Karen D. Novielli

HEALTH BELIEFS AND ATTITUDES TOWARD THE PREVENTION OF OSTEOPOROSIS IN OLDER WOMEN

ObjectiveA pilot study to determine health belief factors associated with osteoporosis prevention behaviors in peri-and postmenopausal women. DesignWe administered a survey to a convenience sample of 60 women aged 40–95 years old in an urban family practice center and an associated retirement community. The self-reported questionnaire addressed demographics, osteoporosis risk factors, current preventive behaviors for osteoporosis, and health beliefs. ResultsThe majority of women (89%) believed that osteoporosis is a serious condition, but only 29% perceived a personal susceptibility. Women were less concerned about osteoporosis when compared with cancer, cardiovascular disease, and neurologic disorders. Only 40% of women were taking active measures to prevent osteoporosis. There was no significant relationship between active osteoporosis prevention behaviors and five health belief factors (motivation, barrier, active participant in health care, frustration, and benefit) (p ≥ 0.43). However, active behaviors to prevent osteoporosis were found to correlate with the single item “I am worried about developing osteoporosis” (p = 0.03). Most women surveyed would be willing to exercise and take calcium and a multivitamin to prevent osteoporosis. ConclusionFew women are taking active measures to prevent osteoporosis despite their belief that it is a serious condition. Our data suggest that most women do not perceive a personal susceptibility to the disease. Only women who reported actively worrying about developing osteoporosis were more likely to be engaged in significant osteoporosis preventive behaviors.

Potentially inappropriate medication prescribing for elderly outpatients in Emilia Romagna, Italy: a population-based cohort study.

BackgroundIn the US, a growing body of epidemiological studies has documented widespread potentially inappropriate medication prescribing among the elderly in outpatient settings. However, only limited information exists in Europe.ObjectiveTo evaluate the prevalence of potentially inappropriate medication prescribing among elderly outpatients in Emilia Romagna, Italy and to investigate factors associated with potentially inappropriate medication prescribing in that setting.MethodsRetrospective cohort study using the Emilia Romagna outpatient prescription claims database from 1 January 2001 to 31 December 2001 linked with information (age, sex and other variables) available from a demographic file of approximately 1 million Emilia Romagna residents aged ≥65 years. The cohort comprised 849 425 elderly patients who had at least one drug prescription during the study period. The prevalence of potentially inappropriate medication prescribing, as defined by the 2002 Beers’ criteria, was measured together with predictors associated with potentially inappropriate medication prescribing.ResultsA total of 152 641 (18%) elderly Emilia Romagna outpatients had one or more occurrences of potentially inappropriate medication prescribing. Of these, 11.5% received prescriptions for two medications of concern and 1.7% for three or more. Doxazosin (prescribed to 23% of subjects) was the most frequently occurring potentially inappropriate prescribed medication, followed by ketorolac (20.5%), ticlopidine (18.3%) and amiodarone (12.6%). Factors associated with greater likelihood of potentially inappropriate medication prescribing were older age, overall number of drugs prescribed and greater number of chronic conditions. The odds of receiving potentially inappropriate prescribed medications were lower for females, subjects living in more urban areas and subjects with a higher income level.ConclusionsThis study provides strong evidence that potentially inappropriate medication prescribing for elderly outpatients is a substantial problem in Emilia Romagna. Focusing on the prevalence of potentially inappropriate medication prescribing and associated predictors can help in the development of educational programmes targeting outpatient practitioners to influence prescribing behaviour and, therefore, reduce potentially inappropriate medication prescribing.

Predictors of workplace satisfaction for U.S. medical school faculty in an era of change and challenge.

Purpose To examine the current state of satisfaction with the academic medicine workplace among U.S. medical school faculty and the workplace factors that have the greatest influence on global satisfaction. Method The authors used data from the 2009 administration of a medical school faculty job satisfaction survey and used descriptive statistics and &khgr;2 analyses to assess levels of overall satisfaction within faculty subgroups. Multiple regressions used the mean scores of the 18 survey dimensions and demographic variables to predict three global satisfaction measures. Results The survey was completed by 9,638 full-time faculty from 23 U.S. medical schools. Respondents were mostly satisfied on global satisfaction measures including satisfaction with their department (6,506/9,128; 71.3%) and medical school (5,796/9,124; 63.5%) and whether they would again choose to work at their medical school (5,968/8,506; 70.2%). The survey dimensions predicted global satisfaction well, with the final models explaining 51% to 67% of the variance in the dependent measures. Predictors across models include organization, governance, and transparency; focus of mission; recruitment and retention effectiveness; department relationships; workplace culture; and nature of work. Conclusions Despite the relatively unpredictable environmental challenges facing medical schools today, leaders have opportunities to influence and improve the workplace satisfaction of their faculty. Examples of opportunities include fostering a culture characterized by open communication and occasions for faculty input, and remaining vigilant regarding factors contributing to faculty burnout. Understanding what drives faculty satisfaction is crucial for medical schools as they continue to seek excellence in all missions and recruit and retain high-quality faculty.

Change of interest in surgery during medical school: a comparison of men and women.

Despite the increasing enrollment of women in medical school (45.6% for 1999–2000), women continue to be underrepresented in the field of surgery and surgical subspecialties, accounting for 7– 20% of residents in recent years. This trend is not confined to the United States, but is found in Canada, the United Kingdom, and The Netherlands as well. Reasons for the disparity of surgery as a career choice between men and women are incompletely understood, but may involve lifestyle expectations and concerns about feasibility of raising a family, given the demands of the surgical profession. Gender equity in the surgical professions will require a more complete understanding of the reasons women choose not to enter the field. This study was designed to address the following questions: (1) Are there differences in the proportions of men and women who lose or gain interest in surgery during medical school? and (2) What are the variables that contribute to losing or gaining interest in surgery during medical school?

Splenic Infarction after Cocaine Use

To the Editors: Cocaine has been implicated in ischemic injury to multiple organ systems. We report a case of splenic infarction temporally related to cocaine use. A 38-year-old black woman present...

Use of critical incidents to develop a rating form for resident evaluation of faculty teaching

Context  Monitoring the teaching effectiveness of attending physicians is important to enhancing the quality of graduate medical education.

THE IMPORTANCE OF ADVANCE DIRECTIVES IN PRIMARY CARE

The advance directive has been acknowledged widely by patients and physicians as a desirable tool to promote patient autonomy at the end of life. Rates of completion of advance directives, however, remain low among all segments of the population. Significant patient and physician barriers to completion of advance directives are considered. Legal and ethical principles of advance directives, as well as some practical means of overcoming barriers to these important discussions, are reviewed.

The importance of individualized pharmaceutical therapy in the treatment of diabetes mellitus

Individualized pharmaceutical care for patients with diabetes is necessary for several reasons. First, diabetes is a highly complex disease caused by the interplay among genetic, physiological, and environmental factors that vary from individual to individual. Second, the profile of patients with diabetes has evolved to include people of all ages and socioeconomic backgrounds, with varying medical histories and health behaviors. Third, diabetes often occurs concurrently with other medical conditions, especially in certain groups, such as the elderly. While the treatment goals for all patients with diabetes are the same—to stabilize and maintain healthy blood glucose levels to prevent serious complications—the treatment plan used to achieve those goals will vary among individuals. There are many clinically proven options available for the treatment of diabetes. While there are well-established guidelines regarding which intervention is the best option for patients with either type 1 or type 2 diabetes, ind...

Effectiveness of guideline-recommended cardiac drugs for reducing mortality in the elderly medicare heart failure population: a retrospective, survey-weighted, cohort analysis.

AbstractBackground Heart failure (HF) management guidelines recommend that most patients with HF receive an ACE inhibitor or an angiotensin II type 1 receptor antagonist (angiotensin receptor blocker [ARB]) and a β-blocker (β-adrenoceptor antagonist), collectively referred to as ‘cardiac drugs’, based on results from randomized controlled trials showing that these drugs reduce mortality. However, the results of randomized controlled trials may not be generalizable to the population most likely (i.e. the elderly) to receive these drugs in clinical practice. Objective To determine the effectiveness of cardiac drugs for reducing mortality in the elderly Medicare HF population. Study Design Retrospective, survey-weighted, cohort analysis of the 2002 Medicare Current Beneficiary Survey Cost and Use files. Participant 12 697 beneficiaries, of whom 1062 had a diagnosis of HF and 577 were eligible to receive cardiac drugs. Measurements Association between mortality and cardiac drugs, adjusted for sociodemographics, co-morbidity and propensity to receive cardiac drugs. Results The mortality rate among the 577 eligible beneficiaries with HF was 9.7%. The mortality rate for those receiving an ACE inhibitor or ARB alone, a β-blocker alone, or both an ACE inhibitor or ARB and a β-blocker, was 6.1%, 5.9% and 5.3%, respectively; in the absence of any of the three cardiac drugs, the mortality rate was 20.0% (p < 0.0001). In multivariable analyses, mortality rates remained significantly lower for beneficiaries receiving an ACE inhibitor or ARB alone (odds ratio [OR] 0.24; 95% CI 0.11, 0.50), a β-blocker alone (OR 0.17; 95% CI 0.07, 0.41), or both an ACE inhibitor or ARB and a β-blocker (OR 0.24; 95% CI 0.10, 0.55) compared with patients who did not receive any of the three cardiac drugs. Conclusions Use of guideline-recommended cardiac drugs is associated with reduced mortality in the elderly Medicare HF population. Providing evidence of the benefit of cardiac drugs among the elderly with HF will become increasingly important as the size of the Medicare population grows.

Implementing the Logic Model for Measuring the Value of Faculty Affairs Activities

In todays environment of increasing accountability in higher education and health care, it is critical that administrative units of a medical school demonstrate the added value of their activities to the schools mission and that these units discriminate those activities that demonstrate the most return on investment. This is particularly important for administrative units whose activities may not be considered essential to the basic functioning of the medical school. For example, admissions would likely be considered an essential administrative unit that the medical school cannot do without, while faculty development might be considered nonessential. Effective measurement systems serve two purposes. They guide decision making throughout the organization and they serve as a basis for evaluating performance. This article describes use of the program logic model to measure the contribution of faculty affairs and development offices to the recruitment, retention, and development of a medical schools teaching faculty, an outcome central to the mission of the medical school. The process of developing and rewarding faculty for teaching is used to illustrate the application of this method in linking activities of faculty affairs and development offices to outcomes that are of importance to the medical school.