Evaluation & the health professions
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Health care professionals are coming under increased pressure to empirically monitor patient outcomes across settings as a means of improving clinical practice. Within the psychiatric and primary care communities, many have begun utilizing brief psychometric measures of psychological functioning to accomplish these goals. The purpose of this study was to evaluate the psychometric properties and clinical utility of the Depression, Anxiety, and Stress Scales-21-item version (DASS-21), and contribute normative data to facilitate interpretation using a sample of U. ⋯ Scale-level correlations were greater than what has been reported elsewhere (range of rs = .68 to .73), and principal components analysis supported the extraction of only one component accounting for 47% of the item-level variance. However, confirmatory factor analysis (CFA) favored a three-factor structure when compared to a one-factor model. The implications for the health care professions are discussed.
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Job satisfaction has become an increasingly important topic of focus for the medical profession over the last 20 years. This report details the application of factor analysis to validate a widely used 10-item job satisfaction scale that has not previously been validated in a medical practitioner population. ⋯ Australian doctors experienced high levels of job satisfaction overall, but this varied with doctor subpopulation, age, geographic location, and hours worked per week. The validation of this brief scale in a large cohort of Australian doctors provides opportunities for undertaking further exploratory and comparative job satisfaction research in medical practitioner populations.
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There is a desire among many tinnitus researchers and clinicians for greater standardization in the assessment and management of tinnitus. In their commentary on the complexity of tinnitus, Hoare et al. have highlighted the need for strong evidence-based protocols. ⋯ While I agree with the bulk of their commentary there are a few areas where I will offer a counter view. In particular I will address their view that only high-level evidence has a place in forming practice guidelines for tinnitus.
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Tinnitus is a heterogeneous disorder that causes significant impairment in many patients. Treatment is elusive and there is a need for more comprehensive guidelines for diagnosis and management of tinnitus. However, different standardization approaches should be differentiated according to their specific purpose. ⋯ Therefore, medical diagnosis is necessarily the first step in tinnitus management. Treatment guidelines should not be restricted to recommendations that are supported by high-level evidence. They should also contain treatment recommendations that have shown clinically highly relevant effects in case series of specific tinnitus subgroups.
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In Belgium and the Netherlands, consultation of a second independent physician by the attending physician is mandatory in euthanasia cases. In both countries, specialized consultation services have been established to provide physicians trained for that purpose. ⋯ Over 90% of attending physicians in both countries evaluated the consultant's knowledge of palliative care, patient's disease, and judicial procedure, and their communication skills, as sufficient. Consultation with specialized consultation services seems to promote quality of euthanasia consultations.