Patient Preferences of Breast Radiologists' Attire and Appearance

RATIONALE AND OBJECTIVES

To assess patient preferences for breast radiologists' attire and appearance.

MATERIALS AND METHODS

A multi-institutional anonymous, voluntary 19-question survey was administered to patients undergoing screening and diagnostic mammography examinations over a 5-week period. Using a 5-point Likert scale, respondents were asked about their preferences for gender-neutral attire (white coat), male-presenting attire (scrubs, dress shirt with tie, or dress shirt without tie), and female-presenting attire (scrubs, dress, blouse with pants, and blouse with skirt). Patient responses were compared to demographic data using bivariable analysis and multivariable regression.

RESULTS

Response rate was 84.7% (957/1130). Mean respondent age was 57.2 years±11.9. Most respondents agreed/strongly agreed that the breast radiologist's appearance mattered (52.5%, 502/956) followed by being indifferent (28.1%, 269/956). Respondents with greater education levels felt less strongly (p=0.001) about the radiologist's appearance: 63.3% (70/110) less than college cared about appearance compared to 53.5% (266/497) college/vocational and 47.4% (165/348) graduate. Most respondents felt indifferent about a breast radiologist wearing a white coat (68.9%, 657/954) or about male-presenting breast radiologists wearing a tie (77.1%, 734/952) without significant demographic differences. Almost all respondents either prefer/strongly prefer (60.1%, 572/951) or were indifferent (39.6%, 377/951) to all breast radiologists wearing scrubs when performing procedures. While respondents approved of all attire choices overall, most respondents preferred scrubs for both male- and female-presenting breast radiologists (64.0%, 612/957 and 64.9%, 621/957, respectively).

CONCLUSION

A variety of breast radiologists' attire can be worn while maintaining provider professionalism and without compromising patient expectations.

In vitro study on the transmission of multidrug-resistant bacteria from textiles to pig skin

BACKGROUND

The survival of microorganisms on textiles and specifically on healthcare professionals' (HCP) attire has been demonstrated in several studies. The ability of microorganisms to adhere and remain on textiles for up to hours or days raises questions as to their possible role in transmission from textile to skin via HCP to patients.

AIM

To evaluate the presence, survival and transmission of different multidrug-resistant bacteria (MDRB) from HCP attire onto skin.

METHODS

Three MDRB [methicillin-resistant Staphylococcus aureus (MRSA); vancomycin-resistant Enterococcus faecium (VRE); carbapenem-resistant Klebsiella pneumoniae, CRKP)] were inoculated on textiles from scrubs (60% cotton-40% polyester) and white coat (100% cotton) at concentrations of 108 colony-forming units (CFU), 105 CFU, and 103 CFU per mL. The inoculation of swatches was divided in time intervals of 1 min, 5 min, 15 min, 30 min, 1 h, 2 h, 3 h, 4 h, 5 h, and 6 h. At the end of each period, textiles were imprinted onto pig skins and each skin square was inverted onto three different selective chromogenic media. Growth from the pig skin squares was recorded for the 3 MDRB at the three above concentrations, for the whole length of the 6-h experiment.

RESULTS

MRSA was recovered from pig skins at all concentrations for the whole duration of the 6-h study. VRE was recovered from the concentration of 108 CFU/mL for 6 h and from 105 CFU/mL for up to 3 h, while showing no growth at 103 CFU/mL. CRKP was recovered from 108 CFU/mL for 6 h, up to 30 min from 105 CFU/mL and for 1 min from the concentration of 103 CFU/mL.

CONCLUSION

Evidence from the current study shows that MRSA can persist on textiles and transmit to skin for 6 h even at low concentrations. The fact that all MDRB can be sustained and transferred to skin even at lower concentrations, supports that textiles are implicated as vectors of bacterial spread.

Evaluation of child preference for dentist attire and usage of camouflage syringe in reduction of anxiety

Objectives:

The aim of this study is to evaluate the child preference for dentist attire and camouflage versus conventional syringe in reduction of anxiety.

Materials and Methods:

A total of 600 children aged 6–14 years were made to look at a set of six photos of an individual dressed with different colored apron of pink, green, blue, white colors, formal dress, and cartoon character along with conventional syringe and camouflage syringe with a toy-like appearance to permit injection of local anesthesia. Children's anxiety level during injections and with colored coat was assessed and recorded using the Modified Child Dental Anxiety Scale faces version.

Statistical Analysis Used:

SPSS statistical software version 21 and using Chi-square test.

Results:

Among age group of 6–8 years, 65.33% selected colorful apron, while other age groups 9–10, 11–12 years, and 13–14 years selected 47.34%, 57.34%, and 50.67% white coat, respectively (P < 0.05). For syringe, 78% of younger age group (6–10 years) preferred camouflage syringe, whereas 71% of older age group (11–14 years) preferred conventional syringe. Anxiety level of all children for syringe was more compared to that of white coat.

Conclusion:

Younger children prefer colorful attire of dentist and camouflage syringe over conventional compared to older one.

Challenging the Status Quo of Physician Attire in the Palliative Care Setting

BACKGROUND, AIM, AND HYPOTHESIS

This randomized controlled trial aimed to compare the impact of a physician's attire on the perceptions of patients with cancer of compassion, professionalism, and physician preference. Our hypothesis was that patients would perceive the physician with formal attire as more compassionate than the physician wearing casual attire.

MATERIALS AND METHODS

One hundred five adult follow-up patients with advanced cancer were randomized to watch two standardized, 3-minute video vignettes with the same script, depicting a routine physician-patient clinic encounter. Videos included a physician in formal attire with tie and buttoned-up white coat and casual attire without a tie or white coat. Actors, patients, and investigators were all blinded to the purpose and videos watched, respectively. After each video, patients completed validated questionnaires rating their perception of physician compassion, professionalism, and their overall preference for the physician.

RESULTS

There were no significant differences between formal and casual attire for compassion (median [interquartile range], 25 [10-31] vs. 20 [8-27]; p = .31) and professionalism (17 [13-21] vs. 18 [14-22]; p = .42). Thirty percent of patients preferred formal attire, 31% preferred casual attire, and 38% had no preference. Subgroup analysis did not show statistically significant differences among different cohorts of age, sex, marital status, and education level.

CONCLUSION

Doctors' attire did not affect the perceptions of patients with cancer of physician's level of compassion and professionalism, nor did it influence the patients' preference for their doctor or their trust and confidence in the doctor's ability to provide care. There is a need for more studies in this area of communications skills. Clinical trial identification number. NCT03168763 IMPLICATIONS FOR PRACTICE: The significance of physician attire as a means of nonverbal communication has not been well characterized. It is an important element to consider, as patient preferences vary geographically, are influenced by cultural beliefs, and may vary based on particular care settings. Previous studies consisted of nonblinded surveys and found increasing confidence in physicians wearing a professional white coat. Unfortunately, there are no randomized controlled trials, to the authors' knowledge, to confirm the survey findings. In this randomized, blinded clinical trial the researchers found that physician's attire did not affect patients' perception of the physician's level of compassion and professionalism. Attire also did not influence the patients' preferences for their doctor or their trust and confidence in the doctor's ability to provide care.

Children's Perceptions of Dentist's Attire and Environment: A Systematic Review and Meta-analysis

Aim

To assess the children's perceptions of the dentist's attire and environment. The protocol is available in the PROSPERO database.

Search strategies

Systematic searches in the databases were performed in Cochrane, Latin American and Caribbean Health Sciences, PubMed, PsycINFO, Scopus, and Web of Science from their inception to December 12, 2019, Google Scholar, Open Grey, and ProQuest Dissertations.

Selection criteria

Criteria consisted of descriptive studies regarding the above matter while two authors assessed the information. The risk of bias was also performed.

Results

Databases showed 1,544 papers and a two-phase assessment selected 21 studies in narrative and 9 in the quantitative synthesis. A meta-analysis demonstrated no difference between white coat and child-friendly attire (OR = 0.63; 95% CI 0.16-2.49; n = 3,706) and a decorated vs plain dental clinic was the preference of the children's majority (OR = 8.75; 95% CI 1.21-63.37; n = 150).

Conclusion

It can be concluded that there is no difference in the children's perception, white coat vs child-friendly attire; however, children prefer a decorated dental clinic.

How to cite this article

Oliveira LB, Massignan C, De Carvalho RM, et al. Children's Perceptions of Dentist's Attire and Environment: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2020;13(6):700-716.

Hygiene practices during clinical training: knowledge, attitudes and practice among a cohort of South Asian Medical students

BACKGROUND

Proper hygienic practices are important in preventing nosocomial infection. This study aimed to determine knowledge, attitudes and practices (KAP) on hand, attire and equipment hygiene during clinical training among medical students at a State Medical Institution in Sri Lanka.

METHODS

This cross-sectional study was conducted among 3rd, 4th and final (5th) year medical students of the Faculty of Medicine, University of Colombo, who had undergone at least 6 months of clinical training. KAP on hand hygiene (HH), attire hygiene (AH) and equipment hygiene (EH) were assessed using a pre-tested, self-administered questionnaire with a Likert-type scale. KAP scores were graded as follows: good ≥75; moderate:74.9-50; unsatisfactory:49.9-25; poor:< 25%. KAP based on duration of training and gender were compared using independent samples t-tests.

RESULTS

Three hundred thirty-three students participated (mean age 24 ± 1.1 years, male: female = 1: 1.2). Combined KAP scores on hand and attire hygiene were moderate (HH:73%, AH:65%) while equipment hygiene was unsatisfactory (EH:47%). Senior students (5th year) had higher combined KAP and knowledge (K) on hand hygiene (HH KAP 75% vs. 72%, p = 0.01; K:72% vs. 67%, p = 0.001) and equipment hygiene (EH KAP 50% vs. 44%, p = 0.001; K:47% vs. 35%, p = 0.001) compared to junior students (3rd/ 4th years). However, they had lower KAP and P scores on attire hygiene (AH KAP 63% vs. 67%, p = 0.006; P:60% vs. 67%, p = 0.004). Female students had better AH compared to male students (KAP:67% vs. 64% p = 0.01; K 71% vs. 66%, p = 0.048; P:66% vs. 62%, p = 0.05).

CONCLUSIONS

Overall, hand hygiene was moderate among medical students and improved with progression of training. Attire hygiene was also graded as moderate but to a lesser extent compared to hand hygiene, lower in males, and declined over time, indicating need for better reinforcement of attire hygiene practices with progression of clinical training. Equipment hygiene was unsatisfactory among most medical students and thus needs to be highlighted as a potential area to be improved during clinical training. This study suggests that knowledge, attitudes and practices on equipment and attire hygiene among medical students was less satisfactory and needs to receive greater emphasis during medical clinical training.

Eye-tracking in dentistry: What do children notice in the dentist?

OBJECTIVES

To determine, using eye-tracking technology, what children notice the most when they look at the dentist.

METHODS

A total of 41 children viewed 10 images of dentists of different genders and ethnicities, and wearing different attires, on a computer screen. Due to calibration issues with the eye tracking equipment, data from one child was excluded thus resulting in a final sample of 40 children (21 females; 19 males). Participants were aged 4-12 years. A Tobii X2-60 eye-tracking camera was used, which follows the location of participants' gaze as they look at images on a screen. Areas of interest (AOI's) were pre-defined on each image (e.g. eyes, mouth, shirt). Other images were displayed between dentist images with no consecutive dentist images displayed. Number of participants to fixate and mean length of fixation for each AOI were measured.

RESULTS

Visual assessment illustrated that the dentist's face had the highest concentration of fixations, followed by attire. The circum-oral area has significantly more fixations than the eyes. The number of fixations and the mean length of fixation were both longer for the face than for the attire, and for the circum-oral area compared to the eyes. Distractors such as pens and ties exhibited more and longer fixations compared to images without distractors.

CONCLUSIONS

Children fixated most on the dentist's face particularly the circum-oral area, followed by attire. Distractors were able to draw the children's gaze. Importantly, eye-tracking was an effective tool in assessing where children look on dentists' images.

CLINICAL SIGNIFICANCE

This research will provide an understanding of where children focus when they look at a dentist. This has not previously been known and will allow dentists to modify how they present themselves and interact with child patients.

The effect of white coats and gender on medical students' perceptions of physicians

BACKGROUND

Despite the fact that medical schools spend a considerable effort to rate clinical instructors, there is limited evidence regarding the effect of physical characteristics on instructor ratings. White coats have been shown to alter patients' perceptions of physicians although it has not been determined if preceptors who wear white coats are rated differently than their colleagues.

METHODS

Second year medical students were administered a questionnaire with four clinical scenarios depicting medical errors accompanied by a picture of a physician of different sexes and ethnicities. The packages were randomized so that the physicians depicted either had or did not have a white coat.

RESULTS

White coats did not alter the perception of physicians' ratings by medical students although sex and ethnicity/case were associated with the perception of trustworthiness, physician management, competence, professionalism and the perception of medical error.

CONCLUSIONS

Physical characteristics may alter students' ratings of physicians.

Using Hexoskin Wearable Technology to Obtain Body Metrics During Trail Hiking

Use of wearable technology to obtain various body metrics appears to be a trending phenomenon. However there is very little literature supporting the notion that these apparatuses can be used for research purposes in the field. The purpose of this study was to utilize Hexoskin wearable technology shirts (HxS) to obtain data in a pilot study using a trail hiking situation. Ten individuals (male, n = 4, female n = 6) volunteered to participate. On the first day, volunteers completed two approximately flat trail hikes at a self-preferred pace with a 15-minute rest between trials. On the second day, participants completed a strenuous uphill hike (17.6% grade) with a 15-minute rest at the summit and then completed the downhill portion. Body metrics provided by the HxS were average heart rate (HR), maximal HR (MHR), total energy expenditure (EE), average respiratory rate (RR), maximal respiratory rate (MRR), total steps (SC), and cadence (CA). Other measurements obtained were systolic and diastolic blood pressure (SBP, DBP), and ratings of perceived exertion (RPE). Data were analyzed using both one-way repeated measures analysis of variance (ANOVA) with significance accepted at p≤0.05 and intraclass correlation coefficients (ICC) for each variable. Both were determined using Statistical Package for the Social Sciences software (SPSS). No significant differences for trail type were noted for MHR (p=0.38), RR (p=0.45) or MRR (p=0.31). The uphill trail elicited significantly elevated HR (up=154±24 bpm, easy=118±11 bpm, down=129±19 bpm; p=0.04) and EE (up=251±78 kcal, easy=124±38 kcal, down=171±52 kcal; p=0.02). Significant ICC were observed for DBP (r = 0.80, p = 0.02), RR (r = 0.98, p = 0.01), SC (r = 0.97, p = 0.01) and RPE (r = 0.94, p = 0.01). Non-significant correlation were noted for uphill RR vs CA (r=0.51, p=0.16) or RPE vs SBP (r=0.03, p=0.94), HR (r=0.60, p=0.12), and MHR (r=0.70, p=0.051). We utilized HxS to provide physiological data in an applied setting. It should be noted that HR did not register in 5 out of 10 subjects on the easy trail, and 8 of 10 participants during the uphill hike. Additionally, estimated EE appears to be linked to HR intensity. Future investigations taken in an outdoor environment should take these findings into consideration.

The effect of a five-part intervention to decrease omitted medications

PROBLEM

Nursing administrators reported that medication administration errors had continued despite the use of bar code medication administration, especially in terms of omitted medications. Nurse administrators within the study hospital identified a need to add back up safety systems in order to reduce the number of omitted medications. Interruptions and distractions were identified as leading constraints to accurate medication administration.

METHODS

This pre-post quality improvement study used a convenience sample of nurses on one medical surgical unit to observe the effect of specific protocols to decrease interruptions and distractions during medication administration. Nurses' were observed during medication administration cycles, and the medication time was measured in hours and minutes using a stop watch. The number of distractions and interruptions was counted by category. A participant survey was used to determine nurses perceptions of distractions and interruptions experienced.

FINDINGS

The five-part intervention decreased nurses interruptions and distractions by 84% compared with the control group. The results indicated the type of distractions and interruptions nurses typically experience during medication administration was highest from conversation in the environment (M = 5.0 ± 3.4) and by other personnel (M = 6.38 ± 2.6).

CONCLUSION

This process improvement project determined that a five-part protocol would reduce distractions and interruptions for nurses, save time in the process, and reduce omitted medications. Other visible symbols such as a vest with wording may show different results when combined with the other elements of the protocol. Anecdotal comments from nurses during and after observations divulged workplace issues surrounding medication delivery that may need investigation.