==================================HSR29================================== 29. Attitudes of health personnel as it relates to neoplasms, AIDS, and ALS. 1 UI - 87107419 AU - Amchin J ; Polan HJ TI - A longitudinal account of staff adaptation to AIDS patients on a psychiatric unit. AB - As more patients with AIDS and AIDS-related syndromes are admitted to psychiatric units, staffs must meet new diagnostic and therapeutic challenges while adapting to the unique stresses of treating these patients. The authors discuss several case vignettes to illustrate how the staff of a voluntary acute-stay psychiatric unit progressed over a two-year period from having difficulty treating AIDS patients within the usual therapeutic milieu to directly confronting the issues raised by the disease both among themselves and in the patient community. The authors believe that the staff's ability to cope with AIDS patients may have strongly influenced the patient community's ability to cope, and that clinical experience and educational programs were major contributors to the staff's adaptation. They conclude with several recommendations for psychiatric staffs beginning to treat AIDS patients. MH - Acquired Immunodeficiency Syndrome/*PSYCHOLOGY ; Adult ; *Attitude of Health Personnel ; AIDS-Related Complex/PSYCHOLOGY ; Case Report ; Homosexuality ; Human ; Male ; Organic Mental Disorders/*PSYCHOLOGY ; Organic Mental Disorders, Psychotic/PSYCHOLOGY ; Personnel, Hospital/ *PSYCHOLOGY ; *Professional-Patient Relations ; *Psychiatric Department, Hospital SO - Hosp Community Psychiatry 1986 Dec;37(12):1235-8 2 UI - 87106499 AU - Sangster JF ; Gerace TM ; Bass MJ TI - Acceptability of a faecal occult blood screening protocol for carcinoma of the colon in family practice. AB - Cancer of the colon is the second most common malignancy in North America and screening methods are needed for diagnosing the lesions at an early stage. Faecal occult blood screening is a method of secondary prevention which is particularly adaptable to the family practice setting. In order to test the feasibility of using this test in family practice, 16 family physicians participated in a trial screening programme using the Hemoccult II test. During the two-month trial 776 patients over 40 years of age were screened; 19 of the tests were positive but in two cases patients were thought to have failed to follow dietary and medical restrictions. Of the 17 patients with verified positive tests, further investigation showed five patients had neoplastic disease and three of these had malignant disease. The detection rate for cancer of the colon using the Hemoccult II test was therefore 3/776, equivalent to 3.9 per 1000 cases screened. By narrowing the age range for screening patients to between 45 and 75 years, the time involved to screen the population at risk could be decreased. MH - Adult ; Attitude of Health Personnel ; Colonic Neoplasms/DIAGNOSIS/ *PREVENTION & CONTROL ; Diagnostic Errors ; *Family Practice ; Female ; Human ; Male ; *Mass Screening ; Middle Age ; *Occult Blood ; Ontario SO - Fam Pract 1986 Dec;3(4):246-50 3 UI - 87049495 AU - Mackillop WJ ; Ward GK ; O'Sullivan B TI - The use of expert surrogates to evaluate clinical trials in non-small cell lung cancer. AB - One hundred and eighteen doctors who treat pulmonary neoplasms in Ontario were asked how they would wish to be treated if they had non-small cell lung cancer. Four different scenarios were given. The physicians were then asked if they would consent to take part as subjects in one or more clinical trials for which they would be eligible in those situations. The proportion of respondents who would consent to each study ranged from 11% to 64%. Reasons given for refusing to participate as subjects in each trial were varied, but many felt that the trials offered unacceptable options for treatment. Medical oncologists consented to each study more frequently than radiation oncologists, respirologists or thoracic surgeons but all disciplines ranked the 6 studies in the same order of acceptability. It is concluded that some patients with non-oat cell lung cancer currently receive experimental therapies with high risk/benefits ratios which experts in the field would not accept for themselves. It is suggested that the expert surrogate system may be useful as an adjunct to the institutional review board in evaluating new trials before they are activated. MH - *Attitude of Health Personnel ; Carcinoma, Non-Small Cell Lung/*THERAPY ; *Clinical Trials ; Human ; Informed Consent ; Lung Neoplasms/*THERAPY ; Random Allocation ; Support, Non-U.S. Gov't SO - Br J Cancer 1986 Oct;54(4):661-7 4 UI - 87047125 AU - Wachter RM ; Luce JM ; Turner J ; Volberding P ; Hopewell PC TI - Intensive care of patients with the acquired immunodeficiency syndrome. Outcome and changing patterns of utilization. AB - Eighty-two patients with the acquired immunodeficiency syndrome (AIDS) were admitted to the intensive care units (ICUs) at San Francisco General Hospital (SFGH) between March 1981 and December 1985. Of these patients, 69% died in the hospital, as did 87% of patients who required mechanical ventilation because of Pneumocystis carinii pneumonia and respiratory failure. Although the number of hospital admissions of patients with AIDS has increased steadily since the fourth quarter of 1982 (12 admissions) through the fourth quarter of 1985 (158 admissions), the number of admissions to the ICUs peaked at 17 in the second quarter of 1984 and decreased steadily, averaging 5 per quarter in 1985. This decrease was not explained by a reduction in the number of patients with P. carinii pneumonia or an improvement in their treatment. A survey of physicians at SFGH indicated that physicians are aware of the poor prognosis of patients with AIDS with P. carinii pneumonia and respiratory failure, believe that mechanical ventilation is infrequently indicated for this condition, and have become increasingly likely to discuss issues of resuscitation with their patients with AIDS. Therefore, possible explanations for this trend in ICU utilization include changing physician attitudes, in addition to more effective patient counseling and increased availability of hospital and community-based support services that provide alternatives to terminal intensive care. MH - Acquired Immunodeficiency Syndrome/*THERAPY ; Adult ; Attitude of Health Personnel ; Evaluation Studies ; Health Services/*UTILIZATION ; Human ; Male ; Middle Age ; Patient Admission ; Physicians ; Support, U.S. Gov't, P.H.S. SO - Am Rev Respir Dis 1986 Nov;134(5):891-6 5 UI - 87036050 AU - Lewis CE ; Freeman HE ; Kaplan SH ; Corey CR TI - The impact of a program to enhance the competencies of primary care physicians in caring for patients with AIDS. AB - The authors evaluated the impact of a continuing education program on the AIDS-related competencies of primary care physicians in Los Angeles County. In the fall of 1984, telephone interviews were conducted with a random sample of general internists and family and general practitioners. Interviews were completed with 635 physicians, or 63% of the original sample. Less than 30% demonstrated adequate knowledge or practices necessary to deal with patients' AIDS-related symptoms and concerns. These physicians were randomly assigned to one of three treatment groups receiving materials presenting similar content about AIDS in printed, audiocassette or videocassette formats. Follow-up interviews with 81% of the study group revealed significant increases in competence but this was unrelated to the use of the educational materials. Several descriptors of physicians and their practices were significant predictors of competence as assessed on pre- and post-test interviews. MH - *Acquired Immunodeficiency Syndrome ; Attitude of Health Personnel ; California ; Clinical Competence ; *Education, Medical, Continuing ; Human ; Physicians, Family/*EDUCATION ; Random Allocation ; Support, U.S. Gov't, P.H.S. SO - J Gen Intern Med 1986 Sep-Oct;1(5):287-94 6 UI - 87036048 AU - McPhee SJ ; Richard RJ ; Solkowitz SN TI - Performance of cancer screening in a university general internal medicine practice: comparison with the 1980 American Cancer Society Guidelines. AB - The authors evaluated use of seven cancer screening tests by 52 providers in a university general internal medicine practice, using 1980 American Cancer Society (ACS) recommendations as standards for comparison. Performance rates were determined by retrospective medical record reviews of a stratified random sample of 525 patients. In addition, the 48 physicians and four nurse-practitioners in the practice were interviewed to determine their opinions, knowledge and perceived use of the tests. Performance rates were low, significantly below the ACS guidelines for all tests except Pap smear. Providers used the tests significantly more often to evaluate patients with cancer risk factors or for new patients. They significantly overestimated their own performances of six tests. More than a fourth of the providers disagreed with the use of mammography, sigmoidoscopy, pelvic or rectal examinations for screening asymptomatic adults. Their knowledge about cancer screening and the ACS recommendations was highly variable, and frequently quite limited. Providers offered four major reasons for not performing the screening tests: provider forgetfulness, lack of time, inconvenience and logistical difficulties, and patient discomfort or refusal. MH - *Academic Medical Centers ; *American Cancer Society ; Attitude of Health Personnel ; California ; Comparative Study ; Female ; Human ; *Internal Medicine ; Male ; Mass Screening/*STANDARDS/TRENDS ; Neoplasms/ *PREVENTION & CONTROL ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. ; United States ; *Voluntary Health Agencies SO - J Gen Intern Med 1986 Sep-Oct;1(5):275-81 7 UI - 87015799 AU - Ostrow DG ; Gayle TC TI - Psychosocial and ethical issues of AIDS health care programs. AB - The psychiatric, psychosocial, and ethical considerations in the design and evaluation of health care programs for AIDS patients and others with HIV infection are described in this article. The responsibilities of health care providers are considered in the context of the history and epidemiology of AIDS, previous responses of the health care delivery system, and the concerns of the general public. General guidelines for program development are set forth; these guidelines embody ethical principles, the role of education in altering the behavior and attitudes of patients and health care workers, the optimal levels of and precautions for infection control, and the evaluation of a patient's competency and judgement. Several examples of the use of these guidelines to resolve difficult policy issues arising in the treatment of patients with AIDS or HIV infection are also provided. MH - Acquired Immunodeficiency Syndrome/PREVENTION & CONTROL/*PSYCHOLOGY/ THERAPY ; Attitude of Health Personnel ; Burnout, Professional/PSYCHOLOGY ; *Ethics, Medical ; Fear ; Female ; Health Education ; Hospitalization ; Human ; Infant, Newborn ; *Long Term Care ; Male ; Personnel, Hospital ; Pregnancy Complications, Infectious/THERAPY ; Pregnancy ; Voluntary Health Agencies SO - QRB 1986 Aug;12(8):284-9, 292-4 8 UI - 86322387 AU - Cohen MB ; Miller TR ; Gonzales JM ; Sacks ST ; Bottles K TI - Fine-needle aspiration biopsy. Perceptions of physicians at an academic medical center. AB - In an earlier survey, we asked private practitioners in San Francisco about their perceptions of fine-needle aspiration biopsy (FNAB). In the present study we sent the same survey to clinicians in our hospital, a tertiary medical center. Although the response rate to this survey was lower, it appears that FNAB is used more often in our hospital than it is among private practitioners for the evaluation of palpable masses (53% vs 24%), and that it is most often performed by pathologists. Seventy percent of the FNAB at this institution were performed by pathologists; a small percentage (7%) of cases (nonpalpable) were performed by a radiologist for the evaluation of intra-thoracic and intra-abdominal lesions. Fifty-nine percent of private practitioners performed the FNAB themselves, and the remainder (39%) were referred to pathologists, radiologists, and surgeons. That there are differences in perceptions concerning the use of FNAB in a variety of specific clinical settings was also illustrated by this survey. MH - Academic Medical Centers ; Attitude of Health Personnel ; *Biopsy, Needle ; Breast Neoplasms/PATHOLOGY ; Female ; Human ; Male ; *Physicians ; Prostatic Neoplasms/PATHOLOGY ; Questionnaires ; United States SO - Arch Pathol Lab Med 1986 Sep;110(9):813-7 9 UI - 86289591 AU - Loewy EH TI - Duties, fears and physicians. AB - This article deals with the physician's fear of contagion using AIDS as a paradigm. It deals with this in four ways: it examines the concepts of duty, fear and courage in their medical setting; it deals with the historical aspects of the problem; it analyzes the role of social contract and professionalism; and it develops a viewpoint of the physician's obligation based on these considerations and predicated on a view of professionalism and social contract. MH - Acquired Immunodeficiency Syndrome/*PSYCHOLOGY ; *Attitude of Health Personnel ; *Fear ; Human ; Occupational Diseases/*PSYCHOLOGY ; Physician's Role ; Physicians/*PSYCHOLOGY ; Risk-Taking ; Social Responsibility SO - Soc Sci Med 1986;22(12):1363-6 10 UI - 86271541 AU - Schmelkin LP ; Wachtel AB ; Hecht D ; Schneiderman BE TI - Cancer Opinionnaire. Medical students' attitudes toward psychosocial cancer care. AB - A questionnaire assessing attitudes toward psychosocial cancer care (the Cancer Opinionnaire) was constructed. Factor analysis revealed five factors: outcome expectations; candor; interest in treating cancer; psychosocial concerns: role of the physician; and psychosocial concerns: importance to the patient. Reliabilities ranged from 0.68 to 0.82. A multivariate analysis of variance indicated that second-year students, who had been exposed to a required first-year course stressing biopsychosocial concerns of medical care, expressed more positive attitudes than did entering first-year students. Additionally, female medical students expressed more positive attitudes than did male students. Addressing biopsychosocial concerns in the beginning of medical education may help establish a more open and fertile ground upon which later training will be received. MH - *Attitude of Health Personnel ; Comparative Study ; Female ; Human ; Male ; Neoplasms/*THERAPY ; New York City ; Physician's Role ; Questionnaires ; Sex Characteristics ; *Social Environment ; *Social Support ; Statistics ; Students, Medical/*PSYCHOLOGY ; Support, U.S. Gov't, P.H.S. SO - Cancer 1986 Aug 1;58(3):801-6 11 UI - 86271540 AU - Cleeland CS ; Cleeland LM ; Dar R ; Rinehardt LC TI - Factors influencing physician management of cancer pain. AB - It has been asserted that pain due to cancer is not adequately managed, and that physician attitudes may contribute to poor management. Based on responses to questionnaire items assessing attitudes that have been identified as affecting the quality of pain management, two groups of physicians were identified using cluster analysis on selected questionnaire items, and the responses of the two clusters to questions concerning their approach toward pain management were compared. With reference to reported practice, Cluster I physicians (N = 19) were willing to prescribe more potent analgesics and to do so earlier in the course of the disease as compared to Cluster II (N = 72). Cluster I members reported using more modalities of pain therapy, and more often saw scheduled analgesics as appropriate for the management of cancer pain. Groups did not differ in composition of medical specialty, nor in number of cancer patients cared for. More "liberal: attitudes toward pain management were associated with younger age and with more experience in specialized oncology units. MH - Adult ; Aged ; Analgesics, Addictive/THERAPEUTIC USE ; *Attitude of Health Personnel ; Comparative Study ; Female ; Human ; Male ; Middle Age ; Neoplasms/*THERAPY ; Pain, Intractable/*DRUG THERAPY ; Physicians/ *PSYCHOLOGY ; Questionnaires ; Support, U.S. Gov't, P.H.S. SO - Cancer 1986 Aug 1;58(3):796-800 12 UI - 86173566 AU - Owen WF Jr TI - The clinical approach to the male homosexual patient. AB - A history of sexual orientation, practices, and life styles, a complete review of organ systems, and a thorough physical examination are unique but essential elements of the examination of homosexual men. Laboratory screening should take into account the incubation period for infections, the risk for infection based on sexual practices, and cost. Physicians should counsel homosexual men about all aspects of a healthy life style; for this advice to be accepted, however, physicians must develop a relation with their homosexual patients that is based on awareness, expertise, and mutual understanding. MH - Acquired Immunodeficiency Syndrome/DIAGNOSIS/PREVENTION & CONTROL/ TRANSMISSION ; Adult ; Attitude ; Attitude of Health Personnel ; Confidentiality ; Diagnosis, Laboratory ; Female ; *Homosexuality ; Human ; Human T-Cell Leukemia Virus ; Life Style ; Male ; Medical History Taking ; Physician-Patient Relations ; Risk ; Sexually Transmitted Diseases/DIAGNOSIS/TRANSMISSION ; Social Support ; Substance Abuse ; United States SO - Med Clin North Am 1986 May;70(3):499-535 13 UI - 86157165 AU - Raina S ; Spillert CR ; Najem AZ ; Lazaro EJ TI - Current attitudes in the management of obstructive biliary tract disease. AB - The current attitudes of surgeons towards the management of obstructive biliary tract disease were assessed by analyzing the responses of general surgeons to a 20-item questionnaire. The responses indicate that ultrasound is the most favored initial diagnostic test for suspected choledocolithiasis. Ninety-nine per cent of the respondents always or almost always insert a T-tube following exploration of the common bile duct for stones. For patients with stone impacted at the ampulla of Vater, sphincterotomy with or without sphincteroplasty is recommended by 86 per cent of surgeons. However, differences are noted in the approach to management of malignant lesions in the biliary tract. For carcinoma of the head of the pancreas, at laparotomy, if the lesion is resectable, 59 per cent of the surgeons will perform a Whipple procedure, nine per cent a total pancreatectomy, and 28 per cent recommend bypass only. For unresectable carcinoma of the head of the pancreas, 73 per cent perform cholecystojejunostomy, and 26 per cent prefer choledocojejunostomy. In addition to the biliary bypass, only 57 per cent perform a gastric bypass routinely. The favored treatment (62%) for unresectable common bile duct tumors is an internal bypass. However, following bypass, only 45 per cent recommend further treatment with radiation and/or chemotherapy. Therefore, it appears that there is agreement on the treatment of biliary obstruction due to stones. Differences are noted, however, in the approach to the management of malignant disease. MH - *Attitude of Health Personnel ; Biliary Tract/SURGERY ; Biliary Tract Diseases/*SURGERY ; Biliary Tract Neoplasms/SURGERY ; Common Bile Duct Neoplasms/SURGERY ; Human ; Pancreatic Neoplasms/SURGERY ; Questionnaires SO - Am Surg 1986 Apr;52(4):193-6 14 UI - 86146357 AU - Love RR ; Stone HL ; Hughes B TI - Education in cancer prevention for primary care clinicians. AB - In response to increased public interest in cancer prevention and rapidly escalating health care costs, the National Cancer Institute supported the development of cancer prevention courses for health professionals. A multidisciplinary group of physicians, behavioral scientists, and educators developed, field-tested, revised, and evaluated a 12-module, 24-classroom-hour clinical preventive oncology course for primary care physicians. A rationale for education in cancer prevention is presented, the new clinical discipline of preventive oncology is defined, and contributory disciplines are identified. A curriculum based upon detailed learning objectives is described, short-term evaluation data are presented, and a methodology for incorporating a didactic course into a residency program is suggested. The positive reception given to this course by residents warrants optimism concerning application of a biopsychosocial or self-regulative model rather than the traditional biomedical one to clinical medicine and its teaching. MH - Attitude of Health Personnel ; Curriculum ; Human ; *Internship and Residency ; Medical Oncology/*EDUCATION ; Neoplasms/*PREVENTION & CONTROL ; Physicians, Family/*EDUCATION ; Support, U.S. Gov't, P.H.S. ; Teaching/ METHODS ; Videotape Recording SO - Med Pediatr Oncol 1986;14(1):30-5 15 UI - 86142149 AU - Beckham MM ; Rudy EB TI - Acquired immunodeficiency syndrome: impact and implication for the neurological system. AB - Acquired immunodeficiency syndrome (AIDS) has reached epidemic proportions throughout the world. Because at least 40% of AIDS victims are neurologically symptomatic, the neuroscience nurse must be prepared to care for increasing numbers of these patients. This article will define the syndrome, identify risk groups, and discuss the possible etiology. An explanation of the immune system will facilitate understanding of AIDS and its impact on the neurological system. The role of the nurse will be considered, with emphasis on the psychosocial implications of the syndrome for its victims. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS/IMMUNOLOGY/NURSING/ TRANSMISSION ; Attitude of Health Personnel ; Central Nervous System Diseases/ETIOLOGY/IMMUNOLOGY ; Fear ; Human ; Immunity ; Nervous System Diseases/*ETIOLOGY/IMMUNOLOGY/NURSING ; Nurses/PSYCHOLOGY ; Nursing Assessment ; Risk SO - J Neurosci Nurs 1986 Feb;18(1):5-10 16 UI - 86111258 AU - Dolgin MJ ; Katz ER ; Doctors SR ; Siegel SE TI - Caregivers' perceptions of medical compliance in adolescents with cancer. AB - Two studies were conducted to investigate the prevalence and determinants of gross medical regimen noncompliance among adolescent cancer patients. In the first study, 28 children and adolescents were rated by their primary physicians on various aspects of medical regimen compliance, features of their disease, and treatment regimens. Adolescent patients overall were judged to be significantly less compliant than the younger patients (p less than 0.001), with almost half rated as being "poor: or "very poor: compliers. Poor compliance was judged to be a potential threat to the prognoses of over half of the adolescents studied. Adolescents were reported to experience more severe side-effects and more visible physical residua as a result of their illness and treatment than the younger patients. The second study, conducted at a large pediatric referral center, found far fewer compliance problems among the 65 adolescent patients reviewed, with negative ramifications for treatment outcome reported in only nine patients (14%). The impact of medical variables, patient characteristics, and treatment setting on compliance with antineoplastic therapy is discussed. Issues in compliance assessment and considerations for future research are addressed. It is concluded that routine assessment of compliance is crucial for monitoring patient behavior as well as for the reliable evaluation of treatment protocols. MH - Acute Disease ; Adolescence ; *Attitude of Health Personnel ; Child ; Child, Preschool ; Female ; Human ; Leukemia/THERAPY ; Lymphoma/THERAPY ; Male ; Neoplasms/PSYCHOLOGY/*THERAPY ; *Patient Compliance ; Prognosis ; Sick Role SO - J Adolesc Health Care 1986 Jan;7(1):22-7 y