Week In Patient Care Research Articles

Assessment of Professional Quality of Life in the Alabama Physical Therapy Workforce.

The purposes of this study were to 1) determine the level of professional quality of life among physical therapists and physical therapist assistants in Alabama and 2) to identify personal or professional factors that may contribute to compassion satisfaction (CS), burnout, and secondary traumatic stress (STS). This study used a cross-sectional design and mixed-methods survey methodology to calculate odds ratios for factors affecting professional quality of life. Respondents completed a survey that included the Professional Quality of Life (ProQOL) scale, an open-ended question regarding their experience with professional burnout, and personal and professional demographics. Of the 742 physical therapists and physical therapist assistants in Alabama who completed the survey, the majority experienced moderate-high levels of CS and moderate-low levels of burnout and STS. Regression analyses indicated clinicians working 40 or more hours per week in patient care had greater odds for low-moderate CS and moderate-high burnout and STS subscale scores. Clinicians in our sample licensed between 6 to 15 or more than 30years and those working in private outpatient settings had reduced odds of having moderate-high burnout, whereas those working 16 or more years had significantly increased odds for high CS scores. Responses to the open-ended question indicated workload demands and documentation as the top factors contributing to clinician burnout, while the connections with patients and coworkers help minimize such feelings. Individuals later in their career may develop protective factors to mitigate feelings of burnout compared to those early in their career. Also, clinicians working 40 or more hours per week may be more vulnerable to experiencing low-moderate CS and moderate-high burnout. Thus, individual clinicians and employers must evaluate personal, occupational, and systemic factors that contribute to reduced professional quality of life to inform preventive strategies for mitigating burnout.

Scaling the great wall: The impact of communication barriers on quality of psychiatric care in Chinese patients.

Racial and ethnic minorities (such as Chinese-speaking (CS)) are known to have less equitable access to mental health services than Caucasians. These disparities have a powerful influence on minority groups that already endure a greater burden from mental health needs. The aim was to identify perceived provider barriers to care for CS patients. The study involved an 11-item web-based survey to multidisciplinary health professionals in the department of psychiatry at a 75-bed teaching community mental health center. More than half the respondents agreed that there are disparities in the management of CS versus non-CS patients primarily due to the language barrier (46%). However, older participants and participants who worked fewer hours per week in patient care were less likely to agree (rho = -.27, p = .05 and rho = .33, p = .015, respectively) that these perceived difficulties prevented them from caring for these patients. The study revealed that certain modifiable factors like the limited availability of interpreters and culturally appropriate services, rendering psychoeducation and forming therapeutic alliances with CS patients, posed the greatest challenges on inpatient units. In light of these findings, we aim to make recommendations to remediate concerns of limited provider availability by proposing ways to efficiently utilize current resources and advocate for better staffing to improve the overall well-being of this challenging patient subset.

A Case Report on Fever of Unknown Origin in a School Going Child– An Uncommon Answer in a Common Question

Fever is one of the commonest complaints in paediatrics outpatient as well as inpatient department. Fever of unknown origin (FUO) is a diagnosis of exclusion given to the febrile condition lasting more than three weeks with temperature 38.30C or more with unknown cause despite of one week in patient care. Here we present a case of FUO in a child which was investigated thoroughly and managed on the line of enteric fever. However, the patient remained febrile. Hence, further investigations were undertaken and finally, bone marrow culture grew a very uncommon organism- Escherichia coli. The child was treated as per the sensitivity and responded well to treatment and was discharged after improvement. Here, we would like to present this case of FUO to highlight the possibility of bone marrow invasion by an uncommon organism as a source of fever in children.

The pediatric neurosurgical workforce: defining the current supply

The purpose of this study was to determine a reliable estimate of the size, demographic, and practice characteristics of the current pediatric neurosurgical workforce. The authors also sought to differentiate pediatric from nonpediatric neurosurgical practitioners and compare the demographic and practice characteristics of these 2 groups. The term "pediatric practitioner" will be used in this study to describe a practitioner whose practice is > 75% pediatric patients in accordance with the American Board of Pediatric Neurological Surgery (ABPNS) requirements for board certification in pediatric neurosurgery. Those practitioners with < 75% pediatric patients in their practice will be designated as "nonpediatric practitioners." The authors aggregated multiple databases of professional neurosurgical societies in an effort to identify pediatric neurosurgical practitioners. A 30-question survey was then administered to all identified practitioners, and responses were collected for 6 months. Primary analysis of pediatric versus nonpediatric practitioners was performed. Subgroup analyses of the characteristics of the pediatric practitioners were also performed to identify the effects of practitioner age, sex, and practice setting on survey responses. A total of 342 practitioners received the survey, and 267 responded (78.1% response rate); 158 pediatric practitioners and 92 nonpediatric practitioners were identified. Seventeen respondents were excluded from analysis. Pediatric practitioners were more likely to be women, ABPNS certified, have completed a pediatric fellowship, do fewer operative cases per year, have a more frequent call schedule, practice in a freestanding children's hospital, be in academic practice, and in need of recruiting additional faculty. Pediatric practitioners spent fewer hours per week in patient care, and were less likely to have a productivity-based salary or salary incentive based on relative value unit-production. Among pediatric practitioners, American Board of Neurological Surgery and ABPNS certification rates differed significantly among age groups, with older age groups being more likely to be certified by the American Board of Neurological Surgery and ABPNS. The rate of pediatric fellowship completion was significantly higher in the younger age groups. Anticipating retirement by age 65 was significantly more likely in the younger age groups, and hours spent per week spent in teaching and administrative duties were lower in the younger age groups. There were 27 female and 131 male pediatric practitioners. The women were more likely to have completed a pediatric fellowship and performed fewer operative cases per year than the men. Nonacademic pediatric practitioners were more likely to have a relative value unit-based salary incentive, be reimbursed for call coverage, and spend more hours per week in patient care than academic pediatric practitioners. Academic pediatric practitioners spent more hours per week in clinical research. The authors estimate that there are fewer than 200 pediatric neurosurgeons currently practicing in the United States. Current practice patterns unique to pediatrics may have important implications in recruiting and retaining the next generation of pediatric neurosurgeons.

Specialty care by child neurologists

To provide a current profile of the practice of child neurology, report the attitudes of child neurologists toward practice, and analyze the supply of child neurologists. In March 2002, a questionnaire was sent to all active members of the Child Neurology Society (n = 1,051) and to nonmember physicians under age 70 who listed child neurology as a primary or secondary specialty on the American Medical Association Masterfile (n = 433). The response rate was 65%. Eligibility criteria were then applied to arrive at the sample of main specialty in child neurology working at least 20 hours per week in patient care. The final population was 604. Differences in practice characteristics were tested by practice type, and the number of full-time patient care child neurologists was projected by extrapolating to nonrespondents. There are 904 full-time patient care child neurologists in the United States and 1.27 per 100,000 children. Career satisfaction is 90%, yet no growth in the supply is projected over the next 20 years. Wait times for an appointment average 53 and 44 days for a new and return visit, with longer wait times in university settings. Average annual income is 151,000 dollars. The practice characteristics of child neurologists suggest that the specialty will be challenged to meet patient demands.

Procedural Skills of Practicing Gastroenterologists

To find which procedures gastroenterologists do in their practice, where they learned the procedures, and what training they recommend to achieve and maintain competence in each. Mailed survey. A random sample of 700 gastroenterologists who were members of the American College of Physicians, of whom 510 (73%) responded. Gastroenterologists did a median of 27 of the 40 gastroenterology procedures and 3 of the 16 general medicine procedures. A larger number of different procedures was done by those who were board certified in gastroenterology, spent more than 60 hours per week in patient care, graduated after 1969, or practiced in a university setting, a hospital with 250 to 500 beds, or a group limited to gastroenterologists. The majority of respondents had done each of the three most commonly done procedures 200 or more times in the previous year. For 10 procedures studied in detail, the majority had done 9 of the 10 in the past year at least as often as the median recommendation for maintaining competence. The number of procedures recommended to achieve and maintain competence differed little by the age, type of practice, and gastroenterology board certification status of the respondent. For most procedures, the range of recommendations was broad, but the median numbers agreed with other published recommendations. Respondents learned 31% of procedures after they had completed training. The earlier their training, the more likely they had learned the procedure in practice. Gastroenterologists do many different procedures, and this number is influenced by how recently they were trained and the nature of their practice. Respondents learned nearly one third of the procedures they do after they had completed training. It is an important and continuing challenge for the profession to assure that physicians learn and maintain these procedural skills at the highest level of proficiency.

Who should pay for resident education?

House staff stipends and other costs related to maintaining a residency are listed on hospital budgets as "education." This has become a tempting target for hospital administrators and third-party payors, who ask, "Should the patient pay for medical education?" We have studied the workload of house officers on a typical pediatric surgical service in a children's hospital. General surgical residents spend 56.3 hours per week in patient care. This does not count "lag" time or "on call" time, but work that someone else--either a physician, technician, or nurse practitioner would do if there was no residency. This study, as well as others, clearly indicates that residents provide an enormous amount of patient care. It is perfectly justified to include the costs of house officers in the hospital budget.