first-year patient-centered medicine: Topics by Science.gov

Sample records for first-year patient-centered medicine

Creative group performances to assess core competencies in a first-year patient-centered medicine course.

PubMed

Terregino, Carol A; Saks, Norma S

2010-02-15

A novel assessment of systems-based practice and practice-based learning and improvement learning objectives, implemented in a first-year patient-centered medicine course, is qualitatively described. Student learning communities were asked to creatively demonstrate a problem and solution for health care delivery. Skits, filmed performances, plays, and documentaries were chosen by the students. Video recordings were reviewed for themes and the presence of course competencies. All performances demonstrated not only the index competencies of team work and facilitation of the learning of others, but many other core objectives of the course. The assignment was rated positively both by the faculty and the students, and has been added to the assessment modalities of the course.
Creative group performances to assess core competencies in a first-year patient-centered medicine course

PubMed Central

Terregino, Carol A.; Saks, Norma S.

2010-01-01

Introduction A novel assessment of systems-based practice and practice-based learning and improvement learning objectives, implemented in a first-year patient-centered medicine course, is qualitatively described. Methods Student learning communities were asked to creatively demonstrate a problem and solution for health care delivery. Skits, filmed performances, plays, and documentaries were chosen by the students. Video recordings were reviewed for themes and the presence of course competencies. Results All performances demonstrated not only the index competencies of team work and facilitation of the learning of others, but many other core objectives of the course. The assignment was rated positively both by the faculty and the students, and has been added to the assessment modalities of the course. PMID:20174597
Outcomes of Embedded Care Management in a Family Medicine Residency Patient-Centered Medical Home.

PubMed

Newman, Robert J; Bikowski, Richard; Nakayama, Kristy; Cunningham, Tina; Acker, Pam; Bradshaw, Dana

2017-01-01

Much attention is devoted nationally to preventing hospital readmissions and emergency department (ED) use, given the high cost of this care. There is a growing body of evidence from the Patient Centered Primary Care Collaborative that a patient-centered medical home (PCMH) model successfully lowers these costs. Our study evaluates a specific intervention in a family medicine residency PCMH to decrease readmissions and ED utilization using an embedded care manager. The Department of Family and Community Medicine at Eastern Virginia Medical School in Norfolk, VA, hired an RN care manager in May of 2013 with a well-defined job description focused on decreasing hospital readmissions and ED usage. Our primary outcomes for the study were number of monthly hospital admissions and readmissions over 23 months and monthly ED visits over 20 months. Readmission rates averaged 22.2% per month in the first year of the intervention and 18.3% in the second year, a statistically significant 3.9% decrease. ED visits averaged 176 per month in the first year and 146 per month in the second year, a statistically significant 17% reduction. Our study adds to the evidence that a PCMH model of care with an embedded RN care manager can favorably lower readmission rates and ED utilization in a family medicine residency practice. Developing a viable business model to support this important work remains a challenge.
Integrative medicine and patient-centered care.

PubMed

Maizes, Victoria; Rakel, David; Niemiec, Catherine

2009-01-01

Integrative medicine has emerged as a potential solution to the American healthcare crisis. It provides care that is patient centered, healing oriented, emphasizes the therapeutic relationship, and uses therapeutic approaches originating from conventional and alternative medicine. Initially driven by consumer demand, the attention integrative medicine places on understanding whole persons and assisting with lifestyle change is now being recognized as a strategy to address the epidemic of chronic diseases bankrupting our economy. This paper defines integrative medicine and its principles, describes the history of complementary and alternative medicine (CAM) in American healthcare, and discusses the current state and desired future of integrative medical practice. The importance of patient-centered care, patient empowerment, behavior change, continuity of care, outcomes research, and the challenges to successful integration are discussed. The authors suggest a model for an integrative healthcare system grounded in team-based care. A primary health partner who knows the patient well, is able to addresses mind, body, and spiritual needs, and coordinates care with the help of a team of practitioners is at the centerpiece. Collectively, the team can meet all the health needs of the particular patient and forms the patient-centered medical home. The paper culminates with 10 recommendations directed to key actors to facilitate the systemic changes needed for a functional healthcare delivery system. Recommendations include creating financial incentives aligned with health promotion and prevention. Insurers are requested to consider the total costs of care, the potential cost effectiveness of lifestyle approaches and CAM modalities, and the value of longer office visits to develop a therapeutic relationship and stimulate behavioral change. Outcomes research to track the effectiveness of integrative models must be funded, as well as feedback and dissemination strategies
[Patient-centered medicine for tuberculosis medical services].

PubMed

Fujita, Akira; Narita, Tomoyo

2012-12-01

The 2011 edition of Specific Guiding Principles for Tuberculosis Prevention calls for a streamlined medical services system capable of providing medical care that is customized to the patient's needs. The new 21st Century Japanese version of the Directly Observed Treatment Short Course (DOTS) expands the indication of DOTS to all tuberculosis (TB) patients in need of treatment. Hospital DOTS consists of comprehensive, patient-centered support provided by a DOTS care team. For DOTS in the field, health care providers should select optimal administration support based on patient profiles and local circumstances. In accordance with medical fee revisions for 2012, basic inpatient fees have been raised and new standards for TB hospitals have been established, the result of efforts made by the Japanese Society for Tuberculosis and other associated groups. It is important that the medical care system be improved so that patients can actively engage themselves as a member of the team, for the ultimate goal of practicing patient-centered medicine. We have organized this symposium to explore the best ways for practicing patient-centered medicine in treating TB. It is our sincere hope that this symposium will lead to improved medical treatment for TB patients. 1. Providing patient-centered TB service via utilization of collaborative care pathway: Akiko MATSUOKA (Hiroshima Prefectural Tobu Public Health Center) We have been using two types of collaborative care pathway as one of the means of providing patient-centered TB services since 2008. The first is the clinical pathway, which is mainly used by TB specialist doctors to communicate with local practitioners on future treatment plan (e.g. medication and treatment duration) of patients. The clinical pathway was first piloted in Onomichi district and its use was later expanded to the whole of Hiroshima prefecture. The second is the regional care pathway, which is used to share treatment progress, test results and other
Patient Partnerships Transforming Sleep Medicine Research and Clinical Care: Perspectives from the Sleep Apnea Patient-Centered Outcomes Network

PubMed Central

Redline, Susan; Baker-Goodwin, Si; Bakker, Jessie P.; Epstein, Matthew; Hanes, Sherry; Hanson, Mark; Harrington, Zinta; Johnston, James C.; Kapur, Vishesh K.; Keepnews, David; Kontos, Emily; Lowe, Andy; Owens, Judith; Page, Kathy; Rothstein, Nancy

2016-01-01

Due to an ongoing recent evolution in practice, sleep medicine as a discipline has been compelled to respond to the converging pressures to reduce costs, improve outcomes, and demonstrate value. Patient “researchers” are uniquely placed to participate in initiatives that address the specific needs and priorities of patients and facilitate the identification of interventions with high likelihood of acceptance by the “customer.” To date, however, the “patient voice” largely has been lacking in processes affecting relevant policies and practice guidelines. In this Special Report, patient and research leaders of the Sleep Apnea Patient-Centered Outcomes Network (SAPCON), a national collaborative group of patients, researchers and clinicians working together to promote patient-centered comparative effectiveness research, discuss these interrelated challenges in the context of sleep apnea, and the role patients and patient-centered networks may play in informing evidence-based research designed to meet patient's needs. We first briefly discuss the challenges facing sleep medicine associated with costs, outcomes, and value. We then discuss the key role patients and patient-centered networks can play in efforts to design research to guide better sleep health care, and national support for such initiatives. Finally, we summarize some of the challenges in moving to a new paradigm of patient-researcher-clinician partnerships. By forging strong partnerships among patients, clinicians and researchers, networks such as SAPCON can serve as a living demonstration of how to achieve value in health care. Citation: Redline S, Baker-Goodwin S, Bakker JP, Epstein M, Hanes S, Hanson M, Harrington Z, Johnston JC, Kapur VK, Keepnews D, Kontos E, Lowe A, Owens J, Page K, Rothstein N, Sleep Apnea Patient-Centered Outcomes Network. Patient partnerships transforming sleep medicine research and clinical care: perspectives from the Sleep Apnea Patient-Centered Outcomes Network. J
Medicine As a Corporate Enterprise, Patient Welfare Centered Profession, or Patient Welfare Centered Professional Enterprise?

PubMed Central

Singh, Ajai; Singh, Shakuntala

2005-01-01

There is an alarming trend in the field of medicine, whose portents are ominous but do not seem to shake the complacency and merry making doing the rounds. The wants of the medical man have multiplied beyond imagination. The cost of organizing conferences is no longer possible on delegate fees. The bottom-line is: Crores for a Conference Millions for a Mid-Term. However, the problem is that sponsors keep a discreet but careful tab on docs. All in all, costs of medicines escalate, and quality medical care becomes a luxury. The whole brunt of this movement is borne by the patient. Companies like GlaxoSmithKline, Bayer, Pfizer, Bristol-Myers Squibb, AstraZeneca, Schering-Plough, Abbott Labs, TAP Pharmaceuticals, Wyeth and Merck have paid millions of dollars each as compensation in the last few years. The financial condition of many pharmaceutical majors is not buoyant either. Price deflation, increased Rand D spending, and litigation costs are the main reasons. In the future, the messy lawsuits situation would no longer be restricted to industry. It would involve academia and practising doctors as well. Indian pharma industry captains, who were busy raking in the profits at present, would also come under the scanner. If nothing else, it means industry and docs will have to sit down and do some soul searching. Both short and long-term measures will have to be put into place. Short-term measures involve reduction in i) pharma spending over junkets and trinkets; ii) hype over ‘me too’ drugs; iii) manipulation of drug trials; iv) getting pliant researchers into drug trials; iv) manipulation of Journal Editors to publish positive findings about their drug trials and launches; v) and for Indian Pharma, to conduct their own unbiased clinical trial of the latest drug projected as a blockbuster in the West, before pumping in their millions. The long-term measures are related to the way biomedical advance is to be charted. We have to decide whether medicine is to become a
Medicine as a corporate enterprise, patient welfare centered profession, or patient welfare centered professional enterprise?

PubMed

Singh, Ajai; Singh, Shakuntala

2005-11-01

There is an alarming trend in the field of medicine, whose portents are ominous but do not seem to shake the complacency and merry making doing the rounds.The wants of the medical man have multiplied beyond imagination. The cost of organizing conferences is no longer possible on delegate fees. The bottom-line is: Crores for a Conference Millions for a Mid-Term. However, the problem is that sponsors keep a discreet but careful tab on docs. All in all, costs of medicines escalate, and quality medical care becomes a luxury. The whole brunt of this movement is borne by the patient.Companies like GlaxoSmithKline, Bayer, Pfizer, Bristol-Myers Squibb, AstraZeneca, Schering-Plough, Abbott Labs, TAP Pharmaceuticals, Wyeth and Merck have paid millions of dollars each as compensation in the last few years. The financial condition of many pharmaceutical majors is not buoyant either. Price deflation, increased Rand D spending, and litigation costs are the main reasons. In the future, the messy lawsuits situation would no longer be restricted to industry. It would involve academia and practising doctors as well. Indian pharma industry captains, who were busy raking in the profits at present, would also come under the scanner. If nothing else, it means industry and docs will have to sit down and do some soul searching.Both short and long-term measures will have to be put into place. Short-term measures involve reduction in i) pharma spending over junkets and trinkets; ii) hype over 'me too' drugs; iii) manipulation of drug trials; iv) getting pliant researchers into drug trials; iv) manipulation of Journal Editors to publish positive findings about their drug trials and launches; v) and for Indian Pharma, to conduct their own unbiased clinical trial of the latest drug projected as a blockbuster in the West, before pumping in their millions.The long-term measures are related to the way biomedical advance is to be charted. We have to decide whether medicine is to become a corporate
Bridging the gap. The separate worlds of evidence-based medicine and patient-centered medicine.

PubMed

Bensing, J

2000-01-01

Modern medical care is influenced by two paradigms: 'evidence-based medicine' and 'patient-centered medicine'. In the last decade, both paradigms rapidly gained in popularity and are now both supposed to affect the process of clinical decision making during the daily practice of physicians. However, careful analysis shows that they focus on different aspects of medical care and have, in fact, little in common. Evidence-based medicine is a rather young concept that entered the scientific literature in the early 1990s. It has basically a positivistic, biomedical perspective. Its focus is on offering clinicians the best available evidence about the most adequate treatment for their patients, considering medicine merely as a cognitive-rational enterprise. In this approach the uniqueness of patients, their individual needs and preferences, and their emotional status are easily neglected as relevant factors in decision-making. Patient-centered medicine, although not a new phenomenon, has recently attracted renewed attention. It has basically a humanistic, biopsychosocial perspective, combining ethical values on 'the ideal physician', with psychotherapeutic theories on facilitating patients' disclosure of real worries, and negotiation theories on decision making. It puts a strong focus on patient participation in clinical decision making by taking into account the patients' perspective, and tuning medical care to the patients' needs and preferences. However, in this approach the ideological base is better developed than its evidence base. In modern medicine both paradigms are highly relevant, but yet seem to belong to different worlds. The challenge for the near future is to bring these separate worlds together. The aim of this paper is to give an impulse to this integration. Developments within both paradigms can benefit from interchanging ideas and principles from which eventually medical care will benefit. In this process a key role is foreseen for communication and
Stem cell research and regenerative medicine in 2014: first year of regenerative medicine in Japan.

PubMed

Okano, Hideyuki

2014-09-15

It is my great pleasure to announce that we were able to publish the Japan Issue in Stem Cells and Development, especially in this year 2014. This year, 2014, is said to be the First Year of Regenerative Medicine in Japan. This movement is likely to be based on the establishment of a new law system regarding regenerative medicine (an Act for Ensuring the Safety of Regenerative Medicine or the so-called Regenerative Medicine Law) and the partial revision of the Pharmaceutical Affairs Law (PAL). Both laws will come into effect in 2014 in this country. These new law systems are expected to have a great impact on the facilitation of R&D related to regenerative medicine and stem cell biology. In the present Japan Issue, some excellent stem cell research in this country will be introduced to celebrate the First Year of Regenerative Medicine in Japan.
Patient-Centered Care in Renal Medicine: Five Strategies to Meet the Challenge.

PubMed

O'Hare, Ann M

2018-05-01

There is growing interest in patient-centered care, defined by the Institute of Medicine as "care that is respectful of and responsive to individual patient preferences, needs, and values." Although generally accepted as uncontroversial, the notion of "centering" care on our patients is in fact quite revolutionary. Because medical teaching, research, and practice have traditionally been organized around diseases and organ systems rather than patients, making care more patient centered would require no less than a paradigm shift in how we practice medicine. This would call for a frameshift in how we envision our role as health care providers and fundamental changes to the health care delivery systems in which we practice. Although individual providers may have limited power to change health systems (at least in the short term), there are some simple strategies within our reach that can help make our care more patient centered. These include a willingness to listen, make time, go beyond our job description, re-imagine what it means to provide "good" care, and see value in relationship building. Although putting these practices to work in the complex, specialized, and fragmented health systems in which many of us operate may be challenging, I would argue that this is a "beautiful challenge" with potentially far-reaching benefits for both patients and providers. Published by Elsevier Inc.
Care team identification in the electronic health record: A critical first step for patient-centered communication.

PubMed

Dalal, Anuj K; Schnipper, Jeffrey L

2016-05-01

Patient-centered communication is essential to coordinate care and safely progress patients from admission through discharge. Hospitals struggle with improving the complex and increasingly electronic conversation patterns among care team members, patients, and caregivers to achieve effective patient-centered communication across settings. Accurate and reliable identification of all care team members is a precursor to effective patient-centered communication and ideally should be facilitated by the electronic health record. However, the process of identifying care team members is challenging, and team lists in the electronic health record are typically neither accurate nor reliable. Based on the literature and on experience from 2 initiatives at our institution, we outline strategies to improve care team identification in the electronic health record and discuss potential implications for patient-centered communication. Journal of Hospital Medicine 2016;11:381-385. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.
Pediatrics Education in an AHEC Setting: Preparing Students to Provide Patient Centered Medicine

ERIC Educational Resources Information Center

Evans, Steven Owens

2012-01-01

Patient centered medicine is a paradigm of health care that seeks to treat the whole person, rather than only the illness. The physician must understand the patient as a whole by considering the patient's individual needs, social structure, socioeconomic status, and educational background. Medical education includes ways to train students in this…
Quantitative Analysis of Contributing Factors Affecting Patient Satisfaction in Family Medicine Service Clinics at Brooke Army Medical Center

DTIC Science & Technology

2008-06-06

Predictors of patient satisfaction for Brooke Army Medical Center Family Medicine Service primary care clinics was performed. Data was obtained from...Factors Affecting Patient Satisfaction in Family Medicine Service Clinics at Brooke Army Medical Center Presented to MAJ Eric Schmacker, Ph.D. In...study. All patients ’ medical information was protected at all times and under no circumstances will be discussed or released to any outside agency
Transforming primary care training--patient-centered medical home entrustable professional activities for internal medicine residents.

PubMed

Chang, Anna; Bowen, Judith L; Buranosky, Raquel A; Frankel, Richard M; Ghosh, Nivedita; Rosenblum, Michael J; Thompson, Sara; Green, Michael L

2013-06-01

The U.S. faces a critical gap between residency training and clinical practice that affects the recruitment and preparation of internal medicine residents for primary care careers. The patient-centered medical home (PCMH) represents a new clinical microsystem that is being widely promoted and implemented to improve access, quality, and sustainability in primary care practice. We address two key questions regarding the training of internal medicine residents for practice in PCMHs. First, what are the educational implications of practice transformations to primary care home models? Second, what must we do differently to prepare internal medicine residents for their futures in PCMHs? The 2011 Society of General Internal Medicine (SGIM) PCMH Education Summit established seven work groups to address the following topics: resident workplace competencies, teamwork, continuity of care, assessment, faculty development, 'medical home builder' tools, and policy. The output from the competency work group was foundational for the work of other groups. The work group considered several educational frameworks, including developmental milestones, competencies, and entrustable professional activities (EPAs). The competency work group defined 25 internal medicine resident PCMH EPAs. The 2011 National Committee for Quality Assurance (NCQA) PCMH standards served as an organizing framework for EPAs. The list of PCMH EPAs has the potential to begin to transform the education of internal medicine residents for practice and leadership in the PCMH. It will guide curriculum development, learner assessment, and clinical practice redesign for academic health centers.
Patient-centered care in chronic disease management: a thematic analysis of the literature in family medicine.

PubMed

Hudon, Catherine; Fortin, Martin; Haggerty, Jeannie; Loignon, Christine; Lambert, Mireille; Poitras, Marie-Eve

2012-08-01

The objective was to provide a synthesis of the results of the research and discourse lines on main dimensions of patient-centered care in the context of chronic disease management in family medicine, building on Stewart et al.'s model. We developed search strategies for the Medline, Embase, and Cochrane databases, from 1980 to April 2009. All articles addressing patient-centered care in the context of chronic disease management in family medicine were included. A thematic analysis was performed using mixed codification, based on Stewart's model of patient-centered care. Thirty-two articles were included. Six major themes emerged: (1) starting from the patient's situation; (2) legitimizing the illness experience; (3) acknowledging the patient's expertise; (4) offering realistic hope; (5) developing an ongoing partnership; (6) providing advocacy for the patient in the health care system. The context of chronic disease management brings forward new dimensions of patient-centered care such as legitimizing the illness experience, acknowledging patient expertise, offering hope and providing advocacy. Chronic disease management calls for the adaptation of the family physician's role to patients' fluctuating needs. Literature also suggests the involvement of the family physician in care transitions as a component of patient-centered care. Crown Copyright © 2012. Published by Elsevier Ireland Ltd. All rights reserved.
Pharmacy in a New Frontier - The First Five Years at the Johnson Space Center Pharmacy

NASA Technical Reports Server (NTRS)

Bayuse, Tina

2008-01-01

A poster entitled "Space Medicine - A New Role for Clinical Pharmacists" was presented in December 2001 highlighting an up-and-coming role for pharmacists at the Johnson Space Center (JSC) in Houston, Texas. Since that time, the operational need for the pharmacy profession has expanded with the administration s decision to open a pharmacy on site at JSC to complement the care provided by the Flight Medicine and Occupational Medicine Clinics. The JSC Pharmacy is a hybrid of traditional retail and hospital pharmacy and is compliant with the ambulatory care standards set forth by the Joint Commission. The primary charge for the pharmacy is to provide medication management for JSC. In addition to providing ambulatory care for both clinics, the pharmacists also practice space medicine. A pharmacist had been involved in the packing of both the Space Shuttle and International Space Station Medical Kits before the JSC Pharmacy was established; however, the role of the pharmacist in packing medical kits has grown. The pharmacists are now full members of the operations team providing consultation for new drug delivery systems, regulations, and patient safety issues. As the space crews become more international, so does the drug information provided by the pharmacists. This presentation will review the journey of the JSC Pharmacy as it celebrated its five year anniversary in April of 2008. The implementation of the pharmacy, challenges to the incorporation of the pharmacy into an existing health-care system, and the current responsibilities of a pharmacist at the Johnson Space Center will be discussed.
[Focusing on the patient perspective in the use of medicines].

PubMed

Enlund, Hannes; Kastarinen, Helena; Hämeen-Anttila, Katri

2013-01-01

Patients' own views on medicines will grow in importance when trying to improve the quality of medicines use. Today, there is a general trend from paternalism towards concordance. Clarifying the patient's expectations and fears/worries is the first step in establishing a patient centered approach. A reserved attitude towards medicines is common, and therefore two-way communication is essential in ensuring a rational use of medicines. Patients use several information sources, which may cause unnecessary worries and discontinuation of treatment. Improving physicians' communication skills and use of techniques like motivational interviewing may be helpful in managing the situation.
Sublingual versus subcutaneous immunotherapy: patient adherence at a large German allergy center

PubMed Central

Lemberg, Marie-Luise; Berk, Till; Shah-Hosseini, Kija; Kasche, Elena-Manja; Mösges, Ralph

2017-01-01

Background Many placebo-controlled studies have demonstrated that allergen immunotherapy (AIT) is an effective therapy for treating allergies. Both commonly used routes, subcutaneous (SCIT) and sublingual immunotherapy (SLIT), require high patient adherence to be successful. In the literature, numbers describing adherence vary widely; this investigation compares these two routes of therapy directly. Methods All data were retrieved from the patient data management system of a center for dermatology, specific allergology, and environmental medicine in Germany. All 330 patients (aged 13–89 years) included in this study had commenced AIT between 2003 and 2011, thus allowing a full 3-year AIT cycle to be considered for each investigated patient. Results In this specific center, SCIT was prescribed to 62.7% and SLIT to 37.3% of all included patients. The total dropout rate of the whole patient cohort was 34.8%. Overall, SLIT patients showed a higher dropout rate (39.0%) than did SCIT patients (32.4%); however, the difference between these groups was not significant. Also, no significant difference between the overall dropout rates for men and for women was observed. A Kaplan–Meier curve of the patient collective showed a remarkably high dropout rate for the first year of therapy. Conclusion The analysis presented in this single-center study shows that most patients who discontinue AIT do so during the first year of therapy. Patients seem likely to finish the 3-year therapy cycle if they manage to adhere to treatment throughout the first year. Strategies for preventing nonadherence in AIT, therefore, need to be developed and standardized in future investigations. PMID:28115832
First Year Medical Students' Knowledge, Attitudes, and Interest in Geriatric Medicine

ERIC Educational Resources Information Center

Lu, Wei-Hsin; Hoffman, Kimberly G.; Hosokawa, Michael C.; Gray, M. Peggy; Zweig, Steven C.

2010-01-01

The purpose of this study was to examine the impact of an extracurricular geriatric program on medical students' knowledge of, and attitudes toward, the elderly and their interest in studying geriatric medicine. The participants were first-year medical students (n = 137) who joined the Senior Teacher Education Partnership (STEP) program that…

Caring for patients with kidney disease: shifting the paradigm from evidence-based medicine to patient-centered care

PubMed Central

O'Hare, Ann M.; Rodriguez, Rudolph A.; Bowling, Christopher Barrett

2016-01-01

The last several decades have witnessed the emergence of evidence-based medicine as the dominant paradigm for medical teaching, research and practice. Under an evidence-based approach, populations rather than individuals become the primary focus of investigation. Treatment priorities are largely shaped by the availability, relevance and quality of evidence and study outcomes and results are assumed to have more or less universal significance based on their implications at the population level. However, population-level treatment goals do not always align with what matters the most to individual patients—who may weigh the risks, benefits and harms of recommended treatments quite differently. In this article we describe the rise of evidence-based medicine in historical context. We discuss limitations of this approach for supporting real-world treatment decisions—especially in older adults with confluent comorbidity, functional impairment and/or limited life expectancy—and we describe the emergence of more patient-centered paradigms to address these limitations. We explain how the principles of evidence-based medicine have helped to shape contemporary approaches to defining, classifying and managing patients with chronic kidney disease. We discuss the limitations of this approach and the potential value of a more patient-centered paradigm, with a particular focus on the care of older adults with this condition. We conclude by outlining ways in which the evidence-base might be reconfigured to better support real-world treatment decisions in individual patients and summarize relevant ongoing initiatives. PMID:25637639
Patient access and clinical efficiency improvement in a resident hospital-based women's medicine center clinic.

PubMed

Bush, Stephen H; Lao, Michael R; Simmons, Kathy L; Goode, Jeff H; Cunningham, Steve A; Calhoun, Byron C

2007-12-01

To apply the Six Sigma tools of Change Acceleration Process and Work-Out and to improve patient access in an outpatient clinic in a hospital-based residency training program. Observational study. Comparison of productivity in an obstetrics and gynecology clinic after implementation of the Six Sigma principles, with a comparable internal medicine clinic as a control group. Productivity from January 1 through December 31, 2005, was assessed in both clinics. After applying the Six Sigma tools to obstetrics and gynecology, outputs from both clinics from January 1 through December 31, 2006, were analyzed. Wait times for new obstetrical visits decreased from 38 to 8 days. The patient time spent in the clinic dropped from 3.2 to 1.5 hours. Initial gynecologic visits increased by 87% (from 453 to 850 per year), return gynecologic visits increased by 66% (from 1392 to 2311 per year), initial obstetrical visits increased by 55% (from 520 to 808 per year), repeat obstetrical visits increased by 45% (from 2239 to 3243 per year), and the mean patient satisfaction scores increased from 5.75 to 8.54 (on a 10-point scale). The gross clinic revenue increased by 73% in the first 6 months of 2006 over that of the previous year. By contrast, internal medicine patient wait times for new patients and for revisits, patient satisfaction scores, total number of clinic visits, and revenues remained unchanged. Application of the Six Sigma principles resulted in a team approach to solving the clinic's productivity issues.
Medicinal plants used as home remedies: a family survey by first year medical students.

PubMed

Sewani-Rusike, Constance R; Mammen, Marykutty

2014-01-01

There is a hierarchical organisation of knowledge in the use of medicinal plants in communities. Medicinal use knowledge starts in the home and is passed on to family members. Next in the hierarchy are neighbours, village elders and finally, traditional healers being the most knowledgeable. For primary health care this hierarchy is actively followed in seeking remedies for ailments. This study was a survey of medicinal plant knowledge from family members of 1(st) year medical students registered at Walter Sisulu University. A total of 206 first year medical students participated in this study in 2010 and 2011. Results revealed 47 species used as home remedies, 32% of which are food plants. Leaves and roots were reported as most commonly used. The top five ailments managed at home were gastrointestinal problems (25 plants), wounds (19 plants), respiratory tract problems (19 plants), infections, including sexually transmitted diseases (19 plants) and pain including headaches (19 plants). Chronic diseases such as hypertension, diabetes, cancer and reproductive ailments also formed a large group of diseases self-managed at home (29 plants). Family members hold knowledge of medicinal plant use. From this study, first year medical students were made aware of the relationship between common ailments and associated home remedies. This study forms a basis for further study of medicinal plants to validate their use as medicinal remedies.
Current evidence and future perspectives on the effective practice of patient-centered laboratory medicine.

PubMed

Hallworth, Mike J; Epner, Paul L; Ebert, Christoph; Fantz, Corinne R; Faye, Sherry A; Higgins, Trefor N; Kilpatrick, Eric S; Li, Wenzhe; Rana, S V; Vanstapel, Florent

2015-04-01

Systematic evidence of the contribution made by laboratory medicine to patient outcomes and the overall process of healthcare is difficult to find. An understanding of the value of laboratory medicine, how it can be determined, and the various factors that influence it is vital to ensuring that the service is provided and used optimally. This review summarizes existing evidence supporting the impact of laboratory medicine in healthcare and indicates the gaps in our understanding. It also identifies deficiencies in current utilization, suggests potential solutions, and offers a vision of a future in which laboratory medicine is used optimally to support patient care. To maximize the value of laboratory medicine, work is required in 5 areas: (a) improved utilization of existing and new tests; (b) definition of new roles for laboratory professionals that are focused on optimizing patient outcomes by adding value at all points of the diagnostic brain-to-brain cycle; (c) development of standardized protocols for prospective patient-centered studies of biomarker clinical effectiveness or extraanalytical process effectiveness; (d) benchmarking of existing and new tests in specified situations with commonly accepted measures of effectiveness; (e) agreed definition and validation of effectiveness measures and use of checklists for articles submitted for publication. Progress in these areas is essential if we are to demonstrate and enhance the value of laboratory medicine and prevent valuable information being lost in meaningless data. This requires effective collaboration with clinicians, and a determination to accept patient outcome and patient experience as the primary measure of laboratory effectiveness. © 2014 American Association for Clinical Chemistry.
The evolution of integration: innovations in clinical skills and ethics in first year medicine.

PubMed

Brunger, Fern; Duke, Pauline S

2012-01-01

Critical self-reflection, medical ethics and clinical skills are each important components of medical education but are seldom linked in curriculum development. We developed a curriculum that builds on the existing integration of ethics education into the clinical skills course to more explicitly link these three skills. The curriculum builds on the existing integration of clinical skills and ethics in first year medicine. It refines the integration through scheduling changes; adds case studies that emphasise the social, economic and political context of our province's patient population; and introduces reflection on the "culture of medicine" as a way to have students articulate and understand their own values and moral decision making frameworks. This structured Clinical Skills course is a model for successfully integrating critical self-reflection, reflection on the political, economic and cultural contexts shaping health and healthcare, and moral decision making into clinical skills training.
Caring for patients with kidney disease: shifting the paradigm from evidence-based medicine to patient-centered care.

PubMed

O'Hare, Ann M; Rodriguez, Rudolph A; Bowling, Christopher Barrett

2016-03-01

The last several decades have witnessed the emergence of evidence-based medicine as the dominant paradigm for medical teaching, research and practice. Under an evidence-based approach, populations rather than individuals become the primary focus of investigation. Treatment priorities are largely shaped by the availability, relevance and quality of evidence and study outcomes and results are assumed to have more or less universal significance based on their implications at the population level. However, population-level treatment goals do not always align with what matters the most to individual patients-who may weigh the risks, benefits and harms of recommended treatments quite differently. In this article we describe the rise of evidence-based medicine in historical context. We discuss limitations of this approach for supporting real-world treatment decisions-especially in older adults with confluent comorbidity, functional impairment and/or limited life expectancy-and we describe the emergence of more patient-centered paradigms to address these limitations. We explain how the principles of evidence-based medicine have helped to shape contemporary approaches to defining, classifying and managing patients with chronic kidney disease. We discuss the limitations of this approach and the potential value of a more patient-centered paradigm, with a particular focus on the care of older adults with this condition. We conclude by outlining ways in which the evidence-base might be reconfigured to better support real-world treatment decisions in individual patients and summarize relevant ongoing initiatives. Published by Oxford University Press on behalf of ERA-EDTA 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
Optimal threshold estimator of a prognostic marker by maximizing a time-dependent expected utility function for a patient-centered stratified medicine.

PubMed

Dantan, Etienne; Foucher, Yohann; Lorent, Marine; Giral, Magali; Tessier, Philippe

2018-06-01

Defining thresholds of prognostic markers is essential for stratified medicine. Such thresholds are mostly estimated from purely statistical measures regardless of patient preferences potentially leading to unacceptable medical decisions. Quality-Adjusted Life-Years are a widely used preferences-based measure of health outcomes. We develop a time-dependent Quality-Adjusted Life-Years-based expected utility function for censored data that should be maximized to estimate an optimal threshold. We performed a simulation study to compare estimated thresholds when using the proposed expected utility approach and purely statistical estimators. Two applications illustrate the usefulness of the proposed methodology which was implemented in the R package ROCt ( www.divat.fr ). First, by reanalysing data of a randomized clinical trial comparing the efficacy of prednisone vs. placebo in patients with chronic liver cirrhosis, we demonstrate the utility of treating patients with a prothrombin level higher than 89%. Second, we reanalyze the data of an observational cohort of kidney transplant recipients: we conclude to the uselessness of the Kidney Transplant Failure Score to adapt the frequency of clinical visits. Applying such a patient-centered methodology may improve future transfer of novel prognostic scoring systems or markers in clinical practice.
SMART DOCS: A New Patient-Centered Outcomes and Coordinated-Care Management Approach for the Future Practice of Sleep Medicine

PubMed Central

Kushida, Clete A.; Nichols, Deborah A.; Holmes, Tyson H.; Miller, Ric; Griffin, Kara; Cardell, Chia-Yu; Hyde, Pamela R.; Cohen, Elyse; Manber, Rachel; Walsh, James K.

2015-01-01

The practice of medicine is currently undergoing a transformation to become more efficient, cost-effective, and patient centered in its delivery of care. The aim of this article is to stimulate discussion within the sleep medicine community in addressing these needs by our approach as well as other approaches to sleep medicine care. The primary goals of the Sustainable Methods, Algorithms, and Research Tools for Delivering Optimal Care Study (SMART DOCS) are: (1) to introduce a new Patient-Centered Outcomes and Coordinated-Care Management (PCCM) approach for the future practice of sleep medicine, and (2) to test the PCCM approach against a Conventional Diagnostic and Treatment Outpatient Medical Care (CONV) approach in a randomized, two-arm, single-center, long-term, comparative effectiveness trial. The PCCM approach is integrated into a novel outpatient care delivery model for patients with sleep disorders that includes the latest technology, allowing providers to obtain more accurate and rapid diagnoses and to make evidence-based treatment recommendations, while simultaneously enabling patients to have access to personalized medical information and reports regarding their diagnosis and treatment so that they can make more informed health care decisions. Additionally, the PCCM approach facilitates better communication between patients, referring primary care physicians, sleep specialists, and allied health professionals so that providers can better assist patients in achieving their preferred outcomes. A total of 1,506 patients 18 y or older will be randomized to either the PCCM or CONV approach and will be followed for at least 1 y with endpoints of improved health care performance, better health, and cost control. Clinical Trials Registration: ClinicalTrials.gov Identifier: NCT02037438. Citation: Kushida CA, Nichols DA, Holmes TH, Miller R, Griffin K, Cardell CY, Hyde PR, Cohen E, Manber R, Walsh JK. SMART DOCS: a new patient-centered outcomes and coordinated
Road map to a patient-centered research agenda at the intersection of hospital medicine and geriatric medicine.

PubMed

Wald, Heidi L; Leykum, Luci K; Mattison, Melissa L P; Vasilevskis, Eduard E; Meltzer, David O

2014-06-01

As the United States ages, the patient population in acute care hospitals is increasingly older and more medically complex. Despite evidence of a high burden of disease, high costs, and often poor outcomes of care, there is limited understanding of the presentation, diagnostic strategies, and management of acute illness in older adults. In this paper, we present a strategy for the development of a research agenda at the intersection of hospital and geriatric medicine. This approach is informed by the Patient-Centered Outcomes Research Institute (PCORI) framework for identification and prioritization of research areas, emphasizing input from patients and caregivers. The framework's four components are: 1) Topic generation, 2) Gap Analysis in Systematic Review, 3) Value of information (VOI) analysis, and 4) Peer Review. An inclusive process for topic generation requiring the systematic engagement of multiple stakeholders, especially patients, is emphasized. In subsequent steps, researchers and stakeholders prioritize research topics in order to identify areas that optimize patient-centeredness, population impact, impact on clinical decision making, ease of implementation, and durability. Finally, next steps for dissemination of the research agenda and evaluation of the impact of the patient-centered research prioritization process are described.
The Liver Transplant Program at Tianjin First Center Hospital.

PubMed

Shen, Zhongyang

2011-01-01

The liver transplant program at the transplant center of Tianjin First Center Hospital opened in 1994 and has become a leading center for academic research and development in clinical liver transplantation during the past 18 years. As of Nov 30, 2011, we had performed 4,103 liver transplantations in patients ranging from 6 months to 79 years old. Since 1998, the program has ranked first in mainland China in the annual number of liver transplants performed, the cumulative total liver transplants and the number of long-surviving patients. We've accomplished a number of "firsts" among the Chinese liver transplant centers, including: the first split liver transplantation, the first pediatric liver transplant, the first living donor simultaneous liver-kidney transplant, the first dual-graft liver transplant using a domino right lobe and a living donor left lobe, the first laparoscopic assisted live donor right hepatectomy including the middle hepatic vein and we have assembled the first liver transplant chain comprising multiple donors and recipients. We have performed the largest number of living related and split liver transplantations in mainland China. The combined prophylactic protocol of "Lamivudine and HBIG" to prevent HBV recurrence post transplantation was first used by our center in China and now is utilized by most of the domestic transplant centers. We have begun using livers from donors after cardiac death (DCD) during the past 2 years, with careful donor selection and recipient management. All the approaches and techniques we've developed are aimed at the utilization of all types of available grafts. However, increasing the rate of transplantation with excellent graft and recipient survival are still the challenges facing us.
Profiles of medicinal cannabis patients attending compassion centers in rhode island.

PubMed

Zaller, Nickolas; Topletz, Ariel; Frater, Susan; Yates, Gail; Lally, Michelle

2015-01-01

Little is understood regarding medicinal marijuana dispensary users. We sought to characterize socio-demographics and reasons for medicinal marijuana use among medical cannabis dispensary patients in Rhode Island. Participants (n=200) were recruited from one of two Compassion Centers in Rhode Island and asked to participate in a short survey, which included assessment of pain interference using the Brief Pain Inventory (BPI). The majority of participants were male (73%), Caucasian (80%), college educated (68%), and had health insurance (89%). The most common reason for medicinal marijuana use was determined to be chronic pain management. Participants were more likely to have BPI pain interference scores of > 5 if they were older (OR: 1.36, 95% CI: 1.04-1.78) or reported using cannabis as a substitute for prescription medications (OR: 2.47, 95% CI: 1.23-4.95), and were less likely to have interference scores of >5 if they had higher income levels (OR: 0.53, 95% CI: 0.40-0.70) or reported having ever received treatment for an alcohol use disorder. One-fifth of participants had a history of a drug or alcohol use disorder. Most participants report that medicinal cannabis improves their pain symptomology, and are interested in alternative treatment options to opioid-based treatment regimens.
NDEA Language and Area Centers: A Report on the First Five Years.

ERIC Educational Resources Information Center

Bigelow, Donald N.; Legters, Lyman H.

This report documents a broad category of information concerning the first five years of the National Defense Education Act of 1958. Included in the report are the following chapters: (1) concept and practice in non-western area studies, (2) the language and area centers program, (3) impact of the centers program, (4) outlook for the program, and…
Restoring Christ-centered medicine through public policy changes centered around subsidiarity and the doctor–patient relationship

PubMed Central

Donovan, Charles A.; Turner, Grace-Marie

2016-01-01

Many Catholic leaders supported passage of legislation designed to achieve the humanitarian goal of universal or near-universal health coverage. These leaders could not imagine that the resulting law would lead to a severe assault on the practice of Christ-centered medicine. The legislative focus now is on conscience protection and making the Hyde Amendment permanent. But the real change that is needed is a culture that values life and puts doctors and patients, not secular bureaucracies, at the center of healthcare decisions. Many new proposals are being offered with the shared goals of expanding access to affordable health coverage, allowing people to make their own choices without oppressive government mandates, helping the most vulnerable, and protecting the right of citizens and medical professionals to live and work according to their religious values and principles. PMID:28392589
Attitudes of First-year Medical Students Toward the Confidentiality of Computerized Patient Records

PubMed Central

Davis, Luke; Domm, Jennifer A.; Konikoff, Michael R.; Miller, Randolph A.

1999-01-01

Objectives: To investigate the attitudes of students entering medical school toward the confidentiality of computerized medical records. Design: First-year medical students at the Vanderbilt University School of Medicine responded to a series of questions about a hypothetic breach of patient's privacy through a computerized patient record system. Measurements: The individual authors independently grouped the blinded responses according to whether they were consistent with then-current institutional policy. These preliminary groupings were discussed, and final categorizations were made by consensus. Results: While most students had a sense of what was right and wrong in absolute terms, half the class suggested at least one course of action that was deemed to be inconsistent with institutional policies. Conclusions: The authors believe that medical schools should directly address ethical and legal issues related to the use of computers in clinical practice as an integral part of medical school curricula. Several teaching approaches can facilitate a greater awareness of the issues surrounding technology and medicine. PMID:9925228
Patient-centered blood management.

PubMed

Hohmuth, Benjamin; Ozawa, Sherri; Ashton, Maria; Melseth, Richard L

2014-01-01

Transfusions are common in hospitalized patients but carry significant risk, with associated morbidity and mortality that increases with each unit of blood received. Clinical trials consistently support a conservative over a liberal approach to transfusion. Yet there remains wide variation in practice, and more than half of red cell transfusions may be inappropriate. Adopting a more comprehensive approach to the bleeding, coagulopathic, or anemic patient has the potential to improve patient care. We present a patient-centered blood management (PBM) paradigm. The 4 guiding principles of effective PBM that we present include anemia management, coagulation optimization, blood conservation, and patient-centered decision making. PBM has the potential to decrease transfusion rates, decrease practice variation, and improve patient outcomes. PBM's value proposition is highly aligned with that of hospital medicine. Hospitalists' dual role as front-line care providers and quality improvement leaders make them the ideal candidates to develop, implement, and practice PBM. © 2013 Society of Hospital Medicine.
Insights into an Award-Winning Summer Internship Program: The First Six Years.

PubMed

Kashou, Anthony; Durairajanayagam, Damayanthi; Agarwal, Ashok

2016-04-01

Since its inception in 2008, the American Center for Reproductive Medicine's summer internship program in reproductive research and writing has trained 114 students from 23 states within the United States and 10 countries worldwide. Its fundamental goal is to inspire pre-medical and medical students to embrace a career as a physician-scientist. During this intensive course, established scientists and clinicians train interns in the essential principles and fundamental concepts of bench research and scientific writing. Over the first six years (2008~2013), interns have collectively published 98 research articles and performed 12 bench research projects on current and emerging topics in reproductive medicine. Interns have also developed and honed valuable soft skills including time management, communication and presentation skills, as well as life values, which all enhance personal and professional satisfaction. Program graduates are able to recognize the value of medical research and its potential to impact patient care and gain insight into their own career pathway. Between 2011 and 2014, the internship program was thrice awarded a Scholarship in Teaching Award by Case Western Reserve School of Medicine for its innovative teaching approach and positive impact on medical education and student careers. This report highlights the demographics, logistics, implementation, feedback, and results of the first six years of the American Center for Reproductive Medicine's summer internship program at Cleveland Clinic (Cleveland, OH, USA). This may be helpful to other research and academic institutions considering implementing a similar program. In addition, it creates awareness among potential physician-scientists of what the world of research has to offer in both scientific writing and bench research. Finally, it may stimulate further discussion regarding narrowing the gap between physicians and scientists and refinement of the current program.
Insights into an Award-Winning Summer Internship Program: The First Six Years

PubMed Central

Kashou, Anthony; Durairajanayagam, Damayanthi

2016-01-01

Since its inception in 2008, the American Center for Reproductive Medicine's summer internship program in reproductive research and writing has trained 114 students from 23 states within the United States and 10 countries worldwide. Its fundamental goal is to inspire pre-medical and medical students to embrace a career as a physician-scientist. During this intensive course, established scientists and clinicians train interns in the essential principles and fundamental concepts of bench research and scientific writing. Over the first six years (2008~2013), interns have collectively published 98 research articles and performed 12 bench research projects on current and emerging topics in reproductive medicine. Interns have also developed and honed valuable soft skills including time management, communication and presentation skills, as well as life values, which all enhance personal and professional satisfaction. Program graduates are able to recognize the value of medical research and its potential to impact patient care and gain insight into their own career pathway. Between 2011 and 2014, the internship program was thrice awarded a Scholarship in Teaching Award by Case Western Reserve School of Medicine for its innovative teaching approach and positive impact on medical education and student careers. This report highlights the demographics, logistics, implementation, feedback, and results of the first six years of the American Center for Reproductive Medicine's summer internship program at Cleveland Clinic (Cleveland, OH, USA). This may be helpful to other research and academic institutions considering implementing a similar program. In addition, it creates awareness among potential physician-scientists of what the world of research has to offer in both scientific writing and bench research. Finally, it may stimulate further discussion regarding narrowing the gap between physicians and scientists and refinement of the current program. PMID:27169124
[Survey of Specialist Pulmonary Medicine Health Care Structures for Patients with Interstitial Lung Disease in Nordrhein-Westfalen, Germany - A Pilot Project of the Western German Respiratory Society (WdGP)].

PubMed

Hagmeyer, L; Haidl, P; Westhoff, M; Schulte, W; Randerath, W; Lorenz, J

2018-05-22

Survey of specialist pulmonary medicine health care structures for patients with interstitial lung disease (ILD) in Nordrhein-Westfalen, Germany. The Western German Respiratory Society initiated a voluntary registration of ILD expert centers. Structural quality and processes were evaluated by questionnaire. 49 centers were registered, 46 allowed analysis of their center data (15 pulmonology specialist practices, 34 hospital pulmonology departments). Specialist practices saw a median of 360 ILD patients per year (26 % first diagnosis), hospital departments a median of 105 ILD patients per year (63 % first diagnosis). 10 centers diagnose more than 100 new ILD cases per year. Specialist practices report median 50 bronchoscopies per year, hospital departments median 1396. 78 % of the centers participate in a multidisciplinary ILD case conference. Several ILD expert centers were identified in Nordrhein-Westfalen. Outpatient care mainly involves the monitoring of ILD patients, inpatient services focus on complex initial diagnostics or cases with unusual disease behaviour. ILD centers meeting regional health care needs should be supported in their development. © Georg Thieme Verlag KG Stuttgart · New York.
The role of informatics in patient-centered care and personalized medicine.

PubMed

Hanna, Matthew G; Pantanowitz, Liron

2017-06-01

The practice of cytopathology has dramatically changed due to advances in genomics and information technology. Cytology laboratories have accordingly become increasingly dependent on pathology informatics support to meet the emerging demands of precision medicine. Pathology informatics deals with information technology in the laboratory, and the impact of this technology on workflow processes and staff who interact with these tools. This article covers the critical role that laboratory information systems, electronic medical records, and digital imaging plays in patient-centered personalized medicine. The value of integrated diagnostic reports, clinical decision support, and the use of whole-slide imaging to better evaluate cytology samples destined for molecular testing is discussed. Image analysis that offers more precise and quantitative measurements in cytology is addressed, as well as the role of bioinformatics tools to cope with Big Data from next-generation sequencing. This article also highlights the barriers to the widespread adoption of these disruptive technologies due to regulatory obstacles, limited commercial solutions, poor interoperability, and lack of standardization. Cancer Cytopathol 2017;125(6 suppl):494-501. © 2017 American Cancer Society. © 2017 American Cancer Society.
An Integrated Visualization and Basic Molecular Modeling Laboratory for First-Year Undergraduate Medicinal Chemistry

ERIC Educational Resources Information Center

Hayes, Joseph M.

2014-01-01

A 3D model visualization and basic molecular modeling laboratory suitable for first-year undergraduates studying introductory medicinal chemistry is presented. The 2 h practical is embedded within a series of lectures on drug design, target-drug interactions, enzymes, receptors, nucleic acids, and basic pharmacokinetics. Serving as a teaching aid…

[Pharmacovigilance center --internal medicine interactions: A useful diagnostic tool].

PubMed

Rochoy, M; Gautier, S; Bordet, R; Caron, J; Launay, D; Hachulla, E; Hatron, P-Y; Lambert, M

2015-08-01

Patients hospitalized in internal medicine often have unexplained clinical symptoms for which a drug origin can be considered. The prevalence of patients hospitalized for iatrogenic is estimated between 4-22%. We wanted to evaluate the diagnostic value of the regional center of pharmacovigilance to identify or confirm an iatrogenic disease in the department of internal medicine of Lille and characterize factors associated with drug-related side effect. This is a single-center prospective diagnostic study. We included all subsequent requests from the department of internal medicine with the Nord-Pas-de-Calais regional pharmacovigilance center between 2010 and 2012. The opinion of the regional pharmacovigilance centre was held on the record of the adverse drug reaction in the national pharmacovigilance database and analyzed according to the conclusion of iatrogenic used by clinicians in internal medicine (reference diagnosis) with a follow-up to June 2013. The variables relating to the patient, medication and adverse events were analyzed by binary logistic regression. We analyzed 160 contacts: 118 concordant cases, 38 false-positives (drug-related side effect retained by the regional pharmacovigilance center only), 4 false negatives. Registration in the national pharmacovigilance database had a sensitivity of 96% (95% CI [0.92 to 0.99]), a specificity of 46% (95% CI [0.38 to 0.53]), a value positive predictive of 69% (95% CI [0.62 to 0.76]), a negative predictive value of 89% (95% CI [0.84 to 0.94]) and a negative likelihood ratio of 0.1. False-positive had chronological and semiological accountabilities questionable (adjusted RR=2.1, 95% CI [1.2 to 2.8]). In our study, the regional pharmacovigilance center confirms the clinician's suspicion of drug-related side effects and helps to exclude drug-induced with a high negative predictive value. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.
Getting personal: can systems medicine integrate scientific and humanistic conceptions of the patient?

PubMed

Vogt, Henrik; Ulvestad, Elling; Eriksen, Thor Eirik; Getz, Linn

2014-12-01

The practicing doctor, and most obviously the primary care clinician who encounters the full complexity of patients, faces several fundamental but intrinsically related theoretical and practical challenges - strongly actualized by so-called medically unexplained symptoms (MUS) and multi-morbidity. Systems medicine, which is the emerging application of systems biology to medicine and a merger of molecular biomedicine, systems theory and mathematical modelling, has recently been proposed as a primary care-centered strategy for medicine that promises to meet these challenges. Significantly, it has been proposed to do so in a way that at first glance may seem compatible with humanistic medicine. More specifically, it is promoted as an integrative, holistic, personalized and patient-centered approach. In this article, we ask whether and to what extent systems medicine can provide a comprehensive conceptual account of and approach to the patient and the root causes of health problems that can be reconciled with the concept of the patient as a person, which is an essential theoretical element in humanistic medicine. We answer this question through a comparative analysis of the theories of primary care doctor Eric Cassell and systems biologist Denis Noble. We argue that, although systems biological concepts, notably Noble's theory of biological relativity and downward causation, are highly relevant for understanding human beings and health problems, they are nevertheless insufficient in fully bridging the gap to humanistic medicine. Systems biologists are currently unable to conceptualize living wholes, and seem unable to account for meaning, value and symbolic interaction, which are central concepts in humanistic medicine, as constraints on human health. Accordingly, systems medicine as currently envisioned cannot be said to be integrative, holistic, personalized or patient-centered in a humanistic medical sense. © 2014 The Authors. Journal of Evaluation in Clinical
[Centers for bariatric medicine : why and how ?

PubMed

Mégevand, Jean-Marie; Vignaux, Laurence; Maghdessian, Raffi; Pralong, François

2018-03-21

Obesity is a chronic, complex and relapsing disease. Because of this complexity, work up and follow up of affected patients implicate different specialists, working in synergy to diagnose and treat obesity and its complications. This follow up is specialized, and should be available in integrated centers of bariatric medicine offering all modalities of treatments with proven efficacy, whether medical, surgical or psychotherapeutical.
Implementing Personalized Medicine in a Cancer Center

PubMed Central

Fenstermacher, David A.; Wenham, Robert M.; Rollison, Dana E.; Dalton, William S.

2011-01-01

In 2006, the Moffitt Cancer Center partnered with patients, community clinicians, industry, academia, and seventeen hospitals in the United States to begin a personalized cancer care initiative called Total Cancer Care™ . Total Cancer Care was designed to collect tumor specimens and clinical data throughout a patient’s lifetime with the goal of finding “the right treatment, for the right patient, at the right time.” Because Total Cancer Care is a partnership with the patient and involves collection of clinical data and tumor specimens for research purposes, a formal protocol and patient consent process was developed and an information technology platform was constructed to provide a robust “warehouse” for clinical and molecular profiling data. To date, over 76,000 cancer patients from Moffitt and consortium medical centers have been enrolled in the protocol. The TCC initiative has developed many of the capabilities and resources that are building the foundation of personalized medicine. PMID:22157297
Integration of pharmacists into a patient-centered medical home.

PubMed

Scott, Mollie Ashe; Hitch, Bill; Ray, Lisa; Colvin, Gaye

2011-01-01

To define the joint principles of the patient-centered medical home (PCMH) and describe the integration of pharmacists into a PCMH. Family medicine residency training program in North Carolina from 2001 to 2011. Mountain Area Health Education Family Health Center is a family medicine residency training program that is part of the North Carolina Area Health Education Center system. The goal of the organization is to train and retain health care students and residents. The practice is recognized as a level III PCMH by the National Committee for Quality Assurance (NCQA) and seeks to provide quality, safe, patient-centered care according to the joint principles of PCMH. Pharmacists, nurses, nutritionists, care managers, Spanish translators, and behavioral medicine specialists work collaboratively with physicians to provide seamless, comprehensive care. The Department of Pharmacotherapy is embedded in the family medicine clinic. Three pharmacists and two pharmacy residents are involved in providing direct patient care services, ensuring access to community resources, assisting patients with transitions of care, providing interprofessional education, and participating in continuous quality improvement initiatives. The pharmacists serve as clinical pharmacist practitioners and provide medication therapy management services in a pharmacotherapy clinic, anticoagulation clinics, and an osteoporosis clinic and via an inpatient family medicine service. Multiple learners such as student pharmacists, pharmacy residents, and family medicine residents rotate through the various pharmacy clinics to learn about pharmacotherapeutic principles and the role of the pharmacist in PCMH. PCMH is a comprehensive, patient-centered, team-based approach to population management in the primary care setting. Pharmacists play a vital role in PCMH and make fundamental contributions to patient care across health care settings. Such innovations in the ambulatory care setting create a unique niche
Characteristics and prescription patterns of traditional Chinese medicine in atopic dermatitis patients: ten-year experiences at a medical center in Taiwan.

PubMed

Lin, Jing-Fan; Liu, Pi-Hua; Huang, Tzu-Ping; Lien, Angela Shin-Yu; Ou, Liang-Shiou; Yu, Chin-Hui; Yang, Shu-Ling; Chang, Hen-Hong; Yen, Hung-Rong

2014-02-01

Complementary and alternative therapies in treating atopic dermatitis are not uncommon. However, substantial evidence and consensus on treating atopic dermatitis is lacking. The aim of this study is to investigate the characteristics and utilization of traditional Chinese medicine in patients with atopic dermatitis. We retrospectively collected patients with atopic dermatitis at the Chang Gung Memorial Hospital in Taiwan between 2002 and 2011. Patients' demographic data, duration and frequency of treatment, serum total immunoglobulin E levels, and traditional Chinese medicine treatment principles and prescription were analyzed. There were 4145 patients (8.8%) received traditional Chinese medicine therapy between 2002 and 2011. Among them, 2841 (68.54%) chose TCM only and 1304 (31.46%) chose to combine TCM and WM therapies. Those who chose combination therapy were younger, and needed more times of visit and longer duration of treatment. The most frequent comorbid conditions accompany atopic dermatitis were allergic rhinitis (46.06%) and asthma (21.46%). Among the 87,573 prescriptions written for Chinese medicine, the most frequently prescribed herbal formula and single herb were Xiao-Feng-San (Eliminate Wind Powder) (16.98%) and Bai-Xian-Pi (Cortex Dictamni) (12.68%), respectively. The most commonly used therapeutic principles of herbal formulas and single herbs were releasing exterior (20.23%) and clearing heat (41.93%), respectively. Our hospital-based study characterized the utilization patterns of traditional Chinese medicine in atopic dermatitis patients. This information could be used as references for clinical application and provide valuable information for future clinical trials. Copyright © 2013 Elsevier Ltd. All rights reserved.
An eMERGE Clinical Center at Partners Personalized Medicine

PubMed Central

Smoller, Jordan W.; Karlson, Elizabeth W.; Green, Robert C.; Kathiresan, Sekar; MacArthur, Daniel G.; Talkowski, Michael E.; Murphy, Shawn N.; Weiss, Scott T.

2016-01-01

The integration of electronic medical records (EMRs) and genomic research has become a major component of efforts to advance personalized and precision medicine. The Electronic Medical Records and Genomics (eMERGE) network, initiated in 2007, is an NIH-funded consortium devoted to genomic discovery and implementation research by leveraging biorepositories linked to EMRs. In its most recent phase, eMERGE III, the network is focused on facilitating implementation of genomic medicine by detecting and disclosing rare pathogenic variants in clinically relevant genes. Partners Personalized Medicine (PPM) is a center dedicated to translating personalized medicine into clinical practice within Partners HealthCare. One component of the PPM is the Partners Healthcare Biobank, a biorepository comprising broadly consented DNA samples linked to the Partners longitudinal EMR. In 2015, PPM joined the eMERGE Phase III network. Here we describe the elements of the eMERGE clinical center at PPM, including plans for genomic discovery using EMR phenotypes, evaluation of rare variant penetrance and pleiotropy, and a novel randomized trial of the impact of returning genetic results to patients and clinicians. PMID:26805891
An eMERGE Clinical Center at Partners Personalized Medicine.

PubMed

Smoller, Jordan W; Karlson, Elizabeth W; Green, Robert C; Kathiresan, Sekar; MacArthur, Daniel G; Talkowski, Michael E; Murphy, Shawn N; Weiss, Scott T

2016-01-20

The integration of electronic medical records (EMRs) and genomic research has become a major component of efforts to advance personalized and precision medicine. The Electronic Medical Records and Genomics (eMERGE) network, initiated in 2007, is an NIH-funded consortium devoted to genomic discovery and implementation research by leveraging biorepositories linked to EMRs. In its most recent phase, eMERGE III, the network is focused on facilitating implementation of genomic medicine by detecting and disclosing rare pathogenic variants in clinically relevant genes. Partners Personalized Medicine (PPM) is a center dedicated to translating personalized medicine into clinical practice within Partners HealthCare. One component of the PPM is the Partners Healthcare Biobank, a biorepository comprising broadly consented DNA samples linked to the Partners longitudinal EMR. In 2015, PPM joined the eMERGE Phase III network. Here we describe the elements of the eMERGE clinical center at PPM, including plans for genomic discovery using EMR phenotypes, evaluation of rare variant penetrance and pleiotropy, and a novel randomized trial of the impact of returning genetic results to patients and clinicians.
Quality of travel health advice in a French travel medicine and vaccine center: a prospective observational study.

PubMed

Bouldouyre, Marie-Anne; De Verdière, Nathalie Colin; Pavie, Juliette; De Castro, Nathalie; Ponscarme, Diane; Hamane, Samia; Rachline, Anne; Ferret, Samuel; Molina, Jean-Michel

2012-01-01

The number of international trips undertaken by French citizens is rising and we wished to assess the appropriateness of advices given to travelers in a vaccine and travel medicine center in France. We conducted a 3-month prospective study in one center in Paris where prescriptions and advice to travelers are given by trained physicians in travel medicine who have access to a computerized decision support system (Edisan). A questionnaire was used to record trip characteristics, patients' demographics, and prescriptions. Main outcome measure was the adequacy of prescriptions for malaria prophylaxis, yellow fever, and hepatitis A vaccines to French guidelines. A total of 730 subjects were enrolled in this study, with a median age of 28 years. Travel destinations were sub-Saharan Africa (58%), Asia (21%), and South America (18%). Among the 608 patients (83%) traveling to malaria-endemic areas, malaria prophylaxis was in accordance with guidelines in 578/608 patients (95.1%, 95% CI: 93-96.5), and doxycycline was the regimen of choice (48%). Inappropriate malaria prophylaxis was given to eight patients, one of whom developed plasmodium falciparum malaria. All 413 patients (100%, 95% CI: 99-100) traveling to yellow fever-endemic areas who needed vaccination were correctly vaccinated. However, three patients received yellow fever vaccination without indication. Also, 442 of 454 patients (97.4%, 95% CI: 95.4-98.5) eligible to receive hepatitis A vaccination were immunized. Appropriate advice for malaria prophylaxis, yellow fever, and hepatitis A vaccinations was provided in a travel medicine and vaccine center where trained physicians used a computerized decision support system. Even in this setting, however, errors can occur and professional practices should be regularly assessed to improve health care. © 2012 International Society of Travel Medicine.
Reinventing patient-centered computing for the twenty-first century.

PubMed

Goldberg, H S; Morales, A; Gottlieb, L; Meador, L; Safran, C

2001-01-01

Despite evidence over the past decade that patients like and will use patient-centered computing systems in managing their health, patients have remained forgotten stakeholders in advances in clinical computing systems. We present a framework for patient empowerment and the technical realization of that framework in an architecture called CareLink. In an evaluation of the initial deployment of CareLink in the support of neonatal intensive care, we have demonstrated a reduction in the length of stay for very-low birthweight infants, and an improvement in family satisfaction with care delivery. With the ubiquitous adoption of the Internet into the general culture, patient-centered computing provides the opportunity to mend broken health care relationships and reconnect patients to the care delivery process. CareLink itself provides functionality to support both clinical care and research, and provides a living laboratory for the further study of patient-centered computing.
Transforming a family medicine center and residency program into a federally qualified health center.

PubMed

Cousineau, Michael R; Flores, Hector; Cheng, Scott; Gates, Jerry D; Douglas, James H; Clute, Gerald B; Coan, Carl E

2013-05-01

The authors describe a family medicine center before and after a merger between the Keck School of Medicine of the University of Southern California, the California Hospital Medical Center, and the Eisner Pediatric and Family Medical Center in 2012. The merger provided new opportunities to stabilize the financial base of a clinical practice struggling financially and to enhance the training of residents and other health professionals in primary care, which motivated the partners to consider this new model. After 18 months of negotiations, they were able to convert the family medicine center and residency program into a new federally qualified health center. The benefits to this new model include an increase in both patient volume and the quality of education, supporting residency accreditation; a greater number of residents from U.S. medical schools; enhanced education and preparation of primary care physicians for practice in medically underserved communities; enhanced reimbursements and new opportunities for state, local, and federal grants; and quality improvement and new information technology. The partners overcame academic, administrative, legal, and regulatory obstacles, communication barriers, and differences in culture and expectations to achieve this merger. Keys to their success include the commitment of the leaders at the three institutions to the goals of the merger, a dedicated project manager and consultants, opportunities for new revenue sources and reimbursements, and support from a pioneering charitable foundation. The authors conclude by discussing the implications of using community health centers as the focal point for training primary care clinicians and addressing workforce shortages.
The relationship between communication scores from the USMLE Step 2 Clinical Skills examination and communication ratings for first-year internal medicine residents.

PubMed

Winward, Marcia L; Lipner, Rebecca S; Johnston, Mary M; Cuddy, Monica M; Clauser, Brian E

2013-05-01

This study extends available evidence about the relationship between scores on the Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination and subsequent performance in residency. It focuses on the relationship between Step 2 CS communication and interpersonal skills scores and communication skills ratings that residency directors assign to residents in their first postgraduate year of internal medicine training. It represents the first large-scale evaluation of the extent to which Step 2 CS communication and interpersonal skills scores can be extrapolated to examinee performance in supervised practice. Hierarchical linear modeling techniques were used to examine the relationships among examinee characteristics, residency program characteristics, and residency-director-provided ratings. The sample comprised 6,306 examinees from 238 internal medicine residency programs who completed Step 2 CS for the first time in 2005 and received ratings during their first year of internal medicine residency training. Although the relationship is modest, Step 2 CS communication and interpersonal skills scores predict communication skills ratings for first-year internal medicine residents after accounting for other factors. The results of this study make a reasonable case that Step 2 CS communication and interpersonal skills scores provide useful information for predicting the level of communication skill that examinees will display in their first year of internal medicine residency training. This finding demonstrates some level of extrapolation from the testing context to behavior in supervised practice, thus providing validity-related evidence for using Step 2 CS communication and interpersonal skills scores in high-stakes decisions.
Delay between first HIV-related symptoms and diagnosis of HIV infection in patients attending the internal medicine department of the Fondation Jeanne Ebori (FJE), Libreville, Gabon.

PubMed

Okome-Nkoumou, Madeleine; Okome-Miame, Fleur; Kendjo, Eric; Obiang, Guy-Patrick; Kouna, Philomène; Essola-Biba, Olivia; Bruno Boguikouma, Jean; Mboussou, Michel; Clevenbergh, Philippe

2005-01-01

HIV-infected patients (pts) in Africa are often diagnosed at very advanced stages of disease. They seek relief using traditional medicine or religious beliefs. General practitioners (GPs) are often consulted first. Once the HIV diagnosis has been made, concomitant use of alternative and allopathic medicine is also frequent. To describe the delay between presentation of HIV-related symptoms and diagnosis, the first physician consulted, and the use of traditional medicine or religion as an alternative or complement to allopathic medicine in HIV-infected patients. Patients followed for HIV infection at Fondation Jeanne Ebori were retrospectively interviewed to trace their therapeutic itinerary. 150 pts were interviewed. There were 63% females, mean age was 39 years, median CD4 count was 242 cells/microL (102-394), CDC stage A/B/C was 32%/40%/28%, and 57% had very low income. Religious affiliations were Catholic (52%), Protestant (21%), Muslim (3%), "progressive" Church (16%), and none (7%). The median time elapsed between their first symptoms and HIV diagnosis was 124 (20-292) days. The first person consulted was a traditional healer (5%), GP (61%), or private clinics (23%). Traditional healers were consulted for initiation rites in 23%, cure of disease in 90%, or sorcery in 20%. Once allopathic medicine was started, concomitant alternative therapy occurred in 25 (17%) for traditional medicine and 4 (3%) for faith healing. Resort to traditional healer (odds ratio [OR] 2.6, p = .02) and to faith healing (OR 3.1, p = .048) were risk factors for diagnosis delay. Many factors related to patients, the health system, and culture or society are detrimental to an early diagnosis of HIV infection in Gabon. Increasing awareness of the risk of HIV infection throughout the general population and hope and trust in western medicine in patients and non-HIV-specialist physicians, as well as suppression of social stigma, could shorten the delay before diagnosis. Better communication
Assessing Patients' Preference for Integrating Herbal Medicine Within Primary Care Services in Saudi Arabia.

PubMed

Allam, Safaa; Moharam, Maha; Alarfaj, Gada

2014-07-01

Family physician advice and follow-up may be important to reduce the negative aspects of locally marketed herbal remedies and improve the patient outcome. There is a lack of studies assessing the preference of Saudi patients for the integration of herbal medicine into primary care services. To examine the knowledge, attitudes, and practice of Saudi patients toward herbal medicine and its integration into primary care services. A cross-sectional study was conducted between February and March 2013 among adult patients attending the family medicine clinics at a primary care center in Riyadh, Saudi Arabia. A self-administered questionnaire (27 items) was developed and administered to all patients. A total of 240 patients were included in the current analysis. The average age was 33.5 ± 9.9 years, and 61% of the patients were women. Approximately 60% of the patients were aware of herbal medicine use and its possible side effects. More than 85% of the patients believed that herbal containers should be labeled with safety information. Approximately 71% of the patients had a favorable attitude toward integrated services. Approximately 65% of the patients used herbal remedies for themselves, and 42% used them for their children. Preference for integrated services was significantly associated with female sex, better knowledge, positive attitudes toward safety and regulations, and higher level of practice. A good knowledge and a very favorable attitude toward integrating herbal medicine into primary care services were found among a group of patients attending a primary care center in Saudi Arabia. © The Author(s) 2014.
Causes of prolonged hospitalization among general internal medicine patients of a tertiary care center.

PubMed

Ruangkriengsin, Darat; Phisalprapa, Pochamana

2014-03-01

Unnecessary days of prolonged hospitalization may lead to the increase in hospital-related complications and costs, especially in tertiary care center Currently, there have not been many studies about the causes of prolonged hospitalization. Some identified causes could, however, be prevented and improved. To identify the prevalence, causes, predictive factors, prognosis, and economic burden of prolonged hospitalization in patients who had been in general internal medicine wards of the tertiary care center for 7 days or more. Retrospective chart review study was conducted among all patients who were admitted for 7 days or more in general internal medicine wards of Siriraj Hospital, the largest tertiary care center in Thailand. The period of this study was from 1 August 2012 to 30 September 2012. Demographic data, principle diagnosis, comorbid diseases, complications, discharge status, total costs of admission and percentage of reimbursement were collected. The causes of prolonged hospitalization at day 7, 14, 30, and 90 were assessed. Five hundred and sixty-two charts were reviewed. The average length of stay was 25.9 days. The two most common causes of prolonged admission at day 7 were treatment of main diagnosed disease with stable condition (27.6%) and waiting for completion of intravenous antibiotics administration with stable condition (19.5%). The causes of prolonged hospitalization at day 14 were unstable condition from complications (22.6%) and those waiting for completion of intravenous antibiotics administration with stable condition (15.8%). The causes of prolonged admission at day 30 were unstable conditions from complications (25.6%), difficulty weaning or ventilator dependence (17.6%), and caregiver problems (15.2%). The causes of prolonged hospitalization at day 90 were unstable condition from complications (30.0%), caregiver problems (30.0%), and palliative care (25.0%). Poor outcomes were shown in the patients admitted more than 90 days. Percentage
Primary care residents want to learn about the patient-centered medical home.

PubMed

Moreno, Gerardo; Gold, Julia; Mavrinac, Maureen

2014-01-01

The patient-centered medical home (PCMH) is an important model of primary care with a promise of improving quality, reducing costs, and improving patient satisfaction. Many primary care residency programs have PCMH initiatives, but it is unclear if residents are interested in learning more about the PCMH. Our objective was to examine primary care residents' attitudes and knowledge about the PCMH model and how it relates to them. A total of 82 first- through third-year family medicine and internal medicine residents participated in a survey with 25 questions. Descriptive statistics were performed to describe the responses. The survey response rate was 91%. Sixty-one percent of residents thought they had "poor" or "fair" knowledge of the PCMH, and 84% thought it was important to be knowledgeable about the PCMH. Thirty-four percent rated their ability to describe the PCMH as "well" or "very well." Eighty-six percent thought they learned "too little" or "way too little" about the PCMH during medical school. The majority (88%) of residents were interested in learning more about the PCMH. Family and internal medicine residents are interested in learning more about the PCMH during residency. Residents may benefit from experiential learning that focuses on the PCMH.
The business of palliative medicine--part 4: Potential impact of an acute-care palliative medicine inpatient unit in a tertiary care cancer center.

PubMed

Walsh, Declan

2004-01-01

In this study, a hematology/oncology computerized discharge database was qualitatively and quantitatively reviewed using an empirical methodology. The goal was to identify potential patients for admission to a planned acute-care, palliative medicine inpatient unit. Patients were identified by the International Classifications of Disease (ICD-9) codes. A large heterogenous population, comprising up to 40 percent of annual discharges from the Hematology/Oncology service, was identified. If management decided to add an acute-care, palliative medicine unit to the hospital, these are the patients who would benefit. The study predicted a significant change in patient profile, acuity, complexity, and resource utilization in current palliative care services. This study technique predicted the actual clinical load of the acute-care unit when it opened and was very helpful in program development. Our model predicted that 695 patients would be admitted to the acute-care palliative medicine unit in the first year of operation; 655 patients were actually admitted during this time.
Learning experiences and assessment in the first 2 years of the medical course at King's College London School of Medicine.

PubMed

Papachristodoulou, Despo

2010-01-01

The medical curriculum at King's College London School of Medicine is a 5 year course; an extended program (6 years) and a graduate entry program (4 years) are also available. The first 2 years of the curriculum comprise phases 1 and 2. The curriculum consists of core material that is common to all students and student-selected components (students undertake three such components in the first 2 years). Phase 1 lasts 12 weeks and students learn the principles of tissue and organ structure and function. They are also introduced to the practice of medicine (concepts of health, communication, ethics, inter-professional education and medicine in the community). Phase 2 consists of 36 weekly clinical scenarios that place basic medical science in a clinical context. Phase 2 covers cardiovascular, respiratory, gastrointestinal, renal and musculoskeletal systems; nutrition; endocrinology; head and neck anatomy; neuroscience; genetics; and infections. Teaching continues in pri! mary care and in the hospitals and includes basic and advanced life support. Learning experiences include lectures, tutorials, practical classes, dissection and prosection, communication skills, e-learning, student-led sessions and primary care and hospital visits. Assessment consists of in-course assessment (e.g., presentations, tests and essays) and end-of-year examinations which consist of written papers and an objective structured clinical examination at the end of year 2. The main strengths of the program include the scenario format of learning and the practice of medicine early on. The difficulties arise mainly from the large numbers of students (420 per year).
The first center for evidence-based medicine in Lithuania: an opportunity to change culture and improve clinical practice.

PubMed

Beinortas, Tumas; Bauza, Karolis; Howick, Jeremy; Nunan, David; Mahtani, Kamal Ram

2015-05-01

In post-Soviet countries, where medical practice largely relies on experience alone, the incorporation of the best research evidence in clinical practice is limited. In order to promote the awareness and utilization of evidence-based medicine (EBM) among Lithuanian doctors, we organized EBM conferences in each of the two Lithuanian medical schools. More than 500 medical professionals and students attended the conferences in Vilnius (2013) and Kaunas (2014) demonstrating that there is a high demand for formal EBM teaching. Building on the success of these seminal conferences, and to start addressing the lack of EBM practice in the country, the first Lithuanian Centre for Evidence-Based Medicine was established at Vilnius University Medical Faculty in 2014. The Centre will focus on the implementation of EBM teaching in medical school curriculum, formulating management guidelines, writing systematic reviews and supporting Lithuanian authors in doing so. © 2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.
Pediatric Integrative Medicine in Residency Program: Relationship between Lifestyle Behaviors and Burnout and Wellbeing Measures in First-Year Residents.

PubMed

McClafferty, Hilary; Brooks, Audrey J; Chen, Mei-Kuang; Brenner, Michelle; Brown, Melanie; Esparham, Anna; Gerstbacher, Dana; Golianu, Brenda; Mark, John; Weydert, Joy; Yeh, Ann Ming; Maizes, Victoria

2018-04-23

It is widely recognized that burnout is prevalent in medical culture and begins early in training. Studies show pediatricians and pediatric trainees experience burnout rates comparable to other specialties. Newly developed Accreditation Council for Graduate Medical Education (ACGME) core competencies in professionalism and personal development recognize the unacceptably high resident burnout rates and present an important opportunity for programs to improve residents experience throughout training. These competencies encourage healthy lifestyle practices and cultivation of self-awareness, self-regulation, empathy, mindfulness, and compassion—a paradigm shift from traditional medical training underpinned by a culture of unrealistic endurance and self-sacrifice. To date, few successful and sustainable programs in resident burnout prevention and wellness promotion have been described. The University of Arizona Center for Integrative Medicine Pediatric Integrative Medicine in Residency (PIMR) curriculum, developed in 2011, was designed in part to help pediatric programs meet new resident wellbeing requirements. The purpose of this paper is to detail levels of lifestyle behaviors, burnout, and wellbeing for the PIMR program’s first-year residents ( N = 203), and to examine the impact of lifestyle behaviors on burnout and wellbeing. The potential of the PIMR to provide interventions addressing gaps in lifestyle behaviors with recognized association to burnout is discussed.

Science, humanism, judgement, ethics: person-centered medicine as an emergent model of modern clinical practice.

PubMed

Miles, Andrew

2013-01-01

The Medical University of Plovdiv (MUP) has as its motto 'Committed to humanity". But what does humanity in modern medicine mean? Is it possible to practise a form of medicine that is without humanity? In the current article, it is argued that modern medicine is increasingly being practised in a de-personalised fashion, where the patient is understood not as a unique human individual, a person, but rather as a subject or an object and more in the manner of a complex biological machine. Medicine has, it is contended, become distracted from its duty to care, comfort and console as well as to ameliorate, attenuate and cure and that the rapid development of medicine's scientific knowledge is, paradoxically, principally causative. Signal occurrences in the 'patient as a person' movement are reviewed, together with the emergence of the evidence-based medicine (EBM) and patient-centered care (PCC) movements. The characteristics of a model of medicine evolving in response to medicine's current deficiencies--person-centered healthcare (PCH)--are noted and described. In seeking to apply science with humanism, via clinical judgement, within an ethical framework, it is contended that PCH will prove to be far more responsive to the needs of the individual patient and his/her personal circumstances than current models of practice, so that neither a reductive anatomico-pathological, disease-centric model of illness (EBM), nor an aggressive patient-directed, consumerist form of care (PCC) is allowed continued dominance within modern healthcare systems. In conclusion, it is argued that PCH will enable affordable advances in biomedicine and technology to be delivered to patients within a humanistic framework of clinical practice that recognises the patient as a person and which takes full account of his/her stories, values, preferences, goals, aspirations, fears, worries, hopes, cultural context and which responds to his/her psychological, emotional, spiritual and social necessities
Student perceptions of a patient- centered medical training curriculum

PubMed Central

Gallentine, Ashley; Salinas-Miranda, Abraham A.; Shaffer-Hudkins, Emily; Hinojosa, Sara; Monroe, Alicia

2014-01-01

Objectives To evaluate a patient-centered medical training curriculum, the SELECT program, through perceptions of the inaugural student cohort. Methods Data were collected from two focus groups conducted in the university setting, comprised of fifteen first-year medical students who participated in the SELECT program during its inaugural year. A questioning protocol was used to guide the focus group discussion, which was transcribed and hand-coded through thematic analyses. Results Various themes related to patient-centered care were identified. Students noted changes in their attitudes towards interacting with patients in an empowering and educative manner as a result of communication and motivational interviewing exercises. Additionally, they recognized certain external, structural barriers as well as internal conflict between pragmatism and emotional intelligence that could potentially hinder patient-centered care. The impact of family dynamics and social support on quality of life and health outcomes was acknowledged. Students also emphasized the value of collaborating with multiple health professionals. Lastly, students provided suggestions for program improvement, namely additional simulations, more education regarding other healthcare professionals’ roles, more standardized experiences, and application of principles to acute and primary care. Conclusions Upon completion of the first year of the SELECT program, students gained an appreciation for patient-centered care and various factors and skills that facilitate such care. Additionally, they experienced a dissonance between didactic concepts from the curriculum and observed medical practices. This study highlights the educational benefits of a patient-centered medical curriculum and provides suggestions for future improvement. PMID:25341218
Attitudes towards taking Medicine among those patients who either received Olanzapine or First Generation Antipsychotic Agents

PubMed Central

Chengappa, N.R.; Parepally, Haranath; Brar, Jaspreet S.; Gopalani, Aziz; Chalasani, Lokaranjit; Bear, Jonathan; Levine, Joseph

2003-01-01

This project evaluated the attitudes of psychiatric patients towards receiving either olanzapine or the first-generation antipsychotic agents. Newly admitted patients to a state psychiatric hospital who were either prescribed olanzapine (n=35) or other first-generation antipsychotic agents (n=34) were compared on measure of their personal attitudes toward receiving medicines using the Drug Attitude Inventory (DAI). Subjects were evaluated prior to receiving olanzapine and 8 weeks later unless they were discharged or discontinued sooner. The olanzapine-treated group recorded significantly greater improvements on their positive attitude scores toward taking the medicine, and reduced negative attitude scores relative to the comparator group. These results remained statistically significant even after correction of baseline differences between the two groups for the positive attitudes and a statistical trend persisted for negative attitude scores too. During the subsequent 30 month follow-up, significantly fewer of the olanzapine treated subjects (5, 14.3%) were readmitted to the hospital compared with 13 (38.2%) of the comparator group. These data suggest switching patients to olanzapine may improve their attitudes towards taking medicines at least in the short-term. These preliminary data need affirmation or refutation in a controlled random-assignment longer-term clinical trial where specific measures of adherence are evaluated, and where the comparators are the other second generation antipsychotic agents. PMID:21206845
Growth of Integrative Medicine at Leading Cancer Centers Between 2009 and 2016: A Systematic Analysis of NCI-Designated Comprehensive Cancer Center Websites.

PubMed

Yun, Hyeongjun; Sun, Lingyun; Mao, Jun J

2017-11-01

Cancer centers have increasingly offered integrative medicine therapies in response to their patients' unmet needs. We evaluated the growth of integrative medicine in leading academic cancer centers in the United States as reflected by their public-facing websites. We performed a systematic review of 45 National Cancer Institute (NCI)-designated comprehensive cancer center websites. Two researchers independently evaluated whether the websites provided information regarding integrative medicine modalities and, if so, whether the services were provided in the same health system. They compared the proportion of cancer centers providing the information on each modality in 2016 with the data from the prior study in 2009. The most common integrative medicine therapies mentioned on the 45 NCI-designated comprehensive cancer center websites were exercise (97.8%) and acupuncture and meditation (88.9% each), followed by yoga (86.7%), massage (84.4%), and music therapy (82.2%). The majority of the websites also provided information on nutrition (95.6%), dietary supplements (93.3%), and herbs (88.9%). The most common therapies offered in the health systems were acupuncture/massage (73.3% each), meditation/yoga (68.9% each), and consultations about nutrition (91.1%), dietary supplements (84.4%), and herbs (66.7%). Compared with 2009, there was a statistically significant increase in the number of websites mentioning acupuncture, dance therapy, healing touch, hypnosis, massage, meditation, Qigong, and yoga (all P < .05). Leading US cancer centers increasingly present integrative medicine content on their websites, and the majority of them provide these services to patients in the same health systems. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
Patient-Centered Precision Health In A Learning Health Care System: Geisinger's Genomic Medicine Experience.

PubMed

Williams, Marc S; Buchanan, Adam H; Davis, F Daniel; Faucett, W Andrew; Hallquist, Miranda L G; Leader, Joseph B; Martin, Christa L; McCormick, Cara Z; Meyer, Michelle N; Murray, Michael F; Rahm, Alanna K; Schwartz, Marci L B; Sturm, Amy C; Wagner, Jennifer K; Williams, Janet L; Willard, Huntington F; Ledbetter, David H

2018-05-01

Health care delivery is increasingly influenced by the emerging concepts of precision health and the learning health care system. Although not synonymous with precision health, genomics is a key enabler of individualized care. Delivering patient-centered, genomics-informed care based on individual-level data in the current national landscape of health care delivery is a daunting challenge. Problems to overcome include data generation, analysis, storage, and transfer; knowledge management and representation for patients and providers at the point of care; process management; and outcomes definition, collection, and analysis. Development, testing, and implementation of a genomics-informed program requires multidisciplinary collaboration and building the concepts of precision health into a multilevel implementation framework. Using the principles of a learning health care system provides a promising solution. This article describes the implementation of population-based genomic medicine in an integrated learning health care system-a working example of a precision health program.
What factors promote resilience and protect against burnout in first-year pediatric and medicine-pediatric residents?

PubMed

Olson, Kayloni; Kemper, Kathi J; Mahan, John D

2015-07-01

Burnout has high costs for pediatricians and their patients. There is increasing interest in educational interventions to promote resilience and minimize burnout among pediatric trainees. This study tested a conceptual model of factors that might promote resilience and protect against burnout, and which could serve as targets for addressing burnout in pediatric residents. Questionnaires were administered in a cross-sectional survey of (n = 45) first-year pediatric and medicine-pediatric residents. A minority (40%) of residents met one or more criteria for burnout. Physician empathy and emotional intelligence were not significantly correlated with burnout or resilience. Self-compassion and mindfulness were positively associated with resilience and inversely associated with burnout. Thus many residents in this sample endorsed burnout; mindfulness and self-compassion were associated with resilience and may promote resilience and protect against burnout in these trainees. Future studies should explore the impact of training in mindfulness and self-compassion in pediatric trainees. © The Author(s) 2015.
[Tianjin characteristics of integrated traditional Chinese and Western medicine in first aid medical system].

PubMed

Li, Zhijun

2018-05-01

Tianjin, as the earliest city to open up, the exchange of Chinese and Western cultures also started earlier. Therefore, today's emergency medicine system with integrated features of Chinese and Western medicine is formed. Professor Wang Jinda, who works in Tianjin First Center Hospital, makes the theory of "treating bronchitis and treating diseases" and "three methods of three syndromes" for the treatment of severe diseases such as sepsis. The surgical aspect is the treatment of acute abdomen with the combination of Chinese and Western medicine which is proposed by Academician Wu Xianzhong who worked in Tianjin Nankai Hospital. In the aspect of acupuncture and moxibustion, Professor Guo Yi, who works in Tianjin University of Traditional Chinese Medicine, provides the twelve Jing points blood-letting therapy for cerebral diseases such as stroke. Professor Liu Xinqiao from the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine also conducts in-depth studies on brain protection after cardiopulmonary resuscitation (CPR). He proposes the importance of traditional Chinese medicine in addition to mild hypothermia and neuroprotective agents. The author summarized these achievements, in light of which looked forward to the future and proposed the concept of establishing a multi-specialist collaboration and an emergency center with obvious characteristics of integrated Chinese and Western medicine, which would pave the way for the development of integrated Chinese and Western medicine first aid.
The first 5 years since trauma center designation in the Hong Kong Special Administrative Region, People's Republic of China.

PubMed

Leung, Gilberto Ka Kit; Chang, Annice; Cheung, F C; Ho, H F; Ho, Wendy; Hui, S M; Kam, C W; Lai, Albert; Lam, K W; Leung, M; Liu, S H; Lo, C B; Mok, Francis; Rainer, Timothy H; Shen, W Y; So, F L; Wong, Gordon; Wu, Amy; Yeung, Janice; Yuen, W K

2011-05-01

In 1994, the Hong Kong Special Administrative Region (HKSAR) introduced plans to implement a trauma system based on the recommendations outlined by Professor Donald Trunkey in his report to the local Hospital Authority. Five government-subsidized public hospitals were subsequently designated as trauma centers in 2003. This article reviews the initial experience in these five centers. Prospective trauma registries from January 2004 to December 2008 were reviewed. Primary clinical outcome measures were hospital mortality. The Trauma and Injury Severity Score methodology was used for benchmarking with the Major Trauma Outcome Study (MTOS) database. The majority (83.3%) of the 10,462 patients suffered from blunt trauma. Severe injury, defined as Injury Severity Score>15, occurred in 29.7% of patients. The leading causes of trauma were motor vehicle collisions and falls, with crude hospital mortality rates of 6.9% and 10.7%, respectively. The M-statistic was 0.95, indicating comparable case-mix with the MTOS. The worst outcome occurred in the first year. Significant improvement was seen in patients with penetrating injuries. By 2008, these patients had significantly higher survival rates than expected (Z-statistic=0.85). Although the overall mortality rates for blunt trauma were higher than expected, the difference was no longer statistically significant from the second year onward. The case-mix of trauma patients in the HKSAR is comparable with that of the MTOS. A young trauma system relatively unburdened by dissimilar reimbursement and patient access issues may achieve significant improvement and satisfactory patient outcomes. Our findings may serve as a useful benchmark for HK and other Southeast Asian cities and trauma systems to establish local coefficients for future evaluations.
Characteristics of patients contacting a center for undiagnosed and rare diseases.

PubMed

Mueller, Tobias; Jerrentrup, Andreas; Bauer, Max Jakob; Fritsch, Hans Walter; Schaefer, Juergen Rolf

2016-06-21

Little is known about the characteristics of patients seeking help from dedicated centers for undiagnosed and rare diseases. However, information about their demographics, symptoms, prior diagnoses and medical specialty is crucial to optimize these centers' processes and infrastructure. Using a questionnaire, structured information from 522 adult patients contacting a center for undiagnosed and rare diseases was obtained. The information included basic sociodemographic data (age, gender, insurance status), previous hospital admissions, primary symptoms of complaint and previously determined diagnosis. The majority of patients completing the questionnaire were female, 300 (57 %) vs. 222 men (43 %). The median age was 52 years (range 18-92). More than half, 309 (59 %), of our patients had never been admitted to a university hospital. Common diagnoses included other soft tissue disorders, not classified elsewhere (ICD M79, n = 63, 15.3 %), somatoform disorders (ICD F45, n = 51, 12.3 %) and other polyneuropathies (ICD G62, n=36, 8.7 %). The most frequent symptoms were general weakness (n = 180, 36.6 %) followed by arthralgia (n = 124, 25.2 %) and abdominal discomfort (n = 113, 23.0 %). The majority of patients had either internal medicine (81.3 %) and/or neurologic (37.6 %) health problems. Pain-associated diagnoses and the typical "unexplained" medical conditions (chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome) are frequent among people contacting a center dedicated to undiagnosed diseases. The chief symptoms are mostly unspecific. An interdisciplinary organizational approach involving mainly internal medicine, neurology and psychiatry/psychosomatic care is needed.
Integrative Medicine Preferences Among Coccidioidomycosis (Valley Fever) Patients.

PubMed

Short, Jack H; Bradley, Constance; Blair, Janis E; Stewart, Terry D; Burns, Mark W; Patron, Roberto L; Millstine, Denise M

2017-02-01

To understand the extent and modalities of integrative medicine strategies that patients with coccidioidomycosis (valley fever) have incorporated into their treatment regimens. A direct patient survey was distributed, with 100 unique responses, at a single infectious diseases clinic at an academic medical center in Arizona. Eligible patients, defined as those with confirmed coccidioidomycosis or currently under evaluation, were polled on their personal use of 36 integrative medicine modalities. Patients were also asked to indicate their level of fatigue on a 10-point scale in an attempt to correlate levels of fatigue to use of specific integrative medicine modalities. Of the patients surveyed, 64% had used at least one integrative medicine modality, and 53% used two or more, along with conventional medical therapy. The top three modalities were nutrition (39%), massage (27%), and breathing exercises (26%). The mean reported fatigue level was 4.7 on a 10-point scale, with a standard deviation of 3.0. There was no statistically significant association between use of a specific modality and reported level of fatigue. Nearly two thirds of patients (64%) surveyed had used at least one integrative medicine modality throughout the course of their therapy. Clinicians are probably unaware of the extent to which many patients, including this population, have embraced integrative medicine. Awareness of patients' goal and preferences is valuable in shared clinical decision making.
Outcome and complications in peritoneal dialysis patients: a five-year single center experience.

PubMed

Alwakeel, Jamal S; Alsuwaida, Abdulkareem; Askar, Akram; Memon, Nawaz; Usama, Saira; Alghonaim, Mohammed; Feraz, Niaz A; Shah, Iqbal Hamid; Wilson, Hamsaveni

2011-03-01

Peritoneal dialysis (PD) is one of the modes of renal replacement therapy being utilized for the management of end-stage renal failure in King Khalid University Hospital, King Saud University, Riyadh, for more than two decades. The aim of this study was to evaluate the complications related to PD as well as its outcome in patients on this mode of therapy during the period between January 2004 and December 2008. There were 72 patients included in the study, of whom 43 were females. The average age was 50.7 ± 30.1 years (14-88 years). Diabetes was the leading cause of end-stage renal disease (ESRD) seen in 40.2% of the study patients. Twenty-eight patients (38.9%) were on continuous ambulatory peritoneal dialysis (CAPD) and 44 (61.1%) were on automated PD (nocturnal intermittent peritoneal dialysis, NIPD or continuous cycler peritoneal dialysis, CCPD). The mean duration on PD of the study patients was 25.5 ± 16.58 months (1-60 months). The peritonitis rate was one episode per 24.51 patient-months or one episode per 2.04 patient-years. The incidence of peritonitis per person-year was calculated as 0.42. The leading causative agent for peritonitis was Staphylococcus (32%). Exit-site infection (ESI) rate was one episode per 56.21 patient-months. The incidence of ESI was 0.214 per person-years. The most common infective organism for ESI was Pseudomonas aeru-ginosa (58.8%). At the end of 5 years, 35 patients were continuing on PD, 13 patients were shifted to hemodialysis (HD), nine patients underwent renal transplantation, and six patients were transferred to other centers. Among the 13 patients who were shifted to HD, four patients had refractory peritonitis, four others had catheter malfunction, three patients had inadequate clearance on PD and two patients had lack of compliance. A total of 11 patients died during the study period, giving an overall mortality rate of 15.27% for the five-year period. Our study suggests that there has been considerable improvement in
[An analysis of the questionnaire survey about the first year residency training in internal medicine in Peking Union Medical College Hospital].

PubMed

Zhang, Yun; Wang, Wei; Zeng, Xuejun; Huang, Xiaoming; Li, Hang; Zhang, Fengchun; Shen, Ti

2015-09-01

To evaluate the effects of medical residency training program in postgraduate-year-one (PGY-1) residents at Peking Union Medical College (PUMC) Hospital. PGY-1 medical residents at PUMC Hospital were surveyed by a self-administered questionnaire after they completed their first year residency. Forty-nine residents who completed their first year residency training participated in the survey with a 100% response rate. Before training, only a few had bedside (n = 18) and on-call experiences (n = 10). At the end of the one-year-training, all the residents (100%) considered themselves being improved to certain degrees, especially in clinical practice capability, and passed all the examinations. However, 53.1% and 8.2% of all the residents agreed that they need to improve their abilities in teaching (n = 26) and doctor-patient communication (n = 4), respectively. All residents hoped to get further improved by taking part in various forms of teaching activities, including experience summary/sharing and basic skills training. During the first year, 95.9% of them participated in all teaching activities in medicine actively. The tradition and current models of medical residency training program at PUMC Hospital had a significant impact on professional development of the 1st year resident physicians. It is critical to focus on basic skill training and multi-level teaching to improve residents' clinical competency.
Quality in laboratory medicine: 50years on.

PubMed

Plebani, Mario

2017-02-01

The last 50years have seen substantial changes in the landscape of laboratory medicine: its role in modern medicine is in evolution and the quality of laboratory services is changing. The need to control and improve quality in clinical laboratories has grown hand in hand with the growth in technological developments leading to an impressive reduction of analytical errors over time. An essential cause of this impressive improvement has been the introduction and monitoring of quality indicators (QIs) such as the analytical performance specifications (in particular bias and imprecision) based on well-established goals. The evolving landscape of quality and errors in clinical laboratories moved first from analytical errors to all errors performed within the laboratory walls, subsequently to errors in laboratory medicine (including errors in test requesting and result interpretation), and finally, to a focus on errors more frequently associated with adverse events (laboratory-associated errors). After decades in which clinical laboratories have focused on monitoring and improving internal indicators of analytical quality, efficiency and productivity, it is time to shift toward indicators of total quality, clinical effectiveness and patient outcomes. Copyright © 2016 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.
Residency schedule, burnout and patient care among first-year residents.

PubMed

Block, Lauren; Wu, Albert W; Feldman, Leonard; Yeh, Hsin-Chieh; Desai, Sanjay V

2013-09-01

The 2011 US Accreditation Council for Graduate Medical Education (ACGME) mandates reaffirm the need to design residency schedules to augment patient safety and minimise resident fatigue. To evaluate which elements of the residency schedule were associated with resident burnout and fatigue and whether resident burnout and fatigue were associated with lower perceived quality of patient care. A cross-sectional survey of first-year medicine residents at three hospitals in May-June 2011 assessed residency schedule characteristics, including hours worked, adherence to 2003 work-hour regulations, burnout and fatigue, trainee-reported quality of care and medical errors. Response rate was 55/76 (72%). Forty-two of the 55 respondents (76%) met criteria for burnout and 28/55 (51%) for fatigue. After adjustment for age, gender and residency programme, an overnight call was associated with higher burnout and fatigue scores. Adherence to the 80 h working week, number of days off and leaving on time were not associated with burnout or fatigue. Residents with high burnout scores were more likely to report making errors due to excessive workload and fewer reported that the quality of care provided was satisfactory. Burnout and fatigue were prevalent among residents in this study and associated with undesirable personal and perceived patient-care outcomes. Being on a rotation with at least 24 h of overnight call was associated with higher burnout and fatigue scores, but adherence to the 2003 ACGME work-hour requirements, including the 80 h working week, leaving on time at the end of shifts and number of days off in the previous month, was not. Residency schedule redesign should include efforts to reduce characteristics that are associated with burnout and fatigue.
The business of palliative medicine--Part 3: The development of a palliative medicine program in an academic medical center.

PubMed

Nelson, Kristine A; Walsh, Declan

2003-01-01

Palliative medicine is the total continuing care of patients with cancer. Most resources for cancer care focus on curative attempts while often ignoring the symptoms created by the disease and its treatment. Attempts at curative treatment of the malignancy must be coupled with pain and symptom relief psychosocial and spiritual care, and support for the patient and family extending from the time of diagnosis through the bereavement period. To accomplish this important goal, we must establish comprehensive palliative medicine programs in cancer centers throughout the world. These programs must include education, research, and patient care and must work through an interdisciplinary team. The Cleveland Clinic Foundation palliative medicine program (PMP) is composed of a primary inpatient service, consult service, outpatient clinic, hospice homecare, and cancer homecare services. In this article, we describe the structure and development of the program and suggest future avenues for growth.
Lifestyle medicine curriculum for a preventive medicine residency program: implementation and outcomes.

PubMed

Nawaz, Haq; Petraro, Paul V; Via, Christina; Ullah, Saif; Lim, Lionel; Wild, Dorothea; Kennedy, Mary; Phillips, Edward M

2016-01-01

The vast majority of the healthcare problems burdening our society today are caused by disease-promoting lifestyles (e.g., physical inactivity and unhealthy eating). Physicians report poor training and lack of confidence in counseling patients on lifestyle changes. To evaluate a new curriculum and rotation in lifestyle medicine for preventive medicine residents. Training included didactics (six sessions/year), distance learning, educational conferences, and newly developed lifestyle medicine rotations at the Institute of Lifestyle Medicine, the Yale-Griffin Prevention Research Center, and the Integrative Medicine Center. We used a number of tools to assess residents' progress including Objective Structured Clinical Examinations (OSCEs), self-assessments, and logs of personal health habits. A total of 20 residents participated in the lifestyle medicine training between 2010 and 2013. There was a 15% increase in residents' discussions of lifestyle issues with their patients based on their baseline and follow-up surveys. The performance of preventive medicine residents on OSCEs increased each year they were in the program (average OSCE score: PGY1 73%, PGY2 83%, PGY3 87%, and PGY4 91%, p=0.01). Our internal medicine and preliminary residents served as a control, since they did participate in didactics but not in lifestyle medicine rotations. Internal medicine and preliminary residents who completed the same OSCEs had a slightly lower average score (76%) compared with plural for resident, preventive medicine residents (80%). However, this difference did not reach statistical significance (p=0.11). Incorporating the lifestyle medicine curriculum is feasible for preventive medicine training allowing residents to improve their health behavior change discussions with patients as well as their own personal health habits.
Lifestyle medicine curriculum for a preventive medicine residency program: implementation and outcomes

PubMed Central

Nawaz, Haq; Petraro, Paul V.; Via, Christina; Ullah, Saif; Lim, Lionel; Wild, Dorothea; Kennedy, Mary; Phillips, Edward M.

2016-01-01

Background The vast majority of the healthcare problems burdening our society today are caused by disease-promoting lifestyles (e.g., physical inactivity and unhealthy eating). Physicians report poor training and lack of confidence in counseling patients on lifestyle changes. Objective To evaluate a new curriculum and rotation in lifestyle medicine for preventive medicine residents. Methods Training included didactics (six sessions/year), distance learning, educational conferences, and newly developed lifestyle medicine rotations at the Institute of Lifestyle Medicine, the Yale-Griffin Prevention Research Center, and the Integrative Medicine Center. We used a number of tools to assess residents’ progress including Objective Structured Clinical Examinations (OSCEs), self-assessments, and logs of personal health habits. Results A total of 20 residents participated in the lifestyle medicine training between 2010 and 2013. There was a 15% increase in residents’ discussions of lifestyle issues with their patients based on their baseline and follow-up surveys. The performance of preventive medicine residents on OSCEs increased each year they were in the program (average OSCE score: PGY1 73%, PGY2 83%, PGY3 87%, and PGY4 91%, p=0.01). Our internal medicine and preliminary residents served as a control, since they did participate in didactics but not in lifestyle medicine rotations. Internal medicine and preliminary residents who completed the same OSCEs had a slightly lower average score (76%) compared with plural for resident, preventive medicine residents (80%). However, this difference did not reach statistical significance (p=0.11). Conclusion Incorporating the lifestyle medicine curriculum is feasible for preventive medicine training allowing residents to improve their health behavior change discussions with patients as well as their own personal health habits. PMID:27507540
Interest in Integrative Medicine Among Postmenopausal Hormone Receptor–Positive Breast Cancer Patients in the EvAluate-TM Study

PubMed Central

Hack, Carolin C.; Fasching, Peter A.; Fehm, Tanja; de Waal, Johann; Rezai, Mahdi; Baier, Bernd; Baake, Gerold; Kolberg, Hans-Christian; Guggenberger, Martin; Warm, Mathias; Harbeck, Nadia; Wuerstlein, Rachel; Deuker, Jörg-Uwe; Dall, Peter; Richter, Barbara; Wachsmann, Grischa; Brucker, Cosima; Siebers, Jan W.; Fersis, Nikos; Kuhn, Thomas; Wolf, Christopher; Vollert, Hans-Walter; Breitbach, Georg-Peter; Janni, Wolfgang; Landthaler, Robert; Kohls, Andreas; Rezek, Daniela; Noesslet, Thomas; Fischer, Gunnar; Henschen, Stefan; Praetz, Thomas; Heyl, Volker; Kühn, Thorsten; Krauss, Thomas; Thomssen, Christoph; Hohn, Andre; Tesch, Hans; Mundhenke, Christoph; Hein, Alexander; Rauh, Claudia; Bayer, Christian M.; Jacob, Adib; Schmidt, Katja; Belleville, Erik; Hadji, Peyman; Brucker, Sara Y.; Wallwiener, Diethelm; Kümmel, Sherko; Beckmann, Matthias W.; Paepke, Daniela

2016-01-01

Background. Breast cancer patients often use complementary and alternative medicine, but few prospectively collected data on the topic are available specifically for postmenopausal breast cancer patients. A large prospective study was therefore conducted within a noninterventional study in order to identify the characteristics of patients interested in integrative medicine. Methods. The EvAluate-TM study is a prospective, multicenter noninterventional study in which treatment with the aromatase inhibitor letrozole was evaluated in postmenopausal women with hormone receptor–positive primary breast cancer. Between 2008 and 2009, 5045 postmenopausal patients were enrolled at 339 certified breast centers in Germany. As part of the data collection process, patients were asked at the baseline about their interest in and information needs relating to integrative medicine. Results. Of the 5045 patients recruited, 3411 responded to the questionnaire on integrative medicine and took part in the analysis, 1583 patients expressed an interest in integrative medicine, and 1828 patients declared no interest. Relevant predictors of interest in integrative medicine were age, body mass index, tumor size, previous chemotherapy, and use of concomitant medications for other medical conditions. Interest in integrative medicine declined highly significantly (P < .001) with age (<50 years, 74.1%; 50-60 years, 54.1%; >65 years, 38.0%). Patients in favor of integrative medicine were significantly less satisfied with the information received about individual treatments and antihormonal therapy. Patients with interest in integrative medicine were more often interested in rehabilitation and fitness, nutritional counseling, and additional support from self-help organizations. These women were mostly interested in receiving information about their disease and integrative medicine from a physician, rather than from other sources. Conclusions. This study shows that a considerable proportion of
Interest in Integrative Medicine Among Postmenopausal Hormone Receptor-Positive Breast Cancer Patients in the EvAluate-TM Study.

PubMed

Hack, Carolin C; Fasching, Peter A; Fehm, Tanja; de Waal, Johann; Rezai, Mahdi; Baier, Bernd; Baake, Gerold; Kolberg, Hans-Christian; Guggenberger, Martin; Warm, Mathias; Harbeck, Nadia; Wuerstlein, Rachel; Deuker, Jörg-Uwe; Dall, Peter; Richter, Barbara; Wachsmann, Grischa; Brucker, Cosima; Siebers, Jan W; Fersis, Nikos; Kuhn, Thomas; Wolf, Christopher; Vollert, Hans-Walter; Breitbach, Georg-Peter; Janni, Wolfgang; Landthaler, Robert; Kohls, Andreas; Rezek, Daniela; Noesslet, Thomas; Fischer, Gunnar; Henschen, Stefan; Praetz, Thomas; Heyl, Volker; Kühn, Thorsten; Krauss, Thomas; Thomssen, Christoph; Hohn, Andre; Tesch, Hans; Mundhenke, Christoph; Hein, Alexander; Rauh, Claudia; Bayer, Christian M; Jacob, Adib; Schmidt, Katja; Belleville, Erik; Hadji, Peyman; Brucker, Sara Y; Wallwiener, Diethelm; Kümmel, Sherko; Beckmann, Matthias W; Paepke, Daniela

2017-06-01

Breast cancer patients often use complementary and alternative medicine, but few prospectively collected data on the topic are available specifically for postmenopausal breast cancer patients. A large prospective study was therefore conducted within a noninterventional study in order to identify the characteristics of patients interested in integrative medicine. The EvAluate-TM study is a prospective, multicenter noninterventional study in which treatment with the aromatase inhibitor letrozole was evaluated in postmenopausal women with hormone receptor-positive primary breast cancer. Between 2008 and 2009, 5045 postmenopausal patients were enrolled at 339 certified breast centers in Germany. As part of the data collection process, patients were asked at the baseline about their interest in and information needs relating to integrative medicine. Of the 5045 patients recruited, 3411 responded to the questionnaire on integrative medicine and took part in the analysis, 1583 patients expressed an interest in integrative medicine, and 1828 patients declared no interest. Relevant predictors of interest in integrative medicine were age, body mass index, tumor size, previous chemotherapy, and use of concomitant medications for other medical conditions. Interest in integrative medicine declined highly significantly ( P < .001) with age (<50 years, 74.1%; 50-60 years, 54.1%; >65 years, 38.0%). Patients in favor of integrative medicine were significantly less satisfied with the information received about individual treatments and antihormonal therapy. Patients with interest in integrative medicine were more often interested in rehabilitation and fitness, nutritional counseling, and additional support from self-help organizations. These women were mostly interested in receiving information about their disease and integrative medicine from a physician, rather than from other sources. This study shows that a considerable proportion of postmenopausal breast cancer patients are
The characteristics of patients frequently admitted to academic medical centers in the United States

PubMed Central

Williams, Mark V.; Carrier, Danielle; Hensley, Laurie; Thomas, Stephen; Cerese, Julie

2015-01-01

BACKGROUND The recent intense attention to hospital readmissions and their implications for quality, safety, and reimbursement necessitates understanding specific subsets of readmitted patients. Frequently admitted patients, defined as patients who are admitted 5 or more times within 1 year, may have some distinguishing characteristics that require novel solutions. METHODS A comprehensive administrative database (University HealthSystem Consortium's Clinical Data Base/Resource Manager™) was analyzed to identify demographic, social, and clinical characteristics of frequently admitted patients in 101 US academic medical centers. RESULTS We studied 28,291 frequently admitted patients with 180,185 admissions over a 1‐year period (2011–2012). These patients comprise 1.6% of all patients, but account for 8% of all admissions and 7% of direct costs. Their admissions are driven by multiple chronic conditions; compared to other hospitalized patients, they have significantly more comorbidities (an average of 7.1 vs 2.5), and 84% of their admissions are to medical services. A minority, but significantly more than other patients, have comorbidities of psychosis or substance abuse. Moreover, although they are slightly more likely than other patients to be on Medicaid or to be uninsured (27.6% vs 21.6%), nearly three‐quarters have private or Medicare coverage. CONCLUSIONS Patients who are frequently admitted to US academic medical centers are likely to have multiple complex chronic conditions and may have behavioral comorbidities that mediate their health behaviors, resulting in acute episodes requiring hospitalization. This information can be used to identify solutions for preventing repeat hospitalization for this small group of patients who consume a highly disproportionate share of healthcare resources. Journal of Hospital Medicine 2015;10:563–568. © 2015 The Authors Journal of Hospital Medicine published by Wiley Periodicals, Inc. on behalf of Society of Hospital

The Overall Diagnosis: Psychodynamic Psychiatry, Six-Minute Psychotherapy, and Patient-Centered Care.

PubMed

Weinberg, Elizabeth; Mintz, David

2018-06-01

Optimal patient care in psychiatry necessitates attention to the treatment relationship and to the patient's experience as an individual. The growth of patient-centered medicine has led to an increased appreciation of the importance of the biopsychosocial formulation, the personhood of both the patient and the physician, the autonomy and authority of the patient, and the therapeutic alliance. Patient-centered medicine, developed by the seminal psychoanalytic theorist Michael Balint, has its roots in psychodynamic concepts. A psychodynamic approach to psychopharmacology improves psychiatric prescribing, and guides the psychiatrist in providing brief, limited psychotherapy, similar to that which the Balints recommended in primary care practice. Copyright © 2018 Elsevier Inc. All rights reserved.
Proving and Improving. Volume ll: Tools and Techniques for Assessing the First College Year. The First-Year Experience Monograph Series No. 37

ERIC Educational Resources Information Center

Swing, Randy L., Ed.

2004-01-01

This second volume of "Proving and Improving" collects essays from the First-Year Assessment Listserv, which is hosted by the Policy Center on the First Year of College and the National Resource Center. Like the first volume, this one brings together the nation's leading experts and practitioners of assessment in the first college year. They offer…
Narrative medicine: the modern communication between patient and doctor.

PubMed

Coaccioli, S

2011-01-01

In Modern Medicine the ability to communicate represents a true and unique operative methodology which is the basis of Narrative Medicine. This type of approach does not represent an alternative to the traditional model, but rather expands its boundaries while preserving its scientific base; where the feelings, expectations, and desires of the Patient and his interpretation of the disease, more or less obvious, are read in the broad context in which the Patient himself exhibits. Two principle themes in medical training have by now been clearly identified and can be summarized as follows: the ability to understand and to explain (what to say to the patient) and the ability to listen and to comprehend (how to speak to the patient). In this regard the modern Narrative Medicine is a holistic approach to the complexity of the method known as the most effective and most efficient - not only in patient-centered medicine, but also in the improvement of services rendered to both the individual and society at large.
The Impact of Vodcast Utilisation upon Student Learning of Physiology by First Year Graduate to Entry Medicine Students

ERIC Educational Resources Information Center

Rae, Mark G.; McCarthy, Marion

2017-01-01

The current study sought to determine the effectiveness of video-on-demand podcasts (vodcasts) as a tool for facilitating the understanding of Physiology by first year undergraduate Graduate Entry to Medicine (GEM 1) students. Seventy-three GEM 1 students were provided with full length vodcasts of lecture material in advance of each of nine…
Medicine price awareness in chronic patients in Belgium.

PubMed

Fraeyman, Jessica; Symons, Linda; De Loof, Hans; De Meyer, Guido R Y; Remmen, Roy; Beutels, Philippe; Van Hal, Guido

2015-02-01

Under increasing pressure to contain health expenditures governments across Europe have implemented policies to increase responsible medicine use, e.g. by increasing co-insurance paid for by patients. In times of austerity, how do chronic disease patients perceive the medicine price they have to pay? We used a mixed methods research design. First, we distributed a close-ended questionnaire among 983 chronic disease patients in 30 Flemish pharmacies. Second, we performed semi-structured interviews with 15 of these patients. We surveyed for knowledge on the prescription medicine they bought, as well as for their needs for information and their therapeutic compliance. Although patients express a lack (and a need) of information on prices during the consultation with the general practitioner (GP), (s)he hardly addresses medicine prices. Patients often only know the medicine price when they are at the pharmacy and patients need to decide to buy the medicine or not. This often results in patients taking the medicine when considered affordable within their social and financial context. It seems essential that patients are better informed about medicine prices as well as the constraints on physicians to prescribe cost-effectively. Therefore, medicine prices should be discussed more often during physician consults. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
A Comparison of the Preventive Health Care Provided by Women's Health Centers and General Internal Medicine Practices

PubMed Central

Harpole, Linda H; Mort, Elizabeth A; Freund, Karen M; Orav, John; Brennan, Troyen A

2000-01-01

OBJECTIVE To evaluate women's health centers as alternatives to traditional internal medicine practices. DESIGN Cross-sectional mailed survey. SETTING A women's health center and an internal medicine practice at each of three university-affiliated teaching hospitals. PATIENTS There were 3,035 female patients randomly selected to receive a mailed survey after their office visits. MEASUREMENTS AND MAIN RESULTS The survey asked for patient characteristics, patient satisfaction, and rates of gender-specific preventive health services. The survey response rate was 64% (1,942/3,035). Patients at women's health centers were younger, more educated, had higher physical functioning but lower mental health functioning, and more of them were single and employed. Patient satisfaction was similar at the two types of practices, although patients at women's health centers were more satisfied with certain aspects of the patient-provider interaction. After adjusting for measured differences in patient characteristics and site, patients at women's health centers were more likely to receive discussions on hormone replacement therapy (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.1, 2.2) and dietary calcium (OR 1.3; 95% CI 1.1, 1.6). They were also more likely to receive their gender-specific preventive health services from their primary care provider: breast examination (OR 2.0; 95% CI 1.5, 2.6), Pap smear (OR 2.4; 95% CI 1.9, 3.1), hormone replacement therapy discussion (OR 2.2; 95% CI 1.5, 3.3), and dietary calcium discussion (OR 2.6; 95% CI 1.7, 3.9). These findings remained when the analyses were limited to patients of female providers only. CONCLUSIONS In this study, patients at women's health centers were more likely to receive gender-specific health prevention counseling than patients at internal medicine practices. Moreover, patients were more likely to receive their gender-specific preventive health services from their primary care providers. PMID:10632827
Factors Influencing Patient Selection of an Orthopaedic Sports Medicine Physician.

PubMed

Manning, Blaine T; Bohl, Daniel D; Saltzman, Bryan M; Cotter, Eric J; Wang, Kevin C; Epley, Chad T; Verma, Nikhil N; Cole, Brian J; Bach, Bernard R

2017-08-01

The rise in consumer-centric health insurance plans has increased the importance of the patient in choosing a provider. There is a paucity of studies that examine how patients select an orthopaedic sports medicine physician. To evaluate factors that patients consider when choosing an orthopaedic sports medicine physician. Case series; Level of evidence, 4. A total of 1077 patients who sought treatment by 3 sports medicine physicians were administered an anonymous questionnaire. The questionnaire included 19 questions asking respondents to rate the importance of specific factors regarding the selection of orthopaedic sports medicine physicians on a scale of 1 (not important at all) to 10 (very important). The remaining 6 questions were multiple-choice and regarded the following criteria: preferred physician age, appointment availability, clinic waiting room times, travel distance, and medical student/resident involvement. Of the 1077 consecutive patients administered the survey, 382 (35%) responded. Of these, 59% (n = 224) were male, and 41% (n = 158) were female. In ranking the 19 criteria in terms of importance, patients rated board certification (9.12 ± 1.88), being well known for a specific area of expertise (8.27 ± 2.39), and in-network provider status (8.13 ± 2.94) as the 3 most important factors in selecting an orthopaedic sports medicine physician. Radio, television, and Internet advertisements were rated the least important. Regarding physician age, 63% of patients would consider seeking a physician who is ≤65 years old. Approximately 78% of patients would consider seeking a different physician if no appointments were available within 4 weeks. The study results suggest that board certification, being well known for a specific area of expertise, and health insurance in-network providers may be the most important factors influencing patient selection of an orthopaedic sports medicine physician. Advertisements were least important to patients. Patient
Comparing the Course of Mental Health Over the First Year After Stroke With Healthy Controls in Colombia, South America.

PubMed

Sutter, Megan; Olabarrieta Landa, Laiene; Calderón Chagualá, Amilkar; Chacón Peralta, Helmer; Vergara Torres, Gina; Perrin, Paul B; Arango-Lasprilla, Juan Carlos

2017-01-01

Stroke is a primary cause of death and disability in upper-middle-income countries such as Colombia. Given the lack of comprehensive rehabilitation for stroke patients in Colombia, there is a need to assess longitudinal mental health problems poststroke in this region. To compare the course of mental health in stroke patients to healthy controls over the first year poststroke in Ibague, Colombia. Cross-sectional study. The Psychological Attention Center of Antonio Nariño University in Ibague, Colombia. Stroke patients (n = 50) and age- and gender-matched healthy controls (n = 50). Patients and controls completed self-report Spanish versions of demographic information, injury-related characteristics, and mental health questionnaires MAIN OUTCOME MEASUREMENTS: Outcomes assessed included mental health (depression, anxiety, and stress) at 3, 6, and 12 months poststroke. Hierarchical linear models suggested that stroke patients had worse depression and anxiety over time than controls (P < .001). Among patients, depression and anxiety decreased over time (P < .001), whereas stress increased over time (P < .01). The findings suggest that although anxiety and depression improved over time in stroke patients, their mental health remained significantly lower than that of controls. This is the first study to examine the course of mental health over the first year poststroke in Latin America, specifically in Ibague, Colombia. Despite the improvements in anxiety and depression over the first year poststroke, patient anxiety and depression were still worse in comparison to those in healthy controls. The current findings indicate a need for rehabilitation services in Colombia, especially targeting mental health issues. I. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Community medicine in action: an integrated, fourth-year urban continuity preceptorship.

PubMed

Brill, John R; Jackson, Thomas C; Stearns, Marjorie A

2002-07-01

To provide an opportunity for fourth-year students at the University of Wisconsin Medical School in Madison to immerse in urban community medicine during a 34-week program. This experience enhances the integrity of the fourth year as well as merges medicine and public health perspectives in medical education as called for by the Medicine and Public Health Initiative. A limited number of fourth-year Wisconsin medical students have the opportunity to select a one-year, continuity-based preceptorship at the Milwaukee clinical campus with a focus in one of three domains: family medicine, internal medicine, or women's health. Students participate in the following clinical activities: a one-year, integrated preceptorship (one to three half days per week in a primary preceptor's office), medicine subinternship, senior surgery clerkship, selectives (16-20 weeks of clerkships relevant to preceptorship focus area), and one month of out-of-city electives. Complementing this community-based clinical experience is the opportunity to develop an increased appreciation for urban community health issues and resources by participating in a required urban community medicine clerkship and a mentored student scholarly project focusing on an aspect of urban community medicine and population health. All students begin the year in July with a four-week urban community medicine clerkship, which is based on the St. Luke's family practice residency's community medicine rotation and arranged by residency faculty. They conduct a "windshield survey" of a Milwaukee neighborhood, observing health hazards and identifying assets, and then present these observations to others in the clerkship. During this first month, students are introduced to the work of a variety of social service agencies, the Milwaukee City Health Department, and the Aurora Health Care/UW community clinics, which serve the state's most diverse zip codes. They meet with providers and researchers who share their expertise in
Implementing a Narrative Medicine Curriculum During the Internship Year: An Internal Medicine Residency Program Experience.

PubMed

Wesley, Tiffany; Hamer, Diana; Karam, George

2018-04-18

Narrative medicine develops professional and communication skills that align with Accreditation Council for Graduate Medical Education competencies. However, little is known about a narrative medicine curriculum's impact on physicians in training during residency. Implementing a narrative medicine curriculum during residency can be challenging because of time constraints and limited opportunity for nonclinical education. Six sessions were implemented throughout one academic year to expose first-year internal medicine residents (interns) to narrative medicine. Attendance and participation were documented. At the end of the year, interns completed an open-ended survey to gauge their perception of their experience with the sessions. In total, 17 interns attended at least 1 narrative medicine session, and each session averaged 5.4 attendees. Thirteen eligible interns completed the survey. Thematic analysis identified 3 predominant themes: Mindfulness, physician well-being, and professionalism. Overall, the narrative medicine sessions were well attended and the curriculum was well received. This intervention demonstrates the value of a narrative medicine curriculum during medical resident training. Large prospective studies are necessary to identify the long-term benefits of such a curriculum.
[TRENDS OF PERMANENT PACEMAKER IMPLANTATION IN A SINGLE CENTER OVER A 20-YEAR PERIOD].

PubMed

Antonelli, Dante; Ilan, Limor Bushar; Freedberg, Nahum A; Feldman, Alexander; Turgeman, Yoav

2015-05-01

To review the changes in permanent pacemaker implantation indications, pacing modes and patients' demographics over a 20-year period. We retrospectively retrieved data on patients who underwent first implantation of the pacemaker between 1-1-1991 and 31-12-2010. One thousand and nine (1,009) patients underwent a first pacemaker implantation during that period; 535 were men (53%), their mean age was 74.6±19.5 years; the highest rate of implanted pacemaker was in patients ranging in age from 70-79 years, however there was an increasing number of patients aged over 80 years. The median survival time after initial pacemaker implantation was 8 years. Syncope was the most common symptom (62.5%) and atrioventricular block was the most common electrocardiographic indication (56.4%) leading to pacemaker implantation. There was increased utilization of dual chamber and rate responsive pacemakers over the years. There was no difference regarding mode selection between genders. Pacemaker implantation rates have increased over a 20-year period. Dual chamber replaced most of the single ventricular chamber pacemaker and rate responsive pacemakers became the norm. The data of a small volume center are similar to those reported in pacemaker surveys of high volume pacemaker implantation centers. They confirm adherence to the published guidelines for pacing.
Effects of Patient-centered Medical Home Transformation on Child Patient Experience.

PubMed

Harder, Valerie S; Krulewitz, Julianne; Jones, Craig; Wasserman, Richard C; Shaw, Judith S

2016-01-01

Patient experience, 1 of 3 aims for improving health care, is rarely included in studies of patient-centered medical home (PCMH) transformation. This study examines the association between patient experience and National Committee on Quality Assurance (NCQA) PCMH transformation. This was a cross-sectional study of parent-reported child patient experience from PCMH and non-PCMH practices. It used randomly sampled experience surveys completed by 2599 patients at 29 pediatric and family medicine PCMH (n = 21) and non-PCMH (n = 8) practices in Vermont from 2011 to 2013. Patient experiences related to child development and prevention were assessed using the Consumer Assessment of Health care Providers and Systems (CAHPS). A 10-point increase in NCQA score at PCMH practices is associated with a 3.1% higher CAHPS child prevention score (P = .004). Among pediatric practices, PCMH recognition is associated with 7.7% (P < .0005) and 7.2% (P < .0005) higher CAHPS child development and prevention composite scores, respectively. Among family medicine practices, PCMH recognition is associated with 7.4% (P = .001) and 11.0% (P < .0005) lower CAHPS child development and prevention composite scores, respectively. Our results suggest that PCMH recognition may improve child patient experience at pediatric practices and worsen experience at family medicine practices. These findings warrant further investigation into the differential influence of NCQA PCMH transformation on family medicine and pediatric practices. © Copyright 2016 by the American Board of Family Medicine.
Awake Craniotomy: First-Year Experiences and Patient Perception.

PubMed

Joswig, Holger; Bratelj, Denis; Brunner, Thomas; Jacomet, Alfred; Hildebrandt, Gerhard; Surbeck, Werner

2016-06-01

Awake craniotomy for brain lesions in or near eloquent brain regions enables neurosurgeons to assess neurologic functions of patients intraoperatively, reducing the risk of permanent neurologic deficits and increasing the extent of resection. A retrospective review was performed of a consecutive series of patients with awake craniotomies in the first year of their introduction to our tertiary non-university-affiliated neurosurgery department. Operation time, complications, and neurologic outcome were assessed, and patient perception of awake craniotomy was surveyed using a mailed questionnaire. There were 24 awake craniotomies performed in 22 patients for low-grade/high-grade gliomas, cavernomas, and metastases (average 2 cases per month). Mean operation time was 205 minutes. Failure of awake craniotomy because of intraoperative seizures with subsequent postictal impaired testing or limited cooperation occurred in 2 patients. Transient neurologic deficits occurred in 29% of patients; 1 patient sustained a permanent neurologic deficit. Of the 18 patients (82%) who returned the questionnaire, only 2 patients recalled significant fear during surgery. Introducing awake craniotomy to a tertiary non-university-affiliated neurosurgery department is feasible and resulted in reasonable operation times and complication rates and high patient satisfaction. Copyright © 2016 Elsevier Inc. All rights reserved.
Evaluating the value of a web-based natural medicine clinical decision tool at an academic medical center

PubMed Central

2011-01-01

Background Consumer use of herbal and natural products (H/NP) is increasing, yet physicians are often unprepared to provide guidance due to lack of educational training. This knowledge deficit may place consumers at risk of clinical complications. We wished to evaluate the impact that a natural medicine clinical decision tool has on faculty attitudes, practice experiences, and needs with respect to H/NP. Methods All physicians and clinical staff (nurse practitioners, physicians assistants) (n = 532) in departments of Pediatrics, Family and Community Medicine, and Internal Medicine at our medical center were invited to complete 2 electronic surveys. The first survey was completed immediately before access to a H/NP clinical-decision tool was obtained; the second survey was completed the following year. Results Responses were obtained from 89 of 532 practitioners (16.7%) on the first survey and 87 of 535 (16.3%) clinicians on the second survey. Attitudes towards H/NP varied with gender, age, time in practice, and training. At baseline, before having an evidence-based resource available, nearly half the respondents indicated that they rarely or never ask about H/NP when taking a patient medication history. The majority of these respondents (81%) indicated that they would like to learn more about H/NP, but 72% admitted difficulty finding evidence-based information. After implementing the H/NP tool, 63% of database-user respondents indicated that they now ask patients about H/NP when taking a drug history. Compared to results from the baseline survey, respondents who used the database indicated that the tool significantly increased their ability to find reliable H/NP information (P < 0.0001), boosted their knowledge of H/NP (p < 0.0001), and increased their confidence in providing accurate H/NP answers to patients and colleagues (P < 0.0001). Conclusions Our results demonstrate healthcare provider knowledge and confidence with H/NP can be improved without costly and
Designing and Implementing a 5-Year Transfusion Medicine Diploma Program in China.

PubMed

Li, Tingting; Wang, Wenjing; Zhang, Ling; Zhou, Ye; Lai, Fucai; Fu, Yongshui; Wang, Chuanxi; Yang, Baocheng; Zhu, Weigang; Wu, Yanyun; Allain, Jean-Pierre; Stevens, Lori; Li, Chengyao

2017-04-01

The need for physicians and technical consultants specialized in transfusion medicine is urgent in China, as there are 20 000 hospitals and 500 blood centers in need of staff with this expertise. The progress made in transfusion medicine as a specialty has been relatively slow in China. Current Chinese medical education and service systems have not developed transfusion medicine as a stand-alone medical specialty. Most physicians receive only minimal training in transfusion medicine in medical school. This training is usually integrated into surgical training and addresses the most common technologies. In 2008, a 5-year bachelor's diploma program in transfusion medicine was established as an undergraduate specialty in Southern Medical University, Guangzhou, China. This article intends to summarize the 8 years of experience educating undergraduates in the specialty of transfusion medicine. Copyright © 2017. Published by Elsevier Inc.
Implementing a Narrative Medicine Curriculum During the Internship Year: An Internal Medicine Residency Program Experience

PubMed Central

Wesley, Tiffany; Hamer, Diana; Karam, George

2018-01-01

Introduction Narrative medicine develops professional and communication skills that align with Accreditation Council for Graduate Medical Education competencies. However, little is known about a narrative medicine curriculum’s impact on physicians in training during residency. Implementing a narrative medicine curriculum during residency can be challenging because of time constraints and limited opportunity for nonclinical education. Methods Six sessions were implemented throughout one academic year to expose first-year internal medicine residents (interns) to narrative medicine. Attendance and participation were documented. At the end of the year, interns completed an open-ended survey to gauge their perception of their experience with the sessions. Results In total, 17 interns attended at least 1 narrative medicine session, and each session averaged 5.4 attendees. Thirteen eligible interns completed the survey. Thematic analysis identified 3 predominant themes: Mindfulness, physician well-being, and professionalism. Discussion Overall, the narrative medicine sessions were well attended and the curriculum was well received. This intervention demonstrates the value of a narrative medicine curriculum during medical resident training. Large prospective studies are necessary to identify the long-term benefits of such a curriculum. PMID:29702059
Assessment of Family Resource and Youth Services Centers: A First Year Report to the Prichard Committee.

ERIC Educational Resources Information Center

Roeder, Phillip W.

Based on interviews with those involved in the adoption and implementation of the Kentucky Education Reform Act (KERA) and its Youth Service Centers, as well as on analysis of program data gathered by state and local agencies, this first year assessment is intended to highlight successes in the early stages of implementation, raise appropriate…
First-Year Maternal Employment and Child Development in the First Seven Years.

PubMed

Brooks-Gunn, Jeanne; Han, Wen-Jui; Waldfogel, Jane

2010-08-01

with the cognitive outcomes. Second, we examine the role of the child's gender and temperament and the mother's occupation in moderating the associations between first-year maternal employment and cognitive outcomes, but find few significant interactions for either child characteristics or mother's occupation. Third, we examine the role of an extensive set of potential mediators - the mother's earnings, the home environment, and the type and quality of child care. We find that mothers who worked full time have higher income in the first year of life and thereafter, that mothers who worked part time have higher HOME and maternal sensitivity scores than mothers who did not work or worked full time, and that mothers who worked either full time or part time were more likely to place their children in high-quality child care by age 3 and 4 ½ and their children spent more time in center-based care by age 4 ½ than in families where mothers did not work in the first year of life. However, we also find some links between first-year maternal employment and elevated levels of maternal depressive symptoms thereafter. Turning to results from structural equation modeling, we find that the overall effects of first-year maternal employment on the cognitive outcomes are neutral. This occurs because significantly negative direct effects of full-time first-year employment are offset by significantly positive indirect effects working through more use of center-based care and greater maternal sensitivity by age 4 ½. Regarding social and emotional outcomes, several findings, again limited to non-Hispanic white children, stand out. First, we find no significant associations between first-year maternal employment and later social and emotional outcomes (including attachment security) when comparing children whose mothers worked full-time or part-time in the first year with the reference group of children whose mothers did not work in the first year, although in models that take the timing
First-Year Maternal Employment and Child Development in the First Seven Years

PubMed Central

Brooks-Gunn, Jeanne; Han, Wen-Jui; Waldfogel, Jane

2010-01-01

associated with the cognitive outcomes. Second, we examine the role of the child’s gender and temperament and the mother’s occupation in moderating the associations between first-year maternal employment and cognitive outcomes, but find few significant interactions for either child characteristics or mother’s occupation. Third, we examine the role of an extensive set of potential mediators – the mother’s earnings, the home environment, and the type and quality of child care. We find that mothers who worked full time have higher income in the first year of life and thereafter, that mothers who worked part time have higher HOME and maternal sensitivity scores than mothers who did not work or worked full time, and that mothers who worked either full time or part time were more likely to place their children in high-quality child care by age 3 and 4 ½ and their children spent more time in center-based care by age 4 ½ than in families where mothers did not work in the first year of life. However, we also find some links between first-year maternal employment and elevated levels of maternal depressive symptoms thereafter. Turning to results from structural equation modeling, we find that the overall effects of first-year maternal employment on the cognitive outcomes are neutral. This occurs because significantly negative direct effects of full-time first-year employment are offset by significantly positive indirect effects working through more use of center-based care and greater maternal sensitivity by age 4 ½. Regarding social and emotional outcomes, several findings, again limited to non-Hispanic white children, stand out. First, we find no significant associations between first-year maternal employment and later social and emotional outcomes (including attachment security) when comparing children whose mothers worked full-time or part-time in the first year with the reference group of children whose mothers did not work in the first year, although in models that
Knowledge of HIV Testing Guidelines Among US Internal Medicine Residents: A Decade After the Centers for Disease Control and Prevention's Routine HIV Testing Recommendations.

PubMed

Dandachi, Dima; Dang, Bich N; Wilson Dib, Rita; Friedman, Harvey; Giordano, Thomas

2018-05-01

Ten years after the Centers for Disease Control and Prevention recommended universal HIV screening, rates remain low. Internal medicine residents are the front-line medical providers for large groups of patients. We evaluated the knowledge of internal medicine residents about HIV testing guidelines and examined adherence to universal HIV testing in an outpatient setting. A cross-sectional survey of internal medicine residents at four residency programs in Chicago was conducted from January to March 2016. Aggregate data on HIV screening were collected from 35 federally qualified community health centers in the Chicago area after inclusion of an HIV testing best practice alert in patients' electronic medical records. Of the 192 residents surveyed, 130 (68%) completed the survey. Only 58% were aware of universal HIV screening and 49% were aware that Illinois law allows for an opt-out HIV testing strategy. Most of the residents (64%) ordered no more than 10 HIV tests in 6 months. The most frequently reported barriers to HIV testing were deferral because of urgent care issues, lack of time, and the perception that patients were uncomfortable discussing HIV testing. From July 2015 to February 2016, the average HIV testing adherence rate in the 35 health centers was 18.2%. More effort is needed to change HIV testing practices among internal medicine residents so that they will adopt this approach in their future clinical practice. Improving knowledge about HIV testing and addressing other HIV testing barriers are essential for such a successful change.

Teaching About the Doctor-Patient Relationship in the First Postgraduate Year.

ERIC Educational Resources Information Center

Sledge, William H.; And Others

1987-01-01

Introduction of a course on the doctor-patient relationship in the clinically demanding first postgraduate year encountered two problems: student perceptions that the content was not necessary or was too burdensome, and the tendency of residents to feel guilty or inadequate in patient relationships at that stage of training. (MSE)
The Efficacy of Incentives to Motivate Continued Fitness-Center Attendance in College First-Year Students: A Randomized Controlled Trial

ERIC Educational Resources Information Center

Pope, Lizzy; Harvey, Jean

2014-01-01

Objective: To determine whether fitness-center attendance established with the provision of weekly monetary incentives persisted after the discontinuation, or decreased frequency, of incentives. Participants: One hundred seventeen first-year college students participated during the 2011-2012 academic year. Methods: A randomized controlled trial…
Partnering With Patients in the Development and Lifecycle of Medicines

PubMed Central

Anderson, James; Boutin, Marc; Dewulf, Lode; Geissler, Jan; Johnston, Graeme; Joos, Angelika; Metcalf, Marilyn; Regnante, Jeanne; Sargeant, Ifeanyi; Schneider, Roslyn F.; Todaro, Veronica; Tougas, Gervais

2015-01-01

The purpose of medicines is to improve patients' lives. Stakeholders involved in the development and lifecycle management of medicines agree that more effective patient involvement is needed to ensure that patient needs and priorities are identified and met. Despite the increasing number and scope of patient involvement initiatives, there is no accepted master framework for systematic patient involvement in industry-led medicines research and development, regulatory review, or market access decisions. Patient engagement is very productive in some indications, but inconsistent and fragmentary on a broader level. This often results in inefficient drug development, increasing evidence requirements, lack of patient-centered outcomes that address unmet medical needs and facilitate adherence, and consequently, lack of required therapeutic options and high costs to society and involved parties. Improved patient involvement can drive the development of innovative medicines that deliver more relevant and impactful patient outcomes and make medicine development faster, more efficient, and more productive. It can lead to better prioritization of early research; improved resource allocation; improved trial protocol designs that better reflect patient needs; and, by addressing potential barriers to patient participation, enhanced recruitment and retention. It may also improve trial conduct and lead to more focused, economically viable clinical trials. At launch and beyond, systematic patient involvement can also improve the ongoing benefit-risk assessment, ensure that public funds prioritize medicines of value to patients, and further the development of the medicine. Progress toward a universal framework for patient involvement requires a joint, precompetitive, and international approach by all stakeholders, working in true partnership to consolidate outputs from existing initiatives, identify gaps, and develop a comprehensive framework. It is essential that all stakeholders
Views of new internal medicine faculty of their preparedness and competence in physician-patient communication

PubMed Central

Mueller, Paul S; Barrier, Patricia A; Call, Timothy G; Duncan, Alan K; Hurley, Daniel L; Multari, Adamarie; Rabatin, Jeffrey T; Li, James TC

2006-01-01

Background We sought to assess self-rated importance of the medical interview to clinical practice and competence in physician-patient communication among new internal medicine faculty at an academic medical center. Methods Since 2001, new internal medicine faculty at the Mayo Clinic College of Medicine (Rochester, Minnesota) have completed a survey on physician-patient communication. The survey asks the new faculty to rate their overall competence in medical interviewing, the importance of the medical interview to their practice, their confidence and adequacy of previous training in handling eight frequently encountered challenging communication scenarios, and whether they would benefit from additional communication training. Results Between 2001 and 2004, 75 general internists and internal medicine subspecialists were appointed to the faculty, and of these, 58 (77%) completed the survey. The faculty rated (on a 10-point scale) the importance of the medical interview higher than their competence in interviewing; this difference was significant (average ± SD, 9.4 ± 1.0 vs 7.7 ± 1.2, P < .001). Similar results were obtained by sex, age, specialty, years since residency or fellowship training, and perceived benefit of training. Experienced faculty rated their competence in medical interviewing and the importance of the medical interview higher than recent graduates (ie, less than one year since training). For each challenging communication scenario, the new faculty rated the adequacy of their previous training in handling the scenario relatively low. A majority (57%) said they would benefit from additional communication training. Conclusion Although new internal medicine faculty rate high the importance of the medical interview, they rate their competence and adequacy of previous training in medical interviewing relatively low, and many indicate that they would benefit from additional communication training. These results should encourage academic medical centers
Use of Complementary and Alternative Medicine (CAM) in cancer patients: An Italian multicenter survey

PubMed Central

Berretta, Massimiliano; Pepa, Chiara Della; Tralongo, Paolo; Fulvi, Alberto; Martellotta, Ferdinando; Lleshi, Arben; Nasti, Guglielmo; Fisichella, Rossella; Romano, Carmela; De Divitiis, Chiara; Taibi, Rosaria; Fiorica, Francesco; Di Francia, Raffaele; Di Mari, Anna; Del Pup, Lino; Crispo, Anna; De Paoli, Paolo; Santorelli, Adriano; Quagliariello, Vincenzo; Iaffaioli, Rosario Vincenzo; Tirelli, Umberto; Facchini, Gaetano

2017-01-01

Introduction Complementary and Alternative Medicine (CAM) include a wide range of products (herbs, vitamins, minerals, and probiotics) and medical practices, developed outside of the mainstream Western medicine. Patients with cancer are more likely to resort to CAM first or then in their disease history; the potential side effects as well as the costs of such practices are largely underestimated. Patients and method We conducted a descriptive survey in five Italian hospitals involving 468 patients with different malignancies. The survey consisted of a forty-two question questionnaire, patients were eligible if they were Italian-speaking and receiving an anticancer treatment at the time of the survey or had received an anticancer treatment no more than three years before participating in the survey. RESULTS Of our patients, 48.9% said they use or have recently used CAM. The univariate analysis showed that female gender, high education, receiving treatment in a highly specialized institute and receiving chemotherapy are associated with CAM use; at the multivariate analysis high education (Odds Ratio, (OR): 1.96 95% Confidence Interval, CI, 1.27-3.05) and receiving treatment in a specialized cancer center (OR: 2.75 95% CI, 1.53-4.94) were confirmed as risk factors for CAM use. Conclusion Roughly half of our patients receiving treatment for cancer use CAM. It is necessary that health professional explore the use of CAM with their cancer patients, educate them about potentially beneficial therapies in light of the limited available evidence of effectiveness, and work towards an integrated model of health-care provision. PMID:28212560
Overspecialized and undertrained? Patient diversity encountered by medical students during their internal medicine clerkship at a university hospital.

PubMed

Melderis, Simon; Gutowski, Jan-Philipp; Harendza, Sigrid

2015-03-31

During the four-month internal medicine clerkship in their final year, undergraduate medical students are closely involved in patient care. Little is known about what constitutes their typical learning experiences with respect to patient diversity within the different subspecialties of internal medicine and during on call hours. 25 final year medical students (16 female, 9 male) on their internal medicine clerkship participated in this observational single-center study. To detail the patient diversity encountered by medical students at a university hospital during their 16-week internal medicine clerkship, all participants self-reported their patient contacts in the different subspecialties and during on call hours on patient encounter cards. Patients' chief complaint, suspected main diagnosis, planned diagnostic investigations, and therapy in seven different internal medicine subspecialties and the on call medicine service were documented. 496 PECs were analysed in total. The greatest diversity of chief complaints (CC) and suspected main diagnoses (SMD) was observed in patients encountered on call, with the combined frequencies of the three most common CCs or SMDs accounting for only 23% and 25%, respectively. Combined, the three most commonly encountered CC/SMD accounted for high percentages (82%/63%), i.e. less diversity, in oncology and low percentages (37%/32%), i.e. high diversity, in nephrology. The percentage of all diagnostic investigations and therapies that were classified as "basic" differed between the subspecialties from 82%/94% (on call) to 37%/50% (pulmonology/oncology). The only subspecialty with no significant difference compared with on call was nephrology for diagnostic investigations. With respect to therapy, nephrology and infectious diseases showed no significant differences compared with on call. Internal medicine clerkships at a university hospital provide students with a very limited patient diversity in most internal medicine
The first survey on defensive medicine in radiation oncology.

PubMed

Ramella, Sara; Mandoliti, Giovanni; Trodella, Lucio; D'Angelillo, Rolando Maria

2015-05-01

Defensive Medicine occurs when doctors order tests, procedures, visits or avoid high-risk patients and procedures, primarily to reduce their exposure to malpractice liability. Some medical specialities are at "high-risk" for legal argument, but no data is actually available for radiation oncology. We present here the first survey of radiation oncologists' views regarding malpractice liability and defensive medicine practice. A three-page questionnaire was sent to 611 active radiation oncologists, members of the Italian Association of Radiation Oncology (AIRO), with questions pertaining to the incidence, nature and causes in their practice of defensive medicine. A total of 361 questionnaires were completed (59 % feedback). Physicians practise defensive medicine by ordering further imaging studies (39 %) or laboratory tests (35 %), referring patients to consultants (43 %) or prescribing additional medication (35 %). Approximately, 70 % declared that the climate of opinion that exists towards doctors is one of the major issues for practising defensive medicine. Although radiation oncology is generally considered a "medium/low risk" speciality for defensive medicine, the present survey reflects a widespread use of this behaviour in daily practice. Investigating which radiation oncologist categories are more prone to defensive medical behaviour can be advantageous for implementing programmes aimed at improving awareness of this phenomenon and to increase good clinical practice.
How to treat a patient with chronic low back pain - methodology and results of the first international case conference of integrative medicine.

PubMed

Brinkhaus, Benno; Lewith, George; Rehberg, Benno; Heusser, Peter; Cummings, Mike; Michalsen, Andreas; Teut, Michael; Willich, Stefan N; Irnich, Dominik

2011-02-01

Complementary and alternative medicine (CAM) is frequently used in patients in industrialised countries. Despite this popularity, there remains a considerable deficit of discourse and cooperation between physicians practicing CAM and conventional medicine. The aim is to present the methodology and results of the first international case conference on integrative medicine (IM) dealing with a patient with low back pain. In this paper the methodological tool "case conference on IM" is also described. The interactive case conference took place on November 20th, 2009 as part of the "2nd European Congress of IM" in Berlin, Germany. An experienced expert panel from both conventional medicine and CAM developed integrative medical diagnoses and therapeutic strategies using as their starting point an individual patient case on chronic low back pain (LBP). The case was selected because LBP is a common diagnosis with considerable economic impact and a problem which is often treated with CAM. In this case conference, the expert panel agreed on a diagnosis of "chronic non-specific LBP with somatic and psychological factors" and proposed multi-modal short- and long-term treatment including of CAM. The importance of the patient-physician-relationship and the consultation process with appropriate consultation time for treatment success was highlighted. There was consensus that the diagnostic process and resulting treatment plan should be individualised and focussed on the patient as a complete person, identifying the significance the disease has for the patient and not just on the disease for itself. Considerable differences were found amongst the experts regarding the first steps of treatment and each expert saw possibilities of "effective and adequate treatment" being met by their own individual treatment method. The case conference on integrative medicine stimulated an intensive exchange between the approaches used by conventional medicine and CAM clarifying different treatment
Traditional Chinese medicine as adjunctive therapy improves the long-term survival of lung cancer patients.

PubMed

Liao, Yueh-Hsiang; Li, Chia-Ing; Lin, Cheng-Chieh; Lin, Jaung-Geng; Chiang, Jen-Huai; Li, Tsai-Chung

2017-12-01

Traditional Chinese medicine is one of the popular alternative treatments for cancer, mainly enhancing host immune response and reducing adverse effect of chemotherapy. This study first explored traditional Chinese medicine treatment effect on long-term survival of lung cancer patients. This study evaluated whether traditional Chinese medicine combined with conventional cancer treatment improved overall survival of lung cancer patients. We had conducted a retrospective cohort study on 111,564 newly diagnosed lung cancer patients in 2000-2009 from National Health Insurance Program database. A total of 23,803 (21.31%) patients used traditional Chinese medicine for lung cancer care. Eligible participants were followed up until 2011 with a mean follow-up period of 1.96 years (standard deviation 2.55) for non-TCM users and 3.04 years (2.85) for traditional Chinese medicine users. Patients with traditional Chinese medicine utilization were significantly more likely to have a 32% decreased risk of death [hazard ratio = 0.62; 95% confidence interval = 0.61-0.63], compared with patients without traditional Chinese medicine utilization after multivariate adjustment. We also observed a similar significant reduction risk across various subgroups of chronic lung diseases. Qing Zao Jiu Fei Tang was the most effective traditional Chinese medicine agent for mortality reduction both in the entire lung cancer (0.81; 0.72-0.91) and matched populations (0.86; 0.78-0.95). This study demonstrated adjunctive therapy with traditional Chinese medicine may improve overall survival of lung cancer patients. This study also suggested traditional Chinese medicine may be used as an adjunctive therapy for cancer treatment. These observational findings need being validated by future randomized controlled trials to rule out the possibility of effect due to holistic care.
'What do patients want?' Tailoring medicines information to meet patients' needs.

PubMed

Young, Amber; Tordoff, June; Smith, Alesha

2017-11-01

Medicines information leaflets can equip patients to be in control of their own healthcare and support the safe and effective use of medicines. The design and content of leaflets influences patients' willingness to read them, and poor examples can cause patient confusion and anxiety. Researchers examined the literature over the past 8 years to determine the content and design of medicine information leaflets that patients prefer in order to read, understand, and use them effectively. It was found that existing leaflets do not meet patients' needs and appear ineffective. Leaflets lack the information patients seek and may contain non-essential material, affecting patients' perception of, and willingness to read them. Additionally, the acceptable leaflet length varies between patients. Application of good design principles improves readability, comprehension, and ability to locate information. Medicine information leaflets must meet patients' needs and be well designed. Tailoring information leaflets to patient characteristics and requirements would enhance effectiveness. Passive provision of pre-printed leaflets is outdated, unvalued and ineffective. Using automated computer systems for leaflet tailoring with the ability to further adapt patients' information might be the best way forward. Copyright © 2016 Elsevier Inc. All rights reserved.
Use of Complementary and Alternative Medicine (CAM) in cancer patients: An Italian multicenter survey.

PubMed

Berretta, Massimiliano; Della Pepa, Chiara; Tralongo, Paolo; Fulvi, Alberto; Martellotta, Ferdinando; Lleshi, Arben; Nasti, Guglielmo; Fisichella, Rossella; Romano, Carmela; De Divitiis, Chiara; Taibi, Rosaria; Fiorica, Francesco; Di Francia, Raffaele; Di Mari, Anna; Del Pup, Lino; Crispo, Anna; De Paoli, Paolo; Santorelli, Adriano; Quagliariello, Vincenzo; Iaffaioli, Rosario Vincenzo; Tirelli, Umberto; Facchini, Gaetano

2017-04-11

Complementary and Alternative Medicine (CAM) include a wide range of products (herbs, vitamins, minerals, and probiotics) and medical practices, developed outside of the mainstream Western medicine. Patients with cancer are more likely to resort to CAM first or then in their disease history; the potential side effects as well as the costs of such practices are largely underestimated. We conducted a descriptive survey in five Italian hospitals involving 468 patients with different malignancies. The survey consisted of a forty-two question questionnaire, patients were eligible if they were Italian-speaking and receiving an anticancer treatment at the time of the survey or had received an anticancer treatment no more than three years before participating in the survey. Of our patients, 48.9% said they use or have recently used CAM. The univariate analysis showed that female gender, high education, receiving treatment in a highly specialized institute and receiving chemotherapy are associated with CAM use; at the multivariate analysis high education (Odds Ratio, (OR): 1.96 95% Confidence Interval, CI, 1.27-3.05) and receiving treatment in a specialized cancer center (OR: 2.75 95% CI, 1.53-4.94) were confirmed as risk factors for CAM use. Roughly half of our patients receiving treatment for cancer use CAM. It is necessary that health professional explore the use of CAM with their cancer patients, educate them about potentially beneficial therapies in light of the limited available evidence of effectiveness, and work towards an integrated model of health-care provision.
Alcohol septal ablation in obstructive hypertrophic cardiomyopathy: four years of experience at a reference center.

PubMed

Fiarresga, António; Cacela, Duarte; Galrinho, Ana; Ramos, Ruben; de Sousa, Lídia; Bernardes, Luís; Patrício, Lino; Cruz Ferreira, Rui

2014-01-01

We describe our center's initial experience with alcohol septal ablation (ASA) for the treatment of obstructive hypertrophic cardiomyopathy. The procedure, its indications, results and clinical outcomes will be addressed, as will its current position compared to surgical myectomy. To assess the results of ASA in all patients treated in the first four years of activity at our center. We retrospectively studied all consecutive and unselected patients treated by ASA between January 2009 and February 2013. In the first four years of experience 40 patients were treated in our center. In three patients (7.5%) the intervention was repeated. Procedural success was 84%. Minor complications occurred in 7.5%. Two patients received a permanent pacemaker for atrioventricular block (6% of those without previous pacemaker). The major complication rate was 5%. There were no in-hospital deaths; during clinical follow-up (22 ± 14 months) cardiovascular mortality was 2.5% and overall mortality was 5%. The results presented reflect the initial experience of our center with ASA. The success rate was high and in line with published results, but with room to improve with better patient selection. ASA was shown to be safe, with a low complication rate and no procedure-related mortality. Our experience confirms ASA as a percutaneous alternative to myectomy for the treatment of symptomatic patients with obstructive hypertrophic cardiomyopathy refractory to medical treatment. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.
The international translational regenerative medicine center.

PubMed

Alexis, Mardi de Veuve; Grinnemo, Karl-Henrik; Jove, Richard

2012-11-01

The International Translational Regenerative Medicine Center, an organizing sponsor of the World Stem Cell Summit 2012, is a global initiative established in 2011 by founding partners Karolinska Institutet (Stockholm, Sweden) and Beckman Research Institute at City of Hope (CA, USA) with a mission to facilitate the acceleration of translational research and medicine on a global scale. Karolinska Institutet, home of the Nobel Prize in Medicine or Physiology, is one of the most prestigious medical research institutions in the world. The Beckman Research Institute/City of Hope is ranked among the leading NIH-designated comprehensive cancer research and treatment institutions in the USA, has the largest academic GMP facility and advanced drug discovery capability, and is a pioneer in diabetes research and treatment.
Robotics in medicine

NASA Astrophysics Data System (ADS)

Kuznetsov, D. N.; Syryamkin, V. I.

2015-11-01

Modern technologies play a very important role in our lives. It is hard to imagine how people can get along without personal computers, and companies - without powerful computer centers. Nowadays, many devices make modern medicine more effective. Medicine is developing constantly, so introduction of robots in this sector is a very promising activity. Advances in technology have influenced medicine greatly. Robotic surgery is now actively developing worldwide. Scientists have been carrying out research and practical attempts to create robotic surgeons for more than 20 years, since the mid-80s of the last century. Robotic assistants play an important role in modern medicine. This industry is new enough and is at the early stage of development; despite this, some developments already have worldwide application; they function successfully and bring invaluable help to employees of medical institutions. Today, doctors can perform operations that seemed impossible a few years ago. Such progress in medicine is due to many factors. First, modern operating rooms are equipped with up-to-date equipment, allowing doctors to make operations more accurately and with less risk to the patient. Second, technology has enabled to improve the quality of doctors' training. Various types of robots exist now: assistants, military robots, space, household and medical, of course. Further, we should make a detailed analysis of existing types of robots and their application. The purpose of the article is to illustrate the most popular types of robots used in medicine.
Outcomes of chlorine exposure: a 5-year poison center experience in 598 patients.

PubMed

LoVecchio, Frank; Blackwell, Scott; Stevens, Donna

2005-06-01

The outcome after chlorine exposures has been poorly described. We conducted a 5-year retrospective poison control center review of chlorine exposure cases. The inclusion criteria were self (or surrogate) reported concentrated 'chlorine' liquid (> or =10% concentration of sodium hypochorite) or tablet (> or =90% concentration) exposure. Two reviewers blinded to the main purpose of the study reviewed charts and a third reviewed 10% of the charts, and a kappa score was calculated. Parameters reviewed included the type of exposure (tablets, liquid or both), symptoms (cough, chest pain, etc.), time to symptom onset, treatment received, hospital referral rate and outcomes. A total of 598 patient records were reviewed, with a mean age of 29.63 years (range 11-82); 41.5% (248) were exposures to tablets and 53.5% (320) were exposed to liquid chlorine, with the remainder exposed to both. Complaints included shortness of breath, eye irritation, nasal complaints, cough, and skin complaints. Sixty-nine patients were evaluated at a healthcare facility (11 referred by a poison control center and 58 were self-referrals). Five patients were admitted and four out of the five had a history of reactive airway disease. The mean time to peak symptoms was 94.4 min, 63.2% reached peak symptoms within 30 min, and 82% within 120 min, with 74% of all patients asymptomatic within 150 min. All five admitted patients were discharged within 48 h, and all others remained clinically well at a 24 h telephone follow-up. Exposure to chlorine tablets and liquid rarely requires hospital referral with almost all symptoms resolving within 24 h.
[Use of alternative medicine in the treatment of allergic diseases].

PubMed

Félix Berumen, José Alfredo; González Díaz, Sandra Nora; Canseco González, Carlos; Arias Cruz, Alfredo

2004-01-01

The alternative medicine and the complementary medicine are forms of treatment very spread and frequently demanded by patients with allergic diseases. According to recent studies, homeopathy, acupuncture and herbal medicine are the most commonly used types of alternative medicine. To know the frequency in the use of different types of alternative medicine for the treatment of allergic diseases in patients attended at the Centro Regional de Alergia e Immunologia Clínica of the Hospital Universitario de Monterrey, Nuevo León. A transversal, descriptive and observational study was done by the use of questionnaires applied to patients and/or patients' relatives attended in this Center. This survey included questions to focus the investigation in the use of a Iternative medicine for the treatment of any allergic disease. The data analysis was done by descriptive statistics. Four hundred one questionnaires were applied. The average age of the patients was of 14 years (range from 1 to 73 years). Fourty-seven percent (189 patients) were female and 58.2% (212 patients) were male. The diagnoses included: allergic rhinitis in 215 patients (53.6), asthma in 97 (24.2%), rhinitis and asthma in 73 (18.2) and atopic dermatitis in 16 (4%). Out of the patients 34.4% (138) had used at least one type of alternative medicine for the treatment of their allergic disease. Homeopathy was the most commonly used type of alternative medicine (78.2%), followed by the natural medicine (31.5%). Alternative medicine for the treatment of allergic diseases is frequent in patients who attend to this center. Homeopathy and the natural medicine are the most used.
Verified Centers, Nonverified Centers or Other Facilities: A National Analysis of Burn Patient Treatment Location

PubMed Central

Zonies, David; Mack, Christopher; Kramer, Bradley; Rivara, Frederick; Klein, Matthew

2009-01-01

Background Although comprehensive burn care requires significant resources, patients may be treated at verified burn centers, non-verified burn centers, or other facilities due to a variety of factors. The purpose of this study was to evaluate the association between patient and injury characteristics and treatment location using a national database. Study Design We performed an analysis of all burn patients admitted to United States hospitals participating in the Healthcare Cost and Utilization Project over 2 years. Univariate and multivariate analyses were performed to identify patient and injury factors associated with the likelihood of treatment at designated burn care facilities. Definitve care facilities were categorized as American Burn Association verified centers, non-verified burn centers, or other facilities. Results Over the two years, 29,971 burn patients were treated in 1,376 hospitals located in 19 participating states. A total of 6,712 (22%) patients were treated at verified centers, with 26% and 52% treated at non-verified or other facilities, respectively. Patients treated at verified centers were younger than those at non-verified or other facilities (33.1 years vs. 33.7 years vs. 41.9 years, p<0.001) and had a higher rate of inhalation injury (3.4% vs. 3.2% vs. 2.2%, p<0.001). Independent factors associated with treatment at verified centers include burns to the head/neck (RR 2.4, CI 2.1-2.7), hand (RR 1.8, CI 1.6-1.9), electrical injury (RR 1.4, CI 1.4, CI 1.2-1.7), and fewer co-morbidities (RR 0.55, CI 0.5-0.6). Conclusions More than two-thirds of significantly burned patients are treated at non-verified burn centers in the U.S. Many patients meeting ABA criteria for transfer to a burn center are being treated at non-burn center facilities. PMID:20193892
Putting patients first: a novel patient-centered model for medical enterprise success.

PubMed

Dhawan, Naveen

2014-01-01

This article introduces a new way of viewing patient-customers. It encourages a greater emphasis on patients' needs and the importance of considering dimensions of the patient experience to better serve them. It also draws from examples in the general business world as they can be applied to medical enterprises. The author introduces a model that directs all business activities toward the end consumer with an underlying guidance by patient needs. A business is advised to understand its customer, design a patient-directed vision, and focus on creating a unique customer experience. The article delineates key action items for physicians and administrators that will allow them to better meet their patient-customers' needs and develop loyalty. By practicing a patient-centered approach and following these guidelines, one may ensure greater success of the medical enterprise.
Advancing Patient-centered Outcomes in Emergency Diagnostic Imaging: A Research Agenda.

PubMed

Kanzaria, Hemal K; McCabe, Aileen M; Meisel, Zachary M; LeBlanc, Annie; Schaffer, Jason T; Bellolio, M Fernanda; Vaughan, William; Merck, Lisa H; Applegate, Kimberly E; Hollander, Judd E; Grudzen, Corita R; Mills, Angela M; Carpenter, Christopher R; Hess, Erik P

2015-12-01

Diagnostic imaging is integral to the evaluation of many emergency department (ED) patients. However, relatively little effort has been devoted to patient-centered outcomes research (PCOR) in emergency diagnostic imaging. This article provides background on this topic and the conclusions of the 2015 Academic Emergency Medicine consensus conference PCOR work group regarding "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." The goal was to determine a prioritized research agenda to establish which outcomes related to emergency diagnostic imaging are most important to patients, caregivers, and other key stakeholders and which methods will most optimally engage patients in the decision to undergo imaging. Case vignettes are used to emphasize these concepts as they relate to a patient's decision to seek care at an ED and the care received there. The authors discuss applicable research methods and approaches such as shared decision-making that could facilitate better integration of patient-centered outcomes and patient-reported outcomes into decisions regarding emergency diagnostic imaging. Finally, based on a modified Delphi process involving members of the PCOR work group, prioritized research questions are proposed to advance the science of patient-centered outcomes in ED diagnostic imaging. © 2015 by the Society for Academic Emergency Medicine.
Patient Perspectives of Midlevel Providers in Orthopaedic Sports Medicine.

PubMed

Manning, Blaine T; Bohl, Daniel D; Hannon, Charles P; Redondo, Michael L; Christian, David R; Forsythe, Brian; Nho, Shane J; Bach, Bernard R

2018-04-01

Midlevel providers (eg, nurse practitioners and physician assistants) have been integrated into orthopaedic systems of care in response to the increasing demand for musculoskeletal care. Few studies have examined patient perspectives toward midlevel providers in orthopaedic sports medicine. To identify perspectives of orthopaedic sports medicine patients regarding midlevel providers, including optimal scope of practice, reimbursement equity with physicians, and importance of the physician's midlevel provider to patients when initially selecting a physician. Cross-sectional study; Level of evidence, 3. A total of 690 consecutive new patients of 3 orthopaedic sports medicine physicians were prospectively administered an anonymous questionnaire prior to their first visit. Content included patient perspectives regarding midlevel provider importance in physician selection, optimal scope of practice, and reimbursement equity with physicians. Of the 690 consecutive patients who were administered the survey, 605 (87.7%) responded. Of these, 51.9% were men and 48.1% were women, with a mean age of 40.5 ± 15.7 years. More than half (51.2%) perceived no differences in training levels between physician assistants and nurse practitioners. A majority of patients (62.9%) reported that the physician's midlevel provider is an important consideration when choosing a new orthopaedic sports medicine physician. Patients had specific preferences regarding which services should be physician provided. Patients also reported specific preferences regarding those services that could be midlevel provided. There lacked a consensus on reimbursement equity for midlevel practitioners and physicians, despite 71.7% of patients responding that the physician provides a higher-quality consultation. As health care becomes value driven and consumer-centric, understanding patient perspectives on midlevel providers will allow orthopaedic sports medicine physicians to optimize efficiency and patient

[Dialin: infection surveillance network for haemodialysis patients. First results].

PubMed

Ayzac, Louis; Béruard, Michel; Girard, Raphaële; Hannoun, Jacques; Kuentz, François; Marc, Jean-Michel; Moreau-Gaudry, Xavier; Roche, Catherine; Tressières, Benoît; Uzan, Marc

2009-02-01

To show results of the first year of an infection surveillance network for haemodialysis patients (Dialin). In order to improve the security and quality of care, six haemodialysis centers have organized an infection watching network. The purpose of the network is to compare of the watching results between centers. This comparison includes vascular access infection (VAI), bacteraemia and C viral hepatitis. The heterogeneous pattern has been also taken into account. SURVEY TYPE: Multicenter prospective permanent survey. Six hundred and sixty-four haemodialyzed chronic patients, followed during one year (2005), in six voluntary haemodialysis centers. This survey has based on 71,688 treatment sessions corresponding to 6257.5 months of haemodialysis (HM). As with the heterogeneity among centers, the acquired infection standardized ratios (observed/expected) (AISR) and 95% confidence interval are computed with Cox model which includes confounding factors found in literature or in the preliminary stage of the survey. VAI crude rate was 0.47 per 100HM, 0.10 per 1000 native fistulae utilisation days, 0.45 per 1000 days of prosthetic graft utilisation and 0.44 per 1000 days of catheter utilisation. Bacteraemia crude incidence rate was 0.69 per 100HM, 0.02 per 1000 days of native fistulae utilisation, 0.00 per 1000 days of prosthetic graft utilisation and 0.39 per 1000 days of catheter utilisation. No new case of C viral hepatitis was found. Prevalence rate at the beginning of the survey was 5.3% (35 over 664). Two centers had a significantly high AISR for VAI and two centers had a significantly low AISR for VAI. One center had a significantly high AISR for bacteraemia and one center had a significantly low AISR for bacteraemia. The first year of Dialin running demonstrates the importance of standardised surveillance method in VAI and bacteraemia surveillance but not for viral hepatitis.
Shared Decision Making in the Emergency Department: Development of a Policy-Relevant Patient-Centered Research Agenda

PubMed Central

Grudzen, Corita R.; Anderson, Jana R.; Carpenter, Christopher R.; Hess, Erik P.

2016-01-01

SUMMARY SDM in emergency medicine has the potential to improve the quality, safety, and outcomes of ED patients. Given that the ED is the gateway to care for patients with a variety of illnesses and injuries, SDM in the ED is relevant to numerous healthcare disciplines. We conducted a patient-centered one-day conference to define and develop a high-priority, timely research agenda. Participants included researchers, patients, stakeholder organizations, and content experts across many areas of medicine, health policy agencies, and federal and foundation funding organizations. The results of this conference published in this issue of Academic Emergency Medicine will provide an essential summary of the future research priorities for SDM to increase quality of care and patient-centered outcomes. PMID:27396583
[Clinical and medicine characteristics of patients with Parkinson's syndrome].

PubMed

Liu, Huan; Xie, Yan-Ming; Yi, Dan-Hui; Wang, Yong-Yan

2014-09-01

This study analyze the characteristics and clinical medicine in 17 hospitals all over China, based on hospital information system diagnostic information database, including 4 497 cases of hospitalized patients with Parkinson's syndrome. Results indicate, the most common comorbidities are infarction, hypertension, coronary heart disease, diabetes and lung infections, including cerebral infarction, the combined incidence of hypertension in men reached 33.46% and 30.05%, respectively, it is slightly lower in the females. Men with coronary heart disease are more than women, women with diabetes and bone disease are more than men. Combined incidence of the disease increases with age, vascular factors occupy an important position. The most common combined diseases in patients with 90 years of age or older are coronary heart disease, lung infection, and often accompanied by metabolic disorders and nutritional emergency, critical care. Constipation, depression, anxiety, sleep disorders, cognitive impairment are common non-motor symptoms. The drug categories associated with Parkinson's core symptoms treatment are about 20% to 30% of clinical medicine, the others are associated with the treatment of combined disease, clinical medicine and disease spectrum consistent. Blood circulation topped Chinese agents applied frequency, reaching 44.52%; laxative drugs accounted for 11.66%; detoxification agent representing 9.46%. The first twenty Chinese medicine of the applying frequency reached 56.07% of the total utilization, including 12 kinds of traditional Chinese medicine injections, accounting for 60%. Therefore, in the diagnosis and treatment of Parkinsons syndrome, the treatment of comorbidities is very important, more attentions should be paid to vascular factors of the disease, Chinese medicine should be more concerned to improve the non-motor symptoms, give full play to the pharmaceutical multi-target, the overall regulation of advantages, integrative medicine, and improve
The First Year of the Food and Drug Administration Oncology Center of Excellence: Landmark Approvals in a Dynamic Regulatory Environment.

PubMed

Goldberg, Kirsten B; Blumenthal, Gideon M; Pazdur, Richard

The Food and Drug Administration formally established the Oncology Center of Excellence (OCE) in January 2017, as authorized by the 21st Century Cures Act, to expedite the development and review of certain drugs, biologics, and devices for the treatment of cancer. In its first year, the OCE conducted the clinical reviews for several products, including the first 2 chimeric antigen receptor T-cell therapies approved for the treatment of advanced hematologic malignancies and an in vitro diagnostic next-generation sequencing panel, FoundationOne CDx. The OCE also worked with professional societies and patient advocates on efforts to modernize clinical trial eligibility criteria, resulting in recommendations regarding minimal age, brain metastases, organ dysfunction, and human immunodeficiency virus coinfection. Altogether in 2017, the Food and Drug Administration approved 16 new drug and biologic applications, 30 supplemental drug and biologic applications, and 2 biosimilar applications in oncology.
Medicine 2000 years ago: the case of Qumran and other biblical sites.

PubMed

Moss, G A

2000-12-01

Since the eighteenth century, the dominance of orthodox or allopathic medicine in the West led to the branding of other forms of medicine as alternative. However, research shows a narrowing in the gap in popularity of the two methods and it is possible to envision a time when alternative medicine and mainstream medicine will work in tandem. As the West completes a year of millennium celebrations and looks back to the events that shaped the founding of the first millennium two thousand years ago, it is appropriate to increase our understanding of the form medicine took at that time. Research on Qumran and other biblical sites shows that the therapies offered there were based on alternative therapies such as herbal medicine and hydrotherapy as well as conventional therapy such as surgery. The article shows that the twin reliance on alternative and orthodox methods emerging today, marks a return to a pattern of provision which prevailed at the time the first millennium was born.
Herbal medicine use among patients with chronic diseases.

PubMed

Tulunay, Munevver; Aypak, Cenk; Yikilkan, Hulya; Gorpelioglu, Suleyman

2015-01-01

Complementary and alternative medicine (CAM) is commonly used all over the world, and herbal medicines are the most preferred ways of CAM. The aim of this study was to determine the frequency of herbal medicine use among patients with chronic diseases. A cross-sectional descriptive study was conducted from April 2014 to December 2014 among patients who had been diagnosed with diabetes mellitus (DM), hypertension (HT), and hyperlipidemia (HL) in Family Medicine Department of Dışkapı Yıldırım Beyazıt Training and Research Hospital, in Ankara. A questionnaire about herbal drug use was applied by face to face interview to the participants. A total of 217 patients were included in this study. The mean age of the participants was 56.6 ± 9.7 years (55 male and 162 female). The rate of herbal medicine use was 29%. Herbal medicine use among female gender was significantly higher (P = 0.040). Conventional medication use was found to be lower among herbal medicine consumers. There was no relationship between herbal medicine use and type of chronic disease, living area, and occupation or education level. Most frequently used herbs were lemon (39.6%) and garlic (11.1%) for HT, cinnamon (12.7%) for DM, and walnut (6.3%) for HL. In this study, herbal medicine use was found to be higher among patients who had been diagnosed with chronic diseases. Therefore, physicians should be aware of herbal medicine usage of their patients and inform them about the effectivity and side effects of herbal medicines.
77 FR 31862 - National Center for Complementary & Alternative Medicine; Notice of Closed Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-30

... Complementary & Alternative Medicine; Notice of Closed Meetings Pursuant to section 10(d) of the Federal... Alternative Medicine Special Emphasis Panel; HCS Collaboratory Coordinating Center (U54). Date: July 9, 2012... Scientific Review, National Center for Complementary and Alternative Medicine, NIH, 6707 Democracy Blvd...
Year-End Clinic Handoffs: A National Survey of Academic Internal Medicine Programs.

PubMed

Phillips, Erica; Harris, Christina; Lee, Wei Wei; Pincavage, Amber T; Ouchida, Karin; Miller, Rachel K; Chaudhry, Saima; Arora, Vineet M

2017-06-01

While there has been increasing emphasis and innovation nationwide in training residents in inpatient handoffs, very little is known about the practice and preparation for year-end clinic handoffs of residency outpatient continuity practices. Thus, the latter remains an identified, yet nationally unaddressed, patient safety concern. The 2014 annual Association of Program Directors in Internal Medicine (APDIM) survey included seven items for assessing the current year-end clinic handoff practices of internal medicine residency programs throughout the country. Nationwide survey. All internal medicine program directors registered with APDIM. Descriptive statistics of programs and tools used to formulate a year-end handoff in the ambulatory setting, methods for evaluating the process, patient safety and quality measures incorporated within the process, and barriers to conducting year-end handoffs. Of the 361 APDIM member programs, 214 (59%) completed the Transitions of Care Year-End Clinic Handoffs section of the survey. Only 34% of respondent programs reported having a year-end ambulatory handoff system, and 4% reported assessing residents for competency in this area. The top three barriers to developing a year-end handoff system were insufficient overlap between graduating and incoming residents, inability to schedule patients with new residents in advance, and time constraints for residents, attendings, and support staff. Most internal medicine programs do not have a year-end clinic handoff system in place. Greater attention to clinic handoffs and resident assessment of this care transition is needed.
The 2016 Academic Emergency Medicine Consensus Conference, Shared Decision Making in the Emergency Department: Development of a Policy-relevant Patient-centered Research Agenda May 10, 2016, New Orleans, LA.

PubMed

Grudzen, Corita R; Anderson, Jana R; Carpenter, Christopher R; Hess, Erik P

2016-12-01

Shared decision making in emergency medicine has the potential to improve the quality, safety, and outcomes of emergency department (ED) patients. Given that the ED is the gateway to care for patients with a variety of illnesses and injuries and the safety net for patients otherwise unable to access care, shared decision making in the ED is relevant to numerous disciplines and the interests of the United States (U.S.) public. On May 10, 2016 the 16th annual Academic Emergency Medicine (AEM) consensus conference, "Shared Decision Making: Development of a Policy-Relevant Patient-Centered Research Agenda" was held in New Orleans, Louisiana. During this one-day conference clinicians, researchers, policy-makers, patient and caregiver representatives, funding agency representatives, trainees, and content experts across many areas of medicine interacted to define high priority areas for research in 1 of 6 domains: 1) diagnostic testing; 2) policy, 3) dissemination/implementation and education, 4) development and testing of shared decision making approaches and tools in practice, 5) palliative care and geriatrics, and 6) vulnerable populations and limited health literacy. This manuscript describes the current state of shared decision making in the ED context, provides an overview of the conference planning process, the aims of the conference, the focus of each respective breakout session, the roles of patient and caregiver representatives and an overview of the conference agenda. The results of this conference published in this issue of AEM provide an essential summary of the future research priorities for shared decision making to increase quality of care and patient-centered outcomes. © 2016 by the Society for Academic Emergency Medicine.
76 FR 35227 - National Center for Complementary & Alternative Medicine; Notice of Closed Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-16

... Complementary & Alternative Medicine; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... Alternative Medicine Special Emphasis Panel, NIH-HMO Collaboratory Coordinating Center (U54). Date: July 14... Scientific Review, National Center for Complementary, and Alternative Medicine, NIH, 6707 Democracy Blvd...
The impact of incentives on intrinsic and extrinsic motives for fitness-center attendance in college first-year students.

PubMed

Pope, Lizzy; Harvey, Jean

2015-01-01

A criticism of incentives for health behaviors is that incentives undermine intrinsic motivation. The objective of this study was to determine the impact of monetary incentive provision on participation motives for exercise in first-year college students at a northeastern public university. Randomized-controlled trial. Public university in the Northeastern United States. One hundred seventeen first-year college students. Participants were randomized to one of three conditions: a control condition receiving no incentives for meeting fitness-center attendance goals; a discontinued-incentive condition receiving weekly incentives during fall semester 2011, and no incentives during spring semester 2012; or a continued-incentive condition receiving weekly incentives during fall semester, and incentives on a variable-interval schedule during spring semester. The Exercise Motivation Inventory 2 measured exercise participation motives at baseline, end of fall semester, and end of spring semester. Fitness-center attendance was monitored by using ID-card check-in/check-out records. Repeated-measures analyses using linear mixed models with first-order autoregressive covariance structures were run to compare motive changes in the three conditions. Participation motives of Enjoyment and Revitalization associated with intrinsic motivation did not decrease significantly over time in any of the conditions, F(4, 218) = 2.25, p = .065 and F(4, 220) = 1.67, p = .16, respectively. Intrinsically associated participation motives for exercise did not decrease with incentive provision. Therefore, incentives may encourage fitness-center attendance without negatively impacting participation motives for exercise.
Permanent epicardial pacing in pediatric patients: 12-year experience at a single center.

PubMed

Kwak, Jae Gun; Kim, Soo-Jin; Song, Jin Young; Choi, Eun Young; Lee, Sang Yoon; Shim, Woo Sup; Lee, Chang-Ha; Lee, Cheul; Park, Chun Soo

2012-02-01

Permanent cardiac pacing is not often done in children, and when done is usually accomplished through epicardial pacing. We reviewed a 12-year experience with the implantation of epicardial pacemakers by our clinical group. Fifty-three patients who underwent their first implantation of an epicardial pacemaker before the age of 18 years and between 1997 and 2009 were included in our study. The mean age of the patients at the time of first pacemaker implantation was 5.7±4.8 years. Indications for pacemaker implantation included postoperative or congenital atrioventricular block and sinus node dysfunction. The patients underwent 105 operations for the replacement of pacemaker pulse generators and 75 operations for the replacement of pacemaker leads. The most commonly used generator mode was the rate-responsive accelerometer-based (DDDR) mode, which was used in 40.9% of the patients. We used more non-steroid-eluting leads (70.1%) than steroid-eluting leads (29.1%). The overall duration of follow-up in the study was 8.0±4.5 years (range, 2.1 months to approximately 17.0 years). Freedom from the need for generator replacement was 98.0%, 60.7%, and 11.1% at 1, 5, and 8 years, respectively. A tendency toward early generator exhaustion was observed among younger patients (p=0.058). The generator mode used for pacing did not significantly affect generator longevity. Freedom from the need for lead replacement was 98.3%, 83.8%, and 63.6% at 1, 5, and 10 years, respectively. The mean longevity of the leads used in the study was 10.8±0.8 years. Neither patient age at the time of lead implantation nor type of lead significantly affected lead longevity. Lead longevity was sufficiently long and did not vary significantly according to type of lead. Generator longevity was not affected by lead type, generator mode, or patient age at the time of pacemaker implantation. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
'She gave it her best shot right away': patient experiences of biomedical and patient-centered communication.

PubMed

Swenson, Sara L; Zettler, Patti; Lo, Bernard

2006-05-01

Medical educators and researchers recommend a patient-centered interviewing style, but little empirical data exists regarding what aspects of physician communication patients like and why. We investigated patient responses to videotaped doctor-patient vignettes to ascertain what they liked about patient-centered and biomedical communication. We conducted semi-structured interviews with 230 adult medicine patients who viewed videotapes depicting both patient-centered and biomedical physician communication styles. We used a mixed methods approach to derive a "ground-up" framework of patient communication preferences. Respondents who preferred different communication styles articulated different sets of values, important physician behaviors, and physician-patient role expectations. Participants who preferred the patient-centered physician (69%) liked that she worked with and respected patients and explored what the patient wanted. Participants who preferred the biomedical physician (31%) liked that she prevented harm, demonstrated medical authority, and delivered information clearly. Patients like (and dislike) patient-centered communication for thoughtful, considered reasons that appear grounded in their values and expectations about physicians, patients, and the clinical encounter. Better understanding the diversity of patient communication preferences may lead to more effective and individualized care.
Have First-Year Emergency Medicine Residents Achieved Level 1 on Care-Based Milestones?

PubMed Central

Weizberg, Moshe; Bond, Michael C.; Cassara, Michael; Doty, Christopher; Seamon, Jason

2015-01-01

Background Residents in Accreditation Council for Graduate Medical Education accredited emergency medicine (EM) residencies were assessed on 23 educational milestones to capture their progression from medical student level (Level 1) to that of an EM attending physician (Level 5). Level 1 was conceptualized to be at the level of an incoming postgraduate year (PGY)-1 resident; however, this has not been confirmed. Objectives Our primary objective in this study was to assess incoming PGY-1 residents to determine what percentage achieved Level 1 for the 8 emergency department (ED) patient care–based milestones (PC 1–8), as assessed by faculty. Secondary objectives involved assessing what percentage of residents had achieved Level 1 as assessed by themselves, and finally, we calculated the absolute differences between self- and faculty assessments. Methods Incoming PGY-1 residents at 4 EM residencies were assessed by faculty and themselves during their first month of residency. Performance anchors were adapted from ACGME milestones. Results Forty-one residents from 4 programs were included. The percentage of residents who achieved Level 1 for each subcompetency on faculty assessment ranged from 20% to 73%, and on self-assessment from 34% to 92%. The majority did not achieve Level 1 on faculty assessment of milestones PC-2, PC-3, PC-5a, and PC-6, and on self-assessment of PC-3 and PC-5a. Self-assessment was higher than faculty assessment for PC-2, PC-5b, and PC-6. Conclusions Less than 75% of PGY-1 residents achieved Level 1 for ED care-based milestones. The majority did not achieve Level 1 on 4 milestones. Self-assessments were higher than faculty assessments for several milestones. PMID:26692971
Complementary and alternative medicine and supportive care at leading cancer centers: a systematic analysis of websites.

PubMed

Brauer, Jeremy A; El Sehamy, Adam; Metz, James M; Mao, Jun J

2010-02-01

With increasing frequency, patients with cancer and their family members are turning to the Internet to educate themselves about their disease and treatment options, including complementary and alternative medicine (CAM) and supportive care. However, very little is known about how national leading cancer centers represent these therapies via their websites. Simulating the perspective of an information-seeking patient or family member, we performed a systematic analysis of the websites of 41 National Cancer Institute designated comprehensive cancer centers. Two researchers independently evaluated websites, recorded CAM information, and rated quality of the websites using a 4-item Likert scale (overall, information, presentation, and navigation) with Cronbach's alpha = 0.97. Rating was adequately correlated between the two raters (correlation coefficient 0.8). Of 41 centers, 12 (29%) did not have functional websites with regard to information related to CAM. The most common CAM approaches mentioned were: acupuncture (59%), meditation/nutrition/spiritual support/yoga (56% for each), massage therapy (54%), and music therapy (51%). Twenty-three (23; 56%) presented information on support groups, 19 (46%) on patient seminars, 18 (44%) on survivorship effort, and 17 (41%) on symptom management clinics. Twenty-nine (29) (71%) of these websites had a telephone number available, 22 (54%) mentioned at least one ongoing research opportunity, and 19 (46%) provided links to the National Center for Complementary and Alternative Medicine website. Median rating of the quality of websites was 50 of 100, with only 7 (17%) of centers receiving a composite score 80 (excellent) or better. While a growing number of leading cancer centers provide information about CAM and supportive oncology information for patients via their websites, the quality and ease of navigation of these sites remain highly variable. Effective development and redesign of many of the websites is needed to better
Timing and Outcome of Referral to the First Stand-Alone Palliative Care Center in the Eastern Mediterranean Region, the Palliative Care Center of Kuwait.

PubMed

Al-Saleh, Khaled; Al-Awadi, Ahmad; Soliman, Najla A; Mostafa, Sobhy; Mostafa, Mohammad; Mostafa, Wafaa; Alsirafy, Samy A

2017-05-01

Compared to other regions of the world, palliative care (PC) in the Eastern Mediterranean region is at an earlier stage of development. The Palliative Care Center of Kuwait (PCC-K) was established a few years ago as the first stand-alone PC center in the region. This study was conducted to investigate the timing of referral to the PCC-K and its outcome. Retrospective review of referrals to the PCC-K during its first 3 years of action. Late referral was defined as referral during the last 30 days of life. During the 3-year period, 498 patients with cancer were referred to the PCC-K of whom 467 were eligible for analysis. Referral was considered late in 58% of patients. Nononcology facilities were more likely to refer patients late when compared to oncology facilities ( P = .033). The palliative performance scale (PPS) was ≤30 in 59% of late referrals and 21% in earlier referrals ( P < .001). Among 467 referred patients, 342 (73%) were eligible for transfer to the PCC-K, 102 (22%) were ineligible, and 23 (5%) died before assessment by the PCC-K consultation team. From the 342 eligible patients, the family caregivers refused the transfer of 64 (19%) patients to the PCC-K. Patients are frequently referred late to the PCC-K. Further research to identify barriers to PC and its early integration in Kuwait is required. The PPS may be useful in identifying late referrals.
New Mexico Center for Isotopes in Medicine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burchiel, Scott W.

2012-12-13

The purpose of the New Mexico Center for Isotopes in Medicine (NMCIM) is to support research, education and service missions of the UNM College of Pharmacy Radiopharmaceutical Sciences Program (COP RSP) and the Cancer Research and Treatment Center (CRTC). NMCIM developed and coordinated unique translational research in cancer radioimaging and radiotherapy agents based on novel molecules developed at UNM and elsewhere. NMCIM was the primary interface for novel radioisotopes and radiochemistries developed at the Los Alamos National Laboratory (LANL) for SPECT/PET imaging and therapy. NMCIM coordinated the use of the small animal imaging facility with the CRTC provided support servicesmore » to assist investigators in their studies. NMCIM developed education and training programs that benefited professional, graduate, and postdoctoral students that utilized its unique facilities and technologies. UNM COP RSP has been active in writing research and training grants, as well as supporting contract research with industrial partners. The ultimate goal of NMCIM is to bring new radiopharmaceutical imaging and therapeutic agents into clinical trials that will benefit the health and well being of cancer and other patients in New Mexico and the U.S.« less
Teaching Emergency Care to First-Year Medical Students

ERIC Educational Resources Information Center

McCally, Michael; And Others

1977-01-01

At the George Washington University School of Medicine a 52-hour course in emergency care was adapted for first-year medical students from an 81-hour program for training emergency medical technicians. (Author/LBH)
Choice of speciality amongst first-year medical students in the Nelson R. Mandela School of Medicine, University of KwaZulu-Natal

PubMed Central

Naidu, Edwin; Naidu, Jesse

2013-01-01

Abstract Background Trends in career choice amongst medical graduates have considerable implications for the percentage of the workforce available for training. Objective To investigate and review factors affecting career choice by undergraduate first-year medical students. Method This was a cross-sectional study using a closed-ended, semi-structured survey instrument. Two hundred and four questionnaires were administered to all first-year medical students at the Nelson R. Mandela School of Medicine in the first term of the 2012 academic session. Results The questionnaire was completed by 167 out of 204 students (81.8% response rate). Most of the respondents were South Africans (91%) and blacks (72%), with a higher proportion of women to men (2:1). The majority (86%) intended to undertake their postgraduate training in surgical specialties (53%), general surgery (50%) and cardiology (46%). Few were interested in an academic career in basic sciences (27.6%), either because they were not interested in research and/or teaching (48%), not clinically-orientated (20%), or found it to be an unattractive choice (12.3%). The top perceived career-related factors favouring choice of speciality were personal interest and benefits to patients as many (83%) respondents still viewed the medical profession as having a bright future in South Africa. Conclusions Our study highlighted the fact that self and patient interests were strong determinants of speciality choices by the students and the role of parents and practice in rural areas were considered least as potential influencing factors. This would appear to be a good indicator that the healthcare sector may be boosted in the future by doctors who are wholeheartedly committed to the service of the communities with the greatest disease burden.
Traditional/restrictive vs patient-centered intensive care unit visitation: perceptions of patients' family members, physicians, and nurses.

PubMed

Riley, Bettina H; White, Joseph; Graham, Shannon; Alexandrov, Anne

2014-07-01

Patient-centered intensive care units (ICUs) are advocated by professional organizations for critical care nursing and medicine. The patient-centered ICU paradigm recognizes the patient-family unit as inseparable and supports visitation designed to meet the needs of patients and patients' families. To understand perceptions about patient-centered ICUs among patients' family members, physicians, and nurses from 5 ICUs that had restrictive visitation and to guide development of a patient-centered, open visitation paradigm. Patients' family members, nurses, and physicians from 5 ICUs with a traditional/restrictive visitation policy at a southeastern academic, tertiary care hospital were invited to participate in focus group meetings to understand perceptions about patient-centered care. All qualitative work was taped, transcribed, reviewed, and corrected after each session. Corrected transcripts and observer notes were integrated and coded. Patients' families identified facilitators of patient-centeredness as nurses' and physicians' communication, concern, compassion, closeness, and flexibility. However, competing roles of control over the patient's health care served as barriers to a patient-centered paradigm. Patient-centered care is an expectation among patients, patients' families, and health quality advocates. These exploratory methods increased understanding of the powerful perceptions of family members, physicians, and nurses involved with patient care and provided direction to plan interventions to implement patient-centered, family-supportive ICU services. ©2014 American Association of Critical-Care Nurses.

Demystifying the Chemistry Literature: Building Information Literacy in First-Year Chemistry Students through Student-Centered Learning and Experiment Design

ERIC Educational Resources Information Center

Bruehl, Margaret; Pan, Denise; Ferrer-Vinent, Ignacio J.

2015-01-01

This paper describes curriculum modules developed for first-year general chemistry laboratory courses that use scientific literature and creative experiment design to build information literacy in a student-centered learning environment. Two curriculum units are discussed: Exploring Scientific Literature and Design Your Own General Chemistry…
The First Sports Medicine Books in English.

ERIC Educational Resources Information Center

Ryan, Allan J.

The modern history of sports medicine is chronicled in a discussion of the first writings in English on sports medicine. What may have been the first writing in English is a section on first aid in the ENCYCLOPEDIA OF SPORT, published in England in 1898. It describes injuries commonly sustained in angling, boxing, cricket, cycling, football,…
Five-Year Experience of an Inpatient Palliative Care Unit at an Academic Referral Center.

PubMed

Shinall, Myrick C; Martin, Sara F; Nelson, Jill; Miller, Richard S; Semler, Matthew W; Zimmerman, Eli E; Noblit, Christy C; Ely, E Wesley; Karlekar, Mohana

2018-01-01

Palliative care units (PCUs) staffed by specialty-trained physicians and nurses have been established in a number of medical centers. The purpose of this study is to review the 5-year experience of a PCU at a large, urban academic referral center. We retrospectively reviewed a prospectively collected database of all admissions to the PCU at Vanderbilt University Medical Center in the first 5 years of its existence, from 2012 through 2017. Over these 5 years, there were 3321 admissions to the PCU. No single underlying disease process accounted for the majority of the patients, but the largest single category of patients were those with malignancy, who accounted for 38% of admissions. Transfers from the intensive care unit accounted for 50% of admissions, with 43% of admissions from a hospital floor and 7% coming from the emergency department or a clinic. Median length of stay in the PCU was 3 days. In hospital deaths occurred for 50% of admitted patients, while 38% of patients were discharged from the PCU to hospice. These data show that a successful PCU is enabled by buy in from a wide variety of referring specialists and by a multidisciplinary palliative care team focused on care of the actively dying patient as well as pain and symptom management, advance care planning, and hospice referral since a large proportion of referred patients do not die in house.
Optimizing Patient-centered Communication and Multidisciplinary Care Coordination in Emergency Diagnostic Imaging: A Research Agenda.

PubMed

Sabbatini, Amber K; Merck, Lisa H; Froemming, Adam T; Vaughan, William; Brown, Michael D; Hess, Erik P; Applegate, Kimberly E; Comfere, Nneka I

2015-12-01

Patient-centered emergency diagnostic imaging relies on efficient communication and multispecialty care coordination to ensure optimal imaging utilization. The construct of the emergency diagnostic imaging care coordination cycle with three main phases (pretest, test, and posttest) provides a useful framework to evaluate care coordination in patient-centered emergency diagnostic imaging. This article summarizes findings reached during the patient-centered outcomes session of the 2015 Academic Emergency Medicine consensus conference "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." The primary objective was to develop a research agenda focused on 1) defining component parts of the emergency diagnostic imaging care coordination process, 2) identifying gaps in communication that affect emergency diagnostic imaging, and 3) defining optimal methods of communication and multidisciplinary care coordination that ensure patient-centered emergency diagnostic imaging. Prioritized research questions provided the framework to define a research agenda for multidisciplinary care coordination in emergency diagnostic imaging. © 2015 by the Society for Academic Emergency Medicine.
OCIS: 15 years' experience with patient-centered computing.

PubMed

Enterline, J P; Lenhard, R E; Blum, B I; Majidi, F M; Stuart, G J

1994-01-01

In the mid-1970s, the medical and administrative staff of the Oncology Center at Johns Hopkins Hospital recognized a need for a computer-based clinical decision-support system that organized patients' information according to the care continuum, rather than as a series of event-specific data. This is especially important in cancer patients, because of the long periods in which they receive complex medical treatment and the enormous amounts of data generated by extremely ill patients with multiple interrelated diseases. During development of the Oncology Clinical Information System (OCIS), it became apparent that administrative services, research systems, ancillary functions (such as drug and blood product ordering), and financial processes should be integrated with the basic patient-oriented database. With the structured approach used in applications development, new modules were added as the need for additional functions arose. The system has since been moved to a modern network environment with the capacity for client-server processing.
Complementary and Alternative Medicine Use in Individuals Presenting for Care at a Comprehensive Cancer Center.

PubMed

Judson, Patricia L; Abdallah, Reem; Xiong, Yin; Ebbert, Judith; Lancaster, Johnathan M

2017-03-01

To define the use of complementary and alternative medicine (CAM) in individuals presenting for care at a comprehensive cancer center. A total of 17 639 individuals presenting to an NCI-designated Comprehensive Cancer Center (and consortium sites) completed a questionnaire regarding CAM use. Data were analyzed using the univariate χ 2 test to assess CAM use associated with a number of variables, including cancer status, age, gender, marital status, ethnicity, race, employment, and education level. Eighty-seven percent of individuals who completed the CAM survey acknowledged CAM therapy use within the previous 12 months. Of the 5 broad categories of CAM, the most commonly used were biologically based approaches (14 759/17 639 [83.67%]), mind-body interventions (4624/17 485 [26.45%]), manipulative and body-based therapies (3957/17 537 [22.56%]), alternative medical systems (429/15 952 [2.69%]), and energy therapies (270/15 872 [1.7%]). CAM use was more prevalent among women, non-Hispanics, Caucasians, patients 60 to 69 years of age, and those who are married, have a higher level of education, and are employed ( P < .005). This is the largest report of CAM use in individuals presenting for care at a comprehensive cancer center. Our analysis revealed that a very high percentage of patients utilize CAM. Because many of these CAM interventions are not studied in oncology patients, additional research on safety, efficacy, and mechanisms of action are essential. Furthermore, it is important that oncologists understand CAM modalities and counsel their patients about their use.
Building a personalized medicine infrastructure at a major cancer center.

PubMed

Meric-Bernstam, Funda; Farhangfar, Carol; Mendelsohn, John; Mills, Gordon B

2013-05-20

Our understanding of cancer biology is rapidly increasing, as is the availability and affordability of high throughput technologies for comprehensive molecular characterization of tumors and the individual's own genetic makeup. Thus, the time is right to implement personalized molecular medicine for all patients with cancer. Personalized approaches span the full cancer care spectrum from risk stratification to prevention, screening, therapy, and survivorship programs. Several molecular therapeutics have entered clinical trials creating a huge opportunity to couple genomic markers with this emerging drug tool kit. The number of patients managed in major cancer centers creates a challenge to the implementation of genomic technologies required to successfully deliver on the promise of personalized cancer care. This requires a major investment in infrastructure to facilitate rapid deployment of multiplex, cost-effective, and tissue-sparing assays relevant across multiple tumor lineages in the Clinical Laboratory Improvement Amendments (CLIA) environment. Efforts must be made to ensure that assays are accessible to patients most likely to be enrolled onto molecular-marker-driven trials and that the tests are billable and payable, which will make them accessible to a wide range of patients. As the number of patients and aberrations increase, it will become critical to provide decision support for genomic medicine. Institutional commitment is needed to optimize accessibility and quality of research biopsies and to facilitate novel personalized cancer therapy trials. This article will focus on the challenges and opportunities that accompany the building of infrastructure for personalized cancer therapy.
Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity

PubMed Central

Schneider, Eric B.; Kodadek, Lisa M.; Adler, Rachel R.; Ranjit, Anju; Torain, Maya; Shields, Ryan Y.; Snyder, Claire; Schuur, Jeremiah D.; Vail, Laura; German, Danielle; Peterson, Susan; Lau, Brandyn D.

2017-01-01

Importance The Institute of Medicine and The Joint Commission recommend routine documentation of patients’ sexual orientation in health care settings. Currently, very few health care systems collect these data since patient preferences and health care professionals’ support regarding collection of data about patient sexual orientation are unknown. Objective To identify the optimal patient-centered approach to collect sexual orientation data in the emergency department (ED) in the Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity study. Design, Setting, and Participants An exploratory, sequential, mixed-methods design was used first to evaluate qualitative interviews conducted in the Baltimore, Maryland, and Washington, DC, areas. Fifty-three patients and 26 health care professionals participated in the qualitative interviews. Interviews were followed by a national online survey, in which 1516 (potential) patients (244 lesbian, 289 gay, 179 bisexual, and 804 straight) and 429 ED health care professionals (209 physicians and 220 nurses) participated. Survey participants were recruited using random digit dialing and address-based sampling techniques. Main Outcomes and Measures Qualitative interviews were used to obtain the perspectives of patients and health care professionals on sexual orientation data collection, and a quantitative survey was used to gauge patients' and health care professionals' willingness to provide or obtain sexual orientation information. Results Mean (SD) age of patient and clinician participants was 49 (16.4) and 51 (9.4) years, respectively. Qualitative interviews suggested that patients were less likely to refuse to provide sexual orientation than providers expected. Nationally, 154 patients (10.3%) reported that they would refuse to provide sexual orientation; however, 333 (77.8%) of all clinicians thought patients would refuse to provide sexual orientation. After adjustment for
Hospitalist and Internal Medicine Leaders' Perspectives of Early Discharge Challenges at Academic Medical Centers.

PubMed

Patel, Hemali; Fang, Margaret C; Mourad, Michelle; Green, Adrienne; Wachter, Robert M; Murphy, Ryan D; Harrison, James D

2018-06-01

Improving early discharges may improve patient flow and increase hospital capacity. We conducted a national survey of academic medical centers addressing the prevalence, importance, and effectiveness of early-discharge initiatives. We assembled a list of hospitalist and general internal medicine leaders at 115 US-based academic medical centers. We emailed each institutional representative a 30-item online survey regarding early-discharge initiatives. The survey included questions on discharge prioritization, the prevalence and effectiveness of early-discharge initiatives, and barriers to implementation. We received 61 responses from 115 institutions (53% response rate). Forty-seven (77%) "strongly agreed" or "agreed" that early discharge was a priority. "Discharge by noon" was the most cited goal (n = 23; 38%) followed by "no set time but overall goal for improvement" (n = 13; 21%). The majority of respondents reported early discharge as more important than obtaining translators for non-English-speaking patients and equally important as reducing 30-day readmissions and improving patient satisfaction. The most commonly reported factors delaying discharge were availability of postacute care beds (n = 48; 79%) and patient-related transport complications (n = 44; 72%). The most effective early discharge initiatives reported involved changes to the rounding process, such as preemptive identification and early preparation of discharge paperwork (n = 34; 56%) and communication with patients about anticipated discharge (n = 29; 48%). There is a strong interest in increasing early discharges in an effort to improve hospital throughput and patient flow. © 2017 Society of Hospital Medicine.
Effect of patient socioeconomic status on perceptions of first- and second-year medical students

PubMed Central

Woo, James K.H.; Ghorayeb, Sahar H.; Lee, Cheong K.; Sangha, Harpreet; Richter, Suzanne

2004-01-01

Background Physician decision-making and perceptions of patients are affected by a patient's socioeconomic status (SES). We sought to determine if the perceptions of first- and second-year medical students are similarly affected. We also wanted to determine whether a student's own SES affects his or her perceptions of patients from a low or high SES background. Methods Two similar videos of a physician–patient interview were created. One video featured a patient of apparently high SES and the other featured a patient of apparently low SES. Differences in SES were portrayed by means of clothing, accessories and dialogue. First- and second-year medical students at the University of Western Ontario were recruited to view 1 of the videos and to answer a questionnaire using a 5-point Likert scale. Results Responses were obtained from 205 (89%) of the 231 medical students invited to participate. Respondents' perceptions of the low SES and high SES patients were significantly different in the following respects. The low SES patient was perceived to be less compliant in taking medications and less likely to return for follow-up visits; was perceived to have a lower level of social support, poorer overall health and a worse prognosis; and was perceived to be more adversely affected in his occupational duties by illness (p < 0.05). Furthermore, second-year students who watched the video with the low SES patient were less inclined to want that patient in their practice than second-year students who watched the video with the high SES patient (p = 0.032). One hundred and six students (52%) were categorized as having high SES and 37 (18%) as having low SES (the remaining students were categorized as having mid-level SES). Among students who watched the video with the low SES patient, the level of agreement with the statement “This person is the kind of patient I would like to have in my practice” was greater among low SES students than among high SES students (p = 0
Health behaviors of head and neck cancer patients the first year after diagnosis.

PubMed

Duffy, Sonia A; Khan, Mumtaz J; Ronis, David L; Fowler, Karen E; Gruber, Stephen B; Wolf, Gregory T; Terrell, Jeffrey E

2008-01-01

This prospective, cohort study is the first to describe 5 health behaviors of head and neck cancer patients the first year after diagnosis. Patients (N = 283) were recruited in otolaryngology clinic waiting rooms and asked to complete written surveys. A medical record audit was also conducted. Descriptive statistics and multivariate analyses were conducted to determine which variables were associated with the 5 health behaviors. Half of the patients smoked and 25% were problem drinkers. Over half of the smokers and drinkers quit 1 year post-diagnosis. Smoking and problem drinking were highly associated and both were associated with lower body mass index (BMI) (p < .01). Moreover, physical activity and sleep were associated with each other (p < .01). Low SLEEP (Medical Outcomes Study Sleep Scale) scores were common and highly associated with depression (p < .01). The health behaviors of head and neck cancer patients are interrelated, and assessing and treating these behaviors together may be beneficial. Copyright (c) 2007 Wiley Periodicals, Inc.
A patient-centered research agenda for the care of the acutely ill older patient.

PubMed

Wald, Heidi L; Leykum, Luci K; Mattison, Melissa L P; Vasilevskis, Eduard E; Meltzer, David O

2015-05-01

Hospitalists and others acute-care providers are limited by gaps in evidence addressing the needs of the acutely ill older adult population. The Society of Hospital Medicine sponsored the Acute Care of Older Patients Priority Setting Partnership to develop a research agenda focused on bridging this gap. Informed by the Patient-Centered Outcomes Research Institute framework for identification and prioritization of research areas, we adapted a methodology developed by the James Lind Alliance to engage diverse stakeholders in the research agenda setting process. The work of the Partnership proceeded through 4 steps: convening, consulting, collating, and prioritizing. First, the steering committee convened a partnership of 18 stakeholder organizations in May 2013. Next, stakeholder organizations surveyed members to identify important unanswered questions in the acute care of older persons, receiving 1299 responses from 580 individuals. Finally, an extensive and structured process of collation and prioritization resulted in a final list of 10 research questions in the following areas: advanced-care planning, care transitions, delirium, dementia, depression, medications, models of care, physical function, surgery, and training. With the changing demographics of the hospitalized population, a workforce with limited geriatrics training, and gaps in evidence to inform clinical decision making for acutely ill older patients, the identified research questions deserve the highest priority in directing future research efforts to improve care for the older hospitalized patient and enrich training. © 2015 Society of Hospital Medicine.
Positive effects, side effects, and adverse events of clinical holistic medicine. A review of Gerda Boyesen's nonpharmaceutical mind-body medicine (biodynamic body-psychotherapy) at two centers in the United Kingdom and Germany.

PubMed

Allmer, Charlotte; Ventegodt, Søren; Kandel, Isack; Merrick, Joav

2009-01-01

To review adverse events of intensive, clinical holistic medicine (CHM) as it is practiced in holistic body-psychotherapy in England and Germany. Gerda Boyesen's "biodynamic body-psychotherapy" (BBP) is an intensive type of holistic mind-body medicine used by Boyesen at two centers. About 13,500 patients were treated during 1985-2005 period and studied for side effects and adverse events. The first author worked closely with Boyesen 1995-2005 with full insight in all aspects of the therapy and provided the data on side-effects. Therapy helped chronic patients with physical, psychological, sexual, psychiatric and existential problems to improve health, ability, and quality of life (NNT (number needed to treat) = 1-3). Effective in the treatment of mentally ill patients (schizophrenia, anxiety, poor mental health, low general ability). For retraumatization, brief reactive psychosis, depression, depersonalization and derealization, implanted memories, side effects from manipulations of the body, suicide/suicide attempts, hospitalization for physical and mental health problem during or 90 days after treatment, NNH (number needed to harm) > 13,500. Intensive, holistic non-drug medicine is helpful for physical, sexual, psychological, psychiatric and existential problems and is completely safe for the patient. The therapeutic value TV = NNH/NNT > 5,000. Altogether about 18,000 patients treated with different subtypes of CHM in four different countries have now been evaluated for effects, side effects and adverse events, with similar results.
Factors related to complementary/alternative medicine use among cancer patients in central Anatolia.

PubMed

Er, Ozlem; Mistik, Selcuk; Ozkan, Metin; Ozturk, Ahmet; Altinbas, Mustafa

2008-01-01

We aimed to evaluate the prevalence of and factors related to the use of complementary/alternative medicine among cancer patients undergoing or following conventional treatment at the Erciyes University Oncology Hospital in Central Anatolia. Face-to-face interview and a questionnaire were carried out with cancer patients attending the outpatient clinic of Medical Oncology. Questionnaire items included patients' demographic data, treatment, use of complementary/alternative medicine and possible related factors. Multivariate analysis was performed to compare the factors related to use of complementary/alternative medicine. A total of 268 consecutive cancer patients were enrolled in the study. Overall, 43% of the patients were using or had used complementary/alternative medicine. Totally, 90% of the patients using complementary/alternative medicine utilized herbs, and most of the herbs used were stinging nettle. Nearly half of the patients using complementary/alternative medicine (46.1%) were aiming to fight the disease. Among users, nearly half of them regarded the method used as effective and 54 (50.5%) suggested the use of complementary/alternative medicine to other patients. Only 23.1% of the patients discussed the use of complementary/alternative medicine with their physician. In logistic regression analysis, younger age, higher educational status, advanced stage of the disease, longer duration of the disease and current treatment status were significantly associated with the use of complementary/alternative medicine. In our regression model, the predictivity rate of these variables was 72.2% for use of complementary/alternative medicine according to the backward Wald test. Use of complementary/alternative medicine among cancer patients in our center is modestly high, and the most common method is herbal therapy. Communication between the patient and the physician should be improved on this subject.
Legalization of Medicinal Marijuana Has Minimal Impact on Use Patterns in Patients With Inflammatory Bowel Disease.

PubMed

Merker, Ami M; Riaz, Mahrukh; Friedman, Sonia; Allegretti, Jessica R; Korzenik, Joshua

2018-05-18

Patients with inflammatory bowel disease (IBD) have reported use of marijuana to treat symptoms of the disease, yet its classification as a Schedule 1 substance by the federal government has restricted its use. In 2012, Massachusetts legalized medicinal marijuana. We aimed to assess the impact of legalization on use in IBD. Consecutive patients with IBD, cared for at a tertiary care center in Boston, were surveyed regarding use of marijuana, including its perceived benefits and attitudes. Data were then compared with results of a similar survey study conducted at our center in 2012, before marijuana's legalization. The survey was completed by 302 patients. There was a significant increase in marijuana use overall from 12.3% in 2012 to 22.8% in 2017 (P < 0.001). However, there was no significant increase in medicinal use from 2012 to 2017. On bivariate analysis, severe disease, as assessed by SIBDQ score, prior hospitalization, biologic therapy use, prior surgery, and chronic abdominal pain, was found to be more predictive of medicinal use now than in 2012. Among patients surveyed who have never used marijuana, 39.4% reported being interested in using medicinal marijuana, and 54.3% indicated that legalization did not affect their likelihood of using medicinal marijuana. In an IBD tertiary care center, we identified an overall upward trend in marijuana use but no significant change in medicinal use since its legalization in 2012. Our data suggests that the legalization of medical marijuana has resulted in an insignificant change in medicinal marijuana use in this population. 10.1093/ibd/izy141_video1izy141.video15786500236001.
Dreams, Hopes, Realities: NASA's Goddard Space Flight Center, the First Forty Years

NASA Technical Reports Server (NTRS)

Wallace, Lane E.

1999-01-01

Throughout history, the great achievements of civilizations and cultures have been recorded in lists of dates and events. But to look only at the machinery, discoveries, or milestones is to miss the value of these achievements. Each goal achieved or discovery or made represents a supreme effort on the part of individual people who came and worked together for a purpose greater than themselves. Driven by an innate curiosity of the spirit, we have built civilizations and discovered new worlds, always reaching out beyond what we knew or thought was possible. These efforts may have used ships or machinery, but the achievement was that of the humans who made those machines possible- remarkable people willing to endure discomfort, frustration, fatigue, and the risk of failure in the hope of finding out something new. This is the case with the history of the Goddard Space Flight Center. This publication traces the legacy of successes, risks, disappointments and internationally recognized triumphs of the Center's first 40 years. It is a story of technological achievement and scientific discovery; of reaching back to the dawn of time and opening up a new set of eyes on our own planet Earth. In the end, it is not a story about machinery or discoveries, but a story about ourselves. If we were able to step off our planet, and if we continue to discover new mysteries and better technology, it is because the people who work at Goddard always had a passion for exploration and the dedication to make it happen. The text that follows is a testimony to the challenges people at the Goddard Space Flight Center have faced and overcome over almost half a century. Today, we stand on the threshold of a new and equally challenging era. It will once again test our ingenuity, skills, and flexibility as we find new ways of working with our colleagues in industry, government, and academia. Doing more with less is every bit as ambitious as designing the first science instrument to study the
Making genomic medicine evidence-based and patient-centered: a structured review and landscape analysis of comparative effectiveness research.

PubMed

Phillips, Kathryn A; Deverka, Patricia A; Sox, Harold C; Khoury, Muin J; Sandy, Lewis G; Ginsburg, Geoffrey S; Tunis, Sean R; Orlando, Lori A; Douglas, Michael P

2017-10-01

Comparative effectiveness research (CER) in genomic medicine (GM) measures the clinical utility of using genomic information to guide clinical care in comparison to appropriate alternatives. We summarized findings of high-quality systematic reviews that compared the analytic and clinical validity and clinical utility of GM tests. We focused on clinical utility findings to summarize CER-derived evidence about GM and identify evidence gaps and future research needs. We abstracted key elements of study design, GM interventions, results, and study quality ratings from 21 systematic reviews published in 2010 through 2015. More than half (N = 13) of the reviews were of cancer-related tests. All reviews identified potentially important clinical applications of the GM interventions, but most had significant methodological weaknesses that largely precluded any conclusions about clinical utility. Twelve reviews discussed the importance of patient-centered outcomes, although few described evidence about the impact of genomic medicine on these outcomes. In summary, we found a very limited body of evidence about the effect of using genomic tests on health outcomes and many evidence gaps for CER to address.Genet Med advance online publication 13 April 2017.
Making genomic medicine evidence-based and patient-centered: a structured review and landscape analysis of comparative effectiveness research

PubMed Central

Phillips, Kathryn A.; Deverka, Patricia A.; Sox, Harold C.; Khoury, Muin J.; Sandy, Lewis G.; Ginsburg, Geoffrey S.; Tunis, Sean R.; Orlando, Lori A.; Douglas, Michael P.

2017-01-01

Comparative effectiveness research (CER) in genomic medicine (GM) measures the clinical utility of using genomic information to guide clinical care in comparison to appropriate alternatives. We summarized findings of high-quality systematic reviews that compared the analytic and clinical validity and clinical utility of GM tests. We focused on clinical utility findings to summarize CER-derived evidence about GM and identify evidence gaps and future research needs. We abstracted key elements of study design, GM interventions, results, and study quality ratings from 21 systematic reviews published in 2010 through 2015. More than half (N = 13) of the reviews were of cancer-related tests. All reviews identified potentially important clinical applications of the GM interventions, but most had significant methodological weaknesses that largely precluded any conclusions about clinical utility. Twelve reviews discussed the importance of patient-centered outcomes, although few described evidence about the impact of genomic medicine on these outcomes. In summary, we found a very limited body of evidence about the effect of using genomic tests on health outcomes and many evidence gaps for CER to address. Genet Med advance online publication 13 April 2017 PMID:28406488
Anti-aging medicine: a patient/practitioner movement to redefine aging.

PubMed

Mykytyn, Courtney Everts

2006-02-01

Having enjoyed tremendous growth for the past 5 years, the anti-aging medicine movement is redefining aging so that it becomes a target for biomedical intervention. Targeting aging for intervention dislodges popular understandings of aging: for anti-aging practitioners it no longer matters if aging is natural since it can be itself the target of therapy. So-called "age-associated" diseases like cancer are, in this framework, conceived of as symptoms of aging. Anti-aging medicine is a broad term that may comprise groups selling remedies over the Internet, companies touting the "anti-aging"ness of their products, practitioners who work outside of scientific medicine, and practitioners of anti-aging medicine in clinics who believe that their work is strictly scientific. This article, drawing from more than 3 years of ethnographic interviews, participant observation in clinics and conferences, and a review of the literature, considers the last group. It examines the involvement stories of anti-aging medicine practitioners in two Western United States metropolitan cities. These stories reflect the practices of anti-aging medicine practitioners and the accompanying rationale for involvement. Often originally patients themselves, practitioners frame their involvement with the anti-aging movement in three ways. First, they describe aging as it is currently experienced as a time of decline, suffering, and weakness. This anguish is not inevitable, they argue, and their work toward treating aging biomedically is situated as clearly moral. Secondly, intense frustration with the current biomedical environment has motivated practitioners to look for other ways in which to practice: anti-aging medicine is their chosen alternative. Finally, with dramatic expectations of future biotechnologies and disdain for current medical treatments of old age, anti-aging practitioners embrace a scientific revolutionary identity. These stories of migrations from patient to practitioner reveal
Attitudes of nursing staff toward interprofessional in-patient-centered rounding.

PubMed

Sharma, Umesh; Klocke, David

2014-09-01

Historically, medicine and nursing has had a hierarchical and patriarchal relationship, with physicians holding monopoly over knowledge-based practice of medical care, thus impeding interprofessional collaboration. Power gradient prevents nurses from demanding cooperative patient rounding. We surveyed attitudes of nursing staff at our tertiary care community hospital, before and after implementation of a patient-centered interprofessional (hospitalist-nurse) rounding process for patients. There was a substantial improvement in nursing staff satisfaction related to the improved communication (7%-54%, p < 0.001) and rounding (3%-49%, p < 0.001) by hospitalist providers. Patient-centered rounding also positively impacted nursing workflow (5%-56%, p < 0.001), nurses' perceptions of value as a team member (26%-56%, p = 0.018) and their job satisfaction (43%-59%, p = 0.010). Patient-centered rounding positively contributed to transforming the hospitalist-nurse hierarchical model to a team-based collaborative model, thus enhancing interprofessional relationships.

Johnson Space Center Flight Medicine Clinic Experience

NASA Technical Reports Server (NTRS)

Landry, Trela

2006-01-01

Being a member of the Flight Medicine Clinic (FMC) Staff is a great experience. I joined the FMC staff 2 years ago when I became part of the Kelsey-Seybold team. The FMC staff consists of Flight Surgeons, Family Clinic Physician, Nursing staff, Wellness Coordinator and Support staff. We serve as the Primary Care Physicians for the astronauts and their families and provide annual physicals for the retired astronauts. We have approximately 800 patients in the FMC. As the Family Clinic Physician, I care for the astronaut spouses and children and provide annual physicals for the retired astronauts. Since we have a small patient population, we have the opportunity to spend increased personal time with our patients, which I enjoy. We have a pretty healthy patient population, who are very interested in their overall health and preventive care. In preparation for a shuttle launch, our nursing staff assists the flight surgeons with the astronaut physical exams, which occur 10 days prior to launch and again 3 days after their return. We also provide Primary Contact physicals for the families and guests, who will be in close contact with shuttle crew members. During these physicals, we provide education, emphasizing the importance of preventing the spread of communicable diseases to shuttle crew members. Being a part of the Space Medicine Program is an honor. To know that you contribute in some way to our nation s Space Program is very special. (This article was prepared by Dr. Trela Landry, M.D. for inclusion in a Kelsey-Seybold newsletter on 25 OCT 2006.)
Laboratory and clinical predictors of 30-day survival for patients on Extracorporeal Membrane Oxygenation (ECMO): 8-Year experience at Albert Einstein College of Medicine, Montefiore Medical Center.

PubMed

Francischetti, Ivo M B; Szymanski, James; Rodriguez, Daniel; Heo, Moonseong; Wolgast, Lucia R

2017-08-01

Survival of patients on ECMO has remained stable in every population. Laboratory values predictors of survival are required to improve patient care. Clinical Looking Glass software was used to assess Electronic Medical Records (EMRs) of patients at Albert Einstein College of Medicine, Montefiore Medical Center (2007-2014). Our population comprises of 166 adults and was divided in survivors and non-survivors, within 30days. Indications for ECMO were cardiac (65%), respiratory (25%) and infectious diseases (<10%). Eighty six patients (51.8%) survived the procedure. Gender, body weight, ejection fraction, diastolic blood pressure, and socio-economic status did not differ among survivors and non-survivors. In contrast, younger patients (45yo vs 55yo, p=0.0001) and higher systolic blood pressure (115mmHg vs 103mmHg, p=0.025) have favorable outcome. Univariate analysis shows that pre-cannulation values for creatinine (p=0.0003), chloride (p=0.009), bicarbonate (p=0.015) and pH (p=0.03) have prognostic value. Post-cannulation aPTT, pH, platelet and lymphocyte counts also have discriminative power. Notably, multiple logistic regressions for Multivariate Analysis identified chloride (OR 1.07; 95% CI 1.02-1.13; p=0.004), pH (OR 3.35; 95% CI 1.89-5.9; p<0.0001) and aPTT (OR 0.98; 95% CI 0.976-0.998; p=0.024) as independent risk factors for 30-day mortality. These results imply that pre-existing renal conditions and hemostatic dysregulation contribute to poor outcome. Finally, patients on VV-ECMO have increase odds of survival (OR 1.88; 95% CI 1.06-3.34; p=0.029). Laboratory markers identified herein may guide the management of patients on ECMO. Copyright © 2017 Elsevier Inc. All rights reserved.
78 FR 64963 - National Center for Complementary & Alternative Medicine; Amended Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-30

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Center for Complementary & Alternative Medicine; Amended Notice of Meeting Notice is hereby given of a change in the meeting of the National Center for Complementary and Alternative Medicine Special Emphasis Panel, October...
Acute Trauma Factor Associations With Suicidality Across the First 5 Years After Traumatic Brain Injury.

PubMed

Kesinger, Matthew R; Juengst, Shannon B; Bertisch, Hillary; Niemeier, Janet P; Krellman, Jason W; Pugh, Mary Jo; Kumar, Raj G; Sperry, Jason L; Arenth, Patricia M; Fann, Jesse R; Wagner, Amy K

2016-08-01

To determine whether severity of head and extracranial injuries (ECI) is associated with suicidal ideation (SI) or suicide attempt (SA) after traumatic brain injury (TBI). Factors associated with SI and SA were assessed in this inception cohort study using data collected 1, 2, and 5 years post-TBI from the National Trauma Data Bank and Traumatic Brain Injury Model Systems (TBIMS) databases. Level I trauma centers, inpatient rehabilitation centers, and the community. Participants with TBI from 15 TBIMS Centers with linked National Trauma Data Bank trauma data (N=3575). Not applicable. SI was measured via the Patient Health Questionnaire 9 (question 9). SA in the last year was assessed via interview. ECI was measured by the Injury Severity Scale (nonhead) and categorized as none, mild, moderate, or severe. There were 293 (8.2%) participants who had SI without SA and 109 (3.0%) who had SA at least once in the first 5 years postinjury. Random effects logit modeling showed a higher likelihood of SI when ECI was severe (odds ratio=2.73; 95% confidence interval, 1.55-4.82; P=.001). Drug use at time of injury was also associated with SI (odds ratio=1.69; 95% confidence interval, 1.11-2.86; P=.015). Severity of ECI was not associated with SA. Severe ECI carried a nearly 3-fold increase in the odds of SI after TBI, but it was not related to SA. Head injury severity and less severe ECI were not associated with SI or SA. These findings warrant additional work to identify factors associated with severe ECI that make individuals more susceptible to SI after TBI. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea.

PubMed

Bae, Jong-Myon

2017-07-01

In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care. As a practical measure to reduce the cost burden of cancer, appropriate cancer care should be established. Ensuring appropriateness requires patient-doctor communication to ensure that utility values are shared and that autonomous decisions are made regarding medical services. Thus, strategies for reducing the cost burden of cancer through ensuring appropriate patient-centered care include introducing value-based medicine, conducting cost-utility studies, and developing patient decision aids.
Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea

PubMed Central

2017-01-01

In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care. As a practical measure to reduce the cost burden of cancer, appropriate cancer care should be established. Ensuring appropriateness requires patient-doctor communication to ensure that utility values are shared and that autonomous decisions are made regarding medical services. Thus, strategies for reducing the cost burden of cancer through ensuring appropriate patient-centered care include introducing value-based medicine, conducting cost-utility studies, and developing patient decision aids. PMID:28768400
Evaluating Cancer Patients' Expectations and Barriers Toward Traditional Chinese Medicine Utilization in China: A Patient-Support Group-Based Cross-Sectional Survey.

PubMed

Sun, Lingyun; Mao, Jun J; Vertosick, Emily; Seluzicki, Christina; Yang, Yufei

2018-06-01

Traditional Chinese medicine (TCM) is widely used among Chinese cancer patients. However, little is known about Chinese patients' expectations and barriers toward using TCM for cancer. We conducted a cross-sectional survey within a patient-support group, the Beijing Anti-Cancer Association. We measured the outcome, Chinese cancer survivors' expectations and barriers toward TCM utilization, using a modified version of ABCAM (Attitudes and Beliefs towards Complementary and Alternative Medicine), the ABTCM (Attitudes and Beliefs towards Traditional Chinese Medicine). We used multivariate models to evaluate the impact of socioeconomic status and clinical factors on their expectations and barriers (including treatment concerns and logistical challenges domain) toward TCM. Among 590 participants, most patients expected TCM to boost their immune system (96%), improve their physical health (96%), and reduce symptoms (94%). Many had logistical challenges (difficulty decocting herbs (58%) and finding a good TCM physician (55%)). A few were concerned that TCM might interfere with conventional treatments (7.6%), and that many TCM treatments are not based on scientific research (9.1%). In the multivariable regression model, age ≤60 years was independently associated with higher expectation score ( P = .031). Age ≤60 years (coefficient 5.0, P = .003) and localized disease (coefficient 9.5, P = .001) were both associated with higher treatment concerns. Active employment status (coefficient 9.0, P = .008) and localized disease (coefficient 7.5, P = .030) were related to more logistical challenges. Age and cancer stage were related to Chinese cancer patients' perceived expectations and barriers toward TCM use. Understanding these attitudes is important for reshaping the role that TCM plays in China's patient-centered comprehensive cancer care model.
Colorectal Cancer Screening Rates Increased after Exposure to the Patient-Centered Medical Home (PCMH).

PubMed

Green, Beverly B; Anderson, Melissa L; Chubak, Jessica; Baldwin, Laura Mae; Tuzzio, Leah; Catz, Sheryl; Cole, Alison; Vernon, Sally W

2016-01-01

The patient-centered medical home (PCMH) includes comprehensive chronic illness and preventive services, including identifying patients who are overdue for colorectal cancer screening (CRCS). The association between PCMH implementation and CRCS during the Systems of Support to Increase Colorectal Cancer Screening Trial (SOS) is described. The SOS enrolled 4664 patients from 21 clinics from August 2008 to November 2009. Patients were randomized to usual care, mailed fecal kits, kits plus brief assistance, or kits plus assistance and navigation. A PCMH model that included a workflow for facilitating CRCS was implemented at all study clinics in late 2009. Patients enrolled early had little exposure to the PCMH, whereas patients enrolled later were exposed during most of their first year in the trial. Logistic regression models were used to assess the association between PCMH exposure and CRCS. Usual care patients with ≥8 months in the PCMH had higher CRCS rates than those with ≤4 months in the PCMH (adjusted difference, 10.1%; 95% confidence interval, 5.7-14.6). SOS interventions led to significant increases in CRCS, but the magnitude of effect was attenuated by exposure to the PCMH (P for interaction = .01). Exposure to a PCMH was associated with higher CRCS rates. Automated mailed and centrally delivered stepped interventions increased CRCS rates, even in the presence of a PCMH. © Copyright 2016 by the American Board of Family Medicine.
Immediate Symptom Relief After a First Session of Massage Therapy or Reiki in Hospitalized Patients: A 5-year Clinical Experience from a Rural Academic Medical Center.

PubMed

Vergo, Maxwell T; Pinkson, Briane M; Broglio, Kathleen; Li, Zhongze; Tosteson, Tor D

2018-04-05

There is an increasing demand for and use of alternative and complementary therapies, such as reiki and massage therapy, in hospital-based settings. Most controlled studies and practice-based reports include oncology and surgical patient populations; thus the effect in a more heterogeneous hospitalized patient population is hard to estimate. We examined the immediate symptom relief from a single reiki or massage session in a hospitalized population at a rural academic medical center. Retrospective analysis of prospectively collected data on demographic, clinical, process, and quality of life for hospitalized patients receiving massage therapy or reiki. A 396-bed rural academic and tertiary medical center in the United States. Hospitalized patients requesting or referred to the healing arts team who received either a massage or reiki session and completed both a pre- and post-therapy symptom questionnaire. First session of routine reiki or massage therapy during a hospital stay. Differences between pre- and postsession patient-reported scores in pain, nausea, fatigue, anxiety, depression, and overall well-being using an 11-point Likert scale. Patients reported symptom relief with both reiki and massage therapy. Analysis of the reported data showed reiki improved fatigue (-2.06 vs. -1.55 p < 0.0001) and anxiety (-2.21 vs. -1.84 p < 0.001) statistically more than massage. Pain, nausea, depression, and well being changes were not statistically different between reiki and massage encounters. Immediate symptom relief was similar for cancer and noncancer patients for both reiki and massage therapy and did not vary based on age, gender, length of session, and baseline symptoms. Reiki and massage clinically provide similar improvements in pain, nausea, fatigue, anxiety, depression, and overall well-being while reiki improved fatigue and anxiety more than massage therapy in a heterogeneous hospitalized patient population. Controlled trials should be considered to
Homeopathic treatment in emergency medicine: a case series.

PubMed

Oberbaum, M; Schreiber, R; Rosenthal, C; Itzchaki, M

2003-01-01

Following a multiple-casualty construction disaster in Israel, members of The Center of Integrated Complementary Medicine joined in the emergency activity of the Shaare Zedek Medical Center. They administered homeopathic treatment to injured patients to supplement conventional orthopaedic treatment. This was to our knowledge the first time that complementary medicine had been used officially in conjunction with conventional medicine in an emergency situation. Our objective is to report and summarize the rationale, procedures and outcome of the complementary medicine intervention. Fifteen orthopaedic patients were included. They were treated by homeopathy in two phases starting 24 h post-trauma. All patients initially received Arnica montana 200CH in a single dose. Anxiety was treated with Aconite 200CH in nine patients, Opium 200CH in three, Ignatia 200CH in two and Arsenicum album 200CH in one according to type of anxiety. One day later, most patients reported a lessening of pain, 58% felt improvement, 89% had reduced anxiety, and overall, 61% felt that homeopathic treatment was helpful. In the second phase, 48 h post-trauma, specific complaints were addressed with classical homeopathy. At discharge patients rated the homeopathic treatment successful in 67% of the specific complaints. Several issues relating to the use of homeopathy in emergency medicine and its relation to conventional treatment are discussed. These include compliance, the conduct of rounds, shortage of time and staff, and the procurement of medicines.
[Managing patients with prostate cancer in Italy during the first year after diagnosis. A cost description based on a sample of 8 urological wards].

PubMed

Lazzaro, Carlo

2003-09-01

The aim of the paper is to report of an empirical retrospective study (1994-1999) on the cost of managing patient with prostate cancer (PC) during the first year after diagnosis in Italy. In January 2000, a questionnaire on qualitative, quantitative and economic data concerning the clinical path expected for patients with PC (diagnosis; staging; follow-up; drug; surgery; chemotherapy and radiotherapy) was sent to 14 Italian urological wards (UWs), 5 school of medicine-based (Northern Italy: 2; Central Italy: 1; Southern Italy: 2), 4 self-governing hospital-based (Northern Italy: 1; Southern Italy: 3), 5 Health Authorities hospital-based (Northern Italy: 2; Central Italy: 2; Southern Italy: 1). UWs were expected to contribute to analysis with 15 patients' records per year each, for a total amount of 1.260 filled questionnaires. Only medical costs related to patient management have been considered; hospitals and Health Authorities overheads were not taken into account. A cost description was performed considering the hospital viewpoint. We received 416 out of 1.260 expected questionnaires (redemption rate: 33%) from 8 out of 14 UWs: 2 school of medicine-based (Central Italy: 1; Southern Italy: 1); 2 self-governing hospital-based (Southern Italy: 2); 4 Health Authorities hospital-based (Northern Italy: 1; Central Italy: 3). Only 411 out of 416 questionnaires were included in data analysis. Patients' average age at the time of diagnosis was 74.1 years (range: 68.6-76.7). A moderate percentage of neoplasms in patients' relatives was reported (17.8%; 5.6% for PC). The average cost per patient with CP during the first year after diagnosis was Euro 6,575.31 (range: Euro 5,035.65-Euro 12,367.69). The cost-driver was drug therapy (43.07%), followed by surgery (26.41%), diagnosis (12.39%), staging (8.58%); follow-up (8.25%) and radiotherapy (1.30%); no data on chemotherapy was reported. Diagnosis, staging and follow-up tests and procedures were performed mainly in outpatient
Use of alternative medicine by patients in a rural family practice clinic.

PubMed

del Mundo, Winfred F B; Shepherd, William C; Marose, Thomas D

2002-03-01

There has been an increasing awareness of the use of alternative medicine and its effect on health care in the United States. However, no previous study has looked at its use among primary care patients in a rural setting. We conducted this study to determine the patterns of use of alternative medicine in this population. A questionnaire was distributed to 750 adult patients in a family practice clinic in northern Pennsylvania. Our response rate was 88% (664/750). Forty-seven percent of patients reported using at least one form of alternative medicine during the past year The most-common types used were chiropractic (used by 17.2% of respondents), relaxation techniques (16.9%), herbal medicine (16.9%), and massage (14.2%). The patients surveyed used alternative medicine more for its benefits than because of dissatisfaction with conventional medicine. Only 51% of patients told their physician about their use of alternative medicine. A significant number of rural family practice patients are using alternative medicine. To better address their patients' needs, primary care physicians should routinely ask patients about their use of alternative medicine and advise them accordingly.
Predicting academic performance of medical students: the first three years.

PubMed

Höschl, C; Kozený, J

1997-06-01

The purpose of this exploratory study was to identify a cluster of variables that would most economically explain variations in the grade point averages of medical students during the first 3 years of study. Data were derived from a study of 92 students admitted to the 3rd Faculty of Medicine in 1992-1993 academic year and who were still in the medical school at the end of the sixth semester (third year). Stepwise regression analysis was used to build models for predicting log-transformed changes in grade point average after six semesters of study-at the end of the first, second, and third years. Predictor variables were chosen from four domains: 1) high school grade point averages in physics, mathematics, and the Czech language over 4 years of study, 2) results of admission tests in biology, chemistry, and physics, 3) admission committee's assessment of the applicant's ability to reproduce a text, motivation to study medicine, and social maturity, and 4) scores on the sentimentality and attachment scales of the Tridimensional Personality Questionnaire. The regression model, which included performance in high school physics, results of the admission test in physics, assessment of the applicant's motivation to study medicine, and attachment scale score, accounted for 32% of the change in grade point average over six semesters of study. The regression models using the first-, second-, and third-year grade point averages as the dependent variables showed slightly decreasing amounts of explained variance toward the end of the third year of study and within domains, changing the structure of predictor variables. The results suggest that variables chosen from the assessment domains of high school performance, written entrance examination, admission interview, and personality traits may be significant predictors of academic success during the first 3 years of medical study.
75 FR 11186 - National Center for Complementary and Alternative Medicine Announcement of Workshop on Natural...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-10

... Complementary and Alternative Medicine Announcement of Workshop on Natural Products ACTION: Notice. SUMMARY: As part of its strategic planning process, the National Center for Complementary and Alternative Medicine... attend. Seating is limited. Background: The National Center for Complementary and Alternative Medicine...
Training for Leadership Roles in Academic Medicine: Opportunities for Psychologists in the AAMC LEAD Program.

PubMed

LaPaglia, Donna; Thompson, Britta; Hafler, Janet; Chauvin, Sheila

2017-06-01

Psychologists' roles within academic medicine have expanded well beyond research and scholarship. They are active as providers of patient care, medical education, and clinical supervision. Although the number of psychologists in academic health centers continues to grow, they represent a small portion of total medical school faculties. However, with the movement toward collaborative care models, emphasis on interprofessional teams, and increased emphasis on psychological science topics in medical curricula, psychologists are well-positioned to make further contributions. Another path through which psychologists can further increase their contributions and value within academic health centers is to aspire to leadership roles. This article describes the first author's reflections on her experiences in a two-year, cohort-based, educational leadership development certificate program in academic medicine. The cohort was comprised largely of physicians and basic scientists, and a small number of non-physician participants of which the first author was the only clinical psychologist. The insights gained from this experience provide recommendations for psychologists interested in leadership opportunities in academic medicine.
Refill adherence and persistence to lipid‐lowering medicines in patients with type 2 diabetes: A nation‐wide register‐based study

PubMed Central

Hero, Christel; Eliasson, Björn; Franzén, Stefan; Svensson, Ann‐Marie; Miftaraj, Mervete; Gudbjörnsdottir, Soffia; Eeg‐Olofsson, Katarina; Andersson Sundell, Karolina

2017-01-01

Abstract Purpose This study aimed to describe and compare refill adherence and persistence to lipid‐lowering medicines in patients with type 2 diabetes by previous cardiovascular disease (CVD). Methods We followed 97 595 patients (58% men; 23% with previous CVD) who were 18 years of age or older when initiating lipid‐lowering medicines in 2007–2010 until first fill of multi‐dose dispensed medicines, death, or 3 years. Using personal identity numbers, we linked individuals' data from the Swedish Prescribed Drug Register, the Swedish National Diabetes Register, the National Patient Register, the Cause of Death Register, and the Longitudinal Integration Database for Health Insurance and Labour Market Studies. We assessed refill adherence using the medication possession ratio (MPR) and the maximum gap method, and measured persistence from initiation to discontinuation of treatment or until 3 years after initiation. We analyzed differences in refill adherence and persistence by previous CVD in multiple regression models, adjusted for socioeconomic status, concurrent medicines, and clinical characteristics. Results The mean age of the study population was 64 years, 80% were born in Sweden, and 56% filled prescriptions for diabetes medicines. Mean MPR was 71%, 39% were adherent according to the maximum gap method, and mean persistence was 758 days. Patients with previous CVD showed higher MPR (3%) and lower risk for discontinuing treatment (12%) compared with patients without previous CVD (P < 0.0001). Conclusions Patients with previous CVD were more likely to be adherent to treatment and had lower risk for discontinuation compared with patients without previous CVD. PMID:28799214
Toward competency-based curricula in patient-centered spiritual care: recommended competencies for family medicine resident education.

PubMed

Anandarajah, Gowri; Craigie, Frederic; Hatch, Robert; Kliewer, Stephen; Marchand, Lucille; King, Dana; Hobbs, Richard; Daaleman, Timothy P

2010-12-01

Spiritual care is increasingly recognized as an important component of medical care. Although many primary care residency programs incorporate spiritual care into their curricula, there are currently no consensus guidelines regarding core competencies necessary for primary care training. In 2006, the Society of Teachers of Family Medicine's Interest Group on Spirituality undertook a three-year initiative to address this need. The project leader assembled a diverse panel of eight educators with dual expertise in (1) spirituality and health and (2) family medicine. The multidisciplinary panel members represented different geographic regions and diverse faith traditions and were nationally recognized senior faculty. They underwent three rounds of a modified Delphi technique to achieve initial consensus regarding spiritual care competencies (SCCs) tailored for family medicine residency training, followed by an iterative process of external validation, feedback, and consensus modifications of the SCCs. Panel members identified six knowledge, nine skills, and four attitude core SCCs for use in training and linked these to competencies of the Accreditation Council for Graduate Medical Education. They identified three global competencies for use in promotion and graduation criteria. Defining core competencies in spiritual care clarifies training goals and provides the basis for robust curricula evaluation. Given the breadth of family medicine, these competencies may be adaptable to other primary care fields, to medical and surgical specialties, and to medical student education. Effective training in this area may enhance physicians' ability to attend to the physical, mental, and spiritual needs of patients and better maintain sustainable healing relationships.
Physician gender and patient centered communication: the moderating effect of psychosocial and biomedical case characteristics.

PubMed

Shin, Dong Wook; Roter, Debra L; Roh, Yong Kyun; Hahm, Sang Keun; Cho, BeLong; Park, Hoon-Ki

2015-01-01

Female physicians have a more patient-centered communication style than their male counterparts; however, few studies have investigated how the biomedical or psychosocial nature of a patient diagnosis might moderate this relationship. Seventy six 3rd year residents (50 male and 26 females) seeking board certification from the Korean Academy of Family Medicine participated in the 2013 Clinical Practice Examination by conducting two simulated patient (SP) interviews, one presenting a largely psychosocial case and the other largely biomedical. The interview recordings were coded with the Roter Interaction Analysis System (RIAS). Female physicians and their SPs engaged in more dialog than male physicians in both cases. Female physicians were more patient-centered than males for the psychosocial case (t = -3.24, P < 0.05), however, their scores did not differ for the biomedical case. In multivariate analysis, a significant interaction between physician gender and case (z = -3.90, P < 0.001) similarly demonstrated greater female patient-centeredness only for the predominantly psychosocial case. Case characteristics moderated the association between physician gender and patient-centeredness. Case characteristics need to be considered in future research on the association of physician gender and the patient-centered communication, as well as in the tailoring of physician communication training. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Narrative medicine in metastatic prostate cancer reveals ways to improve patient awareness & quality of care.

PubMed

Vincentis, Giuseppe De; Monari, Fabio; Baldari, Sergio; Salgarello, Matteo; Frantellizzi, Viviana; Salvi, Elisabetta; Reale, Luigi; Napolitano, Silvia; Conti, Giario; Cortesi, Enrico

2018-06-15

To describe the journey of patients with metastatic castration-resistant prostate cancer (mCRPC) in treatment with radium-223. A multiperspective analysis was performed using narrative medicine in four Italian centers. The substantial impact of mCRPC on quality of life through all phases of the disease was described. After an initial lack of awareness of the disease or denial of its effects, symptoms of pain, fatigue and side effects often led to sadness, fear and loneliness. The majority underwent radium-223 therapy positively, restoring their quality of life and routine activities. Using narrative medicine, the importance of a patient-centered approach in the pathway of care for patients with mCRPC through all the stages of the disease was highlighted.
Liver transplant center variability in accepting organ offers and its impact on patient survival

PubMed Central

Goldberg, David S.; French, Benjamin; Lewis, James D.; Scott, Frank I; Mamtani, Ronac; Gilroy, Richard; Halpern, Scott D.; Abt, Peter L

2015-01-01

Background & Aims Despite an allocation system designed to give deceased-donor livers to the sickest patients, many transplantable livers are declined by U.S. transplant centers. It is unknown whether centers vary in their propensities to decline organs for the highest-priority patients, and how these decisions directly impact patient outcomes. Methods We analyzed Organ Procurement and Transplantation Network (OPTN) data from 5/1/07-6/17/13, and included all adult liver-alone waitlist candidates offered an organ that was ultimately transplanted. We evaluated acceptance rates of liver offers for the highest-ranked patients and their subsequent waitlist mortality. Results Of the 23,740 unique organ offers, 8,882 (37.4%) were accepted for the first-ranked patient. Despite adjusting for organ quality and recipient severity of illness, transplant centers within and across geographic regions varied strikingly (p<0.001) in the percentage of organ offers they accepted for the highest-priority patients. Among all patients ranked first on waitlists, the adjusted center-specific organ acceptance rates ranged from 15.7% to 58.1%. In multivariable models, there was a 27% increased odds of waitlist mortality for every 5% absolute decrease in a center’s adjusted organ offer acceptance rate (adjusted OR: 1.27, 95% CI: 1.20–1.32). However, the absolute difference in median 5-year adjusted graft survival was 4% between livers accepted for the first-ranked patient, compared to those declined and transplanted at a lower position. Discussion There is marked variability in center practices regarding accepting livers allocated to the highest-priority patients. Center-level decisions to decline organs substantially increased patients’ odds of dying on the waitlist without a transplant. PMID:26626495

CHA2 DS2 -VASc score and clinical outcomes of patients with chest pain discharged from internal medicine wards following acute coronary syndrome rule-out.

PubMed

Topaz, Guy; Haisraely, Ory; Shacham, Yacov; Beery, Gil; Shilo, Lotan; Kassem, Nuha; Pereg, David; Kitay-Cohen, Yona

2018-04-01

Chest-pain patients deemed safe for discharge from internal medicine wards might still be at risk for adverse outcomes. CHA 2 DS 2 -VASc score improves risk stratification of low-risk chest-pain patients discharged after acute coronary syndrome (ACS) rule-out. We accessed medical records of patients who were admitted to internal medicine wards at a single medical center during 2010-2016 and discharged following an ACS rule-out. Patients were classified according to CHA 2 DS 2 -VASc score: 0-1 (low), 2-3 (intermediate), >3 (high). Primary endpoint was occurrence of ACS at 1 year; 30-day and 1-year all-cause mortality (ACM) were secondary outcomes. Of 12 449 patients, 7057 (57%) had low, 3781 (30%) intermediate, and 1611 (13%) high CHA 2 DS 2 -VASc scores. Compared with a low score, intermediate and high scores were associated with significantly increased risk for 1-year ACS during the first year (OR: 2.89, 95% CI: 1.91-4.37, P < 0.01 and OR: 4.84, 95% CI: 3.02-7.74, P < 0.01, respectively). Each 1-point increase in CHA 2 DS 2 -VASc was associated with a 37% increased risk for 1-year ACS. A higher CHA 2 DS 2 -VASc score was associated with significantly higher 30-day ACM. Hazard ratios for 30-day ACM were 1.9 (95% CI: 1.1-3.4, P = 0.03) and 4.4 (95% CI: 2.4-7.9, P < 0.01) for intermediate and high CHA 2 DS 2 -VASc scores, respectively, compared with a low score. Each 1-point increase in CHA 2 DS 2 -VASc score was associated with 43% increased risk for 30-day mortality. High CHA 2 DS 2 -VASc score (>3) was associated with adverse outcomes among chest-pain patients discharged from internal medicine wards following ACS rule-out. © 2018 Wiley Periodicals, Inc.
Medical students' creative projects on a third year pediatrics clerkship: a qualitative analysis of patient-centeredness and emotional connection.

PubMed

Shapiro, Johanna; Ortiz, Diane; Ree, You Ye; Sarwar, Minha

2016-03-16

Increasingly, medical educators are incorporating reflective writing and original creative work into educational practices with the goals of stimulating student self-awareness, appreciation of multiple perspectives, and comfort with ambiguity and uncertainty. This study investigated students' creative projects to assess the extent to which they adopted a patient/relationship-centered, emotionally connected position toward patients and families. Over a 10 year period, students on a required third year pediatrics clerkship individually or in groups completed either a reflection or an education project using a creative medium. 520 projects (representing 595 students, 74.7 % of total eligible students) were qualitatively analyzed according to various thematic and emotion-based dimensions. The majority of projects were personal narrative essays and poetry. The largest number of project themes related to the importance of patient/relationship-centered medicine with patients. The next largest number of projects focused on health education of parents, patients, or classmates. In telling their stories, students were more likely to use a personal voice representing either their or the patient's perspective than an objective, impersonal one. In terms of emotional tone, projects were more likely to be serious than humorous. The largest number of students' emotions expressed an empathic tone. Students identified a large number and wide range of both negative and positive feelings in themselves and their patients. The majority of student emotions were positive, while the majority of patient and family emotions were negative. Students' preference for patient-centered, relational themes, as well as their tendency to favor the first voice, empathic tone, and willingness to express a range of positive and negative emotions in presenting their projects, suggests that they valued emotional connection with patients and families during the pediatrics clerkship experience.
Student-centered tutoring as a model for patient-centeredness and empathy.

PubMed

Meirovich, Adaya; Ber, Rosalie; Moore, Michael; Rotschild, Avi

2016-01-01

Curriculum planners and medical teachers attempt to enhance medical students' empathy and patient-centeredness. Despite educational efforts, there is stability in medical students' empathy and patient-centered medicine during the preclinical stage and a decline in both of them throughout the clinical years. Student-tutor relationship plays a key role in students' learning. This study tests the effect of learner-centered tutoring on students' empathy, patient-centeredness, and behavior. The cohort of 55 students was divided into groups of seven or eight. The experimental group's tutors underwent LC mentoring. Empathy was assessed with the Jefferson Scale of Physician Empathy for Students; PC attitude was assessed with the Patient-Provider Orientation Scale (PPOS). Behavior was assessed by simulations of doctor-patient encounters with 32 students at the end of the third year. Each student participated in three such simulations, during which we analyzed ten aspects of physician-patient communication via Roter interaction analysis system (RIAS)-coded audiotapes. A significant group difference was found for three RIAS categories: building a relationship and patient-centeredness, where the mean percentage of the experimental group was significantly higher than that of the control group, and gathering data, where the mean percentage of the experimental group was significantly lower than that of the control group. A significant correlation was found in the experimental group between empathy and positive talk and between PPOS and three of the RIAS categories: gathering data, psychosocial talk, and patient-centeredness. A significant negative correlation was found in the experimental group between PPOS and two of the RIAS categories: negative talk and doctor-centeredness. Two significant negative correlations were found in the control group: between empathy and patient-centeredness and PPOS and negative talk. The LC approach supports two of the RIAS categories, corresponding
Quality of life among older stroke patients in Taiwan during the first year after discharge.

PubMed

Shyu, Yea-Ing L; Maa, Suh-Hwa; Chen, Sien-Tsong; Chen, Min-Chi

2009-08-01

To explore the one-year poststroke trajectories in health-related quality of life and physical function in a sample of older stroke patients in Taiwan. Health-related quality of life has repeatedly been reported as decreased in poststroke patients. The vast majority of information on the health-related quality of life of older patients after stroke is based on data collected in Western developed countries. In contrast, little is known about older stroke patients in Asian countries. A descriptive, prospective and correlational design was used. Older stroke survivors (n = 98) were assessed at the end of one, three, six and 12 months after hospital discharge for health-related quality of life (measured by the Medical Outcomes Study Short Form 36) and physical functioning (measured by the Chinese Barthel Index and Instrumental Activities of Daily Living Scale). The subjects, who were 65-88 years old, performed considerably worse at 12 months after hospital discharge in social and physical functioning (means = 61.1, 54.8, respectively) than the age-matched community-dwelling norm (means = 78.7, 69.7, respectively). During the first year after discharge, subjects improved significantly on the Medical Outcomes Study Short Form 36 physical component summary scale and role limitations due to physical problems; during the first three months after discharge, they improved significantly on performance of activities of daily living and instrumental activities of daily living; and from the third to sixth month after discharge, they improved significantly in physical functioning. The first year, especially the first three months after hospital discharge, is critical for improvements in health-related quality of life and physical functioning for older stroke survivors in Taiwan. Older Taiwanese/Chinese people who suffer a stroke will likely benefit from interventions during the first 12 months after discharge and the most effective interventions may be earlier, during the first
Eight year review of hemodialysis: treated patients in a tertiary center in Southern Nigeria.

PubMed

Okaka, Enajite I; Unuigbe, Evelyn I

2014-01-01

Hemodialysis (HD) is the readily available modality of renal replacement therapy in Nigeria today. The number of centers for HD continues to increase, but the majority is still located in the big cities and towns. A retrospective descriptive study in which records of patients on HD from 2004 to 2011 were reviewed. Data in respect of patients' sex, age, occupation and etiology of kidney disease were collected. Data were analyzed using Statistical Package for the Social Sciences statistical software version 16 (SPSS Inc, Chicago IL). A total of 1278 new patients were admitted for HD over the period of review; 60.9% (778) were males and 39.1% (500) females. Mean age of male patients was significantly higher than that of the females (P < 0.01). Those under the age of 40 years constituted 45.4% (580) of the study population, whereas 43.8% (560) were unskilled workers. Nearly 81.1% had CKD while 18.9% (241) had acute kidney injury (AKI). The most common cause of CKD and AKI were chronic glomerulonephritis (CGN) and sepsis respectively. This review showed a preponderance of males in the dialyzed population with males significantly older than the female patients. Patients aged ≤ 40 years and unskilled workers formed a large proportion of the population of HD treated patients. CGN and sepsis were the most common causes of CKD and AKI respectively.
Characterization and Management of Borderline Ovarian Tumors - Results of a Retrospective, Single-center Study of Patients Treated at the Department of Gynecology and Obstetrics of the University Medicine Greifswald.

PubMed

Koensgen, Dominique; Weiss, Martin; Assmann, Kathrin; Brucker, Sara Y; Wallwiener, Diethelm; Stope, Matthias B; Mustea, Alexander

2018-03-01

Borderline ovarian tumors (BOT) are malignant epithelial ovarian tumors with a very low incidence, therefore lacking sufficient clinical experience in diagnostics and treatment. This study characterized the histology, clinical features, diagnostics and therapy of BOT including patients treated at the Department of Gynecology and Obstetrics of the University Medicine Greifswald. In this retrospective, single-center study, patients with BOT treated between 1990 and 2010 were analyzed according to their histological and clinical reports. A total of 54 patients were enrolled. The median age was 54.6 (range=23-83) years. Distribution of histological subtypes was: serous in 31 patients (57.4 %) and mucinous in 23 patients (42.6%). All patients underwent surgery. Eight patients (14.8%) were treated according to actual therapy recommendations during the initial surgery. Eight patients (14.8%) received adjuvant chemotherapy contrary to treatment recommendations. In the case of 36 patients (66.7%), a frozen section was taken intraoperatively, which matched the definitive histological result in 88.9%. During average follow-up of 70.3 months (range=0-231 months), two patients (3.7%) developed tumor recurrence after 9 and 29 months, respectively, two patients (3.7%) died of causes other than BOT. Our study critically demonstrated that until a few years ago, BOTs were not usually treated according to international therapy recommendations. Nevertheless, the rate of tumor recurrence was very low. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
Use of Complementary and Alternative Medicine (CAM) as Part of the Oncological Treatment: Survey about Patients' Attitude towards CAM in a University-Based Oncology Center in Germany.

PubMed

Kessel, Kerstin A; Lettner, Sabrina; Kessel, Carmen; Bier, Henning; Biedermann, Tilo; Friess, Helmut; Herrschbach, Peter; Gschwend, Jürgen E; Meyer, Bernhard; Peschel, Christian; Schmid, Roland; Schwaiger, Markus; Wolff, Klaus-Dietrich; Combs, Stephanie E

2016-01-01

To understand if and which patients would be open-minded to Complementary and Alternative Medicine (CAM) use parallel to their oncological treatment. Moreover, we sought to determine which methods are most accepted and which are the primary motivators to use CAM. We developed and anonymously conducted a questionnaire for patients in the oncology center (TU Munich). Questions focus on different CAM methods, previous experiences, and willingness to apply or use CAM when offered in a university-based setting. A total of 171 of 376 patients (37.4% women, 62.0% men, 0.6% unknown) participated. This corresponds to a return rate of 45%. Median age was 64 years (17-87 years). Of all participants, 15.2% used CAM during their oncological therapy; 32.7% have used it in the past. The majority (81.9%) was not using CAM during therapy; 55.5% have not used CAM in the past respectively. The analysis revealed a significant correlation between education and CAM use during therapy (r = 0.18; p = 0.02), and CAM use in the past (r = 0.17; p = 0.04). Of all patients using CAM during therapy, favored methods were food supplements (42.3%), vitamins/minerals (42.3%), massage (34.6%). Motivations are especially the reduction of side effect and stress, the positive effect of certain CAM-treatments on the immune system and tumor therapy. Results showed no difference between women and men. Most patients not having had any experience with CAM complain about the deficiency of information by their treating oncologist (31.4%) as well as missing treatment possibilities (54.3%). Since many patients believe in study results demonstrating the efficacy of CAM, it stresses our task to develop innovative study protocols to investigate the outcomes of certain CAM on symptom reduction or other endpoints. Thus, prospective trials and innovative evidence-based treatment concepts to include CAM into high-end oncology is what patients demand and what a modern oncology center should offer.
Medicine Based Evidence and Personalized Care of Patients.

PubMed

Horwitz, Ralph I; Charlson, Mary E; Singer, Burton H

2018-04-27

For the past 70 years, evidence generation for patient management in clinical medicine has been dominated by Evidence Based Medicine (EBM) with its emphasis on Randomized Controlled Trials (RCTs). EBM can tell us about the benefits of treatment in the average patient but not for the patient at hand; for how to initiate treatment but not how to adjust or modify therapy after treatment has started; for treatment efficacy when compared to placebo but less often when compared to other effective treatments; when outcomes are chosen as hard endpoints, but not when the predominant concerns of patients are physical limitations or social functioning or psychological distress. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Sports hernias: experience in a sports medicine center.

PubMed

Santilli, O L; Nardelli, N; Santilli, H A; Tripoloni, D E

2016-02-01

Chronic pain of the inguino-crural region or "pubalgia" explains the 0.5-6.2% of the consultations by athletes. Recently, areas of weakness in the posterior wall called "sports hernias," have been identified in some of these patients, capable of producing long-standing pain. Several authors use different image methods (CT, MRI, ultrasound) to identify the lesion and various techniques of repair, by open or laparoscopic approaches, have been proposed but there is no evidence about the superiority of one over others due to the difficulty for randomizing these patients. In our experience, diagnosis was based on clinical and ultrasound findings followed by laparoscopic exploration to confirm and repair the injury. The present study aims to assess the performance of our diagnostic and therapeutic management in a series of athletes affected by "pubalgia". 1450 athletes coming from the orthopedic office of a sport medicine center were evaluated. In 590 of them (414 amateur and 176 professionals) sports hernias were diagnosed through physical examination and ultrasound. We performed laparoscopic "TAPP" repair and, thirty days after, an assessment was performed to determine the evolution of pain and the degree of physical activity as a sign of the functional outcome. We used the U Mann-Whitney test for continuous scale variables and the chi-square test for dichotomous variables with p < 0.05 as a level of significance. In 573 patients ultrasound examination detected some protrusion of the posterior wall with normal or minimally dilated inguinal rings, which in 498 of them coincided with areas affected by pain. These findings were confirmed by laparoscopic exploration that also diagnosed associated contralateral (30.1%) and ipsilateral defects, resulting in a total of 1006 hernias. We found 84 "sport hernias" in 769 patients with previous diagnosis of adductor muscle strain (10.92%); on the other hand, in 127 (21.52%) of our patients with "sport hernias" US detected
Thirty years of critical care medicine

PubMed Central

2010-01-01

Critical care medicine is a relatively young but rapidly evolving specialty. On the occasion of the 30th International Symposium on Intensive Care and Emergency Medicine, we put together some thoughts from a few of the leaders in critical care who have been actively involved in this field over the years. Looking back over the last 30 years, we reflect on areas in which, despite large amounts of research and technological and scientific advances, no major therapeutic breakthroughs have been made. We then look at the process of care and realize that, here, huge progress has been made. Lastly, we suggest how critical care medicine will continue to evolve for the better over the next 30 years. PMID:20550727
Death and caring for dying patients: exploring first-year nursing students' descriptive experiences.

PubMed

Ek, Kristina; Westin, Lars; Prahl, Charlotte; Osterlind, Jane; Strang, Susann; Bergh, Ingrid; Hammarlund, Kina

2014-10-01

To describe first-year nursing students' experiences of witnessing death and providing end-of-life care. This study is part of a larger longitudinal project. Interviews (n=17) were conducted with nursing students at the end of their first year of education. To analyse the interviews (lived-experience descriptions), a thematic analysis, 'a search for meaning' ( Van Manen, 1997 ) was applied. The results are presented within the framework of four separate themes: (1) The thought of death is more frightening than the actual experience, (2) Daring to approach the dying patient and offering something of oneself, (3) The experience of not sufficing in the face of death and (4) Being confronted with one's own feelings. Nursing students require continuous support and opportunity to reflect and discuss their experiences about caring for dying patients and confronting death throughout the entirety of their education. In addition, teachers and clinical supervisors need to give support using reflective practice to help students to develop confidence in their capacity for caring for dying patients.
[Tinnitus Center at the Nofer Institute of Occupational Medicine--earliest experience].

PubMed

Guzek, Wojciech J; Sułkowski, Wiesław J; Kowalska, Sylwia; Makowska, Zofia

2002-01-01

Of the 150 patients admitted in 2001 to the Tinnitus Center located at the Nofer Institute of Occupational Medicine, Łódź, Poland, 80 were subjected to complex examinations consisted of standardized questionnaire on medical history, psychological tests and audiological assessment. The diagnostic procedure was completed for 52 patients (23 females and 29 males; mean age: 53 years). In this group, five patients were found to have conductive hearing loss due to chronic eustachtis or otosclerosis. They were excluded from further studies. Among the other 47 patients, 26 showed normal hearing threshold and 21 suffered from uni- or bilateral sensorineural hearing loss. Hyperacusis was diagnosed in 16 cases. The measurements of brainstem evoked potentials revealed V wave latency asymmetry in 7 cases, which implied the necessity to perform CT or MNR. In neither of cases did this diagnosis confirm the suspected tumor development (n. VIII neurinoma or pontocerebral angle tumor. The preliminary assessment of treatment efficacy for subjective tinnitus with use of retraining therapy yielded the following conclusions: 1. The application of hearing aid brings about an immediate improvement in the patient's self-assessment of hearing and a better tolerance towards tinnitus. 2. A systematic all-day wear of noise generators contributes to the patient's increased tolerance towards tinnitus, improved mental condition and alleviated hyperacusis. 3. The efficacy of the tinnitus retraining therapy, following Jastreboff, depends on providing the patient with detailed information on the causes and mechanisms of tinnitus development. 4. The negative diagnostics for tumor within the cranial cavity has not only a soothing effect on the patient as it relieves his/her stress, but it can also be a good starting point for the tinnitus retraining therapy.
Predictors for patient knowledge and reported behaviour regarding driving under the influence of medicines: a multi-country survey.

PubMed

Monteiro, Susana P; van Dijk, Liset; Verstraete, Alain G; Alvarez, F Javier; Heissing, Michael; de Gier, Johan J

2012-01-20

Reports on the state of knowledge about medicines and driving showed an increased concern about the role that the use of medicines might play in car crashes. Much of patient knowledge regarding medicines comes from communications with healthcare professionals. This study, part of the DRUID (Driving Under the Influence of Drugs, alcohol and medicines) project, was carried out in four European countries and attempts to define predictors for knowledge of patients who use driving-impairing medicines. The influence of socio-demographic variables on patient knowledge was investigated as well as the influence of socio-demographic factors, knowledge and attitudes on patients' reported behaviour regarding driving under the influence of medicines. Pharmacists handed out questionnaires to patients who met the inclusion criteria: 1) prevalent user of benzodiazepines, antidepressants or first generation antihistamines for systemic use; 2) age between 18 and 75 years old and 3) actual driver of a motorised vehicle. Factors affecting knowledge and reported behaviour towards driving-impairing medicines were analysed by means of multiple linear regression analysis and multiple logistic regression analysis, respectively. A total of 633 questionnaires (out of 3.607 that were distributed to patients) were analysed. Patient knowledge regarding driving under the influence of medicines is better in younger and higher educated patients. Information provided to or accessed by patients does not influence knowledge. Patients who experienced side effects and who have a negative attitude towards driving under the influence of impairing medicines are more prone to change their driving frequency behaviour than those who use their motorised vehicles on a daily basis or those who use anti-allergic medicines. Changes in driving behaviour can be predicted by negative attitudes towards driving under the influence of medicines but not by patients' knowledge regarding driving under the influence of
Predictors for patient knowledge and reported behaviour regarding driving under the influence of medicines: a multi-country survey

PubMed Central

2012-01-01

Background Reports on the state of knowledge about medicines and driving showed an increased concern about the role that the use of medicines might play in car crashes. Much of patient knowledge regarding medicines comes from communications with healthcare professionals. This study, part of the DRUID (Driving Under the Influence of Drugs, alcohol and medicines) project, was carried out in four European countries and attempts to define predictors for knowledge of patients who use driving-impairing medicines. The influence of socio-demographic variables on patient knowledge was investigated as well as the influence of socio-demographic factors, knowledge and attitudes on patients' reported behaviour regarding driving under the influence of medicines. Methods Pharmacists handed out questionnaires to patients who met the inclusion criteria: 1) prevalent user of benzodiazepines, antidepressants or first generation antihistamines for systemic use; 2) age between 18 and 75 years old and 3) actual driver of a motorised vehicle. Factors affecting knowledge and reported behaviour towards driving-impairing medicines were analysed by means of multiple linear regression analysis and multiple logistic regression analysis, respectively. Results A total of 633 questionnaires (out of 3.607 that were distributed to patients) were analysed. Patient knowledge regarding driving under the influence of medicines is better in younger and higher educated patients. Information provided to or accessed by patients does not influence knowledge. Patients who experienced side effects and who have a negative attitude towards driving under the influence of impairing medicines are more prone to change their driving frequency behaviour than those who use their motorised vehicles on a daily basis or those who use anti-allergic medicines. Conclusions Changes in driving behaviour can be predicted by negative attitudes towards driving under the influence of medicines but not by patients' knowledge
Use of Complementary and Alternative Medicine Treatments by Patients with Obstructive Sleep Apnea Hypopnea Syndrome

PubMed Central

Sood, Amit; Narayanan, Sujata; Wahner-Roedler, Dietlind L.; Knudsen, Kayla; Sood, Richa; Loehrer, Laura L.; Hanson, Andrew C.; Kuzniar, Tomasz J.; Olson, Eric J.

2007-01-01

Study Objectives: To assess the proportion of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) reporting previous or current use and interest in future use of complementary and alternative medicine (CAM) therapies. Design: Cross-sectional, point-of-care, anonymous survey. Setting: Sleep disorders center at a Midwest tertiary care center. Participants: Six hundred forty-six consecutive patients undergoing polysomnography. Measurements: The survey instrument comprised 45 items specifically related to CAM therapies, in addition to obtaining baseline data. Results: Response rate was 81% (522/646). A total of 406/522 (78%) patients were diagnosed with OSAHS. Mean age ± SD was 57 ± 14 years, and 267 participants (66%) were men. Overall, 237 (58%) participants reported ever using CAM. Ever and current CAM use specifically for improving sleep was reported by 20% and 7% of the participants, respectively. Twenty-six percent of participants reported ever using biologic products, and 52% reported ever using nonbiologic CAM treatments. A high proportion (58%) of the participants showed interest in future CAM use for improving sleep. Conclusion: A high proportion of patients with OSAHS report previous or current use, and interest in future use, of CAM treatments. This underscores the need to conduct further research in this field. Citation: Sood A; Narayanan S; Wahner-Roedler DL; Knudsen K; Sood R; Loehrer LL; Hanson AC; Kuzniar TJ; Olson EJ. Use of complementary and alternative medicine treatments by patients with obstructive sleep apnea hypopnea syndrome. J Clin Sleep Med 2007;3(6):575-579. PMID:17993037
Computers in medicine: patients' attitudes

PubMed Central

Cruickshank, P. J.

1984-01-01

Data are presented from two surveys where a 26-item questionnaire was used to measure patients' attitudes to diagnostic computers and to medical computers in general. The first group of respondents were 229 patients who had been given outpatient appointments at a hospital general medical clinic specializing in gastrointestinal problems, where some had experienced a diagnostic computer in use. The second group of respondents were 416 patients attending a group general practice where there was no computer. Patients who had experience of the diagnostic computer or a personal computer had more favourable attitudes to computers in medicine as did younger people and males. The two samples of patients showed broadly similar attitudes, and a notable finding was that over half of each group believed that, with a computer around, the personal touch of the doctor would be lost. PMID:6471021
Statistical analysis of twenty years (1993 to 2012) of data from mainland China's first intervention center for children with autism spectrum disorder.

PubMed

Zhou, Wei-Zhen; Ye, Adam Yongxin; Sun, Zhong-Kai; Tian, Hope Huiping; Pu, Tad Zhengzhang; Wu, Yu-Yu; Wang, Dan-Dan; Zhao, Ming-Zhen; Lu, Shu-Juan; Yang, Chang-Hong; Wei, Liping

2014-01-01

Autism spectrum disorder (ASD) is characterized by persistent deficits in social communication and interaction, and restrictive and repetitive patterns of behavior, interests or activities. This study aimed to analyze trends in ASD diagnosis and intervention in 20 years of data from the Beijing Stars and Rain Education Institute for Autism (SR), the first autism intervention center in mainland China, and from a recent survey of members of the Heart Alliance, an industry association of autism intervention centers in China. We analyzed the registration data at the SR from 1993 to 2012 for a total of 2,222 children who had a parent-reported diagnosis of ASD and 612 of 'autistic tendencies'. Most of the children who were the primary focus of our analyses were age six and under. We also analyzed results of a survey we conducted in 2013 of 100 member centers of the Heart Alliance. Generalized Estimating Equations, multiple linear regression and the Mann-Whitney test were used for data analysis. Statistically significant findings are reported here. The number of hospitals where SR children received their diagnosis increased from several in the early 1990s to 276 at present. The proportion of 'autistic tendencies' diagnosis increased 2.04-fold from 1998 to 2012 and was higher for children diagnosed at a younger age. The mean age at first diagnosis of ASD or 'autistic tendencies' decreased by 0.27 years every decade. A higher level of parental education was statistically significantly associated with an earlier diagnosis of the child. The mean parental age at childbirth increased by about 1.48 years per decade, and the mean maternal age was 1.40 and 2.10 years higher than that in the national population censuses of 2000 and 2010, respectively. At the time of the survey 3,957 children with ASD were being trained at the 100 autism intervention centers. Ninety-seven of these centers opened after the year 2000. Economically underdeveloped regions are still underserved. This
A qualitative analysis of patient-centered dentistry in consultations with dental phobic patients.

PubMed

Kulich, Károly R; Berggren, Ulf; Hallberg, Lillemor R-M

2003-01-01

Dental phobia is regarded as one of the greatest obstructions to adequate dental care. It has long been established that fearful dental patients are particularly sensitive to dentists' behavior and performance of dental care. There is a need for the establishment of a systematic theory of dentist-patient communication and new methods analyzing how dentists interact with their patients. In this qualitative study, thirty semi-structured interviews were conducted in 1998 and 1999 with five dentists (three male and two female). Dentists consulted on two occasions with 15 newly enrolled, consecutive dental phobic patients (2 male and 13 female) in a Swedish clinic specializing in the treatment of odontophobia. The time interval between consultation one and two was approximately 2-3 weeks. Analysis of the transcribed interviews was based by the principles of Grounded Theory. The study identified one core category, "Holistic perception and understanding of the patient", two categories, "The dentist's positive outlook on people" and "The dentist's positive view of patient contact", and six further subcategories. Findings support previous models of patient-centered medicine and contribute to a better understanding of how patient-centered dentists interact with dental phobic patients.
Gender and first authorship of papers in family medicine journals 2006--2008.

PubMed

Schrager, Sarina; Bouwkamp, Carla; Mundt, Marlon

2011-03-01

Despite increasing numbers of women attending medical school and completing residencies, women continue to lag behind men in academic achievement. Other specialties have found that women publish fewer journal articles than men. While family medicine is becoming increasingly gender balanced, the aim of this study was to evaluate the gender balance of published material within family medicine journals. All original articles were reviewed in five family medicine journals published in the United States (Family Medicine, Journal of Family Practice, Journal of the American Board of Family Medicine, Annals of Family Medicine, and American Family Physician) between 2006-2008. The articles were categorized based on type of publication and gender of first author. The editorial boards of each of the journals were examined to determine gender breakdown. A total of 2,126 articles were included in the study. Females were first author on 712 (33.5%) of the articles, and males authored 1,414 (66.5%). There was no significant difference between years. More female authors wrote original research, and fewer wrote letters to the editor. Only Family Medicine had gender parity on its editorial board. Female authors wrote about a third of all original publications in family medicine journals between 2006-2009 even though they comprise 44% of the faculty. Further research can evaluate reasons for this gender disparity.
Value-based medicine: concepts and application.

PubMed

Bae, Jong-Myon

2015-01-01

Global healthcare in the 21st century is characterized by evidence-based medicine (EBM), patient-centered care, and cost effectiveness. EBM involves clinical decisions being made by integrating patient preference with medical treatment evidence and physician experiences. The Center for Value-Based Medicine suggested value-based medicine (VBM) as the practice of medicine based upon the patient-perceived value conferred by an intervention. VBM starts with the best evidence-based data and converts it to patient value-based data, so that it allows clinicians to deliver higher quality patient care than EBM alone. The final goals of VBM are improving quality of healthcare and using healthcare resources efficiently. This paper introduces the concepts and application of VBM and suggests some strategies for promoting related research.

Value-based medicine: concepts and application

PubMed Central

Bae, Jong-Myon

2015-01-01

Global healthcare in the 21st century is characterized by evidence-based medicine (EBM), patient-centered care, and cost effectiveness. EBM involves clinical decisions being made by integrating patient preference with medical treatment evidence and physician experiences. The Center for Value-Based Medicine suggested value-based medicine (VBM) as the practice of medicine based upon the patient-perceived value conferred by an intervention. VBM starts with the best evidence-based data and converts it to patient value-based data, so that it allows clinicians to deliver higher quality patient care than EBM alone. The final goals of VBM are improving quality of healthcare and using healthcare resources efficiently. This paper introduces the concepts and application of VBM and suggests some strategies for promoting related research. PMID:25773441
[The Luxembourg Society for Sports Medicine (SLM) after 60 years].

PubMed

Delagardelle, Charles

2012-01-01

This review will mainly focus the last 10 years of the society's history because several important changes occurred during this relatively short period. The most important was the creation of the first clinical sports medicine department in Luxembourg in 2004. This modern new infrastructure was made possible by the recruitment of 2 highly competent sports physicians, the excellent collaboration of the governing board of the Centre Hospitalier de Luxembourg (CHL) and the support of the sports minister. In 2008 the new department received the label "Medical Olympic Centre of Luxembourg". One year later a Research Lab of Sports Medicine (CRP-Santé) completed the new concept. Thus within 4 years the structure of Luxembourgish sports medicine was completely rearranged and includes today orthopaedic surgery and traumatology, functional rehabilitation, sports cardiology, exercise physiology, physiotherapy and specific sports medicine research. An important new challenge of the SLMS will be to integrate the external sports physicians into this new infrastructure. Another ongoing mission of the SLMS will be the education and training of new young sports medicine specialists. Here the new department could play an outstanding role and the SLMS is in close negotiations with the University of Luxembourg, in charge of academic education in Luxembourg. A recruitment of new young sports physicians is necessary to perpetuate the routine sports medicine exams in the 15 regional centres in Luxembourg, where such an exam is mandatory in order to get an official sports licence. Since 2010 an ECG exam has been added for all new licence candidates, according to the recent recommendations of the scientific societies. New young sports physicians will also be needed to assure the medical attendance of the different national teams of Luxembourg. Until 1985 these activities were confined only to the Olympic teams every 4 years, but since the implementation of the Games of the Small European
[Comparison of efficacy of different neurometabolic and vasoactive medicines in ischemic stroke patients's rehabilitation].

PubMed

Galkin, A S; Koval'chuk, V V; Gusev, A O

2011-01-01

The aim of present investigation is research of influence of vasoactive and neurometabolic medicines in stroke patients's rehabilitation. We had analysed 280 stroke patients. The degree of rehabilitation had been defined with the help of Barthel and Lindmark scales. The degree of cognitive functions's rehabilitation had been defined with the help of MMSE scale. For every medicine coefficients of efficiency were calculated. As the result of the present investigation the medicine's efficiency was found out. The most efficient medicines in ischaemic stroke patients's rehabilitation among the investigated ones are the medicines which activate the neuronal metabolism, first of all,--ceraxon (citicoline).
On the practice of ignoring center-patient interactions in evaluating hospital performance.

PubMed

Varewyck, Machteld; Vansteelandt, Stijn; Eriksson, Marie; Goetghebeur, Els

2016-01-30

We evaluate the performance of medical centers based on a continuous or binary patient outcome (e.g., 30-day mortality). Common practice adjusts for differences in patient mix through outcome regression models, which include patient-specific baseline covariates (e.g., age and disease stage) besides center effects. Because a large number of centers may need to be evaluated, the typical model postulates that the effect of a center on outcome is constant over patient characteristics. This may be violated, for example, when some centers are specialized in children or geriatric patients. Including interactions between certain patient characteristics and the many fixed center effects in the model increases the risk for overfitting, however, and could imply a loss of power for detecting centers with deviating mortality. Therefore, we assess how the common practice of ignoring such interactions impacts the bias and precision of directly and indirectly standardized risks. The reassuring conclusion is that the common practice of working with the main effects of a center has minor impact on hospital evaluation, unless some centers actually perform substantially better on a specific group of patients and there is strong confounding through the corresponding patient characteristic. The bias is then driven by an interplay of the relative center size, the overlap between covariate distributions, and the magnitude of the interaction effect. Interestingly, the bias on indirectly standardized risks is smaller than on directly standardized risks. We illustrate our findings by simulation and in an analysis of 30-day mortality on Riksstroke. © 2015 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.
Pediatric colonoscopy in South China: a 12-year experience in a tertiary center.

PubMed

Lei, Pingguang; Gu, Fang; Hong, Liru; Sun, Yuli; Li, Minrui; Wang, Huiling; Zhong, Bihui; Chen, Minhu; Cui, Yi; Zhang, Shenghong

2014-01-01

To investigate: 1) the demographics and clinical characteristics, 2) the findings, and 3) the safety and effectiveness in a cohort of Chinese pediatric patients undergoing colonoscopy. The study participants were consecutive patients aged ≤14 years old that underwent their first colonoscopy in the endoscopy center at the First Affiliated Hospital, Sun Yat-sen University between Jan. 1, 2001 and Dec. 31, 2012. Demographic, clinical, endoscopic, and pathological findings were collected. The cohort consisted of 322 patients, including 218 boys (67.7%) and 104 girls (32.3%). The median age was 8.0 years old and ranged from 9 months to 14 years old. Hematochezia (48.8%) and abdominal pain/discomfort (41.3%) were the most common presentations preceding pediatric colonoscopy. The caecal intubation success rate was 96.3%. No serious complications occurred during the procedures. A total of 227 patients (70.5%) received a positive diagnosis under endoscopy, including 138 patients with polyps and 53 patients with inflammatory bowel disease (IBD). Among the patients with polyps, 71.0% were juvenile polyps. Comparisons between years 2001-2006 and 2007-2012 showed that the IBD detection rate increased significantly (4.6% vs. 22.4%, P<0.001), while the opposite occurred for the polyp detection rate (73.1% vs. 27.6%, P<0.001). Colonoscopy in pediatric patients is a safe and effective procedure. Polyps are the primary finding during colonoscopy. In South China there has been an increase in pediatric patients diagnosed with IBD over the past decade. However, a large epidemiological study is needed to confirm our findings.
Maryland Multipayor Patient-centered Medical Home Program

PubMed Central

Marsteller, Jill A.; Hsu, Yea-Jen; Gill, Christine; Kiptanui, Zippora; Fakeye, Oludolapo A.; Engineer, Lilly D.; Perlmutter, Donna; Khanna, Niharika; Rattinger, Gail B.; Nichols, Donald

2018-01-01

Objective: To evaluate impact of the Maryland Multipayor Patient-centered Medical Home Program (MMPP) on: (1) quality, utilization, and costs of care; (2) beneficiaries’ experiences and satisfaction with care; and (3) perceptions of providers. Design: 4-year quasiexperimental design with a difference-in-differences analytic approach to compare changes in outcomes between MMPP practices and propensity score-matched comparisons; pre-post design for patient-reported outcomes among MMPP beneficiaries. Subjects: Beneficiaries (Medicaid-insured and privately insured) and providers in 52 MMPP practices and 104 matched comparisons in Maryland. Intervention: Participating practices received unconditional financial support and coaching to facilitate functioning as medical homes, membership in a learning collaborative to promote education and dissemination of best practices, and performance-based payments. Measures: Sixteen quality, 20 utilization, and 13 cost measures from administrative data; patient-reported outcomes on care delivery, trust in provider, access to care, and chronic illness management; and provider perceptions of team operation, team culture, satisfaction with care provided, and patient-centered medical home transformation. Results: The MMPP had mixed impact on site-level quality and utilization measures. Participation was significantly associated with lower inpatient and outpatient payments in the first year among privately insured beneficiaries, and for the entire duration among Medicaid beneficiaries. There was indication that MMPP practices shifted responsibility for certain administrative tasks from clinicians to medical assistants or care managers. The program had limited effect on measures of patient satisfaction (although response rates were low) and on provider perceptions. Conclusions: The MMPP demonstrated mixed results of its impact and indicated differential program effects for privately insured and Medicaid beneficiaries. PMID:29462077
Patients in need of medicine information.

PubMed

Kazaryan, I; Sevikyan, A

2015-01-01

Reliable medicine information is important not only for physicians and pharmacists, but also for patients [6]. However, the results of studies implemented in some countries show that patients may have slightly different needs and preferences in using sources of information [1, 4, 5, 7]. The main objective of patient medicines information is assisting consumers to achieve safe and effective use of pharmaceuticals [2, 3]. To identify patients' needs in medicine information and sources they use to receive it. We interviewed 1059 people who had visited community pharmacies in 10 regions of Armenia and Yerevan. Previously developed questionnaire was used for interviewing patients. Statistical analysis was conducted using SPSS program. We found that consumers need medicine information. 68.9% of respondents often use pharmaceuticals only if necessary medicines information is available. The majority of them believe that it is important to have information about therapeutic indications of pharmaceuticals to be used (91.8%), their dosage and method of administration (91.1%), contraindications (82.4%), adverse reactions (81.9%) and the simultaneous use of multiple medicines (76.5%). 58.9% of consumers value information about medicine's price. More than 70% of patients often seek information from health professionals and use medicines package information leaflets (PIL), and more than 75% of respondents mainly trust the same sources. 71.5% of respondents read package leaflets, while 42.0% of consumers do this several times. Only 36.7% of respondents completely understand information in a leaflet. Patients in Armenia need medicine information. They prefer to receive information from sources they trust.Many patients do not understand the content of package information leaflets (PILs) due to barriers, which can be removed by introducing appropriate regulatory provisions for their content and readability.
More than 5000 patients with metastatic melanoma in Europe per year do not have access to recommended first-line innovative treatments.

PubMed

Kandolf Sekulovic, L; Peris, K; Hauschild, A; Stratigos, A; Grob, J-J; Nathan, P; Dummer, R; Forsea, A-M; Hoeller, C; Gogas, H; Demidov, L; Lebbe, C; Blank, C; Olah, J; Bastholt, L; Herceg, D; Neyns, B; Vieira, R; Hansson, J; Rutkowski, P; Krajsova, I; Bylaite-Bucinskiene, M; Zalaudek, I; Maric-Brozic, J; Babovic, N; Banjin, M; Putnik, K; Weinlich, G; Todorovic, V; Kirov, K; Ocvirk, J; Zhukavets, A; Kukushkina, M; De La Cruz Merino, L; Ymeri, A; Risteski, M; Garbe, C

2017-04-01

Despite the efficacy of innovative treatments for metastatic melanoma, their high costs has led to disparities in cancer care among different European countries. We analysed the availability of these innovative therapies in Europe and estimated the number of patients without access to first-line recommended treatment per current guidelines of professional entities such as the European Society for Medical Oncology (ESMO), the European Organisation for Research and Treatment of Cancer (EORTC), the European Association of Dermato-Oncology (EADO), and European Dermatology Forum (EDF). Web-based online survey was conducted in 30 European countries with questions about the treatment schedules from 1st May 2015 to 1st May 2016: number of metastatic melanoma patients, registration and reimbursement of innovative medicines (updated data, as of 1st October 2016), percentage of patients treated and availability of clinical studies and compassionate-use programmes. The recommended BRAF inhibitor (BRAFi) + MEK inhibitor (MEKi) combination was both registered and fully reimbursed in 9/30 (30%) countries, and in 13/30 (43%) (all from Eastern Europe) not reimbursed. First-line immunotherapy with anti-PD1 antibodies was registered and fully reimbursed in 14/30 (47%) countries, while in 13/30 (43%) (all from Eastern Europe) not reimbursed. It was estimated that in Europe 19,600 patients with metastatic melanoma are treated, and 5238 (27%) do not have access to recommended first-line therapy. Significant correlation was found between human development index (HDI, UNDP report 2015), (r = 0.662; p < 0.001), health expenditure per capita (r = 0.695; p < 0.001) and the Mackenbach score of health policy performance (r = 0.765; p < 0.001) with the percentage of patients treated with innovative medicines and a number of reimbursed medicines. Great discrepancy exists in metastatic melanoma treatment across Europe. It is crucial to increase the awareness of national and
Thirdspace Explorations in Online Writing Studios: Writing Centers, Writing in the Disiplines and First Year Composition in the Corporate University

ERIC Educational Resources Information Center

Miley, Michelle L.

2013-01-01

This study explores the use of online writing studios housed in the University Writing Center and attached to a Writing in the Disciplines course in the College of Technology and a First Year Composition program. The original goal of the online writing studio, modified from Grego and Thompson's (2009) writing studio approach, was to create an…
Viral Hepatitis A in 108 Adult Patients During an Eight-Year Observation at a Single Center in Poland.

PubMed

Bura, Maciej; Michalak, Michał; Chojnicki, Michał K; Kowala-Piaskowska, Arleta; Mozer-Lisewska, Iwona

2015-01-01

Hepatitis A is related to significant morbidity and occasional mortality. Based on data from the Polish National Institute of Hygiene, from 2000 to 2013 a mean of 213 hepatitis A cases were reported yearly. The aim of the study was to assess selected data in adults hospitalized for symptomatic hepatitis A during an eight-year period in a single center in the Wielkopolska Region of Poland. All the hepatitis A patients hospitalized in the center from 2005 to 2013 were analyzed retrospectively. Data were extracted from the medical records of these individuals. The disease was confirmed by anti-HAV IgM testing. In total, 108 patients (71 men and 37 women), aged 18-65 years, were identified. All but 1 patient recovered (99.1%) and in 6 cases (5.6%) a relapse occurred. Risk factors for hepatitis A were identified in 56 patients (52%), with travel abroad being the most common one (32 patients); 19 cases were secondary and 5 patients were men who have sex with men. One hepatitis A outbreak was noted in the region during the study period. Acalculous cholecystitis was found in 33.3% of the patients who underwent abdominal ultrasound. This tended to be more common among older individuals (47.8% in patients over 40 vs. 22.6% in patients aged 18-40, p=0.0521). Patients with this finding had significantly higher mean peak ALT in comparison to those with no gallbladder abnormalities. Although hepatitis A in adults is typically a benign, self-limited disease, it can occasionally have a fatal course. In a significant proportion of patients with an evident risk factor for hepatitis A, the possibility of active prophylaxis was not used. Hepatitis A should be regarded as a sexually transmitted infection. Acalculous cholecystitis is a frequent finding among adults with symptomatic hepatitis A.
Complementary and alternative medicine use in Iranian patients with diabetes mellitus.

PubMed

Hashempur, Mohammad Hashem; Heydari, Mojtaba; Mosavat, Seyed Hamdollah; Heydari, Seyyed Taghi; Shams, Mesbah

2015-09-01

There is increasing interest in complementary and alternative medicine generally, and especially by those affected by chronic diseases, such as diabetes mellitus. We aimed to determine the prevalence and pattern of complementary and alternative medicine use among patients suffering from diabetes mellitus in Shiraz, southern Iran. Another objective was to explore associated factors for use of complementary and alternative medicine among patients with diabetes mellitus. A 19-item semi-structured questionnaire (open- and close-ended) was administered to 239 patients with diabetes mellitus in this cross-sectional study. It was carried out in two outpatient diabetes clinics affiliated with the Shiraz University of Medical Sciences, Shiraz, Iran. One hundred and eighty patients (75.3%) used at least one type of complementary and alternative medicine in the last year prior to the interview. Patients with diabetes mellitus who were living in a large family (≥5 members), not taking insulin, and believed that complementary and alternative medicine have synergistic effects with conventional medicine, were independently and significantly (P values: 0.02, 0.04, and 0.01, respectively) more likely to use complementary and alternative medicine. Most of the users (97.7%) reported use of herbal preparations, and 89.4% of users did not change their medication, neither in medication schedule nor its dosage. The use of complementary and alternative medicine, especially herbal remedies, is popular among diabetes patients in Shiraz, Iran. This use is associated with patients' family size, type of conventional medications and their view about concomitant use of complementary and conventional medicine.
Transforming Patient Experience: Health Web Science Meets Medicine 2.0

PubMed Central

2014-01-01

Until recently, the Western biomedical paradigm has been effective in delivering health care, however this model is not positioned to tackle complex societal challenges or solve the current problems facing health care and delivery. The future of medicine requires a shift to a patient-centric model and in so doing the Internet has a significant role to play. The disciplines of Health Web Science and Medicine 2.0 are pivotal to this approach. This viewpoint paper argues that these disciplines, together with the field of design, can tackle these challenges. Drawing together ideas from design practice and research, complexity theory, and participatory action research we depict design as an approach that is fundamentally social and linked to concepts of person-centered care. We discuss the role of design, specifically co-design, in understanding the social, psychological, and behavioral dimensions of illness and the implications for the design of future care towards transforming the patient experience. This paper builds on the presentations and subsequent interdisciplinary dialogue that developed from the panel session "Transforming Patient Experience: Health Web Science Meets Web 2.0" at the 2013 Medicine 2.0 conference in London. PMID:25075246
Transforming patient experience: health web science meets medicine 2.0.

PubMed

McHattie, Lynn-Sayers; Cumming, Grant; French, Tara

2014-01-01

Until recently, the Western biomedical paradigm has been effective in delivering health care, however this model is not positioned to tackle complex societal challenges or solve the current problems facing health care and delivery. The future of medicine requires a shift to a patient-centric model and in so doing the Internet has a significant role to play. The disciplines of Health Web Science and Medicine 2.0 are pivotal to this approach. This viewpoint paper argues that these disciplines, together with the field of design, can tackle these challenges. Drawing together ideas from design practice and research, complexity theory, and participatory action research we depict design as an approach that is fundamentally social and linked to concepts of person-centered care. We discuss the role of design, specifically co-design, in understanding the social, psychological, and behavioral dimensions of illness and the implications for the design of future care towards transforming the patient experience. This paper builds on the presentations and subsequent interdisciplinary dialogue that developed from the panel session "Transforming Patient Experience: Health Web Science Meets Web 2.0" at the 2013 Medicine 2.0 conference in London.
Use of complementary and alternative medicine by patients with arthritis.

PubMed

Unsal, Ayla; Gözüm, Sebahat

2010-04-01

The aims of this study were to determine the prevalence of complementary and alternative medicine use in patients with arthritis, the types of complementary and alternative medicine used, pertinent socio-demographic factors associated with complementary and alternative medicine use and its perceived efficacy. Arthritis is a major health issue, and the use of complementary and alternative medicine among patients with arthritis is common. This is a descriptive cross-sectional study. Data were obtained from 250 patients with arthritis at the physiotherapy and immunology clinics Atatürk University Hospital in eastern Turkey between May-July 2005 using a questionnaire developed specifically for this study. The instrument included questions on socio-demographic information, disease specifics and complementary and alternative medicine usage. Seventy-six per cent of participants reported use of at least one form of complementary and alternative medicine in the previous year. Complementary and alternative medicine users and non-users were not significantly different in most socio-demographic characteristics including age, gender, marital status and education level with the exception of economic status. We categorised treatment into six complementary and alternative medicine categories: 62.6% of patients used thermal therapies; 41.5% used oral herbal therapies; 40.5% used hot therapies; 32.6% used externally applied (skin) therapies; 28.4% used massage and 12.6% used cold therapies. All forms of complementary and alternative medicine except thermal and oral herbal therapies were perceived as very effective by more than half of study participants. Complementary and alternative medicine therapy is widely used by patients with arthritis and has perceived beneficial effects. It is important for nurses and other health care professionals to be knowledgeable about the use of complementary and alternative medicine therapies when providing care to patients with arthritis because of
Does clinical exposure matter? Pilot assessment of patient visits in an urban family medicine residency program.

PubMed

Iglar, Karl; Murdoch, Stuart; Meaney, Christopher; Krueger, Paul

2018-01-01

To determine the number of patient visits, patient demographic information, and diagnoses in an urban ambulatory care setting in a family medicine residency program, and assess the correlation between the number of patient visits and residents' in-training examination (ITE) scores. Retrospective analysis of data from resident practice profiles, electronic medical records, and residents' final ITE scores. Family medicine teaching unit in a community hospital in Barrie, Ont. Practice profile data were from family medicine residents enrolled in the program from July 1, 2013, to June 30, 2014, and electronic medical record and ITE data were from those enrolled in the program from July 1, 2010, to June 30, 2015. Number of patient visits, patient characteristics (eg, sex, age), priority topics addressed in clinic, resident characteristics (eg, age, sex, level of residency), and residents' final ITE scores. Between July 1, 2013, and June 30, 2014, there were 11 115 patient visits. First-year residents had a mean of 5.48 patient visits per clinic, and second-year residents had a mean of 5.98 patient visits per clinic. A Pearson correlation coefficient of 0.68 was found to exist between the number of patients seen and the final ITE scores, with a 10.5% difference in mean score between residents who had 1251 or more visits and those who had 1150 or fewer visits. Three diagnoses (ie, epistaxis, meningitis, and neck pain) deemed important for Certification by the College of Family Physicians of Canada were not seen by any of the residents in clinic. There is a moderate correlation between the number of patients seen by residents in ambulatory care and ITE scores in family medicine. It is important to assess patients' demographic information and diagnoses made in resident practices to ensure an adequate clinical experience. Copyright© the College of Family Physicians of Canada.
Patient-centred advice is effective in improving adherence to medicines.

PubMed

Clifford, Sarah; Barber, Nick; Elliott, Rachel; Hartley, Elaine; Horne, Rob

2006-06-01

To assess the effects of pharmacists giving advice to meet patients' needs after starting a new medicine for a chronic condition. A prospective health technology assessment including a randomised controlled trial of a pharmacist-delivered intervention to improve adherence using a centralised telephone service to patients at home in England. Patients were eligible for recruitment if they were receiving the first prescription for a newly prescribed medication for a chronic condition and were 75 or older or suffering from stroke, cardiovascular disease, asthma, diabetes or rheumatoid arthritis. Incidence of non-adherence, problems with the new medicine, beliefs about the new medicine, safety and usefulness of the interventions. Five hundred patients consented and were randomised. At 4-week follow-up, non-adherence was significantly lower in the intervention group compared to control (9% vs. 16%, P = 0.032). The number of patients reporting medicine-related problems was significantly lower in the intervention group compared to the control (23% vs. 34%, P = 0.021). Intervention group patients also had more positive beliefs about their new medicine, as shown by their higher score on the "necessity-concerns differential" (5.0 vs. 3.5, P = 0.007). The phone calls took a median of 12 min each. Most advice was judged by experts to be safe and helpful, and patients found it useful. Overall, these findings show benefits from pharmacists meeting patients' needs for information and advice on medicines, soon after starting treatment. While a substantially larger trial would be needed to confirm that the effect is real and sustained, these initial findings suggest the service may be safe and useful to patients.
Minimized extracorporeal circulation system in coronary artery bypass surgery: a 10-year single-center experience with 2243 patients.

PubMed

Puehler, Thomas; Haneya, Assad; Philipp, Alois; Zausig, York A; Kobuch, Reinhard; Diez, Claudius; Birnbaum, Dietrich E; Schmid, Christof

2011-04-01

Coronary artery bypass grafting (CABG) is the gold standard for the surgical therapy of multivessel coronary artery disease. To reduce the side effects, associated with standard extracorporeal circulation (ECC), a concept of minimal extracorporeal circulation (MECC) was devised in our center. We report on our 10-year experience with the MECC for coronary revascularization. From January 1998 to August 2009, 2243 patients underwent CABG with MECC in our center. In a retrospective observational study, we analyzed indication, preoperative patient co-morbidity, postoperative clinical course, and perioperative outcome of all patients operated on with MECC. Furthermore, the risk factors for mortality in the MECC group were assessed. Patients showed a mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) of 4.5±0.1%. The mean age of the patients was 66.8±9.1 years. The overall 30-day mortality after CABG with MECC was 2.3%, ranging from 1.1% for elective to 13.0% for emergent patients and was significantly better than standard ECC. Only 15.3% (n=344) of patients with MECC required intra-operative blood transfusion. Postoperative catecholamine support, red blood cell transfusion, need for hemodialysis, release of creatinine kinase, incidence of stroke, and postoperative delirium were low after MECC revascularization. Ejection fraction below 30% (odds ratio (OR): 5.1), emergent operation (OR: 9.4), and high-dose catecholamine therapy (OR: 2.6) were associated predictors for mortality. MECC until now is an established concept and has become an alternative for ECC in routine CABG in our center. The use of the MECC system is associated with low mortality and conversion rate. Excellent survival rates and low transfusion requirements in the perioperative course were achieved. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Mentoring, Advocacy, and Leadership: Revisiting First-Year Student Advocate Award Recipients

ERIC Educational Resources Information Center

White, Michelle M.; Anttonen, Ralph G.

2007-01-01

This study revisited research on award-winning campus leaders who were effective change agents working on the behalf of first-year students (Anttonen & Chaskes, 2002). Participants were recipients of the "Outstanding First-Year Student Advocate Award" given annually by the National Resource Center for the First-Year Experience and Students in…
Integrating family medicine and complementary medicine in cancer care: a cross-cultural perspective.

PubMed

Ben-Arye, Eran; Israely, Pesi; Baruch, Erez; Dagash, Jamal

2014-10-01

In this paper, we describe the case study of a 27 year-old Arab female patient receiving palliative care for advanced breast cancer who was referred to complementary medicine (CM) consultation provided within a conventional oncology department. We explore the impact of the integrative CM practitioners' team of three family physicians and one Chinese medicine practitioner on the patient's well-being and specifically on the alleviation of her debilitating hot flashes and insomnia. This quality of life improvement is also affirmed by comparing the Edmonton Symptom Assessment Scale (ESAS) and Measure Yourself Concerns and Well-being (MYCAW) questionnaires administered at the initial and follow-up assessment sessions. In conclusion, we suggest that family physicians trained in evidence-based complementary medicine are optimal integrators of holistic patient-centered supportive care. The inclusion of trained CM practitioners in a multi-disciplinary integrative team may enhance the bio-psycho-social-spiritual perspective, and provide additional practical therapies that improve the quality of life of patients confronting cancer. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Labor unions in medicine: the intersection of patient advocacy and self-advocacy.

PubMed

Manthous, Constantine A

2014-05-01

Labor unions have been a weak force in the medical marketplace. To briefly review the history of physicians' and nurses' labor unions, explore the ethics of unions in medicine, and offer a solution that simultaneously serves patients and professionals. A selective review of the literature. Labor unions of medical professionals pose an ethical quandary, that is a tension between selfless patient advocacy versus self-advocacy. The primary role of labor unions has been to extract from management benefits for employees. The threat of work actions is the primary tool that labor unions can apply to encourage management to negotiate mutually acceptable conditions of employment. Work actions-namely slow-downs and strikes-may harm patients and may therefore run afoul of professionals' primary duty to the primacy of patients' welfare. An alternative model is offered wherein medical unions align self-centered and patient-centered interests and leverage the Public Good, in the form of public opinion, to encourage good-faith bargaining with management. As medicine becomes increasingly corporatized, physicians will join nurses in "at-will employment" arrangements whereby self-advocacy and patient advocacy may be impacted. Although labor unions have been a means of counterbalancing unchecked discretion of corporate management, conventional labor unions may run afoul of medical ethical principles. Reconsideration and innovation, to address this ethical dilemma, could provide a solution that aligns both clinicians' and patients' welfare.

77 FR 24971 - National Center for Complementary & Alternative Medicine; Notice of Closed Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-26

... Complementary & Alternative Medicine; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... Alternative Medicine Special Emphasis Panel; Education, conferences, training. Date: June 22, 2012. Time: 8 a..., [email protected] . Name of Committee: National Center for Complementary and Alternative Medicine...
78 FR 47328 - National Center for Complementary & Alternative Medicine; Notice of Closed Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-05

... Complementary & Alternative Medicine; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... Alternative Medicine Special Emphasis Panel; ZAT1 HS 14 Training, Education and AREA grants. Date: October 25..., Ph.D., Scientific Review Officer, National Center For Complementary and Alternative Medicine...
Effect of center practices on the choice of the first dialysis modality for children and young adults.

PubMed

Hogan, Julien; Ranchin, Bruno; Fila, Marc; Harambat, Jérome; Krid, Saoussen; Vrillon, Isabelle; Roussey, Gwenaelle; Fischbach, Michel; Couchoud, Cécile

2017-04-01

Peritoneal dialysis (PD) remains the modality of choice in children, but there is no clear evidence to support a better outcome in children treated with PD. We aimed to assess factors that have an impact on the choice of dialysis modality in children and young adults in France and sought to determine the roles of medical factors and center practices. We included all patients aged <20 years at the start of renal replacement therapy (RRT), recorded in the French RRT Registry between 2002 and 2013. Hierarchical logistic regression models were used to study the association between the patient/center characteristics and the probability of receiving PD as the first dialysis modality. We included 806 patients starting RRT in 177 centers, 23 of which were specialized pediatric centers. Six hundred and one patients (74.6 %) started with hemodialysis (HD), whereas 205 (25.4 %) started with PD. A greater probability of PD was found in younger children, whereas starting the treatment in an emergency setting was associated with a low use of PD. We found a significant variability among centers that accounted for 43 % of the total variability. The probability of PD was higher in adult centers and was proportional to the rate of PD in the center. Center practices are a major factor in the choice of dialysis modality. This raises concerns about patient and family choices and to what extent doctors may influence the final decision. Further pediatric studies focusing on children's and parents' wishes are needed to provide care as close as possible to patients' and families' expectations.
SU-E-T-529: Is MFO-IMPT Robust Enough for the Treatment of Head and Neck Tumors? A 2-Year Outcome Analysis Following Proton Therapy On the First 50 Oropharynx Patients at the MD Anderson Cancer Center

DOE Office of Scientific and Technical Information (OSTI.GOV)

Frank, S; Garden, A; Anderson, M

Purpose: Multi-field optimization intensity modulated proton therapy (MFO-IMPT) for oropharyngeal tumors has been established using robust planning, robust analysis, and robust optimization techniques. While there are inherent uncertainties in proton therapy treatment planning and delivery, outcome reporting are important to validate the proton treatment process. The purpose of this study is to report the first 50 oropharyngeal tumor patients treated de-novo at a single institution with MFO-IMPT. Methods: The data from the first 50 patients with squamous cell carcinoma of the oropharynx treated at MD Anderson Cancer Center from January 2011 to December 2014 on a prospective IRB approved protocolmore » were analyzed. Outcomes were analyzed to include local, regional, and distant treatment failures. Acute and late toxicities were analyzed by CTCAE v4.0. Results: All patients were treated with definitive intent. The median follow-up time of the 50 patients was 25 months. Patients by gender were male (84%) and female (16%). The average age was 61 years. 50% of patients were never smokers and 4% were current smokers. Presentation by stage; I–1, II–0, III– 9, IVA–37 (74%), IVB–3. 88% of patients were HPV/p16+. Patients were treated to 66–70 CGE. One local failure was reported at 13 months following treatment. One neck failure was reported at 12 months. 94% of patients were alive with no evidence of disease. One patient died without evidence of disease. There were no Grade 4 or Grade 5 toxicities. Conclusion: MFO-IMPT for oropharyngeal tumors is robust and provides excellent outcomes 2 years after treatment. A randomized trial is underway to determine if proton therapy will reduce chronic late toxicities of IMRT.« less
Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity : The EQUALITY Study.

PubMed

Haider, Adil H; Schneider, Eric B; Kodadek, Lisa M; Adler, Rachel R; Ranjit, Anju; Torain, Maya; Shields, Ryan Y; Snyder, Claire; Schuur, Jeremiah D; Vail, Laura; German, Danielle; Peterson, Susan; Lau, Brandyn D

2017-06-01

The Institute of Medicine and The Joint Commission recommend routine documentation of patients' sexual orientation in health care settings. Currently, very few health care systems collect these data since patient preferences and health care professionals' support regarding collection of data about patient sexual orientation are unknown. To identify the optimal patient-centered approach to collect sexual orientation data in the emergency department (ED) in the Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity study. An exploratory, sequential, mixed-methods design was used first to evaluate qualitative interviews conducted in the Baltimore, Maryland, and Washington, DC, areas. Fifty-three patients and 26 health care professionals participated in the qualitative interviews. Interviews were followed by a national online survey, in which 1516 (potential) patients (244 lesbian, 289 gay, 179 bisexual, and 804 straight) and 429 ED health care professionals (209 physicians and 220 nurses) participated. Survey participants were recruited using random digit dialing and address-based sampling techniques. Qualitative interviews were used to obtain the perspectives of patients and health care professionals on sexual orientation data collection, and a quantitative survey was used to gauge patients' and health care professionals' willingness to provide or obtain sexual orientation information. Mean (SD) age of patient and clinician participants was 49 (16.4) and 51 (9.4) years, respectively. Qualitative interviews suggested that patients were less likely to refuse to provide sexual orientation than providers expected. Nationally, 154 patients (10.3%) reported that they would refuse to provide sexual orientation; however, 333 (77.8%) of all clinicians thought patients would refuse to provide sexual orientation. After adjustment for demographic characteristics, only bisexual patients had increased odds of refusing to provide sexual
Developing and implementing core competencies for integrative medicine fellowships.

PubMed

Ring, Melinda; Brodsky, Marc; Low Dog, Tieraona; Sierpina, Victor; Bailey, Michelle; Locke, Amy; Kogan, Mikhail; Rindfleisch, James A; Saper, Robert

2014-03-01

The Consortium of Academic Health Centers for Integrative Medicine defines integrative medicine as "the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, health care professionals, and disciplines to achieve optimal health and healing." Over the past three decades, the U.S. public increasingly has sought integrative medicine approaches. In an effort to train medical professionals to adequately counsel patients on the safe and appropriate use of these approaches, medical schools and residencies have developed curricula on integrative medicine for their trainees. In addition, integrative medicine clinical fellowships for postresidency physicians have emerged to provide training for practitioners interested in gaining greater expertise in this emerging field. Currently, 13 clinical fellowships in integrative medicine exist in the United States, and they are predominantly connected to academic medical centers or teaching affiliate hospitals. In 2010, the Consortium of Academic Health Centers for Integrative Medicine, represented by 56 member academic health care institutions with a shared commitment to advance the principles and practices of integrative medicine, convened a two-year task force to draft integrative medicine fellowship core competencies. These competencies would guide fellowship curriculum development and ensure that graduates possessed a common body of knowledge, skills, and attitudes. In this article, the authors discuss the competencies and the task force's process to develop them, as well as associated teaching and assessment methods, faculty development, potential barriers, and future directions.
A Randomized Controlled Trial to Decrease Job Burnout in First-Year Internal Medicine Residents Using a Facilitated Discussion Group Intervention.

PubMed

Ripp, Jonathan A; Fallar, Robert; Korenstein, Deborah

2016-05-01

Background Burnout is common in internal medicine (IM) trainees and is associated with depression and suboptimal patient care. Facilitated group discussion reduces burnout among practicing clinicians. Objective We hypothesized that this type of intervention would reduce incident burnout among first-year IM residents. Methods Between June 2013 and May 2014, participants from a convenience sample of 51 incoming IM residents were randomly assigned (in groups of 3) to the intervention or a control. Twice-monthly theme-based discussion sessions (18 total) led by expert facilitators were held for intervention groups. Surveys were administered at study onset and completion. Demographic and personal characteristics were collected. Burnout and burnout domains were the primary outcomes. Following convention, we defined burnout as a high emotional exhaustion or depersonalization score on the Maslach Burnout Inventory. Results All 51 eligible residents participated; 39 (76%) completed both surveys. Initial burnout prevalence (10 of 21 [48%] versus 7 of 17 [41%], P = .69), incidence of burnout at year end (9 of 11 [82%] versus 5 of 10 [50%], P = .18), and secondary outcomes were similar in intervention and control arms. More residents in the intervention group had high year-end depersonalization scores (18 of 21 [86%] versus 9 of 17 [53%], P = .04). Many intervention residents revealed that sessions did not truly free them from clinical or educational responsibilities. Conclusions A facilitated group discussion intervention did not decrease burnout in resident physicians. Future discussion-based interventions for reducing resident burnout should be voluntary and effectively free participants from clinical duties.
Penile Prosthesis First and Replacement Surgeries: Analysis of Patient and Partner Satisfaction.

PubMed

Lledó-García, Enrique; Jara-Rascón, José; Moncada Iribarren, Ignacio; Piñero-Sánchez, Javier; Aragón-Chamizo, Juan; Hernández-Fernández, Carlos

2015-07-01

Among the many treatments for erectile dysfunction, implantation of a penile prosthesis has been associated with high patient satisfaction rates. Prosthesis replacement has become an accepted procedure in the event of device malfunction or complications, but to our knowledge, there are no data regarding the impact of implant replacement on patients and partner satisfaction. The aim of our study was to assess and to compare the level of satisfaction, with a first or second penile prosthesis implantation (PPI), in men with refractory erectile dysfunction and their partners. A survey study based on a five-item questionnaire was carried out at our center between January 1999 and January 2012. The main outcome measure used was the level of patient and partner satisfaction with sexual intercourse after PPI. Of the 190 eligible patients, 149 (78%) completed the survey (110 underwent a first implant and 39 a reimplant). Seventy-nine percent of first-time implanted patients and 80% of the reimplanted patients (P > 0.05; not significant [ns]) reported satisfactory sexual intercourse (very or moderately satisfied), while 74% and 80% of their partners reported satisfactory intercourses, respectively (P > 0.05; ns). Overall, 73.7% of first implants and 70% of second implants reported that they would undergo the procedure again if the PPI failed (P > 0.05; ns). With regards to cosmetic aspects, 13% of the first implants' and 15% of second implants' partners reported either penile shortness or soft glans as the main causes of their dissatisfaction. Only 2.4% of first implants and 1% of reimplanted patients expressed difficulty in manipulating the device. PPI is successful in returning the ability for satisfactory sexual intercourse to both first implant and reimplanted patients and their respective partners. © 2015 International Society for Sexual Medicine.
78 FR 42528 - National Center for Complementary & Alternative Medicine; Notice of Closed Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-16

... Complementary & Alternative Medicine; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... Alternative Medicine Special Emphasis Panel RFA-AT-11-011: Mechanistic Research on CAM Natural Products (R01... Center for Complementary & Alternative Medicine, NIH, 6707 Democracy Blvd., Suite 401, Bethesda, MD 20892...
78 FR 66755 - National Center for Complementary & Alternative Medicine; Notice of Closed Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-06

... Complementary & Alternative Medicine; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... Alternative Medicine Special Emphasis Panel; RFA-AT14-001 and AT14- 002: SBIR Methods Development for Natural... Scientific Review, National Center for Complementary, & Alternative Medicine, NIH, 6707 Democracy Blvd...
75 FR 57970 - National Center for Complementary & Alternative Medicine; Notice of Closed Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-23

... Complementary & Alternative Medicine; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... Complementary and Alternative Medicine Special Emphasis Panel, Centers of Excellence for Research on CAM (CERC... Complementary, & Alternative Medicine, NIH, 6707 Democracy Blvd., Suite 401, Bethesda, MD 20892, 301-594-3456...
The First 2 Years of Activity of a Specialized Organ Procurement Center: Report of an Innovative Approach to Improve Organ Donation.

PubMed

Marsolais, P; Durand, P; Charbonney, E; Serri, K; Lagacé, A-M; Bernard, F; Albert, M

2017-06-01

The number of patients requiring organ transplants continues to outgrow the number of organs donated each year. In an attempt to improve the organ donation process and increase the number of organs available, we created a specialized multidisciplinary team within a specialized organ procurement center (OPC) with dedicated intensive care unit (ICU) beds and operating rooms. The OPC was staffed with ICU nurses, operating room nurses, organ donor management ICU physicians, and multidisciplinary staff. All organ donors within a designated geographic area were transferred to and managed within the OPC. During the first 2 years of operation, 126 patients were referred to the OPC. The OPC was in use for a total of 3527 h and involved 253 health workers. We retrieved 173 kidneys, 95 lungs, 68 livers, 37 hearts, and 13 pancreases for a total of 386 organs offered for transplantation. This translates to a total of 124.6 persons transplanted per million population, which compares most favorably to recently published numbers in developed countries. The OPC clearly demonstrates potential to increase the number of deceased donor organs available for transplant. Further studies are warranted to better understand the exact influence of the different components of the OPC on organ procurement. © 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.
Prevalence of Tramadol Consumption in First Seizure Patients; a One-Year Cross-sectional Study

PubMed Central

Asadi, Payman; Monsef Kasmaei, Vahid; Ziabari, Seyyed Zia; Zohrevandi, Behzad; Moadab Manesh, Aslan

2015-01-01

Introduction: Previous studies have shown that there is a probability of seizure even with therapeutic doses of tramadol. Yet, no accurate data exist regarding this problem in Iran. Therefore, the present study aimed to evaluate the prevalence of tramadol consumption in patients with first seizure referred to the emergency department (ED). Methods: In the present retrospective one-year cross-sectional study, all patients who were referred to the ED of Poursina Hospital, Rasht, Iran, with the complaint of first seizure were evaluated. Demographic data and data regarding history of tramadol consumption, duration, total dose, last dose, and time passed from the last dose of consumption were recorded and analyzed regarding the study questions using SPSS 20. Results: 383 (68.9%) out of the 556 patients referred to the ED, were experiencing their first seizure (mean age 26.43 ± 6.48 years; 70.5% male). 84 (21.9%) patients had recently used tramadol. History of seizure in the family of tramadol consumers was significantly lower (3.6% compared to 11%; p = 0.036). Mean total tramadol consumption dose in the last 24 hours was 140.17 ± 73.53 mg (range: 50-300 mg). Duration of tramadol consumption was less than 10 days in 84.5% (df: 2; χ2 = 96.1; p < 0.001). In addition, 62 (73.8%) patients had seizure within 6 hours of consumption (df: 3; χ2 = 29.5; p < 0.001). Conclusion: Results of the present study showed that 21.9% of the patients with first seizure had a history of tramadol consumption. Seizure following tramadol consumption is more prevalent in the initial 10 days and within 6 hours of consumption. In addition, it seems that lower doses of tramadol may also induce seizure. PMID:26495407
Clinical presentation and epidemiology of brain tumors firstly diagnosed in adults in the Emergency Department: a 10-year, single center retrospective study.

PubMed

Comelli, Ivan; Lippi, Giuseppe; Campana, Valentina; Servadei, Franco; Cervellin, Gianfranco

2017-07-01

Several patients with new onset brain tumors present to the Emergency Department (ED) complaining for new symptoms. Although information exists on symptom prevalence in the entire population of patients with brain tumors, little is known about the clinical presentation in ED. This retrospective study was planned to investigate clinical presentation and epidemiology of brain tumors firstly diagnosed in a large urban ED throughout a 10-year period. All medical records of patients aged ≥18 years, discharged from our ED with a diagnosis of brain tumor were retrieved from the electronic hospital database during a 10-year period (2006 to 2015). The records were reassessed for selecting only brain tumors firstly diagnosed in the ED. The symptoms at presentation were divided in six categories: (I) headache; (II) seizures; (III) focal signs; (IV) altered mental status; (V) nausea/vomiting/dizziness; (VI) trauma. For all cases, the hospital record was retrieved, to obtain histologic classification of tumors. Patients with inflammatory neoformations were excluded from the study. Overall, 205 patients with firstly diagnosed brain tumor were identified among 870,135 ED visits (i.e., <1%). Glial tumors were the most frequent (50% of the entire sample). No significant differences were found between mean age of patients in the different histologically based groups (meningiomas 66±14; glioblastomas 65±16 years; metastases 66±13 years; other miscellaneous 66±19 years). Focal signs accounted for more than 50% of all presentation signs/symptoms. First presentation of brain tumor in the ED is not a rare occurrence, so that the emergency physicians should be aware of this possibility.
Impact of Continued Mailed Fecal Tests in the Patient-Centered Medical Home: Year 3 of the Systems of Support to Increase Colon Cancer Screening and Follow-Up Randomized Trial

PubMed Central

Green, Beverly B.; Anderson, Melissa L.; Chubak, Jessica; Fuller, Sharon; Meenan, Richard T.; Vernon, Sally W.

2016-01-01

BACKGROUND The current study was conducted to determine the effect of continuing a centralized fecal occult blood test (FOBT) mailed program on screening adherence. METHODS A patient-level randomized controlled trial was conducted in 21 patient-centered medical home primary care clinics between January 2010 and November 2012. A total of 2208 patients ranging in age from 52 to 75 years in a substudy of the Systems of Support to Increase Colon Cancer Screening and Follow-Up (SOS) trial were randomized at year 3 to continued automated interventions (Continued group), which included mailed information regarding colorectal cancer (CRC) screening choices, and were mailed stool kit tests or to a group in which interventions were stopped (Stopped group). The main outcomes and measures were the completion of CRC screening in year 3 and by subgroup characteristics, respectively. RESULTS Adherence to CRC screening in year 3 was found to be significantly higher in patients in the Continued group compared with those in the Stopped group (53.3% vs 37.3%; adjusted net difference, 15.6% [P<.001]). This difference was entirely due to greater completion of FOBT (adjusted net difference, 18.0% [P<.001]). Year 3 CRC screening rates were highest in patients in the Continued group completing FOBT in both years 1 and 2 (77.2%), followed by patients completing only 1 FOBT in 1 of the 2 years (44.6%), with low rates of CRC testing reported among patients not completing any FOBT within the first 2 years (18.1%). CONCLUSIONS A centralized mailed FOBT CRC screening program continued to be more effective than patient-centered medical home usual-care interventions, but only for those patients who had previously completed FOBT testing. Research is needed regarding how to engage patients not completing CRC testing after being mailed at least 2 rounds of FOBT tests. PMID:26488332
Tell Me Your Story: A Pilot Narrative Medicine Curriculum During the Medicine Clerkship.

PubMed

Chretien, Katherine C; Swenson, Rebecca; Yoon, Bona; Julian, Ricklie; Keenan, Jonathan; Croffoot, James; Kheirbek, Raya

2015-07-01

Narrative medicine educational interventions may enhance patient-centered care, yet most educational interventions do not involve actual patient-provider interactions, nor do they assess narrative competence, a key skill for its practice. An experiential narrative medicine curriculum for medical students was developed and piloted. The purpose of the study was to develop narrative competence, practice attentive listening, and stimulate reflection. Participants were third-year medicine clerkship students. The curriculum involved 1) an introductory session, 2) a patient storytelling activity, and 3) a group reflection session. For the storytelling activity, students elicited illness narratives in storytelling form from patients, listened attentively, wrote their versions of the story, and then read them back to patients. Five student focus groups were conducted between July 2011 and March 2012 (n = 31; 66%) to explore students' experiences, student-patient dynamics, challenges, and what they learned. Patient interviews (n = 17) on their experience were conducted in January 2013. Thematic analysis of the audiotaped stories of ten patients and corresponding student-written stories helped gauge narrative competence. The curriculum was found to be feasible and acceptable to both patients and students. Some patients and students were profoundly moved. Ongoing focus groups resulted in continual process improvement. Students' stories showed attainment of narrative competence.
Differences between medical student and faculty perceptions of the competencies needed for the first year of residency.

PubMed

Fürstenberg, Sophie; Harendza, Sigrid

2017-11-09

Different guidelines and frameworks like the CanMEDs model or entrustable professional activities (EPAs) describe competencies required for successful and professional work of residents. Not all competencies are of equal importance for graduates when they start their residency. The aim of this study was to evaluate the relevance of different competencies for a first year resident from the perspective of physicians and medical students. In an online study, 178 of 475 surgeons and internists including residents and attendings and 102 of 728 first and last year undergraduate medical students from the University Medical Center Hamburg-Eppendorf ranked 25 competencies according to their relevance for entrustment decisions in first year residents. The rankings of the competencies by residents and attendings and by first year and last year medical student were compared. Additionally, the rankings were also compared to the literature. Physicians and medical students rated 'Responsibility' as the most important competency for first year residents. Physicians ranked 'Teamwork and collegiality' and 'Structure, work planning and priorities' within the top 10 competencies significantly higher than medical students. The competency ranks between attendings and residents only showed one significant difference between attendings and residents, where 'Coping with mistakes', was ranked significantly higher by residents. Medical students ranked 'Active listening to patients', 'Advising patients' and 'Handling emotions of patients and their relatives' significantly higher than physicians. Final year students ranked 'Structure, work planning and priorities', 'Coping with mistakes', and 'Verbal communication with colleagues and supervisors' significantly higher than first year students. Even though physicians and medical students agree that 'Responsibility' is the most important competency for entrustment decisions in the first year of residency, medical students rate competencies
Pharmacotherapeutic failure in a large cohort of patients with insomnia presenting to a sleep medicine center and laboratory: subjective pretest predictions and objective diagnoses.

PubMed

Krakow, Barry; Ulibarri, Victor A; McIver, Natalia D

2014-12-01

To measure the frequency of pharmacotherapeutic failure and its association with the diagnosis of sleep-disordered breathing among patients with chronic insomnia disorder. In a retrospective review of medical records from January 1, 2005, through December 31, 2012, we identified an inclusive, consecutive series of 1210 patients with insomnia disorder, 899 (74.3%) of whom used sleep aids either occasionally (168 [18.7%]) or regularly (731 [81.3%]). Patients presented to a community-based sleep medicine center in Albuquerque, New Mexico, with typical referral patterns: 743 (61.4%) were referred by primary care physicians, 211 (17.4%) by specialists, 117 (9.7%) by mental health professionals, and 139 (11.5%) by self-referral. Pharmacotherapeutic failure was assessed from subjective insomnia reports and a validated insomnia severity scale. Polysomnography with pressure transducer (an advanced respiratory technology not previously used in a large cohort of patients with insomnia) measured sleep-disordered breathing. Objective data yielded accuracy rates for 3 pretest screening tools used to measure risk for sleep-disordered breathing. Of the total sample of 1210 patients, all 899 (74.3%) who were taking over-the-counter or prescription sleep aids had pharmacotherapeutic failure. The 710 patients taking prescription drugs (79.0%) reported the most severe insomnia, the fewest sleep-associated breathing symptoms, and the most medical and psychiatric comorbidity. Of the 942 patients objectively tested (77.9%), 860 (91.3%) met standard criteria, on average, for a moderate to severe sleep-associated breathing disorder, yet pretest screening sensitivity for sleep-disordered breathing varied widely from 63.7% to 100%. Positive predictive values were high (about 90%) for all screens, but a tool commonly used in primary care misclassified 301 patients (32.0% false-negative results). Pharmacotherapeutic failure and sleep-disordered breathing were extremely common among treatment
Use of Alternative and Complementary Medicine in Patients with Malignant Diseases in High-Volume Cancer Center and Future Aspects

PubMed

Kust, Davor; Šamija, Ivan; Marić-Brozić, Jasmina; Svetec, Branka; Miletić, Marija; Mamić, Gordana; Bolanča, Ante; Kusić, Zvonko; Fröbe, Ana

2016-12-01

Usage of complementary and alternative medicine (CAM) is steadily increasing over the last decades, gaining medical, economic and sociological importance. The aim of the present study was to assess the use of complementary and alternative therapies in cancer patients. A cross-sectional, descriptive survey design was used to collect data through an anonymous questionnaire. A total of 267 patients were included in the study. The prevalence of CAM use among cancer patients in this study was 60.3%. It was found that 61 heterogeneous CAM therapies were used, the most popular among patients being naturopathy/folk medicine. In multivariate logistic regression analysis, independent predictors of CAM use were high income, divorced status, female sex and younger age. In conclusion, considering the fact that a large proportion of patients used at least one CAM approach, we need to continue our efforts to improve the patient-oncologist communication in order to deliver most reliable information to patients and to better understand the possible standard medicine-CAM interactions. According to results of the latest studies, CAM therapies that help manage pain, nausea, fatigue, anxiety, and other symptoms should be integrated into the patient overall care.
Rehabilitation for the management of knee osteoarthritis using comprehensive traditional Chinese medicine in community health centers: study protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background It is becoming increasingly necessary for community health centers to make rehabilitation services available to patients with osteoarthritis of the knee. However, for a number of reasons, including a lack of expertise, the small size of community health centers and the availability of only simple medical equipment, conventional rehabilitation therapy has not been widely used in China. Consequently, most patients with knee osteoarthritis seek treatment in high-grade hospitals. However, many patients cannot manage the techniques that they were taught in the hospital. Methods such as acupuncture, tuina, Chinese medical herb fumigation-washing and t’ai chi are easy to do and have been reported to have curative effects in those with knee osteoarthritis. To date, there have been no randomized controlled trials validating comprehensive traditional Chinese medicine for the rehabilitation of knee osteoarthritis in a community health center. Furthermore, there is no standard rehabilitation protocol using traditional Chinese medicine for knee osteoarthritis. The aim of the current study is to develop a comprehensive rehabilitation protocol using traditional Chinese medicine for the management of knee osteoarthritis in a community health center. Method/design This will be a randomized controlled clinical trial with blinded assessment. There will be a 4-week intervention utilizing rehabilitation protocols from traditional Chinese medicine and conventional therapy. Follow-up will be conducted for a period of 12 weeks. A total of 722 participants with knee osteoarthritis will be recruited. Participants will be randomly divided into two groups: experimental and control. Primary outcomes will include range of motion, girth measurement, the visual analogue scale, and results from the manual muscle, six-minute walking and stair-climbing tests. Secondary outcomes will include average daily consumption of pain medication, ability to perform daily tasks and health

Rehabilitation for the management of knee osteoarthritis using comprehensive traditional Chinese medicine in community health centers: study protocol for a randomized controlled trial.

PubMed

Yan, Hu; Su, Youxin; Chen, Lidian; Zheng, Guohua; Lin, Xueyi; Chen, Baojun; Zhou, Bihong; Zhang, Qing

2013-11-04

It is becoming increasingly necessary for community health centers to make rehabilitation services available to patients with osteoarthritis of the knee. However, for a number of reasons, including a lack of expertise, the small size of community health centers and the availability of only simple medical equipment, conventional rehabilitation therapy has not been widely used in China. Consequently, most patients with knee osteoarthritis seek treatment in high-grade hospitals. However, many patients cannot manage the techniques that they were taught in the hospital. Methods such as acupuncture, tuina, Chinese medical herb fumigation-washing and t'ai chi are easy to do and have been reported to have curative effects in those with knee osteoarthritis. To date, there have been no randomized controlled trials validating comprehensive traditional Chinese medicine for the rehabilitation of knee osteoarthritis in a community health center. Furthermore, there is no standard rehabilitation protocol using traditional Chinese medicine for knee osteoarthritis. The aim of the current study is to develop a comprehensive rehabilitation protocol using traditional Chinese medicine for the management of knee osteoarthritis in a community health center. This will be a randomized controlled clinical trial with blinded assessment. There will be a 4-week intervention utilizing rehabilitation protocols from traditional Chinese medicine and conventional therapy. Follow-up will be conducted for a period of 12 weeks. A total of 722 participants with knee osteoarthritis will be recruited. Participants will be randomly divided into two groups: experimental and control. Primary outcomes will include range of motion, girth measurement, the visual analogue scale, and results from the manual muscle, six-minute walking and stair-climbing tests. Secondary outcomes will include average daily consumption of pain medication, ability to perform daily tasks and health-related quality-of-life assessments
75 FR 35075 - National Center for Complementary & Alternative Medicine; Notice of Closed Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-21

... Complementary & Alternative Medicine; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... Alternative Medicine Special Emphasis Panel; PCCTR (U 19). Date: July 15-16, 2010. Time: 5 p.m. to 5 p.m..., Office of Scientific Review, National Center for Complementary, & Alternative Medicine, NIH, 6707...
Complementary medicine use in patients with head and neck cancer in Ireland.

PubMed

Amin, Mohamed; Glynn, F; Rowley, S; O'Leary, G; O'Dwyer, T; Timon, C; Kinsella, J

2010-08-01

The objectives of the study were: first, to determine the prevalence of traditional medicine (TM) and complementary and alternative medicine (CAM) use in head and neck cancer patients in Ireland; second, to educate ourselves on the plethora of CAM/TM options available to patients outside the dominion of conventional medicine. The study design consisted of a cross-sectional survey carried out in three head and neck cancer centres. Self-administered questionnaires were distributed to 110 head and neck cancer patients attending the three cancer centres and data were collected for statistical analysis. A total of 106 patients completed the questionnaire; 21.7% of the participants used CAM/TM since their diagnosis with head and neck cancer. CAM/TM usage was higher in female (34.3%) than in male patients (16.2%). CAM/TM use was more common in the 41-50-year age group, in patients with higher educational levels and those holding strong religious beliefs, and also in married than single patients. The most common types of CAM/TM used were spiritual and laying on of hands. The most common reasons reported for using CAM/TM were to counteract the ill effects of treatment and increase the body's ability to fight cancer. Sources of information on CAM/TM were friends (65%), family (48%) and media (21%). This survey reveals a high prevalence of CAM/TM use in head and neck cancer patients, hence emphasising the need for otolaryngologists to educate themselves on the various therapies available to be able to provide informative advice. There is an urgent need for evidence-based investigation of various CAM/TM therapies currently offered to patients.
Predictors of yoga use among internal medicine patients.

PubMed

Cramer, Holger; Lauche, Romy; Langhorst, Jost; Paul, Anna; Michalsen, Andreas; Dobos, Gustav

2013-07-13

Yoga seems to be an effective means to cope with a variety of internal medicine conditions. While characteristics of yoga users have been investigated in the general population, little is known about predictors of yoga use and barriers to yoga use in internal medicine patients. The aim of this cross-sectional analysis was to identify sociodemographic, clinical, and psychological predictors of yoga use among internal medicine patients. A cross-sectional analysis was conducted among all patients being referred to a Department of Internal and Integrative Medicine during a 3-year period. It was assessed whether patients had ever used yoga for their primary medical complaint, the perceived benefit, and the perceived harm of yoga practice. Potential predictors of yoga use including sociodemographic characteristics, health behavior, internal medicine diagnosis, general health status, mental health, satisfaction with health, and health locus of control were assessed; and associations with yoga use were tested using multiple logistic regression analysis. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for significant predictors. Of 2486 participants, 303 (12.19%) reported having used yoga for their primary medical complaint. Of those, 184 (60.73%) reported benefits and 12 (3.96%) reported harms due to yoga practice. Compared to yoga non-users, yoga users were more likely to be 50-64 years old (OR = 1.45; 95%CI = 1.05-2.01; P = 0.025); female (OR = 2.45; 95%CI = 1.45-4.02; P < 0.001); and college graduates (OR = 1.61; 95%CI = 1.14-2.27; P = 0.007); and less likely to currently smoke (OR = 0.61; 95%CI = 0.39-0.96; P = 0.031). Manifest anxiety (OR = 1.47; 95%CI = 1.06-2.04; P = 0.020); and high internal health locus of control (OR = 1.92; 95%CI = 1.38-2.67; P < 0.001) were positively associated with yoga use, while high external-fatalistic health locus of control (OR = 0.66; 95%CI = 0.47-0.92; P = 0.014) was negatively associated with yoga use. Yoga was
Bringing Rounds Back to the Patient: A One-Year Evaluation of the Chiefs' Service Model for Inpatient Teaching.

PubMed

Bennett, Nadia L; Flesch, Judd D; Cronholm, Peter; Reilly, James B; Ende, Jack

2017-04-01

The Chiefs' Service (CS), a structured approach to inpatient teaching rounds, focuses on resident education and patient-centered care without disrupting patient census sizes or admitting cycles. It has five key elements: morning huddles; bedside rounds; diagnostic "time-outs"; day-of-discharge rounds; and postdischarge follow-up rounds. The authors hypothesized the CS model would be well received by residents and considered more effective than more-traditional rounds. The CS was implemented on Penn Presbyterian Medical Center's general medicine inpatient service using a quasi-experimental design. Its first year (January 2013-January 2014) was evaluated with a mixed-methods approach. Residents completed end-of-rotation evaluation questionnaires; 20 CS and 10 traditional service (TS) residents were interviewed. Measures of resident agreement on questionnaire items were compared across groups using independent sample t testing. A modified grounded theory approach was used to assess CS residents' perspectives on the CS elements and identify emergent themes. The questionnaires were completed by 183/188 residents (response rate 97%). Compared with TS residents, CS residents reported significantly greater satisfaction in the domains of resident education and patient care, and they rated the overall value of the rotation significantly higher. The majority of CS residents found the CS elements to be effective. CS residents described the CS as focused on resident education, patient-centered care, and collaboration with an interdisciplinary team. The CS approach to inpatient rounding is seen by residents as valuable and is associated with positive outcomes in terms of residents' perceptions of learning, interdisciplinary communication, and patient care.
Effect of Weekend Admissions on the Treatment Process and Outcomes of Internal Medicine Patients

PubMed Central

Huang, Chun-Che; Huang, Yu-Tung; Hsu, Nin-Chieh; Chen, Jin-Shing; Yu, Chong-Jen

2016-01-01

Abstract Many studies address the effect of weekend admission on patient outcomes. This population-based study aimed to evaluate the relationship between weekend admission and the treatment process and outcomes of general internal medicine patients in Taiwan. A total of 82,340 patients (16,657 weekend and 65,683 weekday admissions) aged ≥20 years and admitted to the internal medicine departments of 17 medical centers between 2007 and 2009 were identified from the Taiwan National Health Insurance Research Database. A generalized estimating equation (GEE) analysis was used to compare patients admitted on weekends and those admitted on weekdays. Patients who were admitted on weekends were more likely to undergo intubation (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.16–1.39; P < 0.001) and/or mechanical ventilation (OR, 1.25; 95% CI, 1.15–1.35; P < 0.001), cardio-pulmonary resuscitation (OR: 1.45; 95% CI: 1.05–2.01; P = 0.026), and be transferred to the intensive care unit (ICU) (OR: 1.16; 95% CI: 1.03–1.30; P = 0.015) compared with those admitted on weekdays. Weekend-admitted patients also had higher odds of in-hospital mortality (OR: 1.19; 95% CI: 1.09–1.30; P < 0.001) and hospital treatment cost (OR: 1.04; 95% CI: 1.01–1.06; P = 0.008) than weekday-admitted patients. General internal medicine patients who were admitted on weekends experienced more intensive care procedures and higher ICU admission, in-hospital mortality, and treatment cost. Intensive care utilization may serve as early indicator of poorer outcomes and a potential entry point to offer preventive intervention before proceeding to intensive treatment. PMID:26871788
The Role of the Library in the First College Year. The First-Year Experience Monograph Series No. 45

ERIC Educational Resources Information Center

Hardesty, Larry, Ed.

2007-01-01

While the library is at the center of many campuses physically, it is often an overlooked and underused resource in improving the learning and success of first-year college students. Librarians, classroom faculty, administrators, and higher education researchers come together to explore the potential of the library in shaping the student…
Diabetes Stories: Use of Patient Narratives of Diabetes to Teach Patient-Centered Care

ERIC Educational Resources Information Center

Kumagai, Arno K.; Murphy, Elizabeth A.; Ross, Paula T.

2009-01-01

A critical component to instituting compassionate, patient-centered diabetes care is the training of health care providers. Our institution developed the Family Centered Experience (FCE), a comprehensive 2-year preclinical program based on longitudinal conversations with patients about living with chronic illness. The goal of the FCE is to explore…
A Student-Led Introduction to Lesbian, Gay, Bisexual, and Transgender Health for First-Year Medical Students.

PubMed

Grosz, Andrea M; Gutierrez, Daniel; Lui, Andrea A; Chang, Julia J; Cole-Kelly, Kathy; Ng, Henry

2017-01-01

Lesbian, gay, bisexual, and transgender (LGBT) individuals face significant health disparities. This is in part because many physicians are not sensitive to, and/or are underprepared to address, LGBT-specific concerns. To help meet this need, we, a group of second- and fourth-year medical students with faculty oversight, organized a session on LGBT health for first-year medical students. The three second-year and one fourth-year student authors designed a mandatory session for the 167 first-years at Case Western Reserve University School of Medicine in Cleveland, OH. The 2-hour session consisted of a student-delivered presentation, a patient panel, and a small-group session. Students' LGBT health knowledge and confidence in providing care were assessed anonymously before and after the session, and individuals' pre- and post-session assessments were paired using student-generated identifiers. A total of 73 complete, matched pre-/post-session assessments were received. Students' familiarity with LGBT terminology and demographics increased significantly after the session. Students' perceived preparedness and comfort in providing LGBT-specific care significantly improved in most areas as well. Students strongly praised the session, in particular the patient panel. A student-led educational session on LGBT health can effectively improve first-year medical students' LGBT knowledge and confidence to provide care.
Association between gastrointestinal bleeding and 3-year mortality in patients with acute, first-ever ischemic stroke.

PubMed

Chou, Yu-Fang; Weng, Wei-Chieh; Huang, Wen-Yi

2017-10-01

The influence of gastrointestinal bleeding on clinical presentation and outcomes of patients with acute ischemic stroke remains controversial. We investigate the effect of gastrointestinal bleeding on the outcomes of patients with acute, first-ever ischemic stroke. We enrolled 934 patients with acute, first-ever ischemic stroke and followed up them for 3years. Patients were divided into 2 groups according to the presence or absence of gastrointestinal bleeding during acute stroke stage. Clinical presentation, stroke risk factors, laboratory data, co-morbidities, and outcomes were recorded. Seventy-six (8.1%) patients had gastrointestinal bleeding at admission. The prevalence of old age, atrial fibrillation, and previous transient ischemic attack was higher in patients with gastrointestinal bleeding (P<0.001, P=0.038, and P=0.018, respectively). Total anterior circulation syndrome occurred more frequently among patients with gastrointestinal bleeding (P<0.001). The mean length of acute ward stay, initial impaired consciousness, and stroke in evolution were higher in patients with gastrointestinal bleeding (P<0.001, P<0.001, and P<0.001, respectively). The occurrence of pneumonia and dependent functional outcome were higher in patients with gastrointestinal bleeding (P<0.001 and P<0.001, respectively). A multivariate Cox regression analysis revealed that gastrointestinal bleeding is a significant risk factor for 3-year all-cause mortality (hazard ratio=2.76; 95% confidence interval=1.61-4.72; P<0.001). In conclusion, gastrointestinal bleeding is associated with increased risk of 3-year mortality in patients with acute, first-ever ischemic stroke. Prophylactic therapies for gastrointestinal bleeding might improve ischemic stroke outcome. Copyright © 2017 Elsevier Ltd. All rights reserved.
Breast cancer patients' satisfaction with individual therapy goals and treatment in a standardized integrative medicine consultancy service.

PubMed

Hack, Carolin C; Antoniadis, Sophia; Hackl, Janina; Langemann, Hanna; Schwitulla, Judith; Fasching, Peter A; Beckmann, Matthias W; Theuser, Anna-Katharin

2018-07-01

Complementary medicine services are nowadays usually quite heterogeneous, and little information is available on standards for running an integrative medicine consultancy service. This study aimed to assess patients' satisfaction with a standardized treatment service on integrative medicine. Using a cross-sectional design, 75 breast cancer patients from the integrative medicine consultancy service at the University Breast Center for Franconia were evaluated between January 2016 and March 2017. At primary consultation, patients answered a standardized questionnaire on their medical history and treatment goals regarding integrative medicine. In a subsequent interview, patients evaluated their satisfaction with the treatment service and individual treatment goals. 72% of the patients (n = 54) reported high satisfaction with the overall approach of the treatment service. 76% of the patients (n = 57) were very satisfied or satisfied with their individual treatment plans. The most frequently reported goals were to slow tumor progression (n = 64, 85.3%), reducing the side effects of conventional cancer treatments (n = 60, 80%), and a desire to participate actively in the treatment of breast cancer (n = 64, 85.3%). Using a standardized procedure in integrative medicine allows a high quality level to be offered to patients. Overall, breast cancer patients report very high satisfaction with the integrative medicine consultancy service and state long-term treatment goals. Hence, long-term treatment with integrative medicine methods should be taken into consideration.
Patients first! Engaging the hearts and minds of nurses with a patient-centered practice model.

PubMed

Small, Deborah C; Small, Robert M

2011-05-31

Like every healthcare system today, the Cleveland Clinic health system is a combination of medical hospitals, institutes, and services in which the implementation of uniform care methodologies faces significant barriers. The guiding principle of the Cleveland Clinic, 'Patients First,' focuses on the principle of patient- and family-centered care (PFCC) but deliberately lacks details due to the wide scope of care delivered by the organization. The Stanley Shalom Zielony Institute of Nursing Excellence (the Nursing Institute) at the Cleveland Clinic was charged with standardizing nursing practice across a system with 11,000 registered nurses and 800 advanced practice nurses. The challenge involved providing firm direction on delivering PFCC that was appropriate for all clinical disciplines and could be implemented quickly across existing practices and technologies. Successful implementation required full engagement in the concept of PFCC by what the Institute for Healthcare Improvement has termed the 'hearts and minds' of nurses. To achieve these ends, development of a systemwide nursing practice model was initiated. In this article the authors identify the essence of PFCC, consider barriers to PFCC, review their process of developing PFCC, and describe how the Cleveland Clinic health system has implemented a PFCC nursing practice model. In doing so the authors explore how the concept of 'Passion for Nursing' was used to stimulate nurse engagement in PFCC.
Applying patient centered approach in management of pulmonary tuberculosis: A case report from Malaysia.

PubMed

Atif, M; Sulaiman, Sas; Shafi, Aa; Muttalif, Ar; Ali, I; Saleem, F

2011-06-01

A 24 year university student with history of productive cough was registered as sputum smear confirmed case of pulmonary tuberculosis. During treatment, patient suffered from itchiness associated with anti tuberculosis drugs and was treated with chlorpheniramine (4mg) tablet. Patient missed twenty eight doses of anti tuberculosis drugs in continuation phase claiming that he was very busy in his studies and assignments. Upon questioning he further explained that he was quite healthy after five months and unable to concentrate on his studies after taking prescribed medicines. His treatment was stopped based on clinical improvement, although he did not complete six months therapy. Two major reasons; false perception of being completely cured and side effects associated with anti TB drugs might be responsible for non adherence. Non sedative anti histamines like fexofenadine, citrizine or loratidine should be preferred over first generation anti histamines (chlorpheniramine) in patients with such lifestyle. Patient had not completed full course of chemotherapy, which is preliminary requirement for a case to be classified as "cure" and "treatment completed". Moreover, patient had not defaulted for two consecutive months. Therefore, according to WHO treatment outcome categories, this patient can neither be classified as "cure" or "treatment completed" nor as "defaulter". Further elaboration of WHO treatment outcome categories is required for adequate classification of patients with similar characteristics. Likelihood of non adherence can be significantly reduced by applying the WHO recommended "Patient Centered Approach" strategy. Close friend, class mate or family member can be selected as treatment supporter to ensure adherence to treatment.
76 FR 30735 - National Center for Complementary & Alternative Medicine; Notice of Closed Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-26

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Center for Complementary & Alternative Medicine; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... Alternative Medicine [[Page 30736
[The synopsis of results of the 20 year activities of the Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University (Sechenovsky University)].

PubMed

Pigolkin, Yu I; Lomakin, Yu V; Zolotenkova, G V; Shilova, M A; Dubrovin, I A; Leonova, E N; Khodulapov, A V

The present article was designed to summarize the results of the 20 year scientific, practical, and educational activities of the Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University (Sechenovsky University). The main directions of the research work and achievements of the Department's staff are described, and the prospects for its further development are highlighted. The new approaches to and technologies for the teaching and training specialists in forensic medicine are introduced to meet the novel requirements imposed in the framework of the ongoing reform of higher medical education in accordance with the main principles of the Bologna declaration.
Medicinal marijuana for epilepsy: a case series study.

PubMed

Ladino, Lady Diana; Hernández-Ronquillo, Lizbeth; Téllez-Zenteno, José Francisco

2014-11-01

To describe the social, clinical and use-patterns characteristics of medicinal marijuana use among patients with epilepsy (PWEs). Eighteen PWEs with prescriptions for medicinal marijuana from a Canadian adult-epilepsy clinic were included in this study. Eighteen patients had a prescription of medicinal marijuana from a total population of 800 PWEs in our center (2.2%). Mean age of patients was 30±7.4 (19-50) years. Twelve (67%) patients were males. Eleven (61%) patients had drug-resistant epilepsy. Eleven (61%) patients suffered a psychiatric comorbidity and reported the use of illicit substances or heavy alcohol or tobacco consumption. Only two (11%) patients were married; the rest of patients (89%) were single or divorced. The drug use pattern was similar among patients. All patients asked for marijuana permission in the epilepsy clinic. Most (83%) had a previous history of marijuana smoking, with a mean of 6.6±3 (1-15) years. The mean consumption dose was 2.05±1.8 (0.5-8) grams per day. Ten (56%) patients reported withdrawal seizure exacerbation when they stopped the marijuana. Only two patients (11%) reported side effects, and all patients found medicinal marijuana very helpful for seizure control and improvement of mood disorder. PWEs using medicinal marijuana have a common profile. They are usually young single men with drug-resistant epilepsy and psychiatric comorbidity. Most used marijuana before formal prescription and all believe the drug was effective on their seizure control. Because of the concurrent use of other antiseizure medications, it is complex to estimate the actual effect of marijuana.
The deaf strong hospital program: a model of diversity and inclusion training for first-year medical students.

PubMed

Thew, Denise; Smith, Scott R; Chang, Christopher; Starr, Matt

2012-11-01

Recent research indicates that the cultural competence training students receive during medical school might not adequately address the issues that arise when caring for patients of different cultures. Because of their unique communication, linguistic, and cultural issues, incorporating deaf people who use sign language into cultural competence education at medical schools might help to bridge this gap in cross-cultural education. The Deaf Strong Hospital (DSH) program at the University of Rochester School of Medicine and Dentistry, started in 1998, exposes first-year medical students to the issues that are relevant to providing effective patient care and to establishing multicultural sensitivity early in their medical education. Because medical students better acquire cross-cultural competence through hands-on experience rather than through lectures, the DSH program, which includes a role-reversal exercise in which medical students play the role of the patients, provides such a model for other medical schools and health care training centers to use in teaching future health care providers how to address the relevant cultural, linguistic, and communication needs of both their deaf patients and their non-English-speaking patients. This article describes the DSH program curriculum, shares findings from both medical students' short-term and long-term postprogram evaluations, and provides a framework for the implementation of a broader cultural and linguistic sensitivity training program specific to working with and improving the quality of health care among deaf people.
Planning a new library in an age of transition: the Washington University School of Medicine Library and Biomedical Communications Center.

PubMed Central

Crawford, S; Halbrook, B

1990-01-01

In an era of great technological and socioeconomic changes, the Washington University School of Medicine conceptualized and built its first Library and Biomedical Communications Center in seventy-eight years. The planning process, evolution of the electronic library, and translation of functions into operating spaces are discussed. Since 1983, when the project was approved, a whole range of information technologies and services have emerged. The authors consider the kind of library that would operate in a setting where people can do their own searches, order data and materials through an electronic network, analyze and manage information, and use software to create their own publications. Images PMID:2393757
One hundred years since the birth of academician Dimitar Arsov, founder and nestor of the modern internal medicine in the Republic of Macedonia.

PubMed

Polenaković, M

2013-01-01

Dimitar Arsov was born in Kriva Palanka on September 28, 1908 and died on July 2, 1974 in Skopje; he had finished elementary education in Kriva Palanka, high school (1922-1926) in Kumanovo, Macedonia and Col-lege of Medicine (1926-1932), Ph. D. University of Paris, Sorbone, France, 1936. He returned to Macedonia in 1937. In 1947 he was elected and Assistant Professor and in 1950 a Docent at the Faculty of Medicine in Skopje. He was appointed Director of the Clinic of Medicine and Head of the Chair of Internal Medicine, who served at those positions in the period 1952-74. In 1958 he was elected Professor of Internal Medicine. The first habilitation of the Medical Faculty in Skopje was defended by D. Arsov in 1954, titled: "The Effects of the Intravenous Epinephrine on the Hypersplenism of Malaria and Cala-Azar". On August 18, 1967, D. Arsov was elected Full Member and also the first member in the field of medicine of the Macedonian Academy of Sciences and Arts. The excellent experience in the work with the patients, precise observation of the symptoms and syndromes of the diseases in each patient, knowing the most advanced therapy at that time enabled D. Arsov to make conclusion for possibility of new therapy and gave him the material for writing scientific papers. In the first half of the 50s, during his regular work, Arsov discovers a new, internationally recognized therapy for rheumatism. Patients of both Cala-Azar and inflammatory rheumatism were treated with small doses of adrenaline therapy and they felt drastic decrease in rheumatism inflammation within one week. This therapy was used a couple of years in several countries around the world. He participated in the undergraduate and graduate studies. He contributed to the development of 2,240 graduated doctors and under his management over 300 doctors specialized in internal medicine and became specialists internists. Under his management, numerous habilitations and dissertations in internal medicine were
Academic retainer medicine: an innovative business model for cross-subsidizing primary care.

PubMed

Lucier, David J; Frisch, Nicholas B; Cohen, Brian J; Wagner, Michael; Salem, Deeb; Fairchild, David G

2010-06-01

Retainer-medicine primary care practices, commonly referred to as "luxury" or "concierge" practices, provide enhanced services to patients beyond those available in traditional practices for a yearly retainer fee. Adoption of retainer practices has been largely absent in academic health centers (AHCs). Reasons for this trend stem primarily from ethical concerns, such as the potential for patient abandonment when physicians downsize from larger, traditional practices to smaller, retainer-medicine practices.In 2004, the Department of Medicine at Tufts Medical Center developed an academic retainer-medicine primary care practice within the Division of General Medicine that not only generates financial support for the division but also incorporates a clinical and business model that is aligned with the mission and ethics of an academic institution.In contrast to private retainer-medicine practices, this unique business model addresses several of the ethical issues associated with traditional retainer practices-it does not restrict net access to care and it neutralizes concerns about patient abandonment. Addressing the growing primary care shortage, the model also presents the opportunity for a retainer practice to cross-subsidize the expansion of general medicine in an academic medical setting. The authors elucidate the benefits, as well as the inherent challenges, of embedding an academic retainer-medicine practice within an AHC.

Consumerism: forcing medical practices toward patient-centered care.

PubMed

Ozmon, Jeff

2007-01-01

Consumerism has been apart of many industries over the years; now consumerism may change the way many medical practices deliver healthcare. With the advent of consumer-driven healthcare, employers are shifting the decision-making power to their employees. Benefits strategies like health savings accounts and high-deductible insurance plans now allow the patients to control how and where they spend their money on medical care. Practices that seek to attract the more affluent and informed consumers are beginning to institute patient-centered systems designs that invite patients to actively participate in their healthcare. This article will outline the changes in the healthcare delivery system facing medical practices, the importance of patient-centered care, and six strategies to implement to change toward more patient-centered care.
Developing a patient-centered outcome measure for complementary and alternative medicine therapies II: Refining content validity through cognitive interviews

PubMed Central

2011-01-01

Background Available measures of patient-reported outcomes for complementary and alternative medicine (CAM) inadequately capture the range of patient-reported treatment effects. The Self-Assessment of Change questionnaire was developed to measure multi-dimensional shifts in well-being for CAM users. With content derived from patient narratives, items were subsequently focused through interviews on a new cohort of participants. Here we present the development of the final version in which the content and format is refined through cognitive interviews. Methods We conducted cognitive interviews across five iterations of questionnaire refinement with a culturally diverse sample of 28 CAM users. In each iteration, participant critiques were used to revise the questionnaire, which was then re-tested in subsequent rounds of cognitive interviews. Following all five iterations, transcripts of cognitive interviews were systematically coded and analyzed to examine participants' understanding of the format and content of the final questionnaire. Based on this data, we established summary descriptions and selected exemplar quotations for each word pair on the final questionnaire. Results The final version of the Self-Assessment of Change questionnaire (SAC) includes 16 word pairs, nine of which remained unchanged from the original draft. Participants consistently said that these stable word pairs represented opposite ends of the same domain of experience and the meanings of these terms were stable across the participant pool. Five pairs underwent revision and two word pairs were added. Four word pairs were eliminated for redundancy or because participants did not agree on the meaning of the terms. Cognitive interviews indicate that participants understood the format of the questionnaire and considered each word pair to represent opposite poles of a shared domain of experience. Conclusions We have placed lay language and direct experience at the center of questionnaire revision
Current presentation and management of 7148 patients with atrial fibrillation in cardiology and internal medicine hospital centers: the ATA AF study.

PubMed

Di Pasquale, Giuseppe; Mathieu, Giovanni; Maggioni, Aldo Pietro; Fabbri, Gianna; Lucci, Donata; Vescovo, Giorgio; Pirelli, Salvatore; Chiarella, Francesco; Scherillo, Marino; Gulizia, Michele Massimo; Gussoni, Gualberto; Colombo, Fabrizio; Panuccio, Domenico; Nozzoli, Carlo; Berisso, Massimo Zoni

2013-09-10

Atrial fibrillation (AF) is associated with a high risk of stroke and mortality. To describe the difference in AF management of patients (pts) referred to Cardiology (CARD) or Internal Medicine (MED) units in Italy. From May to July 2010, 360 centers enrolled 7148 pts (54% in CARD and 46% in MED). Median age was 77 years (IQR 70-83). Hypertension was the most prevalent associated condition, followed by hypercholesterolemia (28.9%), heart failure (27.7%) and diabetes (24.3%). MED pts were older, more frequently females and more often with comorbidities than CARD pts. In the 4845 pts with nonvalvular AF, a CHADS2 score ≥ 2 was present in 53.0% of CARD vs 75.3% of MED pts (p<.0001). Oral anticoagulants (OAC) were prescribed in 64.2% of CARD vs 46.3% of MED pts (p<.0001); OAC prescription rate was 49.6% in CHADS2 0 and 56.2% in CHADS2 score ≥ 2 pts. At the adjusted analysis patients managed in MED had a significantly lower probability to be treated with OAC. Rate control strategy was pursued in 51.4% of the pts (60.5% in MED and 43.6% in CARD) while rhythm control was the choice in 39.8% of CARD vs 12.9% of MED pts (p<.0001). Cardiologists and internists seem to manage pts with large epidemiological differences. Both CARD and MED specialists currently fail to prescribe OAC in accordance with stroke risk. Patients managed by MED specialists have a lower probability to receive an OAC treatment, irrespective of the severity of clinical conditions. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Project ASPIRE: Incorporating Integrative Medicine Into Residency Training

PubMed Central

Nawaz, Haq; Via, Christina M.; Ali, Ather; Rosenberger, Lisa D.

2016-01-01

Griffin Hospital, a community hospital affiliated with Yale School of Public Health and Yale School of Medicine, received Health Resources and Services Administration funding to strengthen and improve its combined internal medicine and general preventive medicine residency program by incorporating an integrative medicine curriculum. The purpose of project ASPIRE (Advancing Skills of Preventive medicine residents through Integrative medicine Education, Research and Evaluation) was to create, implement, and evaluate a needs-based, innovative training curriculum in integrative medicine. Through this robust new training, the authors aimed to produce preventive medicine-trained physicians with competencies in integrative medicine to collaboratively work with other integrative medicine practitioners in interdisciplinary teams to provide holistic, patient-centered care. The multifaceted collaborative curriculum was composed of didactics, grand rounds, journal club, objective structured clinical examinations, and two new practicum rotations in integrative medicine. The new practicum rotations included block rotations at the Integrative Medicine Center at Griffin Hospital and the Yale Stress Center. Between 2012 and 2014, three cohorts participated in the curriculum; two of these cohorts included three advanced preventive medicine residents each and the fourth included four residents. Project faculty conducted 14 lectures and journal clubs, and two grand rounds. Six of the ten participating residents (60%) completed integrative medicine clinical rotations. Residents’ attitudes toward integrative medicine were evaluated through self-assessment using the Complementary, Alternative, and Integrative Medicine Attitudes Questionnaire; data were analyzed in 2015. This article describes the results of this prospective observational study based on single-institution experience over the course of the 2-year project period. PMID:26477907
First-year dental students' motivation and attitudes for choosing the dental profession.

PubMed

Avramova, Nadya; Yaneva, Krassimira; Bonev, Boyko

2014-01-01

To determine first-year dental students' current motivation and attitudes for choosing the dental profession at the Faculty of Dental Medicine, Medical University - Sofia, Bulgaria. An anonymous questionnaire, consisting of 12 questions about students' socio-demographic profile and their motivation for choosing dentistry, was administered to 119 first-year dental students at the Faculty of Dental Medicine of the Medical University of Sofia. The study was conducted at the beginning of the 2012-2013 academic year. The data was processed and analyzed with the following software: Microsoft Windows Server 2008 R2; Microsoft SQL Server 2008; Internet Information Server 7.5.; Microsoft SharePoint Server 2010. The majority of the students (73%) were self-motivated for choosing dentistry as a career; 61% of them did not have relatives in the medical profession; 43% chose dental medicine because it is a prestigious, humane and noble profession; 50% - for financial security; 59% - because of the independence that it provides. There were no significant differences in the motivation between males and females. Independence, financial security and 'prestige' were the predominant motivating factors in this group of first-year dental students. Determining the reasons for choosing dentistry has important implications for the selection and training of students as well as for their future job satisfaction. Copyright © 2014 by Academy of Sciences and Arts of Bosnia and Herzegovina.
Student-centered tutoring as a model for patient-centeredness and empathy

PubMed Central

Meirovich, Adaya; Ber, Rosalie; Moore, Michael; Rotschild, Avi

2016-01-01

Background Curriculum planners and medical teachers attempt to enhance medical students’ empathy and patient-centeredness. Despite educational efforts, there is stability in medical students’ empathy and patient-centered medicine during the preclinical stage and a decline in both of them throughout the clinical years. Student–tutor relationship plays a key role in students’ learning. This study tests the effect of learner-centered tutoring on students’ empathy, patient-centeredness, and behavior. Participants and methods The cohort of 55 students was divided into groups of seven or eight. The experimental group’s tutors underwent LC mentoring. Empathy was assessed with the Jefferson Scale of Physician Empathy for Students; PC attitude was assessed with the Patient–Provider Orientation Scale (PPOS). Behavior was assessed by simulations of doctor–patient encounters with 32 students at the end of the third year. Each student participated in three such simulations, during which we analyzed ten aspects of physician–patient communication via Roter interaction analysis system (RIAS)-coded audiotapes. Results A significant group difference was found for three RIAS categories: building a relationship and patient-centeredness, where the mean percentage of the experimental group was significantly higher than that of the control group, and gathering data, where the mean percentage of the experimental group was significantly lower than that of the control group. A significant correlation was found in the experimental group between empathy and positive talk and between PPOS and three of the RIAS categories: gathering data, psychosocial talk, and patient-centeredness. A significant negative correlation was found in the experimental group between PPOS and two of the RIAS categories: negative talk and doctor–centeredness. Two significant negative correlations were found in the control group: between empathy and patient-centeredness and PPOS and negative talk
Health status, resource consumption, and costs of dysthymia. A multi-center two-year longitudinal study.

PubMed

Barbui, Corrado; Motterlini, Nicola; Garattini, Livio

2006-02-01

In this study we estimated the health status, resource consumption and costs of a large cohort of patients with early and late-onset dysthymia. The DYSCO (DYSthymia COsts) project is a multi-center observational study which prospectively followed for two years a randomly chosen sample of patients with dysthymia in the Italian primary health care system. A total of 501 patients were followed for two years; 81% had early-onset dysthymic disorder. During the study, improvement was seen in most domains of the 36-Item Short Form Health Survey (SF-36) questionnaire. Comparison of the SF-36 scores for the two groups showed that only the physical health index significantly differed during the two years. The use of outpatient consultations, laboratory tests and diagnostic procedures was similar in the two groups, but patients with early-onset dysthymia were admitted significantly more than late-onset cases. Hospital admissions were almost entirely responsible for the higher total cost per patient per year of early-onset dysthymia. A first limitation of this study is that general practitioners were selected on the basis of their willingness to participate, not at random; secondly, no information was collected on concomitant psychiatric comorbidities. The present study provides the first prospective, long-term data on service use and costs in patients with dysthymia. Differently from patients with early-onset dysthymia, patients with late-onset dysthymia were admitted less and cost less.
The Chromosome 18 Clinical Resource Center.

PubMed

Cody, Jannine D; Hasi-Zogaj, Minire; Heard, Patricia; Hill, Annice; Rupert, David; Sebold, Courtney; Soileau, Bridgette; Hale, Daniel E

2018-05-01

The Chromosome 18 Clinical Research Center has created a pediatrician-friendly virtual resource center for managing patients with chromosome 18 abnormalities. To date, children with rare chromosome abnormalities have been cared for either symptomatically or palliatively as a reaction to the presenting medical problems. As we enter an era of genomic-informed medicine, we can provide children, even those with individually unique chromosome abnormalities, with proactive medical care and management based on the most contemporary data on their specific genomic change. It is problematic for practicing physicians to obtain and use the emerging data on specific genes because this information is derived from diverse sources (e.g., animal studies, case reports, in vitro explorations) and is often published in sources that are not easily accessible in the clinical setting. The Chromosome 18 Clinical Resource Center remedies this challenging problem by curating and synthesizing the data with clinical implications. The data are collected from our database of over 26 years of natural history and medical data from over 650 individuals with chromosome 18 abnormalities. The resulting management guides and video presentations are a first edition of this collated data specifically oriented to guide clinicians toward the optimization of care for each child. The chromosome 18 data and guides also serve as models for an approach to the management of any individual with a rare chromosome abnormality of which there are over 1,300 born every year in the US alone. © 2018 The Authors. Molecular Genetics & Genomic Medicine published by Wiley Periodicals, Inc.
75 FR 1796 - National Center for Complementary and Alternative Medicine; Notice of Closed Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-13

... Complementary and Alternative Medicine; Notice of Closed Meetings Pursuant to section 10(d) of the Federal... Alternative Medicine Special Emphasis Panel, Clinical Science-- Review of NCCAM Clinical R21 and K..., National Center for Complementary, and Alternative Medicine, NIH, 6707 Democracy Blvd., Suite 401, Bethesda...
75 FR 30039 - National Center for Complementary and Alternative Medicine; Notice of Closed Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-28

... Complementary and Alternative Medicine; Notice of Closed Meetings Pursuant to section 10(d) of the Federal... Complementary and Alternative Medicine Special Emphasis Panel; Education Panel. Date: June 24-25, 2010. Time: 5... of Committee: National Center for Complementary and Alternative Medicine Special Emphasis Panel; RFA...
Complementary, alternative, integrative, or unconventional medicine?

PubMed

Penson, R T; Castro, C M; Seiden, M V; Chabner, B A; Lynch, T J

2001-01-01

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded the Kenneth B. Schwartz Center. The Schwartz Center is a non-profit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and sustenance to the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. Interest in complementary and alternative medicine (CAM) has grown exponentially in the past decade, fueled by Internet marketing, dissatisfaction with mainstream medicine, and a desire for patients to be actively involved in their health care. There is a large discordance between physician estimates and reported prevalence of CAM use. Many patients do not disclose their practices mainly because they believe CAM falls outside the rubric of conventional medicine or because physicians do not ask. Concern about drug interactions and adverse effects are compounded by a lack of Food and Drug Administration regulation. Physicians need to be informed about CAM and be attuned to the psychosocial needs of patients.
Violence against health workers in Family Medicine Centers.

PubMed

Al-Turki, Nouf; Afify, Ayman Am; AlAteeq, Mohammed

2016-01-01

Health care violence is a significant worldwide problem with negative consequences on both the safety and well-being of health care workers as well as workplace activities. Reports examining health care violence in Saudi Arabia are limited and the results are conflicting. To estimate the prevalence and determine the demographic and occupational characteristics associated with workplace violence in primary care centers in Riyadh, Saudi Arabia. A cross-sectional study included 270 health care workers in 12 family medicine centers in Riyadh during November and December 2014. A structured self-administered questionnaire was used to estimate the frequency, timing, causes, reactions, and consequences of workplace violence plus participants' demographic and occupational data. A total 123 health care workers (45.6%) experienced some kind of violence over 12 months prior to the study. These included physical (6.5%) and nonphysical violence (99.2%), including verbal violence (94.3%) and intimidation (22.0%). Offenders were patients (71.5%) in the majority of cases, companions (20.3%), or both (3.3%). Almost half (48.0%) of health care workers who experienced violence did nothing, 38.2% actively reported the event, and 13.8% consulted a colleague. A significant association of workplace violence was found with working multiple shifts, evening or night shift, and lack of an encouraging environment to report violence. Workplace violence is still a significant problem in primary care centers. The high frequency of violence together with underreporting may indicate the inefficiency of the current safety program. More safety programs and training activities for health care workers, efficient reporting system, and zero tolerance policies need to be implemented to minimize workplace violence against health workers.
Patient-Centered Medical Home Knowledge and Attitudes of Residents and Faculty: Certification Is Just the First Step

PubMed Central

El Rayess, Fadya; Goldman, Roberta; Furey, Christopher; Chandran, Rabin; Goldberg, Arnold R.; Anandarajah, Gowri

2015-01-01

Background The patient-centered medical home (PCMH) is an accepted framework for delivering high-quality primary care, prompting many residencies to transform their practices into PCMHs. Few studies have assessed the impact of these changes on residents' and faculty members' PCMH attitudes, knowledge, and skills. The family medicine program at Brown University achieved Level 3 PCMH accreditation in 2010, with training relying primarily on situated learning through immersion in PCMH practice, supplemented by didactics and a few focused clinical activities. Objective To assess PCMH knowledge and attitudes after Level 3 PCMH accreditation and to identify additional educational needs. Methods We used a qualitative approach, with semistructured, individual interviews with 12 of the program's 13 postgraduate year 3 residents and 17 of 19 core faculty. Questions assessed PCMH knowledge, attitudes, and preparedness for practicing, teaching, and leading within a PCMH. Interviews were analyzed using the immersion/crystallization method. Results Residents and faculty generally had positive attitudes toward PCMH. However, many expressed concerns that they lacked specific PCMH knowledge, and felt inadequately prepared to implement PCMH principles into their future practice or teaching. Some exceptions were faculty and resident leaders who were actively involved in the PCMH transformation. Barriers included lack of time and central roles in PCMH activities. Conclusions Practicing in a certified PCMH training program, with passive PCMH roles and supplemental didactics, appears inadequate in preparing residents and faculty for practice or teaching in a PCMH. Purposeful curricular design and evaluation, with faculty development, may be needed to prepare the future leaders of primary care. PMID:26692970
[50 years' of the Institute of Sports Medicine at the Charles University Medical School on the 650th anniversary of its founding].

PubMed

Novotný, V

1999-01-01

In an agreeable shadow of the great 650th anniversary of Charles University foundation (1348-1998), arising of the first Institute of Sports Medicine round the world on Medical Faculty in Prague (1948-1998) was commemorated by scientific session. Since J. E. Purkynĕ (1850) have gone idea of favourable effect of body training for human health by representatives of Prague Medical Faculty, till Doctor J. Král, who started lectures for medical students in this discipline in 1933. Rise of Institute of Sports Medicine was approved in 1934, but its realization thanks to Professor Král, was performed after 2nd World War in 1948. From the beginning, students have lectures within the framework of daily study of whole wide of the branche, including practical exercises and closing examine. First text book of sports medicine and first book about clinic in sports medicine was written (J. Král). Members of Institute lectured on many foreign universities and scientific congresses and published more than 2,500 scientific works, some of them have world priority. For example first wireless transmission of heart frequency (V. Seliger, V. Kruta), cardiologic observations during big sports load (J. Král, Z. Hornof), discoveries at biochemical laboratory (J. Král, A. Zenísek), at medical functional anthropologic laboratory (V. Novotný), introducing of remedial exercises in clinical practice (L. Schmid, M. Zintlová, J. Chrástek) etc. In the set out choice of literary citation it is put on only fragment of publications which document scientific activity of jubileeing Institute. For period of duration of Institute more than hundred thousand patients were examined--both sportives and non-sportives, young and old. Contemporary trend goes from classic care about sportsmen towards preventive medicine. Attention is focused first of all to testing of middle aged and older patients in sense of prevention of cardiovascular and metabolic diseases and indication for specific movement load
Patient acceptability of 3D printed medicines.

PubMed

Goyanes, Alvaro; Scarpa, Mariagiovanna; Kamlow, Michael; Gaisford, Simon; Basit, Abdul W; Orlu, Mine

2017-09-15

Patient-centric medicine is a derivative term for personalised medicine, whereby the pharmaceutical product provides the best overall benefit by meeting the comprehensive needs of the individual; considering the end-user from the beginning of the formulation design process right through development to an end product is a must. One way in which to obtain personalised medicines, on-site and on-demand is by three-dimensional printing (3DP). The aim of this study was to investigate the influence of the shape, size and colour of different placebo 3D printed tablets (Printlets™) manufactured by fused deposition modelling (FDM) 3DP on end-user acceptability regarding picking and swallowing. Ten different printlet shapes were prepared by 3DP for an open-label, randomised, exploratory pilot study with 50 participants. Participant-reported outcome (PRO) and researcher reported outcome (RRO) were collected after picking and swallowing of selected printlet geometries including sphere, torus, disc, capsule and tilted diamond shapes. The torus printlet received the highest PRO cores for ease of swallowing and ease of picking. Printlets with a similar appearance to conventional formulations (capsule and disc shape) were also found to be easy to swallow and pick which demonstrates that familiarity is a critical acceptability attribute for end-users. RRO scores were in agreement with the PRO scores. The sphere was not perceived to be an appropriate way of administering an oral solid medicine. Smaller printlet sizes were found to be preferable; however it was found that the perception of size was driven by the type of shape. Printlet colour was also found to affect the perception of the end-user. Our study is the first to guide the pharmaceutical industry towards developing patient-centric medicine in different geometries via 3DP. Overall, the highest acceptability scores for torus printlets indicates that FDM 3DP is a promising fabrication technology towards increasing patient
75 FR 13137 - National Center For Complementary and Alternative Medicine; Notice of Closed Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-18

... Complementary and Alternative Medicine; Notice of Closed Meeting Pursuant to section 10(d) of the Federal... Alternative Medicine Special Emphasis Panel; International Center for Research in CAM. Date: April 12, 2010... Complementary and Alternative Medicine, NIH, 6707 Democracy Blvd., Suite 401, Bethesda, MD 20892, (301) 451-6570...
Quality of Care of Hospitalized Infective Endocarditis Patients: Report from a Tertiary Medical Center.

PubMed

Kashef, Mohammad Amin; Friderici, Jennifer; Hernandez-Montfort, Jaime; Atreya, Auras R; Lindenauer, Peter; Lagu, Tara

2017-06-01

There have been no recent studies describing the management and outcomes of patients with infective endocarditis (IE). We conducted a retrospective cohort study of adult patients admitted to a tertiary medical center from 2007 to 2011 with a Duke criteria consistent discharge diagnosis of IE. We examined concordance with guideline recommendations. Outcomes included embolic events, inhospital and 1-year mortality, length of stay (LOS) and cardiac surgery. We used descriptive statistics to describe the cohort and Fisher exact and unpaired t tests to compare native valve endocarditis (NVE) with prosthetic valve endocarditis (PVE). Of 170 patients, definite IE was present in 135 (79.4%) and possible IE in 35 (20.6%); 74.7% had NVE, and 25.3% had PVE. Mean ± standard deviation age was 60.0 ± 17.9 years. Comparing PVE to NVE, patients with PVE were less likely to have embolic events (14.0% vs. 32.3%; P = 0.03), had shorter LOS (median 12.0 days vs. 14.0 days; P = 0.047), but they did not show a statistically significant difference in inhospital mortality (20.9% vs. 12.6%; P = 0.21). Of 170, patients 27.6% (n = 47) underwent valve surgery. Most patients received timely blood cultures and antibiotics. Guideline-recommended consults were underused, with 86.5%, 54.1%, and 47.1% of patients receiving infectious disease, cardiac surgery, and cardiology consultation, respectively. As the number of consultations increased (from 0 to 3), we observed a nonsignificant trend toward reduction in 6-month readmission and 12-month mortality. IE remains a disease with significant morbidity and mortality. There are gaps in the care of IE patients, most notably underuse of specialty consultation. Journal of Hospital Medicine 2017;12:414-420. © 2017 Society of Hospital Medicine
Does non-adherence to DMARDs influence hospital-related healthcare costs for early arthritis in the first year of treatment?

PubMed

Pasma, Annelieke; Schenk, Charlotte; Timman, Reinier; van 't Spijker, Adriaan; Appels, Cathelijne; van der Laan, Willemijn H; van den Bemt, Bart; Goekoop, Robert; Hazes, Johanna M W; Busschbach, Jan J V

2017-01-01

Non-adherence to disease-modifying antirheumatic drugs (DMARDs) is suspected to relate to health care costs. In this study we investigated this relation in the first year of treatment. In a multi-center cohort study with a one year follow up, non-adherence was continuously measured using electronic monitored medication jars. Non-adherence was defined as the number of days with a negative difference between expected and observed opening of the container. Cost measurement focused on hospital costs in the first year: consultations, emergency room visits, hospitalization, medical procedures, imaging modalities, medication costs, and laboratory tests. Cost volumes were registered from patient medical files. We applied multivariate regression analyses for the association between non-adherence and costs, and other variables (age, sex, center, baseline disease activity, diagnosis, socioeconomic status, anxiety and depression) and costs. Of the 275 invited patients, 206 were willing to participate. 74.2% had rheumatoid arthritis, 20.9% had psoriatic arthritis and 4.9% undifferentiated arthritis. 23.7% of the patients were more than 20% non-adherent over the follow-up period. Mean costs are € 2117.25 (SD € 3020.32). Non-adherence was positively related to costs in addition to baseline anxiety. Non-adherence is associated with health care costs in the first year of treatment for arthritis. This suggests that improving adherence is not only associated with better outcome, but also with savings.
Municipal resources and patient outcomes through the first year after a hip fracture.

PubMed

Ruths, Sabine; Baste, Valborg; Bakken, Marit Stordal; Engesæter, Lars Birger; Lie, Stein Atle; Haugland, Siren

2017-02-16

Hip fractures represent major critical events for older people, and put huge demands on economic and personnel resources. Most hip fracture patients are in need of postoperative rehabilitation services. Through the Coordination Reform, the municipalities in Norway were given increased responsibility for community-based treatment and rehabilitation after surgery. The purpose of this study was to examine associations between municipal resources and patient outcomes through the first year after a hip fracture, focusing on survival and health-related quality of life. We conducted a nationwide cohort study on people experiencing a hip fracture in 2011-2012 in Norway, with a 1-year follow-up. We obtained data on date of hip fracture, demographics, total morbidity (ASA) score, health-related quality of life (EQ-5D-3 L), date of death if applicable, municipality of residence (Norwegian Hip Fracture Register), date of hospital readmission due to complications (Norwegian Patient Register), and information on municipalities' characteristics (Municipality-State-Reporting). The study population comprised 15,757 patients, mean age 80.8 years, 68.6% women. All-cause mortality was 8.6% at 30 days, and 25.3% at 12 months. Mortality was lower in the municipalities with the highest overall staff time for rehabilitation. A high proportion of the population aged 80+, was associated with low rates of self-reported anxiety/depression 12 months after surgery, as well as higher general health scores (EQ-5D VAS). There were no other differences in outcome according to rehabilitation resources, when comparing municipalities with the highest and lowest staffing. The study revealed no substantial impact of municipal resources on survival and health-related quality of life through the first year after a hip fracture. To evaluate major organizational changes and allocate resources according to best practice, there is a need to monitor health outcomes and use of resources over time through
Perceived Sources of Stress Among First-Year Podiatric Medical Students

ERIC Educational Resources Information Center

Wilson, Richard C.; Stienstra, John J.

1978-01-01

In a study of stress (tension, discomfort, or distress) at the Illinois College of Podiatric Medicine, 132 first-year students answered a questionnaire asking them to rank the level of stress in various situations. Current and anticipated sources of stress and their rankings are reported. (LBH)

Effectiveness of a 2-year menopause medicine curriculum for obstetrics and gynecology residents.

PubMed

Christianson, Mindy S; Washington, Chantel I; Stewart, Katherine I; Shen, Wen

2016-03-01

Previous work has shown American obstetrics and gynecology (OB/GYN) residents are lacking in menopause training. Our objective was to assess the effectiveness of a 2-year menopause medicine curriculum in improving OB/GYN residents' knowledge and self-assessed competency in menopause topics. We developed a menopause medicine-teaching curriculum for OB/GYN residents at our academic hospital-based residency program. The 2-year curriculum was composed of year 1: four 1-hour lectures and one 2-hour lab with cases presentations, and year 2: three 1-hour lectures and one 2-hour lab. Core topics included menopause physiology, hormone therapy, breast health, bone health, cardiovascular disease, and autoimmune disease. Pre- and posttests assessed resident knowledge and comfort in core topics, and a pre- and postcurriculum survey assessed utility and learning satisfaction. From July 2011 to June 2013, 34 OB/GYN residents completed the menopause curriculum annually with an average attendance at each module of 23 residents. Pre-/posttest scores improved from a mean pretest score of 57.3% to a mean posttest score of 78.7% (P < 0.05). Before the curriculum, most residents did not feel comfortable managing menopause patients with 75.8% reporting feeling "barely comfortable" and 8.4% feeling "not at all comfortable." After the 2-year curriculum, 85.7% reported feeling "comfortable/very comfortable" taking care of menopause patients. The majority of residents (95.2%) reported the menopause curriculum was "extremely useful." A 2-year menopause medicine curriculum for OB/GYN residents utilizing lectures and a lab with case studies is an effective modality to improve resident knowledge required to manage menopause patients.
Patients' attitudes toward the attire of male physicians: a single-center study in Saudi Arabia.

PubMed

Batais, Mohammad Ali

2014-01-01

The doctor-patient relationship has been influenced by the appearance of physicians, and there is an association between a physician's physical appearance and the patients' initial perceptions of physician competence. This study aims to explore patients' preferences toward the attire of a male physician, and to examine if a physician's choice of uniform influences the degree of trust, confidence, and follow-up care among respondents. A cross-sectional survey conducted among patients of the Alwazarat family medicine center in Riyadh, Saudi Arabia. A self-administered questionnaire was completed by 300 patients (50% were male and 83.6% had received a secondary education; the mean age was 33.4 [10.1] years) in the Alwazarat family medicine center in Riyadh. The questionnaire was also customized for the local setting with the inclusion of photos of a male doctor in Saudi Arabian national costume, and 3 other dress styles (Western dress with white coat, scrubs with white coat, and scrubs only). Overall, across all questions regarding physician dress style preferences, participants significantly preferred Western dress (39.9%, P < .001), followed by Saudi national dress (26.3%), a scrub suit with a white coat (22.3%), and scrubs only (11.5%). Respondents reported that they were more likely to follow medical advice and would return for follow-up care if a physician wore Western dress. They were significantly more willing to share their social, sexual, and psychological problems with a physician wearing Saudi national dress (P < .001). The importance of a physician's appearance was ranked significantly higher by older patients (P=.002). Respondents were more likely to favor a physician wearing Western attire with a white coat. However, Saudi national dress, followed by Western dress, is the preferred attire when physicians are dealing with social, sexual, and psychological problems.
Complementary and Alternative Medicine for Patients

MedlinePlus

... Ask about Your Treatment Research Complementary and Alternative Medicine for Patients Complementary and alternative medicine (CAM) is ... based on scientific evidence from research studies. Complementary medicine refers to treatments that are used with standard ...
Development and Evaluation of a Mandatory Course in Geriatric Medicine for Fourth Year Medical Students.

PubMed

Freter, Susan; Gordon, Janet; Mallery, Laurie

2006-12-01

As the population ages, older adults will make up an increasing proportion of the practices of most physicians. Because of this, education of medical students in Geriatric Medicine is essential, yet there is considerable variability in the amount, timing within the curriculum, and content of geriatric training in Medical Schools. Our goal was to develop and evaluate an integrated, mandatory 3-week geriatric medicine course for fourth year medical students with emphasis on knowledge acquisition. All fourth year medical students at Dalhousie Medical School underwent 2 ½ days of didactic teaching on core geriatric topics and a 2-week clinical rotation. Pre-rotation knowledge testing occurred on the first day of the rotation. On the final examination, students were retested on the 15 pre-rotation questions, as well as 5 additional questions that they had not encountered previously. There was a statistically significant improvement in examination performance from 46.9% on the pretest to 78.6% on the final examination (t=24.7, p˂.001). It is unlikely that the significant improvement in scores is simply a result of repeat testing, as students tended to score better on the five additional questions that they had not seen before. We developed a geriatric medicine course for fourth year medical students, in one integrated 3-week block, using a combination of didactic teaching and clinical encounters. We used students as their own controls, using the same questions pre- and post-rotation, and demonstrated significant knowledge acquisition on a variety of topics pertaining to geriatric medicine and care of the older patient. Future research should address the issue of translating acquired knowledge in geriatric medicine into demonstrated clinical skills when caring for the elderly.
Patient assessment of effectiveness and satisfaction with traditional medicine, globalized complementary and alternative medicines, and allopathic medicines for cancer in Pakistan.

PubMed

Tovey, Philip; Broom, Alex; Chatwin, John; Hafeez, Muhammad; Ahmad, Salma

2005-09-01

Virtually no research has been conducted on patient assessments of traditional medicines and allopathic medicines for cancer care in poorer countries marked by pluralistic medical environments. Pakistan represents an excellent case for such a study because of the coexistence of culturally and historically specific indigenous traditional medicine, the strong presence of allopathic medicine, and, to a lesser extent, the availability of some globalized complementary and alternative medicines. To gain a preliminary understanding of cancer patients' perceptions of effectiveness and satisfaction with traditional medicine, globalized complementary and alternative medicine, and allopathy in the context of a pluralistic medical environment. Structured survey of 362 cancer patients, from diverse regions in the Punjab province and Northwest Frontier province, who were being treated in 4 different hospitals in Lahore, Pakistan. Use of traditional medicine remains high among cancer patients, with traditional healers used by the majority of those surveyed. Although patients' perceptions of the overall effectiveness of traditional medicines for treating cancer are low, those patients who do use traditional medicines still have high levels of satisfaction with these modalities. This is distinct from levels of satisfaction with, and perceptions of effectiveness of, Western cancer treatments, which were synonymous in this group of patients. Important differences in patient perceptions were found within groups (eg, between different forms of traditional healers) as well as between them. This study showed considerable support for complementary and alternative medicine/traditional medicine but also significant variation in usage of and perceptions of local traditional medicines. More research needs to be done to explore the social processes underlying this variation in cancer patients' preferences for particular traditional medicines.
75 FR 63498 - National Center for Complementary and Alternative Medicine; Notice of Closed Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-15

... Complementary and Alternative Medicine; Notice of Closed Meeting Pursuant to section 10(d) of the Federal... Alternative Medicine Special Emphasis Panel; Clinical Review of R01s. Date: October 26, 2010. Time: 11 a.m. to...: Hungyi Shau, Scientific Review Officer, National Center for Complementary and Alternative Medicine...
Evolution of the Behavioral Sciences Branch of the Space Medicine and Health Care Systems Office at the Johnson Space Center.

PubMed

Fiedler, Edna R; Carpenter, Frank E

2005-06-01

This paper presents a brief history of psychology and psychiatry roles in psychological selection and how these roles have evolved into the Behavioral Sciences Branch at the Johnson Space Center USC), Houston, TX. Since the initial selection of the Mercury Seven, the first United States astronauts, psychologists and psychiatrists have been involved in astronaut selection activities. Initially very involved in psychological selection of astronauts, the role of behavioral health specialists waned during the Gemini and Apollo years. With the onset of the NASA/Mir/International Space Station Program, the introduction of payload and mission specialists, and international collaboration, the evolving need for behavioral health expertise became apparent. Medical and psychological selection processes were revisited and the Johnson Space Center developed a separate operational unit focused on behavioral health and performance. This work unit eventually became the Behavioral Sciences branch of the Space Medicine and Health Care Systems Office. Research was allocated across groups at JSC, other NASA space centers, and the National Space Biomedical Research Institute, and was funded by NASA Headquarters. The current NASA focus on human space exploration to the Moon and beyond re-emphasizes the importance of the human-centered approach.
Impact of continued mailed fecal tests in the patient-centered medical home: Year 3 of the Systems of Support to Increase Colon Cancer Screening and Follow-Up randomized trial.

PubMed

Green, Beverly B; Anderson, Melissa L; Chubak, Jessica; Fuller, Sharon; Meenan, Richard T; Vernon, Sally W

2016-01-15

The current study was conducted to determine the effect of continuing a centralized fecal occult blood test (FOBT) mailed program on screening adherence. A patient-level randomized controlled trial was conducted in 21 patient-centered medical home primary care clinics between January 2010 and November 2012. A total of 2208 patients ranging in age from 52 to 75 years in a substudy of the Systems of Support to Increase Colon Cancer Screening and Follow-Up (SOS) trial were randomized at year 3 to continued automated interventions (Continued group), which included mailed information regarding colorectal cancer (CRC) screening choices, and were mailed stool kit tests or to a group in which interventions were stopped (Stopped group). The main outcomes and measures were the completion of CRC screening in year 3 and by subgroup characteristics, respectively. Adherence to CRC screening in year 3 was found to be significantly higher in patients in the Continued group compared with those in the Stopped group (53.3% vs 37.3%; adjusted net difference, 15.6% [P<.001]). This difference was entirely due to greater completion of FOBT (adjusted net difference, 18.0% [P<.001]). Year 3 CRC screening rates were highest in patients in the Continued group completing FOBT in both years 1 and 2 (77.2%), followed by patients completing only 1 FOBT in 1 of the 2 years (44.6%), with low rates of CRC testing reported among patients not completing any FOBT within the first 2 years (18.1%). A centralized mailed FOBT CRC screening program continued to be more effective than patient-centered medical home usual-care interventions, but only for those patients who had previously completed FOBT testing. Research is needed regarding how to engage patients not completing CRC testing after being mailed at least 2 rounds of FOBT tests. Cancer 2016;122:312-321. © 2015 American Cancer Society. © 2015 American Cancer Society.
Teaching Sustainable Water Resources and Low Impact Development: A Project Centered Course for First-Year Undergraduates

NASA Astrophysics Data System (ADS)

Cianfrani, C. M.

2009-12-01

Teaching Sustainable Water Resources and Low Impact Development: A Project Centered Course for First-Year Undergraduates Christina M. Cianfrani Assistant Professor, School of Natural Science, Hampshire College, 893 West Avenue, Amherst, MA 01002 Sustainable water resources and low impact development principles are taught to first-year undergraduate students using an applied design project sited on campus. All students at Hampshire College are required to take at least one natural science course during their first year as part of their liberal arts education. This requirement is often met with resistance from non-science students. However, ‘sustainability’ has shown to be a popular topic on campus and ‘Sustainable Water Resources’ typically attracts ~25 students (a large class size for Hampshire College). Five second- or third-year students are accepted in the class as advanced students and serve as project leaders. The first-year students often enter the class with only basic high school science background. The class begins with an introduction to global water resources issues to provide a broad perspective. The students then analyze water budgets, both on a watershed basis and a personal daily-use basis. The students form groups of 4 to complete their semester project. Lectures on low impact design principles are combined with group work sessions for the second half of the semester. Students tour the physical site located across the street from campus and begin their project with a site analysis including soils, landcover and topography. They then develop a building plan and identify preventative and mitigative measures for dealing with stormwater. Each group completes TR-55 stormwater calculations for their design (pre- and post-development) to show the state regulations for quantity will be met with their design. Finally, they present their projects to the class and prepare a formal written report. The students have produced a wide variety of creative
No longer waiting for an accident to happen: Simulation in emergency medicine.

PubMed

Ellison, Stefanie; Sullivan, Christine; McCullough, Robert

2013-01-01

The practice of emergency medicine (EM) requires proficient and expert skills in multiple high risk procedures. The emergency physician in-training needs a safe and realistic environment in which to practice and perfect the skills necessary to care for patients ranging from the critically ill to the patient with difficult intravenous access. Undergraduate medical, education overall has a need for training that enables students to develop the knowledge, skills and attitudes to practice in a variety of specialties. This article provides an overview of simulation in a three-year emergency medicine residency at Truman Medical Center, in a required final year clerkship for all medical students at the University of Missouri-Kansas City, and discusses national trends for the use of simulation in emergency medicine.
Family-centered maternity care for deaf refugees: the patient-centered medical home in action.

PubMed

Balachandra, Shirish K; Carroll, Jennifer K; Fogarty, Colleen T; Finigan, Elizabeth G

2009-12-01

The intersection of 2 underserved populations-refugees and deaf individuals-presents novel challenges to health care systems and has not been described previously. A patient-centered medical home (PCMH) is uniquely equipped to provide outstanding primary care to disadvantaged groups. As an illustrative case study, we present our experience applying principles of the PCMH to address an extremely challenging clinical situation: providing high-quality maternity care to a recently immigrated Vietnamese refugee couple lacking formal language skills. We describe how enhanced access, continuity, coordination, and cultural appropriateness can facilitate favorable outcomes in even daunting circumstances. By collaborating with multiple interpreters, the health center staff, and the extended family, we effectively mobilized an expanded system of care to ensure informed consent and shared decision making, ultimately culminating in a successful labor and vaginal delivery. Through organizational and individual commitment to the tenets of the PCMH, we demonstrate the particular strengths of family medicine training sites in caring for similar patients and families with complex cultural and linguistic barriers to care.
Cancer Impact, Complementary/Alternative Medicine Beliefs, and Quality of Life in Cancer Patients.

PubMed

Kuo, Ya-Hui; Tsay, Shiow-Luan; Chang, Chun-Chi; Liao, Yen-Chi; Tung, Heng-Hsin

2018-03-01

The purpose of this study was to explore the relationships among cancer impact, belief in complementary and alternative medicine (CAM), CAM use, and quality of life (QOL). The study used a cross-sectional, descriptive correlational design with convenience sampling. A total of 122 cancer patients participated. Data were collected at a medical center in Chunghua, Taiwan. The questionnaires included the Chinese version of the Cancer Problem in Living Scale (CPILS), Complementary and Alternative Medicine Belief Inventory (CAMBI), Complementary and Alternative Medicine scale, and Chinese versions of QOL scales, including the Functional Assessment of Cancer Therapy-General (FACT-G). The mean age was 56.5 years, and most participants were male (n = 69, 56.6%), had completed high school or above (n = 56, 45.9%), and were married (n = 109, 89.3%). The most common type of cancer was oral (n = 17, 13.9%), followed by esophageal (n = 15, 12.3%) and colorectal (n = 13, 10.7%). Cancer patients, on average, use one or two types of CAM. The impact of cancer is significantly related to age (F = 7.12, p < 0.05), and income is related to QOL (F = 3.61, p < 0.05). Pearson correlations showed that the use of CAM was positively associated with belief in CAM (CAMBI) (r = 0.26, p = 0.01), and the impact of cancer was highly negatively associated with QOL (r = -0.71, p = 0.001). The predictors of QOL were the impact of cancer and use of CAM, and the impact of cancer accounted for 51% of the variance in QOL. This study supports research on the impact of cancer, belief in CAM, and use of CAM as related to QOL in cancer patients. These results can be used to provide options to clinicians and cancer patients.
A Successful Model for a Comprehensive Patient Flow Management Center at an Academic Health System.

PubMed

Lovett, Paris B; Illg, Megan L; Sweeney, Brian E

2016-05-01

This article reports on an innovative approach to managing patient flow at a multicampus academic health system, integrating multiple services into a single, centralized Patient Flow Management Center that manages supply and demand for inpatient services across the system. Control of bed management was centralized across 3 campuses and key services were integrated, including bed management, case management, environmental services, patient transport, ambulance and helicopter dispatch, and transfer center. A single technology platform was introduced, as was providing round-the-clock patient placement by critical care nurses, and adding medical directors. Daily bed meetings with nurse managers and charge nurses drive action plans. This article reports immediate improvements in the first year of operations in emergency department walkouts, emergency department boarding, ambulance diversion, growth in transfer volume, reduction in lost transfers, reduction in time to bed assignment, and bed turnover time. The authors believe theirs is the first institution to integrate services and centralize bed management so comprehensively. © The Author(s) 2014.
Epidemiologic data of trauma-related lower limb amputees: A single center 10-year experience.

PubMed

Yaşar, Evren; Tok, Fatih; Kesikburun, Serdar; Ada, A Mustafa; Kelle, Bayram; Göktepe, A Salim; Yazıcıoğlu, Kamil; Tan, A Kenan

2017-02-01

The aim of this study is three fold: 1) to introduce epidemiologic data of patients with trauma-related amputations as a 10-year experience of a rehabitation center; 2) to determine comorbidities and secondary conditions of lower limb loss; 3) to determine the rehospitalization reasons for lower limb amputee patients. This retrospective study was conducted in a tertiary rehabilitation center in Turkey. Clinical and demographic data of amputees including sex, age, employment status, time since amputation, time after amputation to first hospitalization, length of hospitalization, how many times the patient was hospitalized, reason for hospitalization, stump complications, comorbid conditions, amputation level and K classifacation were documented. Three hundred ninetynine patients with a mean age of 23,48±6,04 (4-74) years were included in this study. Mean duration after amputation was 119,71±68,86months. Patients were 3,43±2,53 times hospitalized. Landmine explosion was the most common etiology of amputation with 370 patients (92.7%). Below knee amputation was the most common amputation level with 230 (50,77%) amputations. 399 patients were hospitalized 1369 times and the most common hospitalization reason were stump complications (356 times, 26,00%). Spur formation (202 times) was the most common stump complications. Pyscologic disorders were the most common comorbidity with 68 patient (37,56%). Patients with traumatic limb amputations are likely to experience several complications and comorbidities. Prevention of secondary conditions affecting those living with the loss of a limb is an important part of amputee rehabilitation and may prevent rehospitalization. Copyright © 2016 Elsevier Ltd. All rights reserved.
Reconceptualizing Pain through Patient-Centered Care in the Complementary and Alternative Medicine Therapeutic Relationship.

PubMed

Agarwal, Vinita

2018-06-05

The study aim was to understand the patient description of the therapeutic relationship with their CAM provider in the context of pain self-management. Because pain is a subjective state, its assessment depends on patient perception of and response to pain. For nurses to provide empathetic and compassionate care, there is a need to explicate patient perceptions of the therapeutic relationship to (re)conceptualize models of patient-centered care. Inductive qualitative content analysis of patient interviews was conducted to identify how patients described therapeutic relationship themes and understand self-management of pain. Participants were individuals working with a CAM practitioner and solicited through purposive and snowball sampling in collaboration with the practitioners from the mid-Atlantic region of the United States in 2016 (N=13). Verbatim transcriptions of audio-recorded semi-structured in-depth interviews (430 single-spaced pages approximately) were content analyzed. Patients described the therapeutic relationship with the provider as a (a) giver, who was "in-tune" with their sense of self to support self-affirmation through empathetic listening and (b) guide, who connected the mind and body through their practice to support self-reflective learning. This description of the CAM therapeutic relationship advances understandings of readjustment of patient relationship with pain through the provider's empathetic listening and connecting the mind and the body to support patient self-affirmation of pain experiences and self-reflective learning. The findings illuminate how a feminist standpoint contributes to understandings of the therapeutic relationship that centers patient subjectivity and co-construction of meaning-making processes to support self-management of pain. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Application of alternative medicine in gastrointestinal cancer patients.

PubMed

Nikolić, Ivan; Smiljenić, Dragana; Kukić, Biljana; Bogdanović, Bogdan; Petrović, Tomislav; Ivković-Kapicl, Tatjana; Kozarski, Dejan; Djan, Igor

2012-11-01

[corrected] Alternative medicine is a set of therapeutic procedures which are no part of official practice. At present, the use of alternative medicine among cancer patients is significant and the purpose of this study was to get more information on the methods and products of alternative medicine. Thus, the aim of the study was to determine the frequency of the use of alternative medicine among gastrointestinal cancer patients. The research was conducted using an anonymous questionnaire in writing. We included 205 patients with the diagnosis of gastrointestinal malignancy in the study but the questionnaire was fulfilled by 193 patients and the presented data were based on their answers. The questions were about the sociodemographic characteristics of the patients, the reasons for their use of alternative medicine, and their information sources about alternative medicine. We divided existing alternative therapies into 6 categories: herbal therapy, special diets, psychotherapy, body-mind therapy, spiritual therapy, and other supplements. A total of 48 (24.9%) patients did not use any type of alternative therapy; 145 (75.1%) patients used at least one product and 124 (64.25%) patients used herbal preparations (beetroot juice was consumed by 110 [56.99%] patients); 136 (70.5%) patients were informed about alternative therapies by other patients; 145 (75.1%) used alternative medicine to increase the chances for cure; 88 (45.6%) of interviewed patients would like to participate in future research in this field. The use of alternative medicine is evidently significant among cancer patients. Further research should be conducted in order to find out interactions of these products with other drugs and potential advantages and disadvantages of this form of treatment.
Interest and use of mental health and specialty behavioral medicine counseling in US primary care patients.

PubMed

Baron, Kelly G; Lattie, Emily; Ho, Joyce; Mohr, David C

2013-03-01

Counseling interventions have the potential to improve health and quality of life for primary care patients, but there are few studies describing the interest in and utilization of counseling among this patient population in the USA. The purpose of the study was to evaluate interest in mental health and specialty behavioral medicine counseling and predictors of utilization over 1 year among US primary care patients. Participants in this two-survey longitudinal study included 658 primary care patients in an urban US academic medical center (461 females, age M = 51.05, SD = 15.46 years). Retention rate was 61.2% at survey 2. Patient demographics, depression, anxiety, and interest in counseling services were assessed through a survey mailed 1 week following an outpatient appointment. Respondents to survey 1 were re-contacted 1 year later to assess. Interest and use of the following counseling services were evaluated in the relevant subgroups: mental health (the entire sample and patients with elevated anxiety and/or depression), health/lifestyle (overweight and obese participants), smoking cessation (current and occasional smokers), and pain management (participants with elevated daily pain ratings). At survey 1, 45.7% of the sample reported interest in mental health counseling, and 58.9% of the sample reported interest in behavioral medicine counseling. Among overweight or obese participants, 59.9% were interested in health/lifestyle counseling. Among smokers, 55.3% were interested in smoking cessation, and among participants with chronic pain, 33.8% were interest in pain management. Rates of utilization of services at survey 2 were 21.3% for mental health, 7.7% for health/lifestyle, 6.7% for smoking cessation, and 6.6% for pain management. Interest in receiving services at survey 1 was the strongest predictor of utilization. Results demonstrate high interest but low utilization over 1 year among US primary care patients. Identifying patients interested in
77 FR 4052 - National Center for Complementary & Alternative Medicine; Amended Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-26

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Center for Complementary & Alternative Medicine; Amended Notice of Meeting Notice is hereby given of a change in the meeting of the National Advisory Council for Complementary and Alternative Medicine, February 3, 2012, 8...
Recognition as a patient-centered medical home: fundamental or incidental?

PubMed

Dohan, Daniel; McCuistion, Mary Honodel; Frosch, Dominick L; Hung, Dorothy Y; Tai-Seale, Ming

2013-01-01

Little is known about reasons why a medical group would seek recognition as a patient-centered medical home (PCMH). We examined the motivations for seeking recognition in one group and assessed why the group allowed recognition to lapse 3 years later. As part of a larger mixed methods case study, we conducted 38 key informant interviews with executives, clinicians, and front-line staff. Interviews were conducted according to a guide that evolved during the project and were audio-recorded and fully transcribed. Transcripts were analyzed and thematically coded. PCMH principles were consistent with the organization's culture and mission, which valued innovation and putting patients first. Motivations for implementing specific PCMH components varied; some components were seen as part of the organization's patient-centered culture, whereas others helped the practice compete in its local market. Informants consistently reported that National Committee for Quality Assurance recognition arose incidentally because of a 1-time incentive from a local group of large employers and because the organization decided to allocate some organizational resources to respond to the complex reporting requirements for about one-half of its clinics. Becoming patient centered and seeking recognition as such ran along separate but parallel tracks within this organization. As the Affordable Care Act continues to focus attention on primary care redesign, this apparent disconnect should be borne in mind.
75 FR 19979 - National Center for Complementary and Alternative Medicine Announcement of Workshop on the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-16

... Complementary and Alternative Medicine Announcement of Workshop on the Deconstruction of Back Pain ACTION: Notice. SUMMARY: The National Center for Complementary and Alternative Medicine (NCCAM) invites the... Alternative Medicine (NCCAM) was established in 1999 with the mission of exploring complementary and...

Comparison of Ramadan-specific education level in patients with diabetes seen at a Primary and a Tertiary care center of Karachi-Pakistan.

PubMed

Masood, Shabeen Naz; Alvi, Syed Faraz Danish; Ahmedani, Muhammad Yakoob; Kiran, Shazia; Zeeshan, Nimra Fatima; Basit, Abdul; Shera, A Samad

2014-01-01

To compare Ramadan-specific education level in fasting patients with diabetes at a Primary and a Tertiary care center. An observational study was conducted in the Outpatient departments of a Primary care center and a Tertiary care center in Karachi-Pakistan. Recruitment of patients started at the end of Ramadan 2011 and continued till three months after Ramadan 2011. All patients with diabetes who observed fast during the month of Ramadan 2011 were included in the study. In Primary care center, patients were attended by physicians only, while at Tertiary care center patients were seen by physicians, diabetes educator and dietician. For data collection, standardized questionnaire based interview was conducted on one to one basis by trained healthcare professionals. Same questionnaire was used at both the centers. A total of 392 and 199 patients with diabetes recruited at Primary and Tertiary care centers, respectively. Ramadan-specific diabetes education received by 213 (55%) and 123 (61.80%) patients with diabetes at Primary and Tertiary care centers, respectively. Compared to Primary care center, patients at Tertiary care centers were more aware about components of Ramadan-specific diabetes education such as signs and symptoms of hypoglycemia and hyperglycemia, dose of medicines/insulin during Ramadan fasting, dose of medicines/insulin when not fasting, self-monitoring of blood glucose, dietary modifications, physical activity, adequate nutrition and adequate hydration during Ramadan (p<0.05). It was observed that Ramadan-specific education level of patients at Tertiary care center was significantly better compared to patients at Primary care center. Copyright © 2014 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Violence against health workers in Family Medicine Centers

PubMed Central

Al-Turki, Nouf; Afify, Ayman AM; AlAteeq, Mohammed

2016-01-01

Background Health care violence is a significant worldwide problem with negative consequences on both the safety and well-being of health care workers as well as workplace activities. Reports examining health care violence in Saudi Arabia are limited and the results are conflicting. Objective To estimate the prevalence and determine the demographic and occupational characteristics associated with workplace violence in primary care centers in Riyadh, Saudi Arabia. Methods A cross-sectional study included 270 health care workers in 12 family medicine centers in Riyadh during November and December 2014. A structured self-administered questionnaire was used to estimate the frequency, timing, causes, reactions, and consequences of workplace violence plus participants’ demographic and occupational data. Results A total 123 health care workers (45.6%) experienced some kind of violence over 12 months prior to the study. These included physical (6.5%) and nonphysical violence (99.2%), including verbal violence (94.3%) and intimidation (22.0%). Offenders were patients (71.5%) in the majority of cases, companions (20.3%), or both (3.3%). Almost half (48.0%) of health care workers who experienced violence did nothing, 38.2% actively reported the event, and 13.8% consulted a colleague. A significant association of workplace violence was found with working multiple shifts, evening or night shift, and lack of an encouraging environment to report violence. Conclusion Workplace violence is still a significant problem in primary care centers. The high frequency of violence together with underreporting may indicate the inefficiency of the current safety program. More safety programs and training activities for health care workers, efficient reporting system, and zero tolerance policies need to be implemented to minimize workplace violence against health workers. PMID:27330300
Traditional Chinese Medicine Use among Chinese Immigrant Cancer Patients

PubMed Central

Leng, Jennifer C.F.; Gany, Francesca

2017-01-01

Background Traditional Chinese Medicine (TCM) includes both herbal remedies and non-herbal practices. Chinese cancer patients are at particularly high risk for herb-drug interactions. Providers, both primary care physicians (PCPs) and oncologists, frequently do not ask patients about TCM use, with potentially dangerous consequences. Objective This study describes an assessment of TCM use while undergoing conventional cancer treatment, among a cohort of Chinese immigrant cancer patients in New York City. Design and Participants The Immigrant Health and Cancer Disparities Service at Memorial Sloan-Kettering Cancer Center (MSKCC) assists underserved cancer patients through a patient navigation program, the Cancer Portal Project. Six questions related to TCM are included in the existing Portal Needs Assessment Intake. Mandarin or Cantonese speaking Portal patients enrolled between January 2010 and May 2012 were surveyed. Results 109 Chinese-speaking patients were enrolled in Portal during the study period. 46 completed the TCM questions. 96% preferred to speak Mandarin, Cantonese, or Fujianese in the healthcare setting. 39% (n=18) of the 46 participants reported using TCM since being diagnosed with cancer. Nearly all (n=16) who used TCM reported using herbal medicines. Ten TCM users did not describe sharing their use with Western doctors. Eight (44%) of TCM users reported concurrently using TCM and conventional cancer treatment. Conclusions Larger scale studies should further explore the concurrent use of TCM and conventional cancer treatment in this unique population. Future research should also address patient-provider communication related to concurrent use of TCM and cancer treatment. This is also an important area of education for both patients and providers. PMID:24072455
Patients' and procedural characteristics of AV-block during slow pathway modulation for AVNRT-single center 10year experience.

PubMed

Wasmer, Kristina; Dechering, Dirk G; Köbe, Julia; Leitz, Patrick; Frommeyer, Gerrit; Lange, Phillip S; Kochhäuser, Simon; Reinke, Florian; Pott, Christian; Mönnig, Gerold; Breithardt, Günter; Eckardt, Lars

2017-10-01

Permanent AV-block is a recognized and feared complication of slow pathway modulation for AVNRT. We aimed to assess incidence of transient and permanent AV-block as well as consequences of transient AV-block in a large contemporary AVNRT ablation cohort. We searched our single center prospective ablation database for occurrence of transient and permanent AV-block during slow pathway modulation between January 2004 and October 2015. We analyzed patients' and procedural characteristics as well as outcome of patients in whom transient or permanent AV-block occurred. Of 9170 patients who underwent a catheter ablation at our institution between January 2004 and October 2015, 2101 patients (64% women, mean age 50±18years) underwent slow pathway modulation. In three patients, permanent AV-block occurred during RF application. Additional two patients had transient AV-block that recovered (after a few minutes and 25min), but recurred within two days of the procedure. All five patients underwent dual chamber pacemaker implantation (0.2%). Transient AV-block related to RF delivery occurred in 44 patients (2%). Transient mechanical AV-block occurred in additional 17 patients (0.8%). In 12 patients, ablation was continued despite transient AV-block. One of these patients developed permanent AV-block. Permanent AV-block following slow pathway modulation is a rare event, occurring in 0.2% of patients in a large contemporary single center cohort. Transient AV-block is more frequent (2%). Copyright © 2017 Elsevier B.V. All rights reserved.
Behaviors of providers of traditional korean medicine therapy and complementary and alternative medicine therapy for the treatment of cancer patients.

PubMed

Yu, Jun-Sang; Kim, Chun-Bae; Kim, Ki-Kyong; Lee, Ji-Eun; Kim, Min-Young

2015-03-01

In Korea, cancer is one of the most important causes of death. Cancer patients have sought alternative methods, like complementary and alternative medicine (CAM) together with Western medicine, to treat cancer. Also, there are many kinds of providers of CAM therapy, including providers of Korean oriental medicine therapy. The purpose of this study is to identify the behaviors of Korean oriental medicine therapy and CAM therapy providers who treat cancer patients and to provide background knowledge for establishing a new policy with the management and quality control of CAM. Structured and well organized questionnaires were made, and 350 persons were surveyed concerning the providers of CAM or Korean oriental medicine. The questionnaires were collected and analyzed. The questionnaires (182) were collected. The questionnaires identified a total of 73 known providers, such as medicinal professionals or other providers of CAM suppliers, 35.6% of whom had had experience with treating cancer patients (52.6% vs. 29.6%). The treatment methods were a little different: alternative therapy and nutritional therapy being preferred by medicinal professionals and mind body modulation therapy and alternative therapy being preferred by other CAM providers. Four patients (7.4%) experienced side effects, and 6 patients (12.5%) experienced legal problems. As the method for managing the therapy, CAM providers, medicinal professionals, and other CAM providers had different viewpoints. For example, some CAM providers stated that both legislation and an official education on CAM or a national examination were needed as a first step to establish the provider's qualifications and that as a second step, a license test was needed for quality control. To the contrary, medicinal professionals stated that a license test was needed before legislation. Adequate management and quality control of CAM providers is thought to involve both education and legislation.
Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality-improvement project.

PubMed

Hoyer, Erik H; Friedman, Michael; Lavezza, Annette; Wagner-Kosmakos, Kathleen; Lewis-Cherry, Robin; Skolnik, Judy L; Byers, Sherrie P; Atanelov, Levan; Colantuoni, Elizabeth; Brotman, Daniel J; Needham, Dale M

2016-05-01

To determine whether a multidisciplinary mobility promotion quality-improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS). Implemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. There were 3352 patients admitted during the QI project period. The Johns Hopkins Highest Level of Mobility (JH-HLM) scale, an 8-point ordinal scale ranging from bed rest (score = 1) to ambulating ≥250 feet (score = 8), was used to quantify mobility. Changes in JH-HLM scores were compared for the first 4 months of the project (ramp-up phase) versus 4 months after project completion (post-QI phase) using generalized estimating equations. We compared the relative change in median LOS for the project months versus 12 months prior among the QI units, using multivariable linear regression analysis adjusting for 7 demographic and clinically relevant variables. Comparing the ramp-up versus post-QI phases, patients reaching JH-HLM's ambulation status increased from 43% to 70% (P < 0.001), and patients with improved JH-HLM mobility scores between admission and discharge increased from 32% to 45% (P < 0.001). For all patients, the QI project was associated with an adjusted median LOS reduction of 0.40 (95% confidence interval [CI]: -0.57 to -0.21, P < 0.001) days compared to 12 months prior. A subgroup of patients expected to have a longer LOS (expected LOS >7 days), were associated with a significantly greater adjusted median reduction in LOS of 1.11 (95% CI: -1.53 to -0.65, P < 0.001) days. Increased mobility was not associated with an increase in injurious falls compared to 12 months prior on the QI units (P = 0.73). Active prevention of a decline in physical function that commonly occurs during hospitalization may be achieved with a structured QI approach. In an adult medicine population, our QI project was associated with improved
A novel patient-centered "intention-to-treat" metric of U.S. lung transplant center performance.

PubMed

Maldonado, Dawn A; RoyChoudhury, Arindam; Lederer, David J

2018-01-01

Despite the importance of pretransplantation outcomes, 1-year posttransplantation survival is typically considered the primary metric of lung transplant center performance in the United States. We designed a novel lung transplant center performance metric that incorporates both pre- and posttransplantation survival time. We performed an ecologic study of 12 187 lung transplant candidates listed at 56 U.S. lung transplant centers between 2006 and 2012. We calculated an "intention-to-treat" survival (ITTS) metric as the percentage of waiting list candidates surviving at least 1 year after transplantation. The median center-level 1-year posttransplantation survival rate was 84.1%, and the median center-level ITTS was 66.9% (mean absolute difference 19.6%, 95% limits of agreement 4.3 to 35.1%). All but 10 centers had ITTS values that were significantly lower than 1-year posttransplantation survival rates. Observed ITTS was significantly lower than expected ITTS for 7 centers. These data show that one third of lung transplant candidates do not survive 1 year after transplantation, and that 12% of centers have lower than expected ITTS. An "intention-to-treat" survival metric may provide a more realistic expectation of patient outcomes at transplant centers and may be of value to transplant centers and policymakers. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.
Use and interest in complementary and alternative medicine among college students seeking healthcare at a university campus student health center.

PubMed

Nguyen, Jannett; Liu, Michael A; Patel, Rohini J; Tahara, Keli; Nguyen, Annie L

2016-08-01

There is growing data on complementary and alternative medicine (CAM) preferences among college students. While several studies have focused on undergraduate students, there is limited data on graduate students. Cross sectional analysis of undergraduate and graduate students seeking medical care at the University of California Irvine's Student Health Center (SHC). The survey assessed previous CAM use and preferences for future CAM use and education. The majority (67.0%) had used CAM within the last year, 27.0% would use CAM for their current health condition, and 51.9% would consider CAM for their current health condition if they were more knowledgeable. Most respondents desired more CAM education and indicated that they would try CAM modalities if covered under insurance. Most college students requested more knowledge to assist in their decisions to use CAM. These findings provide insight for health centers on the preferences of college student patients. Copyright © 2016 Elsevier Ltd. All rights reserved.
Estimation of internal exposure to 99Mo in nuclear medicine patients.

PubMed

Silva, I C O A; Lucena, E A; Souza, W O; Dantas, A L A; Dantas, B M

2010-05-10

(99m)Tc is the most widely used radionuclide in nuclear medicine. It is obtained by elution of (99)Mo-(99m)Tc generators. Depending on the quality of the generator and its integrity, (99)Mo may be extracted from the column during the elution process, becoming a radionuclidic impurity in the (99m)Tc eluate. This fact would impart an unnecessary dose to the patients submitted to diagnostic procedures. The aim of this work is to evaluate (99)Mo incorporation and internal effective doses in nuclear medicine patients through bioassay techniques, providing information on the metabolism of molybdenum in humans. A methodology based on in vivo and in vitro measurements was developed. In vivo measurements were performed with a NaI detector installed in the IRD WBC. Urine samples were analysed with a HPGe at the IRD bioassay laboratory. Patients showed detectable activities of (99)Mo in whole body and urine. Results were interpreted with AIDE software. Estimated incorporation was compared to predicted values based on ICRP model. Effective doses were in the order of micro sieverts. Results suggest the need to implement a routine quality control program of radionuclidic impurity of (99)Mo in (99m)Tc eluates to be conducted by radiopharmacy laboratories of nuclear medicine centers.
Evaluation of My Medication Passport: a patient-completed aide-memoire designed by patients, for patients, to help towards medicines optimisation.

PubMed

Barber, Susan; Thakkar, Kandarp; Marvin, Vanessa; Franklin, Bryony Dean; Bell, Derek

2014-08-19

A passport-sized booklet, designed by patients for patients to record details about their medicines, has been developed as part of a wider project focusing on improving prescribing in the elderly ('ImPE'). We undertook an evaluation of 'My Medication Passport' to gain an understanding of its value to patients and how it may be used in communications about medicines. The Passport was launched in secondary care with the initial users being older people discharged home after an admission to one of the four North West London participating Trusts. The uptake subsequently spread to other (community) locations and other age groups. We recruited more than 200 patients from a cohort who had been given a passport as part of the improvement projects at one of four sites. Of them, 63% (133) completed the structured telephone questionnaire including 27% for whom English was not their first language. Approximately half of the respondents were male and 40% were over 70 years of age. More than half of the respondents had found their medication passport useful or helpful in some way; 42% through sharing details from it with others (most frequently family, carer or doctor) or using it as a platform for conversations with healthcare professionals. One-third of those questioned carried the passport with them at all times. My Medication Passport has been positively evaluated; we have a better understanding of how it is used by patients, what they are recording and how it can be an aid to dialogue about medicines with family, carers and healthcare professionals. Further development and spread is underway including an App for smartphones that will be subject to wider evaluation to include feedback from clinicians. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Evaluation of My Medication Passport: a patient-completed aide-memoire designed by patients, for patients, to help towards medicines optimisation

PubMed Central

Barber, Susan; Thakkar, Kandarp; Marvin, Vanessa; Franklin, Bryony Dean; Bell, Derek

2014-01-01

Objectives A passport-sized booklet, designed by patients for patients to record details about their medicines, has been developed as part of a wider project focusing on improving prescribing in the elderly (‘ImPE’). We undertook an evaluation of ‘My Medication Passport’ to gain an understanding of its value to patients and how it may be used in communications about medicines. Setting The Passport was launched in secondary care with the initial users being older people discharged home after an admission to one of the four North West London participating Trusts. The uptake subsequently spread to other (community) locations and other age groups. Participants We recruited more than 200 patients from a cohort who had been given a passport as part of the improvement projects at one of four sites. Of them, 63% (133) completed the structured telephone questionnaire including 27% for whom English was not their first language. Approximately half of the respondents were male and 40% were over 70 years of age. Results More than half of the respondents had found their medication passport useful or helpful in some way; 42% through sharing details from it with others (most frequently family, carer or doctor) or using it as a platform for conversations with healthcare professionals. One-third of those questioned carried the passport with them at all times. Conclusions My Medication Passport has been positively evaluated; we have a better understanding of how it is used by patients, what they are recording and how it can be an aid to dialogue about medicines with family, carers and healthcare professionals. Further development and spread is underway including an App for smartphones that will be subject to wider evaluation to include feedback from clinicians. PMID:25138809
Utilization of rapid response resources and outcomes in a comprehensive cancer center*.

PubMed

Austin, Charles A; Hanzaker, Chris; Stafford, Renae; Mayer, Celeste; Culp, Loc; Lin, Feng-Chang; Chang, Lydia

2014-04-01

To compare the differences in characteristics and outcomes of cancer center patients with other subspecialty medical patients reviewed by rapid response teams. A retrospective cohort study of hospitalized general medicine patients, subspecialty medicine patients, and oncology patients requiring rapid response team activation over a 2-year period from September 2009 to August 2011. Five hundred fifty-seven subspecialty medical patients required rapid response team intervention. A single academic medical center in the southeastern United States (800+ bed) with a dedicated 50-bed inpatient comprehensive cancer care center. Data abstraction from computerized medical records and a hospital quality improvement rapid response database. Of the 557 patients, 135 were cancer center patients. Cancer center patients had a significantly higher Charlson Comorbidity Score (4.4 vs 2.9, < 0.001). Cancer center patients had a significantly longer hospitalization period prior to rapid response team activation (11.4 vs 6.1 d, p < 0.001). There was no significant difference between proportions of patients requiring ICU transfer between the two groups (odds ratio, 1.2; 95% CI, 0.8-1.8). Cancer center patients had a significantly higher in-hospital mortality compared with the other subspecialty medical patients (33% vs 18%; odds ratio, 2.2; 95% CI, 1.50-3.5). If the rapid response team event required an ICU transfer, this finding was more pronounced (56% vs 23%; odds ratio, 4.0; 95% CI, 2.0-7.8). The utilization of rapid response team resources during the 2-year period studied was also much higher for the oncology patients with 37.34 activations per 1,000 patient discharges compared with 20.86 per 1,000 patient discharges for the general medical patients. Oncology patients requiring rapid response team activation have a significantly higher in-hospital mortality rate, particularly if the rapid response team requires ICU transfer. Oncology patients also utilize rapid response team
Innovative patient-centered skills training addressing challenging issues in cancer communications: Using patient's stories that teach.

PubMed

Bishop, Thomas W; Gorniewicz, James; Floyd, Michael; Tudiver, Fred; Odom, Amy; Zoppi, Kathy

2016-05-01

This workshop demonstrated the utility of a patient-centered web-based/digital Breaking Bad News communication training module designed to educate learners of various levels and disciplines. This training module is designed for independent, self-directed learning as well as group instruction. These interactive educational interventions are based upon video-recorded patient stories. Curriculum development was the result of an interdisciplinary, collaborative effort involving faculty from the East Tennessee State University (ETSU) Graduate Storytelling Program and the departments of Family and Internal Medicine at the James H. Quillen College of Medicine. The specific goals of the BBN training module are to assist learners in: (1) understanding a five-step patient-centered model that is based upon needs, preferences, and expectations of patients with cancer and (2) individualizing communication that is consistent with patient preferences in discussing emotions, informational detail, prognosis and timeline, and whether or not to discuss end-of-life issues. The pedagogical approach to the training module is to cycle through Emotional Engagement, Data, Modeled Practices, Adaptation Opportunities, and Feedback. The communication skills addressed are rooted in concepts found within the Reaching Common Ground communication training. A randomized control study investigating the effectiveness of the Breaking Bad News module found that medical students as well as resident physicians improved their communication skills as measured by an Objective Structured Clinical Examination. Four other similarly designed modules were also created: Living Through Treatment, Transitions: From Curable to Treatable/From Treatable to End-of-Life, Spirituality, and Family. © The Author(s) 2016.
[The differences in speciality preferences and career determinant factors between first- and fifth-year medical school students].

PubMed

Uemoto, Asuka; Kawamoto, Ryuichi; Abe, Masanori; Kusunoki, Tomo; Kohara, Katsuhiko; Miki, Tetsuro

2015-01-01

In Japan, the imbalance in the medical workforce has caused a deterioration of rural medicine. We explored the differences in speciality preferences and career determinant factors among students to identify keys to increase the recruitment of physicians to rural areas. We conducted a survey of first- and fifth-year medical students, using a questionnaire enquiring about their specialty preference and career determinant factors. The data were analyzed with a chi-square test. A higher percentage of first-year students preferred to be basic medicine scientists, while fifth-year students considered internal medicine subspecialities, obstetrics and gynecology, anesthesia, and ophthalmology to be the most desirable. The factor analysis yielded five factors responsible for these findings; high social approval of the specialty, working hours, income, advice from senior classmates and doctors, and the work environment. The percentage of students who considered rural practice as a choice for thier future plan and had an awareness of the collapse of rural medicine was lower in the fifth-year students than in the first-year students. To increase the medical work force in provincial areas, it is necessary to strengthen not only the medical system with regard to general medicine, but also to offer better medical education in rural areas. More information about rural practice should therefore be transmitted to medical students.
The First National Pain Medicine Summit--final summary report.

PubMed

Lippe, Philipp M; Brock, Charles; David, Jose; Crossno, Ronald; Gitlow, Stuart

2010-10-01

and organizations dedicated to improving pain care, the first National Pain Medicine Summit. The process began with the adoption of Resolution 321 (A-08) at an AMA Annual House of Delegates meeting in June 2008. Resolution 321 (A-08) states, in part, that "...the AMA encourages relevant specialties to collaborate in studying: 1) the scope and practice and body of knowledge encompassed by the field of Pain Medicine; 2) the adequacy of undergraduate, graduate, and post graduate education in the principles and practices of the field of Pain Medicine, considering the current and anticipated medical need for the delivery of quality pain care; and 3) appropriate training and credentialing criteria for this multi-disciplinary field of medical practice." The next step was delegating the responsibility for implementing Resolution 321 (A-08) to the Pain and Palliative Medicine Specialty Section Council (PPMSSC). The PPMSSC, under the direction of its chairman, Philipp M. Lippe, MD, FACS, assumed responsibility in November 2008 for identifying a process that would achieve the goals established by Resolution 321 (A-08). The PPMSSC in turn established an Advisory Committee, charged with strategic planning, and an Implementation Committee, charged with tactical operations. The two groups began work immediately. The process included three distinct phases centered on a Pain Medicine Summit. Phase One involved a modified Delphi process identifying the five most pressing and relevant themes in pain care. Phase Two consisted of the Pain Medicine Summit itself, including a gathering of representatives from across the pain care spectrum to address the previously identified five most pressing themes. Phase Three was the preparation of this report, which describes the conclusions drawn and recommendations developed by the attendees at the Pain Medicine Summit. Based on a recommendation from the Advisory Committee, the PPMSSC decided to retain the services of a consulting firm to help the
The first open heart corrections of tetralogy of Fallot. A 26-31 year follow-up of 106 patients.

PubMed Central

Lillehei, C W; Varco, R L; Cohen, M; Warden, H E; Gott, V L; DeWall, R A; Patton, C; Moller, J H

1986-01-01

Tetralogy of Fallot became a correctable malformation on August 31, 1954, and from that data through 1960, 106 patients (ages 4 months-45 years) who underwent open repairs at the University of Minnesota and were discharged, have been followed (99% complete) until death or for 26-31 years (mean: 23.7 years, 2424 patient years). The purposes of this study were to determine survival, morbidity, hemodynamics, educational/employment attainments, and relation of these to surgical technics. Operations were done by cross circulation (6 patients) and bubble oxygenator (100 patients). This group had the first uses of patch ventricular septal defect closure, outflow root, infundibuloplasty, atresia correction, ischemic arrests, and pacemakers among other innovations. Twenty-one (of 105 patients) have died during the followup: eight deaths in the first 10 years, 12 between 10 and 20 years, and 1 greater than 20 years. The causes of death were sudden (5), accidental (4), congestive failure (2), reoperation (2), suicide (2), and other (2). Actuarial survival at 30 years was 77%. Late complications were ten reoperations, five arrhythmias, and one endocarditis. Actuarial freedom from reoperations at 30 years was 91%. Cardiac recatheterizations in 62 patients disclosed only 10 with residual shunts. Peak right ventricular systolic pressures were less than 40 mmHg (34 patients), 41-60 mm (2 patients), 61-70 mm (4 patients), greater than 71 mm (4 patients). Thirty-four patients (32%) completed college, ten of these completed graduate school (5 masters degrees, 2 M.D.'s, 2 Ph.D.'s, 1 lawyer). Fifteen others attended college, and nine received technical school diplomas. Forty patients (18 men, 22 women) had progeny, with 82 (93%) live births and six major cardiac defects (7.3%). In summary, complete repair gave excellent late results in this group cared for very early in the open heart era. Survivors led productive lives without restrictions in education and employment. Many of the
Patient Narratives as a Teaching Tool: A Pilot Study of First-Year Medical Students and Patient Educators Affected by Intellectual/Developmental Disabilities.

PubMed

Coret, Alon; Boyd, Kerry; Hobbs, Kevin; Zazulak, Joyce; McConnell, Meghan

2017-12-28

People with intellectual and developmental disabilities (IDD) face complex biopsychosocial challenges and are medically underserved. This is in part due to insufficient resources and supports but can also be attributed to a lack of adequate physician training in addressing the unique needs of this population. This study aimed to introduce 1st-year medical students to the IDD population using a blended educational experience that included video narratives of and direct interactions with people affected by IDD. The goal of this intervention was to promote person-centered attitudes and communication among early medical trainees. The study recruited 27 first-year medical students and randomly assigned each to 1 of 2 groups. The control group received an introductory video lecture about IDD healthcare, followed by a quiz. The narrative group received the same lecture, followed by reflective discussion of videos featuring people living with IDD sharing their perspectives and stories. All students then participated in 4 simulated clinical encounters with patient educators (PEs) who have lived experiences of IDD. Focus groups were conducted with students following the simulated encounters to explore their experiences and perceptions of this blended learning activity. Moreover, secondary quantitative data were collected to assess students' performance in the clinical encounters, along with self-reports of comfort, confidence, and competence of interacting with people with IDD (pre- and postparticipation). All students thought that the blended educational experience was valuable and enjoyable, commenting on the importance of adaptable language and engagement of people with IDD, as well as the merits of reflecting on patient narratives. Students also discussed feelings of discomfort stemming from a lack of knowledge and previous exposure to IDD and how this discomfort might motivate them to learn more and develop their skills further. In addition, descriptive analyses
Electrocardiographic signs of autonomic imbalance in medicated patients with first-episode schizophrenia spectrum disorders--relations to first treatment discontinuation and five-year remission status.

PubMed

Bodén, Robert; Lindström, Leif; Rautaharju, Pentti; Sundström, Johan

2012-04-01

To explore measures in electrocardiograms (ECG) influenced by autonomic balance in early schizophrenia spectrum disorders and to examine their relation to subsequent first antipsychotic pharmacotherapy discontinuation and five-year remission status. Twelve-lead ECGs were recorded at baseline in 58 patients with first-episode schizophrenia spectrum disorders and in 47 healthy controls of similar age. Selected ECG variables included heart rate and measures of repolarization. Pharmacotherapy data were extracted from medical records. At a five-year follow-up the patients were interviewed and assessed with the positive and negative syndrome scale. Patients had higher heart rate and a different ST-T pattern than the controls. High T-wave amplitudes in the leads aVF and V5 and ST-elevations in V5 were associated both with higher risk of an earlier discontinuation of first antipsychotic pharmacotherapy and with non-remission five years later. In this longitudinal cohort study, simple ECG measures influenced by autonomic balance in the early phase of schizophrenia spectrum disorders contained prognostic information. As this is the first report of this association and is based on a relatively small sample, the results should be interpreted with caution. Copyright © 2010 Elsevier Masson SAS. All rights reserved.
Self-reported Improvement in Side Effects and Quality of Life With Integrative Medicine in Breast Cancer Patients.

PubMed

Hack, Carolin C; Hackl, Janina; Hüttner, Nina B M; Langemann, Hanna; Schwitulla, Judith; Dietzel-Drentwett, Svenja; Fasching, Peter A; Beckmann, Matthias W; Theuser, Anna-Katharin

2018-05-01

Although the demand from patients for integrative medicine is increasing, complementary medicine services are still quite heterogeneous and have not been incorporated into clinical routine. The aim of this study was to systematically evaluate improvements in side effects and quality of life associated with a hospital-based integrative medicine program in the modern breast cancer patient care setting. In a cross-sectional study, integrative health counseling and treatment were evaluated in women with breast cancer. Over a 15-month period, data for 75 patients from an integrative medicine consultancy service with standardized operating procedures were collected at the University Breast Center for Franconia. At baseline, the patients answered a questionnaire on their medical history, symptoms, and the treatment goals they were hoping to achieve with integrative medicine. In the follow-up, patient-reported outcomes related to side effects of conventional cancer treatment and patients' quality of life were analyzed. Among 60 patients with the therapy goal of reducing the side effects of conventional treatment, 46 (76.7%) were successful. Among 57 patients hoping to improve disease-related quality of life, 46 (82%) reported success. Whereas patients with metastatic disease achieved a reduction in the side effects of conventional therapy, quality-of-life improvements were predominantly achieved by patients with a good treatment prognosis. Breast cancer patients benefit from the counseling and treatment provided with integrative medicine in all phases of tumor disease. Integrative treatment services should be included as part of patient care in clinical routine work to offer patients the maximum quality of care and safety with complementary therapies.
Heart retransplantation: a 23-year single-center clinical experience.

PubMed

Schnetzler, B; Pavie, A; Dorent, R; Camproux, A C; Leger, P; Delcourt, A; Gandjbakhch, I

1998-04-01

The main causes of allograft failure after cardiac transplantation are primary graft dysfunction, intractable acute rejection, and coronary graft disease. Despite the important progress in the last several years in graft preservation, surgical techniques, immunosuppression, and treatment of coronary graft disease, retransplantation in selected cases is the only way to achieve long-term recipient survival. We compare here in a case-control study 24 retransplantations with 47 first transplants in patients matched for date of transplantation. Between 1973 and 1996, 1,063 patients underwent cardiac transplantation in our institution. In this cohort, 22 patients had a total of 24 retransplantations (2 second-time retransplantations). The causes of retransplantations were primary graft failure (n=4), acute rejection (n=7), coronary graft disease (n=11), and miscellaneous (n=2). Survival at 1 and 5 years of patients with retransplantations is 45.5% and 31.2%, and survival of control patients is 59.4% and 38.8% (p=0.07). An interval between first transplantation and retransplantation shorter (n=11) or longer (n=13) than 1 year is associated with a 1-year survival of 27.3% and 61.5% and a 4-year survival of 27.3% and 46%, respectively (not significant). Intervals shorter than 1 year between first transplantation and retransplantation were exclusively secondary to primary graft failure or intractable acute rejection. In the face of lack of donor grafts, these and other data indicate that retransplantation should be considered cautiously, especially when the interval between the first transplantation and retransplantation is short.

Primary Care Physicians Practicing Preventive Medicine in the Outpatient Setting

PubMed Central

Snipelisky, David; Carter, Kimberly; Sundsted, Karna; Burton, M. Caroline

2016-01-01

Background: Preventive care is an important part of primary care medicine, yet much variation in its practice exists. The aim of this study is to assess physicians’ perspectives of practicing preventive medicine and evaluate which topics are deemed most important. Methods: All primary care medicine providers at two separate academic medical centers (Mayo Clinic, MN and Mayo Clinic, FL) were surveyed via an E-mail questionnaire assessing physicians’ perception of the role of preventive medicine during both acute/routine and yearly visits, physicians’ perception of patients’ response to preventive medicine topics, and which preventive medicine topics are commonly practiced. Results: Of 445 providers meeting inclusion criteria, a total of 183 (41.1%) responded. Providers were more likely to engage patients in preventive medicine during yearly visits more so than acute visits (3.82 vs. 4.72, range 1–5 Likert Scale), yet providers were very likely to partake in such practices during both visits. Providers perceived that patients received the practice of preventive medicine very well (4.13 on 1–5 Likert Scale). No significant difference between provider practice and patient perception was noted between the two sites, although there was some variation based on clinical experience of the provider. Providers were found to most commonly practice topics recommended by the United States Preventive Services Task Force. Conclusions: Our study found a high predisposition to practicing preventive medicine. Providers seem to practice according to published evidence-based medicine recommendations. PMID:26941906
Patient's medicines brought to hospital: an overlooked resource?

PubMed

Ware, G J

1993-10-27

To quantify potential cost advantages and identify practical safeguards required for utilising patients own medicines while in hospital, and returning them on discharge. All medicines brought in by patients in two wards of a geriatric assessment and rehabilitation unit at Auckland Hospital were examined by the pharmacist, and their suitability for re-issue assessed. Medicines were regarded as suitable for use where they could be positively identified, had been dispensed within 3 months of admission, or if packed in foil, provided the expiry date and manufacturer identification were on the foil. Medicines (260 items) totalling $2,976, assessed over a 6 month period, were regarded as suitable for use by the patient, with a mean value of $11.36 per patient. Patients own medicines used within the hospital with a unit-of-issue distribution system, and taken home by them on discharge, would provide appreciable savings for the hospital medicine budget and reduction in waste of the overall health dollar.
Factors affecting nebulised medicine adherence in adult patients with cystic fibrosis: a qualitative study.

PubMed

Hogan, Alice; Bonney, Mary-Ann; Brien, Jo-Anne; Karamy, Rita; Aslani, Parisa

2015-02-01

Nebulised medicines contribute to the high treatment burden experienced by patients with cystic fibrosis (CF). This study explored experiences of adult patients with CF when using nebulised medicines, factors impacting on their adherence to nebulised therapy and strategies they used to facilitate adherence. Community setting, in Sydney, Australia. Ten patients with CF were recruited through a CF patient organisation. Semi-structured face-to-face interviews were conducted, addressing the study objectives. Interviews were audio-recorded, transcribed verbatim and content analysed for anticipated and emergent themes. Experiences with using nebulised medicines; and barriers and facilitators of adherence to nebulised medicines. Participants' age ranged from 22 to 45 years, with half being male. Four broad themes (with more specific sub-themes) were identified from the interviews: experiences with using nebulised medicines (cleaning nebuliser, time taken to use nebuliser medicine, flexibility in use of nebuliser); feelings about using nebulised medicines (necessary/important, dislike, part of life); factors impacting non-adherence (time consuming therapy, side effects/effects of medicine, work/social demands, lack of perceived importance); factors and strategies facilitating adherence (perceived medicine importance, habit/routine, support, health benefits, technology/medicine dose form, timetabling). Nebulised therapy for cystic fibrosis patients takes a substantial amount of time, with patients trying to alter their routine to incorporate nebulising into their daily lives. However there are still many factors that lead to low adherence, including work/social demands and travelling. Patients balance the necessity for nebulised therapy against the barriers, and engage in intentional non-adherence at times. Future strategies and resources should target and address specific factors identified by patients with CF as being important and impacting their adherence to nebulised
Patients' perspectives on antiepileptic medication: relationships between beliefs about medicines and adherence among patients with epilepsy in UK primary care.

PubMed

Chapman, S C E; Horne, R; Chater, A; Hukins, D; Smithson, W H

2014-02-01

Nonadherence to antiepileptic drugs (AEDs) can result in suboptimal outcomes for patients. This study aimed to assess the utility of a theory-based approach to understanding patient perspectives on AEDs and adherence. Patients with epilepsy, identified by a GP case note review, were mailed validated questionnaires assessing their perceptions of AEDs and their adherence to them. Most (84.9%) of the 398 AED-treated respondents accepted the necessity of AEDs, but over half expressed doubts, with 55% disagreeing or uncertain about the statement 'I would prefer to take epilepsy medication than risk a seizure'. Over a third (36.4%) expressed strong concerns about the potential negative effects of AEDs. We used self-report and medication possession ratio to classify 36.4% of patients as nonadherent. Nonadherence was related to beliefs about medicines and implicit attitudes toward AEDs (p<0.05). Adherence-related attitudes toward AEDs were correlated with general beliefs about pharmaceuticals (BMQ General: General Harm, General Overuse, and General Benefit scales) and perceptions of personal sensitivity to medicines (PSM scale). We identified salient, adherence-related beliefs about AEDs. Patient-centered interventions to support medicine optimization for people with epilepsy should take account of these beliefs. © 2013.
Persistence of impaired health status of Q fever patients 4 years after the first Dutch outbreak.

PubMed

Limonard, G J M; Peters, J B; Besselink, R; Groot, C A R; Dekhuijzen, P N R; Vercoulen, J H; Nabuurs-Franssen, M H

2016-04-01

A significant proportion of Q fever patients from the first Dutch Q fever outbreak in 2007 showed impairment in health status up to 1 year after infection. Interested in whether this decrease in health status persisted, we set out to determine the health status in the same cohort of patients, 4 years after primary infection and to compare health status scores at the individual patient level between 1 and 4 years follow-up. Health status was assessed with the Nijmegen Clinical Screening Instrument (NCSI). Patients were serologically tested to exclude patients with possible, probable or proven chronic Q fever. Results on the NCSI sub-domains at group level [2008 (n = 54) and 2011 (n = 46)] showed a persistent significant percentage of patients exhibiting clinically relevant ('severe') scores for all NCSI sub-domains. After 4 years, undue fatigue was present in 46% and exactly half of all patients experienced a severely impaired general quality of life. Patients with NCSI scores available in both 2008 and 2011 (n = 37) showed no difference in all sub-domain scores, except for a small decrease in dyspnoea emotions in 2011. In this group, a significant proportion of patients either improved or worsened in one or more sub-domains of health status. We conclude that at the group level, health status of Q fever patients remained impaired 4 years after primary infection. At the individual patient level, health status may change.
Regulating Medicines in Croatia: Five-year Experience of Agency for Medicinal Products and Medical Devices

PubMed Central

Tomić, Siniša; Filipović Sučić, Anita; Plazonić, Ana; Truban Žulj, Rajka; Macolić Šarinić, Viola; Čudina, Branka; Ilić Martinac, Adrijana

2010-01-01

Aim To present the activities of the Agency for Medicinal Products and Medical Devices in the first 5 years of its existence and to define its future challenges. Methods Main activities within the scope of the Agency as a regulatory authority were retrospectively analyzed for the period from 2004-2008. Data were collected from the Agency’s database and analyzed by descriptive statistics. Results The number of issued medicine authorizations rose from 240 in 2004 to 580 in 2008. The greatest number of new chemical and biological entities was approved in 2005. The greatest number of regular quality controls (n = 5833) and special quality controls was performed in 2008 (n = 589), while the greatest number of off-shelf quality controls (n = 132) was performed in 2007. The greatest number of medicine labeling irregularities was found in 2007 (n = 19) and of quality irregularities in 2004 (n = 9). The greatest number of adverse reactions was reported in 2008 (n = 1393). The number of registered medical devices rose from 213 in 2004 to 565 in 2008. Conclusion Over its 5 years of existence, the Agency has successfully coped with the constant increase in workload. In the future, as Croatia enters the European Union, the Agency will have to face the challenge of joining the integrated European regulatory framework. PMID:20401952
My First Patient Program to introduce first-year pharmacy students to health promotion and disease prevention.

PubMed

Maffeo, Carrie; Chase, Patricia; Brown, Bonnie; Tuohy, Kevin; Kalsekar, Iftekhar

2009-10-01

To implement and assess the effectiveness of a program to teach pharmacy students the importance of taking personal responsibility for their health. The My First Patient Program was created and lectures were incorporated into an existing first-year course to introduce the concepts of health beliefs, behavior modification, stress management, substance abuse, and nutrition. Each student received a comprehensive health screening and health risk assessment which they used to develop a personal health portfolio and identify strategies to attain and/or maintain their personal health goals. Student learning was assessed through written assignments and student reflections, follow-up surveys, and course evaluations. Students' attainment of health goals and their ability to identify their personal health status illustrated the positive impact of the program. This program serves as a model for colleges and schools of pharmacy and for other health professions in the instruction of health promotion, disease prevention, and behavior modification.
[Results of the first human papilloma virus center in Hungary (2007-2011)].

PubMed

Galamb, Adám; Pajor, Attila; Langmár, Zoltán; Sobel, Gábor

2011-11-06

Human papilloma virus (HPV) is the most common sexually transmitted infection in the 21st century. It has been established that infections with specific HPV types are contributing factors to cervical cancer. Approximately 99.7% of cervical cancers are associated with high risk HPV types. HPV testing plays an important role in the prevention, by decreasing the prevalence and the mortality of cervical cancer. There are 16 HPV-centers operating in Hungary, in which patients undergo HPV screening, cervical exams, and treatment based on standardized guidelines. The first HPV-center was founded in 2007 in Budapest, at the 2nd Department of Obstetrics and Gynecology, Semmelweis University. This study aimed to define the presence and prevalence of HPV-DNA in the cervical swab samples obtained from patients in our center. Authors conducted to assess the age-specific-prevalence, and HPV type distribution, the associated cervical abnormalities, comparing our results with international data. Overall 1155 woman underwent HPV-testing and genotyping, using polymerase chain reaction. Overall, 55.5% of patients had positive test for HPV DNA types, in which 38.5% for high-risk HPV DNA. Overall prevalence was the highest among females aged 15 to 25 years (62.9%). The most common HPV type found was the high risk type 16 (19.5% among the patients with positive HPV testing). Presence of high risk HPV with concurrent cervical cytological abnormality was in 32%. More than two-thirds of woman with cytological atypia (70.6%) were infected with two or more high risk HPV types. HPV 16 was detected in 32% of patients with cytological abnormalities. The results suggest that the prevalence of HPV in this study population exceeds the international data. The results attracts the attention the peak prevalence of the high risk types in the youngest age-group, and the higher risk of cervical abnormality in case of presence of two or more HPV types. The dominance of type 16 and 18 was predictable, but
Formative feedback from the first-person perspective using Google Glass in a family medicine objective structured clinical examination station in the United States.

PubMed

Youm, Julie; Wiechmann, Warren

2018-01-01

This case study explored the use of Google Glass in a clinical examination scenario to capture the first-person perspective of a standardized patient as a way to provide formative feedback on students' communication and empathy skills 'through the patient's eyes.' During a 3-year period between 2014 and 2017, third-year students enrolled in a family medicine clerkship participated in a Google Glass station during a summative clinical examination. At this station, standardized patients wore Google Glass to record an encounter focused on communication and empathy skills 'through the patient's eyes.' Students completed an online survey using a 4-point Likert scale about their perspectives on Google Glass as a feedback tool (N= 255). We found that the students' experiences with Google Glass 'through the patient's eyes' were largely positive and that students felt the feedback provided by the Google Glass recording to be helpful. Although a third of the students felt that Google Glass was a distraction, the majority believed that the first-person perspective recordings provided an opportunity for feedback that did not exist before. Continuing exploration of first-person perspective recordings using Google Glass to improve education on communication and empathy skills is warranted.
[Social representation of family support for diabetic patients in users of a family medicine unit in Chalco, State of Mexico].

PubMed

Rodríguez, Alejandra; Camacho, Esteban Jaime; Escoto, María Del Consuelo; Contreras, Georgina; Casas, Donovan

2014-08-27

The goal of this study is to compare and interpret the meaning of family support for diabetic patients and their families using social representations according to a structural approach of Abric's theory. The study was carried out in a Family Medicine Center of the Chalco Municipality in Mexico State. The population studied comprised ten diabetic patient-family pairs. The first part of the study was a simple word association test that aimed to find terms or statements related to the concept of "family support", as well as its frequency of appearance and range of association. Once the terms or statements were obtained, they were categorized according to their "support" capabilities. A semi-structured interview for each category was conducted as well as a graphic analysis of Friedman's meanings. The discourse of diabetic patients was compared to that of the families in order to find similarities and differences. Evocation of terms was done in the first part of the study, and it was found that the emotional domain was central to the discourse. However, in the second part of the study, when categorization and analysis of discourse is performed, there are differences in the centrality of terms and statements. The family tends to center in the active domain, whereas the patient centers in the emotional domain. This study brings up the emotional needs of the patient as essential components of support efforts. This promotes reflection about changing strategies in the design of public healthcare programs in that they may include family support from the viewpoint of otherness.
76 FR 55073 - National Center for Complementary & Alternative Medicine; Notice of Closed Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-06

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Center for Complementary & Alternative Medicine; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory Committee Act, as amended (5 U.S.C. App.), notice is hereby given of the National Advisory Council for Complementary and Alternative Medicine ...
Abdominal aortic aneurysm. Prevalence and associated risk factors in a population of patients hospitalised in Internal Medicine.

PubMed

Belloch García, S L

2018-05-29

To determine the prevalence of previously undiagnosed abdominal aortic aneurysm (AAA) in patients hospitalised in a department of internal medicine, as well as the associated risk factors. An observational, cross-sectional, single-centre, randomised study was conducted on 241 patients hospitalised in Internal Medicine. The patients were older than 50 years, had no previous diagnosis of AAA and underwent clinical ultrasonography. The dependent variable was the presence or absence of an aneurysm. The independent variables were age, sex, cardiovascular risk factors, cardiovascular disease, renal function, ankle brachial index (ABI), family history (first degree) of AAA or of early ischaemic heart disease. A bivariate and multivariate analysis was conducted in the statistical analysis. The prevalence of AAA was 2.9% (95% CI: 0.8-5). The cases were confirmed through ultrasonography or computed tomography by the Department of Radiology. All patients were men with a history of smoking and with an age≥65 years. The bivariate analysis found an association between being male (OR, 9.39), smoking (OR, 13.08), ischaemic heart disease (OR, 5.6; 95% CI: 1.21-25.91; P<.05) and ABI<0.9 (OR, 12.50; 95% CI: 2.34-66.77; P<.05). In the multivariate analysis, the independently associated variable was an ABI<0.9 (OR, 10.758; 95% CI: 1.968-58.815; P=.006). The prevalence of undiagnosed AAA in patients older than 50 years hospitalised in internal medicine was 2.9%. The data lead us to recommend AAA screening for this population of male patients with a history of smoking and an ABI<0.9. Clinical ultrasonography enables this screening in a reliable manner. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.
Use of medicines and adherence to standard treatment guidelines in rural community health centers, Timor-Leste.

PubMed

Higuchi, Michiyo; Okumura, Junko; Aoyama, Atsuko; Suryawati, Sri; Porter, John

2015-03-01

The use of medicines and nurses'/midwives' adherence to standard treatment guidelines (STGs) were examined in Timor-Leste during the early stage of the nation's new health system development. A cross-sectional study was conducted as the quantitative element of mixed methods research. Retrospective samples from patient registration books and prospective observations were obtained in 20 randomly selected rural community health centers. The medicines use indicators, in particular the level of injection use, in Timor-Leste did not suggest overprescription. Prescribers with clinical nurse training prescribed significantly fewer antibiotics than those without such training (P < .01). The adjusted odds ratio of prescribing adherence for clinical nurse training, after accounting for confounders and prescriber clustering, was 6.6 (P < .01). STGs for nonphysician health professionals at the primary health care level have potential value in basic health care delivery, including appropriate use of medicines, in resource-limited communities when strategically developed and introduced. © 2012 APJPH.
Academic Medicine's Critical Role in the "Third Curve" of Health Care.

PubMed

Paz, Harold L

2016-05-01

Over the last several years, the health care landscape has changed at an unprecedented rate due to new economic and regulatory forces ushered in by the Affordable Care Act and the introduction of innovative technologies, such as personalized medicine, that are poised to open the door to consumer-driven health care. Tremendous pressure exists on academic health centers to rapidly evolve clinically while not abandoning their unique academic mission. The convergence of personalized medicine, new digital technologies, and changes in health professionals' scope of practice alongside new payment structures will accelerate the move to a patient-centered health system. In this Commentary, the author argues that these new tools and resources must be embraced to improve the health of patients. With the traditional, fee-for-service model of care as "Curve I" and the post-Flexner era of population-based medicine as "Curve II," the author identifies the emergence of "Curve III," which is characterized by patient-centered, consumer-directed models of care. As the old models of health care undergo transition and the impact of technology and analytics grow, future practitioners must be trained to embrace this change and function effectively in the "third curve" of consumer-driven health care.
Development of a Post-Graduate Year 2 Pharmacy Residency in Clinical Pharmacogenetics

PubMed Central

Hoffman, James M.; Gammal, Roseann S.; Relling, Mary V.; Crews, Kristine R.

2017-01-01

Purpose The structure and development of an innovative clinical pharmacogenetics post-graduate year 2 (PGY2) ASHP-accredited residency program is described. Summary The advent of the era of genomics has left practitioners wondering how to interpret the data obtained from sequencing and genotyping patients. In order to train the next leaders in the area of implementing pharmacogenetics, St. Jude Children’s Research Hospital established the first accredited residency program in clinical pharmacogenetics. The 12-month long PGY2 residency was created in accordance with the ASHP standards for advanced practice residencies. The resident learns to optimize patient outcomes through the expert provision of evidence-based, patient-centered precision medicine as an integral part of an interdisciplinary team. The resident gains hands-on experience in a dynamic environment regarding all aspects of running a clinical pharmacogenetics service. Since the first resident graduated in 2012, the program has graduated one resident each year. Conclusion To fill a need for pharmacists trained in pharmacogenetics, an innovative PGY2 residency in clinical pharmacogenetics was successfully developed. Upon completion of the program, residents are equipped with the clinical skills and necessary experience to drive precision medicine forward and lead the implementation of pharmacogenetics in various healthcare settings. PMID:28274984
Traditional Chinese medicine use among Chinese immigrant cancer patients.

PubMed

Leng, Jennifer C F; Gany, Francesca

2014-03-01

Traditional Chinese Medicine (TCM) includes both herbal remedies and non-herbal practices. Chinese cancer patients are particularly at high risk for herb-drug interactions. Providers, both primary care physicians and oncologists, frequently do not ask patients about TCM use, which has potentially dangerous consequences. This study describes an assessment of TCM use while undergoing conventional cancer treatment, among a cohort of Chinese immigrant cancer patients in New York City. The Immigrant Health and Cancer Disparities Service at Memorial Sloan-Kettering Cancer Center assists underserved cancer patients through a patient navigation program, the Cancer Portal Project. Six questions related to TCM are included in the existing Portal Needs Assessment Intake. Mandarin- or Cantonese-speaking Portal patients enrolled between January 2010 and May 2012 were surveyed. One hundred nine Chinese-speaking patients were enrolled in the Portal Project during the study period. Forty-six completed the TCM questions. Ninety-six percent preferred to speak Mandarin, Cantonese, or Fujianese in the healthcare setting. Thirty-nine percent (n = 18) of the 46 participants reported using TCM since being diagnosed with cancer. Nearly all (n = 16) who used TCM reported using herbal medicines. Ten TCM users did not describe sharing their use with Western doctors. Eight (44%) of TCM users reported concurrently using TCM and conventional cancer treatment. Larger scale studies should further explore the concurrent use of TCM and conventional cancer treatment in this unique population. Future research should also address patient-provider communication related to the concurrent use of TCM and cancer treatment. This is also an important area of education for both patients and providers.
Clinical utilization and cost outcomes from an integrative medicine independent physician association: an additional 3-year update.

PubMed

Sarnat, Richard L; Winterstein, James; Cambron, Jerrilyn A

2007-05-01

Our initial report analyzed clinical and cost utilization data from the years 1999 to 2002 for an integrative medicine independent physician association (IPA) whose primary care physicians (PCPs) were exclusively doctors of chiropractic. This report updates the subsequent utilization data from the IPA for the years 2003 to 2005 and includes first-time comparisons in data points among PCPs of different licensures who were oriented toward complementary and alternative medicine (CAM). Independent physician association-incurred claims and stratified random patient surveys were descriptively analyzed for clinical utilization, cost offsets, and member satisfaction compared with conventional medical IPA normative values. Comparisons to our original publication's comparative blinded data, using nonrandom matched comparison groups, were descriptively analyzed for differences in age/sex demographics and disease profiles to examine sample bias. Clinical and cost utilization based on 70,274 member-months over a 7-year period demonstrated decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance for the same health maintenance organization product in the same geography and time frame. During the past 7 years, and with a larger population than originally reported, the CAM-oriented PCPs using a nonsurgical/nonpharmaceutical approach demonstrated reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone. Decreased utilization was uniformly achieved by all CAM-oriented PCPs, regardless of their licensure. The validity and generalizability of this observation are guarded given the lack of randomization, lack of statistical analysis possible, and potentially biased data in this population.
Evaluation of travel medicine practice by yellow fever vaccination centers in England, Wales, and Northern Ireland.

PubMed

Boddington, Nicola L; Simons, Hilary; Launders, Naomi; Gawthrop, Mary; Stillwell, Alexandra; Wong, Claire; Mathewson, John; Hill, David R

2012-01-01

The National Travel Health Network and Centre (NaTHNaC) introduced a program of registration, training, standards, and audit for yellow fever vaccination centers (YFVCs) in England, Wales, and Northern Ireland (EWNI) in 2005. Prior to rolling out the program, NaTHNaC surveyed YFVCs in England. To reassess the practice of YFVCs in 2009, 4 years after the institution of the NaTHNaC program, to identify areas for ongoing support, and to assess the impact of the program. In 2009, all YFVCs in EWNI were asked to complete a questionnaire on type of practice, administration of travel vaccines, staff training, vaccine storage and patient record keeping, use of travel health information, evaluation of NaTHNaC yellow fever (YF) training, and resource and training needs. Data were analyzed using Microsoft Excel® and STATA 9®. The questionnaire was completed by 1,438 YFVCs (41.5% of 3,465 YFVCs). Most YFVCs were based in General Practice (87.4%). In nearly all YFVCs (97.0%), nurses advised travelers and administered YF vaccine. An annual median of 50 doses of YF vaccine was given by each YFVC. A total of 96.7% of nurses had received training in travel medicine, often through study days run by vaccine manufacturers. The internet was frequently used for information during travel consultations (84.8%) and NaTHNaC's on-line and telephone advice resources were highly rated. Following YF training, 95.8% of attendees expressed improved confidence regarding YF vaccination issues. There was excellent adherence to vaccination standards: ≥ 94% correctly stored vaccines, recorded refrigerator temperatures, and maintained YF vaccination records. In the 4 years since institution of the NaTHNaC program for YFVCs, there has been improved adherence to basic standards of immunization practice and increased confidence of health professionals in YF vaccination. The NaTHNaC program could be a model for other national public health bodies, as they establish a program for YF centers. © 2012
Electronic health communication: an educational application for this principle of the Patient-centered Medical Home.

PubMed

Barnhart, Amber; Lausen, Harald; Smith, Tracey; Lopp, Lauri

2010-05-01

The Patient-centered Medical Home (PCMH) relies on comprehensive, consistent, and accessible communication for the patient with all members of their health care team. "E-medicine" and health information technology (HIT) create many new possibilities in addition to standard face-to-face encounters. There is interest by both physicians and patients for enhanced access through electronic communication. However, there is little published literature regarding specific educational programs for medical professionals using electronic communication with patients. Faculty in a required 6-week family medicine clerkship developed, implemented, and evaluated an electronic health communication curriculum. This curriculum consists of a didactic session on electronic health communication including anticipated errors of communication and common clinical pitfalls. Each clerkship student receives a weekly e-mail from a standardized patient centered on a clinical question. Additionally, each e-mail contains a different communication challenge or predicted error. Students receive feedback each week on the e-mails and are evaluated with an objective structured clinical exam (OSCE) during the final week. The results of the weekly e-mails and the final OSCE show that students improve overall but continue to make predicted errors in communication despite didactic instruction and actual practice. These results reinforce the need for medical student education on electronic health communication with patients.
Patient-centered communication to assess and enhance patient adherence to glaucoma medication.

PubMed

Hahn, Steven R

2009-11-01

Using an understanding of a patient's difficulty in revealing nonadherence and patient-centered communication skills to identify and address barriers to adherence to glaucoma medication regimens. In addition to cost and logistical difficulties with obtaining and administering medicine, a patient's adherence to medication is influenced by the balance between the perceived need for medication and concerns about taking medication. This article is based on both the author's clinical experience and peer-reviewed research on effective doctor-patient communication and assessment and management of nonadherence. Three strategies have been identified that help physicians to detect and address problems with adherence: (1) a 4-step adherence assessment interview designed to detect nonadherence that decreases patient resistance to revealing nonadherence by applying a shared decision-making process and mitigating social undesirability; (2) asking open-ended questions in ask-tell-ask sequences; and (3) tailoring interventions to the patient's stage of readiness for change. Patients conceal nonadherence because they want to be thought of by their physicians as good patients. They are driven to nonadherence by an imbalance between their perceived need for medication and their concerns about taking it. Patient-centered communication techniques can engage the patient in shared decision making about medication, thereby redefining the good patient as someone who works with his or her health care provider to address adherence barriers. Those barriers can be explored with open-ended questions designed to elicit the patient's understanding and concerns, to provide information, and to assess change in the patient's understanding and attitudes. Communication will be more effective if it is based on the patient's stage of readiness to adopt adherent self-management practices. Proprietary or commercial disclosure may be found after the references.

[100 years with certificates: Danish Society of Insurance Medicine 1902-2002].

PubMed

Permin, Henrik

2002-01-01

Danish Society of Insurance Medicine was formed in 1902 as an association between the Danish Society of Accident Insurance and the Danish Society of Life Insurance Medicine, both founded a year before. The purpose of the society is to apply and to further the scientific basis of insurance medicine. The meetings also play a role as a forum for discussions. The members of the society are all working part-time in an insurance company in Denmark (in contrast to many other countries where it is a full-time job). The members are mainly specialists in medicine and surgery. During the first half life of the society nearly all members were high-qualified doctors, i.e. professors and consultants at a university hospital in Copenhagen usually with a doctoral degree. These prominent doctors had a significant influence on insurance medicine in Denmark. The managing directors of the Insurance Companies were invited to the meetings. Many scientific works and textbooks were written on the subject. The society arranges two meetings yearly - one concerning with life insurance and one with accident-insurance medicine. Previously, the question put to the medical adviser was always "Which impairments can still be insured?", but today the question is the opposite "Which impairments are not insurable?" The members have increased to currently 112, still only men, but today the members are younger, comprise fewer professors and fewer with a doctoral degree. During the last 6 years, all interested members in the insurance companies have been invited to the meetings, providing a broader input for the discussions. The topic of the meeting is of current interest: new laws or a new treatment of a disease (medication, surgery) which has been introduced. One to three speakers open the meeting, followed by a discussion. The meetings are always concluded with a light meal and a glass of wine, in earlier days also with cigars and Danish schnaps. 190 meetings have been held during the last 100 years
Rehabilitation activities, out-patient visits and employment in patients and partners the first year after ICU: a descriptive study.

PubMed

Agård, A S; Lomborg, K; Tønnesen, E; Egerod, I

2014-04-01

To describe the influence of critical illness on patients and their partners in relation to rehabilitation, healthcare consumption and employment during the first year after Intensive Care Unit discharge. Longitudinal, observational and descriptive. Five Danish Intensive Care Units. Data were collected from hospital charts, population registers and interviews with 18 patients and their partners at 3 and 12 months after intensive care discharge. Descriptive statistical analysis was performed. Post-discharge inpatient rehabilitation was median (range) 52 (15-174) days (n=10). Community-based training was 12 (3-34) weeks (n=15). Neuropsychological rehabilitation following brain damage was 13-20 weeks (n=3). Number of out-patient visits 1 year before and 1 year after were mean 3 versus 8, and General Practitioner visits were 12 versus 18. Three patients resumed work at pre-hospitalisation employment rates after 12 months. After the patients' stay in intensive care, partners' mean full-time sick leave was 17 (range 0-124) days and 21 (range 0-106) days part time. Partners often had long commutes. Most patients had comprehensive recovery needs requiring months of rehabilitation. Some partners needed extensive sick leave. The study reveals the human cost of critical illness and intensive care for patients and partners in the Danish welfare system. Copyright © 2013 Elsevier Ltd. All rights reserved.
[Can narrative medicine be an answer to patient physician relationship teaching according to students' demand in medical education curricula?].

PubMed

Goupy, François; Abgrall-Barbry, Gaëlle; Aslangul, Elisabeth; Chahwakilian, Anne; Delaitre, Didier; Girard, Thomas; Lassaunière, Jean-Michel; Roche, Nicolas; Szwebel, Tali-Anne; Dantchev, Nicolas; Triadou, Patrick; Le Jeunne, Claire

2013-01-01

Coming from literature and medicine and medical humanities north American seminars, narrative medicine has applied narratology for analyzing patients' discourse and has been taught during a decade. At Paris Descartes School of Medicine a twenty-hour narrative medicine elective program including whole class lectures and writing and reading small group exercises for second year medical students has been assessed using satisfaction questionnaires. Although several students were uncomfortable with the first writing and reading exercises, the whole satisfaction scores demonstrate that this new program is very well appreciated even when students did not choose this program because they were interested with the patient physician relationship. These results have been confirmed when all students state this program should be continued and when half of them state this program should be offered to more students or made mandatory. The primary focus on literary characteristics of patients' and physicians' discourses, without ignoring psychoanalysis theory, has shown to be safe for young students. Writing exercises are encouraged but not mandatory, and reading is optional if ever they feel embarrassed after producing their own texts. Narrative medicine impact on students' attitudes and behaviors has now to be assessed before implementing new educational programs. Copyright © 2012. Published by Elsevier Masson SAS.
[Certified medical centers--A measurable benefit to patients?!].

PubMed

Eberlein-Gonska, Maria; Schellong, Sebastian; Baumann, Michael

2007-01-01

The establishment of medical centers should meet the high requirements of the healthcare system. They should provide innovative solutions for a number of problems, e.g. the interdisciplinary collaboration of various health departments with due regard to their autonomy. This is reminiscent of the implementation and advancement of a quality management system required by law where a clear idea of how to manage the organizational and procedural structures as an integral part of the management concept implemented is missing. The genuine efforts to implement and advance interdisciplinary medical centers are up against "bogus models" created out of sheer marketing interests. The term "medical center" has so far not been protected under trademark law, leaving patients, relatives or even the referring physicians unsure about how to judge a medical center's actual performance. The same is true of certified centers. Their numbers are growing, but not so the transparency about the amount of measurable, traceable and understandable benefits that a certified center provides to the patient. Therefore clear demands need to be placed on certified centers, especially with regard to the implementation of a concept that provides interdisciplinarity and process-oriented transparent structures and defines quality ratios and quality objectives. This includes providing resources for the continuous collection and evaluation of hard and soft data as well as deriving improvement measures. The three centers of the University Hospital Dresden--the University Cancer Center, the University Vascular Center and the University Pain Center--fulfil this high demand. They have created fundamentals for measurable improvement of patient care and are able to present first results.
[Shaare Zedek Medical Center's model of an integrated division of internal medicine].

PubMed

Yinnon, Amos M; Munter, Gabriel; Friedmann, Reuven; Katz, David; Nesher, Gideon; Tichler, Thomas; Zevin, Shoshana

2014-01-01

The specialty and practice of internal medicine have been subject to serious challenges in the last two decades. We describe the integrative model of internal medicine as developed in our hospital, providing solutions to some major challenges. Major components include: (1) Senior physicians and residents are employed by the Division rather than individual Departments of Medicine, allowing for balanced distribution of professional capabilities. (2) Two medical departments specialize in geriatric medicine, while the other departments take care of younger, more intellectually challenging patients. Senior and junior staff members rotate through these departments, allowing for exposure to different patient populations and professional expertise. (3) The backbone of senior physicians is rewarded by a set of incentives, including dedicated time for research. (4) Senior staff from the subspecialties contributes annually 1-2 months as senior physicians in the departments and receive academic and other compensation for their efforts. (5) In cases where medical departments elsewhere are flooded with corridor admissions (a source of frustration and burnout), a short admission unit in the emergency department relieves internal medicine pressures and shortens evaluation and therapy for many patients. Our integrative model of internal medicine allows for improved patient and staff distribution, greater satisfaction among patients and family members, greater professional satisfaction among physicians, while resident vacancies are filled with competent residents.
[Observational study of patients admitted to an Internal Medicine service].

PubMed

Delgado Morales, J L; Alonso del Busto, R; Pascual Calleja, I; Villacorta Martín, M M; Ergueta Martín, P; González Sarmiento, E

2004-01-01

To analyse the entered more frequent disease in an Internal Medicine Department, the reasons for hospital admission diagnosis at discharge (according to entrance symptom's guide), the group of affected population and its correlation among them. Over a total of 758 internal medicine admissions of the University Hospital of Valladolid during the year 1999 based on the information of discharge and clinical histories, a descriptive and observational epidemic study was made using the variables of sex, age, reason for admission (guide symptom) and diagnosis at discharge. The obtained results were represented by mean of diagrams of sectors and bars according to the analyzed variables. The data synthesis was made by measures of central tendency and dispersion. SPSS 10.0 version for windows program was used for the statistical study. The non parametric analysis for independent samples was made by the test of median and the U of Mann Whitney, and the parametric by chi-squired test and resistance of Kolmogorov-Smirnov. The median of age is 70 years. Rank 84 years. Interquartile rank 23, fashion in men 75 years and in women 86. The distribution in sex men 51%, women 49%. The more frequent reasons for entrance are dyspnea (35%) and neurological focus (11%). The more frequent diagnosis at discharge are dyspnea and chronic obstructive lung disease worsened by respiratory infection (11%), pneumonia (8%) and acute ischemic stroke (7%). In-patients in this service, are advanced in years (mainly women) (alpha = 0.05). The age does not get a normal distribution (alpha = 0.05). The frequency of the distribution in sex is similar. The most frequent reason for admission is dyspnea (35%). The most frequent diagnoses at discharge are chronic obstructive lung disease (11%), pneumonia (8%) and acute ischemic stroke (7%). The primary and secondary prevention and an improvement of the therapeutic measures of chronic cardiopulmonary disease would reduce significantly the welfare pressure in
The Use of Complementary and Alternative Medicine in Hospitalized Patients with Type 2 Diabetes Mellitus in Israel.

PubMed

Koren, Ronit; Lerner, Ayelet; Tirosh, Amit; Zaidenstein, Ronit; Ziv-Baran, Tomer; Golik, Ahuva; Koren, Shlomit

2015-07-01

The use of complementary and alternative medicine (CAM) has been on the rise in recent years in the general population, as well as among patients with chronic diseases such as diabetes mellitus. The aim of this study was to add information regarding the use of CAM in patients with type 2 diabetes mellitus (DM2) in Israel and explore possible interactions between CAM and prescription medication (PM). This is a cross-sectional study based on questionnaires. The study included type 2 diabetic patients who were hospitalized in an internal medicine department at Assaf Harofeh Medical Center, Zerifin, Israel, between December 2013 and December 2014. Possible interactions between CAM and PM were evaluated by a clinical pharmacist and a clinical pharmacologist. Out of 111 diabetic patients, 23.4% used CAM. There was no significant difference between the consumers and nonconsumers in terms of age, education, income, smoking, or alcohol habits. Only 11 of the 26 CAM consumers informed their physician regarding the use. We found possible drug-herb interactions in 19 of the 26 CAM consumers. A major interaction was found between omega-3 and antiaggregants and was encountered in 7 (26.9%) of the CAM consumers. Other minor and major interactions were found with vitamin E, ginkgo-biloba, co-enzyme Q10, green tea, fenugreek seeds, pyridoxine, and dandelion. Since CAM consumption is on the rise, it is desirable to improve our knowledge concerning their potential effects and adverse effects, especially in conjunction with PM. Given the complexity of pharmaceutics in patients with chronic diseases, among them patients with DM, the use of supplementary medicine cannot be ignored.
Successful introduction of Model for End-stage Liver Disease scoring in deceased donor liver transplantation in Korea: analysis of first 1 year experience at a high-volume transplantation center.

PubMed

Ha, Soo-Min; Hwang, Shin; Song, Gi-Won; Ahn, Chul-Soo; Moon, Deok-Bog; Ha, Tae-Yong; Jung, Dong-Hwan; Park, Gil-Chun; Kim, Ki-Hun; Kim, Dae-Yeon; Namgung, Jungman; Kang, Woo-Hyoung; Kim, Seok-Hwan; Jwa, Eunkyoung; Kwon, Jae-Hyeon; Cho, Hui-Dong; Jung, Yong-Kyu; Kang, Sang-Hyeon; Lee, Sung-Gyu

2017-11-01

Model for End-stage Liver Disease (MELD) score was adopted in June 2016 in Korea. We analyzed changes in volumes and outcomes of deceased donor liver transplantation (DDLT) for 1 year before and after introduction of MELD scoring at Asan Medical Center. There were 64 cases of DDLT in 1 year before MELD introduction and 106 in 1 year after MELD introduction, an increase of 65%. The volume of DDLTs abruptly increased during first 3 months, but then returned to its usual level before MELD introduction, which indicated 3-month depletion of accumulated recipient pool with high MELD scores. The number of pediatric DDLT cases increased from 3 before MELD introduction to 11 after it, making up 21.4% and 47.8% of all cases of pediatric liver transplantation, respectively. The number of cases of retransplanted DDLTs increased from 4 to 27, representing 6.3% and 25.5% of all DDLT cases, respectively. The number of status 1 DDLT cases increased from 5 to 12, being 7.8% and 11.3% of all cases. Patient survival outcomes were similar before and after MELD introduction. The number of DDLTs temporarily increased after adoption of MELD scoring due to accumulated recipient pool with high MELD scores. The numbers of retransplanted and pediatric DDLT cases significantly increased. Patient survival in adult and pediatric DDLT was comparable before and after adoption of MELD scoring. These results imply that Korean MELD score-based allocation system was successfully established within its first year.
"Ms. B changes doctors": using a comic and patient transition packet to engineer patient-oriented clinic handoffs (EPOCH).

PubMed

Pincavage, Amber T; Lee, Wei Wei; Venable, Laura Ruth; Prochaska, Megan; Staisiunas, Daina D; Beiting, Kimberly J; Czerweic, M K; Oyler, Julie; Vinci, Lisa M; Arora, Vineet M

2015-02-01

Few patient-centered interventions exist to improve year-end residency clinic handoffs. Our purpose was to assess the impact of a patient-centered transition packet and comic on clinic handoff outcomes. The study was conducted at an academic medicine residency clinic. Participants were patients undergoing resident clinic handoff 2011-2013 PROGRAM DESCRIPTION: Two months before the 2012 handoff, patients received a "transition packet" incorporating patient-identified solutions (i.e., a new primary care provider (PCP) welcome letter with photo, certificate of recognition, and visit preparation tool). In 2013, a comic was incorporated to stress the importance of follow-up. Patients were interviewed by phone with response rates of 32 % in 2011, 43 % in 2012 and 36 % in 2013. Most patients who were interviewed were aware of the handoff post-packet (95 %). With the comic, more patients recalled receiving the packet (44 % 2012 vs. 64 % 2013, p< 0.001) and correctly identified their new PCP (77 % 2012 vs. 98 % 2013, p< 0.001). Among patients recalling the packet, most (70 % 2012; 65 % 2013) agreed it helped them establish rapport. Both years, fewer patients missed their first new PCP visit (43 % in 2011, 31 % in 2012 and 26 % in 2013, p< 0.001). A patient-centered transition packet helped prepare patients for clinic handoffs. The comic was associated with increased packet recall and improved follow-up rates.
Are patients who use alternative medicine dissatisfied with orthodox medicine?

PubMed

Donnelly, W J; Spykerboer, J E; Thong, Y H

1985-05-13

Approximately 45% of asthmatic families and 47% of non-asthmatic families had consulted an alternative-medicine practitioner at some time. The most popular form of alternative medicine was chiropractic (21.1% and 26.4%, respectively), followed by homoeopathy/naturopathy (18.8% and 12.7%, respectively), acupuncture (9.4% and 10.9%, respectively), and herbal medicine (4.7% and 6.4%, respectively), while the remainder (20.3% and 11.8% respectively) was distributed among iridology, osteopathy, hypnosis, faith healing and megavitamin therapy. More families were satisfied with orthodox medicine (87.1% and 93.6%, respectively) than with alternative medicine (84.2% and 75.1%, respectively). Crosstabulation analysis of pooled data both from asthma and from non-asthma groups showed that 76.4% were satisfied both with orthodox and with alternative medicine, and 16.4% were satisfied with orthodox, but not with alternative, medicine. In contrast, only 2.7% were dissatisfied with orthodox medicine and satisfied with alternative medicine (chi2 = 9.33; P less than 0.01). These findings do not support the view that patients who use alternative medicine are those who are disgruntled with orthodox medicine.
[RABIN MEDICAL CENTER - A TERTIARY CENTER OF EXCELLENCE IN SERVICE, TEACHING AND RESEARCH].

PubMed

Niv, Yaron; Halpern, Eyran

2017-04-01

Rabin Medical Center (RMC) belongs to Clalit Health Services and is a tertiary, academic medical center with all the facilities of modern and advanced medicine. Annually in the RMC, 650,000 patients are treated in the outpatient clinics, and 100,000 patients are hospitalized in the hospital departments. All these patients are treated by 4500 devoted staff members, including 1000 physicians and 2000 nurses. RMC is one of the largest, centrally located medical centers for medical and nursing students' education in Israel, taking place in clinical departments, as well as in basic sciences courses. We also have a nursing school attached to the hospital. Our vision supports excellence in research. We have a special Research Department that supports RMC researchers, with research coordinators, and all the relevant facilities to assist in clinical and basic science studies. We also promote collaboration efforts with many academic centers in Israel and abroad. The scope of RMC research is broad, including 700 new studies every year and 1500 active studies currently. This issue of Harefuah is dedicated to the clinical and basic science research conducted at RMC with original papers presenting research performed by our departments and laboratories.
[Reliability of the PROFUND index to predict 4-year mortality in polypathological patients].

PubMed

Díez-Manglano, Jesús; Del Corral Beamonte, Esther; Ramos Ibáñez, Rosa; Lambán Aranda, María Pilar; Toyas Miazza, Carla; Rodero Roldán, María Del Mar; Ortiz Domingo, Concepción; Munilla López, Eulalia; de Escalante Yangüela, Begoña

2016-09-16

To determine the usefullness of the PROFUND index to assess the risk of global death after 4 years in polypathological patients. Multicenter prospective cohort (Internal Medicine and Geriatrics) study. Polypathological patients admitted between March 1st and June 30th 2011 were included. For each patient, data concerning age, sex, living at home or in a nursing residence, polypathology categories, Charlson, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale, delirium, number of drugs, hemoglobin and creatinine values were gathered, and the PROFUND index was calculated. The follow-up lasted 4 years. We included 441 patients, 324 from Internal Medicine and 117 from Geriatrics, with a mean age of 80.9 (8.7) years. Of them, 245 (55.6%) were women. Heart (62.7%), neurological (41.4%) and respiratory (37.3%) diseases were the most frequent. Geriatrics inpatients were older and more dependants and presented greater cognitive deterioration. After 4 years, 335 (76%) patients died. Mortality was associated with age, dyspnoea, Barthel index<60, delirium, advanced neoplasia and≥4 admissions in the last year. The area under the curve of the PROFUND index was 0.748, 95% CI 0.689-0.806, P<.001 in Internal Medicine and 0.517, 95% CI 0.369-0.666, P=.818 in Geriatrics patients, respectively. The PROFUND index is a reliable tool for predicting long-term global mortality in polypathological patients from Internal Medicine but not from Geriatrics departments. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.
Why evidence-based medicine failed in patient care and medicine-based evidence will succeed.

PubMed

Horwitz, Ralph I; Singer, Burton H

2017-04-01

Evidence-based medicine (EBM) has succeeded in strengthening the evidence base for population medicine. Where EBM has failed is in answering the practicing doctor's question of what a likely outcome would be when a given treatment is administered to a particular patient with her own distinctive biological and biographical (life experience) profile. We propose Medicine-based evidence (MBE), based on the profiles of individual patients, as the evidence base for individualized or personalized medicine. MBE will build an archive of patient profiles using data from all study types and data sources, and will include both clinical and socio-behavioral information. The clinician seeking guidance for the management of an individual patient will start with the patient's longitudinal profile and find approximate matches in the archive that describes how similar patients responded to a contemplated treatment and alternative treatments. Copyright © 2017 Elsevier Inc. All rights reserved.
Effect of a Patient-Centered Communication Intervention on Oncologist-Patient Communication, Quality of Life, and Health Care Utilization in Advanced Cancer

PubMed Central

Epstein, Ronald M.; Duberstein, Paul R.; Fenton, Joshua J.; Fiscella, Kevin; Hoerger, Michael; Tancredi, Daniel J.; Xing, Guibo; Gramling, Robert; Mohile, Supriya; Franks, Peter; Kaesberg, Paul; Plumb, Sandy; Cipri, Camille S.; Street, Richard L.; Shields, Cleveland G.; Back, Anthony L.; Butow, Phyllis; Walczak, Adam; Tattersall, Martin; Venuti, Alison; Sullivan, Peter; Robinson, Mark; Hoh, Beth; Lewis, Linda; Kravitz, Richard L.

2018-01-01

IMPORTANCE Observational studies demonstrate links between patient-centered communication, quality of life (QOL), and aggressive treatments in advanced cancer, yet few randomized clinical trials (RCTs) of communication interventions have been reported. OBJECTIVE To determine whether a combined intervention involving oncologists, patients with advanced cancer, and caregivers would promote patient-centered communication, and to estimate intervention effects on shared understanding, patient-physician relationships, QOL, and aggressive treatments in the last 30 days of life. DESIGN, SETTING, AND PARTICIPANTS Cluster RCT at community- and hospital-based cancer clinics in Western New York and Northern California; 38 medical oncologists (mean age 44.6 years; 11 (29%) female) and 265 community-dwelling adult patients with advanced nonhematologic cancer participated (mean age, 64.4 years, 146 [55.0%] female, 235 [89%] white; enrolled August 2012 to June 2014; followed for 3 years); 194 patients had participating caregivers. INTERVENTIONS Oncologists received individualized communication training using standardized patient instructors while patients received question prompt lists and individualized communication coaching to identify issues to address during an upcoming oncologist visit. Both interventions focused on engaging patients in consultations, responding to emotions, informing patients about prognosis and treatment choices, and balanced framing of information. Control participants received no training. MAIN OUTCOMES AND MEASURES The prespecified primary outcome was a composite measure of patient-centered communication coded from audio recordings of the first oncologist visit following patient coaching (intervention group) or enrollment (control). Secondary outcomes included the patient-physician relationship, shared understanding of prognosis, QOL, and aggressive treatments and hospice use in the last 30 days of life. RESULTS Data from 38 oncologists (19 randomized
Attitudes toward and education about complementary and alternative medicine among adult patients with depression in Taiwan.

PubMed

Hsu, Mei-Chi; Moyle, Wendy; Creedy, Debra; Venturato, Lorraine; Ouyang, Wen-Chen; Sun, Gwo-Ching

2010-04-01

To investigate patients' attitudes toward complementary and alternative medicine, the education nurses provided about complementary and alternative medicine for treating depression and to test whether such education mediates the effect of complementary and alternative medicine use and attitudes toward complementary and alternative medicine. Although we know that attitudes influence behaviour, very few studies simultaneously explore the relationship between attitudes, education and complementary and alternative medicine use. Survey. This study was conducted as part of a larger survey, using face-to-face survey interviews with 206 adult patients aged 50 years or over and hospitalised in conventional hospitals in Taiwan for treatment of depression. The attitudes toward complementary and alternative medicine and patient education about complementary and alternative medicine instruments were specially developed for the study. Participants expressed slightly favourable attitudes toward complementary and alternative medicine. Many participants (50%) expressed that they were willing to try any potential treatment for depression. They believed that complementary and alternative medicine helped them to feel better and to live a happier life. However, 66.5% of participants reported that they had inadequate knowledge of complementary and alternative medicine. Participants with a higher monthly income, longer depression duration and religious beliefs hold more positive attitudes toward complementary and alternative medicine. Most participants were not satisfied with the education they received about complementary and alternative medicine. Patient education about complementary and alternative medicine was found to be a mediator for the use of complementary and alternative medicine. Patient education from nurses may predict patients' attitudes toward complementary and alternative medicine. Continuing nursing education is needed to enable nurses to respond knowledgeably to
Electronic Health Record Impacts on Family Medicine Teachers: Survey of Third-Year Medical Student Clerkship Preceptors at an Academic Medical Center.

PubMed

Curry, Elizabeth; Oser, Tamara K; Oser, Sean M

2017-10-01

Electronic Health Record (EHR) use in clinical practice has accelerated in recent years. While several aspects of EHR use have been extensively studied, there is little data on EHR impacts on medical student educators, especially those involved in outpatient family medicine. This study evaluated perceived impacts of EHR use on clinician teachers of outpatient family medicine. The study used a mixed methods survey of clinicians who teach third-year medical students during the required family and community medicine outpatient clerkship at a Mid-Atlantic medical school. Among 50 completed surveys, most respondents reported that the EHR had impacted their teaching (70% reported at least one negative effect; 84% reported at least one positive effect). Positive impacts included more easily viewing information, more effectively teaching evidence-based medicine, and teaching about EHR use itself. Negative impacts included less time teaching or interacting with students, and a perception that EHR use impedes development of students' critical thinking and clinical integration skills. Providers who have taught medical students both with and without EHR in place (>P=.024), those over 50 years old (>P=.019), and those with at least 5 years teaching experience (>P=.006) were more likely to report negative impacts. Most preceptors reported that EHR use had both positive and negative impacts on their teaching of medical students, though the negative effects were perceived by respondents as more substantial, consistent with a theme of decreased enthusiasm for teaching due to EHR use. These findings can be used to help inform faculty development and education initiatives.
["AGAINST ALL ODDS" - PROMOTING RESEARCH, CLINICAL DEVELOPMENT AND MEDICAL SERVICES OF THE CONFLICT IN THE GALILEE MEDICAL CENTER].

PubMed

Bornstein, Jacob

2017-05-01

The Galilee Medical Center (GMC) is unique in several aspects. Firstly, in the clinical aspect: In recent years, led by the Director of Medical Center, Dr. Masad Barhoum, a considerable momentum of development has taken place to reduce health discrepancies between the center and the periphery. Despite the under- financing of the health system in the Galilee, the GMC opened new clinical departments, introduced advanced medical technology and key staff members were added. This approach is depicted in publications presented in the current issue. Secondly, the aspect of medicine standoff: The GMC is the nearest hospital to the border with neighboring countries. It is also a tertiary center for trauma, due to the establishment of the Department of Neurosurgery, Department of Oral and Maxillofacial Surgery and the Departments of Orthopedic Surgery, general invasive radiology and invasive radiology of the brain. In recent years, the medical center treated hundreds of victims of the civil war in Syria, a third of them - women and children. The injured patients presented unique medical problems that are described in the papers in this issue. Thirdly, the research aspect: The medical center is the main teaching facility of medical students of the Faculty of Medicine in the Galilee of Bar-Ilan University. The Faculty of Medicine, led by the Dean, Prof. Ran Tur-Kaspa, promotes research and teaching in the medical center. Even before the establishment of the Faculty of Medicine, former hospital director, Prof. Shaul Shasha, not only extolled the importance of research, but established a research laboratory years ago. The laboratory continues to pursue translational research by the physicians of the medical center, led by Dr. Shifra Sela and Prof. Batya Kristal, and supported by the current medical center director, Dr. Masad Barhoum. Several studies conducted in this research laboratory are published herewith. With these unique aspects and despite the discrimination in funding
Precision Medicine and a Patient-Orientated Approach: Is this the Future for Tracking Cardiovascular Disorders?

PubMed

Pretorius, Etheresia

2017-01-01

The latest statistics from the 2016 heart disease and stroke statistics update shows that cardiovascular disease is the leading global cause of death, currently accounting for more than 17.3 million deaths per year. Type II diabetes is also on the rise with out-of-control numbers. To address these pandemics, we need to treat patients using an individualized patient care approach, but simultaneously gather data to support the precision medicine initiative. Last year the NIH announced the precision medicine initiative to generate novel knowledge regarding diseases, with a near-term focus on cancers, followed by a longer-term aim, applicable to a whole range of health applications and diseases. The focus of this paper is to suggest a combined effort between the latest precision medicine initiative, researchers and clinicians; whereby novel techniques could immediately make a difference in patient care, but long-term add to knowledge for use in precision medicine. We discuss the intricate relationship between individualized patient care and precision medicine and the current thoughts regarding which data is actually suitable for the precision medicine data gathering. The uses of viscoelastic techniques in precision medicine are discussed and how these techniques might give novel perspectives on the success of treatment regimes of cardiovascular patients are explored. Thrombo-embolic stroke, rheumathoid arthritis and type II diabetes are used as examples of diseases where precision medicine and a patient-orientated approach can possibly be implemented. In conclusion it is suggested that if all role players work together by embracing a new way of thought in treating and managing cardiovascular disease and diabetes will we be able to adequately address these out-ofcontrol conditions. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.
The "PD First" policy in Thailand: three-years experiences (2008-2011).

PubMed

Dhanakijcharoen, Prateep; Sirivongs, Dhavee; Aruyapitipan, Surapol; Chuengsaman, Piyatida; Lumpaopong, Adisorn

2011-09-01

Universal coverage (UC) scheme is a reformed national healthcare insurance that has been set up since the year 2002 and covers more than 80% of Thai population who are self-employed and do not work as government employees. Initially, this scheme offered only basic and comprehensive healthcare while renal replacement therapy (RRT), the financial cost of which was high, was not included. Without the support from the government healthcare insurance, the patients and their families will become insolvency. The benefit of peritoneal dialysis (PD) over hemodialysis (HD) has been shown in terms of medical expenses and cost-effectiveness. The "PD First" policy in Thailand has been implemented on January 1st 2008 as a model of initial treatment of end stage renal disease (ESRD) patients under the UC scheme. During the year 2008-2011, 12,753 cases, 6,177 were male and 6,576 were female, registered in this modality. The technical survivals at 1, 2 and 3 years were 92, 85 and 80%, respectively while the patient survivals were 79, 66 and 57% at 1, 2 and 3 years, respectively. The hematocrit level had been significantly increased from 25.9 +/- 5% in October 2009 to 28.0 +/- 5% in October 2010. The Peritonitis rate was decreased from 20.7 per patient months during the year 2009 to 25.8 per patient months at the year 2011 and the exit-site infection rate was 1 episode per 40.7 patient months. Currently, there are 111 PD centers that service for ESRD patients nationwide. There are strong supports from The National Health Security Office, The Nephrology Society of Thailand, The Dialysis Nurse Association, The Kidney Foundation of Thailand The Ministry of Public Health, The Thai Kidney Patient Association, Chulalongkorn University, Thai Red Cross Society, community, and social network, all of which are the major factors to guarantee the salutary outcomes in the future.
Financial expectations of first-year veterinary students.

PubMed

Lim, Christine C; Schulhofer-Wohl, Sam; Root Kustritz, Margaret V; Molgaard, Laura K; Lee, David

2015-07-15

To assess student awareness of the financial costs of pursuing a veterinary education, to determine student expectations for financial returns of a veterinary career, and to identify associations between student debt and factors such as future career plans or personality type. Survey. First-year veterinary students at the University of Minnesota College of Veterinary Medicine. In 2013, prior to the first day of class, all incoming first-year students received an email invitation to complete an online survey. The survey contained questions about demographics, current financial situation, current debt, expected debt at graduation, expected annual income following graduation, intent to pursue specialty training, and Myers-Briggs personality type. 72 of 102 (71%) students completed the survey; 65 respondents answered all relevant questions and provided usable data. Student responses for expected debt at graduation were comparable to national averages for veterinary college graduates; responses for expected annual income following graduation were lower than averages for University of Minnesota veterinary college graduates and national averages. However, students predicted even lower annual income if they did not attend veterinary college. Expected debt and expected annual income were not correlated with factors such as personality type or future career plans. Results indicated that first-year veterinary students were aware of the financial costs of their veterinary education and had realistic expectations for future salaries. For typical veterinary students, attending veterinary college appeared to be financially worthwhile, given lower expected earnings otherwise.

Assessment of the Patient-Centered and Family-Centered Care Experience of Total Joint Replacement Patients Using a Shadowing Technique.

PubMed

Marcus-Aiyeku, Ulanda; DeBari, Margaret; Salmond, Susan

2015-01-01

In 2030, when baby boomers reach 65 years of age and represent 18% of the population, it is anticipated that 67 million adults will have a diagnosis of arthritis increasing the demand for total hip and knee arthroplasty. With the growing emphasis on patient- and family-centered care, the aim of this project was to assess the patient experience of patients and families throughout the entire spectrum of the total joint replacement service line care at a university regional trauma hospital. A shadowing methodology as defined by the Institute for Health Improvement was utilized. Eight patient/family groups undergoing total joint replacements were shadowed. The mapped care experience included time, caregiver, activity, shadower observations, and impressions. Findings revealed inconsistencies in the delivery of patient- and family-centered care. Communication and interactions were predominantly provider-centric, with a focus on care routines versus the patient and family, and anticipation that care would be medically directed.
Digital retinal imaging in a residency-based patient-centered medical home.

PubMed

Newman, Robert; Cummings, Doyle M; Doherty, Lisa; Patel, Nick R

2012-03-01

Diabetic retinopathy is the leading cause of blindness in adults in the United States, and early screening/treatment may preserve vision. This study examined the feasibility of using non-mydriatic digital retinal imaging (DRI) for retinopathy screening in a busy family medicine residency program at the point of care using a nurse-driven protocol. We compared the number of diabetics screened during a 1-year period before and after DRI protocol implementation. We also determined the prevalence of retinopathy, assessed patient satisfaction with the alternative screening process, and tracked ophthalmologic appointment compliance for patients referred because of abnormal screening results. Screening approximately doubled from 161 patients/year before the protocol to 330 patients/year after protocol implementation. However, DRI screening had no impact on ophthalmologic appointment compliance; only 58% of 153 patients referred for ophthalmologic evaluation because of positive screening findings completed their referral appointment. Seven cases needing urgent ophthalmologic treatment were identified. Satisfaction with primary care retinopathy screening was high. Use of a nurse-driven protocol for digital retinal imaging at the point of care dramatically improves rates of annual retinopathy screening in academic family medicine practice and can identify patients who require subspecialty referral. However, DRI screening does not improve visit compliance rates with ophthalmologists for evaluation and management.
Flipping Patients and Frames: The Patient in Relational Medicine

PubMed Central

Zukier, Henri

2017-01-01

Medicine has evolved in two opposite directions. Evidence-based medicine focuses more on laboratory and computer data than on the patient. Yet experimental data also provide growing evidence for the importance of the patient’s social-psychological “demand” side of medicine, to complement the doctor’s bio-cognitive “supply” side. The patient’s mindset has major diagnostic and therapeutic effects. The patient’s experience is shaped by perceptions of four dimensions: meaning, agency, self-image, and temporal focus. The patient’s perceptions are linked in part to the therapeutic context, through the interaction between doctor and patient. In that proximal setting, the dimensions can be reshaped, for better and worse. These dynamics point to the inherently interactional nature of medicine and to the significant role of medical social sciences in the therapeutic context. PMID:28786808
Uncovering paradoxes from physicians' experiences of patient-centered ward-round.

PubMed

Bååthe, Fredrik; Ahlborg, Gunnar; Edgren, Lars; Lagström, Annica; Nilsson, Kerstin

2016-05-03

Purpose The purpose of this paper is to uncover paradoxes emerging from physicians' experiences of a patient-centered and team-based ward round, in an internal medicine department. Design/methodology/approach Abductive reasoning relates empirical material to complex responsive processes theory in a dialectical process to further understandings. Findings This paper found the response from physicians, to a patient-centered and team-based ward round, related to whether the new demands challenged or confirmed individual physician's professional identity. Two empirically divergent perspectives on enacting the role of physician during ward round emerged: We-perspective and I-perspective, based on where the physician's professional identity was centered. Physicians with more of a We-perspective experienced challenges with the new round, while physicians with more of an I-perspective experienced alignment with their professional identity and embraced the new round. When identity is challenged, anxiety is aroused, and if anxiety is not catered to, then resistance is likely to follow and changes are likely to be hampered. Practical implications For change processes affecting physicians' professional identity, it is important for managers and change leaders to acknowledge paradox and find a balance between new knowledge that needs to be learnt and who the physician is becoming in this new procedure. Originality/value This paper provides increased understanding about how physicians' professional identity is interacting with a patient-centered ward round. It adds to the knowledge about developing health care in line with recent societal requests and with sustainable physician engagement.
Clinical characteristics and one-year mortality according to admission renal function in patients with a first acute heart failure hospitalization.

PubMed

Formiga, Francesc; Moreno-Gonzalez, Rafael; Chivite, David; Casado, Jesús; Escrihuela-Vidal, Francesc; Corbella, Xavier

2018-02-01

Chronic kidney disease is related to poor outcomes in patients with heart failure (HF). Few studies have assessed whether renal function influences one-year mortality risk in patients admitted for the first time for acute HF. We reviewed the medical records of all patients aged >50 years admitted within a two-year period for a first episode of decompensated HF. The sample was divided according to the patients' estimated glomerular filtration rate (eGFR) on admission into three groups (eGFR >60, 30-60 and <30 ml/min/1.73 m 2 ). Index admission and one-year all-cause mortality rates were compared between groups using Cox regression analysis. A total of 985 patients were included in the study, mean age 78.4±9 years, and with mean admission eGFR of 60.5±26 ml/min/1.73 m 2 . Of these, 516 (52.3%) patients had eGFR <60 ml/min/1.73 m 2 . One-year all-cause mortality was 25.4%, with a significant association between worse eGFR category and mortality (p<0.0001). Cox regression analysis assessing eGFR as a categorical variable confirmed this association (HR 1.378; p=0.030), together with older age (HR 1.066; p<0.001), previous diagnosis of hypertension (HR 0.527; p<0.001), and both lower systolic blood pressure (HR 0.993; p=0.009) and higher serum potassium on admission (HR 1.471; p <0.001). Renal impairment is common in HF patients, even at the time of first admission. In this group of HF patients the presence of renal impairment was associated with higher mid-term (one-year) mortality risk. Copyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.
Imbalanced network biomarkers for traditional Chinese medicine Syndrome in gastritis patients.

PubMed

Li, Rui; Ma, Tao; Gu, Jin; Liang, Xujun; Li, Shao

2013-01-01

Cold Syndrome and Hot Syndrome are thousand-year-old key therapeutic concepts in traditional Chinese medicine (TCM), which depict the loss of body homeostasis. However, the scientific basis of TCM Syndrome remains unclear due to limitations of current reductionist approaches. Here, we established a network balance model to evaluate the imbalanced network underlying TCM Syndrome and find potential biomarkers. By implementing this approach and investigating a group of chronic superficial gastritis (CSG) and chronic atrophic gastritis (CAG) patients, we found that with leptin as a biomarker, Cold Syndrome patients experience low levels of energy metabolism, while the CCL2/MCP1 biomarker indicated that immune regulation is intensified in Hot Syndrome patients. Such a metabolism-immune imbalanced network is consistent during the course from CSG to CAG. This work provides a new way to understand TCM Syndrome scientifically, which in turn benefits the personalized medicine in terms of the ancient medicine and complex biological systems.
Imbalanced network biomarkers for traditional Chinese medicine Syndrome in gastritis patients

PubMed Central

Li, Rui; Ma, Tao; Gu, Jin; Liang, Xujun; Li, Shao

2013-01-01

Cold Syndrome and Hot Syndrome are thousand-year-old key therapeutic concepts in traditional Chinese medicine (TCM), which depict the loss of body homeostasis. However, the scientific basis of TCM Syndrome remains unclear due to limitations of current reductionist approaches. Here, we established a network balance model to evaluate the imbalanced network underlying TCM Syndrome and find potential biomarkers. By implementing this approach and investigating a group of chronic superficial gastritis (CSG) and chronic atrophic gastritis (CAG) patients, we found that with leptin as a biomarker, Cold Syndrome patients experience low levels of energy metabolism, while the CCL2/MCP1 biomarker indicated that immune regulation is intensified in Hot Syndrome patients. Such a metabolism-immune imbalanced network is consistent during the course from CSG to CAG. This work provides a new way to understand TCM Syndrome scientifically, which in turn benefits the personalized medicine in terms of the ancient medicine and complex biological systems. PMID:23529020
NERMLS: The First Year *

PubMed Central

Colby, Charles C.; Bloomquist, Harold; Hodges, T. Mark

1969-01-01

The Countway Library, Boston, was the nation's first Regional Medical Library under the Regional Medical Library Program of the NLM. New England Regional Medical Library Service (NERMLS) began in October 1967 and is the outgrowth of traditional extramural services of the Harvard and Boston Medical Libraries (constituents of the Countway). During the first year over 27,000 requests were received of which 84 percent were filled. Some problems of document delivery (and their solution) are recounted. Other activities were: a limited amount of reference work; distribution of a Serials List; and planning for a region-wide medical library service. Proposals call for consultation and education, regional reference service, and improved document delivery service. Emphasis is placed on the role of the Community Hospital as a center for continuing education and the need to strengthen and assist hospital medical libraries. With the Postgraduate Medical Institute, Boston, NERMLS assisted in the compilation of a small physician-selected medical Core Collection which would serve as a minimum standard collection for community hospital libraries. PMID:5823504
Endovascular aortic repair: first twenty years.

PubMed

Koncar, Igor; Tolić, Momcilo; Ilić, Nikola; Cvetković, Slobodan; Dragas, Marko; Cinara, Ilijas; Kostić, Dusan; Davidović, Lazar

2012-01-01

Endovascular aortic/aneurysm repair (EVAR) was introduced into clinical practice at the beginning of the nineties. Its fast development had a great influence on clinicians, vascular surgeons and interventional radiologists, educational curriculums, patients, industry and medical insurance. The aim of this paper is to present the contribution of clinicians and industry to the development and advancement of endovascular aortic repair over the last 20 years. This review article presents the development of EVAR by focusing on the contribution of physicians, surgeons and interventional radiologists in the creation of the new field of vascular surgery termed hybrid vascular surgery, and also the contribution of technological advancement by a significant help of industrial representatives--engineers and their counselors. This article also analyzes studies conducted in order to compare the successfulness of EVAR with up-to-now applied open surgical repair of aortic aneurysms, and some treatment techniques of other aortic diseases. During the first two decades of its development the EVAR method was rapidly progressing and was adopted concurrently with the expansion of technology. Owing to large randomized studies, early and long-term results indicate specific complications of this method, thus influencing further technological improvement and defining risk patients groups in whom the use of the technique should be avoided. Good results are insured only in centers, specialized in vascular surgery, which have on their disposal adequate conditions for solving all complications associated with this method.
A fourth-year medical school rotation in quality, patient safety, and population medicine.

PubMed

Dysinger, Wayne S; Pappas, James M

2011-10-01

Quality improvement and population medicine are skills that are increasingly important for physicians to possess. Methods to achieve foundational acquisition of these skills in medical school have not been well described in the past. The primary goal of this project is to provide hands-on, experiential learning in full-cycle population-based care. A description is given of a 4-week, team-based, rapid-cycle quality improvement project embedded in a required fourth-year medical school rotation. Over the course of 4 years a nonspecialty generic Ambulatory Care rotation was converted to a population-based learning rotation. For the last 3 years this rotation has required students to participate in teams of three to four students to assess, plan, implement, and evaluate a quality improvement project. Between 2008 and 2010 a total of 510 students completed the rotation. During this time the project component of the rotation received a 53% average rating of "excellent" or "above average." Qualitative evaluation indicates the project to be an acceptable and worthwhile educational experience for medical students, adding new insights and occasionally career-changing perspectives. Although experiential team-based quality improvement projects are a new format for learning in the medical school environment, it can be implemented in a format that is acceptable and beneficial to future physicians and healthcare systems. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Investigating preventive-medicine consultations in first-opinion small-animal practice in the United Kingdom using direct observation.

PubMed

Robinson, N J; Brennan, M L; Cobb, M; Dean, R S

2016-02-01

Preventive-medicine consultations account for a large proportion of the veterinary caseload and previous research has suggested these consultations are fundamentally different from those in which the animal is presented for a specific health problem. There has been recent controversy around some aspects of preventive medicine for cats and dogs, and the full health benefits of the preventive-medicine consultation remain unclear. The aim of this study was to compare characteristics of the consultation and the problems discussed during the consultation between preventive-medicine consultations and other types of consultations. Data were gathered during direct observation of small-animal consultations in seven first-opinion practices in the United Kingdom. Data collected included type of clinical examination performed, patient signalment, and details of all problems discussed (including whether the problem was presenting or non-presenting, new or pre-existing, who had raised the problem, body system affected and whether an action was taken). A two-level multivariable logistic-regression model was developed, with canine and feline patients at Level 1 nested within consulting veterinary surgeons at Level 2, and a binary outcome variable of preventive-medicine consultation versus specific health-problem consultation. A total of 1807 patients were presented, of which 690 (38.2%) presented for a preventive-medicine consultation. Dogs were the most frequently presented species (n=1168; 64.6%) followed by cats (n=510; 28.2%), rabbits (n=86; 4.8%) and patients of other species (n=43; 2.4%). The five variables remaining in the multi-level model were whether multiple patients were presented, patient age, clinical examination type, weighing and number of problems discussed. Species, breed, sex, neutering status and practice did not remain in the final model. Many non-presenting problems, including both preventive-medicine problems and specific-health problems, were discussed and
Survival of the first arteriovenous fistula in 96 patients on chronic hemodialysis.

PubMed

Radoui, Aicha; Lyoussfi, Zineb; Haddiya, Intissar; Skalli, Zoubair; El Idrissi, Redouane; Rhou, Hakima; Ezzaitouni, Fatima; Ouzeddoun, Naima; El Mesnaoui, Abbes; Bayahia, Rabea; Benamar, Loubna

2011-07-01

Native arteriovenous fistula (AVF) represents the best vascular approach for chronic hemodialysis. The aim of this study was to determine the survival of the first AVF and to identify the factors responsible for poor AVF survival. A retrospective study was conducted on 96 chronic hemodialysis patients benefiting from the creation and cannulation of their first AVF at our center, with a minimum follow-up period of 1 year. We collected demographic, clinical, and biological data, as well as analyzed the following AVF characteristics: anatomic site, cannulation time, survival, and complications. To identify the predictive factors of poor AVF survival, we defined and compared two groups of patients on the basis of whether they lost their first AVF during the evolution. Patients' mean age was 42.1 ± 13 years, with predominantly female patients. Mean AVF cannulation time was 17.5 ± 24 days. AVF loss was mainly related to thrombosis in 29% of the cases and stenosis in 9.4%. AVF survival was 87%, 77%, 71%, 67%, and 64% after 1, 3, 5, 8, and 10 years of hemodialysis, respectively. In our study, the main factors associated with AVF loss were lengthy jugular venous catheters placement (p = 0.004), short AVF cannulation time after its creation (p = 0.03), and hypotension episodes during dialysis (p = 0.03). Long-term survival and quality of life in hemodialysis depend on an appropriate dialysis carried out-thanks to a correct vascular approach! According to the previously published data, survival of the first AVF can vary between 10% and 36% at 10 years. In our study, survival of the first native AVF was satisfying because it reached 64% at 10 years. Early AVF creation and prevention and management of its complications remain the safest and most comfortable solution to ensure AVF survival and thus a satisfying survival and quality of life in chronic hemodialysis patients. Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.
Mental disorders frequency alternative and complementary medicine usage among patients with hypertension and type 2 diabetes mellitus.

PubMed

Keskin, Ahmet; BIlge, Ugur

2014-01-01

Diabetes mellitus (DM) and hypertension (HT) are chronic disorders with which mental disorders may coexist and for which patients may resort to alternative medicine use. Alternative and complementary medicine is a treatment option that patients tend to use. This study is to determine the prevalence of mental disorders among patients diagnosed with DM and HT and their use of alternative medicine methods. Materials and Methods The study was conducted in a primary care setting. The data were collected from the Family Health Center No. 4 at Ηankaya, Ankara, Turkey. It involved patients aged between 18 and 65, who were on follow-up treatment for DM and HT. Patients accepted to participate in the study were administered the sociodemographic data form, the Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire and the alternative medicine inquiry form. One hundred and sixteen patients with HT and 119 patients with DM (type 2) were recruited for the study. In this study, 47.4% of HT patients and 53.8% of the DM patients were diagnosed with a PRIME-MD. The most commonly encountered disorder was mood disorders, in 37.1% of the HT patients and 45.4% of the DM patients. In this study, four HT patients (0.3%) and no DM patients stated that they resorted to complimentary medicine, which can use be used alongside conventional medical treatment and may help to feel better and cope better with any chronic condition. All four HT patients were using multivitamin combinations to support the treatment. As the alternative medicine usage was described as treatment used instead of conventional medical treatment we did not find any patient using alternative medicine. Mental disorders may coexist with HT and DM. Some of the HT and DM patients suffering from a mental disorder seek psychiatric support, while others do not. We believe that it is important to examine patients for mental disorders, while being followed-up for a chronic disease.
[Nahabed Roussignan, the first professor of deontology at the Royal School of Medicine].

PubMed

Yildirim, N

1995-01-01

This study based on researches utilizing the American and Ottoman sources, deals with the claim upon the lectures given by Roussignan (Rusinyan Efendi), especially at the Royal School of Medicine and describes his medical career as follows. Nahabed Roussignan who graduated from Paris School of Medicine in 1849, returned to Istanbul in 1851 and was appointed as the private physician to Fuad Pasha, upon the request of Dr. Serviçen. In the meantime he worked at the Bab-i Seraskeri Hastanesi (the Hospital of the Military Ministry) until 1860 and also started to work at the Military High School as a doctor of medicine. As to the Royal School of Medicine, he taught pathological anatomy between 1864-1872. There are not any records to prove his being a faculty member during this year. He was probably in financial shortage because of unemployment during that year, as stated by Artin Mezbour. The following year he was employed at in the School of Medicine again, through his friends' support. this time he taught logic and French composition between 1874-1876 and instructed deontology for a little while in 1876. He collected his lectures on logic as a Textbook of Philosophy. He passed away in the same week, so this book was published posthumously (Istanbul 1879). Since he died on November 29th 1876, at the end of the year, his name was included in the State Yearbook of 1877, but was misspelled as "Rüsteban". To sum up, deontology as an independant discipline at the Royal School of Medicine began to be lectured for the first time by N. Roussignan in 1876, and succeeding his death these lectures were taken over by Dr. Hovsep Nouridjan (Nurican Efendi). Istepan Arslanian, who was claimed to be the lecturer of these courses after Roussignan, was in Rumelie during 1875-1876 and employed in Austria in 1877; therefore he could never have taught deontology during this period.
Health Transformation Project and Defensive Medicine Practice among Neurosurgeons in Turkey

PubMed Central

Solaroglu, Ihsan; Izci, Yusuf; Yeter, H. Gokce; Metin, M. Mert; Keles, G. Evren

2014-01-01

Background The term “Defensive” medicine was coined in the early 1970′s and has been an important topic of scientific investigation and professional debate ever since. Objective The aim of this study was to investigate the characteristics of defensive medicine, its reasons, and the extent to which it is practiced in the Turkish health care system. This is the first national survey to study the practice of defensive medicine among neurosurgeons in Turkey. Methods The present cross-sectional study on defensive medicine assessed neurosurgeons registered at the Turkish Neurosurgical Society, who are actively working in various centers and hospitals within the Turkish health care system. A 40-question survey was adapted from existing measures described in the literature and was completed by a total of 404 neurosurgeons, representing 36.7% of the neurosurgeons registered at the Turkish Neurosurgical Society. Results Seventy-two percent of the participants in the current study reported practicing defensive medicine. This practice was mainly reported among inexperienced neurosurgeons (74.4%). Most were younger than 40 years of age (75.2%), working in state hospitals/universities (72.7%), and living in the Marmara region (38%). Respondents reported engaging in defensive medicine by avoiding high-risk surgery (62.6%), ordering additional imaging studies (60.9%) and laboratory tests (33.7%), and referring patients to consultants (31.2%). Most participants consider every patient as a potential threat in terms of a medical lawsuit (68.3%) and do not believe the courts can distinguish malpractice from complications (89.6%). Conclusion Concerns and perceptions about medical liability lead neurosurgeons to practice defensive medicine. By avoiding high-risk surgery, ordering unnecessary diagnostic tests, and referring the patients to consultants, neurosurgeons try to minimize the risk of malpractice and protect themselves from legal risks, resulting in higher healthcare
Health transformation project and defensive medicine practice among neurosurgeons in Turkey.

PubMed

Solaroglu, Ihsan; Izci, Yusuf; Yeter, H Gokce; Metin, M Mert; Keles, G Evren

2014-01-01

The term "Defensive" medicine was coined in the early 1970's and has been an important topic of scientific investigation and professional debate ever since. The aim of this study was to investigate the characteristics of defensive medicine, its reasons, and the extent to which it is practiced in the Turkish health care system. This is the first national survey to study the practice of defensive medicine among neurosurgeons in Turkey. The present cross-sectional study on defensive medicine assessed neurosurgeons registered at the Turkish Neurosurgical Society, who are actively working in various centers and hospitals within the Turkish health care system. A 40-question survey was adapted from existing measures described in the literature and was completed by a total of 404 neurosurgeons, representing 36.7% of the neurosurgeons registered at the Turkish Neurosurgical Society. Seventy-two percent of the participants in the current study reported practicing defensive medicine. This practice was mainly reported among inexperienced neurosurgeons (74.4%). Most were younger than 40 years of age (75.2%), working in state hospitals/universities (72.7%), and living in the Marmara region (38%). Respondents reported engaging in defensive medicine by avoiding high-risk surgery (62.6%), ordering additional imaging studies (60.9%) and laboratory tests (33.7%), and referring patients to consultants (31.2%). Most participants consider every patient as a potential threat in terms of a medical lawsuit (68.3%) and do not believe the courts can distinguish malpractice from complications (89.6%). Concerns and perceptions about medical liability lead neurosurgeons to practice defensive medicine. By avoiding high-risk surgery, ordering unnecessary diagnostic tests, and referring the patients to consultants, neurosurgeons try to minimize the risk of malpractice and protect themselves from legal risks, resulting in higher healthcare expenditure and longer treatment periods.
Cerebrospinal meningitis in a 30 -year -old patient as first manifestation of pituitary macroadenoma.

PubMed

Andrysiak -Mamos, Elżbieta; Żochowska, Ewa; Kaźmierczyk -Puchalska, Agnieszka; Sagan, Leszek; Sowińska -Przepiera, Elżbieta; Zając -Marczewska, Małgorzata; Kojder, Ireneusz; Syrenicz, Anhelli

antibiotic therapy, the patient was transferred to the Department of Neurosurgery of the PMU for further surgical treatment. Transsphenoidal resection of the sellar -suprasellar tumor and sphenoid sinus reconstruction were performed. Histopathology report confirmed the diagnosis of pituitary adenoma. The patient in relatively good condition, with partial hemiparesis on the left side of the body, able to stand with support, not able to walk, with speech disturbances and able to follow commands was transferred to the rehabilitation center. One year later, follow- -up MRI scan showed deepened sella turcica, filled with a mass corresponding to postoperative material. No evidence of disease progression has been found. Neuroinfection may be the first manifestation of pituitary macroadenoma.
Person-centered medical interview

PubMed Central

Đorđević, Veljko; Braš, Marijana; Brajković, Lovorka

2012-01-01

Abstract We are witnessing an unprecedented development of medical science and personalized medicine. However, technological superiority must not make us lose sight of the physical, psychological, social, and spiritual totality of the patient. The core of the medical profession has always been and will be the relationship between the health professional and the person seeking assistance. However, the traditional relationship between the physician and the patient has changed and is greatly impacted by huge social, philosophical, economic, and scientific developments. It is important to develop and promote the culture of health instead of the culture of illness through a patient-doctor collaborative partnership, as well as partnership among professionals. Person-centered medical interview is an important bridge between personalized and person-centered medicine. PMID:22911522
THE STRUCTURE AND FUNCTION OF DEPARTMENTS OF MEDICINE

PubMed Central

LANDEFELD, C. SETH

2016-01-01

The structure and function of departments of medicine are important for several reasons. First, departments of medicine are the biggest departments in virtually every medical school and in most universities with a medical school, and they are the largest professional units in most academic medical centers. In fact, Petersdorf described them as “the linchpins of medical schools” (1). Departments of medicine account for one-fourth or more of the academic medical enterprise: they include about one-fourth of the faculty of medical school, account for roughly one-fourth of the patient care and clinical revenue of academic medical centers, and their faculty perform a disproportionate share of teaching and research, accounting for up to 45% of National Institutes of Health (NIH) – funded research in some medical schools. Second, the department’s ability to fulfill its role and advance its mission depends on its structure and function. Finally, lessons learned from examining the structure and function of departments of medicine may guide other departments and schools of medicine themselves in improving their structure and function. This paper describes the issues that face departments of medicine in 2016. I begin by providing the context for these issues with a definition of a department of medicine, describing briefly the history of departments, and stating their mission. PMID:28066053
Towards personalized medicine for patients with autoimmune diseases: Opportunities and challenges.

PubMed

Tavakolpour, Soheil

2017-10-01

There is generally no cure for autoimmune disorders, but the symptoms can be managed. Currently available drugs/treatments are more potent than those in the past decades. However, finding the right drug and right patients has remained a serious problem. We should revise our diagnosis criteria to more accurate ones. During the recent years, personalized medicine has attracted much attention. However, it needs to be well-explained for autoimmune diseases. Personalized medicine aims to find the most optimum drugs for a patient. Hence, recognizing the drugs based on genetics and molecular profile of patients, needs a comprehensive protocol. This study attempted to discuss the most practical and effective ways for identifying right patient and right drug. Patients should be divided into subpopulations. According to the last diagnosis criteria and therapeutic options, it was attempted to highlight the gaps or contradictions in current understanding and suggest what the future of research in this area may hold. Various factors could be considered, including genes variants, genes expression, epigenetic alterations, immune responses, and also basic and obvious characteristics (sex, age, ethnic, etc.). Moreover, advantages, disadvantages, obstacles, and opportunities during the personalized medicine for autoimmune diseases have been discussed in great detail. Finally, creation of a global library that covers all the aspects of personalized medicines for different types of autoimmune disease was suggested. In conclusion, revising diagnosis and treatments of autoimmune diseases toward personalized medicine could be the revolutionary step for having more effective and safer therapeutic options. Copyright © 2017 European Federation of Immunological Societies. Published by Elsevier B.V. All rights reserved.

Medical care for 4- to 5-year-olds with cleft lip/palate at the Tawanchai Center: geoinformatics study.

PubMed

Pattaranit, Rumpan; Songsung, Chainarong; Simmalee, Krisda; Pradubvong, Suteera; Thanapaisal, Chaiwit

2012-11-01

The incidence of cleft lip and cleft palate in Thailand is based on reports from three hospitals in Northeastern Thailand. There are 2.49 new babies born with cleft lip and cleft palate and craniofacial deformities for every 1,000 babies the highest incidence in the world. Area 7 Office of the National Health Security Office (NHSO) comprises Khon Kaen, Roi Et, Mahasarakam and Kalasin. The number of newborns with cleft lip and palate is an estimated 114 cases/year. A retrospective geoinformatics study was conducted using the medical records of 4- to 5-year-olds with cleft lip and cleft palate registered with the Tawanchai Center Srinagarind Hospital. To study the distribution of 4- to 5-year-olds with cleft lip and palate using geoinformatics. This retrospective study was conducted using data from the medical records, which contains the records of 4- to 5-year-olds with cleft lip and cleft palate admitted to Srinagarind Hospital. The 54-patient sample groups were registered at the Tawanchai Center Faculty of Medicine, Khon Kaen University, under the aegis of the NHSO (Area 7-Khon Kaen). The data were collected using self-administered questionnaires between May and June 2012 and geoinformatics, to study the distribution of patients' vis-a-vis the various parameters. Among the 27 male and 27femalepatients, 51.85% had cleft lip with cleft palate. Most of the cleft lip patients (7 cases; 41.18%) were in Khon Kaen, while 4 (44.44%) of the cleft palate patients were in Roi-Et and 11 (39.29%) of the cleft lip with palate patients were in Khon Kaen. Most cleft lip patients were in Roi-Et province: 1 case in each of four districts. Similarly, most cases of cleft palate were in Roi-Et province: 1 case in each of four districts. Finally, most cases (5; 50%) of cleft lip with cleft palate were found in Roi-Et province, mostly in the central (Muang) district. The use of Arc View software as an instrument for geoinformatics, spatial data collection helped to clarify the district
[The first three Nordic Nobel laureates in physiology or medicine].

PubMed

Pernow, B

1997-01-01

Among all the Nobel Laureates in physiology or medicine there are five from Denmark and seven from Sweden. The first three Laureates are presented in this paper. Over 50 years have elapsed since they were awarded and the Nobel archives are now open for scrutiny, providing insight into how the Nobel committee interpreted the instruction given in Nobel's will at that time. Niels Finsen (1860-1904, Nobel Laureate 1903) devoted his short life to a continuous study of the biological effects of sunshine, which resulted in a method aimed at utilizing the bacteriocide properties of sun rays in the treatment of various skin diseases and especially tuberculosis. Finsen published his first paper on this topic in 1896 and his method revolutionized the current treatment of this disease. Approximately forty Finsen Institutes were established in Europe and the USA within the subsequent five years. Alvar Gullstrand (1869-1930, Nobel Laureate 1911) was an ophthalmologist but his main interest was mathematical physics, where he achieved results of utmost importance for clinical opthalmology. He systematically studied the optical system, from the physical properties of light rays to optimal images in different media of the eye. He formulated general laws if image, which he extrapolated to the human eye. He also devised several techniques, some of which still used in ophthalmology. August Krogh (1874-1949, Nobel Laureate 1920) was a zoological physiologist, actively involved in various fields, including human muscle physiology and metabolism, capillary circulation in the frog, water regulation in the desert rat and the jumping capacity of the grasshopper. He was the founder of modern human exercise physiology and sport medicine. Krogh received the Nobel prize the year after he published his first paper on the regulation of the motor activity of capillaries, which reflected the Nobel committee's desire at that time to support a young scientist in the most successul period of his career
Multipayer patient-centered medical home implementation guided by the chronic care model.

PubMed

Gabbay, Robert A; Bailit, Michael H; Mauger, David T; Wagner, Edward H; Siminerio, Linda

2011-06-01

A unique statewide multipayer ini Pennsylvania was undertaken to implement the Patient-Centered Medical Home (PCMH) guided by the Chronic Care Model (CCM) with diabetes as an initial target disease. This project represents the first broad-scale CCM implementation with payment reform across a diverse range of practice organizations and one of the largest PCMH multipayer initiatives. Practices implemented the CCM and PCMH through regional Breakthrough Series learning collaboratives, supported by Improving Performance in Practice (IPIP) practice coaches, with required monthly quality reporting enhanced by multipayer infrastructure payments. Some 105 practices, representing 382 primary care providers, were engaged in the four regional collaboratives. The practices from the Southeast region of Pennsylvania focused on diabetes patients (n = 10,016). During the first intervention year (May 2008-May 2009), all practices achieved at least Level 1 National Committee for Quality Assurance (NCQA) Physician Practice Connections Patient-Centered Medical Home (PPC-PCMH) recognition. There was significant improvement in the percentage of patients who had evidence-based complications screening and who were on therapies to reduce morbidity and mortality (statins, angiotensin-converting enzyme inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients. Transforming primary care delivery through implementation of the PCMH and CCM supported by multipayer infrastructure payments holds significant promise to improve diabetes care.
Management of pediatric patients with concussion by emergency medicine physicians.

PubMed

Kinnaman, Karen A; Mannix, Rebekah C; Comstock, R Dawn; Meehan, William P

2014-07-01

Despite an increase in concussion diagnoses among pediatric patients, little is known about the management of pediatric patients with concussion in emergency departments (EDs). The objective of this study was to assess strategies used by emergency medicine physicians when treating pediatric patients with concussions. A 17-item questionnaire was e-mailed to members of the American Academy of Pediatrics Section on Emergency Medicine. Two serial e-mails were distributed at 2-week intervals to nonresponders. The survey included multiple-choice and free-text questions that were created by the team of investigators on the basis of prior surveys of family practitioners and physical trainers. We collected demographic information and specific information regarding the use of medications, neuropsychological testing, neuroimaging, return-to-play decision making, and use of published guidelines. Simple descriptive statistics were used. Two hundred sixty-five (29%) physicians completed the questionnaire, of which 52% had been an attending physician for more than 10 years. Ninety-nine percent of the respondents reported managing concussions, with the majority (76%) seeing more than 24 patients with concussion per year. Most clinicians (81%) reported using a published guideline in their management of concussions. The symptoms most likely to prompt head imaging in the ED included a focal neurological deficit (92%), altered mental status (82%), and intractable vomiting (80%). Most (91%) respondents reported using medications to manage the symptoms of patients with concussion, mainly acetaminophen (78%) and nonsteroidal anti-inflammatory medications (77%), whereas 54% of the respondents used ondansetron and 7% of the respondents used narcotics. More than half (56%) of the respondents referred patients with concussion for neuropsychological testing from the ED. Of those, nearly half (49%) of the respondents refer their patients to a sports concussion clinic, whereas 5% of the
Task Force 1. Report of the Task Force on Patient Expectations, Core Values, Reintegration, and the New Model of Family Medicine

PubMed Central

Green, Larry A.; Graham, Robert; Bagley, Bruce; Kilo, Charles M.; Spann, Stephen J.; Bogdewic, Stephen P.; Swanson, John

2004-01-01

should be reliably provided in family medicine practices, and an itemization of key attributes and core values that define the specialty. It also proposed and described a New Model of family medicine for people of all ages and both genders that emphasizes patient-centered, evidence-based, whole-person care provided through a multidisciplinary team approach in settings that reduce barriers to access and use advanced information systems and other new technologies. The task force recommended a time of active experimentation to redesign the work and workplace of family physicians; the development of revised financial models for family medicine, and a national resource to provide assistance to individual practices moving to New Model practice; and cooperation with others pursuing the transformation of frontline medicine to better serve the public. CONCLUSIONS Unless there are changes in the broader health care system and within the specialty, the position of family medicine in the United States will be untenable in a 10- to 20-year time frame. Even within the constraints of today’s flawed health care system, there are major opportunities for family physicians to realize improved results for patients and economic success. A period of aggressive experimentation and redevelopment of family medicine is needed now. The future success of the discipline and its impact on public well-being depends in large measure on family medicine’s ability to rearticulate its vision and competencies in a fashion that has greater resonance with the public while substantially revising the organization and processes by which care is delivered. When accomplished, family physicians will achieve more fully the aspirations articulated by the specialty’s core values and contribute to the solution of the nation’s serious health care problems.
An Investigation of the Use of Traditional Chinese Medicine and Complementary and Alternative Medicine in Stroke Patients.

PubMed

Yeh, Mei-Ling; Chiu, Wei-Ling; Wang, Yu-Jen; Lo, Chyi

This study aimed to investigate the use of traditional Chinese medicine and complementary and alternative medicine in stroke patients in Taiwan. Chinese herbal medicine, massage, acupuncture, natural products, and exercise were widely used among stroke patients. Integrating safe and effective traditional Chinese medicine and complementary and alternative medicine into conventional therapies is suggested.
[The skin substitute center--a need in the treatment of patients with severe burns].

PubMed

Pieptu, D; Luchian, S

1999-01-01

The treatment of the severe burned patient has two main dimensions acting in an interdependent manner. First it is the life keeping and the second is skin resurfacing in a fair period of time. The failure of one of these two components leads to the patient's death. In the absence of the autografts the skin resurfacing has to be made by permanent skin substitutes--cultured epithelium, dermal equivalents or reconstructed skin, developed by a special unit, a Skin Substitute Center. The paper is setting the utility of such a center in our area, and the possible developing directions. It is our firm opinion that in case of failure to develop such a center, despite all the financial efforts directed toward the infrastructure of a modern Burn Unit affiliated to an University Accident Hospital, all the surgical experience cumulated during the past 13 years by a very motivated team, good quality results are still to be expected. Any patient with a deep second degree burn on more than 50% TBSA will be a potentially victim as in early 60s.
Rate of patient workups by non-emergency medicine residents in an academic emergency department.

PubMed

Stone, C K; Stapczynski, J S; Thomas, S H; Koury, S I

1996-02-01

To quantify the number of patients seen per hour by non-emergency medicine (non-EM) residents in a university hospital ED. This retrospective observational study was performed in a university hospital ED and level I trauma center. The facility had no EM residency, but was staffed with 24-hour EM faculty coverage. A computerized tracking system was searched for the number of patients seen by each of 93 non-EM residents for 12 nonconsecutive months. The ED schedule for each month was used to calculate the number of hours worked by each resident. From these figures, the number of patients seen per hour by each resident was calculated. The postgraduate years of training of the residents were as follows: 78 (84%) were PGY1, ten (11%) were PGY2, and five (5%) were PGY3. All the residents combined saw a mean 0.95 +/- 0.20 patients/hour, with a range from 0.58 to 1.75 patients/hour. There was no significant difference between the numbers of patients seen when compared by specialty using the Tukey-Kramer test (alpha = 0.05). The rate at which non-EM residents work up patients is consistent with previously reported rates for EM residents.
[The first national Whole-time Training Class for Western Physicians Learning Traditional Chinese Medicine in China].

PubMed

Sun, Qiaosi; Hu, Xiaofeng

2015-11-01

On 19 October, 1955, at the time when the Academy of Traditional Chinese Medicine affiliated with the Ministry of Health was established, the opening ceremony of the first Whole-time Training Class for Western Physicians Learning Systematically Traditional Chinese Medicine was also held. Altogether 84 new graduates from western medical colleges and skilled doctors of western medicine from all over the country were registered. During the 2.5 year term of training, the students learnt 16 professional courses and then practiced at the clinic, and graduated with gratifying results in July, 1958. On 11 October the same year, Chairman Mao made an important instruction to the report submitted by the Leading Party Group of the Ministry of Health, "A Report to the Party Central Committee about the situation, results and experience of Whole-time Training Class for Western Physicians Learning Traditional Chinese Medicine", by pointing out that "in the future, the Training Class for Western Physicians Learning Traditional Chinese Medicine should be held across the country hereafter. This is a top issue and is not to be ignored".
Trauma center staffing, infrastructure, and patient characteristics that influence trauma center need.

PubMed

Faul, Mark; Sasser, Scott M; Lairet, Julio; Mould-Millman, Nee-Kofi; Sugerman, David

2015-01-01

The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care. We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443). The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions ("trauma center need") as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM) was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need. Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need. Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the construction of new trauma centers or when coordinating care within state or regional
Herbal medicines for advanced colorectal cancer.

PubMed

Guo, Zhongning; Jia, Xiaoqiang; Liu, Jian Ping; Liao, Juan; Yang, Yufei

2012-05-16

Herbal medicine has been widely used in patients with advanced colorectal cancer in China, but its efficacy has not been confirmed. To evaluate the beneficial effect and safety on Chinese herbal medicine therapy for advanced stage colorectal cancer, and it's influence on the patients' quality of life. The following electronic databases were searched: BIOSIS Previews, Cochrane Controlled Trials Register, Medline EMBASE, Biological Abstracts, until Aug. 2011. Manual searching was performed on 16 types of Chinese journals which started from their respective first publication dates, as well as unpublished conference proceedings. No language restriction was applied. Randomized or quasi-randomised controlled trials on the treatment of advanced stage colorectal cancer by herbal medicines or herbal medicines combined with chemotherapy, regardless of blinding. The data were extracted independently by two reviewers. Methodological quality of the included in trials was assessed according to the following parameters: randomisation, allocation concealment, double blinding, and drop-out rates. A total of 20 randomised controlled trials with 1304 participants were identified. All the 20 trials compared the use of herbal medicines with chemotherapy and chemotherapy alone in the treatment of advanced stage colorectal cancers.Compared with chemotherapy alone, the use of Quxie capsule combined with chemotherapy could decrease mortality rate (RR 0.17, 95% CI 0.03 to 0.97); the use of Jianpi Jiedu formula, Xiaozheng formula and Yiqi Huoxue herbal medicine combined with chemotherapy respectively could improve 1-year survival rate significantly; the use of Xiaozheng Formula in conjunction with chemotherapy could improve 3-year survival rate. There were 10 herbal medicines showing benefit in improving quality of life. Herbal medicines did not show additional benefit in response rate or stability rate. No trials reported serious adverse effect from herbal medicine. Some herbal medicines
Interprofessional transformation of clinical education: The first six years of the Veterans Affairs Centers of Excellence in Primary Care Education.

PubMed

Harada, Nancy D; Traylor, Laural; Rugen, Kathryn Wirtz; Bowen, Judith L; Smith, C Scott; Felker, Bradford; Ludke, Deborah; Tonnu-Mihara, Ivy; Ruberg, Joshua L; Adler, Jayson; Uhl, Kimberly; Gardner, Annette L; Gilman, Stuart C

2018-02-20

This paper describes the Centers of Excellence in Primary Care Education (CoEPCE), a seven-site collaborative project funded by the Office of Academic Affiliations (OAA) within the Veterans Health Administration of the United States Department of Veterans Affairs (VA). The CoEPCE was established to fulfill OAA's vision of large-scale transformation of the clinical learning environment within VA primary care settings. This was accomplished by funding new Centers within VA facilities to develop models of interprofessional education (IPE) to teach health professions trainees to deliver high quality interprofessional team-based primary care to Veterans. Using reports and data collected and maintained by the National Coordinating Center over the first six years of the project, we describe program inputs, the multicomponent intervention, activities undertaken to develop the intervention, and short-term outcomes. The findings have implications for lessons learned that can be considered by others seeking large-scale transformation of education within the clinical workplace and the development of interprofessional clinical learning environments. Within the VA, the CoEPCE has laid the foundation for IPE and collaborative practice, but much work remains to disseminate this work throughout the national VA system.
[Diabetic foot risk in patients with type II diabetes mellitus in a family medicine unit].

PubMed

Márquez-Godínez, S A; Zonana-Nacach, A; Anzaldo-Campos, M C; Muñoz-Martínez, J A

2014-01-01

To determine the risk of diabetic foot in patients with type II diabetes mellitus (DM) seen in a Family Medicine Unit. The study included type II DM patients with a disease duration ≥ 5 years seen in a Family Medicine Unit, Tijuana, Mexico, during September-December 2011. Neuropathy was assessed with the Diabetic Neuropathy Symptom questionnaire, and pressure sensation using a 10-g Semmes-Weinstein monofilament. A patient had a high risk of diabetic foot if there was sensitivity loss, foot deformities, and non-palpable pedal pulses. We studied 205 patients with an average (± SD) age and DM duration of 59 ± 10 years and 10.7 ± 6.7 years, respectively. Ninety one patients (44%) had a high risk of developing diabetic foot, and it was associated with; an education of less than 6 years (OR 2.3; 95%CI: 1-1-4.1), DM disease duration ≥ 10 years (OR 5.1; 95%CI: 2.8-9.4), female gender (OR 2.0; 95%CI: 1.1-3.6), monthly familiar income <236 euros (OR 2.0; 95%CI: 1.1-3.8), and a glycosylated hemoglobin ≥ 7.0% (OR 2.8; 95%CI: 1.5-5.0). It is necessary that all DM patients seen in a family medicine clinic have a yearly screening for the early detection of diabetic neuropathy, since they have a high risk of diabetic foot. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.
Herbal Medicine Practices of Patients With Liver Cancer in Peru: A Comprehensive Study Toward Integrative Cancer Management

PubMed Central

Rojas Rojas, Teresa; Bourdy, Geneviève; Ruiz, Eloy; Cerapio, Juan-Pablo; Pineau, Pascal; Gardon, Jacques; Doimi, Franco; Deparis, Xavier; Deharo, Eric; Bertani, Stéphane

2016-01-01

Rationale: The highest burden of liver cancer occurs in developing countries, where the use of herbal medicine (HM) is still widespread. Despite this trend, few studies have been conducted to report HM practices of patients with a hepatic tumor in the developing world. Hence, this study aimed to document the use of HM among patients with liver cancer in Peru. Study Design and Methods: A comparative behavioral epidemiological survey was conducted among liver cancer patients attending the National Cancer Institute of Peru. Information was obtained by direct interviews based on a semistructured questionnaire. The use of HM in Peruvian liver cancer patients was reported, first, regarding general consumption prior to the onset of disease, and second, after the appearance of symptoms that patients would relate to their tumor. In parallel, general consumption of HM in noncancerous people was assessed as a comparative figure. A correspondence analysis was performed to reveal potential associations between the symptoms of cancer and the specific use of HM. Results: Eighty-eight patients and 117 noncancerous individuals participated in the survey. Overall, 68.3% of the people interviewed claimed to use HM on a regular basis for general health preservation. Furthermore, 56.8% of the patients turned to plants first to treat the disorders for which they later came to the cancer care center. When compared with the number of plant species used routinely (n = 78), a selection of plants was made by patients in response to the symptoms of cancer (n = 46). At least 2 plant species, Aloe vera and Morinda citrifolia, were significantly associated with the treatment of liver cancer–related symptoms in the patient group. Conclusions: The present study is the first survey on the HM practices of patients with liver cancer in Latin America and, more broadly, in the developing world. Our findings confirm that HM remains one of the principal primary health care resources in Peru, even for a
Precision Medicine: From Science To Value.

PubMed

Ginsburg, Geoffrey S; Phillips, Kathryn A

2018-05-01

Precision medicine is making an impact on patients, health care delivery systems, and research participants in ways that were only imagined fifteen years ago when the human genome was first sequenced. Discovery of disease-causing and drug-response genetic variants has accelerated, while adoption into clinical medicine has lagged. We define precision medicine and the stakeholder community required to enable its integration into research and health care. We explore the intersection of data science, analytics, and precision medicine in the formation of health systems that carry out research in the context of clinical care and that optimize the tools and information used to deliver improved patient outcomes. We provide examples of real-world impact and conclude with a policy and economic agenda necessary for the adoption of this new paradigm of health care both in the United States and globally.
Treatment of Depression and Anxiety by Naturopathic Physicians: An Observational Study of Naturopathic Medicine Within an Integrated Multidisciplinary Community Health Center.

PubMed

Breed, Cindy; Bereznay, Catherine

2017-05-01

This project was designed to assess the quality of care received by patients with depression and anxiety who were seen by naturopathic physicians in a community health center. The Natural Medicine Quality Improvement Project for the Treatment of Depression and Anxiety (NMQP-DA) was conducted over a 26-month period from December 2009 through February 2012 at HealthPoint, a non-profit, consumer-governed, community health center network located in suburban King County, Washington. A total of 112 patients enrolled in the NMQP-DA, and 60 were seen for two or more visits, thus meeting eligibility criteria for inclusion in the study. The mean number of visits was 3.3. The Patient Health Questionnaire (PHQ-9) depression screener and the Generalized Anxiety Disorder 7-item scale (GAD-7) anxiety screener were the outcome measures. The overall improvement in symptoms of depression and anxiety was highly significant (p < 0.0001) when comparing the group's average initial screener scores to their average final screener scores for both depression (16.4 vs. 8.6) and anxiety (12.4 vs. 7.2). The response rate, as measured by a 50% decrease in scores, for those with initial scores ≥10 was 58.6% for depression (PHQ-9) and 50% for anxiety (GAD-7). This study adds new data to the limited literature on the nature and effectiveness of naturopathic medicine to treat anxiety and depression in the context of an integrative community health center.
The democratization of medicine.

PubMed

Cellini, Gary L

2015-11-01

We can give patients the data, devices, education, and point of care access they need to 1) determine their genomic risk, 2) to manage their co-morbid conditions to delay CKD progression, 3) to manage the first 100 days of dialysis, 4) to differentiate the stress on the body with home versus in center dialysis, 5) to manage their 8-15 medications better, 6) to virtually access their health care professionals 24/7, and 7) to empower them to improve their clinical and financial outcomes. All of this is possible with technology and through the democratization of medicine.
Health Information Technology Coordination to Support Patient-centered Care Coordination.

PubMed

Steichen, O; Gregg, W

2015-08-13

To select papers published in 2014, illustrating how information technology can contribute to and improve patient-centered care coordination. The two section editors performed a literature review from Medline and Web of Science to select a list of candidate best papers on the use of information technology for patient-centered care coordination. These papers were peer-reviewed by external reviewers and three of them were selected as "best papers". The first selected paper reports a qualitative study exploring the gap between current practices of care coordination in various settings and idealized longitudinal care plans. The second selected paper illustrates several unintended consequences of HIT designed to improve care coordination. The third selected paper shows that advanced analytic techniques in medical informatics can be instrumental in studying patient-centered care coordination. The realization of true patient-centered care coordination is dependent upon a number of factors. Standardization of clinical documentation and HIT interoperability across organization and settings is a critical prerequisite for HIT to support patient-centered care coordination. Enabling patient involvement is an efficient means for goal setting and health information sharing. Additionally, unintended consequences of HIT tools (both positive and negative) must be measured and taken into account for quality improvement.
Confidence in palliative care issues by medical students and internal medicine residents.

PubMed

Storarri, Ana Carolina Montouro; de Castro, Giovana Dalmedico; Castiglioni, Lilian; Cury, Patricia Maluf

2017-12-16

Palliative care (PC) is a relatively new field in Brazil, but this knowledge is of great importance in medical practice. To evaluate the degree of confidence among medical students and first-year and second-year internal medicine residents in addressing issues of death and terminal illness with patients and their families. A modified version of the Self-Efficacy in Palliative Care Scale was applied to 293 students in their first year to sixth year at the School of Medicine of São José do Rio Preto and to 43 residents in their first year or second year of medical practice at the same institution in Brazil, in 2015. The questionnaire evaluated students' opinions on the need to include theoretical and practical classes on PC in the medical school. Students in their fifth year of medical school were more confident than the students in their first, second, third and fourth years; there were no statistically significant differences between fifth-year students, sixth-year students and the internal medicine residents. Residents were more confident than all of the medical school students except those in their fifth year (P<0.05) because they have more contact with terminally ill patients than other students do; fifth-year medical students are likely overestimating their abilities. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Outcomes of Non-Metastatic Gestational Trophoblastic Neoplasia: Twelve Year Experience from a Northern Thailand Tertiary Care Center.

PubMed

Suprasert, Prapaporn; Manopunya, Manatsawee

2015-01-01

Gestational trophoblastic neoplasia (GTN) is the malignant form of gestational trophoblastic disease. In non-metastatic GTN, the outcomes of treatment are impressive with methotrexate (MTX) or actinomycin D. We retrospectively reviewed the outcomes of non-metastatic GTN treated at our center from January, 1999 to December, 2013. One hundred and nine patients were recruited to the study. The median age was 33.1 years and over 90% were referral cases. Abnormal vaginal symptoms developed in 37.6% while 56.4% were asymptomatic. The most common antecedent pregnancy was a complete mole (92.7%) with the median interval time from antecedent pregnancy to GTN development being 2.0 months. The median pretreatment B-hCG was 5,624 mIu/ ml. The most common first line treatment was methotrexate (MTX) and folinic acid (91.7%) followed by weekly MTX (4.6%), etoposide+ MTX+actinomycin D (EMA) (2.8%), and actinomycin D (0.9%), with the median number of cycles at 5.0. The positive response to first line chemotherapy was 73.8%. The patients were given subsequent chemotherapeutic regimens after resistance to the first line therapy and showed a final remission rate of 89.9%.The significant factor that was frequently found in patients who were non-responders to the first line treatment was a hysterectomy procedure. Two patients developed lung metastasis and brain metastasis at one and four years after the first treatment, respectively. In conclusion, the outcomes of non-metastatic GTN were excellent. However, the patients need long term follow up due to the possibility of developing multiple organ metastases.

Tomsk Cardiology Center program on lasers in cardiovascular: first results

NASA Astrophysics Data System (ADS)

Gordov, Eugeni P.; Karpov, Rostislav S.; Dudko, Victor A.; Shipulin, Vladimir M.

1994-12-01

Recent progress in biomedical optics resulted in increased activity in this area at a number of different centers. Reported are the first results of the program directed to incorporate at Tomsk Cardiology Center experience gained in Tomsk optical profile research institutions in areas of light-matter interaction, high resolution spectroscopy, laser physics and relevant software and their usage in cardiac therapy, surgery, and diagnostics. To coordinate research work in this direction the special unit-laboratory of laser medicine is organized at the Center. Laboratory activity goes in the following directions: study of spectral properties of vessel walls in norm and atherosclerosis, comparative study of different wavelength laser radiation action on normal and atherosclerotically damaged tissues, novel approach to intravascular imaging, and usage of high sensitive laser spectroscopy for early diagnosis of cardiac diseases. The spectroscopic study of AP and normal tissue is aimed at understanding of differences in internal energy structures and ways of energy migration which are of critical importance for reaching selective laser action on normal and deceased tissues. To compare thermal, mechanical, and photo-chemical variations of tissues caused by laser radiation the XeCl excimer laser with Raman shifting cell and Nd:YAG laser with second, third, and fourth harmonic converters are employed. Fine influence of pulse duration, intensity, and repetition rates on AP removal is considered in laboratory experiments with vessel samples. Preliminary results on theoretical consideration for determination of spectroscopically detectable markers of some cardiac diseases are reported as well.
Laparoscopic Sleeve Gastrectomy Outcomes of 750 Patients: A 2.5-Year Experience at a Bariatric Center of Excellence.

PubMed

Altun, Hasan; Batman, Burcin; Uymaz, Salim D; Serin, Rahmi K; Salman, Serpil; Tayyareci, Yelda; Ece, Ferah; Hurkal, Tugce; Dal, Didem

2016-12-01

Laparoscopic sleeve gastrectomy (LSG) is gaining popularity worldwide. This retrospective cohort study evaluated the outcomes of a large cohort of patients with obesity who underwent LSG in a Bariatric Center of Excellence. All consecutive patients who underwent LSG between July 2013 and April 2016 were identified retrospectively. Preoperative and postoperative variables and comorbidities were recorded. The study consisted of 750 patients. Their mean age was 37.4 years; 72% were women, and the mean body mass index was 42.8 kg/m. The most common preoperative comorbidities were diabetes (23.3%), hyperlipidemia (21.9%), hypertension (21.1%), and obstructive sleep apnea (21.1%). The rates of comorbidity resolution during follow-up were 80.6%, 74.4%, 82.9%, and 94.3%, respectively. The percentage average excess weight loss 1, 3, and 6 months and 1 and 2 years after surgery was 29.4%±11.3%, 54.4%±17.7%, 76.9%±20.9%, 85.5%±23.6%, and 89.7%±27.6%, respectively. There was no mortality. LSG effectively and safely induced weight loss and comorbidity resolution.
An Evidence-Based Course in Complementary Medicines

PubMed Central

Hughes, Jeff

2012-01-01

Objective. To evaluate the impact of an evidence-based course in complementary medicines on the attitudes, knowledge, and professional practice behavior of undergraduate pharmacy students. Design. A required 12-week evidence-based complementary medicine course was designed and introduced into the third-year undergraduate pharmacy curriculum. The course included a combination of traditional lectures, interactive tutorial sessions, and a range of formal assessments. Assessment. Pre- and post-course survey instruments were administered to assess changes in students’ attitudes, perceptions, knowledge, and the likelihood they would recommend the use of complementary medicines in a pharmacy practice environment. Conclusion. Completion of a required evidence-based complementary medicines course resulted in a positive change in pharmacy students’ perceptions of the value of various complementary medicines as well as in their willingness to recommend them, and provided students with the required knowledge to make patient-centered recommendations for use of complementary medicines in a professional pharmacy practice setting. These findings support the need for greater evidence-based complementary medicine education within pharmacy curricula to meet consumer demand and to align with pharmacists’ professional responsibilities. PMID:23275665
Use of medicines by patients of the primary health care of the Brazilian Unified Health System

PubMed Central

Costa, Clarisse Melo Franco Neves; Silveira, Micheline Rosa; Acurcio, Francisco de Assis; Guerra, Augusto Afonso; Guibu, Ione Aquemi; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair; Costa, Ediná Alves; do Nascimento, Renata Cristina Rezende Macedo; de Araújo, Vânia Eloísa; Álvares, Juliana

2017-01-01

ABSTRACT OBJECTIVE To characterize the use of medicines by patients of the primary health care of the Brazilian Unified Health System (SUS). METHODS This is a cross-sectional, exploratory, and descriptive study, part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). Interviews were carried out with patients present in the services by semi-structured questionnaires. Sociodemographic, clinical, and use of medicines variables were assessed and the use of medicines in the 30 days prior to the interview was also verified. The population was stratified into three age groups: 18 to 44, 45 to 64, and 65 years or more. The differences between the age groups were verified using the Student’s t-test for continuous variables and chi-square test for the categorical ones. The complex samples analysis plan was employed. The medicines were classified according to the Anatomical Therapeutic Chemical Classification System. RESULTS Of the 8,803 patients interviewed, 6,511 (76.2%) reported to have used medicines in the 30 days prior to the interview. On average, each patient used 2.32 medicines, without difference between the sexes. Among medicine users, 18.2% were aged 65 years or more. Compared to the other age groups, older adults presented more comorbidities, used more medicines, and self-reported worse health conditions. They were also less educated, reported worse economic situation, and lived alone. The medicines that were mostly used were “other analgesics and antipyretics” (3rd ATC level) and Losartan (5th ATC level). CONCLUSIONS Most medicine users had lower education level and presented comorbidities. The most used medicines were the antihypertensive ones. Self-medication was higher among young people. Most patients reported to use generic medicines. The average number of medicines and the
Changes to Hearing Levels Over the First Year After Stapes Surgery: An Analysis of 139 Patients.

PubMed

Nash, Robert; Patel, Bhavesh; Lavy, Jeremy

2018-06-15

Stapes surgery is performed for hearing restoration in patients with otosclerosis. Results from stapes surgery are good, although a small proportion will have a persistent conductive hearing loss and will consider revision surgery. The timing of such surgery depends on expected changes to hearing thresholds during the postoperative period. We performed a retrospective case series analysis of a database of outcomes from stapes surgery performed between July 26, 2013 and March 11, 2016 at one center. Hearing outcomes over the year subsequent to surgery were recorded. There was a significant improvement in hearing outcomes between the postoperative visit at 6 weeks (mean air-bone gap 6.0 dB) and the hearing outcome at 6 months (mean air-bone gap 3.3 dB) (p < 0.01). This improvement was maintained at 12 months (mean air-bone gap 3.1 dB), although there were individual patients whose hearing outcome improved or deteriorated during this period. Improvements in air conduction thresholds mirrored improvements in air-bone gap measurements. Patients with an initial suboptimal or poor result after stapes surgery may observed improvement in their hearing thresholds in the year after surgery. These patients may have large preoperative air-bone gaps, and have a trend to have obliterated footplates. Revision surgery should not be considered until at least 6 months after primary surgery.
Unplanned 30-Day Readmissions in a General Internal Medicine Hospitalist Service at a Comprehensive Cancer Center.

PubMed

Manzano, Joanna-Grace M; Gadiraju, Sahitya; Hiremath, Adarsh; Lin, Heather Yan; Farroni, Jeff; Halm, Josiah

2015-09-01

Hospital readmissions are considered by the Centers for Medicare and Medicaid as a metric for quality of health care delivery. Robust data on the readmission profile of patients with cancer are currently insufficient to determine whether this measure is applicable to cancer hospitals as well. To address this knowledge gap, we estimated the unplanned readmission rate and identified factors influencing unplanned readmissions in a hospitalist service at a comprehensive cancer center. We retrospectively analyzed unplanned 30-day readmission of patients discharged from the General Internal Medicine Hospitalist Service at a comprehensive cancer center between April 1, 2012, and September 30, 2012. Multiple independent variables were studied using univariable and multivariable logistic regression models, with generalized estimating equations to identify risk factors associated with readmissions. We observed a readmission rate of 22.6% in our cohort. The median time to unplanned readmission was 10 days. Unplanned readmission was more likely in patients with metastatic cancer and those with three or more comorbidities. Patients discharged to hospice were less likely to be readmitted (all P values < .01). We observed a high unplanned readmission rate among our population of patients with cancer. The risk factors identified appear to be related to severity of illness and open up opportunities for improving coordination with primary care physicians, oncologists, and other specialists to manage comorbidities, or perhaps transition appropriate patients to palliative care. Our findings will be instrumental for developing targeted interventions to help reduce readmissions at our hospital. Our data also provide direction for appropriate application of readmission quality measures in cancer hospitals. Copyright © 2015 by American Society of Clinical Oncology.
Compliance and persistence of antidepressants versus anticonvulsants in patients with neuropathic pain during the first year of therapy.

PubMed

Gharibian, Derenik; Polzin, Jennifer K; Rho, Jay P

2013-05-01

Neuropathic pain (NP) is a chronic condition that has human, social, and economic consequences. A variety of agents can be used for treatment; however, antidepressants and anticonvulsants are the 2 classes most widely studied and represent first-line agents in the management of NP. Little information is known about the adherence patterns of these medications during the first year of therapy in patients with NP. To examine the compliance and persistence of antidepressants versus anticonvulsants in patients with NP during the first year of therapy. Using electronic medical and pharmacy data for the Kaiser Permanente Southern California region, the adherence patterns for patients with a NP diagnosis prescribed an antidepressant or an anticonvulsant were studied. Compliance and persistence were measured using the medication possession ratio and the Refill-Sequence model, respectively. The study included 1817 patients with NP diagnosis taking either an antidepressant or an anticonvulsant. Within the antidepressant group, 42.9% were considered compliant, compared with 43.7% in the anticonvulsant group. Subanalysis of the 2 cohorts revealed that patients on venlafaxine were the most compliant (69.4%) compared with patients taking gabapentin (44.4%) and tricyclic antidepressants (41.8%) (P<0.01). Only 21.2% of patients in the antidepressant group and 21.4% in the anticonvulsant group were considered persistent with their medication refills. Compliance and persistence rates were similar for patients with NP diagnosis taking antidepressants and anticonvulsants. Higher compliance was observed among patients taking venlafaxine; however, this population did have a small sample size.
[Etiological profile of secondary Raynaud's phenomenon in an internal medicine department. About 121 patients].

PubMed

Ben Salem, T; Tougorti, M; Bziouech, S; Lamloum, M; Khanfir, M; Ben Ghorbel, I; Houman, M H

2018-02-01

Raynaud's phenomenon is a reversible episodic vasospastic disorder triggered by cold or emotion. Two types of Raynaud's phenomenon were distinguished: Raynaud's disease and secondary Raynaud's phenomenon. The purpose of this study was to determine the etiologic profile of secondary Raynaud's phenomenon in an internal medicine department. A descriptive retrospective study including patients with secondary Raynaud's phenomenon followed in a tertiary internal medicine department between 2000 and 2013. We included 121 patients. The sex ratio M/F was 0.16. The mean age at the onset of Raynaud's phenomenon was 41.7 years. The average age of patients at the time of the etiologic diagnosis was 47.3 years. The mean delay between Raynaud's phenomenon onset and the first consultation was 41.33 months. Raynaud's phenomenon involved hands in all cases and feet in 16.10% of cases with a typical form in most cases (41.4%). Complications (digital ulcers and scars) were noted in 32.23% of cases. Nail fold capillaroscopy showed scleroderma pattern in 49.52% of patients. Antinuclear antibodies were positive in 88.49% of patients. Interstitial lung disease was reported in 54.04% of cases. Connective tissue diseases were diagnosed in 86.77% of patients. Other secondary Raynaud's phenomenon causes were vasculitis (6.61%), atherosclerosis (1.65%) and medical or professional causes (1.65%). The most frequent one cause systemic sclerosis (n=61, 98%) followed by systemic lupus erythematosus (11.57%) and primary Sjögren syndrome (6.61%). In our study, the Raynaud's phenomenon was most frequently secondary to connective tissue diseases. This may be a selection bias because our department is a third-line unit where patients are often referred for systemic disease suspicion. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Center of Excellence for Laser Applications in Medicine, Microlaser Microscope

DOE Office of Scientific and Technical Information (OSTI.GOV)

Webb, R. H.

The Center of Excellence for Laser Applications in Medicine at the Schepens Eye Research Institute (SERI) is a Center for: A core group of researchers who support each other and their various projects for real-time medical imaging and diagnostics in contiguous space at SERI. Clinical collaborators who participate in the core research at SERI, MEEI, and local ophthalmology practices, and at associated sites around the world. Industrial partners who transfer our technology to commercial products that will reach clinical usage everywhere. Students, post-doctoral associates and medical fellows who work with us and learn how to practice real-time medical imaging andmore » diagnostics.« less
An evidence-based patient-centered method makes the biopsychosocial model scientific.

PubMed

Smith, Robert C; Fortin, Auguste H; Dwamena, Francesca; Frankel, Richard M

2013-06-01

To review the scientific status of the biopsychosocial (BPS) model and to propose a way to improve it. Engel's BPS model added patients' psychological and social health concerns to the highly successful biomedical model. He proposed that the BPS model could make medicine more scientific, but its use in education, clinical care, and, especially, research remains minimal. Many aver correctly that the present model cannot be defined in a consistent way for the individual patient, making it untestable and non-scientific. This stems from not obtaining relevant BPS data systematically, where one interviewer obtains the same information another would. Recent research by two of the authors has produced similar patient-centered interviewing methods that are repeatable and elicit just the relevant patient information needed to define the model at each visit. We propose that the field adopt these evidence-based methods as the standard for identifying the BPS model. Identifying a scientific BPS model in each patient with an agreed-upon, evidence-based patient-centered interviewing method can produce a quantum leap ahead in both research and teaching. A scientific BPS model can give us more confidence in being humanistic. In research, we can conduct more rigorous studies to inform better practices. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study.

PubMed

Muscaritoli, Maurizio; Lucia, Simone; Farcomeni, Alessio; Lorusso, Vito; Saracino, Valeria; Barone, Carlo; Plastino, Francesca; Gori, Stefania; Magarotto, Roberto; Carteni, Giacomo; Chiurazzi, Bruno; Pavese, Ida; Marchetti, Luca; Zagonel, Vittorina; Bergo, Eleonora; Tonini, Giuseppe; Imperatori, Marco; Iacono, Carmelo; Maiorana, Luigi; Pinto, Carmine; Rubino, Daniela; Cavanna, Luigi; Di Cicilia, Roberto; Gamucci, Teresa; Quadrini, Silvia; Palazzo, Salvatore; Minardi, Stefano; Merlano, Marco; Colucci, Giuseppe; Marchetti, Paolo

2017-10-03

In cancer patients, malnutrition is associated with treatment toxicity, complications, reduced physical functioning, and decreased survival. The Prevalence of Malnutrition in Oncology (PreMiO) study identified malnutrition or its risk among cancer patients making their first medical oncology visit. Innovatively, oncologists, not nutritionists, evaluated the nutritional status of the patients in this study. PreMiO was a prospective, observational study conducted at 22 medical oncology centers across Italy. For inclusion, adult patients (>18 years) had a solid tumor diagnosis, were treatment-naive, and had a life expectancy >3 months. Malnutrition was identified by the Mini Nutritional Assessment (MNA), appetite status with a visual analog scale (VAS), and appetite loss with a modified version of Anorexia-Cachexia Subscale (AC/S-12) of the Functional Assessment of Anorexia-Cachexia Therapy (FAACT). Of patients enrolled ( N= 1,952), 51% had nutritional impairment; 9% were overtly malnourished, and 43% were at risk for malnutrition. Severity of malnutrition was positively correlated with the stage of cancer. Over 40% of patients were experiencing anorexia, as reported in the VAS and FAACT questionnaire. During the prior six months, 64% of patients lost weight (1-10 kg). Malnutrition, anorexia, and weight loss are common in cancer patients, even at their first visit to a medical oncology center.
American Association of Poison Control Centers

Science.gov Websites

centers in their efforts to prevent and treat poison exposures. Poison centers offer free, confidential º Over-the-Counter Medicine Safety Over-the-Counter Medicine Safety is a 100% free, evidence-based after the close of the data year in the journal Clinical Toxicology and is available for download free
Three-year follow-up results of a residential community reintegration program for patients with chronic acquired brain injury.

PubMed

Geurtsen, Gert J; van Heugten, Caroline M; Martina, Juan D; Rietveld, Antonius C; Meijer, Ron; Geurts, Alexander C

2012-05-01

To evaluate outcomes of a residential community reintegration program 3 years after treatment on independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation. A follow-up assessment 3 years after treatment was compared with the 1-year follow-up assessment in a prospective cohort study. A tertiary rehabilitation center for acquired brain injury. Of the 67 patients assessed at the 1-year follow-up, 63 subjects (94%; 42 men; mean age at admission to treatment 24.7y; mean time postonset 5.1y) were available at the 3-year follow-up and taken into account in the analyses. A structured residential treatment program directed at improving independence in domestic life, work, leisure time, and social interactions. Community Integration Questionnaire, Employability Rating Scale, living situation, school, work situation, work hours, Center for Epidemiological Studies-Depression scale, and the World Health Organization Quality of Life Scale Abbreviated (5 scales). There were no significant differences for any of the outcome measures between the 1-year and 3-year follow-up assessment. These results indicate that the established significant and clinically relevant improvements after a residential community reintegration program remain stable in the long term. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Monitoring of allograft vasculopathy by intravascular ultrasound one month and one year after heart transplantation: A single center study.

PubMed

Bedanova, Helena; Orban, Marek; Tretina, Martin; Fila, Petr; Horvath, Vladimir; Krejci, Jan; Nemec, Petr

2016-03-01

The aim of this trial was to use intravascular ultrasound (IVUS) to determine whether cardiac allograft vasculopathy (CAV) starts progressing during the first year after heart transplantation (HTx). We retrospectively analyzed 51 patients (11 women) who received heart transplants in our center between January 2010 and September 2013 and underwent coronary angiography as well as IVUS examination one month and one year after HTx. Patients with proven calcification and fibrotic plates in the IVUS examination one month after HTx constituted a group with defined donor-transmitted atherosclerosis (DTA). In patients without DTA, measurements of maximal intimal thickening (MIT) were made in two predetermined locations. Eight of the 51 patients had DTA, while 43 did not. These were divided based on maximal intimal thickness (MIT) into a group with MIT < 0.5 mm (27) and MIT ≥ 0.5 mm (16). No patient with MIT < 0.5 mm developed allograft vasculopathy within one year after HTx. CAV developed in three patients (P = 0.045) out of the 16 patients with MIT ≥ 0.5. In patients with DTA, a statistically significant deterioration in percent area stenosis (PAS) occurred in both artery sections (P = 0.01). Our trial showed that CAV progresses during the first year after HTx significantly more frequently in patients with DTA and MIT ≥ 0.5 mm. It is essential in these patients to implement an IVUS control examination one year after transplantation. The results can lead to a change in treatment strategy to prevent further progress of the disease.
Association Between Use of Traditional Chinese Medicine Herbal Therapy and Survival Outcomes in Patients With Stage II and III Colorectal Cancer: A Multicenter Prospective Cohort Study.

PubMed

Xu, Yun; Mao, Jun J; Sun, Lingyun; Yang, Lin; Li, Jie; Hao, Yingxu; Li, Huashan; Hou, Wei; Chu, Yuping; Bai, Yu; Jia, Xiaoqiang; Wang, Jinwan; Shen, Lin; Zhang, Ying; Wang, Jianbin; Liu, Jianping; Yang, Yufei

2017-11-01

Chinese cancer patients often use Traditional Chinese Medicine (TCM) herbal medicine during or after active cancer treatments. However, little is known about how TCM herbal medicine impacts cancer outcomes. This study aimed to evaluate the association between TCM herbal therapy and survival outcomes in patients with stage II or III colorectal cancer. We conducted an eight-center prospective cohort study in China among patients who had undergone radical resection for stage II and III colorectal cancer. All patients received comprehensive conventional treatments according to National Comprehensive Cancer Network (NCCN) guidelines, and follow-up visits were conducted over five years. We defined high exposure as a patient's use of TCM individualized herbs for more than one year, ascertained via clinical interviews. The primary outcome was disease-free survival (DFS), with overall survival (OS) as a secondary outcome. Between April 2007 and February 2009, we enrolled 312 patients into the cohort; 166 (53.2%) met the definition of high exposure to TCM herbs. Adjusting for covariates, high exposure to TCM was associated with both better DFS (hazard ratio [HR] = 0.62, 95% confidence interval [CI] = 0.39 to 0.98) and OS (HR = 0.31, 95% CI = 0.14 to 0.68). In subgroup exploratory analysis, the effects demonstrated that the differences in outcomes were statistically significant in patients who had received chemotherapy. Longer duration of TCM herbal use is associated with improved survival outcomes in stage II and III colorectal cancer patients in China. More research is needed to evaluate the effects and underlying mechanisms of herbal medicine on colorectal cancer outcomes. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
Implementation of an Integrative Oncological Concept in the Daily Care of a German Certified Breast Cancer Center.

PubMed

Schad, Friedemann; Thronicke, Anja; Merkle, Antje; Steele, Megan L; Kröz, Matthias; Herbstreit, Cornelia; Matthes, Harald

2018-01-01

In recent decades the concept of integrative medicine has attracted growing interest in patients and professionals. At the Gemeinschaftskrankenhaus Havelhöhe (GKH), a hospital specialized in anthroposophical medicine, a breast cancer center (BCC) has been successfully certified for more than 5 years. The objective of the present study was to analyze how integrative strategies were implemented in the daily care of primary breast cancer patients. Clinical, demographic, and follow-up data as well as information on non-pharmacological interventions were analyzed. In addition, BCC quality measures were compared with data of the National Breast Cancer Benchmarking Report 2016. Between 2011 and 2016, 741 primary breast cancer patients (median age 57.4 years) were treated at the GKH BCC. 91.5% of the patients showed Union for International Cancer Control (UICC) stage 0, I, II, or III and 8.2% were in UICC stage IV. 97% of the patients underwent surgery, 53% radiation, 38% had hormone therapy, and 25% received cytostatic drugs. 96% of the patients received non-pharmacological interventions and 32% received Viscum album L. Follow-up was performed in up to 93% of the patients 2 years after first diagnosis. Compared to nationwide benchmarking BCCs, the GKH BCC met the requirements in central items. The results of the present study show that integrative therapies offered by the concept of anthroposophical medicine can be implemented in the daily care and treatment of a certified BCC. However, as national guidelines on integrative concepts in oncology are missing, further studies are needed for a systematic evaluation of integrative treatment and care concepts in this field. © 2018 The Author(s). Published by S. Karger GmbH, Freiburg.
Patient-centered prioritization of bladder cancer research.

PubMed

Smith, Angela B; Chisolm, Stephanie; Deal, Allison; Spangler, Alejandra; Quale, Diane Z; Bangs, Rick; Jones, J Michael; Gore, John L

2018-05-04

Patient-centered research requires the meaningful involvement of patients and caregivers throughout the research process. The objective of this study was to create a process for sustainable engagement for research prioritization within oncology. From December 2014 to 2016, a network of engaged patients for research prioritization was created in partnership with the Bladder Cancer Advocacy Network (BCAN): the BCAN Patient Survey Network (PSN). The PSN leveraged an online bladder cancer community with additional recruitment through print advertisements and social media campaigns. Prioritized research questions were developed through a modified Delphi process and were iterated through multidisciplinary working groups and a repeat survey. In year 1 of the PSN, 354 patients and caregivers responded to the research prioritization survey; the number of responses increased to 1034 in year 2. The majority of respondents had non-muscle-invasive bladder cancer (NMIBC), and the mean time since diagnosis was 5 years. Stakeholder-identified questions for noninvasive, invasive, and metastatic disease were prioritized by the PSN. Free-text questions were sorted with thematic mapping. Several questions submitted by respondents were among the prioritized research questions. A final prioritized list of research questions was disseminated to various funding agencies, and a highly ranked NMIBC research question was included as a priority area in the 2017 Patient-Centered Outcomes Research Institute announcement of pragmatic trial funding. Patient engagement is needed to identify high-priority research questions in oncology. The BCAN PSN provides a successful example of an engagement infrastructure for annual research prioritization in bladder cancer. The creation of an engagement network sets the groundwork for additional phases of engagement, including design, conduct, and dissemination. Cancer 2018. © 2018 American Cancer Society. © 2018 American Cancer Society.
Utility of C4d immunostaining in the first year after pediatric and young adult heart transplantation.

PubMed

Xu, Ying; Galambos, Csaba; Reyes-Múgica, Miguel; Miller, Susan A; Zeevi, Adriana; Webber, Steven A; Feingold, Brian

2013-01-01

C4d assessment of endomyocardial biopsies (EMBs) after heart transplantation (HTx) has been widely adopted to aid in the diagnosis of antibody-mediated rejection (AMR), yet it remains unclear whether or not to assess all patients routinely and with what frequency/duration. In this study we sought to evaluate the utility of routine C4d immunostaining in the first year after pediatric and young adult HTx. We reviewed pre-transplant alloantibody and clinical data, including serial EMB reports, on all 51 patients who received HTx at our center since we instituted routine C4d staining of all first-year EMBs. C4d was considered positive if diffuse capillary staining (≥ 2(+)) was present. Rare/focal capillary staining or absence of staining was considered negative. Twenty-six of 406 first-year EMBs (6%) were C4d(+) in 6 (12%) patients. Sixty-five percent of all C4d(+) EMBs occurred by 30 days post-transplant. Five of 6 patients had pre-transplant donor-specific antibody (DSA) ≥ 4,000 MFI. The sixth patient had neither pre-transplant anti-HLA antibodies nor a positive donor-specific cytotoxicity crossmatch (DSXM), but there was clinical concern for AMR. Among the entire cohort, 5 of 10 patients with pre-transplant DSA ≥ 4,000 MFI and/or a positive DSXM were C4d(+) compared with only 1 of 41 without (50% vs 2%; p = 0.001). In the first year after HTx, C4d(+) occurred early and only in children and young adults with pre-transplant DSA or with clinical suspicion of AMR. Although our data suggest that assessment limited to the first 90 days post-transplant in patients with pre-transplant DSA ≥ 4,000 MFI may be appropriate in the absence of clinical concern for AMR, further research is needed to determine the optimum strategy for post-transplant surveillance. Copyright © 2013 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
Graphic Pathographies and the Ethical Practice of Person-Centered Medicine.

PubMed

Myers, Kimberly R; Goldenberg, Michael D F

2018-02-01

Graphic medicine is a swiftly growing movement that explores, theoretically and practically, the use of comics in medical education and patient care. At the heart of graphic medicine are graphic pathographies, stories of illness conveyed in comic form. These stories are helpful tools for health care professionals who seek new insight into the personal, lived experience of illness and for patients who want to learn more about their disease from others who have actually experienced it. Featuring excerpts from five graphic pathographies, this essay illustrates how the medium can be used to educate patients and enhance empathy in health care professionals, particularly with regard to informed consent and end-of-life issues. © 2018 American Medical Association. All Rights Reserved.
Fifty years of sociological leadership at Social Science and Medicine.

PubMed

Timmermans, Stefan; Tietbohl, Caroline

2018-01-01

In this review article, we examine some of the conceptual contributions of sociology of health and illness over the past fifty years. Specifically, we focus on research dealing with medicalization, the management of stigma, research on adherence and compliance, and patient-doctor interaction. We show how these themes that originated within sociology, diffused in other disciplines. Sociology in Social Science and Medicine started as an applied research tradition but morphed into a robust, stand-alone social science tradition. Copyright © 2017 Elsevier Ltd. All rights reserved.

Online video bridges gap between orientation and first session for arts in medicine volunteers.

PubMed

Gregory, Dianne

2009-01-01

An online video assignment was developed to facilitate transition from the orientation session to the first contact with hospital patients for music therapy majors and other students enrolled in an Arts in Medicine service learning course (AIMS). All students (N = 84) completed a 2 hour hospital orientation session. After the orientation session the experimental group (n = 42) completed an online video assignment before volunteering at the hospital The control group (n = 42) began volunteering after the orientation session without completing the video assignment. Analysis indicates the majority of both groups initiated their first session independently without assistance from other AIMS volunteers, an experienced AIM volunteer, an AIM assistant, or hospital staff member. The majority of both groups also engaged at least one patient during their first visit at the hospital. Content analysis of "first contact" weekly reports, however, indicated experimental group students wrote longer reports and included more positive comments, particularly about patients, compared to control group students. Volunteers in the experimental group also began their contacts as scheduled on the course calendar compared to later starting dates of control group volunteers.
Outcome of renal transplantation in patients with diabetic nephropathy -- a single-center experience.

PubMed

Kute, Vivek B; Vanikar, Aruna V; Trivedi, Hargovind L; Shah, Pankaj R; Goplani, Kamal R; Gumber, Manoj R; Patel, Himanshu V; Godara, Suraj M; Modi, Pranjal R; Shah, Veena R

2011-06-01

Type 2 diabetes mellitus (DM) is the commonest cause of end-stage renal disease (ESRD) worldwide. Data scarcity on renal transplantation (RTx) outcome in diabetic nephropathy (DN) prompted us to review our experience. This retrospective single-center, 5-year study was undertaken to evaluate patient and graft survival and function, evaluated by serum creatinine (SCr), rejection episodes, and mortality in patients. One hundred type 2 DM-ESRD patients underwent RTx [80 living-related (LRD), 20 deceased donor (DD)] at our center following cardiac fitness of recipient. Post-transplant immunosuppression consisted of calcineurin inhibitor-based regimen. The mean donor age in the LRD group was 40.6 years and 52 years in the DD group. Male recipients constituted 95% in the LRD and 65% in the DD group. Over a mean follow-up of 2.47 years, 1- and 5-year patient/graft survival in LRDRTx was 85.1%/95.9% and 82.6%/95.9%, respectively, and mean SCr (in mg/dl) at 1 and 5 years was 1.38 and 1.58 mg/dl, respectively, with 20% of cases developing acute rejection (AR) episodes. Fifteen percent of patients died, mainly due to infections, and 1.3% died of coronary artery disease (CAD). In DDRTx, over a mean follow-up of 3.17 years, 1- and 4-year patient/graft survival was 72%/89.7% and 54%/89.7%, respectively; mean SCr at 1 and 4 years was 1.40 and 1.75 mg/dl, respectively, with 20% of cases developing AR episodes. Totally, 30% of patients were lost, mainly due to infections, and 10% of patients died from cerebrovascular events. In our center, in patients with RTx for type 2 DM diabetic nephropathy, the 4- and 5-year patient and graft survival rates and graft function can be considered acceptable. The results are better in LRDRTx than in DDRTx patients.
Patient characteristics, resource use and outcomes associated with general internal medicine hospital care: the General Medicine Inpatient Initiative (GEMINI) retrospective cohort study

PubMed Central

Verma, Amol A.; Guo, Yishan; Kwan, Janice L.; Lapointe-Shaw, Lauren; Rawal, Shail; Tang, Terence; Weinerman, Adina; Cram, Peter; Dhalla, Irfan A.; Hwang, Stephen W.; Laupacis, Andreas; Mamdani, Muhammad M.; Shadowitz, Steven; Upshur, Ross; Reid, Robert J.; Razak, Fahad

2017-01-01

Background: The precise scope of hospital care delivered under general internal medicine services remains poorly quantified. The purpose of this study was to describe the demographic characteristics, medical conditions, health outcomes and resource use of patients admitted to general internal medicine at 7 hospital sites in the Greater Toronto Area. Methods: This was a retrospective cohort study involving all patients who were admitted to or discharged from general internal medicine at the study sites between Apr. 1, 2010, and Mar. 31, 2015. Clinical data from hospital electronic information systems were linked to administrative data from each hospital. We examined trends in resource use and patient characteristics over the study period. Results: There were 136 208 admissions to general internal medicine involving 88 121 unique patients over the study period. General internal medicine admissions accounted for 38.8% of all admissions from the emergency department and 23.7% of all hospital bed-days. Over the study period, the number of admissions to general internal medicine increased by 32.4%; there was no meaningful change in the median length of stay or cost per hospital stay. The median patient age was 73 (interquartile range [IQR] 57-84) years, and the median number of coexisting conditions was 6 (IQR 3-9). The median acute length of stay was 4.6 (IQR 2.5-8.6) days, and the median total cost per hospital stay was $5850 (IQR $3915-$10 061). Patients received at least 1 computed tomography scan in 52.2% of admissions. The most common primary discharge diagnoses were pneumonia (5.0% of admissions), heart failure (4.7%), chronic obstructive pulmonary disease (4.1%), urinary tract infection (4.0%) and stroke (3.6%). Interpretation: Patients admitted to general internal medicine services represent a large, heterogeneous, resource-intensive and growing population. Understanding and improving general internal medicine care is essential to promote a high
Patient characteristics, resource use and outcomes associated with general internal medicine hospital care: the General Medicine Inpatient Initiative (GEMINI) retrospective cohort study.

PubMed

Verma, Amol A; Guo, Yishan; Kwan, Janice L; Lapointe-Shaw, Lauren; Rawal, Shail; Tang, Terence; Weinerman, Adina; Cram, Peter; Dhalla, Irfan A; Hwang, Stephen W; Laupacis, Andreas; Mamdani, Muhammad M; Shadowitz, Steven; Upshur, Ross; Reid, Robert J; Razak, Fahad

2017-12-11

The precise scope of hospital care delivered under general internal medicine services remains poorly quantified. The purpose of this study was to describe the demographic characteristics, medical conditions, health outcomes and resource use of patients admitted to general internal medicine at 7 hospital sites in the Greater Toronto Area. This was a retrospective cohort study involving all patients who were admitted to or discharged from general internal medicine at the study sites between Apr. 1, 2010, and Mar. 31, 2015. Clinical data from hospital electronic information systems were linked to administrative data from each hospital. We examined trends in resource use and patient characteristics over the study period. There were 136 208 admissions to general internal medicine involving 88 121 unique patients over the study period. General internal medicine admissions accounted for 38.8% of all admissions from the emergency department and 23.7% of all hospital bed-days. Over the study period, the number of admissions to general internal medicine increased by 32.4%; there was no meaningful change in the median length of stay or cost per hospital stay. The median patient age was 73 (interquartile range [IQR] 57-84) years, and the median number of coexisting conditions was 6 (IQR 3-9). The median acute length of stay was 4.6 (IQR 2.5-8.6) days, and the median total cost per hospital stay was $5850 (IQR $3915-$10 061). Patients received at least 1 computed tomography scan in 52.2% of admissions. The most common primary discharge diagnoses were pneumonia (5.0% of admissions), heart failure (4.7%), chronic obstructive pulmonary disease (4.1%), urinary tract infection (4.0%) and stroke (3.6%). Patients admitted to general internal medicine services represent a large, heterogeneous, resource-intensive and growing population. Understanding and improving general internal medicine care is essential to promote a high-quality, sustainable health care system. Copyright 2017
Impact of pharmacy worker training and deployment on access to essential medicines for children under five in Malawi: a cluster quasi-experimental evaluation.

PubMed

Babigumira, Joseph B; Lubinga, Solomon J; Jenny, Alisa M; Larsen-Cooper, Erin; Crawford, Jessica; Matemba, Charles; Stergachis, Andy

2017-09-11

Poor access to essential medicines is common in many low- and middle-income countries, partly due to an insufficient and inadequately trained workforce to manage the medicines supply chain. We conducted a prospective impact evaluation of the training and deployment of pharmacy assistants (PAs) to rural health centers in Malawi. A quasi-experimental design was used to compare access to medicines in two districts where newly trained PAs were deployed to health centers (intervention) and two districts with no trained PAs at health centers (comparison). A baseline household survey and two annual post-intervention household surveys were conducted. We studied children under five years with a history of fever, cough and difficulty in breathing, and diarrhea in the previous two weeks. We collected data on access to antimalarials, antibiotics and oral rehydration salts (ORS) during the childrens' symptomatic periods. We used difference-in-differences regression models to estimate the impact of PA training and deployment on access to medicines. We included 3974 children across the three rounds of annual surveys: 1840 (46%) in the districts with PAs deployed at health centers and 2096 (53%) in districts with no PAs deployed at health centers. Approximately 80% of children had a fever, nearly 30% had a cough, and 43% had diarrhea in the previous two weeks. In the first year of the program, the presence of a PA led to a significant 74% increase in the odds of access to any antimalarial, and a significant 49% increase in the odds of access to artemisinin combination therapies. This effect was restricted to the first year post-intervention. There was no effect of presence of a PA on access to antibiotics or ORS. The training and deployment of pharmacy assistants to rural health centers in Malawi increased access to antimalarial medications over the first year, but the effect was attenuated over the second year. Pharmacy assistants training and deployment demonstrated no impact on
Service and Education: The Association Between Workload, Patient Complexity, and Teaching on Internal Medicine Inpatient Services.

PubMed

Ratcliffe, Temple A; Crabtree, Meghan A; Palmer, Raymond F; Pugh, Jacqueline A; Lanham, Holly J; Leykum, Luci K

2018-04-01

Attending rounds remain the primary venue for formal teaching and learning at academic medical centers. Little is known about the effect of increasing clinical demands on teaching during attending rounds. To explore the relationships among teaching time, teaching topics, clinical workload, and patient complexity variables. Observational study of medicine teaching teams from September 2008 through August 2014. Teams at two large teaching hospitals associated with a single medical school were observed for periods of 2 to 4 weeks. Twelve medicine teaching teams consisting of one attending, one second- or third-year resident, two to three interns, and two to three medical students. The study examined relationships between patient complexity (comorbidities, complications) and clinical workload variables (census, turnover) with educational measures. Teams were clustered based on clinical workload and patient complexity. Educational measures of interest were time spent teaching and number of teaching topics. Data were analyzed both at the daily observation level and across a given patient's admission. We observed 12 teams, 1994 discussions (approximately 373 h of rounds) of 563 patients over 244 observation days. Teams clustered into three groups: low patient complexity/high clinical workload, average patient complexity/low clinical workload, and high patient complexity/high clinical workload. Modest associations for team, patient complexity, and clinical workload variables were noted with total time spent teaching (9.1% of the variance in time spent teaching during a patient's admission; F[8,549] = 6.90, p < 0.001) and number of teaching topics (16% of the variance in the total number of teaching topics during a patient's admission; F[8,548] = 14.18, p < 0.001). Clinical workload and patient complexity characteristics among teams were only modestly associated with total teaching time and teaching topics.
Factors associated with absenteeism, presenteeism and activity impairment in patients in the first years of RA.

PubMed

Bansback, Nick; Zhang, Wei; Walsh, David; Kiely, Patrick; Williams, Richard; Guh, Daphne; Anis, Aslam; Young, Adam

2012-02-01

To understand the impact of the early years of RA on all aspects of work productivity, and determine how this is related to clinical markers. Previous research on work productivity has examined predominantly early retirement and absenteeism. The impact of reduced work performance (presenteeism) and activity impairment is less well understood in early RA populations. Working patients enrolled in an RA inception cohort were recruited into a nested study. A questionnaire incorporating the Work Productivity and Activity Impairment (WPAI) instrument was administered with a number of clinical outcomes, including the Multidimensional Health Assessment Questionnaire (MD-HAQ) and scales for pain, fatigue and patient assessment of disease patient global assessment (PtGA). Analysis included 150 RA patients, with the mean age at onset being 48 years (s.d. 10 years) and disease duration from symptom onset being 49 months. Patients had relatively mild disease: MD-HAQ (0.6), pain (3.6), PtGA (3.6) and fatigue (4.6). Of the 92% patients working for pay, 19% reported missing work (absenteeism) in the past week due to their health, accounting for 46% of their working time. Even while at work, ∼25% of actual hours was lost due to poor health, while outside work 33% of patients' regular daily activities were prevented. In multivariate analyses, disease severity was associated with the presence of absenteeism, presenteeism and activity impairment. Patients able to self-schedule their work had lower presenteeism and activity impairment. Productivity loss is common in patients in the first years of RA who are in paid work and was associated with work characteristics and adverse clinical outcomes.
Long-term outcome of epilepsy with onset in the first three years of life: Findings from a large cohort of patients.

PubMed

Vignoli, Aglaia; Peron, Angela; Turner, Katherine; Scornavacca, Giulia Federica; La Briola, Francesca; Chiesa, Valentina; Zambrelli, Elena; Canevini, Maria Paola

2016-07-01

To describe the clinical features of patients with seizure onset within the first three years of life, and to evaluate risk factors for long-term prognosis. We selected 266 patients among 3096 individuals consecutively observed at a single Epilepsy Center between 1992 and 2012, and retrospectively analyzed their clinical, EEG, neuro-radiological and genetic characteristics. Mean ages at epilepsy onset and at follow-up were 14.9 months and 29.3 years, respectively. Mean follow-up period 8.2 years. We identified a recognizable etiology in 147 individuals (55.2%), while 76 (28.6%) were classified as unknown cause and 43 (16.2%) as genetic, according to the ILAE criteria. Thirty-four patients (27.9%) had a confirmed genetic diagnosis and 12 (9.8%) had a metabolic diagnosis. Febrile seizures (p = 0.008), positive family history (p = 0.049), drug resistance (p = 0.048), moderate (p = 0.04) and severe intellectual disability (p = 0.005) were significantly more frequent in patients with seizure onset 0-12 months than in those with onset 13-36 months. Multiple regression analysis demonstrated a link between early age of epilepsy onset and intellectual disability (p = 0.008). No further variables were significantly associated with age at epilepsy onset (for etiology p = 0.095, for drug resistance p = 0.646, and for neuro-radiological findings p = 0.087). Our study demonstrated worse outcome in symptomatic epilepsies in a large and representative sample. We also confirmed that the earlier age at seizure onset, the poorest the epilepsy outcome. Copyright © 2016 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
Thirty years of family medicine publications in Israel (1975-2004): what, where, and how much?

PubMed

Pshetizky, Y; Tandeter, H; Tabenkin, H; Vinker, S; Lahad, A; Karkabi, K; Kitai, E; Hermoni, D; Shvartzman, P

2009-01-01

Departments of family medicine in Israel were established in the 1970s. Until now, little or no effort has been made to characterize the productivity of Israeli board-certified family medicine physicians in publishing peer-reviewed scientific articles. Publications were identified by 2 methods. First, a PubMed search by names of current and past faculty from all the departments of family medicine in Israel (1975-2004). Secondly, all of the departments in Israel forwarded a list of all publications by their faculty (including those that do not appear in Medline). The abstracts of all publications were extracted and were separately and blindly evaluated by 2 reviewers. Publications were classified according to Medline citation, language, journal impact factor, and publication type. A total of 1165 publications were identified and analyzed. More than half of the articles were published in the last 10 years. Seventy-two percent were cited in Medline. Publications in English encompassed 64.7% of the publications, Hebrew 34.6%, and 0.7% other. Approximately 6% of the articles were published in journals with impact factor > or =3, with research articles accounting for 46.9%. The publication output of family medicine in Israel averaged 85.4 publications per 1000 family medicine physicians per year. Almost 70% of the articles were published in non-family medicine journals. Academically affiliated, board-certified family medicine physicians published at higher rates, averaging 334.3 per 1000 academic family medicine physicians per year (data available for 2000-2004 only). Publishing and research are important to the development of family medicine as an academic profession, in which Israeli family physicians show significant productivity.
Firework injuries at a major trauma and burn center: A five-year prospective study.

PubMed

Wang, Cheng; Zhao, Ran; Du, Wei-Li; Ning, Fang-Gang; Zhang, Guo-An

2014-03-01

In China, fireworks are an integral part of the celebration of the annual Spring Festival, but the number of injuries associated with their private use seen in emergency rooms increases dramatically. To raise awareness and help guide future prevention practices in this city, we investigated the epidemiology of firework-related injuries presented at our trauma and burn center in Beijing during the Spring Festivals of 2007-2011. Patients were interviewed using a pre-coded questionnaire to elicit information regarding age, gender, causes, injured body part, type of injury, diagnosis, and disposition. From 2007 to 2011, during the Spring Festivals 734 patients with fire-work related injuries were seen at our trauma and burn center in Beijing, the median patients of the five year were 140(136-150). The mean age of the patients was 26±15.3 years (range, 1-95 years). Of the 734 patients, the highest proportion of injuries were the 5-14 year-old age group The majority of the patients were male (87.9%), the overall male:female ratio was 7.41:1, and males were predominant in all age groups. For all 5 years, the incidence of firework-related injuries during the Spring Festival Holidays peaked specifically on the first, fifth, and last days, respectively. Injuries were mainly due to improper handling (415/610, 68.0%) or setting off illegal fireworks (195/610, 32.0%). The most frequently injured body parts were the hands and fingers (32.0%), head or face except eyes (28.3%), and trunk (22.4%). Burns were the most common type of injury (65.7%), most of the burned patients (437/453) were between 1% and 10%, and the most common region burned were hands and fingers (218/754). Contusions or lacerations were the second common type of injury (34.3%). Most of the patients (642, 87.5%) were treated and released, while 37 (5%) were treated and transferred, and 55 (7.5%) were admitted for advanced treatment. The private use of fireworks during the Spring Festival Holidays is associated
Patient-reported outcomes (PROs): the significance of using humanistic measures in clinical trial and clinical practice.

PubMed

Refolo, P; Minacori, R; Mele, V; Sacchini, D; Spagnolo, A G

2012-10-01

Patient-reported outcome (PRO) is an "umbrella term" that covers a whole range of potential types of measurement but it is used specifically to refer to all measures quantifying the state of health through the evaluation of outcomes reported by the patient himself/herself. PROs are increasingly seen as complementary to biomedical measures and they are being incorporated more frequently into clinical trials and clinical practice. After considering the cultural background of PROs - that is the well known patient-centered model of medicine -, their historical profile (since 1914, the year of the first outcome measure) and typologies, the paper aims at debating their methodological complexity and implementation into practice. Some clinical trials and therapeutic managements utilizing patient-centered measures will be also analyzed.
Attitudes and preferences concerning interprofessional education of first-year students and experienced medical and nursing staff.

PubMed

Kolb, Stephan; Vasilakis, Thomas; Stein, Barbara; Stadelmann, Jessica; Münzinger, Angelika; Fley, Gabriele; Hach, Isabel; Jassmann, Marco; Härlein, Jürgen

2017-03-01

In order to enhance patient outcome and patient safety in healthcare, interprofessional education (IPE) has over the years become a specific area of interest focusing on teaching concepts, research methods, and implementation strategies. To achieve commitment and positive attitudes as part of the institutional readiness towards IPE, the adoption of change management aspects can support its early implementation. This short report presents results of a baseline survey on attitudes and preferences for IPE among first-year students in medicine and nursing, as well as among chief physicians, nurse directors, and administrative directors at the associated university hospital. For the survey, the UWE-IP (University of the West of England Interprofessional Questionnaire) was used along with ten customised questions. Overall, a high degree of approval for IPE was observed in all participants. Furthermore, participants showed positive attitudes in three of the four UWE-IP subscales. However, neutral to negative attitudes were documented in subscale interprofessional interaction.
Prolonged length of stay in hospitalized internal medicine patients.

PubMed

Barba, Raquel; Marco, Javier; Canora, Jesús; Plaza, Susana; Juncos, Sara Nistal; Hinojosa, Juan; Bailon, Manuel Mendez; Zapatero, Antonio

2015-12-01

Targeting patients with prolonged hospitalizations may represent an effective strategy for reducing average hospital length of stay (LOS). We sought to characterize predictors of prolonged hospitalization among internal medicine patients in an effort to guide future improvement efforts. We conducted a retrospective cohort study using administrative data of internal medicine patients from all hospitals of the Spanish Public Health Service between January 1st, 2005 and December 31st, 2013. Multivariable logistic regression was performed to assess the association between sociodemographic and clinical variables and prolonged LOS, defined as >30days. Of 5,275,139 discharges, 166,470 (3.2%) had a prolonged LOS. Prolonged hospitalizations accounted for 17.4% of total inpatient days and contributed 0.5days to an average LOS of 9.8days during the study period. Prolonged hospitalizations were associated with younger age (odds ratio [OR]: 0.97 per 10-year increase in age, 95% confidence interval [CI]: 0.96-0.98) and male gender (OR 0.88 IC95% 0.87-0.89). Compared to patients without prolonged LOS, prolonged LOS patients were more likely to require a palliative care consult (OR: 2.48, 95% CI: 2.39-2.58), surgery (OR: 6.9 95% CI: 6.8-7.0); and be discharged to a post-acute-care facility (OR: 2.91, 95% CI: 2.86-2.95). Prolonged hospitalizations in a small proportion of patients were an important contributor to overall LOS and particularly affected complex hospital stays who were not discharged home. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
[Nanna Svartz (1890-1986) : The first female professor of medicine in Sweden].

PubMed

Wollheim, F A

2017-11-01

Nanna Svartz was a charismatic character who played a significant role in Swedish medicine in the mid-twentieth century. As one of five brothers and sisters, she escaped an early death from tuberculosis. She reached 96 years of age. Her diligence and sense of duty were legendary, along with her ambition to fully prove herself as "the first female professor". She inherited a certain insecurity from her father that led to her difficulty in taking criticism. Despite extensive academic obligations, she worked as a treating doctor for 55 years and always took her time with her patients, especially if they held important public positions. Nanna was honoured several times in her lifetime. Among others, she was a member of the Leopoldina, the National Academy of Germany, and received many honorary doctorates, for example, from Rockefeller College (USA) and the Åbo University (Turku, Finland). She was an honorary member of over 40 scientific societies. Underneath the new auditorium in the Karolinska Institute, a restaurant and a street in her home town of Västerås bear her name. An annual international Nanna Svartz Lecture is held by the Swedish Society for Rheumatology, and a Nanna Svartz Prize is awarded annually to a deserving young Swedish rheumatologist.
Complex decision making in patients with dementia in an internal medicine department.

PubMed

Kabelka, Ladislav

2017-10-01

With the increase of polymorbidity, extending life expectancy and improving treatment options for chronic diseases, the care for dementia is moving into other areas of medicine. The length and quality of life with advanced dementia is directly dependent on the quality of medical and nursing care, early detection and treatment of complications, nutritional support and palliative care plan. Significant is also the support for family carers. The key coordinators of care for patients with dementia are general practitioners (GPs), geriatricians, psychiatrists, and an increasingly important role play internists. Case reports of patients admitted to an internal medicine department. Description of clinical experiences with caring on patients with dementia. In the internal departments of regional hospitals, there is a room for adjustment of the care plan, for comprehensive assessment of the patient and for making crucial decisions regarding nutrition, treatment of chronic diseases, consideration of previously expressed wishes in the context of the patient condition, and potential prognostic indicators. This assessment must result in a comprehensive documentation and communication with patients, and in the case of advanced dementia with their family members. The general internal medicine is very often the first place where the patient has a chance to hear about indication for palliative care. Without the availability of a multidisciplinary assessment, good communication and documentation, it is unrealistic to expect that the hospital would provide comprehensive care for patients with dementia.
[Auto-dialysis: an 11-year experience of a hemodialysis center in France].

PubMed

Montagnac, R; Schillinger, F

1996-03-30

Report 11 years of experience with self-managed hemodialysis in patients medically apt for extra-hospital dialysis and living close enough to small outpatient hemodialysis units to become totally self-sufficient. Among the 276 patients with chronic renal failure managed at the hemodialysis center at the Troyes hospital during the 11-year study period from 1984 through 1994, self-managed hemodialysis at small outpatient units was initiated in 127 (46%). None of these 127 patients required medical assistance or specific care during dialysis sessions. At initial hospital admission, only 60/127 (47%) were totally self-sufficient: 52 (41%) were later graft recipients; and 21 (16.5%) had to return to the hospital for a medical or surgical condition incompatible with extra-hospital care but all of these 21 patients remained self-sufficient. Extra-hospital hemodialysis in units close to the patients residence offers patients a better quality of life, even when medical assistance is required. All patients who require hemodialysis can thus be treated at lower cost without compromising quality of treatment. Perfect self-sufficiency may not be a goal in itself, but self-managed hemodialysis can be a very useful technique for patients without major medical problems. Continuing contact with the organizing hemodialysis center guarantees the safety of the system.
Precision Medicine: From Science to Value

PubMed Central

Ginsburg, Geoffrey S; Phillips, Kathryn A

2018-01-01

Precision medicine is poised to have an impact on patients, health care delivery systems and research participants in ways that were only imagined 15 years ago when the human genome was first sequenced. While discovery using genome-based technologies has accelerated, these have only begun to be adopted into clinical medicine. Here we define precision medicine and the stakeholder ecosystem required to enable its integration into research and health care. We explore the intersection of data science, analytics and precision medicine in creating a learning health system that carries out research in the context of clinical care and at the same time optimizes the tools and information used to delivery improved patient outcomes. We provide examples of real world impact, and conclude with a policy and economic agenda that will be necessary for the adoption of this new paradigm of health care both in the United States and globally. PMID:29733705
Validation of an instrument to measure patients' experiences of medicine use: the Living with Medicines Questionnaire.

PubMed

Krska, Janet; Katusiime, Barbra; Corlett, Sarah A

2017-01-01

Medicine-related burden is an increasingly recognized concept, stemming from the rising tide of polypharmacy, which may impact on patient behaviors, including nonadherence. No instruments currently exist which specifically measure medicine-related burden. The Living with Medicines Questionnaire (LMQ) was developed for this purpose. This study validated the LMQ in a sample of adults using regular prescription medicines in the UK. Questionnaires were distributed in community pharmacies and public places in southeast England or online through UK health websites and social media. A total of 1,177 were returned: 507 (43.1%) from pharmacy distribution and 670 (56.9%) online. Construct validity was assessed by principal components analysis and item reduction undertaken on the original 60-item pool. Known-groups analysis assessed differences in mean total scores between participants using different numbers of medicines and between those who did or did not require assistance with medicine use. Internal consistency was assessed by Cronbach's alpha. Free-text comments were analyzed thematically to substantiate underlying dimensions. A 42-item, eight-factor structure comprising intercorrelated dimensions (patient-doctor relationships and communication about medicines, patient-pharmacist communication about medicines, interferences with daily life, practical difficulties, effectiveness, acceptance of medicine use, autonomy/control over medicines and concerns about medicine use) was derived, which explained 57.4% of the total variation. Six of the eight subscales had acceptable internal consistency (α>0.7). More positive experiences were observed among patients using eight or fewer medicines compared to nine or more, and those independent with managing/using their medicines versus those requiring assistance. Free-text comments, provided by almost a third of the respondents, supported the domains identified. The resultant LMQ-2 is a valid and reliable multidimensional measure of
[Activities of voivodeship occupational medicine centers in workplace health promotion in 2008].

PubMed

Goszczyńska, Eliza

2010-01-01

The paper aims to present the activities of the largest Voivodeship Occupational Medicine Centers (VOMCs) in Poland in the area of workplace health promotion in 2008. It was compiled on the basis of written reports concerning these activities sent by the Centers to the Polish National Center for Workplace Health Promotion, Nofer Institute of Occupational Medicine, Łódź. Their analysis shows a greatly varied level of engagement in and understanding of health promotion--from simple single actions (in the field of health education and screening) to long-running programs, including various ways of influencing people the programs are addressed to. In 2008, there were 78 such programs in the country, the most popular of them were those focused on occupational voice disorders and tobacco smoke). VOMCs perceive external factors, unfavorable or indifferent attitudes towards promoting health of their employees on the part of employers as well as financial constraints, as the most common obstacles in undertaking activities in the field of workplace health promotion. At the same time, they link achievements in this field mostly with their own activities, including effective cooperation with various partners and their well qualified and experienced employees.
Effect of Weekend Admissions on the Treatment Process and Outcomes of Internal Medicine Patients: A Nationwide Cross-Sectional Study.

PubMed

Huang, Chun-Che; Huang, Yu-Tung; Hsu, Nin-Chieh; Chen, Jin-Shing; Yu, Chong-Jen

2016-02-01

Many studies address the effect of weekend admission on patient outcomes. This population-based study aimed to evaluate the relationship between weekend admission and the treatment process and outcomes of general internal medicine patients in Taiwan.A total of 82,340 patients (16,657 weekend and 65,683 weekday admissions) aged ≥20 years and admitted to the internal medicine departments of 17 medical centers between 2007 and 2009 were identified from the Taiwan National Health Insurance Research Database. A generalized estimating equation (GEE) analysis was used to compare patients admitted on weekends and those admitted on weekdays.Patients who were admitted on weekends were more likely to undergo intubation (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.16-1.39; P < 0.001) and/or mechanical ventilation (OR, 1.25; 95% CI, 1.15-1.35; P < 0.001), cardio-pulmonary resuscitation (OR: 1.45; 95% CI: 1.05-2.01; P = 0.026), and be transferred to the intensive care unit (ICU) (OR: 1.16; 95% CI: 1.03-1.30; P = 0.015) compared with those admitted on weekdays. Weekend-admitted patients also had higher odds of in-hospital mortality (OR: 1.19; 95% CI: 1.09-1.30; P < 0.001) and hospital treatment cost (OR: 1.04; 95% CI: 1.01-1.06; P = 0.008) than weekday-admitted patients.General internal medicine patients who were admitted on weekends experienced more intensive care procedures and higher ICU admission, in-hospital mortality, and treatment cost. Intensive care utilization may serve as early indicator of poorer outcomes and a potential entry point to offer preventive intervention before proceeding to intensive treatment.

Inhaled medicinal cannabis and the immunocompromised patient.

PubMed

Ruchlemer, Rosa; Amit-Kohn, Michal; Raveh, David; Hanuš, Lumír

2015-03-01

Medicinal cannabis is an invaluable adjunct therapy for pain relief, nausea, anorexia, and mood modification in cancer patients and is available as cookies or cakes, as sublingual drops, as a vaporized mist, or for smoking. However, as with every herb, various microorganisms are carried on its leaves and flowers which when inhaled could expose the user, in particular immunocompromised patients, to the risk of opportunistic lung infections, primarily from inhaled molds. The objective of this study was to identify the safest way of using medicinal cannabis in immunosuppressed patients by finding the optimal method of sterilization with minimal loss of activity of cannabis. We describe the results of culturing the cannabis herb, three methods of sterilization, and the measured loss of a main cannabinoid compound activity. Systematic sterilization of medicinal cannabis can eliminate the risk of fatal opportunistic infections associated with cannabis among patients at risk.
Patients' expectations of medicines--a review and qualitative synthesis.

PubMed

Dohnhammar, Ulrica; Reeve, Joanne; Walley, Tom

2016-04-01

An increasing part of prescribing of medicines is done for the purpose of managing risk for disease and is motivated by clinical and economic benefit on a long-term, population level. This makes benefit from medicines less tangible for individuals. Sociology of pharmaceuticals includes personal and social perspectives in the study of how medicines are used. We use two characterizations of patients' expectations of medicines to start forming a description of how individuals conceptualize benefits from risk management medicines. We reviewed the literature on patients' expectations with a focus on the influences on expectations regarding medicines prescribed for long-term conditions. Searches in Medline and Scopus identified 20 studies for inclusion, describing qualitative aspects of beliefs, views, thoughts and expectations regarding medicines. A qualitative synthesis using a constant comparative thematic analysis identified four themes describing influences on expectations: a need to achieve a specific outcome; the development of experiences and evaluation over time; negative values such as dependency and social stigma; and personalized meaning of the necessity and usefulness of medicines. The findings in this synthesis resonate with previous research into expectations of medicines for prevention and treatment of different conditions. However, a gap in the knowledge regarding patients' conceptualization of future benefits with medicines is identified. The study highlights suggestions for further empirical work to develop a deeper understanding of the role of patients' expectations in prescribing for long-term risk management. © 2015 John Wiley & Sons Ltd.
[Experience of integrated traditional Chinese and Western medicine in first case of imported Zika virus disease in China].

PubMed

Deng, Yichu; Zeng, Liping; Bao, Wen; Xu, Pinghua; Zhong, Gongrong

2016-02-01

Zika virus disease is an acute infectious disease caused by Zika virus transmitted through Aedes mosquitoes. To explore the therapeutic effect of integrated traditional Chinese and Western Medicine for Zika virus disease, the treatment process of the first imported case in China was reviewed. The first imported Zika virus disease in China was admitted to Ganxian People's Hospital in Jiangxi Province on February 6th, 2016, and the patient received isolation treatment for 9 days and cured later. The effect of antiviral treatments including Xiyanping injection was evaluated based on clinical diagnosis and treatment process of the patient. A 34-year old male patient was admitted with chief complaint of fever for 9 days, orbital pain and itching rash for 4 days on February 6th, 2016. (1) Epidemiological characteristics: the patient was bitted by mosquitoes during his business trip in Venezuela since January 1st, where Zika virus disease was spreading. On January 20th he had dizziness without fever, and the symptom disappeared after taking medicines without details. Paroxysmal dizziness, chills and mild fever without myalgia was experienced on January 28th. On February 3rd small red rash appeared in the neck, spreading to anterior part of chest, limbs and trunk, and the fever, fatigue, nausea was continued, and a new symptom of paroxysmal pain in back of ears and orbits appeared, during which he had not go to hospital. The symptoms relieved on February 4th. He returned to Ganxian County on February 5th, he had yellow stool 3 times with normal temperature, without abdominal pain, and red rash still appeared in the neck. He went to Ganxian People's Hospital on February 6th, 2016. (2) Clinical manifestation: the vital signs showed a temperature of 36.8?centigrade, a pulse rate of 80 bpm, a respiratory rate of 20 bpm, and a blood pressure of 110/70 mmHg (1 mmHg = 0.133 kPa). It was showed by physical examination that red rash appeared in the neck, and no superficial enlarged
User-centered design of quality of life reports for clinical care of patients with prostate cancer

PubMed Central

Izard, Jason; Hartzler, Andrea; Avery, Daniel I.; Shih, Cheryl; Dalkin, Bruce L.; Gore, John L.

2014-01-01

Background Primary treatment of localized prostate cancer can result in bothersome urinary, sexual, and bowel symptoms. Yet clinical application of health-related quality-of-life (HRQOL) questionnaires is rare. We employed user-centered design to develop graphic dashboards of questionnaire responses from patients with prostate cancer to facilitate clinical integration of HRQOL measurement. Methods We interviewed 50 prostate cancer patients and 50 providers, assessed literacy with validated instruments (Rapid Estimate of Adult Literacy in Medicine short form, Subjective Numeracy Scale, Graphical Literacy Scale), and presented participants with prototype dashboards that display prostate cancer-specific HRQOL with graphic elements derived from patient focus groups. We assessed dashboard comprehension and preferences in table, bar, line, and pictograph formats with patient scores contextualized with HRQOL scores of similar patients serving as a comparison group. Results Health literacy (mean score, 6.8/7) and numeracy (mean score, 4.5/6) of patient participants was high. Patients favored the bar chart (mean rank, 1.8 [P = .12] vs line graph [P <.01] vs table and pictograph); providers demonstrated similar preference for table, bar, and line formats (ranked first by 30%, 34%, and 34% of providers, respectively). Providers expressed unsolicited concerns over presentation of comparison group scores (n = 19; 38%) and impact on clinic efficiency (n = 16; 32%). Conclusion Based on preferences of prostate cancer patients and providers, we developed the design concept of a dynamic HRQOL dashboard that permits a base patient-centered report in bar chart format that can be toggled to other formats and include error bars that frame comparison group scores. Inclusion of lower literacy patients may yield different preferences. PMID:24787105
User-centered design of quality of life reports for clinical care of patients with prostate cancer.

PubMed

Izard, Jason; Hartzler, Andrea; Avery, Daniel I; Shih, Cheryl; Dalkin, Bruce L; Gore, John L

2014-05-01

Primary treatment of localized prostate cancer can result in bothersome urinary, sexual, and bowel symptoms. Yet clinical application of health-related quality-of-life (HRQOL) questionnaires is rare. We employed user-centered design to develop graphic dashboards of questionnaire responses from patients with prostate cancer to facilitate clinical integration of HRQOL measurement. We interviewed 50 prostate cancer patients and 50 providers, assessed literacy with validated instruments (Rapid Estimate of Adult Literacy in Medicine short form, Subjective Numeracy Scale, Graphical Literacy Scale), and presented participants with prototype dashboards that display prostate cancer-specific HRQOL with graphic elements derived from patient focus groups. We assessed dashboard comprehension and preferences in table, bar, line, and pictograph formats with patient scores contextualized with HRQOL scores of similar patients serving as a comparison group. Health literacy (mean score, 6.8/7) and numeracy (mean score, 4.5/6) of patient participants was high. Patients favored the bar chart (mean rank, 1.8 [P = .12] vs line graph [P < .01] vs table and pictograph); providers demonstrated similar preference for table, bar, and line formats (ranked first by 30%, 34%, and 34% of providers, respectively). Providers expressed unsolicited concerns over presentation of comparison group scores (n = 19; 38%) and impact on clinic efficiency (n = 16; 32%). Based on preferences of prostate cancer patients and providers, we developed the design concept of a dynamic HRQOL dashboard that permits a base patient-centered report in bar chart format that can be toggled to other formats and include error bars that frame comparison group scores. Inclusion of lower literacy patients may yield different preferences. Copyright © 2014 Mosby, Inc. All rights reserved.
Advanced ultrasound training for fourth-year medical students: a novel training program at The Ohio State University College of Medicine.

PubMed

Bahner, David P; Royall, Nelson A

2013-02-01

Ultrasound training and education in medical schools is rare, and the foci of current ultrasound curricula are limited. There is a significant need for advanced ultrasound training models in medical school curricula to reduce educational burdens for physician residency programs and improve overall physician competency.The authors describe and evaluate the advanced ultrasound training program developed at The Ohio State University College of Medicine (OSU COM). The OSU COM program is a longitudinal advanced ultrasound curriculum for fourth-year medical students pursuing specialties that require frequent use of focused ultrasound. One hundred fifty student participants have completed the yearlong program to date. Participants engage in didactic lectures, journal club sessions, hands-on training, teaching and patient-modeling activities, and complete a final project. Experienced Ohio State University Medical Center faculty are recruited from specialties that frequently use ultrasound (e.g., emergency medicine, internal medicine, obstetrics-gynecology). A multimodal instructional assessment approach ensures that ultrasound training yields experience with cognitive, behavioral, and constructive learning components. The authors discuss the benefits of the program as well as its challenges and future directions.The advanced ultrasound training program at OSU COM demonstrates a novel approach to providing ultrasound training for medical students, offering a feasible model for meeting training guidelines without increasing the educational requirements for residency programs.
Primary care-public health linkages: Older primary care patients with prediabetes & type 2 diabetes encouraged to attend community-based senior centers.

PubMed

Noël, Polly H; Parchman, Michael L; Finley, Erin P; Wang, Chen-Pin; Bollinger, Mary; Espinoza, Sara E; Hazuda, Helen P

2016-12-01

The Institute of Medicine (IOM) suggests that primary care-public health integration can improve health outcomes for vulnerable patients, but the extent to which formal linkages may enhance patients' use of community resources, or the factors that may influence providers to encourage their patients to use these resources, remain unclear. We conducted baseline assessments in 2014-2015 with 149 older adults with prediabetes or diabetes who had recently joined three senior centers linked to a network of primary care clinics in San Antonio, Texas. In addition to collecting sociodemographic and clinical characteristics, we asked members to identify their source of primary care and whether a health care provider had encouraged them to go to the senior center. We also asked members why they had joined the senior centers and which programs interested them the most. Members' source of primary care was not associated with being encouraged to attend the senior centers by a health care professional. Multivariable analysis indicated that participants with total annual household incomes of $20,000 or less [OR = 2.78; 95% CI = (1.05, 7.14)] and those reporting 12 years of education or less [OR = 3.57; 95% CI = (1.11, 11.11)] were significantly more likely to report being encouraged to attend the senior center by a health care provider. Providers who are aware of community-based resources to support patient self-management may be just as likely to encourage their socioeconomically vulnerable patients with prediabetes or diabetes to use them as providers who have a more formal partnership with the senior centers.
Cannabis use among patients at a comprehensive cancer center in a state with legalized medicinal and recreational use

PubMed Central

Woodfield, Maresa C.; Lee, Christine M.; Cheng, Guang‐Shing; Baker, Kelsey K.; Marquis, Sara R.; Fann, Jesse R.

2017-01-01

BACKGROUND Cannabis is purported to alleviate symptoms related to cancer treatment, although the patterns of use among cancer patients are not well known. This study was designed to determine the prevalence and methods of use among cancer patients, the perceived benefits, and the sources of information in a state with legalized cannabis. METHODS A cross‐sectional, anonymous survey of adult cancer patients was performed at a National Cancer Institute–designated cancer center in Washington State. Random urine samples for tetrahydrocannabinol provided survey validation. RESULTS Nine hundred twenty‐six of 2737 eligible patients (34%) completed the survey, and the median age was 58 years (interquartile range [IQR], 46‐66 years). Most had a strong interest in learning about cannabis during treatment (6 on a 1‐10 scale; IQR, 3‐10) and wanted information from cancer providers (677 of 911 [74%]). Previous use was common (607 of 926 [66%]); 24% (222 of 926) used cannabis in the last year, and 21% (192 of 926) used cannabis in the last month. Random urine samples found similar percentages of users who reported weekly use (27 of 193 [14%] vs 164 of 926 [18%]). Active users inhaled (153 of 220 [70%]) or consumed edibles (154 of 220 [70%]); 89 (40%) used both modalities. Cannabis was used primarily for physical (165 of 219 [75%]) and neuropsychiatric symptoms (139 of 219 [63%]). Legalization significantly increased the likelihood of use in more than half of the respondents. CONCLUSIONS This study of cancer patients in a state with legalized cannabis found high rates of active use across broad subgroups, and legalization was reported to be important in patients' decision to use. Cancer patients desire but are not receiving information about cannabis use during their treatment from oncology providers. Cancer 2017;123:4488‐97. © 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the
Cannabis use among patients at a comprehensive cancer center in a state with legalized medicinal and recreational use.

PubMed

Pergam, Steven A; Woodfield, Maresa C; Lee, Christine M; Cheng, Guang-Shing; Baker, Kelsey K; Marquis, Sara R; Fann, Jesse R

2017-11-15

Cannabis is purported to alleviate symptoms related to cancer treatment, although the patterns of use among cancer patients are not well known. This study was designed to determine the prevalence and methods of use among cancer patients, the perceived benefits, and the sources of information in a state with legalized cannabis. A cross-sectional, anonymous survey of adult cancer patients was performed at a National Cancer Institute-designated cancer center in Washington State. Random urine samples for tetrahydrocannabinol provided survey validation. Nine hundred twenty-six of 2737 eligible patients (34%) completed the survey, and the median age was 58 years (interquartile range [IQR], 46-66 years). Most had a strong interest in learning about cannabis during treatment (6 on a 1-10 scale; IQR, 3-10) and wanted information from cancer providers (677 of 911 [74%]). Previous use was common (607 of 926 [66%]); 24% (222 of 926) used cannabis in the last year, and 21% (192 of 926) used cannabis in the last month. Random urine samples found similar percentages of users who reported weekly use (27 of 193 [14%] vs 164 of 926 [18%]). Active users inhaled (153 of 220 [70%]) or consumed edibles (154 of 220 [70%]); 89 (40%) used both modalities. Cannabis was used primarily for physical (165 of 219 [75%]) and neuropsychiatric symptoms (139 of 219 [63%]). Legalization significantly increased the likelihood of use in more than half of the respondents. This study of cancer patients in a state with legalized cannabis found high rates of active use across broad subgroups, and legalization was reported to be important in patients' decision to use. Cancer patients desire but are not receiving information about cannabis use during their treatment from oncology providers. Cancer 2017;123:4488-97. © 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution
Effect of a Patient-Centered Communication Intervention on Oncologist-Patient Communication, Quality of Life, and Health Care Utilization in Advanced Cancer: The VOICE Randomized Clinical Trial.

PubMed

Epstein, Ronald M; Duberstein, Paul R; Fenton, Joshua J; Fiscella, Kevin; Hoerger, Michael; Tancredi, Daniel J; Xing, Guibo; Gramling, Robert; Mohile, Supriya; Franks, Peter; Kaesberg, Paul; Plumb, Sandy; Cipri, Camille S; Street, Richard L; Shields, Cleveland G; Back, Anthony L; Butow, Phyllis; Walczak, Adam; Tattersall, Martin; Venuti, Alison; Sullivan, Peter; Robinson, Mark; Hoh, Beth; Lewis, Linda; Kravitz, Richard L

2017-01-01

Observational studies demonstrate links between patient-centered communication, quality of life (QOL), and aggressive treatments in advanced cancer, yet few randomized clinical trials (RCTs) of communication interventions have been reported. To determine whether a combined intervention involving oncologists, patients with advanced cancer, and caregivers would promote patient-centered communication, and to estimate intervention effects on shared understanding, patient-physician relationships, QOL, and aggressive treatments in the last 30 days of life. Cluster RCT at community- and hospital-based cancer clinics in Western New York and Northern California; 38 medical oncologists (mean age 44.6 years; 11 (29%) female) and 265 community-dwelling adult patients with advanced nonhematologic cancer participated (mean age, 64.4 years, 146 [55.0%] female, 235 [89%] white; enrolled August 2012 to June 2014; followed for 3 years); 194 patients had participating caregivers. Oncologists received individualized communication training using standardized patient instructors while patients received question prompt lists and individualized communication coaching to identify issues to address during an upcoming oncologist visit. Both interventions focused on engaging patients in consultations, responding to emotions, informing patients about prognosis and treatment choices, and balanced framing of information. Control participants received no training. The prespecified primary outcome was a composite measure of patient-centered communication coded from audio recordings of the first oncologist visit following patient coaching (intervention group) or enrollment (control). Secondary outcomes included the patient-physician relationship, shared understanding of prognosis, QOL, and aggressive treatments and hospice use in the last 30 days of life. Data from 38 oncologists (19 randomized to intervention) and 265 patients (130 intervention) were analyzed. In fully adjusted models, the
Tissue Engineering and Regenerative Medicine 2017: A Year in Review.

PubMed

Park, Kyung Min; Shin, Young Min; Kim, Kyobum; Shin, Heungsoo

2018-04-26

In 2017, a new paradigm change caused by artificial intelligence and big data analysis resulted in innovation in each field of science and technology, and also significantly influenced progress in tissue engineering and regenerative medicine (TERM). TERM has continued to make technological advances based on interdisciplinary approaches and has contributed to the overall field of biomedical technology, including cancer biology, personalized medicine, development biology, and cell-based therapeutics. While researchers are aware that there is still a long way to go until TERM reaches the ultimate goal of patient treatment through clinical translation, the rapid progress in convergence studies led by technological improvements in TERM has been encouraging. In this review, we highlighted the significant advances made in TERM in 2017 (with an overlap of 5 months in 2016). We identified major progress in TERM in a manner similar to previous reviews published in the last few years. In addition, we carefully considered all four previous reviews during the selection process and chose main themes that minimize the duplication of the topics. Therefore, we have identified three areas that have been the focus of most journal publications in the TERM community in 2017: (i) advanced biomaterials and three-dimensional (3D) cell printing, (ii) exosomes as bioactive agents for regenerative medicine, and (iii) 3D culture in regenerative medicine.
[Personalized medicine, privatized medicine? legal and public health stakes].

PubMed

Rial-Sebbag, Emmanuelle

2014-11-01

Personalized medicine is booming. It tends to provide a medical management "tailored" for groups of patients, or for one unique patient, but also to identify risk groups to develop public health strategies. In this context, some radicalization phenomenon can emerge, leading to not only personalized medicine but also privatized medicine, which can lead to a capture of the medical public resource. If the "privatization" of medicine is not limited to producing adverse effects, several potentially destabilizing phenomena for patients still remain. First, some objective factors, like the adjustment of scientific prerequisites, are emerging from personalized medicine practices (clinical trial, public health policy) and are interfering with the medical doctor/patient relationship. Another risk emerges for patients concomitantly to their demand for controlling their own health, in terms of patients' security although these risks are not clearly identified and not effectively communicated. These practices, related to a privatized medicine, develop within the healthcare system but also outside, and the government and legislators will have to take into account these new dimensions in drafting their future regulations and policies. © 2014 médecine/sciences – Inserm.
Analysis of spirometry results in hospitalized patients aged over 65 years.

PubMed

Wróblewska, Izabela; Oleśniewicz, Piotr; Kurpas, Donata; Sołtysik, Mariusz; Błaszczuk, Jerzy

2015-01-01

The growing population of the elderly, as well as the occurrence of coexisting diseases and polypharmacy, is the reason why diseases of patients aged $65 years belong to the major issues of the contemporary medicine. Among the most frequent diseases of the elderly, there are respiratory system diseases. They are difficult to diagnose because of the patient group specificity, which is the reason for increased mortality among seniors, caused by underdiagnosis. The study objective was to assess the factors influencing spirometry results in hospitalized patients aged ≥65 years with respiratory system disorders. In the research, 217 (100%) patients aged ≥65 years who underwent spirometry at the Regional Medical Center of the Jelenia Góra Valley Hospital in Poland were analyzed. In the statistical analysis, the STATISTICA 9.1 program, the t-test, the Shapiro-Wilk test, the ANOVA test, and the Scheffé's test were applied. The majority of the patients (59.4%) were treated in the hospital. The most frequent diagnosis was malignant neoplasm (18%). The study showed a statistically significant dependence between the forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC parameters and the time of hospitalization, as well as between the FVC and FEV1 parameters and the age of patients. The FVC parameter values turned out to be dependent on the main diagnosis. Highest results were noted in patients with the diagnosis of sleep apnea or benign neoplasm. A low FVC index can reflect restrictive ventilation defects, which was supported by the performed analyses. Highest FEV1/FVC values were observed in nonsmokers, which confirms the influence of nicotine addiction on the incidence of respiratory system diseases. The respondents' sex and the established diagnosis statistically significantly influenced the FVC index result, and the diet influenced the FEV1/FVC parameter result.
Professionalism, responsibility, and service in academic medicine.

PubMed

Souba, W W

1996-01-01

Academic medical centers have responded to health care reform initiatives by launching a series of strategic plans designed to maintain patient flow and reduce hospital expenditures. Thought is also being given to processes by which the faculty can individually and collectively adjust to these changes and maintain morale at a time when reductions in the labor force and pay cuts are virtually certain. Physicians are concerned because managed care threatens their autonomy and jeopardizes the traditional ways in which they have carried out their multiple missions. Some doctors believe that it will become increasingly difficult to obtain genuine satisfaction from their job. The strategies that academic medical centers have begun to use to address the numerous challenges posed by a system of health care based on managed competition are reviewed. Potential mechanisms by which academic departments can continue to find fulfillment in an environment that threatens their traditional missions and values are discussed. A study of the social and historical origins of medicine in the United States reveals that the introduction of corporate medicine in the United States was destined to happen. Strategies implemented by academic medical centers in response to managed care include building an integrated delivery network, the acquisition of primary care practices, increasing cost-effectiveness, and creating physician-hospital organizations. Emphasis must be placed on integrating traditional core values (excellence, leadership, and innovation) with newer values such as patient focus, accountability, and diversity. A shift from rugged individualism to entrepreneurial teamwork is crucial. These reforms, although frightening at the onset, can serve to reaffirm our commitment to academic medicine and preserve our mission. The evolving managed care environment offers unique opportunities for academic medical centers to shape and positively impact health care delivery in the twenty-first
Factors influencing prognosis and functional outcome one year after a first-time stroke in a Caribbean population.

PubMed

Galanth, Sophie; Tressieres, Benoit; Lannuzel, Annie; Foucan, Patrick; Alecu, Cosmin

2014-11-01

To evaluate functional outcome and quality of life 1 year poststroke in a Caribbean population. Prospective study of patients with a first hemispheric stroke admitted consecutively between December 2010 and February 2011. The patients were evaluated (1) in the emergency department, (2) when discharged from the hospital, and (3) 1 year poststroke. A university hospital. Of the 140 consecutive patients with stroke, 78 (42% women, 24.4% hemorrhagic stroke) were included in the study. None. Patients were evaluated using the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), FIM, and Medical Outcomes Study 36-Item Short-Form Health Survey. The mean age of the participants was 62.1±17.7 years; 70.5% of patients had hypertension, 29.4% had diabetes, and 23.6% had chronic renal failure. At 1 year poststroke, the mortality rate was 29.4%, and the recurrence rate 2.6%. We evaluated 39 of the 55 survivors (71%). Score evolution (emergency department vs 1y later) is as follows: for the NIHSS, it was 6.2±4.9 versus 3.3±3.9 (z=-3.578; P<.001); and for the mRS score ≤2, it was 54.2% versus 66.7% (χ(2)=14.182; P=.25). The FIM score on discharge from the hospital versus 1 year later was 103.2±28.2 versus 101.7±31.5 (z=-1.008; P=.313). Multivariate analysis showed that aphasia, hemianopia, and incontinence significantly influenced the 1-year FIM score (P<.001). Quality of life, a patient-reported outcome measure of health-related quality of life, was significantly altered concerning vitality, role physical, and role emotional. One year after a first stroke, despite significant improvement of neurologic impairment, the level of dependency did not change and quality of life was altered. Aphasia, hemianopia, and incontinence significantly influenced functional state. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Electives in complementary medicine: are we preaching to the choir?

PubMed

Kemper, Kathi J; Larrimore, Deborah; Dozier, Jean; Woods, Charles

2005-11-01

Many medical schools offer electives on complementary medicine, but little is known about the characteristics of students who sign up for such electives compared with those who do not. Compare enrollees to nonenrollees in an elective course on therapeutic touch and healing touch (TTHT). Cross-sectional survey. Wake Forest University School of Medicine, second-year course on medicine as a profession. Second-year medical students who returned surveys: 22 who signed up for an elective on TTHT and 58 who did not. Anonymous surveys included questions about demographics, attitudes, practices, and the Maslach Burnout Inventory (MBI). Those who signed up for the elective were more likely to be women (73% for TTHT vs 33% for others, P < .01). Nearly all students thought that being centered and compassionate were very important. Students who signed up for TTHT were less likely to report feeling confident in being able to be centered when it was quiet (41% vs 64%, respectively, very confident, P < .04) and less confident in their ability to demonstrate nonverbal comforting behaviors (9% vs 43%, respectively, very confident, P = .02). Only 18% of elective vs 66% of others reported being centered during patient encounters (P < .001). The TTHT students and their classmates reported comparable levels of burnout. Elective students were no more likely than classmates to believe that it is very important to be centered and to extend compassion toward patients; they reported being less confident and practicing these skills less often than their classmates. Burnout was not less common among those in the elective. Electives may not be "preaching to the choir." Future studies need to determine whether training enhances confidence and skills and whether it protects against developing burnout.
Predictors of Late Reperfusion in STEMI Patients Undergoing Primary Angioplasty. Impact of the Place of First Medical Contact.

PubMed

Carol Ruiz, Antoni; Masip Utset, Josep; Ariza Solé, Albert

2017-03-01

The benefit of primary angioplasty may be reduced if there are delays to reperfusion. Identification of the variables associated with these delays could improve health care. Analysis of the Codi Infart registry of Catalonia and of the time to angioplasty depending on the place of first medical contact. In 3832 patients analyzed, first medical contact took place in primary care centers in 18% and in hospitals without a catheterization laboratory in 37%. Delays were longer in these 2 groups than in patients attended by the outpatient emergency medical system or by hospitals with a catheterization laboratory (P < .0001, results in median): first medical contact to reperfusion indication time was 42minutes in both (overall 35minutes); first medical contact to artery opening time was 131 and 143minutes, respectively (overall 121minutes); total ischemia time was 230 and 260minutes (overall 215minutes). First medical contact to artery opening time > 120minutes was strongly associated with first medical contact in a center without a catheterization laboratory (OR, 4.96; 95% confidence interval, 4.14-5.93), and other factors such as age, previous coronary surgery, first medical contact during evening hours, nondiagnostic electrocardiogram, and Killip class ≥ III. Mortality at 30 days and 1 year was 5.6% and 8.7% and was independently associated with age, longer delay to angioplasty, Killip class ≥ II, and first medical contact in a center with a catheterization laboratory. In more than 50% of patients requiring primary angioplasty, the first medical contact occurs in centers without a catheterization laboratory, which is an important predictor of delay from diagnosis to artery opening. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.
Trends in one-year mortality for stroke in a tertiary academic center in Saudi Arabia: a 5-year retrospective analysis.

PubMed

Almekhlafi, Mohammed A

2016-01-01

Numerous studies have reported a decline in stroke-related mortality in developed countries. To assess trends in one-year mortality following a stroke diagnosis in Saudi Arabia. Retrospective longitudinal cohort study. Single tertiary care center from 2010 through 2014. All patients admitted with a primary admitting diagnosis of stroke. Demographic data (age, gender, nationality), risk factor profile, stroke subtypes, in-hospital complications and mortality data as well as cause of death were collected for all patients. A multivariable logistic regression model was used to assess factors associated with one-year mortality following a stroke admission. One-year mortality. In 548 patients with a mean age of 62.9 years (SD 16.9), the most frequent vascular risk factors were hypertension (90.6%), diabetes (65.5%), and hyperlipidemia (27.2%). Hemorrhagic stroke was diagnosed in 9.9%. The overall mortality risk was 26.9%. Non-Saudis had a significantly higher one-year mortality risk compared with Saudis (25% vs. 16.8%, respectively; P=.025). The most frequently reported causes of mortality were neurological and related to the underlying stroke (32%), sepsis (30%), and cardiac or other organ dysfunction-related (each 9%) in addition to other etiologies (collectively 9.5%) such as pulmonary embolism or an underlying malignancy. Significant predictors in the multivariate model were age (P < .0001), non-Saudi nationality (OR 1.8, CI 95 1.1 to 2.9; P=.019), and hospital length of stay (OR 1.01, CI 95 1 to 1.004; P=.001). We observed no decline in stroke mortality in our center over the 5-year span. The establishment of stroke systems of care, use of thrombolytic agents, and opening of a stroke unit should play an important role in a decline in stroke mortality. Retrospective single center study. Mortality data were available only for patients who died in our hospital.
[Current Research Activities on Person-Centered Medicine in Academic Institutes of General Practice in Germany and Austria].

PubMed

Weber, Annemarie; Schelling, Jörg; Kohls, Niko; van Dyck, Marcus; Poggenburg, Stephanie; Vajda, Christian; Hirsch, Jameson; Sirois, Fuschia; Toussaint, Loren; Offenbächer, Martin

2017-10-11

Aim of study Person-centered medicine (PCM) with its focus on humanistic-biographical-oriented medicine and integrated, positive-salutogenic health is a central aspect in the patient-physician relationship in general practice. The objective of this analysis is to assess the prevalence and type of research project in academic institutions of general practice in Germany (Ger) and Austria (At) and the thematic priorities of the projects in the areas PCM, health promotion (HP), prevention (PRE) and conventional medicine (CM). Methods A search was conducted (September-December 2015) on the websites of 30 institutes and divisions of general medicine for their current research projects. The retrieved projects were assigned to five categories: PCM, HP, PRE, CM and others. Subsequently, we identified the targeted patient groups of the projects as well as the thematic focus in the categories PCM, HP, PRE and CM with focus on PCM and HP. Results 541 research projects were identified, 452 in Germany and 89 in Austria. Research projects were only included if they were explicitly indicated as research-oriented. Seventy projects addressed PCM aspects, 15 projects HP aspects, 32 projects PRE aspects and 396 projects CM aspects. The most frequently target groups in the categories PCM (24 of 70) and HP (7 of 15) were chronically ill patients. The most common thematic focus in PCM was communication (13 of 70) and in HP, physical activity (6 of 15). Conclusion The vast majority of research projects investigated conventional medical topics. The percentage of research activities in the field of PCM (13%) or PCM including HP (16%) in Ger and At is below the European average of 20%. From our point of view, PCM and HP need to be implemented to a greater extent in general practice. © Georg Thieme Verlag KG Stuttgart · New York.
Personal history and quality of life in chronic myeloid leukemia patients: a cross-sectional study using narrative medicine and quantitative analysis.

PubMed

Breccia, Massimo; Graffigna, Guendalina; Galimberti, Sara; Iurlo, Alessandra; Pungolino, Ester; Pizzuti, Michele; Maggi, Alessandro; Falzetti, Franca; Capalbo, Silvana Franca; Intermesoli, Tamara; Maffioli, Margherita; Elena, Chiara; Melosi, Alessandro; Simonetti, Federico; Capochiani, Enrico; Seta, Roberta Della; Pacilli, Matteo; Luppi, Mario; Di Renzo, Nicola; Mastrullo, Lucia; Trabacchi, Elena; Vallisa, Daniele; Rapezzi, Davide; Orlandi, Ester Maria; Gambacorti-Passerini, Carlo; Efficace, Fabio; Alimena, Giuliana

2016-11-01

Tyrosine kinase inhibitors (TKIs) drastically changed the outcome of patients diagnosed with chronic myeloid leukemia (CML). Several reports indicated the advantage of continue long-term adherence associated with positive outcome. Therefore, it is important to better understand from the patient's standpoint the experience of living with the disease and the related treatment. In this study, quantitative analysis and narrative medicine were combined to get insights on this issue in a population of 257 patients with CML in chronic phase treated with TKIs (43 % men, with a median age of 58 years, 27 % aged 31-50 years), followed for a median time of 5 years. Sixty-one percent of patients enrolled were treated in first line, whereas 37 % were treated in second line. The results showed more positive perceptions and acceptance in males compared to females, without impact of disease on relationships. Level of positive acceptance was more evident in elderly compared to younger patients, with a close connection with median time from diagnosis. Overall, female patients reported negative perceptions and an impact of disease on family daily living. The majority of patients understood the importance of continue adherence to treatment, with 27 % resulting less adherent (60 % for forgetfulness), even if well informed and supported by his/her physician. Narrative medicine, in association to quantitative analysis, can help physicians to understand needs of their patients in order to improve communication.

Patients presenting to an outpatient sport medicine clinic with concussion

PubMed Central

Ouellet, Jérôme; Boisvert, Leslie; Fischer, Lisa

2016-01-01

Abstract Objective To describe the characteristics of patients who presented to outpatient sport and exercise medicine clinics with concussion. Design Retrospective chart review of electronic medical records. Setting Three specialized sport and exercise medicine clinics in London, Ont. Participants A total of 283 patients presenting with concussion. Main outcome measures Data collected included demographic variables (age and sex), sport participation at the time of injury, previous medical history (including history of concussion), Post-Concussion Symptom Scale (PCSS) scores, and return-to-play (RTP) variables (delay and outcome). Results The mean age of patients presenting for care was 17.6 years; 70.9% of patients were younger than 18 years of age (considered pediatric patients); 58.8% of patients were male; and 31.7% of patients had a previous history of concussion. The main sports associated with injury were hockey (40.0%), soccer (12.6%), and football (11.7%). Return to play was granted to 50.9% of patients before the 3-week mark and 80.2% of patients before 8 weeks. Total PCSS scores (maximum score was 132) and neck scores (part of the PCSS, maximum score was 6) were significantly higher in adults compared with pediatric patients (36.2 vs 27.6, P = .02, and 1.8 vs 1.2, P = .02, respectively). A significant difference was seen in RTP, with pediatric patients returning earlier than adults did (P = .04). This difference was not seen when comparing males with females (P = .07). Longer duration of follow-up did not influence RTP outcomes. Previous history of concussion was associated with restriction from contact or collision sports (P < .001). Conclusion Given the age and sex variability found in this study, as well as in previous published reports, it is important to manage each patient individually using current best available practice strategies to optimize long-term outcomes.
MSU Medical Colleges Blended Learning for First Year Science Courses: Uniting Pedagogy to Maximize Experience and Real World Limitations

ERIC Educational Resources Information Center

Lovell, Kathryn; Vignare, Karen

2009-01-01

At Michigan State University the two medical schools, College of Human Medicine (CHM; M.D. degree) and College of Osteopathic Medicine (COM; D.O. degree), have offered the same science courses to first year students for many years. Science departments report to both colleges, and the same faculty can effectively teach the content required in the…
Comparing mortality of peritoneal and hemodialysis patients in the first 2 years of dialysis therapy: a marginal structural model analysis.

PubMed

Lukowsky, Lilia R; Mehrotra, Rajnish; Kheifets, Leeka; Arah, Onyebuchi A; Nissenson, Allen R; Kalantar-Zadeh, Kamyar

2013-04-01

There are conflicting research results about the survival differences between hemodialysis and peritoneal dialysis, especially during the first 2 years of dialysis treatment. Given the challenges of conducting randomized trials, differential rates of modality switch and transplantation, and time-varying confounding in cohort data during the first years of dialysis treatment, use of novel analytical techniques in observational cohorts can help examine the peritoneal dialysis versus hemodialysis survival discrepancy. This study examined a cohort of incident dialysis patients who initiated dialysis in DaVita dialysis facilities between July of 2001 and June of 2004 and were followed for 24 months. This study used the causal modeling technique of marginal structural models to examine the survival differences between peritoneal dialysis and hemodialysis over the first 24 months, accounting for modality change, differential transplantation rates, and detailed time-varying laboratory measurements. On dialysis treatment day 90, there were 23,718 incident dialysis-22,360 hemodialysis and 1,358 peritoneal dialysis-patients. Incident peritoneal dialysis patients were younger, had fewer comorbidities, and were nine and three times more likely to switch dialysis modality and receive kidney transplantation over the 2-year period, respectively, compared with hemodialysis patients. In marginal structural models analyses, peritoneal dialysis was associated with persistently greater survival independent of the known confounders, including dialysis modality switch and transplant censorship (i.e., death hazard ratio of 0.52 [95% confidence limit 0.34-0.80]). Peritoneal dialysis seems to be associated with 48% lower mortality than hemodialysis over the first 2 years of dialysis therapy independent of modality switches or differential transplantation rates.
Progress in Vaccine-Preventable and Respiratory Infectious Diseases-First 10 Years of the CDC National Center for Immunization and Respiratory Diseases, 2006-2015.

PubMed

Schuchat, Anne; Anderson, Larry J; Rodewald, Lance E; Cox, Nancy J; Hajjeh, Rana; Pallansch, Mark A; Messonnier, Nancy E; Jernigan, Daniel B; Wharton, Melinda

2018-07-01

The need for closer linkages between scientific and programmatic areas focused on addressing vaccine-preventable and acute respiratory infections led to establishment of the National Center for Immunization and Respiratory Diseases (NCIRD) at the Centers for Disease Control and Prevention. During its first 10 years (2006-2015), NCIRD worked with partners to improve preparedness and response to pandemic influenza and other emergent respiratory infections, provide an evidence base for addition of 7 newly recommended vaccines, and modernize vaccine distribution. Clinical tools were developed for improved conversations with parents, which helped sustain childhood immunization as a social norm. Coverage increased for vaccines to protect adolescents against pertussis, meningococcal meningitis, and human papillomavirus-associated cancers. NCIRD programs supported outbreak response for new respiratory pathogens and oversaw response of the Centers for Disease Control and Prevention to the 2009 influenza A(H1N1) pandemic. Other national public health institutes might also find closer linkages between epidemiology, laboratory, and immunization programs useful.
Early Impact Of CareFirst's Patient-Centered Medical Home With Strong Financial Incentives.

PubMed

Afendulis, Christopher C; Hatfield, Laura A; Landon, Bruce E; Gruber, Jonathan; Landrum, Mary Beth; Mechanic, Robert E; Zinner, Darren E; Chernew, Michael E

2017-03-01

In 2011 CareFirst BlueCross BlueShield, a large mid-Atlantic health insurance plan, implemented a payment and delivery system reform program. The model, called the Total Care and Cost Improvement Program, includes enhanced payments for primary care, significant financial incentives for primary care physicians to control spending, and care coordination tools to support progress toward the goal of higher-quality and lower-cost patient care. We conducted a mixed-methods evaluation of the initiative's first three years. Our quantitative analyses used spending and utilization data for 2010-13 to compare enrollees who received care from participating physician groups to similar enrollees cared for by nonparticipating groups. Savings were small and fully shared with providers, which suggests no significant effect on total spending (including bonuses). Our qualitative analysis suggested that early in the program, many physicians were not fully engaged with the initiative and did not make full use of its tools. These findings imply that this and similar payment reforms may require greater time to realize significant savings than many stakeholders had expected. Patience may be necessary if payer-led reform is going to lead to system transformation. Project HOPE—The People-to-People Health Foundation, Inc.
The Perceived Impact of the Foundations of Excellence in the First Year of College Project

ERIC Educational Resources Information Center

Malaski, Donna Lynn-Molnar

2014-01-01

The Foundations of Excellence in the First Year of College Project was formed in 2002 by the Policy Center on the First Year of College for the purpose of assisting institutions of higher education create a first-year experience for their students that is meaningful and can lead to an increase in retention rates for the institutions. To date, no…
Subsequent Malignant Neoplasms in a Population-Based Cohort of Pediatric Cancer Patients: A Focus on the First 5 Years.

PubMed

Pole, Jason D; Gu, Lan Ying; Kirsh, Victoria; Greenberg, Mark L; Nathan, Paul C

2015-10-01

The purpose was to describe the development of subsequent malignant neoplasms (SMN) among a population-based cohort of pediatric cancer patients, with a focus on SMNs that occurred within the first 5 years from diagnosis. The cohort was identified from POGONIS, an active provincial registry. Cohort members were Ontario residents ages 0 to 14.9 years at primary diagnosis between January 1985 and December 2008. SMNs that developed <18 years were captured by POGONIS, whereas SMNs diagnosed later were identified through linkage. Cumulative incidence and standardized incidence ratios (SIR) were calculated, and proportional hazards models were estimated to examine factors associated with SMN development. A total of 7,920 patients were eligible. 2.4% (188/7,920) developed 197 SMNs. Mean follow-up time was 10.7 years (SD = 7.6 years; range, 0.0-26.4 years) with mean time to SMN of 8.5 years (SD = 6.3 years; range, 0.0-24.9 years). The SIR for the development of a SMN was 9.9 [95% confidence interval (CI), 8.6-11.4]. 40.6% of SMNs (80/197) developed within 5 years. Early SMNs were more likely to be leukemia and lymphoma. Factors associated with early SMN were primary diagnosis of a bone tumor (OR, 4.88; 95% CI, 1.52-15.60), exposure to radiotherapy (OR, 1.82; 95% CI, 1.02-3.22), and the highest dose of epipodophyllotoxin (OR, 3.74; 95% CI, 1.88-7.42). Over 40% of SMNs diagnosed in childhood cancer patients occurred in the first 5 years after diagnosis, suggesting a need for early and ongoing surveillance. The early development of certain SMNs reinforces the need for early and continued surveillance at all stages for pediatric cancer patients. ©2015 American Association for Cancer Research.
[Epilepsy and epileptic syndromes during the first year of life].

PubMed

Durá-Travé, T; Yoldi-Petri, M E; Hualde-Olascoaga, J; Etayo-Etayo, V

To analyse the epidemiological characteristics and the relative distribution of the different types of epilepsy and epileptic syndromes during the first year of life. An analysis was performed of the patient records of all patients with epilepsy diagnosed during their first year of life who were submitted to a developmental check-up in the year 2007. The sample consisted of 60 patients (27 boys and 33 girls). Epidemiological and clinical data were collected, together with the findings from complementary examinations. The diagnostic criteria applied were those of the International League Against Epilepsy. The mean age at the time of diagnosis was 6.3 months. The mean follow-up time was 7.6 years. The aetiology was symptomatic in 40 cases (66.7%), cryptogenic in 16 (26.7%) and idiopathic in four cases (6.7%). Neuroimaging tests detected abnormalities in 34 patients (56.7%). West's syndrome (30%), symptomatic focal epilepsies (23.3%) and epilepsies linked to specific syndromes (16.7%) were the epileptic syndromes with the highest prevalence. Learning disabilities were observed in 82.5% of the children. Most epilepsies that present during the first year of life are symptomatic and/or cryptogenic, and are accompanied by psychoneurological impairment and/or resistance to therapy, which condition cognitive disorders that are eligible for specialised psycho-pedagogical intervention.
Patient Satisfaction with Spanish Pain Centers: Observational Study with More than 3,000 Patients

PubMed Central

Hernández-Puiggròs, Patricia; Tesedo Nieto, Javier; Acín Lázaro, María Pilar; Carrera González, Alfredo; Soler, Miguel José Arranz; Maldonado Vega, Sergio

2016-01-01

Chronic pain is a serious problem in Spain. This multicenter, epidemiological 3-month follow-up study investigates pain management efficacy in Spanish centers using patient satisfaction criteria. 3,414 eligible adult patients (65,6% female) with moderate to severe chronic pain from 146 pain centers were included. Patient satisfaction was assessed based onto question 18 of Spanish healthcare barometer-CSI. Pain evolution (Brief Pain Inventory-Short Form (BPI-SF) and visual analog scale (VAS)), quality of life/EuroQol-5, and pain control expectations fulfillment were also assessed. Mean age was 61.3 years. 64.4% of participating centers employed multidisciplinary pain management approach. After 3 months, mean patient satisfaction was 7.8 (1–10) on the CIS barometer. Medical staff received the highest scores, whereas waiting for tests, appointment request to appointment date time, and waiting times at the center the lowest. Mean pain decreased from 7.4 to 4.0; BPI-SF intensity decreased from 6.5 to 3.8; pain control expectations were met in 78.7% of patients; EuroQoL-5D utility index increased from 0.37 to 0.62, p < 0.001, and health status (VAS) from 40.6 to 61.9, p < 0.001. Chronic pain patients (90%) are satisfied with Spanish centers care; 80% had their pain control expectations met. Quality of life improved remarkably: 71% felt moderately to significantly better. However, waiting times need improvement. PMID:27516902
Evaluating Validity Evidence for USMLE Step 2 Clinical Skills Data Gathering and Data Interpretation Scores: Does Performance Predict History-Taking and Physical Examination Ratings for First-Year Internal Medicine Residents?

PubMed

Cuddy, Monica M; Winward, Marcia L; Johnston, Mary M; Lipner, Rebecca S; Clauser, Brian E

2016-01-01

To add to the small body of validity research addressing whether scores from performance assessments of clinical skills are related to performance in supervised patient settings, the authors examined relationships between United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) data gathering and data interpretation scores and subsequent performance in history taking and physical examination in internal medicine residency training. The sample included 6,306 examinees from 238 internal medicine residency programs who completed Step 2 CS for the first time in 2005 and whose performance ratings from their first year of residency training were available. Hierarchical linear modeling techniques were used to examine the relationships among Step 2 CS data gathering and data interpretation scores and history-taking and physical examination ratings. Step 2 CS data interpretation scores were positively related to both history-taking and physical examination ratings. Step 2 CS data gathering scores were not related to either history-taking or physical examination ratings after other USMLE scores were taken into account. Step 2 CS data interpretation scores provide useful information for predicting subsequent performance in history taking and physical examination in supervised practice and thus provide validity evidence for their intended use as an indication of readiness to enter supervised practice. The results show that there is less evidence to support the usefulness of Step 2 CS data gathering scores. This study provides important information for practitioners interested in Step 2 CS specifically or in performance assessments of medical students' clinical skills more generally.
The Use of Traditional Vietnamese Medicine Among Vietnamese Immigrants Attending an Urban Community Health Center in the United States.

PubMed

Nguyen, Long T; Kaptchuk, Ted J; Davis, Roger B; Nguyen, Giac; Pham, Van; Tringale, Stephen M; Loh, Yen Lin; Gardiner, Paula

2016-02-01

Little is known about Traditional Vietnamese Medicine (TVM) and its use among Vietnamese immigrants in the United States. This study aimed to characterize TVM and improve understanding of its use among Vietnamese outpatients attending an urban clinic. This cross-sectional observation study was performed by mailing bilingual surveys to a stratified random sample of 400 Vietnamese adult patients (≥18 years of age) who had visited a community health center in Boston, Massachusetts, at least once in the prior 12 months. The data were analyzed by using descriptive and multivariable regression statistics. The use of TVM and the factors influencing their use were reported. Among the 216 respondents, 68% reported using TVM. Of those users, the median age was 56 years and 68% were female, 51% had lived in the United States for less than 13 years, and 91% spoke English "not well or not at all." Among the 89% who reported using TVM of indigenous origin, 62% used "wind scraping," 35% used herbal pills/products, and 30% used "wind snatching." Sixty-one percent used therapies of foreign origin; of those, 51% used Asian-originated TVM (herbs, 25%; Eastern massage, 23%) and 38% used Western-influenced TVM (diet supplements, 28%; Western massage, 8%). TVM was mostly used for pain conditions (57%), "staying well" (38%), and cough/colds (27%). Forty-five percent ignored the question on revealing TVM use to providers; of those who answered, 57% said "no." Fifty-one percent of TVM users reported using Western medicine for the same problem, while 46% used TVM and Western medicine within 2 days of each other. Self-rated health (odds ratio [OR], 2.61; 95% confidence interval [CI], 1.34-5.06), household size (OR, 2.09; 95% CI, 1.04-4.22), and education (OR, 2.65; 95% CI, 1.03-6.80) were associated with TVM use. TVM is an important component of the healthcare of urban Vietnamese and needs to be further investigated. Healthcare providers need to encourage open discussion to better care for
Adapting an Effective Counseling Model from Patient-centered Care to Improve Motivation in Clinical Training Programs.

PubMed

Hamada, Hisayuki; Martin, Dawn; Batty, Helen P

2006-12-01

The value of establishing a patient-centered relationship within the context of the clinical encounter is well documented. The learner-centered method of medical education parallels the patient-centered clinical method; therefore, it should be explored as a method for teaching in the context of the learning encounter. In Japan and other Asian countries, rotations through services not related to the learner's chosen medical specialty are mandatory parts of the medical internship. Participation and effort in these rotations are often met with resistance from learners and are a common problem for medical educators. We adapted the counseling method for patients based on patient-centered methods such as motivational interviewing and solution-focused therapy to address this common problem. We show one case of a medical resident who lost his motivation to learn during his training. A resident has many kinds of mental and physical stress. One such problem arises from the gap between what they want to do and what they have to do. Strategies from motivational interviewing and solution-focused therapy were adapted to successfully resolve a common teaching problem in Japan. A physician teacher (preceptor) helped this resident solve the issue for himself instead of arguing in favor of change. The positive aspects of the counseling method were based on patient-centered medicine and proved useful and effective in counseling for medical residents. We may take the lessons learned from using patient-centered counseling methods to further develop a clear and systematic process of counseling methods for residents to conduct learner-centered medical education.
Medical Malpractice in Wuhan, China: A 10-Year Autopsy-Based Single-Center Study.

PubMed

He, Fanggang; Li, Liliang; Bynum, Jennifer; Meng, Xiangzhi; Yan, Ping; Li, Ling; Liu, Liang

2015-11-01

Medical disputes in China are historically poorly documented. In particular, autopsy-based evaluation and its impact on medical malpractice claims remain largely unstudied. This study aims to document autopsy findings and medical malpractice in one of the largest cities of China, Wuhan, located in Hubei Province. A total of 519 autopsies were performed by the Department of Forensic Medicine, Wuhan University School of Medicine, Wuhan, China, over a 10-year period between 2004 and 2013. Of these cases, 190 (36.6%) were associated with medical malpractice claims. Joint evaluation by forensic pathologists and clinicians confirmed that 97 (51.1%) of the 190 claims were approved medical malpractice cases. The percentage of approved malpractice cases increased with patient age and varied according to medical setting, physician specialty, and organ system. The clinico-pathological diagnostic discrepancy was significantly different among various physician specialties (P = 0.031) and organ systems (P = 0.000). Of those cases involved in malpractice claims, aortic dissection, coronary heart disease, and acute respiratory infection were most common. Association between incorrect diagnosis and malpractice was significant (P = 0.001). This is the first report on China's medical malpractice and findings at autopsy which reflects the current state of health care services in one of the biggest cities in China.
Assessment of first-year post-graduate residents: usefulness of multiple tools.

PubMed

Yang, Ying-Ying; Lee, Fa-Yauh; Hsu, Hui-Chi; Huang, Chin-Chou; Chen, Jaw-Wen; Cheng, Hao-Min; Lee, Wen-Shin; Chuang, Chiao-Lin; Chang, Ching-Chih; Huang, Chia-Chang

2011-12-01

Objective Structural Clinical Examination (OSCE) usually needs a large number of stations with long test time, which usually exceeds the resources available in a medical center. We aimed to determine the reliability of a combination of Direct Observation of Procedural Skills (DOPS), Internal Medicine in-Training Examination (IM-ITE(®)) and OSCE, and to verify the correlation between the small-scale OSCE+DOPS+IM-ITE(®)-composited scores and 360-degree evaluation scores of first year post-graduate (PGY(1)) residents. Between 2007 January to 2010 January, two hundred and nine internal medicine PGY1 residents completed DOPS, IM-ITE(®) and small-scale OSCE at our hospital. Faculty members completed 12-item 360-degree evaluation for each of the PGY(1) residents regularly. The small-scale OSCE scores correlated well with the 360-degree evaluation scores (r = 0.37, p < 0.021). Interestingly, the addition of DOPS scores to small-scale OSCE scores [small-scale OSCE+DOPS-composited scores] increased it's correlation with 360-degree evaluation scores of PGY(1) residents (r = 0.72, p < 0.036). Further, combination of IM-ITE(®) score with small-scale OSCE+DOPS scores [small-scale OSCE+DOPS+IM-ITE(®)-composited scores] markedly enhanced their correlation with 360-degree evaluation scores (r = 0.85, p < 0.016). The strong correlations between 360-degree evaluation and small-scale OSCE+DOPS+IM-ITE(®)-composited scores suggested that both methods were measuring the same quality. Our results showed that the small-scale OSCE, when associated with both the DOPS and IM-ITE(®), could be an important assessment method for PGY(1) residents. Copyright © 2011. Published by Elsevier B.V.
The CLR/NLM Health Sciences Library Management Intern Program: first year.

PubMed Central

Maina, W E; Jenkins, C G; Meakin, F A

1980-01-01

The first year of the Health Sciences Library Management Intern Program, funded by the National Library of Medicine and administered by the Council on Library Resources, has recently been completed. This paper discusses the origins of the internship, the selection of the successful applicants, and the motivation of the interns and host directors. The basic components of the intership year are described, and its effects on the host libraries and interns are considered. The immediate future of the internship is outlined, and other methods for training health sciences library administrators are briefly discussed. PMID:7356493
Internal Medicine House Officers' Performance as Assessed by Experts and Standardized Patients.

ERIC Educational Resources Information Center

Calhoun, Judith G.; And Others

1987-01-01

Three chronically ill patients were trained to evaluate the performance of 31 second-year internal medicine house officers based upon: a checklist for the medical data elicited during the medical interview; the process of the interview; and the physical examination technique. (Author/MLW)
Appraising stroke risk in maintenance hemodialysis patients: a large single-center cohort study.

PubMed

Power, Albert; Chan, Kakit; Singh, Seema K; Taube, David; Duncan, Neill

2012-02-01

Stroke incidence in hemodialysis patients is up to 10 times greater than in the general population and is associated with a worse prognosis. Factors influencing stroke risk by subtype and subsequent prognosis are poorly described in the literature. Retrospective single-center cohort study. 2,384 established maintenance hemodialysis patients at a single center from January 1, 2002, to June 1, 2009. Patient demographics, comorbid conditions. Incidence of acute stroke (International Classification of Diseases, 9th Revision codes 430, 431, 432.9, 433.1, and 434.1 with evidence of compatible neuroimaging), patient survival. Cumulative patient survival, incidence of acute fatal and nonfatal stroke. 127 strokes occurred during 9,541 total patient-years of follow-up. First (incident) stroke occurred at a rate of 14.9/1,000 patient years (95% CI, 12.2-17.9) with a predominance of ischemic compared with hemorrhagic subtypes (11.2 vs 3.7/1,000 patient-years). 54% of hemorrhagic strokes occurred in patients of South Asian ethnicity compared with ischemic strokes, which occurred predominantly in white patients (45% of events). Diabetes mellitus (HR, 1.92; 95% CI, 1.29-2.85; P = 0.001) and prior cerebrovascular disease (HR, 4.54; 95% CI, 3.07-6.72; P < 0.001) were independently associated with incident cerebrovascular accident on multivariate analysis. Acute stroke was associated with worse patient survival (HR, 3.26; 95% CI, 2.47-4.30; P < 0.001) and overall 1-year mortality of 24%, which was significantly worse in patients with hemorrhagic events (39% vs 19% mortality for ischemic subtypes). Serum albumin level >3.5 g/L (HR, 0.38; 95% CI, 0.19-0.76; P = 0.007) and C-reactive protein level >3.0 mg/l (HR, 1.36; 95% CI, 1.12-1.64; P = 0.002) influenced survival after stroke on multivariate analysis. Retrospective analysis of data cannot prove causality. The high incidence of stroke in hemodialysis patients is associated with high mortality, especially hemorrhagic subtypes. Strict
Academic medicine amenities unit: developing a model to integrate academic medical care with luxury hotel services.

PubMed

Kennedy, David W; Kagan, Sarah H; Abramson, Kelly Brennen; Boberick, Cheryl; Kaiser, Larry R

2009-02-01

The interface between established values of academic medicine and the trend toward inpatient amenities units requires close examination. Opinions of such units can be polarized, reflecting traditional reservations about the ethical dilemma of offering exclusive services only to an elite patient group. An amenities unit was developed at the University of Pennsylvania Health System in 2007, using an approach that integrated academic medicine values with the benefits of philanthropy and service excellence to make amenities unit services available to all patients. Given inherent internal political concerns, a broadly based steering committee of academic and hospital leadership was developed. An academically appropriate model was conceived, anchored by four principles: (1) integration of academic values, (2) interdisciplinary senior leadership, (3) service excellence, and (4) recalibrated occupancy expectations based on multiple revenue streams. Foremost is ensuring the same health care is afforded all patients throughout the hospital, thereby overcoming ethical challenges and optimizing teaching experiences. Service excellence frames the service ethic for all staff, and this, in addition to luxury hotel-style amenities, differentiates the style and feel of the unit from others in the hospital. Recalibrated occupancy creates program viability given revenue streams redefined to encompass gifts and patient revenue, including both reimbursement and self-pay. The medical-surgical amenities patient-care unit has enjoyed a successful first year and a growing stream of returning patients and admitting physicians. Implications for other academic medical centers include opportunities to extrapolate service excellence throughout the hospital and to cultivate philanthropy to benefit services throughout the medical center.
Patients Prioritize Waitlist over Post-Transplant Outcomes When Evaluating Kidney Transplant Centers.

PubMed

Husain, S Ali; Brennan, Corey; Michelson, Ariane; Tsapepas, Demetra; Patzer, Rachel E; Schold, Jesse D; Mohan, Sumit

2018-06-26

Factors that patients value when choosing a transplant center have not been well studied. In order to guide the improvement of patient-facing materials, we conducted an anonymous electronic survey of National Kidney Foundation Patient Panel members that assessed relative importance of patient experience, practical considerations, transplant center reputation, center experience, and waitlist when selecting a transplant center. 409 respondents completed the survey, of whom 68% were kidney transplant recipients and 32% had chronic kidney disease or were on dialysis (CKD). Participants had mean age 56±12 years and were predominantly female (61%), white (79%), and had an associate's degree or higher (68%). Participants most often prioritized waitlist when evaluating transplant centers (transplanted 26%, CKD 40%), and waitlist was almost twice as likely as outcomes to be ranked most important (30% vs 17%). Education level and transplant status were significantly associated with center prioritization. Waitlisted respondents most commonly (48%) relied on physicians for information when selecting a center, while a minority cited transplant-specific organizations. In order to improve shared decision-making, materials outlining center-specific waitlist features should be prioritized. Novel patient-oriented metrics for measuring transplant center quality that align with patient priorities must be explored. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Research studies on patients' illness experience using the Narrative Medicine approach: a systematic review

PubMed Central

Fioretti, Chiara; Mazzocco, Ketti; Oliveri, Serena; Masiero, Marianna; Pravettoni, Gabriella

2016-01-01

Objective Since its birth about 30 years ago, Narrative Medicine approach has increased in popularity in the medical context as well as in other disciplines. This paper aims to review Narrative Medicine research studies on patients' and their caregivers' illness experience. Setting and participants MEDLINE, Psycinfo, EBSCO Psychological and Behavioural Science, The Cochrane Library and CINAHL databases were searched to identify all the research studies which focused on the Narrative Medicine approach reported in the title, in the abstract and in the keywords the words ‘Narrative Medicine’ or ‘Narrative-based Medicine’. Primary and secondary outcome measures: number of participants, type of disease, race and age of participants, type of study, dependent variables, intervention methods, assessment. Results Of the 325 titles screened, we identified 10 research articles fitting the inclusion criteria. Our systematic review showed that research on Narrative Medicine has no common specific methodology: narrative in Medicine is used as an intervention protocol as well as an assessment tool. Patients' characteristics, types of disease and data analysis procedures differ among the screened studies. Conclusions Narrative Medicine research in medical practice needs to find clear and specific protocols to deepen the impact of narrative on medical practice and on patients' lives. PMID:27417197

Why doctors consider leaving UK medicine: qualitative analysis of comments from questionnaire surveys three years after graduation

PubMed Central

Lambert, Trevor W; Goldacre, Michael J

2017-01-01

Objective To report the reasons why doctors are considering leaving medicine or the UK. Design Questionnaire survey. Setting UK. Participants Questionnaires were sent three years after graduation to all UK medical graduates of 2008 and 2012. Main outcome measures Comments from doctors about their main reasons for considering leaving medicine or the UK (or both). Results The response rate was 46.2% (5291/11,461). Among the 60% of respondents who were not definitely intent on remaining in UK medicine, 50% were considering working in medicine outside the UK and 10% were considering leaving medicine. Among those considering working in medicine outside the UK, the most commonly cited reasons were to gain wider experience, that things would be ‘better’ elsewhere and a negative view of the National Health Service and its culture, state and politics. Other reasons included better training or job opportunities, better pay and conditions, family reasons and higher expectations. Three years after graduation, doctors surveyed in 2015 were significantly more likely than doctors surveyed in 2011 to cite factors related to the National Health Service, to pay and conditions, to their expectations and to effects on work–life balance and patient care. Among those considering leaving medicine, the dominant reason for leaving medicine was a negative view of the National Health Service (mentioned by half of those in this group who commented). Three years after graduation, doctors surveyed in 2015 were more likely than doctors surveyed in 2011 to cite this reason, as well as excessive hours and workload, and financial reasons. Conclusions An increasingly negative view is held by many doctors of many aspects of the experience of being a junior doctor in the National Health Service, and the difficulty of delivering high-quality patient care within what many see as an under-funded system. Policy changes designed to encourage more doctors to remain should be motivated by a desire to
Why doctors consider leaving UK medicine: qualitative analysis of comments from questionnaire surveys three years after graduation.

PubMed

Lambert, Trevor W; Smith, Fay; Goldacre, Michael J

2018-01-01

Objective To report the reasons why doctors are considering leaving medicine or the UK. Design Questionnaire survey. Setting UK. Participants Questionnaires were sent three years after graduation to all UK medical graduates of 2008 and 2012. Main outcome measures Comments from doctors about their main reasons for considering leaving medicine or the UK (or both). Results The response rate was 46.2% (5291/11,461). Among the 60% of respondents who were not definitely intent on remaining in UK medicine, 50% were considering working in medicine outside the UK and 10% were considering leaving medicine. Among those considering working in medicine outside the UK, the most commonly cited reasons were to gain wider experience, that things would be 'better' elsewhere and a negative view of the National Health Service and its culture, state and politics. Other reasons included better training or job opportunities, better pay and conditions, family reasons and higher expectations. Three years after graduation, doctors surveyed in 2015 were significantly more likely than doctors surveyed in 2011 to cite factors related to the National Health Service, to pay and conditions, to their expectations and to effects on work-life balance and patient care. Among those considering leaving medicine, the dominant reason for leaving medicine was a negative view of the National Health Service (mentioned by half of those in this group who commented). Three years after graduation, doctors surveyed in 2015 were more likely than doctors surveyed in 2011 to cite this reason, as well as excessive hours and workload, and financial reasons. Conclusions An increasingly negative view is held by many doctors of many aspects of the experience of being a junior doctor in the National Health Service, and the difficulty of delivering high-quality patient care within what many see as an under-funded system. Policy changes designed to encourage more doctors to remain should be motivated by a desire to address
Who wants to be a surgeon? A study of 300 first year medical students

PubMed Central

Fysh, Thomas HS; Thomas, Geraint; Ellis, Harold

2007-01-01

Background While medicine in general is becoming more female-dominated, women are still under-represented in surgery. Opinion is divided as to whether this is due to lifestyle considerations, disinterest or perceived discrimination. It is not clear at what stage these careers decisions are made. Methods 300 first year medical students at Guy's King's and St Thomas' School of Medicine (GKT) were asked their view on possible career choices at this stage. Results While men represented only 38% of the student population, they represented over two-thirds of the students wishing to pursue a career in surgery. Women still opt for general practice and paediatrics. Conclusion Surgery is a disproportionately unpopular career choice of the female first-year medical students of GKT compared to the male students. It appears that the choice is freely made and, at this stage at least, does not represent concerns about compatibility with lifestyle. PMID:17239248
A model for partnering first-year student pharmacists with community-based older adults.

PubMed

Martin, Beth A; Porter, Andrea L; Shawl, Lauren; Motl Moroney, Susannah E

2012-06-18

To design, integrate, and assess the effectiveness of an introductory pharmacy practice experience intended to redefine first-year student pharmacists' views on aging and medication use through their work with a healthy, community-based older-adult population. All students (N = 273) completed live skills training in an 8-hour boot camp provided during orientation week. Teams were assigned an independently living senior partner, completed 10 visits and reflections, and documented health-related information using an electronic portfolio (e-portfolio). As determined by pre- and post-experience survey instruments, students gained significant confidence in 7 skill areas related to communication, medication interviews, involving the partner in health care, and applying patient-care skills. Student reflections, in-class presentations, and e-portfolios documented that personal attitudes toward seniors changed over time. Senior partners enjoyed mentoring and interacting with students and many experienced health improvements as a result of the interaction. The model for partnering first-year student pharmacists with community-based older adults improved students' skills and fostered their connections to pharmacist roles and growth as person-centered providers.
The attractiveness of family medicine among Polish medical students.

PubMed

Gowin, Ewelina; Horst-Sikorska, Wanda; Michalak, Michał; Avonts, Dirk; Buczkowski, Krzysztof; Lukas, Witold; Korman, Tomasz; Litwiejko, Alicja; Chlabicz, Sławomir

2014-06-01

In many developed countries tuning supply and demand of medical doctors is a continuous challenge to meet the ever changing needs of community and individual patients. The long study period for medical doctors creates the opportunity to observe the current career preferences of medical students and evolution in time. To investigate the career choices of Polish students in different stages of their medical education. Medical students at five Polish medical universities were questioned about their career aspirations in the first, third and sixth year. A total of 2020 students were recruited for the survey. Among first year students 17% preferred family medicine as final career option, compared to 20% in the third year, and 30% in the sixth year (significant trend, P < 0.0001). In particular, female students prefer family medicine: 71% women versus 62% women in the group with a preference for a non-family medicine orientation (P = 0.008). Medical students rejecting a career as a family doctor stated that the impossibility to work in a hospital environment was the determining factor. The opportunity for professional development seems to be an important determining factor in the choice of a medical specialty in Poland. The proportion of Polish students choosing family medicine increases during their progress in medical education, with one third of students interested in a career in family medicine by year six.
Comparing Mortality of Peritoneal and Hemodialysis Patients in the First 2 Years of Dialysis Therapy: A Marginal Structural Model Analysis

PubMed Central

Lukowsky, Lilia R.; Mehrotra, Rajnish; Kheifets, Leeka; Arah, Onyebuchi A.; Nissenson, Allen R.

2013-01-01

Summary Background and objectives There are conflicting research results about the survival differences between hemodialysis and peritoneal dialysis, especially during the first 2 years of dialysis treatment. Given the challenges of conducting randomized trials, differential rates of modality switch and transplantation, and time-varying confounding in cohort data during the first years of dialysis treatment, use of novel analytical techniques in observational cohorts can help examine the peritoneal dialysis versus hemodialysis survival discrepancy. Design, setting, participants, & measurements This study examined a cohort of incident dialysis patients who initiated dialysis in DaVita dialysis facilities between July of 2001 and June of 2004 and were followed for 24 months. This study used the causal modeling technique of marginal structural models to examine the survival differences between peritoneal dialysis and hemodialysis over the first 24 months, accounting for modality change, differential transplantation rates, and detailed time-varying laboratory measurements. Results On dialysis treatment day 90, there were 23,718 incident dialysis—22,360 hemodialysis and 1,358 peritoneal dialysis—patients. Incident peritoneal dialysis patients were younger, had fewer comorbidities, and were nine and three times more likely to switch dialysis modality and receive kidney transplantation over the 2-year period, respectively, compared with hemodialysis patients. In marginal structural models analyses, peritoneal dialysis was associated with persistently greater survival independent of the known confounders, including dialysis modality switch and transplant censorship (i.e., death hazard ratio of 0.52 [95% confidence limit 0.34–0.80]). Conclusions Peritoneal dialysis seems to be associated with 48% lower mortality than hemodialysis over the first 2 years of dialysis therapy independent of modality switches or differential transplantation rates. PMID:23307879
Primary immunodeficiency diseases: a 30-year patient registry from the referral center for primary immunodeficiencies in Greece.

PubMed

Michos, Athanasios; Raptaki, Maria; Tantou, Sofia; Tzanoudaki, Marianna; Spanou, Kleopatra; Liatsis, Manolis; Constantinidou, Nikki; Paschali, Evangelia; Varela, Ioanna; Moraloglou, Olga; Bakoula, Chryssa; Kanariou, Maria

2014-10-01

Primary Immunodeficiencies (PID) represent a group of heterogeneous immune diseases with important biological significance. We reviewed the records of children diagnosed with PID in the Referral Center for PID in our country in order to describe the epidemiological, clinical and laboratory characteristics of immunodeficient patients. During a 30-year period, 147 patients (101 males, 68.7 %), with a mean age of 6.5 years at the time of diagnosis, were diagnosed with PID. The most prevalent diagnoses of PID were: "Combined Immunodeficiency" in 46 (31.3 %) patients, "Well-defined immunodeficiency syndrome" in 35 (23.1 %) patients, "Predominantly antibody deficiency" in 30 (20.4 %) patients and "Congenital defect of phagocyte function or both" in 28 (19 %) patients. There was a higher prevalence of males with "Combined immunodeficiency" (p < 0.033) and "Predominantly antibody deficiency" (p < 0.02) compared to females. The median age of children at the onset of symptoms and at the time of diagnosis was 0.5y (IQR: 0.1-2.5) and 2y (IQR: 0.6-7.2), respectively. The median diagnostic delay was 0.9y (IQR: 0.2-4.8). This period was shorter for patients with "Combined immunodeficiency" [median 0.3y (IQR: 0.1-1)], and longer for those with "Predominantly antibody deficiency" [median 3.2y (IQR: 0.2-5.9) or "Disease of immune dysregulation" [median 3.2y (IQR: 0.1-6.6)]. Comparing the rates in our population with those of the European Registry (ESID), the rates of "Combined immunodeficiencies", "Well-defined syndromes" and "Congenital birth defects and/or function of phagocytes" were significantly higher in this study (p <0,001). PID registry analysis improves knowledge in the field of Immunology and enhances awareness, early detection, diagnosis, and management of this rare but significant group of diseases.
Incidence of refeeding syndrome in internal medicine patients.

PubMed

Kraaijenbrink, B V C; Lambers, W M; Mathus-Vliegen, E M H; Siegert, C E H

2016-03-01

Refeeding syndrome is a potentially fatal shift of fluids and electrolytes that may occur after reintroducing nutrition in a malnourished patient. Its incidence in internal medicine patients is not known. We aimed at determining the incidence in a heterogeneous group of patients acutely admitted to a department of internal medicine. All patients acutely admitted to the department of internal medicine of a teaching community hospital in Amsterdam, the Netherlands, between 22 February 2011 and 29 April 2011, were included. We applied the National Institute for Health and Care Excellence (NICE) criteria for determining people at risk of refeeding syndrome and took hypophosphataemia as the main indicator for the presence of this syndrome. Of 178 patients included in the study, 97 (54%) were considered to be at risk of developing refeeding syndrome and 14 patients actually developed the syndrome (14% of patients at risk and 8% of study population). Patients with a malignancy or previous malignancy were at increased risk of developing refeeding syndrome (p < 0.05). Measurement of muscle strength over time was not associated with the occurrence of refeeding syndrome. The Short Nutritional Assessment Questionnaire score had a positive and negative predictive value of 13% and 95% respectively. The incidence of refeeding syndrome was relatively high in patients acutely admitted to the department of internal medicine. Oncology patients are at increased risk of developing refeeding syndrome. When taking the occurrence of hypophosphataemia as a hallmark, no other single clinical or composite parameter could be identified that accurately predicts the development of refeeding syndrome.
Patients' poor communication with their doctors in the first visit of the gynecological endocrinology outpatient clinics.

PubMed

Li, Xiao-Hong; Han, Zi-Yan; She, Wen-Jing; Lei, Hai-Ke

2016-01-01

To investigate patients' communication with their gynecologists in the first visit of the gynecological endocrinology outpatient clinics. We developed a questionnaire to evaluate 379 women' expectations of their first visit, information-giving about illness, and understanding of the consultation they encountered from April to August 2010. Descriptive statistics and multiple linear regression analysis were used to analyze the data. Before the first visit, 55% (208/379) of participants hoped to get the doctors' special attention, and 60% (227/379) of patients expected a very satisfying consultation. During the consultation, only 34% (129/379) of patients provided their case history clearly according to physicians' inquiry, 21% (81/379) of patients understood the examination and 28% (105/379) of patients understood the therapeutic regime after doctors' explanation. Correlation analysis showed that sociodemographic characteristics such as young age (under 20 years old), low level of education (primary school or less), and lack of medical knowledge affected patients' information-giving about illness and understanding of their first visit (all ps < 0.05). Patients expected a patient-centered doctor-patient communication in gynecological endocrinology outpatient clinics. They could not communicate well with their doctors, which was affected by age, education, and medical background.
Imported Malaria in the Material of the Institute of Maritime and Tropical Medicine: A Review of 82 Patients in the Years 2002–2014

PubMed Central

Kuna, Anna; Gajewski, Michal; Szostakowska, Beata; Nahorski, Waclaw L.; Myjak, Przemyslaw; Stanczak, Joanna

2015-01-01

Malaria is, along with tuberculosis and HIV/AIDS, one of the three most dangerous infectious diseases in the world. In the absence of native cases since 1963, malaria has remained in Poland an exclusively imported disease, mainly occurring in people travelling to tropical and subtropical areas for professional reasons. The aim of this study was the epidemiological and clinical analysis of 82 patients admitted to the University Center for Maritime and Tropical Medicine (UCMTM), Gdynia, Poland, with a diagnosis of malaria between 2002 and 2014. The “typical” patient with malaria was male, middle-aged, returned from Africa within the preceding 4 weeks, had not used appropriate chemoprophylaxis, and had not applied nonpharmacological methods of prophylaxis, except for window insect screens. P. falciparum was the most frequent species. The most common symptoms included fever, shivers and intensive sweating, thrombocytopenia, elevated creatinine, LDH, D-dimers and CRP, hepatomegaly, and splenomegaly. Within the analyzed group, severe malaria according to WHO standards was diagnosed in 20.7% of patients. Our report presents analysis of the largest series of patients treated for imported malaria in Poland. PMID:26451382
Infectious Complications of Noncombat Trauma Patients Provided Care at a Military Trauma Center

DTIC Science & Technology

2010-05-01

complication~ and risk factors of noncombat trauma patients cared for in a military le,·ell trauma center with an a\\sociated burn unit u~ing the... risk factors for infection, and since the combat tnjured population is generally without serious comorbidities, MTLITARY MEDICINE, Vol. 175, M ay 20...wound infection’> were most common in the JTTR. Risk factors for in fection seen 1n the BAMC TR more closely reflected those reported in other studies
A patient centered electronic health: eHealth system development.

PubMed

Schiza, Eirini C; Neokleous, Kleanthis C; Petkov, Nikolai; Schizas, Christos N

2015-01-01

Medical practice and patient-doctor relationship will continue improving while technology is integrated in our everyday life. In recent years the term eHealth landmarked a new era with improved health provider's skills and knowledge, and increased patient participation in medical care activities. To show why the design and implementation of a healthcare system needs to follow a specific philosophy dictated by the level of eHealth maturity of a country and its citizens. Based on the maturity level, an adaptable framework for implementing an Electronic Health System at national level is derived, guided by the Patient Centered Philosophy as defined and introduced by the EU directives. Implementation prerequisites are analyzed together with guiding principles for identifying the maturity level of an organization or country. Cyprus being a small EU country, it can be used as pilot site for the whole Europe, was chosen for this study and its maturity level analysis is presented. Recommendations that determine general steps needed to prepare the ground for an adequate patient-centered national healthcare system are accompanied. The implementation of an integrated Electronic Health Record at National level, as a prerequisite for a patient-centered eHealth environment is evidently demonstrated.
Personalized medicine: a confluence of traditional and contemporary medicine.

PubMed

Jafari, Samineh; Abdollahi, Mohammad; Saeidnia, Soodabeh

2014-01-01

Traditional systems of medicine have attained great popularity among patients in recent years. Success of this system in the treatment of disease warrants consideration, particularly in cases for which conventional medicine has been insufficient. This study investigates the similarities in principles and approaches of 3 traditional systems and explores whether conventional medicine is able to exploit the advantages of traditional systems. This study first identifies and explores the advantages of 3 well-known systems-traditional Iranian medicine (TIM), ayurveda, and traditional Chinese medicine (TCM)-that are similar in their basic principles and methods. Second, it clarifies whether and how conventional medicine could exploit the advantages of traditional systems as it modernizes, to become more personalized. Finally, this study investigates the possibility that conventional medicine could benefit from traditional typology to improve its personalization. The acknowledgment of the unity of humans and nature, applying rational methods, and personalized approaches is fundamentally similar in the 3 systems. Additionally, they all promote the holistic view that health is harmony and disease is disharmony of the body. Other similarities include their recognition of the unique nature of every person and their categorization of people into different body types. Although conventional medicine has mostly failed to incorporate the advantages of traditional medicine, its integration with traditional medicine is achievable. For instance, exploiting traditional typologies in genomic and other studies may facilitate personalization of conventional medicine. From its review, the research team concludes that prospects are bright for the integration of traditional and conventional medicines and, consequently, for a dramatic improvement in health systems.
Attitudes and use of medicinal plants during pregnancy among women at health care centers in three regions of Mali, West-Africa.

PubMed

Nergard, Cecilie Sogn; Ho, Thi Phung Than; Diallo, Drissa; Ballo, Ngolo; Paulsen, Berit Smestad; Nordeng, Hedvig

2015-10-09

Although, medicinal plants have been important for women's health historically, the knowledge about such use during pregnancy in developing countries is limited. This is the first quantitative, ethnobotanical study on Malian women's use of and attitudes towards the use of medicinal plants during pregnancy. The aim of the study was to describe Malian women's use of medicinal plants during pregnancy according to indications and to evaluate the potentially safety of such use. The overall aim was to preserve valuable information about medicinal plants for women's reproductive health for the future. Data was collected through structured interviews of 209 pregnant women or mothers in three health care centers in Mali. The women were interviewed about their uses of medicinal plants during pregnancy and their attitudes to such use. Nine specific medicinal plants commonly used in Mali and treatment of eleven common ailments in pregnancy were specifically queried about. In total, 79.9 % had used medicinal plants during pregnancy. Only 17 women (8.5 %) had received a recommendation from a traditional practitioner (TP). The most commonly used medicinal plants were Lippia chevalieri (55.5 %), Combretum micranthum (39.7 %), Parkia biglobosa (12.0 %) and Vepris heterophylla (8.1 %). The most common reasons for use were for well-being (37.7 %), symptoms of malaria (37.1 %) and "increased salt-elimination" (to reduce edema) (19.2 %). For treatment of symptoms of malaria and urinary tract infections during pregnancy, the women's choices of medicinal plants agreed with those previously reported from interviews with TPs. Almost 30 % believed that medicinal plants had no adverse effects for the mother. This study showed an extensive use and knowledge of medicinal plants during pregnancy in three regions in Mali. However, exclusive use of medicinal plants as treatment of malaria and urinary tract infections during pregnancy may pose a health risk for the mother and her unborn child. A
Stakeholders' Recommendations to Improve Patient-centered "LGBTQ" Primary Care in Rural and Multicultural Practices.

PubMed

Kano, Miria; Silva-Bañuelos, Alma Rosa; Sturm, Robert; Willging, Cathleen E

2016-01-01

Individuals among gender/sexual minorities share experiences of stigma and discrimination, yet have distinctive health care needs influenced by ethnic/racial minority and rural realities. We collected qualitative data from lesbian/gay/bisexual/transgender (LGBT) and queer persons across the largely rural, multicultural state of New Mexico, particularly those from understudied ethnic groups, regarding factors facilitating or impeding patient-centered primary care. The themes identified formed the basis for a statewide summit on LGBT health care guidelines and strategies for decreasing treatment gaps. Three to 15 individuals, ages 18 to 75 years, volunteered for 1 of 4 town hall dialogues (n = 32), and 175 people took part in the summit. Participants acknowledged health care gaps pertinent to LGBT youth, elders, American Indians, and Latinos/Latinas, expressing specific concern for rural residents. This preliminary research emphasizes the need to improve primary care practices that treat rural and ethnic-minority LGBT people and offers patient-driven recommendations to enhance care delivery while clinic-level transformations are implemented. © Copyright 2016 by the American Board of Family Medicine.
Suicide attempts in patients with systemic lupus erythematosus: a single-center experience and literature review.

PubMed

Tang, Kuo-Tung; Hsieh, Chia-Wei; Hsieh, Tsu-Yi; Lan, Joung-Liang; Chen, Yi-Hsing; Chen, Der-Yuan

2015-01-01

Suicide is a global health issue, and an increase in suicide risk has been found in patients with systemic lupus erythematosus (SLE) when compared with the general population. However, only a few studies have described suicide attempts in patients with SLE in detail. The aim of this study is to describe the suicide attempts in patients with SLE in a tertiary hospital in Taiwan. A total of 8 patients with SLE, 7 women and 1 man, with 12 suicide attempts among them were identified among 2469 patients visiting a tertiary medical center in Taiwan, from March 1, 2003 to November 30, 2013. Their demographic data, lupus manifestations throughout their disease course, laboratory data, and details of their suicide attempts were retrospectively documented. We also searched the MEDLINE database and found 4 articles in English describing suicide attempts in 14 patients with SLE. The median age of the 8 patients with SLE in our hospital who attempted suicide was 33 years (range: 19-77 years). Neuropsychiatric SLE developed in 5 (63%) of these patients before the attempts, and psychiatric disorders were diagnosed in 5 (63%) of them. We also observed a high prevalence of neuropsychiatric SLE (71%) and psychiatric disorders (86%) in patients with SLE in the literature who had attempted suicide. We demonstrated that previous neuropsychiatric SLE and comorbid psychiatric disorders are prevalent in patients with SLE who attempt suicide. If a rheumatologist suspects that a patient with SLE has a psychiatric disorder, he or she should refer the patient to a psychiatrist. Copyright © 2015 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.
Practice of forensic medicine and pathology in Sri Lanka.

PubMed

Balachandra, A Thambirajah; Vadysinghe, Amal N; William, Anita L

2011-02-01

The practice of forensic medicine and pathology in Sri Lanka is based on the British model. Medical students during their third and fourth years receive approximately 50 hours of lectures and tutorials in forensic medicine and pathology and then undergo an examination. After completing an internship, these doctors are sent to various hospitals throughout Sri Lanka where they may be asked to perform medicolegal examinations on victims and suspects in rape cases, persons suspected of being under the influence of drugs and/or alcohol, and, injured live patients. As well, they may be asked to perform medicolegal autopsies. Depending upon their experience, some medical officers may be designated as judicial medical officers and appointed full time to do medicolegal work. Up until 1980, judicial medical officers with at least 2 years of work experience were allowed to obtain their postgraduate qualifications in the United Kingdom. However, since 1981 and the establishment of its own Postgraduate Institute of Medicine in Colombo, Sri Lanka, medical officers are offered 2 postgraduate programs in forensic medicine and pathology, a diploma in legal medicine and a doctorate in medicine (forensic medicine). After completing the doctorate in forensic medicine, doctors are allowed to train abroad for a further year in an approved center. Upon return they can then be appointed as consultant judicial medical officers. The practice of forensic medicine and pathology in Sri Lanka is unique and vibrant. However, due to the country's prevailing civil war, the practice of forensic medicine and pathology is suboptimal.
Portal-endocrine and gastric-exocrine drainage technique of pancreas transplantation provides an easy access for evaluation of pancreatic allograft dysfunction: six-year experience at a single center.

PubMed

Zibari, Gazi B; Fallahzadeh, Mohammad Kazem; Hamidian Jahromi, Alireza; Zakhary, Joseph; Dies, David; Wellman, Greg; Singh, Neeraj; Shokouh-Amiri, Hosein

2014-01-01

The aim of this study is to report our six-year experience with portal-endocrine and gastric-exocrine drainage technique of pancreatic transplantation, which was first developed and implemented at our center in 2007. In this study, the outcomes of all patients at our center who had pancreas transplantation with portal-endocrine and gastric-exocrine drainage technique were evaluated. From October 2007 to November 2013, 38 patients had pancreas transplantation with this technique - 31 simultaneous kidney pancreas and seven pancreas alone. Median duration of follow-up was 3.8 years. One-, three-, and five-year patient and graft survival rates were 94%, 87%, 70% and 83%, 65%, 49%, respectively. For pancreas allograft dysfunction evaluation, 51 upper endoscopies were performed in 14 patients; donor duodenal biopsies were successfully obtained in 45 (88%). We detected nine episodes of acute rejection (eight patients) and seven episodes of cytomegalovirus (CMV) duodenitis (six patients). No patient developed any complication due to upper endoscopy. Portal-endocrine and gastric-exocrine drainage technique of pancreas transplantation provides lifelong easy access to the transplanted duodenum for evaluation of pancreatic allograft dysfunction.
The influence of clinical, environmental, and socioeconomic factors on five-year patient survival after kidney transplantation.

PubMed

Ruppel, Priscila; Felipe, Claudia R; Medina-Pestana, Jose O; Hiramoto, Liliane Lumi; Viana, Laila; Ferreira, Alexandra; Aguiar, Wilson; Ivani, Mayara; Bessa, Adrieli; Cristelli, Marina; Gaspar, Melissa; Tedesco-Silva, Helio

2018-06-04

The risk of death after kidney transplant is associated with the age of the recipient, presence of comorbidities, socioeconomic status, local environmental characteristics and access to health care. To investigate the causes and risk factors associated with death during the first 5 years after kidney transplantation. This was a single-center, retrospective, matched case-control study. Using a consecutive cohort of 1,873 kidney transplant recipients from January 1st 2007 to December 31st 2009, there were 162 deaths (case group), corresponding to 5-year patient survival of 91.4%. Of these deaths, 25% occurred during the first 3 months after transplant. The most prevalent cause of death was infectious (53%) followed by cardiovascular (24%). Risk factors associated with death were history of diabetes, dialysis type and time, unemployment, delayed graft function, number of visits to center, number of hospitalizations, and duration of hospital stay. After multivariate analysis, only time on dialysis, number of visits to center, and days in hospital were still associated with death. Patients who died had a non-significant higher number of treated acute rejection episodes (38% vs. 29%, p = 0.078), higher mean number of adverse events per patient (5.1 ± 3.8 vs. 3.8 ± 2.9, p = 0.194), and lower mean eGFR at 3 months (50.8 ± 25.1 vs. 56.7 ± 20.7, p = 0.137) and 48 months (45.9 ± 23.8 vs. 58.5 ± 20.2, p = 0.368). This analysis confirmed that in this population, infection is the leading cause of mortality over the first 5 years after kidney transplantation. Several demographic and socioeconomic risk factors were associated with death, most of which are not readily modifiable.
Use of complementary and alternative medicine in head and neck cancer patients.

PubMed

Lim, C M; Ng, A; Loh, K S

2010-05-01

To determine the prevalence and profile of patients who use complementary and alternative medicine, within a cohort of head and neck cancer patients. Cross-sectional survey. Ninety-three consecutive head and neck cancer patients being followed up at the department of otolaryngology head and neck surgery were surveyed using an interviewer-administered questionnaire. The prevalence of complementary and alternative medicine use was 67.8 per cent. Patients who used complementary and alternative medicine were more likely to be female, better educated and younger, compared with non-users. A total of 82.5 per cent (52/63) perceived complementary and alternative medicine to be effective, even though they were aware of the lack of research and endorsement by their physician regarding such medicine. The use of complementary and alternative medicine by head and neck cancer patients is common, regardless of efficacy or cost. Clinicians should routinely ask patients about their use of complementary and alternative medicine, to facilitate communication and enable appropriate use of such medicine.

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