremor-dominant, mixed) with the strongest impairment of pain inhibition in the akinetic-rigid subtype. Conclusions There were no significant differences between CPM responses of patients compared to healthy controls or between patients “on” and “off” medication. Differences between PD subtypes at a trend level point towards different pathophysiological mechanisms underlying the three PD subtypes which warrant

Factors that influence adherence to antiretroviral treatment in an urban population, Jakarta, Indonesia.

PubMed

Weaver, Emma Rosamond Nony; Pane, Masdalina; Wandra, Toni; Windiyaningsih, Cicilia; Herlina; Samaan, Gina

2014-01-01

Although the number of people receiving antiretroviral therapy (ART) in Indonesia has increased in recent years, little is known about the specific characteristics affecting adherence in this population. Indonesia is different from most of its neighbors given that it is a geographically and culturally diverse country, with a large Muslim population. We aimed to identify the current rate of adherence and explore factors that influence ART adherence. Data were collected from ART-prescribed outpatients on an HIV registry at a North Jakarta hospital in 2012. Socio-demographic and behavioral characteristics were explored as factors associated with adherence using logistics regression analyses. Chi squared test was used to compare the difference between proportions. Reasons for missing medication were analyzed descriptively. Two hundred and sixty-one patients participated, of whom 77% reported ART adherence in the last 3 months. The level of social support experienced was independently associated with adherence where some social support (p = 0.018) and good social support (p = 0.039) improved adherence compared to poor social support. Frequently cited reasons for not taking ART medication included forgetting to take medication (67%), busy with something else (63%) and asleep at medication time (60%). This study identified that an increase in the level of social support experienced by ART-prescribed patients was positively associated with adherence. Social support may minimize the impact of stigma among ART prescribed patients. Based on these findings, if social support is not available, alternative support through community-based organizations is recommended to maximize treatment success.

Successful patient recruitment in CT imaging clinical trials: what factors influence patient participation?

PubMed

Hollada, Jacqueline; Marfori, Wanda; Tognolini, Alessia; Speier, William; Ristow, Lindsey; Ruehm, Stefan G

2014-01-01

Analyze factors that influence participation in research studies that use coronary computed tomography (CT) imaging. A 12-point survey using a questionnaire was conducted on 80 subjects, of whom 40 agreed to participate in a cardiovascular CT imaging research study (enrolling subjects) and 40 declined participation (non-enrolling subjects). Potential factors that motivated the acceptance or refusal of enrollment were evaluated using a 5-point Likert scale. The following aspects were addressed: (1) additional health information, (2) free imaging, (3) altruistic benefit to society, (4) monetary compensation, (5) radiation exposure, (6) role as an experimental subject, (7) possible loss of confidentiality, (8) contrast or investigational drug use, (9) premedication use, (10) blood draw or intravenous placement, (11) time commitment, and (12) personal medical opinion. Response distributions were obtained for each question and compared between enrolling and non-enrolling groups. Enrolling subjects gave significantly higher ratings than non-enrolling subjects for the following factors: additional health information (P < .001), free imaging (P < .001), and the altruistic benefit to society (P < .001). For non-enrolling subjects, concern for possible drug use or contrast injection (P < .001), concern for possible premedication (P < .001), and personal availability or time commitment (P < .001) were all given significantly higher ratings. Concern for radiation exposure (P = .002) and personal medical opinion (P < .001) received significantly high ratings among both groups but did not differ between groups. Several influential concerns and benefits were identified from potential research subjects. Knowledge of what influences patient participation in studies involving CT imaging may allow researchers to effectively address concerns and highlight the potential benefits related to participation. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

Factors influencing pacing in triathlon

PubMed Central

Wu, Sam SX; Peiffer, Jeremiah J; Brisswalter, Jeanick; Nosaka, Kazunori; Abbiss, Chris R

2014-01-01

Triathlon is a multisport event consisting of sequential swim, cycle, and run disciplines performed over a variety of distances. This complex and unique sport requires athletes to appropriately distribute their speed or energy expenditure (ie, pacing) within each discipline as well as over the entire event. As with most physical activity, the regulation of pacing in triathlon may be influenced by a multitude of intrinsic and extrinsic factors. The majority of current research focuses mainly on the Olympic distance, whilst much less literature is available on other triathlon distances such as the sprint, half-Ironman, and Ironman distances. Furthermore, little is understood regarding the specific physiological, environmental, and interdisciplinary effects on pacing. Therefore, this article discusses the pacing strategies observed in triathlon across different distances, and elucidates the possible factors influencing pacing within the three specific disciplines of a triathlon. PMID:25258562

Professional identity in medical students: pedagogical challenges to medical education.

PubMed

Wilson, Ian; Cowin, Leanne S; Johnson, Maree; Young, Helen

2013-01-01

Professional identity, or how a doctor thinks of himself or herself as a doctor, is considered to be as critical to medical education as the acquisition of skills and knowledge relevant to patient care. This article examines contemporary literature on the development of professional identity within medicine. Relevant theories of identity construction are explored and their application to medical education and pedagogical approaches to enhancing students' professional identity are proposed. The influence of communities of practice, role models, and narrative reflection within curricula are examined. Medical education needs to be responsive to changes in professional identity being generated from factors within medical student experiences and within contemporary society.

How clinical medical students perceive others to influence their self-regulated learning.

PubMed

Berkhout, Joris J; Helmich, Esther; Teunissen, Pim W; van der Vleuten, Cees P M; Jaarsma, A Debbie C

2017-03-01

Undergraduate medical students are prone to struggle with learning in clinical environments. One of the reasons may be that they are expected to self-regulate their learning, which often turns out to be difficult. Students' self-regulated learning is an interactive process between person and context, making a supportive context imperative. From a socio-cultural perspective, learning takes place in social practice, and therefore teachers and other hospital staff present are vital for students' self-regulated learning in a given context. Therefore, in this study we were interested in how others in a clinical environment influence clinical students' self-regulated learning. We conducted a qualitative study borrowing methods from grounded theory methodology, using semi-structured interviews facilitated by the visual Pictor technique. Fourteen medical students were purposively sampled based on age, gender, experience and current clerkship to ensure maximum variety in the data. The interviews were transcribed verbatim and were, together with the Pictor charts, analysed iteratively, using constant comparison and open, axial and interpretive coding. Others could influence students' self-regulated learning through role clarification, goal setting, learning opportunities, self-reflection and coping with emotions. We found large differences in students' self-regulated learning and their perceptions of the roles of peers, supervisors and other hospital staff. Novice students require others, mainly residents and peers, to actively help them to navigate and understand their new learning environment. Experienced students who feel settled in a clinical environment are less susceptible to the influence of others and are better able to use others to their advantage. Undergraduate medical students' self-regulated learning requires context-specific support. This is especially important for more novice students learning in a clinical environment. Their learning is influenced most

The influence of globalization on medical regulation: a descriptive analysis of international medical graduates registered through alternative licensure routes in Ontario.

PubMed

Yen, Wendy; Hodwitz, Kathryn; Thakkar, Niels; Martimianakis, Maria Athina Tina; Faulkner, Dan

2016-12-01

The increasing globalization of the medical profession has influenced health policy, health human resource planning, and medical regulation in Canada. Since the early 2000s, numerous policy initiatives have been created to facilitate the entry of international medical graduates (IMGs) into the Canadian workforce. In Ontario, the College of Physicians and Surgeons of Ontario (CPSO) developed alternative licensure routes to increase the ability of qualified IMGs to obtain licenses to practice. The current study provides demographic and descriptive information about the IMGs registered through the CPSO's alternative licensure routes between 2000 and 2012. An analysis of the characteristics and career trajectories of all IMGs practicing in the province sheds light on broader globalization trends and raises questions about the future of health human resource planning in Canada. As the medical profession becomes increasingly globalized, health policy and regulation will continue to be influenced by trends in international migration, concerns about global health equity, and the shifting demographics of the Canadian physician workforce. Implications for future policy development in the complex landscape of medical education and practice are discussed.

The influence of globalization on medical regulation: a descriptive analysis of international medical graduates registered through alternative licensure routes in Ontario

PubMed Central

Yen, Wendy; Hodwitz, Kathryn; Thakkar, Niels; Martimianakis, Maria Athina (Tina); Faulkner, Dan

2016-01-01

The increasing globalization of the medical profession has influenced health policy, health human resource planning, and medical regulation in Canada. Since the early 2000s, numerous policy initiatives have been created to facilitate the entry of international medical graduates (IMGs) into the Canadian workforce. In Ontario, the College of Physicians and Surgeons of Ontario (CPSO) developed alternative licensure routes to increase the ability of qualified IMGs to obtain licenses to practice. The current study provides demographic and descriptive information about the IMGs registered through the CPSO’s alternative licensure routes between 2000 and 2012. An analysis of the characteristics and career trajectories of all IMGs practicing in the province sheds light on broader globalization trends and raises questions about the future of health human resource planning in Canada. As the medical profession becomes increasingly globalized, health policy and regulation will continue to be influenced by trends in international migration, concerns about global health equity, and the shifting demographics of the Canadian physician workforce. Implications for future policy development in the complex landscape of medical education and practice are discussed. PMID:28344705

Influence of Psychological Empowerment on Organizational Commitment among Medical Employees in a Hospital Setting.

PubMed

Kebriaei, A; Rakhshaninejad, M; Mohseni, M

2014-12-01

People within organizations are a key factor for efficiency. Thus employee empowerment has become a popular management strategy. The study aimed to investigate the relationship between psychological empowerment and organizational commitment among medical staff of a hospital in Zahedan city. This cross sectional study was carried out in 2013. A random sample of 172 medical employees in Khatam-ol-Anbia hospital at Zahedan city was selected and responded to items of the questionnaires using a 7-point Likert scale ranging from 1 to 7. For measuring psychological empowerment and organizational commitment, Mishra & Spreitzer's scale and Meyer and Allen's questionnaire were used. A higher score means a higher degree of psychological empowerment or organizational commitment. Analysis was carried out using SPSS. The level of organizational commitment and psychological empowerment significantly were higher than average. There was a significant positive relationship between employees' empowerment and their commitment to organization. Psychological empowerment was a significant predictor of organizational commitment (β = .524). Out of the five dimensions of empowerment three dimensions are significant predictors of commitment and explain 37.1% of the variance in commitment. Due to The positive influence of psychological empowerment on organizational commitment, programs for in-service education should focus on facilitating psychological empowerment to improve and increase organizational commitment. Also, since impact of employees psychological empowerment on organizational commitment partially supported, there are other variables that influence the organizational commitment.

Australian medical students and their choice of surgery as a career: a review.

PubMed

Grigg, Megan; Arora, Manit; Diwan, Ashish D

2014-09-01

Surgery is an emotionally, physically and mentally challenging profession, and medical students factor in many variables when choosing surgery as a career choice. The aim of this study is to review the available literature on the factors influencing Australian medical students' choice of surgery as their career. A search of EMBASE and MEDLINE with the search terms 'medical students' AND 'surgery'; 'medical students' AND 'career pathways'; 'medical students' AND 'career choices' was conducted. Additionally, Google Scholar and the reference list of some articles were canvassed for suitable areas of study. Lifestyle factors were the main reason influencing medical student's career choices. A balance between work, family and lifestyle was found to be important, and a surgical career choice was not always compatible with this. In particular, female students placed more importance on family and lifestyle factors when opting for non-surgical careers. Positive exposure and/or experiences in a surgical environment, perceived prestige and perceived financial reward were associated with surgical career choice. There is a need to better understand the factors influencing surgical and non-surgical career choice among Australian medical students, and develop appropriate interventions to promote surgery as a career. This article does not discuss personality traits of people who go into surgery. © 2013 Royal Australasian College of Surgeons.

[The prevalence and influencing factors of eye diseases for IT industry video operation workers].

PubMed

Zhao, Liang-liang; Yu, Yan-yan; Yu, Wen-lan; Xu, Ming; Cao, Wen-dong; Zhang, Hong-bing; Han, Lei; Zhang, Heng-dong

2013-05-01

on the results of SIT experiment,having statistical significance. The health-situation of IT industry video operation workers' eye is not optimistic, most of workers are lack of protection awareness; we need to strengthen propaganda and education according to its influencing factors and to improve the level of medical control and prevention for eye diseases in relevant industries.