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Context: Computerized systems to remind physicians to provide appropriate care have not been widely evaluated in large numbers of patients in multiple clinical settings.Objective: To examine whether a computerized reminder system operating in multiple Veterans Affairs (VA) ambulatory care clinics improves resident physician compliance with standards of ambulatory care.Design, Setting, and Participants: A total of 275 resident physicians at 12 VA medical centers were randomly assigned in firms or half-day clinic blocks to either a reminder group (n = 132) or a control group (n = 143). During a 17-month study period (January 31, 1995-June 30, 1996), the residents cared for 12,989 unique patients for whom at least 1 of the studied standards of care (SOC) was applicable.Main Outcome Measures: Compliance with 13 SOC, tracked using hospital databases and encounter forms completed by residents, compared between residents in the reminder group vs those in the control group.Results: Measuring compliance as the proportion of patients in compliance with all applicable SOC by their last visit during the study period, the reminder group had statistically significantly higher rates of compliance than the control group for all standards combined (58.8% vs 53.5%; odds ratio [OR], 1.24; 95% confidence interval [CI], 1.08-1.42; P =.002) and for 5 of the 13 standards examined individually. Measuring compliance as the proportion of all visits for which care was indicated in which residents provided proper care, the reminder group also had statistically significantly higher rates of compliance than the control group for all standards combined (17.9% vs 12.2%; OR, 1.57; 95% CI, 1.45-1.71; P<.001) and for 9 of the 13 standards examined individually. The benefit of reminders, however, declined throughout the course of the study, even though the reminders remained active.Conclusions: Our data indicate that reminder systems installed at multiple sites can improve residents' compliance to multiple SOC. The benefits of such systems, however, appear to deteriorate over time. Future research needs to explore methods to better sustain the benefits of reminders. JAMA. 2000;284:1411-1416. [ABSTRACT FROM AUTHOR]

Eighty-four consecutive clients at an urban clinic in Zimbabwe, who were seeking treatment for suspected STDs, were interviewed to ascertain the barriers and triggers which guided their behaviour. Most respondents regarded having an STD as a serious problem, and were aware of the efficacy of condoms in protecting them from STDs; nevertheless, very few reported using condoms regularly. Knowledge of STDs was patchy, with very few showing an understanding that they may be asymptomatic. The main trigger for attendance was the presence of debilitating symptoms. Men were significantly more likely than women to have visited the clinic for STD treatment on a previous occasion. Most had tried some form of self-treatment before attending; relatively few reported consulting a traditional healer. The cost of treatment was a clear barrier to attendance for a number of respondents. [ABSTRACT FROM AUTHOR]

The relationships among physicians' interviewing techniques, the amount and type of data gathered, and patients' perceptions of the interviewing process were studied. Thirty-one Internal Medicine house officers each interviewed one of three standardized patients. The house officers' thoroughness of data collection was assessed by the patients and by a trained evaluator. A videotape of each interview was analyzed at the National Board of Medical Examiners using the interaction analysis system for interview evaluation, ISIE-81, to define house officers' interviewing techniques. From the physicians' problem-solving perspective, data elicitation was positively related to the length of the interview, asking psychosocial questions, the use of narrow questions, and the amount of time the patient talked. The patients' assessments of house officers' data-gathering thoroughness were also positively influenced by interview length, the use of narrow questions, and inquiries about their psychosocial histories. The use of broad questions by the house officer was positively related to the patient's feelings about and reaction to the interaction. This study potentially explains some of the differences that appear to exist between patients' and physicians' judgments about and perceptions of the medical interviewing process. [ABSTRACT FROM AUTHOR]

Objectives: A descriptive study was performed to better understand the possible utility of immersive virtual reality simulation for training first responders in a mass casualty event., Methods: Utilizing a virtual reality cave automatic virtual environment (CAVE) and high-fidelity human patient simulator (HPS), a group of experts modeled a football stadium that experienced a terrorist explosion during a football game. Avatars (virtual patients) were developed by expert consensus that demonstrated a spectrum of injuries ranging from death to minor lacerations. A group of paramedics was assessed by observation for decisions made and action taken. A critical action checklist was created and used for direct observation and viewing videotaped recordings., Results: Of the 12 participants, only 35.7% identified the type of incident they encountered. None identified a secondary device that was easily visible. All participants were enthusiastic about the simulation and provided valuable comments and insights., Conclusions: Learner feedback and expert performance review suggests that immersive training in a virtual environment has the potential to be a powerful tool to train first responders for high-acuity, low-frequency events, such as a terrorist attack.

Objective: This study aimed to establish the views of a group of mental health professionals from various disciplines working in mental health service in a British hospital about the needs of clients who had experienced childhood sexual abuse., Method: Staff members were asked to complete an anonymous survey which asked questions relating to knowledge of sexual abuse and its effects, and the needs of clients and staff in working with this client group. A total of 54 people responded to the survey, 42 were female, 11 male. Most (72%) reported having over 10 years experience working in mental health, working in both in-patient and out-patient settings., Results: While respondents were reasonably knowledgeable about childhood sexual abuse, they were not very comfortable, competent or supported in their work with this client group. There were no differences in responses according to the age or gender of respondents, but less experienced staff were more likely to feel supported. Those that had received training and/or supervision felt significantly more capable in working with this client group., Conclusions: The study offers some support for the development of specialist training, consultancy and supervision programs for mental health staff in the area of child sexual abuse.