GRADUATING PHYSIOTHERAPISTS' PERCEPTIONS OF THEIR CAREER CHOICE

A survey of 72% of final year physiotherapy students at Cumberland College found that they were very satisfied with their career choice, few considered changing their occupation and changes in students' conceptions of physiotherapy had mostly been in a positive direction. They said that the most valued aspects of their career choice were the opportunity to accomplish something worthwhile, the friendliness of the people they worked with, and the opportunity to develop skills and abilities. Few students planned to leave the workforce but 69% hoped to be employed part-time during early childrearing. Some implications of such anticipated work patterns are discussed

Time spent by health managers in two cultures on work pursuits : real time, ideal time and activities' importance

Objectives: We compared health managers' judgements of: (1) the time they spent on nine major work activities, (2) the time they thought they should allocate and (3) the importance they attributed to each pursuit. These and managers' reasons for devoting time to activities were examined in an Anglo and a Confucian-Asian country. Method: A questionnaire survey of Australian (n=251) and Singaporean health managers (n=340). Results: In both countries, the correlation between judgements of time spent on activities/activities' importance (1 and 3) was significantly less than the correlation between time spent/time that should be spent (1 and 2), which was less than the correlation between time that should be spent/activities' importance (2 and 3). Singaporeans said they devoted more time to some activities but the importance attached to work pursuits and the reasons given for actual time allocation were similar cross-culturally. Conclusions: There was evidence of considerable disparity between managers' actual and preferred time allocation and of the globalization of health managers' work values. Evidence regarding time use might contribute to a rethink of how managers' efficiency and effectiveness are construed.14 page(s

A Survey of staff attitudes and comparative managerial and non-managerial views in a clinical directorate

Widespread implementation of clinical directorates (CDs) has displaced traditional structures of hospitals over the past 20 years. Responses range from support for involving clinicians in organizational processes along with the associated managerial benefits, to criticism that foreshadows potential negative effects and warns that CDs will not of themselves resolve embedded health sector problems. There is limited empirical evidence about the transition and the views of staff toward CDs. To investigate staff attitudes, a questionnaire was developed and administered in a survey of 107 staff in a large hospital that had introduced CDs three years previously. Attitudes were assessed in terms of their intensity, polarity, uncertainty and positivism toward CDs. Managers and other staff held similar attitudes on 66% of questionnaire items. Significant differences were found in the remaining one-third of items. Managers were positive about CDs, whereas non-managers' approval was limited and muted. Managers' attitudes were more intense, less uncertain and less polarized than were non-managers'. They differed primarily in the areas of working relations and power. Over recent years, CDs seem to have become institutionalized and investigations into their operation have declined. Our results suggest that taking the benefits of CDs for granted is premature.26 page(s

Ambulance officers' use of online clinical evidence

Background: Hospital-based clinicians have been shown to use and attain benefits from online evidence systems. To our knowledge there have been no studies investigating whether and how ambulance officers use online evidence systems if provided. We surveyed ambulance officers to examine their knowledge and use of the Clinical Information Access Program (CIAP), an online evidence system providing 24-hour access to information to support evidence-based practice. Methods: A questionnaire was completed by 278 ambulance officers in New South Wales, Australia. Comparisons were made between those who used CIAP and officers who had heard of, but not used CIAP. Results: Half the sample (48.6%) knew of, and 28.8% had used CIAP. Users were more likely to have heard of CIAP from a CIAP representative/presentation, non-users from written information. Compared to ambulance officers who had heard of but had not used CIAP, users were more likely to report better computer skills and that their supervisors regarded use of CIAP as a legitimate part of ambulance officers' clinical role. The main reasons for non-use were lack of access(49.0%) and training(31.4%). Of users, 51.3% rated their skills at finding information as good/very good, 67.5% found the information sought all/most of the time, 87.3% believed CIAP had the potential to improve patient care and 28.2% had directly experienced this. Most access to CIAP occurred at home. The databases frequently accessed were MIMS (A medicines information database) (73.8%) and MEDLINE(67.5%). The major journals accessed were Journal of Emergency Nursing(37.5%), American Journal of Medicine(30.0%) and JAMA(27.5%). Conclusion: Over half of ambulance officers had not heard of CIAP. The proportion who knew about and used CIAP was also low. Reasons for this appear to be a work culture not convinced of CIAP's relevance to pre-hospital patient care and lack of access to CIAP at work. Ambulance officers who used CIAP accessed it primarily from home and valued it highly. Lack of access to CIAP at central work locations deprives ambulance officers of many of the benefits of an online evidence system.8 page(s

Gender differences in the symptoms and physical and mental well-being of dyspeptics : a population based study

Purpose: To compare women and men with dyspepsia in terms of symptoms, physical and mental well-being and the relationships between individual symptoms and well-being. Methods: A cross-sectional random telephone survey of 2300 Australians identified 748 people with dyspepsia who were interviewed regarding the number, types and severity of symptoms and physical (PCS) and mental well-being (MCS) measured by the SF-12. Results: There were no significant gender differences in number or average severity of symptoms. Bloating, nausea, and early satiety were significantly more frequent among women; food regurgitation and heartburn in men. Dyspeptics (PCS = 47.1, MCS = 46.0) had poorer physical (p < 0.001) and mental well-being (p < 0.001) than did non-dyspeptics (PCS = 53.5, MCS = 55.3). Among dyspeptics, women (PCS = 46.4, MCS = 44.7) had poorer physical (p < 0.05) and mental well-being (p < 0.001) than males (PCS = 47.9, MCS = 47.5). Some symptoms were associated with low well-being for both sexes e.g. nausea. For women retching was related to poor physical well-being, and food regurgitation, dysphagia. bloating and epigastric pain to poor mental well-being. Among men epigastric pain and heartburn were associated with poor physical well-being, acid regurgitation with poor mental well-being, and vomiting with both. Conclusions: Dyspeptics report poorer physical and mental well-being than do non-dyspeptics. The difference between groups is greater for mental well-being, especially among women. Both physical and social factors may contribute to gender differences.9 page(s

Cognitive anxiety : a method of content analysis for verbal samples

The work of such psychologists as Kelly, McReynolds, Epstein, and Lazarus suggested the need for a measure of cognitive anxiety and provided a definition of that construct. A method of content analysis of verbal samples was devised and found to have adequate interjudge reliability. Normative data for five groups of subjects were provided. The validity of the measure as representative of a reaction to being unable to anticipate and integrate experience meaningfully was demonstrated in (a) the higher scores of groups of subjects who were currently coping with new experiences than those who were not, (b) the significant correlation of its scores with a state rather than trait anxiety measures, (c) the variability of its scores over time as observed in a generalizeability study, and (d) the higher scores of subjects when they were dealing with experiences for which meaningful anticipation was relatively difficult.11 page(s

Changes in the Characteristics of Physiotherapy Students in New South Wales over the Decade 1976–1986

Responses to a survey comparing the backgrounds and career attitudes of incoming physiotherapy students in 1976 and 1986 indicated that female students in 1986 were more ambitious, more committed to full time careers, attached greater importance to professional recognition, pay and promotion, had more egalitarian attitudes toward women's role, had fewer romantic attachments and wanted fewer children. Responses of male students in 1986 revealed that they were older than women students, were somewhat more ambitious and conservative and were more concerned with their surroundings and freedom at work

A 9 year prospective cohort study of endoscoped patients with upper gastrointestinal symptoms

Despite the high prevalence of upper gastrointestinal symptoms and associated costs of diagnosis and management, evidence regarding long-term outcomes is scant. We studied symptom outcomes 18 months (FU1) and 8/9 years (FU2) post-index endoscopy to identify demographic, diagnostic and treatment factors associated with outcomes. A retrospective review of medical records at two Australian teaching hospitals identified a cohort of 302 patients who had an index endoscopy (performed by 23 endoscopists) 18 months previously. Patients were interviewed at FU1 and FU2. In total 34% (95%CI: 29.0 39.8) of patients were asymptomatic at FUI and 41% (95%CI: 35.6-46.6) at FU2. For 63%, outcomes at FUI predicted long-term outcome, with 19% (95%CI: 14.6-23.4) asymptomatic and 44% (95%CI: 38.4-50.0) symptomatic at both times. Those whose symptom status changed were as likely to deteriorate as improve (p > 0.05). Number and severity of presenting symptoms (F = 3.3, df = 3,277, p < 0.05) and older age (F = 2.8, df = 2,301, p < 0.05) were associated with poorer outcomes. Long-term outcome was unrelated to endoscopic diagnosis. Those symptomatic were significantly more likely to be on proton pump inhibitors (PPIs) or Histamine2 Receptor Antagonists (H2RAs) than those who were asymptomatic. Use of PPIs at FU2 was associated with a significantly better outcome than use of H2RAs. However this impact was relatively small, with 69% of patients on PPIs and 84% on H2RAs symptomatic at FU2. Upper gastrointestinal symptoms prompting endoscopy are chronic for the majority of patients regardless of diagnosis. Endoscopic diagnosis is of limited value in predicting long-term outcomes. The association between poor outcome and use of H2RAs and PPIs challenges views about their long-term effectiveness in symptom control.9 page(s

Psychological reactions to the onset of chronic illness

Patients (N = 126) interviewed during hospitalization at the onset of chronic illness were found to be experiencing considerable emotional arousal. Their psychological reactions were assessed by applying content analysis scales to accounts of their current experiences and comparing these with the accounts of non-patients. Multivariate analysis of variance indicated that patients experienced significantly more anxiety, depression, and directly and indirectly expressed anger, as well as positive feelings and that they perceived themselves to be more helpless. Canonical analyses were applied to investigate the relationships between patients' reactions and their biographic and illness-related characteristics. Patients' reactions were related to demographic factors and their perceptions of their handicaps. No relationships were found between patterns of reaction and patients' life styles, medical records of their illnesses or the types of their disabilities.