A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / End‐of‐life (EOL) care and decision‐making in pediatrics is a challenging and complex aspect of patient care experienced by residents and physician attendings. Previous studies have evaluated determinants that contribute to physicians’ attitudes towards EOL care as well as preparedness of students and residents in EOL decision‐making. However, the determinants contributing to a physician’s ability to make such decisions and feel confident in addressing EOL issues are dynamic. Recognizing that decision‐making changes over time, identifying when these changes occur may demonstrate the need for educational interventions for medical students and residents early in their career to help prepare them for EOL decision‐making. A longitudinal assessment of changes in attitudes and knowledge of EOL discussions and how they impact EOL decision‐making was not previously evaluated. This preliminary study establishes a baseline for medical student, resident, and attendings for EOL decision‐making and those factors that contribute to their decisions. This preliminary data has demonstrated a difference amongst attendings compared to residents and students. Despite low probability of survival, residents and students are more likely to select more aggressive management options when compared to attendings. Data obtained after completion of future surveys will show when decision‐making changes, which factors contribute to these changes and their significance in making decisions, and when participants are comfortable addressing EOL care.

The PDA is an important technology in clinical medicine. Although PDAs are widely utilized by medical students and residents, older teaching faculty have not readily adopted them. The medical library can position itself as a leader in training patrons to use these devices. The East Tennessee State University (ETSU) Quillen College of Medicine Library (QCOML) staff trained older, experienced teaching faculty to use PDAs loaded with ePocrates and InfoRetriever databases. The training was rated highly and several faculty members became PDA users. The library is now considered the place to go on campus for PDA help.

The topic of the thesis is {\clqq} The examination of state of health of citizens for the purposes of social welfare benefits.{\crqq} Medical statement sevice ensures this activity, which has a wide medical, social, employment and economic importance. On 1st January 2006 the first instance medical statement service was divided into the insurance and non-insurance system. OSSZ and ČSSZ continues providing examinations for the insurance systems while the examination for the non-insurance system is carried out by physicians of the newly created examination services of employment agencies. The paper aims at analysing the so far experience of the medical statement service after the division into the insurance and non-insurance system. I presume that the division of the medical statement service and its transformation have been effective. I have dealt with the medical statement system in the most wide context. In the theoretical part I have concentrated on historical development of the medical statement service, on its system and the scope of activity of the medical statement service and I did not omit the examination of state of health of citizens for the purposes of the social welfare systems. In the practical part I concentrated on physicians carrying out medical statements for employment agencies and district administrations of social welfare, on their feelings, opinions on the reorganization of the medical statement service in 2006. The research was carried out in Central Bohemia region with the view to evaluate the division of the medical statement service in the insurance and non-insurance system. A quantitave attitude was chosen for this research usingt the questionnaire method. Two types of questionnaires were handed out: for physicians of the medical statement service of employment agencies and for physicians of medical statement service of district administration of social welfare system. In total there were 40 questionnaires handed out to the physicians of medical statement service of district administration of social welfare system and 25 to the physicians of the medical statement service of employment agencies. 34 (100%) questionnaires were used filled by the employment agencies physicians and 16 (100%) questionnaires filled by the physicians of the district administration of social welfare system. I chose the graph form to process the research part of the paper. The principal hypothesis was confirmed. For both the physicians of the medical statement service of employment agencies and physicians of medical statement service of district administration of social welfare system was proved that the division of the medical statement service into the insurance and non-insurance system was effective. Further activities within the organization of the medical statement service should endeavour to depict small discrepancies and to ensure a continuous improvement of the system.