Journal articles on the topic 'Physicians (General practice) Victoria Psychology'
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Over, Ray, Ann Parry, Joy Geddes, and Mary Levens. "Psychologists in private practice in victoria." Australian Psychologist 20, no. 3 (November 1985): 239–50. http://dx.doi.org/10.1080/00050068508256170.
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Bray, James H., and John C. Rogers. "Linking psychologists and family physicians for collaborative practice." Professional Psychology: Research and Practice 26, no. 2 (April 1995): 132–38. http://dx.doi.org/10.1037/0735-7028.26.2.132.
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Linn, Ruth. "Moral Reasoning and Behavior of Striking Physicians in Israel." Psychological Reports 60, no. 2 (April 1987): 443–53. http://dx.doi.org/10.2466/pr0.1987.60.2.443.
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Routine daily experience does not always provide physicians and moral researchers the opportunity to focus on the ways in which personal moral values are put into practice. An extreme situation—a physicians' strike—provided such an opportunity. This paper is based on interviews with 50 Israeli striking physicians. The extent to which the physicians' justifications of their action reflected their moral competence, is discussed.
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Twilling, Lisa L., Mark E. Sockell, and Lucia S. Sommers. "Collaborative practice in primary care: Integrated training for psychologists and physicians." Professional Psychology: Research and Practice 31, no. 6 (2000): 685–91. http://dx.doi.org/10.1037/0735-7028.31.6.685.
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Richardsen, Astrid M., and Ronald J. Burke. "Occupational Stress and Work Satisfaction among Canadian Women Physicians." Psychological Reports 72, no. 3 (June 1993): 811–21. http://dx.doi.org/10.2466/pr0.1993.72.3.811.
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The present study examined relationships among occupational stress, job satisfaction, and various individual characteristics and job-related variables in a population of 303 women physicians. Analysis showed that time pressures and threat of malpractice litigation were sources of stress and that over-all satisfaction was related to satisfaction with both professional and social aspects of the job. Low satisfaction was related to wanting higher income, changes in practice procedures, and several stressors, such as time pressures. Stress and satisfaction were also related to attitudes toward health care. Women who experienced high stress and low satisfaction were more likely to have negative views of the functioning of the health care system. In addition, demographic and practice variables contributed to negative attitudes.
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Hallinan, Christine Mary, Jane Maree Gunn, and Yvonne Ann Bonomo. "Implementation of medicinal cannabis in Australia: innovation or upheaval? Perspectives from physicians as key informants, a qualitative analysis." BMJ Open 11, no. 10 (October 2021): e054044. http://dx.doi.org/10.1136/bmjopen-2021-054044.
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Objective We sought to explore physician perspectives on the prescribing of cannabinoids to patients to gain a deeper understanding of the issues faced by prescriber and public health advisors in the rollout of medicinal cannabis. Design A thematic qualitative analysis of 21 in-depth interviews was undertaken to explore the narrative on the policy and practice of medicinal cannabis prescribing. The analysis used the Diffusion of Innovations (DoI) theoretical framework to model the conceptualisation of the rollout of medicinal cannabis in the Australian context. Setting Informants from the states and territories of Victoria, New South Wales, Tasmania, Australian Capital Territory, and Queensland in Australia were invited to participate in interviews to explore the policy and practice of medicinal cannabis prescribing. Participants Participants included 21 prescribing and non-prescribing key informants working in the area of neurology, rheumatology, oncology, pain medicine, psychiatry, public health, and general practice. Results There was an agreement among many informants that medicinal cannabis is, indeed, a pharmaceutical innovation. From the analysis of the informant interviews, the factors that facilitate the diffusion of medicinal cannabis into clincal practice include the adoption of appropriate regulation, the use of data to evaluate safety and efficacy, improved prescriber education, and the continuous monitoring of product quality and cost. Most informants asserted the widespread assimilation of medicinal cannabis into practice is impeded by a lack of health system antecedents that are required to facilitate safe, effective, and equitable access to medicinal cannabis as a therapeutic. Conclusions This research highlights the tensions that arise and the factors that influence the rollout of cannabis as an unregistered medicine. Addressing these factors is essential for the safe and effective prescribing in contemporary medical practice. The findings from this research provides important evidence on medicinal cannabis as a therapeutic, and also informs the rollout of potential novel therapeutics in the future.
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Pereira, M. Graça, Alfonso Alonso Fachado, and Thomas Edward Smith. "Practice of Biopsychosocial Medicine in Portugal: Perspectives of Professionals Involved." Spanish journal of psychology 12, no. 1 (May 2009): 217–25. http://dx.doi.org/10.1017/s1138741600001621.
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Although, recently, the biopsychosocial approach has been emphasized in the practice of family medicine, how psychologists and physicians interact in collaborative family health care practice is still emerging in Portugal. This article describes a qualitative study that focused on the understanding of psychologists and family physicians' perceptions of their role and the collaborative approach in health care.A questionnaire gathered information regarding collaboration, referral, training and the practice of biopsychosocial medicine. A content analysis on respondents' discourse was performed. Results show that both physicians and psychologists agree on the importance of the biopsychosocial model and interdisciplinary collaboration. However, they also mentioned several difficulties that have to do with the lack of psychologists working full time in health care centers, lack of communication and different expectancies regarding each other roles in health care delivery.Both physicians and psychologists acknowledge the lack of academic training and consider the need for multidisciplinary teams in their training and practice to improve collaboration and integrative care. Implications for future research and for the practice of biopsychosocial medicine are addressed.
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ROGG, LOTTE, PETER KJÆR GRAUGAARD, and JON HÅVARD LOGE. "Physicians' interpretation of the prognostic term “terminal”: A survey among Norwegian physicians." Palliative and Supportive Care 4, no. 3 (September 2006): 273–78. http://dx.doi.org/10.1017/s1478951506060342.
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Objective: Optimal clinical practice depends upon a precise language with common understanding of core terms. The aim of the present study was to examine how Norwegian physicians understand the commonly used but poorly defined term “terminal.”Methods: A questionnaire was mailed to 1605 Norwegian physicians, representative of the Norwegian medical community. Nine hundred and sixty-eight responded and defined “terminal” in expected weeks left to live. The effects of gender, age, specialty, and experience with prognostication toward end of life on the estimation of “terminal” were investigated.Results: Norwegian physicians on average expect a “terminal” patient to have 3.6 (± 3.5SD) weeks to live with expectation ranging from 0 to 26 weeks. The majority (83.5%) defined “terminal” as less than 5 weeks' survival; 15.0% as 5 to 12 weeks' survival and 1.5% as more than 12 weeks' survival. No difference between genders was observed, whereas the youngest physicians (27–39 years) held shorter definitions than the other age groups. Physicians in internal medicine, surgery, and anaesthesiology held significantly shorter estimations of “terminal” than did physicians in general practice, public health, and psychiatry.Significance of results: Our study shows that the majority of Norwegian physicians restrict “terminal” to the last 2–4 weeks of patients' lives. A life expectancy of a few days compared to several weeks should lead to different clinical actions. Efforts should therefore be made to come to a common definition of the term. In our opinion the use of “terminal” should be limited to when death is expected within a few days.
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Katz, Roger C. "“Difficult Patients” as Family Physicians Perceive Them." Psychological Reports 79, no. 2 (October 1996): 539–44. http://dx.doi.org/10.2466/pr0.1996.79.2.539.
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The physician-patient relationship is an important part of medical care. This study examined events that can jeopardize that relationship, i.e., patients' behaviors and attributes that physicians find frustrating. Data were collected from practicing family physicians ( N = 34) using a 32-item questionnaire developed by the author. Items were drawn from previous research on the behaviors of difficult patients and checked for relevance by two family physicians before the study began. Coefficient alpha was .92. Participants were predominantly male physicians who had been in practice for an average of 18 years. They were asked to indicate if they found specific patients' characteristics frustrating or annoying by using a 9-point scale with end-points of “not at all frustrating or annoying” (1) and “very frustrating or annoying” (9). The physicians rated half of the listed patients' attributes as at least moderately frustrating (mean rating >6). Over 80% of the physicians were frustrated by patients who expected a “cure,” brought up new symptoms at the last moment, appeared to be malingering, or refused to take responsibility for their health. They were least frustrated by disease-related conditions such as degenerative or chronic illnesses. The physicians' ratings were unrelated to their years of experience. Results are discussed in relation to changing disease patterns which have occurred in this country over the last half-century.
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Lahham, Aroub, Angela T. Burge, Christine F. McDonald, and Anne E. Holland. "How do healthcare professionals perceive physical activity prescription for community-dwelling people with COPD in Australia? A qualitative study." BMJ Open 10, no. 8 (August 2020): e035524. http://dx.doi.org/10.1136/bmjopen-2019-035524.
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ObjectivesClinical practice guidelines recommend that people with chronic obstructive pulmonary disease (COPD) should be encouraged to increase their physical activity levels. However, it is not clear how these guidelines are applied in clinical practice. This study aimed to understand the perspectives of respiratory healthcare professionals on the provision of physical activity advice to people with COPD. These perspectives may shed light on the translation of physical activity recommendations into clinical practice.DesignA qualitative study using thematic analysis.SettingHealthcare professionals who provided care for people with COPD at two major tertiary referral hospitals in Victoria, Australia.Participants30 respiratory healthcare professionals including 12 physicians, 10 physical therapists, 4 nurses and 4 exercise physiologists.InterventionsSemistructured voice-recorded interviews were conducted, transcribed verbatim and analysed by two independent researchers using an inductive thematic analysis approach.ResultsHealthcare professionals acknowledged the importance of physical activity for people with COPD. They were conscious of low physical activity levels among such patients; however, few specifically addressed this in consultations. Physicians described limitations including time constraints, treatment prioritisation and perceived lack of expertise; they often preferred that physical therapists provide more comprehensive assessment and advice regarding physical activity. Healthcare professionals perceived that there were few evidence-based strategies to enhance physical activity. Physical activity was poorly differentiated from the prescription of structured exercise training. Although healthcare professionals were aware of physical activity guidelines, few were able to recall specific recommendations for people with COPD.ConclusionPractical strategies to enhance physical activity prescription may be required to encourage physical activity promotion in COPD care.
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Huijer, Huda Abu-Saad, Hani Dimassi, and Sarah Abboud. "Perspectives on palliative care in Lebanon: Knowledge, attitudes, and practices of medical and nursing specialties." Palliative and Supportive Care 7, no. 3 (September 2009): 339–47. http://dx.doi.org/10.1017/s1478951509990277.
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AbstractObjective:Our objective was to determine the knowledge, attitudes, and practices of physicians and nurses on Palliative Care (PC) in Lebanon, across specialties.Method:We performed a cross-sectional descriptive survey using a self-administered questionnaire; the total number of completed and returned questionnaires was 868, giving a 23% response rate, including 74.31% nurses (645) and 25.69% physicians (223).Results:Significant differences were found between medical and surgical nurses and physicians concerning their perceptions of patients' and families' outbursts, concerns, and questions. Knowledge scores were statistically associated with practice scores and degree. Practice scores were positively associated with continuing education in PC, exposure to terminally ill patients, and knowledge and attitude scores. Acute critical care and oncology were found to have lower practice scores than other specialties.Significance of results:Formal education in palliative care and development of palliative care services are very much needed in Lebanon to provide holistic care to terminally ill patients.
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Sah, Sunita, and Adriane Fugh-Berman. "Physicians under the Influence: Social Psychology and Industry Marketing Strategies." Journal of Law, Medicine & Ethics 41, no. 3 (2013): 665–72. http://dx.doi.org/10.1111/jlme.12076.
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It is easier to resist at the beginning than at the end.– Leonardo da VinciPhysicians often believe that a conscious commitment to ethical behavior and professionalism will protect them from industry influence. Despite increasing concern over the extent of physician-industry relationships, physicians usually fail to recognize the nature and impact of subconscious and unintentional biases on therapeutic decision-making. Pharmaceutical and medical device companies, however, routinely demonstrate their knowledge of social psychology processes on behavior and apply these principles to their marketing. To illustrate how pharmaceutical marketing strategies use psychological techniques to promote targeted therapies, we draw on the relevant social psychology literature on conflicts of interest and on the six principles of influence articulated by the eminent social psychologist Robert Cialdini. Hospitals, professional organizations, medical educators, and other stakeholders must also draw on social psychology to respond effectively to commercial activities that compromise good medical practice.
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AlOlayan, Abdullah, Abdulaziz Almutairi, Riyaz Shaik, Mohammad Ahmad, Maathir Alhumam, Shaden Almutairi, Raghad Alghassab, Abdullah Ghazi, and Waleed Khalid. "Knowledge, attitude, and practice of physicians toward asthma inhaler techniques in Qassim, Saudi Arabia." Journal of Complementary Medicine Research 13, no. 4 (2022): 111. http://dx.doi.org/10.5455/jcmr.2022.13.04.22.
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Introduction: Asthma is a chronic inflammatory disease of the airways. Inflammation in airways leads to hypersensitivity and airway obstruction which is responsible for the symptoms of asthma like wheezing, dyspnea, chest tightness and cough that aggravates in the morning. The prevalence ranges from 1.1 to 9.9% in adults. Systemic therapy and inhalational therapy comprising of bronchodilators and steroids are the two major treatment options. Aims & objectives: To assess physicians' knowledge, attitude, and practise toward asthma inhaler devices and inhalation techniques, and classify physician’s attitudes as either poor or adequate. Methodology: A cross sectional study was conducted in Qassim, Saudi Arabia among healthcare providers for a duration of 6 months. Practicing physicians in the three major cities in Qassim were included in the study while non-practicing physicians and those practicing in the small cities and peripheries were excluded. Data collection was done by using a predesigned self-reported online questionnaire consisting of 22 items under 3 major sections- demography, knowledge and practice of physicians. Templates were generated in MS Excel sheet and analysis of data was done using SPSS software. Chi square test was the test of significance used and p<0.05 was considered significant. Results: Metered-dose inhaler (MDI) with a spacer (56, 62.2%) was the most preferred device among dry powder inhalers (18, 20%) and nebulization solution (16, 17.8%). Most of the physicians responded correctly that the first and foremost step in correct MDI inhalation was shaking the device (67, 74.4%). More than three-fifths (57, 63.3%) of physicians claimed to have taught the caregivers on each visit to use an inhaler. The increasing age of the physician was found to be associated with a better understanding, positive attitude and good practice. A significant difference was seen based on the nationality (p 0.003) and the speciality of the physician (p 0.012) in their understanding of inhaled corticosteroids. Conclusion: Older male physicians and a family physician rather than a general physician were found to have better knowledge and a positive attitude toward advising patients regarding inhalers.
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Penderell, Adrienne, and Kevin Brazil. "The spirit of palliative practice: A qualitative inquiry into the spiritual journey of palliative care physicians." Palliative and Supportive Care 8, no. 4 (September 28, 2010): 415–20. http://dx.doi.org/10.1017/s1478951510000271.
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AbstractObjective:Much is known about the important role of spirituality in the delivery of multidimensional care for patients at the end of life. Establishing a strong physician–patient relationship in a palliative context requires physicians to have the self-awareness essential to establishing shared meaning and relationships with their patients. However, little is known about this phenomenon and therefore, this study seeks a greater understanding of physician spirituality and how caring for the terminally ill influences this inner aspect.Method:A qualitative descriptive study was used involving face-to-face interviews with six practicing palliative care physicians.Results:Conceptualized as a separate entity from religion, spirituality was described by participants as a notion relating to meaning, personal discovery, self-reflection, support, connectedness, and guidance. Spirituality and the delivery of care for the terminally ill appeared to be interrelated in a dynamic relationship where a physician's spiritual growth occurred as a result of patient interaction and that spiritual growth, in turn, was essential for providing compassionate care for the palliative patient. Spirituality also served as an influential force for physicians to engage in self-care practices.Significance of results:With spirituality as a pervasive force not only in the lives of palliative care patients, but also in those of healthcare providers, it may prove to be beneficial to use this information to guide future practice in training and education for palliative physicians in both the spiritual care of patients and in practitioner self care.
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Leroy, Victoire, Yaohua Chen, Naiara Demnitz, Florence Pasquier, Pierre Krolak-Salmon, Bertrand Fougère, and Françcois Puisieux. "Is Fall Risk Systematically Evaluated in Memory Clinics? A National Survey of Practice in France." Journal of Alzheimer's Disease 81, no. 4 (June 15, 2021): 1483–91. http://dx.doi.org/10.3233/jad-201585.
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Background: Falls are a major health problem in older persons but are still under-diagnosed and challenging to prevent. Current guidelines do not target high-risk populations, especially people living with dementia. In France, people with neurocognitive disorders are mainly referred to memory clinics (MCs). Objective: We aimed to survey the routine practice of physicians working in MCs regarding fall risk assessment. Methods: We conducted a cross-sectional survey in France from January to May 2019 among physicians working in MCs, through an anonymous online questionnaire: twenty-seven questions about the physician’s background and their practice of fall risk assessment, especially use of clinical and paraclinical tools. We compared the results according to the age and the specialty of the physician. Results: We obtained 171 responses with a majority of women (60%) and geriatricians (78%). All age classes and all French regions were represented. Most of respondents (98.8%) stated that they address gait and/or falls in outpatient clinic and 95.9%in day hospitals. When asked about how they assess fall risk, fall history (83%) and gait examination (68.4%) were the most widely used, while orthostatic hypotension (24%) and clinical standardized tests (25.7%) were less common. Among standardized tests, One-leg Balance, Timed Up and Go Test, and gait speed measurements were the most used. Geriatricians had more complete fall risk assessment than neurologists (e.g., 56%versus 13%for use of standardized tests, p < 0.0001). Conclusion: Almost all physicians addressed the question of fall in MC, but practices are widely heterogeneous. Further investigations are needed to standardize fall risk assessment in MCs.
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Eikelboom, Willem S., Michiel Coesmans, Rik Ossenkoppele, Esther van den Berg, and Janne M. Papma. "301 - The diagnostic and treatment challenges of behavioral and psychological symptoms in Alzheimer’s disease; a qualitative study in memory clinic practice." International Psychogeriatrics 32, S1 (October 2020): 57. http://dx.doi.org/10.1017/s104161022000201x.
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Introduction:Behavioral and psychological symptoms in dementia (BPSD) have great impact on the daily lives of Alzheimer’s disease (AD) patients and their caregivers. Timely recognition and treatment of these symptoms may benefit quality of life, caregiver burden, and delay disease progression. In this qualitative study we examine the experiences of memory clinic physicians with the recognition and management of BPSD in early stages of AD.Methods:Semi-structured interviews were held with 8 physicians (5 neurologists, 3 geriatricians) employed at memory clinics of academic or general hospitals in the Netherlands. Two independent researchers coded verbatim transcripts of the interviews, followed by a consensus meeting on preliminary themes. In the upcoming months, additional interviews will be conducted until data saturation is reached.Results:Preliminary results indicate substantial variability in how memory clinic physicians recognize and diagnose BPSD in AD. Themes are: 1. Prevalence of BPSD in early stages of AD; e.g. ‘BPSD is more often present in late stages of AD […]’ vs. ‘I see this often, very often, I think these are the main problems people with AD face’). 2. Systematic assessment; some physicians consider it part of their clinical work-up to assess behavioral changes while other physicians do not touch upon BPSD. 3. Barriers for assessment; e.g. a lack of time, and not being able to observe BPSD occurring at home in a memory clinic setting. Treatment and management of BPSD in AD also differed greatly. Themes are 1. Treatment type; Two physicians discussed using a person-centered non-pharmacological approach, others refer patients with BPSD to daycare, a case manager or psychiatrist, or treat ‘problematic’ behaviors with psychotropic drugs. 2. Capabilities; some physicians experience managing BPSD in AD as very difficult, while others are confident about their capabilities. The majority suggests that collaboration with GPs or case managers may benefit treating these complex symptoms.Conclusion:There are remarkable differences in the recognition and management of BPSD in patients with AD visiting memory clinics in the Netherlands. Considering the potential benefit of early recognition and treatment, a first crucial step is discussing standardization of recognition and management of BPSD in memory clinics.
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Campbell, Eric G., Sowmya R. Rao, Julie Ressalam, Dragana Bolcic-Jankovic, Rosa Lawrence, Jaime M. Moore, and Lisa I. Iezzoni. "Caring for Adults With Significant Levels of Intellectual Disability in Outpatient Settings: Results of a National Survey of Physicians." American Journal on Intellectual and Developmental Disabilities 128, no. 1 (December 22, 2022): 36–48. http://dx.doi.org/10.1352/1944-7558-128.1.36.
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Abstract Between 1% and 2% of the U.S. population has an intellectual disability (ID) and often experience disparities in health care. Communication patterns and sedation use for routine medical procedures are important aspects of care for this population. We explored physicians' communication patterns and sedation use in caring for patients with significant levels of ID through a mailed survey of 1,400 physicians among seven specialties in outpatient settings (response rate = 61.0%). Among physicians who saw at least one patient with significant levels of ID in an average month, 74.8% reported usually/always communicating primarily with someone other than the patient. Among specialists, 85.5% (95% CI: 80.5%–90.5%) reported doing so, compared to 69.9% (95% CI: 64.4%–75.4%) for primary care physicians (p < 0.001). Also, 11.4% reported sedating at least one patient with significant levels of ID for a routine procedure. Three quarters of physicians reported communicating primarily with persons other than the patient usually or always—an approach that, in some instances, may not align with best medical practice. The percentage of physicians who report sedating at least one individual is associated with significant ID and the physician's volume of patients with significant ID.
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DuBois, James M., Heidi A. Walsh, John T. Chibnall, Emily E. Anderson, Michelle R. Eggers, Mobolaji Fowose, and Hannah Ziobrowski. "Sexual Violation of Patients by Physicians: A Mixed-Methods, Exploratory Analysis of 101 Cases." Sexual Abuse 31, no. 5 (June 19, 2017): 503–23. http://dx.doi.org/10.1177/1079063217712217.
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A mixed-method, exploratory design was used to examine 101 cases of sexual violations in medicine. The study involved content analysis of cases to characterize the physicians, patient-victims, the practice setting, kinds of sexual violations, and consequences to the perpetrator. In each case, a criminal law framework was used to examine how motives, means, and opportunity combined to generate sexual misconduct. Finally, cross-case analysis was performed to identify clusters of causal factors that explain specific kinds of sexual misconduct. Most cases involved a combination of five factors: male physicians (100%), older than the age of 39 (92%), who were not board certified (70%), practicing in nonacademic settings (94%) where they always examined patients alone (85%). Only three factors (suspected antisocial personality, physician board certification, and vulnerable patients) differed significantly across the different kinds of sexual abuse: personality disorders were suspected most frequently in cases of rape, physicians were more frequently board certified in cases of consensual sex with patients, and patients were more commonly vulnerable in cases of child molestation. Drawing on study findings and past research, we offer a series of recommendations to medical schools, medical boards, chaperones, patients, and the national practitioners database.
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Farrow, Freeman L. "The Anti-Patient Psychology of Health Courts: Prescriptions from a Lawyer-Physician." American Journal of Law & Medicine 36, no. 1 (March 2010): 188–220. http://dx.doi.org/10.1177/009885881003600104.
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Critics of the current medical malpractice tort system claim that adjudication of malpractice claims before generalist judges and lay juries contributes to rising costs of medical malpractice insurance premiums and medical care. They claim that properly deciding issues in this realm requires specialized knowledge of medicine and medical technology that juries, and even judges of general jurisdiction, do not possess. One lobbying group alleges there is a continuing medical malpractice litigation crisis in the United States, evidenced by increasing medical costs, deaths from needless medical errors, departure of physicians from the practice of medicine due to increasing medical malpractice insurance premiums, and random medical justice in medical malpractice cases. Whether there is a direct, causal correlation between the increasing cost of medical malpractice insurance premiums and medical malpractice litigation is debatable.
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Armstrong, Patricia, and Jim Grant. "How Research Helped Us To Move From Awareness to Action and Then to Systems Development." Australian Journal of Environmental Education 20, no. 1 (2004): 13–24. http://dx.doi.org/10.1017/s0814062600002263.
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AbstractHow can an organisation move from awareness raising, in the form of natural history poster production, to the development of systems that change organisations? Through close integration of research and practice, the Gould League has achieved this transformation. It began with extensive research into best practice environmental education, going beyond the traditional boundaries of environmental education to areas that included the psychology of culture change, business management, systems thinking, governance, drug education, marketing and organisational psychology. This broad approach to research has led to the development of highly effective sustainability education programs, such as Waste Wise Schools and Sustainable Schools.The Waste Wise Schools Program, funded by EcoRecycle Victoria and managed in consultation with the Gould League, is an action-based waste education program. Originating in Victoria in 1998, it has been adopted by over a third of Victorian schools and has led to widespread outcomes, including waste reductions of up to 95%. There is strong evidence from surveys that this program is sustainable in schools over time and research confirms that the program is contributing to changes in the waste-wise thinking and behaviour of the families of the children at these schools.A model for culture change in schools, based on the experiences of the Waste Wise Schools Program, has also been developed. This model, a valuable tool in the continual improvement of Waste Wise Schools, has applications to sustainability education in general.
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Mohd Mydin, Fadzilah Hanum, and Sajaratulnisah Othman. "Elder Abuse and Neglect Intervention in the Clinical Setting: Perceptions and Barriers Faced by Primary Care Physicians in Malaysia." Journal of Interpersonal Violence 35, no. 23-24 (August 21, 2017): 6041–66. http://dx.doi.org/10.1177/0886260517726411.
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This qualitative study attempts to explore the definition, perceptions, practice experience, and barriers of primary care physicians (PCPs) in identifying and intervening in cases of elder abuse and neglect at the primary care level. Semistructured in-depth interview was conducted among 10 PCPs. Participants were selected by purposive sampling. The interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. In general, PCPs showed consistency in defining elder abuse and neglect. PCPs considered that they were optimally positioned to intervene in cases of elder abuse and neglect, but indicated the potential of overlooking such problems. The hurdles faced by PCPs in the identification and intervention of elder abuse were determined to be occurring at three levels: clinical, organizational, and policy. At the clinical level, PCPs recognize that they are lacking both the confidence and knowledge of elder abuse and neglect intervention. PCPs’ conflicting personal and professional beliefs create barriers during the clinical practice. Time constraints, patients’ other clinical problems, and, in addition, the preservation of a good doctor–patient relationship overshadow the importance of addressing and intervening in elder abuse and neglect issues during the consultation. This is further exacerbated by the barriers perceived by the patients: their nondisclosure and reluctance to accept outside intervention. At the organizational level, the lack of efficient interagency networks or support for the health system poses barriers. At the policy level, the absence of legislation specifically addressing elder abuse also creates considerable difficulties. However, PCPs gave differing responses when asked about a law concerning the elderly and mandatory reporting. Addressing these multilevel barriers is critical for ensuring that opportunities arising at the primary care level for elder maltreatment intervention are correctly utilized.
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Friberg, Febe, Eva Lidén, Cecilia Håkanson, and Joakim Öhlén. "Communicating bodily changes: Physicians' ways of enabling patient understanding in gastrointestinal cancer consultations." Palliative and Supportive Care 13, no. 3 (May 2, 2014): 661–71. http://dx.doi.org/10.1017/s1478951514000352.
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AbstractObjective:To explore how physicians communicatively enable patients' understanding of bodily changes in gastrointestinal cancer care consultations.Method:Two datasets were used. The first consisted of transcribed video-recorded palliative care consultations with three oncologists and six patients diagnosed with advanced gastrointestinal cancer, in the context of outpatient palliative care. The second dataset was audio-recorded transcriptions from diagnostic consultations with six surgeons and seven patients diagnosed with colorectal cancer, in the context of cancer surgery. An inductively driven and iterative analysis of interaction was performed, guided by Wetherell et al. (2001).Results:Two overarching communicative strategies were identified: (1) “visualizing strategies,” with the dimensions: visible strategies (visualizing with what you actually or potentially can see), sensory strategies (visualizing with what is possible to feel), and imaginative strategies; and (2) “contrasting strategies,” with the dimensions: contrasting subjective experiences and contrasting between the patient and other people.Significance of results:The visualizing and contrasting communicative strategies form parts of physicians' tacit and experience-based knowledge. The strategies employed by physicians reveal clear potentials to enable patients' understanding and sense making of bodily changes. However, these strategies need to be explicated and problematized as parts of both consultation practice and basic medical education. By means of increased awareness, physicians can more easily identify turning points in patients' levels of understanding, thereby enriching ordinary medical consultations with reflected pedagogical strategies and skills in how to dialogue in a person-centered manner.
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Markham, Fred W., and James J. Diamond. "Psychosocial Beliefs of Medical Students Planning to Specialize in Family Medicine." Psychological Reports 80, no. 3 (June 1997): 987–92. http://dx.doi.org/10.2466/pr0.1997.80.3.987.
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The psychosocial orientation of fourth-year medical students planning careers in family medicine was compared to those selecting other specialities using the Physician Belief Scale. This scale has shown that practicing family physicians have a greater psychosocial orientation than those in other specialities such as internal medicine. The current study was done to see whether students choosing family medicine already have this greater orientation before they begin training as residents. 664 fourth-year medical students received surveys during their senior year and 378 (57%) returned completed surveys. Female students had a significantly greater psychosocial orientation than their male peers, but there were no significant differences between students planning residencies in family medicine and those selecting other residencies. The greater orientation of family doctors would appear to be a product of further training and experience either during residency or later during the actual practice of family medicine.
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Hil, Richard, and Charlie Brennan. "Return to type?: Problems in the identification of ‘antisocial behaviours’ in children and young people." Children Australia 29, no. 1 (2004): 26–30. http://dx.doi.org/10.1017/s1035077200005873.
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This article critically examines the contents of an Executive Summary of a recent study of ‘antisocial behaviour’ among a cohort of adolescents in Victoria. It is argued that in both theoretical and methodological terms the study suffers from a number of serious shortcomings that may have serious implications for certain populations if ensuing policies are translated into practice. Additionally, the general theoretical trajectory of the study fits into the new culture of ‘risk management’ which also has important implications for those populations defined by the powerful as aberrant or troublesome.
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Blair, Emilie M., Darin B. Zahuranec, Jane Forman, Bailey K. Reale, Kenneth M. Langa, Bruno Giordani, Angela Fagerlin, Colleen Kollman, Rachael T. Whitney, and Deborah A. Levine. "Physician Diagnosis and Knowledge of Mild Cognitive Impairment." Journal of Alzheimer's Disease 85, no. 1 (January 4, 2022): 273–82. http://dx.doi.org/10.3233/jad-210565.
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Background: Older adults with mild cognitive impairment (MCI) receive fewer guideline-concordant treatments for multiple health conditions than those with normal cognition. Reasons for this disparity are unclear. Objective: To better understand this disparity, we describe physician understanding and experience with patient MCI, particularly physician identification of MCI, ability to distinguish between MCI and dementia, and perspectives on education and training in MCI and dementia. Methods: As part of a mixed-methods study assessing the influence of patient MCI on physician recommendations for acute myocardial infraction and stroke treatments, we conducted a descriptive qualitative study using semi-structured interviews of physicians from three specialties. Key question topics included participants’ identification of MCI, impressions of MCI and dementia awareness within their practice specialty, and perspectives on training and education in MCI. Results: The study included 22 physicians (8 cardiologists, 7 neurologists, and 7 internists). We identified two primary themes: There is 1) a lack of adequate understanding of the distinction between MCI and dementia; and 2) variation in physician approaches to identifying whether an older adult has MCI. Conclusion: These findings suggest that physicians have a poor understanding of MCI. Our results suggest that interventions that improve physician knowledge of MCI are needed.
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Blondeau, Danielle, Serge Dumont, Louis Roy, and Isabelle Martineau. "Attitudes of Quebec doctors toward sedation at the end of life: An exploratory study." Palliative and Supportive Care 7, no. 3 (September 2009): 331–37. http://dx.doi.org/10.1017/s1478951509990265.
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AbstractObjective:The induction of sedation at the end of life is a much debated practice and not very documented. The goal of this study was to explore the practice from both a clinical and ethical point of view.Methods:Data were collected through semistructured interviews with 19 Quebec physicians working in palliative care.Results:Doctors' first priority was their patients, not patients' families. Clinically, the therapeutic aim of sedation was strictly to relieve suffering on the part of the patient. Ethically, getting the patient's consent was imperative. The family's consent was only required in cases of incapacity. Generally, sedation and euthanasia were seen as two distinct practices.Significance of the research:There are still very few guidelines regarding end-of-life sedation in Québec, and its normative framework is more implicit than explicit. It should be noted that most of the respondents regarded sedation and euthanasia as two distinct practices.
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Andrew, Melissa H., and Catherine Shea. "Geriatric psychiatry education in Canada: the pathway to subspecialty recognition." International Psychogeriatrics 22, no. 6 (May 18, 2010): 919–26. http://dx.doi.org/10.1017/s1041610210000414.
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ABSTRACTBackground: This paper outlines the evolution of the training of Canadian physicians and other professionals in the mental health care needs of older adults over the past 2 decades, which has culminated in long-awaited subspecialty recognition by the Royal College of Physicians and Surgeons of Canada (RCPSC). Despite the fact that Canada has more than 4000 psychiatrists officially recognized by RCPSC, and a national body of more than 200 members who practice primarily in geriatric psychiatry, the status of geriatric psychiatry as a subspecialty of psychiatry in Canada remained “unofficial” until 2009.Methods: Early along the pathway toward subspecialization, Canadian educational efforts focused on enhancing the capacity of primary care physicians and other mental health professionals to meet the mental health needs of older adults. Over the past decade, and with the encouragement of RCPSC, Canadian psychiatric educators have carefully and collaboratively defined the competencies necessary for general psychiatrists to practice across the life span, thereby influencing the psychiatry training programs to include dedicated time in geriatric psychiatry, and a more consistently defined training experience.Results: With these two important building blocks in place, Canadian psychiatry was truly ready to move ahead with subspecialization. Three new psychiatric subspecialties – geriatric, child and adolescent, and forensic – were approved at the RCPSC in September 2009.Conclusions: The developments of the past 20 years have paved the way for a subspecialty geriatric psychiatry curriculum that will be well-aligned with a new general psychiatry curriculum, and ready to complement the existing mental health work force with subspecialized skills aimed at caring for the most complex elderly patients.
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McEwan, Troy E., Daniel E. Shea, and James R. P. Ogloff. "The Development of the VP-SAFvR: An Actuarial Instrument for Police Triage of Australian Family Violence Reports." Criminal Justice and Behavior 46, no. 4 (October 12, 2018): 590–607. http://dx.doi.org/10.1177/0093854818806031.
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This study describes the rationale, development, and validation of the Victoria Police Screening Assessment for Family Violence Risk (VP-SAFvR). The actuarial instrument was developed on a sample of 24,446 Australian police reports from 2013-2014. Information from each report and criminal histories of those involved were collected with 12-month follow-up, and binary logistic regression used to develop an improper predictive model. The selected VP-SAFvR cut-off score correctly identified almost three quarters of cases with further reports, while half of those without were accurately excluded. It was effective for frontline police triage decision-making, with few screened-out cases reporting further family violence, while those screened-in required additional risk assessment. Predictive validity was adequate and consistent across family relationships and demographic groups, although it was less effective in predicting future family violence reports involving same-sex couples or child perpetrators. Further evaluation in a field trial is necessary to determine the validity of the VP-SAFvR in practice.
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Meaklim, H., L. Meltzer, M. Junge, I. Rehm, M. Monfries, G. Kennedy, R. Bucks, and M. Jackson. "P092 Improving Postgraduate Psychology Students’ Sleep and Insomnia Knowledge with a Sleep Education Workshop." SLEEP Advances 2, Supplement_1 (October 1, 2021): A51. http://dx.doi.org/10.1093/sleepadvances/zpab014.136.
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Abstract Introduction Trainee psychologists receive limited sleep and insomnia education during postgraduate study. This study examined the delivery of a sleep psychology training workshop for postgraduate psychology students and examined changes in sleep knowledge from pre- to post-workshop. Methods A 6-hour Sleep Psychology Workshop was delivered to postgraduate psychology students around Victoria. Online pre- and post-workshop questionnaires were used to evaluate changes in sleep psychology knowledge and collect feedback on the workshop. Results The participants were 187 students (82% female, M age = 32), most of whom were in their 5th year of psychology training (69%) and had not received any sleep education during their postgraduate studies at the date of the intervention (77%). Students’ sleep knowledge significantly improved after workshop completion (pre: 56% vs. post: 80% correct), t(107)= -21.41, p < .001. Students provided positive feedback about the workshop, with 96% rating the workshop as excellent/very good and 86% reporting that they would recommend the workshop to other postgraduate students. Overall, 94% of students agreed/strongly agreed that the sleep psychology workshop improved their confidence to manage sleep disturbances in their future psychology practice. Discussion Postgraduate psychology students require sleep and insomnia education. This study demonstrates that students’ sleep psychology knowledge can improve after a 6-hour sleep education and training workshop and provides initial positive feedback about the benefits of sleep and insomnia education for postgraduate students.
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Robinson, Frank Eric, Markus A. Feufel, Valerie L. Shalin, Debra Steele-Johnson, and Brian Springer. "Rational Adaptation: Contextual Effects in Medical Decision Making." Journal of Cognitive Engineering and Decision Making 14, no. 2 (February 24, 2020): 112–31. http://dx.doi.org/10.1177/1555343420903212.
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Research and practice in medical decision making value consistency with standardized intervention, potentially neglecting the impact of various environmental features such as workload or the constraints of local work practice. This study presents both qualitative and quantitative analyses of emergency physicians’ decision-making processes in their natural work setting to examine the impact of contextual features. We study contextual effects on two separable decision-making processes identified in quantified observational data: goal enactment and goal establishment. Whereas goal enactment responds to hospital differences and patient difficulty as main effects, goal establishment responds to their interaction. Our emphasis on goal establishment expands the scope of a medical decision-making literature focused on diagnosis, and extends to other professions and the more general conceptualization of expertise. From a theoretical perspective, we emphasize the importance of accounting for contextual variability within the bounds of expert behavior. Practically, we provide real-world examples of context effects that bear on the standardization of care, cost differences between hospitals, and the conceptualization of quality medical care.
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Yaman, Hakan. "Exploring dementia management attitudes in primary care: a key informant survey to primary care physicians in 25 European countries." International Psychogeriatrics 30, no. 9 (January 3, 2018): 1413–14. http://dx.doi.org/10.1017/s1041610217003003.
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I read with great interest the study of Petrazzuoli et al. (2017) on exploring dementia management attitudes in primary care. The authors made a laudable effort to evaluate this important issue, which certainly needs timely attention. The high response rate from 25 member countries of the European General Practice Research Network is astonishing.
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Eisemann, Martin, Jörg Richter, Barbara Bauer, Rainer Bonelli, and Franz Porzsolt. "Physicians' Decision-Making in Incompetent Elderly Patients: A Comparative Study Between Austria, Germany (East, West), and Sweden." International Psychogeriatrics 11, no. 3 (September 1999): 313–24. http://dx.doi.org/10.1017/s1041610299005876.
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In order to investigate to what extent various determinants in the decision-making process for the treatment of severely ill incompetent patients are influenced by cultural and sociopolitical factors, 540 physicians in Austria, Germany (East and West), and Sweden, countries representing different healthcare systems, were surveyed using a self-administered questionnaire. It provided three case vignettes with different levels of information about the patient's treatment wishes in case of incompetence in a life-threatening situation. We found a general trend to a lower level of treatment in line with the patient's wishes when the information provided was more detailed. Remarkably, a substantial number of doctors did not comply with the patient's wishes. Ethical concerns and patient's wishes appeared as the most important factors whereas religious beliefs of the physician and hospital costs scored lowest. Because of the variability of treatment decisions and the importance of various factors determining the decision-making, an advance directive may be a feasible way of reducing the number of conflicts in critical situations. We recommend that ethical issues of clinical practice should be emphasized in the medical curriculum and in the training of physicians.
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Choi, Philip J., Farr A. Curlin, and Christopher E. Cox. "Addressing religion and spirituality in the intensive care unit: A survey of clinicians." Palliative and Supportive Care 17, no. 2 (April 30, 2018): 159–64. http://dx.doi.org/10.1017/s147895151800010x.
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AbstractObjectiveStudies have shown that when religious and spiritual concerns are addressed by the medical team, patients are more satisfied with their care and have lower healthcare costs. However, little is known about how intensive care unit (ICU) clinicians address these concerns. The objective of this study was to determine how ICU clinicians address the religious and spiritual needs of patients and families.MethodWe performed a cross-sectional survey study of ICU physicians, nurses, and advance practice providers (APPs) to understand their attitudes and beliefs about addressing the religious and spiritual needs of ICU patients and families. Each question was designed on a 4- to 5-point Likert scale. A total of 219 surveys were collected over a 4-month period.ResultA majority of clinicians agreed that it is their responsibility to address the religious/spiritual needs of patients. A total of 79% of attendings, 74% of fellows, 89% of nurses, and 83% of APPs agreed with this statement. ICU clinicians also feel comfortable talking to patients about their religious/spiritual concerns. In practice, few clinicians frequently address religious/spiritual concerns. Only 14% of attendings, 3% of fellows, 26% of nurses, and 17% of APPs say they frequently ask patients about their religious/spiritual needs.Significance of resultsThis study shows that ICU clinicians see it as their role to address the religious and spiritual needs of their patients, and report feeling comfortable talking about these issues. Despite this, a minority of clinicians regularly address religious and spiritual needs in clinical practice. This highlights a potential deficit in comprehensive critical care as outlined by many national guidelines.
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Neumann, Joseph K., and Frederick V. Leppien. "Impact of Religious Values and Medical Specialty on Professional Inservice Decisions." Journal of Psychology and Theology 25, no. 4 (December 1997): 437–48. http://dx.doi.org/10.1177/009164719702500404.
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Research indicates that professional group and religion affect decision making. Five hundred board-certified physicians from each of 5 specialty areas (General Surgery, Psychiatry, Internal Medicine, Pathology, and Family Practice) were mailed vignettes reflecting 1 of 4 value systems (Evangelical Christian, Liberal Protestant, Humanist, or Hindu) in a randomized survey. One hundred twenty-five vignettes of every value system were mailed to each specialty yielding a total of 500 per specialty. Respondents were asked to rate 1 vignette which provided a brief description of a professional inservice. Questions for rating covered approval and interest in the training as well as requests for respondent descriptive information. About 40% of the total group responded. Humanist and Hindu vignettes were clearly more approved than Liberal Protestant and Evangelical Christian (EC) vignettes. Medical specialty was not an independent factor but was significant in interaction with value type. Personal interest/value similarity correlated highly with approval ratings. Dissimilarity with parental religious values was a frequent moderating variable and varied significantly among medical specialty groups. Religious values influence medical nonclinical decisions. Implications concerning separation of church and state issues, research strategy, and medical ethical and training activities were discussed to encourage more openness in the area of medical decisions and theistic/non-theistic religious values.
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Baidawi, Susan, and Philip Mendes. "Young people transitioning from out-of-home care and problematic substance use The views of young people and workers in Victoria." Children Australia 35, no. 4 (2010): 23–30. http://dx.doi.org/10.1017/s1035077200001255.
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Existing research findings indicate that young people from state care backgrounds experience higher rates of substance use and misuse than the general population. This study explored the nature of this relationship via semi-structured, qualitative interviews with four young people who had recently transitioned from state care and three workers in the out-of-home care field, plus a focus group with seven out-of-home care and leaving care workers. The findings suggest that a range of individual, interpersonal and systematic factors contribute to problematic substance use. They include the use of self-medication to address past and present trauma, a lack of meaningful and stable relationships, and state care policies and practices that lead to young people experiencing premature and unplanned exits from state care. Some significant implications for policy and practice are identified.
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Liddell, Margaret. "Young Women Subject to Statutory Orders and the Transition to Independence: Contradictions in policy and practice." Children Australia 17, no. 3 (1992): 17–22. http://dx.doi.org/10.1017/s1035077200013298.
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This paper examines the way the state welfare system deals with young women who are subject to statutory orders and their need for support as they move towards independence. Young women’s views of their needs are highlighted. Evidence is drawn from the author’s and other relevant Australian and overseas research. The issues are examined within the context of general community trends and policy and practice implications are studied using Community Services Victoria as a case example.A variety of social and economic factors are leading to young people in the general community living with their parents for longer periods of time. In contrast, young people subject to statutory orders, especially young women, are often being discharged from these orders - and thus isolated from adult guidance - shortly after they pass their mid-teens.Assumptions about these young women’s needs - that they no longer require nor wish for support and are ready for complete independence at this early age - are challenged. The legal, organisational and practice constraints which reinforce these assumptions are analysed. The apparent contradiction arising from young women refusing services which they also say they require, is also discussed.The author demonstrates that there is a need for a reconceptualisation of the issue. A new kind of partnership between workers and young women on statutory orders is needed and a policy and administrative framework which facilitates this. The implications of the findings for practice and policy - and especially the important contribution ttiat young women’s views can make to the development of social policy - are presented.
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Timmons, Suzanne, Anna de Siún, Emer Begley, and Mary Manning. "184 A National Survey of Clinicians who Assess People with Suspected Dementia: Service Characteristics and Practice." Age and Ageing 48, Supplement_3 (September 2019): iii1—iii16. http://dx.doi.org/10.1093/ageing/afz102.42.
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Abstract Background The Irish National Dementia Strategy (2014) identified timely diagnosis and intervention as a priority area. The National Dementia Office established a Dementia Diagnostic Project to develop a framework for diagnostic services nationally. As part of preparatory work, a national survey explored baseline peri-diagnostic practice in geriatric medicine, neurology and psychiatry of old age services. Methods A survey was developed by the project steering group, piloted, and then distributed to all 86 Geriatricians, 39 Neurologists, and 34 Psychiatrists of Old Age Psychiatrists in Ireland. Two reminder e-mails were sent. Results In total, 56 clinicians responded (response rate 35%). The majority (74%) saw 1-20 people with suspected dementia (PwSD) per month. Most referrals came from General Practitioners or other physicians; but rarely from Health and Social Care Professionals. Most people were referred specifically for their memory complaint, rather than a co-morbidity. Waiting times for urgent review varied between 24 hours and 4 years; neurology services had the longest waiting times. Only 30% saw PwSD in a dedicated clinic; about the same proportion saw PwSD in their own home; or in residential care settings. About half reported assessing people with intellectual disability and suspected dementia, mainly the neurologists. The Montreal Cognitive Assessment was the most commonly used cognitive tool (89%), followed by the Addenbrook’s Cognitive Examination (56%). Only 17% commonly used functional brain imaging in diagnosis, mainly neurologists; half of respondents ‘never’ or ‘rarely’ used cerebrospinal fluid analysis. Multidisciplinary input was mainly from Occupational Therapists (61%), Psychology/Neuropsychology (52%), and Nursing disciplines (33%). When asked which discipline would most benefit their diagnostic service, neurologists all chose psychology input; geriatricians selected a range of disciplines. Conclusion The significant variability within current services who see PwSD, in terms of multidisciplinary involvement, waiting times, setting, and supporting investigations, supports the need for a national diagnostic framework.
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Hameed, Usman, Cheryl Dellasega, and Anna Scandinaro. "Assessment of irritability in school-aged children by pediatric, family practice, and psychiatric providers." Clinical Child Psychology and Psychiatry 25, no. 2 (July 29, 2019): 333–45. http://dx.doi.org/10.1177/1359104519865591.
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Background: Irritability, a common behavioral problem for school-aged children, is often first assessed by primary care providers, who manage about a third of mental health conditions in children. Until recent changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM), irritability was often associated with mood disorders, which may have led to increases in bipolar disorder diagnosis and prescription of mood stabilizing medication. Objective: Our aim was to explore differences between the approaches psychiatric and primary care providers use to assess irritability. Methods: A single trained interviewer conducted detailed interviews and collected demographic data from a homogeneous group of physicians that saturated with a sample size of 17 pediatric, family medicine, and psychiatric providers who evaluate and treat school-aged children. Qualitative and quantitative data were collected and analyzed. Results: In general, primary care providers chose to refer children with irritability to mental health specialists when medication management became complex, while the psychiatric providers chose behavior modification and parent education strategies rather than medications. The psychiatric group had a significantly higher caseload mix, prior experience with irritability, and more confidence in their assessment capabilities. There was lack of continuing medical education about irritability in all groups. Conclusion: This preliminary study highlights the importance of collaboration between primary care and subspecialties to promote accurate assessment and subsequent treatment of school-aged children with irritability, who can represent a safety concern for self and others. More research is needed to establish an efficient method of assessing and managing irritability in primary care and better utilization of specialists.
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Fecteau, Gary, and Richard Nicki. "COGNITIVE BEHAVIOURAL TREATMENT OF POST TRAUMATIC STRESS DISORDER AFTER MOTOR VEHICLE ACCIDENT." Behavioural and Cognitive Psychotherapy 27, no. 3 (July 1999): 201–14. http://dx.doi.org/10.1017/s135246589927302x.
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Post traumatic stress disorder (PTSD) and other reactions including driving phobias and depression have in recent years been clearly identified as common motor vehicle accident (MVA) sequelae. To date, no treatment outcome data exist for PTSD following MVA beyond case study reports and one pilot investigation. The present study reports on the first randomized control trial for PTSD following MVA. Twenty volunteer participants who had motor vehicle accidents resulting in physical injury requiring medical attention and PTSD were recruited through rehabilitation service providers, other psychologists, community physicians, and lawyers. Assessments included a structured interview for diagnosis of post traumatic stress disorder (Clinician Administered PTSD Scale) by an independent rater, a range of self-report symptom questionnaires and a behavioural test wherein they had their heart rate and subjective distress measured in reaction to idiosyncratic audio descriptions of their accident. Participants were randomly assigned to eight to ten hours of individual cognitive-behavioural therapy (n=10) or to a wait list control group (n=10). Treatment included education about post-trauma reactions, relaxation training, exposure therapy with cognitive restructuring and instruction for self-directed graduated behaviour practice. Results demonstrated statistically and clinically significant treatment effects across structured interviews, self-report questionnaires and the behavioural test. Treatment gains were maintained over a 6 month follow-up using self-report questionnaires.
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Ellison, Patricia H., and Claire B. Kopp. "A Note on Interdisciplinary Research in Developmental/Behavioral Pediatrics/Psychology." Pediatrics 75, no. 5 (May 1, 1985): 883–86. http://dx.doi.org/10.1542/peds.75.5.883.
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In sum, we have offered a few observations about the practice of interdisciplinary research. Now, in addition to our rather specific suggestions, we want to add a few general comments about the interactions of professionals who are actually involved in interdisciplinary research. Collaboration between physicians and psychologists can be enriching, stimulating, and rewarding. But it can also be problematic, because the former do not have much exposure to research and the latter do not have much exposure to clinical issues. Bringing these skills together may require many hours of discussion and reading each other's publications. Overall, physicians need to improve their research skills. Reading statistics texts, taking courses, handling data sets, reviewing other researchers' statistical designs are all reasonable strategies. Psychologists also need to expand their knowledge base. Reading the clinical literature is a start, but this ought to be supplemented by consistent exposure to the clinical milieu. The physician, who has access to the clinical milieu, needs to be sensitive to the question of exposure. Our final comments about collaboration are perhaps the most sensitive ones. The maintenance of a solid physician and psychologist research collaboration requires thoughtfulness, understanding, tact, and nurturance. Consider the status and responsiblities of the physician. He or she often outranks the psychologist, has access to the subject population, daily confronts ethical issues surrounding patient diagnoses, and controls communication of information to child and family. A sense of being in charge develops. Consequently, the psychologist may be perceived as being an adjunct to the research, responsible for day-to-day operations and committing ideas to paper. This is not a good formula for research. There are no easy answers for resolving these difficult interpersonal situations. Some interdisciplinary teams have found that frequent communication helps, others have turned to interinstitution collaborations, and a few have established written guidelines for almost all aspects of the research (responsibility for decision making, day-to-day operations, first authorship on articles, etc). Addressing these delicate issues in the beginning, with intermittent reexamination, will generally lead to a successful endpoint. These reflections are offered to our colleagues in the hope that interdisciplinary research will thrive and become a mainstay of both pediatrics and developmental psychology. After all, facilitating the growth of the child is a primary goal for each discipline.
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Aigbogun, Myrlene Sanon, Martin Cloutier, Marjolaine Gauthier-Loiselle, Annie Guerin, Martin Ladouceur, Ross A. Baker, Michael Grundman, et al. "Real-World Treatment Patterns and Characteristics Among Patients with Agitation and Dementia in the United States: Findings from a Large, Observational, Retrospective Chart Review." Journal of Alzheimer's Disease 77, no. 3 (September 29, 2020): 1181–94. http://dx.doi.org/10.3233/jad-200127.
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Background: Few studies have examined patient characteristics and treatment patterns among patients with dementia and agitation in the United States (US). Objective: To examine real-world treatment patterns and characteristics of patients with agitation related to dementia who were treated with antipsychotics in US residential care and community-based settings. Methods: This retrospective chart review collected US physician-level data from patients 55 to 90 years old initiated on an antipsychotic medication for the treatment of agitation related to dementia from January 2018 to May 2018. Clinical characteristics and treatment patterns were assessed overall and stratified by residential care and community-based settings. Results: A total of 313 participating physicians, 59.5% of whom were primary care physicians, abstracted 801 patient charts (residential care: n = 312; community-based: n = 489). Of patients with agitation who were initiated on an antipsychotic, most patients (74.5%) were initiated within 3 months of the onset of their studied agitation episode, and 62.8% experienced multiple agitation episodes before initiation. While non-pharmacological therapies are recommended first-line approach for agitation in dementia, use of non-pharmacological therapy before initiation of antipsychotics was reported for only 37.8% of patients in residential care and 21.3% in community-based settings. Conclusion: Most patients were initiated on an antipsychotic treatment after multiple episodes of agitation and largely without initial non-pharmacological therapy, suggesting that current treatment guideline recommendations for first-line non-pharmacological intervention may not be adequately followed in clinical practice. Understanding the clinical burden and treatment patterns among dementia patients with agitation is imperative for effective disease management.
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Loch-Neckel, Gecioni, and Maria Aparecida Crepaldi. "Pharmacist contributions for basic care from the perspective of professionals of familial health care teams." Brazilian Journal of Pharmaceutical Sciences 45, no. 2 (June 2009): 263–72. http://dx.doi.org/10.1590/s1984-82502009000200011.
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This study aimed to investigate the social representations of professionals included in the team of Family Health Strategy (physicians, nurses and dentists) respecting the action possibilities and contributions of the pharmacist for the basic care, and based on social psychology and, particularly, on the theory of social representations. The epistemological basis of the research is qualitative, and the data were collected by means of individual semi-structured interviews, which were submitted to analysis of categorical thematic content. Apparently, the majority of professionals already inserted in the team know and recognize the importance of professional pharmacists in the basic care, as well as their potential contribution to this topic. The representations were constructed according to the following parameters: a) the study object and the intervention area, b) the individual practice of every professional and c) his/her action in specific cases. The quality of the professional or personal experience concerning the action of these professionals has contributed for the knowledge about the possibilities of pharmacists' intervention in basic care.
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Hengartner, Michael P., and Martin Plöderl. "False Beliefs in Academic Psychiatry: The Case of Antidepressant Drugs." Ethical Human Psychology and Psychiatry 20, no. 1 (July 2018): 6–16. http://dx.doi.org/10.1891/1559-4343.20.1.6.
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Antidepressant drugs are the mainstay of depression treatment in both primary and specialized mental health care. However, academic psychiatry holds false beliefs about antidepressants and we expose two of them in this essay. First, recent attitude surveys conducted among psychiatrists and general practitioners have revealed that physicians attribute antidepressants’ effects mostly to the drugs’ pharmacologic action and less so to placebo effects. Second, academic psychiatry maintains that physical dependence to antidepressant drugs does not exist and that “discontinuation symptoms” upon stopping maintenance pharmacotherapy are benign and affect only a small minority of antidepressant users. As we review in this essay, these beliefs are at odds with the scientific literature. The largest and most comprehensive meta-analysis of antidepressant trials conducted to date indicates that 88% of the drugs’ treatment outcome is accounted for by placebo effect. Furthermore, physical dependence appears to be a serious issue, as severe and persistent withdrawal reactions affect up to 50% of antidepressant users according to several studies. Correcting false beliefs prevailing in academic psychiatry is needed and has important implications for psychiatric training, continuing medical education, and practice.
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Zadeh, Sima, Maryland Pao, and Lori Wiener. "Opening end-of-life discussions: How to introduce Voicing My CHOiCES™, an advance care planning guide for adolescents and young adults." Palliative and Supportive Care 13, no. 3 (March 13, 2014): 591–99. http://dx.doi.org/10.1017/s1478951514000054.
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AbstractObjective:Each year, more than 11,000 adolescents and young adults (AYAs), aged 15–34, die from cancer and other life-threatening conditions. In order to facilitate the transition from curative to end-of-life (EoL) care, it is recommended that EoL discussions be routine, begin close to the time of diagnosis, and continue throughout the illness trajectory. However, due largely to discomfort with the topic of EoL and how to approach the conversation, healthcare providers have largely avoided these discussions.Method:We conducted a two-phase study through the National Cancer Institute with AYAs living with cancer or pediatric HIV to assess AYA interest in EoL planning and to determine in which aspects of EoL planning AYAs wanted to participate. These results provided insight regarding what EoL concepts were important to AYAs, as well as preferences in terms of content, design, format, and style. The findings from this research led to the development of an age-appropriate advance care planning guide, Voicing My CHOiCES™.Results:Voicing My CHOiCES™: An Advanced Care Planning Guide for AYAbecame available in November 2012. This manuscript provides guidelines on how to introduce and utilize an advance care planning guide for AYAs and discusses potential barriers.Significance of Results:Successful use of Voicing My CHOiCES™ will depend on the comfort and skills of the healthcare provider. The present paper is intended to introduce the guide to providers who may utilize it as a resource in their practice, including physicians, nurses, social workers, chaplains, psychiatrists, and psychologists. We suggest guidelines on how to: incorporate EoL planning into the practice setting, identify timepoints at which a patient's goals of care are discussed, and address how to empower the patient and incorporate the family in EoL planning. Recommendations for introducing Voicing My CHOiCES™ and on how to work through each section alongside the patient are provided.
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Jorge, Beatriz, Catarina Pedro Fernandes, Juliana Carvalho, and Mariana Duarte Mangas. "448 - Euthanasia and Dementia." International Psychogeriatrics 32, S1 (October 2020): 168. http://dx.doi.org/10.1017/s1041610220003002.
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Background:The practice of assisted dying is increasingly being discussed in a growing number of countries and is progressively regarded as a last-resort option for those suffering from severe and irreversible diseases. Recently, euthanasia in patients with psychiatric disorders and dementia has taken a prominent place in the public debate, since little is known about the prevalence and practice of euthanasia in these particular cases. Remaining a controversial subject, this study aims to describe the evolution and characteristics in reported euthanasia cases, focusing in dementia patients and the perspective from different countries regarding the nature of suffering, the voluntariness of the request and the role of the physician in the process.Methods:A non-systematic review was performed, searching Pubmed/MEDLINE and Google Scholar for articles using the keywords dementia, euthanasia and assisted dying. Resultant articles were cross-referenced for other relevant articles not identified in the initial search.Results:Physicians consider less likely to perform euthanasia in patients with dementia, compared to patients with a severe and life-limiting somatic illness such as cancer. Both physicians and members of the general public acknowledge difficulties in the assessment of the voluntariness of the request and the extent of suffering of patients with advanced dementia, considering that communication is compromised. While euthanasia on the grounds of unbearable suffering caused by dementia remains a comparatively limited practice, its prevalence has risen and is related to loss of dignity or the knowledge that the lasting memory of their loved ones will be of the decomposed version of oneself.Conclusions:It is likely that the number of euthanasia requests from patients suffering from dementia and/or accumulation of health problems related to old age will continue to grow. The question of how policy makers and care providers should respond to these requests is, therefore, highly relevant, as welll as the development of practice guidelines, if medical staff is to respond adequately to these delicate requests.
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Ma, Da, Evangeline Yee, Jane K. Stocks, Lisanne M. Jenkins, Karteek Popuri, Guillaume Chausse, Lei Wang, Stephan Probst, and Mirza Faisal Beg. "Blinded Clinical Evaluation for Dementia of Alzheimer’s Type Classification Using FDG-PET: A Comparison Between Feature-Engineered and Non-Feature-Engineered Machine Learning Methods." Journal of Alzheimer's Disease 80, no. 2 (March 23, 2021): 715–26. http://dx.doi.org/10.3233/jad-201591.
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Background: Advanced machine learning methods can aid in the identification of dementia risk using neuroimaging-derived features including FDG-PET. However, to enable the translation of these methods and test their usefulness in clinical practice, it is crucial to conduct independent validation on real clinical samples, which has yet to be properly delineated in the current literature. Objective: In this paper, we present our efforts to enable such clinical translational through the evaluation and comparison of two machine-learning methods for discrimination between dementia of Alzheimer’s type (DAT) and Non-DAT controls. Methods: FDG-PET-based dementia scores were generated on an independent clinical sample whose clinical diagnosis was blinded to the algorithm designers. A feature-engineered approach (multi-kernel probability classifier) and a non-feature-engineered approach (3D convolutional neural network) were analyzed. Both classifiers were pre-trained on cognitively normal subjects as well as subjects with DAT. These two methods provided a probabilistic dementia score for this previously unseen clinical data. Performance of the algorithms were compared against ground-truth dementia rating assessed by experienced nuclear physicians. Results: Blinded clinical evaluation on both classifiers showed good separation between the cognitively normal subjects and the patients diagnosed with DAT. The non-feature-engineered dementia score showed higher sensitivity among subjects whose diagnosis was in agreement between the machine-learning models, while the feature-engineered approach showed higher specificity in non-consensus cases. Conclusion: In this study, we demonstrated blinded evaluation using data from an independent clinical sample for assessing the performance in DAT classification models in a clinical setting. Our results showed good generalizability for two machine-learning approaches, marking an important step for the translation of pre-trained machine-learning models into clinical practice.
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Barnes, Michael P. "Standards in Neurological Rehabilitation, June 1997." Behavioural Neurology 10, no. 2-3 (1997): 1–7. http://dx.doi.org/10.1155/1997/467394.
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The European Federation of Neurological Societies (EFNS) Scientific Panel on Neurorehabilitation established a Task Force on standards in neurological rehabilitation in June 1996. The remit for the Task Force was to: (1) produce a report on the state of neurological rehabilitation across Europe; and (2) recommend standards for the provision of neurological services for disabled people. The main conclusions of the Task Force were as follows: (1) A questionnaire circulated to each European member country has indicated a significant lack of adequate neurological rehabilitation facilities across Europe. Very few countries have any established network of neurological rehabilitation centres. Few countries have adequately trained neurological rehabilitation physicians, therapists or nurses. Such poor facilities should be seen in the context of the large numbers and increasing prevalence of people with neurological disabilities. (2) The Task Force has summarized the significant benefits that can follow from the establishment of a dedicated and cost effective neurological rehabilitation service including functional improvement, reduction of unnecessary complications, better coordination and use of limited resources, improved opportunities for education, training and research and a clear point of contact for the disabled person. (3) The Task Force recommends minimum standards for the prevention of neurological disability including access to health education, genetic counselling and emergency resources. The Task Force also encourages governments to invest in improved legislation for accident prevention. (4) The Task Force has outlined some minimum standards for the staffing of a neurological rehabilitation service including improved training both for neurologists and rehabilitation physicians. Such training could include a cross-national training programme both for physicians and other health care staff. (5) The Task Force supports a two-tier system of neurological services. We believe that disabled individuals should have access to a regional specialist service as well as a local community service. The regional specialist service would cater for people with more complicated and severe disabilities, including spinal injury and severe brain injury. The regional centres would provide specialist expertise for wheelchairs and special seating, orthotics, continence and urological services, aids and equipment including communication aids and environmental controls, prosthetics and driving assessment. The Task Force additionally endorses the development of local and community based rehabilitation teams with clear links to the regional centre. (6) The Task Force recognizes the limited amount of rehabilitation research and encourages individuals, universities and governments to invest more in rehabilitation research. Such investment should produce benefits for disabled people and their carers and in the long term benefits for the national economy. (7) The Task Force realizes that neurological rehabilitation is poorly developed both in Europe and the world as a whole. We firmly endorse international co-operation in this field and are happy to co-operate with any international organization in order to develop such links for clinical, educational or research initiatives. (8) The Task Force encourages individual countries to produce a document summarizing their own situation with regard to these standards and to produce a timetable for action to improve their situation. The EFNS Task Force would be pleased to assist in the publication of such deliberations or to act as a focus for international education and research or for sharing of examples of good practice.
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Scott, T. L., J. Liddle, N. A. Pachana, E. Beattie, and G. K. Mitchell. "Managing the transition to non-driving in patients with dementia in primary care settings: facilitators and barriers reported by primary care physicians." International Psychogeriatrics 32, no. 12 (February 20, 2019): 1419–28. http://dx.doi.org/10.1017/s1041610218002326.
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ABSTRACTObjectives:This research addresses dementia and driving cessation, a major life event for affected individuals, and an immense challenge in primary care. In Australia, as with many other countries, it is primarily general practitioners (GPs) who identify changes in cognitive functioning and monitor driving issues with their patients with dementia. Qualitative evidence from studies with family members and other health professionals shows it is a complicated area of practice. However we still know little from GPs about how they manage the challenges with their patients and the strategies that they use to facilitate driving cessation.Methods:Data were collected through five focus groups with 29 GPs at their primary care practices in metropolitan and regional Queensland, Australia. A semi-structured topic guide was used to direct questions addressing decision factors and management strategies. Discussions were audio recorded, transcribed verbatim and thematically analyzed.Results:Regarding the challenges of raising driving cessation, four key themes emerged. These included: (i) Considering the individual; (ii) GP-patient relationships may hinder or help; (iii) Resources to support raising driver retirement; and (iv) Ethical dilemmas and ethical considerations. The impact of discussing driving cessation on GPs is discussed.Conclusions:The findings of this study contribute to further understanding the experiences and needs of primary care physicians related to managing driving retirement with their patients with dementia. Results support a need for programs regarding identification and assessment of fitness to drive, to upskill health professionals and particularly GPs to manage the complex issues around dementia and driving cessation, and explore cost-effective and timely delivery of such support to patients.
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Korc-Grodzicki, Beatriz, Yesne Alici, Christian Nelson, Koshy Alexander, Ruth Manna, Natalie Gangai, Megan J. Shen, Patricia A. Parker, and Smita C. Banerjee. "Addressing the quality of communication with older cancer patients with cognitive deficits: Development of a communication skills training module." Palliative and Supportive Care 18, no. 4 (April 16, 2020): 419–24. http://dx.doi.org/10.1017/s1478951520000218.
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AbstractObjectiveEffective communication is an essential part of patient-centered care. The complexity of cancer care in older adults makes communication challenging, particularly when older patients have cognitive deficits and lose their autonomy. This paper describes the development, implementation, and evaluation of a communication skills training module for health care providers (HCPs) who work with older adults with cancer, with or at risk of developing cognitive deficits.MethodUsing a pre-post single arm study design, 99 HCPs from a comprehensive cancer center in North-East USA, who worked primarily with geriatric patients, participated in the study. Participants included Advance Practice Providers (including Nurse Practitioners and Physician Assistants; n = 24, 24.2%); nurses (n = 23, 23.2%), social workers (n = 14, 14.1%), physicians (n = 13, 13.1%), and “other” HCPs (including occupational therapists, physical therapists, and psychologists; n = 20, 20.2%). The HCPs participated in a one-day geriatric communication skills training program in groups of 12–15 over a 2-year period. Participants complete pre-post surveys on module evaluation and perception of self-efficacy as well as pre-post video-recorded Standardized Patient Assessment (SPA) to evaluate communication skill uptake.ResultsMost participants evaluated the module positively; over 90% indicated that they agreed or strongly agreed with five of the six module evaluation items. HCPs’ self-efficacy in communicating with cancer patients with cognitive deficits significantly increased from pre- to post-module training. There was a significant increase in the following communication skill use from pre- to post-training: checking patient preferences, declaring agenda, and inviting agenda.Significance of resultsResults demonstrated a successful implementation of the program as evidenced through favorable program evaluation, significant gains in self-efficacy, as well as significant improvement in several communication skills.
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Rossi, Alessandro Alberto, Maria Marconi, Federica Taccini, Claudio Verusio, and Stefania Mannarini. "From Fear to Hopelessness: The Buffering Effect of Patient-Centered Communication in a Sample of Oncological Patients during COVID-19." Behavioral Sciences 11, no. 6 (June 14, 2021): 87. http://dx.doi.org/10.3390/bs11060087.
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Background: COVID-19 represents a threat both for the physical and psychological health of oncological patients experiencing heightened distress levels to which the fear of the virus is also added. Moreover, fear of COVID-19 could lead oncological patients to experience feelings of hopelessness related to their medical care. Patient-centered communication may act as a buffer against the aforementioned variables. This study aimed to test the role of doctor–patient communication in the relationship between fear of COVID-19 and hopelessness. Methods: During the COVID-19 pandemic, a sample of 90 oncological outpatients was recruited (40 males (44.4%) and 50 females (55.6%), mean age = 66.08 (SD = 12.12)). A structured interview was developed and used during the pandemic to measure the patients’ perceived (A) fear of COVID-19, and (B) feelings of hopelessness, and (C) physicians’ use of empathetic and (D) clear language during the consultation. A multiple mediation model was tested, and the effects between males and females were also compared. Results: Empathetic and clear doctor–patient communication buffered the adverse effect of the fear of COVID-19 on hopelessness through a full-mediation model. The effects did not differ between males and females in the overall model but its indirect effects. Discussions: Patient-centered communication using empathy and clear language can buffer the adverse effect of the fear of COVID-19 and protect oncological patients from hopelessness during the pandemic. These findings might help to improve clinical oncological practice.