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Management of coronary risk factors by registered nurses versus usual care in patients with unstable angina pectoris (A Chest Pain Evaluation in The Emergency room [CHEER] substudy)

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第2期86卷 133-138页

作者： Allison, TG Farkouh, ME Smars, PA Evans, RW Squires, RW Gabriel, SE Kopecky, SL Gibbons, RJ Reeder, GS Mayo Clin & Mayo Fdn Div Cardiovasc Dis & Internal Med Rochester MN 55905 USA Mt Sinai Med Ctr Cardiovasc Inst New York NY 10029 USA Mayo Clin & Mayo Fdn Div Emergency Med Serv & Internal Med Rochester MN 55905 USA Mayo Clin & Mayo Fdn Div Hlth Serv Res & Internal Med Rochester MN 55905 USA

This study examined whether nurses could manage coronary risk factors in patients with unstable angina more effectively than physicians practicing usual care. Three hundred twenty-six patients were randomized in the emergency room to a 6-month program of risk factor management by a registered nurse versus participation in usual care. The nurse intervention consisted of a 30-minute counseling visit at 6 to 10 days after the chest pain episode and a second 30-minute session 1 month later. Multiple risk factors were assessed and addressed: smoking, blood lipids, blood pressure, blood glucose, physical inactivity, weight, psychological stress, and social isolation. Compared with usual care, nurse intervention patients significantly reduced both triglycerides (-29 +/- 8 vs 5 +/- 6 mg/dl;p <0.0004) and weight (-0.9 +/- 3.3 vs +0.1 +/- 2.1 kg;p = 0.0071), and had corresponding improvements in self-reported diet compliance and exercise (+34 +/- 106 vs +9 +/- 98 minutes, p = 0.0491). No significant differences between groups were observed in terms of 6-month changes in total, high-density lipoprotein, or low-density lipoprotein cholesterol, blood pressure, fasting blood glucose, percent body fat or waist-hip ratio, or psychological distress scores. The 6-month rate of recurrent events (cardiac death, out-of-hospital cardiac arrest, myocardial infarction) and/or revascularizations (coronary artery bypass surgery or coronary angioplasty) was lower in the nurse intervention group (1% vs 9%;p = 0.002). We conclude that a nurse-delivered risk factor intervention program for patients with chest pain is feasible and more effective than usual care in terms of fostering lifestyle changes that may lower coronary risk. (C)2000 by Excerpta Medico, inc.

关键词：心绞痛不稳定型/血液心绞痛不稳定型/流行病学心绞痛不稳定型/治疗临床工作能力/统计学和数值数据咨询急症护理/标准急诊室医院/标准急诊室医院/统计学和数值数据生活方式医务人员医院/标准明尼苏达/流行病学危险因素老年人女(雌)性人类男(雄)性中年人

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Current understanding of clinical governance: a study of dental health care providers

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BRITISH DENTAL JOURNAL 1999年第10期187卷 555-556页

作者： Nicklin, PV Batchelor, PA Univ York Ctr Dent Serv Studies Innovat Ctr York YO10 5DG N Yorkshire England Univ London Kings Coll Dept Dent Publ Hlth & Community Dent Educ London SE5 9RW England

Objective To quantify what dental care providers understand by clinical governance and how it may impact on their activites Design A self-completed questionnaire administered to attendees at two postgraduate courses. Results A total of 71 forms were completed, a response rate of 88%. The majority of those responding recognised that clincial governance would impact in clinical areas of activity. However, nearly a third felt that any legislation would not affect receptionists or dental surgery assistants. Over 30% of respondents failed to keep records of any mistakes that occurred in their practices, a feature that is central to risk management. While overall the respondents felt that clinical governance would help to raise standards, there was also the fear that it would lead to increased litigation. Conclusion There is at present a lack of understanding of clinical governance and how it will impart on the profession. If GDPs are to sustain public and political confidence in their clinical practice the issue of clinical governance must be embraced by the profession.

关键词：临床工作能力/立法和法学临床工作能力/统计学和数值数据牙医师/立法和法学牙医师/统计学和数值数据牙医师女/立法和法学牙医师女/统计学和数值数据英格兰质量保证卫生保健/立法和法学质量保证卫生保健/统计学和数值数据女(雌)性人类男(雄)性

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CHARACTERISTICS OF RATINGS OF PHYSICIAN COMPETENCE BY PROFESSIONAL ASSOCIATES

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EVALUATION & THE HEALTH PROFESSIONS 1989年第4期12卷 409-423页

作者： CARLINE, JD WENRICH, M RAMSEY, PG UNIV WASHINGTON SCH MEDSEATTLEWA 98195 USA

Although the evaluation of medical students and residents frequently includes the use of global ratings scales as measures of clinical competence, few studies have investigated the use of global ratings in evaluating the performance of practicing physicians, or the psychometric properties of these ratings. In this article, the characteristics of ratings of physician competence by professional associates are described, using practicing internists as the subjects for the study. Ratings of nine aspects of clinical competence for 210 internists were obtained from four physician associates with whom patient care had been shared. The results suggest that ratings of physicians' clinical competence by professional associates are both reliable and potentially useful in identifying physicians with low performance. Studies are needed to clarify further the psychometric properties of peer ratings, and to determine factors that affect these ratings.

关键词：医务工作者的态度临床工作能力/统计学和数值数据内科学实习医师和住院医师职务/标准护理监督同行评议医生行政负责人心理测定学问卷调查外科学美国

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RELIABILITY AND ACCURACY OF RESIDENT EVALUATIONS OF SURGICAL FACULTY

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EVALUATION & THE HEALTH PROFESSIONS 1992年第3期15卷 313-324页

作者： RISUCCI, DA LUTSKY, L ROSATI, RJ TORTOLANI, AJ CORNELL UNIV MED CTRCOLL MEDNEW YORKNY 10021

This study examines the reliability and accuracy of ratings by general surgery residents of surgical faculty. Twenty-three of 33 residents anonymously and voluntarily evaluated 62 surgeons in June, 1988;24 of 28 residents evaluated 64 surgeons in June, 1989. Each resident rated each surgeon on a 5-point scale for each of 10 areas of performance: technical ability, basic science knowledge, clinical knowledge, judgment, peer relations, patient relations, reliability, industry, personal appearance, and reaction to pressure. Reliability analyses evaluated internal consistency and interrater correlation. Accuracy analyses evaluated halo error, leniency/severity, central tendency, and range restriction. Ratings had high internal consistency (coefficient alpha = 0.97). Interrater correlations were moderately high (average Pearson correlation = 0.63 among raters). Ratings were generally accurate, with halo error most prevalent and some evidence of leniency. Ratings by chief residents had the least halo. Results were generally replicable across the two academic years. We conclude that anonymous ratings of surgical faculty by groups of residents can provide a reliable and accurate evaluation method, ratings by chief residents are most accurate, and halo error may pose the greatest threat to accuracy, pointing to the need for greater definition of evaluation items and scale points.

关键词：方差分析医务工作者的态度临床工作能力/统计学和数值数据全体教工医学院校/标准全体教工医学院校/统计学和数值数据卫生服务研究/方法卫生服务研究/统计学和数值数据医院病床数 500张以上实习医师和住院医师职务/统计学和数值数据职业间关系纽约外科学/教育外科学/人力

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A study of the effects of the appointment of a Clinical Nurse Educator in one Victorian Emergency department

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Accident and Emergency Nursing 2000年第2期8卷 71-78页

作者： Considine, Julie Hood, Kerry Emergency Department Dandenong Hospital Dandenong Vic. 3175 David Street Australia

The Clinical Nurse Educator (CNE) project saw the appointment and evaluation of a CNE position in the Emergency Department at Dandenong Hospital, Australia. The study aimed to identify the educational needs of nursing staff, the self reported levels of knowledge of nursing staff, the perceptions of nursing staff surrounding education and clinical support and to compare responses over the 6 month period to identify any statistically significant changes. Data was collected at three intervals during the study period and the responses compared using the Kruskal-Wallis test(H). Since the appointment of the CNEs, the reported levels of knowledge increased for all areas of emergency nursing included in the study. Tutorials, in-service education sessions, direct clinical support and self-directed learning packages were reported to be useful educational methods. There were increases in the reported adequacy of in-service education (P = 0.0000), level of clinical support and satisfaction with current level of knowledge in emergency nursing. Nursing staff found the process of basic and advanced life support assessment less intimidating (P= 0.0031), more important and less affected by workload constraints of the ED (P = 0.0002). The reported thoroughness of orientation of new employees (P = 0.0005) and levels of clinical support and education when orientated to the triage role (P = 0.0225) also increased. © 2000 Harcourt Publishers Ltd.

关键词：临床工作能力/统计学和数值数据急症护理/教育急症护理/标准急诊室医院/人力急诊室医院/标准在职培训护理人员医院/教育护理人员医院/标准人员配备和时间安排问卷调查维多利亚

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Practice and attitudes of primary care physicians in a rural southern state concerning HIV/AIDS patients

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Journal of Health and Social Policy 1993年第3期4卷 65-78页

作者： Strahan, N. Gandy, M. Thompson, F.E. Page, M.D. Phillips, D.M. Replogle, W.H. Bureau of Preventive Health Services Mississippi State Dept of Health MS United States

In preparing for the development of a plan of care for persons with AIDS and other HIV related conditions, the HIV Services Planning Program, a joint effort of the Department of Family Medicine of the University of Mississippi Medical Center and the Bureau of Preventive Health of the Mississippi State Department of Health, conducted a survey of all primary care physicians throughout the state of Mississippi. The purpose of the survey was to determine health care services provided to persons with HIV/AIDS. Specific areas of interest included: (a) type of medical specialty;(b) location of primary practice;(c) services provided for persons with HIV/AIDS;and (d) utilization of universal blood and body fluid precautions, i.e., barrier techniques. Descriptive statistics were utilized in analyzing responses.

关键词：获得性免疫缺陷综合征/流行病学获得性免疫缺陷综合征/治疗获得性免疫缺陷综合征/传播医务工作者的态度临床工作能力/统计学和数值数据 HIV感染/流行病学 HIV感染/治疗 HIV感染/传播密西西比/流行病学医生病人关系医师家庭/心理学医师家庭/统计学和数值数据防护服/统计学和数值数据防护服/利用问卷调查转诊和会诊/统计学和数值数据地区卫生计划综合预防/统计学和数值数据女(雌)性人类男(雄)性

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Survey of US dentists' knowledge and opinions about oral pharyngeal cancer

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 2000年第5期131卷 653-661页

作者： Yellowitz, JA Horowitz, AM Drury, TF Goodman, HS NIDCR NIH Bethesda MD 20892 USA Univ Maryland Sch Dent Dept Oral Hlth Care Delivery Baltimore MD 21201 USA Maryland Dept Hlth & Mental Hyg Off Oral Hlth Baltimore MD USA

Background, Oral pharyngeal cancer constitutes the most life-threatening of all dental and craniofacial conditions. The U.S. five-year survival rate of 52 percent for these cancers is one of the lowest and has not changed in decades. Methods. The authors mailed a pretested survey to 7,000 randomly selected general dentists;They obtained information on 3,200 dentists' levels of knowledge about oral pharyngeal cancer risks and diagnostic procedures for providing an oral cancer examination, as well as about related opinions and interest in continuing education, or CE, courses on the topic. The authors carried out analyses using unweighted data;they used both bivariate and logistic analytical techniques and evaluated at a significance level of P less than or equal to .01. Results. Based on responses to 14 questions, the average knowledge of oral cancer risks score was 8.4. About one-half of dentists surveyed knew the two most common sites of intraoral cancer and that most oral cancers are diagnosed at a late stage. Conclusions. The reported knowledge of these dentists regarding oral cancer suggests that they are not as knowledgeable as they could be about cancer prevention and early detection and that they recognize these deficiencies. Most of the dentists were interested in oral cancer CE. Clinical Implications. Dentists need to know where in the mouth to look and what types of lesions to look for to provide a comprehensive oral cancer examination.

关键词：医务工作者的态度临床工作能力/统计学和数值数据牙医师/心理学牙医师/统计学和数值数据牙医师女/心理学牙医师女/统计学和数值数据教育牙科继续开业医生牙科/统计学和数值数据口腔肿瘤/诊断咽肿瘤/诊断危险因素美国成年人女(雌)性人类男(雄)性中年人

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Development and preliminary evaluation of an instrument designed to assess dental students' communication skills.

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BRITISH DENTAL JOURNAL 2000年第1期188卷 40-44页

作者： Theaker, ED Kay, EJ Gill, S Univ Manchester Dept Dent Med & Surg Manchester M15 6FH Lancs England

The aim of this study was to develop, and assess the inter-observer reliability of an instrument for evaluating dental students' communication skills. Methods used were process-tracking of interactions between experienced practitioners and patients, development of the instrument and its simultaneous use by two researchers observing 43 third year dental students prior to communication skills training. The results found that the instrument was appropriate for the purpose for which it was designed, and was easy to utilise. There were no significant differences between observers' total scores. Item-specific weighted kappa scores showed almost perfect agreement between observers for all but four of the 31 items. The lowest interobserver weighted kappa score was for the measurement of eye contact (k = 0.60). In conclusion, assessment of communication skills is now a necessity in the undergraduate curriculum. Preliminary analysis of an instrument of communication skills in the dental surgery indicates that it may be possible to do this reliably.

关键词：临床工作能力/统计学和数值数据信息交流牙医病人关系教育考核/方法评价研究(主题) 结果可重复性学生牙科/心理学学生牙科/统计学和数值数据人类

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Use of discriminant and regression analyses to modify a clinical certification board examination.

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Journal of dental education 1999年第6期63卷 459-463页

作者： Gerrow, J.D. Boyd, M.A. Scott, D.A. Boulais, A.P. Faculty of Dentistry Dalhousie University Canada.

The National Dental Examining Board of Canada (NDEB) conducts mandatory, high stakes, pass/fail, certification examinations for dental licensure. One of these examinations was a seven-part, simulated clinical examination in which candidates were required to perform procedures on typodonts. These requirements were two intracoronal and two extracoronal preparations, an amalgam restoration, a provisional crown, and a diagnostic wax-up. Feedback from candidates and examiners indicated that one or more of the requirements may not have been contributing effectively to the overall evaluation of candidates. The NDEB's Clinical Examination Committee therefore requested that an in-depth statistical analysis be performed to identify potential areas of concern and to provide a basis for modifying the examinations. The results of two examination sessions with a total of 168 candidates were subjected to both a discriminant and a logistic regression analysis. Every candidate had results for each of the seven requirements, and no candidate participated in both sessions of the examination. The discriminant analysis revealed that six of the seven requirements could be used to reliably assign examinees according to their true pass/fail classifications. Stepwise discriminant analysis resulted in a 98.81 percent classification success rate with a corresponding 2.50 percent false-positive classification error rate. The logistic regression analysis showed that five components correctly predicted 99.40 percent with a 1.25 percent false-positive rate. The Clinical Examination Committee concluded that one requirement (diagnostic wax-up) should be eliminated and that a second requirement (PFM preparation) be significantly modified and reevaluated. This study demonstrates the usefulness of statistical methods in the analysis and modification of a clinical certification board examination.

关键词：加拿大证明/统计学和数值数据临床工作能力/统计学和数值数据牙冠(假体)/统计学和数值数据牙科汞合金牙模型牙修复体设计/统计学和数值数据牙修复永久/分类牙修复永久/统计学和数值数据判别分析教育考核/统计学和数值数据假阳性反应反馈许可证牙科/统计学和数值数据 Logistic模型结果评价(卫生保健) 可重复性结果蜡类人类

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An initial evaluation of standards for case presentations.

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Journal of dental education 2000年第9期64卷 651-656页

作者： Glaros, A.G. Carlson, E.C. Department of Dental Public Health and Behavioral Science University of Missouri-Kansas City 64108 USA.

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