Use of point-of-care online clinical evidence by junior and senior doctors in New South Wales public hospitals.

BACKGROUND: The Clinical Information Access Program (CIAP), an online evidence retrieval system, provides NSW health professionals in public hospitals with 24 h access to information supporting evidence-based practice. AIM: To assess the frequency and type of CIAP usage by senior and junior medical staff and doctors' attitudes to CIAP. METHODS: A convenience sample of 25% of doctors from 65 randomly selected public hospitals completed a survey. Junior (n = 392) and senior (n = 684) doctors' responses were compared using chi2 analyses and t-tests. RESULTS: Most doctors had heard of CIAP (71.8%) and 60.6% had used it. More junior (72.4%) than senior (53.8%) doctors had used CIAP and junior doctors found it easier to use. Of the users 93.5% believed CIAP had the potential to improve patient care; 55.2% had directly experienced this. Most usage (61.5%) occurred at point-of-care; 74% of users found all/most of the information they sought and 71.6% found the search time to be 'good/excellent'. Users had increased their usage in the past year and predicted increased future usage. The most popular databases were Medline and MIMS. Age, access to other evidence, and lack of training, time and computer skills were associated with non-usage. Junior and senior users differed in 4 of 15 reasons for using CIAP. CONCLUSIONS: CIAP is used and valued by the majority of doctors. Patterns of usage, online experiences and the attitudes toward CIAP of senior doctors who use CIAP are relatively similar to those of junior doctors.

Attitudes towards disabilities in a multicultural society.

Health practitioners (N = 665) from the Chinese, Italian, German, Greek, Arabic and Anglo Australian communities used social distance scales to rate the attitudes of people in their communities toward 20 disability groups. Significant differences were found in community attitudes toward people with 19 of these disabilities. Overall the German community expressed greatest acceptance of people with disabilities, followed by the Anglo, Italian, Chinese, Greek and Arabic groups. However the relative degree of stigma attached to the various disabilities by the communities was very similar. In all communities, people with asthma, diabetes, heart disease and arthritis were the most, and people with AIDS, mental retardation, psychiatric illness and cerebral palsy, the least accepted of the disability groups. These stigma hierarchies were remarkably similar to other hierarchies reported over the last 23 years. The findings have important implications for people with disabilities and health practitioners in multicultural societies.

Perceptions of responsibility for the care of the aged in six Australian communities.

The influence of cultural values on beliefs as to who is responsible for the care of frail aged people was examined in a survey of 371 health practitioners from the Chinese, German, Greek, Italian, Arabic-speaking and Anglo Australian communities. All communities attributed a major responsibility to government. The communities differed significantly in their perceptions of the role of community, ethnic and religious organisations, and the family in providing care. There were marked community differences in the perceptions of which family members have the major responsibility to provide care.

A survey of post-poliomyelitis sequelae: Manifestations, effects on people's lives and responses to treatment.

An Australia-wide questionnaire survey was conducted of 318 people who contracted polio between 1907 and 1962. It examined their medical histories, post-polio symptoms, effects of these symptoms on respondent's lives, and treatments found to be effective or ineffective. The average respondent was experiencing increasing muscle weakness, pain and fatigue. These imposed major restrictions on daily living activities and resulted in fear and depression. Physiotherapists were the allied health professionals most likely to be consulted. Physiotherapy was rated as providing considerable or some relief by a relatively high proportion (80 per cent) of clients but it also attracted criticism primarily due to vigorous exercise programs that increased fatigue and weakness. Aspects of the care of people with late effects of polio are discussed.

Gender differences in allied health students' knowledge of disabled women and men.

Disabled women experience greater handicaps than disabled men do. A survey of 907 students in six allied health professions indicated that the majority lacked knowledge of 13 sex differences in frequency of occurrence of physical disabilities and handicaps. Female students revealed greater unawareness. Students who recognized sex differences in frequency of disabilities were more likely to correctly identify predominantly male disabilities but tended to incorrectly attribute predominantly female disabilities to men. This trend was stronger among male subjects. Beliefs regarding sex differences in handicaps suggest that disabled men are perceived as coping more effectively with disability. Results are a matter of concern given that health practitioners' knowledge and expectations influence rehabilitation outcomes.

Crafty birds and fitness fiends: relationships of professional and leisure activities.

Stereotypes of therapists were found to contain a 'kernel of truth' in a survey comparing the active and passive leisure pursuits of female physiotherapy (N = 100) and occupational therapy (N = 107) graduates and undergraduates. Physiotherapists had relatively more active leisure patterns as adolescents and undergraduates. Occupational therapists had relatively passive leisure patterns that persisted after graduation. These findings support the spillover hypothesis of a work-leisure relationship. Following graduation physiotherapists adopted more passive leisure pursuits which supports the compensation theory of leisure. However, physiotherapy graduates felt deprived of sport and experienced less leisure satisfaction than occupational therapists.

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.

Patterns of psychological reaction to asthma in children.

Asthmatic children were matched with a group of nonasthmatic children for sex and age. Scores on content analysis scales representing nine emotional elements on their reactions were compared. Lack of emotional expression was hypothesized but not observed in the asthmatics. The main pattern of reaction identified was of directly and indirectly expressed anger and statements of helplessness, yet many expressions of competence and good feelings. This pattern did not vary according to sex or grade of the children, but only according to age. Preadolescent asthmatic children showed more depression and fewer good feelings than the younger children, and their characteristic pattern was dominated by indirectly expressed anger.

The addiction experience as a function of the addict's history.

Application of personal construct theory to addicts in treatment led to a series of hypotheses about their psychological reactions and how these might differ with differences in their histories. Their scores on a set of content analysis scales were compared with those of a relatively non-stressed group and a relatively stressed group matched for sex and age. The chief element in the pattern of experiential elements which was identified was uncertainty. Addicts also expressed more anxiety, depression and anger (directly and indirectly) and reported fewer social interactions than the non-stressed group; however, for most of these elements they were similar to the similarly stressed group of young people with whom they were compared. The pattern of experience of addiction was found to vary according to the employment, addiction and criminal histories of the addicts, their treatment histories as represented by their counsellors' assessments of them and the social supports available to them.

Sources of anxiety in drug addiction.

A sample of drug addicts (N = 60) in treatment were interviewed, and their descriptions of their lives were elicited and recorded. Their scores on a measure of anxiety based on content analysis of these descriptions were compared with those of two other groups of people matched for sex and age. The chief element in the pattern of anxiety that differentiated the groups was shame. Addicts also expressed more guilt, loneliness, fear of death, and vague worries than the other groups. This pattern was found to vary with the criminal history of the addicts and their counselors' assessment of them. Implications were discussed.

Career development of female physiotherapists: stage four of a longitudinal survey.

Career development of 62 female physiotherapists was surveyed 5 years after graduation, in this fourth stage of a longitudinal study: 87.1 per cent were currently employed. Job satisfaction was high as was work involvement. About half had specialized and the majority had attended short courses, workshops and seminars. Work pressure (too much to do and too little time) was the most frequently rated work stressor. The physiotherapists reported themselves being in good health, experiencing little role conflict and moderate satisfaction from various areas of their lives. As in previous surveys they indicated that they planned to have an average of 3 children and interrupt their careers while the children were young.

Coping with chronic illness: strategy preferences, changes in preferences and associated emotional reactions.

Coping strategy preferences, changes in those preferences and their associations with different patterns of psychological reaction were investigated in three studies of chronically ill patients. A simple self-appraisal device, consisting of the ranking of six clusters of strategies, was used to assess patients' coping preferences. In Study 1 patients were found to prefer optimism, and probably fatalism , more than non-patients, while non-patients preferred action strategies and, to some extent, interpersonal coping. In Study 2 coronary patients were bound to prefer more optimism strategies but fewer escape strategies than other chronically ill patients. All patients also changed some of their coping preferences over time, preferring optimism in hospital and fatalism at home. Study 3 showed preferences for action strategies to be associated with desirable psychological reaction patterns such as relatively little uncertainty and helplessness. Preferences for escape strategies were linked with patterns which may be less desirable, such as much anxiety and indirectly expressed anger. Optimism and fatalism , although preferred by many patients, were associated with patterns of psychological reaction in which desirable and undesirable elements were mixed. Preferences for control strategies proved to be linked with reactions of patients when in hospital only, while those for interpersonal coping proved to be reaction-linked only when patients were at home.

Cultural differences in reactions to patient behaviour: a comparison of Swedish and Australian health professionals.

Scott hypothesised that there are national differences in the theories held by health professionals regarding rehabilitation. Thus they have different perceptions of and reactions to patient behaviours. This was tested by comparing the reactions of female physiotherapists, occupational therapists and nurses in Sweden (N = 51) and Australia (N = 83) to behaviours of patients belonging to six diagnostic groups. It was predicted that national differences would be influenced by Australians' endorsement of a more psycho-social model of health care and Swedes' stronger beliefs in personal responsibility for health. Questionnaires containing case histories of the six patients and transcripts of interviews in which they expressed either depression, optimism, dependence, independence, self-blame or denial of blame for their illnesses were distributed to subjects. Case histories and interview transcripts were combined differently in six forms of the questionnaire. Subjects rated their impressions and evaluations of each patient on 14 Likert type scales and answered the question, "If the patient had said this to you how would you have reacted?" Subjects completed the Health Locus of Control Scale on which Swedes proved to have significantly stronger beliefs regarding personal responsibility for health. Highly significant differences were found in discriminant analyses of reactions to the six behaviours. Australians were more likely to perceive patients as dependent, depressed and poorly adjusted. They responded verbally to patients' feelings, recommended counselling and liked patients more. Swedes were more likely to react with specific treatments and technical aids. Swedes regarded patients who were dependent or who did not blame themselves as having poorer prognoses. Few differences occurred in ratings of the typicality of patients' behaviours or the degree of patients' acceptance or coping. The findings have particular relevance to multi-cultural nations. Bias may have occurred in the results because subjects represented only 40% of those sent the questionnaires.

Patterns of anxiety in the chronically ill.

A sample of chronically ill patients was interviewed in order to establish some of their biographic characteristics and their perceptions of their handicaps and handicap-related goals when hospitalized and seven months later in the community. Other variables of interest were the type of disability they suffered (from their medical records) and two measures of the success of their rehabilitation (based on patients' perceptions and goals). Canonical correlation was used to relate each of these sets of variables to a set of anxiety measures taken after patients were discharged into the community. These measures represented different sources of anxiety which had been derived by content analysis of patients' relatively unstructured comments about their current experiences of their illnesses. Three major patterns of anxiety were identified. The first consistent of fears of death and vague worries but little loneliness. It was associated with being married and being dissatisfied with work experience and with having visual and communication disabilities. The second consisted of guilt and vague worries and was experienced by patients who perceived themselves to be handicapped in most of their activities but not in relating to others. The third involved the source of anxiety which was most important to chronically ill patients--fears about body damage. This was found to be associated with patients' concurrent perceptions of their handicaps. These bodily fears, together with loneliness, were more likely to be expressed by patients with less successful rehabilitation than those with more successful rehabilitation. Some of the implications of these findings for the care of the chronically ill are discussed.

Coping with chronic illness: the mediating role of biographic and illness-related factors.

The aim of this research was to examine the mediating roles played by a range of biographic and illness-related factors in preferences for strategies for coping with chronic illness. Chronically-ill patients assessed their own coping strategy preference by ranking six clusters of strategies. Information was also obtained about their demographic characteristics, life styles, illness roles, the degree of their disability, their perceived handicaps and their perceived achievement of their rehabilitation goals. Multiple regression analyses of each of these six sets of variables on each coping strategy were carried out to identify patterns of association between them. (1) Preferences for action strategies were found to be associated with patient-related factors (demographic characteristics, life style and illness role). (2) Control strategies were associated with illness-related factors (illness role, degree of disability, perceived handicap and achievement of rehabilitation goals). (3) Escape strategies were ranked higher by women than by men, sex being their only significant predictor. (4) Preferences for fatalism, unlike those for action strategies, were associated with relatively low social status and relatively little interpersonal involvement or social commitment. (5) Preferences for optimism were related only to patients' perceptions of their handicaps. (6) Interpersonal coping was not found to be associated with any of this wide range of biographic illness-related factors.

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 experienced 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.