Solar project description for Helio-Thermics, Inc., lot 6 single family residence; Greenville, South Carolina

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Moore, D.

1981-03-01

An instrumented single family residence in Greenville, South Carolina, has approximately 1086 square feet on conditioned space. Solar energy is used for space heating the home and preheating domestic and water (DHW). Solar energy enters the attic through a 416 square foot aperture which is double glazed with corrugated, translucent, fiberglass reinforced, acrylic panels. Warm air accumulates in the peak of the attic roof and circulates through the conditioned space or through storage by an air handler. Solar energy is stored in an 870 cubic foot storage bin containing 85,460 pounds of crushed rock located under the house. cold water is preheated in the attic by thermosiphoning water from the 80 gallon preheat tank through a manifold system of copper tubes. These tubes are attached to black sheet metal plates. Preheated city water is stored in the preheat tank and supplied, on demand, to a conventional 80 gallon DHW tank. When solar energy is insufficient to satisfy the space heating load, a water to air heat exchanger in the hot air supply duct provides auxiliary energy for space heating. A gas fired water heater provides auxiliary energy for the water to air heat exchanger and the DHW.

Training Family Medicine Residents to Perform Home Visits: A CERA Survey.

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Sairenji, Tomoko; Wilson, Stephen A; D'Amico, Frank; Peterson, Lars E

2017-02-01

Home visits have been shown to improve quality of care, save money, and improve outcomes. Primary care physicians are in an ideal position to provide these visits; of note, the Accreditation Council for Graduate Medical Education no longer requires home visits as a component of family medicine residency training. To investigate changes in home visit numbers and expectations, attitudes, and approaches to training among family medicine residency program directors. This research used the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2015. Questions addressed home visit practices, teaching and evaluation methods, common types of patient and visit categories, and barriers. There were 252 responses from 455 possible respondents, representing a response rate of 55%. At most programs, residents performed 2 to 5 home visits by graduation in both 2014 (69% of programs, 174 of 252) and 2015 (68%, 172 of 252). The vast majority (68%, 172 of 252) of program directors expect less than one-third of their graduates to provide home visits after graduation. Scheduling difficulties, lack of faculty time, and lack of resident time were the top 3 barriers to residents performing home visits. There appeared to be no decline in resident-performed home visits in family medicine residencies 1 year after they were no longer required. Family medicine program directors may recognize the value of home visits despite a lack of few formal curricula.

Training family medicine residents to practice collaboratively with psychology trainees.

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Porcerelli, John H; Fowler, Shannon L; Murdoch, William; Markova, Tsveti; Kimbrough, Christina

2013-01-01

This article will describe a training curriculum for family medicine residents to practice collaboratively with psychology (doctoral) trainees at the Wayne State University/Crittenton Family Medicine Residency program. The collaborative care curriculum involves a series of patient care and educational activities that require collaboration between family medicine residents and psychology trainees. Activities include: (1) clinic huddle, (2) shadowing, (3) pull-ins and warm handoffs, (4) co-counseling, (5) shared precepting, (6) feedback from psychology trainees to family medicine residents regarding consults, brief interventions, and psychological testing, (7) lectures, (8) video-observation and feedback, (9) home visits, and (10) research. The activities were designed to teach the participants to work together as a team and to provide a reciprocal learning experience. In a brief three-item survey of residents at the end of their academic year, 83% indicated that they had learned new information or techniques from working with the psychology trainees for assessment and intervention purposes; 89% indicated that collaborating with psychology trainees enhanced their patient care; and 89% indicated that collaborating with psychology trainees enhanced their ability to work as part of a team. Informal interviews with the psychology trainees indicated that reciprocal learning had taken place. Family medicine residents can learn to work collaboratively with psychology trainees through a series of shared patient care and educational activities within a primary care clinic where an integrated approach to care is valued.

The Single Graduate Medical Education (GME) Accreditation System Will Change the Future of the Family Medicine Workforce.

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Peabody, Michael R; O'Neill, Thomas R; Eden, Aimee R; Puffer, James C

2017-01-01

Due to the Accreditation Council for Graduate Medical Education (ACGME)/American Osteopathic Association (AOA) single-accreditation model, the specialty of family medicine may see as many as 150 programs and 500 trainees in AOA-accredited programs seek ACGME accreditation. This analysis serves to better understand the composition of physicians completing family medicine residency training and their subsequent certification by the American Board of Family Medicine. We identified residents who completed an ACGME-accredited or dual-accredited family medicine residency program between 2006 and 2016 and cross-tabulated the data by graduation year and by educational background (US Medical Graduate-MD [USMG-MD], USMG-DO, or International Medical Graduate-MD [IMG-MD]) to examine the cohort composition trend over time. The number and proportion of osteopaths completing family medicine residency training continues to rise concurrent with a decline in the number and proportion of IMGs. Take Rates for USMG-MDs and USMG-IMGs seem stable; however, the Take Rate for the USMG-DOs has generally been rising since 2011. There is a clear change in the composition of graduating trainees entering the family medicine workforce. As the transition to a single accreditation system for graduate medical education progresses, further shifts in the composition of this workforce should be expected. © Copyright 2017 by the American Board of Family Medicine.

Entry of US Medical School Graduates Into Family Medicine Residencies: 2015-2016.

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Kozakowski, Stanley M; Travis, Alexandra; Bentley, Ashley; Fetter, Gerald

2016-10-01

This is the 35th national study conducted by the American Academy of Family Physicians (AAFP) that reports retrospectively the percentage of graduates from MD-granting and DO-granting medical schools who entered Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residency programs as first-year residents. Approximately 8.7% of the 18,929 students graduating from US MD-granting medical schools and 15.5% of the 5,314 students graduating from DO-granting medical schools between July 2014 and June 2015 entered an ACGME family medicine residency in 2015. Together, 10.2% of graduates of MD- and DO-granting schools entered family medicine. Of the 1,640 graduates of the MD-granting medical schools who entered a family medicine residency in 2015, 80% graduated from 70 of the 134 schools (52%). In 2015, DO-granting medical schools graduated 823 into ACGME-accredited family medicine residencies, 80% graduating from 19 of the 32 schools (59%). In aggregate, medical schools west of the Mississippi River represent less than a third of all MD-granting schools but have a rate of students selecting family medicine that is 40% higher than schools located east of the Mississippi. Fifty-one percent (24/47) of states and territories containing medical schools produce 80% of the graduates entering ACGME-accredited family medicine residency programs. A rank order list of MD-granting medical schools was created based on the last 3 years' average percentage of graduates who became family medicine residents, using the 2015 and prior AAFP census data.

Geographic Region, Size, and Program Type in Family Practice Residencies.

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Berg, Jolene K.; Garrard, Judith

1981-01-01

Research on residency education in family practice is discussed. Programmatic variables are examined: geographic region, size, and type of program. Definitions of these variables are provided, the current distribution of family practice residency programs across each of these variables is described, and data for use by other researchers is…

Out of the picture: a study of family drawings by children from step-, single-parent, and non-step families.

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Dunn, Judy; O'Connor, Thomas G; Levy, Irit

2002-12-01

Investigated the family drawings of 180 children ages 5 to 7 years in various family settings, including stepfather, single-parent, complex stepfamilies, and 2-parent control families. The relations of family type and biological relatedness to omission of family members and grouping of parents were examined. Children from step- and single-parent families were more likely to exclude family members than children from "control" non-step families, and exclusion was predicted from biological relatedness. Children who were biologically related to both resident parents were also more likely to group their parents together. Omission of family members was found to be associated with children's adjustment (specifically more externalizing and internalizing behavior) as reported by teachers and parents. The results indicate that biological relatedness is a salient aspect of very young children's representations of their families. The association between adjustment and exclusion of family members and grouping of parents indicates that family drawings may be useful research and clinical tools, when used in combination with other methods of assessment.

Entry of US Medical School Graduates Into Family Medicine Residencies: 2014-2015.

Science.gov (United States)

Kozakowski, Stanley M; Fetter, Gerald; Bentley, Ashley

2015-10-01

This is the 34th national study conducted by the American Academy of Family Physicians (AAFP) that reports retrospectively the percentage of graduates from US MD-granting and DO-granting medical schools who entered Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residency programs as first-year residents in 2014. Approximately 8.5% of the 18,241 students graduating from US MD-granting medical schools between July 2013 and June 2014 entered a family medicine residency. Of the 1,458 graduates of the US MD-granting medical schools who entered a family medicine residency in 2014, 80% graduated from 69 of the 131 schools. Eleven schools lacking departments or divisions of family medicine produced only a total of 26 students entering family medicine. In aggregate, medical schools west of the Mississippi River represent less than a third of all US MD-granting schools but have an aggregate rate of students selecting family medicine that is two-thirds higher than schools to the east of the Mississippi. A rank order list of US MD-granting medical schools was created based on the last 3 years' average percentage of graduates who became family medicine residents, using the 2014 and prior AAFP census data. US MD schools continue to fail to produce a primary care workforce, a key measure of social responsibility as measured by their production of graduates entering into family medicine. DO-granting and international medical school graduates filled the majority of ACGME-accredited family medicine first-year resident positions in 2014.

Family medicine residency training and burnout: a qualitative study

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Kimberly Rutherford

2014-12-01

Conclusions: The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors.

Resident and family member perceptions of cultural diversity in aged care homes.

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Xiao, Lily Dongxia; Willis, Eileen; Harrington, Ann; Gillham, David; De Bellis, Anita; Morey, Wendy; Jeffers, Lesley

2017-03-01

Similar to many developed nations, older people living in residential aged care homes in Australia and the staff who care for them have become increasingly multicultural. This cultural diversity adds challenges for residents in adapting to the care home. This study explores: (i) residents' and family members' perceptions about staff and cultural diversity, and (ii) culturally and linguistically diverse residents' and family members' experiences. An interpretive study design employing a thematic analysis was applied. Twenty-three residents and seven family members participated in interviews. Four themes were identified from interpreting residents and family members' perceptions of the impact of cultural diversity on their adaptation to aged care homes: (i) perceiving diversity as an attraction; (ii) adapting to cross-cultural communication; (iii) adjusting to diet in the residential care home; and (iv) anticipating individualized psychosocial interactions. The findings have implications for identifying strategies to support staff from all cultural backgrounds in order to create a caring environment that facilitates positive relationships with residents and supports residents to adjust to the care home. © 2016 John Wiley & Sons Australia, Ltd.

The State of Communication Education in Family Medicine Residencies.

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Jansen, Kate L; Rosenbaum, Marcy E

2016-06-01

Communication skills are essential to medical training and have lasting effects on patient satisfaction and adherence rates. However, relatively little is reported in the literature identifying how communication is taught in the context of residency education. Our goal was to determine current practices in communication curricula across family medicine residency programs. Behavioral scientists and program directors in US family medicine residencies were surveyed via email and professional organization listservs. Questions included whether programs use a standardized communication model, methods used for teaching communication, hours devoted to teaching communication, as well as strengths and areas for improvement in their program. Analysis identified response frequencies and ranges complemented by analysis of narrative comments. A total of 204 programs out of 458 family medicine residency training sites responded (45%), with 48 out of 50 US states represented. The majority of respondents were behavioral scientists. Seventy-five percent of programs identified using a standard communication model; Mauksch's patient-centered observation model (34%) was most often used. Training programs generally dedicated more time to experiential teaching methods (video review, work with simulated patients, role plays, small groups, and direct observation of patient encounters) than to lectures (62% of time and 24% of time, respectively). The amount of time dedicated to communication education varied across programs (average of 25 hours per year). Respondent comments suggest that time dedicated to communication education and having a formal curriculum in place are most valued by educators. This study provides a picture of how communication skills teaching is conducted in US family medicine residency programs. These findings can provide a comparative reference and rationale for residency programs seeking to evaluate their current approaches to communication skills teaching and

Remediation plans in family medicine residency

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Audétat, Marie-Claude; Voirol, Christian; Béland, Normand; Fernandez, Nicolas; Sanche, Gilbert

2015-01-01

Abstract Objective To assess use of the remediation instrument that has been implemented in training sites at the University of Montreal in Quebec to support faculty in diagnosing and remediating resident academic difficulties, to examine whether and how this particular remediation instrument improves the remediation process, and to determine its effects on the residents’ subsequent rotation assessments. Design A multimethods approach in which data were collected from different sources: remediation plans developed by faculty, program statistics for the corresponding academic years, and students’ academic records and rotation assessment results. Setting Family medicine residency program at the University of Montreal. Participants Family medicine residents in academic difficulty. Main outcome measures Assessment of the content, process, and quality of remediation plans, and students’ academic and rotation assessment results (successful, below expectations, or failure) both before and after the remediation period. Results The framework that was developed for assessing remediation plans was used to analyze 23 plans produced by 10 teaching sites for 21 residents. All plans documented cognitive problems and implemented numerous remediation measures. Although only 48% of the plans were of good quality, implementation of a remediation plan was positively associated with the resident’s success in rotations following the remediation period. Conclusion The use of remediation plans is well embedded in training sites at the University of Montreal. The residents’ difficulties were mainly cognitive in nature, but this generally related to deficits in clinical reasoning rather than knowledge gaps. The reflection and analysis required to produce a remediation plan helps to correct many academic difficulties and normalize the academic career of most residents in difficulty. Further effort is still needed to improve the quality of plans and to support teachers.

Teaching wound care to family medicine residents on a wound care service

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Little SH

2013-08-01

Full Text Available Sahoko H Little,1,2 Sunil S Menawat,1,3 Michael Worzniak,1 Michael D Fetters2 1Oakwood Annapolis Family Medicine Residency, Wayne, Michigan, USA; 2University of Michigan, Department of Family Medicine, Ann Arbor, Michigan, USA; 3Ghent Family Medicine Residency, Eastern Virginia Medical School, Norfolk, Virginia, USA Abstract: Primary care physicians often care for patients with chronic wounds, and they can best serve patients if they have knowledge and proficient skills in chronic wound care, including sharp debridement. The Oakwood Annapolis Family Medicine Residency in Michigan, USA developed a Wound Care Service, incorporating wound care training during the surgical rotation. Effectiveness of the wound care training was evaluated through pre- and posttesting of residents, to assess changes in knowledge and comfort in treating chronic wounds. The results demonstrate significant improvement in residents’ knowledge and comfort in wound care. This innovation demonstrates the feasibility of educating residents in chronic wound care through hands-on experience. Keywords: wound care education, primary care, residency education, surgery rotation, curriculum development

Preparing residents for family practice: role of an integrated “Triple C” curriculum

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Joseph Lee

2013-03-01

Full Text Available Background: There is limited understanding of the impact of Triple C competency-based curriculums on the preparation of residents for family practice. This paper describes a competency-based curriculum within an integrated longitudinal block design and presents preliminary evaluation data on the impact of this curriculum on preparedness for family practice. Methods: First and second year family medicine residents were surveyed as a component of a year-end program evaluation to assess the extent to which the residency program is preparing them to engage in a variety of practice domains, the likelihood that they would engage in these domains, and the extent to which this residency program is comprehensive, relevant to their development as a family physician, and promotes interprofessional practice. Results: Residents perceived themselves as prepared to engage in most practice areas and their intentions to engage in various practice domains were positively correlated to their ratings of preparedness. Ratings reflected that residents perceived this program as comprehensive and relevant to their development as a family physician and they perceived a high degree of encouragement for interprofessional practice. Conclusions: This study provides some preliminary evidence that an integrated competency-based curriculum, with an emphasis on interprofessional practice has the potential to effectively prepare residents for practice in family medicine.

Development and Examination of a Family Triadic Measure to Examine Quality of Life Family Congruence in Nursing Home Residents and Two Family Members.

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Aalgaard Kelly, Gina

2015-01-01

Objective: The overall purpose of this study was to propose and test a conceptual model and apply family analyses methods to understand quality of life family congruence in the nursing home setting. Method: Secondary data for this study were from a larger study, titled Measurement, Indicators and Improvement of the Quality of Life (QOL) in Nursing Homes . Research literature, family systems theory and human ecological assumptions, fostered the conceptual model empirically testing quality of life family congruence. Results: The study results supported a model examining nursing home residents and two family members on quality of life family congruence. Specifically, family intergenerational dynamic factors, resident personal and social-psychological factors, and nursing home family input factors were examined to identify differences in quality of life family congruence among triad families. Discussion: Formal family involvement and resident cognitive functioning were found as the two most influential factors to quality of life family congruence (QOLFC).

Impact of the Primary Care Exception on Family Medicine Resident Coding.

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Cawse-Lucas, Jeanne; Evans, David V; Ruiz, David R; Allcut, Elizabeth A; Andrilla, C Holly A; Thompson, Matthew; Norris, Thomas E

2016-03-01

The Medicare Primary Care Exception (PCE) allows residents to see and bill for less-complex patients independently in the primary care setting, requiring attending physicians only to see patients for higher-level visits and complete physical exams in order to bill for them as such. Primary care residencies apply the PCE in various ways. We investigated the impact of the PCE on resident coding practices. Family medicine residency directors in a five-state region completed a survey regarding interpretation and application of the PCE, including the number of established patient evaluation and management codes entered by residents and attending faculty at their institution. The percentage of high-level codes was compared between residencies using chi-square tests. We analyzed coding data for 125,016 visits from 337 residents and 172 faculty physicians in 15 of 18 eligible family medicine residencies. Among programs applying the PCE criteria to all patients, residents billed 86.7% low-mid complexity and 13.3% high-complexity visits. In programs that only applied the PCE to Medicare patients, residents billed 74.9% low-mid complexity visits and 25.2% high-complexity visits. Attending physicians coded more high-complexity visits at both types of programs. The estimated revenue loss over the 1,650 RRC-required outpatient visits was $2,558.66 per resident and $57,569.85 per year for the average residency in our sample. Residents at family medicine programs that apply the PCE to all patients bill significantly fewer high-complexity visits. This finding leads to compliance and regulatory concerns and suggests significant revenue loss. Further study is required to determine whether this discrepancy also reflects inaccuracy in coding.

Family Skills for General Psychiatry Residents: Meeting ACGME Core Competency Requirements

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Berman, Ellen M.; Heru, Alison M.; Grunebaum, Henry; Rolland, John; Wood, Beatrice; Bruty, Heidi

2006-01-01

Objective: The authors discuss the knowledge, attitudes, and skills needed for a resident to be competent in supporting and working with families, as mandated by the residency review committee (RRC) core competencies. Methods: The RRC core competencies, as they relate to patients and their families, are reviewed. The Group for Advancement of…

Closing the door on pharma? A national survey of family medicine residencies regarding industry interactions.

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Fugh-Berman, Adriane; Brown, Steven R; Trippett, Rachel; Bell, Alicia M; Clark, Paige; Fleg, Anthony; Siwek, Jay

2011-05-01

To assess the extent and type of interactions U.S. family medicine residencies permit industry to have with medical students and residents. In 2008, the authors e-mailed a four-question survey to residency directors or coordinators at all 460 accredited U.S. family medicine residencies concerning the types of industry support and interaction permitted. The authors conducted quantitative and qualitative analyses of survey responses and written comments. Residencies that did not permit any industry food, gifts, samples, or support of residency activities were designated "pharma-free." The survey response rate was 62.2% (286/460). Among responding family medicine residencies, 52.1% refused drug samples, 48.6% disallowed industry gifts or food, 68.5% forbade industry-sponsored residency activities, and 44.1% denied industry access to students and residents at the family medicine center. Seventy-five residencies (26.2%) were designated as "pharma-free." Medical-school-based and medical-school-administered residencies were no more likely than community-based residencies to be pharma-free. Among the 211 programs that permitted interaction, 68.7% allowed gifts or food, 61.1% accepted drug samples, 71.1% allowed industry representatives access to trainees in the family medicine center, and 37.9% allowed industry-sponsored residency activities. Respondents commented on challenges inherent to limiting industry interactions. Many programs noted recent changes in plans or practices. Most family medicine residencies limit industry interaction with trainees. Because industry interactions can have adverse effects on rational prescribing, residency programs should assess the benefits and harms of these relationships. Copyright © by the Association of American medical Colleges.

Family Satisfaction With Nursing Home Care: The Role of Facility Characteristics and Resident Quality-of-Life Scores

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Shippee, Tetyana P.; Henning-Smith, Carrie; Gaugler, Joseph E.; Held, Robert; Kane, Robert L.

2018-01-01

This article explores the factor structure of a new family satisfaction with nursing home care instrument and determines the relationship of resident quality of life (QOL) and facility characteristics with family satisfaction. Data sources include (1) family satisfaction interviews (n = 16,790 family members), (2) multidimensional survey of resident QOL (n = 13,433 residents), and (3) facility characteristics (n = 376 facilities). We used factor analysis to identify domains of family satisfaction and multivariate analyses to identify the role of facility-level characteristics and resident QOL on facility-mean values of family satisfaction. Four distinct domains were identified for family satisfaction: “care,” “staff,” “environment,” and “food.” Chain affiliation, higher resident acuity, more deficiencies, and large size were all associated with less family satisfaction, and resident QOL was a significant (albeit weak) predictor of family satisfaction. Results suggest that family member satisfaction is distinct from resident QOL but is associated with resident QOL and facility characteristics. PMID:26534835

Balancing the Roles of a Family Medicine Residency Faculty: A Grounded Theory Study.

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Reitz, Randall; Sudano, Laura; Siler, Anne; Trimble, Kristopher

2016-05-01

Great variety exists in the roles that family medicine residency faculty fill in the lives of their residents. A family medicine-specific model has never been created to describe and promote effective training relationships. This research aims to create a consensus model for faculty development, ethics education, and policy creation. Using a modified grounded theory methods, researchers conducted phone interviews with 22 key informants from US family medicine residencies. Data were analyzed to delineate faculty roles, common role conflicts, and ethical principles for avoiding and managing role conflicts. Key informants were asked to apply their experience and preferences to adapt an existing model to fit with family medicine residency settings. The primary result of this research is the creation of a family medicine-specific model that describes faculty roles and provides insight into how to manage role conflicts with residents. Primary faculty roles include Role Model, Advisor, Teacher, Supervisor, and Evaluator. Secondary faculty roles include Friendly Colleague, Wellness Supporter, and Helping Hand. The secondary roles exist on a continuum from disengaged to enmeshed. When not balanced, the secondary roles can detract from the primary roles. Differences were found between role expectations of physician versus behavioral science faculty and larger/university/urban residencies versus smaller/community/rural residencies. Diversity of opinion exists related to the types of roles that are appropriate for family medicine faculty to maintain with residents. This new model is a first attempt to build consensus in the field and has application to faculty development, ethics education, and policy creation.

Otolaryngology Training for Family Practice Residents.

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And Others; Rood, Stewart R.

1980-01-01

The faculty of the Department of Otolaryngology, University of Pittsburgh School of Medicine, has designed a rotation in the otolaryngology service, that is a basic clinical orientation to ear, nose and throat medicine, to fit the one-month block committed by the local family practice residency training program. The program is described and its…

Designing and implementing a resiliency program for family medicine residents.

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Brennan, Julie; McGrady, Angele

2015-01-01

Family medicine residents are at risk for burnout due to extended work hours, lack of control over their work schedule, and challenging work situations and environments. Building resiliency can prevent burnout and may improve a resident's quality of life and health behavior. This report describes a program designed to build resiliency, the ability to bounce back from stress, in family medicine residents in a medium sized U.S. residency training program. Interactive sessions emphasized building self-awareness, coping skills, strengths and meaning in work, time management, self-care, and connections in and outside of medicine to support resident well-being. System changes which fostered wellness were also implemented. These changes included increasing the availability of fresh fruits in the conference and call room, purchasing an elliptical exercise machine for the on call room, and offering a few minutes of mindfulness meditation daily to the inpatient residents. Results to date show excellent acceptance of the program by trainees, increased consumption of nutritious foods, more personal exercise, and self-reported decreased overreactions to stress. Resiliency programs can effectively serve to meet accreditation requirements while fostering residents' abilities to balance personal and professional demands. © The Author(s) 2015.

Psychiatry Training in Canadian Family Medicine Residency Programs

OpenAIRE

Kates, Nick; Toews, John; Leichner, Pierre

1985-01-01

Family physicians may spend up to 50% of their time diagnosing and managing mental disorders and emotional problems, but this is not always reflected in the training they receive. This study of the teaching of psychiatry in the 16 family medicine residency programs in Canada showed that although the majority of program directors are reasonably satisfied with the current training, they see room for improvement—particularly in finding psychiatrists with a better understanding of family practice...

Four years of training in family medicine: implications for residency redesign.

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Sigmon, J Lewis; McPherson, Vanessa; Little, John M

2012-09-01

In light of the ongoing consideration for extending the length of residency education in family medicine in the United States, this paper reports the findings from a retrospective, qualitative study of six family physicians that elected to extend their residency training from 3 to 4 years. Each participant completed a written questionnaire and a structured personal interview focusing on various aspects of career development resulting from the additional year of training. The authors independently evaluated these interviews to identify major themes. All the participants were found to have been involved in teaching medicine, valued a more flexible and expanded curriculum, and appreciated their individualized curricula-based on their respective career interests. Given the opportunity, each would opt again for a fourth year of training. There were mixed opinions as to whether the fourth year should be required of all family medicine residents. Other perceived benefits reported were: a better opportunity to find a personally satisfactory practice, additional time for gaining clarity about career plans, and a higher beginning salary as a result of the additional skills and experiences gained. This study of mid-career physicians supports that a fourth-year (PGY4) curriculum in family medicine may enhance subsequent career satisfaction. Further studies of residents in other PGY4 training programs are necessary to assess outcomes comparing our findings as well as guide the discipline's leaders in residency redesign.

Occupational Therapy in Multidisciplinary Residency in Family and Community Health

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Luzianne Feijó Alexandre Paiva

2013-12-01

Full Text Available In this study, we report the experiences of occupational therapist during the Multidisciplinary Residency Program in Family and Community Health in Fortaleza, Ceará state, Brazil. With the creation of the Support Center for Family Health – NASF, occupational therapists began to participate more effectively in the Family Health Strategy of the Brazilian National Health System. Given this rocess, the category, which historically has trained its professionals following the biomedical model, is faced with the challenge to build a new field of knowledge. Objective: To analyze the inclusion of occupational therapy in the Family Health Strategy within the scope of Multidisciplinary Residency. Methodology: This is a descriptive study of qualitative approach, which was based on the experience of four occupational therapy resident students, performed through the documental analysis of field diaries, scientific papers, and case studies produced between 2009 and 2011. Results: The occupational therapists as well as the other NASF professionals operated the logic of Matrix Support to the Family Health teams, sharing their knowledge and assisting in resolving complex cases of the families, groups, and communities served. In this context, we found people with different relationships with their doings and a reduced repertoire of activities. The occupational therapists invested in the creation or consolidation of groups in the Family Health Centers and in the territory, which also stood as living and socializing spaces, focusing on prevention and health promotion.

EKG analysis skills of family practice residents in the United Arab Emirates: a comparison with US data.

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Margolis, S; Reed, R

2001-06-01

Concern has been raised about the electrocardiogram (EKG) analysis skills of family practice residents in the United States. This study examined EKG analysis skills of family practice residents, medical students, interns, and general practitioners (GPs) in the United Arab Emirates (UAE), a different environment. The measurement instrument was a set of 10 EKGs, used in a study of US family practice residents. Two of the EKGs were normal, and there were 14 clinical abnormalities in the remainder. There was no significant difference in the correct diagnosis of acute myocardial infarction between US family practice residents and UAE family practice residents, medical students, or GPs. Interns' diagnoses were significantly poorer. The mean score for correctly identifying acute myocardial infarction and both normal EKGs was not significantly different between groups: 2.50 medical students, 2.35 interns, 2.58 UAE family practice residents, 2.67 FD, and 2.55 US family practice residents. However, the US family practice resident mean score of 11.26 for all 16 clinical findings was significantly higher than any group in the UAE: 5.35 medical students, 5.87 interns, 6.08 UAE family practice residents, 5.69 family physicians. Difficulty in EKG interpretation transcends geographic boundaries, suggesting that new approaches to teaching these skills need to be explored. Improved EKG reading skills by family physicians are generally needed in both the United States and the UAE.

Cultural transition of international medical graduate residents into family practice in Canada.

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Triscott, Jean A C; Szafran, Olga; Waugh, Earle H; Torti, Jacqueline M I; Barton, Martina

2016-05-04

To identify the perceived strengths that international medical graduate (IMG) family medicine residents possess and the challenges they are perceived to encounter in integrating into Canadian family practice. This was a qualitative, exploratory study employing focus groups and interviews with 27 participants - 10 family physicians, 13 health care professionals, and 4 family medicine residents. Focus group/interview questions addressed the strengths that IMGs possess and the challenges they face in becoming culturally competent within the Canadian medico-cultural context. Qualitative data were audiotaped, transcribed, and analyzed thematically. Participants identified that IMG residents brought multiple strengths to Canadian practice including strong clinical knowledge and experience, high education level, the richness of varied cultural perspectives, and positive personal strengths. At the same time, IMG residents appeared to experience challenges in the areas of: (1) communication skills (language nuances, unfamiliar accents, speech volume/tone, eye contact, directness of communication); (2) clinical practice (uncommon diagnoses, lack of familiarity with care of the opposite sex and mental health conditions); (3) learning challenges (limited knowledge of Canada's health care system, patient-centered care and ethical principles, unfamiliarity with self-directed learning, unease with receiving feedback); (4) cultural differences (gender roles, gender equality, personal space, boundary issues; and (5) personal struggles. Residency programs must recognize the challenges that can occur during the cultural transition to Canadian family practice and incorporate medico-cultural education into the curriculum. IMG residents also need to be aware of cultural differences and be open to different perspectives and new learning.

A comparison of surgery and family medicine residents' perceptions of cross-cultural care training.

Science.gov (United States)

Chun, Maria B J; Jackson, David S; Lin, Susan Y; Park, Elyse R

2010-12-01

The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt's Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups' reported impressions of importance and level of instruction received in cross-cultural care. Twenty surgery and 15 family medicine residents participated in the study. Significant differences were found between surgery and family medicine residents on most ratings of the amount of training they received in cross-cultural skills. Specifically, family medicine residents reported having received more training on: 1) determining how patients want to be addressed, 2) taking a social history, 3) assessing their understanding of the cause of illness, 4) negotiating their treatment plan, 5) assessing whether they are mistrustful of the health care system and÷or doctor, 6) identifying cultural customs, 7) identifying how patients make decisions within the family, and 8) delivering services through a medical interpreter. One unexpected finding was that surgery residents, who reported not receiving much formal cultural training, reported higher mean scores on perceived skillfulness (i.e. ability) than family medicine residents. The disconnect may be linked to the family medicine residents' training in cultural humility - more knowledge and understanding of cross-cultural care can paradoxically lead to perceptions of being less prepared or skillful in this area. Hawaii Medical Journal Copyright 2010.

Educational contracts in family medicine residency training.

OpenAIRE

Mahood, S.; Rojas, R.; Andres, D.; Zagozeski, C.; White, G.; Bradel, T.

1994-01-01

An educational contract for family medicine residency training and evaluation addresses many of the difficulties and challenges of current postgraduate medical education. This article identifies important principles for developing a contractual approach; describes the contract used in one program and its implementation; and discusses its theory, advantages, and limitations.

Cost of Incremental Expansion of an Existing Family Medicine Residency Program.

Science.gov (United States)

Ashkin, Evan A; Newton, Warren P; Toomey, Brian; Lingley, Ronald; Page, Cristen P

2017-07-01

Expanding residency training programs to address shortages in the primary care workforce is challenged by the present graduate medical education (GME) environment. The Medicare funding cap on new GME positions and reductions in the Health Resources and Services Administration (HRSA) Teaching Health Center (THC) GME program require innovative solutions to support primary care residency expansion. Sparse literature exists to assist in predicting the actual cost of incremental expansion of a family medicine residency program without federal or state GME support. In 2011 a collaboration to develop a community health center (CHC) academic medical partnership (CHAMP), was formed and created a THC as a training site for expansion of an existing family medicine residency program. The cost of expansion was a critical factor as no Federal GME funding or HRSA THC GME program support was available. Initial start-up costs were supported by a federal grant and local foundations. Careful financial analysis of the expansion has provided actual costs per resident of the incremental expansion of the residencyRESULTS: The CHAMP created a new THC and expanded the residency from eight to ten residents per year. The cost of expansion was approximately $72,000 per resident per year. The cost of incremental expansion of our residency program in the CHAMP model was more than 50% less than that of the recently reported cost of training in the HRSA THC GME program.

Socializing Identity Through Practice: A Mixed Methods Approach to Family Medicine Resident Perspectives on Uncertainty.

Science.gov (United States)

Ledford, Christy J W; Cafferty, Lauren A; Seehusen, Dean A

2015-01-01

Uncertainty is a central theme in the practice of medicine and particularly primary care. This study explored how family medicine resident physicians react to uncertainty in their practice. This study incorporated a two-phase mixed methods approach, including semi-structured personal interviews (n=21) and longitudinal self-report surveys (n=21) with family medicine residents. Qualitative analysis showed that though residents described uncertainty as an implicit part of their identity, they still developed tactics to minimize or manage uncertainty in their practice. Residents described increasing comfort with uncertainty the longer they practiced and anticipated that growth continuing throughout their careers. Quantitative surveys showed that reactions to uncertainty were more positive over time; however, the difference was not statistically significant. Qualitative and quantitative results show that as family medicine residents practice medicine their perception of uncertainty changes. To reduce uncertainty, residents use relational information-seeking strategies. From a broader view of practice, residents describe uncertainty neutrally, asserting that uncertainty is simply part of the practice of family medicine.

Does clinical exposure matter? Pilot assessment of patient visits in an urban family medicine residency program.

Science.gov (United States)

Iglar, Karl; Murdoch, Stuart; Meaney, Christopher; Krueger, Paul

2018-01-01

To determine the number of patient visits, patient demographic information, and diagnoses in an urban ambulatory care setting in a family medicine residency program, and assess the correlation between the number of patient visits and residents' in-training examination (ITE) scores. Retrospective analysis of data from resident practice profiles, electronic medical records, and residents' final ITE scores. Family medicine teaching unit in a community hospital in Barrie, Ont. Practice profile data were from family medicine residents enrolled in the program from July 1, 2013, to June 30, 2014, and electronic medical record and ITE data were from those enrolled in the program from July 1, 2010, to June 30, 2015. Number of patient visits, patient characteristics (eg, sex, age), priority topics addressed in clinic, resident characteristics (eg, age, sex, level of residency), and residents' final ITE scores. Between July 1, 2013, and June 30, 2014, there were 11 115 patient visits. First-year residents had a mean of 5.48 patient visits per clinic, and second-year residents had a mean of 5.98 patient visits per clinic. A Pearson correlation coefficient of 0.68 was found to exist between the number of patients seen and the final ITE scores, with a 10.5% difference in mean score between residents who had 1251 or more visits and those who had 1150 or fewer visits. Three diagnoses (ie, epistaxis, meningitis, and neck pain) deemed important for Certification by the College of Family Physicians of Canada were not seen by any of the residents in clinic. There is a moderate correlation between the number of patients seen by residents in ambulatory care and ITE scores in family medicine. It is important to assess patients' demographic information and diagnoses made in resident practices to ensure an adequate clinical experience. Copyright© the College of Family Physicians of Canada.

Finding the Perfect Match: Factors That Influence Family Medicine Residency Selection.

Science.gov (United States)

Wright, Katherine M; Ryan, Elizabeth R; Gatta, John L; Anderson, Lauren; Clements, Deborah S

2016-04-01

Residency program selection is a significant experience for emerging physicians, yet there is limited information about how applicants narrow their list of potential programs. This study examines factors that influence residency program selection among medical students interested in family medicine at the time of application. Medical students with an expressed interest in family medicine were invited to participate in a 37-item, online survey. Students were asked to rate factors that may impact residency selection on a 6-point Likert scale in addition to three open-ended qualitative questions. Mean values were calculated for each survey item and were used to determine a rank order for selection criteria. Logistic regression analysis was performed to identify factors that predict a strong interest in urban, suburban, and rural residency programs. Logistic regression was also used to identify factors that predict a strong interest in academic health center-based residencies, community-based residencies, and community-based residencies with an academic affiliation. A total of 705 medical students from 32 states across the country completed the survey. Location, work/life balance, and program structure (curriculum, schedule) were rated the most important factors for residency selection. Logistic regression analysis was used to refine our understanding of how each factor relates to specific types of residencies. These findings have implications for how to best advise students in selecting a residency, as well as marketing residencies to the right candidates. Refining the recruitment process will ensure a better fit between applicants and potential programs. Limited recruitment resources may be better utilized by focusing on targeted dissemination strategies.

Psychiatry training in canadian family medicine residency programs.

Science.gov (United States)

Kates, N; Toews, J; Leichner, P

1985-01-01

Family physicians may spend up to 50% of their time diagnosing and managing mental disorders and emotional problems, but this is not always reflected in the training they receive. This study of the teaching of psychiatry in the 16 family medicine residency programs in Canada showed that although the majority of program directors are reasonably satisfied with the current training, they see room for improvement-particularly in finding psychiatrists with a better understanding of family practice, in integrating the teaching to a greater degree with clinical work, thereby increasing its relevance, and in utilizing more suitable clinical settings.

Leadership training in a family medicine residency program: Cross-sectional quantitative survey to inform curriculum development.

Science.gov (United States)

Gallagher, Erin; Moore, Ainsley; Schabort, Inge

2017-03-01

To assess the current status of leadership training as perceived by family medicine residents to inform the development of a formal leadership curriculum. Cross-sectional quantitative survey. Department of Family Medicine at McMaster University in Hamilton, Ont, in December 2013. A total of 152 first- and second-year family medicine residents. Family medicine residents' attitudes toward leadership, perceived level of training in various leadership domains, and identified opportunities for leadership training. Overall, 80% (152 of 190) of residents completed the survey. On a Likert scale (1 = strongly disagree, 4 = neutral, 7 = strongly agree), residents rated the importance of physician leadership in the clinical setting as high (6.23 of 7), whereas agreement with the statement "I am a leader" received the lowest rating (5.28 of 7). At least 50% of residents desired more training in the leadership domains of personal mastery, mentorship and coaching, conflict resolution, teaching, effective teamwork, administration, ideals of a healthy workplace, coalitions, and system transformation. At least 50% of residents identified behavioural sciences seminars, a lecture and workshop series, and a retreat as opportunities to expand leadership training. The concept of family physicians as leaders resonated highly with residents. Residents desired more personal and system-level leadership training. They also identified ways that leadership training could be expanded in the current curriculum and developed in other areas. The information gained from this survey might facilitate leadership development among residents through application of its results in a formal leadership curriculum. Copyright© the College of Family Physicians of Canada.

Home Care Services as Teaching Sites for Geriatrics in Family Medicine Residencies.

Science.gov (United States)

Laguillo, Edgardo

1988-01-01

A national survey of family medicine programs and residency training in geriatrics found almost half using home care services as teaching sites. In the program design preferred by residents, the resident followed the patient long-term and discussed management with a multidisciplinary team. An alternative combined rotation is discussed. (Author/MSE)

The Cost of Family Medicine Residency Training: Impacts of Federal and State Funding.

Science.gov (United States)

Pauwels, Judith; Weidner, Amanda

2018-02-01

Numerous organizations are calling for the expansion of graduate medical education (GME) positions nationally. Developing new residency programs and expanding existing programs can only happen if financial resources are available to pay for the expenses of training beyond what can be generated in direct clinical income by the residents and faculty in the program. The goal of this study was to evaluate trended data regarding the finances of family medicine residency programs to identify what financial resources are needed to sustain graduate medical education programs. A group of family medicine residency programs have shared their financial data since 2002 through a biennial survey of program revenues, expenses, and staffing. Data sets over 12 years were collected and analyzed, and results compared to analyze trends. Overall expenses increased 70.4% during this period. Centers for Medicare and Medicaid Services (CMS) GME revenue per resident increased by 15.7% for those programs receiving these monies. Overall, total revenue per resident, including clinical revenues, state funding, and any other revenue stream, increased 44.5% from 2006 to 2016. The median cost per resident among these programs, excluding federal GME funds, is currently $179,353; this amount has increased over the 12 years by 93.7%. For this study group of family medicine programs, data suggests a cost per resident per year, excluding federal and state GME funding streams, of about $180,000. This excess expense compared to revenue must be met by other agencies, whether from CMS, the Health Resources and Services Administration (HRSA), state expenditures or other sources, through stable long-term commitments to these funding mechanisms to ensure program viability for these essential family medicine programs in the future.

Toward shared decision making: using the OPTION scale to analyze resident-patient consultations in family medicine

NARCIS (Netherlands)

Pellerin, M.A.; Elwyn, G.; Rousseau, M.; Stacey, D.; Robitaille, H.; Legare, F.

2011-01-01

PURPOSE: Do residents in family medicine practice share decision making with patients during consultations? This study used a validated scale to score family medicine residents' shared decision-making (SDM) skills in primary care consultations and to determine whether residents' demographic

Reintegrating Family Therapy Training in Psychiatric Residency Programs: Making the Case

Science.gov (United States)

Rait, Douglas; Glick, Ira

2008-01-01

Objective: Given the marginalization of couples and family therapy in psychiatric residency programs over the past two decades, the authors propose a rationale for the reintegration of these important psychosocial treatments into the mainstream of general psychiatric residency education. Methods: After reviewing recent trends in the field that…

Competency Assessment in Family Medicine Residency: Observations, Knowledge-Based Examinations, and Advancement.

Science.gov (United States)

Mainous, Arch G; Fang, Bo; Peterson, Lars E

2017-12-01

The Family Medicine (FM) Milestones are competency-based assessments of residents in key dimensions relevant to practice in the specialty. Residency programs use the milestones in semiannual reviews of resident performance from the time of entry into the program to graduation. Using a national sample, we investigated the relationship of FM competency-based assessments to resident progress and the complementarity of milestones with knowledge-based assessments in FM residencies. We used midyear and end-of-year milestone ratings for all FM residents in Accreditation Council for Graduate Medical Education-accredited programs during academic years 2014-2015 and 2015-2016. The milestones contain 22 items across 6 competencies. We created a summative index across the milestones. The American Board of Family Medicine database provided resident demographics and in-training examination (ITE) scores. We linked information to the milestone data. The sample encompassed 6630 FM residents. The summative milestone index increased, on average, for each cohort (postgraduate year 1 [PGY-1] to PGY-2 and PGY-2 to PGY-3) at each assessment. The correlation between the milestone index that excluded the medical knowledge milestone and ITE scores was r  = .195 ( P  ITE scores and composite milestone assessments were higher for residents who advanced than for those who did not. Competency-based assessment using the milestones for FM residents seems to be a viable multidimensional tool to assess the successful progression of residents.

Conflict between nursing home staff and residents' families: does it increase burnout?

Science.gov (United States)

Abrahamson, Kathleen; Jill Suitor, J; Pillemer, Karl

2009-09-01

In this study, the authors examine the influence of conflict between nursing home staff and family members of residents on staff burnout. Data were collected from interviews with a representative sample of 655 nursing home nurses and nursing assistants. Hypotheses were tested using structural equation modeling. Results indicate that conflict with family members increases staff burnout and decreases staff satisfaction. Staff and family conflict increases when staff members feel they do not have enough time to complete required tasks. Level of conflict decreases when staff perceive that family members have care expectations that are similar to their own. Interestingly, staff who have personal experience as family caregivers are more likely to report conflict with family members of residents, a result that necessitates further study. Staff burnout and dissatisfaction affects both individuals and organizations. Policy that addresses staff and family interaction can have an important place in the design and delivery of long-term care.

Use of computers and the Internet by residents in US family medicine programmes.

Science.gov (United States)

King, Richard V; Murphy-Cullen, Cassie L; Mayo, Helen G; Marcee, Alice K; Schneider, Gregory W

2007-06-01

Computers, personal digital assistants (PDA), and the Internet are widely used as resources in medical education and clinical care. Educators who intend to incorporate these resources effectively into residency education programmes can benefit from understanding how residents currently use these tools, their skills, and their preferences. The researchers sent questionnaires to 306 US family medicine residency programmes for all of their residents to complete. Respondents were 1177 residents from 125 (41%) programmes. Access to a computer was reported by 95% of respondents. Of these, 97% of desktop and 89% of laptop computers could access the Internet. Residents accessed various educational and clinical resources. Half felt they had 'intermediate' skills at Web searches, 23% had 'some skills,' and 27% were 'quite skilled.' Those under 30 years of age reported higher skill levels. Those who experienced a Web-based curriculum in medical school reported higher search skills and greater success in finding clinical information. Respondents preferred to use technology to supplement the didactic sessions offered in resident teaching conferences. Favourable conditions exist in family medicine residency programmes to implement a blend of traditional and technology-based learning experiences. These conditions include residents' experience, skills, and preferences.

Constructing the meaning of quality of life for residents in care homes in the Lebanon: perspectives of residents, staff and family.

Science.gov (United States)

Adra, Marina Gharibian; Hopton, John; Keady, John

2015-12-01

Located in two care homes in Lebanon, the study explores the perspectives of quality of life for a sample of older residents, care staff and family caregivers. Quality of life for older people living in care homes is traditionally reported in the literature as a Westernised construct and so far little is known about its meanings from an Arabic cultural perspective and context. There is also a knowledge gap about the conditions of older people living in care homes in Lebanon. The study was a qualitative exploration of perspectives of quality of life of older residents, care staff and family caregivers. Two care homes for older people situated in Beirut took part in the study. Between 2010 and 2011 semi-structured interviews were undertaken with a sample of 20 residents, eight family caregivers and 11 care staff. Data were analysed using the constant comparative method. Four categories emerged from this analytical process: (i) maintaining family connectedness; (ii) engaging in worthwhile activities; (iii) maintaining and developing significant relationships; and (iv) holding and practicing spiritual beliefs. The emergence of these categories confirmed the complex, interrelated and multidimensional nature of quality of life for residents and other stakeholders. The findings supplement an emerging body of knowledge about the composition of quality of life for older residents in Lebanon. Improving the quality of life of older residents will require action in respect of all of the domains identified in study. Moving nursing practice from task-based care to relationship-centred approaches was seen as pivotal in helping to develop quality of life for residents living in the participating care homes. The findings have implications for education, nursing practice and research in Lebanon and help start an evidence base for care. © 2015 John Wiley & Sons Ltd.

Meeting the Needs of Single-Parent Families.

Science.gov (United States)

Olson, Myrna R.; Haynes, Judith A.

1992-01-01

Schools can better meet the needs of single-parent families in the following ways: (1) acknowledge the diversity of single-parent families; (2) avoid assumptions about single-parent families; (3) provide educators with information about differing family structures; and (4) facilitate the connection between single parents and schools. (11…

NON-MUSCULOSKELETAL SPORTS MEDICINE LEARNING IN FAMILY MEDICINE RESIDENCY PROGRAMS

Directory of Open Access Journals (Sweden)

Pasqualino Caputo

2008-06-01

, descriptive statistics such as the means, standard deviations, and reliabilities of the scales were not equal across years. Therefore, we analyzed data separately by year, and then combined the results across years using meta-analysis. We first discuss the logic of analyzing the data for a single year, and then present the logic of combining the analyses.We expected that the residents in programs with sports medicine fellowships would show superior performance on the non-musculoskeletal sports medicine items. However, because assignment to fellowship was not random, we wanted to control for any possible differences in general family medicine knowledge that might exist between those residents who did and did not have a sports medicine fellowship at their residency program. Therefore, we treated scores on the family medicine scale as a covariate. We computed analysis of covariance (fellowship being a categorical independent variable with non-musculoskeletal sports medicine items as the dependent variable. The results allow for a statistical test of the effect of sports medicine fellowship while holding general family medicine knowledge constant. In other words, we applied a statistical control for self-selection into groups. We present results both with and without statistical control (i.e., both with and without the covariate because statistical control in the absence of random assignment to treatment, results in a very conservative test of the treatment effect when the treatment and covariate are correlated.To combine the studies, we used the method recommended by Hedges and colleagues (Hedges and Olkin, 1985; Hedges and Vevea, 1998. For each year, we first transformed the raw data to standardized scores by subtracting the variable's mean and dividing by the variable's standard deviation, so that all transformed variables had a mean of zero and a standard deviation of one. We then computed the analysis of covariance for each year and found the standardized regression weight

Learning behaviour and preferences of family medicine residents under a flexible academic curriculum.

Science.gov (United States)

Sy, Alice; Wong, Eric; Boisvert, Leslie

2014-11-01

To determine family medicine residents' learning behaviour and preferences outside of clinical settings in order to help guide the development of an effective academic program that can maximize their learning. Retrospective descriptive analysis of academic learning logs submitted by residents as part of their academic training requirements between 2008 and 2011. London, Ont. All family medicine residents at Western University who had completed their academic program requirements (N = 72) by submitting 300 or more credits (1 credit = 1 hour). Amount of time spent on various learning modalities, location where the learning took place, resources used for self-study, and the objective of the learning activity. A total of 72 residents completed their academic requirements during the study period and logged a total of 25 068 hours of academic learning. Residents chose to spend most of their academic time engaging in self-study (44%), attending staff physicians' teaching sessions (20%),and participating in conferences, courses, or workshops (12%) and in postgraduate medical education sessions (12%). Textbooks (26%), medical journals (20%), and point-of-care resources (12%) were the 3 most common resources used for self-study. The hospital (32%), residents' homes (32%),and family medicine clinics (14%) were the most frequently cited locations where academic learning occurred. While all physicians used a variety of educational activities, most residents (67%) chose self-study as their primary method of learning. The topic for academic learning appeared to have some influence on the learning modalities used by residents. Residents used a variety of learning modalities and chose self-study over other more traditional modalities (eg, lectures) for most of their academic learning. A successful academic program must take into account residents' various learning preferences and habits while providing guidance and training in the use of more effective learning methods and

Impact of a family medicine resident wellness curriculum: a feasibility study.

Science.gov (United States)

Runyan, Christine; Savageau, Judith A; Potts, Stacy; Weinreb, Linda

2016-01-01

Up to 60% of practicing physicians report symptoms of burnout, which often peak during residency. Residency is also a relevant time for habits of self-care and resiliency to be emphasized. A growing literature underscores the importance of this; however, evidence about effective burnout prevention curriculum during residency remains limited. The purpose of this project is to evaluate the impact of a new, 1-month wellness curriculum for 12 second-year family medicine residents on burnout, empathy, stress, and self-compassion. The pilot program, introduced during a new rotation emphasizing competencies around leadership, focused on teaching skills to cultivate mindfulness and self-compassion in order to enhance empathy and reduce stress. Pre-assessments and 3-month follow-up assessments on measures of burnout, empathy, self-compassion, and perceived stress were collected to evaluate the impact of the curriculum. It was hypothesized that this curriculum would enhance empathy and self-compassion as well as reduce stress and burnout among family medicine residents. Descriptive statistics revealed positive trends on the mean scores of all the measures, particularly the Mindfulness Scale of the Self-Compassion Inventory and the Jefferson Empathy Scale. However, the small sample size and lack of sufficient power to detect meaningful differences limited the use of inferential statistics. This feasibility study demonstrates how a residency wellness curriculum can be developed, implemented, and evaluated with promising results, including high participant satisfaction.

Diabetes Mellitus Coding Training for Family Practice Residents.

Science.gov (United States)

Urse, Geraldine N

2015-07-01

Although physicians regularly use numeric coding systems such as the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to describe patient encounters, coding errors are common. One of the most complicated diagnoses to code is diabetes mellitus. The ICD-9-CM currently has 39 separate codes for diabetes mellitus; this number will be expanded to more than 50 with the introduction of ICD-10-CM in October 2015. To assess the effect of a 1-hour focused presentation on ICD-9-CM codes on diabetes mellitus coding. A 1-hour focused lecture on the correct use of diabetes mellitus codes for patient visits was presented to family practice residents at Doctors Hospital Family Practice in Columbus, Ohio. To assess resident knowledge of the topic, a pretest and posttest were given to residents before and after the lecture, respectively. Medical records of all patients with diabetes mellitus who were cared for at the hospital 6 weeks before and 6 weeks after the lecture were reviewed and compared for the use of diabetes mellitus ICD-9 codes. Eighteen residents attended the lecture and completed the pretest and posttest. The mean (SD) percentage of correct answers was 72.8% (17.1%) for the pretest and 84.4% (14.6%) for the posttest, for an improvement of 11.6 percentage points (P≤.035). The percentage of total available codes used did not substantially change from before to after the lecture, but the use of the generic ICD-9-CM code for diabetes mellitus type II controlled (250.00) declined (58 of 176 [33%] to 102 of 393 [26%]) and the use of other codes increased, indicating a greater variety in codes used after the focused lecture. After a focused lecture on diabetes mellitus coding, resident coding knowledge improved. Review of medical record data did not reveal an overall change in the number of diabetic codes used after the lecture but did reveal a greater variety in the codes used.

Awareness of dementia by family carers of nursing home residents dying with dementia: a post-death study.

Science.gov (United States)

Penders, Yolanda W H; Albers, Gwenda; Deliens, Luc; Vander Stichele, Robert; Van den Block, Lieve

2015-01-01

High-quality palliative care for people with dementia should be patient-centered, family-focused, and include well-informed and shared decision-making, as affirmed in a recent white paper on dementia from the European Association for Palliative Care. To describe how often family carers of nursing home residents who died with dementia are aware that their relative has dementia, and study resident, family carer, and care characteristics associated with awareness. Post-death study using random cluster sampling. Structured questionnaires were completed by family carers, nursing staff, and general practitioners of deceased nursing home residents with dementia in Flanders, Belgium (2010). Of 190 residents who died with dementia, 53.2% of family carers responded. In 28% of cases, family carers indicated they were unaware their relative had dementia. Awareness by family carers was related to more advanced stages of dementia 1 month before death (odds ratio = 5.4), with 48% of family carers being unaware when dementia was mild and 20% unaware when dementia was advanced. The longer the onset of dementia after admission to a nursing home, the less likely family carers were aware (odds ratio = 0.94). Family carers are often unaware that their relative has dementia, that is, in one-fourth of cases of dementia and one-fifth of advanced dementia, posing considerable challenges for optimal care provision and end-of-life decision-making. Considering that family carers of residents who develop dementia later after admission to a nursing home are less likely to be aware, there is room for improving communication strategies toward family carers of nursing home residents. © The Author(s) 2014.

Training on the clock: family medicine residency directors' responses to resident duty hours reform.

Science.gov (United States)

Peterson, Lars E; Johnson, Hillary; Pugno, Perry A; Bazemore, Andrew; Phillips, Robert L

2006-12-01

The Accreditation Council for Graduate Medical Education's 2003 restrictions on resident duty hours (RDH) raised concerns among educators about potential negative impacts on residents' training. In the early wake of these restrictions, little is known about how RDH reform impacts training in primary care. The authors surveyed family medicine (FM) residency program directors (PDs) for their perceptions of the impact of RDH regulations on training in primary care. All PDs of 472 FM residency programs were asked via list-serve to complete an anonymous Internet-based survey in the fall of 2004. The survey solicited PDs' opinions about changes in staff and in residents' training experiences with respect to implementation of RDH regulations. Descriptive and qualitative analyses were conducted. There were 369 partial and 328 complete responses, for a response rate of 69% (328/472). Effects of the RDH regulations are varied. Fifty percent of FMPDs report increased patient-care duties for attendings, whereas 42% report no increase. Nearly 80% of programs hired no additional staff. Sixty percent of programs eliminated postcall clinics, and nearly 40% implemented a night-float system. Administrative hassles and losses of professionalism, educational opportunity, and continuity of care were common concerns, but a sizeable minority feel that residents will be better off under the new regulations. Many FMPDs cited increased faculty burden and the risk of lower-quality educational experiences for their trainees. Innovations for increasing the effectiveness of teaching may ultimately compensate for lost educational time. If not, alternatives such as extending the length of residency must be considered.

Aspects of indignity in nursing home residences as experienced by family caregivers

DEFF Research Database (Denmark)

Nåden, Dagfinn; Høy, Bente; Lohne, Vibeke

2013-01-01

or deprived from the perspective of family caregivers? In this article, we focus only on indignity in care. This study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods in this part of this study consisted of individual research interviews. Altogether......, the sample consisted of 28 family caregivers of nursing home residents. The empirical material was interpreted using a hermeneutical approach. The overall theme that emerged was as follows: 'A feeling of being abandoned'. The sub-themes are designated as follows: deprived of the feeling of belonging...

Smart Growth and the Challenge of Nimby: Multifamily Dwellings and their Association with Single-Family House Selling Prices in Tallahasse, Florida, USA

Directory of Open Access Journals (Sweden)

Huston GIBSON

2013-06-01

Full Text Available Citizens protest development when they consider it undesirable. One type of development commonly perceived as undesirable by single-family home owners is proximate multifamily housing, often considered a cause of property devaluation. This study assesses multifamily housing, by typology, and its monetary association with proximate single-family housing prices. The research design is a cross-sectional study using multivariate regression. The unit of analysis is the detached single-family dwelling. The study population is a sample taken from all arms-length owner-occupied, primary residence, detached single-family property transactions recorded in Tallahassee-Leon County, Florida, USA, during 2008. The key findings show no statistically significant negative associations between multifamily housing and single-family property selling prices in the sample; in fact, the two were positively correlated. These findings address single-family homeowner concerns about proximate multifamily housing and should bolster the political feasibility of Smart Growth policy, which recommends denser urban infill.

Family residency and psychosomatic problems among adolescents in Sweden: The impact of child-parent relations.

Science.gov (United States)

Hagquist, Curt

2016-02-01

Profound changes in family structure took place in many countries, during the second part of the previous century. The purpose of this paper is to analyse the association between the type of family residency and psychosomatic problems in younger and older adolescents, particularly focusing on alternate residency, and to examine the impact of child-parent relations. We used data collected in 2009 by Statistics Sweden among 172,298 Swedish students in Grade 6 and Grade 9 (approximate ages 12 and 15 years old); comprising 80% and 86%, respectively, of the entire population of students in those grades. We collected the data with a questionnaire, completed anonymously in school: We used the Psychosomatic Problems (PSP) scale as the outcome measure. The type of family residency showed a weaker association with psychosomatic problems than the child-parent relationships did. Living in non-intact families increased the probability of adolescent psychosomatic problems by 0-0.05, compared to intact families. In Grade 9, there were no differences in psychosomatic problems between the students in alternate residency and those living with their two parents; and in Grade 6, these differences were relatively small. In comparison, a worse relationship with parents increased the probability of psychosomatic problems by 0.11-0.17, depending on the school grade and type of family residency. The structure of the family, as well as the child-parent relationships needs to be taken into account, to properly estimate the magnitude of the family situation as a determinant of adolescent psychosomatic problems. Our results justify universal intervention at the policy level. © 2015 the Nordic Societies of Public Health.

Impact of a family medicine resident wellness curriculum: a feasibility study

Directory of Open Access Journals (Sweden)

Christine Runyan

2016-06-01

Full Text Available Background: Up to 60% of practicing physicians report symptoms of burnout, which often peak during residency. Residency is also a relevant time for habits of self-care and resiliency to be emphasized. A growing literature underscores the importance of this; however, evidence about effective burnout prevention curriculum during residency remains limited. Objectives: The purpose of this project is to evaluate the impact of a new, 1-month wellness curriculum for 12 second-year family medicine residents on burnout, empathy, stress, and self-compassion. Methods: The pilot program, introduced during a new rotation emphasizing competencies around leadership, focused on teaching skills to cultivate mindfulness and self-compassion in order to enhance empathy and reduce stress. Pre-assessments and 3-month follow-up assessments on measures of burnout, empathy, self-compassion, and perceived stress were collected to evaluate the impact of the curriculum. It was hypothesized that this curriculum would enhance empathy and self-compassion as well as reduce stress and burnout among family medicine residents. Results: Descriptive statistics revealed positive trends on the mean scores of all the measures, particularly the Mindfulness Scale of the Self-Compassion Inventory and the Jefferson Empathy Scale. However, the small sample size and lack of sufficient power to detect meaningful differences limited the use of inferential statistics. Conclusions: This feasibility study demonstrates how a residency wellness curriculum can be developed, implemented, and evaluated with promising results, including high participant satisfaction.

Family Support in Nursing Homes Serving Residents with a Mental Health History

Science.gov (United States)

Frahm, Kathryn; Gammonley, Denise; Zhang, Ning Jackie; Paek, Seung Chun

2010-01-01

Using 2003 nursing home data from the Minimum Data Set (MDS) database, this study investigated the role of family support among nursing homes serving residents with a mental health history. Exploratory factor analysis was used to create and test a conceptual model of family support using indicators located within the MDS database. Families were…

Interior design preferences of residents, families, and staff in two nursing homes.

Science.gov (United States)

Miller, D B; Goldman, L E; Woodman, S A

1985-01-01

The small number of respondents and the absence of specific demographic data concerning the three categories of respondents represented definite limitations. Further investigation in other long-term care facilities clearly is indicated. However, as a preliminary survey of preferences in nursing home interior design, several interesting findings have emerged: Patients, staff and families all emphasized patient safety and function over aesthetics. Yet, more residents than staff and families were concerned with appearance. Although experts advocate creating a home-like atmosphere in the nursing home, 50% or more of each group applied different criteria for specific design elements for private homes and for long-term care institutions. Design preferences for the three groups were similar, with an emphasis on modern furniture, painted walls, resilient tile rather than carpet, blinds, pastel and warm colors, and the use of paintings as accessories. Contrary to study assumptions, design features that promote patient individuality (e.g., patient artwork) received much greater emphasis from staff than from patients and families. Environmental change was considered an important aspect of interior design. Of the three constituencies, staff was most aware of periodic changes in decor and considered change as "very important" more often than did families or patients. As the nature of the nursing home patient population has changed--with residents presenting more disability and less rehabilitation potential and less likelihood of returning home--the ambiance of facilities has assumed even more importance. Clearly, the design preferences of residents who live in the facility are of paramount importance. However, it is also helpful to have an environment that is pleasing to family members who often experience difficulty in ongoing visitations, particularly to intellectually impaired relatives. Maintaining staff morale at a high level is a constant challenge in a long-term care

Solar energy heating system design package for a single-family residence at New Castle, Pennsylvania

Energy Technology Data Exchange (ETDEWEB)

1977-08-01

The design of a solar heating and hot water system for the New Castle Redevelopment Authority's single-family dwelling located at New Castle, Pennsylvania is described. Documentation submitted by the contractor for Government review of plans, specifications, cost trade studies and verification status for approval to commit the system to fabrication is presented. Also included are system integration drawings, major subsystems drawings, and architect's specifications and plans.

An Update of Oral Health Curricula in US Family Medicine Residency Programs.

Science.gov (United States)

Silk, Hugh; Savageau, Judith A; Sullivan, Kate; Sawosik, Gail; Wang, Min

2018-06-01

National initiatives have encouraged oral health training for family physicians and other nondental providers for almost 2 decades. Our national survey assesses progress of family medicine residency programs on this important health topic since our last survey in 2011. Family medicine residency program directors (PDs) completed an online survey covering various themes including number of hours of oral health (OH) teaching, topics covered, barriers, evaluation, positive influences, and program demographics. Compared to 2011, more PDs feel OH should be addressed by physicians (86% in 2017 vs 79% in 2011), yet fewer programs are teaching OH (81% vs 96%) with fewer hours overall (31% vs 45% with 4 or more hours). Satisfaction with the competence of graduating residents in OH significantly decreased (17% in 2017 vs 32% in 2011). Program directors who report graduates being well prepared to answer board questions on oral health topics are more likely to have an oral health champion (P<0.001) and report satisfaction with the graduates' level of oral health competency (P<0.001). Programs with an oral health champion, or having a relationship with a state or national oral health coalition, or having routine teaching from a dental professional are significantly more likely to have more hours of oral health curriculum (P<0.001). Family medicine PDs are more aware of the importance of oral health, yet less oral health is being taught in residency programs. Developing more faculty oral health champions and connecting programs to dental faculty and coalitions may help reduce this educational void.

Single-Parent Families in Rural Communities

Science.gov (United States)

Lewis, Ken

1978-01-01

Presenting national statistics on single-parent families, this article illustrates the need for serious study of this phenomenon, suggesting that changing divorce laws, increased single-parent adoptions, and an increase in the number of supportive services for single-parent families are contingencies having significant bearing upon the…

Teaching-skills training programs for family medicine residents: systematic review of formats, content, and effects of existing programs.

Science.gov (United States)

Lacasse, Miriam; Ratnapalan, Savithiri

2009-09-01

To review the literature on teaching-skills training programs for family medicine residents and to identify formats and content of these programs and their effects. Ovid MEDLINE (1950 to mid-July 2008) and the Education Resources Information Center database (pre-1966 to mid-July 2008) were searched using and combining the MeSH terms teaching, internship and residency, and family practice; and teaching, graduate medical education, and family practice. The initial MEDLINE and Education Resources Information Center database searches identified 362 and 33 references, respectively. Titles and abstracts were reviewed and studies were included if they described the format or content of a teaching-skills program or if they were primary studies of the effects of a teaching-skills program for family medicine residents or family medicine and other specialty trainees. The bibliographies of those articles were reviewed for unidentified studies. A total of 8 articles were identified for systematic review. Selection was limited to articles published in English. Teaching-skills training programs for family medicine residents vary from half-day curricula to a few months of training. Their content includes leadership skills, effective clinical teaching skills, technical teaching skills, as well as feedback and evaluation skills. Evaluations mainly assessed the programs' effects on teaching behaviour, which was generally found to improve following participation in the programs. Evaluations of learner reactions and learning outcomes also suggested that the programs have positive effects. Family medicine residency training programs differ from all other residency training programs in their shorter duration, usually 2 years, and the broader scope of learning within those 2 years. Few studies on teaching-skills training, however, were designed specifically for family medicine residents. Further studies assessing the effects of teaching-skills training in family medicine residents are

Child abuse training and knowledge: a national survey of emergency medicine, family medicine, and pediatric residents and program directors.

Science.gov (United States)

Starling, Suzanne P; Heisler, Kurt W; Paulson, James F; Youmans, Eren

2009-04-01

The objective of this study was to determine the level of knowledge, comfort, and training related to the medical management of child abuse among pediatrics, emergency medicine, and family medicine residents. Surveys were administered to program directors and third-year residents at 67 residency programs. The resident survey included a 24-item quiz to assess knowledge regarding the medical management of physical and sexual child abuse. Sites were solicited from members of a network of child abuse physicians practicing at institutions with residency programs. Analyzable surveys were received from 53 program directors and 462 residents. Compared with emergency medicine and family medicine programs, pediatric programs were significantly larger and more likely to have a medical provider specializing in child abuse pediatrics, have faculty primarily responsible for child abuse training, use a written curriculum for child abuse training, and offer an elective rotation in child abuse. Exposure to child abuse training and abused patients was highest for pediatric residents and lowest for family medicine residents. Comfort with managing child abuse cases was lowest among family medicine residents. On the knowledge quiz, pediatric residents significantly outperformed emergency medicine and family medicine residents. Residents with high knowledge scores were significantly more likely to come from larger programs and programs that had a center, provider, or interdisciplinary team that specialized in child abuse pediatrics; had a physician on faculty responsible for child abuse training; used a written curriculum for child abuse training; and had a required rotation in child abuse pediatrics. By analyzing the relationship between program characteristics and residents' child abuse knowledge, we found that pediatric programs provide far more training and resources for child abuse education than emergency medicine and family medicine programs. As leaders, pediatricians must

Association of Group Prenatal Care in US Family Medicine Residencies With Maternity Care Practice: A CERA Secondary Data Analysis.

Science.gov (United States)

Barr, Wendy B; Tong, Sebastian T; LeFevre, Nicholas M

2017-03-01

Group prenatal care has been shown to improve both maternal and neonatal outcomes. With increasing adaption of group prenatal care by family medicine residencies, this model may serve as a potential method to increase exposure to and interest in maternity care among trainees. This study aims to describe the penetration, regional and program variations, and potential impacts on future maternity care practice of group prenatal care in US family medicine residencies. The CAFM Educational Research Alliance (CERA) conducted a survey of all US family medicine residency program directors in 2013 containing questions about maternity care training. A secondary data analysis was completed to examine relevant data on group prenatal care in US family medicine residencies and maternity care practice patterns. 23.1% of family medicine residency programs report provision of group prenatal care. Programs with group prenatal care reported increased number of vaginal deliveries per resident. Controlling for average number of vaginal deliveries per resident, programs with group prenatal care had a 2.35 higher odds of having more than 10% of graduates practice obstetrics and a 2.93 higher odds of having at least one graduate in the past 5 years enter an obstetrics fellowship. Residency programs with group prenatal care models report more graduates entering OB fellowships and practicing maternity care. Implementing group prenatal care in residency training can be one method in a multifaceted approach to increasing maternity care practice among US family physicians.

[Patient safety culture in Family practice residents of Galicia].

Science.gov (United States)

Portela Romero, Manuel; Bugarín González, Rosendo; Rodríguez Calvo, María Sol

To determine the views held by Family practice (FP) residents on the different dimensions of patient safety, in order to identify potential areas for improvement. A cross-sectional study. Seven FP of Galicia teaching units. 182 FP residents who completed the Medical Office Survey on Patient Safety Culture questionnaire. The Medical Office Survey on Patient Safety Culture questionnaire was chosen because it is translated, validated, and adapted to the Spanish model of Primary Care. The results were grouped into 12 composites assessed by the mentioned questionnaire. The study variables were the socio-demographic dimensions of the questionnaire, as well as occupational/professional variables: age, gender, year of residence, and teaching unit of FP of Galicia. The "Organisational learning" and "Teamwork" items were considered strong areas. However, the "Patient safety and quality issues", "Information exchange with other settings", and "Work pressure and pace" items were considered areas with significant potential for improvement. First-year residents obtained the best results and the fourth-year ones the worst. The results may indicate the need to include basic knowledge on patient safety in the teaching process of FP residents in order to increase and consolidate the fragile patient safety culture described in this study. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Family Policies and Children's School Achievement in Single- versus Two-Parent Families.

Science.gov (United States)

Pong, Suet-Ling; Dronkers, Jaap; Hampden-Thompson, Gillian

2003-01-01

Investigates the gap in math and science achievement of third- and fourth-graders who live with a single parent versus those who live with two parents in 11 countries. Finds single parenthood to be less detrimental when family policies equalize resources between single- and two-parent families. Concludes that national family policies can offset…

Are Self-study Procedural Teaching Methods Effective? A Pilot Study of a Family Medicine Residency Program.

Science.gov (United States)

Deffenbacher, Brandy; Langner, Shannon; Khodaee, Morteza

2017-11-01

A family medicine residency is a unique training environment where residents are exposed to care in multiple settings, across all ages. Procedures are an integral part of family medicine practice. Family medicine residency (FMR) programs are tasked with the job of teaching these skills at a level of intensity and frequency that allows a resident to achieve competency of such skills. In an environment that is limited by work hour restrictions, self-study teaching methods are one way to ensure all residents receive the fundamental knowledge of how to perform procedures. We developed and evaluated the efficacy of a self-study procedure teaching method and procedure evaluation checklist. A self-study procedure teaching intervention was created, consisting of instructional articles and videos on three procedures. To assess the efficacy of the intervention, and the competency of the residents, pre- and postintervention procedure performance sessions were completed. These sessions were reviewed and scored using a standardized procedure performance checklist. All 24 residents participated in the study. Overall, the resident procedure knowledge increased on two of the three procedures studied, and ability to perform procedure according to expert-validated checklist improved significantly on all procedures. A self-study intervention is a simple but effective way to increase and improve procedure training in a way that fits the complex scheduling needs of a residency training program. In addition, this study demonstrates that the procedure performance checklists are a simple and reliable way to increase assessment of resident procedure performance skills in a residency setting.

A Research Project on Successful Single-Parent Families.

Science.gov (United States)

Barry, Ann

1979-01-01

Studies variables associated with successful single-parent families. Single parents volunteered to share their positive family experiences. Information was sought on ages of family members and length of single-parent family status, education level and income, relations with absent parent, and relations with children. A hypothesis and counseling…

Teaching Humanities in Medicine: The University of Massachusetts Family Medicine Residency Program Experience

Science.gov (United States)

Silk, Hugh; Shields, Sara

2012-01-01

Humanities in medicine (HIM) is an important aspect of medical education intended to help preserve humanism and a focus on patients. At the University of Massachusetts Family Medicine Residency Program, we have been expanding our HIM curriculum for our residents including orientation, home visit reflective writing, didactics and a department-wide…

Installation guidelines for Solar Heating System, single-family residence at New Castle, Pennsylvania

Energy Technology Data Exchange (ETDEWEB)

1980-01-01

The Solar Heating System installer guidelines are provided for each subsystem and includes testing and filling the system. This single-family residential heating system is a solar-assisted, hydronic-to-warm-air system with solar-assisted domestic water heating. It is composed of the following major components: liquid cooled flat plate collectors; water storage tank; passive solar-fired domestic water preheater; electric hot water heater; heat pump with electric backup; solar hot water coil unit; tube-and-shell heat exchanger, three pumps, and associated pipes and valving in an energy transport module; control system; and air-cooled heat purge unit. Information is also provided on the operating procedures, controls, caution requirements, and routine and schedule maintenance. Information consists of written procedures, schematics, detail drawings, pictures and manufacturer's component data.

Training the "assertive practitioner of behavioral science": advancing a behavioral medicine track in a family medicine residency.

Science.gov (United States)

Butler, Dennis J; Holloway, Richard L; Fons, Dominique

2013-01-01

This article describes the development of a Behavioral Medicine track in a family medicine residency designed to train physicians to proactively and consistently apply advanced skills in psychosocial medicine, psychiatric care, and behavioral medicine. The Behavioral Medicine track emerged from a behavioral science visioning retreat, an opportunity to restructure residency training, a comparative family medicine-psychiatry model, and qualified residents with high interest in behavioral science. Training was restructured to increase rotational opportunities in core behavioral science areas and track residents were provided an intensive longitudinal counseling seminar and received advanced training in psychopharmacology, case supervision, and mindfulness. The availability of a Behavioral Medicine track increased medical student interest in the residency program and four residents have completed the track. All track residents have presented medical Grand Rounds on behavioral science topics and have lead multiple workshops or research sessions at national meetings. Graduate responses indicate effective integration of behavioral medicine skills and abilities in practice, consistent use of brief counseling skills, and good confidence in treating common psychiatric disorders. As developed and structured, the Behavioral Medicine track has achieved the goal of producing "assertive practitioners of behavioral science in family medicine" residents with advanced behavioral science skills and abilities who globally integrate behavioral science into primary care.

A Comparison of Surgery and Family Medicine Residents' Perceptions of Cross-Cultural Care Training of Cross-Cultural Care Training

Science.gov (United States)

Jackson, David S; Lin, Susan Y; Park, Elyse R

2010-01-01

The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt's Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups' reported impressions of importance and level of instruction received in cross-cultural care. Twenty surgery and 15 family medicine residents participated in the study. Significant differences were found between surgery and family medicine residents on most ratings of the amount of training they received in cross-cultural skills. Specifically, family medicine residents reported having received more training on: 1) determining how patients want to be addressed, 2) taking a social history, 3) assessing their understanding of the cause of illness, 4) negotiating their treatment plan, 5) assessing whether they are mistrustful of the health care system and/or doctor, 6) identifying cultural customs, 7) identifying how patients make decisions within the family, and 8) delivering services through a medical interpreter. One unexpected finding was that surgery residents, who reported not receiving much formal cultural training, reported higher mean scores on perceived skillfulness (i.e. ability) than family medicine residents. The disconnect may be linked to the family medicine residents' training in cultural humility — more knowledge and understanding of cross-cultural care can paradoxically lead to perceptions of being less prepared or skillful in this area. PMID:21225585

"Maintaining connections but wanting more": the continuity of familial relationships among assisted-living residents.

Science.gov (United States)

Tompkins, Catherine J; Ihara, Emily S; Cusick, Alison; Park, Nan Sook

2012-01-01

Social support is a key component of well-being for older adults, particularly for those who have moved from independent living to assisted living involving a transformation of roles, relationships, and responsibilities. Twenty-nine assisted-living facility residents were interviewed to understand the perceived continuity of relationships with family and friends. An inductive approach to thematic analysis revealed 1 main theme and 3 subthemes. The main theme that emerged was: maintaining connections but wanting more. Residents appreciated maintaining connections with family and friends, but often expressed feelings of discontentment with the continuity of former relationships. The subthemes included: appreciating family and friends, waiting for more, and losing control. Implications for research and practice are discussed.

The effect of a simple educational intervention on interest in early abortion training among family medicine residents.

Science.gov (United States)

Wu, Justine P; Bennett, Ian; Levine, Jeffrey P; Aguirre, Abigail Calkins; Bellamy, Scarlett; Fleischman, Joan

2006-06-01

We aimed to assess the effect of an educational intervention on the interest in and support for abortion training among family medicine residents. We conducted a cross-sectional survey before and after an educational lecture on medical and surgical abortion in primary care among 89 residents in 10 New Jersey family medicine programs. Before the lecture, there was more interest in medical abortion training than surgical abortion. Resident interest in surgical abortion and overall support for abortion training increased after the educational intervention (p<.01). Efforts to develop educational programs on early abortion care may facilitate the integration of abortion training in family medicine.

Improving family medicine resident training in dementia care: an experiential learning opportunity in Primary Care Collaborative Memory Clinics.

Science.gov (United States)

Lee, Linda; Weston, W Wayne; Hillier, Loretta; Archibald, Douglas; Lee, Joseph

2018-06-21

Family physicians often find themselves inadequately prepared to manage dementia. This article describes the curriculum for a resident training intervention in Primary Care Collaborative Memory Clinics (PCCMC), outlines its underlying educational principles, and examines its impact on residents' ability to provide dementia care. PCCMCs are family physician-led interprofessional clinic teams that provide evidence-informed comprehensive assessment and management of memory concerns. Within PCCMCs residents learn to apply a structured approach to assessment, diagnosis, and management; training consists of a tutorial covering various topics related to dementia followed by work-based learning within the clinic. Significantly more residents who trained in PCCMCs (sample = 98), as compared to those in usual training programs (sample = 35), reported positive changes in knowledge, ability, and confidence in ability to assess and manage memory problems. The PCCMC training intervention for family medicine residents provides a significant opportunity for residents to learn about best clinical practices and interprofessional care needed for optimal dementia care integrated within primary care practice.

Five Key Leadership Actions Needed to Redesign Family Medicine Residencies.

Science.gov (United States)

Kozakowski, Stanley M; Eiff, M Patrice; Green, Larry A; Pugno, Perry A; Waller, Elaine; Jones, Samuel M; Fetter, Gerald; Carney, Patricia A

2015-06-01

New skills are needed to properly prepare the next generation of physicians and health professionals to practice in medical homes. Transforming residency training to address these new skills requires strong leadership. We sought to increase the understanding of leadership skills useful in residency programs that plan to undertake meaningful change. The Preparing the Personal Physician for Practice (P4) project (2007-2014) was a comparative case study of 14 family medicine residencies that engaged in innovative training redesign, including altering the scope, content, sequence, length, and location of training to align resident education with requirements of the patient-centered medical home. In 2012, each P4 residency team submitted a final summary report of innovations implemented, overall insights, and dissemination activities during the study. Six investigators conducted independent narrative analyses of these reports. A consensus meeting held in September 2012 was used to identify key leadership actions associated with successful educational redesign. Five leadership actions were associated with successful implementation of innovations and residency transformation: (1) manage change; (2) develop financial acumen; (3) adapt best evidence educational strategies to the local environment; (4) create and sustain a vision that engages stakeholders; and (5) demonstrate courage and resilience. Residency programs are expected to change to better prepare their graduates for a changing delivery system. Insights about effective leadership skills can provide guidance for faculty to develop the skills needed to face practical realities while guiding transformation.

Behavioral science priorities in residency education: The perspective of practicing family physicians.

Science.gov (United States)

Brandt-Kreutz, Richard L; Ferguson, Kyle E; Sawyer, Devin

2015-12-01

The family medicine residency behavioral science curriculum is more effective if prioritized to match what is needed in practice after graduation. Two prior studies (Kendall, Marvel, & Cruickshank, 2003; Marvel & Major, 1999) identified physician priorities for behavioral science education. The present study extends this research to include topics from more recent curriculum guidelines and examines the extent to which size of community and perceived competence correlate with prioritization of Washington state family physicians. Practicing family physicians in Washington state (N = 2,270) were invited to complete the survey. Respondents provided demographic and practice information. Respondents then rated, on a scale from 1 to 4, 35 behavioral science topics on 2 different scales including (a) priority to be given in residency education and (b) perceived level of competence. A total of 486 responded and 430 completed both priority and competence scales for a response rate of 19%. The top half of 35 topics of the present study included the top 13 topics found in the 2 prior studies. Priority and competence scales were moderately correlated (r = .48, n = 430, p = .001). There was a small significant correlation with size of community and priority ratings (r = .13, n = 435, p = .006). Family physicians in Washington state prioritize behavioral science topics in residency education similar to Colorado and Mississippi. The results of this study support recent ACGME guidelines, in that training should focus on common psychiatric illnesses, including depression and anxiety, and interpersonal processes. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Pass rates on the American Board of Family Medicine Certification Exam by residency location and size.

Science.gov (United States)

Falcone, John L; Middleton, Donald B

2013-01-01

The Accreditation Council for Graduate Medical Education (ACGME) sets residency performance standards for the American Board of Family Medicine Certification Examination. This study aims are to describe the compliance of residency programs with ACGME standards and to determine whether residency pass rates depend on program size and location. In this retrospective cohort study, residency performance from 2007 to 2011 was compared with the ACGME performance standards. Simple linear regression was performed to see whether program pass rates were dependent on program size. Regional differences in performance were compared with χ(2) tests, using an α level of 0.05. Of 429 total residency programs, there were 205 (47.8%) that violate ACGME performance standards. Linear regression showed that program pass rates were positively correlated and dependent on program size (P family medicine training programs do not meet the ACGME examination performance standards. Pass rates are associated with residency program size, and regional variation occurs. These findings have the potential to affect ACGME policy and residency program application patterns.

Expectations of clinical teachers and faculty regarding development of the CanMEDS-Family Medicine competencies: Laval developmental benchmarks scale for family medicine residency training.

Science.gov (United States)

Lacasse, Miriam; Théorêt, Johanne; Tessier, Sylvie; Arsenault, Louise

2014-01-01

The CanMEDS-Family Medicine (CanMEDS-FM) framework defines the expected terminal enabling competencies (EC) for family medicine (FM) residency training in Canada. However, benchmarks throughout the 2-year program are not yet defined. This study aimed to identify expected time frames for achievement of the CanMEDS-FM competencies during FM residency training and create a developmental benchmarks scale for family medicine residency training. This 2011-2012 study followed a Delphi methodology. Selected faculty and clinical teachers identified, via questionnaire, the expected time of EC achievement from beginning of residency to one year in practice (0, 6, 12, […] 36 months). The 15-85th percentile intervals became the expected competency achievement interval. Content validity of the obtained benchmarks was assessed through a second Delphi round. The 1st and 2nd rounds were completed by 33 and 27 respondents, respectively. A developmental benchmarks scale was designed after the 1st round to illustrate expectations regarding achievement of each EC. The 2nd round (content validation) led to minor adjustments (1.9±2.7 months) of intervals for 44 of the 92 competencies, the others remaining unchanged. The Laval Developmental Benchmarks Scale for Family Medicine clarifies expectations regarding achievement of competencies throughout FM training. In a competency-based education system this now allows identification and management of outlying residents, both those excelling and needing remediation. Further research should focus on assessment of the scale reliability after pilot implementation in family medicine clinical teaching units at Laval University, and corroborate the established timeline in other sites.

Introduction of handheld computing to a family practice residency program.

Science.gov (United States)

Rao, Goutham

2002-01-01

Handheld computers are valuable practice tools. It is important for residency programs to introduce their trainees and faculty to this technology. This article describes a formal strategy to introduce handheld computing to a family practice residency program. Objectives were selected for the handheld computer training program that reflected skills physicians would find useful in practice. TRGpro handheld computers preloaded with a suite of medical reference programs, a medical calculator, and a database program were supplied to participants. Training consisted of four 1-hour modules each with a written evaluation quiz. Participants completed a self-assessment questionnaire after the program to determine their ability to meet each objective. Sixty of the 62 participants successfully completed the training program. The mean composite score on quizzes was 36 of 40 (90%), with no significant differences by level of residency training. The mean self-ratings of participants across all objectives was 3.31 of 4.00. Third-year residents had higher mean self-ratings than others (mean of group, 3.62). Participants were very comfortable with practical skills, such as using drug reference software, and less comfortable with theory, such as knowing the different types of handheld computers available. Structured training is a successful strategy for introducing handheld computing to a residency program.

Investigation of current university research concerning energy conversion and conservation in small single-family dwellings

Science.gov (United States)

Grossman, G. R.; Roberts, A. S., Jr.

1975-01-01

An investigation was made of university research concerning energy conversion and conservation techniques which may be applied in small single-family residences. Information was accumulated through published papers, progress reports, telephone conversations, and personal interviews. A synopsis of each pertinent investigation is given. Finally, a discussion of the synopses is presented and recommendations are made concerning the applicability of concepts for the design and construction of NASA-Langley Research Center's proposed Technology Utilization House in Hampton, Virginia.

Online short-term heat load forecasting for single family houses

DEFF Research Database (Denmark)

Bacher, Peder; Madsen, Henrik; Nielsen, Henrik Aalborg

2013-01-01

. Every hour the hourly heat load for each house the following two days is forecasted. The forecast models are adaptive linear time-series models and the climate inputs used are: ambient temperature, global radiation, and wind speed. A computationally efficient recursive least squares scheme is used......This paper presents a method for forecasting the load for heating in a single-family house. Both space and hot tap water heating are forecasted. The forecasting model is built using data from sixteen houses in Sønderborg, Denmark, combined with local climate measurements and weather forecasts...... variations in the heat load signal (predominant only for some houses), peaks presumably from showers, shifts in resident behavior, and uncertainty of the weather forecasts for longer horizons, especially for the solar radiation....

Does empowering resident families or nursing home employees in decision making improve service quality?

Science.gov (United States)

Hamann, Darla J

2014-08-01

This research examines how the empowerment of residents' family members and nursing home employees in managerial decision making is related to service quality. The study was conducted using data from 33 nursing homes in the United States. Surveys were administered to more than 1,000 employees on-site and mailed to the primary-contact family member of each resident. The resulting multilevel data were analyzed using hierarchical linear modeling. The empowerment of families in decision making was positively associated with their perceptions of service quality. The empowerment of nursing staff in decision making was more strongly related to service quality than the empowerment of nonnursing staff. Among nursing staff, the empowerment of nursing assistants improved service quality more than the empowerment of nurses. © The Author(s) 2013.

Exploring the role of classroom-based learning in professional identity formation of family practice residents using the experiences, trajectories, and reifications framework.

Science.gov (United States)

Chen, Luke Y C; Hubinette, Maria M

2017-08-01

Classroom-based learning such as academic half day has undervalued social aspects. We sought to explore its role in the professional identity development of family medicine residents. In this case study, residents and faculty from four training sites in the University of British Columbia Department of Family Practice were interviewed. The "experiences, trajectories, and reifications (ETR) framework" was used as a sensitizing tool for modified inductive (thematic) analysis of the transcripts. Classroom-based learning provided a different context for residents' interpretation of their clinical experiences, characterized as a "home base" for rotating urban residents, and a connection to a larger academic community for residents in rural training sites. Both these aspects were important in creating a positive trajectory of professional identity formation. Teaching directed at the learning needs of family physicians, and participation of family practice faculty as teachers and role models was a precipitation of a curriculum "centered in family medicine." Interactions between family medicine residents and faculty in the classroom facilitated the necessary engagements to reify a shared understanding of the discipline of family practice. Classroom-based learning has substantial impact on professional identity formation at an individual and collective level.

Family policy instruments oriented towards single parent families in the Czech Republic and in selected European countries

OpenAIRE

Kohlová, Hana

2014-01-01

This bachelor thesis deals with family policy oriented towards single parent families. This thesis tries to define reasons why single parent families are arising. It addresses the divorce rate, birth rate, and extramarital fertility. Differences between families with both parents and single parent families are defined and the subjective views of single parents in the Czech Republic are described in this thesis. Provisions from family policy, which take into account single parent families in t...

75 FR 9867 - Discontinuation of the Notice of Availability of Funding; Multi-Family Housing, Single Family...

Science.gov (United States)

2010-03-04

... Discontinuation of the Notice of Availability of Funding; Multi- Family Housing, Single Family Housing AGENCY... its existing and continuing Multi-Family and Single-Family Housing programs for which it receives... Analyst, Multi- Family Housing Programs, telephone 202-720-1753 and Myron Wooden, Loan Specialist, Single...

Parental experience of family resources in single-parent families having a child with cancer.

Science.gov (United States)

Huang, I-Chen; Mu, Pei-Fan; Chiou, Tzeon-Jye

2008-10-01

The purpose of this study was to explore the essence of family experiences in terms of family resources and how these assist a single-parent caring for a child with cancer. When families face stresses caused by cancer, they need to readjust their roles, interactive patterns and relationships, both inside and outside the family. During the adaptation process, family resources may assist recovery from stress and a return to equilibrium. Most research has emphasised the support resources available to two-parent families during the treatment process. There is a lack of information on the experiences of single-parent families and their available resources together with the functions and roles played by family resources during the adjustment process. Qualitative. Five major themes were identified: (i) facing the disease with courage; (ii) hope kindled by professionals; (iii) constructing parental role ability; (iv) assisting the children to live with the illness; and (v) family flexibility. The results of the current study demonstrate that single-parent families with a child suffering from cancer employ family resources to assist family adjustment and to maintain family function/equilibrium. These results explain the dynamic interactions between the multiple levels of resources available to the family. The study results provide evidence-based information that identifies the nature of family resources in single-parent families and describes how these resources can be applied to assist the families.

Short-term heat load forecasting for single family houses

DEFF Research Database (Denmark)

Bacher, Peder; Madsen, Henrik; Nielsen, Henrik Aalborg

2013-01-01

This paper presents a method for forecasting the load for space heating in a single-family house. The forecasting model is built using data from sixteen houses located in Sønderborg, Denmark, combined with local climate measurements and weather forecasts. Every hour the hourly heat load for each...... house the following two days is forecasted. The forecast models are adaptive linear time-series models and the climate inputs used are: ambient temperature, global radiation and wind speed. A computationally efficient recursive least squares scheme is used. The models are optimized to fit the individual...... noise and that practically all correlation to the climate variables are removed. Furthermore, the results show that the forecasting errors mainly are related to: unpredictable high frequency variations in the heat load signal (predominant only for some houses), shifts in resident behavior patterns...

The challenges of implementing advanced access for residents in family medicine in Quebec. Do promising strategies exist?

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Abou Malham, Sabina; Touati, Nassera; Maillet, Lara; Breton, Mylaine

2018-12-01

The advanced access (AA) model is a highly recommended innovation to improve timely access to primary healthcare. Despite that many studies have shown positive impacts for healthcare professionals, and for patients, implementing this model in clinics with a teaching mission for family medicine residents poses specific challenges. To identify these challenges within these clinics, as well as potential strategies to address them. The authors adopted a qualitative multiple case study design, collected data in 2016 using semi-structured interviews (N = 40) with healthcare professionals and clerical staff in four family medicine units in Quebec, and performed a thematic analysis. They validated results through a discussion workshop, involving many family physicians and residents practicing in different regions Results: Five challenges emerged from the data: 1) choosing, organizing residents' patient; 2) managing and balancing residents' appointment schedules; 3) balancing timely access with relational continuity; 4) understanding the AA model; 5) establishing collaborative practices with other health professionals. Several promising strategies were suggested to address these challenges, including clearly defining residents' patient panels; adopting a team-based care approach; incorporating the model into academic curriculum and clinical training; proactive and ongoing education of health professionals, residents, and patients; involving residents in the change process and in adjustment strategies. To meet the challenges of implementing AA, decision-makers should consider exposing residents to AA during academic training and clinical internships, involving them in team work on arrival, engaging them as key actors in the implementation and in intra- and inter-professional collaborative models.

Pregnancy among residents enrolled in general surgery (PREGS): a survey of residents in a single Canadian training program.

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Merchant, Shaila; Hameed, Morad; Melck, Adrienne

2011-12-01

Interest in general surgery has declined, and lack of adequate accommodation for pregnancy and parenting may be a deterrent. We explored resident experiences with these issues within a single general surgery program. We surveyed residents enrolled in the University of British Columbia general surgery program from 1997 to 2009 using a Web-based survey tool. Information regarding demographics, pregnancy, postpartum issues and issues pertaining to maternity/parenting policies was obtained. We used the Student t test, Z test and Fisher exact test for statistical comparisons. Of the 81 residents surveyed, 53 responded (65% response rate). There were fewer pregnancies during residency among female residents than among partners of male residents (PMRs; 9 pregnancies for 6 of 25 residents v. 23 pregnancies for 15 of 28 PMRs, p = 0.002). One of 9 pregnancies among female residents and 5 of 23 among PMRs ended in miscarriage (p > 0.99). Female residents and PMRs reported pregnancy-related complications with equal frequency. All female residents breastfed for at least 6 months; however, 67% (4 of 6) felt their resident role prevented them from breastfeeding as long as they would have liked. Most (5 of 6, 83%) pursued a graduate degree or research during their "maternity leave." More than 50% of residents reported that their own workload increased because of a colleague's pregnancy. Many (36 of 53, 68%) were unaware of the existence of any maternity/parenting policy, and most were in favour of instituting such a policy. Resident mothers do not breastfeed for the desired duration, and precluding factors must be explored. Contingency plans are needed so colleagues are not overburdened when pregnant residents cannot perform clinical duties. General surgery programs must have a formal policy addressing these issues.

Association between women's autonomy and family planning outcome in couples residing in Isfahan

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Kohan, Shahnaz; Talebian, Ferdos; Ehsanpour, Soheila

2014-01-01

Background: One of the important factors in the prediction of family planning outcome is paying attention to women's role in decision making concerning fertility and household affairs. With the improvement of women's status and autonomy, their control over fertility is expected to increase. The present study aimed to investigate the association between women's autonomy and family planning outcome of the couples residing in Isfahan. Materials and Methods: This is cross-sectional study. Two hundred and seventy women of childbearing age, eligible for family planning and residing in Isfahan, were selected through random cluster sampling and they filled a researcher-made questionnaire. Women's autonomy was measured with the questions on their decision-making autonomy concerning household affairs and physical mobility autonomy. The association between women's autonomy and family planning outcome was analyzed through statistical methods. Results: The results showed that the mean of women's decision-making, physical mobility, and general autonomy was 50. Women's autonomy had a direct significant association with the type of contraception method (P = 0.01) and the length of usage of their present contraception method (P = 0.04) as well as where they received family planning services (P = 0.02). Conclusions: Analysis of data revealed women with higher autonomy used a more efficient contraception method and continued their contraception method for a longer time, which leads to improvement of couples’ family planning outcome. Therefore, family planning services should be planned and provided with women's autonomy under consideration. PMID:25400671

Medicine in the 21st century: recommended essential geriatrics competencies for internal medicine and family medicine residents.

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Williams, Brent C; Warshaw, Gregg; Fabiny, Anne Rebecca; Lundebjerg Mpa, Nancy; Medina-Walpole, Annette; Sauvigne, Karen; Schwartzberg, Joanne G; Leipzig, Rosanne M

2010-09-01

Physician workforce projections by the Institute of Medicine require enhanced training in geriatrics for all primary care and subspecialty physicians. Defining essential geriatrics competencies for internal medicine and family medicine residents would improve training for primary care and subspecialty physicians. The objectives of this study were to (1) define essential geriatrics competencies common to internal medicine and family medicine residents that build on established national geriatrics competencies for medical students, are feasible within current residency programs, are assessable, and address the Accreditation Council for Graduate Medical Education competencies; and (2) involve key stakeholder organizations in their development and implementation. Initial candidate competencies were defined through small group meetings and a survey of more than 100 experts, followed by detailed item review by 26 program directors and residency clinical educators from key professional organizations. Throughout, an 8-member working group made revisions to maintain consistency and compatibility among the competencies. Support and participation by key stakeholder organizations were secured throughout the project. The process identified 26 competencies in 7 domains: Medication Management; Cognitive, Affective, and Behavioral Health; Complex or Chronic Illness(es) in Older Adults; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care. The competencies map directly onto the medical student geriatric competencies and the 6 Accreditation Council for Graduate Medical Education Competencies. Through a consensus-building process that included leadership and members of key stakeholder organizations, a concise set of essential geriatrics competencies for internal medicine and family medicine residencies has been developed. These competencies are well aligned with concerns for residency training raised in a recent Medicare Payment Advisory

Newborn well-child visits in the home setting: a pilot study in a family medicine residency.

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Lakin, Ashley; Sutter, Mary Beth; Magee, Susanna

2015-03-01

The purpose of our study was to pilot a home visit program targeting neonates conducted by family medicine residents. While the literature shows that home visit programs are successful at preventing adverse outcomes for young children, such as improving parenting practices and promoting breastfeeding, no data exist about newborn home visits conducted by resident physicians. Residents conducted newborn home visits precepted by a family medicine faculty member from June 2012--May 2013. Subjects were recruited from the residency continuity practice and randomized to receive two home visits (which replaced two office visits) or routine office-based newborn care. All participants were surveyed using the validated WHOQOL-BREF quality of life scale and a patient satisfaction instrument. Metrics were also obtained from the electronic medical record. Mothers and resident physicians completed an open-ended questionnaire about their experience. All patients, whether receiving office-based or home-based care, rated their care highly. Significant differences were seen in usage of acute care in the first 6 months of life, and mothers in the home visit group trended toward initiating breastfeeding at a higher rate. The home visit group ranked their quality of life higher across all domains when compared to the control group, approaching statistical significance in two domains. Residents providing home visits reported increased connectedness to patients and improved confidence in anticipatory guidance delivery. Home visits are valuable for families with newborns, in terms of minimizing acute care service usage, breastfeeding promotion, and perhaps increasing maternal perceptions of well-being. A home visit program has the potential to enhance resident education and the doctor-patient relationship.

Development of a New South Dakota Rural Family Medicine Residency Program.

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Heisler, Jean; Huber, Thomas; Huntington, Mark K

2017-11-01

The healthcare workforce is a priority in South Dakota. It has been estimated that 8,000 additional healthcare workers beyond those in practice in 2010 will be needed by 2020. In 2016, the South Dakota Department of Health included in its budget funds for the development of a new Rural Family Medicine Residency Training Program as one of the steps toward addressing the physician component of these workforce needs. This new program has just received its accreditation and is recruiting the inaugural class of resident physicians for the spring of 2018. This article provides a concise overview of the program's initial development. Copyright© South Dakota State Medical Association.

Impact of Residency Training Redesign on Residents' Clinical Knowledge.

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Waller, Elaine; Eiff, M Patrice; Dexter, Eve; Rinaldo, Jason C B; Marino, Miguel; Garvin, Roger; Douglass, Alan B; Phillips, Robert; Green, Larry A; Carney, Patricia A

2017-10-01

The In-training Examination (ITE) is a frequently used method to evaluate family medicine residents' clinical knowledge. We compared family medicine ITE scores among residents who trained in the 14 programs that participated in the Preparing the Personal Physician for Practice (P4) Project to national averages over time, and according to educational innovations. The ITE scores of 802 consenting P4 residents who trained in 2007 through 2011 were obtained from the American Board of Family Medicine. The primary analysis involved comparing scores within each academic year (2007 through 2011), according to program year (PGY) for P4 residents to all residents nationally. A secondary analysis compared ITE scores among residents in programs that experimented with length of training and compared scores among residents in programs that offered individualized education options with those that did not. Release of ITE scores was consented to by 95.5% of residents for this study. Scores of P4 residents were higher compared to national scores in each year. For example, in 2011, the mean P4 score for PGY1 was 401.2, compared to the national average of 386. For PGY2, the mean P4 score was 443.1, compared to the national average of 427, and for PGY3, the mean P4 score was 477.0, compared to the national PGY3 score of 456. Scores of residents in programs that experimented with length of training were similar to those in programs that did not. Scores were also similar between residents in programs with and without individualized education options. Family medicine residency programs undergoing substantial educational changes, including experiments in length of training and individualized education, did not appear to experience a negative effect on resident's clinical knowledge, as measured by ITE scores. Further research is needed to study the effect of a wide range of residency training innovations on ITE scores over time.

Single-parent family forms and children's educational performance in a comparative perspective: Effects of school's share of single-parent families

NARCIS (Netherlands)

Lange, M. de; Dronkers, J.A.; Wolbers, M.H.J.

2014-01-01

Living in a single-parent family is negatively related with children's educational performance compared to living with 2 biological parents. In this article, we aim to find out to what extent the context of the school's share of single-parent families affects this negative relationship. We use

Family medicine residents’ perceived level of comfort in treating common sports injuries across residency programs in the United States

Directory of Open Access Journals (Sweden)

Amoako AO

2015-03-01

Full Text Available Adae O Amoako,1 Agyenim B Amoako,2 George GA Pujalte3 1Department of Family and Community Medicine, Penn State Hershey Medical Center, Hershey, PA, USA; 2Department of Family Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA; 3Sports Medicine, Divisions of Primary Care, and Orthopedics, Mayo Clinic Health System, Waycross, GA, USA Background and objective: Family physicians are expected to be comfortable in treating common sports injuries. Evidence shows a limited level of comfort in treating these injuries in pediatric and internal medicine residents. Studies are lacking, however, in family medicine residents. The purpose of this study is to assess the comfort level of family medicine residents in treating common sports injuries in adults and children based on their perceived level of knowledge and attitudes. Methods: This is a cross-sectional study of family medicine residents in the United Sates. A written survey of 25 questions related to sports injury knowledge and factors affecting comfort level were collected. A chi-square test was implemented in calculating P-values. Results: Five hundred and fifty-seven residents responded to the survey. A higher percentage of doctors of osteopathy (86.6%, 82.5%, 69.6%, and 68.7% compared to doctors of medicine (78.5%, 71.6%, 53.4%, and 52.8% respectively identified ankle sprain, concussion, plantar fasciitis, and lateral epicondylitis as common injuries, and felt comfortable in treating them (P-values =0.015, 0.004, 0.0001, and 0.0002, respectively. Residents with high interest in sports medicine correctly identified the injuries as common and felt comfortable treating them as well (knowledge, P=0.027, 0.0029, <0.0001, and 0.0001, respectively; comfort level, P=0.0016, <0.0001, 0.0897, and 0.0010, respectively. Conclusion: Medical education background, factors that affect training, and an interest in sports medicine contribute to residents' knowledge and comfort

How Entrustment Is Informed by Holistic Judgments Across Time in a Family Medicine Residency Program: An Ethnographic Nonparticipant Observational Study.

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Sagasser, Margaretha H; Fluit, Cornelia R M G; van Weel, Chris; van der Vleuten, Cees P M; Kramer, Anneke W M

2017-06-01

Entrustment has mainly been conceptualized as delegating discrete professional tasks. Because residents provide most of their patient care independently, not all resident performance is visible to supervisors; the entrustment process involves more than granting discrete tasks. This study explored how supervisors made entrustment decisions based on residents' performance in a long-term family medicine training program. A qualitative nonparticipant observational study was conducted in 2014-2015 at competency-based family medicine residency programs in the Netherlands. Seven supervisor-resident pairs participated. During two days, one researcher observed first-year residents' patient encounters, debriefing sessions, and supervisor-resident educational meetings and interviewed them separately afterwards. Data were collected and analyzed using iterative, phenomenological inductive research methodology. The entrustment process developed over three phases. Supervisors based their initial entrustment on prior knowledge about the resident. In the ensuing two weeks, entrustment decisions regarding independent patient care were derived from residents' observed general competencies necessary for a range of health problems (clinical reasoning, decision making, relating to patients); medical knowledge and skills; and supervisors' intuition. Supervisors provided supervision during and after encounters. Once residents performed independently, supervisors kept reevaluating their decisions, informed by residents' overall growth in competencies rather than by adhering to a predefined set of tasks. Supervisors in family medicine residency training took a holistic approach to trust, based on general competencies, knowledge, skills, and intuition. Entrustment started before training and developed over time. Building trust is a mutual process between supervisor and resident, requiring a good working relationship.

Psychosocial Training in U.S. Internal Medicine and Family Practice Residency Programs.

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Gaufberg, Elizabeth H.; Joseph, Robert C.; Pels, Richard J.; Wyshak, Grace; Wieman, Dow; Nadelson, Carol C.

2001-01-01

Surveyed directors of internal medicine (IM) and family practice (FP) residency programs regarding the format, content, and quantity of psychosocial training in their programs, their opinions on topics related to such training, and program demographics. Found considerable variation in content and time devoted to psychosocial training within and…

The effect of dual accreditation on family medicine residency programs.

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Mims, Lisa D; Bressler, Lindsey C; Wannamaker, Louise R; Carek, Peter J

2015-04-01

In 1985, the American Osteopathic Association (AOA) Board of Trustees agreed to allow residency programs to become dually accredited by the AOA and Accreditation Council for Graduate Medical Education (ACGME). Despite the increase in such programs, there has been minimal research comparing these programs to exclusively ACGME-accredited residencies. This study examines the association between dual accreditation and suggested markers of quality. Standard characteristics such as regional location, program structure (community or university based), postgraduate year one (PGY-1) positions offered, and salary (PGY-1) were obtained for each residency program. In addition, the faculty to resident ratio in the family medicine clinic and the number of half days residents spent in the clinic each week were recorded. Initial Match rates and pass rates of new graduates on the ABFM examination from 2009 to 2013 were also obtained. Variables were analyzed using chi-square and Student's t test. Logistic regression models were then created to predict a program's 5-year aggregate initial Match rate and Board pass rate in the top tertile as compared to the lowest tertile. Dual accreditation was obtained by 117 (27.0%) of programs. Initial analyses revealed associations between dually accredited programs and mean year of initial ACGME program accreditation, regional location, program structure, tracks, and alternative medicine curriculum. When evaluated in logistic regression, dual accreditation status was not associated with Match rates or ABFM pass rates. By examining suggested markers of program quality for dually accredited programs in comparison to ACGME-only accredited programs, this study successfully established both differences and similarities among the two types.

Are single-parent families different from two-parent families in the treatment of adolescent bulimia nervosa using family-based treatment?

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Doyle, Angela Celio; McLean, Carmen; Washington, Blaine N; Hoste, Renee Rienecke; le Grange, Daniel

2009-03-01

To examine whether family-based treatment (FBT) for adolescent bulimia nervosa (BN), which emphasizes family involvement in helping to reduce binge eating and purging behaviors, is differentially efficacious in single-parent families versus two-parent families. Forty-one adolescents (97.6% female; 16.0 +/- 1.7 years old) with either BN (n = 18) or subthreshold BN (n = 23) were randomized to FBT as part of a larger randomized controlled trial studying treatments for adolescent BN. Two-parent (n = 27; 65.9%) and single-parent (n = 14; 34.2%) families were compared on demographic variables, presence of comorbid psychiatric illnesses, and symptoms of BN at baseline, post, and 6-month follow-up. ANOVA and chi-square analyses revealed no statistically significant differences between two-parent and single-parent families on any variables with the exception of ethnicity, for which a greater proportion of Caucasians and Hispanic families had two- parent families compared with African-American families (chi(2) = 8.68, p = .01). These findings suggest that FBT may be an appropriate and efficacious treatment for single-parent families as well as two-parent families, despite the reliance on parental intervention to reduce bulimic symptoms and normalize eating patterns.

Literacy, Education, and Inequality: Assimilation and Resistance Narratives from Families Residing at a Homeless Shelter

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Jacobs, Mary M.

2014-01-01

In this article, I draw on data from my qualitative dissertation study of the literacy practices of five families who resided in a homeless shelter to complicate the relationship between literacy, education, and inequality. Homelessness is examined through the lens of sponsorship to understand the differential access the families have to powerful…

Single-Parent Family Forms and Children's Educational Performance in a Comparative Perspective: Effects of School's Share of Single-Parent Families

Science.gov (United States)

de Lange, Marloes; Dronkers, Jaap; Wolbers, Maarten H. J.

2014-01-01

Living in a single-parent family is negatively related with children's educational performance compared to living with 2 biological parents. In this article, we aim to find out to what extent the context of the school's share of single-parent families affects this negative relationship. We use pooled data from the Organisation for Economic…

A Single Father's Shopping Bag: Purchasing Decisions in Single-Father Families

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Ziol-Guest, Kathleen M.

2009-01-01

Using data from the 1980 to 2003 panels of the Consumer Expenditure Survey, this article examines purchasing decisions in father-headed single-parent families. Single-father expenditures are compared to both married-parent expenditures and single-mother expenditures on 17 broad categories of household-level goods and services. Multivariate…

The emotional context facing nursing home residents' families: a call for role reinforcement strategies from nursing homes and the community.

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Bern-Klug, Mercedes

2008-01-01

Identify useful concepts related to the emotional context facing family members of nursing home residents. These concepts can be used in future studies to design and test interventions that benefit family caregivers. Secondary data analyses of qualitative ethnographic data. Two nursing homes in a large Midwestern city; 8 months of data collection in each. 44 family members of nursing home residents whose health was considered, "declining." Role theory was used to design and help interpret the findings. Data included transcripts of conversations between family members and researchers and were analyzed using a coding scheme developed for the secondary analysis. Comments about emotions related to the social role of family member were grouped into three categories: relief related to admission, stress, and decision making support/stress. Subcategories of stress include the role strain associated with "competing concerns" and the psychological pressures of 1) witnessing the decline of a loved one in a nursing home, and 2) guilt about placement. Decision-making was discussed as a challenge which family members did not want to face alone; support from the resident, health care professionals, and other family members was appreciated. Family members may benefit from role reinforcement activities provided by nursing home staff and community members. All nursing home staff members (in particular social workers) and physicians are called upon to provide educationa and support regarding nursing home admissions, during the decline of the resident, and especially regarding medical decision-making. Community groups are asked to support the family member by offering assistance with concrete tasks (driving, visiting, etc.) and social support.

Single molecule diffusion and the solution of the spherically symmetric residence time equation.

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Agmon, Noam

2011-06-16

The residence time of a single dye molecule diffusing within a laser spot is propotional to the total number of photons emitted by it. With this application in mind, we solve the spherically symmetric "residence time equation" (RTE) to obtain the solution for the Laplace transform of the mean residence time (MRT) within a d-dimensional ball, as a function of the initial location of the particle and the observation time. The solutions for initial conditions of potential experimental interest, starting in the center, on the surface or uniformly within the ball, are explicitly presented. Special cases for dimensions 1, 2, and 3 are obtained, which can be Laplace inverted analytically for d = 1 and 3. In addition, the analytic short- and long-time asymptotic behaviors of the MRT are derived and compared with the exact solutions for d = 1, 2, and 3. As a demonstration of the simplification afforded by the RTE, the Appendix obtains the residence time distribution by solving the Feynman-Kac equation, from which the MRT is obtained by differentiation. Single-molecule diffusion experiments could be devised to test the results for the MRT presented in this work. © 2011 American Chemical Society

Examining trust in health professionals among family caregivers of nursing home residents with advanced dementia.

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Boogaard, Jannie A; Werner, Perla; Zisberg, Anna; van der Steen, Jenny T

2017-12-01

In a context of increasing emphasis on shared decision-making and palliative care in dementia, research on family caregivers' trust in health professionals in advanced dementia is surprisingly scant. The aim of the present study was to assess trust in nursing home health professionals of family caregivers of nursing home residents with advanced dementia, and possible correlates, such as family caregivers' satisfaction, involvement in care, care burden and patients' symptom burden. A cross-sectional study was carried out using structured questionnaires administered through the telephone. Generalized estimating equation analyses with adjustment for nursing home clustering were applied to assess the most important associations with family caregivers' trust. A total of 214 family caregivers of persons with dementia residing in 25 nursing homes participated in the study. The majority of the participants (67%) were women and adult children (75%). The majority of the family caregivers trusted physicians, nurses and nurses' aides at a moderate-to-high level. Approximately half to one-third reported moderate-to-low levels of trust. Higher levels of trust were associated with more positive care outcomes, such as higher family satisfaction with care and more positive evaluations of physician-family communication. The present study showed the importance of family caregivers trusting nursing home health professionals for their experiences as caregivers. Although causation cannot be established, increased family caregivers' trust in nursing home health professionals by improving communication and exchange of information might provide a good basis for providing optimal palliative care in advanced dementia. Geriatr Gerontol Int 2017; 17: 2466-2471. © 2017 Japan Geriatrics Society.

Dimensions of Family Functioning: Perspectives of Low-Income African American Single Parent Families

Science.gov (United States)

Mccreary, Linda L.; Dancy, Barbara L.

2004-01-01

Family functioning is influenced by socio-economic status, culture, family structure, and developmental stage, and is assessed primarily using instruments developed for middle-income European American two-parent families. These instruments may not validly assess low-income African American single-parent families. This qualitative study was…

Development and evaluation of brochures for fall prevention education created to empower nursing home residents and family members.

Science.gov (United States)

Schoberer, Daniela; Eglseer, Doris; Halfens, Ruud J G; Lohrmann, Christa

2018-06-01

In this study, we describe the development of evidence- and theory-based fall prevention educational material and its evaluation from the users' perspectives. To reduce risk factors for falling in nursing homes, nursing staff must enact multifactorial fall prevention intervention programmes. A core component of these programmes is to educate residents and their family members, both verbally and in a written form. However, users can only benefit from educational material if it is based on current scientific evidence, easy to understand and process and customised. We followed a structured procedure during the development process, while considering various aspect of quality. To assess the understandability and usefulness of the resulting educational materials, we conducted a qualitative content analysis study. The educational materials development process incorporated several iterative steps including a systematic literature search and the application of frameworks for designing and writing the materials. To evaluate the material, we performed six focus group discussions separately with residents, family members and nursing staff from two nursing homes (total of 32 participants). Residents' brochures included clear information on avoiding external risks as well as coping strategies after a fall event. Family members' brochures were more comprehensive, including both concrete tips and outlining the advantages and disadvantages of interventions. Residents and family members had no difficulties understanding the material and tried to apply the content to their individual situations. Nursing staff commented on some ambiguities and incongruities relating to current nursing care practice. By involving users in the development of evidence-based educational materials, nursing staff can achieve a high acceptance rate for the materials and motivate users to address the topic. The involvement of users is essential for developing educational material that meets users' needs

Residency education through the family medicine morbidity and mortality conference.

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Kim, Curi; Fetters, Michael D; Gorenflo, Daniel W

2006-09-01

The value of the morbidity and mortality conference (M&MC) has received little examination in the primary care literature. We sought to understand the educational content of M&MCs by examining data from a family medicine training program. Archived morbidity and mortality conference data (July 2001-July 2003) were retrieved from two University of Michigan family medicine adult inpatient services (one community based and one university based). We used chi-square and t test to compare demographic variables and adverse events between hospital sites. We qualitatively analyzed written comments about adverse events. Both family medicine services shared similar diagnoses, patient volume, length of stay, and gender distribution of patients, but the community hospital had an older average patient age (67.9 years versus 52.9 years) and a higher outpatient complication rate. Analysis of the qualitative data revealed patterns of adverse events, such as an association between avoidable admissions and inadequate pain control, that could be improved through educational intervention. Although family medicine residents' experiences in university and community hospitals were comparable, there were differences in patient populations and case complexity. Modifying the M&MC format could enhance its effectiveness as an educational tool about adverse events.

Competency-based evaluation tools for integrative medicine training in family medicine residency: a pilot study

Directory of Open Access Journals (Sweden)

Schneider Craig

2007-04-01

Full Text Available Abstract Background As more integrative medicine educational content is integrated into conventional family medicine teaching, the need for effective evaluation strategies grows. Through the Integrative Family Medicine program, a six site pilot program of a four year residency training model combining integrative medicine and family medicine training, we have developed and tested a set of competency-based evaluation tools to assess residents' skills in integrative medicine history-taking and treatment planning. This paper presents the results from the implementation of direct observation and treatment plan evaluation tools, as well as the results of two Objective Structured Clinical Examinations (OSCEs developed for the program. Methods The direct observation (DO and treatment plan (TP evaluation tools developed for the IFM program were implemented by faculty at each of the six sites during the PGY-4 year (n = 11 on DO and n = 8 on TP. The OSCE I was implemented first in 2005 (n = 6, revised and then implemented with a second class of IFM participants in 2006 (n = 7. OSCE II was implemented in fall 2005 with only one class of IFM participants (n = 6. Data from the initial implementation of these tools are described using descriptive statistics. Results Results from the implementation of these tools at the IFM sites suggest that we need more emphasis in our curriculum on incorporating spirituality into history-taking and treatment planning, and more training for IFM residents on effective assessment of readiness for change and strategies for delivering integrative medicine treatment recommendations. Focusing our OSCE assessment more narrowly on integrative medicine history-taking skills was much more effective in delineating strengths and weaknesses in our residents' performance than using the OSCE for both integrative and more basic communication competencies. Conclusion As these tools are refined further they will be of value both in improving

[Patient safety culture in family and community medicine residents in Aragon].

Science.gov (United States)

Rodríguez-Cogollo, R; Paredes-Alvarado, I R; Galicia-Flores, T; Barrasa-Villar, J I; Castán-Ruiz, S

2014-01-01

having an appropriate patient safety culture is the first recommendation to improve it. The aim of this article is to determine the safety culture in family medicine residents and then to identify improvement strategies. an online cross-sectional survey of residents in family medicine teaching units of Aragon using the translated, validated and adapted to Spanish, Medical Office Survey on Patient Safety Culture (MOSPS) questionnaire. The results were grouped in 12-dimensional responses for analysis, and the mean value of each dimension was calculated. Perceptions were described by Percentages of Positive (PRP) and Negative Responses (PRN) to each dimension. positive results were seen in «the Patient Care Tracking/Follow-up». There were significant differences in the «Information Exchange With Other Settings», «Staff Training» and «Overall Perceptions of Patient Safety and Quality». Study participants viewed «Work Pressure and Pace» negatively. the institutions providing health services, as well as their staff, are increasingly aware of the importance of improving Patient Safety, and the results of this study allowed us to present information that helps identify weaknesses, and to design initiatives and strategies to improve care practices. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

Residents' and preceptors' perceptions of the use of the iPad for clinical teaching in a family medicine residency program.

Science.gov (United States)

Archibald, Douglas; Macdonald, Colla J; Plante, Judith; Hogue, Rebecca J; Fiallos, Javier

2014-08-20

As Family Medicine programs across Canada are transitioning into a competency-based curriculum, medical students and clinical teachers are increasingly incorporating tablet computers in their work and educational activities. The purpose of this pilot study was to identify how preceptors and residents use tablet computers to implement and adopt a new family medicine curriculum and to evaluate how they access applications (apps) through their tablet in an effort to support and enhance effective teaching and learning. Residents and preceptors (n = 25) from the Family Medicine program working at the Pembroke Regional Hospital in Ontario, Canada, were given iPads and training on how to use the device in clinical teaching and learning activities and how to access the online curriculum. Data regarding the use and perceived contribution of the iPads were collected through surveys and focus groups. This mixed methods research used analysis of survey responses to support the selection of questions for focus groups. Reported results were categorized into: curriculum and assessment; ease of use; portability; apps and resources; and perceptions about the use of the iPad in teaching/learning setting. Most participants agreed on the importance of accessing curriculum resources through the iPad but recognized that these required enhancements to facilitate use. The iPad was considered to be more useful for activities involving output of information than for input. Participants' responses regarding the ease of use of mobile technology were heterogeneous due to the diversity of computer proficiency across users. Residents had a slightly more favorable opinion regarding the iPad's contribution to teaching/learning compared to preceptors. iPad's interface should be fully enhanced to allow easy access to online curriculum and its built-in resources. The differences in computer proficiency level among users should be reduced by sharing knowledge through workshops led by more skillful i

Existing sustainable renovation concepts for single-family houses

DEFF Research Database (Denmark)

Tommerup, Henrik M.; Vanhoutteghem, Lies; Svendsen, Svend

2010-01-01

In the Nordic Innovation Centre Project, SuccessFamilies, the main objective is to change the business environment in order to speed up the implementation of sustainable renovation of single-family houses – proposing new service concepts that will combine both the technical solutions, financing...... with individual solutions, traditional warehouses ”do-it-yourself-shops” and some actors marketing single products. To speed up the implementation of sustainable renovation of single-family houses there is a great need for full-service packages. Existing technical renovation concepts, typically focusing...... services as well as other promoting issues to overcome the behavioural, organizational, legal and social barriers that exist in sustainable renovation. A starting point for such a change has been to get an overview of the existing sustainable renovation concepts, i.e. full-service concepts and technical...

Knowledge and misconceptions about immunizations among medical students, pediatric, and family medicine resident.

Science.gov (United States)

Tañón, Vilmarie; Borrero, Clarimar; Pedrogo, Yasmín

2010-01-01

Previous research has indicated that, despite being the most trusted source of health information, medical students, residents and other health related professionals lack accurate and current knowledge regarding immunization practices. To evaluate medical students and primary care resident knowledge about immunizations. Self-administered survey given to students from four medical schools, Pediatrics residents (2 training programs) and Family Medicine residents (2 programs). Data was analyzed using Statistix 8.0. One-way ANOVA test was used to compare means, and a p-value less than 0.05 was considered statistically significant. Participants (N=376) included 3rd (64%) and 4th (18%) year medical students and a homogenous distribution of 1st, 2nd and 3rd year residents. The mean percent of correct answers about immunizations was 61%. The participants showed poor knowledge about indications (62% correct answers), contraindications (46% correct answers) and myths (71% correct answers). Knowledge about immunizations correlated with higher levels of education (p immunizations followed by books (48%) and the internet (36%). They referred poor exposure to immunizations in clinical settings. Most medical students do not have the expected knowledge about immunization indications and contraindications. Residents were not proficient in immunization contraindications. Both groups had an adequate understanding about vaccination myths. Efforts towards ensuring adequate exposure to immunizations education during training years are needed in order to eliminate one of the barriers to adequate immunizations in children.

Residents' experiences of abuse, discrimination and sexual harassment during residency training. McMaster University Residency Training Programs.

Science.gov (United States)

Cook, D J; Liutkus, J F; Risdon, C L; Griffith, L E; Guyatt, G H; Walter, S D

1996-06-01

To assess the prevalence of psychological abuse, physical assault, and discrimination on the basis of gender and sexual orientation, and to examine the prevalence and impact of sexual harassment in residency training programs. Self-administered questionnaire. McMaster University, Hamilton, Ont. Residents in seven residency training programs during the academic year from July 1993 to June 1994. Of 225 residents 186 (82.7%) returned a completed questionnaire, and 50% of the respondents were women. Prevalence of psychological abuse, physical assault and discrimination on the basis of gender and sexual orientation experienced by residents during medical training, prevalence and residents' perceived frequency of sexual harassment. Psychological abuse was reported by 50% of the residents. Some of the respondents reported physical assault, mostly by patients and their family members (14.7% reported assaults by male patients and family members, 9.8% reported assaults by female patients and family members), 5.4% of the female respondents reported assault by male supervising physicians. Discrimination on the basis of gender was reported to be common and was experienced significantly more often by female residents than by male residents (p sexual orientation. Most of the respondents experienced sexual harassment, especially in the form of sexist jokes, flirtation and unwanted compliments on their dress or figure. On average, 40% of the respondents, especially women (p sexual harassment to someone (p sexual harassment were embarassment (reported by 24.0%), anger (by 23.4%) and frustration (20.8%). Psychological abuse, discrimination on the basis of gender and sexual harassment are commonly experienced by residents in training programs. A direct, progressive, multidisciplinary approach is needed to label and address these problems.

76 FR 31217 - Single Family Housing Guaranteed Loan Program

Science.gov (United States)

2011-05-31

... Farm Service Agency 7 CFR Part 1980 RIN 0575-AC83 Single Family Housing Guaranteed Loan Program... the Rural Housing Service (RHS) Section 502 Single Family Housing Guaranteed Loan Program (SFHGLP) by eliminating the lender's published Department of Veterans Affairs (VA) rate for first mortgage loans with no...

Developing an integrated evidence-based medicine curriculum for family medicine residency at the University of Alberta.

Science.gov (United States)

Allan, G Michael; Korownyk, Christina; Tan, Amy; Hindle, Hugh; Kung, Lina; Manca, Donna

2008-06-01

There is general consensus in the academic community that evidence-based medicine (EBM) teaching is essential. Unfortunately, many postgraduate programs have significant weakness in their EBM programs. The Family Medicine Residency committee at the University of Alberta felt their EBM curriculum would benefit from critical review and revision. An EBM Curriculum Committee was created to evaluate previous components and develop new strategies as needed. Input from stakeholders including faculty and residents was sought, and evidence regarding the teaching and practical application of EBM was gathered. The committee drafted goals and objectives, the primary of which were to assist residents to (1) become competent self-directed, lifelong learners with skills to effectively and efficiently keep up to date, and 2) develop EBM skills to solve problems encountered in daily practice. New curriculum components, each evidence based, were introduced in 2005 and include a family medicine EBM workshop to establish basic EBM knowledge; a Web-based Family Medicine Desktop promoting easier access to evidence-based Internet resources; a brief evidence-based assessment of the research project enhancing integration of EBM into daily practice; and a journal club to support peer learning and growth of rapid appraisal skills. Issues including time use, costs, and change management are discussed. Ongoing evaluation of the curriculum and its components is a principal factor of the design, allowing critical review and adaptation of the curriculum. The first two years of the curriculum have yielded positive feedback from faculty and statistically significant improvement in multiple areas of residents' opinions of the curriculum and comfort with evidence-based practice.

Striving for work-life balance: effect of marriage and children on the experience of 4402 US general surgery residents.

Science.gov (United States)

Sullivan, Michael C; Yeo, Heather; Roman, Sanziana A; Bell, Richard H; Sosa, Julie A

2013-03-01

To determine how marital status and having children impact US general surgical residents' attitudes toward training and personal life. There is a paucity of research describing how family and children affect the experience of general surgery residents. Cross-sectional survey involving all US categorical general surgery residents. Responses were evaluated by resident/program characteristics. Statistical analysis included the χ test and hierarchical logistic regression modeling. A total of 4402 residents were included (82.4% response rate) and categorized as married, single, or other (separated/divorced/widowed). Men were more likely to be married (57.8% vs 37.9%, P work (P work (P work hours caused strain on family life (P work (P = 0.001), were happy at work (P = 0.001), and reported a good program fit (P = 0.034), but had strain on family life (P work [odds ratio (OR): 1.22, P = 0.035], yet feeling that work caused family strain (OR: 1.66, P work (OR: 0.81, P = 0.007). Residents who were married or parents reported greater satisfaction and work-life conflict. The complex effects of family on surgical residents should inform programs to target support mechanisms for their trainees.

A Structural Approach to Unresolved Mourning in Single Parent Family Systems.

Science.gov (United States)

Fulmer, Richard H.

1983-01-01

Considers the mother's depression as a special problem in therapy of single-parent families, resulting from unresolved mourning maintained by the family system. Offers reasons why the single-parent family's structure seems inherently vulnerable to unresolved mourning. Suggests techniques of Structural Family Therapy to facilitate mourning in such…

Effectiveness of a Formal Mentorship Program in Family Medicine Residency: The Residents’ Perspective

Directory of Open Access Journals (Sweden)

Marie Andrades

2013-01-01

Full Text Available Introduction. Mentoring is a recognized form of teaching learning strategy in postgraduate medical education. This paper describes the effectiveness of a formal mentorship program from the residents’ perspective after a year of implementation. Methods. The Aga Khan University Family Medicine Residency Program is the first program in Pakistan to our knowledge to implement formal mentorship for all four years of residency. A mentorship program was developed, implemented, and evaluated a year later using a rating scale. The 10-point Likert scale consisted of questions on academics, clinical work, research, administrative issues, and personal/social issues. Results. The response rate was 95% (. Eighty percent ( were women. Satisfaction level in seeking help was the highest for academics (75%. Residents scored mentorship as low in helping to tackle their personal problems (20%. Barriers reported in rapport building with mentor were time constraints and gender difference. The most useful attributes of the mentor which helped rapport building were accessibility, active listening, support for emotional needs, and trustworthiness. Conclusion. Mentoring has a role in trainees’ personal and professional growth especially when their needs are addressed. The effectiveness of the mentorship program in residency can improve if the residents are allowed to choose their own mentors.

What Health and Aged Care Culture Change Models Mean for Residents and Their Families: A Systematic Review.

Science.gov (United States)

Petriwskyj, Andrea; Parker, Deborah; Brown Wilson, Christine; Gibson, Alexandra

2016-04-01

A range of commercialized programs are increasingly being adopted which involve broad culture change within care organizations to implement person-centered care. These claim a range of benefits for clients; however, the published evidence for client and family outcomes from culture change is inconclusive and the evidence for these specific models is difficult to identify. The purpose of this review was to identify and evaluate the peer-reviewed evidence regarding consumer outcomes for these subscription-based models. The review followed the Joanna Briggs Institute procedure. The review considered peer-reviewed literature that reported on studies conducted with health and aged care services, their staff, and consumers, addressed subscription-based person-centered culture change models, and were published in English up to and including 2015. The review identified 19 articles of sufficient quality that reported evidence relating to consumer outcomes and experience. Resident outcomes and family and resident satisfaction and experiences were mixed. Findings suggest potential benefits for some outcomes, particularly related to quality of life and psychiatric symptoms, staff engagement, and functional ability. Although residents and families identified some improvements in residents' lives, both also identified problematic aspects of the change related to staff adjustment and staff time. Outcomes for these models are at best comparable with traditional care with limited suggestions that they result in poorer outcomes and sufficient potential for benefits to warrant further investigation. Although these models may have the potential to benefit residents, the implementation of person-centered principles may affect the outcomes. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Methodology and assumptions for evaluating heating and cooling energy requirements in new single-family residential buildings: Technical support document for the PEAR (Program for Energy Analysis of Residences) microcomputer program

Energy Technology Data Exchange (ETDEWEB)

Huang, Y.J.; Ritschard, R.; Bull, J.; Byrne, S.; Turiel, I.; Wilson, D.; Hsui, C.; Foley, D.

1987-01-01

This report provides technical documentation for a software package called PEAR (Program for Energy Analysis of Residences) developed by LBL. PEAR offers an easy-to-use and accurate method of estimating the energy savings associated with various energy conservation measures used in site-built, single-family homes. This program was designed for use by non-technical groups such as home builders, home buyers or others in the buildings industry, and developed as an integral part of a set of voluntary guidelines entitled Affordable Housing Through Energy Conservation: A Guide to Designing and Constructing Energy Efficient Homes. These guidelines provide a method for selecting and evaluating cost-effective energy conservation measures based on the energy savings estimated by PEAR. This work is part of a Department of Energy program aimed at conducting research that will improve the energy efficiency of the nation's stock of conventionally-built and manufactured homes, and presenting the results to the public in a simplified format.

Preparing Residents for Teaching Careers: The Faculty for Tomorrow Resident Workshop.

Science.gov (United States)

Lin, Steven; Gordon, Paul

2017-03-01

Progress toward growing the primary care workforce is at risk of being derailed by an emerging crisis: a critical shortage of family medicine faculty. In response to the faculty shortage, the Society of Teachers of Family Medicine (STFM) launched a 2-year initiative called "Faculty for Tomorrow" (F4T). The F4T Task Force created a workshop designed to increase residents' interest in, and prepare them for, careers in academic family medicine. We aimed to evaluate the effectiveness of this workshop. Participants were family medicine residents who preregistered for and attended the F4T Resident Workshop at the 2016 STFM Annual Spring Conference. The intervention was a full-day, 9-hour preconference workshop delivered by a multi-institutional faculty team. Participants were asked to complete a questionnaire before and immediately after the workshop. Data collected included demographics, residency program characteristics, future career plans, self-reported confidence in skills, and general knowledge relevant to becoming faculty. A total of 75 participants attended the workshop. The proportion of those who were "extremely likely" to pursue a career in academic family medicine increased from 58% to 72%. Participants reported statistically significant improvements in their confidence in clinical teaching, providing feedback to learners, writing an effective CV, knowledge about the structure of academic family medicine, and knowledge about applying for a faculty position. The STFM F4T Resident Workshop was effective at increasing participants' interest in academic careers, as well as self-reported confidence in skills and knowledge relevant to becoming faculty. The data collected from participants regarding their career plans may inform future interventions.

Lifestyle medicine course for family medicine residents: preliminary assessment of the impact on knowledge, attitudes, self-efficacy and personal health.

Science.gov (United States)

Malatskey, Lilach; Bar Zeev, Yael; Tzuk-Onn, Adva; Polak, Rani

2017-09-01

The WHO estimates that by 2020 two-thirds of the diseases worldwide will be the result of unhealthy lifestyle habits. Less than half of primary care physician graduates feel prepared to give lifestyle behaviour counselling. Our objective was to evaluate the impact of lifestyle medicine (LM) course on self-reported knowledge, attitudes, self-efficacy and health behaviour of family medicine residents. Based on the Israeli syllabus for the study of LM, we delivered five face to face 20 H courses. Pre/post data were collected by knowledge, attitudes, self-efficacy and personal health survey: RESULTS: A total of 112 family medicine residents participated in one of the five courses, of which 91 (81.3%) filled both pre and post surveys. Participates showed an improvement in self-reported knowledge and capacity to manage patients in regard to smoking, weight management and physical activity. An improvement was noted in personal health behaviour of overweight participant's in regard to self-reported physical activity. A comprehensive LM syllabus based course has a positive impact on family medicine residents LM counselling abilities. We suggest that LM course should be considered as a potential permanent addition to the family medicine residency programme. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A Look at the Single Parent Family: Implications for the School Psychologist.

Science.gov (United States)

Burns, Christine W.; Brassard, Marla R.

1982-01-01

Reviews the effects on parents and children of living in a single parent family, and suggests ways in which school psychologists can aid schools and single parent families. Presents school-based interventions for children and parents. Suggests changes in administrative policies to meet the needs of single parent families. (Author)

Family Conflict and Children's Self-Concepts: A Comparison of Intact and Single-Parent Families.

Science.gov (United States)

Raschke, Helen J.; Raschke, Vernon J.

1979-01-01

Using the Piers-Harris Children's Self-Concept Scale to measure self-concept, and self-reports for family structure and family conflict, no significant differences in self-concept scores of children from intact, single-parent, reconstituted, or other types of families were found. Self-concept scores were significantly lower for children reporting…

Results of chart reviews conducted to evaluate primary care patients seen by second and third year family medicine residents for potential adverse polypharmacy

Directory of Open Access Journals (Sweden)

Chang LF

2007-06-01

Full Text Available Objective: To determine the prescribing patterns of family medicine residents for patients aged more than 60 years with 2 or more chronic diseases and seen at least twice in a 12 month timeframe.Methods: This is a descriptive analysis which was based on chart reviews. The setting was the University of Illinois-Rockford Family Practice Residency. Patients aged 60 years with 2 or more chronic diseases who were seen at least twice by second and third year residents.Results: Findings from this chart review include: 28.8% of the prescribed medications were not effective for the documented condition, 26.3% of the prescribed doses were incorrect, and 44.5% of the drugs prescribed were not the least expensive alternative.Discussion: This preliminary study suggests a need for a focused intervention with family medicine residents regarding inappropriate polypharmacy issues with older patients.

Impact of family and gender on career goals: results of a national survey of 4586 surgery residents.

Science.gov (United States)

Viola, Kate V; Bucholz, Emily; Yeo, Heather; Piper, Crystal L; Piper, Crystal; Bell, Richard H; Sosa, Julie Ann

2010-05-01

To determine how marriage, children, and gender influence US categorical general surgery residents' perceptions of their profession and motivations for specialty training. Cross-sectional national survey administered after the January 2008 American Board of Surgery In-service Training Examination. Two hundred forty-eight US general surgery residency programs. All US categorical general surgery residents. We evaluated demographic characteristics with respect to survey responses using the chi(2) test, analysis of variance, and multivariate logistic regression. Interaction terms between variables were assessed. Perceptions of respondents regarding the future of general surgery and the role of specialty training in relation to anticipated income and lifestyle. The survey response rate was 75.0% (4586 respondents). Mean age was 30.6 years; 31.7% were women, 51.3% were married, and 25.4% had children. Of the respondents, 28.7% believed general surgery is becoming obsolete (30.1% of men and 25.9% of women; P = .004), and 55.1% believed specialty training is necessary for success (56.4% of men and 52.7% of women; P = .02). Single residents and residents without children were more likely to plan for fellowship (59.1% single vs 51.9% married, P Marital status, children, and gender appear to have a powerful effect on general surgery residents' career planning.

Two-year outcomes of the Early Risers prevention trial with formerly homeless families residing in supportive housing.

Science.gov (United States)

Gewirtz, Abigail H; DeGarmo, David S; Lee, Susanne; Morrell, Nicole; August, Gerald

2015-04-01

This article reports 2-year outcomes from a cluster randomized, controlled trial of the Early Risers (ER) program implemented as a selective preventive intervention in supportive housing settings for homeless families. Based on the goals of this comprehensive prevention program, we predicted that intervention participants receiving ER services would show improvement in parenting and child outcomes relative to families in treatment-as-usual sites. The sample included 270 children in 161 families, residing in 15 supportive housing sites; multimethod, multi-informant assessments conducted at baseline and yearly thereafter included parent and teacher report of child adjustment, parent report of parenting self-efficacy, and parent-child observations that yielded scores of effective parenting practices. Data were modeled in HLM7 (4-level model accounting for nesting of children within families and families within housing sites). Two years' postbaseline, intent-to-treat (ITT) analyses indicated that parents in the ER group showed significantly improved parenting self-efficacy, and parent report indicated significant reductions in ER group children's depression. No main effects of ITT were shown for observed parenting effectiveness. However, over time, average levels of parenting self-efficacy predicted observed effective parenting practices, and observed effective parenting practices predicted improvements in both teacher- and parent-report of child adjustment. This is the first study to our knowledge to demonstrate prevention effects of a program for homeless families residing in family supportive housing. (c) 2015 APA, all rights reserved).

Motherhood during residency training: challenges and strategies.

Science.gov (United States)

Walsh, Allyn; Gold, Michelle; Jensen, Phyllis; Jedrzkiewicz, Michelle

2005-07-01

To determine what factors enable or impede women in a Canadian family medicine residency program from combining motherhood with residency training. To determine how policies can support these women, given that in recent decades the number of female family medicine residents has increased. Qualitative study using in-person interviews. McMaster University Family Medicine Residency Program. Twenty-one of 27 family medicine residents taking maternity leave between 1994 and 1999. Semistructured interviews. The research team reviewed transcripts of audiotaped interviews for emerging themes; consensus was reached on content and meaning. NVIVO software was used for data analysis. Long hours, unpredictable work demands, guilt because absences from work increase workload for colleagues, and residents' high expectations of themselves cause pregnant residents severe stress. This stress continues upon return to work; finding adequate child care is an added stress. Residents report receiving less support from colleagues and supervisors upon return to work; they associate this with no longer being visibly pregnant. Physically demanding training rotations put additional strain on pregnant residents and those newly returned to work. Flexibility in scheduling rotations can help accommodate needs at home. Providing breaks, privacy, and refrigerators at work can help maintain breastfeeding. Allowing residents to remain involved in academic and clinical work during maternity leave helps maintain clinical skills, build new knowledge, and promote peer support. Pregnancy during residency training is common and becoming more common. Training programs can successfully enhance the experience of motherhood during residency by providing flexibility at work to facilitate a healthy balance among the competing demands of family, work, and student life.

Agricultural and residential pesticides in wipe samples from farmworker family residences in North Carolina and Virginia.

OpenAIRE

Quandt, Sara A; Arcury, Thomas A; Rao, Pamela; Snively, Beverly M; Camann, David E; Doran, Alicia M; Yau, Alice Y; Hoppin, Jane A; Jackson, David S

2004-01-01

Children of farmworkers can be exposed to pesticides through multiple pathways, including agricultural take-home and drift as well as residential applications. Because farmworker families often live in poor-quality housing, the exposure from residential pesticide use may be substantial. We measured eight locally reported agricultural pesticides and 13 pesticides commonly found in U.S. houses in residences of 41 farmworker families with at least one child < 7 years of age in western North Caro...

Family cohesion moderates the relationship between acculturative stress and depression in Japanese adolescent temporary residents.

Science.gov (United States)

Roley, Michelle E; Kawakami, Ryoko; Baker, Jessica; Hurtado, Gabriela; Chin, Andrew; Hovey, Joseph D

2014-12-01

Acculturative stress is a risk factor for depression, and may be important in the risk for depression among acculturating Japanese adolescents. However, little to no research has been published on the mental health of acculturating Japanese adolescents. Further, although family cohesion has been shown to be protective against depression across ethnic groups, no prior research has examined family cohesion as a protective factor for Japanese adolescents. To examine these relationships, 26 Japanese temporary resident adolescents and 76 parents in the Midwest were recruited to participate. Moderate to strong correlations between acculturative stress, depression, likelihood for and seriousness of family conflict were found. A regression analysis found that likelihood for family conflict moderated the relationship between acculturative stress and depression. Findings broaden our understanding of the role of acculturative stress and family conflict on depression risk for Japanese adolescent immigrants.

Modification Effects of Family Economic Status and School Factors on Depression Risk of Single-Father Family Children in Mid-Taiwan Area

Science.gov (United States)

Lin, Jin-Ding; Hsieh, Yu-Hsin; Lin, Fu-Gong

2013-01-01

The incidence of single-parent families has increased significantly in Taiwan in recent years. Children born in single-parent families are predisposed to suffering from emotional problems. We aimed to determine if the children of single-parent families are more depressive than children from both-parent families, and to examine the individual and…

Perceptions of Personal and Familial Adjustment by Children from Intact, Single-Parent, and Reconstituted Families.

Science.gov (United States)

Nunn, Gerald D.; And Others

1983-01-01

Investigated children's (N=566) personal and familial adjustment as a function of familial configuration and gender. The results revealed less positive adjustment among children from divorced families. Males appeared to be favorably affected within the single-parent configuration, while females were more favorably adjusted within the reconstituted…

Support for and aspects of use of educational games in family medicine and internal medicine residency programs in the US: a survey

OpenAIRE

Wilson Mark C; Mustafa Reem; Gunukula Sameer; Akl Elie A; Symons Andrew; Moheet Amir; Schünemann Holger J

2010-01-01

Abstract Background The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States. Methods We conducted a survey of family medicine and internal medicine residency program directors in the United Stat...

Activities pattern of planned settlement’s residence and its influence toward settlement design

Science.gov (United States)

Nirfalini Aulia, Dwira

2018-03-01

Everyday activity of residents in a housing area will create activities pattern. Utilization of public spaces in a housing area with repeating activities pattern will affect the design of public spaces. Changes in public space usage in a housing area happen as a result of residents’ activities pattern. The goal of this paper is to identify residents’ activity pattern and connect its influence towards public spaces utilization in planned housing in micro and urban area in macro. Housing residents classified into four respondent groups based on marriage status which is unmarried, single parents, the family without child and family with a child. The method used in this research is the qualitative descriptive approach. Research finding showed that housing area with housing facilities capable of creating happiness and convenience for its residents doing their activities in public spaces.

Single Family Loan Sale Initiative - National Offering

Data.gov (United States)

Department of Housing and Urban Development — The FHA Office of Housing is conducting a series of mortgage loan sales under the Single Family Loan Sale (SFLS) Initiative. The current sales structure consists of...

Understanding the design and economics of distributed tri-generation systems for home and neighborhood refueling - Part I: Single family residence case studies

Energy Technology Data Exchange (ETDEWEB)

Li, Xuping; Ogden, Joan M. [University of California, Davis, One Shields Avenue, Davis, CA 95616 (United States)

2011-02-15

The potential benefits of hydrogen as a transportation fuel will not be achieved until hydrogen vehicles capture a substantial market share. However, although hydrogen fuel cell vehicle (FCV) technology has been making rapid progress, the lack of a hydrogen infrastructure remains a major barrier for FCV adoption and commercialization. The high cost of building an extensive hydrogen station network and the foreseeable low utilization in the near term discourages private investment. Based on the past experience of fuel infrastructure development for motor vehicles, innovative, distributed, small-volume hydrogen refueling methods may be required to refuel FCVs in the near term. Among small-volume refueling methods, home and neighborhood tri-generation systems (systems that produce electricity and heat for buildings, as well as hydrogen for vehicles) stand out because the technology is available and has potential to alleviate consumer's fuel availability concerns. In addition, it has features attractive to consumers such as convenience and security to refuel at home or in their neighborhood. The objective of this paper is to provide analytical tools for various stakeholders such as policy makers, manufacturers and consumers, to evaluate the design and the technical, economic, and environmental performances of tri-generation systems for home and neighborhood refueling. An interdisciplinary framework and an engineering/economic model is developed and applied to assess home tri-generation systems for single family residences (case studies on neighborhood systems will be provided in a later paper). Major tasks include modeling yearly system operation, exploring the optimal size of a system, estimating the cost of electricity, heat and hydrogen, and system CO{sub 2} emissions, and comparing the results to alternatives. Sensitivity analysis is conducted, and the potential impacts of uncertainties in energy prices, capital cost reduction (or increase), government

Understanding the design and economics of distributed tri-generation systems for home and neighborhood refueling - Part I: Single family residence case studies

International Nuclear Information System (INIS)

Li, Xuping; Ogden, Joan M.

2011-01-01

The potential benefits of hydrogen as a transportation fuel will not be achieved until hydrogen vehicles capture a substantial market share. However, although hydrogen fuel cell vehicle (FCV) technology has been making rapid progress, the lack of a hydrogen infrastructure remains a major barrier for FCV adoption and commercialization. The high cost of building an extensive hydrogen station network and the foreseeable low utilization in the near term discourages private investment. Based on the past experience of fuel infrastructure development for motor vehicles, innovative, distributed, small-volume hydrogen refueling methods may be required to refuel FCVs in the near term. Among small-volume refueling methods, home and neighborhood tri-generation systems (systems that produce electricity and heat for buildings, as well as hydrogen for vehicles) stand out because the technology is available and has potential to alleviate consumer's fuel availability concerns. In addition, it has features attractive to consumers such as convenience and security to refuel at home or in their neighborhood. The objective of this paper is to provide analytical tools for various stakeholders such as policy makers, manufacturers and consumers, to evaluate the design and the technical, economic, and environmental performances of tri-generation systems for home and neighborhood refueling. An interdisciplinary framework and an engineering/economic model is developed and applied to assess home tri-generation systems for single family residences (case studies on neighborhood systems will be provided in a later paper). Major tasks include modeling yearly system operation, exploring the optimal size of a system, estimating the cost of electricity, heat and hydrogen, and system CO 2 emissions, and comparing the results to alternatives. Sensitivity analysis is conducted, and the potential impacts of uncertainties in energy prices, capital cost reduction (or increase), government incentives and

Adolescents’ Self-Esteem in Single and Two-Parent Families

Science.gov (United States)

Alami, Ali; Khosravan, Shahla; Sadegh Moghadam, Leila; Pakravan, Fateme; Hosseni, Fateme

2014-01-01

Background: Self-esteem is one of the basic needs for all individuals especially in adolescence. The aim of this study was to determine associations between adolescents’ self-esteem and perceived maternal parenting styles as well as its dimensions in terms of family type. Methods: In this analytic cross-sectional study, 356 high school students (250 two-parent nuclear family and 106 single-parent family) participated and filled out the Coppersmith self-esteem and the Robinson and colleagues (2001) perceived parenting styles questionnaires. Data were analyzed by SPSS software, version 18. To assess the relationship between participants’ self-esteem and parenting styles and dimensions, Mantel–Haenszel Chi-square test was used to adjust the effect of potential confounder variables. P≤0.05 was considered statistically significant. Results: From a total of 370 questionnaires, 356 questionnaires were completed. The mean±SD of the participants’ self-esteem score was 38.49±6.55. Mean±SD of self-esteem score among the two-parent and single-parent students was 39.06±6.36 and 37.42±7.28, respectively (P=0.034). Dominant parenting style in both families was authoritative style. There were significant associations between the respondents’ self-esteem and their perceived parenting styles, after matching sex, family income, level of education, and parents job (Pparenting styles and improve self-esteem. Therefore, considering the relationship between child-rearing style and adolescent self-esteem, assessing other relating factors with adolescent self-esteem especially in single-parent family, such as father absence stigma, is suggested. PMID:25349847

Adolescents' self-esteem in single and two-parent families.

Science.gov (United States)

Alami, Ali; Khosravan, Shahla; Sadegh Moghadam, Leila; Pakravan, Fateme; Hosseni, Fateme

2014-04-01

Self-esteem is one of the basic needs for all individuals especially in adolescence. The aim of this study was to determine associations between adolescents' self-esteem and perceived maternal parenting styles as well as its dimensions in terms of family type. In this analytic cross-sectional study, 356 high school students (250 two-parent nuclear family and 106 single-parent family) participated and filled out the Coppersmith self-esteem and the Robinson and colleagues (2001) perceived parenting styles questionnaires. Data were analyzed by SPSS software, version 18. To assess the relationship between participants' self-esteem and parenting styles and dimensions, Mantel-Haenszel Chi-square test was used to adjust the effect of potential confounder variables. P≤0.05 was considered statistically significant. From a total of 370 questionnaires, 356 questionnaires were completed. The mean±SD of the participants' self-esteem score was 38.49±6.55. Mean±SD of self-esteem score among the two-parent and single-parent students was 39.06±6.36 and 37.42±7.28, respectively (P=0.034). Dominant parenting style in both families was authoritative style. There were significant associations between the respondents' self-esteem and their perceived parenting styles, after matching sex, family income, level of education, and parents job (Pparenting styles and improve self-esteem. Therefore, considering the relationship between child-rearing style and adolescent self-esteem, assessing other relating factors with adolescent self-esteem especially in single-parent family, such as father absence stigma, is suggested.

[Comparison of the factors influencing children's self-esteem between two parent families and single parent families].

Science.gov (United States)

Sok, Sohyune R; Shin, Sung Hee

2010-06-01

This study was done to compare factors influencing children's self-esteem between two parent families and single parent families. The participants were 692 children aged 11 to 13 yr (388 in two parent families and 304 in single parent families) recruited from 20 community agencies and 5 elementary schools in Gyeonggi Province and Seoul City, South Korea. Data were collected from May to July, 2007 using a survey questionnaire containing items on self-esteem, internal control, problematic behavior, school record, family hardiness, parent-child communication and social support. The data were analyzed using SPSS 15.0 program and factors affecting children's self-esteem were analyzed by stepwise multiple regression. Scores for the study variables were significantly different between the two groups. The factors influencing children's self-esteem were also different according to family type. For two parent families, internal control, problematic behavior, school record, and parent-child communication significantly predicted the level of self-esteem (adjusted R(2)=.505, psingle parent families, social support, family hardiness, internal control, problematic behavior, school record, and parent-child communication significantly predicted the level of self-esteem (adjusted R(2)=.444, p<.001). Nurse working with children should consider family type-specific factors influencing their self-esteem.

Resident partnerships: an effective strategy for training in primary care.

Science.gov (United States)

Adam, P; Williamson, H A; Zweig, S C; Delzell, J E

1997-06-01

To facilitate resident training in the ambulatory setting, a few family practice residency programs use a partnership system to train residents. Partnerships are pairs of residents from the same year that rotate together on inpatient services. We identified and characterized the advantages and disadvantages of partnership programs in family practice residencies. We conducted a national survey of family practice residencies, followed by phone interviews with residency directors of programs with partnerships. A total of 305 of 407 (75%) residencies responded; 10 programs fit our definition of partnership. Program directors were positive about resident partnerships. Benefits included improved outpatient continuity, enhanced medical communication skills, and emotional and intellectual support. Disadvantages were decreased inpatient exposure and difficulty coordinating residents' schedules. Directors were favorable about partnerships, which seem to be an underutilized technique to improve residency training.

Family strengths, motivation, and resources as predictors of health promotion behavior in single-parent and two-parent families.

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Ford-Gilboe, M

1997-06-01

The extent to which selected aspects of family health potential (strengths, motivation, and resources) predicted health work (health-related problem-solving and goal attainment behaviors) was examined in a Canadian sample of 138 female-headed single-parent families and two-parent families. The mother and one child (age 10-14) each completed mailed self-report instruments to assess the independent variables of family cohesion, family pride, mother's non-traditional sex role orientation, general self-efficacy, internal health locus of control, network support, community support, and family income, as well as the dependent variable, health work. With the effects of mothers' education held constant, the independent variables predicted 22 to 27% of the variance in health work in the total sample and each family type. Family cohesion was the most consistent predictor of health work, accounting for 8 to 13% of the variance. The findings challenge existing problem-oriented views of single-parent families by focusing on their potential to engage in health promotion behavior.

Resident cross-cultural training, satisfaction, and preparedness.

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Frintner, Mary Pat; Mendoza, Fernando S; Dreyer, Benard P; Cull, William L; Laraque, Danielle

2013-01-01

To describe the diversity of pediatric residents and examine relationships of cross-cultural training experiences with training satisfaction, perceived preparedness for providing culturally effective care, and attitudes surrounding care for underserved populations. A cross-sectional survey was conducted of a national random sample of graduating pediatric residents and an additional sample of minority residents. Using weighted analysis, we used multivariate regression to test for differences in satisfaction, preparedness, and attitudes between residents with more and less cross-cultural experiences during residency, controlling for residents' characteristics and experiences before training. The survey response rate was 57%. Eleven percent were Hispanic, 61% white, 21% Asian, 9% African American, 9% other racial/ethnic groups; 34% grew up in a bi- or multilingual family. Ninety-three percent of residents were satisfied with their residency training, 81% with the instruction they received on health and health care disparities, and 54% on global health issues. Ninety-six percent of residents felt they were prepared to care for patients from diverse backgrounds, but fewer felt prepared to care for families with beliefs at odds with Western medicine (49%) and families who receive alternative or complementary care (37%). Residents with more cross-cultural experiences during residency reported being better prepared than those with less experience to care for families with limited English proficiency (adjusted odds ratio [aOR] 2.11; 95% confidence interval [CI] 1.40-3.17), new immigrants (aOR 1.91; 95% CI 1.32-2.75), and with religious beliefs that might affect clinical care (aOR 1.62; 95% CI 1.13-2.32). Pediatric residents begin their training with diverse cross-cultural backgrounds and experiences. Residency experiences in cross-cultural care contribute to feelings of preparedness to care for diverse US children. Copyright © 2013 Academic Pediatric Association. Published

Support for and aspects of use of educational games in family medicine and internal medicine residency programs in the US: a survey.

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Akl, Elie A; Gunukula, Sameer; Mustafa, Reem; Wilson, Mark C; Symons, Andrew; Moheet, Amir; Schünemann, Holger J

2010-03-25

The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States. We conducted a survey of family medicine and internal medicine residency program directors in the United States. The questionnaire asked the program directors whether they supported the use of educational games, their actual use of games, and the type of games being used and the purpose of that use. Of 434 responding program directors (52% response rate), 92% were in support of the use of games as an educational strategy, and 80% reported already using them in their programs. Jeopardy like games were the most frequently used games (78%). The use of games was equally popular in family medicine and internal medicine residency programs and popularity was inversely associated with more than 75% of residents in the program being International Medical Graduates. The percentage of program directors who reported using educational games as teaching tools, review tools, and evaluation tools were 62%, 47%, and 4% respectively. Given a widespread use of educational games in the training of medical residents, in spite of limited evidence for efficacy, further evaluation of the best approaches to education games should be explored.

Support for and aspects of use of educational games in family medicine and internal medicine residency programs in the US: a survey

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Wilson Mark C

2010-03-01

Full Text Available Abstract Background The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States. Methods We conducted a survey of family medicine and internal medicine residency program directors in the United States. The questionnaire asked the program directors whether they supported the use of educational games, their actual use of games, and the type of games being used and the purpose of that use. Results Of 434 responding program directors (52% response rate, 92% were in support of the use of games as an educational strategy, and 80% reported already using them in their programs. Jeopardy like games were the most frequently used games (78%. The use of games was equally popular in family medicine and internal medicine residency programs and popularity was inversely associated with more than 75% of residents in the program being International Medical Graduates. The percentage of program directors who reported using educational games as teaching tools, review tools, and evaluation tools were 62%, 47%, and 4% respectively. Conclusions Given a widespread use of educational games in the training of medical residents, in spite of limited evidence for efficacy, further evaluation of the best approaches to education games should be explored.

Parent-Child Relationships in Nondivorced, Divorced Single-Mother, and Remarried Families.

Science.gov (United States)

Hagan, Margaret Stanley; And Others

1992-01-01

Over time, mother-child relationships in families with remarried mothers grew increasingly similar to those in families whose parents had never divorced. Relationships in single-mother families remained different from those in the other two types of families. Stepfathers were less likely to be authoritative than were nondivorced fathers. (BC)

Geriatrics Curricula for Internal and Family Medicine Residents: Assessing Study Quality and Learning Outcomes.

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Cheng, Huai Yong; Davis, Molly

2017-02-01

Prior reviews of geriatrics curricula for internal medicine (IM) and family medicine (FM) residents have not evaluated study quality or assessed learning objectives or specific IM or FM competencies. This review of geriatrics curricula for IM and FM residents seeks to answer 3 questions: (1) What types of learning outcomes were measured? (2) How were learning outcomes measured? and (3) What was the quality of the studies? We evaluated geriatrics curricula that reported learning objectives or competencies, teaching methods, and learning outcomes, and those that used a comparative design. We searched PubMed and 4 other data sets from 2003-2015, and assessed learning outcomes, outcome measures, and the quality of studies using the Medical Education Research Study Quality Instrument (MERSQI) and Best Evidence Medical Education (BEME) methods. Fourteen studies met inclusion criteria. Most curricula were intended for IM residents in the inpatient setting; only 1 was solely dedicated to FM residents. Median duration was 1 month, and minimum geriatrics competencies covered were 4. Learning outcomes ranged from Kirkpatrick levels 1 to 3. Studies that reported effect size showed a considerable impact on attitudes and knowledge, mainly via pretests and posttests. The mean MERSQI score was 10.5 (range, 8.5-13) on a scale of 5 (lowest quality) to 18 (highest quality). Few geriatrics curricula for IM and FM residents that included learning outcome assessments were published recently. Overall, changes in attitudes and knowledge were sizeable, but reporting was limited to low to moderate Kirkpatrick levels. Study quality was moderate.

Adolescents’ Self-Esteem in Single and Two-Parent Families

OpenAIRE

Alami, Ali; Khosravan, Shahla; Sadegh Moghadam, Leila; Pakravan, Fateme; Hosseni, Fateme

2014-01-01

Background: Self-esteem is one of the basic needs for all individuals especially in adolescence. The aim of this study was to determine associations between adolescents’ self-esteem and perceived maternal parenting styles as well as its dimensions in terms of family type. Methods: In this analytic cross-sectional study, 356 high school students (250 two-parent nuclear family and 106 single-parent family) participated and filled out the Coppersmith self-esteem and the Robinson and colleagues (...

Anxiety and depression levels among multidisciplinary health residents

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Daniela Salvagni Rotta

2016-01-01

Full Text Available Objective: to assess symptoms of anxiety and depression of professionals of Multidisciplinary Health Residence Programs. Methods: this is a cross-sectional study, performed with fifty professionals, using three instruments: one for socioeconomic and demographic data, and the Beck’s Anxiety and Depression Scale. Results: predominance of females (92.0%, average age 26 years old, single (88.0%, family income from two to five salaries (56.0% satisfied with the work (82.0% and thought about quitting the program (56.0% showed anxiety (50.0% and depression (28.0%. Conclusion: there was an association between anxiety and depression in multidisciplinary residents, which points to the need for rethinking strategies for identifying these symptoms and control of stress factors for the promotion of mental health.

Depression and quality of life for women in single-parent and nuclear families.

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Landero Hernández, René; Estrada Aranda, Benito; González Ramírez, Mónica Teresa

2009-05-01

This is a cross-sectional study which objectives are 1) to determine the predictors for perceived quality of life and 2) to analyze the differences between women from single-parent families and bi-parent families, about their quality of life, depression and familiar income. We worked with a non-probabilistic sample of 140 women from Monterrey, N.L, Mexico, 107 are from bi-parent families and 33 from single parent families. Some of the results show that women from single-parent families have lower quality of life (Z = -2.224, p = .026), lower income (Z = -2.727, p = .006) and greater depression (Z = -6.143, p = .001) than women from bi-parental families. The perceived quality of life's predictors, using a multiple regression model (n = 140) were depression, income and number of children, those variables explaining 25.4% of variance.

Beyond Family-Friendly: The Construct and Measurement of Singles-Friendly Work Culture

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Casper, Wendy J.; Weltman, David; Kwesiga, Eileen

2007-01-01

Although research has examined work-family issues and organizational support for employees' family responsibilities, few studies have explored the work-life issues of single employees without children. The current study examines single employees' perceptions of how their organizations support their work-life balance in comparison to employees with…

Post-divorce custody arrangements and binuclear family structures of Flemish adolescents

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An Katrien Sodermans

2013-03-01

Full Text Available BACKGROUND Because of the tendency towards equal parental rights in post-divorce custody decisions, the number of children living partially in two households after divorce has increased. Because of this evolution, traditional family typologies have been challenged. OBJECTIVE In this study, we want to describe the post-divorce custody arrangements and family configurations of Flemish adolescents (between 12 and 18 years old. METHODS We use four waves of the Leuven Adolescents and Families Study, a yearly survey in which adolescents are questioned at school about their family life, family relationships and various dimensions of their wellbeing. Our research sample consists of 1525 adolescents who experienced a parental break-up. First, we present information on the proportion of adolescents in different custody arrangements, according to divorce cohort, age and sex. Next, we describe post-divorce family configurations, according to the custody arrangement and different criteria of co-residence between children and step-parents. RESULTS We observe a higher proportion of adolescents spending at least 33Š of time in both parental households (shared residence for more recent divorce cohorts. A large proportion of adolescents is living with a new partner of the mother or father, but there are important differences, according to the criteria used to define stepfamily configurations. CONCLUSIONS The relatively high incidence figures of children in shared residence challenge the current dichotomous post-divorce family concept in terms of single parent families and stepfamilies. Family typologies applying a binuclear perspective are therefore increasingly meaningful and necessary. In addition, shared residence increases the chance of co-residence with at least one step-parent, and increases the proportion of children with a part-time residential stepmother.

Pharmacist-Physician Collaboration at a Family Medicine Residency Program: A Focus Group Study

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Keri Hager

2018-02-01

Full Text Available Background: In response to transforming healthcare and pursuit of the Triple Aim, many health systems have added team members to expand the capabilities and effectiveness of the team to facilitate these aims. The objective of this study was to explore knowledge and perceptions of pharmacist-physician collaboration among family medicine residents (FMR, family medicine faculty (FMF, and pharmacist faculty and residents in a practice where clinical pharmacy services were relatively new. Understanding the nuances of pharmacist-physician interactions will provide insight into how to improve FMR education to prepare learners for patient-centered, team-based practice. Methods: An exploratory descriptive qualitative study design was used to articulate perceptions of professional roles and team-based care in an interprofessional family medicine community-based clinical practice. Five, 60-minute focus groups were conducted in a clinical training setting that focuses on preparing family medicine physicians for collaborative rural primary care practice. Results: Twenty-one FMRs, eight FMF, and six clinical pharmacists participated. Three themes emerged from the focus groups and were consistent across the groups: 1 roles of pharmacists recognized by physicians in different settings, 2 benefits to collaboration, and 3 keys to successful pharmacist-physician collaboration which include a developing the relationship, b optimizing communication, c creating beneficial clinical workflow, d clarifying roles and responsibilities, and e increasing opportunities for meaningful interactions. Conclusion: This study demonstrated that by co-locating physicians and pharmacists in the same environment, and providing a basic structure for collaboration, a collaborative working relationship can be initiated. Practices looking to have more effective collaborative working relationships should strive to increase the frequency of interactions of the professions, help the

Two families from New England with usher syndrome type IC with distinct haplotypes.

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DeAngelis, M M; McGee, T L; Keats, B J; Slim, R; Berson, E L; Dryja, T P

2001-03-01

To search for patients with Usher syndrome type IC among those with Usher syndrome type I who reside in New England. Genotype analysis of microsatellite markers closely linked to the USH1C locus was done using the polymerase chain reaction. We compared the haplotype of our patients who were homozygous in the USH1C region with the haplotypes found in previously reported USH1C Acadian families who reside in southwestern Louisiana and from a single family residing in Lebanon. Of 46 unrelated cases of Usher syndrome type I residing in New England, two were homozygous at genetic markers in the USH1C region. Of these, one carried the Acadian USH1C haplotype and had Acadian ancestors (that is, from Nova Scotia) who did not participate in the 1755 migration of Acadians to Louisiana. The second family had a haplotype that proved to be the same as that of a family with USH1C residing in Lebanon. Each of the two families had haplotypes distinct from the other. This is the first report that some patients residing in New England have Usher syndrome type IC. Patients with Usher syndrome type IC can have the Acadian haplotype or the Lebanese haplotype compatible with the idea that at least two independently arising pathogenic mutations have occurred in the yet-to-be identified USH1C gene.

Residents' perceptions of an integrated longitudinal curriculum: a qualitative study.

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Lubitz, Rebecca; Lee, Joseph; Hillier, Loretta M

2015-01-01

The purpose of this study was to explore family medicine residents' perceptions of a newly restructured integrated longitudinal curriculum. A purposeful sample of 16 family medicine residents participated in focus group interviews conducted from a grounded theory perspective to identify the characteristics of this training model that contribute to and that challenge learning. Eight key themes were identified: continuity of care, relevance to family medicine, autonomy, program-focused preparation, professional development as facilitated by role modeling, patient volume, clarity of expectations for learners, and logistics. Positive learning experiences were marked by high levels of autonomy, continuity, and relevance to family medicine. Less favorable learning experiences were characterized by limited opportunities for continuity of care, limited relevance to family medicine practice and unclear expectations for the resident's role. Family physician-led learning experiences contributed to residents' understanding of the full scope of family medicine practice, more so than specialist-led experiences. The logistics of implementing the integrated block were challenging and negatively impacted continuity and learning. This study suggests that an integrated longitudinalized family medicine block training model has the potential to support the principles of a longitudinal integrated competency-based curriculum to effectively prepare residents for family medicine practice.

Efficiency of single-family houses and harmonisation of their life cycle participants’ interests

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Nerija Kvederyte

2000-01-01

Full Text Available An efficient single-family house is the main purpose of the life cycle. It determines the necessity to evaluate various decisions of the life cycle of single-family houses and possibilities to satisfy objectives and requirements of the participants of that process. To design and achieve an effective process of the life cycle of a single-family house, it is necessary to take care of its efficiency starting from the determination of needs and objectives and ending with the usage of a building.

Rwandan family medicine residents expanding their training into South Africa: the use of South-South medical electives in enhancing learning experiences.

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Flinkenflögel, Maaike; Ogunbanjo, Gboyega; Cubaka, Vincent Kalumire; De Maeseneer, Jan

2015-08-01

International medical electives are well-accepted in medical education, with the flow of students generally being North-South. In this article we explore the learning outcomes of Rwandan family medicine residents who completed their final year elective in South Africa. We compare the learning outcomes of this South-South elective to those of North-South electives from the literature. In-depth interviews were conducted with Rwandan postgraduate family medicine residents who completed a 4-week elective in South Africa during their final year of training. The interviews were thematically analysed in an inductive way. The residents reported important learning outcomes in four overarching domains namely: medical, organisational, educational, and personal. The learning outcomes of the residents in this South-South elective had substantial similarities to findings in literature on learning outcomes of students from the North undertaking electives in the Southern hemisphere. Electives are a useful learning tool, both for Northern students, and students from universities in the South. A reciprocity-framework is needed to increase mutual benefits for Southern universities when students from the North come for electives. We suggest further research on the possibility of supporting South-South electives by Northern colleagues.

Perspectives about family meals from single-headed and dual-headed households: a qualitative analysis.

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Berge, Jerica M; Hoppmann, Caroline; Hanson, Carrie; Neumark-Sztainer, Dianne

2013-12-01

Cross-sectional and longitudinal research has shown that family meals are protective for adolescent healthful eating behaviors. However, little is known about what parents think of these findings and whether parents from single- vs dual-headed households have differing perspectives about the findings. In addition, parents' perspectives regarding barriers to applying the findings on family meals in their own homes and suggestions for more widespread adoption of the findings are unknown. The current study aimed to identify single- and dual-headed household parents' perspectives regarding the research findings on family meals, barriers to applying the findings in their own homes, and suggestions for helping families have more family meals. The current qualitative study included 59 parents who participated in substudy of two linked multilevel studies-EAT 2010 (Eating and Activity in Teens) and Families and Eating and Activity in Teens (F-EAT). Parents (91.5% female) were racially/ethnically and socioeconomically diverse. Data were analyzed using a grounded theory approach. Results from the current study suggest that parents from both single- and dual-headed households have similar perspectives regarding why family meals are protective for healthful eating habits for adolescents (eg, provides structure/routine, opportunities for communication, connection), but provide similar and different reasons for barriers to family meals (eg, single-headed=cost vs dual-headed=lack of creativity) and ideas and suggestions for how to increase the frequency of family meals (eg, single-headed=give fewer options vs dual-headed=include children in the meal preparation). Findings can help inform public health intervention researchers and providers who work with adolescents and their families to understand how to approach discussions regarding reasons for having family meals, barriers to carrying out family meals, and ways to increase family meals depending on family structure. Copyright �

Duration of residence and disease occurrence among refugees and family reunited immigrants: test of the 'healthy migrant effect' hypothesis.

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Norredam, Marie; Agyemang, Charles; Hoejbjerg Hansen, Oluf K; Petersen, Jørgen H; Byberg, Stine; Krasnik, Allan; Kunst, Anton E

2014-08-01

The 'healthy migrant effect' (HME) hypothesis postulates that health selection has a positive effect on migrants' health outcomes, especially in the first years after migration. We examined the potential role of the HME by assessing the association between residence duration and disease occurrence. We performed a historical prospective cohort study. We included migrants who obtained residence permits in Denmark between 1 January 1993 and 31 December 2010 (n = 114,331). Occurrence of severe conditions was identified through linkage to the Danish National Patient Register. Hazard Ratios (HRs) were modelled for disease incidence by residence duration since arrival (0-5 years; 0-10 years; 0-18 years) adjusting for age and sex. Compared with Danish-born individuals, refugees and family reunited immigrants had lower HRs of stroke and breast cancer within 5 years after arrival; however, HRs increased at longer follow-up. For example, HRs of stroke among refugees increased from 0.77 (95% CI: 0.66; 0.91) to 0.96 (95% CI: 0.88; 1.05). For ischaemic heart disease (IHD) and diabetes, refugees and family reunited migrants had higher HRs within 5 years after arrival, and most HRs had increased by end of follow-up. For example, HRs of IHD among family reunited migrants increased from 1.29 (95% CI: 1.17; 1.42) to 1.43 (95% CI: 1.39; 1.52). In contrast, HRs for TB and HIV/AIDS showed a consistent decrease over time. Our analyses of the effect of duration of residence on disease occurrence among migrants imply that, when explaining migrants' advantageous health outcomes, the ruling theory of the HME should be used with caution, and other explanatory models should be included. © 2014 John Wiley & Sons Ltd.

How Residents Learn From Patient Feedback: A Multi-Institutional Qualitative Study of Pediatrics Residents' Perspectives.

Science.gov (United States)

Bogetz, Alyssa L; Orlov, Nicola; Blankenburg, Rebecca; Bhavaraju, Vasudha; McQueen, Alisa; Rassbach, Caroline

2018-04-01

Residents may view feedback from patients and their families with greater skepticism than feedback from supervisors and peers. While discussing patient and family feedback with faculty may improve residents' acceptance of feedback and learning, specific strategies have not been identified. We explored pediatrics residents' perspectives of patient feedback and identified strategies that promote residents' reflection on and learning from feedback. In this multi-institutional, qualitative study conducted in June and July 2016, we conducted focus groups with a purposive sample of pediatrics residents after their participation in a randomized controlled trial in which they received written patient feedback and either discussed it with faculty or reviewed it independently. Focus group transcripts were audiorecorded, transcribed, and analyzed for themes using the constant comparative approach associated with grounded theory. Thirty-six of 92 (39%) residents participated in 7 focus groups. Four themes emerged: (1) residents valued patient feedback but felt it may lack the specificity they desire; (2) discussing feedback with a trusted faculty member was helpful for self-reflection; (3) residents identified 5 strategies faculty used to facilitate their openness to and acceptance of patient feedback (eg, help resident overcome emotional responses to feedback and situate feedback in the context of lifelong learning); and (4) residents' perceptions of feedback credibility improved when faculty observed patient encounters and solicited feedback on the resident's behalf prior to discussions. Discussing patient feedback with faculty provided important scaffolding to enhance residents' openness to and reflection on patient feedback.

Single-Family Houses That Meet The Future Energy Demands

DEFF Research Database (Denmark)

Rose, Jørgen; Svendsen, Svend

2002-01-01

). Before any further tightening of the regulations are introduced, however, it is necessary to illustrate the consequences of such actions with regard to finance, building technology, indoor climate and comfort. Therefore a series of investigations and experimental projects are being launched, in order...... to examine these consequences thoroughly. The department is presently contributing to this end by participating in quite a few investigative projects, where single-family houses are designed to meet the proposed future energy demands. This paper describes the results obtained from one such project where...... the department, in co-operation with a major building entrepreneur, has developed a single-family house that shows that there are no evident problems in meeting the future energy demands....

Supervisor continuity or co-location: Which matters in residency education? Findings from a qualitative study of remote supervisor family physicians in Australia and Canada

DEFF Research Database (Denmark)

Wearne, Susan M.; Wearne, Susan M.; Wearne, Susan M.

2015-01-01

but less overt components of residency education. Method Insights from sociocultural learning theory and work-based learning provided a theoretical framework. In 2011-2012, 16 family physicians in Australia and Canada were asked in-depth how they remotely supervised residents' work and learning......, and for their reflections on this experience. The verbatim interview transcripts and researchers' memos formed the data set. Template analysis produced a description and interpretation of remote supervision. Results Thirteen Australian family physicians from five states and one territory, and three Canadians from one...

Motivational readiness of children to school in nuclear and single parent families

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Kateryna Ostrovska

2015-12-01

Full Text Available The aim of the paper is a comparison of psychological readiness of the child to go to school in nuclear and single parent families. To obtain the objectives of the paper the following methods were used: 1 methods “Two schools” by L.A Venger to identify the level of formation of internal position of the student; 2 the method “Motivational research studies in older preschoolers” by M.R. Ginsburg; 3 method “Pattern” by L.I. Tsehanskaya to determine the degree of development of skills training activities; 4 method “Graphic dictation” by D. El’konin to study the ability to follow adult instructions. The investigated group consisted of 40 students from first grade secondary school - 20 students from nuclear families (12 girls and 8 boys and 20 students from single parent families (9 girls and 11 boys. As a result of qualitative, comparative and correlation analysis it was shown that readiness of children to go to school susbstantially depends on completness of their families. The children from families have a higher level of skill training and internal position than children from single parent families. This occurs because both parents pay more attention to the children in the forming of a willingness to learn in school. The studies have shown that in the group of children from nuclear families dominate the highest level of development of skills training activities, increased formation of internal positions and childrens social motivation. These indicators are the hallmarks of readiness to learn at school. Also, some recommendations to teachers are provided as for increase of motivation to learn in children from single parent families.

Feasibility of identifying families for genetic studies of birth defects using the National Health Interview Survey

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Nolan Vikki G

2004-05-01

Full Text Available Abstract Background The purpose of this study was to determine whether the National Health Interview Survey is a useful source to identify informative families for genetic studies of birth defects. Methods The 1994/1995 National Health Interview Survey (NHIS was used to identify households where individuals with two or more birth defects reside. Four groups of households were identified: 1 single non-familial (one individual with one birth defect; 2 single familial (more than one individual with one birth defect; 3 multiple non-familial (one individual with more than one birth defect, and 4 multiple familial (more than one individual with more than one birth defect. The March 2000 U.S. Census on households was used to estimate the total number of households in which there are individuals with birth defects. Results Of a total of 28,094 households and surveyed about birth defects and impairments, 1,083 single non-familial, 55 multiple non-familial, 54 single familial, and 8 multiple familial households were identified. Based on the 2000 U.S. census, it is estimated that there are 4,472,385 households where at least one person has one birth defect in the United States and in 234,846 of them there are at least two affected individuals. Western states had the highest prevalence rates. Conclusions Population-based methods, such as the NHIS, are modestly useful to identify the number and the regions where candidate families for genetic studies of birth defects reside. Clinic based studies and birth defects surveillance systems that collect family history offer better probability of ascertainment.

Book reading styles in dual-parent and single-mother families.

Science.gov (United States)

Blake, Joanna; Macdonald, Silvana; Bayrami, Lisa; Agosta, Vanessa; Milian, Andrea

2006-09-01

Whereas many studies have investigated quantitative aspects of book reading (frequency), few have examined qualitative aspects, especially in very young children and through direct observations of shared reading. The purpose of this study was to determine possible differences in book-reading styles between mothers and fathers and between mothers from single- and dual-parent families. It also related types of parental verbalizations during book reading to children's reported language measures. Dual-parent (29) and single-parent (24) families were observed in shared book reading with their toddlers (15-month-olds) or young preschoolers (27-month-olds). Parent-child dyads were videotaped while book reading. The initiator of each book-reading episode was coded. Parents' verbalizations were exhaustively coded into 10 categories. Mothers completed the MacArthur Communicative Development Inventory, and the children were given the Bayley scales. All parents differentiated their verbalizations according to the age rather than the gender of the child, but single mothers imitated female children more than males. Few differences in verbalizations were found between mothers and fathers or between mothers from single- and dual-parent families. Fathers allowed younger children to initiate book-reading episodes more than mothers. For both age groups of children, combined across families, verbalizations that related the book to the child's experience were correlated with reported language measures. Questions and imitations were related to language measures for the older age group. The important types of parental verbalizations during shared book reading for children's language acquisition are relating, questions and imitations.

[Single-family rooms for neonatal intensive care units impacts on preterm newborns, families, and health-care staff. A systematic literature review].

Science.gov (United States)

Servel, A-C; Rideau Batista Novais, A

2016-09-01

The quality of the environment is an essential point in the care of preterm newborns. The design of neonatal intensive care units (NICUs) (open-bay, single-patient room, single-family room) directly affects both the preterm newborns and their caregivers (parents, healthcare staff). The aim of this systematic review was to evaluate the impact of single-family rooms on the preterm newborn, its parents, and the staff. Single-family rooms improve outcome for the preterm newborn, with increasing parental involvement and better control of the environment (fewer inappropriate stimulations such as high levels of noise and illumination). This kind of NICU design also improves parental and staff satisfaction. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

The effects of small-scale, homelike facilities for older people with dementia on residents, family caregivers and staff: design of a longitudinal, quasi-experimental study.

Science.gov (United States)

Verbeek, Hilde; van Rossum, Erik; Zwakhalen, Sandra M G; Ambergen, Ton; Kempen, Gertrudis I J M; Hamers, Jan P H

2009-01-20

Small-scale and homelike facilities for older people with dementia are rising in current dementia care. In these facilities, a small number of residents live together and form a household with staff. Normal, daily life and social participation are emphasized. It is expected that these facilities improve residents' quality of life. Moreover, it may have a positive influence on staff's job satisfaction and families involvement and satisfaction with care. However, effects of these small-scale and homelike facilities have hardly been investigated. Since the number of people with dementia increases, and institutional long-term care is more and more organized in small-scale and homelike facilities, more research into effects is necessary. This paper presents the design of a study investigating effects of small-scale living facilities in the Netherlands on residents, family caregivers and nursing staff. A longitudinal, quasi-experimental study is carried out, in which 2 dementia care settings are compared: small-scale living facilities and regular psychogeriatric wards in traditional nursing homes. Data is collected from residents, their family caregivers and nursing staff at baseline and after 6 and 12 months of follow-up. Approximately 2 weeks prior to baseline measurement, residents are screened on cognition and activities of daily living (ADL). Based on this screening profile, residents in psychogeriatric wards are matched to residents living in small-scale living facilities. The primary outcome measure for residents is quality of life. In addition, neuropsychiatric symptoms, depressive symptoms and social engagement are assessed. Involvement with care, perceived burden and satisfaction with care provision are primary outcome variables for family caregivers. The primary outcomes for nursing staff are job satisfaction and motivation. Furthermore, job characteristics social support, autonomy and workload are measured. A process evaluation is performed to investigate to

The impact of single and shared rooms on family-centred care in children's hospitals.

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Curtis, Penny; Northcott, Andy

2017-06-01

To explore whether and how spatial aspects of children's hospital wards (single and shared rooms) impact upon family-centred care. Family-centred care has been widely adopted in paediatric hospitals internationally. Recent hospital building programmes in many countries have prioritised the provision of single rooms over shared rooms. Limited attention has, however, been paid to the potential impact of spatial aspects of paediatric wards on family-centred care. Qualitative, ethnographic. Phase 1; observation within four wards of a specialist children's hospital. Phase 2; interviews with 17 children aged 5-16 years and 60 parents/carers. Sixty nursing and support staff also took part in interviews and focus group discussions. All data were subjected to thematic analysis. Two themes emerged from the data analysis: 'role expectations' and 'family-nurse interactions'. The latter theme comprised three subthemes: 'family support needs', 'monitoring children's well-being' and 'survey-assess-interact within spatial contexts'. Spatial configurations within hospital wards significantly impacted upon the relationships and interactions between children, parents and nurses, which played out differently in single and shared rooms. Increasing the provision of single rooms within wards is therefore likely to directly affect how family-centred care manifests in practice. Nurses need to be sensitive to the impact of spatial characteristics, and particularly of single and shared rooms, on families' experiences of children's hospital wards. Nurses' contribution to and experience of family-centred care can be expected to change significantly when spatial characteristics of wards change and, as is currently the vogue, hospitals maximise the provision of single rather than shared rooms. © 2016 John Wiley & Sons Ltd.

Family Policies and Academic Achievement by Young Children in Single-Parent Families: An International Comparison. Population Research Institute Working Paper.

Science.gov (United States)

Pong, Suet-ling; Dronkers, Jaap; Hampden-Thompson, Gillian

This study investigates the differences in the degree of low academic achievement of third and fourth graders living with single-parent families from 11 industrialized countries. The United States ranks first among the countries compared in terms of the achievement gap for children in single- and two-parent families. After controlling for…

Integrating motivational interviewing and narrative therapy to teach behavior change to family medicine resident physicians.

Science.gov (United States)

Oshman, Lauren D; Combs, Gene N

2016-05-01

Motivational interviewing is a useful skill to address the common problem of patient ambivalence regarding behavior change by uncovering and strengthening a person's own motivation and commitment to change. The Family Medicine Milestones underline the need for clear teaching and monitoring of skills in communication and behavior change in Family Medicine postgraduate training settings. This article reports the integration of a motivational interviewing curriculum into an existing longitudinal narrative therapy-based curriculum on patient-centered communication. Observed structured clinical examination for six participants indicate that intern physicians are able to demonstrate moderate motivational interviewing skill after a brief 2-h workshop. Participant self-evaluations for 16 participants suggest a brief 2-h curriculum was helpful at increasing importance of learning motivational interviewing by participants, and that participants desire further training opportunities. A brief motivational interviewing curriculum can be integrated into existing communication training in a Family Medicine residency training program. © The Author(s) 2016.

Full-service concept for energy efficient renovation of single-family houses

DEFF Research Database (Denmark)

Vanhoutteghem, Lies; Tommerup, Henrik M.; Svendsen, Svend

2011-01-01

the solutions. Such one-stop-shops in the form of full-service providers of energy efficient renovation of single-family house are missing in the Nordic countries, although this service is vital to open up the market. As part of the Nordic research project `SuccesFamilies´ with the purpose to change...... houses. A one-stop-shop in the form of a full-service concept could be seen as a possibility to make it easy for the homeowner to comply with possible future requirements to realize far-reaching energy savings in connection with extensive renovations, provided that the building sector offers...... includes an ideal full-service concept and technical renovation solutions targeted to different types of single-family houses....

Risk of work injury among adolescent students from single and partnered parent families.

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Wong, Imelda S; Breslin, F Curtis

2017-03-01

Parental involvement in keeping their children safe at work has been examined in a handful of studies, with mixed results. Evidence has suggested that non-work injury risk is higher among children from single-parent families, but little is known about their risk for work-related injuries. Five survey cycles of the Canadian Community Health Survey were pooled to create a nationally representative sample of employed 15-19-year old students (N = 16,620). Multivariable logistic regression estimated the association between family status and work injury. Risk of work-related repetitive strains (OR:1.24, 95%CI: 0.69-2.22) did not differ by family type. However, children of single parents were less likely to sustain a work injury receiving immediate medical care (OR:0.43, 95%CI: 0.19-0.96). Despite advantages and disadvantages related to family types, there is no evidence that work-related injury risk among adolescents from single parent families is greater than that of partnered-parent families. Am. J. Ind. Med. 60:285-294, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Residents with mild cognitive decline and family members report health students 'enhance capacity of care' and bring 'a new breath of life' in two aged care facilities in Tasmania.

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Elliott, Kate-Ellen J; Annear, Michael J; Bell, Erica J; Palmer, Andrew J; Robinson, Andrew L

2015-12-01

Care provided by student doctors and nurses is well received by patients in hospital and primary care settings. Whether the same is true for aged care residents of nursing homes with mild cognitive decline and their family members is unknown. To investigate the perspectives of aged care residents with mild cognitive decline and their family members on interdisciplinary student placements in two residential aged care facilities (RACF) in Tasmania. A mixed methods design was employed with both qualitative and quantitative data collected. All participants were interviewed and completed a questionnaire on residents' quality of life, during or after a period of student placements in each facility (October-November, 2012). Qualitative data were coded for themes following a grounded theory approach, and quantitative data were analysed using SPSS. Twenty-one participants (13 residents and 8 family members) were recruited. Four themes were identified from the qualitative data and included (i) increased social interaction and facility vibrancy; (ii) community service and personal development, (iii) vulnerability and sensitivity (learning to care) and (iv) increased capacity and the confidence of enhanced care. Residents' quality of life was reported to be mostly good in the presence of the students, despite their high care needs. Residents with mild cognitive decline and their family members perceive a wide array of benefits of student provided care in RACFs including increased social interaction. Future quantitative research should focus on whether changes in care occur for residents as a result of student involvement. © 2014 The Authors Health Expectations Published by John Wiley & Sons Ltd.

A Comparison Study of Single-Parent Families Living on Remote, Rural Islands and in Urban Settings in Japan.

Science.gov (United States)

Hiratani, Yuko; Hohashi, Naohiro

2016-06-01

Nursing interventions that aim to enhance the family environment are necessary to help single-parent families with children to improve family functioning. The cultural and social factors that are unique to Japan's remote islands should be considered to assess the influence of this unique setting on family functioning. The objectives of this study were to evaluate the family functioning of child-rearing single-parent families living in different environments and to investigate the association between family demographics and family functioning. A self-administered questionnaire, the Japanese version of the Survey of Family Environment, was used to evaluate the sufficiency of family functioning. The participants were families with children enrolled in nurseries and kindergartens who were either living in remote, rural islands or in an urban city on the mainland in Japan. Family functioning was significantly higher for single-parent families living on the islands than for those living in the city in terms of media use, participation in community activities, and the collaboration of family members in child-rearing. Family functioning of single-parent families correlated significantly with household income, the parent's gender, family members' health, and family life cycle. Single-parent families living on Japanese offshore islands maintained family functioning through mutual support and the effective use of information technology. Nevertheless, single-parent families require additional support to improve their healthcare and financial situations.

Training in childhood obesity management in the United States: a survey of pediatric, internal medicine-pediatrics and family medicine residency program directors

Directory of Open Access Journals (Sweden)

Rhodes Erinn T

2010-02-01

Full Text Available Abstract Background Information about the availability and effectiveness of childhood obesity training during residency is limited. Methods We surveyed residency program directors from pediatric, internal medicine-pediatrics (IM-Peds, and family medicine residency programs between September 2007 and January 2008 about childhood obesity training offered in their programs. Results The response rate was 42.2% (299/709 and ranged by specialty from 40.1% to 45.4%. Overall, 52.5% of respondents felt that childhood obesity training in residency was extremely important, and the majority of programs offered training in aspects of childhood obesity management including prevention (N = 240, 80.3%, diagnosis (N = 282, 94.3%, diagnosis of complications (N = 249, 83.3%, and treatment (N = 242, 80.9%. However, only 18.1% (N = 54 of programs had a formal childhood obesity curriculum with variability across specialties. Specifically, 35.5% of IM-Peds programs had a formal curriculum compared to only 22.6% of pediatric and 13.9% of family medicine programs (p Conclusions While most residents receive training in aspects of childhood obesity management, deficits may exist in training quality with a minority of programs offering a formal childhood obesity curriculum. Given the high prevalence of childhood obesity, a greater emphasis should be placed on development and use of effective training strategies suitable for all specialties training physicians to care for children.

Training in childhood obesity management in the United States: a survey of pediatric, internal medicine-pediatrics and family medicine residency program directors.

Science.gov (United States)

Wolff, Margaret S; Rhodes, Erinn T; Ludwig, David S

2010-02-17

Information about the availability and effectiveness of childhood obesity training during residency is limited. We surveyed residency program directors from pediatric, internal medicine-pediatrics (IM-Peds), and family medicine residency programs between September 2007 and January 2008 about childhood obesity training offered in their programs. The response rate was 42.2% (299/709) and ranged by specialty from 40.1% to 45.4%. Overall, 52.5% of respondents felt that childhood obesity training in residency was extremely important, and the majority of programs offered training in aspects of childhood obesity management including prevention (N = 240, 80.3%), diagnosis (N = 282, 94.3%), diagnosis of complications (N = 249, 83.3%), and treatment (N = 242, 80.9%). However, only 18.1% (N = 54) of programs had a formal childhood obesity curriculum with variability across specialties. Specifically, 35.5% of IM-Peds programs had a formal curriculum compared to only 22.6% of pediatric and 13.9% of family medicine programs (p obesity training was competing curricular demands (58.5%). While most residents receive training in aspects of childhood obesity management, deficits may exist in training quality with a minority of programs offering a formal childhood obesity curriculum. Given the high prevalence of childhood obesity, a greater emphasis should be placed on development and use of effective training strategies suitable for all specialties training physicians to care for children.

Representation in the Care Planning Process for Nursing Home Residents With Dementia.

Science.gov (United States)

McCreedy, Ellen; Loomer, Lacey; Palmer, Jennifer A; Mitchell, Susan L; Volandes, Angelo; Mor, Vincent

2018-05-01

Federally mandated assessments of nursing home (NH) residents drive individualized care planning. Residents with cognitive impairment may not be able to meaningfully communicate their care needs and preferences during this process-a gap that may be partially addressed by involving surrogates. We describe the prevalence of family participation in the care planning process for long-stay NH residents with varying degrees of cognitive impairment. Retrospective study using administrative data made available as part of an ongoing pragmatic cluster randomized controlled trial. A total of 292 NHs from 1 large for-profit NH system. Long-stay NH residents in 2016. We identified all care planning assessments conducted in 2016 for long-stay NH residents. Cognitive functioning was defined using the Cognitive Function Scale. The Minimum Data Set was used to determine whether a resident, family member, and/or legal guardian participated in the assessment process. Certification and Survey Provider Enhance Reporting system data was used to identify facility-level correlates of family participation. Bivariate and multivariable hierarchical regression results are presented. The analytic sample included 18,552 long-stay NH residents. Family member/representative participation varied by degree of resident cognitive impairment; 8% of residents with no cognitive impairment had family or representative participation in care planning during 2016, compared with 26% of residents with severe impairment. NHs with more social workers had greater family participation in care planning. Available NH characteristics do not explain most of the variation in family participation between NHs (residual intraclass correlation = .57). Only a minority of family members and surrogates participate in NH care planning, even for residents with severe cognitive impairment. The association between social work staffing and participation suggests family involvement may be a measure of quality improvement

Resident and parental perceptions of adolescent problems and family communications in a low socioeconomic population.

Science.gov (United States)

Hawley, L E; Shear, C L; Stark, A M; Goodman, P R

1984-11-01

This cross-sectional survey of a low socioeconomic patient group was designed to determine the prevalence and severity of parentally perceived behavioral problems in adolescents as well as to investigate the correlation between such problems and single parenting, family communications, and medical care delivered. The sample population consisted of 79 parents and 121 teenagers selected from a family practice center. The medical record and telephone interview were the sources of information. Results include a parental perception of a high prevalence of problems with school grades (48 percent), school attendance (38 percent), and household problems (chores and sibling rivalry). Of low prevalence but high severity were perceived problems related to suicidal ideation, running away, sexual activity, and gang membership. Single-parent homes had a threefold higher incidence of behavioral problems, a greater degree of communication, and a lower use of community resources than two-parent families. None of the approximately 400 perceived behavioral problems listed by parents was found in the family physicians' master problem list. The results indicate the need for physician education of low socioeconomic and single-parent patients with regard to communication and coping style. In addition, it appears that training programs should provide more education in the care of adolescents.

What is a family? Kinship, reproductive practices and single mothers by choice

DEFF Research Database (Denmark)

Ravn, Tine

of single mothers by choice, the paper explores how the women conceive and enact the notions of family and kinship in terms of creating significant relations and networks. Furthermore, the paper shows and discusses how a complex interplay of biogenetic and social ties impacts on these family conceptions...... to one emerging ‘new’ family form represented by single mothers by choice (SMC’s) who by means of donor insemination and/or IVF treatment, intentionally choose to conceive a child and act as the sole parent. Based on very initial findings from a larger Danish biographical narrative interview study...

Biological aspects of the development and self-concept in adolescents living in single-parent families.

Science.gov (United States)

Vecek, Andrea; Vidović, Vesna; Milicić, Jasna; Spoljar-Vrzina, Sanja; Vecek, Nenad; Arch-Vecek, Branka

2009-09-01

In this study we investigate whether there are differences between adolescents who grow up in single-parent families and those who grow up in nucleus families. We have decided that there are no differences in the physical development between the adolescents who are growing up in single parent families and those growing up in nucleus families. There is no difference in the self-concept between these two groups, except in the ethical and moral self-image of adolescents living with one parent. Adolescents living in single-parent families have a weaker moral self-image. It can thus be concluded that physical development and positive self-concept (a favorable image of oneself) in adolescents do not depend on whether an adolescent is growing up in a single-parent or a nucleus family, but on the different characteristics of parents and their relationship with children, whether they are married or not. For the children development the best is healthy marriage of their parents.

Lack of chart reminder effectiveness on family medicine resident JNC-VI and NCEP III guideline knowledge and attitudes

Directory of Open Access Journals (Sweden)

Upshur Ross EG

2004-07-01

Full Text Available Abstract Background The literature demonstrates that medical residents and practicing physicians have an attitudinal-behavioral discordance concerning their positive attitudes towards clinical practice guidelines (CPG, and the implementation of these guidelines into clinical practice patterns. Methods A pilot study was performed to determine if change in a previously identified CPG compliance factor (accessibility would produce a significant increase in family medicine resident knowledge and attitude toward the guidelines. The primary study intervention involved placing a summary of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI and the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP III CPGs in all patient (>18 yr. charts for a period of three months. The JNC VI and NCEP III CPGs were also distributed to each Wayne State family medicine resident, and a copy of each CPG was placed in the preceptor's area of the involved clinics. Identical pre- and post- intervention questionnaires were administered to all residents concerning CPG knowledge and attitude. Results Post-intervention analysis failed to demonstrate a significant difference in CPG knowledge. A stastically significant post-intervention difference was found in only on attitude question. The barriers to CPG compliance were identified as 1 lack of CPG instruction; 2 lack of critical appraisal ability; 3 insufficient time; 4 lack of CPG accessibility; and 5 lack of faculty modeling. Conclusion This study demonstrated no significant post intervention changes in CPG knowledge, and only one question that reflected attitude change. Wider resident access to dedicated clinic time, increased faculty modeling, and the implementation of an electronic record/reminder system that uses a team-based approach are compliance factors that

Community-Level Characteristics Associated With Variation in Rates of Homelessness Among Families and Single Adults

Science.gov (United States)

Fargo, Jamison D.; Munley, Ellen A.; Byrne, Thomas H.; Montgomery, Ann Elizabeth; Culhane, Dennis P.

2013-01-01

Objectives. We modeled rates of family and single-adult homelessness in the United States in metropolitan and nonmetropolitan regions and as a function of community-level demographic, behavioral, health, economic, and safety net characteristics. Methods. We entered community-level characteristics and US Department of Housing and Urban Development point-in-time counts for a single night in January 2009 into separate mixed-effects statistical analyses that modeled homelessness rates for 4 subpopulations: families and single adults in metropolitan and nonmetropolitan regions. Results. Community-level factors accounted for 25% to 50% of the variance in homelessness rates across models. In metropolitan regions, alcohol consumption, social support, and several economic indicators were uniquely associated with family homelessness, and drug use and homicide were uniquely associated with single-adult homelessness. In nonmetropolitan regions, life expectancy, religious adherence, unemployment, and rent burden were uniquely associated with family homelessness, and health care access, crime, several economic indicators, and receipt of Supplemental Security Income were uniquely associated with single-adult homelessness. Conclusions. Considering homeless families and single adults separately enabled more precise modeling of associations between homelessness rates and community-level characteristics, indicating targets for interventions to reduce homelessness among these subpopulations. PMID:24148057

Community-level characteristics associated with variation in rates of homelessness among families and single adults.

Science.gov (United States)

Fargo, Jamison D; Munley, Ellen A; Byrne, Thomas H; Montgomery, Ann Elizabeth; Culhane, Dennis P

2013-12-01

We modeled rates of family and single-adult homelessness in the United States in metropolitan and nonmetropolitan regions and as a function of community-level demographic, behavioral, health, economic, and safety net characteristics. We entered community-level characteristics and US Department of Housing and Urban Development point-in-time counts for a single night in January 2009 into separate mixed-effects statistical analyses that modeled homelessness rates for 4 subpopulations: families and single adults in metropolitan and nonmetropolitan regions. Community-level factors accounted for 25% to 50% of the variance in homelessness rates across models. In metropolitan regions, alcohol consumption, social support, and several economic indicators were uniquely associated with family homelessness, and drug use and homicide were uniquely associated with single-adult homelessness. In nonmetropolitan regions, life expectancy, religious adherence, unemployment, and rent burden were uniquely associated with family homelessness, and health care access, crime, several economic indicators, and receipt of Supplemental Security Income were uniquely associated with single-adult homelessness. Considering homeless families and single adults separately enabled more precise modeling of associations between homelessness rates and community-level characteristics, indicating targets for interventions to reduce homelessness among these subpopulations.

Changes in Personal Relationships During Residency and Their Effects on Resident Wellness: A Qualitative Study

OpenAIRE

Law, Marcus; Lam, Michelle; Wu, Diana; Veinot, Paula; Mylopoulos, Maria

2017-01-01

Purpose Residency poses challenges for residents’ personal relationships. Research suggests residents rely on family and friends for support during their training. The authors explored the impact of residency demands on residents’ personal relationships and the effects changes in those relationships could have on their wellness. Method The authors used a constructivist grounded theory approach. In 2012–2014, they conducted semistructured interviews with a purposive and theoretical sample of 1...

Analysis of the Lifecycle Impacts and Potential for Avoided Impacts Associated with Single Family Homes

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Learn how recovering construction and demolition materials from single-family homes and reusing them in building and road construction and other applications helps offset the environmental impacts associated with single-family homes.

Economy Controls Energy Retrofits of Danish Single-family Houses

DEFF Research Database (Denmark)

Mortensen, Andrea; Heiselberg, Per; Knudstrup, Mary-Ann

2014-01-01

A great energy saving potential is found in the 440,000 Danish single-family houses erected between 1960 and 1979, but the potential is not exploited. To utilize this potential homeowners must be motivated to conduct energy saving retrofits. This paper presents results from a survey from 2012 where...... 883 Danish single-family house owners completed a questionnaire about energy retrofit. The objective of this paper is, based on the survey results, to determine how Danish homeowners can be motivated to conduct energy retrofits. The conclusion is that the financial aspect of an energy retrofit...... about the potential improvements within these parameters is found among the homeowners and therefore there is a vital need for more information about this. A combination of this knowledge of the non-economic improvements, a sensible investment size and information and education about the current...

Canadian residents' perceptions of cross-cultural care training in graduate medical school.

Science.gov (United States)

Singh, Barinder; Banwell, Emma; Groll, Dianne

2017-12-01

The Royal College of Physicians and Surgeons of Canada specifies both respect for diversity as a requirement of professionalism and culturally sensitive provision of medical care. The purpose of the present study was to evaluate the perception of preparedness and attitudes of medical residents to deliver cross-cultural care. The Cross Cultural Care Survey was sent via e-mail to all Faculty of Medicine residents (approx. 450) in an academic health sciences centre. Comparisons were made between psychiatry residents, family medicine residents, and other residency groups with respect to training, preparedness, and skillfulness in delivering cross-cultural care. Seventy-three (16%) residents responded to the survey. Residents in psychiatry and family medicine reported significantly more training and formal evaluation regarding cross-cultural care than residents in other programs. However, there were no significant differences in self-reported preparedness and skillfulness. Residents in family medicine were more likely to report needing more practical experience working with diverse groups. Psychiatry residents were less likely to report inadequate cross-cultural training. While most residents reported feeling skillful and prepared to work with culturally diverse groups, they report receiving little additional instruction or formal evaluation on this topic, particularly in programs other than psychiatry and family medicine.

An Electronic Mail List for a Network of Family Practice Residency Programs: A Good Idea?

Directory of Open Access Journals (Sweden)

Jodi Summers Holtrop

2001-08-01

Full Text Available The use of an electronic mailing list as a means of communication among faculty in a network of university-affiliated family practice residency programs was evaluated. Faculty were automatically subscribed to the list by the list owner. Messages were tracked for one year and a written evaluation survey was sent. Ninety two messages were sent, with 52% of the messages being posted information. While most (65% survey respondents reported reading 61% or more of the messages, with only 33% ever actually posted at least one message to the list. Given that faculty were automatically subscribed and that there were only 84 total members, the list may have failed to reach a critical mass of active participants. It is concluded that an email list for network faculty did not function as an online discussion group, although it was extremely beneficial as a way of posting information to affiliated residency faculty.

Occurrence of Legionella in hot water systems of single-family residences in suburbs of two German cities with special reference to solar and district heating.

Science.gov (United States)

Mathys, Werner; Stanke, Juliane; Harmuth, Margarita; Junge-Mathys, Elisabeth

2008-03-01

A total of 452 samples from hot water systems of randomly selected single family residences in the suburbs of two German cities were analysed for the occurrence of Legionella. Technical data were documented using a standardized questionnaire to evaluate possible factors promoting the growth of the bacterium in these small plumbing systems. All houses were supplied with treated groundwater from public water works. Drinking water quality was within the limits specified in the German regulations for drinking water and the water was not chlorinated. The results showed that plumbing systems in private houses that provided hot water from instantaneous water heaters were free of Legionella compared with a prevalence of 12% in houses with storage tanks and recirculating hot water where maximum counts of Legionella reached 100,000 CFU/100ml. The presence of L. pneumophila accounted for 93.9% of all Legionella positive specimens of which 71.8% belonged to serogroup 1. The volume of the storage tank, interrupting circulation for several hours daily and intermittently raising hot water temperatures to >60 degrees C had no influence on Legionella counts. Plumbing systems with copper pipes were more frequently contaminated than those made of synthetic materials or galvanized steel. An inhibitory effect due to copper was not present. Newly constructed systems (water preparation had a marked influence. More than 50% of all houses using district heating systems were colonized by Legionella. Their significantly lower hot water temperature is thought to be the key factor leading to intensified growth of Legionella. Although hot water systems using solar energy to supplement conventional hot water supplies operate at temperatures 3 degrees C lower than conventional systems, this technique does not seem to promote proliferation of the bacterium. Our data show convincingly that the temperature of the hot water is probably the most important or perhaps the only determinant factor for

The cost-effectiveness of training US primary care physicians to conduct colorectal cancer screening in family medicine residency programs.

Science.gov (United States)

Edwardson, Nicholas; Bolin, Jane N; McClellan, David A; Nash, Philip P; Helduser, Janet W

2016-04-01

Demand for a wide array of colorectal cancer screening strategies continues to outpace supply. One strategy to reduce this deficit is to dramatically increase the number of primary care physicians who are trained and supportive of performing office-based colonoscopies or flexible sigmoidoscopies. This study evaluates the clinical and economic implications of training primary care physicians via family medicine residency programs to offer colorectal cancer screening services as an in-office procedure. Using previously established clinical and economic assumptions from existing literature and budget data from a local grant (2013), incremental cost-effectiveness ratios are calculated that incorporate the costs of a proposed national training program and subsequent improvements in patient compliance. Sensitivity analyses are also conducted. Baseline assumptions suggest that the intervention would produce 2394 newly trained residents who could perform 71,820 additional colonoscopies or 119,700 additional flexible sigmoidoscopies after ten years. Despite high costs associated with the national training program, incremental cost-effectiveness ratios remain well below standard willingness-to-pay thresholds under base case assumptions. Interestingly, the status quo hierarchy of preferred screening strategies is disrupted by the proposed intervention. A national overhaul of family medicine residency programs offering training for colorectal cancer screening yields satisfactory incremental cost-effectiveness ratios. However, the model places high expectations on primary care physicians to improve current compliance levels in the US. Copyright © 2016 Elsevier Inc. All rights reserved.

Residents' Perspectives on Careers in Academic Medicine: Obstacles and Opportunities.

Science.gov (United States)

Lin, Steven; Nguyen, Cathina; Walters, Emily; Gordon, Paul

2018-03-01

Worsening faculty shortages in medical schools and residency programs are threatening the US medical education infrastructure. Little is known about the factors that influence the decision of family medicine residents to choose or not choose academic careers. Our study objective was to answer the following question among family medicine residents: "What is your greatest concern or fear about pursuing a career in academic family medicine?" Participants were family medicine residents who attended the Faculty for Tomorrow Workshop at the Society of Teachers of Family Medicine Annual Spring Conference in 2016 and 2017. Free responses to the aforementioned prompt were analyzed using a constant comparative method and grounded theory approach. A total of 156 participants registered for the workshops and 95 (61%) answered the free response question. Eight distinct themes emerged from the analysis. The most frequently recurring theme was "lack of readiness or mentorship," which accounted for nearly one-third (31%) of the codes. Other themes included work-life balance and burnout (17%), job availability and logistics (15%), lack of autonomy or flexibility (11%), competing pressures/roles (10%), lower financial rewards (4%), politics and bureaucracy (4%), and research (3%). To our knowledge, this is the first study to identify barriers and disincentives to pursuing a career in academic medicine from the perspective of family medicine residents. There may be at least eight major obstacles, for which we summarize and consider potential interventions. More research is needed to understand why residents choose, or don't choose, academic careers.

RADPED: an approach to teaching communication skills to radiology residents

International Nuclear Information System (INIS)

Goske, Marilyn J.; Reid, Janet R.; Yaldoo-Poltorak, Dunya; Hewson, Mariana

2005-01-01

The Accreditation Council for Graduate Medical Education mandates that radiology residency programs teach communication skills to residents. The purpose of this paper is to present a mnemonic, RADPED, that can be used to enhance communication in the radiology setting. It reminds the resident of the salient points to address during an imaging encounter with pediatric patients and their families for the purpose of enhancing communication. Recent history and research in medical communication are reviewed. Various communication guides used by primary care physicians, such as SEGUE, and the Kalamazoo consensus statement are discussed. This methodology was adapted into a format that could be used to teach communication skills to radiology residents in the context of an imaging encounter. RADPED reminds the resident to establish rapportwith the patient, ask questionsas to why the patient and family are presenting for the study, discuss the exam, perform the procedure, use exam distractions, and discussthe results with the referring physician and family when appropriate. This guide is available with movie clips as part of an on-line pediatric radiology curriculum. This simple memory aid promotes the key points necessary to optimize the radiology resident's encounter with pediatric patients and their families. (orig.)

Single-Family Energy Auditor Job Task Analysis

Energy Technology Data Exchange (ETDEWEB)

Head, Heather R [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Kurnik, Charles W [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

2018-05-02

The National Renewable Energy Laboratory (NREL) is contracted by the U.S. Department of Energy (DOE) Weatherization Assistance Program (WAP) to develop and maintain the resources under the Guidelines for Home Energy Professionals (GHEP) project. As part of the GHEP strategy to increase the quality of work conducted for single-family, residential energy-efficiency retrofits, the Home Energy Professionals Job Task Analysis are used as the foundation for quality training programs and trainers.

Patient safety principles in family medicine residency accreditation standards and curriculum objectives

Science.gov (United States)

Kassam, Aliya; Sharma, Nishan; Harvie, Margot; O’Beirne, Maeve; Topps, Maureen

2016-01-01

Abstract Objective To conduct a thematic analysis of the College of Family Physicians of Canada’s (CFPC’s) Red Book accreditation standards and the Triple C Competency-based Curriculum objectives with respect to patient safety principles. Design Thematic content analysis of the CFPC’s Red Book accreditation standards and the Triple C curriculum. Setting Canada. Main outcome measures Coding frequency of the patient safety principles (ie, patient engagement; respectful, transparent relationships; complex systems; a just and trusting culture; responsibility and accountability for actions; and continuous learning and improvement) found in the analyzed CFPC documents. Results Within the analyzed CFPC documents, the most commonly found patient safety principle was patient engagement (n = 51 coding references); the least commonly found patient safety principles were a just and trusting culture (n = 5 coding references) and complex systems (n = 5 coding references). Other patient safety principles that were uncommon included responsibility and accountability for actions (n = 7 coding references) and continuous learning and improvement (n = 12 coding references). Conclusion Explicit inclusion of patient safety content such as the use of patient safety principles is needed for residency training programs across Canada to ensure the full spectrum of care is addressed, from community-based care to acute hospital-based care. This will ensure a patient safety culture can be cultivated from residency and sustained into primary care practice. PMID:27965349

ASSOCIATION BETWEEN SINGLE-PARENT FAMILY STRUCTURE AND AGE OF SEXUAL DEBUT AMONG YOUNG PERSONS IN JAMAICA.

Science.gov (United States)

Oshi, Daniel C; Mckenzie, Jordan; Baxter, Martin; Robinson, Royelle; Neil, Stephan; Greene, Tayla; Wright, Wayne; Lodge, Jeorghino

2018-02-26

There is a high and increasing proportion of single-parent families in Jamaica. This has raised concerns about the potential impact of single-parent families on the social, cognitive and behavioural development of children, including their sexual relationships. The aim of this study was to investigate the association between being raised in a single-parent family and age of sexual debut among young people in Jamaica. The study was cross-sectional in design, and based on a multi-stage sampling procedure. The study was conducted in July/September 2016. The study sample comprised 233 respondents (110 males and 123 females) aged from 18 to 35 years (mean 26.37 years; SD 5.46). Respondents completed a self-administered questionnaire with questions on socio-demographic characteristics, family structure, sexual debut and current sexual behaviour. Ninety-seven (41.7%) respondents grew up in single-parent families. A total of 201 (86.3%) had had sex (102 males and 99 females). Their mean age of sexual debut was 15.51 years (SD 3.41). Sixty-five (32.3%) had early sexual debut (single-parent families were more likely to have had early sexual debut (56.9%; n=37) compared with those from two-parent families (43.1%, n=28; p=0.004). Only 44.6% (n=29) of those who experienced early sexual debut used a condom during their first sexual encounter compared with 73% (n=100) of those who had a later sexual debut (≥16 years; p=single-father family structure was a significant predictor of early sexual debut (AOR 5.5; 95%CI: 1.1-25.8). The study found a significant association between single-parent family structure and age of sexual debut.

Routine training is not enough: structured training in family planning and abortion improves residents' competency scores and intentions to provide abortion after graduation more than ad hoc training.

Science.gov (United States)

Macisaac, Laura; Vickery, Zevidah

2012-03-01

Abortion provision remains threatened by the paucity of physicians trained to provide them. Lack of training during residency has been cited by obstetrician and gynecologist (ob-gyn) physicians as a reason for not including abortion in their practice. We administered surveys on interest, competency and intention to provide abortions to two groups of ob-gyn residents: one experiencing a new comprehensive and structured family planning rotation, and another group at our affiliate hospital's residency program receiving "ad hoc" training during their routine gynecology rotations. Surveys were anonymous and blinded to investigator. The structured family planning rotation group compared to the ad hoc group reported significantly increased competency score using a Likert scale in manual vacuum aspiration (MVA) (4.5 vs. 1; p=.003) and had a higher proportion reporting intent to provide office MVA postresidency (100% vs. 39%; p=.01) and being trained to 22.5 weeks' vs. 12 weeks' gestation (p=.005). In bivariate analysis, competency in MVA was associated with higher intentions to provide MVA after residency (p=.007). A structured rotation in family planning and abortion for obstetrics/gynecology residents results in increases in competency and intentions to provide abortion, and an association between the two. In-hospital structured training proved to be superior to ad hoc training in our affiliate institution in improving competency and intention to provide abortion after residency. Copyright © 2012 Elsevier Inc. All rights reserved.

77 FR 23238 - Guidelines for Home Energy Professionals: Standard Work Specifications for Single Family Energy...

Science.gov (United States)

2012-04-18

...: Comments on the Guidelines for Home Energy Professionals: Standard Work Specifications for Single Family... DEPARTMENT OF ENERGY Office of Energy Efficiency and Renewable Energy Guidelines for Home Energy Professionals: Standard Work Specifications for Single Family Energy Upgrades AGENCY: Office of Energy...

Biological Aspects of the Development and Self-Concept in Adolescents Living in Single-Parent Families

OpenAIRE

Veček, Andrea; Vidović, Vesna; Miličić, Jasna; Špoljar-Vržina, Sanja; Veček, Nenad; Arch-Veček, Branka

2009-01-01

In this study we investigate whether there are differences between adolescents who grow up in single-parent families and those who grow up in nucleus families. We have decided that there are no differences in the physical development between the adolescents who are growing up in single parent families and those growing up in nucleus families. There is no difference in the self-concept between these two groups, except in the ethical and moral self-image of adolescents living with one parent. A...

Parental leave for residents and pediatric training programs.

Science.gov (United States)

2013-02-01

The American Academy of Pediatrics (AAP) is committed to the development of rational, equitable, and effective parental leave policies that are sensitive to the needs of pediatric residents, families, and developing infants and that enable parents to spend adequate and good-quality time with their young children. It is important for each residency program to have a policy for parental leave that is written, that is accessible to residents, and that clearly delineates program practices regarding parental leave. At a minimum, a parental leave policy for residents and fellows should conform legally with the Family Medical Leave Act as well as with respective state laws and should meet institutional requirements of the Accreditation Council for Graduate Medical Education for accredited programs. Policies should be well formulated and communicated in a culturally sensitive manner. The AAP advocates for extension of benefits consistent with the Family Medical Leave Act to all residents and interns beginning at the time that pediatric residency training begins. The AAP recommends that regardless of gender, residents who become parents should be guaranteed 6 to 8 weeks, at a minimum, of parental leave with pay after the infant's birth. In addition, in conformance with federal law, the resident should be allowed to extend the leave time when necessary by using paid vacation time or leave without pay. Coparenting, adopting, or fostering of a child should entitle the resident, regardless of gender, to the same amount of paid leave (6-8 weeks) as a person who takes maternity/paternity leave. Flexibility, creativity, and advanced planning are necessary to arrange schedules that optimize resident education and experience, cultivate equity in sharing workloads, and protect pregnant residents from overly strenuous work experiences at critical times of their pregnancies.

Single Family Loan Sale Initiative - Neighborhood Stabilization Outcome Pool Offering

Data.gov (United States)

Department of Housing and Urban Development — The FHA Office of Housing is conducting a series of mortgage loan sales under the Single Family Loan Sale (SFLS) Initiative. The current sales structure consists of...

Removing the Australian tax exemption on healthy food adds food stress to families vulnerable to poor nutrition.

Science.gov (United States)

Landrigan, Timothy J; Kerr, Deborah A; Dhaliwal, Satvinder S; Savage, Victoria; Pollard, Christina M

2017-12-01

To assess the impact of changing the Australian Goods and Services Tax (GST) on household food stress, which occurs when >25% of disposable income needs to be spent on food. Weekly healthy meal plan costs for average-income (AI), low-income (LI) and welfare-dependent (WDI) families were calculated using the 2013 Western Australian (WA) Food Access and Costs Survey. Four GST scenarios were compared: 1) status quo; 2) increasing GST to 15%; 3) expanding base to include exempt foods at 10% GST; and 4) expanding base to include exempt foods and increasing the tax to 15%. Single-parent families risk food stress regardless of their income or the GST scenario (requiring 24-42% of disposable income). The probability of food stress in Scenario 1 is 100% for WDI two-parent families and 36% for LI earners. In Scenarios 3 and 4, food stress probability is 60-72% for two-parent LI families and AI single-parent families, increasing to 88-94% if residing in very remote areas. There is food stress risk among single-parent, LI and WDI families, particularly those residing in very remote areas. Implications for public health: Expanding GST places an additional burden on people who are already vulnerable to poor nutrition and chronic disease due to their socioeconomic circumstances. © 2017 The Authors.

Effect of family-style meals on energy intake and risk of malnutrition in dutch nursing home residents: A randomized controlled trial

NARCIS (Netherlands)

Nijs, K.A.N.D.; Graaf, de C.; Siebelink, E.; Blauw, Y.H.; Vanneste, V.; Kok, F.J.; Staveren, van W.A.

2006-01-01

Background. Social facilitation and meal ambiance have beneficial effects on food intake in healthy adults. Extrapolation to the nursing home setting may lead to less malnutrition among the residents. Therefore, we investigate the effect of family-style meals on energy intake and the risk of

Family Structure and Family Processes in Mexican American Families

OpenAIRE

Zeiders, Katharine H.; Roosa, Mark W.; Tein, Jenn-Yun

2011-01-01

Despite increases in single-parent families among Mexican Americans (MA), few studies have examined the association of family structure and family adjustment. Utilizing a diverse sample of 738 Mexican American families (21.7% single parent), the current study examined differences across family structure on early adolescent outcomes, family functioning, and parent-child relationship variables. Results revealed that early adolescents in single parent families reported greater school misconduct,...

Method for planning extensive energy renovation of detached single-family houses

DEFF Research Database (Denmark)

Grøn Bjørneboe, Matilde

, and 22% occurs in single-family houses, making this the largest single contributor to the total consumption after road transport (DEA, 2015a). There is a large potential for achieving energy savings in this sector, especially among the large number of single-family houses built in the 1960s and 1970s...... that the use of this approach produced a better renovation with a larger energy saving. The initial evaluation helped the house owners identify a maintenance backlog, and the use of an independent advisor helped ensure quality throughout the process. Renovations are too often carried out for just one purpose......: maintenance, to update functions or to reduce energy consumption. But a lot can be gained by combining these efforts, which can reduce expenses for planning and execution and avoid doing things twice. Research for this thesis demonstrated this approach by carrying out a renovation based on maintenance...

A Weak Embrace: Popular and Scholarly Depictions of Single-Parent Families, 1900-1998

Science.gov (United States)

Usdansky, Margaret L.

2009-01-01

The growth of single-parent families constitutes one of the most dramatic and most studied social changes of the 20th century. Evolving attitudes toward these families have received less attention. This paper explores depictions of these families in representative samples of popular magazine (N = 474) and social science journal (N = 202) articles.…

Training at a faith-based institution matters for obstetrics and gynecology residents: results from a regional survey.

Science.gov (United States)

Guiahi, Maryam; Westhoff, Carolyn L; Summers, Sondra; Kenton, Kimberly

2013-06-01

Prior data suggest that opportunities in family planning training may be limited during obstetrics and gynecology (Ob-Gyn) residency training, particularly at faith-based institutions with moral and ethical constraints, although this aspect of the Ob-Gyn curriculum has not been formally studied to date. We compared Ob-Gyn residents' self-rated competency and intentions to provide family planning procedures at faith-based versus those of residents at non-faith-based programs. We surveyed residents at all 20 Ob-Gyn programs in Illinois, Indiana, Iowa, and Wisconsin from 2008 to 2009. Residents were queried about current skills and future plans to perform family planning procedures. We examined associations based on program and residents' personal characteristics and performed multivariable logistic regression analysis. A total of 232 of 340 residents (68%) from 17 programs (85%) returned surveys. Seven programs were faith-based. Residents from non-faith-based programs were more likely to be completely satisfied with family planning training (odds ratio [OR]  =  3.4, 95% confidence limit [CI], 1.9-6.2) and to report they "understand and can perform on own" most procedures. Most residents, regardless of program type, planned to provide all surveyed family planning services. Despite similar intentions to provide family planning procedures after graduation, residents at faith-based training programs were less satisfied with their family planning training and rate their ability to perform family planning services lower than residents at non-faith-based training programs.

E-conferencing for delivery of residency didactics.

Science.gov (United States)

Markova, Tsveti; Roth, Linda M

2002-07-01

While didactic conferences are an important component of residency training, delivering them efficiently is a challenge for many programs, especially when residents are located in multiple sites, as they are at Wayne State University School of Medicine in the Department of Family Medicine. Our residents find it difficult to travel from our hospitals or rotation sites to a centralized location for conferences. In order to overcome this barrier, we implemented distance learning and electronically delivered the conferences to the residents. We introduced an Internet-delivered, group-learning interactive conference model in which the lecturer is in one location with a group of residents and additional residents are in multiple locations. We launched the project in July 2001 using external company meeting services to schedule, coordinate, support, and archive the conferences. Equipment needed in each location consisted of a computer with an Internet connection, a telephone line, and a LCD projector (a computer monitor sufficed for small groups). We purposely chose simple distance-learning technology and used widely available equipment. Our e-conferencing had two components: (1) audio transmission via telephone connection and (2) visual transmission of PowerPoint presentations via the Internet. The telephone connection was open to all users, allowing residents to ask questions or make comments. Residents chose a conference location depending on geographic proximity to their rotation locations. Although we could accommodate up to 50 sites, we focused on a small number of locations in order to facilitate interaction among residents and faculty. Each conference session is archived and stored on the server for one week so those residents whose other residency-related responsibilities precluded attendance can view any conferences they have missed. E-conferencing proved to be an effective method of delivering didactics in our residency program. Its many advantages included

Energy efficient demand controlled ventilation in single family houses

DEFF Research Database (Denmark)

Nielsen, Toke Rammer; Drivsholm, Christian

2010-01-01

This paper presents a strategy for a simple demand controlled ventilation system for single family houses where all sensors and controls are located in the air handling unit. The strategy is based on sensing CO2-concentration and moisture content in the outdoor air and exhaust air. The CO2...

Burnout Comparison among Residents in Different Medical Specialties

Science.gov (United States)

Martini, Shahm; Arfken, Cynthia L.; Churchill, Amy; Balon, Richard

2004-01-01

Objective: To investigate resident burnout in relation to work and home-related factors. Method: Maslach Burnout Inventory was mailed to residents in eight different medical specialties, with a response rate of 35%. Results: Overall, 50% of residents met burnout criteria, ranging from 75% (obstetrics/gynecology) to 27% (family medicine). The first…

Overcoming Barriers in Working with Families

Science.gov (United States)

Heru, Alison M.; Drury, Laura

2006-01-01

Objective: The Accreditation Council for Graduate Medical Education and the Residency Review Committee for psychiatry outline the expected competencies for residents. These competencies include working with families. This article describes barriers that residents face when working with families, and offers ways to overcome these barriers. Method:…

Cognitive Impairments Are Different in Single-Incidence and Multi-Incidence ADHD Families

Science.gov (United States)

Oerlemans, Anoek M.; Hartman, Catharina A.; Bruijn, Yvette G. E.; Franke, Barbara; Buitelaar, Jan K.; Rommelse, Nanda N. J.

2015-01-01

Background: We may improve our understanding of the role of common versus unique risk factors in attention-deficit/hyperactivity disorder (ADHD) by examining ADHD-related cognitive deficits in single- (SPX), and multi-incidence (MPX) families. Given that individuals from multiplex (MPX) families are likely to share genetic vulnerability for the…

Trabalho em equipe multiprofissional: a perspectiva dos residentes médicos em saúde da família Working in multiprofessional teams: the perspectives of family health residents

Directory of Open Access Journals (Sweden)

Ricardo Corrêa Ferreira

2009-10-01

Full Text Available A residência médica brasileira, cada vez mais, especializa os médicos em suas práticas, desprezando as práticas multiprofissionais que orientam a integralidade em saúde. Na tentativa de romper com essa prática, a residência multiprofissional em saúde da família foi proposta objetivando formar profissionais que visem o cuidado integral à saúde das pessoas. Neste contexto, a Faculdade de Medicina de Marília, em 2003, iniciou esta residência, tendo como núcleo central o trabalho multiprofissional em equipes de saúde da família. Analisou-se, neste estudo, a percepção dos residentes médicos em saúde da família acerca do trabalho multiprofissional desenvolvido no Programa de Saúde da Família. A abordagem qualitativa foi o método desta investigação. Os dados coletados foram interpretados por meio da análise temática de conteúdo, construindo-se três categorias empíricas: Âncoras e balizas da visão interdisciplinar no trabalho em equipe permeiam a perspectiva da residência em saúde da família; Os conflitos e paradoxos do trabalho em equipe e a manutenção da linha de montagem; Dilemas do trabalho em equipe frente a uma estrutura hierarquizada. A análise dos dados aponta para o avanço que o trabalho em equipe multiprofissional traz para a formação médica, pois permite uma visão de perspectivas que, sem a equipe, não seria possível.Brazilian medical residency is increasingly specializing physicians in his practices undervaluing the multiprofessional practices that guide the integrality in health. Aiming at changing this practice, the multiprofessional residency in family health was proposed to prepare professionals searching for a comprehensive health care to the general public. In this context, in 2003, Faculdade de Medicina de Marília started this residency program having as the main idea the multiprofessional work in family health teams. The study shows the perception of family health residents at Faculdade

Moisture supply in Danish single-family houses – the influence of building style

DEFF Research Database (Denmark)

Hansen, Ernst Jan de Place; Møller, Eva B.

2017-01-01

According to ISO 13788 internal moisture supply in dwellings can be described by humidity classes defined by outdoor temperature, occupancy and ventilation. Hygrothermal measurements in 500 Danish single-family houses were made to investigate if building style and geographical location are import......According to ISO 13788 internal moisture supply in dwellings can be described by humidity classes defined by outdoor temperature, occupancy and ventilation. Hygrothermal measurements in 500 Danish single-family houses were made to investigate if building style and geographical location...

Unlocking Solar for Low- and Moderate-Income Residents: A Matrix of Financing Options by Resident, Provider, and Housing Type

Energy Technology Data Exchange (ETDEWEB)

Cook, Jeffrey J. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Bird, Lori A. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2018-01-02

Historically the low and moderate income (LMI) market has been underserved by solar photovoltaics (PV), in part due to the unique barriers LMI residents face to participation in the PV market. The intent of this report is to identify the most promising strategies state policymakers might consider to finance PV for LMI customers across three housing types: single family, multi-family, and manufactured housing. The result is a financing matrix that documents the first and second tier financing options states may consider for each housing type. The first tier options were selected based upon their potential impact on LMI PV deployment. Second tier financing approaches could also be used to achieve state policy goals, but may not have as much effect on the relevant LMI market segment. Nevertheless, each financing option comes with tradeoffs that state policymakers may wish to consider when they make decisions about which financing approaches are best suited to achieve their LMI PV deployment goals.

Detail, Facture, and Colour in the Architecture of Polish Single-Family Houses after 1989

Science.gov (United States)

Sztafrowski, Marek

2017-10-01

The article presents single-family houses architecture transformations since 1989, with particularly close attention paid to the significance of detail, facture, and colour. The article presents the architecture as an art of designing and building facilities with both use and aesthetic value, an art of shaping space and building forms. Architectural work should correspond to the intended function, technique, economic and aesthetic requirements, thus shaping all elements of human immediate environment, both inside and outside of the building. Architecture of the building is perceived as form, structure, and function, as well as detail, facture, and colour. Facture and colour are created through materials used for external finishes. The solid of the building is noticed first while looking at the building, then the finishes detail such as colour, facture, and detail. Materials for external finishes are commonly selected for their aesthetic value equally with their technical characteristics. The detail was always a characteristic element of style. However, currently the fashion for details can be observed, the fashion for usage of materials for external finishes and inter-connected with that colour and facture. The architecture of Polish single-family houses underwent considerable metamorphosis after system change of 1989 - from destitute in form, devoid in detail and colour socmodernism, to architecture extremely varied in terms of form, utilised structures, materials, and detail. Hence, appearance of the phenomenon called fashion can be observed in the architecture, understood as constant changeability, seeking novelty, and creation based on opinion-forming centres. The architectural fashion consists of form, function, structure, building materials, detail, facture, and colour trends, e.g. after rejecting socmodernism, steep roofs characteristic for single-family houses trend started. After 1989, initially individual single-family house projects were created; however

Teaching adaptive leadership to family medicine residents: what? why? how?

Science.gov (United States)

Eubank, Daniel; Geffken, Dominic; Orzano, John; Ricci, Rocco

2012-09-01

Health care reform calls for patient-centered medical homes built around whole person care and healing relationships. Efforts to transform primary care practices and deliver these qualities have been challenging. This study describes one Family Medicine residency's efforts to develop an adaptive leadership curriculum and use coaching as a teaching method to address this challenge. We review literature that describes a parallel between the skills underlying such care and those required for adaptive leadership. We address two questions: What is leadership? Why focus on adaptive leadership? We then present a synthesis of leadership theories as a set of process skills that lead to organization learning through effective work relationships and adaptive leadership. Four models of the learning process needed to acquire such skills are explored. Coaching is proposed as a teaching method useful for going beyond information transfer to create the experiential learning necessary to acquire the process skills. Evaluations of our efforts to date are summarized. We discuss key challenges to implementing such a curriculum and propose that teaching adaptive leadership is feasible but difficult in the current medical education and practice contexts.

Media education in pediatric residencies: a national survey.

Science.gov (United States)

Christakis, Dimitri A; Frintner, Mary Pat; Mulligan, Deborah A; Fuld, Gilbert L; Olson, Lynn M

2013-01-01

Little is known about the current state of residency education with respect to counseling parents about media usage and whether trainees consider it to be adequate. A national survey of graduating pediatric residents was conducted in the United States to determine the amount of training they receive on traditional and new media, their perceptions of its quality, and their self-reported practices regarding talking to families about media usage. A 58% response rate was achieved with no evidence of response bias based on age or gender. Only 38% rated their residency program as "very good" or "excellent" in preparing them to provide anticipatory guidance on the effects of media on children and adolescents. In logistic regression analyses, controlling for demographic characteristics, more training on media issues was a significant predictor for usually/always advising families on traditional, passive media (adjusted odds ratio = 3.29; 95% confidence interval 2.26-4.81) and usually/always advising families on new, interactive media use (adjusted odds ratio = 3.96; 95% confidence interval 2.61-6.00) during well-child visits. The majority of residents believe their training on children in media is inadequate. Enhanced training on media is needed in US pediatric residencies. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Coping as a Mediator Between Parental Attachment and Resilience: An Examination of Differential Effects Between Chinese Adolescents From Single Parent Families Versus Those From Intact Families.

Science.gov (United States)

Guo, Xiamei

2018-01-01

The crude divorce rate has been increasing steadily for over a decade in China. Consequently, more and more children have to face the challenge of growing up in single parent families. The current study investigated the mediating effects of problem-oriented and emotion-oriented coping on the relationship between parental attachment and psychological resilience among a sample of Chinese adolescents from single parent families and intact families. Participants were 975 high school students (44.30% males; aged 15-19 years, M = 16.32 years, SD = 0.74), 871 from intact families and 104 from single parent families. Structural equation modeling showed that security in maternal attachment was positively associated with resilience through the indirect effect of reduced emotion-oriented coping among adolescents from single parent families. Among adolescents from intact families, security in maternal attachment was both directly associated with resilience and indirectly through enhanced problem-oriented and reduced emotion-oriented coping. Security in paternal attachment was associated with resilience both directly and indirectly through enhanced problem-oriented coping as well among those from intact families. Female adolescents exhibited significantly lower levels of resilience than male adolescents did regardless of the marital status of their parents. Limitations and suggestions for future research are discussed.

Analysis of Installed Measures and Energy Savings for Single-Family Residential Better Buildings Projects

Energy Technology Data Exchange (ETDEWEB)

Heaney, M. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Polly, B. [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

2015-04-30

This report presents an analysis of data for residential single-family projects reported by 37 organizations that were awarded federal financial assistance (cooperative agreements or grants) by the U.S. Department of Energy’s Better Buildings Neighborhood Program.1 The report characterizes the energy-efficiency measures installed for single-family residential projects and analyzes energy savings and savings prediction accuracy for measures installed in a subset of those projects.

Two semidetached single family houses in Prague

OpenAIRE

DIEGO JOVELLS, FERNANDO JOSÉ

2015-01-01

Trabajo Fin de Grado de modalidad Intercambios Académicos. České Vysoké Učení Technické v Praze | Czech Technical University in Prague [en] This Bachelor’s Thesis is intent on building a single family house in Veleslavín, a district of Prague, part of Prague 6, situated in the west of the city. The chosen foundations, the structure, the installations of electricity, cold and hot water, heating system, and sanitation network are going to be studied in this project. Some plans will be done, ...

Germline mutation rates in families residing in high level natural radiation areas of Kerala coast in southwest India

International Nuclear Information System (INIS)

Das, Birajalaxmi; Ghosh, Anu; Ahmad, Shazia; Saini, DivyaIakshmi; Chauhan, P.S.; Seshadri, M.

2010-01-01

For this study, 200 nuclear families have been analyzed using over 40 mini- and microsatellite markers. Cord blood samples for the child and peripheral blood samples for the parent(s) were collected in EDTA vacuutainers from the hospital units located in High Level Natural Radiation Areas (HLNRA) and Normal Level Natural Radiation Areas (NLNRA). Both the parents of the newborn were exposed to the background dose. The families were grouped into four distinct dose groups - NLNRA group 5.00 mGy/year. An overall mutation rate of 2.08 X 10 -3 per cell per generation was observed for NLNRA and 2.12 X 10 -3 per cell per generation for HLNRA families. No radiation induced dose response was observed for the stratified groups. Thus, this study shows that mutation rates at mini- and microsatellites in the off springs of the parents living in the high background radiation areas of Kerala does not vary with radiation exposure. This is the first report to understand germline mutation rates at hypervariable loci in families residing in high level natural radiation areas of the world

The model of children's social adjustment under the gender-roles absence in single-parent families.

Science.gov (United States)

Chen, I-Jun; Zhang, Hailun; Wei, Bingsi; Guo, Zeyao

2018-01-14

This study aimed to evaluate the effects of the gender-role types and child-rearing gender-role attitude of the single-parents, as well as their children's gender role traits and family socio-economic status, on social adjustment. We recruited 458 pairs of single parents and their children aged 8-18 by purposive sampling. The research tools included the Family Socio-economic Status Questionnaire, Sex Role Scales, Parental Child-rearing Gender-role Attitude Scale and Social Adjustment Scale. The results indicated: (a) single mothers' and their daughters' feminine traits were both higher than their masculine traits, and sons' masculine traits were higher than their feminine traits; the majority gender-role type of single parents and their children was androgyny; significant differences were found between children's gender-role types depending on different raiser, the proportion of girls' masculine traits raised by single fathers was significantly higher than those who were raised by single mothers; (b) family socio-economic status and single parents' gender-role types positively influenced parental child-rearing gender-role attitude, which in turn, influenced the children's gender traits, and further affected children's social adjustment. © 2018 International Union of Psychological Science.

Mental health status of unmarried youth living in single parent families: a case study from India.

Science.gov (United States)

Sinha, Atreyee; Ram, Faujdar

2018-02-16

In South Asian countries like India, family system lays a strong foundation in societies and therefore, the context and consequences of single parent family structures are markedly different from that of the West. In these societies single parenthood is mainly an outcome of untimely death of any one of the parents. This study tried to examine the influence of parents' survival status on the mental health of youth in India. "Youth in India: situation and Needs (2006-2007)" survey data was used in the present study. We compared two groups of unmarried young population aged 15-24 y (n = 28 637): one having both parents alive and another having only one parent alive. Bivariate and multivariate techniques were applied to analyze the data. Results revealed that around 11% of the unmarried youth belonged to single parent families. Findings underscored a significant association between parent's survival and mental health of youth; respondents from single parent families were more likely to report metal health problems Moreover, effects of parents' survival were significant on females' mental health rather than males'. Policies must focus on reducing stress of young people growing up in single parent families through enhanced educational and employment opportunities.

Coparenting experiences in African American families: an examination of single mothers and their nonmarital coparents.

Science.gov (United States)

Gonzalez, Michelle; Jones, Deborah; Parent, Justin

2014-03-01

African American youth from single-mother homes continue to be overrepresented in statistics on risk behavior and delinquency, a trend that many be attributed to father-absence, socioeconomic disadvantage, and compromises in parenting more typical of single than two-parent families. Yet, this risk-focused perspective ignores a long-standing strength of the African American community, the involvement and potential protective impact of extended family members in childrearing. This study describes the experiences of 95 African American single mothers and their nonmarital coparents who participated in a study of African American single-mother families with an 11-16-year-old child. Specifically, the study examines: (a) the extent to which nonmarital coparents are involved in childrearing; (b) the relative levels of risk (i.e., depression, mother-coparent conflict) and protective (i.e., parenting) associated with maternal and coparent involvement; and (c) how similarly and/or differently coparent and mother variables operate with regard to youth externalizing problems. Findings reveal that a range of family members and other adults actively participate in childrearing in African American single-mother families, coparents do not differ from mothers on certain study variables (i.e., depression and mother-coparent conflict) but do for others (parenting), and coparent involvement is associated with youth adjustment in ways that are similar to our more established understanding of maternal involvement. The potential clinical implications of the findings are discussed and future research directions are highlighted. © 2014 FPI, Inc.

Carbon isotopes in otolith amino acids identify residency of juvenile snapper (Family: Lutjanidae) in coastal nurseries

KAUST Repository

McMahon, Kelton; Berumen, Michael L.; Mateo, Ivan; Elsdon, Travis S.; Thorrold, Simon R.

2011-01-01

This study explored the potential for otolith geochemistry in snapper (Family: Lutjanidae) to identify residency in juvenile nursery habitats with distinctive carbon isotope values. Conventional bulk otolith and muscle stable isotope analyses (SIA) and essential amino acid (AA) SIA were conducted on snapper collected from seagrass beds, mangroves, and coral reefs in the Red Sea, Caribbean Sea, and Pacific coast of Panama. While bulk stable isotope values in otoliths showed regional differences, they failed to distinguish nursery residence on local scales. Essential AA δ13C values in otoliths, on the other hand, varied as a function of habitat type and provided a better tracer of residence in different juvenile nursery habitats than conventional bulk otolith SIA alone. A strong linear relationship was found between paired otolith and muscle essential AA δ13C values regardless of species, geographic region, or habitat type, indicating that otolith AAs recorded the same dietary information as muscle AAs. Juvenile snapper in the Red Sea sheltered in mangroves but fed in seagrass beds, while snapper from the Caribbean Sea and Pacific coast of Panama showed greater reliance on mangrove-derived carbon. Furthermore, compound-specific SIA revealed that microbially recycled detrital carbon, not water-column-based new phytoplankton carbon, was the primary carbon source supporting snapper production on coastal reefs of the Red Sea. This study presented robust tracers of juvenile nursery residence that will be crucial for reconstructing ontogenetic migration patterns of fishes among coastal wetlands and coral reefs. This information is key to determining the importance of nursery habitats to coral reef fish populations and will provide valuable scientific support for the design of networked marine-protected areas. © 2011 Springer-Verlag.

Carbon isotopes in otolith amino acids identify residency of juvenile snapper (Family: Lutjanidae) in coastal nurseries

KAUST Repository

McMahon, Kelton

2011-08-26

This study explored the potential for otolith geochemistry in snapper (Family: Lutjanidae) to identify residency in juvenile nursery habitats with distinctive carbon isotope values. Conventional bulk otolith and muscle stable isotope analyses (SIA) and essential amino acid (AA) SIA were conducted on snapper collected from seagrass beds, mangroves, and coral reefs in the Red Sea, Caribbean Sea, and Pacific coast of Panama. While bulk stable isotope values in otoliths showed regional differences, they failed to distinguish nursery residence on local scales. Essential AA δ13C values in otoliths, on the other hand, varied as a function of habitat type and provided a better tracer of residence in different juvenile nursery habitats than conventional bulk otolith SIA alone. A strong linear relationship was found between paired otolith and muscle essential AA δ13C values regardless of species, geographic region, or habitat type, indicating that otolith AAs recorded the same dietary information as muscle AAs. Juvenile snapper in the Red Sea sheltered in mangroves but fed in seagrass beds, while snapper from the Caribbean Sea and Pacific coast of Panama showed greater reliance on mangrove-derived carbon. Furthermore, compound-specific SIA revealed that microbially recycled detrital carbon, not water-column-based new phytoplankton carbon, was the primary carbon source supporting snapper production on coastal reefs of the Red Sea. This study presented robust tracers of juvenile nursery residence that will be crucial for reconstructing ontogenetic migration patterns of fishes among coastal wetlands and coral reefs. This information is key to determining the importance of nursery habitats to coral reef fish populations and will provide valuable scientific support for the design of networked marine-protected areas. © 2011 Springer-Verlag.

Comparison of Parenting Style in Single Child and Multiple Children Families

OpenAIRE

Masoumeh Alidosti; Seyedeh Leila Dehghani; Akbar Babaei-Heydarabadi; Elahe Tavassoli

2016-01-01

Background and Purpose: Family is the first and the most important structure in human civilization in which social lifestyles, mutual understanding, and compatibility is learned. Studies have shown that parenting style, is one the most important and fundamental factors in personality development. The purpose of this study was comparison of parenting style in single child and multiple children families. Materials and Methods: This study, in total, 152 mothers from Andimeshk city, Iran, wer...

Indoor climate perceived as improved after energy retrofitting of single-family houses

DEFF Research Database (Denmark)

Knudsen, Henrik Nellemose; Jensen, Ole Michael

2014-01-01

The need for energy retrofitting of the Danish single-family houses is massive, especially for the high proportion of single-family houses built in the 1960s and 1970s. But even though the potential benefits are many, only few families embark on a major energy retrofit. There may be many reasons...... for this. An obvious one may be limited knowledge of non-energy benefits, e.g. in relation to the indoor climate. The objective of this study was to explain this limited effort to save energy by identifying barriers and incentives among house owners in relation to energy retrofitting of one’s own house....... Moreover, it was investigated among house owners, who had carried out energy retrofitting, whether a number of factors, including the perceived indoor climate, became better or worse after retrofitting. A questionnaire survey was carried out among 1,990 house owners in a municipality north of Copenhagen...

Family involvement in timely detection of changes in health of nursing homes residents: A qualitative exploratory study.

Science.gov (United States)

Powell, Catherine; Blighe, Alan; Froggatt, Katherine; McCormack, Brendan; Woodward-Carlton, Barbara; Young, John; Robinson, Louise; Downs, Murna

2018-01-01

To explore family perspectives on their involvement in the timely detection of changes in their relatives' health in UK nursing homes. Increasingly, policy attention is being paid to the need to reduce hospitalisations for conditions that, if detected and treated in time, could be managed in the community. We know that family continue to be involved in the care of their family members once they have moved into a nursing home. Little is known, however, about family involvement in the timely detection of changes in health in nursing home residents. Qualitative exploratory study with thematic analysis. A purposive sampling strategy was applied. Fourteen semi-structured one-to-one interviews with family members of people living in 13 different UK nursing homes. Data were collected from November 2015-March 2016. Families were involved in the timely detection of changes in health in three key ways: noticing signs of changes in health, informing care staff about what they noticed and educating care staff about their family members' changes in health. Families suggested they could be supported to detect timely changes in health by developing effective working practices with care staff. Families can provide a special contribution to the process of timely detection in nursing homes. Their involvement needs to be negotiated, better supported, as well as given more legitimacy and structure within the nursing home. Families could provide much needed support to nursing home nurses, care assistants and managers in timely detection of changes in health. This may be achieved through communication about their preferred involvement on a case-by-case basis as well as providing appropriate support or services. © 2017 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

On the thermal inertia and time constant of single-family houses

Energy Technology Data Exchange (ETDEWEB)

Hedbrant, J.

2001-08-01

Since the 1970s, electricity has become a common heating source in Swedish single-family houses. About one million small houses can use electricity for heating, about 600.000 have electricity as the only heating source, A liberalised European electricity market would most likely raise the Swedish electricity prices during daytime on weekdays and lower it at other times. In the long run, electrical heating of houses would be replaced by fuels, but in the shorter perspective, other strategies may be considered. This report evaluates the use of electricity for heating a dwelling, or part of it, at night when both the demand and the price are low. The stored heat is utilised in the daytime some hours later, when the electricity price is high. Essential for heat storage is the thermal time constant. The report gives a simple theoretical framework for the calculation of the time constant for a single-family house with furniture. Furthermore the comfort time constant, that is, the time for a house to cool down from a maximum to a minimum acceptable temperature, is derived. Two theoretical model houses are calculated, and the results are compared to data from empirical studies in three inhabited test houses. The results show that it was possible to store about 8 kWh/K in a house from the seventies and about 5 kWh/K in a house from the eighties. The time constants were 34 h and 53 h, respectively. During winter conditions with 0 deg C outdoor, the 'comfort' time constants with maximum and minimum indoor temperatures of 23 and 20 deg C were 6 h and 10 h. The results indicate that the maximum load-shifting potential of an average single family house is about 1 kw during 16 daytime hours shifted into 2 kw during 8 night hours. Upscaled to the one million Swedish single-family houses that can use electricity as a heating source, the maximum potential is 1000 MW daytime time-shifted into 2000 MW at night.

Residents’ and preceptors’ perceptions of the use of the iPad for clinical teaching in a family medicine residency program

Science.gov (United States)

2014-01-01

Background As Family Medicine programs across Canada are transitioning into a competency-based curriculum, medical students and clinical teachers are increasingly incorporating tablet computers in their work and educational activities. The purpose of this pilot study was to identify how preceptors and residents use tablet computers to implement and adopt a new family medicine curriculum and to evaluate how they access applications (apps) through their tablet in an effort to support and enhance effective teaching and learning. Methods Residents and preceptors (n = 25) from the Family Medicine program working at the Pembroke Regional Hospital in Ontario, Canada, were given iPads and training on how to use the device in clinical teaching and learning activities and how to access the online curriculum. Data regarding the use and perceived contribution of the iPads were collected through surveys and focus groups. This mixed methods research used analysis of survey responses to support the selection of questions for focus groups. Results Reported results were categorized into: curriculum and assessment; ease of use; portability; apps and resources; and perceptions about the use of the iPad in teaching/learning setting. Most participants agreed on the importance of accessing curriculum resources through the iPad but recognized that these required enhancements to facilitate use. The iPad was considered to be more useful for activities involving output of information than for input. Participants’ responses regarding the ease of use of mobile technology were heterogeneous due to the diversity of computer proficiency across users. Residents had a slightly more favorable opinion regarding the iPad’s contribution to teaching/learning compared to preceptors. Conclusions iPad’s interface should be fully enhanced to allow easy access to online curriculum and its built-in resources. The differences in computer proficiency level among users should be reduced by sharing

Effects of Family Structure and the Experience of Parental Separation: A Study on Adolescents’ Well-Being

Directory of Open Access Journals (Sweden)

Sabine Walper

2015-10-01

Full Text Available Large numbers of studies, mostly from the U.S., have addressed the effects of parental separation and divorce, pointing to disadvantages of children and adolescents growing up in separated families. However, evidence on this topic varies across countries and is limited for Germany. Using longitudinal data from waves 1 and 3 of the German Family Panel pairfam, we investigated differences in adolescents’ well-being by comparing stable nuclear families (n = 1968, single mother families (n = 360, and stepfather families (n = 214, as well as an additional smaller group of adolescents whose parents separated between waves 1 and 3 (“prospective separators”; n = 76. Adolescents’ satisfaction with different domains of life (family, education/work, and their general life satisfaction as well as their self-esteem were used as indicators of well-being. A series of multiple regression analyses tested the effects of family structure on well-being at T1 and changes in well-being over time, controlling for various background factors. Furthermore, likely mediation effects of infrequent contact to the non-resident father and economic strain were tested. The findings show (relatively minor effects of parental separation, namely lower well-being among youth1 in single mother families compared to nuclear families. Disadvantages of youth in single mother families could only be partly explained by the higher financial strain generally experienced in these families. Youth in stepfather families reported a similar overall well-being as adolescents in nuclear families, but indicated a greater decrease in family satisfaction over time. Pre-separation disadvantages among prospective separators were limited to greater dissatisfaction with school. Infrequent contact with the non-resident father did not affect adolescents’ well-being. Effects of family structure did not differ between boys and girls, but maternal education moderated the effects of family structure

Perspectives and expectations for telemedicine opportunities from families of nursing home residents and caregivers in nursing homes.

Science.gov (United States)

Chang, Jun-Yih; Chen, Liang-Kung; Chang, Chia-Ching

2009-07-01

This study assessed current perspectives and expectations for telemedicine by nursing home caregivers and families of nursing home patients in Taipei, Taiwan. A total of 116 interviews were conducted with family members (n=37) and caregivers (n=79) using an original, four-part questionnaire devised to assess the expectations and concerns related to prospective telemedicine opportunities, including consumer attitude, knowledge of and interest in medicine, concerns and worries about telemedicine, and anticipated benefits of telemedicine. Statistical significance between the two groups was observed in sex, age, and educational level (all pexpectations concerning benefits of telemedicine. More than 60% of family members or caregivers expected improved efficiency and quality of hospital and nursing home health care, greater rapport between nursing homes and either staff or patients, reduced overall medical costs of caregiving, and reduced staff/caregiver working hours. The acceptable cost was anything up to $15.30 USD per month. Nursing home caregivers and families of nursing home patients are highly interested in telemedicine; however, they are only willing to pay a slightly higher cost of nursing care for this service. The challenge for the future in this industry is to balance peoples' demands and telemedicine's associated costs. Results of this study suggest that caregivers and families of nursing home residents favour telemedicine implementation to provide enhanced care coordination in nursing homes when economic circumstances are favourable.

Medical Student Interest in Flexible Residency Training Options.

Science.gov (United States)

Piotrowski, Madison; Stulberg, Debra; Egan, Mari

2018-05-01

Medical residents continue to experience high rates of burnout during residency training even after implementation of the 2003 Accreditation Council for Graduate Medical Education duty-hour restrictions. The purpose of this study is to determine medical student interest in flexible residency training options. Researchers developed an 11-question survey for second through fourth-year medical students. The populations surveyed included medical students who were: (1) attending the 2015 American Academy of Family Physicians National Conference, the 2015 Family Medicine Midwest Conference, and (2) enrolled at University of Chicago Pritzker School of Medicine, University of Illinois College of Medicine at Chicago, Drexel University College of Medicine, and Case Western Reserve University School of Medicine. The survey was completed by 789 medical students. Over half of medical students surveyed indicated that they would be interested in working part-time during some portion of their residency training (51%), and that access to part-time training options would increase their likelihood of applying to a particular residency program (52%). When given the option of three residency training schedules of varying lengths, 41% of male students and 60% of female students chose a 60-hour workweek, even when that meant extending the residency length by 33% and reducing their yearly salary to $39,000. There is considerable interest among medical students in access to part-time residency training options and reduced-hour residency programs. This level of interest indicates that offering flexible training options could be an effective recruitment tool for residency programs and could improve students' perception of their work-life balance during residency.

Single Parent Family Structure as a Predictor of Alcohol Use among Secondary School Students: Evidence from Jamaica

Science.gov (United States)

Oshi, Sarah N; Abel, Wendel D; Agu, Chinwendu F; Omeje, Joachim C; Smith, Patrice Whitehorne; Ukwaja, Kingsley N; Ricketts Roomes, Tana; Meka, Ijeoma A; Weaver, Steve; Rae, Tania; Oshi, Daniel C

2018-04-23

The aim of this study was to examine the potential relationship between Jamaican secondary students’ alcohol drinking habits and their family structure. Methods: Data collected from a nationally representative survey of 3,365 students were analysed. Descriptive and inferential statistics were performed. Results: Out of the 3,365 students, 1,044 (31.0%) were from single-parent families. Single-parent families, married-parent families and common law-parent families were significantly associated with lifetime use of alcohol (AOR= 1.72, 95% CI= 1.06 - 2.79; AOR= 1.73, 95% CI= 1.07- 2.81, AOR= 1.94, 95%CI= 1.17- 3.21 respectively). However, family structure was not significantly associated with past year and past month alcohol use. Students whose parents “sometimes” knew their whereabouts were significantly less likely to use alcohol in their lifetime compared to students whose parents “Always” knew where the students were. Conclusion: Family structure is an independent predictor of alcohol use among high school students in Jamaica. Being from single-parent families, married-parent and common- law parent families were significantly associated with increased likelihood for lifetime alcohol use. Creative Commons Attribution License

Dynamics of postmarital residence among the Hadza: a kin investment model.

Science.gov (United States)

Wood, Brian M; Marlowe, Frank W

2011-07-01

When we have asked Hadza whether married couples should live with the family of the wife (uxorilocally) or the family of the husband (virilocally), we are often told that young couples should spend the first years of a marriage living with the wife's family, and then later, after a few children have been born, the couple has more freedom--they can continue to reside with the wife's kin, or else they could join the husband's kin, or perhaps live in a camp where there are no close kin. In this paper, we address why shifts in kin coresidence patterns may arise in the later years of a marriage, after the birth of children. To do so, we model the inclusive fitness costs that wives might experience from leaving their own kin and joining their husband's kin as a function of the number of children in their nuclear family. Our model suggests that such shifts should become less costly to wives as their families grow. This simple model may help explain some of the dynamics of postmarital residence among the Hadza and offer insight into the dynamics of multilocal residence, the most prevalent form of postmarital residence among foragers.

An International Look at the Single-Parent: Family Structure Matters More for U.S. Students

Science.gov (United States)

Woessmann, Ludger

2015-01-01

When Daniel Patrick Moynihan raised the issue of family structure half a century ago, his concern was the increase in black families headed by women. Since then, the share of children raised in single-parent families in the United States has grown across racial and ethnic groups and with it evidence regarding the impact of family structure on…

Family structure and child anemia in Mexico.

Science.gov (United States)

Schmeer, Kammi K

2013-10-01

Utilizing longitudinal data from the nationally-representative Mexico Family Life Survey, this study assesses the association between family structure and iron-deficient anemia among children ages 3-12 in Mexico. The longitudinal models (n = 4649), which control for baseline anemia status and allow for consideration of family structure transitions, suggest that children living in stable-cohabiting and single-mother families and those who have recently experienced a parental union dissolution have higher odds of anemia than those in stable-married, father-present family structures. Interaction effects indicate that unmarried family contexts have stronger associations with anemia in older children (over age five); and, that the negative effects of parental union dissolution are exacerbated in poorer households. Resident maternal grandparents have a significant beneficial effect on child anemia independent of parental family structure. These results highlight the importance of family structure for child micronutrient deficiencies and suggest that understanding social processes within households may be critical to preventing child anemia in Mexico. Copyright © 2012 Elsevier Ltd. All rights reserved.

A Comparison of Surgery and Family Medicine Residents' Perceptions of Cross-Cultural Care Training of Cross-Cultural Care Training

OpenAIRE

Chun, Maria BJ; Jackson, David S; Lin, Susan Y; Park, Elyse R

2010-01-01

The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt's Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups' reported impressions of importance and level of instruc...

Theory and design of an Annual Cycle Energy System (ACES) for residences

Energy Technology Data Exchange (ETDEWEB)

Nephew, E.A.; Abbatiello, L.A.; Ballou, M.L.

1980-05-01

The basic concept of the Annual Cycle Energy System (ACES) - an integrated system for supplying space heating, hot water, and air conditioning to a building - and the theory underlying its design and operation are described. Practical procedures for designing an ACES for a single-family residence, together with recommended guidelines for the construction and installation of system components, are presented. Methods are discussed for estimating the life-cycle cost, component sizes, and annual energy consumption of the system for residential applications in different climatic regions of the US.

Resident transitions to assisted living: a role for social workers.

Science.gov (United States)

Fields, Noelle LeCrone; Koenig, Terry; Dabelko-Schoeny, Holly

2012-08-01

This study explored key aspects of resident transitions to assisted living (AL), including the frequency and importance of preadmission resident education and the potential role of social workers in this setting. To examine the factors that may help or hinder resident transitions to AL, a written survey was administered to a statewide, geographically representative purposive sample of Medicaid Assisted Living Waiver providers (N = 28). Findings suggest a positive relationship between the availability of a social worker and the frequency and importance of resident preadmission education in several areas. Results also suggest a gap between what AL providers believe is important for resident transitions and what is actually happening in their facilities. Social workers may play a significant role in providing preadmission education and are well positioned to address the unmet psychosocial needs of residents and family members during the transition to AL. Future studies should specifically examine the contributing role of social workers during the period of adjustment to AL and the effect of social work services on the well-being of AL residents and families in AL settings.

Structural Model for Antisocial Behavior: Generalization to Single-Mother Families.

Science.gov (United States)

Baldwin, David V.; Skinner, Martie L.

1989-01-01

The purpose of this study was to replicate the "basic training" structural model in Patterson's (1982) coercion theory, extending its scope to single-mother families with younger (six- to eight-year-old) boys. Significance of the successful replication was seen to lie in implications for the generalizability of the model across family…

Coparenting Experiences in African American Families: An Examination of Single Mothers and their Non-Marital Coparents

Science.gov (United States)

Gonzalez, Michelle; Jones, Deborah J.; Parent, Justin

2015-01-01

African American youth from single mother homes continue to be overrepresented in statistics on risk behavior and delinquency, a trend that many be attributed to father-absence, socioeconomic disadvantage, and compromises in parenting more typical of single than two-parent families. Yet, this risk-focused perspective ignores a long-standing strength of the African American community, the involvement and potential protective impact of extended family members in childrearing. This study describes the experiences of 95 African American single mothers and their non-marital coparents who participated in a study of African American single mother families with an 11 to 16 year old child. Specifically, the study examines: 1) the extent to which nonmarital coparents are involved in childrearing; 2) the relative levels of risk (i.e., depression, mother-coparent conflict) and protective (i.e., parenting) associated with maternal and coparent involvement; and 3) how similarly and/or differently coparent and mother variables operate with regard to youth externalizing problems. Findings reveal that a range of family members and other adults actively participate in childrearing in African American single mother families, coparents do not differ from mothers on certain study variables (i.e., depression and mother-coparent conflict) but do for others (parenting), and coparent involvement is associated with youth adjustment in ways that are similar to our more established understanding of maternal involvement. The potential clinical implications of the findings are discussed and future research directions are highlighted. PMID:24479612

[Life project of residents and institutional approach in nursing homes].

Science.gov (United States)

Chanut, Corinne

The life project in a nursing home involves all the players concerned: first of all, the resident, then the caregivers, the families and the institution. This unifying tool, organised around the elderly, helps to develop collective competencies, favours the integration of new residents and reassures families. This article presents a nursing home's experience of setting up a life project. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Investigations of Intelligent Solar Heating Systems for Single Family House

DEFF Research Database (Denmark)

Andersen, Elsa; Chen, Ziqian; Fan, Jianhua

2014-01-01

Three differently designed intelligent solar heating systems are investigated experimentally in a test facility. The systems provide all the needed yearly heating demand in single family houses. The systems are based on highly stratified tanks with variable auxiliary heated volumes. The tank is a......, the control strategy of intelligent solar heating systems is investigated and the yearly auxiliary energy use of the systems and the electricity price for supplying the consumers with domestic hot water and space heating are calculated....... systems.The system will be equipped with an intelligent control system where the control of the electrical heating element(s)/heat pump is based on forecasts of the variable electricity price, the heating demand and the solar energy production.By means of numerical models of the systems made in Trnsys......Three differently designed intelligent solar heating systems are investigated experimentally in a test facility. The systems provide all the needed yearly heating demand in single family houses. The systems are based on highly stratified tanks with variable auxiliary heated volumes. The tank...

Women residents, women physicians and medicine's future.

Science.gov (United States)

Serrano, Karen

2007-08-01

The number of women in medicine has increased dramatically in the last few decades, and women now represent half of all incoming medical students. Yet residency training still resembles the historical model when there were few women in medicine. This article reviews the issues facing women in residency today. Data suggest that the experience of female residents is more negative than that of males. Unique challenges facing female residents include the existence of gender bias and sexual harassment, a scarcity of female mentors in leadership positions, and work/family conflicts. Further research is needed to understand the experience of female residents and to identify barriers that hinder their optimal professional and personal development. Structural and cultural changes to residency programs are needed to better accommodate the needs of female trainees.

19 CFR 148.103 - Family grouping of allowances.

Science.gov (United States)

2010-04-01

... 19 Customs Duties 2 2010-04-01 2010-04-01 false Family grouping of allowances. 148.103 Section 148... Value § 148.103 Family grouping of allowances. (a) Generally. When members of a family residing in one... household. “Members of a family residing in one household” shall include all persons, regardless of age, who...

Development of an air heating system for single family housing

DEFF Research Database (Denmark)

Afshari, Alireza; Gunner, Amalie; Nikolaisen, Christian Grønborg

2017-01-01

The initial objective of the project was to break with common thinking about Space heating and to document that air heating can be used as the sole source of heating in a single Family house. The basic idea is that the ventilation must be installed in any case and it may equally well form the heat...

Supporting At-Risk Youth and Their Families to Manage and Prevent Diabetes: Developing a National Partnership of Medical Residency Programs and High Schools.

Science.gov (United States)

Gefter, Liana; Morioka-Douglas, Nancy; Srivastava, Ashini; Rodriguez, Eunice

2016-01-01

The Stanford Youth Diabetes Coaches Program (SYDCP) is a school based health program in which Family Medicine residents train healthy at-risk adolescents to become diabetes self-management coaches for family members with diabetes. This study evaluates the impact of the SYDCP when disseminated to remote sites. Additionally, this study aims to assess perceived benefit of enhanced curriculum. From 2012-2015, 10 high schools and one summer camp in the US and Canada and five residency programs were selected to participate. Physicians and other health providers implemented the SYDCP with racial/ethnic-minority students from low-income communities. Student coaches completed pre- and posttest surveys which included knowledge, health behavior, and psychosocial asset questions (i.e., worth and resilience), as well as open-ended feedback questions. T-test pre-post comparisons were used to determine differences in knowledge and psychosocial assets, and open and axial coding methods were used to analyze qualitative data. A total of 216 participating high school students completed both pre-and posttests, and 96 nonparticipating students also completed pre- and posttests. Student coaches improved from pre- to posttest significantly on knowledge (pknowledge gain, pride in helping family members, improved relationships and connectedness with family members, and lifestyle improvements. Overall, when disseminated, this program can increase health knowledge and some psychosocial assets of at-risk youth and holds promise to empower these youth with health literacy and encourage them to adopt healthy behaviors.

Prevalence and covariates of food insecurity among residents of single-room occupancy housing in Chicago, IL, USA.

Science.gov (United States)

Bowen, Elizabeth A; Bowen, Sarah K; Barman-Adhikari, Anamika

2016-04-01

Emerging evidence suggests that food insecurity is a significant public health concern among people who are homeless or marginally housed. The present study assessed prevalence of food insecurity and its covariates among a group of marginally housed individuals living in single-room occupancy (SRO) dwellings, a population for which there is little extant health or nutrition research. Cross-sectional survey incorporating the Household Food Insecurity Access Scale. Ten private SRO residences in the Uptown neighbourhood of Chicago, IL, USA, 2013. SRO residents over 18 years of age who were able to communicate verbally in English (n 153). Food insecurity was widespread among SRO residents, with 75 % of the sample considered food insecure and 52 % meeting criteria for severe food insecurity. Bivariate analyses indicated that female gender, eating most meals at a soup kitchen, having a mental health condition, problem drinking, having at least one chronic health condition, and diabetes were all significantly associated with food insecurity. In the multivariate ordered logistic regression model, eating most meals at a soup kitchen remained as the only significant correlate of food insecurity (OR=10·13). SRO residents and other marginally housed populations face unique food access challenges. Although targeted assistance in the form of food stamps and congregate meal programmes remains critical, efforts to prevent and address food insecurity among homeless and marginally housed individuals should include policy interventions that recognize poverty as the root cause of food insecurity and aim to increase overall income and improve housing conditions.

Embryo genome profiling by single-cell sequencing for preimplantation genetic diagnosis in a β-thalassemia family

DEFF Research Database (Denmark)

Xu, Yanwen; Chen, Shengpei; Yin, Xuyang

2015-01-01

for a β-thalassemia-carrier couple to have a healthy second baby. We carried out sequencing for single blastomere cells and the family trio and further developed the analysis pipeline, including recovery of the missing alleles, removal of the majority of errors, and phasing of the embryonic genome...... leukocyte antigen matching tests. CONCLUSIONS: This retrospective study in a β-thalassemia family demonstrates a method for embryo genome recovery through single-cell sequencing, which permits detection of genetic variations in preimplantation genetic diagnosis. It shows the potential of single...

Female autonomy, the family, and industrialization in Java.

Science.gov (United States)

Wolf, D L

1988-03-01

It is generally argued that industrialization has an adverse affect on the position of women due to their exclusion from industrial employment and the resulting erosion of their status. This article addresses a case study of the question of gender stratification and industrialization by analyzing the relationship between factory daughters and their families in Java, Indonesia. From an initial 1-month daily survey of income and expenditures conducted among 14 workers in Nuwun, Wolf found that although they contributed 28% of their wages to the family, in cash or in kind, they overspent their wages by 40%. She then designed a more extensive survey, including questions about access to other income, debts, and savings. To determine if the relationship between daughters and family economy was related to residence, she expanded the survey to include 3 different groups of workers: commuters, migrants, and residents. Commuters lived with their parents in the agricultural village, Nuwan, and were the sole focus of the 1st income survey. Migrants were boarders in an industrialized village, Pamit, and residents walked to work. Single women are the focus of this paper due to the very different contribution daughters can potentially make to the family's welfare. The case study suggests that industrialization at the very least maintains, and may even enhance, female status within the family. To summarize, if a family can release a daughter for factory employment and can forgo the returns from her labor, there are eventual benefits for both the worker and her family. Worker-daughters are less of a financial burden on families. The savings provide surplus income that is not used for subsistence needs. Families gain tangible status goods that are displayed in the house and, at the same time, have access to insurance for crises and cash needs. Daughters, on the other hand, choose what to purchase and for whom. They gain prestige as donors of thoughtful gifts to family members, and

Rounds Today: A Qualitative Study of Internal Medicine and Pediatrics Resident Perceptions.

Science.gov (United States)

Rabinowitz, Raphael; Farnan, Jeanne; Hulland, Oliver; Kearns, Lisa; Long, Michele; Monash, Bradley; Bhansali, Priti; Fromme, H Barrett

2016-10-01

Attending rounds is a key component of patient care and education at teaching hospitals, yet there is an absence of studies addressing trainees' perceptions of rounds. To determine perceptions of pediatrics and internal medicine residents about the current and ideal purposes of inpatient rounds on hospitalist services. In this multi-institutional qualitative study, the authors conducted focus groups with a purposive sample of internal medicine and pediatrics residents at 4 teaching hospitals. The constant comparative method was used to identify themes and codes. The study identified 4 themes: patient care, clinical education, patient/family involvement, and evaluation. Patient care included references to activities on rounds that forwarded care of the patient. Clinical education pertained to teaching/learning on rounds. Patient/family involvement encompassed comments about incorporating patients and families on rounds. Evaluation described residents demonstrating skill for attendings. Resident perceptions of the purposes of rounds aligned with rounding activities described by prior observational studies of rounds. The influence of time pressures and the divergent needs of participants on today's rounds placed these identified purposes in tension, and led to resident dissatisfaction in the achievement of all of them. Suboptimal congruency exists between perceived resident clinical education and specialty-specific milestones. These findings suggest a need for education of multiple stakeholders by (1) enhancing faculty teaching strategies to maximize clinical education while minimizing inefficiencies; (2) informing residents about the value of patient interactions and family-centered rounds; and (3) educating program directors in proper alignment of inpatient rotational objectives to the milestones.

24 CFR 982.602 - SRO: Who may reside in an SRO?

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false SRO: Who may reside in an SRO? 982... URBAN DEVELOPMENT SECTION 8 TENANT BASED ASSISTANCE: HOUSING CHOICE VOUCHER PROGRAM Special Housing Types Single Room Occupancy (sro) § 982.602 SRO: Who may reside in an SRO? A single person may reside in...

78 FR 27240 - Announcing the Award of a New Single-Source Award to the National Council on Family Violence in...

Science.gov (United States)

2013-05-09

....095] Announcing the Award of a New Single-Source Award to the National Council on Family Violence in... single-source cooperative agreement to the National Council on Family Violence to support the National Domestic Violence Hotline (Hotline). SUMMARY: The Administration for Children and Families (ACF...

Preparing Future Leaders: An Integrated Quality Improvement Residency Curriculum.

Science.gov (United States)

Potts, Stacy; Shields, Sara; Upshur, Carole

2016-06-01

The Accreditation Council for Graduate Medical Education (ACGME) has recognized the importance of quality improvement (QI) training and requires that accredited residencies in all specialties demonstrate that residents are "integrated and actively participate in interdisciplinary clinical quality improvement and patient safety activities." However, competing demands in residency training may make this difficult to accomplish. The study's objective is to develop and evaluate a longitudinal curriculum that meets the ACGME requirement for QI and patient safety training and links to patient-centered medical home (PCMH) practices. Residents in the Worcester Family Medicine Residency (WFMR) participated in a faculty-developed quality improvement curriculum that included web-based tutorials, quality improvement projects, and small-group sessions across all 3 years of residency. They completed self-evaluations of knowledge and use of curricular activities annually and at graduation, and comparisons were made between two graduating classes, as well as comparison of end of PGY2 to end of PGY3 for one class. Graduating residents who completed the full 3 years of the curriculum rated themselves as significantly more skilled in nine of 15 areas assessed at end of residency compared to after PGY2 and reported confidence in providing future leadership in a focus group. Five areas were also rated significantly higher than prior-year residents. Involving family medicine residents in a longitudinal curriculum with hands-on practice in implementing QI, patient safety, and chronic illness management activities that are inclusive of PCMH goals increased their self-perceived skills and leadership ability to implement these new and emerging evidence-based practices in primary care.

Changes in Personal Relationships During Residency and Their Effects on Resident Wellness: A Qualitative Study.

Science.gov (United States)

Law, Marcus; Lam, Michelle; Wu, Diana; Veinot, Paula; Mylopoulos, Maria

2017-11-01

Residency poses challenges for residents' personal relationships. Research suggests residents rely on family and friends for support during their training. The authors explored the impact of residency demands on residents' personal relationships and the effects changes in those relationships could have on their wellness. The authors used a constructivist grounded theory approach. In 2012-2014, they conducted semistructured interviews with a purposive and theoretical sample of 16 Canadian residents from various specialties and training levels. Data analysis occurred concurrently with data collection, allowing authors to use a constant comparative approach to explore emergent themes. Transcripts were coded; codes were organized into categories and then themes to develop a substantive theory. Residents perceived their relationships to be influenced by their evolving professional identity: Although personal relationships were important, being a doctor superseded them. Participants suggested they were forced to adapt their personal relationships, which resulted in the evolution of a hierarchy of relationships that was reinforced by the work-life imbalance imposed by their training. This poor work-life balance seemed to result in relationship issues and diminish residents' wellness. Participants applied coping mechanisms to manage the conflict arising from the adaptation and protect their relationships. To minimize the effects of identity dissonance, some gravitated toward relationships with others who shared their professional identity or sought social comparison as affirmation. Erosion of personal relationships could affect resident wellness and lead to burnout. Educators must consider how educational programs impact relationships and the subsequent effects on resident wellness.

Validity and applicability of the Mini International Neuropsychiatric Interview administered by family medicine residents in primary health care in Brazil.

Science.gov (United States)

de Azevedo Marques, João Mazzoncini; Zuardi, Antonio W

2008-01-01

To evaluate the validity and applicability of the Mini International Neuropsychiatric Interview (MINI) used by family medicine residents in primary health care (PHC) in Brazil. Training for administrating the MINI was given as part of a broad psychiatry education program. Interviews were held with 120 PHC patients who were at least 15 years old. MINI was administered by 25 resident physicians, while the Structured Clinical Interview for Diagnosis (SCID) was administered by a psychiatrist blind to patients' results on the MINI, and the diagnoses on both interviews were compared. The resident physicians answered questions on the applicability of the MINI. Concordance levels for any mental disorder, the broader current diagnostic categories and the most common specific diagnoses were analyzed. Kappa coefficients ranged between 0.65 and 0.85; sensitivity, between 0.75 and 0.92; specificity, between 0.90 and 0.99; positive predictive values (PPV), between 0.60 and 0.86; negative predictive values (NPV), between 0.92 and 0.99; and accuracy, between 0.88 and 0.98. The resident physicians considered MINI comprehensibility and clinical relevance satisfactory. These good psychometric results in a real-world setting may be related to a special training program, which is more frequent, intensive and diversified. In these conditions, the MINI is a useful tool for general practitioners.

Family Support Center Village: A Unique Approach for Low-Income Single Women with Children

Science.gov (United States)

Graber, Helen V.; Wolfe, Jayne L.

2004-01-01

The Family Support Center, recognizing the need for single women with children to maintain stability, has developed a program referred to as the Family Support Center Village, which incorporates a service enriched co-housing model. The "Village" will be the catalyst for these mothers' self-sufficiency and will provide opportunities to develop…

Residents' perceptions of tourism impacts and attitudes towards tourism policies.

OpenAIRE

Brida, J.G.; Disegna, Marta; Osti, L.

2014-01-01

The purpose of this paper is to explore residents' perceptions of tourism impacts and how they affect attitudes towards local tourism policies. Particular attention is paid to the analysis of community attachment and employment sector of residents. This study presents the results of a quantitative survey among residing families of a small mountain community located in the North-East of Italy. The findings reveal that residents perceptions on economic, environmental and socio-cultural impacts ...

[Induced abortion: a comparison between married and single women residing in the city of São Paulo in 2008].

Science.gov (United States)

de Souza e Silva, Rebeca; Andreoni, Solange

2012-07-01

The scope of this study was to evaluate the association between having had an induced abortion and marital status (being single or legally married) in women residing in the city of São Paulo. This analysis is derived from a broader population survey on abortion conducted in 2008. In this study we focus on the subset of 389 single and legally married women between 15 and 49 years of age. Logistic regression models were used to evaluate the association between induced abortion and being single or married, monitoring age, education, income, number of live births, contraceptive use and acceptance of the practice of abortion. Being single was the only characteristic associated with having had an induced abortion, in other words, when faced with a pregnancy single women were four times more likely to have an abortion than married women (OR=3.9; p=0.009).

Feasibility of an innovative third-year chief resident system: an internal medicine residency leadership study

Directory of Open Access Journals (Sweden)

Victor O. Kolade

2014-07-01

Full Text Available Introduction: The role of the internal medicine chief resident includes various administrative, academic, social, and educational responsibilities, fulfillment of which prepares residents for further leadership tasks. However, the chief resident position has historically only been held by a few residents. As fourth-year chief residents are becoming less common, we considered a new model for rotating third-year residents as the chief resident. Methods: Online surveys were given to all 29 internal medicine residents in a single university-based program after implementation of a leadership curriculum and specific job description for the third-year chief resident. Chief residents evaluated themselves on various aspects of leadership. Participation was voluntary. Descriptive statistics were generated using SPSS version 21. Results: Thirteen junior (first- or second-year resident responses reported that the chief residents elicited input from others (mean rating 6.8, were committed to the team (6.8, resolved conflict (6.7, ensured efficiency, organization and productivity of the team (6.7, participated actively (7.0, and managed resources (6.6. Responses from senior residents averaged 1 point higher for each item; this pattern repeated itself in teaching evaluations. Chief resident self-evaluators were more comfortable running a morning report (8.4 than with being chief resident (5.8. Conclusion: The feasibility of preparing internal medicine residents for leadership roles through a rotating PGY-3 (postgraduate year chief residency curriculum was explored at a small internal medicine residency, and we suggest extending the study to include other programs.

The stress of residency: recognizing the signs of depression and suicide in you and your fellow residents.

Science.gov (United States)

Hochberg, Mark S; Berman, Russell S; Kalet, Adina L; Zabar, Sondra R; Gillespie, Colleen; Pachter, H Leon

2013-02-01

Stress, depression, and suicide are universal but frequently unrecognized issues for women and men in residency training. Stress affects cognitive and psychomotor performance both inside and outside of the operating room. Stress impairs the 2 key components of a surgeon's responsibilities: intellectual judgment and technical skill. We hypothesized that the recognition of depression, substance abuse, failing personal relationships, and potential suicide is poor among surgeons. If residents can recognize the signs of stress, depression, and suicide among colleagues, we believe it will not only improve their quality of life but also may preserve it. We first determined baseline resident knowledge of the signs of surgical stress including fatigue; burn out; depression; physician suicide; drug and alcohol abuse; and their effects on family, friends, and relationships. We then developed a curriculum to identify these signs in first, second, third, and fourth year surgical residents were identified as the target learners. The major topics discussed were depression; physician suicide; drug and alcohol abuse; and the effects of stress on family, friends, and our goals. Secondary objectives included identifying major sources of stress, general self-awareness, understanding professional choices, and creating a framework to manage stress. Residents participated in an interactive seminar with a surgical facilitator. Before and after the seminar, a multiple-choice test was administered with questions to assess knowledge of the signs of stress (eg, fatigue, burn out, and depression). Twenty-one residents participated in this study. Seventeen completed the pretest, and 21 participated in the interactive seminar and completed the post-test. The pretest revealed that surgical residents were correct in 46.8% (standard deviation [SD] = 25.4%) of their responses. The postseminar test showed an improvement to 89.7% (SD = 6.1%, P abuse, divorce, and suicide, educating house staff about

Survey of Sexual Education among Residents from Different Specialties

Science.gov (United States)

Morreale, Mary K.; Arfken, Cynthia L.; Balon, Richard

2010-01-01

Objective: This study aims to determine how residents are being educated regarding sexual health, and it assesses attitudes toward sexual education and barriers to evaluating patients' sexuality. Methods: An anonymous Internet survey was sent to 195 residents in family practice, internal medicine, obstetrics and gynecology, and psychiatry at a…

Cold Storage for a Single-Family House in Italy

OpenAIRE

Luigi Mongibello; Giorgio Graditi

2016-01-01

This work deals with the operation, modeling, simulation, and cost evaluation of two different cold storage systems for a single-family house in Italy, that differ from one another on the cold storage material. The two materials used to perform the numerical simulations of the cold storage systems are represented by cold water and a phase change material (PCM), and the numerical simulations have been realized by means of numerical codes written in Matlab environment. The main finding of the p...

Advanced x-ray stress analysis method for a single crystal using different diffraction plane families

International Nuclear Information System (INIS)

Imafuku, Muneyuki; Suzuki, Hiroshi; Sueyoshi, Kazuyuki; Akita, Koichi; Ohya, Shin-ichi

2008-01-01

Generalized formula of the x-ray stress analysis for a single crystal with unknown stress-free lattice parameter was proposed. This method enables us to evaluate the plane stress states with any combination of diffraction planes. We can choose and combine the appropriate x-ray sources and diffraction plane families, depending on the sample orientation and the apparatus, whenever diffraction condition is satisfied. The analysis of plane stress distributions in an iron single crystal was demonstrated combining with the diffraction data for Fe{211} and Fe{310} plane families

Energy renovation of single-family houses in Denmark utilising long-term financing based on equity

DEFF Research Database (Denmark)

Kragh, Jesper; Rose, Jørgen

2011-01-01

This paper aims to present an economic overview of the opportunities for energy renovation of single-family houses in Denmark financed over the long term. The paper focuses on the economic difference between energy savings and the repayment of investment. Taking out the average remaining 20% equity...... in long-term property mortgage loans and utilising it for extensive energy renovation improves both the economy and the extent of included measures. Approximately 30% of energy consumption in Denmark is used for space heating. The existing 1 million single-family houses account for approximately half...

Comparison of adolescents' perceptions and behaviors in single- and two-parent families.

Science.gov (United States)

Rosenthal, D; Hansen, J

1980-10-01

This study investigated the self-concepts, school achievement, occupational aspirations, vocational maturity, and perceptions of parents of children from two-parent and single-parent homes. The sample contained 559 children, 19% from single-parent homes. A multivariateF indicated children from two-parent homes had significantly higher school grades and occupational aspirations. There were also significant differences in children's perceptions of relationships with fathers, but not with mothers. It was argued that family structure has an impact on adolescents' perceptions and behaviors.

Teaching ethics to paediatrics residents: the centrality of the therapeutic alliance.

Science.gov (United States)

Taylor, Holly A; McDonald, Erin L; Moon, Margaret; Hughes, Mark T; Carrese, Joseph A

2009-10-01

Previous research on ethical issues encountered by medical professionals in training and practice have presented the thematic content of the cases they encounter rather than the activities in which clinicians engage and in which they most often encounter ethical issues. We conducted a direct observation study of paediatrics residents and their preceptors seeing patients in an out-patient general paediatrics clinic. Our objectives were to describe the everyday ethics-related issues paediatrics residents encounter as they interact with patients. Our ultimate goal is to use this knowledge to enhance current efforts to teach ethics to paediatrics residents. The study team directly observed paediatrics residents discussing patients with their faculty preceptors (19 half-day sessions, 76 hours) in an out-patient general paediatrics clinic located in an urban academic medical centre. Each interaction between resident and preceptor about a single patient was considered a case for further analysis. A total of 247 cases were recorded. Forty-one of the cases were coded as having ethics-related content. A constant comparative method of qualitative data analysis revealed that residents were most likely to encounter ethical issues when engaged in the following activities: (i) maintaining a therapeutic alliance with the caregiver (e.g. the parent); (ii) prioritising patient or family needs; (iii) adjusting to the power embodied by the role of doctors, and (iv) distinguishing suboptimal care from abuse or neglect. In addition, our findings indicate that it is through their efforts to maintain the therapeutic alliance with the caregivers of their patients that residents engage in and integrate three processes: developing their medical knowledge; adhering to professional norms, and balancing the power inherent in the doctor's role with their responsibility to serve the patient's interests. Medical faculty tasked with teaching ethics to paediatrics residents can utilise the results

No More Second-Class Taxpayers: How Income Splitting Can Bring Fairness to Canada’s Single Income Families

Directory of Open Access Journals (Sweden)

Matt Krzepkowski

2013-04-01

Full Text Available The Canadian personal income tax system does not pay much attention to whether the amount of money an individual brings home is supplemented by the income of a spouse or not. That means that families where one spouse earns more than the other get taxed at a higher rate than families where two working partners earn the same total income split evenly between two paycheques. In fact, a family with just a single earner making $70,000 a year pays 30 per cent more in taxes every year than a family with two partners making $35,000 a year. A single-earner family taking in $120,000 a year pays the same income tax as a dualearning couple making $141,000 between them. The federal Conservative government has at least suggested it wants to finally level that playing field — nearly six decades after a royal commission recommended that the income tax system be changed to recognize total family household income, rather than focusing on each individual’s income. Given that Canada’s income tax system aims to treat people in similar circumstances as equally as possible, it is certainly time to let couples split their income so they do not face a penalty in higher tax rates than those faced by couples bringing home the same amount of total pay. While couples with just a single earner enjoy some advantages, a dual-earning couple does not — namely the extra time the stay-at-home spouse is able to use to raise children and produce other unpaid, home-based benefits — that can be accounted for using other means. Specifically, cutting out the transferability of the unused portion of the basic personal tax exemption for couples splitting income — requiring couples splitting their income to each earn money in order to use this credit — is one way to account for the difference in unpaid benefits that single-income families do typically enjoy more than dual-income couples. That is one mechanism; there may still be others the government might consider. But the

An Investigation of Energy Storage Possibilities in Single Family Houses for Smart Grid Purposes

DEFF Research Database (Denmark)

Andersen, Palle; Pedersen, Tom S.; Nielsen, Kirsten M.

2014-01-01

In Denmark it will be a challenge in near future to balance the electrical grid due to a large increase in the renewable energy production mainly from wind turbines. Smart grid solutions which exploit all storage capacities are essential to meet this challenge. In this work single family houses...... with heat pumps and floor heating are investigated for storage capability. The aim is to shift energy consumption a few hours in time to mitigate the effect of fluctuating production from wind and other renewable energy sources on the grid. Based on measurements in six inhabited houses for approximately...... a year prediction models are analysed. The main topic of this work is to investigate how behaviour of inhabitants affect the quality of predictions. Unfortunately the output of the models for single inhabited single family houses seems to give large standard deviations of the predictions, and aggregated...

Differences in School Behavior and Achievement between Children from Intact, Reconstituted, and Single-Parent Families.

Science.gov (United States)

Featherstone, Darin R.; And Others

1992-01-01

Analyzed differences in school behavior and achievement among students (n=530) in grades six through nine from intact, reconstituted, and single-parent families. Students from intact, two-parent families had fewer absences and tardies, higher grade point averages, and fewer negative and more positive teacher behavioral ratings than did those from…

A social work study on family patterns and street children

Directory of Open Access Journals (Sweden)

Mohammad Reza Iravani

2014-06-01

Full Text Available This paper presents a social work study on relationship between various family characteristics and street children in rural area as well as city of Esfahan, Iran. The proposed study selects a sample of 150 street children, 75 from city and 75 from rural area, and using some statistical tests verifies the effects of three factors including family income, place of residency and family size on street children. The results indicate that the city residence had more street children than rural residence did. In addition, there was a meaningful difference between the number of street children in low-income families and high-income families. Finally, the survey results indicate that big size families more likely suffered from street children than low size families did.

The Work and Family Responsibilities of Black Women Single Parents. Working Paper No. 148.

Science.gov (United States)

Malson, Michelene R.; Woody, Bette

One aspect of the general rise in the number of single parent households is the high proportion of them that are headed by black women. Black families headed by women tend to be larger and are more likely to be impoverished. Contrary to popular belief, many black single mothers considered poor are employed women, not recipients of welfare. An…

[Simulation-based intervention to improve anesthesiology residents communication with families of critically ill patients--preliminary prospective evaluation].

Science.gov (United States)

Berkenstadt, Haim; Perlson, Daria; Shalomson, Orit; Tuval, Atalia; Haviv-Yadid, Yael; Ziv, Amitai

2013-08-01

Although effective communication with families of critically ill patients is a vital component of quality care, training in this field is neglected. The article aims to validate communication skills training program for anesthesiology residents in the intensive care set up. Ten anesthesia residents, following 3 months of Intensive Care Unit (ICU) rotation, had 4 hours of lectures and one day simulation-based communication skills training with families of critically ill patients. Participants completed an attitude questionnaire over 3 time periods--before training [t1], immediately following training (t2) and three months following training (t3). The participants' communication skills were assessed by two blinded independent observers using the SEGUE framework while performing a simulation-based scenario at t1 and t3. Seven participants finished the study protocol. Participants ndicated communication importance as 3.68 +/- 0.58 (t1), 4.05 +/- 0.59 (t2), 4.13 +/- 0.64 (t3); their communication ability as 3.09 +/- 0.90 (t1), 3.70 +/- 0.80 (t2), 3.57 +/- 0.64 (t3); the contribution of lecture to communication 3.04 +/- 0.43 (t1), 3.83 +/- 0.39 (t2), 3.87 +/- 0.51 (t3), and contribution of simulation training to communication 3.00 +/- 0.71 (t1), 4.04 +/- 0.52 (t2), 3.84 +/- 0.31 (t3). The differences did not reach statistical significance. Objective assessment of the communication skills using the SEGUE framework indicated that 6/7 participants improved their communication skills, with communication ability before training at 2.66 +/- 0.83 and 1 month following training it was 3.38 +/- 0.78 (p = 0.09). This preliminary study demonstrates the value of communication skills training in the intensive care environment.

Single-machine scheduling with release dates, due dates and family setup times

NARCIS (Netherlands)

Schutten, Johannes M.J.; van de Velde, S.L.; van de Velde, S.L.; Zijm, Willem H.M.

1996-01-01

We address the NP-hard problem of scheduling n independent jobs with release dates, due dates, and family setup times on a single machine to minimize the maximum lateness. This problem arises from the constant tug-of-war going on in manufacturing between efficient production and delivery

Impact of caring for a child with cancer on single parents compared with parents from two-parent families.

Science.gov (United States)

Klassen, Anne F; Dix, David; Papsdorf, Michael; Klaassen, Robert J; Yanofsky, Rochelle; Sung, Lillian

2012-01-01

It is currently unknown how the intensive and often prolonged treatment of childhood cancer impacts on the lives of single parents. Our aims were to determine whether single parents differ from parents from two-parent families in terms of caregiver demand (the time and effort involved in caregiving), and health-related quality of life (HRQL). Forty single parents and 275 parents from two-parent families were recruited between November 2004 and February 2007 from five pediatric oncology centers in Canada. Parents were asked to complete a questionnaire booklet composed of items and scales to measure caregiver demand and HRQL (SF-36). The booklet also measured the following constructs: background and context factors, child factors, caregiving strain, intrapsychic factors, and coping factors. Single parents did not differ from parents from two-parent families in caregiving demand and physical and psychosocial HRQL. Compared with Canadian population norms for the SF-36, both groups reported clinically important differences (i.e., worse health) in psychosocial HRQL (effect size ≥ -2.00), while scores for physical HRQL were within one standard deviation of population norms. Our findings suggest that the impact of caregiving on single parents, in terms of caregiving demand and HRQL is similar to that of parents from two-parent families. Copyright © 2011 Wiley Periodicals, Inc.

Family socioeconomic status and child executive functions: the roles of language, home environment, and single parenthood.

Science.gov (United States)

Sarsour, Khaled; Sheridan, Margaret; Jutte, Douglas; Nuru-Jeter, Amani; Hinshaw, Stephen; Boyce, W Thomas

2011-01-01

The association between family socioeconomic status (SES) and child executive functions is well-documented. However, few studies have examined the role of potential mediators and moderators. We studied the independent and interactive associations between family SES and single parenthood to predict child executive functions of inhibitory control, cognitive flexibility, and working memory and examined child expressive language abilities and family home environment as potential mediators of these associations. Sixty families from diverse SES backgrounds with a school-age target child (mean [SD] age = 9.9 [0.96] years) were evaluated. Child executive functioning was measured using a brief battery. The quality of the home environment was evaluated using the Home Observation for the Measurement of the Environment inventory. Family SES predicted the three child executive functions under study. Single parent and family SES were interactively associated with children's inhibitory control and cognitive flexibility; such that children from low SES families who were living with one parent performed less well on executive function tests than children from similarly low SES who were living with two parents. Parental responsivity, enrichment activities and family companionship mediated the association between family SES and child inhibitory control and working memory. This study demonstrates that family SES inequalities are associated with inequalities in home environments and with inequalities in child executive functions. The impact of these disparities as they unfold in the lives of typically developing children merits further investigation and understanding.

Negotiating end-of-life decision making: a comparison of Japanese and U.S. residents' approaches.

Science.gov (United States)

Gabbay, Baback B; Matsumura, Shinji; Etzioni, Shiri; Asch, Steven M; Rosenfeld, Kenneth E; Shiojiri, Toshiaki; Balingit, Peter P; Lorenz, Karl A

2005-07-01

To compare Japanese and U.S. resident physicians' attitudes, clinical experiences, and emotional responses regarding making disclosures to patients facing incurable illnesses. From September 2003 to June 2004, the authors used a ten-item self-administered anonymous questionnaire in a cross-sectional survey of 103 internal medicine residents at two U.S. sites in Los Angeles, California, and 244 general medical practice residents at five Japanese sites in Central Honshu, Kyushu, Okinawa, Japan. The Japanese residents were more likely to favor including the family in disclosing diagnosis (95% versus 45%, pguilt about these behaviors. The residents' approaches to end-of-life decision making reflect known cultural preferences related to the role of patients and their families. Although Japanese trainees were more likely to endorse the role of the family, they expressed greater uncertainty about their approach. Difficulty and uncertainty in end-of-life decision making were common among both the Japanese and U.S. residents. Both groups would benefit from ethical training to negotiate diverse, changing norms regarding end-of-life decision making.

Psychotherapy Training: Residents' Perceptions and Experiences.

Science.gov (United States)

Kovach, Jessica G; Dubin, William R; Combs, Christopher J

2015-10-01

This survey examined actual training hours in psychotherapy modalities as reported by residents, residents' perceptions of training needs, and residents' perceptions of the importance of different aspects of psychotherapy training. A brief, voluntary, anonymous, Internet-based survey was developed. All 14 program directors for Accreditation Council for Graduate Medical Education accredited programs in Pennsylvania, New Jersey, and Delaware provided email addresses for current categorical residents. The survey inquired about hours of time spent in various aspects of training, value assigned to aspects of training, residents' involvement in their own psychotherapy, and overall resident wellness. The survey was e-mailed to 328 residents. Of the 328 residents contacted, 133 (40.5%) responded. Median reported number of PGY 3 and 4 performed versus perceived ideal hours of supportive therapy, cognitive behavioral therapy (CBT), and psychodynamic therapy did not differ. Answers for clinical time utilizing these modalities ranged from "none or less than 1 h" per month to 20+ h per month. PGY 3 and 4 residents reported a median of "none or less than 1 h" per month performed of interpersonal, dialectical behavior therapy, couples/family/group, and child therapies but preferred more time using these therapies. Residents in all years of training preferred more hours of didactic instruction for all psychotherapies and for medication management. Residents ranked teaching modalities in the following order of importance: supervision, hours of psychotherapy performed, personal psychotherapy, readings, and didactic instruction. Residents engaged in their own psychotherapy were significantly more likely to rank the experiential aspects of psychotherapy training (personal psychotherapy, supervision, and hours performed) higher than residents not in psychotherapy. Current psychotherapy training for psychiatry residents is highly variable, but overall, residents want more

Theoretical overview of heating power and necessary heating supply temperatures in typical Danish single-family houses from the 1900s

DEFF Research Database (Denmark)

Østergaard, Dorte Skaarup; Svendsen, Svend

2016-01-01

in typical Danish single-family houses constructed in the 1900s. The study provides a simplified theoretical overview of typical building constructions and standards for the calculation of design heat loss and design heating power in Denmark in the 1900s. The heating power and heating demand in six typical...... Danish single-family houses constructed in the 1900s were estimated based on simple steady-state calculations. We found that the radiators in existing single-family houses should not necessarilrbe expected to be over-dimensioned compared to current design heat loss. However, there is considerable...... potential for using low-temperature space heating in existing single-family houses in typical operation conditions. Older houses were not always found to require higher heating system temperatures than newer houses. We found that when these houses have gone through reasonable energy renovations, most...

Government Should Subsidize, Not Tax, Marriage: Social Policies Have Influenced the Rate of Growth in Single-Parent Families

Science.gov (United States)

Peterson, Paul E.

2015-01-01

Based upon reflections from the Moynihan report of 1965, this author notes that the root causes of the growth in single-parent families have yet to be well identified, making it difficult to figure out where to go next. However, from 1965 onward, social policies have influenced the rate of growth in single-parent families. What is needed is a…

Single-machine scheduling with release dates, due dates, and family setup times

NARCIS (Netherlands)

J.M.J. Schutten (Marco); S.L. van de Velde (Steef); W.H.M. Zijm

1996-01-01

textabstractWe address the NP-hard problem of scheduling n independent jobs with release dates, due dates, and family setup times on a single machine to minimize the maximum lateness. This problem arises from the constant tug-of-war going on in manufacturing between efficient production and delivery

Knowledge and Utilization of Electrocardiogram among Resident ...

African Journals Online (AJOL)

2017-10-26

Oct 26, 2017 ... knowledge and utilization of ECG among family medicine residents in Nigeria. Materials and ... doctors regarding their ECG requests, preferred source of interpretation, most common ECG ..... There are no conflicts of interest.

Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project): a clinical trial by clusters.

Science.gov (United States)

Del Cura-González, Isabel; López-Rodríguez, Juan A; Sanz-Cuesta, Teresa; Rodríguez-Barrientos, Ricardo; Martín-Fernández, Jesús; Ariza-Cardiel, Gloria; Polentinos-Castro, Elena; Román-Crespo, Begoña; Escortell-Mayor, Esperanza; Rico-Blázquez, Milagros; Hernández-Santiago, Virginia; Azcoaga-Lorenzo, Amaya; Ojeda-Ruiz, Elena; González-González, Ana I; Ávila-Tomas, José F; Barrio-Cortés, Jaime; Molero-García, José M; Ferrer-Peña, Raul; Tello-Bernabé, María Eugenia; Trujillo-Martín, Mar

2016-05-17

Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6 months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit

Child health insurance coverage: a survey among temporary and permanent residents in Shanghai.

Science.gov (United States)

Lu, Mingshan; Zhang, Jing; Ma, Jin; Li, Bing; Quan, Hude

2008-11-17

Under the current healthcare system in China, there is no government-sponsored health insurance program for children. Children from families who move from rural and interior regions to large urban centres without a valid residency permit might be at higher risk of being uninsured due to their low socioeconomic status. We conducted a survey in Shanghai to describe children's health insurance coverage according to their migration status. Between 2005 and 2006, we conducted an in-person health survey of the adult care-givers of children aged 7 and under, residing in five districts of Shanghai. We compared uninsurance rates between temporary and permanent child residents, and investigated factors associated with child health uninsurance. Even though cooperative insurance eligibility has been extended to temporary residents of Shanghai, the uninsurance rate was significantly higher among temporary (65.6%) than permanent child residents (21.1%, adjusted odds ratio (OR): 5.85, 95% confidence interval (95% CI): 4.62-7.41). For both groups, family income was associated with having child health insurance; children in lower income families were more likely to be uninsured (OR: 1.96, 95% CI: 1.40-2.96). Children must rely on their parents to make the insurance purchase decision, which is constrained by their income and the perceived benefits of the insurance program. Children from migrant families are at even higher risk for uninsurance due to their lower socioeconomic status. Government initiatives specifically targeting temporary residents and providing health insurance benefits for their children are urgently needed.

An assessment of efficient water heating options for an all-electric single family residence in a mixed-humid climate

Science.gov (United States)

Balke, Elizabeth C.; Healy, William M.; Ullah, Tania

2016-01-01

An evaluation of a variety of efficient water heating strategies for an all-electric single family home located in a mixed-humid climate is conducted using numerical modeling. The strategies considered include various combinations of solar thermal, heat pump, and electric resistance water heaters. The numerical model used in the study is first validated against a year of field data obtained on a dual-tank system with a solar thermal preheat tank feeding a heat pump water heater that serves as a backup. Modeling results show that this configuration is the most efficient of the systems studied over the course of a year, with a system coefficient of performance (COPsys) of 2.87. The heat pump water heater alone results in a COPsys of 1.9, while the baseline resistance water heater has a COPsys of 0.95. Impacts on space conditioning are also investigated by considering the extra energy consumption required of the air source heat pump to remove or add heat from the conditioned space by the water heating system. A modified COPsys that incorporates the heat pump energy consumption shows a significant drop in efficiency for the dual tank configuration since the heat pump water heater draws the most heat from the space in the heating season while the high temperatures in the solar storage tank during the cooling season result in an added heat load to the space. Despite this degradation in the COPsys, the combination of the solar thermal preheat tank and the heat pump water heater is the most efficient option even when considering the impacts on space conditioning. PMID:27990058

An assessment of efficient water heating options for an all-electric single family residence in a mixed-humid climate.

Science.gov (United States)

Balke, Elizabeth C; Healy, William M; Ullah, Tania

2016-12-01

An evaluation of a variety of efficient water heating strategies for an all-electric single family home located in a mixed-humid climate is conducted using numerical modeling. The strategies considered include various combinations of solar thermal, heat pump, and electric resistance water heaters. The numerical model used in the study is first validated against a year of field data obtained on a dual-tank system with a solar thermal preheat tank feeding a heat pump water heater that serves as a backup. Modeling results show that this configuration is the most efficient of the systems studied over the course of a year, with a system coefficient of performance (COP sys ) of 2.87. The heat pump water heater alone results in a COP sys of 1.9, while the baseline resistance water heater has a COP sys of 0.95. Impacts on space conditioning are also investigated by considering the extra energy consumption required of the air source heat pump to remove or add heat from the conditioned space by the water heating system. A modified COP sys that incorporates the heat pump energy consumption shows a significant drop in efficiency for the dual tank configuration since the heat pump water heater draws the most heat from the space in the heating season while the high temperatures in the solar storage tank during the cooling season result in an added heat load to the space. Despite this degradation in the COP sys , the combination of the solar thermal preheat tank and the heat pump water heater is the most efficient option even when considering the impacts on space conditioning.

Experimental investigations on solar heating/heat pump systems for single family houses

DEFF Research Database (Denmark)

Andersen, Elsa; Perers, Bengt

In the period 2013-2017 the project “Experimental investigations on solar heat pump systems for single family houses” is carried out at Department of Civil Engineering, Technical University of Denmark. The aim of this project is to increase the knowledge of the heat and mass transfer in the combi...

Implementing the Namaste Care Program for residents with advanced dementia: exploring the perceptions of families and staff in UK care homes.

Science.gov (United States)

Stacpoole, Min; Hockley, Jo; Thompsell, Amanda; Simard, Joyce; Volicer, Ladislav

2017-10-01

Increasing numbers of older people with advanced dementia are cared for in care homes. No cure is available, so research focused on improving quality of life and quality of care for people with dementia is needed to support them to live and die well. The Namaste Care programme is a multi-dimensional care program with sensory, psycho-social and spiritual components intended to enhance quality of life and quality of care for people with advanced dementia. The aim of the study was to establish whether the Namaste Care program can be implemented in UK care homes; and what effect Namaste Care has on the quality of life of residents with advanced dementia, their families and staff. This article explores the qualitative findings of the study, reporting the effect of the programme on the families of people with advanced dementia and care home staff, and presenting their perceptions of change in care. An organisational action research methodology was used. Focus groups and interviews were undertaken pre/post implementation of the Namaste Care program. The researcher kept a reflective diary recording data on the process of change. A comments book was available to staff and relatives in each care home. Data was analysed thematically within each care home and then across all care homes. Six care homes were recruited in south London: one withdrew before the study was underway. Of the five remaining care homes, four achieved a full Namaste Care program. One care home did not achieve the full program during the study, and another discontinued Namaste Care when the study ended. Every home experienced management disruption during the study. Namaste Care challenged normal routinised care for older people with advanced dementia. The characteristics of care uncovered before Namaste was implemented were: chaos and confusion, rushing around, lack of trust, and rewarding care. After the programme was implemented these perceptions were transformed, and themes of calmness, reaching out to

Osteosarcoma inheritance in two families of Scottish deerhounds.

Science.gov (United States)

Dillberger, John E; McAtee, Sara Ann

2017-01-01

Osteosarcoma is the most common neoplastic disease in Scottish Deerhounds. For Deerhounds, a 2007 population-based study concluded that a single dominant genetic factor largely governed disease risk. For Greyhounds, Rottweilers, and Irish Wolfhounds, a 2013 genome-wide association study found multiple genetic markers in each breed, with each marker only weakly associated with the disease. We obtained from two breeders the pedigrees, age (if alive) or age at death, and osteosarcoma status for two families of Scottish Deerhounds, designated Cohorts K and T. A dog was considered unaffected only if it was osteosarcoma-free and at least 8.5 years old. We analyzed the data in two ways, by assuming either a single recessive genetic factor or a single dominant genetic factor with high penetrance. Cohort K contained 54 evaluable dogs representing 12 litters. Cohort T contained 56 evaluable dogs representing eight litters. Osteosarcoma seemed clearly heritable in both cohorts; however, having a parent with osteosarcoma raised a pup's risk of developing osteosarcoma to 38% for Cohort K but 78% for Cohort T, suggesting the possibility of different genetic risk factors in each cohort. In Cohort K, osteosarcoma inheritance fit well with a single, recessive, autosomal risk factor, although we could not rule out the possibility of a single dominant risk factor with incomplete penetrance. In Cohort T, inheritance could be explained well by a single, dominant, autosomal risk factor but was inconsistent with recessive expression. Inheritance of osteosarcoma in two Scottish Deerhound families could be explained well by a single genetic risk factor residing on an autosome, consistent with a 2007 report. In one family, inheritance was consistent with dominant expression, as previously reported. In the other family, inheritance fit better with recessive expression, although the possibility of a dominant genetic factor influenced by one or more other genetic factors could not be ruled

Hospice family members’ perceptions and experiences with end-of-life care in the nursing home

Science.gov (United States)

Washington, Karla; Kruse, Robin L.; Albright, David L; Lewis, Alexandria; Demiris, George

2014-01-01

Objective Despite the fact that more than 25% of Americans die in nursing homes, end-of-life care has consistently been found to be less than adequate in this setting. Even for those residents on hospice, end-of-life care has been found to be problematic. This study had two research questions; 1) How do family members of hospice nursing home residents differ in their anxiety, depression, quality of life, social networks, perceptions of pain medication, and health compared to family members of community dwelling hospice patients? 2) What are family members’ perceptions of and experiences with end-of-life care in the nursing home setting? Methods This study is a secondary mixed methods analysis of interviews with family members of hospice nursing home residents and a comparative statistical analysis of standard outcome measures between family members of hospice patients in the nursing home and family member of hospice patients residing in the community. Results Outcome measures for family members of nursing home residents were compared (n=176) with family members of community dwelling hospice patients (n=267). The family members of nursing home residents reported higher quality of life however, levels of anxiety, depression, perceptions of pain medicine, and health were similar for hospice family members in the nursing home and in the community. Lending an understanding to the stress for hospice family members of nursing home residents concerns were found with collaboration between the nursing home and the hospice, nursing home care that did not meet family expectations, communication problems, and resident care concerns including pain management. Some family members reported positive end-of-life care experiences in the nursing home setting. Conclusion These interviews identify a multitude of barriers to quality end-of-life care in the nursing home setting, and demonstrate that support for family members is an essential part of quality end-of-life care for

Leadership Book Club: An Innovative Strategy to Incorporate Leadership Development Into Pharmacy Residency Programs.

Science.gov (United States)

Chappell, Alyssa; Dervay, Katelyn

2016-09-01

Purpose: To describe an innovative strategy for incorporating leadership training and development across multiple postgraduate year 2 (PGY2) pharmacy residency programs at a single institution. Background: Tampa General Hospital has 7 pharmacy residency positions: 4 postgraduate year 1 (PGY1) residents and a single resident for each of the 3 PGY2 programs (critical care, emergency medicine, and solid organ transplant). Administrative topics are incorporated across the PGY1 and PGY2 residency programs, with each PGY2 program having additional administrative topics specific to their specialty area. Summary: What began as an elective administrative topic discussion for the PGY2 emergency medicine resident has evolved over time into a longitudinal leadership book club. The leadership book club is utilized to meet the residency goals and objectives related to leadership development for all 3 PGY2 programs. Each year a single book is identified through the American Society of Health-System Pharmacists (ASHP) Leadership Academy book list or by participant suggestion. The book is then divided into 4 sections with corresponding hour-long discussions that occur quarterly throughout the residency year. The residency program directors (RPDs) and co-RPDs lead the initial discussion, and each PGY2 resident leads 1 of the subsequent 3 discussions. Based on resident feedback, the leadership book club is an innovative and effective strategy to incorporate leadership training and development into residency training. Conclusion: It is imperative to foster the development of leadership skills in pharmacy residency programs to prevent a future leadership gap in health system pharmacy. Leadership book club is a unique strategy to incorporate leadership training longitudinally across multiple PGY2 residency programs at a single institution.

Advance care planning for nursing home residents with dementia: policy vs. practice.

Science.gov (United States)

Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal

2016-03-01

The aims of this study were: to evaluate the advance care planning policy for people with dementia in nursing homes; to gain insight in the involvement of residents with dementia and their families in advance care planning, and in the relationship between the policy and the actual practice of advance care planning. Through advance care planning, nursing home residents with dementia are involved in care decisions, anticipating their reduced decision-making capacity. However, advance care planning is rarely realized for this group. Prevalence and outcomes have been researched, but hardly any research has focused on the involvement of residents/families in advance care planning. Observational cross-sectional study in 20 nursing homes. The ACP audit assessed the views of the nursing homes' staff on the advance care planning policy. In addition, individual conversations were analysed with 'ACP criteria' (realization of advance care planning) and the 'OPTION' instrument (involvement of residents/families). June 2013-September 2013. Nursing homes generally met three quarters of the pre-defined criteria for advance care planning policy. In almost half of the conversations, advance care planning was explained and discussed substantively. Generally, healthcare professionals only managed to involve residents/families on a baseline skill level. There were no statistically significant correlations between policy and practice. The evaluations of the policy were promising, but the actual practice needs improvement. Future assessment of both policy and practice is recommended. Further research should focus on communication interventions for implementing advance care planning in the daily practice. © 2015 John Wiley & Sons Ltd.

The pregnant female surgical resident

Directory of Open Access Journals (Sweden)

Shifflette V

2018-05-01

Full Text Available Vanessa Shifflette,1 Susannah Hambright,2 Joseph Darryl Amos,1 Ernest Dunn,3 Maria Allo4 1Associates in Surgical Acute Care, Methodist Dallas Medical Center, Dallas, TX, USA; 2Methodist Surgical Associates, Methodist Dallas Medical Center, Dallas, TX, USA; 3Graduate Medical Education - General Surgery, Methodist Dallas Medical Center, Dallas, TX, USA; 4Santa Clara Valley Medical Center, San Jose, CA, USA Background: Surgery continues to be an intense, time-consuming residency. Many medical students decide against surgery as a profession due to the long work hours and family strain. The pregnant female surgical resident has an added stress factor compared to her male counterpart. Methods: We distributed an electronic, online 26-question survey to 32 general surgery programs in the southwestern region of the United States. Each program distributed our survey to the female surgical residents who had been pregnant during residency in the last 5 years. Each program was re-contacted 6 weeks after the initial contact. Most questions were in a 5-point Likert scale format. The responses were collected and analyzed using the Survey Monkey website. Results: An unvalidated survey was sent to 32 general surgery programs and 26 programs responded (81%. Each program was asked for the total number of possible responses from female residents that met our criteria (60 female residents. Seven of the programs (27% stated that they have had zero residents pregnant. We had 22 residents respond (37%. Over half of the residents (55% were pregnant during their 2nd or 3rd year of residency, with only 18% pregnant during a research year. Thirty-one percent had a lower American Board of Surgery In-Training Exam (ABSITE score. Ninety percent of the residents were able to take 4 weeks or more for maternity leave. Most of the residents (95% stated that they would do this again during residency given the opportunity, but many of the residents felt that returning back to work

Enhancing physical and social environments to reduce obesity among public housing residents: rationale, trial design, and baseline data for the Healthy Families study.

Science.gov (United States)

Quintiliani, Lisa M; DeBiasse, Michele A; Branco, Jamie M; Bhosrekar, Sarah Gees; Rorie, Jo-Anna L; Bowen, Deborah J

2014-11-01

Intervention programs that change environments have the potential for greater population impact on obesity compared to individual-level programs. We began a cluster randomized, multi-component multi-level intervention to improve weight, diet, and physical activity among low-socioeconomic status public housing residents. Here we describe the rationale, intervention design, and baseline survey data. After approaching 12 developments, ten were randomized to intervention (n=5) or assessment-only control (n=5). All residents in intervention developments are welcome to attend any intervention component: health screenings, mobile food bus, walking groups, cooking demonstrations, and a social media campaign; all of which are facilitated by community health workers who are residents trained in health outreach. To evaluate weight and behavioral outcomes, a subgroup of female residents and their daughters age 8-15 were recruited into an evaluation cohort. In total, 211 households completed the survey (RR=46.44%). Respondents were Latino (63%), Black (24%), and had ≤ high school education (64%). Respondents reported ≤2 servings of fruits & vegetables/day (62%), visiting fast food restaurants 1+ times/week (32%), and drinking soft drinks daily or more (27%). The only difference between randomized groups was race/ethnicity, with more Black residents in the intervention vs. control group (28% vs. 19%, p=0.0146). Among low-socioeconomic status urban public housing residents, we successfully recruited and randomized families into a multi-level intervention targeting obesity. If successful, this intervention model could be adopted in other public housing developments or entities that also employ community health workers, such as food assistance programs or hospitals. Copyright © 2014 Elsevier Inc. All rights reserved.

Land cover in single-family housing areas and how it correlates with urban form

DEFF Research Database (Denmark)

Nielsen, Mette Boye; Jensen, Marina Bergen

2015-01-01

Land cover composition is a valuable indicator of the ecological performance of a city. Single-family housing areas constitute a substantial part of most cities and may as such play an important role for sustainable urban development. From aerial photos we performed detailed GIS-based mapping...... of land cover in three detached single-family housing areas in Denmark of different urban form but comparable housing densities (ranging from 10.0 to 11.3 houses per hectare). The findings were subjected to statistical analysis and landscape metrics. Land cover varied with urban form: A traditional...... spatial configuration with rectangular parcels contained significantly more vegetation and less impervious surfaces per parcel than newer Radburn-inspired configurations with more quadratic parcels. Correlation analysis showed size of paved access ways to be positively correlated with distance from road...

Familiarity with Long-acting Reversible Contraceptives among Obstetrics and Gynecology, Family Medicine, and Pediatrics Residents: Results of a 2015 National Survey and Implications for Contraceptive Provision for Adolescents.

Science.gov (United States)

Davis, Susan A; Braykov, Nikolay P; Lathrop, Eva; Haddad, Lisa B

2018-02-01

To assess familiarity with long-acting reversible contraceptives (LARC) among current obstetrics and gynecology (OB/GYN), family medicine (FM), and pediatrics senior residents in the United States. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We selected 156 OB/GYN, FM, and pediatrics residency programs using the American Medical Association Freida database. Senior residents completed a survey addressing any training they had received on LARC, and rated their comfort level counseling about and inserting LARC. Residents rated their likelihood of recommending LARC to an adolescent, nulliparous patient, and indicated whether they would like additional training on LARC. Descriptive and analytic statistics were generated using R statistical software (The R Project for Statistical Computing; https://www.r-project.org). The survey was completed by 326 of 1,583 residents (20.6% response rate); at least 1 resident completed the survey at 105 (67.3%) of the residency programs contacted. Most programs (84.8%) provided some training on LARC. Residents in OB/GYN programs were comfortable counseling about and inserting contraceptive implants (97%, 83%), copper intrauterine devices (IUDs; 100%, 86%), and levonorgestrel (LNG) IUDs (100%, 86%). In FM programs, fewer residents were comfortable counseling about and inserting contraceptive implants (71%, 47%), copper IUDs (68%, 21%), and LNG IUDs (79%, 18%). Residents in pediatrics programs had low comfort levels counseling about contraceptive implants (14%), copper IUDs (14%), and LNG IUDs (25%); no pediatrics residents were comfortable inserting LARC. OB/GYN residents were significantly more likely to recommend a LARC to an adolescent, nulliparous patient (P = .019). Most pediatric and FM residents desired additional training on LARC (82.7% and 60.7%, respectively). This study shows that knowledge gaps exist regarding LARC among FM and pediatrics residents. Copyright © 2017 North American Society for

Assessing resident's knowledge and communication skills using four different evaluation tools.

Science.gov (United States)

Nuovo, Jim; Bertakis, Klea D; Azari, Rahman

2006-07-01

This study assesses the relationship between 4 Accreditation Council for Graduate Medical Education (ACGME) outcome project measures for interpersonal and communication skills and medical knowledge; specifically, monthly performance evaluations, objective structured clinical examinations (OSCEs), the American Board of Family Practice in-training examination (ABFP-ITE) and the Davis observation code (DOC) practice style profiles. Based on previous work, we have DOC scoring for 29 residents from the University of California, Davis Department of Family and Community Medicine. For all these residents we also had the results of monthly performance evaluations, 2 required OSCE exercises, and the results of 3 American Board of Family Medicine (ABFM) ITEs. Data for each of these measures were abstracted for each resident. The Pearson correlation coefficient was used to assess the presence or lack of correlation between each of these evaluation methods. There is little correlation between various evaluation methods used to assess medical knowledge, and there is also little correlation between various evaluation methods used to assess communication skills. The outcome project remains a 'work in progress', with the need for larger studies to assess the value of different assessment measures of resident competence. It is unlikely that DOC will become a useful evaluation tool.

Using skype as an alternative for residency selection interviews.

Science.gov (United States)

Edje, Louito; Miller, Christine; Kiefer, Jacklyn; Oram, David

2013-09-01

Residency interviews can place significant time and financial burdens on applicants. To determine whether the use of Skype as a screening tool during interview season in a family medicine residency is cost-effective and time-efficient for the applicant and the residency program. We surveyed 2 groups of medical students during interviews for our family medicine program. Thirty-two students were interviewed via our face-to-face, traditional interview (TI) process, and 10 students, the second group, who did not meet the program's standard interview selection criteria for TI, underwent our Skype interview (SI) process. Using an unpaired t test, we found that the applicants' costs of an SI were significantly less than a TI, $566 (95% confidence interval [CI] $784-$349, P Skype may be a cost-effective and time-efficient screening tool for both the applicant and the program. Alternate uses of SI may include the time-sensitive, postmatch Supplemental Offer and Acceptance Program.

Energy Renovation of Danish Single-Family Houses

DEFF Research Database (Denmark)

Mortensen, Andrea

2015-01-01

. The results show that despite the barriers the owners can in fact be motivated to perform private energy renovations. A sound project economy is all-important for this to happen and it should if possible be supported by improvements in both comfort, indoor environment and architecture to increase......The PhD project is based on requirements from the European Union to reduce the energy consumption and on current renovation needs of and a huge energy saving potential in the Danish single-family houses from the 1960’s and 1970’s. The project focuses on the barriers for energy renovations...... of these houses and on defining motivation factors for the homeowners. The barriers are many and variating in influence and studies show that both professionals and homeowners are affected. The barriers range from lack of interest and knowledge to uncertainties about among others economy and technical solutions...

Housing as a Social Determinant of Health: Exploring the Relationship between Rent Burden and Risk Behaviors for Single Room Occupancy Building Residents.

Science.gov (United States)

Bowen, Elizabeth A; Mitchell, Christopher G

2016-01-01

A growing body of health determinants research recognizes that housing and health are intimately linked. This study explores the relationship between rent burden (the ratio of rent to income) and health risk behaviors among a sample of single room occupancy (SRO) building residents. Cross-sectional data were gathered from a sample of 162 residents living in privately owned, for-profit SROs in Chicago. Findings indicated that participants who had full rental subsidies and thus were designated in a no-rent-burden category were more likely to engage in risk behaviors including illicit drug use, having multiple sexual partners, and having sex without a condom, in comparison to participants with moderate or high-rent burdens. These findings suggest that interventions to increase housing stability and affordability and bolster reliable income sources (in addition to rental subsidies) may be key in reducing risk behaviors and improving health for vulnerably housed populations such as SRO residents.

Geriatric core competencies for family medicine curriculum and enhanced skills: care of elderly.

Science.gov (United States)

Charles, Lesley; Triscott, Jean A C; Dobbs, Bonnie M; McKay, Rhianne

2014-06-01

There is a growing mandate for Family Medicine residency programs to directly assess residents' clinical competence in Care of the Elderly (COE). The objectives of this paper are to describe the development and implementation of incremental core competencies for Postgraduate Year (PGY)-I Integrated Geriatrics Family Medicine, PGY-II Geriatrics Rotation Family Medicine, and PGY-III Enhanced Skills COE for COE Diploma residents at a Canadian University. Iterative expert panel process for the development of the core competencies, with a pre-defined process for implementation of the core competencies. Eighty-five core competencies were selected overall by the Working Group, with 57 core competencies selected for the PGY-I/II Family Medicine residents and an additional 28 selected for the PGY-III COE residents. The core competencies follow the CanMEDS Family Medicine roles. Both sets of core competencies are based on consensus. Due to demographic changes, it is essential that Family Physicians have the required skills and knowledge to care for the frail elderly. The core competencies described were developed for PGY-I/II Family Medicine residents and PGY-III Enhanced Skills COE, with a focus on the development of geriatric expertise for those patients that would most benefit.

Quality assessment and improvement of post graduate family medicine training in the USA.

Science.gov (United States)

Hoekzema, Grant S; Maxwell, Lisa; Gravel, Joseph W; Mills, Walter W; Geiger, William; Honeycutt, J David

2016-09-01

In 2013, the World Organisation of Family Doctors published training standards for post-graduate medical education (GME) in Family Medicine/General Practice (FP/GP). GME quality has not been well-defined, other than meeting accreditation standards. In 2009, the Association of Family Medicine Residency Directors (AFMRD) developed a tool that would aid in raising the quality of family medicine residency training in the USA. We describe the development of this quality improvement tool, which we called the residency performance index (RPI), and its first three years of use by US family medicine residency (FMR) programmes. The RPI uses metrics specific to family medicine training in the USA to help programmes identify strengths and areas for improvement in their educational activities. Our review of three years of experience with the RPI revealed difficulties with collecting data, and lack of information on graduates' scope of practice. It also showed the potential usefulness of the tool as a programme improvement mechanism. The RPI is a nationwide, standardised, programme quality improvement tool for family medicine residency programmes in the USA, which was successfully launched as part of AFMRD's strategic plan. Although some initial challenges need to be addressed, it has the promise to aid family medicine residencies in their internal improvement efforts. This model could be adapted in other post-graduate training settings in FM/GP around the world.

[Part-time residency training in Israel].

Science.gov (United States)

Fishbain, Dana; Levi, Baruch; Borow, Malke; Ashkenazi, Shai; Lindner, Arie

2012-08-01

Full-time work has long been perceived as a cornerstone of medical residency, the consensus being that a resident must apply the bulk of his time and attention to his professional training. Demographic and cultural changes that have taken place over the last several years, specifically the rise in the number of female doctors and the importance of leisure time to the younger generation, have intensified the need to find new and innovative ways to deal with the plight of the resident population. One idea, already in effect in many Western countries, is the institution of part-time residency programs. The possibility of fulfilling residency requirements on a part-time basis is intended to assist medical residents in integrating their professional development with their personal and family life, without compromising the quality of their training. A number of research studies conducted over the last several years in countries that allow part-time residency, among them the United States, England and Switzerland, aimed to examine the quality of part-time training. The various studies evinced a high level of satisfaction from the program both by the residents themselves and their supervisors, and in many aspects those doing residency part-time received higher appraisals than their full-time colleagues. Some of the residents polled noted that they would have totally foregone the practice of medicine had there not been an option to complete residency part-time. In light of the experience throughout the world and the changing landscape in Israel, the Scientific Council of the Israeli Medical Association decided to examine the issue and its various aspects, and weighed all the considerations in favor and against part-time residency. Recently, the Scientific Council approved the launch of a pilot program to allow part-time residency in several fields that were carefully selected according to specific criteria. Once the Ministry of Health completes the LegisLation process, part

Perceived Social Support And Life Satisfaction Of Residents In A Nursing Home In Turkey

OpenAIRE

Çimen, Mesut; Akbolat, Mahmut

2016-01-01

Abstract: This study was conducted to identify the factors that affect the perception of social support and life satisfaction of selected nursing home residents in Turkey, using the Multidimensional Scale of Perceived Social Support (MSPSS) and the Satisfaction with Life Scale (SWLS). 80 residents participated in the study. Results of univariate analyses indicated that family-based perceived social support of nursing home residents is significantly higher in married residents and in residents...

Death Notification: Someone Needs To Call the Family.

Science.gov (United States)

Ombres, Rachel; Montemorano, Lauren; Becker, Daniel

2017-06-01

The death notification process can affect family grief and bereavement. It can also affect the well-being of involved physicians. There is no standardized process for making death notification phone calls. We assumed that residents are likely to be unprepared before and troubled after. We investigated current death notification practices to develop an evidence-based template for standardizing this process. We used results of a literature review and open-ended interviews with faculty, residents, and widows to develop a survey regarding resident training and experience in death notification by phone. We invited all internal medicine (IM) residents at our institution to complete the survey. Sixty-seven of 93 IM residents (72%) responded to the survey. Eighty-seven percent of responders reported involvement in a death that required notification by phone. Eighty percent of residents felt inadequately trained for this task. Over 25% reported that calls went poorly. Attendings were involved in 17% of cases. Primary care physicians were not involved. Nurses and chaplains were not involved. Respondents never delayed notification of death until family arrived at the hospital. There was no consistent approach to rehearsing or making the call, advising families about safe travel to the hospital, greeting families upon arrival, or following up with expressions of condolence. Poor communication skills during death notification may contribute to complicated grief for surviving relatives and stress among physicians. This study is the first to describe current practices of death notification by IM residents. More training is needed and could be combined with training in disclosure of medical error.

[Teacher's perfomance assessment in Family Medicine specialization].

Science.gov (United States)

Martínez-González, Adrián; Gómez-Clavelina, Francisco J; Hernández-Torres, Isaías; Flores-Hernández, Fernando; Sánchez-Mendiola, Melchor

2016-01-01

In Mexico there is no systematic evaluation of teachers in medical specialties. It is difficult to identify appropriate teaching practices. The lack of evaluation has limited the recognition and improvement of teaching. The objective of this study was to analyze feedback from students about teaching activities of teachers-tutors responsible for the specialization course in family medicine, and evaluate the evidence of reliability and validity of the instrument applied online. It was an observational and cross-sectional study. Seventy eight teachers of Family Medicine of medical residency were evaluated by 734 resident´s opinion. The anonymous questionnaire to assess teaching performance by resident's opinion and it is composed of 5 dimensions using a Likert scale. Descriptive and inferential statistics (t test, one-way ANOVA and factor analysis) were used. Residents stated that teaching performance is acceptable, with an average of 4.25 ± 0.93. The best valued dimension was "Methodology" with an average of 4.34 ± .92 in contrast to the "assessment" dimension with 4.16 ± 1.04. Teachers of specialization in family medicine have acceptable performance by resident's opinion. The online assessment tool meets the criteria of validity and reliability.

Comparison of Parenting Style in Single Child and Multiple Children Families

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Masoumeh Alidosti

2016-06-01

Full Text Available Background and Purpose: Family is the first and the most important structure in human civilization in which social lifestyles, mutual understanding, and compatibility is learned. Studies have shown that parenting style, is one the most important and fundamental factors in personality development. The purpose of this study was comparison of parenting style in single child and multiple children families. Materials and Methods: This study, in total, 152 mothers from Andimeshk city, Iran, were selected by random sampling. Data were collected from a health-care center was chosen randomly, mothers who had 5-7 years old children were enrolled in this study. The data collecting tool was the questionnaire which investigates permissive, authoritative, and authoritarian parenting styles in parents. After data entry in SPSS software, the collected data were analyzed by ANOVA, independent t-test, and Pearson correlation test. Results: The mean age of the participants was 32.71 ± 5.39 years old participated in this study. 69 mothers (45.4% had one child, 53 (34.9% had 2 children, and 30 mothers (19.7% had 3 and more children. The mean score of permissive parenting style was 19.97 ± 5.13 in single child families; the mean score of authoritative (19.56 ± 4.70 and authoritarian parenting style (34.50 ± 2.81 that difference was significantly (P < 0.050. Conclusion: According to the results of this study, it seems that having more children would make parents more logical and paves the way for upbringing children. Therefore, it is recommended to plan some educational programs about this issue for parents.

Cognitive Vulnerabilities to Depression for Adolescents in Single-Mother and Two-Parent Families

Science.gov (United States)

Daryanani, Issar; Hamilton, Jessica L.; McArthur, Brae Anne; Steinberg, Laurence; Abramson, Lyn. Y.; Alloy, Lauren B.

2017-01-01

Although research consistently suggests that adolescents in single-mother families are at increased risk for depression, the mechanisms that explain this relationship are unclear. In a community sample of adolescents (N = 368; ages 12–16; 50% female; 50% White) and their mothers (42% single), adolescents completed measures of depressive symptoms, rumination, and depressogenic inferential style at baseline and two yearly follow-ups. Mothers reported on stressful events that occurred in the child’s life from birth until baseline. Adolescents raised by single mothers, relative to partnered mothers, experienced more childhood stressors and higher rumination levels at one-year follow-up. Additionally, higher rumination mediated the relationship between single motherhood and greater youth depressive symptoms at the two-year follow-up. Clinical implications and developmental considerations are discussed. PMID:27858293

Cognitive Vulnerabilities to Depression for Adolescents in Single-Mother and Two-Parent Families.

Science.gov (United States)

Daryanani, Issar; Hamilton, Jessica L; McArthur, Brae Anne; Steinberg, Laurence; Abramson, Lyn Y; Alloy, Lauren B

2017-01-01

Although research consistently suggests that adolescents in single-mother families are at increased risk for depression, the mechanisms that explain this relationship are unclear. In a community sample of adolescents (N = 368; ages 12-16; 50 % female; 50 % White) and their mothers (42 % single), adolescents completed measures of depressive symptoms, rumination, and depressogenic inferential style at baseline and two yearly follow-ups. Mothers reported on stressful events that occurred in the child's life from birth until baseline. Adolescents raised by single mothers, relative to partnered mothers, experienced more childhood stressors and higher rumination levels at 1-year follow-up. Additionally, higher rumination mediated the relationship between single motherhood and greater youth depressive symptoms at the 2-year follow-up. Clinical implications and developmental considerations are discussed.

National impacts of the Weatherization Assistance Program in single-family and small multifamily dwellings

Energy Technology Data Exchange (ETDEWEB)

Brown, M.A.; Berry, L.G.; Balzer, R.A.; Faby, E.

1993-05-01

Since 1976, the US Department of Energy (DOE) has operated one of the largest energy conservation programs in the nation -- the low-income Weatherization Assistance Program. The program strives to increase the energy efficiency of dwellings occupied by low-income persons in order to reduce their energy consumption, lower their fuel bills, increase the comfort of their homes, and safeguard their health. It targets vulnerable groups including the elderly, people with disabilities, and families with children. The most recent national evaluation of the impacts of the Program was completed in 1984 based on energy consumption data for households weatherized in 1981. DOE Program regulations and operations have changed substantially since then: new funding sources, management principles, diagnostic procedures, and weatherization technologies have been incorporated. Many of these new features have been studied in isolation or at a local level; however, no recent evaluation has assessed their combined, nationwide impacts to date or their potential for the future. In 1990, DOE initiated such an evaluation. This evaluation is comprised of three ``impact`` studies (the Single-Family Study, High-Density Multifamily Study, and Fuel-Oil Study) and two ``policy`` studies. Altogether, these five studies will provide a comprehensive national assessment of the Weatherization Assistance Program as it existed in the 1989 Program Year (PY 1989). This report presents the results of the first phase of the Single-Family Study. It evaluates the energy savings and cost effectiveness of the Program as it has been applied to the largest portion of its client base -- low-income households that occupy single-family dwellings, mobile homes, and small (2- to 4-unit) multifamily dwellings. It is based upon a representative national sample that covers the full range of conditions under which the program was implemented in PY 1989.

Redesigning journal club in residency

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Al Achkar M

2016-05-01

Full Text Available Morhaf Al Achkar Department of Family Medicine, Indiana University, Indianapolis, IN, USA Abstract: The gap between production and implementation of knowledge is the main reason for the suboptimal quality of health care. To eliminate this gap and improve the quality of patient care, journal club (JC in graduate medical education provides an opportunity for learning the skills of evidence-based medicine. JC, however, continues to face many challenges mainly due to poorly defined goals, inadequate preparation, and lack of interest. This article presents an innovative model to prepare and present JC based on three pillars: dialogical learning through group discussion, mentored residents as peer teachers, and including JC as part of a structured curriculum to learn evidence-based medicine. This engaging model has the potential to transform JC from a moribund session that is daunting for residents into a lively discussion to redefine clinical practice using the most current evidence. Keywords: journal club, residents, peer teaching, evidence-based medicine, dialogical learning

Attitudes towards family formation in cohabiting and single childless women in their mid- to late thirties.

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Birch Petersen, Kathrine; Sylvest, Randi; Nyboe Andersen, Anders; Pinborg, Anja; Westring Hvidman, Helene; Schmidt, Lone

2016-04-01

This study aimed to explore attitudes towards family formation in single or cohabiting childless women of advanced age. The design comprised semi-structured qualitative interviews of 20 women aged 34-39 years attending the Fertility Assessment and Counselling Clinic, Rigshospitalet, Copenhagen. A sample of 10 single women and 10 cohabiting women was chosen with equal distribution of postgraduate education length. Data were analysed using content analysis following the method of Graneheim and Lundman and consolidated criteria for reporting qualitative research (COREQ). The general attitude towards family formation was characterized by a fear of the consequences of choosing motherhood on one hand, and a 'ticking biological clock' and a wish to establish a nuclear family on the other. The women idealized the perception of perfect mothering in terms of uncompromising expectations of child rearing and showed an increasing awareness of solo motherhood as a possible solution to advanced age, the wish of a child and single status compared to earlier studies. Our study contributes to knowledge and understanding of personal considerations related to childbearing in nullipara women in their mid- to late 30s and may be useful in a fertility assessment and counselling setting.

Career goals and expectations of men and women pharmacy residents.

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King, C M; Oliver, E J; Jeffrey, L P

1982-11-01

Personal and professional characteristics of men and women hospital pharmacy residents were studied to identify differences that could affect future hospital pharmacy practice. Residents in 111 ASHP-accredited pharmacy residency programs received a survey containing questions on demographic information, reasons for selecting a residency, areas of professional interest, postresidency career goals, responsibilities to home and family, and advantages and disadvantages associated with gender. Of 286 residents receiving questionnaires, 226 responded; the percentages of men and women responding corresponded to the ratio of men and women in hospital pharmacy residencies. While men and women expressed educational goals that were not significantly different, more men than women had earned or were in the process of earning advanced degrees. No significant differences were evident between men's and women's plans for marriage and children, but 73% of the women indicated that they would take time out from their practice to raise children, compared with only 9% of the men. The majority of residents did not think their gender affected them in their residency programs, but in professional interactions more men saw gender as an advantage and more women as a disadvantage. Significantly more than women aspired to be hospital pharmacy directors. The results suggest that men are obtaining advanced training closer to the time they graduate from pharmacy school and that in the future women competing for promotions may be older than men competing for comparable positions. Those planning pharmacy staffing should consider the needs of women, and men, who expect to take time out from their careers for family responsibilities and possibly seek part-time positions when they return to the work force.

Employment and satisfaction trends among general surgery residents from a community hospital.

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Cyr-Taro, Amy E; Kotwall, Cyrus A; Menon, Rema P; Hamann, M Sue; Nakayama, Don K

2008-01-01

Physician satisfaction is an important and timely issue in health care. A paucity of literature addresses this question among general surgeons. To review employment patterns and job satisfaction among general surgery residents from a single university-affiliated institution. All general surgery residents graduating from 1986 to 2006, inclusive, were mailed an Institutional Review Board-approved survey, which was then returned anonymously. Information on demographics, fellowship training, practice characteristics, job satisfaction and change, and perceived shortcomings in residency training was collected. A total of 31 of 34 surveys were returned (91%). Most of those surveyed were male (94%) and Caucasian (87%). Sixty-one percent of residents applied for a fellowship, and all but 1 were successful in obtaining their chosen fellowship. The most frequent fellowship chosen was plastic surgery, followed by minimally invasive surgery. Seventy-one percent of residents who applied for fellowship felt that the program improved their competitiveness for a fellowship. Most of the sample is in private practice, and of those, 44% are in groups with more than 4 partners. Ninety percent work less than 80 hours per week. Only 27% practice in small towns (population job. Twenty-three percent agreed that they had difficulty finding their first job, and 30% had fewer job offers than expected. Thirty-five percent of the graduates have changed jobs: 29% of the residents have changed jobs once, and 6% have changed jobs at least twice since completing training. Reasons for leaving a job included colleague issues (82%), financial issues (82%), inadequate referrals (64%), excessive trauma (64%), and marriage or family reasons (55% and 55%, respectively). One half to three fourths of the graduates wished they had more teaching on postresidency business and financial issues, review of contracts, and suggestions for a timeline for finding a job. Although general surgical residencies prepare

Simulation-based interpersonal communication skills training for neurosurgical residents.

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Harnof, Sagi; Hadani, Moshe; Ziv, Amitai; Berkenstadt, Haim

2013-09-01

Communication skills are an important component of the neurosurgery residency training program. We developed a simulation-based training module for neurosurgery residents in which medical, communication and ethical dilemmas are presented by role-playing actors. To assess the first national simulation-based communication skills training for neurosurgical residents. Eight scenarios covering different aspects of neurosurgery were developed by our team: (1) obtaining informed consent for an elective surgery, (2) discharge of a patient following elective surgery, (3) dealing with an unsatisfied patient, (4) delivering news of intraoperative complications, (5) delivering news of a brain tumor to parents of a 5 year old boy, (6) delivering news of brain death to a family member, (7) obtaining informed consent for urgent surgery from the grandfather of a 7 year old boy with an epidural hematoma, and (8) dealing with a case of child abuse. Fifteen neurosurgery residents from all major medical centers in Israel participated in the training. The session was recorded on video and was followed by videotaped debriefing by a senior neurosurgeon and communication expert and by feedback questionnaires. All trainees participated in two scenarios and observed another two. Participants largely agreed that the actors simulating patients represented real patients and family members and that the videotaped debriefing contributed to the teaching of professional skills. Simulation-based communication skill training is effective, and together with thorough debriefing is an excellent learning and practical method for imparting communication skills to neurosurgery residents. Such simulation-based training will ultimately be part of the national residency program.

Deprivation of Dignity in Nursing Home Residents

DEFF Research Database (Denmark)

Høy, Bente

2016-01-01

deepened knowledge in how to maintain and promote dignity in nursing home residents. The purpose of this paper is to present results concerning the question: How is nursing home residents’ dignity maintained or deprived from the perspective of close family caregivers? In this presentation we only focus...... on deprivation of dignity. Methodology: The overall design of this study is modified clinical application research. The study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods were individual research interviews. All together the sample consisted of 28...

Family and household demography

NARCIS (Netherlands)

Willekens, F.J.C.; Zeng, Yi

2009-01-01

Households are groups of people that co-reside and share some resources. Families are households of related individuals. Household and family demography is the study of these primary social groups or social units, and in particular of group membership and the relationships between members of the

Family medicine in Peru: consolidating the discipline

Directory of Open Access Journals (Sweden)

Zoila Olga de los Milagros Romero Albino

2013-01-01

Full Text Available Family medicine in Peru had its origins in 1989, when the first family medicine residency was created; thereafter has had stages of improving and decline, there are currently more than 250 family physician graduated, between 70 and 90 seats of residency in annually, not having even insert family medicine in undergraduate medical schools. The inclusion of family physicians in the health system has been torpid, Peru has a mixed health system with multiple insurers and providers and 30% of the population without coverage, no real compliance characteristics of systems based on attention primary and first contact and access, longitudinality, comprehensiveness and coordination. It is expected to strengthen the specialty improve future training scenarios and developing a united health system.

Improving pediatric immunization rates: description of a resident-led clinical continuous quality improvement project.

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Jones, Kyle Bradford; Gren, Lisa H; Backman, Richard

2014-09-01

Increased emphasis is being placed on the continuous quality improvement (CQI) education of residents of all specialties. This article describes a resident-led continuous quality improvement (CQI) project, based on a novel curriculum, to improve the immunization rates of children under 2 years old at the Madsen Family Health Center (MHC). All third-year residents were trained in the FOCUS-PDSA CQI methodology through concurrent didactic lectures and experience leading the CQI team. The CQI team included clinical staff led by a third-year family medicine resident and mentored by a member of the family medicine faculty. Immunization records were distributed to provider-medical assistant teamlets daily for each pediatric patient scheduled in clinic as the intervention. Compliance with the intervention (process measure), as well as immunization rates at 2 and 5 months post-intervention (outcome measure), were monitored. Immunization records were printed on 84% of clinic days from October 24, 2011 to March 31, 2012. The percentage of patients immunized at baseline was 66%. The percentage immunized as of December 31, 2011 was 96% and was 91% as of March 31, 2012. An important educational experience was organized for third-year family medicine residents through learning CQI skills, leading a CQI team, and directing a CQI project to completion. Significant improvement in the percentage of patients under 2 years old immunized at the MHC was achieved by presenting provider-medical assistant teamlets with immunization records of all pediatric patients on the daily clinic schedule.

SPECIAL TRAITS OF MANIFESTATION OF DEFENCIVE MECHANISMS DURING DEVELOPMENT OF SELF-ATTITUDE OF TEENAGERS FROM FULL AND SINGLE-PARENT FAMILIES

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A. E. Melojan

2015-01-01

Full Text Available The article is devoted to one of the problems of personality development of today’s teenagers pertaining to their self-attitude and psychological defence. It presents the results of a comparative analysis of self-attitude development specifics and manifestation of defence mechanisms in teenagers from full and single-parent families as well as special traits of interconnection of self-attitude main components and some types of psychological defence that are typical for them. Better well-being and greater disposition to approve of themselves has been revealed among those raised in full families as against a tendency to self-disparagement, besides the more intensive use of psychological defence, of their peers from single-parent families. It has been established that family structure defined by the principle “full” - “single-parent” is an important factor of self-attitude development and manifestation of psychological defence in teenagers.

The role of topography on catchment‐scale water residence time

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McGuire, K.J.; McDonnell, Jeffery J.; Weiler, M.; Kendall, C.; McGlynn, B.L.; Welker, J.M.; Seibert, J.

2005-01-01

The age, or residence time, of water is a fundamental descriptor of catchment hydrology, revealing information about the storage, flow pathways, and source of water in a single integrated measure. While there has been tremendous recent interest in residence time estimation to characterize watersheds, there are relatively few studies that have quantified residence time at the watershed scale, and fewer still that have extended those results beyond single catchments to larger landscape scales. We examined topographic controls on residence time for seven catchments (0.085–62.4 km2) that represent diverse geologic and geomorphic conditions in the western Cascade Mountains of Oregon. Our primary objective was to determine the dominant physical controls on catchment‐scale water residence time and specifically test the hypothesis that residence time is related to the size of the basin. Residence times were estimated by simple convolution models that described the transfer of precipitation isotopic composition to the stream network. We found that base flow mean residence times for exponential distributions ranged from 0.8 to 3.3 years. Mean residence time showed no correlation to basin area (r2 organization (i.e., topography) rather than basin area controls catchment‐scale transport. Results from this study may provide a framework for describing scale‐invariant transport across climatic and geologic conditions, whereby the internal form and structure of the basin defines the first‐order control on base flow residence time.

A phenomenologic investigation of pediatric residents' experiences being parented and giving parenting advice.

Science.gov (United States)

Bax, A C; Shawler, P M; Blackmon, D L; DeGrace, E W; Wolraich, M L

2016-09-01

Factors surrounding pediatricians' parenting advice and training on parenting during residency have not been well studied. The primary purpose of this study was to examine pediatric residents' self-reported experiences giving parenting advice and explore the relationship between parenting advice given and types of parenting residents received as children. Thirteen OUHSC pediatric residents were individually interviewed to examine experiences being parented and giving parenting advice. Phenomenological methods were used to explicate themes and secondary analyses explored relationships of findings based upon Baumrind's parenting styles (authoritative, authoritarian, permissive). While childhood experiences were not specifically correlated to the parenting advice style of pediatric residents interviewed, virtually all reported relying upon childhood experiences to generate their advice. Those describing authoritative parents reported giving more authoritative advice while others reported more variable advice. Core interview themes related to residents' parenting advice included anxiety about not being a parent, varying advice based on families' needs, and emphasis of positive interactions and consistency. Themes related to how residents were parented included discipline being a learning process for their parents and recalling that their parents always had expectations, yet always loved them. Pediatric residents interviewed reported giving family centered parenting advice with elements of positive interactions and consistency, but interviews highlighted many areas of apprehension residents have around giving parenting advice. Our study suggests that pediatric residents may benefit from more general educational opportunities to develop the content of their parenting advice, including reflecting on any impact from their own upbringing.

A 15-year review of the Stanford Internal Medicine Residency Program: predictors of resident satisfaction and dissatisfaction

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Kahn JS

2017-08-01

Full Text Available James S Kahn,1–3 Ronald M Witteles,3,4 Kenneth W Mahaffey,3–5 Sumbul A Desai,2,3 Errol Ozdalga,2,3 Paul A Heidenreich1,3 1Veterans Affairs Palo Alto Health Care System, Palo Alto, 2Division of Primary Care and Population Health, 3Department of Medicine, 4Division of Cardiovascular Medicine, 5Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, CA, USA Introduction: Satisfaction with training and with educational experiences represents important internal medicine (IM programmatic goals. Graduates from IM residency programs are uniquely poised to provide insights into their educational and training experiences and to assess whether these experiences were satisfactory and relevant to their current employment. Methods: We surveyed former IM residents from the training program held during the years 2000–2015 at the Department of Medicine, Stanford University. The first part of the survey reviewed the IM residency program and the second part sought identifying data regarding gender, race, ethnicity, work, relationships, and financial matters. The primary outcome was satisfaction with the residency experience. Results: Of the 405 individuals who completed the Stanford IM residency program in the study period, we identified 384 (95% former residents with a known email address. Two hundred and one (52% former residents responded to the first part and 185 (48% answered both the parts of the survey. The mean age of the respondents was 36.9 years; 44% were female and the mean time from IM residency was 6.1 (±4.3 years. Fifty-eight percent reported extreme satisfaction with their IM residency experience. Predictors associated with being less than extremely satisfied included insufficient outpatient experience, insufficient international experience, insufficient clinical research experience, and insufficient time spent with family and peers. Conclusion: The residents expressed an overall high satisfaction rate with

Fathering and adolescents' psychological adjustment: the role of fathers' involvement, residence and biology status.

Science.gov (United States)

Flouri, E

2008-03-01

Studies on fathering and child mental health are now increasingly looking for specificity in children's psychological adjustment, indicating whether the impact of fathering is diagnostically specific or non-specific. Data from 435 fathers of secondary school-aged children in Britain were used to explore the association between resident biological fathers', non-resident biological fathers' and stepfathers' involvement and children's total difficulties, prosocial behaviour, emotional symptoms, conduct problems, hyperactivity and peer problems (all measured with the Strengths and Difficulties Questionnaire) in adolescence. After controlling for child-, father- and family-related factors, fathers' involvement was negatively associated with children's total difficulties and hyperactivity, was positively associated with children's prosocial behaviour, and was unrelated with children's emotional symptoms, conduct problems and peer problems. There was no non-resident biological father effect. Compared with resident biological fathers, stepfathers reported more total difficulties, conduct problems and hyperactivity in their children even after adjusting for involvement. Whether this reflects stepfathers' low tolerance levels or biological fathers' complacency, as sociobiologists would argue, or whether this is due to pre-existing predispositions of children in families which separate and restructure, to the effects of these multiple family changes or to the high exposure of children in restructured families to parental risk factors, is, given the data available and the study design, unclear. However, this study showed that, compared with their peers in biological father families, adolescents in stepfather families are perceived to be at higher risk of behaviour problems, and that father involvement is related to specific aspects of child adjustment.

Political violence and child adjustment in Northern Ireland: Testing pathways in a social-ecological model including single-and two-parent families.

Science.gov (United States)

Cummings, E Mark; Schermerhorn, Alice C; Merrilees, Christine E; Goeke-Morey, Marcie C; Shirlow, Peter; Cairns, Ed

2010-07-01

Moving beyond simply documenting that political violence negatively impacts children, we tested a social-ecological hypothesis for relations between political violence and child outcomes. Participants were 700 mother-child (M = 12.1 years, SD = 1.8) dyads from 18 working-class, socially deprived areas in Belfast, Northern Ireland, including single- and two-parent families. Sectarian community violence was associated with elevated family conflict and children's reduced security about multiple aspects of their social environment (i.e., family, parent-child relations, and community), with links to child adjustment problems and reductions in prosocial behavior. By comparison, and consistent with expectations, links with negative family processes, child regulatory problems, and child outcomes were less consistent for nonsectarian community violence. Support was found for a social-ecological model for relations between political violence and child outcomes among both single- and two-parent families, with evidence that emotional security and adjustment problems were more negatively affected in single-parent families. The implications for understanding social ecologies of political violence and children's functioning are discussed.

Political violence and child adjustment in Northern Ireland: Testing pathways in a social ecological model including single and two-parent families

Science.gov (United States)

Cummings, E. Mark; Schermerhorn, Alice C.; Merrilees, Christine E.; Goeke-Morey, Marcie C.; Shirlow, Peter; Cairns, Ed

2013-01-01

Moving beyond simply documenting that political violence negatively impacts children, a social ecological hypothesis for relations between political violence and child outcomes was tested. Participants were 700 mother-child (M=12.1years, SD=1.8) dyads from 18 working class, socially deprived areas in Belfast, Northern Ireland, including single- and two-parent families. Sectarian community violence was associated with elevated family conflict and children’s reduced security about multiple aspects of their social environment (i.e., family, parent-child relations, and community), with links to child adjustment problems and reductions in prosocial behavior. By comparison, and consistent with expectations, links with negative family processes, child regulatory problems and child outcomes were less consistent for nonsectarian community violence. Support was found for a social ecological model for relations between political violence and child outcomes among both single and two parent families, with evidence that emotional security and adjustment problems were more negatively affected in single-parent families. The implications for understanding social ecologies of political violence and children’s functioning are discussed. PMID:20604605

Association between Family Structure and Physical Activity of Chinese Adolescents

Directory of Open Access Journals (Sweden)

Lijuan Wang

2016-01-01

Full Text Available Background. This study examines the association between family structure and moderate-to-vigorous physical activity (MVPA of adolescents in China. Methods. The participants included 612 adolescents (317 boys and 295 girls from Shanghai with ages ranging from 10 to 16 years. Accelerometers were used to measure the duration of MVPA of adolescents, and questionnaires on family structure were completed by the parents of these adolescents. Results. Findings suggested that family structure significantly increased the likelihood of adolescents engaging in physical activity (PA and explained 6% of MPVA variance. Adolescents living in single-parent households and step families were more physically active than those living in two-parent homes and with biological parents, respectively. However, adolescents residing with grandparents were less active than those living with neither grandparent. No significant difference was found in MVPA time between adolescents living with one sibling and those without siblings. Conclusion. Family environment may be considered in the development of PA interventions and policies, and adolescents living with their grandparents may be targeted in PA promotion.

Introduction of laparoscopic low anterior resection for rectal cancer early during residency: a single institutional study on short-term outcomes.

Science.gov (United States)

Ogiso, Satoshi; Yamaguchi, Takashi; Hata, Hiroaki; Kuroyanagi, Hiroya; Sakai, Yoshiharu

2010-11-01

Laparoscopic surgery for rectal cancer is unpopular because it is technically challenging. Suitable training systems have not been widely studied or established despite the steep learning curve for this procedure. We developed a systematic training program that enables resident surgeons to perform laparoscopic low anterior resection (LLAR) for rectal cancer and evaluated the safety and feasibility of this training program. We analyzed prospectively gathered data on all LLARs for rectal cancer performed at a single center over a 7-year period. Patients were assessed for demographic characteristics, tumor characteristics, operative procedure, operative time, blood loss, conversion to open surgery, complications, time to bowel recovery, distal margin, and number of lymph nodes harvested. We compared the early surgical, oncological, and functional outcomes of LLARs performed by expert surgeons with those of LLARs performed by resident surgeons for both intraperitoneal and extraperitoneal rectal cancer. All analyses were performed on an intention-to-treat basis. A total of 137 patients met the inclusion criteria for this study. Of the 75 LLARs for intraperitoneal rectal cancer, 40 were performed by expert surgeons (I-E group) and 35 by resident surgeons (I-R group). Of the 62 LLARs for extraperitoneal rectal cancer, 51 were performed by expert surgeons (E-E group) and 11 by resident surgeons (E-R group). The operative time was longer in the E-R group than in the E-E group. The time to resumption of diet was longer in the I-E group than in the I-R group. The other early outcomes, including blood loss, anastomotic leakage, conversion to open surgery, and number of lymph nodes harvested, were similar in the I-E and I-R groups and in the E-E and E-R groups. Our systematic training program on LLAR for rectal cancer enables resident surgeons to perform this procedure safely early during residency, with acceptable short-term outcomes.

Life After Welfare Reform: Low-Income Single Parent Families, Pre- and Post-TANF.

Science.gov (United States)

Peterson, Janice; Song, Xue; Jones-DeWeever, Avis

This study used data from the first and last waves of the 1996 U.S. Census Bureau's Survey of Income and Program Participation to compare the characteristics and wellbeing of low-income, single parent families before and after passage of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), noting the characteristics and…

EFFECTS OF NATURAL AND FORCED BASEMENT VENTILATION ON RADON LEVELS IN SINGLE FAMILY DWELLINGS

Science.gov (United States)

The report gives, for the first time, results of an extensive study of the effect of ventilation on radon concentrations and radon entry rate in a single-family dwelling. Measurements of radon concentrations, building dynamics, and environmental parameters made in Princeton Unive...

78 FR 41075 - Federal Housing Administration (FHA): Single Family Quality Assurance-Solicitation of Information...

Science.gov (United States)

2013-07-09

... Administration (FHA): Single Family Quality Assurance--Solicitation of Information on Quality Lending Practices... the efficiency and effectiveness of FHA's quality assurance process (QAP). The objective of FHA's QAP is to promote quality lending practices by FHA's approved lenders; practices that protect the...

76 FR 66950 - Privacy Act; Notice of Revision of System of Records, the Single Family Housing Enterprise Data...

Science.gov (United States)

2011-10-28

... Family Mortgage Asset Recovery Technology System (SMART) 5. A80S--Single Family Acquired Assets..., inclusive communities and quality affordable homes. This notice deletes and supersedes prior notice..., address, date of birth, home address, and social security number; racial/ethnic background, if disclosed...

Energy Efficiency Potential in the U.S. Single-Family Housing Stock

Energy Technology Data Exchange (ETDEWEB)

Wilson, Eric J. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Christensen, Craig B. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Horowitz, Scott G. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Robertson, Joseph J. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Maguire, Jeffrey B. [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

2017-12-19

Typical approaches for assessing energy efficiency potential in buildings use a limited number of prototypes, and therefore suffer from inadequate resolution when pass-fail cost-effectiveness tests are applied, which can significantly underestimate or overestimate the economic potential of energy efficiency technologies. This analysis applies a new approach to large-scale residential energy analysis, combining the use of large public and private data sources, statistical sampling, detailed building simulations, and high-performance computing to achieve unprecedented granularity - and therefore accuracy - in modeling the diversity of the single-family housing stock. The result is a comprehensive set of maps, tables, and figures showing the technical and economic potential of 50 plus residential energy efficiency upgrades and packages for each state. Policymakers, program designers, and manufacturers can use these results to identify upgrades with the highest potential for cost-effective savings in a particular state or region, as well as help identify customer segments for targeted marketing and deployment. The primary finding of this analysis is that there is significant technical and economic potential to save electricity and on-site fuel use in the single-family housing stock. However, the economic potential is very sensitive to the cost-effectiveness criteria used for analysis. Additionally, the savings of particular energy efficiency upgrades is situation-specific within the housing stock (depending on climate, building vintage, heating fuel type, building physical characteristics, etc.).

DNA residence time is a regulatory factor of transcription repression

Science.gov (United States)

Clauß, Karen; Popp, Achim P.; Schulze, Lena; Hettich, Johannes; Reisser, Matthias; Escoter Torres, Laura; Uhlenhaut, N. Henriette

2017-01-01

Abstract Transcription comprises a highly regulated sequence of intrinsically stochastic processes, resulting in bursts of transcription intermitted by quiescence. In transcription activation or repression, a transcription factor binds dynamically to DNA, with a residence time unique to each factor. Whether the DNA residence time is important in the transcription process is unclear. Here, we designed a series of transcription repressors differing in their DNA residence time by utilizing the modular DNA binding domain of transcription activator-like effectors (TALEs) and varying the number of nucleotide-recognizing repeat domains. We characterized the DNA residence times of our repressors in living cells using single molecule tracking. The residence times depended non-linearly on the number of repeat domains and differed by more than a factor of six. The factors provoked a residence time-dependent decrease in transcript level of the glucocorticoid receptor-activated gene SGK1. Down regulation of transcription was due to a lower burst frequency in the presence of long binding repressors and is in accordance with a model of competitive inhibition of endogenous activator binding. Our single molecule experiments reveal transcription factor DNA residence time as a regulatory factor controlling transcription repression and establish TALE-DNA binding domains as tools for the temporal dissection of transcription regulation. PMID:28977492

Measuring general surgery residents' communication skills from the patient's perspective using the Communication Assessment Tool (CAT).

Science.gov (United States)

Stausmire, Julie M; Cashen, Constance P; Myerholtz, Linda; Buderer, Nancy

2015-01-01

The Communication Assessment Tool (CAT) has been used and validated to assess Family and Emergency Medicine resident communication skills from the patient's perspective. However, it has not been previously reported as an outcome measure for general surgery residents. The purpose of this study is to establish initial benchmarking data for the use of the CAT as an evaluation tool in an osteopathic general surgery residency program. Results are analyzed quarterly and used by the program director to provide meaningful feedback and targeted goal setting for residents to demonstrate progressive achievement of interpersonal and communication skills with patients. The 14-item paper version of the CAT (developed by Makoul et al. for residency programs) asks patients to anonymously rate surgery residents on discrete communication skills using a 5-point rating scale immediately after the clinical encounter. Results are reported as the percentage of items rated as "excellent" (5) by the patient. The setting is a hospital-affiliated ambulatory urban surgery office staffed by the residency program. Participants are representative of adult patients of both sexes across all ages with diverse ethnic backgrounds. They include preoperative and postoperative patients, as well as those needing diagnostic testing and follow-up. Data have been collected on 17 general surgery residents from a single residency program representing 5 postgraduate year levels and 448 patient encounters since March 2012. The reliability (Cronbach α) of the tool for surgery residents was 0.98. The overall mean percentage of items rated as excellent was 70% (standard deviations = 42%), with a median of 100%. The CAT is a useful tool for measuring 1 facet of resident communication skills-the patient's perception of the physician-patient encounter. The tool provides a unique and personalized outcome measure for identifying communication strengths and improvement opportunities, allowing residents to receive

Who are the fathers in Healthy Families Arizona? An examination of father data in at-risk families.

Science.gov (United States)

Shapiro, Alyson F; Krysik, Judy; Pennar, Amy L

2011-07-01

Despite substantial research documenting the importance of father-child relations, little is known about fathers in families considered at risk for child abuse, and this lack of information makes adequate targeting of fathers in interventions challenging. This research aims to provide information that will aid interventions in targeting fathers and addressing father-related family issues through: (a) providing descriptive information regarding fathers in families at risk for child abuse, and (b) examining aspects of family well-being relative to father involvement. Analyses were conducted on mother-report data in families eligible for the Healthy Families Arizona prevention program (N = 197). Results indicated that although only 15% of parents in the sample were married, 47% of families had resident fathers, and 77% of fathers had some contact with their new babies. Families with greater father involvement had better prenatal care, higher incomes, less maternal involvement in Child Protective Services, less physical domestic violence (DV), and greater maternal mental health reflected through less loneliness. These findings have implications for targeting nonresident as well as resident fathers in families at risk for child abuse and for exploring DV issues in families with noninvolved fathers. © 2011 American Orthopsychiatric Association.

Sense of community in Hong Kong: relations with community-level characteristics and residents' well-being.

Science.gov (United States)

Mak, Winnie W S; Cheung, Rebecca Y M; Law, Lawrence S C

2009-09-01

Sense of community (SOC) has been one of the most studied topics in community psychology. However, no empirical study to date has investigated SOC in Hong Kong and its relations with community characteristics and residents' psychological well-being. A representative sample of 941 Hong Kong Chinese based on a randomized household survey was conducted in all 18 districts in Hong Kong. Results of hierarchical linear modeling indicated that SOC was not associated with sociodemographic indicators on both the individual-level (i.e., gender, age, family income, education level, type of residence, and area-to-capita ratio of residence) and the community-level (i.e., proportion of individuals with tertiary education, median family income, ownership of residence, population density, and resident stability). SOC was negatively related to daily hassles and positively with social support and quality of life. Conceptualization of SOC in Hong Kong was discussed.

How can a successful multi-family residential recycling programme be initiated within Baltimore City, Maryland?

Science.gov (United States)

Schwebel, Michael B

2012-07-01

Baltimore City formally began recycling in 1989 with all neighbourhoods having residential collection by 1992. Although the city of 637 000 has recycled for approximately 20 years, almost all residents in multi-family residential (MFR) housing have been and are still barred from participating at their residences. Discussions with City officials and residents have verified this antiquated policy of exclusion within MFR housing. Yet, the policy is still observed by the Department of Public Works even though the updated single-stream Code states that the 'Director of Public Works must collect all. . .recyclable materials. . .from all dwellings, including multiple-family dwellings'. The purpose of this study's is to provide policies, regulations, and recommendations for implementing requisite MFR recycling within Baltimore City. The study's methodology follows a case study approach by examining three cities in the United States that currently mandate MFR recycling: Chicago, Illinois; Boston, Massachusetts; and Arlington, Virginia. Post-analysis suggests that while some cities' MFR programmes perform poorly, each city's strengths aid in creating specific proposals that can produce a successful MFR recycling program in Baltimore City. These tenets of a future MFR recycling program form the basis of a successful MFR recycling program that will allow all city residents to participate via initiatives in the categories of both programme, accessibility, and informing and self-review.

Energy renovation of an old single-family house

DEFF Research Database (Denmark)

Overgaard, L.L.; Tommerup, Henrik M.; Svendsen, Svend

2005-01-01

After having identified a large potential for profitable energy renovation of the existing building stock, a demonstration project was carried out in practice. This paper deals with the methods and results from the demonstration project concerning a 161 m² poorly insulated single-family house built...... saving improvements carried out in the project are “easy to carry out” and cost-beneficial measures such as cavity wall insulation, loft insulation, insulation of walls under windows and a new second window-frame with energy-saving glass. The work was carried out by professional contractors at a total......). If a conservative way of financing the building work of 157,000 DKK is assumed, the first year’s cost equals DKK 8,500 and the house owner will gain a net saving the first year of DKK 7,500....

Listening to children: gaining a perspective of the experiences of poverty and social exclusion from children and young people of single-parent families.

Science.gov (United States)

Walker, Janet; Crawford, Karin; Taylor, Francesca

2008-07-01

This paper reports on the experiences and views of children and young people of single-parent families, as findings from a European Union-funded research project undertaken in England, Greece and Cyprus. The objectives of the research project were to investigate how children and young people of single-parent families understand and experience their worlds as members of these families: whether and to what extent they experience poverty and social exclusion and how they cope with the challenges that this confronts them with. Methodology was replicated in each of the countries; however, this paper draws on the English experiences. Semistructured interviews (40) and focus groups (four) were undertaken with children of single parents. In addition, focus groups were undertaken with children of two-parent families (four), focus groups with single parents, focus groups with two-parent families (four) and individual interviews with key professionals. Detailed discussion guides were followed, with open-ended questions to allow participants to express their feelings and ideas in their own words. The research sample included children from single-parent and two-parent families, aged 6 years to 16 years, balanced in terms of age, gender and geographical location. Findings demonstrate the children's and young people's understanding of the impact of poverty and social exclusion on their family life and their everyday experiences. The positive benefits of being in a single-parent family are highlighted, with 'time poverty' raised as a significant issue. Children and young people are aware of their poverty and how it influences exclusion from friendships, play, leisure and community activities. Policy needs to take account of the systematic reality of children's experiences; alliances with adults that support meaningful involvement and participation by children and young people will make a significant contribution to this.

Stress and burnout in residents: impact of mindfulness-based resilience training

Directory of Open Access Journals (Sweden)

Goldhagen BE

2015-08-01

Full Text Available Brian E Goldhagen,1 Karen Kingsolver,2 Sandra S Stinnett,1 Jullia A Rosdahl1 1Department of Ophthalmology, 2Department of Family and Community Medicine, Duke University Medical Center, Durham, NC, USABackground and objective: Stress and burnout impact resident physicians. This prospective study tests the hypothesis that a mindfulness-based resilience intervention would decrease stress and burnout in residents.Methods: Resident physicians from the Departments of Family Medicine, Psychiatry, and Anesthesia at Duke University, Durham, NC, USA, participated in two or three 1-hour sessions of mindfulness-based resilience activities, which introduced mindful-awareness and included practical exercises for nurturing resilience. Anonymous surveys were distributed before (completed by 47 residents and after the intervention (both completed by 30 residents; a follow-up survey was distributed 1 month later (seven residents completed all three surveys. The survey included the Depression Anxiety Stress Scale, 21-question version (DASS-21, the Oldenburg Burnout Inventory, the Mindful Attention Awareness Scale, and ten questions from the Cognitive Failures Questionnaire.Results: At baseline, most residents’ scores were in the normal range with respect to stress; however, female residents had higher DASS-21 scores than male residents (31.7, females vs 18.4, males; P=0.002. Most residents’ burnout scores were in the abnormal range, both with respect to exhaustion (38/47 residents, subscore ≥2.25 and disengagement (37/47 residents, subscore ≥2.1. Higher perceived levels of stress correlated with the instruments. Analysis of the surveys before and after the intervention showed no significant short-term change in stress, burnout, mindful-awareness, or cognitive failure. There was a trend for females and post-medical school graduate year 1 and 2 (PGY1 and PGY2 residents to have a reduction in DASS-21 scores after intervention. There was also a trend of

Female-partnered and single women's contact motivations and experiences with donor-linked families.

Science.gov (United States)

Goldberg, A E; Scheib, J E

2015-06-01

What are female-partnered and single mothers' motivations and experiences at one donor insemination (DI) program with regard to contacting other families who share the same sperm donor? By and large, women reported seeking contact to obtain (i) support for their children and/or themselves, and (ii) information about shared traits and medical problems, ultimately describing a range of contact experiences, both positive (e.g. special bond created) and negative (e.g. uncomfortable encounters). There is a growing phenomenon of donor insemination families-parents and/or offspring-seeking others who share their donor (i.e. are 'donor-linked'). There is limited understanding about parental motivations and experiences-especially in the presence of a second parent-due to the methodological constraints of previous quantitative studies. Semi-structured telephone interviews were conducted with 50 donor insemination mothers (14 single, 36 female-partnered). Participants were recruited by email invitation to parent members of a family-matching service at one donor insemination program in the USA. The criterion for inclusion was having matched to at least one donor-linked family. Among the 50 mothers interviewed, all had at least one child conceived via donor insemination, who was between ages 0 and 15 years at first contact. Families matched with a median of three donor-linked families (range 1-10). Interview data were analyzed through qualitative (i.e. thematic) analysis. Overarching themes emerged of seeking contact to obtain (i) support and (ii) information about children's shared physical and psychological traits. Some wanted to increase their child's family network, through adding a sibling, but more often as extended family. Data, from partnered parents especially, revealed the challenges of balancing the boundaries of family formed without the genetic link with the perceived benefits of exploring the child's donor origins. Interviews focused on openness and information

Sleep disturbances predict prospective declines in resident physicians’ psychological well-being

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Alice A. Min

2015-07-01

Full Text Available Background: Medical residency can be a time of increased psychological stress and sleep disturbance. We examine the prospective associations between self-reported sleep quality and resident wellness across a single training year. Methods: Sixty-nine (N=69 resident physicians completed the Brief Resident Wellness Profile (M=17.66, standard deviation [SD]=3.45, range: 0–17 and the Pittsburgh Sleep Quality Index (M=6.22, SD=2.86, range: 12–25 at multiple occasions in a single training year. We examined the 1-month lagged effect of sleep disturbances on residents’ self-reported wellness. Results: Accounting for residents’ overall level of sleep disturbance across the entire study period, both the concurrent (within-person within-occasion effect of sleep disturbance (B=−0.20, standard error [SE]=0.06, p=0.003, 95% confidence interval [CI]: −0.33, −0.07 and the lagged within-person effect of resident sleep disturbance (B=−0.15, SE=0.07, p=0.037, 95% CI: −0.29, −0.009 were significant predictors of decreased resident wellness. Increases in sleep disturbances are a leading indicator of resident wellness, predicting decreased well-being 1 month later. Conclusions: Sleep quality exerts a significant effect on self-reported resident wellness. Periodic evaluation of sleep quality may alert program leadership and the residents themselves to impending decreases in psychological well-being.

SBS symptoms in relation to dampness and ventilation in inspected single-family houses in Sweden.

Science.gov (United States)

Smedje, Greta; Wang, Juan; Norbäck, Dan; Nilsson, Håkan; Engvall, Karin

2017-10-01

To investigate the relationships between symptoms compatible with the sick building syndrome (SBS) in adults and building dampness and ventilation in single-family houses. Within the Swedish BETSI study, a national sample of single-family houses were inspected by professional building experts, and adults living in the houses answered a questionnaire on SBS. Relationships between building factors and SBS were analysed using logistic regression. Of the respondents, 23% reported having had weekly SBS symptoms during the last three months. A large proportion of houses exhibited building or construction problems. In total, 40% of houses had dampness problems in the foundation, and this was related to a higher prevalence of both mucous and dermal symptoms, and any SBS symptoms. Furthermore, high air humidity was related to more symptoms, with the relationship with absolute humidity being stronger than that with relative humidity or moisture load. Symptoms were also more prevalent in houses with a high U value, reflecting a poor thermal insulation. Compared to natural ventilation, living in a house with mechanical supply and exhaust ventilation was related to a lower prevalence of general symptoms and any SBS symptoms, but there were only weak associations between measured air exchange rate and symptoms. A large proportion of single-family houses have dampness problems in the foundation, and pollutants may enter the living space of the house and affect the health of the occupants. Furthermore, absolute air humidity should be measured more often in indoor air studies.

GIS residency footprinting: analyzing the impact of family medicine graduate medical education in Hawai'i.

Science.gov (United States)

Hixon, Allen L; Buenconsejo-Lum, Lee E; Racsa, C Philip

2012-04-01

Access to care for patients in Hawai'i is compromised by a significant primary care workforce shortage. Not only are there not enough primary care providers, they are often not practicing in locations of high need such as rural areas on the neighbor islands or in the Pacific. This study used geographic information systems (GIS) spatial analysis to look at practice locations for 86 University of Hawai'i Family Medicine and Community Health graduates from 1993 to the 2010. Careful alumni records were verified and entered into the data set using the street address of major employment. Questions to be answered were (1) what percentage of program graduates remain in the state of Hawai'i and (2) what percentage of graduates practice in health professional shortage areas (HPSAs) throughout the United States. This study found that 73 percent of graduates remain and practice in Hawai'i with over 36 percent working in Health Professional Shortage Areas. Spatial analysis using GIS residency footprinting may be an important analytic tool to ensure that graduate medical education programs are meeting Hawai'i's health workforce needs.

PLACE OF RESIDENCE: THE SPACE OF SOCIO-PEDAGOGICAL TRANSFORMATIONS

Directory of Open Access Journals (Sweden)

M. P. Guriyanova

2017-01-01

Full Text Available Introduction. In modern society Pedagogics is no longer the domain only of tutors, school teachers and teachers of educational institutions of general and vocational training of various levels. Pedagogics, being in integration with Sociology, Philosophy, Psychology, and Cultural Science, has an impact on sociocultural life of both all society and local communities, along with well-being of children and families, and population’s quality of life. In some regions ofRussia, state bodies responsible for the administration of education and social sphere call for Social Pedagogics in order to consolidate the population; to solve local problems; to strengthen the family and government institutions. Social Pedagogics, in contrast to financial-economic measures, can not change unsatisfactory material conditions and poor housing, but contributes to the spread of ideas of humanity, mutual aid, solidarity and cooperation; then stimulates positive creation that is especially important when a person or his/her family are in difficult life situations.The aims of the publication are: to disclose the leading tendencies of socio-pedagogical and socio-cultural activity with children and families at the place of residence; to represent the results of the first stage of the project “Development and Realization of Socio-Pedagogical Potential of Territorial Communities” developed at the Institute for Study of Childhood, Family and Education of the Russian Academy of Education.Methodology and research methods. The research provided in the article is based on system-activity approach. When studying the general background of social transformations, non-system approach was used, which importance increases in connection with the growing dynamics of social changes, ambiguity of a vital context, instability and diversity of society development. The analysis of municipalwork with children and families at the place of residence and assessment of practical activities

The role of coparents in African American single-mother families: the indirect effect of coparent identity on youth psychosocial adjustment.

Science.gov (United States)

Parent, Justin; Jones, Deborah J; Forehand, Rex; Cuellar, Jessica; Shoulberg, Erin K

2013-04-01

The majority (67%) of African American youth live in single-parent households, a shift in the family structure that has been linked to increased risk for both internalizing and externalizing problem behaviors. Although the majority of single mothers endorse the assistance of another adult or family member in child rearing, relatively little is known about who is engaged in this nonmarital coparenting role (i.e., grandmother, father/social father, aunt, and female family friend) and how it relates to coparenting quality, maternal parenting, and youth psychosocial outcomes (i.e., internalizing and externalizing problems). This question, which is critical to the advancement of family focused programming for youth in these families, is addressed in this study. The participants examined in the current study were 159 African American single-mother child dyads. Adolescents' maternal grandmothers constituted the largest proportion of coparents in the sample (37.2%), followed by the mothers' female family friends (22.5%), adolescents' maternal aunts (12.7%), and adolescents' fathers/social fathers (11%). Differences emerged among groups of coparents in support and conflict with the mother. Specifically, grandmothers, aunts, and female family friends provided significantly more instrumental support than fathers. Furthermore, grandmothers and fathers had more conflict with the mother, both generally and specifically in front of the child, than aunts or female family friends. In turn, these differences were associated directly and indirectly through maternal parenting with internalizing and externalizing problems. Clinical implications and future directions are discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Tobin's q for Danish single-family houses

DEFF Research Database (Denmark)

Haagerup, Christian Deichmann

from 2003 to 2006. The activity in the construction sector has been increasing too, but with some time lag caused by what seems to be an inelastic supply. In the long run, house prices will be determined by the replacement cost of houses, e.g. the cost of constructing a similar house including the cost...... of land. This can be used as a guide as to how much prices are to fall, in order to bring them back to the fundamental value. It can also be seen as a warning or indication of a price bubble. This paper presents a calculation of the value of Tobin's q for single-family houses in Denmark from 1968 to 2008....... It shows that the value of Tobin's q has risen by around 40 percent from 2003 to 2006, caused by increasing house prices. This was not a sustainable development, and prices and the value of Tobin's q are now falling. In order for the value of Tobin's q to reach its fundamental value of 1, prices have...

Maternal Resources, Parenting Practices, and Child Competence in Rural, Single-Parent African American Families.

Science.gov (United States)

Brody, Gene H.; Flor, Douglas L.

1998-01-01

Tested a model linking maternal/family characteristics to child cognitive and psychosocial competence in African-American 6- to 9-year olds in rural single-mother-headed households. Found that maternal education, religiosity, and financial resources were linked with parenting style, mother-child relationship, and maternal school involvement.…

Family Support and Subjective Well-Being

DEFF Research Database (Denmark)

Schnettler, Berta; Denegri, Marianela; Miranda, Horacio

2015-01-01

In order to distinguish typologies of university students based on family support received in the form of tangible and intangible resources, their level of satisfaction with life and food-related life as well as subjective happiness, a survey was applied to a non-probabilistic sample of 347...... in the place of residence during the period of studies, socioeconomic level, need to work while studying, frequency and time available for having lunch in the place of residence, and body mass index. The family support students receive as tangible or economic resources is positively related to life...

Effect of field notes on confidence and perceived competence: survey of faculty and residents.

Science.gov (United States)

Laughlin, Tom; Brennan, Amy; Brailovsky, Carlos

2012-06-01

To evaluate the effectiveness of field notes in assessing teachers' confidence and perceived competence, and the effect of field notes on residents' perceptions of their development of competence. A faculty and resident survey completed 5 years after field notes were introduced into the program. Five Dalhousie University family medicine sites--Fredericton, Moncton, and Saint John in New Brunswick, and Halifax and Sydney in Nova Scotia. First- and second-year family medicine residents (as of May 2009) and core family medicine faculty. Residents' outcome measures included beliefs about the effects of field notes on performance, learning, reflection, clinical skills development, and feedback received. Faculty outcome measures included beliefs about the effect of field notes on guiding feedback, teaching, and reflection on clinical practice. Forty of 88 residents (45.5%) participated. Fifteen of 50 faculty (30.0%) participated, which only permitted a discussion of trends for faculty. Residents believed field note-directed feedback reinforced their performance (81.1%), helped them learn (67.6%), helped them reflect on practice and learning (66.7%), and focused the feedback they received, making it more useful (62.2%) (P note-directed feedback helped with clinical skills development (P notes helped to provide more focused (86.7%) and effective feedback (78.6%), improved teaching (75.0%), and encouraged reflection on their own clinical practice (73.3%). Most surveyed residents believed field note use improved the feedback they received and helped them to develop competence through improved performance, learning, reflection, and clinical skills development. The trends from faculty information suggested faculty believed field notes were an effective teaching, feedback, and reflection tool.

Resident challenges with daily life in Chinese long-term care facilities: A qualitative pilot study.

Science.gov (United States)

Song, Yuting; Scales, Kezia; Anderson, Ruth A; Wu, Bei; Corazzini, Kirsten N

As traditional family-based care in China declines, the demand for residential care increases. Knowledge of residents' experiences with long-term care (LTC) facilities is essential to improving quality of care. This pilot study aimed to describe residents' experiences in LTC facilities, particularly as it related to physical function. Semi-structured open-ended interviews were conducted in two facilities with residents stratified by three functional levels (n = 5). Directed content analysis was guided by the Adaptive Leadership Framework. A two-cycle coding approach was used with a first-cycle descriptive coding and second-cycle dramaturgical coding. Interviews provided examples of challenges faced by residents in meeting their daily care needs. Five themes emerged: staff care, care from family members, physical environment, other residents in the facility, and personal strategies. Findings demonstrate the significance of organizational context for care quality and reveal foci for future research. Copyright © 2017 Elsevier Inc. All rights reserved.

Identifying public health competencies relevant to family medicine.

Science.gov (United States)

Harvey, Bart J; Moloughney, Brent W; Iglar, Karl T

2011-10-01

Public health situations faced by family physicians and other primary care practitioners, such as severe acute respiratory syndrome (SARS) and more recently H1N1, have resulted in an increased interest to identify the public health competencies relevant to family medicine. At present there is no agreed-on set of public health competencies delineating the knowledge and skills that family physicians should possess to effectively face diverse public health challenges. Using a multi-staged, iterative process that included a detailed literature review, the authors developed a set of public health competencies relevant to primary care, identifying competencies relevant across four levels, from "post-MD" to "enhanced." Feedback from family medicine and public health educator-practitioners regarding the set of proposed "essential" competencies indicated the need for a more limited, feasible set of "priority" areas to be highlighted during residency training. This focused set of public health competencies has begun to guide relevant components of the University of Toronto's Family Medicine Residency Program curriculum, including academic half-days; clinical experiences, especially identifying "teachable moments" during patient encounters; resident academic projects; and elective public health agency placements. These competencies will also be used to guide the development of a family medicine-public health primer and faculty development sessions to support family medicine faculty facilitating residents to achieve these competencies. Once more fully implemented, an evaluation will be initiated to determine the degree to which these public health competencies are being achieved by family medicine graduates, especially whether they attained the knowledge, skills, and confidence necessary to effectively face diverse public health situations-from common to emergent. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

FRENCH RESIDENCE PERMITS FOR NATIONALS OF COUNTRIES WITHIN THE EUROPEAN ECONOMIC AREA

CERN Multimedia

Relations with the Host States Service; Tel. 72848

2002-01-01

All persons not of French nationality who reside in France for more than three months consecutively, or who, in the case of repeated visits, are effectively present in France for more than three months in any six-month period, must obtain a residence permit. With this in view, the French Ministry of Foreign Affairs issues members of the CERN personnel and their family members with a legitimation document equivalent to a residence permit (Carte spéciale FI or AT, Carte d'assimilé à un membre de mission diplomatique; hereafter: «MFA card»). However, a special procedure applies to persons with permanent resident status (c.f. announcement CERN/DSU-DO/RH/10306 published in March 2001 in CERN Weekly Bulletin No. 11/2001 and which can also be consulted on the Web pages of the Relations with the Host States Service). The Ministry of Foreign Affairs has informed CERN that henceforth, a member of the personnel's family members who wish to take up gainful employment i...

Emotional intelligence in orthopedic surgery residents.

Science.gov (United States)

Chan, Kevin; Petrisor, Brad; Bhandari, Mohit

2014-04-01

Emotional intelligence (EI) is the ability to understand and manage emotions in oneself and others. It was originally popularized in the business literature as a key attribute for success that was distinct from cognitive intelligence. Increasing focus is being placed on EI in medicine to improve clinical and academic performance. Despite the proposed benefits, to our knowledge, there have been no previous studies on the role of EI in orthopedic surgery. We evaluated baseline data on EI in a cohort of orthopedic surgery residents. We asked all orthopedic surgery residents at a single institution to complete an electronic version of the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). We used completed questionnaires to calculate total EI scores and 4 branch scores. Data were analyzed according to a priori cutoff values to determine the proportion of residents who were considered competent on the test. Data were also analyzed for possible associations with age, sex, race and level of training. Thirty-nine residents (100%) completed the MSCEIT. The mean total EI score was 86 (maximum score 145). Only 4 (10%) respondents demonstrated competence in EI. Junior residents (p = 0.026), Caucasian residents (p = 0.009) and those younger than 30 years (p = 0.008) had significantly higher EI scores. Our findings suggest that orthopedic residents score low on EI based on the MSCEIT. Optimizing resident competency in noncognitive skills may be enhanced by dedicated EI education, training and testing.

77 FR 19008 - Guidelines for Home Energy Professionals: Standard Work Specifications for Single Family Energy...

Science.gov (United States)

2012-03-29

.... The development of the Guidelines for Home Energy Professionals: Standard Work Specifications for... DEPARTMENT OF ENERGY Office of Energy Efficiency and Renewable Energy Guidelines for Home Energy Professionals: Standard Work Specifications for Single Family Energy Upgrades AGENCY: Office of Energy...

Religiosity of Muslim Adolescents from Single Parent Families Living in Government-Subsidised Settlement

Directory of Open Access Journals (Sweden)

Fariza, M. S.

2015-12-01

Full Text Available Adolescence is a phase of emotionl turmoil and stress. If not balanced with religious practice, it may cause adolescents to fall into moral and social problems such as breach of school discipline, delinquency, drug addiction and sexual permissiveness. Religiosity is one way for adolescents to deal with challenges in life thereby avoiding immoral activities. This is because religiosity may help to balance adolescent emotional, cognitive and social developments.The purpose of this study is to identify the behaviour and level of religiosity among 30 adolescents from single parents families who settle in government-subsidised area of residence, namely known as the Federal Land Development Authority (FELDA. The area is located in the state of Pahang, situated on the eastern part of Malaysia. These adolescents have been selected as research respondents. This research was conducted as a survey using questionnaire as the research instrument. It was constructed based on the guidelines of Islamic Practice Instrument (IPI (Fariza, 2012 and has already been verified in terms of its validity and reliability. The data analysis has adopted the method of descriptive statistics explained in table form. The research results have found that religiosity or religious behaviour that the adolescents most frequently abide by are staying away from gambling, having good thoughts and expectations of Allah, feeling awed and fear of Allah’s power (taqwa, staying away from fornication (zina and supplication (doa to Allah facing the direction of Qibla. The level of religiosity is medium for most adolescents. This factor explains why not many respondents are involved in moral and disciplinary problems at school. This research finds that generally, religiosity protects adolescents from being involved in immoral activities and other vices.

Central Control of Heat Pump for Smart Grid Purposes Tested on Single Family Houses

DEFF Research Database (Denmark)

Pedersen, Tom S.; Andersen, Palle; Nielsen, Kirsten M.

2013-01-01

A challenge in Denmark in the near future is to balance the electrical grid due to a large increase in the renewable energy production mainly from wind turbines. In this work a central control system using heat pumps in single family houses to help balancing the grid is investigated. The central...

Decision Factors Nurses Use to Assess Pain in Nursing Home Residents With Dementia.

Science.gov (United States)

Monroe, Todd B; Parish, Abby; Mion, Lorraine C

2015-10-01

Nurses caring for older people with various psychiatric illnesses face many obstacles when treating pain. One setting with a high percentage of psychiatric conditions is long-term care where more than half of residents have some form of dementia, and behavioral symptoms of dementia (BSDs) may mimic behavioral displays of pain. Furthermore, two-thirds of nursing home residents have pain. Thus, many nursing home residents with dementia have pain that may be confounded by BSDs. Since many people with dementia are at risk for poor pain management, determining current methods in which nurses assess and manage pain in nursing home residents will aid in recognizing potential barriers to using current pain management guidelines and help develop strategies to enhance nurses' assessment and management of pain in this vulnerable population. The aim of this study was to explore nursing home nurses' cues and practices to identify and alleviate pain in nursing home residents with dementia. Nurses use the constructs of 'comfort' and 'quality of life' as key components in their overall pain assessment strategy in people with dementia. Indeed, the extensive process they use involving frequent reassessment and application of interventions is geared towards "appearance of comfort." Nurses reported difficulty in ascertaining whether a person with dementia was in pain, and they expressed further difficulty determining the intensity associated with resident pain. Nurses further reported that residents with dementia who are not well know by the staff were are greater risk of poor pain management. It was not unusual for nurses to discuss the importance of conflict resolution among family members as well as allowing for open expression of family's concerns. Nurses had to focus not only on the resident's comfort, but also the families' level of comfort with pain management, especially at the end-of-life. Findings support further use and development of discomfort behavior scales to help