Knowledge, Wisdom, and Service: The Meaning and Teaching of Professionalism in Medicine

Papers presented for the Center for the Study of Ethics in Society Western Michigan University. Presented September 29, 2011

Physicians’ Experiences and Opinions Regarding Strategies to Improve Care for Minority Patients

Objective: To assess the views and experiences of a select group of physicians interested in minority health issues regarding promising strategies to improve minority care. Methods: Physicians were asked to respond to a 17-item survey assessing the level of agreement, frequency of implementation of and interest in learning more about 7 promising strategies for alleviating disparities. Results: Most physicians (75-95%) agreed that the 7 proposed strategies could be useful to improve the quality of care provided to minority patients, but only 40-66% of physicians had implemented the strategies sometimes or often in their practices. Between 22 and 29% of physicians were interested in learning more about 6 of the 7 strategies, preferably by CME, seminars and newsletters. Conclusion: Physicians concerned with minority health issues agree that commonly suggested strategies for eliminating racial and ethnic disparities in health care could be useful, but have difficulty implementing such approaches

Variance in Patient Access to Support Persons by Race/Ethnicity and Language Preference: An Analysis of Patient Survey Data

Regulatory and accreditation organizations have advocated open visitation policies and allowance of support persons of patients’ choosing, but it is unknown if support is allowed equitably. Data from hospitalized patients were analyzed to determine access to support persons, stratified by patient-reported race/ethnicity, language, sex, age, and education. A multivariate regression model was constructed using race and language, controlling for site and patient sex, education and age. Additionally, sites’ policies explicitly allowing support persons were correlated to reports of allowance of support persons. Among 1,196 respondents, 17% reported not being allowed a support person or being unsure. African American patients had 2.4 times greater odds of reporting non-allowance of support than their white counterparts, while speakers of a language other than English or Spanish had 3.9 times greater odds. There were no significant differences noted between sites with a policy allowing patient support persons and those with no policy or one in development. Most patients report being allowed a support person, but African Americans and those speaking a language other than English or Spanish have greater odds of reporting not being allowed a support person. Reliable methods of informing all patients of this right are needed

Studies on the Immune Response to Bovine Herpesvirus Type 4 (BHV-4) in Cattle

Systemic cell mediated, systemic antibody, and local antibody responses were evaluated in cattle inoculated with bovine herpesvirus type 4 (BHV-4). Experiment 1 was designed to evaluate an in vitro lymphocyte transformation assay to quantitate the response of peripheral blood leukocytes (PBL) from cattle to BHV-4 infected target cells. Three types of target cells, bovine embryonic lung, bovine skin fibroblast-13, and Vero, were inoculated with BHV-4 at different multiplicities of infection and fixed in glutaraldehyde to retain BHV-4 surface antigens. Optimum effector to target cell ratios and length of incubation for the assay were also determined. Vero cells infected at an MOI of 50 and incubated with PBL for 6 days was optimal for in vitro blastogenesis. Stimulation indices and net counts per minute which were significantly different from preinoculation values were noted following inoculation of adult cows in Experiment 1. Experiment 2 was designed to detect PBLs sensitized to BHV-4 membrane antigens as well as humoral and nasal antibody responses in calves inoculated by either the intranasal-intratracheal (IN, IT) or the intramuscular route (IM). Stimulation indices and net counts per minute obtained following inoculation with BHV-4 by either route were not significantly different from those obtained for uninoculated control calves. Local antibody to BHV-4 in the nasal cavities was measured by an indirect fluorescent antibody procedure and appeared 7 to 10 days after IN, IT inoculation only. Humoral antibody appeared 10 to 14 days after primary inoculation in both groups. Secondary challenge with BHV-4 by the same route resulted in a four-fold increase in humoral antibody for both IN, IT and 1M-inoculated calves at 2 to 4 days following reexposure. A four-fold increase in nasal antibody was only demonstrated after secondary IN, IT challenge

Collecting Race, Ethnicity, and Language Data to Identify and Reduce Health Disparities: Perceptions of Health Plan Enrollees

Abstract available at publisher's website

Adding a subjective dimension to an ICF-based disability measure for people with multiple sclerosis: development and use of a measure for perception of disabilities

OBJECTIVE: The subjective dimension of disability, the perception of disability, is a dimension missing from the International Classification of Functioning, Disability and Health (ICF), and from health-related quality of life (HRQOL) instruments. However, it is a highly relevant dimension for clinical practice as perceived disability may identify care needs. We therefore developed a measure for this subjective dimension of disability in multiple sclerosis (MS) and examined the contribution of this dimension to QOL. METHOD: A measure named the Multiple Sclerosis Impact Profile-Disability Perception (MSIP-DP) was developed to reflect a person's perception of disabilities reported using the original MSIP-disability (MSIP-D) items. MS patients (n=530) completed both MSIP sections, the medical outcome study short form questionnaire (SF-36), the World Health Organisation Quality Of Life-BREF (WHOQOL-BREF) and questions concerning disease severity. The contribution of disability perception (DP) to QOL in MS was estimated using hierarchical multiple regression analyses after controlling for MS severity. RESULTS: Confirmative factor analysis confirmed the hypothesised disability perception domains that correspond with the related disability domains in the MSIP. DP scales yielded sufficient reliability. DP explained a unique and substantial part of the variance in QOL, particularly the perception of impairments in mental functions. DISCUSSION: Results indicated that the subjective dimension of functioning and health operationalised in the MSIP-DP is a relevant concept in explaining QOL in MS. In clinical practice psychological interventions addressing a patient's perception of disability, particularly of impairments in mental functioning, may contribute to QOL

Self-reported oral health problems and the ability to organize dental care of community-dwelling elderly aged >= 75years

BackgroundIt is unclear how many community-dwelling elderly (>= 75years) experience oral health problems (e.g. pain, dry mouth, chewing problems) and how they manage their dental care needs. This study aimed to assess self-reported oral health problems in elderly who are frail or have complex care needs, and their ability to organize dental care when reporting oral pain.MethodsThree thousand five hundred thirty-three community-dwelling elderly participating in the "Embrace" project were asked to complete questionnaires regarding oral status and oral health problems. Frailty was assessed with the Groningen Frailty Indicator (GFI). Intermed for Elderly Self-Assessment (IM-E-SA) was used to determine complexity of care needs. Next, elderly who reported oral pain were interviewed about their oral pain complaints, their need for dental care, and their ability to organize and receive dental care. For statistical analyses Chi(2)-tests and the one-way ANOVA were used.ResultsOne thousand six hundred twenty-two elderly (45.9%) completed the questionnaires. Dry mouth (11.7%) and oral pain (6.2%) were most frequently reported. Among the elderly reporting oral pain, most were registered at a local dentist and could go there when needed (84.3%). Robust elderly visited the dentist independently (87%), frail (55.6%) and complex (26.9%) elderly more often required assistance from caregivers.ConclusionsDry mouth and oral pain are most reported oral health problems among community-dwelling elderly. Elderly with complex care needs report most oral health problems. In case an elderly seeks dental treatment to alleviate an oral pain complaint, most elderly in this study were able to organize dental care and transport to the dentist. Frail and complex elderly often need assistance from caregivers to visit the dentist. Therefore caretakers should keep in mind that when frailty progresses, visiting a dentist may become more and more difficult and the risk for poor oral health increases

Broadening the scope on health problems among the chronically neurologically ill with the International Classification of Functioning (ICF)

Purpose. The aim of this study was to determine ICF items indicating health problems for patients with a chronic neurological disorder such as multiple sclerosis, Parkinson's disease and neuromuscular disease. Method. A Delphi study using three disease-specific panels composed of patients and proxies, medical and non-medical health professionals (N=98). Panels were asked to select items from the International Classification of Functioning, Disability and Health (ICF) reflecting relevant disease-specific health problems. Items appraised as relevant by the panel members were compared with items in established measures namely: the Minimal Record of Disability (MRD) and the Disability and Impact Profile (DIP). Results. Sixty-eight ICF items were considered to be the most relevant, and belonged to four ICF domains. No significant differences were found between the appraisal of items by patients/proxies and health professionals. Agreement across the disease panels appeared to be (very) strong. Differences between the three disease-specific panels were found for the 'Body Functions and Structures' domain: consensus was reached by extension of the inclusion criteria. The ICF-item selection covers almost all items of the established measures. The largest contrast was shown in the item selection for the 'participation' and 'environmental factors' domains. Conclusions. Selected items indicate a broader scope in studying health problems compared with widely used health status measures in neurology, especially for the ICF domains 'Participation' and 'Environmental Factors'