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Problem List (problem + list)

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Medical Sciences100%

Selected Abstracts

Providers' Beliefs, Attitudes, and Behaviors before Implementing a Computerized Pneumococcal Vaccination Reminder

ACADEMIC EMERGENCY MEDICINE, Issue 12 2006
Judith W. Dexheimer MS
Abstract Background The emergency department (ED) has been recommended as a suitable setting for offering pneumococcal vaccination; however, implementations of ED vaccination programs remain scarce. Objectives To understand beliefs, attitudes, and behaviors of ED providers before implementing a computerized reminder system. Methods An anonymous, five-point Likert-scale, 46-item survey was administered to emergency physicians and nurses at an academic medical center. The survey included aspects of ordering patterns, implementation strategies, barriers, and factors considered important for an ED-based vaccination initiative as well as aspects of implementing a computerized vaccine-reminder system. Results Among 160 eligible ED providers, the survey was returned by 64 of 67 physicians (96%), and all 93 nurses (100%). The vaccine was considered to be cost effective by 71% of physicians, but only 2% recommended it to their patients. Although 98% of physicians accessed the computerized problem list before examining the patient, only 28% reviewed the patient's health-maintenance section. Physicians and nurses preferred a computerized vaccination-reminder system in 93% and 82%, respectively. Physicians' preferred implementation approach included a nurse standing order, combined with physician notification; nurses, however, favored a physician order. Factors for improving vaccination rates included improved computerized documentation, whereas increasing the number of ED staff was less important. Relevant implementation barriers for physicians were not remembering to offer vaccination, time constraints, and insufficient time to counsel patients. The ED was believed to be an appropriate setting in which to offer vaccination. Conclusions Emergency department staff had favorable attitudes toward an ED-based pneumococcal vaccination program; however, considerable barriers inherent to the ED setting may challenge such a program. Applying information technology may overcome some barriers and facilitate an ED-based vaccination initiative. [source]

Clear writing, clear thinking and the disappearing art of the problem list

JOURNAL OF HOSPITAL MEDICINE, Issue 4 2007
Daniel M. Kaplan MD
[source]

Defining the content for the objective structured clinical examination component of the Professional and Linguistic Assessments Board examination: development of a blueprint

MEDICAL EDUCATION, Issue 7 2000
Philip Tombleson
Introduction We describe the steps taken to develop an appropriate list of ,clinical problems' used to define the content of the objective structured clinical examination (OSCE) component of the Professional and Linguistic Assessments Board (PLAB) examination. Method A blueprint and list of 255 clinical problems was compiled by reviewing PLAB questions, published curricula of the UK Royal Colleges and other sources such as the General Medical Council's own guidelines. This list was sent to a random sample of 251 successful PLAB candidates who were asked to rate the clinical problems using a scale of ,seen frequently/seldom/never' and to 120 members of the accident and emergency (A&E) specialists' association who were asked to identify ,important' tasks. The list was further validated using activity data obtained for consecutive A&E attendances (934) and admissions (6130) at three hospitals. Results After two mailings, 131/251 (52%) former PLAB candidates and 89/120 (74%) A&E specialists replied. All of the 255 clinical problems were seen by some former candidates and were felt to be important by some A&E specialists. Of the 255 problems, 40 were neither rated as important nor as seen frequently/seldom by over 50% of respondents. The 255 clinical problems covered a mean 94% consecutive A&E attendances and 97·6% reasons for hospital admission. The correlation between clinical problems that were frequently encountered and those felt to be important was rho=0·38 (P < 0·01). Conclusion The clinical problems appear to be appropriate for defining the content of the PLAB OSCE. We suggest that our problem list is useful in that all the problems are seen by some senior house officers, are felt to be important by some A&E specialists and cover greater than or equal to 94% of the conditions for which patients both attend and are admitted from casualty. The correlation between clinical task importance and the frequency that they were seen was only moderate, partly reflecting the relative seriousness of some uncommon medical conditions, which should not be missed on clinical assessment. The content of the OSCE component of the PLAB examination is being reviewed in the light of the findings of this study. The limitations of the study are discussed. [source]

The development of a General Nasal Patient Inventory

CLINICAL OTOLARYNGOLOGY, Issue 5 2001
S.A. Douglas
Most available clinical outcome measures for rhinology patients relate to specific nasal disease or general quality of life. Fairley's validated 12-item questionnaire measures general nasal symptoms, but is a ,physician-derived' clinical tool and may not reflect all the problems that rhinology patients experience. Our aims were to develop a patient-orientated questionnaire, representing the concerns of a large number of rhinology patients, called the General Nasal Patient Inventory (GNPI) and compare this with the Fairley nasal questionnaire (FNQ). The GNPI was developed from the open-ended problem lists of 211 rhinology patients, from the 45 most frequent complaints. Both questionnaires were then administered to 153 general rhinology patients and the results compared. The highest-ranking items for each questionnaire were different, but the total scores were highly correlated (r = 0.79, P < 0.0001). Factor analysis showed six factors to account for 75% of FNQ variance and 18 factors for 78% of GNPI variance. The 45-item GNPI, the first patient-derived, comprehensive nasal questionnaire could be a time-saving tool in rhinology clinics and more sensitive to change after intervention than other available measures. [source]