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Sample records for british medical response

  1. A "crutch to assist in gaining an honest living": dispensary shopkeeping by Scottish general practitioners and the responses of the British medical elite, ca. 1852-1911.

    PubMed

    Jenkinson, Jacqueline

    2012-01-01

    This article examines the practice among general practitioners in Scotland of keeping shops for dispensary and retail purposes in the late nineteenth century. It demonstrates that while doctors kept such open shops in these areas in order to subsidize their income in a crowded medical market, they argued that shopkeeping allowed them to provide medical care in communities where the population was otherwise too poor to pay for such care. The article compares shopkeeping to medical "covering" and assesses the medical hierarchy's reactions to shopkeeping doctors via disciplinary actions taken against some of these doctors by the General Medical Council (GMC). These actions provoked an organized protest among hundreds of doctors (some of it channeled through the British Medical Association), which challenged the methods of the GMC in determining acceptable professional medical standards.

  2. What factors influence British medical students' career intentions?

    PubMed

    Ibrahim, Michael; Fanshawe, Angela; Patel, Vanash; Goswami, Karan; Chilvers, Geoffrey; Ting, Michelle; Pilavakis, Yiannis; Rao, Christopher; Athanasiou, Thanos

    2014-12-01

    The aim of this study was to identify factors that influence career choice in UK medical students. Students at seven institutions were invited to rate how important various factors were on influencing their career choices and how interested they were in pursuing different specialties. The influence of interpersonal relationship networks on career choice was also evaluated. 641 responses were collected. 44% (283) were male, 16% (105) were graduates and 41% (263) were final-year students. For Dermatology (p = 0.009), Paediatrics (p = 0.000), Radiology (p = 0.000), Emergency Medicine (p = 0.018) and Cardiothoracic Surgery (p = 0.000), there was a clear correlation between completing a clinical attachment and an interest in pursuing the specialty. Perceived characteristics of the speciality, individually and in clusters were considered important by specific subgroups of students, such as those interested in surgery. These students considered prestige (p = 0.0003), role models (p = 0.014), financial rewards after training (p = 0.0196) and technical challenge (p = 0.0011) as important factors. Demographics such as sex and age played a significant role in career choice. Interpersonal relationship networks do not have a significant influence on career intentions. This study shows that the career intentions of British medical students are influenced by their undergraduate experience and by the weight they place on different specialty-related factors.

  3. Systemic Medication and Intraocular Pressure in a British Population

    PubMed Central

    Khawaja, Anthony P.; Chan, Michelle P.Y.; Broadway, David C.; Garway-Heath, David F.; Luben, Robert; Yip, Jennifer L.Y.; Hayat, Shabina; Wareham, Nicholas J.; Khaw, Kay-Tee; Foster, Paul J.

    2014-01-01

    Objective To determine the association between systemic medication use and intraocular pressure (IOP) in a population of older British men and women. Design Population-based, cross-sectional study. Participants We included 7093 participants from the European Prospective Investigation into Cancer–Norfolk Eye Study. Exclusion criteria were a history of glaucoma therapy (medical, laser, or surgical), IOP asymmetry between eyes of >5 mmHg, and missing data for any covariables. The mean age of participants was 68 years (range, 48–92) and 56% were women. Methods We measured IOP using the Ocular Response Analyzer. Three readings were taken per eye and the best signal value of the Goldmann-correlated IOP value considered. Participants were asked to bring all their medications and related documentation to the health examination, and these were recorded by the research nurse using an electronic case record form. The medication classes examined were angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, α-blockers, β-blockers, calcium channel blockers, diuretics, nitrates, statins, insulin, biguanides, sulfonylureas, aspirin, and other nonsteroidal anti-inflammatory drugs. We examined associations between medication use and IOP using multivariable linear regression models adjusted for age, sex, and body mass index. Models containing diabetic medication were further adjusted for glycosylated hemoglobin levels. Main Outcome Measures Mean IOP of the right and left eyes. Results Use of systemic β-blockers (−0.92 mmHg; 95% CI, −1.19, −0.65; P<0.001) and nitrates (−0.63 mmHg; 95% CI, −1.12, −0.14; P = 0.011) were independently associated with lower IOP. The observed associations between statin or aspirin use with IOP were no longer significant after adjustment for β-blocker use. Conclusions This is the first population-based study to demonstrate and quantify clinically significant differences in IOP among participants using systemic

  4. A short history of providing medical history within the British medical undergraduate curriculum.

    PubMed

    Metcalfe, N H; Stuart, E

    2014-06-01

    This article aims to discuss the history of medical history in the British medical undergraduate curriculum and it reviews the main characters and organisations that have attempted to earn it a place in the curriculum. It also reviews the arguments for and against the study of the subject that have been used over the last 160 years.

  5. The Crandall Intellectual Achievement Responsibility Questionnaire: A British Validation Study.

    ERIC Educational Resources Information Center

    Reid, Ivan; Croucher, Audrey

    1980-01-01

    Over one thousand British primary schoolchildren completed the Crandall Intellectual Achievement Responsibility Questionnaire. Comparisons with earlier American data provided similar results. The Crandall scale is more closely related to attainment than to intelligence, indicating that high internalized reinforcement responsibility provides a…

  6. British Aid to Medical Schools in Developing Countries

    PubMed Central

    Hubble, Douglas

    1972-01-01

    If the British allocation for overseas aid is increased more generous agreements could be made with host universities and with expatriate staff. It would greatly stimulate overseas service by specialist trainees if the professional colleges and the universities agreed that they would be willing to substitute in their training programmes a year or two of service in an overseas medical school for one or more of their orthodox appointments. Consideration might be given by the councils for postgraduate education to ways of facilitating service overseas by specialist trainees and young consultants. The suggestion of the Royal Commission for the expansion of departmental staff establishments and training pools requires that the temporary expatriate occupying a supernumerary post is absorbed into the establishment on his return. While this may be done now in individual cases by personal arrangement a national agreement between universities and the N.H.S. would be necessary for these secondments to be made on the large scale commensurate to the need. For other returning young doctors not yet in specialist training schemes an assurance that applications for appointments by those who had worked in developing countries would receive favourable weighting, by both university and N.H.S. selection committees, would be very helpful. PMID:5031718

  7. To what extent did the 1858 Medical Act bring unity to the British medical profession?

    PubMed

    Beard, John A S

    2013-05-01

    The Medical Act of 1858 was the culmination of medical, political and social wrangling for several decades before its passage. This essay looks to place the Act in its correct historical context and will specifically consider whether it brought about unity to what was a disparate and factional profession. That it was an important piece of legislation in the history of British healthcare is unquestioned, but the extent to which it directly brought about change is more uncertain. In order to understand the background, content and repercussions of the Act, one must recognize the structure of the medical system at that time. One reason for doing this, as argued by some, is that the Medical Act, like the Apothecaries Act of 1815, was the result of changes to the profession and not the cause of them. Reformists hoped that the Medical Act would unify the profession, yet significant historical, hierarchical and political barriers stood in the way of reform.

  8. Medical Refugees and the Modernisation of British Medicine, 1930–1960

    PubMed Central

    Weindling, Paul

    2015-01-01

    Summary This paper reappraises the position of medical refugees in Britain between the 1930s and 1950s. Advocates of reforming British medicine in terms of its knowledge base and social provision emerged as strongly supportive of the medical refugees. By way of contrast, an élite in the British Medical Association attempted to exercise a controlling regime through the Home Office Advisory Committee. The effects of these divisions are gauged by reconstructing the complete spectrum of refugees as a total population. Applying this methodology of population reconstruction provides a corrective to the notion of a cohesive ‘medical establishment’ exercising rigid and discriminatory controls. PMID:26166948

  9. Mountain goat response to hydroelectric exploration in northwestern British Columbia

    SciTech Connect

    Foster, B.R.; Rahs, E.Y.

    1983-03-01

    The behavioral responses of more than 800 mountain goats, comprised of 195 social groups, were recorded during hydroelectric exploration activities (primarily aircraft) in northwestern British Columbia. Four categories of overt response were recorded during case tests, ranging from maintenance activity to severe flight. More than 80 percent (n=667) of the observed goats elicited some form of behavioral stress-response, with 33 percent (n=265) displaying a severe flight response to local rock or plant cover. Multiple regression analysis inferred goat responses to be statistically independent of the time of year, type, and vertical orientation of disturbance and group size. As expected, significant correlations (p less than or equal to 0.05) existed between distance of disturbance, geographic area, cover availability, and degree of awareness. Responses were stimulated primarily by auditory and secondarily by visual cues. Repeated aerial and ground follow-up surveys documented temporary range abandonment and changing observability indices (habitat use and activity patterns) associated with areas of intense exploration activity. The assessed data offer mitigation possibilities and enable formulation of management guidelines to lessen project impacts during future exploration, construction, and operation phases.

  10. Mountain goat response to hydroelectric exploration in northwestern British Columbia

    NASA Astrophysics Data System (ADS)

    Foster, Bryan R.; Rahs, Engel Y.

    1983-03-01

    The behavioral responses of more than 800 mountain goats, comprised of 195 social groups, were recorded during hydroelectric exploration activities (primarily aircraft) in northwestern British Columbia. Four categories of overt response were recorded during case tests, ranging from maintenance activity to severe flight. More than 80 percent ( n=667) of the observed goats elicited some form of behavioral stress-response, with 33 percent ( n=265) displaying a severe flight response to local rock or plant cover. Multiple regression analysis inferred goat responses to be statistically independent of the time of year, type, and vertical orientation of disturbance and group size. As expected, significant correlations ( p≤0.05) existed between distance of disturbance, geographic area, cover availability, and degree of awareness. Responses were stimulated primarily by auditory and secondarily by visual cues. Repeated aerial and ground follow-up surveys documented temporary range abandonment and changing observability indices (habitat use and activity patterns) associated with areas of intense exploration activity. The assessed data offer mitigation possibilities and enable formulation of management guidelines to lessen project impacts during future exploration, construction, and operation phases.

  11. Modernising medical careers and the British surgeons of the future.

    PubMed

    Chand, Manish; Faruque, Mohammed; Dabbas, Natalie; Nash, Guy F

    2010-05-01

    The Modernising Medical Careers reforms in medical training have led to significant changes in the way junior doctors are trained. However, not all these changes have been welcomed by both trainees and trainers. This article seeks to examine some of the issues regarding training in surgery.

  12. [Margot Jefferys: the British voice of medical sociology].

    PubMed

    Nunes, Everardo Duarte

    2011-03-01

    Margot Jefferys (1916-1999) was not only the person who introduced medical sociology into Great Britain, but also the researcher and professor who, during thirty years, exerted the most deep influence on the teaching of health social sciences either in undergraduate or especially graduate studies, since the beginning of her career, in 1953, at the London School of Hygiene and Tropical Medicine. In addition to create a global panorama concerning the Jefferys' works, this study highlights two texts, which are situated into the field we are researching: the history of health sociology. The first one, published in 1991, discusses the relationships between epidemiology and sociology; and the second, published in 1996, discusses the field of medical sociology. Both texts are a series of considerations regarding the Jefferys' thought and the more recent questions of the field in Great Britain.

  13. Dispensers, obeah and quackery: medical rivalries in post-slavery British Guiana.

    PubMed

    De Barros, Juanita

    2007-08-01

    This paper examines the ambiguous place of medical assistants-dispensers-in a post-slavery British Caribbean colony, British Guiana, from the end of slavery in the 1830s to the early twentieth century. Although the latter were crucial to the functioning of the colonial medical system, local physicians resented them, complaining about the economic threat they posed and at times condemning them as quacks. These attacks were part of a wider discussion about the composition of the medical profession and the role of medical auxiliaries in colonial society, and to an extent, they echoed debates conducted in other jurisdictions in this period. But in the British Caribbean, this discussion was significantly different. There, long-standing views about obeah-an Afro-Creole medico-religious practice-as a particularly dangerous and uncivilised type of quackery was part of the discursive context. That those participating in this debate included African-descended physicians whose arrival in the medical profession was recent and contested demonstrates the vexed and complex nature of professionalisation in a post-slavery society.

  14. The teaching of neurosurgery in UK medical schools: a message from British medical students.

    PubMed

    Skarparis, Yiannis; Findlay, Callum A; Demetriades, Andreas K

    2016-01-01

    A great variability exists in the clinical exposure of neurosurgery across all academic years in UK medical schools, although the effects of this on knowledge level and confidence in referring cases appropriately to specialists have not been reported. A cross-sectional study was carried out involving students in years 1-5 across nine British medical schools. An electronic questionnaire was sent out which consisted of questions concerning the teaching of the subject; and questions assessing the knowledge of basic neurosurgery through mini clinical scenarios testing which specialty should receive a referral. Of 417 participants, 60 were excluded due to incomplete participation. Senior years outperformed students in junior years for correctly answered questions on five neurosurgical scenarios (mean score: years 1-3 (184/357) = 3.33/5, years 4-5 (173/357) = 3.79/5, p < 0.05). Participants in years 1-5 with prior clinical exposure in neurosurgery scored higher than participants who had no exposure (mean score: exposed (247/357) = 4.21/5, not-exposed (110/357) = 3 · 50/5, p < 0.05). Sixty-one percent prefer receiving neurosurgical teaching via increased exposure to operations. Students in years 4-5 with exposure in both classroom and operating theatre scored higher than students with classroom-only experience (mean classroom (69/131) = 3.62/5, mean classroom and operating theatre (62/131) = 4.21/5, p < 0.05); 33.3 % of final-year students reported difficulty in identifying patients that require neurosurgical referral. Students with exposure to an operating theatre outperformed those students exposed to just classroom teaching. Students indicated an increased preference for teaching through the operating theatre scene. One in three final-year medical students had difficulty identifying the need for a neurosurgical referral.If neurosurgical teaching were further enhanced at medical school, it could lead to increased confidence and

  15. Rescue of the remnants: the British emergency medical relief operation in Belsen Camp 1945.

    PubMed

    Trepman, E

    2001-10-01

    The British Army liberated the German concentration camp at Belsen on April 15, 1945. The thousands of inmates (estimates range from 60,000 to 78,900 inmates), mostly Jews from eastern Europe, were dying at a rate of 500-600 per day from disease, and many more were being killed by the German guards and co-workers. Diseases prevalent included typhus, tuberculosis, nutritional and infective diarrhoea, severe malnutrition and starvation, and others. Despite huge obstacles including the ongoing war effort, shortages of supplies, and limited numbers of workers, a relief operation was rapidly organized to control the typhus epidemic and salvage as many inmates as possible. The 10,000 emaciated corpses which had been lying all over the camp were collected and buried in mass graves. Inmates were disinfected with D.D.T., scrubbed in a "human laundry," and evacuated from the typhus-ridden Horror Camp (Camp 1) to a hospital organized in the barracks of the Panzer Training School (Camp 2). Feeding of the inmates was carefully regulated, and some basic medical treatment organized. The relief operation was performed by British Army units, detachments of the British Red Cross, British and Belgian medical students, and other volunteers including those from among the less debilitated inmates. Although 13,000 inmates died after the liberation despite the relief operation, thousands of others were rescued.

  16. Survey of safety and health care in British medical laboratories.

    PubMed Central

    Harrington, J M; Shannon, H S

    1977-01-01

    A retrospective postal survey of 24 000 medical laboratory workers in England, Wales, and Scotland showed highly variable standards of safety and health care. Pre-employment health screening was offered to two-thirds of employees, the physicians being the least likely to be examined (15%). Scottish laboratories provided better safety control than English and Welsh laboratories, while Public Health Service Laboratories had a better record than National Health Service establishments. Mouth pipetting is still practised in 65% of English and Welsh laboratories, and the use of protective clothing is rarely compulsory. The servicing of safety cabinets is often inadequate. Known and suspected carcinogens are still apparently used in a few laboratories (2-10%). In view of the wide variation in standards among laboratories, urgent consideration should be given to establishing regulations for codes of safe practice rather than relying merely on recommendations as at present. PMID:843842

  17. Systemic medication and intraocular pressure in a British population: the EPIC-Norfolk Eye Study.

    PubMed

    Khawaja, Anthony P; Chan, Michelle P Y; Broadway, David C; Garway-Heath, David F; Luben, Robert; Yip, Jennifer L Y; Hayat, Shabina; Wareham, Nicholas J; Khaw, Kay-Tee; Foster, Paul J

    2014-08-01

    To determine the association between systemic medication use and intraocular pressure (IOP) in a population of older British men and women. Population-based, cross-sectional study. We included 7093 participants from the European Prospective Investigation into Cancer-Norfolk Eye Study. Exclusion criteria were a history of glaucoma therapy (medical, laser, or surgical), IOP asymmetry between eyes of >5 mmHg, and missing data for any covariables. The mean age of participants was 68 years (range, 48-92) and 56% were women. We measured IOP using the Ocular Response Analyzer. Three readings were taken per eye and the best signal value of the Goldmann-correlated IOP value considered. Participants were asked to bring all their medications and related documentation to the health examination, and these were recorded by the research nurse using an electronic case record form. The medication classes examined were angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, α-blockers, β-blockers, calcium channel blockers, diuretics, nitrates, statins, insulin, biguanides, sulfonylureas, aspirin, and other nonsteroidal anti-inflammatory drugs. We examined associations between medication use and IOP using multivariable linear regression models adjusted for age, sex, and body mass index. Models containing diabetic medication were further adjusted for glycosylated hemoglobin levels. Mean IOP of the right and left eyes. Use of systemic β-blockers (-0.92 mmHg; 95% CI, -1.19, -0.65; P<0.001) and nitrates (-0.63 mmHg; 95% CI, -1.12, -0.14; P = 0.011) were independently associated with lower IOP. The observed associations between statin or aspirin use with IOP were no longer significant after adjustment for β-blocker use. This is the first population-based study to demonstrate and quantify clinically significant differences in IOP among participants using systemic β-blockers or nitrates. Lower IOP observed in participants using statins or aspirin was explained by

  18. Negotiation strategies and patient empowerment in Spanish and British medical consultations.

    PubMed

    Hernández-López, María de la O

    2011-01-01

    Making a decision is not only one of the physician's most important responsibilities but also one of patients' most sensitive moments in medical encounters. Drawing from pragmatics studies, this paper explores rapport maintenance and/or enhancement (Spencer-Oatey 2000, 2008) in the decision-making strategies that General Practitioners (GPs) and patients employ in 80 encounters in various areas of England and Spain. The results show that such strategies are context-bound and subject to role specifications: while patients may make use of (dis)agreement strategies and initiate decisions and/or self-diagnosis, doctors give options, show empathy, expand explanations or show explicit or implicit (dis) agreement. In relation to this, notable findings were revealed: first, these communicative strategies may vary not only in terms of frequency but also quality and distribution; second, the Spanish interlocutors in the data gathered tend to negotiate through the explicit expression of opinions, while the British interlocutors prefer the discussion of different alternatives and value the other's freedom to act. Third, there is higher tolerance of disagreement in the Spanish data. Fourth, negotiation may be undertaken on the basis of either self-affirmation or consensus-seeking beliefs. Finally, patient empowerment is displayed in divergent ways in both sets of data. In short, the decision-making processes examined are subject to social and psychological factors with a direct impact on communicative styles.

  19. Evaluation of elite British cyclists: the role of the squad medical.

    PubMed

    Callaghan, M J; Jarvis, C

    1996-12-01

    To describe and report results from the procedures and protocols used by the British Cycling Federation during the squad medicals of its elite cyclists. Screening of over 500 elite riders has been done by doctors, dentists, physiotherapists, opticians, and dietitians since 1990. A questionnaire provided additional information on musculoskeletal problems. 523 riders have been examined and 92 (17.5%) have been referred for further assessment or treatment. Most of these riders were sent either to their own general practitioner or to the British Olympic Medical Centre. The questionnaire was completed by 81% of riders. Low back pain was the most common problem that riders encountered (60%), and knee pain the second most common (33%). Four riders failed the eye examination, and a further 11 were classed as borderline. Twenty one per cent of riders undergoing dental examination needed further dental treatment. The squad medical is an important and useful strategy for evaluating elite British cyclists. It shows that a structured system can help early diagnosis and treatment to provide injury-free cyclists at the start of a competitive season. The results from the questionnaire confirm previously unsubstantiated opinions about the incidence of musculoskeletal injuries in cyclists.

  20. Dutch perspectives on the British Medical Association's critique of euthanasia in the Netherlands.

    PubMed

    Cohen-Almagor, R

    2001-01-01

    During the summer of 1999, extensive interviews with some of the leading authorities on the euthanasia policy were conducted in the Netherlands. They were asked: The British Medical Association, in its memorandum before the House of Lords, held that in regard to Holland, "all seem to agree that the so-called rules of careful conduct (official guidelines for euthanasia) are disregarded in some cases. Breaches of rules range from the practice of involuntary euthanasia to failure to consult another practitioner before carrying out euthanasia and to certifying the cause of death as natural". What do you think? Most of the interviewees conceded that this assertion is, indeed, correct. Two interviewees didn't pay much notice to the issue and three others said that the British critique is both true and untrue.

  1. Keeping the culture alive: the laboratory technician in mid-twentieth-century British medical research

    PubMed Central

    Tansey, E.M.

    2008-01-01

    This paper reports results from a detailed study of the careers of laboratory technicians in British medical research. Technicians and their contributions are very frequently missing from accounts of modern medicine, and this project is an attempt to correct that absence. The present paper focuses almost entirely on the Medical Research Council's National Institute for Medical Research in North London, from the first proposal of such a body in 1913 until the mid 1960s. The principal sources of information have been technical staff themselves, largely as recorded in an extensive series of oral history interviews. These have covered a wide range of issues and provide valuable perspectives about technicians' backgrounds and working lives. PMID:18548906

  2. A ride to care--a non-emergency medical transportation service in rural British Columbia.

    PubMed

    Safaei, J

    2011-01-01

    Access to healthcare services is a chronic problem for rural communities throughout the world. The vast geography of Canada has exacerbated the problem for many northern and remote communities that are hundreds of kilometers away from healthcare centers. As a policy response to this problem, in 2006 the Northern Health Authority of the province of British Columbia (BC) initiated 'Connections', a unique medical transportation service. This service has provided subsidized non-emergency transportation for residents in rural and remote northern communities to reach healthcare centers in neighboring cities. The objectives of this study were to examine the reach of the Connections service in enhancing rural and northern BC communities' access to healthcare services, and to determine the factors that contribute to greater frequency of using this service. The study focused on the demographic, socioeconomic, and health profiles of a random sample of 297 service users. The information on the users' profiles was obtained through a survey questionnaire that was administered by a combination of mail correspondence, computer-assisted phone interviews, and en-route while using the service. Both descriptive and inferential methods are used to analyze the data. The inferential method is the Tobit model for censored ordered dependent variable, which is used to estimate the effects of users' profiles in predicting the frequency of using the service. The descriptive findings of the study suggest that users are typically of older age (>80% aged at least 40 years, 48% at least 60 years), and the majority are women (62%), have low socioeconomic status (61% had income<$30,000, 73% were economically inactive) and self-reported poor health (<52% had poor or fair health, 76% had at least one health problem). Among the various users' attributes, older age, higher level of education, lower employment status, and greater number of health problems were found to be statistically significant (p

  3. Opinions and preferences of British Columbia pharmacists and physicians on medication management services

    PubMed Central

    Tsao, Nicole W.; Khakban, Amir; Gastonguay, Louise; Zafari, Zafar; Lynd, Larry D.; Marra, Carlo A.

    2016-01-01

    Background: Medication management (MM) services are being provided by pharmacists across Canada in various forms, but pharmacist-physician collaboration is still not a routine practice in most jurisdictions. This survey aimed to gather pharmacists’ and physicians’ opinions and preferences for MM provision. Methods: Two parallel, cross-sectional online surveys, including best-worst scaling tasks, were designed for pharmacists and physicians in British Columbia to capture and compare their preferences for a number of attributes of MM. Results: Surveys were completed by 119 pharmacists and 146 physicians. Results indicate that pharmacists and physicians had similar opinions on many aspects of MM. Ninety-five percent of pharmacists and 69% of physicians believed that additional health services are needed to help patients optimize the use of their medications. However, the majority of each group felt that they were the most important health care professional in providing this service. Most pharmacists (79%) and some physicians (25%) thought that optimizing use of medications would result in both decreased costs and utilization to the health care system. Both pharmacists and physicians felt that the best attribute of an MM service would be if the services resulted in improved health and medication use for patients. Both groups were motivated by increased remuneration for MM; however, the relative strength of preference for this was higher among physicians. Interestingly, physicians valued improved medication adherence as a result of MM more highly than pharmacists did. Discussion and Conclusion: Most pharmacists and physicians agreed that improving patients’ health and medication use would be the best attribute of MM and that there is a need for such services. However, physicians also had strong preferences for being remunerated for participating in MM provision. PMID:28286592

  4. Annotation: The use of psychotropic medications in children: a British view.

    PubMed

    Bramble, David

    2003-02-01

    Prescribing practices relating to the use of psychotropic medication with mentally disordered children have changed significantly in Britain over recent years. I conducted a review of the modest body of empirical data available relating to the prescribing practices of child psychiatrists, paediatricians and general practitioners (primary care physicians). The data were obtained primarily from postal questionnaire studies but also from British drug studies and a government-sponsored evaluation of the efficacy of stimulant medication. Postgraduate training guidelines for the three principal clinical disciplines are also discussed. Systematic evaluation of prescribing practices has a relatively short history. All the studies reviewed demonstrated consistent methodological weaknesses, the most important of which was reliance upon retrospective reports of prescribing practices from clinicians with no analysis of actual prescription data. No studies relating to the general use of psychotropic medication by paediatricians were found. Child psychiatrists and general practitioners appear to be using a range of drugs for a range of conditions; however, there was evidence of intra- and interdisciplinary variations in practice. It was also evident from the general practitioner data that drug treatments were frequently used for conditions best managed with behavioural methods (e.g., common sleep problems and enuresis). Government prescription data relating to methylphenidate use in ADHD reveal a dramatic rise over the past ten years. Currently, most child psychiatrists use this treatment compared to approximately half the profession only seven years ago. The use of newer antipsychotic agents as well as the SSRI antidepressants appears to be growing in child psychiatric practice. A majority of clinicians surveyed believed that medication was an important treatment modality but also felt that they were relatively unskilled in the field and requested further training. Overall, a

  5. Medical downgrading, self‐perception of health, and psychological symptoms in the British Armed Forces

    PubMed Central

    Rona, R J; Hooper, R; Greenberg, N; Jones, M; Wessely, S

    2006-01-01

    Objective To investigate the contribution of psychological symptoms to limited employability for medical reasons in the British Armed Forces. Methods A sample of 4500 military personnel was randomly selected to receive either a full or an abridged questionnaire. The questionnaires asked whether the participant was medically downgraded and if yes, the reason for it. The full questionnaire included the General Health Questionnaire‐12 (GHQ‐12), the post‐traumatic stress disorder (PTSD) checklist, 15 symptoms to assess somatisation, and selected items of the quality of life SF‐36 questionnaire. The abridged questionnaire included the GHQ‐4, a 14 item PTSD checklist, five symptoms, and the item on self‐perception of health from the SF‐36. Subjects above a threshold score for GHQ, PTSD, and symptoms were considered to have psychological symptoms. Results 12.4% of the participants were medically downgraded. The majority (70.4%) had social or work limitations. Medically downgraded personnel had higher odds ratios in comparison to non‐downgraded personnel for psychological distress 1.84 (95% CI 1.43 to 2.37), PTSD 3.06 (95% CI 1.82 to 5.15), and number of symptoms 2.37 (95% CI 2.37 1.62 to 3.47). GHQ, PTSD, and symptoms scores were mainly, but not exclusively, related to chronic physical injury. Conclusions Psychological symptoms are common among medically downgraded personnel. Although the mechanisms involved are unclear, tackling issues of psychological symptoms among these subjects could contribute to faster restitution to full employability in the Armed Forces. PMID:16556744

  6. Perceptions of British Columbia residents and their willingness to pay for medication management services provided by pharmacists

    PubMed Central

    Tsao, Nicole W.; Khakban, Amir; Gastonguay, Louise; Li, Kathy; Lynd, Larry D.

    2015-01-01

    Background: Across Canada, pharmacists have expanded their scope of practice by performing medication management (MM) services. However, little is currently known about the opinions and attitudes of patients and the general population toward MM services. Methods: A cross-sectional online survey, including a best-worst scaling task, was designed to understand the general public’s opinions, preferences and willingness-to-pay with respect to MM services in British Columbia. Results: Of 977 individuals contacted, 819 responded to the questionnaire (84% response rate). The mean age was 45 years (standard deviation [SD] 16 years), and 37% were male. Overall, 93% of respondents felt that the medication advice from their pharmacist resulted in improvement in patient outcomes and/or medication use. This was also selected as the “best” attribute of MM, while other preferred attributes of MM included being able to obtain an appointment with the pharmacist on the same day or via walk-in, improved patient-physician relationships and MM sessions able to be completed in 15 minutes with the pharmacist. The average willingness to pay for MM was $24.55 (SD $21.44). Younger males with higher household income and those who had had MM in the past were willing to pay more for MM services out of pocket. Discussion and Conclusion: The accessibility of pharmacists was valued highly by respondents who, overall, were supportive of MM services and recognized the potential of pharmacists’ involvement in drug therapy management to improve patient outcomes and medication use. Alternative models of funding are worth considering for the sustainability of MM service provision. PMID:26445584

  7. [Experiments on living subjects: the vivisection debate in German and British medical weekly journals 1919-1939].

    PubMed

    Lisner, Wiebke

    2009-01-01

    By the end of the 1920s, animal experiments were considered a standardized procedure for testing medical substances and therapies. In the context of the so-called "crisis of medicine", however, some physicians and the wider lay public in Germany and Great Britain criticized animal based research. While British antivivisectionists had little relevance in the 1930s, their German counterparts allied with the National Socialist Party and gained social and political force. The debates within the German and British medical profession about doctors' interventions in that debate, as well as the public perception of doctors will be analysed on the basis of the most important medical weekly journals of the time, that were involved in these debates.

  8. (Re-)reading medical trade catalogs: the uses of professional advertising in British medical practice, 1870-1914.

    PubMed

    Jones, Claire L

    2012-01-01

    This article explores how medical practitioners read, used, and experienced medical trade catalogs in late-nineteenth- and early-twentieth-century Britain. Reader responses to the catalog, a book-like publication promoting medical tools, appliances, and pharmaceuticals, have been chronically understudied, as have professional reading practices within medicine more generally. Yet, evidence suggests that clinicians frequently used the catalog and did so in three main ways: to order medical products, to acquire new information about these products, and to display their own product endorsements and product designs. The seemingly widespread nature of these practices demonstrates an individual and collective professional desire to improve medical practice and highlights the importance of studying professional reading practices in the cultural history of medicine.

  9. Has open data arrived at the British Medical Journal (BMJ)? An observational study

    PubMed Central

    Rowhani-Farid, Anisa

    2016-01-01

    Objective To quantify data sharing trends and data sharing policy compliance at the British Medical Journal (BMJ) by analysing the rate of data sharing practices, and investigate attitudes and examine barriers towards data sharing. Design Observational study. Setting The BMJ research archive. Participants 160 randomly sampled BMJ research articles from 2009 to 2015, excluding meta-analysis and systematic reviews. Main outcome measures Percentages of research articles that indicated the availability of their raw data sets in their data sharing statements, and those that easily made their data sets available on request. Results 3 articles contained the data in the article. 50 out of 157 (32%) remaining articles indicated the availability of their data sets. 12 used publicly available data and the remaining 38 were sent email requests to access their data sets. Only 1 publicly available data set could be accessed and only 6 out of 38 shared their data via email. So only 7/157 research articles shared their data sets, 4.5% (95% CI 1.8% to 9%). For 21 clinical trials bound by the BMJ data sharing policy, the per cent shared was 24% (8% to 47%). Conclusions Despite the BMJ's strong data sharing policy, sharing rates are low. Possible explanations for low data sharing rates could be: the wording of the BMJ data sharing policy, which leaves room for individual interpretation and possible loopholes; that our email requests ended up in researchers spam folders; and that researchers are not rewarded for sharing their data. It might be time for a more effective data sharing policy and better incentives for health and medical researchers to share their data. PMID:27737882

  10. Has open data arrived at the British Medical Journal (BMJ)? An observational study.

    PubMed

    Rowhani-Farid, Anisa; Barnett, Adrian G

    2016-10-13

    To quantify data sharing trends and data sharing policy compliance at the British Medical Journal (BMJ) by analysing the rate of data sharing practices, and investigate attitudes and examine barriers towards data sharing. Observational study. The BMJ research archive. 160 randomly sampled BMJ research articles from 2009 to 2015, excluding meta-analysis and systematic reviews. Percentages of research articles that indicated the availability of their raw data sets in their data sharing statements, and those that easily made their data sets available on request. 3 articles contained the data in the article. 50 out of 157 (32%) remaining articles indicated the availability of their data sets. 12 used publicly available data and the remaining 38 were sent email requests to access their data sets. Only 1 publicly available data set could be accessed and only 6 out of 38 shared their data via email. So only 7/157 research articles shared their data sets, 4.5% (95% CI 1.8% to 9%). For 21 clinical trials bound by the BMJ data sharing policy, the per cent shared was 24% (8% to 47%). Despite the BMJ's strong data sharing policy, sharing rates are low. Possible explanations for low data sharing rates could be: the wording of the BMJ data sharing policy, which leaves room for individual interpretation and possible loopholes; that our email requests ended up in researchers spam folders; and that researchers are not rewarded for sharing their data. It might be time for a more effective data sharing policy and better incentives for health and medical researchers to share their data. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  11. Patients' responsibilities in medical ethics.

    PubMed

    Draper, Heather; Sorell, Tom

    2002-08-01

    Patients have not been entirely ignored in medical ethics. There has been a shift from the general presumption that 'doctor knows best' to a heightened respect for patient autonomy. Medical ethics remains one-sided, however. It tends (incorrectly) to interpret patient autonomy as mere participation in decisions, rather than a willingness to take the consequences. In this respect, medical ethics remains largely paternalistic, requiring doctors to protect patients from the consequences of their decisions. This is reflected in a one-sided account of duties in medical ethics. Duties fall mainly on doctors and only exceptionally on patients. Medical ethics may exempt patient from obligations because they are the weaker or more vulnerable party in the doctor-patient relationship. We argue that vulnerability does not exclude obligation. We also look at other ways in which patient responsibilities flow from general ethics: for instance, from responsibilities to others and to the self, from duties of citizens, and from the responsibilities of those who solicit advice. Finally, we argue that certain duties of patients counterbalance an otherwise unfair capacity of doctors as helpers.

  12. Medical telematics in disaster response.

    PubMed

    Benner, Thomas; Schaechinger, Ulrich; Nerlich, Michael

    2003-01-01

    Every year many disasters cause thousands of injuries, deaths, refugees. Depending on the kind of disaster (train/plane accident, flood, earthquake) not only an acute emergency medicine treatment but also general and family medicine and hospital treatment have to be safeguarded over a longer time-period in the disaster area. Regarding to a lot of organizations, institutions and disaster teams taking part in the disaster assistance is there any lack of work or data flow in the medical treatment? From the ODRA flood 1997, the high speed train crash in ESCHEDE 1998, the DANUBE flood 1999 and the ELBE flood in 2002 experience reports were collected. They were analysed with emphasis on data and work flow in the medical treatment and its command system: Standardised command structure? Communication problems? Used communication lines? Language problems? Medical Intelligence distribution? Use of Patient Tracking System? Triage problems? The use of spoken radio communication causes transmission mistakes or misunderstandings and radio-overload and need connection-set-up-time for each call. Manual distribution of same data for many receivers using different communication lines causes a time shift in the up-to-date-information. Language problems during the ODRA flood between German and Polish people led to longer reaction times. Up-to-date triage results as well as up-to-date transportation and hospital information are necessary for medical evacuation. Compared with other reports about these disasters the quality of disaster management depends on the quality of communication and information. The use of health telematics in disaster response helps to cope with the scenario. Modern technologies provide support for building up medical aid although the normal infrastructure is destroyed. To cope with disaster scenarios there are some telematic tools which can be used:--Computer-based Command and Control System--Telemedical support --Data-ressources-network /Medical Intelligence. A

  13. [Delegating medical responsibilities to non-medical staff].

    PubMed

    Wienke, Albrecht

    2008-01-01

    Recently, the medical profession has increasingly engaged in the development of non-medical assistant jobs who try to take on more and more duties that have previously been the physicians' responsibility. Here, medical professionals from the fields of anaesthesiology and surgery should be mentioned in particular. Against this background of medical supply deficits (especially in the newly formed German states) the Federal Government already stated during the negotiations over coalition formation that nursing care professionals need to be involved into medical care much more strongly. In the context of the healthcare reform the Federal Government has thus arranged to alter the rules regarding statutory health insurance physicians by transferring original medical duties and responsibilities to nursing care professionals within the scope of pilot projects. Against this background the German Medical Association has asked all Scientific Medical Societies and medical professional associations to comment on the delegation of medical responsibilities.

  14. Canadian family doctors’ roles and responsibilities toward outbound medical tourists

    PubMed Central

    Johnston, Rory; Crooks, Valorie A.; Snyder, Jeremy; Dharamsi, Shafik

    2013-01-01

    Abstract Objective To explore how Canadian family doctors understand their roles and responsibilities toward patients who seek health care abroad. Design Six focus groups were held with family doctors across British Columbia to explore their experiences with and perspectives on outbound medical tourism. Focus groups were digitally recorded, transcribed, and subsequently thematically coded to discover common issues and themes across the entire data set. Setting Focus groups were held with family doctors in 6 cities in British Columbia that provided representation from all provincial health authorities and a range of urban contexts. Participants A total of 22 currently practising family doctors participated across the 6 focus groups, with groups ranging in size from 2 to 6 participants (average 4 participants). Methods Thematic analysis of the transcripts identified cross-cutting themes that emerged across the 6 focus groups. Main findings Participants reported that medical tourism threatened patients’ continuity of care. Informational continuity is disrupted before patients go abroad because patients regularly omit family doctors from preoperative planning and upon return home when patients lack complete or translated medical reports. Participants believed that their responsibilities to patients resumed once the patients had returned home from care abroad, but were worried about not being able to provide adequate follow-up care. Participants were also concerned about bearing legal liability toward patients should they be asked to clinically support treatments started abroad. Conclusion Medical tourism poses challenges to Canadian family doctors when trying to reconcile their traditional roles and responsibilities with the novel demands of private out-of-country care pursued by their patients. Guidance from professional bodies regarding physicians’ responsibilities to Canadian medical tourists is currently lacking. Developing these supports would help address

  15. Multicenter randomized controlled trial of the management of unresectable malignant mesothelioma proposed by the British Thoracic Society and the British Medical Research Council.

    PubMed

    Girling, David J; Muers, Martin F; Qian, Wendi; Lobban, Dawn

    2002-02-01

    Malignant mesothelioma is almost invariably fatal. The incidence of the disease is rising rapidly in many countries, and there is no generally accepted standard treatment for patients with unresectable disease. According to current British Thoracic Society (BTS) guidelines, patients should be treated with active symptom control (ASC), involving (1) regular follow-up in a specialist clinic; (2) structured assessments of physical, psychological and social problems with appropriate action; (3) rapid involvement of additional specialists; and (4) parallel nursing support. Although many nonrandomized studies have reported tumor responses to anticancer chemotherapy, few have studied palliation and it is not known whether chemotherapy prolongs survival or provides clinically worthwhile palliation with acceptable toxicity when given in addition to ASC. We therefore plan to conduct a multicenter randomized controlled trial comparing (1) ASC alone, (2) ASC plus mitomycin vinblastine and cisplatin (MVP), and (3) ASC plus vinorelbine (N; Navelbine, Pierre Fabre Oncology, Winchester, UK). We chose these chemotherapy regimens because they have been shown in nonrandomized studies to provide good symptom control as recorded by patients. The outcome measures are overall survival, palliation of symptoms, performance status, analgesic usage, toxicity, quality of life, tumor response, and recurrence/progression-free survival. In a preliminary feasibility study, we are assessing the acceptability of the trial design to patients and the suitability of two standard quality-of-life instruments in mesothelioma. Data will help us to decide the final details of the large multicenter trial.

  16. Medical responsibility and air transport.

    PubMed

    Hédouin, V; Lallemand, M; Révuelta, E; Dreszer, M A; Gosset, D

    1998-01-01

    When a medical emergency occurs during a flight operated by a commercial airline, the assistance of a physician-passenger fortuitously present aboard may be requested. This physician becomes bound by both his professional and civil responsibilities. However, in the case of a serious problem, he would usually ignore the question of the jurisprudence of the country where the emergency occurs. In discussing this issue, this paper analyses different situations and risks that the physician may incur and points out various defects in the law not currently covered by existing international conventions.

  17. Measuring Maturity of Use for Electronic Medical Records (EMRs) in British Columbia: The Physician Information Technology Office (PITO).

    PubMed

    Rimmer, Carol; Hagens, Simon; Baldwin, Anne; Anderson, Carol J

    2014-01-01

    This article examines British Columbia (BC)'s Physician Information Technology Office's efforts to measure and improve the use of electronic medical records (EMRs) by select practices in BC with an assessment of their progress using a maturity model, and targeted support. The follow-up assessments showed substantial increases in the physicians' scores resulting from action plans that comprised a series of tailored support activities. Specifically, there was an increase from 21% to 83% of physicians who could demonstrate that they used their EMRs as the principal method of record-keeping.

  18. Effects of discrimination by sex and race on the early careers of British medical graduates during 1981-7.

    PubMed

    McKeigue, P M; Richards, J D; Richards, P

    1990-10-27

    To examine the possible effects of discrimination by sex and race on the career patterns of doctors up to six years after qualifying. Postal questionnaire follow up survey. 1572 Doctors who graduated from five British medical schools in 1981, 1983, and 1985, including 587 women and 131 doctors from ethnic minorities. Reported success rates of applications for training posts. Comparison of the career patterns of women and men yielded no evidence of discrimination against women in competition for posts. In contrast, there were striking differences in career patterns between graduates of native European origin and those of ethnic minority origin. Graduates from ethnic minorities reported lower success rates and more difficulty in obtaining house officer posts, registrar posts, and places in vocational training schemes in general practice. Most of this discrimination seemed to occur at the stage of shortlisting for interview. Graduates from ethnic minorities were more likely than graduates of native European origin to have experienced spells of unemployment while seeking work. They were also more likely to have changed their original choice of career because of difficulty in obtaining suitable training posts or unfavourable career prospects. Discrimination against ethnic minorities occurs in the competition for training posts among graduates from British medical schools. There was no evidence of discrimination against women graduates. Shortlisting procedures based on objective scoring systems may help to ensure equality of opportunity in future.

  19. Effects of discrimination by sex and race on the early careers of British medical graduates during 1981-7.

    PubMed Central

    McKeigue, P M; Richards, J D; Richards, P

    1990-01-01

    OBJECTIVE--To examine the possible effects of discrimination by sex and race on the career patterns of doctors up to six years after qualifying. DESIGN--Postal questionnaire follow up survey. PARTICIPANTS--1572 Doctors who graduated from five British medical schools in 1981, 1983, and 1985, including 587 women and 131 doctors from ethnic minorities. MAIN OUTCOME MEASURES--Reported success rates of applications for training posts. RESULTS--Comparison of the career patterns of women and men yielded no evidence of discrimination against women in competition for posts. In contrast, there were striking differences in career patterns between graduates of native European origin and those of ethnic minority origin. Graduates from ethnic minorities reported lower success rates and more difficulty in obtaining house officer posts, registrar posts, and places in vocational training schemes in general practice. Most of this discrimination seemed to occur at the stage of shortlisting for interview. Graduates from ethnic minorities were more likely than graduates of native European origin to have experienced spells of unemployment while seeking work. They were also more likely to have changed their original choice of career because of difficulty in obtaining suitable training posts or unfavourable career prospects. CONCLUSIONS--Discrimination against ethnic minorities occurs in the competition for training posts among graduates from British medical schools. There was no evidence of discrimination against women graduates. Shortlisting procedures based on objective scoring systems may help to ensure equality of opportunity in future. PMID:2249025

  20. Yaws, syphilis, sexuality, and the circulation of medical knowledge in the British Caribbean and the Atlantic world.

    PubMed

    Paugh, Katherine

    2014-01-01

    This history of the disease categories "yaws" and "syphilis" explores the interplay between European and African medical cultures in the early modern Atlantic world. The assertion made by both early modern and modern medical authorities, that yaws and syphilis are the same disease, prompts a case study of the history of disease that reflects on a variety of issues in the history of medicine: the use of ideas about contagion to demarcate racial and sexual difference at sites around the British Empire; the contrast between persistently holistic ideas about disease causation in the Black Atlantic and the growth of ontological theories of disease among Europeans and Euro-Americans; and the controversy over the African practice of yaws inoculation, which may once have been an effective treatment but was stamped out by plantation owners who viewed it as a waste of their enslaved laborers' valuable time.

  1. From lesion to metaphor: chronic pain in British, French and German medical writings, 1800-1914.

    PubMed

    Hodgkiss, A

    2000-01-01

    This is the first monograph devoted to the history of chronic pain. A novel methodology is used. Examining responses to a problem that remained stable over time anchors a survey of shifting terms and theories and leaves the historical invariance of the clinical syndrome open to textual research. Writings by medical authors from a wide range of professional backgrounds are examined including surgeons, physicians, psychiatrists, neurophysiologists, neurologists and psychoanalysts. Early responses to the problem of chronic pain without structural lesion were the appearance of neuralgia, a neuro-anatomical rewriting of traditional sympathies, extension of the concept of lesion to embrace disturbance of function and appeals to cenesthesis. Later in the century distinctions were drawn between hysterical and neuralgic pain, and between ideogenic, psychogenic and neurogenic pain. Some argued for the physiological equivalence of chronic pain and melancholia, while pain was central to Freud's original notion of conversion. This evidence of continuous discussion of lesionless pain throughout the century challenges the orthodox historical view that the rise of neuroscience meant such pain was simply dismissed as imaginary. The historical invariance of a syndrome of chronic pain without lesion speaks against histories of lesionless syndromes premised on social constructionism. The historical findings are relevant to contemporary debates about the nosology and nature of chronic pain.

  2. Different responses of influenza epidemic to weather factors among Shanghai, Hong Kong, and British Columbia

    NASA Astrophysics Data System (ADS)

    Wang, Xi-Ling; Yang, Lin; He, Dai-Hai; Chiu, Alice PY; Chan, Kwok-Hung; Chan, King-Pan; Zhou, Maigeng; Wong, Chit-Ming; Guo, Qing; Hu, Wenbiao

    2017-02-01

    Weather factors have long been considered as key sources for regional heterogeneity of influenza seasonal patterns. As influenza peaks coincide with both high and low temperature in subtropical cities, weather factors may nonlinearly or interactively affect influenza activity. This study aims to assess the nonlinear and interactive effects of weather factors with influenza activity and compare the responses of influenza epidemic to weather factors in two subtropical regions of southern China (Shanghai and Hong Kong) and one temperate province of Canada (British Columbia). Weekly data on influenza activity and weather factors (i.e., mean temperature and relative humidity (RH)) were obtained from pertinent government departments for the three regions. Absolute humidity (AH) was measured by vapor pressure (VP), which could be converted from temperature and RH. Generalized additive models were used to assess the exposure-response relationship between weather factors and influenza virus activity. Interactions of weather factors were further assessed by bivariate response models and stratification analyses. The exposure-response curves of temperature and VP, but not RH, were consistent among three regions/cities. Bivariate response model revealed a significant interactive effect between temperature (or VP) and RH (P < 0.05). Influenza peaked at low temperature or high temperature with high RH. Temperature and VP are important weather factors in developing a universal model to explain seasonal outbreaks of influenza. However, further research is needed to assess the association between weather factors and influenza activity in a wider context of social and environmental conditions.

  3. Different responses of influenza epidemic to weather factors among Shanghai, Hong Kong, and British Columbia.

    PubMed

    Wang, Xi-Ling; Yang, Lin; He, Dai-Hai; Chiu, Alice Py; Chan, Kwok-Hung; Chan, King-Pan; Zhou, Maigeng; Wong, Chit-Ming; Guo, Qing; Hu, Wenbiao

    2017-02-08

    Weather factors have long been considered as key sources for regional heterogeneity of influenza seasonal patterns. As influenza peaks coincide with both high and low temperature in subtropical cities, weather factors may nonlinearly or interactively affect influenza activity. This study aims to assess the nonlinear and interactive effects of weather factors with influenza activity and compare the responses of influenza epidemic to weather factors in two subtropical regions of southern China (Shanghai and Hong Kong) and one temperate province of Canada (British Columbia). Weekly data on influenza activity and weather factors (i.e., mean temperature and relative humidity (RH)) were obtained from pertinent government departments for the three regions. Absolute humidity (AH) was measured by vapor pressure (VP), which could be converted from temperature and RH. Generalized additive models were used to assess the exposure-response relationship between weather factors and influenza virus activity. Interactions of weather factors were further assessed by bivariate response models and stratification analyses. The exposure-response curves of temperature and VP, but not RH, were consistent among three regions/cities. Bivariate response model revealed a significant interactive effect between temperature (or VP) and RH (P < 0.05). Influenza peaked at low temperature or high temperature with high RH. Temperature and VP are important weather factors in developing a universal model to explain seasonal outbreaks of influenza. However, further research is needed to assess the association between weather factors and influenza activity in a wider context of social and environmental conditions.

  4. RISQy Business (Relationships, Incentives, Supports, and Quality): Evolution of the British Columbia Model of Primary Care (Patient-Centered Medical Home)

    PubMed Central

    MacCarthy, Dan; Hollander, Marcus J

    2014-01-01

    In 2002, the British Columbia Ministry of Health and the British Columbia Medical Association (now Doctors of BC) came together to form the British Columbia General Practice Services Committee to bring about transformative change in primary care in British Columbia, Canada. This committee’s approach to primary care was to respond to an operational problem—the decline of family practice in British Columbia—with an operational solution—assist general practitioners to provide better care by introducing new incentive fees into the fee-for-service payment schedule, and by providing additional training to general practitioners. This may be referred to as a “soft power” approach, which can be summarized in the abbreviation RISQ: focus on Relationships; provide Incentives for general practitioners to spend more time with their patients and provide guidelines-based care; Support general practitioners by developing learning modules to improve their practices; and, through the incentive payments and learning modules, provide better Quality care to patients and improved satisfaction to physicians. There are many similarities between the British Columbian approach to primary care and the US patient-centered medical home. PMID:24867550

  5. RISQy business (Relationships, Incentives, Supports, and Quality): evolution of the British Columbia Model of Primary Care (patient-centered medical home).

    PubMed

    MacCarthy, Dan; Hollander, Marcus J

    2014-01-01

    In 2002, the British Columbia Ministry of Health and the British Columbia Medical Association (now Doctors of BC) came together to form the British Columbia General Practice Services Committee to bring about transformative change in primary care in British Columbia, Canada. This committee's approach to primary care was to respond to an operational problem--the decline of family practice in British Columbia--with an operational solution--assist general practitioners to provide better care by introducing new incentive fees into the fee-for-service payment schedule, and by providing additional training to general practitioners. This may be referred to as a "soft power" approach, which can be summarized in the abbreviation RISQ: focus on Relationships; provide Incentives for general practitioners to spend more time with their patients and provide guidelines-based care; Support general practitioners by developing learning modules to improve their practices; and, through the incentive payments and learning modules, provide better Quality care to patients and improved satisfaction to physicians. There are many similarities between the British Columbian approach to primary care and the US patient-centered medical home.

  6. Response to ‘Discussion: “Streamlined erosional residuals and drumlins in central British Columbia, Canada”’

    NASA Astrophysics Data System (ADS)

    McClenagan, J. Donald

    2014-03-01

    A response is given to 'Discussion: “Streamlined erosional residuals and drumlins in central British Columbia, Canada”'. Emphasis is made that the main purpose of the paper under discussion is to present the recognition of a distinctive landscape pattern in central British Columbia that appears to be an immense anastomosing channel network. A channel network of the magnitude described requires a large magnitude of flowing water to form it. Thus, that recognizable landscape pattern and associated upland landform shapes can be explained as products of water erosion. Such landscape patterns are observed being formed by water today.

  7. From medical astrology to medical astronomy: sol-lunar and planetary theories of disease in British medicine, c. 1700-1850.

    PubMed

    Harrison, M

    2000-03-01

    After 1700, astrology lost the respect it once commanded in medical circles. But the belief that the heavens influenced bodily health persisted - even in learned medicine - until well into the nineteenth century. The continuing vitality of these ideas owed much to the new empirical and mechanical outlook of their proponents. Taking their cue from the work of Robert Boyle and Richard Mead, a number of British practitioners amassed statistical evidence which purported to prove the influence of the Moon upon fevers and other diseases. Such ideas flourished in the colonies and in the medical services of the armed forces, but their exponents were not marginal men. Some, like James Lind, were widely respected and drew support for their views from such influential figures as Erasmus Darwin.

  8. Green Consciousness or Dollar Diplomacy? The British Response to the Threat of Ozone Depletion.

    ERIC Educational Resources Information Center

    Maxwell, James H.; Weiner, Sanford L.

    1993-01-01

    Discusses the British role in the regulation of believed ozone-depleting substances such as chlorofluorocarbons. Recounts the history of the British policies during the emergence of the issue from 1974-80; a period of tactical resistance from 1980-87; and a change in policy from 1987-90. (66 references) (MDH)

  9. The integration of acupuncture within medicine in the UK--the British Medical Acupuncture Society's 25th anniversary.

    PubMed

    Baldry, Peter

    2005-03-01

    Acupuncture was first used in China, probable about 2000 years ago. When acupuncture first arrived in the West in the 17th century, the principles which the Chinese had used to explain its actions were at variance with current scientific knowledge of the body's structure and function. This led to the rejection of acupuncture by the medical profession in the UK, although individual practitioners adopted it with enthusiasm, usually needling the point of maximal tenderness to treat musculoskeletal pain. Acupuncture was more generally accepted in France and Germany, where the pioneering British physician Felix Mann encountered it in the 1950s. He then taught acupuncture to other medical practitioners and organised regular meetings in London, from which the British Medical Acupuncture Society, BMAS, emerged in 1980. The tradition of biannual scientific meetings has continued since then. The Society has many connections with prominent acupuncturists internationally and is a founder member of the International Council of Medical Acupuncture and Related Techniques (ICMART), and has hosted two world congresses. The Society was involved in standardisation of the meridian nomenclature published in 1990. The Society's scientific journal, Acupuncture in Medicine, was founded in 1981 and has gained international recognition, being indexed on several databases. The Society has established regular teaching courses at different levels, which lead to professional qualifications of Certificate and Diploma. The membership is now open to different health professionals, has grown steadily and now stands at nearly 2500. The Society is administered from offices in Cheshire and London. Many individual members have contributed to the Society's characteristic Western 'medical' approach to acupuncture in which needling is seen as a form of neuromuscular stimulation that owes little to traditional meridians or points. The Society has shown a particular interest in acupuncture for myofascial

  10. The use of medical evidence in British trials of suspected Japanese war criminals.

    PubMed

    Roland, Charles G

    2010-01-01

    War crimes trial records are a little-used but fertile source of medical-historical information. They are, however, especially useful when investigating conditions affecting incarcerated Allied servicemen in the Far East because almost all cases are supported by a substantial volume of testimony and depositions by medical personnel. Many national archives contain such material and their holdings are discussed briefly.

  11. Radiation oncology and medical physicists quality assurance in British Columbia Cancer Agency Provincial Prostate Brachytherapy Program.

    PubMed

    Keyes, Mira; Morris, William James; Spadinger, Ingrid; Araujo, Cynthia; Cheung, Arthur; Chng, Nick; Crook, Juanita; Halperin, Ross; Lapointe, Vince; Miller, Stacy; Pai, Howard; Pickles, Tom

    2013-01-01

    To describe in detail British Columbia (BC) Cancer Agency (BCCA) Provincial Prostate Brachytherapy (PB) Quality Assurance (QA) Program. The BCCA PB Program was established in 1997. It operates as one system, unified and supported by electronic and information systems, making it a single PB treatment provider for province of BC and Yukon. To date, >4000 patients have received PB (450 implants in 2011), making it the largest program in Canada. The Program maintains a large provincial prospective electronic database with records on all patients, including disease characteristics, risk stratification, pathology, preplan and postimplant dosimetric data, follow-up of prostate-specific antigen, and toxicity outcomes. QA was an integral part of the program since its inception. A formal QA Program was established in 2002, with key components that include: unified eligibility criteria and planning system, comprehensive database, physics and oncologist training and mentorship programs, peer review process, individual performance outcomes and feedback process, structured continuing education and routine assessment of the program's dosimetry, toxicity and prostate-specific antigen outcomes, administration and program leadership that promotes a strong culture of patient safety. The emphasis on creating a robust, broad-based network of skilled providers has been achieved by the program's requirements for training, education, and the QA process. The formal QA process is considered a key factor for the success of cancer control outcomes achieved at BCCA. Although this QA model may not be wholly transferable to all PB programs, some of its key components may be applicable to other programs to ensure quality in PB and patient safety. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  12. "Mended or ended?" Football injuries and the British and American medical press, 1870-1910.

    PubMed

    Park, R J

    2001-01-01

    'Playing Hurt/Playing Tough', a dominant ideology in today's football (soccer, rugby, American 'gridiron'), is by no means new. Many books, monographs, and articles have examined the historical development of these games, but the attention given to them in the medical press during the late 1800s/early 1900s has been overlooked. The Lancet, Journal of the American Medical Association, and other turn-of-the-century medical publications regularly included accounts and descriptions of injuries and deaths. More telling were the many editorials in which physicians in both Britain and the United States expressed enthusiasm while also lamenting the games' physical and morale effects upon players, asking whether 'football' should be mended or ended.

  13. The medical response to trench nephritis in World War One.

    PubMed

    Atenstaedt, R L

    2006-08-01

    Around the 90-year anniversary of the Battle of the Somme, it is important to remember the international effort that went into responding to the new diseases, which appeared during the First World War, such as trench nephritis. This condition arose among soldiers in spring 1915, characterized by breathlessness, swelling of the face or legs, headache, sore throat, and the presence of albumin and renal casts in urine. It was speedily investigated by the military-medical authorities. There was debate over whether it was new condition or streptococcal nephritis, and the experts agreed that it was a new condition. The major etiologies proposed were infection, exposure, and diet (including poisons). Research pointed to the origin of the disease as being infective rather than toxic, but no definite cause was discovered. A number of labels were given to the disease, including war nephritis. However, trench nephritis was the one used most widely. Trench nephritis was a serious problem for the Allies, leading to 35 000 casualties in the British and 2000 in the American forces. There were also hundreds of deaths. The condition was treated in line with pre-war regimens designed for acute nephritis. No significant preventative methods were implemented for trench nephritis, as there was no consensus regarding causation. The medical response to trench nephritis was largely ineffective, with medical commentators recognizing that there had been a lack of medical progress.

  14. Aquifer responses to El Niño-Southern Oscillation, Southwest British Columbia.

    PubMed

    Fleming, Sean W; Quilty, Edward J

    2006-01-01

    We used climatological composite analysis to investigate El Niño-Southern Oscillation (ENSO) signals in long-term shallow ground water level observations from four wells in the lower Fraser Valley of British Columbia. Significance of differences between warm-phase, cold-phase, and neutral climate states was assessed with a Monte Carlo bootstrap technique. We also considered time series of local precipitation and streamflow for comparison. Composite annual hyetographs suggest that ENSO precipitation impacts are largely limited to winter and spring, with higher and lower rainfall occurring, respectively, under cold-phase and warm-phase episodes. This is consistent with prior work in the region and is found to be directly reflected in both streamflow and ground water level data. The mean magnitude of ENSO terrestrial hydrologic anomalies can be up to approximately 50% of the average seasonal cycle amplitude. ENSO does not appear to systematically affect annual hydrometeorological cycle timing in this study area. However, relative to the surface hydrologic systems considered, aquifers are observed to retain a stronger memory of seasonal ENSO-related precipitation anomalies, with changes potentially extending through the following summer, presumably reflecting storage effects. Most responses appear to be somewhat nonlinear.

  15. Personality, lifestyles, alcohol and drug consumption in a sample of British medical students.

    PubMed

    Ashton, C H; Kamali, F

    1995-05-01

    Personality characteristics and lifestyle variables were assessed in two cohorts of second-year medical students at the University of Newcastle upon Tyne, UK as part of a psychopharmacology 'teach-in' in 1993 and 1994. The pooled sample included 186 students: 77 men, 109 women, mean age 20.4 +/- 1.8 years. Measures included the Eysenck Personality Questionnaire, the Hospital Anxiety Depression Scale, and a questionnaire concerning consumption of alcohol, tobacco, cannabis and other illicit drugs, and physical exercise. The results were compared, where possible, with a similar survey in Newcastle upon Tyne medical students in 1983 and 1984. Personality variables, prevalence of cigarette smoking, levels of caffeine consumption and participation in sports had not changed significantly over the decade. There appeared to be a modest overall increase in alcohol consumption and in the 1993 and 1994 cohorts of students, 25.5% of those who drank alcohol exceeded recommended low risk levels (comparable data not available for 1983 and 1984). Reported use of cannabis and other illicit drugs had more than doubled, and in the present survey 49.2% of students recorded using cannabis and 22% had tried other illicit drugs. Corresponding figures for 1983 and 1984 were 20.9% for cannabis and 3.3% for other illicit drugs. Anxiety levels were not measured in 1983 and 1984 but in the present survey 39.3% of the students had anxiety ratings within the clinically significant range. The high levels of alcohol consumption and illicit drug use, and the high anxiety ratings, in this sample of medical students are a cause for concern.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. Therapeutic drug monitoring (TDM) of antifungal agents: guidelines from the British Society for Medical Mycology.

    PubMed

    Ashbee, H Ruth; Barnes, Rosemary A; Johnson, Elizabeth M; Richardson, Malcolm D; Gorton, Rebecca; Hope, William W

    2014-05-01

    The burden of human disease related to medically important fungal pathogens is substantial. An improved understanding of antifungal pharmacology and antifungal pharmacokinetics-pharmacodynamics has resulted in therapeutic drug monitoring (TDM) becoming a valuable adjunct to the routine administration of some antifungal agents. TDM may increase the probability of a successful outcome, prevent drug-related toxicity and potentially prevent the emergence of antifungal drug resistance. Much of the evidence that supports TDM is circumstantial. This document reviews the available literature and provides a series of recommendations for TDM of antifungal agents.

  17. What is newsworthy? Longitudinal study of the reporting of medical research in two British newspapers

    PubMed Central

    Bartlett, Christopher; Sterne, Jonathan; Egger, Matthias

    2002-01-01

    Objective To assess the characteristics of medical research that is press released by general medical journals and reported in newspapers. Design Longitudinal study. Data sources All original research articles published in Lancet and BMJ during 1999 and 2000. Main outcome measures Inclusion of articles in Lancet or BMJ press releases, and reporting of articles in Times or Sun newspapers. Results Of 1193 original research articles, 517 (43%) were highlighted in a press release and 81 (7%) were reported in one or both newspapers. All articles covered in newspapers had been press released. The probability of inclusion in press releases was similar for observational studies and randomised controlled trials, but trials were less likely to be covered in the newspapers (odds ratio 0.15 (95% confidence interval 0.06 to 0.37)). Good news and bad news were equally likely to be press released, but bad news was more likely to be reported in newspapers (1.74 (1.07 to 2.83)). Studies of women's health, reproduction, and cancer were more likely to be press released and covered in newspapers. Studies from industrialised countries other than Britain were less likely to be reported in newspapers (0.51 (0.31 to 0.82)), and no studies from developing countries were covered. Conclusions Characteristics of articles were more strongly associated with selection for reporting in newspapers than with selection for inclusion in press releases, although each stage influenced the reporting process. Newspapers underreported randomised trials, emphasised bad news from observational studies, and ignored research from developing countries. What is already known on this topicNewspapers are an important source of information about the results of medical researchThere are two stages on the path to newspaper coverage—selection by medical journal editors of articles to be press released and the selection of newsworthy articles by journalistsWhat this study addsExamination of press releasing by the

  18. Therapeutic drug monitoring (TDM) of antifungal agents: guidelines from the British Society for Medical Mycology

    PubMed Central

    Ashbee, H. Ruth; Barnes, Rosemary A.; Johnson, Elizabeth M.; Richardson, Malcolm D.; Gorton, Rebecca; Hope, William W.

    2014-01-01

    The burden of human disease related to medically important fungal pathogens is substantial. An improved understanding of antifungal pharmacology and antifungal pharmacokinetics–pharmacodynamics has resulted in therapeutic drug monitoring (TDM) becoming a valuable adjunct to the routine administration of some antifungal agents. TDM may increase the probability of a successful outcome, prevent drug-related toxicity and potentially prevent the emergence of antifungal drug resistance. Much of the evidence that supports TDM is circumstantial. This document reviews the available literature and provides a series of recommendations for TDM of antifungal agents. PMID:24379304

  19. Do members of the British public know how to contact emergency medical services when abroad?

    PubMed

    Hudson, Kate R; Jawad, Maryam; Kingdon, Samantha; Thomas, Elin H; Roalfe, Andrea K; Daley, Amanda J

    2013-06-01

    There is increased demand for emergency healthcare by the public when abroad. This study aimed to investigate adults' reported level of knowledge about how to contact emergency healthcare services while abroad. A street survey was administered at various times, over several days, to 554 members of the general public who had been abroad in the previous 18 months. Only 33.6% [95% confidence interval (29.6%-37.7%)] of respondents reported that they knew the emergency medical number for the country last visited. This did not differ by sex (34.2% males vs. 33% females). Those fluent in the language of the country last visited were more likely to report knowing the emergency number for that country (54%), compared with those who were not (24.8%) (P<0.001). It is concerning that the majority of the general public do not appear to know how to contact emergency medical services while abroad. More targeted health education campaigns that address this are needed.

  20. Emergency Medical Response Capability Analysis

    DTIC Science & Technology

    1982-07-01

    communication and information transfer between Federal PHS regional staff and individuals responsible for health disaster planning within state health ...study efforts to support the substantial level of advanced planning that is required. II. METHODOLOGY Information on the evolution of civilian health ...Administration - Alcohol, Drug and Mental Health Administration - Centers for Disease Control Veterans Administration Department of Defense - Department of

  1. An assessment of the accuracy and utility of the primary care electronic medical record as used by the British Army.

    PubMed

    Cox, Andrew T; Gillingham, S; Johnson, S A; Sharma, S; Wilson, D

    2016-10-01

    For the purposes of patient safety, audit and research, the electronic patient record (EPR) must be accurate and searchable. No evaluation of the accuracy of EPRs compared with paper records has been made. Furthermore, the use of Read codes is known to be heterogeneous. This study was designed to evaluate the EPR used by the UK Armed Forces. A cross-sectional study reviewing the paper records and EPRs of 50 consecutive soldiers posted to a British Army Training Regiment. There was a pre-enlistment summary in only 38% of the paper notes, although 24% had some primary care records from prior to enlistment. There were 357 entries that should have been transferred to the EPR. Of these, only 190 (53.2%) were transferred with appropriate Read codes, while only 24% of patients reviewed had all their entries appropriately Read coded. There were 168 secondary care letters discovered with 122 (72.6%) generically Read coded and 46 (27.4%) using an appropriate Read code. Of those letters with more than one potential Read code, 34 (73.9%) were coded using all appropriate Read codes. Several incidental errors in the medical records were also discovered with significant patient safety implications. The historical paper-based medical record was found to have many data missing. The transfer of these paper records to the EPR has been inaccurate with many records not transferred or transferred ineffectively. These findings have an impact on patient safety, audit and data security and should trigger a review of how the Armed Forces manage their primary care records. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  2. Framing Higher Education: Questions and Responses in the British Social Attitudes Survey, 1983-2010

    ERIC Educational Resources Information Center

    Mountford-Zimdars, Anna; Jones, Steven; Sullivan, Alice; Heath, Anthony

    2013-01-01

    This article focuses on questions and attitudes towards higher education in the British Social Attitudes (BSA) survey series. First, we analyse the changing BSA questions (1983-2010) in the context of key policy reports. Our results show that changes in the framing of higher education questions correspond with changes in the macro-discourse of…

  3. Effect of British-made videotapes on clinical performance of medical students in Pakistan.

    PubMed

    Mir, M A; Saeed, A K

    1990-01-01

    The efficacy of videotapes, recorded in Cardiff, in improving the clinical performance of final-year medical students in Abbottabad (Pakistan) was tested, by carrying out a structured, stepwise, clinical assessment before and after video teaching in 32 students. All students examined eight systems/subsystems at eight stations and spent 5 min with each patient, during which their performance was checked against structured check-lists by eight examiners. These students had not received any clinical instruction from a specialist rheumatologist, neurologist or endocrinologist during their clinical apprenticeship. Before the video teaching they performed poorly when examining the knee joint, motor system, hands and thyroid status, but when tested again 2 days after video teaching, there was a transformation in their clinical behaviour and their mean (s.d.) score improved from 40 (6.6 per cent) to 57.6 (9.4 per cent; P = 0.001). In contrast to their pre-video performance, they interacted well with the patients and examiners providing a running commentary of their findings, as demonstrated in the videotapes. Among the residual problems were a poor technique of testing tendon reflexes and percussion. All the examiners and 21 of 32 students thought that the structured examination was fairer than the conventional examination. Of the 32 students, 20 thought that video teaching was less effective than personal bedside teaching, while 12 students thought that video was structured better than bedside instruction. All students would welcome video teaching to supplement their existing teaching and would like the structured examination introduced to their curriculum. This study suggests that videotaped demonstrations can be used effectively in transmitting clinical skills to students not exposed to clinical teaching by specialists in various subjects.

  4. 'A band of brothers'-an exploration of the range of medical ethical issues faced by British senior military clinicians on deployment to Afghanistan: a qualitative study.

    PubMed

    Bernthal, Elizabeth M; Draper, H J A; Henning, J; Kelly, J C

    2017-06-01

    To identify and explore features of ethical issues that senior clinicians faced as deployed medical directors (DMDs) to the British Field Hospital in Afghanistan as well as to determine the ethical training requirements for future deployments. A qualitative study in two phases conducted from November 2014 to June 2015. Phase 1 analysed 60 vignettes of cases that had generated ethical dilemmas for DMDs. Phase 2 included focus groups and an interview with 13 DMDs. Phase 1 identified working with limited resources, dual conflict of meeting both clinical and military obligations and consent of children as the most prevalent ethical challenges. Themes found in Phase 2 included sharing clinical responsibilities with clinicians from other countries and not knowing team members' ways of working, in addition to the themes from Phase 1. This study has drawn together examples of scenarios to form a repository that will aid future training. Recommendations included undertaking ethics training together as a team before, during and after deployment which must include all nationalities who are assigned to the same operational tour, so that different ethical views can be explored beforehand. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  5. Medical responsibility in the United Arab Emirates.

    PubMed

    Benomran, Fawzi

    2010-05-01

    Medical responsibility in the United Arab Emirates was formerly defined and governed according to Law 7 of 1975 for the practice of medical professions, which had been a part of civil law. The passing of Law 10 of 2008, namely the "Law on Medical Responsibility in UAE", enacted on 16th December 2008 created a new framework to deal with this issue. One of its provisions required medical practitioners to hold insurance policies, so that insurance companies pays damages to the plaintiff (patient) injured as a result of a physicians' negligence. This paper outlines the issue of medical responsibility and medical negligence. The author's translation of the new law into English is included so that its full text is available for the readers, especially expatriate doctors working in the UAE. Where appropriate, a brief comparison between the old law and new laws is also presented. The objective of this paper is to provide medical practitioners with basic information about the subject in general and to this legislation in particular. It is mandatory for doctors to realize inherent risks involved in the course of their practice. A basic knowledge of the law is required to avoid pitfalls and to safeguard oneself against errors arising from ignorance of the duties and rights of the professional person.

  6. Medical ethics and education for social responsibility.

    PubMed Central

    Roemer, M. I.

    1980-01-01

    The physician, said Henry Sigerist in 1940, has been acquiring an increasingly social role. For centuries, however, codes of medical ethics have concentrated on proper behavior toward individual patients and almost ignored the doctor's responsibilities to society. Major health service reforms have come principally from motivated lay leadership and citizen groups. Private physicians have been largely hostile toward movements to equalize the economic access for people to medical care and improve the supply and distribution of doctors. Medical practice in America and throughout the world has become seriously commercialized. In response, governments have applied various strategies to constrain physicians and induce more socially responsible behavior. But such external pressures should not be necessary if a broad socially oriented code of medical ethics were followed. Health care system changes would be most effective, but medical education could be thoroughly recast to clarify community health problems and policies required to meet them. Sigerist proposed such a new medical curriculum in 1941; if it had been introduced, a social code of medical ethics would not now seem utopian. An international conference might well be convened to consider how physicians should be educated to reach the inspiring goals of the World Health Organization. PMID:7405276

  7. [Medical response to precariousness and poverty].

    PubMed

    Hassin, J

    1996-10-01

    If there is a medical response to precariousness and extreme poverty, there is no illness that is specific of the poor. Diseases that are commonly found here result from the state of being homeless and often addicted. One possible medical response to the problem is to establish specialized institutions as, in Paris, the Nanterre hospital, the Social SAMU (Service d'aide médicale urgente) medical dormitories, and several outpatient clinics for precarious people. The present debate on a "two-tiers medicine" must be considered with pragmatism. Specific structures have to be imagined like places for reception and orientation that allow these patients to get access to general rights for protection and assistance.

  8. [The notion of medical responsibility. Current evolution].

    PubMed

    Michaud, J

    1998-01-01

    Medical responsibility can be evaluated from a penal or a civil standpoint. In the first case it is referable to common law or other specific provisions, notably those included in the laws voted on July 29 1994. In the second case it is viewed within the contractual relationship, since the physician's obligation is theoretically one of means and not of results. The circumstances under which medical responsibility is questioned have evolved under the influence of three factors affecting the medical art: it is now characterized by techniques that have often become scientific; team practice; an increase in patients' demands. Nonetheless it is most important to maintain a genuine relationship of trust between physician and patient.

  9. NASA Medical Response to Human Spacecraft Accidents

    NASA Technical Reports Server (NTRS)

    Patlach, Robert

    2010-01-01

    Manned space flight is risky business. Accidents have occurred and may occur in the future. NASA's manned space flight programs, with all their successes, have had three fatal accidents, one at the launch pad and two in flight. The Apollo fire and the Challenger and Columbia accidents resulted in a loss of seventeen crewmembers. Russia's manned space flight programs have had three fatal accidents, one ground-based and two in flight. These accidents resulted in the loss of five crewmembers. Additionally, manned spacecraft have encountered numerous close calls with potential for disaster. The NASA Johnson Space Center Flight Safety Office has documented more than 70 spacecraft incidents, many of which could have become serious accidents. At the Johnson Space Center (JSC), medical contingency personnel are assigned to a Mishap Investigation Team. The team deploys to the accident site to gather and preserve evidence for the Accident Investigation Board. The JSC Medical Operations Branch has developed a flight surgeon accident response training class to capture the lessons learned from the Columbia accident. This presentation will address the NASA Mishap Investigation Team's medical objectives, planned response, and potential issues that could arise subsequent to a manned spacecraft accident. Educational Objectives are to understand the medical objectives and issues confronting the Mishap Investigation Team medical personnel subsequent to a human space flight accident.

  10. Eliminating child labour in Malawi: a British American Tobacco corporate responsibility project to sidestep tobacco labour exploitation

    PubMed Central

    Otañez, M G; Muggli, M E; Hurt, R D; Glantz, S A

    2006-01-01

    Objectives To examine British American Tobacco and other tobacco industry support of the Eliminating Child Labour in Tobacco Growing Foundation. Design Analyses of internal tobacco industry documents and ethnographic data. Results British American Tobacco co‐founded the Eliminating Child Labour in Tobacco Growing Foundation (ECLT) in October 2000 and launched its pilot project in Malawi. ECLT's initial projects were budgeted at US$2.3 million over four years. Labour unions and leaf dealers, through ECLT funds, have undertook modest efforts such as building schools, planting trees, and constructing shallow wells to address the use of child labour in tobacco farming. In stark contrast, the tobacco companies receive nearly US$40 million over four years in economic benefit through the use of unpaid child labour in Malawi during the same time. BAT's efforts to combat child labour in Malawi through ECLT was developed to support the company's “corporate social responsibility agenda” rather than accepting responsibility for taking meaningful steps to eradicate child labour in the Malawi tobacco sector. Conclusion In Malawi, transnational tobacco companies are using child labour projects to enhance corporate reputations and distract public attention from how they profit from low wages and cheap tobacco. PMID:16728754

  11. A grim contradiction: the practice and consequences of corporate social responsibility by British American Tobacco in Malaysia.

    PubMed

    Barraclough, Simon; Morrow, Martha

    2008-04-01

    In the wake of the World Health Organization Framework Convention on Tobacco Control, corporate social responsibility (CSR) is among the few remaining mechanisms for tobacco corporations publicly to promote their interests. Health advocates may be unaware of the scale, nature and implications of tobacco industry CSR. This investigation aimed to construct a typology of tobacco industry CSR through a case study of the evolution and impact of CSR activities of a particular tobacco corporation in one country - British American Tobacco, Malaysia (BATM), the Malaysian market leader. Methods included searching, compiling and critically appraising publicly available materials from British American Tobacco, BATM, published literature and other sources. The study examined BATM's CSR strategy, the issues which it raises, consequences for tobacco control and potential responses by health advocates. The investigation found that BATM's CSR activities included assistance to tobacco growers, charitable donations, scholarships, involvement in anti-smuggling measures, 'youth smoking prevention' programs and annual Social Reports. BATM has stated that its model is predominantly motivated by social and stakeholder obligations. Its CSR activities have, however, had the additional benefits of contributing to a favourable image, deflecting criticism and establishing a modus vivendi with regulators that assists BATM's continued operations and profitability. It is imperative that health advocates highlight the potential conflicts inherent in such arrangements and develop strategies to address the concerns raised.

  12. Preschooler Study: The Medical, Social and Economic Correlates of Poverty in Preschool Children of British Columbia. A Pilot Study.

    ERIC Educational Resources Information Center

    Tonkin, Roger S.; And Others

    Over 200 families from lower and middle income areas of British Columbia, including a group representing the Indian communities, were studied in this effort to examine poverty as it relates to families, especially to young children. A wide variety of health, social, and economic variables were examined in the hope of developing output criteria for…

  13. [The medical responsibility of an allergist].

    PubMed

    Vilanova, J

    1998-02-01

    The professional civil responsibility of an allergy physician should be restored to the more general framework of medical responsibility. This is at present the objective of considerable public debate. From now on it is known that the developments at present and to come for the most part go beyond the strict requirement of the juridical process. They take up fully a real choice of society. What place do we wish to give to physicians in the future? What new outlines relating to care should be adopted? What must be done for the victims of medical accidents? These are the fundamental questions that we ask ourselves today. The choices that apply, influence, must persuade our society, its made of action and the relationships between the various' components. It must be said that the stakes are enormous. It must also be said that all of this will not be achieved without clashes.

  14. Neutral Caregivers or Military Support? The British Red Cross, the Friends’ Ambulance Unit, and the Problems of Voluntary Medical Aid in Wartime

    PubMed Central

    2015-01-01

    During the First World War the British Red Cross Society (BRCS) served as the coordinating body for voluntary medical aid giving in Britain. Among the many units which came within its purview was the Friends’ Ambulance Unit (FAU), formed by a group of young men whose desire to serve their nation in wartime conflicted with their pacifist principles. Both the BRCS and the FAU were wracked by ideological conflicts in the years which preceded and throughout the war. These struggles over voluntarist identity highlight the contested meanings of service and conscience in wartime. Through a critical examination of the language of official histories and biographies, this article will argue that the war formed a key moment in the relationship between the British state and voluntary medical aid, with the state’s increasing role in the work of such organizations raising questions about the voluntarist principles to which aid organizations laid claim. The struggles that both organizations and individuals within them faced in reconciling the competing pressures that this new relationship created form a legacy of the war which continues to have important implications for the place of medical voluntarism in wartime today. PMID:26213442

  15. Neutral Caregivers or Military Support? The British Red Cross, the Friends' Ambulance Unit, and the Problems of Voluntary Medical Aid in Wartime.

    PubMed

    Meyer, Jessica

    2015-05-01

    During the First World War the British Red Cross Society (BRCS) served as the coordinating body for voluntary medical aid giving in Britain. Among the many units which came within its purview was the Friends' Ambulance Unit (FAU), formed by a group of young men whose desire to serve their nation in wartime conflicted with their pacifist principles. Both the BRCS and the FAU were wracked by ideological conflicts in the years which preceded and throughout the war. These struggles over voluntarist identity highlight the contested meanings of service and conscience in wartime. Through a critical examination of the language of official histories and biographies, this article will argue that the war formed a key moment in the relationship between the British state and voluntary medical aid, with the state's increasing role in the work of such organizations raising questions about the voluntarist principles to which aid organizations laid claim. The struggles that both organizations and individuals within them faced in reconciling the competing pressures that this new relationship created form a legacy of the war which continues to have important implications for the place of medical voluntarism in wartime today.

  16. Ethnic differences in thermal pain responses: a comparison of South Asian and White British healthy males.

    PubMed

    Watson, Paul J; Latif, R Khalid; Rowbotham, David J

    2005-11-01

    The expression and report of pain is influenced by social environment and culture. Previous studies have suggested ethnically determined differences in report of pain threshold, intensity and affect. The influence of ethnic differences between White British and South Asians has remained unexplored. Twenty age-matched, male volunteers in each group underwent evaluation. Cold and warm perception and cold and heat threshold were assessed using an ascending method of limits. Magnitude estimation of pain unpleasantness and pain intensity were investigated with thermal stimuli of 46, 47, 48 and 49 degrees C. Subjects also completed a pain anxiety questionnaire. Data was analysed using t-test, Mann-Whitney and repeated measures analysis of variance as appropriate. There were no differences in cold and warm perception between the two groups. There was a statistically significant difference between the two groups for heat pain threshold (P=0.006) and heat pain intensity demonstrated a significant effect for ethnicity (F=13.84, P=0.001). Although no group differences emerged for cold pain threshold and heat unpleasantness, South Asians demonstrated lower cold pain threshold and reported more unpleasantness at all temperatures but this was not statistically significant. Our study shows that ethnicity plays an important role in heat pain threshold and pain report, South Asian males demonstrated lower pain thresholds and higher pain report when compared with matched White British males. There were no differences in pain anxiety between the two groups and no correlations were identified between pain and pain anxiety Haemodynamic measures and anthropometry did not explain group differences.

  17. Bearing response-ability: theater, ethics and medical education.

    PubMed

    Rossiter, Kate

    2012-03-01

    This paper addresses a growing concern within the medical humanities community regarding the perceived need for a more empathically-focused medical curricula, and advocates for the use of creative pedagogical forms as a means to attend to issues of suffering and relationality. Drawing from the ethical philosophy of Emmanuel Levinas, I critique the notion of empathy on the basis that it erases difference and disregards otherness. Rather, I propose that the concept of empathy may be usefully replaced with that of ethical responsibility, which suggests a shared sense of humanity outside the boundaries of presumed knowledge of the other. To illustrate this argument, I theorize the importance of theater within medical education. Theater, I argue, may engender ethical responsibility in the Levinasian sense, and thus may allow learners to differently engage with the experience of the suffering other. As such, I examine Margaret Edson's widely used play Wit as a platform for such an ethical encounter to occur. Thus, rather than working to understand the value of theater in medical education in terms of knowledge and skill acquisition, I theorize that its primacy within medical curricula arises from its ethical/relational potential, or potential to engender new forms of inter-human relationality.

  18. Twenty years of ecosystem response after clearcutting and slashburning in conifer forests of central British Columbia, Canada

    PubMed Central

    Feller, Michael; Bradfield, Gary

    2017-01-01

    Forests are being clearcut over extensive areas of western North America, but plant community response to harvesting and slashburning under varying climatic conditions in central British Columbia, Canada is still largely unknown. Evaluation of resilience is hampered by the short history of logging, lack of long-term experiments and methodological limitations. To test the effect of clearcut logging, prescribed burning and reforestation on forest resilience, we recorded vascular plant cover repeatedly after treatment between 1981 and 2008 in 16 permanent research installations in three biogeoclimatic zones: Engelmann Spruce-Subalpine Fir, Interior Cedar-Hemlock and Sub-Boreal Spruce. We created a plant-trait dataset for the 181 recorded species to define plant functional types representing groups of plants that behave in similar ways and/or produce similar ecological outcomes. These plant functional types, along with taxonomic analysis of diagnostic and indicator species, were then used to evaluate plant community response to disturbance. Twenty years post-treatment, species diversity increased in all zones and plant abundance was greatest in the Interior Cedar-Hemlock. Cover of understory plant functional types associated with mature conifer forests increased in all zones, constituting a significant proportion (> 40%) of the vegetation community by year 20. Response patterns varied by zone and with time. Understory species diagnostic of mature forests were present in all zones by year 20, but we identified indicator species sensitive to slashburning or requiring more time for recovery, including white-flowered rhododendron (Rhododendron albiflorum) and devil's club (Oplopanax horridus). Overall, loss of compositional or functional diversity following harvest and site remediation was not detected, suggesting that montane and subalpine forests in British Columbia are resilient to this treatment. However, because these forests can be slow to recover from disturbance

  19. Twenty years of ecosystem response after clearcutting and slashburning in conifer forests of central British Columbia, Canada.

    PubMed

    Chandler, Julia R; Haeussler, Sybille; Hamilton, Evelyn H; Feller, Michael; Bradfield, Gary; Simard, Suzanne W

    2017-01-01

    Forests are being clearcut over extensive areas of western North America, but plant community response to harvesting and slashburning under varying climatic conditions in central British Columbia, Canada is still largely unknown. Evaluation of resilience is hampered by the short history of logging, lack of long-term experiments and methodological limitations. To test the effect of clearcut logging, prescribed burning and reforestation on forest resilience, we recorded vascular plant cover repeatedly after treatment between 1981 and 2008 in 16 permanent research installations in three biogeoclimatic zones: Engelmann Spruce-Subalpine Fir, Interior Cedar-Hemlock and Sub-Boreal Spruce. We created a plant-trait dataset for the 181 recorded species to define plant functional types representing groups of plants that behave in similar ways and/or produce similar ecological outcomes. These plant functional types, along with taxonomic analysis of diagnostic and indicator species, were then used to evaluate plant community response to disturbance. Twenty years post-treatment, species diversity increased in all zones and plant abundance was greatest in the Interior Cedar-Hemlock. Cover of understory plant functional types associated with mature conifer forests increased in all zones, constituting a significant proportion (> 40%) of the vegetation community by year 20. Response patterns varied by zone and with time. Understory species diagnostic of mature forests were present in all zones by year 20, but we identified indicator species sensitive to slashburning or requiring more time for recovery, including white-flowered rhododendron (Rhododendron albiflorum) and devil's club (Oplopanax horridus). Overall, loss of compositional or functional diversity following harvest and site remediation was not detected, suggesting that montane and subalpine forests in British Columbia are resilient to this treatment. However, because these forests can be slow to recover from disturbance

  20. Summertime climate response to mountain pine beetle disturbance in British Columbia

    NASA Astrophysics Data System (ADS)

    Maness, H.; Kushner, P. J.; Fung, I.

    2013-01-01

    The present mountain pine beetle infestation in forests in British Columbia ranks among the largest ecological disturbances recorded in Canada so far. These recent outbreaks are thought to have been favoured by large-scale climatic shifts, and may foreshadow outbreaks of a similar magnitude in North American forests over the coming decades. The associated forest dieback could result in substantial shifts in evapotranspiration and albedo, thereby altering the local surface energy balance, and in turn regional temperature and climate. Here we quantify the impact of the Canadian pine beetle disturbance on the local summertime surface energy budget, using measurements of evapotranspiration, albedo and surface temperature, obtained primarily through remote sensing. We show that over the 170,000km2 of affected forest, the typical decrease in summertime evapotranspiration is 19%. Changes to the absorbed short-wave flux are negligible, in comparison. As a result, outgoing sensible and radiative heat fluxes increased by 8% and 1%, respectively, corresponding to a typical increase in surface temperature of 1°C. These changes are comparable to those observed for other types of disturbance, such as wildfire, and may have secondary consequences for climate, including modifications to circulation, cloud cover and precipitation.

  1. Repeatability of Response to Asthma Medications

    PubMed Central

    Wu, Ann; Tantisira, Kelan; Li, Lingling; Schuemann, Brooke; Weiss, Scott

    2010-01-01

    Background Pharmacogenetic studies of drug response in asthma assume that patients respond consistently to a treatment but that treatment response varies across patients, however, no formal studies have demonstrated this. Objective To determine the repeatability of commonly used outcomes for treatment response to asthma medications: bronchodilator response, forced expiratory volume in 1 second (FEV1), and provocative concentration of methacholine producing a 20% decline in FEV1 (PC20). Methods The Childhood Asthma Management Program (CAMP) was a multi-center clinical trial of children randomized to receiving budesonide, nedocromil, or placebo. We determined the intraclass correlation coefficient (ICC) for each outcome over repeated visits over four years in CAMP using mixed effects regression models. We adjusted for the covariates: age, race/ethnicity, height, family income, parental education, and symptom score. We incorporated each outcome for each child as repeated outcome measurements and stratified by treatment group. Results The ICC for bronchodilator response was 0.31 in the budesonide group, 0.35 in the nedocromil group, and 0.40 in the placebo group, after adjusting for covariates. The ICC for FEV1 was 0.71 in the budesonide group, 0.60 in the nedocromil group, and 0.69 in the placebo group, after adjusting for covariates. The ICC for PC20 was 0.67 in the budesonide and placebo groups and 0.73 in the nedocromil group, after adjusting for covariates. Conclusion The within treatment group repeatability of FEV1 and PC20 are high; thus these phenotypes are heritable. FEV1 and PC20 may be better phenotypes than bronchodilator response for studies of treatment response in asthma. PMID:19064281

  2. Enantiospecific Pheromone Production and Response Profiles for Populations of Pine Engraver, Ips pini (SAY) (Coleoptera: Scolytidae), in British Columbia

    Treesearch

    D.R. Miller; J.H. Borden; K.N. Slessor

    1996-01-01

    Analyses of the enantiomeric composition of ipsdienol produced by individual male pine engravers, Ips pini (Say), from six populations in British Columbia, support the hypothesis that New York and Idaho races of this species hybridize in southeastern British Columbia. Production profiles, expressed as frequency distributions of (+):(-) ipsdienol...

  3. Commentary: the 1944 patulin trial: the first properly controlled multicentre trial conducted under the aegis of the British Medical Research Council.

    PubMed

    Chalmers, Iain; Clarke, Mike

    2004-04-01

    The 1948 report of the British Medical Research Council's randomized trial of streptomycin for pulmonary tuberculosis is widely regarded as marking the beginning of the modern history of controlled clinical trials. Four years earlier, however, a methodologically sophisticated multicentre trial conducted under the aegis of the Medical Research Council was reported, which assessed the effects of the antibiotic patulin on the course of common colds. Philip D'Arcy Hart and Joan Faulkner (later Joan Doll) were the secretary and assistant secretary, respectively, to the committee overseeing the trial, and they clearly recognized the importance of preventing foreknowledge of allocations from those admitting patients to the study. To do this and to 'muddle people up', they and Ruth D'Arcy Hart devised a scheme involving the use of two patulin groups and two placebo groups, allocating patients to one of these four groups using strict rotation. Philip D'Arcy Hart believes that this study has been overshadowed by the celebrated streptomycin trial (for which he was also secretary to the oversight committee) because no beneficial effect of patulin was detected, and because the report of the streptomycin trial referred to the use of random sampling numbers to generate the allocation schedule. This article makes clear why we agree with Philip D'Arcy Hart that the 1944 patulin trial deserves wider recognition as the first well controlled, multicentre clinical trial to have been conducted under the aegis of the British Medical Research Council. This status is reflected in the International Journal of Epidemiology's reproduction of the full text of the trial report in this issue of the journal.

  4. British Columbia

    ERIC Educational Resources Information Center

    Walton, Gerald

    2006-01-01

    The province of British Columbia has a dubious history where support for lesbian, gay, bisexual, and transgendered (LGBT) issues in education is concerned. Most notable is the Surrey School Board's decision in 1997 to ban three picture books for children that depict families with two moms or two dads. The North Vancouver School Board has also…

  5. British Columbia

    ERIC Educational Resources Information Center

    Walton, Gerald

    2006-01-01

    The province of British Columbia has a dubious history where support for lesbian, gay, bisexual, and transgendered (LGBT) issues in education is concerned. Most notable is the Surrey School Board's decision in 1997 to ban three picture books for children that depict families with two moms or two dads. The North Vancouver School Board has also…

  6. NASA Medical Response to Human Spacecraft Accidents

    NASA Technical Reports Server (NTRS)

    Patlach, Robert

    2011-01-01

    This slide presentation reviews NASA's role in the response to spacecraft accidents that involve human fatalities or injuries. Particular attention is given to the work of the Mishap Investigation Team (MIT), the first response to the accidents and the interface to the accident investigation board. The MIT does not investigate the accident, but the objective of the MIT is to gather, guard, preserve and document the evidence. The primary medical objectives of the MIT is to receive, analyze, identify, and transport human remains, provide assistance in the recovery effort, and to provide family Casualty Coordinators with latest recovery information. The MIT while it does not determine the cause of the accident, it acts as the fact gathering arm of the Mishap Investigation Board (MIB), which when it is activated may chose to continue to use the MIT as its field investigation resource. The MIT membership and the specific responsibilities and tasks of the flight surgeon is reviewed. The current law establishing the process is also reviewed.

  7. Medical Director Responsibilities to the ESRD Network

    PubMed Central

    DeOreo, Peter B.

    2015-01-01

    The 18 regional ESRD Networks are established in legislation and contract with the Centers for Medicare and Medicaid Services to improve the quality and safety of dialysis, maximize patient rehabilitation, encourage collaboration among and between providers toward common quality goals, and improve the reliability and the use of data in pursuit of quality improvement. The Networks are funded by a $0.50 per treatment fee deducted from the reimbursement to dialysis providers, and their deliverables are determined by a statement of work, which is updated in a new contract every 3 years. The Conditions for Coverage require dialysis providers to participate in Network activities, and failure to do so can be the basis for sanctions against the provider. However, the Networks attempt to foster a collegial relationship with dialysis facilities by offering tools, educational activities, and other resources to assist the facilities in meeting the evolving requirements by the Centers for Medicare and Medicaid Services on the basis of national aims and domains for quality improvement in health care that transcend the ESRD program. Because of his/her responsibility for implementing the quality assessment and performance improvement activities in the facility, the medical director has much to gain by actively participating in Network activities, especially those focused on quality, safety, patient grievance, patient engagement, and coordination of care. Membership on Network committees can also foster the professional growth of the medical director through participation in quality improvement activity development and implementation, authorship of articles in peer-reviewed journals, creation of educational tools and presentations, and application of Network-sponsored materials to improve patient outcomes, engagement, and satisfaction in the medical director’s facility. The improvement of care of patients on dialysis will be beneficial to the facility in achieving its goals of

  8. British Gujarati Indian immigrants' and British Caucasians' beliefs about health and illness.

    PubMed

    Jobanputra, Rena; Furnham, Adrian

    2005-12-01

    This study examined cultural differences in beliefs about health and illness to explore differences in younger and older British Caucasians' and British Gujarati Indian immigrants' beliefs about health and illness. This study required a matched group consisting of first- and second-generation Gujarati Indian immigrants and native British Caucasians to complete a questionnaire assessing their beliefs concerning health and illness. Factor analysis of the health beliefs questionnaire identified six clear factors accounting for 36.04% of the variance. Subsequent ANCOVAs conducted on the factor scores, partialling out the demographic differences between the participants, revealed that Gujarati Indian immigrants agreed with items reflecting supernatural explanations of ill health more than indigenous British Caucasian participants. Older Indian immigrants also rated chance-related factors as more important than older Caucasian immigrants. There were no significant differences between the Gujarati Indian immigrants and British Caucasians in terms of attributions made to psychological factors and self-responsibility, social factors and life circumstances, medical treatment and physical vulnerability and the external environment. Findings are discussed in relation to the model proposed by Helman (2001) and the impact of migration on health beliefs systems; practical implications of the findings are also highlighted.

  9. Hydrologic response of soils to precipitation at Carnation Creek, British Columbia, Canada

    NASA Astrophysics Data System (ADS)

    Fannin, R. J.; Jaakkola, J.; Wilkinson, J. M. T.; Hetherington, E. D.

    2000-02-01

    The extreme hydrologic response of gravelly, sandy soils in the Carnation Creek watershed is examined from observations at 12 standpipe piezometers. The nearly continuous piezometric data are reported as a time series of monthly maximum readings. Ten locations of measurement appear to exhibit an upper limit to the pore water pressure head that is independent of rainfall intensity and duration. Two locations exhibit artesian pressures that appear directly influenced by rainfall characteristics and may last for several hours. We found the impact of individual storms to be highly variable. The spatial variation in hydrologic response is attributed to the influence of preferential flow paths in the soil matrix.

  10. The diets of British schoolchildren. Sub-committee on Nutritional Surveillance. Committee on Medical Aspects of Food Policy.

    PubMed

    1989-01-01

    1. Statistical analysis and interpretation 1.1 This Report deals with the dietary habits of British schoolchildren and the contribution made by school meals in 1983. Since then many Local Education Authorities have introduced active policies to encourage healthy eating, accompanied in the last 4 years by health promotion campaigns, in the light of the publication of the COMA Report on Diet and Cardiovascular Disease in 1984, and other reports on diet and health. 1.2 Data are presented on the food and nutrient intakes of a representative sample of British schoolchildren measured by a 7-day record. Most food and some nutrient intakes were not normally distributed and median values are given in the tables of results. Interpretation and commentary are restricted to findings which achieved statistical significance (p less than 0.05) by parametric analyses. No non-parametric statistical analyses were attempted but data are given in detail in the tables and for those wishing to examine them further, the computer database of the survey is also available through the National Data Archive. Full documentation of the database may be obtained from the Social Survey Division of the Office of Population Censuses and Surveys, (OPCS) London. 2. Foods consumed 2.1 The main sources of dietary energy in the diets of British schoolchildren were bread, chips, milk, biscuits, meat products, cake and puddings. Almost all children in the survey recorded consumption of chips, crisps, cakes and biscuits. Boys recorded more chips consumed than girls along with more milk, breakfast cereals and baked beans; girls recorded more fruit consumed and more girls drank fruit juice than boys. Yogurt, fizzy drinks and sweets were more popular among younger children. Older children recorded consumption of more tea and coffee (para 9.2). 2.2 Scottish primary school children appeared to have a distinctive dietary pattern. They recorded higher median consumption of beef, soups, milk, cheese, sausages

  11. A content analysis of the UK press response to the diagnosis of Ebola in a British healthcare worker.

    PubMed

    Hobbs, Constance; Myles, Puja; Pritchard, Catherine

    2016-09-27

    The Ebola epidemic led to considerable media attention, which may influence public risk perception. Therefore, this study analysed the UK press response following diagnosis of a British healthcare worker (HCW) with Ebola. Using the Nexis database, the frequency of Ebola-related articles in UK national newspaper articles was mapped. This was followed by a content analysis of Ebola-related articles in the four newspapers with highest UK net readership from November 2014 to February 2015. During the 16-week study period, 1349 articles were found. The day with the highest number of Ebola-related articles was 31 December 2014, the day after the diagnosis of Ebola in a UK HCW. Seventy-seven articles were included in the content analysis. Content analysis demonstrated a shift from West African to UK-focused articles, increased discussion of border control, UK policy decisions and criticism, and an increased number of articles with a reassuring/threatening message. UK press coverage of Ebola increased following a HCW's diagnosis, particularly regarding discussion of screening measures. This is likely to have increased risk perception of Ebola in the UK population and may have contributed to subsequent strengthening of UK screening policy beyond World Health Organisation requirements. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  12. Canadian Medical Education Journal Survey evaluations of University of British Columbia residents’ education and attitudes regarding palliative care and physician assisted death

    PubMed Central

    Spicer, David; Paul, Sonia; Tang, Tom; Chen, Charlie; Chase, Jocelyn

    2017-01-01

    Background Little prior research has been conducted regarding resident physicians’ opinions on the subject of Physician Assisted Death (PAD), despite past surveys ascertaining the attitudes of practicing physicians towards PAD in Canada. We solicited British Columbia residents’ opinions on the amount of education they receive about palliative care and physician assisted death, and their attitudes towards the implementation of PAD. Methods We conducted a cross sectional, anonymous online survey with the resident physicians of British Columbia, Canada. Questions included: close-ended questions, graded Likert scale questions, and comments. Results Among the respondents (n=299, response rate 24%), 44% received ≥5 hours of education in palliative care, 40% received between zero and four hours of education, and 16% reported zero hours. Of all respondents, 75% had received no education about PAD and the majority agreed that there should be more education about palliative care (74%) and PAD (85%). Only 35% of residents felt their program provided them with enough education to make an informed decision about PAD, yet 59% would provide a consenting patient with PAD. Half of the respondents believed PAD would ultimately be provided by palliative care physicians. Interpretation Residents desire further education about palliative care and PAD. Training programs should consider conducting a thorough needs assessment and implementing structured education to meet this need. PMID:28344712

  13. Canadian Medical Education Journal Survey evaluations of University of British Columbia residents' education and attitudes regarding palliative care and physician assisted death.

    PubMed

    Spicer, David; Paul, Sonia; Tang, Tom; Chen, Charlie; Chase, Jocelyn

    2017-02-01

    Little prior research has been conducted regarding resident physicians' opinions on the subject of Physician Assisted Death (PAD), despite past surveys ascertaining the attitudes of practicing physicians towards PAD in Canada. We solicited British Columbia residents' opinions on the amount of education they receive about palliative care and physician assisted death, and their attitudes towards the implementation of PAD. We conducted a cross sectional, anonymous online survey with the resident physicians of British Columbia, Canada. Questions included: close-ended questions, graded Likert scale questions, and comments. Among the respondents (n=299, response rate 24%), 44% received ≥5 hours of education in palliative care, 40% received between zero and four hours of education, and 16% reported zero hours. Of all respondents, 75% had received no education about PAD and the majority agreed that there should be more education about palliative care (74%) and PAD (85%). Only 35% of residents felt their program provided them with enough education to make an informed decision about PAD, yet 59% would provide a consenting patient with PAD. Half of the respondents believed PAD would ultimately be provided by palliative care physicians. Residents desire further education about palliative care and PAD. Training programs should consider conducting a thorough needs assessment and implementing structured education to meet this need.

  14. The intimidation of British pediatricians.

    PubMed

    Jenny, Carole

    2007-04-01

    British pediatricians who diagnose and treat child abuse cases have come under attack by the British press and by parents who have been investigated for possible abuse. Now the General Medical Council also is intimidating these pediatricians. The General Medical Council is the licensing authority for physicians in the United Kingdom. This has resulted in fewer pediatricians being willing to care for abused children or to testify in child abuse cases. In the United States, the recent recognition of the pediatric subspecialty of child abuse pediatrics should help set standards for child abuse medical evaluation and testimony.

  15. Targeting brains, producing responsibilities: the use of neuroscience within British social policy.

    PubMed

    Broer, Tineke; Pickersgill, Martyn

    2015-05-01

    Concepts and findings 'translated' from neuroscientific research are finding their way into UK health and social policy discourse. Critical scholars have begun to analyse how policies tend to 'misuse' the neurosciences and, further, how these discourses produce unwarranted and individualizing effects, rooted in middle-class values and inducing guilt and anxiety. In this article, we extend such work while simultaneously departing from the normative assumptions implied in the concept of 'misuse'. Through a documentary analysis of UK policy reports focused on the early years, adolescence and older adults, we examine how these employ neuroscientific concepts and consequently (re)define responsibility. In the documents analysed, responsibility was produced in three different but intersecting ways: through a focus on optimisation, self-governance, and vulnerability. Our work thereby adds to social scientific examinations of neuroscience in society that show how neurobiological terms and concepts can be used to construct and support a particular imaginary of citizenship and the role of the state. Neuroscience may be leveraged by policy makers in ways that (potentially) reduce the target of their intervention to the soma, but do so in order to expand the outcome of the intervention to include the enhancement of society writ large. By attending as well to more critical engagements with neuroscience in policy documents, our analysis demonstrates the importance of being mindful of the limits to the deployment of a neurobiological idiom within policy settings. Accordingly, we contribute to increased empirical specificity concerning the impacts and translation of neuroscientific knowledge in contemporary society whilst refusing to take for granted the idea that the neurosciences necessarily have a dominant role (to play).

  16. British Thoracic Society Study on cryptogenic fibrosing alveolitis: response to treatment and survival

    PubMed Central

    Rudd, Robin M; Prescott, Robin J; Chalmers, J C; Johnston, Ian D A

    2007-01-01

    Background and objective The initial results of a survey of 588 patients with a clinical presentation of cryptogenic fibrosing alveolitis (CFA) also known as idiopathic pulmonary fibrosis, have been published. This article reports further results pertaining to response to treatment and survival. Methods Data on the treatment given and lung function response were collected over 4–6 years. Survival data were collected over 10 years. Results Treatment was given to 445 (76%) patients, 55% were given prednisolone alone and the remainder another immunosuppressive agent, usually with prednisolone. Treated patients had worse lung function initially. At 3 months after study entry, treated patients were more likely to have improved forced vital capacity (FVC) than the untreated patients. Patients whose FVC improved were younger (p = 0.001 analysis of variance (ANOVA)) and had lower initial FVC (p<0.001, ANOVA). Patients who responded to treatment at 3 months or at 1 year survived longer than those who remained stable, who in turn survived longer than those who deteriorated (p = 0.002). These differences were largely accounted for by patients with better lung function surviving longer. Younger age at entry, female sex and higher percentage predicted FVC and reduced carbon monoxide transfer factor at study entry were associated with greater chances of survival at 4 years. Overall median survival from entry was 2.43 years (95% confidence interval (CI) 2.17 to 3.18). Conclusions About a third of patients with CFA showed improved lung function after initiation of corticosteroid or immunosuppressive treatment, and those who improved survived longer. Poorer lung function, male sex and age are adverse prognostic features. Overall survival was poor. PMID:16769717

  17. Medical aid provided by American, Canadian and British Nationals to the Spanish Republic during the Civil War, 1936-1939.

    PubMed

    Shapiro, M F

    1983-01-01

    During international or civil wars, private citizens of noncombatant nations often provide medical aid to one of the contending factions, particularly when they support a participant not favored by their own government. This paper details and analyzes the prominent campaign in the United States, Canada and Great Britain to provide medical aid to the Republicans during the Spanish Civil War (1936 to 1939). The substantial medical aid that was provided clearly alleviated some suffering, but one of the major objectives of the campaign was to arouse public opinion sufficiently to end the boycott of military aid to Republicans; this objective was never achieved. Whether it be in Republican Spain, Vietnam or El Salvador, even a successful medical aid campaign to people in a military conflict may save some lives but may not affect substantially the course of the conflict. Those who are primarily interested in influencing political or military developments, hoping to advance the cause of a particular contending faction, may find tactics other than medical aid campaigns more useful in accomplishing their goals.

  18. [Medical civil responsibility in the year 2000].

    PubMed

    Rougé-Maillart, C; Pessaux, P; Gosset, D; Penneau, M

    2001-10-01

    In France, during the last year, important jurisprudence was established by the French Supreme Court of Appeal concerning the physician's civil responsibility. On october 7, 1998, the Court decided that "the physician is not exempted for the obligation to provide information by the simple fact that these risks only materialize exceptionally". This means that from now, the physician must inform the patient of all risks that might influence the patient's decision, particularly information concerning life-threatening or severe consequences, but also, as in the past, concerning frequent even benign consequences. The limits of this jurisprudence and the completeness of the information, as established in 1998, are emergency, patient refusal and impossibility to inform the patient. In the decree of May 23, 2000, the Court gave its definition of impossibility to inform the patient, thus establishing the "therapeutic limits". But the judges recognized that the requirement for information delivery is independent of the necessary or unnecessary nature of the therapeutic act. However, in the decree of June 20, 2000, the Court established the conditions for awarding indemnities for defective information delivery. Defective information delivery is not sufficient in itself to constitute a civil offense. Real damage is also necessary. To be awarded with an indemnity, the patient must prove that the lack of information affected his/her decision to consent. If it appears that even if he/she had been well informed, the patient had consented to the care given, the physician would not be obliged to provide the patient with an indemnity. The judges want to find a compensation and make the proof easier for the patient. They accept the potential fault when an organ was injured in the course of an operation. But, these decisions concern the proof and they don't modify the medical responsibility. The physicians have got a duty to use reasonable skill and care and they don't have any

  19. Numerical Modelling of Freshwater Flux and Temperature on the Northern British Columbia Coast in support of Marine Oil Spill Response

    NASA Astrophysics Data System (ADS)

    Bourdin, D. R.; Fleming, S. W.; Fortin, V.; Durnford, D. A.

    2014-12-01

    Canada has the longest coastline of any country (>120,000 miles). Canadian response to potential oil spills along its coast is being improved under a high-level federal government strategy, falling under the rubric of the World Class Tanker Safety System (WCTSS). The first component of this strategy focuses on the Kitimat area and its marine approaches on the northern British Columbia (BC) coast. This initiative reflects concerns around both existing ship traffic, and potential increases in tanker traffic associated with the proposed Northern Gateway pipeline. The project includes joint development, between multiple federal departments, of an operational modeling system to predict currents in the coastal ocean. One of Environment Canada's (EC) contributions is the development and implementation of a short-term forecast model of river flows with corresponding stream temperatures. These quantities influence currents in the coastal ocean, which in turn affect oil spill fate and transport. Our platform is based on the Surface Prediction System (SPS), which is essentially a driver for a land surface scheme (LSS) linked to a hydrological routing model, and is related to the earlier MESH platform. LSS's under consideration for use in this mountain rainforest environment are the Canadian Land Surface Scheme (CLASS), and the Soil and Vegetation Simulator (SVS), which is an evolution of the Interactions Soil-Biosphere-Atmosphere (ISBA) model. Runoff and drainage outputs are then routed through the stream network by WATROUTE. The River Basin Model (RBM), a physically-based stream temperature simulator, is also being integrated into SPS to additionally enable water temperature forecasting. The freshwater modelling system will be directly driven by EC's numerical weather prediction (NWP) systems.Preliminary results from this ambitious modeling program are presented, along with recommendations for improvements to physical process representation in the various models employed.

  20. Biologic treatment response among adults with juvenile idiopathic arthritis: results from the British Society for Rheumatology Biologics Register

    PubMed Central

    McErlane, Flora; Foster, Helen E.; Davies, Rebecca; Lunt, Mark; Watson, Kath D.; Symmons, Deborah P. M.

    2013-01-01

    Objective. To describe the use of and response to biologic therapies commenced in adults with JIA. Methods. Patients with arthritis onset <16 years were identified from the British Society for Rheumatology Biologics Register for rheumatoid arthritis (BSRBR-RA) and stratified into ILAR JIA subtypes. Patterns of biologic use and treatment persistence were explored, with disability levels (HAQ) and remission rates [28-Joint Disease Activity Score (DAS28)] evaluated at 6 and 12 months. Results. Arthritis with an onset of <16 years was confirmed in 225 patients and the ILAR subtype was determined in 154 (68%). Only 58 (26%) patients had a diagnosis of JIA recorded in the BSRBR-RA. The median age at biologic commencement was 31 years [interquartile range (IQR) 23–39] and 76% were female. The biologic therapies were etanercept (49%), infliximab (28%), adalimumab (22%) and anakinra (1%). Fifty per cent of patients received more than one biologic during follow-up (2 agents, n = 64; ≥3 agents, n = 49). Treatment persistence at 1 year was 78% (95% CI 71%, 82%), falling to 42% (95% CI 34%, 49%) at 5 years. Both the HAQ and DAS28 improved significantly at 6 months, with 21% and 28% of patients in remission (DAS28 < 2.6) at 6 and 12 months, respectively. Conclusion. This study describes patterns and identifies outcomes of biologic use in a national cohort of adults with JIA. With no national guidance currently available in this area, the choice of first biologic was inconsistent, although treatment outcomes were good. These data confirm that biologic therapies are an important treatment option in adults with active JIA in adulthood. PMID:23873820

  1. The landslide response of alpine basins to post-Little Ice Age glacial thinning and retreat in southwestern British Columbia

    NASA Astrophysics Data System (ADS)

    Holm, Kris; Bovis, Michael; Jakob, Matthias

    2004-02-01

    The role of post-Little Ice Age (LIA) Neoglacial retreat on landslide activity is investigated in 19 alpine basins along the upper Lillooet River Valley, British Columbia. We examine how Neoglacial scouring and glacial recession have modified hillslope form and slope stability, and construct a decision-making flowchart to identify landslide hazards associated with glacial retreat. This work is based on field mapping, GIS analysis, statistical associations between landslides and terrain attributes, and a comparison between Neoglaciated and non-Neoglaciated terrain within each basin. The bedrock landslide response to glacial retreat varies appreciably according to lithology and the extent of glacial scour below the LIA trimline. Valleys carved in weak Quaternary volcanics show significant erosional oversteepening and contain deep-seated slope movement features, active rock fall, rock slides, and rock avalanches near glacial trimlines. Basins in stronger granitic rock rarely show increased bedrock instability resulting from post-LIA retreat, except for shallow-seated rock slides along some trimlines and failures on previously unstable slopes. In surficial materials, landslides associated with post-LIA retreat originate in till or colluvium, as debris slides or debris avalanches, and are concentrated along lateral moraines or glacial trimlines. Significant spatial association was also observed between recent catastrophic failures, gravitational slope deformation, and slopes that were oversteepened then debuttressed by glacial erosion. Eight out of nine catastrophic rock slope failures occurred just above glacial trimlines and all occurred in areas with a previous history of deep-seated gravitational slope movement, implying that this type of deformation is a precursor to catastrophic detachment.

  2. Flying Squad response to medical emergencies.

    PubMed Central

    Barton, D; Pritty, P

    1990-01-01

    The Flying Squad of the Accident and Emergency Department, of the Derbyshire Royal Infirmary, was established in 1955 by Collins. The initial function was to provide emergency care to victims of industrial accidents. However, the spectrum of emergencies they now respond to has expanded and includes predominantly road traffic accidents and medical emergencies. Despite the proliferation of Flying Squads their benefit has been difficult to quantify even in a trauma setting (Robertson & Steedman, 1985; Gorman & Coals, 1983). The outcome in medical emergencies is reported as dismal (Robertson & Steedman, 1985; Rowley & Collins, 1979) yet the number of calls for the flying squad to attend medical emergencies are many. Previous reports have recorded 20-30% of Squad calls responding to medical emergencies (Gorman & Coals, 1983; Rowley & Collins, 1979; Steedman & Robertson, 1986; Harrop & Bodiwala, 1983). PMID:2135174

  3. Do emergency medical system response times matter for health outcomes?

    PubMed

    Wilde, Elizabeth Ty

    2013-07-01

    The introduction of technology aimed at reducing the response times of emergency medical services has been one of the principal innovations in crisis care over the last several decades. These substantial investments have typically been justified by an assumed link between shorter response times and improved health outcomes. However, current medical research does not generally show a relationship between response time and mortality. In this study, we explain the discrepancy between conventional wisdom and mortality; existing medical research fails to account for the endogeneity of incident severity and response times. Analyzing detailed call-level information from the state of Utah's Bureau of Emergency Medical Services, we measure the impact of response time on mortality and hospital utilization using the distance of the incident from the nearest EMS agency headquarters as an instrument for response time. We find that response times significantly affect mortality and the likelihood of being admitted to the hospital, but not procedures or utilization within the hospital.

  4. The Medical Response to Sex Trafficking of Minors in Wisconsin.

    PubMed

    Rabbitt, Angela

    2015-04-01

    Medical professionals are in a unique position to identify and assist pediatric victims of sex trafficking, who experience a high prevalence of physical, mental, and sexual health problems. However, providers report a need for education and guidelines for medical care of this population. A literature review was conducted on the nature and scope of pediatric sex trafficking in Wisconsin, the medical and mental health needs of victims, and existing guidelines for medical management. Few existing medical guidelines for the care of trafficking victims are specific to pediatrics or include specific recommendations for the forensic medical evaluation. Because of legislation and resources specific to Wisconsin, national guidelines may not apply locally. Based on the literature review, as well as input from community partners and medical professionals who frequently provide services to victims, guidelines for the medical care of pediatric sex trafficking victims in Wisconsin were developed. Additional community barriers that may prevent an effective medical response also are discussed.

  5. ADHD: A Psychological Response to an Evolving Concept (Report of a Working Party of the British Psychological Association).

    ERIC Educational Resources Information Center

    Reason, Rea

    1999-01-01

    This article is an abridged version of a British Psychological Society paper that addresses research relevant to current understanding of the notion of attention deficit hyperactivity disorder from an historical, psychological, and biological perspective. Also discusses implications for practice in the light of the information obtained. (Author/CR)

  6. Referrals for neonatal medical care in the United Kingdom over one year. British Association of Perinatal Medicine Working Group.

    PubMed Central

    1989-01-01

    A survey of referrals for neonatal medical care was conducted by neonatal paediatricians in the United Kingdom from 1 August 1986 to 31 July 1987. It was intended to estimate the unmet need for neonatal medical care and to find out what happens after an attempt to transfer a pregnant woman or a baby has been unsuccessful. A total of 3734 attempts had been made, of which 1646 were for in utero cases and 2088 were for postnatal cases. Nationally, about 9% of attempts to transfer (331) were unsuccessful. In most regions a high proportion of attempts that were eventually successful had taken a considerable amount of time to arrange. It is concluded that despite a twofold increase since 1980 in the number of cots available for neonatal intensive care, arrangements for such provision in the UK are not adequate to meet every request for transfer. No health region in England or country in the UK was able to meet every request immediately, and some regions had great difficulties in arranging even those transfers that had been accepted. Such delays in transfer may lead to appreciable extra morbidity and considerable costs in future. PMID:2493842

  7. Oil and the British economy

    SciTech Connect

    Atkinson, F.; Hall, S.

    1983-01-01

    Despite the 1976 discovery of North Sea oil, the British economy has floundered in the early 1980s. To uncover the reasons behind this predicament, the authors examine the North Sea oil sector, show the impact of its recent development on the British economy, and analyze the automatic responses of an economy to the development of such a new sector, the ''Kay debate,'' and the experience of six other countries with oil and the manufacturing industry.

  8. Telemedicine in British Airways.

    PubMed

    Bagshaw, M

    1996-01-01

    In the year ending March 1994, British Airways (BA) carried in excess of 30 million passengers worldwide. There was a total of 2078 reported in-flight medical incidents, with 18 unscheduled diversions for medical reasons. The commonest reported conditions were faints, diarrhoea and vomiting. The BA aircraft medical kit content exceeds the statutory minimum requirement and all cabin crew undergo training in first aid and life support. There is a BA doctor on 24 h call with whom an aircraft captain may communicate via a high-frequency radio link. This link has limitations and immediate contact is not always possible. BA is installing satellite communication facilities in new aircraft and the application of telemedicine utilizing this facility is being explored.

  9. [Responsibility in medical collaborations and care establishments].

    PubMed

    Sarda, F

    1998-01-01

    Criminal Law and Civil Law--that have a general application require personnel misconduct. However, the criminal liability of legal entities is now provided by the law. Public law only deals with the liability of the establishment as a consequence of a fault of the administrative service or of a personnel misconduct. The liability of the closest collaboration of the surgical team (Surgeon, Anaesthesist...) used to be transferred onto the surgeon. The liability of the surgeon is now autonomous but the latter still have a general duty of supervision. There is a wider application of collaboration. One is still liable for his faults but their is a duty of vigilance on partners together with a duty of mutual information of the medical practitioners who successively intervene. There is also a new liability for the lack of mobilisation of adequate skills. Curing Establishments are now considered as partners of the medical agreement and are often sued in case of deficiency of the organisation of medical attendance. The nursing homes shall have now to control the quality of the medical activity.

  10. Case ascertainment of heat illness in the British Army: evidence of under-reporting from analysis of Medical and Command notifications, 2009–2013

    PubMed Central

    Stacey, Michael J; Brett, S; Woods, D; Jackson, S; Ross, D

    2016-01-01

    Background Heat illness in the Armed Forces is considered preventable. The UK military relies upon dual Command and Medical reporting for case ascertainment, investigation of serious incidents and improvement of preventive practices and policy. This process could be vulnerable to under-reporting. Objectives To establish whether heat illness in the British Army has been under-reported, by reviewing concordance of reporting to the Army Incident Notification Cell (AINC) and the Army Health Unit (AHU) and to characterise the burden of heat illness reported by these means. Methods Analysis of anonymised reporting databases held by the AHU and AINC, for the period 2009–2013. Results 565 unique cases of heat illness were identified. Annual concordance of reporting ranged from 9.6% to 16.5%. The overall rate was 13.3%. July was the month with the greatest number of heat illness reports (24.4% of total reporting) and the highest concordance rate (30%). Reports of heat illness from the UK (n=343) exceeded overseas notifications (n=221) and showed better concordance (17.1% vs 12.8%). The annual rate of reported heat illness varied widely, being greater in full-time than reservist personnel (87 vs 23 per100 000) and highest in full-time untrained personnel (223 per100 000). Conclusions The risk of heat illness was global, year-round and showed dynamic local variation. Failure to dual-report casualties impaired case ascertainment of heat illness across Command and Medical chains. Current preventive guidance, as applied in training and on operations, should be critically evaluated to ensure that risk of heat illness is reduced as low as possible. Clear procedures for casualty notification and surveillance are required in support of this and should incorporate communication within and between the two reporting chains. PMID:25717054

  11. S(p)O(2) values in acute medical admissions breathing air--implications for the British Thoracic Society guideline for emergency oxygen use in adult patients?

    PubMed

    Smith, Gary B; Prytherch, David R; Watson, Duncan; Forde, Val; Windsor, Alastair; Schmidt, Paul E; Featherstone, Peter I; Higgins, Bernie; Meredith, Paul

    2012-10-01

    S(p)O(2) is routinely used to assess the well-being of patients, but it is difficult to find an evidence-based description of its normal range. The British Thoracic Society (BTS) has published guidance for oxygen administration and recommends a target S(p)O(2) of 94-98% for most adult patients. These recommendations rely on consensus opinion and small studies using arterial blood gas measurements of saturation (S(a)O(2)). Using large datasets of routinely collected vital signs from four hospitals, we analysed the S(p)O(2) range of 37,593 acute general medical inpatients (males: 47%) observed to be breathing room air. Age at admission ranged from 16 to 105 years with a mean (SD) of 64 (21) years. 19,642 admissions (52%) were aged <70 years. S(p)O(2) ranged from 70% to 100% with a median (IQR) of 97% (95-98%). S(p)O(2) values for males and females were similar. In-hospital mortality for the study patients was 5.27% (range 4.80-6.27%). Mortality (95% CI) for patients with initial S(p)O(2) values of 97%, 96% and 95% was 3.65% (3.22-4.13); 4.47% (3.99-5.00); and 5.67% (5.03-6.38), respectively. Additional analyses of S(p)O(2) values for 37,299 medical admissions aged ≥18 years provided results that were distinctly different to those upon which the current BTS guidelines based their definition of normality. Our findings suggest that the BTS should consider changing its target saturation for actively treated patients not at risk of hypercapnic respiratory failure to 96-98%.

  12. Canadian family doctors' roles and responsibilities toward outbound medical tourists: "Our true role is ... within the confines of our system".

    PubMed

    Johnston, Rory; Crooks, Valorie A; Snyder, Jeremy; Dharamsi, Shafik

    2013-12-01

    To explore how Canadian family doctors understand their roles and responsibilities toward patients who seek health care abroad. Six focus groups were held with family doctors across British Columbia to explore their experiences with and perspectives on outbound medical tourism. Focus groups were digitally recorded, transcribed, and subsequently thematically coded to discover common issues and themes across the entire data set. Focus groups were held with family doctors in 6 cities in British Columbia that provided representation from all provincial health authorities and a range of urban contexts. A total of 22 currently practising family doctors participated across the 6 focus groups, with groups ranging in size from 2 to 6 participants (average 4 participants). Thematic analysis of the transcripts identified cross-cutting themes that emerged across the 6 focus groups. Participants reported that medical tourism threatened patients' continuity of care. Informational continuity is disrupted before patients go abroad because patients regularly omit family doctors from preoperative planning and upon return home when patients lack complete or translated medical reports. Participants believed that their responsibilities to patients resumed once the patients had returned home from care abroad, but were worried about not being able to provide adequate follow-up care. Participants were also concerned about bearing legal liability toward patients should they be asked to clinically support treatments started abroad. Medical tourism poses challenges to Canadian family doctors when trying to reconcile their traditional roles and responsibilities with the novel demands of private out-of-country care pursued by their patients. Guidance from professional bodies regarding physicians' responsibilities to Canadian medical tourists is currently lacking. Developing these supports would help address challenges faced in clinical practice.

  13. The lack of integration of clinical audit and the maintenance of medical dominance within British hospital trusts.

    PubMed

    McErlain-Burns, T L; Thomson, R

    1999-08-01

    Concerns have been expressed repeatedly about the effectiveness of clinical audit. Some have argued that this is limited by the lack of integration within day-to-day practice and with other NHS policy initiatives. We aimed to explore what mechanisms were being used to develop annual clinical audit programmes within NHS Trusts, and to describe the influence of other initiatives on this; to understand how such influences are exerted; and to understand the role of key players, in order to inform future programme development. Semi-structured face-to-face interviews were performed with Chairs of Clinical Audit Committees, Clinical Audit Managers and Co-ordinators (N = 15) in the former Yorkshire Region of the NHS in England. Concerns about the development, planning and integration of clinical audit focused upon an almost exclusive medical dominance and upon how audit leadership could be delivered within the context of hospital management structures. The lack of an overall plan for the development of clinical audit in most sites was seen as enabling the doctors' agenda to dominate. Purchasing authorities were recognized as being important, but often with limited influence. Other influences on the audit agenda, such as research and development (R&D) and clinical risk management, were rarely well co-ordinated. These findings concur with previous studies in identifying a wide range of constraints on the progress of audit. Several of these constraints operate within the internal environment, for example the doctors' agenda, and concerns about management involvement. Such constraints require resolution in order to facilitate the integration of audit with other initiatives and to achieve the goals of audit effectively. Clinical effectiveness and clinical governance may offer a means of facilitating this integration.

  14. Teaching medical students social responsibility: the right thing to do.

    PubMed

    Faulkner, L R; McCurdy, R L

    2000-04-01

    As academic medicine has become more focused on the economic pressures of the marketplace, some educators have expressed concern about whether appropriate attention is being given to the character development and moral education of medical students. The authors conclude that medical schools do indeed have a duty to teach their medical students to be socially responsible. They define a socially responsible individual as a person who takes part in activities that contribute to the happiness, health, and prosperity of a community and its members. They suggest that medical students should participate in carefully designed, socially responsible activities in order to (1) practice and have reinforced such qualities as reliability, trustworthiness, dependability, altruism, and compassion; (2) partially reimburse society for the cost of their medical education; (3) increase their exposure to a population-based approach to health care; and (4) help medical schools fulfill their social contract with the public. The authors outline the process for developing a curriculum to teach social responsibility to medical students and list some of the key questions faculty and administrators must address in the processes of development and implementation. They conclude that while faculty responsible for implementing a curriculum in social responsibility must be highly committed and prepared to address numerous difficult questions concerning the curriculum's philosophy, structure, and function, the potential benefits of such a curriculum are well worth the effort.

  15. Field Report: Medical Response to Super Typhoon Haiyan.

    PubMed

    Noone, Michael

    2015-10-01

    This report describes the experience and observations during a humanitarian medical response 10 days after landfall of Typhoon Haiyan in the Leyte Island region of the Philippines. Loss of availability of local health care providers was observed to affect the ability of the local community to provide for immediate, post-event medical relief.

  16. Chemical and Biological Terrorism: Improvements to Emergency Medical Response.

    ERIC Educational Resources Information Center

    DeGraffenreid, Jeff Gordon

    The challenge facing many emergency medical services (EMS) is the implementation of a comprehensive educational strategy to address emergency responses to terrorism. One such service, Johnson County (Kansas) Medical Action, needed a strategy that would keep paramedics safe and offer the community an effective approach to mitigation. A…

  17. Medical Student Response to a Class Lipid-Screening Project.

    ERIC Educational Resources Information Center

    Lum, Gifford; And Others

    1982-01-01

    Medical students at the State University of New York's Downstate Medical Center initiated and carried out a voluntary project to screen lipids (cholesterol) to identify known coronary risk factors. The incidence of coronary disease factors among these students and the response of students with high cholesterol levels are reported. (Authors/PP)

  18. Medical Student Response to a Class Lipid-Screening Project.

    ERIC Educational Resources Information Center

    Lum, Gifford; And Others

    1982-01-01

    Medical students at the State University of New York's Downstate Medical Center initiated and carried out a voluntary project to screen lipids (cholesterol) to identify known coronary risk factors. The incidence of coronary disease factors among these students and the response of students with high cholesterol levels are reported. (Authors/PP)

  19. Children's Responses to the Medical Evaluation for Child Sexual Abuse.

    ERIC Educational Resources Information Center

    Dubowitz, Howard

    1998-01-01

    Addresses three issues: (1) how children respond to the medical evaluation for sexual abuse; (2) how the trauma of the evaluation experienced by some children can be minimized and the benefits maximized; and (3) how children's responses to the medical evaluation for sexual abuse can be interpreted. (DB)

  20. Metropolitan Medical Response System Act of 2010

    THOMAS, 111th Congress

    Rep. Markey, Edward J. [D-MA-7

    2010-02-03

    02/24/2010 Referred to the Subcommittee on Emergency Communications, Preparedness, and Response. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  1. Metropolitan Medical Response System Act of 2010

    THOMAS, 111th Congress

    Rep. Markey, Edward J. [D-MA-7

    2010-02-03

    02/24/2010 Referred to the Subcommittee on Emergency Communications, Preparedness, and Response. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  2. Metropolitan Medical Response System Act of 2010

    THOMAS, 111th Congress

    Rep. Markey, Edward J. [D-MA-7

    2010-02-03

    House - 02/24/2010 Referred to the Subcommittee on Emergency Communications, Preparedness, and Response. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  3. [The insurance of professional responsibility of medical professionals in Russia].

    PubMed

    2011-01-01

    The article deals with the characteristics of implementation of mandatory insurance of professional risk of medical professionals. The possible directions in resolving actual problems are proposed in the elaboration of normative legal act on insurance of their professional responsibility.

  4. British Communicator Occupations.

    ERIC Educational Resources Information Center

    Tunstall, Jeremy

    Occupations and organizations within the British press and broadcasting systems are examined in this paper. Its sections summarize recent British research on media communicators and discuss characteristics of craft unions and other media organizations; the historical development of the British press; the British Broadcasting Corporation (BBC) and…

  5. British Communicator Occupations.

    ERIC Educational Resources Information Center

    Tunstall, Jeremy

    Occupations and organizations within the British press and broadcasting systems are examined in this paper. Its sections summarize recent British research on media communicators and discuss characteristics of craft unions and other media organizations; the historical development of the British press; the British Broadcasting Corporation (BBC) and…

  6. U.S. medical device reporting: who is responsible?

    PubMed

    Donawa, Maria

    2005-04-01

    When various companies are involved in the manufacture and export of medical devices to the United States (U.S.), it is not always easy to understand the reporting responsibilities under the U.S. Medical Device Reporting regulation. A new rule has been published to help companies better understand the requirements. This article discusses the new rule, ways to determine responsibilities and suggestions for compliance.

  7. [Forensic pediatric autopsy and medical responsibility].

    PubMed

    Rambaud, Caroline; Mireau, Etienne; Durigon, Michel

    2005-06-01

    The integrity of the human body is an intangible human right acknowledged to persist after death. Violating the integrity of the human corpse is a penal act sanctioned by the 1994 version of the French Penal Code. There are only three exceptions: for science (medical autopsy), for public health (organ removal for graft), and for justice (forensic autopsy). The parents' written agreement is needed to perform a pediatric medical autopsy but not for a forensic autopsy. For the forensic pathologist, taking oath does not imply an authorization to override the precepts of humanity nor the Hippocratic Oath. The forensic pathologist remains subject to civil and penal law. This is why forensic pathologists have an obligation of excellence besides their obligation of means. A pediatric autopsy is a specific procedure compared with an adult autopsy and requires specific training. Forensic pathologists, like all pathologists, who does not have sufficient expertise should not perform pediatric autopsy but rather call in a qualified pediatric pathologist. Tissues or organs removed during a forensic autopsy can be used only for diagnostic purposes, and the parents' agreement must be obtained for any other use.

  8. Tropical skin diseases in British military personnel.

    PubMed

    Bailey, Mark S

    2013-09-01

    Skin complaints are common in travellers to foreign countries and are responsible for up to 25% of medical consultations by military personnel during deployments in the tropics. They also have relatively high rates of field hospital admission, medical evacuation and referral to UK Role 4 healthcare facilities. Non-infectious tropical skin diseases include sunburn, heat rash, arthropod bites, venomous bites, contact dermatitis and phytophotodermatitis. During tropical deployments skin infections that commonly occur in military personnel may become more frequent, severe and difficult to treat. Several systemic tropical infections have cutaneous features that can be useful in making early diagnoses. Tropical skin infections such as cutaneous larva migrans, cutaneous myiasis, cutaneous leishmaniasis and leprosy do occur in British troops and require specialist clinical management. This illustrated review focuses on the most significant tropical skin diseases that have occurred in British military personnel in recent years. Clinical management of these conditions on deployments would be improved and medical evacuations could be reduced if a military dermatology 'reach-back' service (including a telemedicine facility) was available.

  9. The Importance of the Medical Record: A Critical Professional Responsibility.

    PubMed

    Ngo, Elizabeth; Patel, Nachiket; Chandrasekaran, Krishnaswamy; Tajik, A Jamil; Paterick, Timothy E

    2016-01-01

    Comprehensive, detailed documentation in the medical record is critical to patient care and to a physician when allegations of negligence arise. Physicians, therefore, would be prudent to have a clear understanding of this documentation. It is important to understand who is responsible for documentation, what is important to document, when to document, and how to document. Additionally, it should be understood who owns the medical record, the significance of the transition to the electronic medical record, problems and pitfalls when using the electronic medical record, and how the Health Information Technology for Economic and Clinical Health Act affects healthcare providers and health information technology.

  10. Medical errors: legal and ethical responses.

    PubMed

    Dickens, B M

    2003-04-01

    Liability to err is a human, often unavoidable, characteristic. Errors can be classified as skill-based, rule-based, knowledge-based and other errors, such as of judgment. In law, a key distinction is between negligent and non-negligent errors. To describe a mistake as an error of clinical judgment is legally ambiguous, since an error that a physician might have made when acting with ordinary care and the professional skill the physician claims, is not deemed negligent in law. If errors prejudice patients' recovery from treatment and/or future care, in physical or psychological ways, it is legally and ethically required that they be informed of them in appropriate time. Senior colleagues, facility administrators and others such as medical licensing authorities should be informed of serious forms of error, so that preventive education and strategies can be designed. Errors for which clinicians may be legally liable may originate in systemically defective institutional administration.

  11. Review on emergency medical response against terrorist attack.

    PubMed

    Wang, De-Wen; Liu, Yao; Jiang, Ming-Min

    2014-01-01

    Terrorism is a global issue and a constant international threat. As a result, anti-terrorism and emergency response strategies are tasks of critical importance that have a direct impact on the national security of every country in the world. This paper reviews new characteristics of international anti-terrorism measures and offers an in-depth reflection on emergency medical response countermeasures; additionally, this paper presents the goals of related research, which include: 1) to present a model of a highly efficient medical response command; 2) to introduce the pre-planning phases of the emergency medical response; 3) to establish a response system capable of handling various types of terror attacks; 4) to promote anti-terrorism awareness to the general public and emphasize its prevention; and 5) to continue basic investigations into emergency medical responses for various types of terrorist attacks (for example, the classifications and characteristics of new injuries, pathophysiology, prevention and treatment of the resultant stress disorders, improved high-efficiency medical response measures and equipment, etc.).

  12. Responsibly managing the medical school--teaching hospital power relationship.

    PubMed

    Chervenak, Frank A; McCullough, Laurence B

    2005-07-01

    The relationship between medical schools and their teaching hospitals involves a complex and variable mixture of monopoly and monopsony power, which has not been previously been ethically analyzed. As a consequence, there is currently no ethical framework to guide leaders of both institutions in the responsible management of this complex power relationship. The authors define these two forms of power and, using economic concepts, analyze the nature of such power in the medical school-teaching hospital relationship, emphasizing the potential for exploitation. Using concepts from both business ethics and medical ethics, the authors analyze the nature of transparency and co-fiduciary responsibility in this relationship. On the basis of both rational self-interest, drawn from business ethics, and co-fiduciary responsibility, drawn from medical ethics, they argue for the centrality of transparency in the medical school-teaching hospital relationship. Understanding the ethics of monopoly and monopsony power is essential for the responsible management of the complex relationship between medical schools and their teaching hospitals and can assist the leadership of academic health centers in carrying out one of their major responsibilities: to prevent the exploitation of monopoly power and monopsony power in this relationship.

  13. Medical responsibility and global environmental change.

    PubMed

    McCally, M; Cassel, C K

    1990-09-15

    Global environmental change threatens the habitability of the planet and the health of its inhabitants. Toxic pollution of air and water, acid rain, destruction of stratospheric ozone, waste, species extinction and, potentially, global warming are produced by the growing numbers and activities of human beings. Progression of these environmental changes could lead to unprecedented human suffering. Physicians can treat persons experiencing the consequences of environmental change but cannot individually prevent the cause of their suffering. Physicians have information and expertise about environmental change that can contribute to its slowing or prevention. Work to prevent global environmental change is consistent with the social responsibility of physicians and other health professionals.

  14. Wakefulness and Visual Responsiveness of Low Medical Risk Preterms.

    ERIC Educational Resources Information Center

    Friedman, Sarah L.; And Others

    1984-01-01

    Studies 45 low-medical-risk preterm infants and 23 healthy term neonates, revealing that preterms are more wakeful but not more visually responsive than full-term infants. Intrameasure correlations suggest that the organization of wakefulness and visual responsiveness is different in full-term neonates and in preterms at expected date of birth.…

  15. Responding to disasters: academic medical centers' responsibilities and opportunities.

    PubMed

    Sklar, David P; Richards, Michael; Shah, Mark; Roth, Paul

    2007-08-01

    Disaster preparedness and disaster response should be a capability of all academic health centers. The authors explore the potential role and impact of academic medical centers (AMC)s in disaster response. The National Disaster Medical System and the evolution of disaster medical assistance teams (DMAT) are described, and the experience at one AMC with DMAT is reviewed. The recent deployment of a DMAT sponsored by an AMC to the Hurricane Katrina disaster is described, and the experience is used to illustrate the opportunities and challenges of future disaster medical training, research, and practice at AMCs. AMCs are encouraged to identify an appropriate academic unit to house and nurture disaster-preparedness activities, participate in education programs for health professionals and the public, and perform research on disaster epidemiology and response. Networks of AMCs offer the potential of acting as a critical resource for those AMCs stricken by a disaster and for communities needing the infusion of highly trained and motivated health care providers. The Association of American Medical Colleges can play a critical role in assisting and coordinating AMC networks through its relationship with all AMCs and the federal government and by increasing the awareness of medical educators and researchers about this important, emerging area of medical knowledge.

  16. Medical professional responsibility for postvasectomy pregnancy.

    PubMed

    Vargas-Blasco, C; Arimany-Manso, J; Gómez-Durán, E L; Martin Fumadó, C; Piqueras-Bartolomé, M; Capdevila-Querol, S; Laborda-Rodriguez, A

    2016-01-01

    The follow-up of patients postvasectomy is frequently limited to a seminogram at 3months if azoospermia is observed. This study evaluates a series of cases of complaints for postvasectomy pregnancy to establish follow-up recommendations that increase the clinical safety and reduce the risk of complaints. We reviewed the database of the Department of Professional Responsibility of the Council of the College of Physicians of Catalonia, finding 28 complaints for postvasectomy pregnancy between 1992 and 2011. We analysed the clinical and legal variables of the cases. A total of 13 extrajudicial complaints (46.43%), 13 civil lawsuits (46.43%) and 2 criminal lawsuits (7.14%) were recorded. Only 10 cases had a signed document of informed consent specific to vasectomy. In 26 cases, the data from the spermogram was available. A single spermogram was conducted in 20 cases (76.92%), 2 spermograms were conducted in 4 cases (15.38%) and none were performed in 2 cases (7.69%). For 9 of the cases (45%) where only a single spermogram was performed, the test was performed before 3months postvasectomy. In 17 cases (65.38%), the result of the last spermogram was azoospermia, and 3 cases had oligospermia (11.54%). There were 2 failures of interpretation of the spermogram (7.69%) and 2 of normospermia (7.69%). In 2 cases, a spermogram was not performed (7.69%). Pregnancy occurred between 4 and 50 months after the intervention. In 12 cases (42.86%), it was considered that the practitioner was responsible. It is recommended that physicians emphasise (during the patient information stage) the possibility of spontaneous recanalisation and to request 2 spermograms, whose result should be azoospermia. Performing the test in the 3months after vasectomy is risky, as is basing the waiting time on the number of ejaculations. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Tips for using mobile audience response systems in medical education

    PubMed Central

    Gousseau, Michael; Sommerfeld, Connor; Gooi, Adrian

    2016-01-01

    Background With growing evidence on the benefits of active learning, audience response systems (ARSs) have been increasingly used in conferences, business, and education. With the introduction of mobile ARS as an alternative to physical clickers, there are increasing opportunities to use this tool to improve interactivity in medical education. Aim The aim of this study is to provide strategies on using mobile ARS in medical education by discussing steps for implementation and pitfalls to avoid. Method The tips presented reflect our commentary of the literature and our experiences using mobile ARS in medical education. Results This article offers specific strategies for the preparation, implementation, and assessment of medical education teaching sessions using mobile ARS. Conclusion We hope these tips will help instructors use mobile ARS as a tool to improve student interaction, teaching effectiveness, and participant enjoyment in medical education. PMID:27942242

  18. The Canadian Armed Forces medical response to Typhoon Haiyan.

    PubMed

    Savage, Erin; Christian, Michael D; Smith, Stephanie; Pannell, Dylan

    2015-06-01

    In the setting of international disaster response, an important challenge is determining when it is appropriate to withdraw deployed assets as the acute disaster response transitions to recovery and rebuilding. We describe our experience with realtime data collection during our medical response to Typhoon Haiyan as a means to guide military aid mission parameters. The operational medical headquarters prospectively developed a database for use in this mission. Mobile medical teams (MMTs) were deployed to provide primary care, and the nurse designated to each MMT was responsible for entering and transmitting data daily to the medical headquarters. Data collected included the MMT location, basic patient demographics, the primary reason for the encounter and any treatment provided. These encounters were then classified as disaster, acute or chronic. Between Nov. 16 and Dec. 16, 2013, medical care was provided to 6596 local nationals; 238 (3.6%) had disaster-related illness or injury, 4321 (65.5%) had acute postdisaster medical conditions and 2037 (30.9%) sought medical care for chronic conditions. Of the 257 patients with traumatic injuries, 28 (11%) had disaster-related injuries and 214 (83%) had acute injuries that occurred postdisaster. The data collected during the mission to the Phillippines was compiled with performance metrics from the other Disaster Assistance Response Team components to help advise the Canadian government regarding mission duration. We recommended that data collection continue on all future missions and be modified to provide further information to larger disaster coordination teams, such as the United Nations Office for the Coordination of Humanitarian Affairs.

  19. The Canadian Armed Forces medical response to Typhoon Haiyan

    PubMed Central

    Savage, LCol Erin; Christian, Maj Michael D.; Smith, Maj Stephanie; Pannell, Capt Dylan

    2015-01-01

    Background In the setting of international disaster response, an important challenge is determining when it is appropriate to withdraw deployed assets as the acute disaster response transitions to recovery and rebuilding. We describe our experience with real-time data collection during our medical response to Typhoon Haiyan as a means to guide military aid mission parameters. Methods The operational medical headquarters prospectively developed a database for use in this mission. Mobile medical teams (MMTs) were deployed to provide primary care, and the nurse designated to each MMT was responsible for entering and transmitting data daily to the medical headquarters. Data collected included the MMT location, basic patient demographics, the primary reason for the encounter and any treatment provided. These encounters were then classified as disaster, acute or chronic. Results Between Nov. 16 and Dec. 16, 2013, medical care was provided to 6596 local nationals; 238 (3.6%) had disaster-related illness or injury, 4321 (65.5%) had acute postdisaster medical conditions and 2037 (30.9%) sought medical care for chronic conditions. Of the 257 patients with traumatic injuries, 28 (11%) had disaster-related injuries and 214 (83%) had acute injuries that occurred postdisaster. Conclusion The data collected during the mission to the Philippines was compiled with performance metrics from the other Disaster Assistance Response Team components to help advise the Canadian government regarding mission duration. We recommended that data collection continue on all future missions and be modified to provide further information to larger disaster coordination teams, such as the United Nations Office for the Coordination of Humanitarian Affairs. PMID:26100775

  20. The educational attributes and responsibilities of effective medical educators.

    PubMed

    Hatem, Charles J; Searle, Nancy S; Gunderman, Richard; Krane, N Kevin; Perkowski, Linda; Schutze, Gordon E; Steinert, Yvonne

    2011-04-01

    Of the many roles that the academic-educator may fulfill, that of teacher is particularly challenging. Building on prior recommendations from the literature, this article identifies the skill set of teachers across the medical education continuum-characteristics of attitude and attributes, knowledge, and pedagogic skills that permit effective teaching to be linked with effective learning and understanding. This examination which characterizes teachers' attitudes, knowledge, and skills serves to reemphasize the centrality of teaching within medical education, provides direction for faculty and institutions alike in the discharge of academic responsibilities, and makes educational accountability clear. This listing of teacher attitudes and responsibilities was vetted in 2009 by medical education leaders from across North America during a national conference on faculty development.A set of recommendations concerning faculty development issues for medical teachers is offered. The recommendations are intended to establish an academic culture in medical education that values and rewards-academically and fiscally-those centrally committed to the role of teacher. The challenges of defining skills, developing and funding programs, and ongoing evaluation must be faced to achieve success in teaching throughout medical education, now and in the future. Faculty members, fellow learners, and patients deserve no less. © by the Association of American Medical Colleges.

  1. Trench foot: the medical response in the first World War 1914-18.

    PubMed

    Atenstaedt, Robert L

    2006-01-01

    The approaching 90-year anniversary of United States entry into the Great War is an apt time to examine the response to trench foot (now called nonfreezing cold injury [NFCI]) in this conflict. Trench foot appeared in the winter of 1914, characterized by pedal swelling, numbness, and pain. It was quickly recognized by military-medical authorities. There was little debate over whether it was frostbite or new condition, and it was quickly accepted as a specific disease. The major etiologies proposed were exposure, diet, and infection. The opinion emerged that it was caused by circulatory changes in the foot caused by cold, wet, and pressure. Predisposing factors included dietary inadequacy and fatigue. A number of labels were first given to the disease. However, the name "trench foot" was eventually officially sanctioned. Trench foot became a serious problem for the Allies, leading to 75 000 casualties in the British and 2000 in the American forces. Therapy for trench foot involved a number of conventional, tried-and-tested, and conservative methods. Some more innovative techniques were used. Amputation was only used as a last resort. Prevention involved general measures to improve the trench environment; modification of the footwear worn by the men; and the provision of greases to protect them from moisture. The medical reaction to this condition seems to have been relatively effective. The causation was identified, and prophylactic measures were introduced to fit this model; these seem to have been successful in reducing the prevalence of the condition by 1917-18.

  2. Best of British: British Information Online.

    ERIC Educational Resources Information Center

    Ojala, Marydee

    1988-01-01

    Discusses the importance of British databases and information services to U.S. business searchers and describes several British databases and services. Topics covered include database contents, available search strategies, access from the United States, language differences, and dating problems. A directory of contacts is provided. (six…

  3. Best of British: British Information Online.

    ERIC Educational Resources Information Center

    Ojala, Marydee

    1988-01-01

    Discusses the importance of British databases and information services to U.S. business searchers and describes several British databases and services. Topics covered include database contents, available search strategies, access from the United States, language differences, and dating problems. A directory of contacts is provided. (six…

  4. Houston's medical disaster response to Hurricane Katrina: part 1: the initial medical response from Trauma Service Area Q.

    PubMed

    Hamilton, Douglas R; Gavagan, Thomas F; Smart, Kieran T; Upton, Lori A; Havron, Douglas A; Weller, Nancy F; Shah, Umair A; Fishkind, Avrim; Persse, David; Shank, Paul; Mattox, Kenneth

    2009-04-01

    After Hurricane Katrina hit the Gulf Coast on August 29, 2005, thousands of ill and injured evacuees were transported to Houston, TX. Houston's regional disaster plan was quickly implemented, leading to the activation of the Regional Hospital Preparedness Council's Catastrophic Medical Operations Center and the rapid construction of a 65-examination-room medical facility within the Reliant Center. A plan for triage of arriving evacuees was quickly developed and the Astrodome/Reliant Center Complex mega-shelter was created. Herein, we discuss major elements of the regional disaster response, including regional coordination, triage and emergency medical service transfers into the region's medical centers, medical care in population shelters, and community health challenges.

  5. Medical Response to Haiti Earthquake: Operation Unified Response

    DTIC Science & Technology

    2011-01-24

    struck Haiti at 4:53 pm, Tues, Jan 12, 2010 –230,000 Deaths * –197,000 Injured – 1.1M Displaced People –3,000,000 Affected People –60% of government...15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Magnitude 7.0 Earthquake vic. Port au Prince 6.1 Aftershock COMFORT Arrives BATAAN ARG Arrives AFSOC...RESPONSE Deployment Timeline ( March ) 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 281110986 754321 JTF-H Conducts RIP w/ARSOUTH Final DHHS Treatment

  6. British Sign Name Customs

    ERIC Educational Resources Information Center

    Day, Linda; Sutton-Spence, Rachel

    2010-01-01

    Research presented here describes the sign names and the customs of name allocation within the British Deaf community. While some aspects of British Sign Language sign names and British Deaf naming customs differ from those in most Western societies, there are many similarities. There are also similarities with other societies outside the more…

  7. British Sign Name Customs

    ERIC Educational Resources Information Center

    Day, Linda; Sutton-Spence, Rachel

    2010-01-01

    Research presented here describes the sign names and the customs of name allocation within the British Deaf community. While some aspects of British Sign Language sign names and British Deaf naming customs differ from those in most Western societies, there are many similarities. There are also similarities with other societies outside the more…

  8. A small single-nozzle rainfall simulator to measure erosion response on different burn severities in southern British Columbia, Canada

    NASA Astrophysics Data System (ADS)

    Covert, Ashley; Jordan, Peter

    2010-05-01

    To study the effects of wildfire burn severity on runoff generation and soil erosion from high intensity rainfall, we constructed an effective yet simple rainfall simulator that was inexpensive, portable and easily operated by two people on steep, forested slopes in southern British Columbia, Canada. The entire apparatus, including simulator, pumps, hoses, collapsible water bladders and sample bottles, was designed to fit into a single full-sized pick-up truck. The three-legged simulator extended to approximately 3.3 metres above ground on steep slopes and used a single Spraying Systems 1/2HH-30WSQ nozzle which can easily be interchanged for other sized nozzles. Rainfall characteristics were measured using a digital camera which took images of the raindrops against a grid. Median drop size and velocity 5 cm above ground were measured and found to be 3/4 of the size of natural rain drops of that diameter class, and fell 7% faster than terminal velocity. The simulator was used for experiments on runoff and erosion on sites burned in 2007 by two wildfires in southern British Columbia. Simulations were repeated one and two years after the fires. Rainfall was simulated at an average rate of 67 mm hr-1 over a 1 m2 plot for 20 minutes. This rainfall rate is similar to the 100 year return period rainfall intensity for this duration at a nearby weather station. Simulations were conducted on five replicate 1 m2 plots in each experimental unit including high burn severity, moderate burn severity, unburned, and unburned with forest floor removed. During the simulation a sample was collected for 30 seconds every minute, with two additional samples until runoff ceased, resulting in 22 samples per simulation. Runoff, overland flow coefficient, infiltration and sediment yield were compared between treatments. Additional simulations were conducted immediately after a 2009 wildfire to test different mulch treatments. Typical results showed that runoff on plots with high burn

  9. Chicago medical response to the 2010 earthquake in Haiti: translating academic collaboration into direct humanitarian response.

    PubMed

    Babcock, Christine; Baer, Carolyn; Bayram, Jamil D; Chamberlain, Stacey; Chan, Jennifer L; Galvin, Shannon; Kim, Jimin; Kinet, Melodie; Kysia, Rashid F; Lin, Janet; Malik, Mamta; Murphy, Robert L; Olopade, C Sola; Theodosis, Christian

    2010-06-01

    On January 12, 2010, a major earthquake in Haiti resulted in approximately 212 000 deaths, 300 000 injuries, and more than 1.2 million internally displaced people, making it the most devastating disaster in Haiti's recorded history. Six academic medical centers from the city of Chicago established an interinstitutional collaborative initiative, the Chicago Medical Response, in partnership with nongovernmental organizations (NGOs) in Haiti that provided a sustainable response, sending medical teams to Haiti on a weekly basis for several months. More than 475 medical volunteers were identified, of whom 158 were deployed to Haiti by April 1, 2010. This article presents the shared experiences, observations, and lessons learned by all of the participating institutions. Specifically, it describes the factors that provided the framework for the collaborative initiative, the communication networks that contributed to the ongoing response, the operational aspects of deploying successive medical teams, and the benefits to the institutions as well as to the NGOs and Haitian medical system, along with the challenges facing those institutions individually and collectively. Academic medical institutions can provide a major reservoir of highly qualified volunteer medical personnel that complement the needs of NGOs in disasters for a sustainable medical response. Support of such collaborative initiatives is required to ensure generalizability and sustainability.

  10. MEDIC: An Approach to Student Responsibility in Drug Usage

    ERIC Educational Resources Information Center

    Coppoc, Gordon L.; Stuckey, William J.

    1977-01-01

    The Minimum Essential Drug Information Checklist (MEDIC) was designed at Purdue University in response to a need for more structure in the approach to drug education in veterinary medicine. It covers: therapeutic goal, routes given, dose form, dose interval, duration of therapy, withdrawal time, cost, precautions, reactions, antidote, and therapy…

  11. [Hospital response and medical management in toxic chemical substance disasters].

    PubMed

    Yeh, I-Jeng; Lin, Tzeng-Jih

    2010-06-01

    A hazardous material is defined as any item or agent which has the potential to cause harm to humans, animals, or the environment, either by itself or through interaction with other factors. Toxic chemical substance events are increasingly common events in our modern world. The numerous variables and special equipment involved make effective response to toxic chemical events an especially critical test of hospital emergency response and patient rescue mechanisms. Inadequacies in management could result in disaster - even when only a simple event and minimal error are involved. This article introduces the general medical management algorithm for toxic chemical substance injury and the hospital incident command systems (HICS) developed and currently used by Taiwanese hospitals. Important steps and frequent mistakes made during medical management procedures are further described. The goal of medical care response and emergency units is to prevent catastrophic disasters in the emergency room and their subsequent results. This article further emphasizes correct patient management not only in terms of medical unit effort, but also in terms of cooperation between various relevant organizations including factory-based industrial health and safety systems, multi-factory union defense systems, coordination centers, fire protection and disaster rescue systems, the Environmental Protection Administration and national defense system in order to achieve the most appropriate management. Such coordination, in particular, requires reinforcement in order to ensure readiness for future response needs.

  12. Research in Continuing Medical Education. An Historical Review (and) Response.

    ERIC Educational Resources Information Center

    Abrahamson, Stephen; Lloyd, John S.

    1984-01-01

    Includes an historical review of continuing medical education (CME) in the United States from 1909, when the Blackburn Plan began, to the post-World War II era, with the growth of instructional technology. Two earlier studies that reviewed evaluation research in CME are discussed. Lloyd's brief response disputes some of Abrahamson's points. (SK)

  13. Continuing Veterinary Medical Education: Responsibilities, Support and Rewards

    ERIC Educational Resources Information Center

    Gage, E. Dean; And Others

    1978-01-01

    The Advanced Studies Committee of the Association of American Veterinary Medical Colleges addresses these questions: What are the responsibilities of the school of veterinary science department in continuing education? How should continuing education be funded? What are the appropriate mechanisms for recognizing or rewarding faculty participation…

  14. Wireless Distribution Systems To Support Medical Response to Disasters

    PubMed Central

    Arisoylu, Mustafa; Mishra, Rajesh; Rao, Ramesh; Lenert, Leslie A.

    2005-01-01

    We discuss the design of multi-hop access networks with multiple gateways that supports medical response to disasters. We examine and implement protocols to ensure high bandwidth, robust, self-healing and secure wireless multi-hop access networks for extreme conditions. Address management, path setup, gateway discovery and selection protocols are described. Future directions and plans are also considered. PMID:16779171

  15. Prevalence and response to antiretroviral therapy of non-B subtypes of HIV in antiretroviral-naive individuals in British Columbia.

    PubMed

    Alexander, Christopher S; Montessori, Valentina; Wynhoven, Brian; Dong, Winnie; Chan, Keith; O'Shaughnessy, Michael V; Mo, Theresa; Piaseczny, Magda; Montaner, Julio S G; Harrigan, P Richard

    2002-03-01

    In North America, the B subtype of the major group (M) of HIV-1 predominates. Phylogenetic analysis of HIV reverse transcriptase and protease sequences isolated from 479 therapy-naive patients, first seeking treatment in British Columbia between June 1997 and August 1998, revealed a prevalence of 4.4% non-B virus. A range of different subtypes was identified, including one subtype A, 11 C, two D, five CRF01_AE, and one sample that could not be reliably subtyped. Baseline CD4 courts were significantly lower in individuals harbouring the non-B subtypes (P = 0.02), but baseline viral loads were similar (P = 0.80). In this study, individuals infected with non-B variants did not have a significantly different virological response to therapy after up to 18 months.

  16. A Comparative Analysis of the Influence of Surface Mining on Hydrological and Geochemical Response of Selected Headwater Streams in the Elk Valley, British Columbia, Canada.

    NASA Astrophysics Data System (ADS)

    Carey, S. K.; Shatilla, N. J.; Szmudrowska, B.; Rastelli, J.; Wellen, C.

    2014-12-01

    Surface mining is a common method of accessing coal. Blasting of overburden rock allows access to mineable ore. In high-elevation environments, the removed overburden rock is deposited in adjacent valleys as waste rock spoils. As part of a multi-year R&D program examining the influence of surface mining on watershed hydrological and water quality responses in the Elk Valley, British Columbia, this study reports on how surface mining affects streamflow hydrological and geochemical response at four reference and four mine-influenced catchments. The hydrology of this environment is dominated by snowmelt and steep topographic gradients. Flows were attenuated in mine-influenced catchments, with spring freshet delayed and more muted responses to precipitation events observed. Dissolved ions were an order of magnitude greater in mine-influenced streams, with more dilution-based responses to flows compared with chemostatic behavior observed in reference streams. Stable isotope signatures in stream water suggested that in both mine-influenced and reference watersheds, stream water was derived from well mixed groundwater as annual variability of stream isotope signatures was dampened compared with precipitation signatures. However, deflection of stream isotopes in response to precipitation were more apparent in reference watersheds. As a group, mine influenced catchments had a heavier isotope signature than reference watersheds, suggesting an enhanced influence of rainfall on recharge. Transit time distributions indicate existing waste rock spoils increase the average time water takes to move through the catchment.

  17. Learning about medical student mistreatment from responses to the medical school graduation questionnaire.

    PubMed

    Mavis, Brian; Sousa, Aron; Lipscomb, Wanda; Rappley, Marsha D

    2014-05-01

    Although evidence of medical student mistreatment has accumulated for more than 20 years, only recently have professional organizations like the Association of American Medical Colleges (AAMC) and the American Medical Association truly acknowledged it as an issue. Since 1991, the AAMC's annual Medical School Graduation Questionnaire (GQ) has included questions about mistreatment. Responses to the GQ have become the major source of evidence of the prevalence and types of mistreatment. This article reviews national mistreatment data, using responses to the GQ from 2000 through 2012; examines how students' experiences have changed over time; and highlights the implications of this information for the broader medical education system. The authors discuss what mistreatment is, including the changing definitions from the GQ; the prevalence, types, and sources of mistreatment; and evidence of students reporting incidents. In addition, they discuss next steps, including better defining mistreatment, specifically public humiliation and belittling, taking into account students' subjective evaluations; understanding and addressing the influence of institutional culture and what institutions can learn from current approaches at other institutions; and developing better systems to report and respond to reports of mistreatment. They conclude with a discussion of how mistreatment currently is conceptualized within the medical education system and the implications of that conceptualization for eradicating mistreatment in the future.

  18. Directing Discipline: State Medical Board Responsiveness to State Legislatures.

    PubMed

    Lillvis, Denise F; McGrath, Robert J

    2017-02-01

    State medical boards are increasingly responsible for regulating medical and osteopathic licensure and professional conduct in the United States. Yet, there is great variation in the extent to which such boards take disciplinary action against physicians, indicating that some boards are more zealous regulators than others. We look to the political roots of such variation and seek to answer a simple, yet important, question: are nominally apolitical state medical boards responsive to political preferences? To address this question, we use panel data on disciplinary actions across sixty-four state medical boards from 1993 through 2006 and control for over-time changes in board characteristics (e.g., composition, independence, budgetary status), regulatory structure, and resources. We show that as state legislatures become more liberal [conservative], state boards increasingly [decreasingly] discipline physicians, especially during unified government and in the presence of highly professional legislatures. Our conclusions join others in emphasizing the importance of state medical boards and the contingent nature of political control of state regulation. In addition, we emphasize the roles that oversight capacity and strategy play in offsetting concerns regarding self-regulation of a powerful organized interest.

  19. Genetics and the British insurance industry.

    PubMed Central

    Cook, E D

    1999-01-01

    Genetics and genetic testing raise key issues for insurance and employment. Governmental and public concern galvanised the British insurance industry into developing a code of practice. The history of the development of the code, issues of genetic discrimination, access to medical information, consent and the dangers of withholding information and the impact on the equity of pooled risk are explored. Proactive steps by the Association of British Insurers suggest that moral reflection not legislation is the way forward. PMID:10226922

  20. HMO encroachment. The Palm Beach County Medical Society's response.

    PubMed

    Fischer, L A

    1987-03-01

    In 1984, the Palm Beach County (Florida) Medical Society faced the invasion of an HMO which, via an expensive advertising plan, urged Medicare recipients to enroll in a program that promised free health care. As physicians watched more and more of their older patients transfer to the HMO, they turned to their local medical society, which formulated a response. It launched a public information campaign designed to give patients the necessary facts about HMOs so they could make an informed decision about joining. The article describe the specific steps the physicians took to battle the new competition.

  1. Hospital outpatients' responses to taking medications with driving warnings.

    PubMed

    Smyth, T; Sheehan, M; Siskind, V

    2013-01-01

    The study investigates the knowledge, intentions, and driving behavior of persons prescribed medications that display a warning about driving. It also examines their confidence that they can self-assess possible impairment, as is required by the Australian labeling system. We surveyed 358 outpatients in an Australian public hospital pharmacy, representing a well-advised group taking a range of medications including those displaying a warning label about driving. A brief telephone follow-up survey was conducted with a subgroup of the participants. The sample had a median age of 53.2 years and was 53 percent male. Nearly three quarters (73.2%) had taken a potentially impairing class of medication and more than half (56.1%) had taken more than one such medication in the past 12 months. Knowledge of the potentially impairing effects of medication was relatively high for most items; however, participants underestimated the possibility of increased impairment from exceeding the prescribed dose and at commencing treatment. Participants' responses to the safety implications of taking drugs with the highest level of warning varied. Around two thirds (62.8%) indicated that they would consult a health practitioner for advice and around half would modify their driving in some way. However, one fifth (20.9%) would drive when the traffic was thought to be less heavy and over a third (37.7%) would modify their medication regime so that they could drive. The findings from the follow-up survey of a subsample taking target drugs at the time of the first interview were also of concern. Only just over half (51%) recalled seeing the warning label on their medications and, of this group, three quarters (78%) reported following the warning label advice. These findings indicated that there remains a large proportion of people who either did not notice or did not consider the warning when deciding whether to drive. There was a very high level of confidence in this group that they could

  2. Fly-By medical care: Conceptualizing the global and local social responsibilities of medical tourists and physician voluntourists.

    PubMed

    Snyder, Jeremy; Dharamsi, Shafik; Crooks, Valorie A

    2011-04-06

    Medical tourism is a global health practice where patients travel abroad to receive health care. Voluntourism is a practice where physicians travel abroad to deliver health care. Both of these practices often entail travel from high income to low and middle income countries and both have been associated with possible negative impacts. In this paper, we explore the social responsibilities of medical tourists and voluntourists to identify commonalities and distinctions that can be used to develop a wider understanding of social responsibility in global health care practices. Social responsibility is a responsibility to promote the welfare of the communities to which one belongs or with which one interacts. Physicians stress their social responsibility to care for the welfare of their patients and their domestic communities. When physicians choose to travel to another county to provide medical care, this social responsibility is expanded to this new community. Patients too have a social responsibility to use their community's health resources efficiently and to promote the health of their community. When these patients choose to go abroad to receive medical care, this social responsibility applies to the new community as well. While voluntourists and medical tourists both see the scope of their social responsibilities expand by engaging in these global practices, the social responsibilities of physician voluntourists are much better defined than those of medical tourists. Guidelines for engaging in ethical voluntourism and training for voluntourists still need better development, but medical tourism as a practice should follow the lead of voluntourism by developing clearer norms for ethical medical tourism. Much can be learned by examining the social responsibilities of medical tourists and voluntourists when they engage in global health practices. While each group needs better guidance for engaging in responsible forms of these practices, patients are at a

  3. Civilian exposure to toxic agents: emergency medical response.

    PubMed

    Baker, David

    2004-01-01

    Civilian populations are at risk from exposure to toxic materials as a result of accidental or deliberate exposure. In addition to industrial hazards, toxic agents designed for use in warfare now are a potential hazard in everyday life through terrorist action. Civil emergency medical responders should be able to adapt their plans for dealing with casualties from hazardous materials (HazMat) to deal with the new threat. Chemical and biological warfare (CBW) and HazMat agents can be viewed as a continuous spectrum. Each of these hazards is characterized by qualities of toxicity, latency of action, persistency, and transmissibility. The incident and medical responses to release of any agent is determined by these characteristics. Chemical and biological wardare agents usually are classified as weapons of mass destruction, but strictly, they are agents of mass injury. The relationship between mass injury and major loss of life depends very much on the protection, organization, and emergency care provided. Detection of a civil toxic agent release where signs and symptoms in casualties may be the first indicator of exposure is different from the military situation where intelligence information and tuned detection systems generally will be available. It is important that emergency medical care should be given in the context of a specific action plan. Within an organized and protected perimeter, triage and decontamination (if the agent is persistent) can proceed while emergency medical care is provided at the same time. The provision of advanced life support (TOXALS) in this zone by protected and trained medical responders now is technically feasible using specially designed ventilation equipment. Leaving life support until after decontamination may have fatal consequences. Casualties from terrorist attacks also may suffer physical as well as toxic trauma and the medical response also should be capable of dealing with mixed injuries.

  4. [The Israeli medical response plan for an unusual biological event].

    PubMed

    Poles, Lion

    2002-05-01

    Lack of national preparedness for biological warfare or a bioterrorism event as well as for a natural outbreak of a dangerous agent may lead to grave consequences (large-scale morbidity and mortality) in the short and long term. Threat assessment and its consequences are the basis for the contingency for such an event, with the medical community playing the leading role. In this article we present the principles of the Israeli medical response plan for an unusual biological event--whether of natural origin or a deliberate attack. The primary goals of the preparedness program are reducing mortality and morbidity, preventing a disaster, decreasing the irrational public response and inducing the resumption of the normal course of life. The program presented and its phases are universal, with the proper modifications needed to be implemented according to the specific etiology and the circumstances of the event. In order to successfully deal with the incident, national-level coordination of many non-medical organizations is required. An integration body in the Ministry of Health is a prerequisite for the early detection of the outbreak and for the rapid and proper identification of the etiologic agent. An effective triage system which screens the truly-exposed, the sick and their contacts among the many worried-well engorging the medical organizations, should be the spearhead for an integrated health system dealing with disease prevention and treatment. Public relations and recruitment of the media for transferring relevant information are a vital part of the response. In this rare and unfamiliar emergency situation the basic principle is to use existing response systems, implementing most of the routine procedures and functions, modified according to guidelines from central governmental bodies.

  5. Medical response to a major radiologic emergency: a primer for medical and public health practitioners.

    PubMed

    Wolbarst, Anthony B; Wiley, Albert L; Nemhauser, Jeffrey B; Christensen, Doran M; Hendee, William R

    2010-03-01

    There are several types of serious nuclear or radiologic emergencies that would require a specialized medical response. Four scenarios of great public health, economic, and psychologic impact are the detonation of a nuclear weapon, the meltdown of a nuclear reactor, the explosion of a large radiologic dispersal device ("dirty bomb"), or the surreptitious placement of a radiation exposure device in a public area of high population density. With any of these, medical facilities that remain functional may have to deal with large numbers of ill, wounded, and probably contaminated people. Special care and/or handling will be needed for those with trauma, blast injuries, or thermal burns as well as significant radiation exposures or contamination. In addition, radiologists, nuclear medicine specialists, and radiation oncologists will be called on to perform a number of diverse and critically important tasks, including advising political and public health leaders, interfacing with the media, managing essential resources, and, of course, providing medical care. This article describes the medical responses needed following a radiologic or nuclear incident, including the symptoms of and specific treatments for acute radiation syndrome and other early health effects. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09090330/-/DC1. (c) RSNA, 2010

  6. Antidepressant medication adherence via interactive voice response telephone calls.

    PubMed

    Castle, Terri; Cunningham, Michael A; Marsh, Gary M

    2012-09-01

    Outpatients given antidepressants discontinue treatment at a high rate during the first few months. We evaluated the effectiveness of Highmark's use of interactive voice response (IVR) to improve antidepressant medication adherence. Quasi-experimental cohort intervention study. We placed 39,020 members newly given antidepressant medication into 3 intervention groups based on results of interactive voice response (IVR) call 1 month post-prescription: (1) not reached; (2) reached but not transferred to depression management consultant (DMC); and (3) reached and transferred to DMC. We evaluated medication adherence based on the Healthcare Effectiveness Data and Information Set effective acute phase (3 months) and continuation phase (6 months) treatment outcomes using member claims data. We used generalized estimating equations to model intervention effectiveness on medication adherence. Adherence increased markedly with age group, with members older than 65 years having a 5.11-fold higher odds (P <.0001) of compliance than the baseline group aged 18 to 24 years. In models adjusted for time, month of intervention, and drug, the odds of compliance for groups (3) and (2) relative to group (1) were 1.34 (P = .009) and 1.19 (P <.001), respectively. In models also adjusted for age group, the group (3) and (2) odds decreased to 1.00 and 1.03 and were not statistically significant. We found that IVR calls had little impact on antidepressant medication adherence rates. Adherence rates increased markedly with increasing age in each intervention group, suggesting that other intervention strategies to improve adherence should focus on the younger segment of the patient population.

  7. Longitudinal expandable shelter for medical response during disasters.

    PubMed

    Miniati, Roberto; Dori, Fabrizio; Iadanza, Ernesto; Lo Sardo, Marco; Boncinelli, Sergio

    2010-01-01

    During medical emergencies, hospitals represent the final point of the whole rescue process. Therefore, effective health mobile structures have to be inserted between hospitals and the place of the event with the aim of giving the best of cures (using appropriate and easy to use equipment) for a safer and faster evacuation to hospitals. Literature review and national and international disaster medicine standards were the basis for this study to provide clinical, hygienical, and organizational needs to satisfy for the medical structure design. Project requirements have been obtained by analyzing structural, organizational, and clinical process necessities. Structural requirements respond to the possibility of installation on every ground type, resistance to every weather condition, and necessity of easy and fast transportation. Technological equipment is obtained from clinical evaluation for patient stabilization. The designed structure results to be a longitudinal expandable shelter (LES) for medical emergencies response organized in three internal functional areas. Possibility of automatic expandability allows rapid transportation and easy deployment. The functional internal organization provides three areas: "Diagnostic," "Therapeutic," and "Pre-evacuation monitoring." Further, longitudinal expandability supports the basic hygienical rules in healthcare processes allowing the unidirectional flow of casualties from dirtier to cleaner areas of the structure. LES represents the answer to expressed requisites by disaster medicine standards and guidelines. It aims to provide an efficient and effective support for sanitary aid in response to disasters or emergencies, by improving aspects related to effectiveness, hygiene, and quality of clinical performances especially for highest critical cases.

  8. Assessing the Ecotoxicologic Hazards of a Pandemic Influenza Medical Response

    PubMed Central

    Colizza, Vittoria; Schmitt, Heike; Andrews, Johanna; Balcan, Duygu; Huang, Wei E.; Keller, Virginie D.J.; Vespignani, Alessandro; Williams, Richard J.

    2011-01-01

    Background: The global public health community has closely monitored the unfolding of the 2009 H1N1 influenza pandemic to best mitigate its impact on society. However, little attention has been given to the impact of this response on the environment. Antivirals and antibiotics prescribed to treat influenza are excreted into wastewater in a biologically active form, which presents a new and potentially significant ecotoxicologic challenge to microorganisms responsible for wastewater nutrient removal in wastewater treatment plants (WWTPs) and receiving rivers. Objectives: We assessed the ecotoxicologic risks of a pandemic influenza medical response. Methods: To evaluate this risk, we coupled a global spatially structured epidemic model that simulates the quantities of antivirals and antibiotics used during an influenza pandemic of varying severity and a water quality model applied to the Thames catchment to determine predicted environmental concentrations. An additional model was then used to assess the effects of antibiotics on microorganisms in WWTPs and rivers. Results: Consistent with expectations, our model projected a mild pandemic to exhibit a negligible ecotoxicologic hazard. In a moderate and severe pandemic, we projected WWTP toxicity to vary between 0–14% and 5–32% potentially affected fraction (PAF), respectively, and river toxicity to vary between 0–14% and 0–30% PAF, respectively, where PAF is the fraction of microbial species predicted to be growth inhibited (lower and upper 95% reference range). Conclusions: The current medical response to pandemic influenza might result in the discharge of insufficiently treated wastewater into receiving rivers, thereby increasing the risk of eutrophication and contamination of drinking water abstraction points. Widespread drugs in the environment could hasten the generation of drug resistance. Our results highlight the need for empirical data on the effects of antibiotics and antiviral medications on WWTPs

  9. Assessing the ecotoxicologic hazards of a pandemic influenza medical response.

    PubMed

    Singer, Andrew C; Colizza, Vittoria; Schmitt, Heike; Andrews, Johanna; Balcan, Duygu; Huang, Wei E; Keller, Virginie D J; Vespignani, Alessandro; Williams, Richard J

    2011-08-01

    The global public health community has closely monitored the unfolding of the 2009 H1N1 influenza pandemic to best mitigate its impact on society. However, little attention has been given to the impact of this response on the environment. Antivirals and antibiotics prescribed to treat influenza are excreted into wastewater in a biologically active form, which presents a new and potentially significant ecotoxicologic challenge to microorganisms responsible for wastewater nutrient removal in wastewater treatment plants (WWTPs) and receiving rivers. We assessed the ecotoxicologic risks of a pandemic influenza medical response. To evaluate this risk, we coupled a global spatially structured epidemic model that simulates the quantities of antivirals and antibiotics used during an influenza pandemic of varying severity and a water quality model applied to the Thames catchment to determine predicted environmental concentrations. An additional model was then used to assess the effects of antibiotics on microorganisms in WWTPs and rivers. Consistent with expectations, our model projected a mild pandemic to exhibit a negligible ecotoxicologic hazard. In a moderate and severe pandemic, we projected WWTP toxicity to vary between 0-14% and 5-32% potentially affected fraction (PAF), respectively, and river toxicity to vary between 0-14% and 0-30% PAF, respectively, where PAF is the fraction of microbial species predicted to be growth inhibited (lower and upper 95% reference range). The current medical response to pandemic influenza might result in the discharge of insufficiently treated wastewater into receiving rivers, thereby increasing the risk of eutrophication and contamination of drinking water abstraction points. Widespread drugs in the environment could hasten the generation of drug resistance. Our results highlight the need for empirical data on the effects of antibiotics and antiviral medications on WWTPs and freshwater ecotoxicity.

  10. Responses to moral dilemmas in medical students and psychiatric residents.

    PubMed

    Stevens, C; Firth, S T

    1977-12-01

    There has been an increasing interest in the area of medical ethics as indicated not only by the recent proliferation of books and articles but also in the re-emergence of crucial moral issues such as euthanasia, abortion and the like. The difficulty with the existing literature is that these reports are often descriptive, anecdotal and situationally relative to the decision maker. In this study, the authors utilized a cognitive developmental approach to studying responses to moral situations not only because this approach is cross-culturally universal but also because it is not subject to situational variables. In this regard, the results of the assessment of medical students and psychiatric residents are presented as well as a comparison of moral reasoning stages in relation to the C.M.A. Code of Ethics. Recommendations for further research are presented.

  11. The medical ethos and social responsibility in clinical medicine.

    PubMed Central

    Francis, C. K.

    2001-01-01

    The medical profession will face many challenges in the new millennium. As medicine looks forward to advances in molecular genetics and the prospect of unprecedented understanding of the causes and cures of human disease, clinicians, scientists and bioethicists may benefit from reflection upon the origins of the medical ethos and its relevance to postmodern medicine. Past distortions of the medical ethos, such as Nazism and the Tuskegee Syphilis Study, as well as more recent experience with the ethical challenges of employer-based market driven managed care, provide important lessons as medicine contemplates the future. Racial and ethnic disparities in health status and access to care serve as a reminders that the racial doctrines that fostered the horrors of the Holocaust and the Tuskegee Syphilis Study have not been completely removed from contemporary thinking. Inequalities in health status based on race and ethnicity, as well as socioeconomic status, attest to the inescapable reality of racism in America. When viewed against a background of historical distortions and disregard for the traditional tenets of the medical ethos, persistent racial and ethnic disparities and health and the prospect of genetic engineering raise the specter of discrimination because of genotype, a postmodern version of "racist medicine" or of a "new eugenics." There is a need to balance medicine's devotion to the wellbeing of the patient and the primacy of the patient-physician relationship against with the need to meet the health care needs of society. The challenge facing the medical profession in the new millennium is to establish an equilibrium between the responsibility to assure quality health care for the individual patient while affecting societal changes to achieve "health for all." PMID:11405593

  12. Two Species with an Unusual Combination of Traits Dominate Responses of British Grasshoppers and Crickets to Environmental Change

    PubMed Central

    Beckmann, Björn C.; Purse, Bethan V.; Roy, David B.; Roy, Helen E.; Sutton, Peter G.; Thomas, Chris D.

    2015-01-01

    There are large variations in the responses of species to the environmental changes of recent decades, heightening interest in whether their traits may explain inter-specific differences in range expansions and contractions. Using a long-term distributional dataset, we calculated range changes of grasshoppers and crickets in Britain between the 1980s and the 2000s and assessed whether their traits (resource use, life history, dispersal ability, geographic location) explain relative performance of different species. Our analysis showed large changes in the distributions of some species, and we found a positive relationship between three traits and range change: ranges tended to increase for habitat generalists, species that oviposit in the vegetation above ground, and for those with a southerly distribution. These findings accord well with the nature of environmental changes over this period (climatic warming; reductions in the diversity and increases in the height of vegetation). However, the trait effects applied mainly to just two species, Conocephalus discolor and Metrioptera roeselii, which had shown the greatest range increases. Once they were omitted from the analysis, trait effects were no longer statistically significant. Previous studies on these two species emphasised wing-length dimorphism as the key to their success, resulting in a high phenotypic plasticity of dispersal and evolutionary-ecological feedback at their expanding range margins. This, combined with our results, suggests that an unusual combination of traits have enabled these two species to undertake extremely rapid responses to recent environmental changes. The fact that our results are dominated by two species only became apparent through cautious testing of the results’ robustness, not through standard statistical checks. We conclude that trait-based analyses may contribute to the assessment of species responses to environmental change and provide insights into underlying mechanisms

  13. Two Species with an Unusual Combination of Traits Dominate Responses of British Grasshoppers and Crickets to Environmental Change.

    PubMed

    Beckmann, Björn C; Purse, Bethan V; Roy, David B; Roy, Helen E; Sutton, Peter G; Thomas, Chris D

    2015-01-01

    There are large variations in the responses of species to the environmental changes of recent decades, heightening interest in whether their traits may explain inter-specific differences in range expansions and contractions. Using a long-term distributional dataset, we calculated range changes of grasshoppers and crickets in Britain between the 1980s and the 2000s and assessed whether their traits (resource use, life history, dispersal ability, geographic location) explain relative performance of different species. Our analysis showed large changes in the distributions of some species, and we found a positive relationship between three traits and range change: ranges tended to increase for habitat generalists, species that oviposit in the vegetation above ground, and for those with a southerly distribution. These findings accord well with the nature of environmental changes over this period (climatic warming; reductions in the diversity and increases in the height of vegetation). However, the trait effects applied mainly to just two species, Conocephalus discolor and Metrioptera roeselii, which had shown the greatest range increases. Once they were omitted from the analysis, trait effects were no longer statistically significant. Previous studies on these two species emphasised wing-length dimorphism as the key to their success, resulting in a high phenotypic plasticity of dispersal and evolutionary-ecological feedback at their expanding range margins. This, combined with our results, suggests that an unusual combination of traits have enabled these two species to undertake extremely rapid responses to recent environmental changes. The fact that our results are dominated by two species only became apparent through cautious testing of the results' robustness, not through standard statistical checks. We conclude that trait-based analyses may contribute to the assessment of species responses to environmental change and provide insights into underlying mechanisms, but

  14. Sexual harassment in the medical profession: legal and ethical responsibilities.

    PubMed

    Mathews, Ben; Bismark, Marie M

    2015-08-17

    Sexual harassment of women in medicine has become a subject of national debate after a senior female surgeon stated that if a woman complained of unwanted advances her career would be jeopardised, and subsequent reports suggest that sexual harassment is a serious problem in the medical profession. Sexual harassment of women in the medical profession by their colleagues presents substantial legal, ethical and cultural questions for the profession. Women have enforceable legal rights to gender equality and freedom from sexual harassment in the workplace. Both individual offenders and employers face significant legal consequences for sexual harassment in every Australian state and territory, and individual medical practitioners and employers need to understand their legal and ethical rights and responsibilities in this context. An individual offender may be personally liable for criminal offences, and for breaching anti-discrimination legislation, duties owed in civil law, professional standards and codes of conduct. An employer may be liable for breaching anti-discrimination legislation, workplace safety laws, duties owed in contract law, and a duty of care owed to the employee. Employers, professional colleges and associations, and regulators should use this national debate as an opportunity to improve gender equality and professional culture in medicine; individuals and employers have clear legal and ethical obligations to minimise sexual harassment to the greatest extent possible.

  15. Recurrent hypersomnia: Report of medication-responsive cases

    PubMed Central

    Perin, Bruna V.; Rodrigues, Iorrana; Giasson, Franciele T.B.; Balen, Matheus; Posenato, Naiana; Forcelini, Cassiano M.

    2015-01-01

    Introduction Recurrent hypersomnia (RH) is a rare disorder without established treatment. Methods We report 2 RH medication-responsive cases with typical characteristics of Kleine–Levin syndrome (KLS). Case-reports A 10 y.o. girl and a 14 y.o. boy presented with sudden sleepiness for 3–9 days (every 2–3 weeks). Physical examination, brain images and blood tests were normal. Polysomnographic findings were heterogenous, including disrupted sleep architecture. MSLTs revealed 2–3 SOREMPs and short sleep latency. Carbamazepine rendered girl׳s sleep normalization, while risperidone normalized boy׳s sleep cycles. Conclusions Facing the absence of clinical trials in RH, reports of responsive cases are the available therapeutic evidence. PMID:26483951

  16. An academic medical center's response to widespread computer failure.

    PubMed

    Genes, Nicholas; Chary, Michael; Chason, Kevin W

    2013-01-01

    As hospitals incorporate information technology (IT), their operations become increasingly vulnerable to technological breakdowns and attacks. Proper emergency management and business continuity planning require an approach to identify, mitigate, and work through IT downtime. Hospitals can prepare for these disasters by reviewing case studies. This case study details the disruption of computer operations at Mount Sinai Medical Center (MSMC), an urban academic teaching hospital. The events, and MSMC's response, are narrated and the impact on hospital operations is analyzed. MSMC's disaster management strategy prevented computer failure from compromising patient care, although walkouts and time-to-disposition in the emergency department (ED) notably increased. This incident highlights the importance of disaster preparedness and mitigation. It also demonstrates the value of using operational data to evaluate hospital responses to disasters. Quantifying normal hospital functions, just as with a patient's vital signs, may help quantitatively evaluate and improve disaster management and business continuity planning.

  17. Incontinence medication response relates to the female urinary microbiota.

    PubMed

    Thomas-White, Krystal J; Hilt, Evann E; Fok, Cynthia; Pearce, Meghan M; Mueller, Elizabeth R; Kliethermes, Stephanie; Jacobs, Kristin; Zilliox, Michael J; Brincat, Cynthia; Price, Travis K; Kuffel, Gina; Schreckenberger, Paul; Gai, Xiaowu; Brubaker, Linda; Wolfe, Alan J

    2016-05-01

    Many adult women have resident urinary bacteria (urinary microbiome/microbiota). In adult women affected by urinary urgency incontinence (UUI), the etiologic and/or therapeutic role of the urinary microbiome/microbiota remains unknown. We hypothesized that microbiome/microbiota characteristics would relate to clinically relevant treatment response to UUI medication per os. Adult women initiating medication treatment orally for UUI and a comparator group of unaffected women were recruited in a tertiary care health-care system. All participants provided baseline clinical data and urine samples. Women with UUI were given 5 mg solifenacin, with potential dose escalation to 10 mg for inadequate UUI symptom control at 4 weeks. Additional data and urine samples were collected from women with UUI at 4 and 12 weeks. The samples were assessed using 16S ribosomal RNA (rRNA) gene sequencing and enhanced quantitative urine culturing. The primary outcome was treatment response as measured by the validated Patient Global Symptom Control (PGSC) questionnaire. Clinically relevant UUI symptom control was defined as a 4 or 5 score on the PGSC. Diversity and composition of the urinary microbiome/microbiota of women with and without UUI differed at baseline. Women with UUI had more bacteria and a more diverse microbiome/microbiota. The clinical response to solifenacin in UUI participants was related to baseline microbiome/microbiota, with responders more likely to have fewer bacteria and a less diverse community at baseline. Nonresponders had a more diverse community that often included bacteria not typically found in responders. Knowledge of an individual's urinary microbiome/microbiota may help refine UUI treatment. Complementary tools, DNA sequencing, and expanded urine culture provide information about bacteria that appear to be related to UUI incontinence status and treatment response in this population of adult women.

  18. Problem Gambling Treatment within the British National Health Service

    ERIC Educational Resources Information Center

    Rigbye, Jane; Griffiths, Mark D.

    2011-01-01

    According to the latest British Gambling Prevalence Survey, there are approximately 300,000 adult problem gamblers in Great Britain. In January 2007, the "British Medical Association" published a report recommending that those experiencing gambling problems should receive treatment via the National Health Service (NHS). This study…

  19. Problem Gambling Treatment within the British National Health Service

    ERIC Educational Resources Information Center

    Rigbye, Jane; Griffiths, Mark D.

    2011-01-01

    According to the latest British Gambling Prevalence Survey, there are approximately 300,000 adult problem gamblers in Great Britain. In January 2007, the "British Medical Association" published a report recommending that those experiencing gambling problems should receive treatment via the National Health Service (NHS). This study…

  20. Mobile Audience Response Systems at a Continuing Medical Education Conference.

    PubMed

    Beaumont, Alexandra; Gousseau, Michael; Sommerfeld, Connor; Leitao, Darren; Gooi, Adrian

    2017-01-01

    Mobile audience response systems (mARS) are electronic systems allowing speakers to ask questions and audience members to respond anonymously and immediately on a screen which enables learners to view their peers' responses as well as their own. mARS encourages increased interaction and active learning. This study aims to examine the perceptions of audience members and speakers towards the implementation of mARS at a national medical conference. mARS was implemented at the CSO Annual Meeting in Winnipeg 2015. Eleven presenters agreed to participate in the mARS trial. Both audience and presenters received instructions. Five-point Likert questions and short answer questions were emailed to all conference attendees and the data was evaluated. Twenty-seven participants responded, 23 audience members and 4 instructors. Overall, responders indicated improved attention, involvement, engagement and recognition of audience's understanding of topics with the use of mARS. mARS was perceived as easy to use, with clear instructions, and the majority of respondents expressed an interest in using mARS in more presentations and in future national medical conferences. Most respondents preferred lectures with mARS over lectures without mARS. Some negative feedback on mARS involved dissatisfaction with how some presenters implemented mARS into the workshops. Overall mARS was perceived positively with the majority of respondents wanting mARS implemented in more national medical conferences. Future studies should look at how mARS can be used as an educational tool to help improve patient outcomes.

  1. Fly-By medical care: Conceptualizing the global and local social responsibilities of medical tourists and physician voluntourists

    PubMed Central

    2011-01-01

    Background Medical tourism is a global health practice where patients travel abroad to receive health care. Voluntourism is a practice where physicians travel abroad to deliver health care. Both of these practices often entail travel from high income to low and middle income countries and both have been associated with possible negative impacts. In this paper, we explore the social responsibilities of medical tourists and voluntourists to identify commonalities and distinctions that can be used to develop a wider understanding of social responsibility in global health care practices. Discussion Social responsibility is a responsibility to promote the welfare of the communities to which one belongs or with which one interacts. Physicians stress their social responsibility to care for the welfare of their patients and their domestic communities. When physicians choose to travel to another county to provide medical care, this social responsibility is expanded to this new community. Patients too have a social responsibility to use their community's health resources efficiently and to promote the health of their community. When these patients choose to go abroad to receive medical care, this social responsibility applies to the new community as well. While voluntourists and medical tourists both see the scope of their social responsibilities expand by engaging in these global practices, the social responsibilities of physician voluntourists are much better defined than those of medical tourists. Guidelines for engaging in ethical voluntourism and training for voluntourists still need better development, but medical tourism as a practice should follow the lead of voluntourism by developing clearer norms for ethical medical tourism. Summary Much can be learned by examining the social responsibilities of medical tourists and voluntourists when they engage in global health practices. While each group needs better guidance for engaging in responsible forms of these practices

  2. Characterization of Statin Dose-response within Electronic Medical Records

    PubMed Central

    Wei, Wei-Qi; Feng, Qiping; Jiang, Lan; Waitara, Magarya S.; Iwuchukwu, Otito F.; Roden, Dan M.; Jiang, Min; Xu, Hua; Krauss, Ronald M.; Rotter, Jerome I.; Nickerson, Deborah A.; Davis, Robert L.; Berg, Richard L.; Peissig, Peggy L.; McCarty, Catherine A.; Wilke, Russell A.; Denny, Joshua C.

    2013-01-01

    Efforts to define the genetic architecture underlying variable statin response have met with limited success possibly because previous studies were limited to effect based on one-single-dose. We leveraged electronic medical records (EMRs) to extract potency (ED50) and efficacy (Emax) of statin dose-response curves and tested them for association with 144 pre-selected variants. Two large biobanks were used to construct dose-response curves for 2,026 (simvastatin) and 2,252 subjects (atorvastatin). Atorvastatin was more efficacious, more potent, and demonstrated less inter-individual variability than simvastatin. A pharmacodynamic variant emerging from randomized trials (PRDM16) was associated with Emax for both. For atorvastatin, Emax was 51.7 mg/dl in homozygous for the minor allele versus 75.0 mg/dl for those homozygous for the major allele. We also identified several loci associated with ED50. The extraction of rigorously defined traits from EMRs for pharmacogenetic studies represents a promising approach to further understand of genetic factors contributing to drug response. PMID:24096969

  3. Executive impairment determines ADHD medication response: implications for academic achievement.

    PubMed

    Hale, James B; Reddy, Linda A; Semrud-Clikeman, Margaret; Hain, Lisa A; Whitaker, James; Morley, Jessica; Lawrence, Kyle; Smith, Alex; Jones, Nicole

    2011-01-01

    Methylphenidate (MPH) often ameliorates attention-deficit/hyperactivity disorder (ADHD) behavioral dysfunction according to indirect informant reports and rating scales. The standard of care behavioral MPH titration approach seldom includes direct neuropsychological or academic assessment data to determine treatment efficacy. Documenting "cool" executive-working memory (EWM) and "hot" self-regulation (SR) neuropsychological impairments could aid in differential diagnosis of ADHD subtypes and determining cognitive and academic MPH response. In this study, children aged 6 to 16 with ADHD inattentive type (IT; n = 19) and combined type (n = 33)/hyperactive-impulsive type (n = 4) (CT) participated in double-blind placebo-controlled MPH trials with baseline and randomized placebo, low MPH dose, and high MPH dose conditions. EWM/ SR measures and behavior ratings/classroom observations were rank ordered separately across conditions, with nonparametric randomization tests conducted to determine individual MPH response. Participants were subsequently grouped according to their level of cool EWM and hot SR circuit dysfunction. Robust cognitive and behavioral MPH response was achieved for children with significant baseline EWM/SR impairment, yet response was poor for those with adequate EWM/ SR baseline performance. Even for strong MPH responders, the best dose for neuropsychological functioning was typically lower than the best dose for behavior. Findings offer one possible explanation for why long-term academic MPH treatment gains in ADHD have not been realized. Implications for academic achievement and medication titration practices for children with behaviorally diagnosed ADHD will be discussed.

  4. Migrant labour, racism and the British National Health Service.

    PubMed

    Kyriakides, Christopher; Virdee, Satnam

    2003-11-01

    This study explores the dynamics of racism, specifically its generation and reproduction as an ideology, and its role in affecting the reception and occupational location of migrant medical labour in Britain. It is argued that the treatment of 'overseas doctors' in Britain draws on a complex interplay between racism and nationalism underpinned by the historical construction of 'welfarism' as a moral legitimator of 'Britishness'. Through an exploration of internal and external immigration controls introduced with the aim of regulating migrant labour, we demonstrate how British social policy and elite discourses of 'race' combine to construct moral prescriptions of threat such that migrants and British-born 'non-whites' entering the British medical profession are forced to negotiate 'saviour/pariah' ascriptions indicative of discriminatory but contradictory processes specific to the operation of the British National Health Service as a normative institution.

  5. Improvement in medical consultation responses with a structured request form.

    PubMed

    Geist, Shin-Mey Rose Y; Geist, James R

    2008-05-01

    Physicians often do not provide adequate information regarding patients' medical conditions when presented with consultation requests (CR) generated by dental students and their instructors about the students' patients. We hypothesized that a structured CR form, which requests specific information by providing a checklist and/or closed-ended questions for physicians to answer, would lead to better communication and improved responses. We also hypothesized that providing in-service education to clinical faculty on the conditions that require and don't require CRs would reduce the number of unwarranted CRs sent to physicians. We assessed the responses obtained with the new form and compared them to findings over a similar period using our older, unstructured CR forms. We also evaluated the numbers of CRs written unnecessarily during both time periods. Improvements in the appropriateness of information provided by physicians were noted with the new CR forms for diabetes mellitus, hypertension, heart murmur, and anticoagulant therapy. The number of CRs written for conditions that did not need a consultation was approximately the same after provision of instruction as before. We conclude that structured CR forms improve the flow of information between dentists and physicians and should enhance student knowledge and skills in soliciting relevant information. Greater efforts must be taken to inform clinical faculty about the indications for CRs.

  6. No Time for Nostalgia!: Asylum-Making, Medicalized Colonialism in British Columbia (1859-97) and Artistic Praxis for Social Transformation

    ERIC Educational Resources Information Center

    Roman, Leslie G.; Brown, Sheena; Noble, Steven; Wainer, Rafael; Young, Alannah Earl

    2009-01-01

    This article asks: How have disability, indigenous arts and cultural praxis transformed and challenged the historical sociological archival research into relationships among asylum-making, medicalized colonialism and eugenics in the Woodlands School, formerly the Victoria Lunatic Asylum, the Provincial Asylum for the Insane in Victoria, BC 1859-72…

  7. No Time for Nostalgia!: Asylum-Making, Medicalized Colonialism in British Columbia (1859-97) and Artistic Praxis for Social Transformation

    ERIC Educational Resources Information Center

    Roman, Leslie G.; Brown, Sheena; Noble, Steven; Wainer, Rafael; Young, Alannah Earl

    2009-01-01

    This article asks: How have disability, indigenous arts and cultural praxis transformed and challenged the historical sociological archival research into relationships among asylum-making, medicalized colonialism and eugenics in the Woodlands School, formerly the Victoria Lunatic Asylum, the Provincial Asylum for the Insane in Victoria, BC 1859-72…

  8. Very serious and non-ignorable problem: Crisis in emergency medical response in catastrophic event.

    PubMed

    Shen, Weifeng; Jiang, Libing; Zhang, Mao; Ma, Yuefeng; Jiang, Guanyu; He, Xiaojun

    2015-12-01

    The crisis of medical response caused by catastrophic events might significantly affect emergency response, and might even initiate more serious social crisis. Therefore, early identification and timely blocking the formation of crisis in the early phase after a major disaster will improve the efficiency of medical response in a major disaster and avoid serious consequences. In the present paper, we described the emergency strategy to crisis management of medical response after a major disaster. Major catastrophic events often lead to various crises, including excess demand, the crisis of response in barrier and the structural crisis in response. The corresponding emergency response strategies include: (i) shunt of catastrophic medical surge; (ii) scalability of medical surge capacity; (iii) matching of the structural elements of response; (iv) maintaining the functions of support system for medical response and maximising the operation of the integrated response system; and (v) selection of appropriate care 'standard' in extreme situations of overload of disaster medical surge. In conclusion, under the impact of a major catastrophic event, medical response is often complex and the medical surge beyond the conventional response capacity and it is easy to be in crisis. In addition to the current consensus of disaster response, three additional aspects should be considered. First, all relevant society forces led by the government and military should be linkages. Second, a powerful medical response system must be based on a strong support system. Third, countermeasures of medical surge should be applied flexibly to the special and specific disaster environment, to promote the effective medical response force. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  9. Key performance indicators in British military trauma.

    PubMed

    Stannard, Adam; Tai, Nigel R; Bowley, Douglas M; Midwinter, Mark; Hodgetts, Tim J

    2008-08-01

    Key performance indicators (KPI) are tools for assessing process and outcome in systems of health care provision and are an essential component in performance improvement. Although KPI have been used in British military trauma for 10 years, they remain poorly defined and are derived from civilian metrics that do not adjust for the realities of field trauma care. Our aim was to modify current trauma KPI to ensure they more faithfully reflect both the military setting and contemporary evidence in order to both aid accurate calibration of the performance of the British Defence Medical Services and act as a driver for performance improvement. A workshop was convened that was attended by senior, experienced doctors and nurses from all disciplines of trauma care in the British military. "Speciality-specific" KPI were developed by interest groups using evidence-based data where available and collective experience where this was lacking. In a final discussion these were streamlined into 60 KPI covering each phase of trauma management. The introduction of these KPI sets a number of important benchmarks by which British military trauma can be measured. As part of a performance improvement programme, these will allow closer monitoring of our performance and assist efforts to develop, train, and resource British military trauma providers.

  10. Divisions and diversity: the complexities of medical refuge in Britain, 1933-1948.

    PubMed

    Decker, Karola

    2003-01-01

    The experiences of medical refugees who came to the United Kingdom from Nazi Germany and occupied Europe in the 1930s and 1940s reflect the general characteristics of the British response to the refugee crisis. This article analyzes the role of the British medical establishment and its interplay with the government and refugee aid organizations. Processes of decision making and changes of policy are revealed, drawing on the files of the "Aliens Committee" at the archive of the British Medical Association, on the private collection of Yvonne Kapp, former administrative head of the Medical Department of the Central Office for Refugees, and on the medical subseries of the archive of the Society for the Protection of Science and Learning. "Divisions" refer to differing interests and attitudes of the institutions, organizations and individuals involved; "diversity" reflects the response to the various nationalities of medical refugees, mainly German, Austrian, Czech, and Polish.

  11. British super-shuttle

    NASA Astrophysics Data System (ADS)

    1984-10-01

    British Aerospace, the nationalized aerospace manufacturer, confirmed that a space shuttle of new design is indeed being studied, and that a model of the craft will be displayed. The British television network ITN had announced that secret plans were being prepared for the construction of a reusable horizontal takeoff super-shuttle, which could breathe atmospheric oxygen to supply its propulsion system. Retracting a first denial according to which the project existed merely as scribbles on the back of an envelope, a British Aerospace spokesperson declared that it was in fact a very serious study. The super-shuttle, called HOTOL (horizontal takeoff and landing), would be placed in orbit as a platform for satellite launching. The spokesperson further indicated that with a certain resemblance to the Concorde, it would be pilotless, remote controlled, and would allow frequent operations at short time intervals.

  12. Leading articles in medical journals in 1966.

    PubMed

    Stimpson, Philippa J; Marks, Daniel Jb

    2016-10-01

    The British Journal of Hospital Medicine is 50 years old. This article takes a look back at articles published during the year of its inception from the British Medical Journal, the Lancet and the Journal of the American Medical Association.

  13. Promoting social responsibility amongst health care users: medical tourists' perspectives on an information sheet regarding ethical concerns in medical tourism.

    PubMed

    Adams, Krystyna; Snyder, Jeremy; Crooks, Valorie A; Johnston, Rory

    2013-12-06

    include the development of a website for ongoing discussion that could contribute to a raised awareness of these concerns and potentially increase social responsibility in the medical tourism industry.

  14. Promoting social responsibility amongst health care users: medical tourists’ perspectives on an information sheet regarding ethical concerns in medical tourism

    PubMed Central

    2013-01-01

    , future research implications should include the development of a website for ongoing discussion that could contribute to a raised awareness of these concerns and potentially increase social responsibility in the medical tourism industry. PMID:24314027

  15. Advanced airway management--a medical emergency response team perspective.

    PubMed

    Haldane, A G

    2010-09-01

    To determine the number of medical emergency response team (MERT) patients undergoing advanced airway management in the peri-evacuation phase and to determine the indications for airway interventions undertaken in flight. This was a retrospective study. Data was collected from patient report and mission debrief forms completed after each MERT mission during Operation HERRICK 10 (April-October 2009). All patients that received advanced airway interventions before or during evacuation were identified. MERTs were involved in the primary transfer of 534 patients during the period studied, 56 (10.5%) underwent advanced airway management, of which 31 (5.8% of total) were initiated by the MERT in the peri-evacuation phase. Twenty five cases (4.7%) underwent advanced airway management by other pre-hospital providers prior to MERT arrival. Of the 31 advanced airway interventions undertaken in-flight, cardiac arrest was the primary indication in only nine cases. The figure of 56 patients requiring advanced airway management is at the higher end of the range expected from the study of historical military data. This may reflect the doctrine of "intelligent tasking", that is sending this physician-led team to the most seriously injured casualties.

  16. The 2012 derecho: emergency medical services and hospital response.

    PubMed

    Kearns, Randy D; Wigal, Mark S; Fernandez, Antonio; Tucker, March A; Zuidgeest, Ginger R; Mills, Michael R; Cairns, Bruce A; Cairns, Charles B

    2014-10-01

    During the early afternoon of June 29, 2012, a line of destructive thunderstorms producing straight line winds known as a derecho developed near Chicago (Illinois, USA). The storm moved southeast with wind speeds recorded from 100 to 160 kilometers per hour (kph, 60 to 100 miles per hour [mph]). The storm swept across much of West Virginia (USA) later that evening. Power outage was substantial as an estimated 1,300,000 West Virginians (more than half) were without power in the aftermath of the storm and approximately 600,000 citizens were still without power a week later. This was one of the worst storms to strike this area and occurred as residents were enduring a prolonged heat wave. The wind damage left much of the community without electricity and the crippling effect compromised or destroyed critical infrastructure including communications, air conditioning, refrigeration, and water and sewer pumps. This report describes utilization of Emergency Medical Services (EMS) and hospital resources in West Virginia in response to the storm. Also reported is a review of the weather phenomena and the findings and discussion of the disaster and implications.

  17. Self-medication of antibacterials without prescription (also called 'over-the-counter' use). A report of a Working Party of the British Society for Antimicrobial Chemotherapy.

    PubMed

    Reeves, D S; Finch, R G; Bax, R P; Davey, P G; Po, A L; Lingam, G; Mann, S G; Pringle, M A

    1999-08-01

    The availability of antimicrobial agents for self-medication may increase and could include antibacterial agents for oral or topical use. Wholesale deregulation of antibacterials would be undesirable and likely to encourage misuse of classes of agents currently important in the management of serious infections. Changed regulation from Prescription-Only Medicine (POM) to Pharmacy (P) medicine of selected agents with indications for short-term use in specific minor infections and illness is likely to have advantages to the user. However, safeguards to their use would need to be included in the Patient Information Leaflet (PIL). Agents and indications for self-medication are discussed. Any alteration in licensed status from POM to P will require careful risk-benefit assessment, including the likely impact on bacterial resistance. Safety issues also include concerns relating to age of the user, pregnancy, underlying disease and the potential for drug interactions. The importance of appropriate information with the PIL is emphasized, as is the role of the pharmacist, while ways of improving adverse event notification and monitoring are discussed. The paucity of good denominator-controlled data on the prevalence of in-vitro resistance is highlighted, and recommendations for improving the situation are made. There are currently no levels of resistance accepted by regulatory bodies on which to base a licensing decision, be it for granting a product licence, renewal of a licence or a change in licensed status from POM to P. Due consideration should be given to: the validation of user-defined indications in comparison with those medically defined; the enhancement of pharmacy advice in the purchase of such agents; improved safety monitoring; the establishment of systematic surveillance of susceptibility data.

  18. The Limits of Movement Politics: The Case of British Feminism.

    ERIC Educational Resources Information Center

    Stetson, Dorothy M.

    Analysis of the British feminist movement from 1850 to 1975 reveals a constant struggle by feminists for equality in the face of legal and social restrictions and a corresponding lack of response by the British government to movement demands. The political organization of the feminist movement is described in four phases. During the first phase,…

  19. Chronocentrism and British criminology.

    PubMed

    Rock, Paul

    2005-09-01

    Criminologists display a largely unexamined propensity to ignore writings that are more than fifteen or so years old, with evident consequences for the public presentation and validation of expert knowledge. A citation study was combined with detailed observations from British criminologists to ascertain quite how that disavowal of the past was accomplished.

  20. British nuclear policymaking

    SciTech Connect

    Bowie, C.J.; Platt, A.

    1984-01-01

    This study analyzes the domestic political, economic, and bureaucratic factors that affect the nuclear policymaking process in Great Britain. Its major conclusion is that, although there have been changes in that process in recent years (notably the current involvement of a segment of the British public in the debate about the deployment of intermediate-range nuclear forces), future British nuclear policymaking will remain much what it has been in the past. Three ideas are central to understanding British thinking on the subject: (1) Britain's long-standing resolve to have her own national nuclear force is largely traceable to her desire to maintain first-rank standing among the nations of the world in spite of loss of empire. (2) Financial considerations have always been important--so much so that they have usually dominated issues of nuclear policy. (3) The executive branch of government dominates the nuclear policymaking process but does not always present a united front. The United States heavily influences British nuclear policy through having supplied Britain since the late 1950s with nuclear data and components of nuclear weapon systems such as Polaris and Trident. The relationship works both ways since the U.S. depends on Britain as a base for deployment of both conventional and nuclear systems.

  1. Prevent and "British Values"

    ERIC Educational Resources Information Center

    Kenny, Alex; Ghale, Baljeet

    2015-01-01

    At the recent National Union of Teachers' conference the role of the Prevent strategy and the introduction of "British Values" in the Office for Standards in Education, Children's Services and Skills framework emerged as key issues for delegates. Two of the speeches made at the conference are presented here.

  2. Okanagan Lake, British Columbia

    NASA Image and Video Library

    1994-10-01

    STS068-155-011 (30 September-11 October 1994) --- (Okanagan Lake, British Columbia) View southward down the lake; Vernon is in the foreground, Kelowna just before the bend in the lake, and Penticton at the far end of the lake. Green crops are still vigorous despite the season (early October); clear-cuts dot the forested hillsides.

  3. The 1985 British Physics Olympiad.

    ERIC Educational Resources Information Center

    Isenberg, Cyril

    1985-01-01

    Presents questions and answers to the 1985 British Physics Olympiad (BPhO) Competition. Comments about the competition (the second year of British participation) and the winners who went to Yugoslavia (and placed second behind the USSR) are included. (JN)

  4. Discrepancies in Mother and Child Perceptions of Spina Bifida Medical Responsibilities During the Transition to Adolescence: Associations With Family Conflict and Medical Adherence

    PubMed Central

    Psihogios, Alexandra M.

    2013-01-01

    Objective This study investigated mother–child discrepancies over perceptions of who is responsible for spina bifida (SB) medical tasks in relation to family conflict and medical adherence. Method 140 youth with SB and their mothers completed questionnaires regarding who is responsible for specific SB medical tasks, family conflict, and medical adherence. An observational measure was also used to assess family conflict. Results Although children viewed themselves as more responsible for medical management than mothers did, mother–child discrepancies were not associated with family conflict or medical adherence. Interaction effects revealed that adherence was better when family conflict was low and when parents were responsible for medical tasks. Conclusions Parental involvement in SB medical care is essential for optimal medical adherence during adolescence. The presence of family conflict also plays an influential role on SB medical adherence. Future research should evaluate the relations between discrepancies, family conflict, and medical adherence across time. PMID:23843631

  5. Simultaneous validation of the Grandway MD2301 digital automatic blood pressure monitor by the British Hypertension Society and the Association for the Advancement of Medical Instrumentation/the International Organization for Standardization protocols.

    PubMed

    Huang, Jinhua; Wang, Yun; Liu, Zhaoying; Wang, Yuling

    2017-02-01

    The aim of this study was to determine the accuracy of the Grandway MD2301 digital automatic blood pressure monitor by the British Hypertension Society (BHS) and the Association for the Advancement of Medical Instrumentation (AAMI)/the International Organization for Standardization (ISO) protocols. A total of 85 participants were included for evaluation based on the requirements of the BHS and the AAMI/ISO protocols. The validation procedure and data analysis followed the protocols precisely. The device achieved A/A grading for the BHS protocol and maintained A/A grading throughout the low, medium and high blood pressure ranges. The device also fulfilled the requirement of the AAMI/ISO protocol with device-observer differences of -0.9±5.6 and 0.8±5.2 mmHg for systolic and diastolic blood pressure, respectively, for criterion 1, and -0.9±4.7 and 0.8±4.2 mmHg, respectively, for criterion 2. The Grandway MD2301 digital automatic blood pressure monitor achieved A/A grade of the BHS protocol and passed the requirements of the AAMI/ISO protocol in adults.

  6. UK national audit against the key performance indicators in the British Association for Sexual Health and HIV Medical Foundation for AIDS and Sexual Health Sexually Transmitted Infections Management Standards.

    PubMed

    McClean, H; Sullivan, A K; Carne, C A; Warwick, Z; Menon-Johansson, A; Clutterbuck, D

    2012-10-01

    A national audit of practice performance against the key performance indicators in the British Association for Sexual Health and HIV (BASHH) and HIV Medical Foundation for AIDS Sexual Health Standards for the Management of Sexually Transmitted Infections (STIs) was conducted in 2011. Approximately 60% and 8% of level 3 and level 2 services, respectively, participated. Excluding partner notification performance, the five lowest areas of performance for level 3 clinics were the STI/HIV risk assessment, care pathways linking care in level 2 clinics to local level 3 services, HIV test offer to patients with concern about STIs, information governance and receipt of chlamydial test results by clinicians within seven working days (the worst area of performance). The five lowest areas of performance for level 2 clinics were participating in audit, having an audit plan for the management of STIs for 2009-2010, the STI/HIV risk assessment, HIV test offer to patients with concern about STIs and information governance. The results are discussed with regard to the importance of adoption of the standards by commissioners of services because of their relevance to other national quality assurance drivers, and the need for development of a national system of STI management quality assurance measurement and reporting.

  7. Roles and responsibilities of chief medical officers in member organizations of the Association of American Medical Colleges.

    PubMed

    Longnecker, David E; Patton, Mary; Dickler, Robert M

    2007-03-01

    To explore the roles of physician leaders who hold titles such as chief medical officer (CMO), vice president for medical affairs, and vice dean for clinical affairs in Association of American Medical Colleges (AAMC) member organizations, and to identify critical success factors for these positions. An Internet-based survey was submitted to 340 physician leaders in 281 AAMC member institutions. The survey posed questions regarding demographics, titles, reporting relationships, time commitments, scope of responsibility, accomplishments, and challenges related to recipients' positions, among other questions. Responses were received from 154 physicians representing 139 institutions (response rates 45% and 49%, respectively). Forty-nine percent of these positions had existed for 10 years or less. The most common administrative title was CMO (48%). Eighty-five percent of these individuals reported directly to the dean or CEO of their organization. The majority of administrative effort involved quality and safety (31%), coordination of clinical care (21%), and graduate medical education (9%). The remainder (39%) encompassed a broad portfolio of responsibilities ranging from information technology (6%) to nursing services (2%). Keys to job success included personal stature and relationships, clear definition of responsibilities, and the commitments of the senior administration to the position. Teaching hospitals and medical schools are creating or strengthening positions for physician leaders, most commonly called CMOs. CMOs' work involves numerous activities beyond the traditional areas of quality and safety. The effectiveness of these positions requires clear definition of the role throughout the organization and strong, evident support from senior executives in the organization.

  8. Teaching Medical Ethics: Some Persistent Questions and Some Responses.

    ERIC Educational Resources Information Center

    Pellegrino, Edmund D.

    1989-01-01

    Issues in the inclusion of medical ethics in the medical curriculum are discussed, including its relevance, whether or not ethics can be taught, whose ethics should be taught, the contribution of the professional ethicist, and the relevance of humanistic studies outside ethics. (MSE)

  9. Teaching Medical Ethics: Some Persistent Questions and Some Responses.

    ERIC Educational Resources Information Center

    Pellegrino, Edmund D.

    1989-01-01

    Issues in the inclusion of medical ethics in the medical curriculum are discussed, including its relevance, whether or not ethics can be taught, whose ethics should be taught, the contribution of the professional ethicist, and the relevance of humanistic studies outside ethics. (MSE)

  10. Broadcasting Science and Medical News: The Responsibilities and Obligations.

    ERIC Educational Resources Information Center

    Crawford, Charles

    1982-01-01

    The interaction between medicine and journalism and the First Amendment is discussed, along with why the education of the public is so important to society. How medical stories are produced for television is explained, and the need for more cooperation between the news media and the medical establishment is advocated. (MLW)

  11. Simultaneous validation of the SunTech CT40 automated blood pressure measurement device by the 1993 British Hypertension Society protocol and the Association for the Advancement of Medical Instrumentation/International Organization for Standardization 81060-2: 2013 standard.

    PubMed

    Polo Friz, Hernan; Punzi, Veronica; Petri, Francesco; Orlandi, Riccardo; Maggiolini, Daniele; Polo Friz, Melisa; Primitz, Laura; Vighi, Giuseppe

    2017-10-01

    This study aimed to perform a simultaneous, third-party, independent validation of the oscillometric SunTech CT40 device for blood pressure (BP) measurement, according to the 1993 protocol of the British Hypertension Society and the standard of the Association for the Advancement of Medical Instrumentation (AAMI)/the International Organization for Standardization (ISO) 81060-2:2013. Patient recruitment, study procedures, and data analysis followed the recommendations stated by the protocols. The study was approved by the institutional review board. A total of 94 participants were included, 52 (55.3%) women, mean±SD age: 63.1±18.0 years, mean±SD arm circumference: 35.0±9.0 cm. The average of observers' entry BPs was 146.9±37.2 mmHg for systolic blood pressure (SBP) and 82.2±22.1 mmHg for diastolic blood pressure (DBP). Differences between the standard measurement and the test device within 5, 10, and 15 mmHg, for the better observer, were 79.4, 96.5, and 100.0% for SBP and 82.6, 97.5, and 100.0% for DBP, respectively. The mean±SD differences between the readings obtained using the test device and those obtained by the observers (AAMI/ISO 81060-2:2013 standard criterion 1) were 0.3±5.0 mmHg (SBP) and -0.8±4.3 mmHg (DBP), and the mean±SD differences between average of reference readings and average of test device readings in each patient (criterion 2) were 0.3±3.9 and -0.8±3.5 mmHg for SBP and DBP, respectively. The CT40 BP device achieved A/A grade of the British Hypertension Society protocol and fulfilled the requirements (criteria 1 and 2) of the AAMI/ISO standard. CT40 can be recommended for BP measurement in adults.

  12. Some effects of stimulant medication on response allocation: a double-blind analysis.

    PubMed

    Kelley, Michael E; Fisher, Wayne W; Lomas, Joanna E; Sanders, Roy Q

    2006-01-01

    Children who are diagnosed with attention deficit hyperactivity disorder (or who engage in behavior consistent with such a diagnosis) are often prescribed stimulant medications for hyperactive or inattentive behaviors. However, the mechanisms by which stimulant medications affect individuals' behavior are rarely evaluated. The purpose of the current study was to evaluate the effects of stimulant medication on response allocation when antecedents and consequences were held constant and equated. Results indicated that the presence of an amphetamine medication (Adderall) influenced response allocation across two concurrently available responses while all other stimulus conditions were held constant.

  13. The Responsibility of Social Work in Medical Education

    PubMed Central

    Elliott, Valerie

    1973-01-01

    This article is a plea for education toward a greater understanding of each other's disciplines for both physicians and social workers. It describes the 1971 summer experience of two medical students, whose perceptions changed over the course of the summer, not only towards social workers, but towards their own treatment approach. Sociology is too generalized and abstract for inclusion in medical education. Social work is more clinical, and should therefore be included. PMID:20468923

  14. British Nuclear Policymaking,

    DTIC Science & Technology

    1984-01-01

    14A.,J.R. Groorn, British Thinking About Nuclear Weapons, Pinter , London, 1974, p. 555. likely, particularly if its conventional forces were deployed...In an atmosphere of crisis, Prime Minister Harold Macmillan met with President Kennedy in late 1962 and quickly hammered out an agreement whereby the...power in 1964, Prime Minister Harold Wilson noted how dependent, in fact, Britain was on the United States for important components of the nuclear force

  15. Validation of the SAA-102 home blood pressure monitor according to the protocols of the European Society of Hypertension, the Association for the Advancement of Medical Instrumentation and the British Society of Hypertension.

    PubMed

    Zaetta, Vania; Daniele, Longo; Perkovic, Davor; Pratticò, Francesco; Barisa, Marlena; Perfetti, Paola; Gabrieli, Alberto; Buonocore, Francesco; Winnicki, Mikolaj

    2007-12-01

    To determine the accuracy of a new oscillometric home blood pressure (BP) monitor for arm BP measurement, the SAA-102, developed by the Sensacare Company. Evaluation of the SAA-102 was performed using validation protocols of the European Society of Hypertension (ESH), the Association for the Advancement of Medical Instrumentation (AAMI), and the British Hypertension Society (BHS). The SAA-102 monitor was assessed on 33 participants according to ESH requirements, which are based on four zones of accuracy differing from the mercury standard by 5, 10, 15 mmHg or more. Then the oscillometric monitor was tested on 85 participants according to AAMI criteria which require a mean device-observers discrepancy within 5+/-8 mmHg. Finally, the electronic device was evaluated on 93 participants according to BHS requirements, which are based on five phases: before-use calibration, in-use assessment, after-use calibration, static device validation and report of the results. The SAA-102 passed all phases of the ESH international protocol for both systolic and diastolic blood pressure (SBP and DBP). The SAA-102 passed also AAMI criteria for SBP and DBP. The mean discrepancy between the SAA-102 and observers was 0.1+/-4.6 and -2.7+/-5.2 mmHg, for SBP and DBP, respectively. According to BHS protocol, the oscillometric monitor achieved final grading of A/A for SBP and DBP, respectively. These data show that the SAA-102 device satisfies ESH, AAMI, and BHS protocols for both SBP and DBP and may be recommended for everyday use for BP monitoring at home and in clinical practice.

  16. The Ethical Perspective of British and American Preservice Teachers.

    ERIC Educational Resources Information Center

    Deering, Thomas E.

    1998-01-01

    Comparison of responses from 38 U.S. and 27 British preservice teachers on the Ethics Position Questionnaire indicated that both groups had high idealism. U.S. teachers had lower relativism scores. (SK)

  17. A Strategic Look at the Federal Medical Response to Disasters

    DTIC Science & Technology

    2007-03-30

    with reserves of fuel . They have emergency stores of pharmaceuticals and medical supplies, and food and water for the staff and patients. Many of the...amounts of supplies and pharmaceuticals. (49) When Hurricane Katrina struck, HHS decided to immediately send what FCMS material was available to support

  18. Response of Faculty Members to Medical Students' Personal Problems.

    ERIC Educational Resources Information Center

    Brown, James C.; Barnett, John M.

    1984-01-01

    A survey of 96 faculty in 12 medical schools showed that faculty average 48.6 minutes a week discussing personal problems with students. The most common problems concern finances, emotional health, and interactions with faculty. Techniques used include listening, questioning, sympathy, and empathy. (MSE)

  19. Donald E. Francke Medal lecture. The transition from apothecary to pharmacist in British hospitals.

    PubMed

    Whittet, T D

    1979-04-01

    The transition from hospital apothecaries to contemporary hospital pharmacists in Great Britain is reviewed, beginning with the monk-apothecaries associated with the monastic infirmaries as early as the 12th century. Briefly reviewed is the use of the title Apothecary, from about the mid-1500s to about the mid-1800s, at three Royal Hospitals--St. Thomas's Hospital, St. Bartholomew's Hospital and the Bethlehem Hospital. The responsibilities, pharmaceutical and otherwise, of persons who held this title over the years are discussed. Pharmaceutical duties were eventually entrusted to the dispenser (or, at St. Thomas's, the pharmaceutist) and then to the pharmacist. The history of hospital apothecaries is also traced at the voluntary hospitals, University College Hospital, and hospitals in Scotland, Wales and the British provinces. British hospital apothecaries changed from a pharmaceutical orientation to a medical orientation, but they retained control of hospital pharmacies for about 50 years after this change was sanctioned legally.

  20. The Medical Reserve Corps as part of the federal medical and public health response in disaster settings.

    PubMed

    Frasca, Dominic R

    2010-09-01

    The Secretary of the Department of Health and Human Services (HHS), through the Office of the Assistant Secretary for Preparedness and Response (ASPR), coordinates federal Emergency Support Function (ESF) #8 preparedness, response, and recovery actions. To address these needs, the ASPR can draw on trained personnel from a variety of sources, both from within and outside HHS. Among the resources under the domain of HHS is the Medical Reserve Corps (MRC), directed by the Office of the Civilian Volunteer Medical Reserve Corps (OCVMRC) in the Office of the Surgeon General. MRC units are community based and function as a way to locally organize and utilize medical and public health professionals, such as physicians, nurses, pharmacists, dentists, veterinarians, and epidemiologists. Nonclinical volunteers, such as interpreters, chaplains, office workers, legal advisors, and others, can fill logistical and support roles in MRC units. This article discusses locally controlled (Hurricanes Gustav and Ike) and federalized (Hurricanes Katrina and Rita) MRC activations, and it describes the advantages of using medical volunteers in a large-scale disaster response setting.

  1. Facilitating The Medical Response Into An Active Shooter Hot Zone

    DTIC Science & Technology

    2016-06-01

    How to Respond, U.S. Department of Homeland Security, 2008, https://www.dhs.gov/xlibrary/assets/active_shooter_booklet.pdf. 2 Morgan Jones, The...88 Thomas C. Hayes, “Gunman Kills 22 and Himself in Texas Cafeteria,” The New York Times, October 17, 1991, http://www.nytimes.com...and begin to hunt for the shooter. Of concern is the need to neutralize the attacker(s) and allow medical attention to begin as fast as possible

  2. "Time enough! Or not enough time!" An oral history investigation of some British and Australian community nurses' responses to demands for "efficiency" in health care, 1960-2000.

    PubMed

    Hallett, Christine E; Madsen, Wendy; Pateman, Brian; Bradshaw, Julie

    2012-01-01

    Oral history methodology was used to investigate the perspectives of retired British district nurses and Australian domiciliary nurses who had practiced between 1960 and 2000. Interviews yielded insights into the dramatic changes in community nursing practice during the last four decades of the 20th century. Massive changes in health care and government-led drives for greater efficiency meant moving from practice governed by "experiential time" (in which perception of time depends on the quality of experience) to practice governed by "measured time" (in which experience itself is molded by the measurement of time). Nurses recognized that the quality of their working lives and their relationships with families had been altered by the social, cultural, and political changes, including the drive for professional recognition in nursing itself, soaring economic costs of health care and push for deinstitutionalization of care. Community nurses faced several dilemmas as they grappled with the demands for efficiency created by these changes.

  3. The "RTR" medical response system for nuclear and radiological mass-casualty incidents: a functional TRiage-TReatment-TRansport medical response model.

    PubMed

    Hrdina, Chad M; Coleman, C Norman; Bogucki, Sandy; Bader, Judith L; Hayhurst, Robert E; Forsha, Joseph D; Marcozzi, David; Yeskey, Kevin; Knebel, Ann R

    2009-01-01

    Developing a mass-casualty medical response to the detonation of an improvised nuclear device (IND) or large radiological dispersal device (RDD) requires unique advanced planning due to the potential magnitude of the event, lack of warning, and radiation hazards. In order for medical care and resources to be collocated and matched to the requirements, a [US] Federal interagency medical response-planning group has developed a conceptual approach for responding to such nuclear and radiological incidents. The "RTR" system (comprising Radiation-specific TRiage, TReatment, TRansport sites) is designed to support medical care following a nuclear incident. Its purpose is to characterize, organize, and efficiently deploy appropriate materiel and personnel assets as close as physically possible to various categories of victims while preserving the safety of responders. The RTR system is not a medical triage system for individual patients. After an incident is characterized and safe perimeters are established, RTR sites should be determined in real-time that are based on the extent of destruction, environmental factors, residual radiation, available infrastructure, and transportation routes. Such RTR sites are divided into three types depending on their physical/situational relationship to the incident. The RTR1 sites are near the epicenter with residual radiation and include victims with blast injuries and other major traumatic injuries including radiation exposure; RTR2 sites are situated in relationship to the plume with varying amounts of residual radiation present, with most victims being ambulatory; and RTR3 sites are collection and transport sites with minimal or no radiation present or exposure risk and a victim population with a potential variety of injuries or radiation exposures. Medical Care sites are predetermined sites at which definitive medical care is given to those in immediate need of care. They include local/regional hospitals, medical centers, other

  4. Rapid response: email, immediacy, and medical humanitarianism in Aceh, Indonesia.

    PubMed

    Grayman, Jesse Hession

    2014-11-01

    After more than 20 years of sporadic separatist insurgency, the Free Aceh Movement and the Indonesian government signed an internationally brokered peace agreement in August 2005, just eight months after the Indian Ocean tsunami devastated Aceh's coastal communities. This article presents a medical humanitarian case study based on ethnographic data I collected while working for a large aid agency in post-conflict Aceh from 2005 to 2007. In December 2005, the agency faced the first test of its medical and negotiation capacities to provide psychiatric care to a recently amnestied political prisoner whose erratic behavior upon returning home led to his re-arrest and detention at a district police station. I juxtapose two methodological approaches-an ethnographic content analysis of the agency's email archive and field-based participant-observation-to recount contrasting narrative versions of the event. I use this contrast to illustrate and critique the immediacy of the humanitarian imperative that characterizes the industry. Immediacy is explored as both an urgent moral impulse to assist in a crisis and a form of mediation that seemingly projects neutral and transparent transmission of content. I argue that the sense of immediacy afforded by email enacts and amplifies the humanitarian imperative at the cost of abstracting elite humanitarian actors out of local and moral context. As a result, the management and mediation of this psychiatric case by email produced a bureaucratic model of care that failed to account for complex conditions of chronic political and medical instability on the ground.

  5. Norepinephrine and cardiovascular responses to maximal exercise in Parkinson's disease on and off medication.

    PubMed

    DiFrancisco-Donoghue, Joanne; Elokda, Ahmed; Lamberg, Eric M; Bono, Nancy; Werner, William G

    2009-09-15

    The aim of this experiment is to understand how Parkinson's disease (PD) medication affects the autonomic responses of individuals during an acute exercise stress test. Fourteen people with PD and fifteen healthy individuals age-matched between 50 and 80 years performed a modified Bruce protocol. Subjects with PD performed the test once off medication (PD-off) and then 1 week later on medication (PD-on). Heart rate (HR), blood pressure (BP), VO(2), and norepinephrine (NE) levels were taken at rest and at peak exercise. At peak exercise HR, BP, and NE values for the PD-on and PD-off group were all significantly lower than healthy controls, regardless of whether subjects were on their medication. Autonomic abnormalities during exercise in this population appear to be disease manifested and not impacted by medications used to treat PD. We can assume, both on and off medication, this population will show markedly lower BP, HR, and NE responses.

  6. The role, responsibilities and status of the clinical medical physicist in AFOMP.

    PubMed

    Ng, K H; Cheung, K Y; Hu, Y M; Inamura, K; Kim, H J; Krisanachinda, A; Leung, J; Pradhan, A S; Round, H; van Doomo, T; Wong, T J; Yi, B Y

    2009-12-01

    This document is the first of a series of policy statements being issued by the Asia-Oceania Federation of Organizations for Medical Physics (AFOMP). The document was developed by the AFOMP Professional Development Committee (PDC) and was endorsed for official release by AFOMP Council in 2006. The main purpose of the document was to give guidance to AFOMP member organizations on the role and responsibilities of clinical medical physicists. A definition of clinical medical physicist has also been provided. This document discusses the following topics: professional aspects of education and training; responsibilities of the clinical medical physicist; status and organization of the clinical medical physics service and the need for clinical medical physics service.

  7. Medical migration and world health

    PubMed Central

    Fraser, Alan G

    1977-01-01

    Everyone knows that British doctors are emigrating and that other doctors, mostly from the third world, are immigrating to Britain. Also everyone thinks that he knows the reasons why. However, the Edinburgh Medical Group thought the various reasons for this medical migration should be examined more closely, and held a symposium (Chairman, Professor A S Duncan, Professor Emeritus of Medical Education in the University of Edinburgh) to examine the causes for medical migration at the present time. Medical teaching and practice is still basically as it has been developed in the West and so overseas doctors trained in Britain take with them not only the medical knowledge and skills but also the attitudes of the West when they return to their own countries. Consequently they wish to settle in the towns and practise as consultants when the real medical problems in many of the developing countries are those of a rural population needing health care rather than treatment in what have been called `disease palaces'. As speakers made clear, a new responsibility must fall on those training doctors from overseas in the British medical schools to fit them not for the dream world of the sophisticated medical scene but for the realities of working in often badly equipped clinics and dealing with common conditions such as malnutrition and other problems of maternity and child health. The symposium also included discussions as to why British doctors wished to emigrate. Money seemed to be the most compelling motive, but opportunities were being limited for their migration for economic and political reasons. Finally, a look at the whole of the medical scene in Britain: perhaps the standard sought in Britain both by the doctor and the patient is too high and too individualistic. Events will show if this be true.

  8. Medical response to catastrophic events: California's planning and the Loma Prieta earthquake.

    PubMed

    Haynes, B E; Freeman, C; Rubin, J L; Koehler, G A; Enriquez, S M; Smiley, D R

    1992-04-01

    The threat of a great earthquake has compelled California to develop a disaster plan for catastrophic medical events that calls for local response with state-coordinated mutual aid and casualty evacuation, if necessary. During the 1989 Loma Prieta earthquake that killed 63 people and injured 3,700, local emergency medical services systems were busy but not stressed excessively. The medical mutual aid system delivered medical personnel, supplies, and blood. One hospital suffered severe nonstructural damage, but it was able to treat large numbers of casualties. Our system performed admirably in this limited response, but was hampered by difficulties with disaster intelligence, communications, emergency medical services dispatch, patient care records, hospital damage, and inadequate disaster training. We describe our state's mutual aid system, the Loma Prieta response, and lessons and recommendations for the future.

  9. U.S. Policy Responses to Calls for the Medical Use of Cannabis

    PubMed Central

    Hall, Wayne

    2015-01-01

    This paper discusses the evolution of U.S. policy responses to calls to allow patients to use cannabis for medical purposes. It first summarizes the research evidence on the safety and efficacy of cannabinoids for various medical uses. It then outlines the challenges in developing new pharmaceutical cannabinoids that are safe, effective, and acceptable to patients. It briefly describes the strengths and limitations of the different ways in which U.S. states have allowed patients to use cannabis for medical purposes. These include allowing access for research trials only, allowing medical necessity as a defense against prosecution, and allowing commercial medical dispensaries to provide cannabis to approved patients. It argues that liberal definitions of indications for medical cannabis use and the commercialization of medical cannabis supply in California have produced the de facto legalization of recreational cannabis use. PMID:26339208

  10. U.S. Policy Responses to Calls for the Medical Use of Cannabis.

    PubMed

    Hall, Wayne

    2015-09-01

    This paper discusses the evolution of U.S. policy responses to calls to allow patients to use cannabis for medical purposes. It first summarizes the research evidence on the safety and efficacy of cannabinoids for various medical uses. It then outlines the challenges in developing new pharmaceutical cannabinoids that are safe, effective, and acceptable to patients. It briefly describes the strengths and limitations of the different ways in which U.S. states have allowed patients to use cannabis for medical purposes. These include allowing access for research trials only, allowing medical necessity as a defense against prosecution, and allowing commercial medical dispensaries to provide cannabis to approved patients. It argues that liberal definitions of indications for medical cannabis use and the commercialization of medical cannabis supply in California have produced the de facto legalization of recreational cannabis use.

  11. 14 CFR 120.113 - Medical Review Officer, Substance Abuse Professional, and Employer Responsibilities.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Medical Review Officer, Substance Abuse... Medical Review Officer, Substance Abuse Professional, and Employer Responsibilities. (a) The employer...-hour request period or pending receipt of the split specimen test result. (c) Substance...

  12. 14 CFR 120.113 - Medical Review Officer, Substance Abuse Professional, and Employer Responsibilities.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Medical Review Officer, Substance Abuse... Medical Review Officer, Substance Abuse Professional, and Employer Responsibilities. (a) The employer...-hour request period or pending receipt of the split specimen test result. (c) Substance...

  13. 14 CFR 120.113 - Medical Review Officer, Substance Abuse Professional, and Employer Responsibilities.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Medical Review Officer, Substance Abuse... Medical Review Officer, Substance Abuse Professional, and Employer Responsibilities. (a) The employer...-hour request period or pending receipt of the split specimen test result. (c) Substance...

  14. 14 CFR 120.113 - Medical Review Officer, Substance Abuse Professional, and Employer Responsibilities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Medical Review Officer, Substance Abuse... Medical Review Officer, Substance Abuse Professional, and Employer Responsibilities. (a) The employer...-hour request period or pending receipt of the split specimen test result. (c) Substance...

  15. 14 CFR 120.113 - Medical Review Officer, Substance Abuse Professional, and Employer Responsibilities.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Medical Review Officer, Substance Abuse... Medical Review Officer, Substance Abuse Professional, and Employer Responsibilities. (a) The employer...-hour request period or pending receipt of the split specimen test result. (c) Substance...

  16. Exercise Responses in Boys with Attention Deficit/Hyperactivity Disorder: Effects of Stimulant Medication

    ERIC Educational Resources Information Center

    Mahon, Anthony D.; Stephens, Brooke R.; Cole, Andrew S.

    2008-01-01

    Objective: The effect of stimulant medication on exercise responses was studied in 14 boys (10.9 plus or minus 1.1 years) with attention deficit/hyperactivity disorder (ADHD). Method: Exercise, with and without medication, was performed at 25 W, 50 W, and 75 W, followed by a peak exercise test. Result: Submaximal heart rate (HR) was significantly…

  17. Exercise Responses in Boys with Attention Deficit/Hyperactivity Disorder: Effects of Stimulant Medication

    ERIC Educational Resources Information Center

    Mahon, Anthony D.; Stephens, Brooke R.; Cole, Andrew S.

    2008-01-01

    Objective: The effect of stimulant medication on exercise responses was studied in 14 boys (10.9 plus or minus 1.1 years) with attention deficit/hyperactivity disorder (ADHD). Method: Exercise, with and without medication, was performed at 25 W, 50 W, and 75 W, followed by a peak exercise test. Result: Submaximal heart rate (HR) was significantly…

  18. Metropolitan Medical Response System Program Act of 2009

    THOMAS, 111th Congress

    Rep. Bilirakis, Gus M. [R-FL-9

    2010-01-21

    01/28/2010 Referred to the Subcommittee on Emergency Communications, Preparedness, and Response. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  19. Metropolitan Medical Response System Program Act of 2009

    THOMAS, 111th Congress

    Rep. Bilirakis, Gus M. [R-FL-9

    2010-01-21

    House - 01/28/2010 Referred to the Subcommittee on Emergency Communications, Preparedness, and Response. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  20. Functional Limitations, Medication Support, and Responses to Drug Costs among Medicare Beneficiaries.

    PubMed

    Whaley, Christopher; Reed, Mary; Hsu, John; Fung, Vicki

    2015-01-01

    Standard Medicare Part D prescription drug benefits include substantial and complex cost-sharing. Many beneficiaries also have functional limitations that could affect self-care capabilities, including managing medications, but also have varying levels of social support to help with these activities. We examined the associations between drug cost responses, functional limitations, and social support. We conducted telephone interviews in a stratified random sample of community-dwelling Medicare Advantage beneficiaries (N = 1,201, response rate = 70.0%). Participants reported their functional status (i.e., difficulty with activities of daily living) and social support (i.e., receiving help with medications). Drug cost responses included cost-reducing behaviors, cost-related non-adherence, and financial stress. We used multivariate logistic regression to assess associations among functional status, help with medications, and drug cost responses, adjusting for patient characteristics. Respondents with multiple limitations who did not receive help with their medications were more likely to report cost-related non-adherence (OR = 3.2, 95% CI: 1.2-8.5) and financial stress (OR = 2.4, 95% CI: 1.3-4.5) compared to subjects with fewer limitations and no help; however, those with multiple limitations and with medication help had similar odds of unfavorable cost responses as those with fewer limitations. The majority of beneficiaries with functional limitations did not receive help with medications. Support with medication management for beneficiaries who have functional limitations could improve adherence and outcomes.

  1. A conceptually based approach to understanding chronically ill patients' responses to medication cost pressures.

    PubMed

    Piette, John D; Heisler, Michele; Horne, Robert; Caleb Alexander, G

    2006-02-01

    Prescription medications enhance the well-being of most chronically ill patients. Many individuals, however, struggle with how to pay for their treatments and as a result experience problems with self-care and health maintenance. Although studies have documented that high out-of-pocket costs are associated with medication non-adherence, little research on prescription cost sharing has been theoretically grounded in knowledge of the more general determinants of patients' self-management behaviors and chronic disease outcomes. We present a conceptual framework for understanding the influence of patient, medication, clinician, and health system factors on individuals' responses to medication costs. We review what is known about how these factors influence medication adherence, identify possible strategies through which clinicians, health systems, and policy-makers may assist patients burdened by their medication costs, and highlight areas in need of further research. Although medication costs represent a burden to chronically ill patients worldwide, most patients report using their medication as prescribed despite the costs, and others report cost-related underuse despite an apparent ability to afford those treatments. The cost-adherence relationship is modified by contextual factors, including patients' characteristics (e.g., age, ethnicity, and attitudes toward medications), the type of medications they are using (e.g., the complexity of dosing and the drug's clinical target), clinician factors (e.g., choice of first-line agent and communication about medication costs), and health system factors (e.g., efforts to influence clinicians' prescribing and to help patients apply for financial assistance programs). Understanding these relationships will enable clinicians and policy-makers to better design pharmacy benefits and assist patients in taking their medication as prescribed. The next generation of studies examining the consequences of prescription drug costs

  2. Environmental and medical geochemistry in urban disaster response and preparedness

    USGS Publications Warehouse

    Plumlee, Geoffrey S.; Morman, Suzette A.; Cook, A.

    2012-01-01

    History abounds with accounts of cities that were destroyed or significantly damaged by natural or anthropogenic disasters, such as volcanic eruptions, earthquakes, wildland–urban wildfires, hurricanes, tsunamis, floods, urban firestorms, terrorist attacks, and armed conflicts. Burgeoning megacities place ever more people in the way of harm from future disasters. In addition to the physical damage, casualties, and injuries they cause, sudden urban disasters can also release into the environment large volumes of potentially hazardous materials. Environmental and medical geochemistry investigations help us to (1) understand the sources and environmental behavior of disaster materials, (2) assess potential threats the materials pose to the urban environment and health of urban populations, (3) develop strategies for their cleanup/disposal, and (4) anticipate and mitigate potential environmental and health effects from future urban disasters.

  3. Geniuses of medical science: Friendly, open and responsible, not mad.

    PubMed

    Oscoz-Irurozqui, Maitane; Ortuño, Felipe

    2016-12-01

    Recent studies based on biography analysis provide support for the notion that the prevalence of mental illness in the creative geniuses of art, literature and science is higher than it is in more ordinary folk. However, this relationship between madness and genius, which was also addressed by the classical philosophers, has been generalized to all branches of professional endeavour. Whilst it may hold true for illustrious personalities of the fine arts, we found that the relationship proves inappropriate to the biographies of ten individuals renowned in history for their innovative contributions to medical science. Furthermore, examination of these ten biographies invites the hypothesis that certain personality traits - especially, agreeableness, conscientiousness and openness to new experience - can act to enhance creativity and protect against mental illness. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Indians Repulse British With Rocket

    NASA Technical Reports Server (NTRS)

    2004-01-01

    During the early introduction of rockets to Europe, they were used only as weapons. Enemy troops in India repulsed the British with rockets. Later, in Britain, Sir William Congreve developed a rocket that could fire to about 9,000 feet. The British fired Congreve rockets against the United States in the War of 1812.

  5. Indians Repulse British With Rocket

    NASA Technical Reports Server (NTRS)

    2004-01-01

    During the early introduction of rockets to Europe, they were used only as weapons. Enemy troops in India repulsed the British with rockets. Later, in Britain, Sir William Congreve developed a rocket that could fire to about 9,000 feet. The British fired Congreve rockets against the United States in the War of 1812.

  6. The global workforce shortages and the migration of medical professions: the Australian policy response

    PubMed Central

    Smith, Saxon D

    2008-01-01

    Medical migration sees the providers of medical services (in particular medical practitioners) moving from one region or country to another. This creates problems for the provision of public health and medical services and poses challenges for laws in the nation state and for laws in the global community. There exists a global shortage of healthcare professionals. Nation states and health rights movements have been both responsible for, and responsive to, this global community shortage through a variety of health policy, regulation and legislation which directly affects the migration of medical providers. The microcosm responses adopted by individual nation states, such as Australia, to this workforce shortage further impact on the global workforce shortage through active recruitment of overseas-trained healthcare professionals. "Push" and "pull" factors exist which encourage medical migration of healthcare professionals. A nation state's approach to health policy, regulation and legislation dramatically helps to create these "push factors" and "pull factors". A co-ordinated global response is required with individual nation states being cognisant of the impact of their health policy, regulations and legislation on the global community through the medical migration of healthcare professionals. PMID:18507867

  7. Mortality in British vegetarians.

    PubMed

    Appleby, Paul N; Key, Timothy J; Thorogood, Margaret; Burr, Michael L; Mann, Jim

    2002-02-01

    To compare the mortality of British vegetarians and non-vegetarians. Analysis of original data from two prospective studies each including a large proportion of vegetarians--the Oxford Vegetarian Study and the Health Food Shoppers Study. Standardised mortality ratios (SMRs) compared with the population of England and Wales were calculated from deaths before age 90 for vegetarians and non-vegetarians in each study. Death rate ratios (DRRs) for vegetarians compared with non-vegetarians within each study were calculated for each of 14 major causes of death. UK. Twenty-one thousand men and women aged 16-89 years at recruitment, including more than 8,000 vegetarians. SMRs for all causes of death were significantly below the reference level of 100 in both studies: 52 (95% confidence interval (CI) 49-56) based on 1,131 deaths in the Oxford Vegetarian Study and 59 (57-61) based on 2,346 deaths in the Health Food Shoppers Study. For all causes of death, the DRR for vegetarians compared with non-vegetarians was close to one in both studies: 1.01 (95% CI 0.89-1.14) in the Oxford Vegetarian Study, 1.03 (0.95-1.13) in the Health Food Shoppers Study. British vegetarians have low mortality compared with the general population. Their death rates are similar to those of comparable non-vegetarians, suggesting that much of this benefit may be attributed to non-dietary lifestyle factors such as a low prevalence of smoking and a generally high socio-economic status, or to aspects of the diet other than the avoidance of meat and fish.

  8. Beyond sun, sand, and stitches: assigning responsibility for the harms of medical tourism.

    PubMed

    Snyder, Jeremy; Crooks, Valorie; Johnston, Rory; Kingsbury, Paul

    2013-06-01

    Medical tourism (MT) can be conceptualized as the intentional pursuit of non-emergency surgical interventions by patients outside their nation of residence. Despite increasing popular interest in MT, the ethical issues associated with the practice have thus far been under-examined. MT has been associated with a range of both positive and negative effects for medical tourists’ home and host countries, and for the medical tourists themselves. Absent from previous explorations of MT is a clear argument of how responsibility for the harms of this practice should be assigned. This paper addresses this gap by describing both backward looking liability and forward looking political responsibility for stakeholders in MT. We use a political responsibility model to develop a decision-making process for individual medical tourists and conclude that more information on the effects of MT must be developed to help patients engage in ethical MT.

  9. [Dose-response relationship: relevance for medical practice].

    PubMed

    Klinkhardt, U; Harder, S

    2000-05-01

    Dose-finding studies are performed routinely in patients and--if appropriate surrogate models exist--also in healthy volunteers. Such studies aim at establishing the optimal dose range for further clinical studies on the efficacy and the risk-benefit ratio of a new drug. The dose-response relationship of a drug is most often described by a sigmoidal curve. Its parameters include the mean effective dose, the maximal effect and the steepness. Interpretation of such curves should be done in the context of the intended clinical indications of the drug. The risk-benefit ratio of a drug can be assessed by overlapping the dose-response curve of wanted and unwanted clinical effects, again, any overlapping (which can be described e.g. by the therapeutic index) should be seen in the context of the indication and available therapeutic alternatives.

  10. Prolonged prenatal psychotropic medication exposure alters neonatal acute pain response.

    PubMed

    Oberlander, Tim F; Eckstein Grunau, Ruth; Fitzgerald, Colleen; Ellwood, Ann-Louise; Misri, Shaila; Rurak, Dan; Riggs, Kenneth Wayne

    2002-04-01

    Selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines are frequently used to treat maternal depression during pregnancy, however the effect of increased serotonin (5HT) and gamma-amino-butyric acid (GABA) agonists in the fetal human brain remains unknown. 5HT and GABA are active during fetal neurologic growth and play early roles in pain modulation, therefore, if prolonged prenatal exposure alters neurodevelopment this may become evident in altered neonatal pain responses. To examine biologic and behavioral effects of prenatal exposure, neonatal responses to acute pain (phenylketonuria heel lance) in infants with prolonged prenatal exposure were examined. Facial action (Neonatal Facial Coding System) and cardiac autonomic reactivity derived from the relationship between respiratory activity and short term variations of heart rate (HRV) were compared between 22 infants with SSRI exposure (SE) [fluoxetine (n = 7), paroxetine (n = 11), sertraline (n = 4)]; 16 infants exposed to SSRIs and clonazepam (SE+) [paroxetine (n = 14), fluoxetine (n = 2)]; and 23 nonexposed infants during baseline, lance, and recovery periods of a heel lance. Length of maternal SSRI use did not vary significantly between exposure groups-[mean (range)] SE:SE+ 183 (31-281):141 (54-282) d (p > 0.05). Infants exposed to SE and SE+ displayed significantly less facial activity to heel lance than control infants. Mean HR increased with lance, but was significantly lower in SE infants during recovery. Using measures of HRV and the transfer relationship between heart rate and respiration, SSRI infants had a greater return of parasympathetic cardiac modulation in the recovery period, whereas a sustained sympathetic response continued in the control group. Prolonged prenatal SSRI exposure appears to be associated with reduced behavioral pain responses and increased parasympathetic cardiac modulation in recovery following an acute neonatal noxious event. Possible 5HT-mediated pain inhibition

  11. What are the concerns of prospective responsible officers about their role in medical revalidation?

    PubMed

    Shepherd, Annabel; Cameron, Niall

    2010-06-01

    The Health and Social Care Act 2008 sets out the requirement for the introduction of responsible officers for the NHS. The paper states that these individuals will be responsible for ensuring that doctors who are revalidated meet the required standards. It is not known how well prepared prospective responsible officers are for their new role. Semi-structured interviews were conducted with 12 medical directors from Scottish health boards who agreed to participate. Prospective responsible officers remain uncertain about their role in medical revalidation. Specific concerns were raised: (1) What will responsible officers be responsible for? (2) How can appraisal be quality assured? (3) How will the information requirements for revalidation be met? and (4) How can organizations meet the requirement for revalidation? We found important issues regarding the arrangements for revalidation which have not previously been described which may impact on the effectiveness of prospective responsible officers.

  12. [Urologic surgery and risks of complaints in medical responsibility].

    PubMed

    Haillot, O; Haertig, A; Vannier, J; Janin, P; Lanson, Y

    1989-01-01

    The card-index study of specialized insurance companies allowed the analysis of 82 cases concerning urological surgical procedures. Forty-two cases went to the Civil Court, 10 to the Penal Court and 5 to the Administrative Tribunal, while 5 cases were simply declared to insurance companies without judiciary consequences. Sixty-two cases concerned private plaintiffs surgeons and 34 cases concerned non specialist urologic surgeons. Sixteen plaintiffs were compensated, 9 after a conciliatory agreement and 7 after trial. There were no penal condemnations (one case on the waiting list). Impotence was the most frequent cause for complaint which was compensated. Next, came incontinence generally secondary to endoscopic resection. Retrospectively, 19 cases seemed to be unwarranted due to the dishonesty of patients (3 patients were prosecuted for unwarranted procedures). On the other hand, 32 cases seemed to be due to a lack of information given to the patients themselves or to their families, either before of after the incriminated act. The risk of prosecution is relatively low in urology. It could be decreased by careful management of the medical chart, by rapid analysis of complications and by a constant effort to inform the patient and his family.

  13. The sense of responsibility in the context of professional activities in Medical Genetics.

    PubMed

    Oliva-Teles, Natália

    2011-11-01

    Medical Genetics is a relatively new field of scientific work that involves a lot of enthusiastic professionals, both in routine (clinical) and research (scientific projects). In either field, different geneticists feel different responsibilities for their work, either because they are different people (personal responsibility) or because they have a different rank in the respective departments (professional responsibility). This paper presents the philosophical views of several authors on the sense of responsibility from the Classical times until the present and reveals the practical, daily responsibilities that are met by these professionals, in four areas of responsibility: personal, professional, scientific and sociatal framework.

  14. Methods for Measuring Student Response to Stimulant Medication: A Meta-Analytic Review

    ERIC Educational Resources Information Center

    Someki, Fumio; Burns, Matthew K.

    2009-01-01

    Measuring student response to interventions has become an important role for school psychologists. Children with Attention-Deficit/Hyperactivity Disorder (ADHD) are frequently treated with stimulant medication, but the response to the treatment is rarely adequately assessed. The current study examined the sensitivity of measures used to assess the…

  15. Prediction of Response to Medication and Cognitive Therapy in the Treatment of Moderate to Severe Depression

    ERIC Educational Resources Information Center

    Fournier, Jay C.; DeRubeis, Robert J.; Shelton, Richard C.; Hollon, Steven D.; Amsterdam, Jay D.; Gallop, Robert

    2009-01-01

    A recent randomized controlled trial found nearly equivalent response rates for antidepressant medications and cognitive therapy in a sample of moderate to severely depressed outpatients. In this article, the authors seek to identify the variables that were associated with response across both treatments as well as variables that predicted…

  16. Prediction of Response to Medication and Cognitive Therapy in the Treatment of Moderate to Severe Depression

    ERIC Educational Resources Information Center

    Fournier, Jay C.; DeRubeis, Robert J.; Shelton, Richard C.; Hollon, Steven D.; Amsterdam, Jay D.; Gallop, Robert

    2009-01-01

    A recent randomized controlled trial found nearly equivalent response rates for antidepressant medications and cognitive therapy in a sample of moderate to severely depressed outpatients. In this article, the authors seek to identify the variables that were associated with response across both treatments as well as variables that predicted…

  17. Facilitators and obstacles in pre-hospital medical response to earthquakes: a qualitative study

    PubMed Central

    2011-01-01

    Background Earthquakes are renowned as being amongst the most dangerous and destructive types of natural disasters. Iran, a developing country in Asia, is prone to earthquakes and is ranked as one of the most vulnerable countries in the world in this respect. The medical response in disasters is accompanied by managerial, logistic, technical, and medical challenges being also the case in the Bam earthquake in Iran. Our objective was to explore the medical response to the Bam earthquake with specific emphasis on pre-hospital medical management during the first days. Methods The study was performed in 2008; an interview based qualitative study using content analysis. We conducted nineteen interviews with experts and managers responsible for responding to the Bam earthquake, including pre-hospital emergency medical services, the Red Crescent, and Universities of Medical Sciences. The selection of participants was determined by using a purposeful sampling method. Sample size was given by data saturation. Results The pre-hospital medical service was divided into three categories; triage, emergency medical care and transportation, each category in turn was identified into facilitators and obstacles. The obstacles identified were absence of a structured disaster plan, absence of standardized medical teams, and shortage of resources. The army and skilled medical volunteers were identified as facilitators. Conclusions The most compelling, and at the same time amenable obstacle, was the lack of a disaster management plan. It was evident that implementing a comprehensive plan would not only save lives but decrease suffering and enable an effective praxis of the available resources at pre-hospital and hospital levels. PMID:21575233

  18. Nurse education in the British armed forces.

    PubMed

    Carter, Chris; Finnegan, Alan P

    2014-10-21

    Defence nurses form the largest registered specialty in the UK defence medical services. Once qualified, defence nurses maintain and develop their nursing and clinical skills in appropriate healthcare settings, and can be deployed in operational environments such as Afghanistan. Workforce planning and staffing establishment levels are defined to meet the needs of British armed forces, allies and, potentially, local populations. Since the workforce is geographically dispersed, deployed or undertaking non-clinical duties, there are constraints on nurses' attempts to maintain basic skills and access continuing professional development. This article explores the concept and the developing role of defence nurse lecturers in improving educational support for defence nurses.

  19. Medical fee and service advertising: a response from physicians.

    PubMed

    Bussom, R S; Darling, J R

    1978-02-01

    Restrictions on advertising about services performed by professional groups have recently been questioned by the government and consumerists. The purpose of this study was to determine physicians' attitudes about the use of advertising in their profession and also to compare these results with responses from dentists, attorneys, and accountants. While a survey of these groups in three metropolitan areas indicate mild support for advertising in general, there was a definite negative reaction to advertising in the respective professions. Participants also reported their attitudes about the effects of advertising on prices and fees, quality of services, and public expectation and governmental regulations. The concepts of social marketing and informative advertising are suggested as approaches that may meet the requirements of both the government and the professions.

  20. Consensus management in the British National Health Service: implications for the United States?

    PubMed

    Schulz, R; Harrison, S

    1984-01-01

    Most operational services within the reorganized British National Health Service are managed by local teams: medical specialist, general practitioner, nurse, administrator, and finance officer. Decision by consensus has worked well to integrate services in a complex and fiscally constrained system. As larger and more formal systems of health care emerge in the United States, the British experience may be relevant.

  1. Accidental Deaths Among British Columbia Indians

    PubMed Central

    Schmitt, N.; Hole, L. W.; Barclay, W. S.

    1966-01-01

    A statistical and epidemiological review of British Columbia native Indian and non-Indian mortality revealed that accidents were the leading cause of death among Indians but ranked only fourth among non-Indians. Comparison of accidental death rates by age and sex showed that, without exception, the rates among Indians were considerably higher than the corressponding rates for non-Indians. While the Indians represented some 2% of the total population of British Columbia, they accounted for over 10% of the total accident fatalities, 29% of drownings, and 21% of fatal burns. Socioeconomic, environmental and psychosocial factors and excessive drinking are considered the chief causes responsible for this rather unusual epidemiological phenomenon. This study revealed certain hazardous conditions which are specific to the Indian's present way of life. In the authors' opinion the recognition of these specific hazards is imperative for the planning of effective preventive campaigns. PMID:5902238

  2. History of British Space Science

    NASA Astrophysics Data System (ADS)

    Massie, Harrie; Robins, M. O.

    2009-12-01

    1. The scientific background; 2. The technical background; 3. The initiation of the Skylark rocket programme; 4. Post IGY developments; 5. The Ariel programme; 6. The European Space Research Organisation; 7. Commonwealth co-operation in space research; 8. Smaller rockets for scientific purposes - Skua and Petrel; 9. Attitude controlled Skylark rockets; 10. The Trend Committee and the Science Research Council; 11. The transformation of ESRO into ESA; 12. The Space Science Committee for Europe; 13. Scientific studies by British space scientists I; 14. Scientific studies by British space scientists II; 15. The contribution from British space scientists to astronomy; 16. Concluding remarks; Appendices; Annexes.

  3. The medical and scientific responsibility of pollen information services.

    PubMed

    Bastl, Katharina; Berger, Markus; Bergmann, Karl-Christian; Kmenta, Maximilian; Berger, Uwe

    2017-01-01

    Pollen information as such is highly valuable and was considered so far as a self-evident good free for the public. The foundation for reliable and serious pollen information is the careful, scientific evaluation of pollen content in the air. However, it is essential to state and define now the requirements for pollen data and qualifications needed for institutions working with pollen data in the light of technical developments such as automated pollen counting and various political interests in aerobiology including attempts to finally acknowledge pollen and spores as relevant biological particles in the air worth being considered for pollution and health directives. It has to be emphasized that inadequate pollen forecasts are a considerable health risk for pollen allergy sufferers. Therefore, the responsibility of institutions involved in pollen monitoring and forecasting is high and should be substantiated with respective qualifications and know-how. We suggest here for the first time a portfolio of quality criteria and demand rigorous scientific monitoring and certification of such institutions in the interest and for the protection of persons affected by a pollen allergy.

  4. Shadow Bowl 2003: a collaborative exercise in community readiness, agency cooperation, and medical response.

    PubMed

    Balch, David; Taylor, Carl; Rosenthal, David; Bausch, Chris; Warner, Dave; Morris, Ray

    2004-01-01

    This paper describes a model for homeland security, community readiness, and medical response that was applied during an operational exercise around Super Bowl XXXVII. In addition, it describes the products provided by private companies involved in the exercise and how they would have contributed to a medical disaster had one occurred. The purpose of Shadow Bowl was to demonstrate community readiness and medical response to a mass casualty event. The goals of the project were to: (1) provide enhanced public safety using an advanced communication network and sensor grid; (2) develop mass casualty surge capabilities through medical reach-back; and (3) build a collaboration model between civilian, military, public, and private partners. The results of the Shadow Bowl Exercise accentuated the value of new telehealth and disaster medicine tools in treating large numbers of patients when infrastructure overload occurs.

  5. Hurricane Katrina: medical response at the Houston Astrodome/Reliant Center Complex.

    PubMed

    Gavagan, Thomas F; Smart, Kieran; Palacio, Herminia; Dyer, Carmel; Greenberg, Stephen; Sirbaugh, Paul; Fishkind, Avrim; Hamilton, Douglas; Shah, Umair; Masi, George; Ivey, R Todd; Jones, Julie; Chiou-Tan, Faye Y; Bloodworth, Donna; Hyman, David; Whigham, Cliff; Pavlik, Valory; Feigin, Ralph D; Mattox, Kenneth

    2006-09-01

    On September 1, 2005, with only 12 hours notice, various collaborators established a medical facility--the Katrina Clinic--at the Astrodome/Reliant Center Complex in Houston. By the time the facility closed roughly two weeks later, the Katrina Clinic medical staff had seen over 11,000 of the estimated 27,000 Hurricane Katrina evacuees who sought shelter in the Complex. Herein, we describe the scope of this medical response, citing our major challenges, successes, and recommendations for conducting similar efforts in the future.

  6. Offshore industry: medical emergency response in the offshore oil and gas industry.

    PubMed

    Ponsonby, Will; Mika, Frano; Irons, Greg

    2009-08-01

    The hunt for oil and gas has taken workers into new more distant locations including those offshore. The remoteness of the offshore platforms and vessels coupled with the potential risk of being cut off by bad weather presents particular challenges for medical emergency response (MER). Firstly to define the challenges for MER in terms of locations, population and epidemiology of injuries and illnesses in the offshore environment. Secondly to give examples of legal requirements and industry standards to manage MER. Thirdly to look at existing and emerging practice to manage these challenges. A review of published literature was supplemented with a summary of current practice in the industry. Medical professionals (medics) working offshore on installations and vessels are primarily responsible for the medical care of the workers. The medics have clinics with suitable medical equipment for managing emergencies as well as providing limited primary care. Some countries have legislation that stipulate minimum requirements. Where there is no national legislation, industry and company guidance is used to define the MER standards. Supervision of the offshore medics is often provided by doctors on shore via radio and phone links. These methods of communication are now being augmented with more sophisticated telemedicine solutions such as the Internet and live video links. These newer solutions allow for prompt high-quality care and provide the scope for a variety of new treatment options to be available for the offshore workforce.

  7. Medical mitigation model: quantifying the benefits of the public health response to a chemical terrorism attack.

    PubMed

    Good, Kevin; Winkel, David; VonNiederhausern, Michael; Hawkins, Brian; Cox, Jessica; Gooding, Rachel; Whitmire, Mark

    2013-06-01

    The Chemical Terrorism Risk Assessment (CTRA) and Chemical Infrastructure Risk Assessment (CIRA) are programs that estimate the risk of chemical terrorism attacks to help inform and improve the US defense posture against such events. One aspect of these programs is the development and advancement of a Medical Mitigation Model-a mathematical model that simulates the medical response to a chemical terrorism attack and estimates the resulting number of saved or benefited victims. At the foundation of the CTRA/CIRA Medical Mitigation Model is the concept of stock-and-flow modeling; "stocks" are states that individuals progress through during the event, while "flows" permit and govern movement from one stock to another. Using this approach, the model is able to simulate and track individual victims as they progress from exposure to an end state. Some of the considerations in the model include chemical used, type of attack, route and severity of exposure, response-related delays, detailed treatment regimens with efficacy defined as a function of time, medical system capacity, the influx of worried well individuals, and medical countermeasure availability. As will be demonstrated, the output of the CTRA/CIRA Medical Mitigation Model makes it possible to assess the effectiveness of the existing public health response system and develop and examine potential improvement strategies. Such a modeling and analysis capability can be used to inform first-responder actions/training, guide policy decisions, justify resource allocation, and direct knowledge-gap studies.

  8. Medical and radiological aspects of emergency preparedness and response at SevRAO facilities.

    PubMed

    Savkin, M N; Sneve, M K; Grachev, M I; Frolov, G P; Shinkarev, S M; Jaworska, A

    2008-12-01

    Regulatory cooperation between the Norwegian Radiation Protection Authority and the Federal Medical Biological Agency (FMBA) of the Russian Federation has the overall goal of promoting improvements in radiation protection in Northwest Russia. One of the projects in this programme has the objectives to review and improve the existing medical emergency preparedness capabilities at the sites for temporary storage of spent nuclear fuel and radioactive waste. These are operated by SevRAO at Andreeva Bay and in Gremikha village on the Kola Peninsula. The work is also intended to provide a better basis for regulation of emergency response and medical emergency preparedness at similar facilities elsewhere in Russia. The purpose of this paper is to present the main results of that project, implemented by the Burnasyan Federal Medical Biophysical Centre. The first task was an analysis of the regulatory requirements and the current state of preparedness for medical emergency response at the SevRAO facilities. Although Russian regulatory documents are mostly consistent with international recommendations, some distinctions lead to numerical differences in operational intervention criteria under otherwise similar conditions. Radiological threats relating to possible accidents, and related gaps in the regulation of SevRAO facilities, were also identified. As part of the project, a special exercise on emergency medical response on-site at Andreeva Bay was prepared and carried out, and recommendations were proposed after the exercise. Following fruitful dialogue among regulators, designers and operators, special regulatory guidance has been issued by FMBA to account for the specific and unusual features of the SevRAO facilities. Detailed sections relate to the prevention of accidents, and emergency preparedness and response, supplementing the basic Russian regulatory requirements. Overall it is concluded that (a) the provision of medical and sanitary components of emergency

  9. The physician as health advocate: translating the quest for social responsibility into medical education and practice.

    PubMed

    Dharamsi, Shafik; Ho, Anita; Spadafora, Salvatore M; Woollard, Robert

    2011-09-01

    There is a growing demand for educating future physicians to be socially responsible. It is not clear, however, how social responsibility is understood and acted on in medical education and practice, particularly within the context of a growing desire to improve health care through an equitable and sustainable delivery system. The authors conduct a concept analysis, exploring the practical philosophical understanding of social responsibility and its implications for medical education and practice. The aim is to inform curricular development, professional practice, and further research on social responsibility. The particular ways in which social responsibility is interpreted can either enhance or establish limits on how it will appear across the continuum of medical education and practice. A physician's place in society is closely tied to a moral sense of responsibility related to the agreed-on professional characteristics of physicianhood in society, the capacity to carry out that role, and the circumstances under which such professionals are called to account for failing to act appropriately according to that role. The requirement for social responsibility is a moral commitment and duty developed over centuries within societies that advanced the notion of a "profession" and the attendant social contract with society. A curriculum focused on developing social responsibility in future physicians will require pedagogical approaches that are innovative, collaborative, participatory, and transformative.

  10. [THE EVALUATION OF RESPONSIBILITY CITIZEN FOR ONE'S OWN HEALTH FROM THE POSITIONS OF MEDICAL WORKERS].

    PubMed

    Dauletkalieva, J A; Kulov, D B

    2015-01-01

    The article demonstrates necessity of implementing principle of solidary responsibility of citizenfore one's own health with purpose of health promotion and development of health care in country and all over the world. The analysis of national and international literature proved that human health in many ways depends on life style. Nowadays, population places the responsibility for one's own health to state, employers and medical personnel. The article presents main results of anonymous questionnaire survey carried out among 723 workers of municipal polyclinics. The software Statisitka was applied to determine relative frequency of occurrence of characteristic in different groups (percentage) and confidence range. The comparative analysis according the Student criterion was applied among physicians and paramedical personnel. The purpose of survey was to evaluate degree of responsibility of population for one's own health from point of view of medical personnel. It is established that 69.5% of physicians and 79.6% of paramedical personnel consider their patients responsible for implementation of prescribed recommendations. The opposite point of view have 30.5% of physicians and 20.4% of paramedical personnel. According opinion of 42.9% Of physicians and 48.9% of paramedical personnel human age has no impact on degree of one's own health caring. The physicians of polyclinics evaluate responsibility of citizenfor one's own health quite low. So, only 11. 6% of physicians and 28.6% of paramedical personnel of polyclinics provide positive reply to the asked question. The majority of physicians (37.4%) and medical nurses (34.2%) are convinced that to increase responsibility for one's own health the activities infield of health education are to be implemented. The application of the mechanism of co-payments for medical services is supported by 34.6% of physicians and 27.4% of medical nurses. The given question caused difficulties with answer among 20.2% of physicians and

  11. Autonomy, consent and responsibility. Part II. Informed consent in medical care and in the law.

    PubMed

    Mellado, J M

    Legal recognition of patient's rights aspired to change clinical relationship and medical lex artis. However, its implementation has been hampered by the scarcity of resources and the abundance of regulations. For several years, autonomy, consent, and responsibility have formed one of the backbones of the medical profession. However, they have sparked controversy and professional discomfort. In the first part of this article, we examine the conceptual and regulatory limitations of the principle of autonomy as the basis of informed consent. We approach the subject from philosophical, historical, legal, bioethical, deontological, and professional standpoints. In the second part, we cover the viability of informed consent in health care and its relationship with legal responsibility.

  12. Utilisation of helicopter emergency medical services in the early medical response to major incidents: a systematic literature review

    PubMed Central

    Johnsen, Anne Siri; Fattah, Sabina; Sollid, Stephen J M; Rehn, Marius

    2016-01-01

    Objective This systematic review identifies, describes and appraises the literature describing the utilisation of helicopter emergency medical services (HEMS) in the early medical response to major incidents. Setting Early prehospital phase of a major incident. Design Systematic literature review performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Web of Science, PsycINFO, Scopus, Cinahl, Bibsys Ask, Norart, Svemed and UpToDate were searched using phrases that combined HEMS and ‘major incidents’ to identify when and how HEMS was utilised. The identified studies were subjected to data extraction and appraisal. Results The database search identified 4948 articles. Based on the title and abstract, the full text of 96 articles was obtained; of these, 37 articles were included in the review, and an additional five were identified by searching the reference lists of the 37 articles. HEMS was used to transport medical and rescue personnel to the incident and to transport patients to the hospital, especially when the infrastructure was damaged. Insufficient air traffic control, weather conditions, inadequate landing sites and failing communication were described as challenging in some incidents. Conclusions HEMS was used mainly for patient treatment and to transport patients, personnel and equipment in the early medical management of major incidents, but the optimal utilisation of this specialised resource remains unclear. This review identified operational areas with improvement potential. A lack of systematic indexing, heterogeneous data reporting and weak methodological design, complicated the identification and comparison of incidents, and more systematic reporting is needed. Trial registration number CRD42013004473. PMID:26861938

  13. Utilisation of helicopter emergency medical services in the early medical response to major incidents: a systematic literature review.

    PubMed

    Johnsen, Anne Siri; Fattah, Sabina; Sollid, Stephen J M; Rehn, Marius

    2016-02-09

    This systematic review identifies, describes and appraises the literature describing the utilisation of helicopter emergency medical services (HEMS) in the early medical response to major incidents. Early prehospital phase of a major incident. Systematic literature review performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Web of Science, PsycINFO, Scopus, Cinahl, Bibsys Ask, Norart, Svemed and UpToDate were searched using phrases that combined HEMS and 'major incidents' to identify when and how HEMS was utilised. The identified studies were subjected to data extraction and appraisal. The database search identified 4948 articles. Based on the title and abstract, the full text of 96 articles was obtained; of these, 37 articles were included in the review, and an additional five were identified by searching the reference lists of the 37 articles. HEMS was used to transport medical and rescue personnel to the incident and to transport patients to the hospital, especially when the infrastructure was damaged. Insufficient air traffic control, weather conditions, inadequate landing sites and failing communication were described as challenging in some incidents. HEMS was used mainly for patient treatment and to transport patients, personnel and equipment in the early medical management of major incidents, but the optimal utilisation of this specialised resource remains unclear. This review identified operational areas with improvement potential. A lack of systematic indexing, heterogeneous data reporting and weak methodological design, complicated the identification and comparison of incidents, and more systematic reporting is needed. CRD42013004473. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  14. Heartrate Response to a Single Submaximal Workload (Astrand’s Test) as an Estimate of Maximal Oxygen Uptake in British Servicemen

    DTIC Science & Technology

    1978-05-01

    UNLIMITED LEVEL REPORT APRE No. 25/77 o HEARTRATE RESPONSE TO A ,•,•, ,ISOnc SINGLE SUBMAXIMAL WORKLOAD "(ASTRAND’S TEST) AS AN ESTIMATE OF MAXIMAL...RESEARCH ESTABLISHRME REPORT No 25/77 HEARTRATE RESPONSE TO A4 SIW)LE§UBHMAXIMAL ORRKLOAD TRANDISTEST) L~-~ AS ANJýSTIMATE OF-ýiAXIMALQYEVPAf .......... by...CJ VNLD10 05 UNLIMITED ARMY PERSONNEL RESEARCH ESTABLISHMENT REPORT No 25/77 HEARTRATE RESPONSE TO A SISGLE SUBMAXIMAL WORKLOAD (RSTRAND’S TEST) AS AN

  15. [Comparison of British and French expatriate doctors' characteristics and motivations].

    PubMed

    Abbas, R; Carnet, D; D'Athis, P; Fiet, C; Le Breton, G; Romestaing, M; Quantin, C

    2015-02-01

    Migration of medical practitioners is rarely studied despite its importance in medical demography: the objective of this study was to analyze the characteristics and motivations of the French doctors settled in the United Kingdom and of the British doctors settled in France. This cross-sectional study was conducted using a self-completed questionnaire sent to all French doctors practicing in the United Kingdom (in 2005) and all British medicine doctors practicing in France (in 2009). The doctors were identified with official data from the National Medical Councils: 244 French doctors practicing in the United Kingdom and 86 British doctors practicing in France. The questionnaire was specifically developed to determine the reasons of moving to the other country, and the level of satisfaction after expatriation. A total of 98 French doctors (out of 244) and 40 British doctors (out of 86) returned the questionnaire. Respondents were mainly general practitioners with a professional experience of 8 to 9 years. The sex ratio was near 1 for both groups with a majority of women among physicians under 50 years. The motivations were different between groups: French doctors were attracted by the conditions offered at the National Health Service, whereas British doctors were more interested in opportunities for career advancement, joining husband or wife, or favourable environmental conditions. Overall, the respondents considered expatriation as satisfactory: 84% of French doctors, compared with only 58% of British doctors, were satisfied with their new professional situation. This study, the first in its kind, leads to a clearer understanding of the migration of doctors between France and the United Kingdom. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  16. How Iranian Medical Trainees Approach their Responsibilities in Clinical Settings; A Grounded Theory Research

    PubMed Central

    Asemani, Omid; Iman, Mohammad Taghi; Moattari, Marzieh; Khayyer, Mohammad; Sharif, Farkhondeh; Tabei, Seyed Ziaaddin

    2015-01-01

    Background: It seems we are now experiencing “responsibility problems” among medical trainees (MTs) and some of those recently graduated from medical schools in Iran. Training responsible professionals have always been one of the main concerns of medical educators. Nevertheless, there is a dearth of research in the literature on “responsibility” especially from the medical education point of view. Therefore, the present study was carried out with the aim of presenting a theoretical based framework for understanding how MTs approach their responsibilities in educational settings. Method: This qualitative study was conducted at Shiraz University of Medical Sciences (SUMS) using the grounded theory methodology. 15 MTs and 10 clinical experts and professional nurses were purposefully chosen as participants. Data was analyzed using the methodology suggested by Corbin and Strauss, 1998. Results: “Try to find acceptance toward expectations”, “try to be committed to meet the expectations” and “try to cope with unacceptable expectations” were three main categories extracted based on the research data. Abstractly, the main objective for using these processes was “to preserve the integrity of student identity” which was the core category of this research too. Moreover, it was also found that practically, “responsibility” is considerably influenced by lots of positive and negative contextual and intervening conditions. Conclusion: “Acceptance” was the most decisive variable highly effective in MTs’ responsibility. Therefore, investigating the “process of acceptance” regarding the involved contextual and intervening conditions might help medical educators correctly identify and effectively control negative factors and reinforce the constructive ones that affect the concept of responsibility in MTs. PMID:26379351

  17. The decade of the nineties at the UCLA Medical Center: responses to dramatic marketplace changes.

    PubMed

    Karpf, M; Schultze, R G; Levey, G

    2000-08-01

    The evolution of the health care marketplace in the nineties in Southern California is described, including the dominance of managed care at the decade's end. The marketplace, especially in Los Angeles, is now one of the most complex, competitive, and challenging medical marketplaces in the country. The University of California, Los Angeles (UCLA) Medical Center and the academic health center of which it is a part have had to respond appropriately and vigorously to survive and to position themselves for the future. This article focuses on the responses of the medical center to these marketplace pressures. The center has recognized single-signature contracting, cost containment, and an emphasis on ambulatory care as fundamental success factors for survival in a complex, organized managed care environment. Data on the medical, financial, and educational performances of the medical center are presented in terms of its responses to the marketplace. Preliminary information about quality of care is presented for three patient-population groups that have been heavily affected by managed care. The need for emphasis on quality and service for future success and the attendant need for emphasis on information systems are discussed. The importance of fundamental understanding of markets is also reviewed. The concomitant approaches to securing the center's academic missions are described, including changes in institutional governance for the entire health sciences center of which the medical center is a part and the establishment of priorities in research, clinical care, and teaching programs, especially teaching programs in primary care.

  18. Health and medical preparedness and response to the 2008 Republican National Convention.

    PubMed

    Hick, John L; Frascone, Ralph J; Grimm, Katherine; Hillman, Merle; Griffith, Jayne; Hogan, Michael; Trotsky-Sirr, Rebecca; Braun, Jane

    2009-12-01

    National security special events occur yearly in the United States. These events require comprehensive advance planning for health and medical contingencies in addition to law enforcement concerns. The planning for and impact of the Republican National Convention (RNC) on the City of St Paul and the Minneapolis-St Paul metropolitan area is described. Descriptive analysis of events was provided by the authors based on their planning and operational experiences. Daily data were gathered from area hospitals, emergency medical services agencies, the National Weather Service, federal medical teams, and the Minnesota Department of Health to capture the impact of the RNC on emergency department activity, nonemergency surgery, emergency medical services run volumes, patient visits to onsite and offsite medical clinics, and general hospital occupancy in the metropolitan area. There were no epidemiological signal events. Weather was not extreme. Confrontations between protestors and law enforcement resulted in frequent use of riot-control agents. Protestors sought medical care from "street medics" and their affiliated free clinics in preference to usual medical facilities. Emergency departments close to the event venue reported decreased patient volumes. Hospitals close to the venue reported significantly decreased nonemergency surgical case volumes. Local hospitals implemented access controls and in 1 case, shut down ventilation systems due to riot-control agent deployment in the streets outside. Emergency medical services volumes were near average, with the exception of St Paul Fire Department on the day of a major protest march. Planning and operational response for the RNC consumed large amounts of time and resources. The RNC had minimal patient impact on the health care system and in fact caused significant volume decreases at hospitals proximate to the venue. Although contingencies available for a mass casualty event were not needed, they must continue to be available

  19. Medications

    MedlinePlus

    ... from becoming larger and causing more serious problems. Antiplatelets are medications that stop blood particles called platelets ... an angioplasty procedure. Aspirin is one type of antiplatelet medicine. (See "Aspirin: Take With Caution" ) Beta blockers ...

  20. The Center for Healthy Weight: an academic medical center response to childhood obesity

    PubMed Central

    Robinson, T N; Kemby, K M

    2012-01-01

    Childhood obesity represents a worldwide medical and public health challenge. Academic medical centers cannot avoid the effects of the obesity epidemic, and must adopt strategies for their academic, clinical and public policy responses to childhood obesity. The Center for Healthy Weight at Stanford University and Lucile Packard Children's Hospital at Stanford provides an example and model of one such strategy. The design provides both breadth and depth through six cores: Research, Patient Care, Community Programs, Advocating for Public Policy Change, Training and Professional Education, and the Healthy Hospital Initiative. The Center and its cores are designed to facilitate interdisciplinary collaboration across the university, medical school, children's hospital and surrounding community. The foci of these cores are likely to be relevant to almost any academic medical center's mission and functions. PMID:25089192

  1. An Intelligent 802.11 Triage Tag For Medical Response to Disasters

    PubMed Central

    Lenert, Leslie A.; Palmer, Douglas A.; Chan, Theodore C; Rao, Ramesh

    2005-01-01

    When medical care is initiated at a mass casualty event, the first activity is the triage of victims, which is the grouping by victims severity of injury. Paper triage tags are often used to mark victims’ triage status and to record information on injuries and treatments administered in the field. In this paper we describe the design and development of an“Intelligent Triage Tag” (ITT), an electronic device to coordinate patient field care. ITTs combine the basic functionality of a paper triage tag with sensors, nonvolatile memory, a microprocessor and 802.11 wireless transmission capabilities. ITTs not only display victims' triage status but also signal alerts, and mark patients for transport or immediate medical attention. ITTs record medical data for later access offsite and help organize care by relaying information on the location of the victims during field treatment. ITTs are a part of the Wireless Information System for Medical Response in Disasters (WIISARD) architecture. PMID:16779078

  2. Rural surgery in British Columbia: is there anybody out there?

    PubMed

    Humber, Nancy; Frecker, Temma

    2008-06-01

    To document surgical procedures performed in British Columbia between 1996 and 2001 at rural hospital sites with no resident specialist surgeons and to define the scope of practice of general practitioner (GP)-surgeons at these small-volume surgical sites. We obtained data from published information available in the medical directories for British Columbia and from the Population Utilization Rates and Referrals For Easy Comparative Tables database (versions 6.0 and 9.0) to conduct a retrospective study of all rural BC hospitals with surgical programs that had no resident specialist surgeon and relied on GP-surgeons for emergency surgical care between 1996 and 2001. We studied surgical programs at the 12 hospitals that met inclusion criteria and interviewed the physician or nurse responsible for the program. Outcomes were measured in terms of the types and volumes of surgical procedures (elective and emergency) from 1996 to 2001, including itinerant surgery. On average, 2690 surgical procedures were performed annually at the 12 hospitals included in the study. Endoscopy, hand surgery, cesarean section, herniorrhaphy, tonsillectomy and dilation and curettage (D&C) were among the top elective and emergency procedures. For each hospital, between 8 and 26 procedures of hand surgery, cesarean section, herniorrhaphy, D&C and appendectomy were performed each year. In the 12 communities studied, 19% of all surgery was emergency and 81% elective. There was significant overlap in the types of emergency and elective procedures. GP-surgeons carried out most of the emergency procedures, which nonetheless accounted for a small portion of their surgical work. GP-surgeons still perform a significant number of emergency and elective surgical procedures in rural BC hospitals. This study defines useful procedures for GP-surgeons in communities without the population base to sustain a resident specialist surgeon. This information can be used to structure training programs for GP

  3. Medical emergency rescue in disaster: the international emergency response to the Haiyan typhoon in Philippines.

    PubMed

    Ling, Feng; Ye, Zhen; Cai, Wenwei; Lu, Ye; Xia, Shichang; Chen, Zhiping; Chen, Enfu; Wang, Xiaofeng; Wang, Zhen; Lv, Huakun; Gong, Zhenyu

    2014-12-01

    Following Typhoon Haiyan, the World Health Organization (WHO) has been supporting the Government of the Philippines in coordinating the incoming relief supplies from more than 30 international humanitarian health organizations. During the 10 days in Abuyong, Philippines, the Chinese medical rescue team consisting of 50 experts specialized in clinical medicine and disease prevention and control action was taken including, medical treatment, environmental disinfection and health education. A total of 1,831 cases and 2,144 outpatients were treated, blood tests, B-ultrasound, electrocardiogram (ECG) and other laboratory examinations were carried out for more than 615 patients; a cumulative 90,000 square meters in external environment were disinfected, and more than 500 health education materials were handed out. Besides, measures of purifying drinking water, and rebuilding the local hospital have also been carried out. The international emergency response to the Haiyan typhoon in Philippines contributed to reconstruct the local disaster health system by the activities from international medical emergency rescue. To improve the capacity of international medical emergency rescue in disaster, the special project of foreign medical emergency rescue should be set in countries' medical emergency rescue, and disaster emergency medical rescue should be reserved as a conventional capacity.

  4. A conflict of responsibilities: a grounded theory study of clinical psychologists' experience of client non-attendance within the British National Health Service.

    PubMed

    Tweed, A E; Salter, D P

    2000-12-01

    Within psychotherapy process research, the effects of client non-attendance upon therapists has been neglected. The present study interviewed six clinical psychologists concerning their experiences of client non-attendance in health service practice in the UK. Their accounts were analysed using a grounded theory method. A core category was identified and termed 'responsibility'. This highlighted conflicting relationships between participants' responsibilities in several areas. A process model pertaining to non-attendance was also developed. Client non-attendance was seen to produce a level of disruption, experienced as an affective reaction and often experienced in terms of negative affect. In response, re-organizational strategies were used to restore equilibrium. Reasons are suggested as to why negative affective reactions were experienced. These include factors concerning therapeutic competency, but also reflect upon the profession's espousal of an 'all-knowing' expert identity. This is seen to be incongruent to the complexities of clinical practice.

  5. "Signs of the times": Medicine and nationhood in British India.

    PubMed

    Chakrabarti, Pratik

    2009-01-01

    Medical practice and research in colonial India historically had been an imperial preserve, dominated by the elite members of the Indian Medical Service. This was contested from the 1900s on by the emerging Indian nationalism. This essay studies debates about the establishment of a medical research institution and how actors imposed the political identities of nationalism on British colonial practices of medical science. At the same time, Indian nationalism was also drawing from other emerging ideas around health and social welfare. The Indian nationalists and doctors sought to build the identities of the new nation and its medicine around their own ideas of its geography, people, and welfare.

  6. A Two-Stage Approach for Medical Supplies Intermodal Transportation in Large-Scale Disaster Responses

    PubMed Central

    Ruan, Junhu; Wang, Xuping; Shi, Yan

    2014-01-01

    We present a two-stage approach for the “helicopters and vehicles” intermodal transportation of medical supplies in large-scale disaster responses. In the first stage, a fuzzy-based method and its heuristic algorithm are developed to select the locations of temporary distribution centers (TDCs) and assign medial aid points (MAPs) to each TDC. In the second stage, an integer-programming model is developed to determine the delivery routes. Numerical experiments verified the effectiveness of the approach, and observed several findings: (i) More TDCs often increase the efficiency and utility of medical supplies; (ii) It is not definitely true that vehicles should load more and more medical supplies in emergency responses; (iii) The more contrasting the traveling speeds of helicopters and vehicles are, the more advantageous the intermodal transportation is. PMID:25350005

  7. A two-stage approach for medical supplies intermodal transportation in large-scale disaster responses.

    PubMed

    Ruan, Junhu; Wang, Xuping; Shi, Yan

    2014-10-27

    We present a two-stage approach for the "helicopters and vehicles" intermodal transportation of medical supplies in large-scale disaster responses. In the first stage, a fuzzy-based method and its heuristic algorithm are developed to select the locations of temporary distribution centers (TDCs) and assign medial aid points (MAPs) to each TDC. In the second stage, an integer-programming model is developed to determine the delivery routes. Numerical experiments verified the effectiveness of the approach, and observed several findings: (i) More TDCs often increase the efficiency and utility of medical supplies; (ii) It is not definitely true that vehicles should load more and more medical supplies in emergency responses; (iii) The more contrasting the traveling speeds of helicopters and vehicles are, the more advantageous the intermodal transportation is.

  8. Biotechnology and ethics in medical education of the new millennium: physician roles and responsibilities.

    PubMed

    Gonnella, Joseph S.; Hojat, Mohammadreza

    2001-07-01

    Although the medical education curriculum varies internationally, we suggest that it is desirable for medical educators to share a universal responsibility to prepare physicians to perform three distinct, yet interrelated professional roles. The first is that of a clinician who has the knowledge and technical skills to care for individual patients, as well as the public. The second role can be viewed as that of an educator, a teacher, or a consultant who has the interpersonal skills and personal qualities to teach, advise and counsel patients and the public about their health and illness, risk factors and healthy lifestyle. The third role is that of a resource manager to enable physicians to care for patients and serve the public not only by drawing on available material assets but also by prudent use of the resources for better serving the most number of people at the least expense without compromising the quality of care. The very nature of the medical profession also obligates medical educators through the world to sensitize medical students and physicians to the ethical responsibilities that are implicit to each of the three aforementioned roles. Although the basic ethical responsibilities of do no harm and confidentiality are universal, certain global changes, such as rapid advancements in biotechnology and resource allocation, are now reshaping medical ethics on every continent. Spawned by the rapid advances in the biomedical sciences, biotechnology is revolutionizing human reproduction, sustaining human life, cloning human beings, and mapping the entire human genetic terrain. These advances imply changes in medical education and formal preparation of physicians in performing their roles as clinicians, educators and resource managers. These biotechnological developments, coupled with the increasing cost of healthcare and maldistribution of resources worldwide, present unprecedented ethical-social challenges that need to be addressed in the education of the

  9. The transplant team's support of kidney transplant recipients to take their prescribed medications: a collective responsibility.

    PubMed

    Williams, Allison; Low, Jac Kee; Manias, Elizabeth; Crawford, Kimberley

    2016-08-01

    To obtain an understanding of how health professionals support the kidney transplant patient to take their medications as prescribed long term. Kidney transplantation requires stringent adherence to complex medication regimens to prevent graft rejection and to maintain general well-being. Medication nonadherence is common in kidney transplantation, emerging in the first few months post-transplantation, leading to poor patient outcomes. Exploratory qualitative design. Five focus groups were conducted with a total of seven renal nurse transplant coordinators, two renal transplant nurse unit managers, seven nephrologists, seven pharmacists, four social workers, and one consumer representative representing all five hospitals offering adult kidney transplantation in Victoria, Australia in 2014. The views of two general practitioners who were unable to attend the focus groups were incorporated into the data set. All data underwent thematic analysis. Analysis revealed that adherence was a collective responsibility involving the whole of the transplant team and the patient via education blitz in hospital, identifying and managing nonadherence, promotion of self-advocacy, and the partnership between the patient and health professional. Patients were directed how to take their complex medications to be self-empowered, yet the partnership between the patient and health professional limited the patient's voice. Although medication adherence was a collective responsibility, communication was often one-way chiefly as a result of staffing and time constraints, hindering effective partnerships necessary for medication adherence. Expert skills in communication and adherence counselling are necessary to identify barriers affecting medication adherence. Patients need to be systematically screened, prepared and supported long-term within an accommodating healthcare system for the reality of caring for their transplanted kidney. Kidney transplant recipients require systematic

  10. Performance indicators for initial regional medical response to major incidents: a possible quality control tool.

    PubMed

    Nilsson, Heléne; Vikström, Tore; Jonson, Carl-Oscar

    2012-12-17

    Timely decisions concerning mobilization and allocation of resources and distribution of casualties are crucial in medical management of major incidents. The aim of this study was to evaluate documented initial regional medical responses to major incidents by applying a set of 11 measurable performance indicators for regional medical command and control and test the feasibility of the indicators. Retrospective data were collected from documentation from regional medical command and control at major incidents that occurred in two Swedish County Councils. Each incident was assigned to one of nine different categories and 11 measurable performance indicators for initial regional medical command and control were systematically applied. Two-way analysis of variance with one observation per cell was used for statistical analysis and the post hoc Tukey test was used for pairwise comparisons. The set of indicators for regional medical command and control could be applied in 102 of the 130 major incidents (78%), but 36 incidents had to be excluded due to incomplete documentation. The indicators were not applicable as a set for 28 incidents (21.5%) due to different characteristics and time frames. Based on the indicators studied in 66 major incidents, the results demonstrate that the regional medical management performed according to the standard in the early phases (1-10 min after alert), but there were weaknesses in the secondary phase (10-30 min after alert). The significantly lowest scores were found for Indicator 8 (formulate general guidelines for response) and Indicator 10 (decide whether or not resources in own organization are adequate). Measurable performance indicators for regional medical command and control can be applied to incidents that directly or indirectly involve casualties provided there is sufficient documentation available. Measurable performance indicators can enhance follow- up and be used as a structured quality control tool as well as constitute

  11. Medical Students' Responses to an Inpatient Suicide: Opportunities for Education and Support

    ERIC Educational Resources Information Center

    Hamaoka, Derrick A.; Fullerton, Carol S.; Benedek, David M.; Gifford, Robert; Nam, Theodore; Ursano, Robert J.

    2007-01-01

    Objective: The authors review third-year medical students' questionnaires to identify the perceptions, themes, and recommendations following an inpatient suicide. Method: The authors reviewed the needs assessment information collected 1 year after an inpatient suicide. The information, originally gathered through responses to a voluntary e-mail…

  12. 42 CFR 494.150 - Condition: Responsibilities of the medical director.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Condition: Responsibilities of the medical director. 494.150 Section 494.150 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS FOR COVERAGE FOR END-STAGE...

  13. 42 CFR 494.150 - Condition: Responsibilities of the medical director.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Responsibilities of the medical director. 494.150 Section 494.150 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS FOR COVERAGE FOR END-STAGE...

  14. 42 CFR 494.150 - Condition: Responsibilities of the medical director.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 false Condition: Responsibilities of the medical director. 494.150 Section 494.150 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS FOR COVERAGE FOR END-STAGE...

  15. 42 CFR 494.150 - Condition: Responsibilities of the medical director.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Condition: Responsibilities of the medical director. 494.150 Section 494.150 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS FOR COVERAGE FOR END-STAGE...

  16. 42 CFR 494.150 - Condition: Responsibilities of the medical director.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Condition: Responsibilities of the medical director. 494.150 Section 494.150 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS FOR COVERAGE FOR END-STAGE...

  17. Toward Diversity-Responsive Medical Education: Taking an Intersectionality-Based Approach to a Curriculum Evaluation

    ERIC Educational Resources Information Center

    Muntinga, M. E.; Krajenbrink, V. Q.; Peerdeman, S. M.; Croiset, G.; Verdonk, P.

    2016-01-01

    Recent years have seen a rise in the efforts to implement diversity topics into medical education, using either a "narrow" or a "broad" definition of culture. These developments urge that outcomes of such efforts are systematically evaluated by mapping the curriculum for diversity-responsive content. This study was aimed at…

  18. Toward Diversity-Responsive Medical Education: Taking an Intersectionality-Based Approach to a Curriculum Evaluation

    ERIC Educational Resources Information Center

    Muntinga, M. E.; Krajenbrink, V. Q.; Peerdeman, S. M.; Croiset, G.; Verdonk, P.

    2016-01-01

    Recent years have seen a rise in the efforts to implement diversity topics into medical education, using either a "narrow" or a "broad" definition of culture. These developments urge that outcomes of such efforts are systematically evaluated by mapping the curriculum for diversity-responsive content. This study was aimed at…

  19. Pharmacy Response to the Boston Marathon Bombings at a Tertiary Academic Medical Center.

    PubMed

    Sylvester, Katelyn W; Rocchio, Megan A; Belisle, Caryn; Matta, Lina; Goralnick, Eric

    2014-08-01

    Effective crisis response requires multidisciplinary communication and rapid action. Our goals are to highlight the experience of a pharmacy department's response to the 2013 Boston Marathon bombing, to discuss the role of the pharmacist in a crisis response, and to identify potential learning opportunities for a future mass casualty event. Our initial response targeted 3 general areas: staffing, supplies, and communication. Pharmacist and technician staffing was increased throughout the hospital, with a 6-fold increase of pharmacists to the emergency department (ED). To ensure adequate supplies were available, inventory on the ED automatic dispensing cabinets (ADC) was assessed for vaccines, antibiotics, and vasoactive medications. ED pharmacists prepared emergent intravenous medications in the ED while the sterile products room bolstered our supply of intravenous medications for patients in the ED and operating room. Overall, there was a 33% increase in the number of ADC transactions, with pharmacists representing 28% of all ADC transactions. To optimize communication, we formulated a comprehensive plan for the timely dissemination of information to the entire pharmacy staff. A mass casualty event is a rare occasion, and it is vital for the pharmacy department to respond rapidly with little notification. The role of a pharmacist is unique and can most effectively triage drug information and medication distribution, especially during times of high demand and high stress. © The Author(s) 2014.

  20. Dignity and cost-effectiveness: analysing the responsibility for decisions in medical ethics.

    PubMed Central

    Robertson, G S

    1984-01-01

    In the operation of a health care system, defining the limits of medical care is the joint responsibility of many parties including clinicians, patients, philosophers and politicians. It is suggested that changes in the potential for prolonging life make it necessary to give doctors guidance which may have to incorporate certain features of utilitarianism, individualism and patient-autonomy. PMID:6502644

  1. Responsive cortical stimulation for the treatment of medically intractable partial epilepsy.

    PubMed

    Morrell, Martha J

    2011-09-27

    This multicenter, double-blind, randomized controlled trial assessed the safety and effectiveness of responsive cortical stimulation as an adjunctive therapy for partial onset seizures in adults with medically refractory epilepsy. A total of 191 adults with medically intractable partial epilepsy were implanted with a responsive neurostimulator connected to depth or subdural leads placed at 1 or 2 predetermined seizure foci. The neurostimulator was programmed to detect abnormal electrocorticographic activity. One month after implantation, subjects were randomized 1:1 to receive stimulation in response to detections (treatment) or to receive no stimulation (sham). Efficacy and safety were assessed over a 12-week blinded period and a subsequent 84-week open-label period during which all subjects received responsive stimulation. Seizures were significantly reduced in the treatment (-37.9%, n = 97) compared to the sham group (-17.3%, n = 94; p = 0.012) during the blinded period and there was no difference between the treatment and sham groups in adverse events. During the open-label period, the seizure reduction was sustained in the treatment group and seizures were significantly reduced in the sham group when stimulation began. There were significant improvements in overall quality of life (p < 0.02) and no deterioration in mood or neuropsychological function. Responsive cortical stimulation reduces the frequency of disabling partial seizures, is associated with improvements in quality of life, and is well-tolerated with no mood or cognitive effects. Responsive stimulation may provide another adjunctive treatment option for adults with medically intractable partial seizures. This study provides Class I evidence that responsive cortical stimulation is effective in significantly reducing seizure frequency for 12 weeks in adults who have failed 2 or more antiepileptic medication trials, 3 or more seizures per month, and 1 or 2 seizure foci.

  2. Response capabilities of the National Guard: a focus on domestic disaster medical response.

    PubMed

    Bochicchio, Daniel

    2010-01-01

    The National Guard has a 373-year history of responding to the nation's call to duty for service both at home and abroad (The National Guard Bureau Web site: Available at http://www.ngb.army.mil/default. aspx.). The National Guard (NG) is a constitutionally unique organization (United States Constitution, US Government Printing Office Web site: Available at http://www.gpoaccess.gov/constitution/index.html.). Today's Guard conducts domestic disaster response and civilian assistance missions on a daily basis. Yet, the NG's role, mission, and capabilities are not well-known or understood. The National Response Framework (NRF) places significant responsibility on the local and state disaster planners (Department of Homeland Security: National Response Framework. US Department of Homeland Security, Washington, DC, January 2008). The public health professionals are an integral component of the disaster planning community. It is critical that the public health community be knowledgeable of types and capabilities of all the response assets at their disposal.

  3. National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module I. The Emergency Medical Technician, His Role, Responsibility, and Training.

    ERIC Educational Resources Information Center

    National Highway Traffic Safety Administration (DOT), Washington, DC.

    This instructor's lesson plan guide is one of fifteen modules designed for use in the training of emergency medical technicians (EMT). Four units are presented: (1) role of the EMT, including the operation of an emerging medical services system; (2) the laws relevant to EMTs functioning in the field; (3) activities and responsibilities of an EMT…

  4. A study on the disaster medical response during the Mauna Ocean Resort gymnasium collapse.

    PubMed

    Cha, Myeong-Il; Kim, Gi Woon; Kim, Chu Hyun; Choa, Minhong; Choi, Dai Hai; Kim, Inbyung; Wang, Soon Joo; Yoo, In Sool; Yoon, Han Deok; Lee, Kang Hyun; Cho, Suck Ju; Heo, Tag; Hong, Eun Seog

    2016-09-01

    To investigate and document the disaster medical response during the Gyeongju Mauna Ocean Resort gymnasium collapse on February 17, 2014. Official records of each institution were verified to select the study population. All the medical records and emergency medical service run sheets were reviewed by an emergency physician. Personal or telephonic interviews were conducted, without a separate questionnaire, if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent. One hundred fifty-five accident victims treated at 12 hospitals, mostly for minor wounds, were included in this study. The collapse killed 10 people. Although the news of collapse was disseminated in 4 minutes, dispatch of 4 disaster medical assistance teams took at least 69 minutes to take the decision of dispatch. Four point five percent were treated at the accident site, 56.7% were transferred to 2 hospitals that were nearest to the collapse site, and 42.6% were transferred to hospitals that were poorly prepared to handle disaster victims. In the Gyeongju Mauna Ocean Resort gymnasium collapse, the initial triage and distribution of patients was inefficient and medical assistance arrived late. These problems had also been noted in prior mass casualty incidents.

  5. A study on the disaster medical response during the Mauna Ocean Resort gymnasium collapse

    PubMed Central

    Cha, Myeong-il; Kim, Gi Woon; Kim, Chu Hyun; Choa, Minhong; Choi, Dai Hai; Kim, Inbyung; Wang, Soon Joo; Yoo, In Sool; Yoon, Han Deok; Lee, Kang Hyun; Cho, Suck Ju; Heo, Tag; Hong, Eun Seog

    2016-01-01

    Objective To investigate and document the disaster medical response during the Gyeongju Mauna Ocean Resort gymnasium collapse on February 17, 2014. Methods Official records of each institution were verified to select the study population. All the medical records and emergency medical service run sheets were reviewed by an emergency physician. Personal or telephonic interviews were conducted, without a separate questionnaire, if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent. Results One hundred fifty-five accident victims treated at 12 hospitals, mostly for minor wounds, were included in this study. The collapse killed 10 people. Although the news of collapse was disseminated in 4 minutes, dispatch of 4 disaster medical assistance teams took at least 69 minutes to take the decision of dispatch. Four point five percent were treated at the accident site, 56.7% were transferred to 2 hospitals that were nearest to the collapse site, and 42.6% were transferred to hospitals that were poorly prepared to handle disaster victims. Conclusion In the Gyeongju Mauna Ocean Resort gymnasium collapse, the initial triage and distribution of patients was inefficient and medical assistance arrived late. These problems had also been noted in prior mass casualty incidents. PMID:27752635

  6. DNA methylation and clinical response to antidepressant medication in major depressive disorder: A review and recommendations.

    PubMed

    Lisoway, Amanda J; Zai, Clement C; Tiwari, Arun K; Kennedy, James L

    2017-01-04

    Antidepressant medications are the most common treatment for major depression and related disorders. Pharmacogenetic studies have demonstrated that response to these medications is associated with genetic variation. While these studies have been invaluable they have yet to explain why a significant number of patients do not respond to their initial medication. The epigenetic modification known as DNA methylation has recently been studied in the context of antidepressant treatment response. As such, the purpose of this article is to review the advances made in the relatively new field of pharmaco-epigenetics of antidepressant response. We included all published articles examining DNA methylation in association with antidepressant treatment response in Major Depressive Disorder from April 2006 to June 2016 using the PubMed, Medline, PsychInfo and Web of Science databases. At the present time, although original articles are limited, epigenetic modifications of SLC6A4, BDNF, and IL11 genes are showing promising results as biomarkers for prediction of antidepressant response. However, research methods and results are heterogeneous and additional studies are required before results are generalizable. At the end of this review we provide recommendations for study design and analytic approaches.

  7. Prediction of Response to Medication and Cognitive Therapy in the Treatment of Moderate to Severe Depression

    PubMed Central

    Fournier, Jay C.; DeRubeis, Robert J.; Shelton, Richard C.; Hollon, Steven D.; Amsterdam, Jay D.; Gallop, Robert

    2009-01-01

    A recent randomized controlled trial found nearly equivalent response rates for antidepressant medications and cognitive therapy in a sample of moderate-to-severely depressed outpatients. In this article, we seek to identify the variables that were associated with response across both treatments as well as variables that predicted superior response in one treatment over the other. The sample consisted of 180 depressed outpatients: 60 of whom were randomly assigned to cognitive therapy; 120 were assigned to antidepressant medications. Treatment was provided for 16 weeks. Chronic depression, older age, and lower intelligence each predicted relatively poor response across both treatments. Three prescriptive variables were identified: marriage, unemployment, and having experienced a greater number of recent life events predicted superior response to cognitive therapy compared to antidepressant medications. Thus, six markers of treatment outcome were identified, each of which might be expected to carry considerable clinical utility. The three prognostic variables identify subgroups that might benefit from alternative treatment strategies; the three prescriptive variables identify groups who appear to respond particularly well to cognitive therapy. PMID:19634969

  8. Comparison of British and French expatriate doctors’ characteristics and motivations

    PubMed Central

    Quantin, Catherine; Abbas, Rachid; Hagi, Mathieu; Breton, Gwenaelle Le; Romestaing, M; Carnet, Dider

    2012-01-01

    Objective The aim of this study was to analyse the migration of doctors between the UK and France, in an attempt to identify the reasons for these migrations. Design This was a cross-sectional study conducted using a self-completed questionnaire. Setting The questionnaire was sent to all British doctors practising in France and to all French doctors practising in the UK. Participants The doctors were identified, thanks to official data of the National Medical Councils. There were 244 French doctors practising in the UK and 86 British doctors practising in France. Outcome measures A questionnaire was specifically developed for the study to determine the reasons why doctors moved to the other country and their level of satisfaction with regard to their expatriation. Results A total of 98 French doctors (of 244) and 40 British doctors (of 86) returned the questionnaire. The motivations of the two studied populations were different: French doctors were attracted by the conditions offered by the National Health Service, whereas British doctors were more interested in opportunities for career advancement, moved to join a husband or wife or to benefit from favourable environmental conditions. Overall, the doctors who responded considered the expatriation a satisfactory experience. After expatriation, 84% of French doctors were satisfied with their new professional situation compared with only 58% of British doctors. Conclusions This study, which is the first of its kind and based on representative samples, has led to a clearer understanding of the migration of doctors between France and the UK. PMID:23192244

  9. A Community-Led Medical Response Effort in the Wake of Hurricane Sandy.

    PubMed

    Kraushar, Matthew L; Rosenberg, Rebecca E

    2015-08-01

    On October 29, 2012, Hurricane Sandy made landfall in the neighborhood of Red Hook in Brooklyn, New York. The massive tidal surge generated by the storm submerged the coastal area, home to a population over 11,000 individuals, including the largest public housing development in Brooklyn. The infrastructure devastation was profound: the storm rendered electricity, heat, water, Internet, and phone services inoperative, whereas local ambulatory medical services including clinics, pharmacies, home health agencies, and other resources were damaged beyond functionality. Lacking these services or lines of communication, medically fragile individuals became isolated from the hospital and 911-emergency systems without a preexisting mechanism to identify or treat them. Medically fragile individuals primarily included those with chronic medical conditions dependent on frequent and consistent monitoring and treatments. In response, the Red Hook community established an ad hoc volunteer medical relief effort in the wake of the storm, filling a major gap that continues to exist in disaster medicine for low-income urban environments. Here we describe this effort, including an analysis of the medically vulnerable in this community, and recommend disaster risk reduction strategies and resilience measures for future disaster events.

  10. Baseline Antihypertensive Drug Count and Patient Response to Hypertension Medication Management.

    PubMed

    Crowley, Matthew J; Olsen, Maren K; Woolson, Sandra L; King, Heather A; Oddone, Eugene Z; Bosworth, Hayden B

    2016-04-01

    Telemedicine-based medication management improves hypertension control, but has been evaluated primarily in patients with low antihypertensive drug counts. Its impact on patients taking three or more antihypertensive agents is not well-established. To address this evidence gap, the authors conducted an exploratory analysis of an 18-month, 591-patient trial of telemedicine-based hypertension medication management. Using general linear models, the effect of medication management on blood pressure for patients taking two or fewer antihypertensive agents at study baseline vs those taking three or more was compared. While patients taking two or fewer antihypertensive agents had a significant reduction in systolic blood pressure with medication management, those taking three or more had no such response. The between-subgroup effect difference was statistically significant at 6 months (-6.4 mm Hg [95% confidence interval, -12.2 to -0.6]) and near significant at 18 months (-6.0 mm Hg [95% confidence interval, -12.2 to 0.2]). These findings suggest that baseline antihypertensive drug count may impact how patients respond to hypertension medication management and emphasize the need to study management strategies specifically in patients taking three or more antihypertensive medications.

  11. An overview of the roles and responsibilities of Chinese medical colleges in body donation programs.

    PubMed

    Zhang, Luqing; Xiao, Ming; Gu, Mufeng; Zhang, Yongjie; Jin, Jianliang; Ding, Jiong

    2014-01-01

    The use of human tissue is critical for gross anatomy education in the health professions. Chinese medical colleges have faced a shortage of anatomical specimens over the past decade. While body donation plays an important role in overcoming this gap, this practice has only recently been introduced in China, and the donation rate is relatively low and fraught with a number of difficulties. In the past, traditional Chinese culture focused on preserving the human body intact, which often limited body donation. In recent years, the public has become more open toward body donation. At Nanjing Medical University, only 20 bodies were donated in 2001. After the university became involved in an organized body donation program, this number increased to 70 donated bodies per year (2007 to 2012). This article describes and reviews Chinese medical colleges as a special case study among body donation programs, particularly in terms of the multiple responsibilities and roles that such institutions must assume in the course of adopting these programs. Medical colleges in China must serve as advocates, coordinators, builders, managers, educators, and beneficiaries in undertaking body donation programs. It is important for medical colleges to recognize these pluripotent roles and educate the public in order to promote body donation programs. This case study may also effectively guide and encourage Chinese medical colleges in refining their own body donation programs in the future.

  12. PG medical training and accreditation: responsibility of the government for the adequate health service delivery.

    PubMed

    Bhattarai, M D

    2012-09-01

    On one hand there is obvious inadequate health coverage to the rural population and on the other hand the densely populated urban area is facing the triple burden of increasing non-communicable and communicable health problems and the rising health cost. The postgraduate medical training is closely interrelated with the adequate health service delivery and health economics. In relation to the prevailing situation, the modern medical education trend indicates the five vital issues. These are i). Opportunity needs to be given to all MBBS graduates for General Specialist and Sub-Specialist Training inside the country to complete their medical education, ii). Urgent need for review of PG residential training criteria including appropriate bed and teacher criteria as well as entry criteria and eligibility criteria, iii). Involvement of all available units of hospitals fulfilling the requirements of the residential PG training criteria, iv). PG residential trainings involve doing the required work in the hospitals entitling them full pay and continuation of the service without any training fee or tuition fee, and v). Planning of the proportions of General Specialty and Sub-Specialty Training fields, particularly General Practice (GP) including its career and female participation. With increased number of medical graduates, now it seems possible to plan for optimal health coverage to the populations with appropriate postgraduate medical training. The medical professionals and public health workers must make the Government aware of the vital responsibility and the holistic approach required.

  13. Bullying among nursing staff: relationship with psychological/behavioral responses of nurses and medical errors.

    PubMed

    Wright, Whitney; Khatri, Naresh

    2015-01-01

    The aim of this article is to examine the relationship between three types of bullying (person-related, work-related, and physically intimidating) with two types of outcomes (psychological/behavioral responses of nurses and medical errors). In addition, it investigates if the three types of bullying behaviors vary with age or gender of nurses and if the extent of bullying varies across different facilities in an institution. Nurses play an integral role in achieving safe and effective health care. To ensure nurses are functioning at their optimal level, health care organizations need to reduce negative components that impact nurses' job performance and their mental and physical health. Mitigating bullying from the workplace may be necessary to create and maintain a high-performing, caring, and safe hospital culture. Using an internal e-mail system, an e-mail requesting the participants to complete the questionnaire on Survey Monkey was sent to a sample of 1,078 nurses employed across three facilities at a university hospital system in the Midwest. Two hundred forty-one completed questionnaires were received with a response rate of 23%. Bullying was measured utilizing the Negative Acts Questionnaire-Revised (NAQ-R). Outcomes (psychological/behavioral responses of nurses and medical errors) were measured using Rosenstein and O'Daniel's (2008) modified scales. Person-related bullying showed significant positive relationships with psychological/behavioral responses and medical errors. Work-related bullying showed a significant positive relationship with psychological/behavioral responses, but not with medical errors. Physically intimidating bullying did not show a significant relationship to either outcome. Whereas person-related bullying was found to be negatively associated with age of nurses, physically intimidating bullying was positively associated with age. Male nurses experienced higher work-related bullying than female nurses. Findings from this study suggest

  14. Differences in maintenance of response upon discontinuation across medication treatments in attention-deficit/hyperactivity disorder.

    PubMed

    Buitelaar, Jan; Asherson, Philip; Soutullo, Cesar; Colla, Michael; Adams, David H; Tanaka, Yoko; Haynes, Virginia S; Escobar, Rodrigo; Upadhyaya, Himanshu

    2015-10-01

    The attention-deficit/hyperactivity disorder (ADHD) treatment literature has been focused on onset-of-effect and short-term effect size, with little exploration of ADHD symptoms upon medication discontinuation. The objective of this narrative review and analysis was to better understand the relapse of ADHD symptoms upon discontinuation of medication treatment in children, adolescents, and adults with ADHD who have responded to medication treatment and to explore differences among different medications in maintaining treatment response. Randomized withdrawal studies of dexmethylphenidate hydrochloride (d-MPH), methylphenidate modified-release (MPH-LA), lisdexamphetamine dimesylate (LDX), guanfacine extended-release (GXR), and atomoxetine (ATX) in both children/adolescents and adults with ADHD were reviewed. The percentage of relapse was significantly higher and the time-to-relapse significantly shorter with placebo compared to active treatment in patients who were previously stable on 5 weeks to 1 year of active treatment, suggesting clinically significant benefit with continued long-term pharmacotherapy. However, percentage of relapse at each time point studied after discontinuing stimulants and GXR appears substantially higher than observed when discontinuing ATX, suggesting longer maintenance of response after discontinuing ATX than after stimulants and GXR. Additionally, slope of relapse percentages over time appears to be more rapid with stimulants or GXR than with ATX. These differences in maintenance of response among ATX, GXR, and stimulants may reflect differences in mechanisms of action and persistence of the medication effect. Alternatively, they may be due to methodological differences, including study design and response/relapse definitions. Continued investigation is needed regarding factors that affect risk of symptom relapse upon discontinuation of pharmacotherapy.

  15. Geophysical logs in British stratigraphy

    SciTech Connect

    Whittaker, A.; Holliday, D.W.; Penn, I.E.

    1985-01-01

    This Special Report outlines the stratigraphic applications of the main geophysical logging tools. It characterises the British geological succession by means of the geophysical log signatures of its principle constituent formations. A large amount of previously unpublished data is provided on a geographical area long known for its importance in the development of the science of stratigraphy. The book in units modern developments of petroleum industry geophysical techniques with long-established stratigraphical discovery/research. Contents include: Introduction; Types of logs commonly used; Some geological uses of geophysical logs; Log signatures in British Stratigraphy; References.

  16. Evidence for evolutionary change associated with the recent range expansion of the British butterfly, Aricia agestis, in response to climate change.

    PubMed

    Buckley, James; Butlin, Roger K; Bridle, Jon R

    2012-01-01

    Poleward range expansions are widespread responses to recent climate change and are crucial for the future persistence of many species. However, evolutionary change in traits such as colonization history and habitat preference may also be necessary to track environmental change across a fragmented landscape. Understanding the likelihood and speed of such adaptive change is important in determining the rate of species extinction with ongoing climate change. We conducted an amplified fragment length polymorphism (AFLP)-based genome scan across the recently expanded UK range of the Brown Argus butterfly, Aricia agestis, and used outlier-based (DFDIST and BayeScan) and association-based (Isolation-By-Adaptation) statistical approaches to identify signatures of evolutionary change associated with range expansion and habitat use. We present evidence for (i) limited effects of range expansion on population genetic structure and (ii) strong signatures of selection at approximately 5% AFLP loci associated with both the poleward range expansion of A. agestis and differences in habitat use across long-established and recently colonized sites. Patterns of allele frequency variation at these candidate loci suggest that adaptation to new habitats at the range margin has involved selection on genetic variation in habitat use found across the long-established part of the range. Our results suggest that evolutionary change is likely to affect species' responses to climate change and that genetic variation in ecological traits across species' distributions should be maximized to facilitate range shifts across a fragmented landscape, particularly in species that show strong associations with particular habitats. © 2011 Blackwell Publishing Ltd.

  17. A next generation electronic triage to aid mass casualty emergency medical response.

    PubMed

    Gao, Tia; White, D

    2006-01-01

    For years, emergency medical response communities have relied upon paper triage tags, clipboards of notes, and voice communications to share information during medical emergencies. This workflow, however, has proven labor intensive, time consuming, and prone to human error [1]. In collaboration with three EMS groups in the Washington, DC Metropolitan area, we have developed a next generation triage system to improve the effectiveness of emergency response. This system includes: 1) electronic triage tags, 2) wearable vital sign sensors, 3) base stations laptops to monitor and manage patients, 4) pervasive tracking software to locate patients at all stages of the disaster response process, and 5) PDAs to support documentation and communication. Our system has evolved through three iterations of rapid-development, field-studies, usability reviews, and focus-group interview. This paper summarizes engineering considerations for technologies that must operate under constraints of medical emergencies. It is our hope that the lessons reported in this paper will help technologists in developing future emergency response systems.

  18. Reinforcement and stimulant medication ameliorate deficient response inhibition in children with Attention-Deficit/Hyperactivity Disorder

    PubMed Central

    Rosch, Keri S.; Fosco, Whitney D.; Pelham, William E.; Waxmonsky, James G.; Bubnik, Michelle G.; Hawk, Larry W.

    2015-01-01

    This study examined the degree to which reinforcement, stimulant medication, and their combination impact response inhibition in children with Attention-Deficit/Hyperactivity Disorder (ADHD). Across three studies, participants with ADHD (n=111, 25 girls) and typically-developing (TD) controls (n=33, 6 girls) completed a standard version of the stop signal task (SST) and/or a reinforcement-manipulation SST with performance-contingent points. In two of these studies, these tasks were performed under placebo or 0.3 and 0.6 mg/kg methylphenidate (MPH) conditions. Cross-study comparisons were conducted to test hypotheses regarding the separate and combined effects of reinforcement and methylphenidate on response inhibition among children with ADHD relative to TD controls. Baseline response inhibition was worse among children with ADHD compared to controls. MPH produced dose-related improvements in response inhibition in children with ADHD; compared to non-medicated TD controls, 0.3 mg/kg MPH normalized deficient response inhibition, and 0.6 mg/kg MPH resulted in better inhibition in children with ADHD. Reinforcement improved response inhibition to a greater extent for children with ADHD than for TD children, normalizing response inhibition. The combination of MPH and reinforcement improved response inhibition among children with ADHD compared to reinforcement alone and MPH alone, also resulting in normalization of response inhibition despite repeated task exposure. Deficient response inhibition commonly observed in children with ADHD is significantly improved with MPH and/or reinforcement, normalizing inhibition relative to TD children tested under standard conditions. PMID:25985978

  19. Reinforcement and Stimulant Medication Ameliorate Deficient Response Inhibition in Children with Attention-Deficit/Hyperactivity Disorder.

    PubMed

    Rosch, Keri S; Fosco, Whitney D; Pelham, William E; Waxmonsky, James G; Bubnik, Michelle G; Hawk, Larry W

    2016-02-01

    This study examined the degree to which reinforcement, stimulant medication, and their combination impact response inhibition in children with Attention-Deficit/Hyperactivity Disorder (ADHD). Across three studies, participants with ADHD (n = 111, 25 girls) and typically-developing (TD) controls (n = 33, 6 girls) completed a standard version of the stop signal task (SST) and/or a reinforcement-manipulation SST with performance-contingent points. In two of these studies, these tasks were performed under placebo or 0.3 and 0.6 mg/kg methylphenidate (MPH) conditions. Cross-study comparisons were conducted to test hypotheses regarding the separate and combined effects of reinforcement and methylphenidate on response inhibition among children with ADHD relative to TD controls. Baseline response inhibition was worse among children with ADHD compared to controls. MPH produced dose-related improvements in response inhibition in children with ADHD; compared to non-medicated TD controls, 0.3 mg/kg MPH normalized deficient response inhibition, and 0.6 mg/kg MPH resulted in better inhibition in children with ADHD. Reinforcement improved response inhibition to a greater extent for children with ADHD than for TD children, normalizing response inhibition. The combination of MPH and reinforcement improved response inhibition among children with ADHD compared to reinforcement alone and MPH alone, also resulting in normalization of response inhibition despite repeated task exposure. Deficient response inhibition commonly observed in children with ADHD is significantly improved with MPH and/or reinforcement, normalizing inhibition relative to TD children tested under standard conditions.

  20. Ethics of care in medical tourism: Informal caregivers' narratives of responsibility, vulnerability and mutuality.

    PubMed

    Whitmore, Rebecca; Crooks, Valorie A; Snyder, Jeremy

    2015-09-01

    This study examines the experiences of informal caregivers in medical tourism through an ethics of care lens. We conducted semi-structured interviews with 20 Canadians who had accompanied their friends or family members abroad for surgery, asking questions that dealt with their experiences prior to, during and after travel. Thematic analysis revealed three themes central to an ethics of care: responsibility, vulnerability and mutuality. Ethics of care theorists have highlighted how care has been historically devalued. We posit that medical tourism reproduces dominant narratives about care in a novel care landscape. Informal care goes unaccounted for by the industry, as it occurs in largely private spaces at a geographic distance from the home countries of medical tourists. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Influence of Parental Health Literacy and Dosing Responsibility on Pediatric Glaucoma Medication Adherence

    PubMed Central

    Freedman, Rebecca B.; Jones, Sarah K.; Lin, Alice; Robin, Alan L.; Muir, Kelly W.

    2013-01-01

    Objective To assess glaucoma medication adherence in children, hypothesizing that poor parental health literacy and eye drop instillation by the child are associated with worse adherence. Methods This prospective, observational study enrolled pediatric patients with glaucoma who were prescribed eye drops. Parent(s) reported who was responsible for eye drop instillation (parent vs child), took the Rapid Estimate of Adult Literacy in Medicine, and were instructed on the use and purpose of the Medication Event Monitoring System. Calculations included average adherence (proportion of prescribed doses taken), dosing errors (number of overdosing or underdosing events in 24 hours), and proportion of doses taken on schedule (doses taken within 2 hours of prescribed dosing interval). Results are reported as mean (SD) or median. Results The study included 46 of the 50 enrolled children who used the Medication Event Monitoring System for 30 days or more. Adherence ranged from 43% to 107% (93%[12%]) and was not associated with age (slope, 0.09 [0.52]; P = .86) but decreased with the parent’s lower health literacy (slope, 0.62 [0.24]; P = .01).The mean number of dosing errors for medications prescribed daily vs twice daily was similar (3.3 vs 2.9; P = .66). The proportion of doses taken on schedule (within 2 hours of prescribed dosing interval) ranged from 3% to 97% (median, 34%; mean, 41% [24%]) and was better when the parent vs the child instilled eye drops (46% [26%] vs 23% [19%]; P < .001). Conclusions Time-dependent glaucoma medication adherence was better when the parent was responsible for eye drop instillation. Overall decreased adherence was associated with decreased parental health literacy. Children of parents with poor health literacy are vulnerable to poor medication adherence; efforts to address poor health literacy may improve outcomes. PMID:22411659

  2. Responses of songbirds to aerial spraying of the microbial insecticide Bacillus thuringiensis var. kurstaki (FORAY 48B) on Vancouver Island, British Columbia, Canada.

    PubMed

    Sopuck, Lennart; Ovaska, Kristiina; Whittington, Bruce

    2002-08-01

    Use of bacterial insecticides containing Bacillus thuringiensis var. kurstaki (Btk) is gaining popularity as an environmentally safe control measure against lepidopteran pests, but indirect effects on nontarget organisms through reduced prey base have received little attention. Aerial spraying of Btk (Foray 48B) over a 12,803-ha area on southeastern Vancouver Island (BC, Canada) in May to June 1999 as part of a gypsy moth (Lymantria dispar) control program provided us with an opportunity to examine the responses of songbirds to spray application. To obtain an estimate of species richness and relative abundance, we conducted standard songbird point-count surveys in Garry oak (Quercus garryana)-dominated habitats in Btk-sprayed and unsprayed areas in April to June 1999 and, one year after spraying, in 2000. These surveys revealed no patterns consistent with adverse effects of spraying on the relative abundance of adult birds or singing males for any of the species, whether examined individually or when combined into foraging guilds. An exception was the spotted towhee (Pipilo maculatus), which in 1999, but not in 2000, occurred at significantly lower numbers in sprayed plots after Btk treatment. Intensive searches of plots in sprayed and unsprayed areas revealed no differences in the numbers of songbird broods between the two areas for any of the species examined.

  3. Validation of self-reported diagnosis of diabetes in the 1946 British birth cohort.

    PubMed

    Pastorino, Silvia; Richards, Marcus; Hardy, Rebecca; Abington, Jane; Wills, Andrew; Kuh, Diana; Pierce, Mary

    2015-10-01

    The aim of this study was to validate self-reported diabetes and age at diagnosis among a sample of the British population, using general practitioners (GPs) as the reference standard. Using data from the Medical Research Council National Survey of Health and Development (NSHD), self-reported diabetes was determined either in response to a direct question at five follow-ups between 1977 and 2010, or from other self-reported medical information. A validation questionnaire was sent to the GP for all participants who reported a diagnosis of diabetes and gave permission to contact their GP (172). The validity of self-reported diabetes was assessed by calculating the percentage of self-reported diabetes cases that were confirmed by their GP, i.e. the positive predictive value (PPV). The difference between self-reported and GP-confirmed age at diagnosis was analysed with a Bland-Altman plot. Completed questionnaires were obtained from 157 GPs (91.2%). Of these, 149 confirmed their patient self-reported diabetes diagnosis (PPV=94.9%). Results were similar when self-reported diabetes was assessed by responses to direct questions only (PPV=95.4%). The average difference between self-reported and GP-reported age at diagnosis was 0.6 years (95% CI 0.2-1.1). We conclude that among the British population questionnaires are a valid method to assess GP-diagnosed diabetes, as measured by responses to a direct question or by patient-reported medical information.

  4. Condition Self-Management in Pediatric Spina Bifida: A Longitudinal Investigation of Medical Adherence, Responsibility-Sharing, and Independence Skills

    PubMed Central

    Psihogios, Alexandra M.; Kolbuck, Victoria

    2015-01-01

    Objective This study aimed to evaluate rates of medical adherence, responsibility, and independence skills across late childhood and adolescence in youth with spina bifida (SB) and to explore associations among these disease self-management variables. Method 111 youth with SB, their parents, and a health professional participated at two time points. Informants completed questionnaires regarding medical adherence, responsibility-sharing, and child independence skills. Results Youth gained more responsibility and independence skills across time, although adherence rates did not follow a similar trajectory. Increased child medical responsibility was related to poorer adherence, and father-reported independence skills were associated with increased child responsibility. Conclusions This study highlights medical domains that are the most difficult for families to manage (e.g., skin checks). Although youth appear to gain more autonomy across time, ongoing parental involvement in medical care may be necessary to achieve optimal adherence across adolescence. PMID:26002195

  5. Dissociation in response to methylphenidate on response variability in a group of medication naïve children with ADHD.

    PubMed

    Johnson, Katherine A; Barry, Edwina; Bellgrove, Mark A; Cox, Marie; Kelly, Simon P; Dáibhis, Aoife; Daly, Michael; Keavey, Michelle; Watchorn, Amy; Fitzgerald, Michael; McNicholas, Fiona; Kirley, Aiveen; Robertson, Ian H; Gill, Michael

    2008-04-01

    Increased variability in reaction time (RT) has been proposed as a cardinal feature of attention deficit hyperactivity disorder (ADHD). Increased variability during sustained attention tasks may reflect inefficient fronto-striatal and fronto-parietal circuitry; activity within these circuits is modulated by the catecholamines. A disruption to dopamine signaling is suggested in ADHD that may be ameliorated by methylphenidate (MPH). This study investigated the effects of MPH administration on the variability in RT and error performance on a sustained attention task of a group of 31 medication naïve children with ADHD, compared with 22 non-ADHD, non-medicated, control children. All children performed the fixed-sequence sustained attention to response task (SART) at two time-points: at baseline and after six weeks. The children with ADHD were tested when medication naive at baseline and after six weeks of treatment with MPH and whilst on medication. The medication naïve children with ADHD performed the SART with greater errors of commission and omission when compared with the control group. They demonstrated greater standard deviation of RT and fast moment-to-moment variability. They did not differ significantly from the control group in terms of slow variability in RT. MPH administration resulted in reduced and normalised levels of commission errors and fast, moment-to-moment variability in RT. MPH did not affect the rate of omission errors, standard deviation of RT or slow frequency variability in RT. MPH administration may have a specific effect on those performance components that reflect sustained attention and top-down control rather than arousal.

  6. Waves in British Workers' Education.

    ERIC Educational Resources Information Center

    McIlroy, John; Spencer, Bruce

    1989-01-01

    Waves of activity in British workers' education include (1) initiation (1899-1920), with the establishment of the Workers' Education Association; (2) consolidation (1920-1940), with the formation of the National Council of Labour Colleges; (3) growth (1940-1964); (4) increased union training (1964-1979); and (5) current attempts to broaden the…

  7. British Industrial Libraries Before 1939

    ERIC Educational Resources Information Center

    Marshall, Margaret R.

    1972-01-01

    British industrial firm libraries are traced from their beginnings till 1939, by which date they had spread to many branches of industry and had been recognized as an important part of the industrial and library worlds, thus establishing standard patterns of work. The origins and significance of Aslib are discussed. (27 references) (Author/NH)

  8. Instructor Training on British Railways

    ERIC Educational Resources Information Center

    Gibson, J. D.

    1970-01-01

    The value of instructor training was recognized by British Railways as early as 1950 with the setting up of a training center at Darlington. This article shows the results of this continuous training experience in the benefits to be obtained from re-appraisal techniques and practical work. (Author/EB)

  9. Children's Superstitions: British and Canadian.

    ERIC Educational Resources Information Center

    McLeish, John

    1984-01-01

    A 100-item test covering nine areas of superstitious belief administered with 10 control items to 1,749 Canadian and British children showed younger children and girls were more superstitious than older children and boys. Academically inclined children were less superstitious. Science-based education had little effect. Implications for Canadian…

  10. Instructor Training on British Railways

    ERIC Educational Resources Information Center

    Gibson, J. D.

    1970-01-01

    The value of instructor training was recognized by British Railways as early as 1950 with the setting up of a training center at Darlington. This article shows the results of this continuous training experience in the benefits to be obtained from re-appraisal techniques and practical work. (Author/EB)

  11. Alcohol and other drugs: the response of the political and medical institutions.

    PubMed

    Pittman, D J; Staudenmeier, W J; Kaplan, A

    1991-08-01

    Formal and informal social control in shaping individual behaviors toward the use of alcohol and other drugs is discussed. Emphasis is placed on formal social control as it occurs in two major institutions. The state, which embodies the political and legal structures of the society is discussed in terms of the social control of some of the consequences of drinking, such as public drunkenness, alcoholism, operating vehicles with specific blood alcohol levels, and crime and alcohol use. The medical institution's involvement in alcohol and drug control is discussed in terms of the physician's role in diagnosing alcohol and drug dependent individuals. Two contemporary cases, those of pregnant addicts and alcohol-related organ transplant patients, illustrate the significant interactions between the responses of the political and medical institutions, and the broader influences that help shape these responses.

  12. Commercial Airline In-Flight Emergency: Medical Student Response and Review of Medicolegal Issues.

    PubMed

    Bukowski, Josh H; Richards, John R

    2016-01-01

    As the prevalence of air travel increases, in-flight medical emergencies occur more frequently. A significant percentage of these emergencies occur when there is no certified physician, nurse, or paramedic onboard. During these situations, flight crews might enlist the help of noncertified passengers, such as medical students, dentists, or emergency medical technicians in training. Although Good Samaritan laws exist, many health care providers are unfamiliar with the limited legal protections and resources provided to them after responding to an in-flight emergency. A 78-year-old woman lost consciousness and became pulseless onboard a commercial aircraft. No physician was available. A medical student responded and coordinated care with the flight crew, ground support physician, and other passengers. After receiving a packet (4 g) of sublingual sucrose and 1 L i.v. crystalloid, the patient regained pulses and consciousness. The medical student made the decision not to divert the aircraft based on the patient's initial response to therapy and, 45 min later, the patient had normal vital signs. Upon landing, she was met and taken by paramedics to the nearest emergency department for evaluation of her collapse. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians are the most qualified to assist in-flight emergencies, but they might not be aware of the medicolegal risks involved with in-flight care, the resources available, and the role of the flight crew in liability and decision making. This case, which involved a medical student who was not given explicit protection under Good Samaritan laws, illustrates the authority of the flight crew during these events and highlights areas of uncertainty in the legislation for volunteer medical professionals. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Utility and assessment of non-technical skills for rapid response systems and medical emergency teams.

    PubMed

    Chalwin, R P; Flabouris, A

    2013-09-01

    Efforts are ongoing to improve outcomes from cardiac arrest and medical emergencies. A promising quality improvement modality is use of non-technical skills (NTS) that aim to address human factors through improvements in performance of leadership, communication, situational awareness and decision-making. Originating in the airline industry, NTS training has been successfully introduced into anaesthesia, surgery, emergency medicine and other acute medical specialities. Some aspects of NTS have already achieved acceptance for cardiac arrest teams. Leadership skills are emphasised in advanced life support training and have shown favourable results when employed in simulated and clinical resuscitation scenarios. The application of NTS in medical emergency teams as part of a rapid response system attending medical emergencies is less certain; however, observations of simulations have also shown promise. This review highlights the potential benefits of NTS competency for cardiac arrest teams and, more importantly, medical emergency teams because of the diversity of clinical scenarios encountered. Discussion covers methods to assess and refine NTS and NTS training to optimise performance in the clinical environment. Increasing attention should be applied to yielding meaningful patient and organisational outcomes from use of NTS. Similarly, implementation of any training course should receive appropriate scrutiny to refine team and institutional performance.

  14. Response to depression treatment in the Aging Brain Care Medical Home model

    PubMed Central

    LaMantia, Michael A; Perkins, Anthony J; Gao, Sujuan; Austrom, Mary G; Alder, Cathy A; French, Dustin D; Litzelman, Debra K; Cottingham, Ann H; Boustani, Malaz A

    2016-01-01

    Objective To evaluate the effect of the Aging Brain Care (ABC) Medical Home program’s depression module on patients’ depression severity measurement over time. Design Retrospective chart review. Setting Public hospital system. Participants Patients enrolled in the ABC Medical Home program between October 1, 2012 and March 31, 2014. Methods The response of 773 enrolled patients who had multiple patient health questionnaire-9 (PHQ-9) scores recorded in the ABC Medical Home program’s depression care protocol was evaluated. Repeatedly measured PHQ-9 change scores were the dependent variables in the mixed effects models, and demographic and comorbid medical conditions were tested as potential independent variables while including random effects for time and intercept. Results Among those patients with baseline PHQ-9 scores >10, there was a significant decrease in PHQ-9 scores over time (P<0.001); however, the effect differed by gender (P=0.015). On average, women’s scores (4.5 point drop at 1 month) improved faster than men’s scores (1 point drop at 1 month). Moreover, both men and women had a predicted drop of 7 points (>50% decline from baseline) on the PHQ-9 at 6 months. Conclusion These analyses demonstrate evidence for the sustained effectiveness of the ABC Medical Home program at inducing depression remission outcomes while employing clinical staff who required less formal training than earlier clinical trials. PMID:27826188

  15. Development of Medical Technology for Contingency Response to Marrow Toxic Agents

    DTIC Science & Technology

    2014-10-30

    MD Anderson Cancer Center BCPeX Business Continuity Plan Exercise MDS Myelodysplastic Syndrome BMCC Bone Marrow Coordinating Center MHC Major...Histocompatibility Complex BMDW Bone Marrow Donors Worldwide MICA MHC Class I-Like Molecule, Chain A BMT Bone Marrow Transplantation MICB MHC Class I-Like...1 of 16 Grant Award N00014-13-1-0039 DEVELOPMENT OF MEDICAL TECHNOLOGY FOR CONTINGENCY RESPONSE TO MARROW TOXIC AGENTS QUARTERLY

  16. Interactive voice response systems for medication identification requests: poison or cure?

    PubMed

    Benson, Blaine E

    2011-11-01

    Interactive voice response systems (IVR) have traditionally been used by banking and credit card industries to rapidly process information requests for their customers. Today IVR technology is being used in clinical medicine to randomize patients in clinical studies, to collect patient data, and to follow-up on recently discharged patients. Use of IVR systems by poison centers is relatively new. This commentary explores the advantages and disadvantages of applying IVR technology to the medication identification requests in poison centers.

  17. Telemedicine in the British Antarctic survey.

    PubMed

    Grant, Iain C

    2004-12-01

    Medicine in the Antarctic is probably the most isolated situation in which a doctor can practise, differing in degree of severity even from that of the Arctic region. The increasing use of Telemedicine has helped to reduce this isolation and to improve access to secondary healthcare for those who live in the most remote bases in the world. The article describes the way in which Antarctic Telemedicine has evolved in the British Antarctic survey, outlining the use of low cost and low technology systems to improve the availability of emergency advice, both to the doctor and to isolated field parties, specialist consultation, medical education, and healthcare records. The Antarctic is a useful proving ground for technologies which may have applications in space and other extreme and isolated environments.

  18. Olfactory responses of medically and economically important mites (Acari: Epidermoptidae and Acaridae) to volatile chemicals.

    PubMed

    Skelton, A C; Birkett, M A; Pickett, J A; Cameron, M M

    2007-03-01

    Dermatophagoides farinae Hughes (Acari: Epidermoptidae), the American house dust mite, and Tyrophagus putrescentiae (Schrank) (Acari: Acaridae), the mold mite, are medically and economically important but controlling them has proved difficult, and recolonization is commonplace. Their behavioral responses to different sources of volatile chemicals are still not fully elucidated. For the first time, the Y-tube olfactometer, which is an enclosed bioassay to resolve responses to test and control volatiles, has been successfully used with these mites. Mites were tested individually, and both T. putrescentiae and D. farinae responded to food volatiles. Y-tube olfactometers may be used to test for potential semiochemicals, thereby increasing knowledge of our behavior of astigmatic mites.

  19. University of Texas Medical Branch telemedicine disaster response and recovery: lessons learned from hurricane Ike.

    PubMed

    Vo, Alexander H; Brooks, George B; Bourdeau, Michael; Farr, Ralph; Raimer, Ben G

    2010-06-01

    Despite previous efforts and expenditure of tremendous resources on creating and simulating disaster response scenarios, true disaster response, specifically for healthcare, has been inadequate. In addition, none of the >200 local and statewide telemedicine programs in the United States has ever responded to a large-scale disaster, let alone, experienced one directly. Based on its experience with hurricanes Rita and, most recently, Ike, the University of Texas Medical Branch (UTMB) experienced its most challenging trials. Although there were significant disruptions to a majority of UTMB's physical and operational infrastructures, its telemedicine services were able to resume near normal activities within the first week of the post-Ike recovery period, an unimaginable feat in the face of such remarkable devastation. This was primarily due in part to the flexibility of its data network, the rapid response, and plasticity of its telemedicine program. UTMB's experiences in providing rapid and effective medical services in the face of such a disaster offer valuable lessons for local, state, and national disaster preparations, policy, and remote medical delivery models and programs.

  20. Medical Operations Console Procedure Evaluation: BME Response to Crew Call Down for an Emergency

    NASA Technical Reports Server (NTRS)

    Johnson-Troop; Pettys, Marianne; Hurst, Victor, IV; Smaka, Todd; Paul, Bonnie; Rosenquist, Kevin; Gast, Karin; Gillis, David; McCulley, Phyllis

    2006-01-01

    International Space Station (ISS) Mission Operations are managed by multiple flight control disciplines located at the lead Mission Control Center (MCC) at NASA-Johnson Space Center (JSC). ISS Medical Operations are supported by the complementary roles of Flight Surgeons (Surgeon) and Biomedical Engineer (BME) flight controllers. The Surgeon, a board certified physician, oversees all medical concerns of the crew and the BME provides operational and engineering support for Medical Operations Crew Health Care System. ISS Medical Operations is currently addressing the coordinated response to a crew call down for an emergent medical event, in particular when the BME is the only Medical Operations representative in MCC. In this case, the console procedure BME Response to Crew Call Down for an Emergency will be used. The procedure instructs the BME to contact a Surgeon as soon as possible, coordinate with other flight disciplines to establish a Private Medical Conference (PMC) for the crew and Surgeon, gather information from the crew if time permits, and provide Surgeon with pertinent console resources. It is paramount that this procedure is clearly written and easily navigated to assist the BME to respond consistently and efficiently. A total of five BME flight controllers participated in the study. Each BME participant sat in a simulated MCC environment at a console configured with resources specific to the BME MCC console and was presented with two scripted emergency call downs from an ISS crew member. Each participant used the procedure while interacting with analog MCC disciplines to respond to the crew call down. Audio and video recordings of the simulations were analyzed and each BME participant's actions were compared to the procedure. Structured debriefs were conducted at the conclusion of both simulations. The procedure was evaluated for its ability to elicit consistent responses from each BME participant. Trials were examined for deviations in procedure task

  1. Genetic studies of DRD4 and clinical response to neuroleptic medications

    SciTech Connect

    Kennedy, J.L.; Petronis, A.; Gao, J.

    1994-09-01

    Clozapine is an atypical antipsychotic drug that, like most other medications, is effective for some people and not for others. This variable response across individuals is likely significantly determined by genetic factors. An important candidate gene to investigate in clozapine response is the dopamine D4 receptor gene (DRD4). The D4 receptor has a higher affinity for clozapine than any of the other dopamine receptors. Furthermore, recent work by our consortium has shown a remarkable level of variability in the part of the gene coding for the third cytoplasmic loop. We have also identified polymorphisms in the upstream 5{prime} putative regulatory region and at two other sites. These polymorphisms were typed in a group of treatment-resistant schizophrenia subjects who were subsequently placed on clozapine (n = 60). In a logistic regression analysis, we compared genotype at the DRD4 polymorphism to response versus non-response to clozapine. Neither the exon-III nor any of the 5{prime} polymorphisms alone significantly predicted response; however, when the information from these polymorphisms was combined, more predictive power was obtained. In a correspondence analysis of the four DRD4 polymorphisms vs. response, we were able to predict 76% of the variance in response. Refinement of the analyses will include assessment of subfactors involved in clinical response phenotype and incorporation of the debrisoquine metabolizing locus (CYP2D6) into the prediction algorithm.

  2. Defining and Measuring Academic Standards: A British Perspective

    ERIC Educational Resources Information Center

    Alderman, Geoffrey

    2009-01-01

    Historically, the definition and measurement of academic standards in British higher education have been the exclusive prerogative of the academic community. The calibration of standards across institutions was the responsibility and purpose of the external-examiner system. But the mechanisms in place to achieve these ends have broken down under…

  3. Learning to Be. A Perspective from British Columbia, Canada

    ERIC Educational Resources Information Center

    Halbert, Judy; Kaser, Linda

    2015-01-01

    This article describes how "learning to be", with a specific focus on social-emotional competencies, has become part of the educational mindset--and educational policy--in British Columbia, Canada. The development of a set of learning progressions for social responsibility, an emphasis on social emotional learning in the new curriculum…

  4. Learning to Be. A Perspective from British Columbia, Canada

    ERIC Educational Resources Information Center

    Halbert, Judy; Kaser, Linda

    2015-01-01

    This article describes how "learning to be", with a specific focus on social-emotional competencies, has become part of the educational mindset--and educational policy--in British Columbia, Canada. The development of a set of learning progressions for social responsibility, an emphasis on social emotional learning in the new curriculum…

  5. Comment: The People's Law School of British Columbia.

    ERIC Educational Resources Information Center

    Sprowls, David

    1980-01-01

    The People's Law School of British Columbia is a nonprofit organization informing laymen of their legal rights and responsibilities. The program features free evening courses cosponsored by community groups in 60 centers around the province. (Journal availability: Canada-United States Law Journal, 11075 East Blvd., Cleveland, OH 44106.) (MSE)

  6. British privatization--taking capitalism to the people.

    PubMed

    Moore, J

    1992-01-01

    From 1983 to 1986, John Moore served in the Thatcher government in Britain, launching that country's privatization program. In "British Privatization--Taking Capitalism to the People, " he describes the thinking behind privatization, the objections raised against it, and the actual measures taken to implement it. With privatization, corporate performance has improved and the government has been able to focus on regulation, not ownership. But in the end, says Moore, the greatest success of British privatization was that it transformed the public's attitude toward ownership and economic responsibility.

  7. Shifting goals in medical communication. Determinants of goal detection and response formation.

    PubMed

    Hulsman, Robert L

    2009-03-01

    Research and education of medical communication different perspective, making the extraction of clear recommendations from research that can be applied in education not always possible. In education, medical communication is encountered from a goal-oriented perspective, which is often lacking in quantitative research where the relationship between process variables and the content of medical practice is often ignored. The aim of this paper is to bring the worlds of research and education together by presenting a comprehensive model of determinants explaining the behavior of physicians in daily practice. A basic notion in this model is that medical communication is goal-oriented, problem-solving behavior. Goals in communication are not fixed, but permanently changing over time. Hence, communication abilities do not rely on behavioral skills only but also on perceptual skills in identifying goals. A number of determinants affect the cognitive processes of goal appraisal and response formation: knowledge, attitudes, social norms, self-efficacy, stressors and interfering goals. Modeling medical communication as goal-oriented problem-solving behavior, and recognizing the complexity of goal appraisal and other key determinants of response formation may provide a common focus for both research and education in measuring, explaining and improving the HCP's behavior. In education not only skill practicing but also reflection on the process and outcomes is important to understand how one acts in practice situations and should act in future situations. In research measurements should be expanded to take contextual and goal-oriented dimensions of the process of communication into account to make findings more relevant for education and practice.

  8. Medical response to the Great East Japan Earthquake in Ishinomaki City

    PubMed Central

    2011-01-01

    Problem The Ishinomaki Red Cross Hospital is the only designated disaster hospital in the Ishinomaki Medical Zone, Japan that was undamaged from the Great East Japan Earthquake in March 2011. The tsunami completely destroyed a large part of the Ishinomaki Medical Zone. Context The Ishinomaki Red Cross Hospital was designed with the capability to respond to disasters. An instruction manual for responding to disasters had been developed and was exercised through drills. Action In accordance with the manual, the hospital disaster task force was established. The Ishinomaki Zone Joint Relief Team coordinated medical support from organizations such as physicians associations, dental associations, self-defence forces medical teams, pharmacists associations, the Japanese Red Cross and relief teams from hospitals all over the country. In three days, the joint relief team directly visited all emergency shelters to make an initial assessment and to collect information about the number and state of health of evacuees, provision of food and drinking-water and the availability of electricity, water and sewerage. Outcome Initial assessment revealed that 35 emergency shelters lacked a sufficient food supply and that 100 shelters had unsanitary conditions. The joint relief team provided the Miyagi Prefecture government and the Ishinomaki municipal government with information about emergency shelters that did not have sufficient food supply. As of 30 September, the activities of the joint relief team were completed, and there was no outbreak of communicable diseases in the Ishinomaki Medical Zone. A total of 328 shelters with 46 480 evacuees were managed by the Ishinomaki Zone Joint Relief Team. Discussion Advanced preparation to quickly establish an initial response system, expertise, and decision-making ability and the ability to get things done are required for disaster response management. PMID:23908895

  9. Supernatural versus medical: Responses to mental illness from undergraduate university students in Trinidad.

    PubMed

    Ramkissoon, AnMarie Kamanie; Donald, Casswina; Hutchinson, Gerard

    2017-06-01

    Background/Introduction: Perceptions about the aetiology of mental illness are likely to influence help-seeking behaviour. Understanding help-seeking behaviour will improve service provision and access. Therefore, this is likely to improve treatment outcomes. We assessed the perceptions and help-seeking behaviours surrounding mental illness in a Trinidadian population of 158 tertiary-level students (136 female, 22 male; mean age 30) by analysing their responses to a questionnaire which asked for responses regarding a case vignette of a 25-year-old young woman exhibiting symptoms suggestive of schizophrenia. Of the respondents, 32.3% attributed the symptoms to supernatural causes. Specifically, 27.8% to someone doing her bad and 24.1% to evil spirits. In all, 77.2% of respondents indicated that mental illness was caused by medical problems and 63.3% to work stress. A minimum of 9.5% of the students therefore have dual perceptions regarding causation (77.2 + 32.3 = 109.5) Those who perceived causation to be supernatural said they would seek help from both medical ( p = .000) and supernatural ( p = .000) modalities. This also applied significantly to those who said the causation was medical, that is, seeking both religious intervention ( p = .000) and medical intervention (.000) as the first path in the health-seeking pathway. Dual help-seeking behaviour seems to be the functional result of an integration of religious and medical models of mental illness causation even in respondents who clearly identified only one of these as the likely cause of the illness behaviour.

  10. Halting the 'sad degenerationist parade': medical concerns about heredity and racial degeneracy in New Zealand psychiatry, 1853-99.

    PubMed

    Dawson, Maree

    2012-01-01

    Historians have focused on early twentieth-century positive eugenics in New Zealand In this article, I argue that the response came from a tradition of concern about heredity and white racial degeneracy, which extended beyond the British Empire. This article focuses on concerns about heredity at the Auckland Mental Hospital between 1850 and 1899, and contextualises these concerns in New Zealand mental hospital statistics from the late-nineteenth century. This article also considers Australasian, British, North and South American medical and immigration legislation history, and contrasts this with the legislation and medical discourses which formed part of a fear of heredity, racial degeneracy, immigration and mental illness in New Zealand.

  11. [Organisational responsibility versus individual responsibility: safety culture? About the relationship between patient safety and medical malpractice law].

    PubMed

    Hart, Dieter

    2009-01-01

    The contribution is concerned with the correlations between risk information, patient safety, responsibility and liability, in particular in terms of liability law. These correlations have an impact on safety culture in healthcare, which can be evaluated positively if--in addition to good quality of medical care--as many sources of error as possible can be identified, analysed, and minimised or eliminated by corresponding measures (safety or risk management). Liability influences the conduct of individuals and enterprises; safety is (probably) also a function of liability; this should also apply to safety culture. The standard of safety culture does not only depend on individual liability for damages, but first of all on strict enterprise liability (system responsibility) and its preventive effects. Patient safety through quality and risk management is therefore also an organisational programme of considerable relevance in terms of liability law.

  12. Foreign medical teams: what role can they play in response to a catastrophic disaster in the US?

    PubMed

    Hanfling, Dan; Bouri, Nidhi

    2013-12-01

    Hurricane Katrina demonstrated that a catastrophic event in the continental United States (US) can overwhelm domestic medical response capabilities. The recent focus on response planning for a catastrophic earthquake in the New Madrid Seismic Zone and the detonation of an improvised nuclear device also underscore the need for improved plans. The purpose of this analysis is to identify the potential role of foreign medical teams (FMTs) in providing medical response to a catastrophic event in the US. We reviewed existing policies and frameworks that address medical response to catastrophic events and humanitarian emergencies and assess current response capabilities by a variety of FMTs. While several policies and plans outline the role of the US in providing medical assistance during foreign disasters, further planning is necessary to identify how the US will integrate foreign medical assistance during a domestic catastrophic event. We provide an overview of considerations related to federal roles and responsibilities for managing and integrating FMTs into the overarching domestic medical response to a catastrophic disaster occurring in the continental US.

  13. Impact of sanctions on procurement of medicine and medical devices in Iran; a technical response.

    PubMed

    Hosseini, Seyed Alireza

    2013-12-01

    Following recent sanctions on foreign trade, financial and banking services, Iran has faced major difficulties for importing medicines (both finished products and pharmaceutical raw materials) and medical devices. Problems with money transfer have made it extremely lengthy in time to import medicine and medical devices and these have negatively affected access to and affordability of medicines. Quality of pharmaceuticals and treatment of patients have also been affected due to changing the sources of imported medicines and raw materials for locally produced pharmaceuticals. Several interventions have been employed during the past few months in Iran to overcome the effects imposed by recent sanctions and drug shortages have been managed to some extent with attempts made by Iran Food and Drug Organization (IRI FDO). As recommended by the experts, a specific Society for Worldwide Interbank Financial Telecommunication line should be allocated for transferring money for medicines and medical devices and certain financial institutions are assigned for this purpose. It is also suggested that defining a white list of Iranian pharmaceuticals and medical device companies together with their foreign counterparts would facilitate this process. It appears that, in a public health prospective, ordinary people and patients are hurt and paying the cost for current sanctions. It remains the responsibility of the public health and international communities to separate public health from politics and to ease the pain of public from sanctions.

  14. Managing Disruptive Behavior by Patients and Physicians: A Responsibility of the Dialysis Facility Medical Director

    PubMed Central

    Jones, Edward R.; Goldman, Richard S.

    2015-01-01

    The Centers for Medicare & Medicaid Services’ Conditions for Coverage make the medical director of an ESRD facility responsible for all aspects of care, including high-quality health care delivery (e.g., safe, effective, timely, efficient, and patient centered). Because of the high-pressure environment of the dialysis facility, conflicts are common. Conflict frequently occurs when aberrant behaviors disrupt the dialysis facility. Patients, family members, friends, and, less commonly appreciated, nephrology clinicians (i.e., nephrologists and advanced care practitioners) may manifest disruptive behavior. Disruptive behavior in the dialysis facility impairs the ability to deliver high-quality care. Furthermore, disruptive behavior is the leading cause for involuntary discharge (IVD) or involuntary transfer (IVT) of a patient from a facility. IVD usually results in loss of continuity of care, increased emergency department visits, and increased unscheduled, acute dialysis treatments. A sufficient number of IVDs and IVTs also trigger an extensive review of the facility by the regional ESRD Networks, exposing the facility to possible Medicare-imposed sanctions. Medical directors must be equipped to recognize and correct disruptive behavior. Nephrology-based literature and tools exist to help dialysis facility medical directors successfully address and resolve disruptive behavior before medical directors must involuntarily discharge a patient or terminate an attending clinician. PMID:25403921

  15. Managing Disruptive Behavior by Patients and Physicians: A Responsibility of the Dialysis Facility Medical Director.

    PubMed

    Jones, Edward R; Goldman, Richard S

    2015-08-07

    The Centers for Medicare & Medicaid Services' Conditions for Coverage make the medical director of an ESRD facility responsible for all aspects of care, including high-quality health care delivery (e.g., safe, effective, timely, efficient, and patient centered). Because of the high-pressure environment of the dialysis facility, conflicts are common. Conflict frequently occurs when aberrant behaviors disrupt the dialysis facility. Patients, family members, friends, and, less commonly appreciated, nephrology clinicians (i.e., nephrologists and advanced care practitioners) may manifest disruptive behavior. Disruptive behavior in the dialysis facility impairs the ability to deliver high-quality care. Furthermore, disruptive behavior is the leading cause for involuntary discharge (IVD) or involuntary transfer (IVT) of a patient from a facility. IVD usually results in loss of continuity of care, increased emergency department visits, and increased unscheduled, acute dialysis treatments. A sufficient number of IVDs and IVTs also trigger an extensive review of the facility by the regional ESRD Networks, exposing the facility to possible Medicare-imposed sanctions. Medical directors must be equipped to recognize and correct disruptive behavior. Nephrology-based literature and tools exist to help dialysis facility medical directors successfully address and resolve disruptive behavior before medical directors must involuntarily discharge a patient or terminate an attending clinician.

  16. Task force St. Bernard: operational issues and medical management of a National Guard disaster response operation.

    PubMed

    Bonnett, Carl J; Schock, Tony R; McVaney, Kevin E; Colwell, Christopher B; Depass, Christopher

    2007-01-01

    After Hurricane Katrina struck the Gulf Coast of the United States on 29 August 2005, it became obvious that the country was facing an enormous national emergency. With local resources overwhelmed, governors across the US responded by deploying thousands of National Guard soldiers and airmen. The National Guard has responded to domestic disasters due to natural hazards since its inception, but an event with the magnitude of Hurricane Katrina was unprecedented. The deployment of >900 Army National Guard soldiers to St. Bernard Parish, Louisiana in the aftermath of the Hurricane was studied to present some of the operational issues involved with providing medical support for this type of operation. In doing so, the authors attempt to address some of the larger issues of how the National Guard can be incorporated into domestic disaster response efforts. A number of unforeseen issues with regards to medical operations, medical supply, communication, preventive medicine, legal issues, and interactions with civilians were encountered and are reviewed. A better understanding of the National Guard and how it can be utilized more effectively in future disaster response operations can be developed.

  17. Toward diversity-responsive medical education: taking an intersectionality-based approach to a curriculum evaluation.

    PubMed

    Muntinga, M E; Krajenbrink, V Q E; Peerdeman, S M; Croiset, G; Verdonk, P

    2016-08-01

    Recent years have seen a rise in the efforts to implement diversity topics into medical education, using either a 'narrow' or a 'broad' definition of culture. These developments urge that outcomes of such efforts are systematically evaluated by mapping the curriculum for diversity-responsive content. This study was aimed at using an intersectionality-based approach to define diversity-related learning objectives and to evaluate how biomedical and sociocultural aspects of diversity were integrated into a medical curriculum in the Netherlands. We took a three-phase mixed methods approach. In phase one and two, we defined essential learning objectives based on qualitative interviews with school stakeholders and diversity literature. In phase three, we screened the written curriculum for diversity content (culture, sex/gender and class) and related the results to learning objectives defined in phase two. We identified learning objectives in three areas of education (medical knowledge and skills, patient-physician communication, and reflexivity). Most diversity content pertained to biomedical knowledge and skills. Limited attention was paid to sociocultural issues as determinants of health and healthcare use. Intersections of culture, sex/gender and class remained mostly unaddressed. The curriculum's diversity-responsiveness could be improved by an operationalization of diversity that goes beyond biomedical traits of assumed homogeneous social groups. Future efforts to take an intersectionality-based approach to curriculum evaluations should include categories of difference other than culture, sex/gender and class as separate, equally important patient identities or groups.

  18. Reevaluating response and failure of medical treatment of endometriosis: a systematic review.

    PubMed

    Becker, Christian M; Gattrell, William T; Gude, Kerstin; Singh, Sukhbir S

    2017-07-01

    To assess patient response rates to medical therapies used to treat endometriosis-associated pain. A systematic review with the use of Medline and Embase. Not applicable. Women receiving medical therapy to treat endometriosis. None. The proportions of patients who: experienced no reduction in endometriosis-associated pain symptoms; had pain symptoms remaining at the end of the treatment period; had pain recurrence after treatment cessation; experienced an increase or no change in disease score during the study; were satisfied with treatment; and discontinued therapy owing to adverse events or lack of efficacy. The change in pain symptom severity experienced during and after treatment, as measured on the visual analog scale, was also assessed. In total, 58 articles describing 125 treatment arms met the inclusion criteria. Data for the response of endometriosis-associated pain symptoms to treatment were presented in only 29 articles. The median proportions of women with no reduction in pain were 11%-19%; at the end of treatment, 5%-59% had pain remaining; and after follow-up, 17%-34% had experienced recurrence of pain symptoms after treatment cessation. After median study durations of 2-24 months, the median discontinuation rates due to adverse events or lack of efficacy were 5%-16%. Few studies of medical therapies for endometriosis report outcomes that are relevant to patients, and many women gain only limited or intermittent benefit from treatment. Copyright © 2017. Published by Elsevier Inc.

  19. Proper oxygen use can help save lives in initial medical emergency response.

    PubMed

    Starr, L M

    1993-03-01

    For many people who deal with medical emergencies--some human resource managers, emergency team administrators, CPR and first aid instructors, EMTs, nurses and physicians--the topic of oxygen use by nonmedical responders at the workplace is poorly understood. Workplace emergency response administrators may find it helpful to become familiar with the current emergency medical literature and learn that the previous literature may no longer apply. Furthermore, fear that use of emergency oxygen by nonmedical responders is "playing doctor," and will lead to some imagined uncontrollable catastrophe is based on statistically and medically unfounded misinformation. As is the case with many uncertain events, the perception of risk is unrelated to the actual risk. Refusing to allow appropriately trained nonmedical responders to use reliable emergency oxygen when it is available is a potentially grave error and makes emergency care in the workplace less efficient and valuable. There are many cases of workplace injury or illness in which oxygen use is not only appropriate but may help save a patient's life. Ensuring that the proper emergency oxygen equipment is available where appropriate and properly training personnel are responsible for first aid can, in some cases, lessen the severity of workplace illness and injury incidents.

  20. Do User-Applied Safety Labels on Medication Syringes Reduce the Incidence of Medication Errors During Rapid Medical Response Intervention for Deteriorating Patients on Wards? A Systematic Search and Review.

    PubMed

    Mikhail, John; Grantham, Hugh; King, Lindy

    2017-09-01

    Intravenous medication errors (MEs) occur during medical emergency situations. An initiative, not yet in common practice, that could address these errors is safety labeling. The aim of this review was to identify and appraise research evidence related to the impact of user-applied medication safety labeling on reducing the incidence of MEs during rapid medical response intervention for patient deterioration in the ward setting. A systematic search and review framework was used to conduct the review. A comprehensive database search was conducted of BioMed Central, Clinical Trials, Cumulative Index to Nursing and Allied Health Literature, Expanded Academic ASAP, Joanna Briggs Institute, MEDLINE, OVID, ProQuest Central, PubMed, Wiley Online Library, and World Health Organization Library. The Young and Solomon (2009) critical appraisal tool was used to critically appraise the identified research articles. Each article was then analyzed using a thematic network strategy to identify commonality. Four primary themes were identified; they were as follows: MEs occur during medical emergency responses (MERs); MEs occur throughout the medication administration process; MERs are stressful and are associated with MEs; and role of medication labeling in reducing MEs during MERs. Greater vigilance is required by health professionals during the medication administration process. The implementation of specific medication safety labeling into the MER could be beneficial in reducing the overall incidence of MEs. Further research is required to validate the merits of a MER medication safety labeling system.

  1. Mental health of British farmers

    PubMed Central

    Thomas, H; Lewis, G; Thomas, D; Salmon, R; Chalmers, R; Coleman, T; Kench, S; Morgan-Capner, P; Meadows, D; Sillis, M; Softley, P; Jenkins, R

    2003-01-01

    Aims: To estimate the prevalence of neurotic symptoms in a sample of British farmers, to investigate whether farming characteristics are associated with psychiatric morbidity, and to test the hypothesis that British farmers have a higher prevalence of depression and thoughts of life not worth living than the British household population. Methods: A total of 425 farmers from Hereford, Norwich, and Preston completed the Revised Clinical Interview Schedule (CIS-R) by computer between March and July 1999. The comparison cohort consisted of 9830 private householders aged 16–64 from the Office of Population Censuses and Surveys National Psychiatric Morbidity Surveys of Great Britain carried out in 1993 in which the CIS-R was administered. All analyses used the commands developed specifically for survey data available in Stata version 6.0. Results: Taking a threshold of an overall score of 12 or more on the CIS-R, only 6% of farmers reported clinically relevant psychiatric morbidity. Psychiatric morbidity was not significantly associated with farm type or size in this study. Farmers reported a lower prevalence of psychiatric morbidity than the general population but were more likely to report thinking that life is not worth living, particularly after the low prevalence of psychiatric morbidity had been taken into account (odds ratio 2.56, 95% CI 1.39 to 4.69). When restricting the comparison to only rural or semirural householders, this increased risk was even more pronounced (odds ratio 3.26, 95% CI 1.51 to 7.02). Conclusions: The relation between depression and suicidal ideation seems to be quite different among farmers and the general population and warrants further investigation. We have shown it is possible to measure mental health systematically in a sample of British farmers. This study should be repeated in the aftermath of the foot and mouth crisis. PMID:12598664

  2. Mental health of British farmers.

    PubMed

    Thomas, H V; Lewis, G; Thomas, D Rh; Salmon, R L; Chalmers, R M; Coleman, T J; Kench, S M; Morgan-Capner, P; Meadows, D; Sillis, M; Softley, P

    2003-03-01

    To estimate the prevalence of neurotic symptoms in a sample of British farmers, to investigate whether farming characteristics are associated with psychiatric morbidity, and to test the hypothesis that British farmers have a higher prevalence of depression and thoughts of life not worth living than the British household population. A total of 425 farmers from Hereford, Norwich, and Preston completed the Revised Clinical Interview Schedule (CIS-R) by computer between March and July 1999. The comparison cohort consisted of 9830 private householders aged 16-64 from the Office of Population Censuses and Surveys National Psychiatric Morbidity Surveys of Great Britain carried out in 1993 in which the CIS-R was administered. All analyses used the commands developed specifically for survey data available in Stata version 6.0. Taking a threshold of an overall score of 12 or more on the CIS-R, only 6% of farmers reported clinically relevant psychiatric morbidity. Psychiatric morbidity was not significantly associated with farm type or size in this study. Farmers reported a lower prevalence of psychiatric morbidity than the general population but were more likely to report thinking that life is not worth living, particularly after the low prevalence of psychiatric morbidity had been taken into account (odds ratio 2.56, 95% CI 1.39 to 4.69). When restricting the comparison to only rural or semirural householders, this increased risk was even more pronounced (odds ratio 3.26, 95% CI 1.51 to 7.02). The relation between depression and suicidal ideation seems to be quite different among farmers and the general population and warrants further investigation. We have shown it is possible to measure mental health systematically in a sample of British farmers. This study should be repeated in the aftermath of the foot and mouth crisis.

  3. Micro- and Nanotechnologies for Intelligent and Responsive Biomaterial-Based Medical Systems

    PubMed Central

    Caldorera-Moore, Mary; Peppas, Nicholas A.

    2009-01-01

    Advances in medical treatments of a wide variety of pathophysiological conditions require the development of better therapeutic agents, as well as a combination of the required therapeutic agents with device-integrated biomaterials that can serve as sensors and carriers. Combination of micro- and nanofabricated systems with intelligent biomaterials that have the ability to sense and respond is a promising avenue for the development of better diagnostic and therapeutic medical systems. Micro- and nano-electromechanical systems (MEMs and NEMs) are now becoming a family of potentially powerful new technologies for drug delivery, diagnostic tools, and tissue engineering. Improvements in micro- and nano-fabrication technology have enhanced the ability to create better performing therapeutic systems for numerous pathophysiological applications. More importantly, MEMS and NEMS-based tissue regeneration scaffolds, biosensors, and drug delivery devices provide new opportunities to mimic the natural intelligence and response of biological systems. PMID:19758574

  4. Micro- and nanotechnologies for intelligent and responsive biomaterial-based medical systems.

    PubMed

    Caldorera-Moore, Mary; Peppas, Nicholas A

    2009-12-17

    Advances in medical treatments of a wide variety of pathophysiological conditions require the development of better therapeutic agents, as well as a combination of the required therapeutic agents with device-integrated biomaterials that can serve as sensors and carriers. Combination of micro- and nano-fabricated systems with intelligent biomaterials that have the ability to sense and respond is a promising avenue for the development of better diagnostic and therapeutic medical systems. Micro- and nano-electromechanical systems (MEMs and NEMs) are now becoming a family of potentially powerful new technologies for drug delivery, diagnostic tools, and tissue engineering. Improvements in micro- and nano-fabrication technologies have enhanced the ability to create better performing therapeutic systems for numerous pathophysiological applications. More importantly, MEMS- and NEMS-based tissue regeneration scaffolds, biosensors, and drug delivery devices provide new opportunities to mimic the natural intelligence and response of biological systems.

  5. An 802.11 Wireless Blood Pulse-Oximetry System for Medical Response to Disasters

    PubMed Central

    Palmer, Douglas A.; Rao, Ramesh; Lenert, Leslie A.

    2005-01-01

    In a mass casualty situation, medical personnel at the disaster site and other field treatment settings may need to monitor the vital signs of hundreds of seriously injured patients with minimal staffing. The conditions may be primitive and personnel may have to improvise infrastructure. As part of our research to enhance medical response to disasters with Internet-enabled systems, we have developed a prototype Wireless Blood Pulse Oximeter system for mass casualty events designed to operate in WiFi hotspots. Pulse ox units were designed using low-cost embedded system technologies to operate in integrated or stand alone environments. Units can report data to a command post on the scene or any remote location with Internet access. The entire system is potentially capable of tracking and monitoring several hundred patients. PMID:16779359

  6. Medical ozone increases methotrexate clinical response and improves cellular redox balance in patients with rheumatoid arthritis.

    PubMed

    León Fernández, Olga Sonia; Viebahn-Haensler, Renate; Cabreja, Gilberto López; Espinosa, Irainis Serrano; Matos, Yanet Hernández; Roche, Liván Delgado; Santos, Beatriz Tamargo; Oru, Gabriel Takon; Polo Vega, Juan Carlos

    2016-10-15

    Medical ozone reduced inflammation, IL-1β, TNF-α mRNA levels and oxidative stress in PG/PS-induced arthritis in rats. The aim of this study was to investigate the medical ozone effects in patients with rheumatoid arthritis treated with methotrexate and methotrexate+ozone, and to compare between them. A randomized clinical study with 60 patients was performed, who were divided into two groups: one (n=30) treated with methotrexate (MTX), folic acid and Ibuprophen (MTX group) and the second group (n=30) received the same as the MTX group+medical ozone by rectal insufflation of the gas (MTX+ozone group). The clinical response of the patients was evaluated by comparing Disease Activity Score 28 (DAS28), Health Assessment Questionnaire Disability Index (HAQ-DI), Anti-Cyclic Citrullinated (Anti-CCP) levels, reactants of acute phase and biochemical markers of oxidative stress before and after 20 days of treatment. MTX+ozone reduced the activity of the disease while MTX merely showed a tendency to decrease the variables. Reactants of acute phase displayed a similar picture. MTX+ozone reduced Anti-CCP levels as well as increased antioxidant system, and decreased oxidative damage whereas MTX did not change. Glutathione correlated with all clinical variables just after MTX+ozone. MTX+ozone increased the MTX clinical response in patients with rheumatoid arthritis. No side effects were observed. These results suggest that ozone can increase the efficacy of MTX probably because both share common therapeutic targets. Medical ozone treatment is capable of being a complementary therapy in the treatment of rheumatoid arthritis.

  7. Sialadenitis after radioiodine therapy. Analysis of factors that influence the response to medical treatment.

    PubMed

    Geres, Alejandra E; Mereshian, Paula Szafryk; Fernández, Silvia; Rey Caro, Daniel Gonzalo; Castro, Ricardo; Podio, Ricardo; Ojeda, Silvia

    2015-12-01

    To assess the incidence of 131I-induced sialadenitis (SD) in patients with differentiated thyroid cancer (DTC), to analyze clinical and other factors related to metabolic radiotherapy that may predict the lack of response to conventional medical therapy (CMT), and to determine the effectiveness of intraductal steroid instillation in patients failing CMT. Fifty-two patients with DTC, 45 females (86.5%) and 7 males (13.5%) with a mean age of 44.21±13.3 years (r=17-74) who received ablation therapy with 131I after total thyroidectomy. Patients with diseases and/or medication causing xerostomia were excluded. Patients underwent salivary gland scintigraphy with 99Tc (10mCi). Eighteen patients (34.62%) had SD and received antibiotics, antispasmodics, and oral steroids for 15 days. They were divided into two groups: responders to medical therapy (n=12, age 44.3±14.4 years, 2 men [17%], 10 women [83%], cumulative dose 225±167.1 mCi) and non-responders to medical treatment, who underwent steroid instillation into the Stensen's duct (n=6 [33%], 2 men [33%], 4 women [67%], age 50±13.8 years, cumulative dose 138.3±61.7 mCi). Scintigraphy showed damage to the parotid and submaxillary glands. Incidence of 131I-induced sialadenitis was similar to that reported by other authors. Age, mean cumulative dose of 131I, and involvement of parotid and submaxillary glands did not condition response to CMT; however, male sex was a conditioning factor. Symptom persistence for more than 15 days makes instillation into the Stensen's duct advisable. This is an effective and safe method to avoid surgical excision of salivary glands. Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  8. "Operation Helping Hands": Massachusetts health and medical response to Hurricane Katrina.

    PubMed

    Condon, Suzanne; Savoia, Elena; Cadigan, Rebecca Orfaly; Getchell, Marya; Burstein, Jonathan L; Auerbach, Bruce; Koh, Howard K

    2010-01-01

    As Hurricane Katrina bore down on New Orleans in August 2005, the city's mandatory evacuation prompted the exodus of an estimated 80% of its 485,000 residents. According to estimates from the US Centers for Disease Control and Prevention (CDC), at least 18 states subsequently hosted more than 200,000 evacuees. In this case study, "Operation Helping Hands" (OHH), the Massachusetts health and medical response in assisting Hurricane Katrina evacuees is described. Operation Helping Hands represents the largest medical response to evacuees in recent Massachusetts history. The data describing OHH were derived from a series of structured interviews conducted with two leading public health officials directing planning efforts, and a sample of first responders with oversight of operations at the evacuation site. Also, a literature review was conducted to identify similar experiences, common challenges, and lessons learned. Activities and services were provided in the following areas: (1) administration and management; (2) medical and mental health; (3) public health; and (4) social support. This study adds to the knowledge base for future evacuation and shelter planning, and presents a conceptual framework that could be used by other researchers and practitioners to describe the process and outcomes of similar operations. This study provides a description of the planning and implementation efforts of the largest medical evacuee experience in recent Massachusetts history, an effort that involved multiple agencies and partners. The conceptual framework can inform future evacuation and shelter initiatives at the state and national levels, and promotes the overarching public health goal of the highest attainable standard of health for all.

  9. Development of a decision support system for the practice of responsible self-medication.

    PubMed

    da Rocha, Chiara E; Lessa, Felipe A S; Venceslau, Daniel O; Sakuraba, Celso S; Barros, Izadora M C; de Lyra, Divaldo P

    2016-02-01

    Responsible self-medication is an integral part of the health system that consists of community pharmacists counseling patients on treating minor illness using non-prescription medications. Systems for properly managing information can assist disease identification and clinical decision-making. To develop a software program to assist community pharmacists in clinical decision-making regarding selfmedication. The study was conducted in northeastern Brazil. The study was conducted from February 2012 to January 2014. System development included identifying minor illnesses commonly treated by community pharmacists and creating simulations of community pharmacies using a simulated patient methodology. Clinical pharmacists, production engineering students, professors, and a pharmacist researcher comprised the development group. Five meetings were held to develop the software, and the system was completed in December 2013. Minor illnesses commonly treated by community pharmacists, and simulated patient methodology. In the first meeting the final list of topics for inclusion in the algorithm indicated the exact questions to be addressed by the community pharmacist to properly manage the complaint. In the second meeting, the discussions in the focus group indicated consensus among pharmacists as to the medications on the list of Groups and Specified Therapeutic Indications of Brazilian Legislation. In the third meeting were defined the parameters to refer patients to the doctor. In the fourth meeting the algorithm was tested using a simulated patient, to observe whether the question order ensures an effective, efficient, and safe decision process for the patient. In the fifth meeting, the algorithm was tested again using a simulated patient with the flu, and all group members agreed upon its final incarnation after refinements to the situations that determined referral to the doctor. The software may contribute to identifying health risk situations (potentially unsafe

  10. Medical planning and response for a nuclear detonation: a practical guide.

    PubMed

    Coleman, C Norman; Adams, Steven; Adrianopoli, Carl; Ansari, Armin; Bader, Judith L; Buddemeier, Brooke; Caro, J Jaime; Casagrande, Rocco; Case, Cullen; Caspary, Kevin; Chang, Arthur S; Chang, H Florence; Chao, Nelson; Cliffer, Kenneth D; Confer, Dennis; Deitchman, Scott; Derenzo, Evan G; Dobbs, Allen; Dodgen, Daniel; Donnelly, Elizabeth H; Gorman, Susan; Grace, Marcy Beth; Hatchett, Richard; Hick, John L; Hrdina, Chad; Jones, Robert; Kane, Elleen; Knebel, Ann; Koerner, John F; Laffan, Alison M; Larson, Leon; Livinski, Alicia; Mackinney, John; Maidment, Bert W; Manning, Ronald; Marinissen, Maria J; Martin, Colleen; Michael, Gretchen; Murrain-Hill, Paula; Nemhauser, Jeffrey B; Norwood, Ann E; Nystrom, Scott; Raheem, Murad; Redlener, Irwin; Sheehan, Kevin; Simon, Steven L; Taylor, Tammy P; Toner, Eric; Wallace, Katherine S; Wieder, Jessica; Weinstock, David M; Wiley, Albert L; Yeskey, Kevin; Miller, Charles W; Whitcomb, Robert C

    2012-12-01

    This article summarizes major points from a newly released guide published online by the Office of the Assistant Secretary for Preparedness and Response (ASPR). The article reviews basic principles about radiation and its measurement, short-term and long-term effects of radiation, and medical countermeasures as well as essential information about how to prepare for and respond to a nuclear detonation. A link is provided to the manual itself, which in turn is heavily referenced for readers who wish to have more detail.

  11. Religiosity and treatment response to antidepressant medication: A prospective multi-site clinical trial

    PubMed Central

    Schettino, Jonathan R.; Olmos, Natasha T.; Myers, Hector F.; Joseph, Nataria T.; Poland, Russell E.; Lesser, Ira M.

    2012-01-01

    The present study examined the relationship between religiosity/spirituality and treatment response to antidepressant medication (citalopram). One-hundred and forty-eight Caucasian and African-American adults with uncomplicated major depression were treated with citalopram (20–60mg/day) over an 8-week period in a prospective multi-site clinical trial. Treatment response was assessed weekly with the Hamilton Rating Scale for Depression. Religiosity (i.e., religious behaviours) and spirituality (i.e., spiritual well-being) were assessed at Week 3. No significant associations between spirituality and treatment response were found; however, there was a strong curvilinear relationship between religiosity and treatment response. Compared to lower or higher levels of religiosity, a moderate level of religiosity was significantly associated with a higher likelihood of remission and greater reduction in severity of depression. This association was independent of social support, ethnicity, gender, education, and baseline depression severity. A moderate amount of religiosity appears to be independently associated with an enhanced treatment response to citalopram. PMID:22736954

  12. Use of a geographic information system (GIS) in the medical response to the Fukushima nuclear disaster in Japan.

    PubMed

    Nagata, Takashi; Kimura, Yoshinari; Ishii, Masami

    2012-04-01

    The Great East Japan Earthquake occurred on March 11, 2011. In the first 10 days after the event, information about radiation risks from the Fukushima Daiichi nuclear plant was unavailable, and the disaster response, including deployment of disaster teams, was delayed. Beginning on March 17, 2011, the Japan Medical Association used a geographic information system (GIS) to visualize the risk of radiation exposure in Fukushima. This information facilitated the decision to deploy disaster medical response teams on March 18, 2011.

  13. Rapid assessment of health needs and medical response after the tsunami in Thailand, 2004-2005.

    PubMed

    Güereña-Burgueño, Fernando; Jongsakul, Krisada; Smith, Bryan L; Ittiverakul, Mali; Chiravaratanond, Orapan

    2006-10-01

    On December 26, 2004, an earthquake triggered a massive tsunami in the Indian Ocean, causing an estimated 183,172 deaths and 40,320 missing in 12 countries. In Thailand, six provinces (Krabi, Phang-Nga, Phuket, Ranong, Satun, and Trang) were affected. U.S. government agencies delivered emergency medical assistance from December 30, 2004, to January 6, 2005. A team from the Armed Forces Research Institute of Medical Sciences conducted a rapid health and needs assessment in southern Thailand. Twelve hospitals were referral centers for tsunami-related medical care. None of the hospitals had been damaged during the tsunami; all activated mass casualty plans. As of October 2005, 5,395 deaths were confirmed and 2,817 individuals were missing. The response of the Thai government to the tsunami was rapid and effective in mitigating the health consequences among survivors and helped prioritize public health interventions and the diversion of U.S. assistance to areas with greater need for international emergency humanitarian assistance.

  14. Disaster epidemiology and medical response in the Chi-Chi earthquake in Taiwan.

    PubMed

    Liang, N J; Shih, Y T; Shih, F Y; Wu, H M; Wang, H J; Shi, S F; Liu, M Y; Wang, B B

    2001-11-01

    We examine the mortality and morbidity associated with earthquakes in the Chi-Chi earthquake in Taiwan in 1999. Crude casualty data were collected from the reports of the government, local health bureaus, and 97 hospitals. The demographic data from the annual report of the Department of Interior were also employed for data analysis. Cross tables showing incidence of deaths and injuries by age, sex, time, and geographic distribution were generated to compare the mortality among different subgroups. Multiple regression models were established to explore the risk factors related to the mortality caused by earthquakes. The following results were found: the mortality rate increased with proximity to the epicenter, mortality was higher among the elderly than among young people, 30% of the victims died from head injuries caused by the collapse of dwellings, and the peak of medical demand was 12 hours after the earthquake and significantly increased demand for care lasted as long as 3 days. Furthermore, the regression model indicated that 78.5% of the variation of locality-age-sex-specific mortality was explained by the intensity of the earthquake, age, population density, distance to epicenter, medical beds per 10,000 people, and physicians per 10,000 people. The results implied that fragile minorities, specifically the elderly and children, require special consideration and attention in regard to disaster rescue and emergency medical care allocation. Epidemiologic analysis can guide disaster response and preparation.

  15. Courses in Physics in Medical Colleges

    ERIC Educational Resources Information Center

    Physics Education, 1975

    1975-01-01

    Provides information concerning programs in medical physics, radiation biology, and radiation physics at eight British medical colleges. Each institution is separately listed, and the provided information typically includes program descriptions, graduate programs, and main branches of research. (MLH)

  16. A brief history of British military experiences with infectious and tropical diseases.

    PubMed

    Bailey, Mark S

    2013-09-01

    Infectious and tropical diseases have been a problem for British expeditionary forces ever since the Crusades. Outbreaks were especially common on Navy ships from the 16th to 18th centuries due to poor living conditions and travel to the tropics. However, since these occurred in small, isolated and controlled environments it meant that naval medical practitioners were able to keep detailed records and develop empirical approaches for their prevention. The first Royal Naval Hospitals were established in response to these diseases and Royal Navy doctors made valuable early contributions towards understanding them. Even larger outbreaks of infectious and tropical diseases occurred in the Army during the Napoleonic, Crimean and Boer Wars and throughout the colonial era, which strongly influenced the formation of the Army Medical Services including provision for teaching and research. The establishment of germ theory led to a golden era of discovery regarding these diseases and British Army doctors made numerous important contributions. Subsequent improvements in prevention, diagnosis and treatment reduced the mortality from infectious and tropical diseases during the World Wars, but they remained a significant problem in the non-European campaigns and also the numerous 'small wars' that followed. Even in the 21st century some of these diseases still cause outbreaks with significant morbidity and impact on deployments, but the military clinical and academic resources to deal with them are now much reduced. Preventive measures such as hygiene, sanitation, infection control, vaccination and chemoprophylaxis are invaluable, but history shows that these can become neglected over time and disrupted or overwhelmed during the early or most intense stages of military operations. This is why military specialists in infectious diseases, tropical medicine, sexual health, medical microbiology and communicable diseases control are still required.

  17. Differential Response of Speed, Amplitude, and Rhythm to Dopaminergic Medications in Parkinson’s Disease

    PubMed Central

    Espay, Alberto J.; Giuffrida, Joe P.; Chen, Robert; Payne, Megan; Mazzella, Filomena; Dunn, Emily; Vaughan, Jennifer E.; Duker, Andrew P.; Sahay, Alok; Kim, Sang Jin; Revilla, Fredy J.; Heldman, Dustin A.

    2012-01-01

    Although movement impairment in Parkinson’s disease includes slowness (bradykinesia), decreased amplitude (hypokinesia), and dysrhythmia, clinicians are instructed to rate them in a combined 0–4 severity scale using the Unified Parkinson’s Disease Rating Scale motor subscale. The objective was to evaluate whether bradykinesia, hypokinesia, and dysrhythmia are associated with differential motor impairment and response to dopaminergic medications in patients with Parkinson’s disease. Eighty five Parkinson’s disease patients performed finger-tapping (item 23), hand-grasping (item 24), and pronation–supination (item 25) tasks OFF and ON medication while wearing motion sensors on the most affected hand. Speed, amplitude, and rhythm were rated using the Modified Bradykinesia Rating Scale. Quantitative variables representing speed (root mean square angular velocity), amplitude (excursion angle), and rhythm (coefficient of variation) were extracted from kinematic data. Fatigue was measured as decrements in speed and amplitude during the last 5 seconds compared with the first 5 seconds of movement. Amplitude impairments were worse and more prevalent than speed or rhythm impairments across all tasks (P < .001); however, in the ON state, speed scores improved exclusively by clinical (P < 10−6) and predominantly by quantitative (P < .05) measures. Motor scores from OFF to ON improved in subjects who were strictly bradykinetic (P < .01) and both bradykinetic and hypokinetic (P < 10−6), but not in those strictly hypokinetic. Fatigue in speed and amplitude was not improved by medication. Hypokinesia is more prevalent than bradykinesia, but dopaminergic medications predominantly improve the latter. Parkinson’s disease patients may show different degrees of impairment in these movement components, which deserve separate measurement in research studies. PMID:21953789

  18. EEG connectivity between the subgenual anterior cingulate and prefrontal cortices in response to antidepressant medication.

    PubMed

    Iseger, Tabitha A; Korgaonkar, Mayuresh S; Kenemans, J Leon; Grieve, Stuart M; Baeken, Chris; Fitzgerald, Paul B; Arns, Martijn

    2017-02-22

    Antidepressant medication is the most common treatment for major depressive disorder (MDD), however, the precise working mechanism underlying these treatments remains unclear. Recent neuromodulation treatments demonstrate that direct stimulation of the dorsolateral prefrontal cortex (DLPFC), dorsomedial prefrontal cortex (DMPFC), and subgenual anterior cingulate (sgACC) relate to clinical improvement, suggesting connectivity alterations of the DLPFC-DMPFC-sgACC network to mediate antidepressant response. The international Study to Predict Optimized Treatment in Depression (iSPOT-D) is an international multicentre study that collected EEG data for 1008 MDD patients, randomized to 3 different antidepressant medications (N=447 MDD with complete pre- and post-treatment data and N=336 non-MDD). Treatment response was defined by a decline of >50% on the Hamilton Rating Score for Depression (HRSD17). We investigated whether connectivity in alpha and theta frequencies of the DLPFC-DMPFC-sgACC network changed from pre- to post-treatment between: (i) patients and controls, and (ii) responders (R) and non-responders (NR). Women exhibited higher alpha and theta connectivity compared to males, both pre- and post-treatment. Furthermore, theta, but not alpha, hypo-connectivity was found for MDD patients. A decreased alpha connectivity after treatment was found only for male responders, while non-responders and females exhibited no changes in alpha connectivity. Decreasing alpha connectivity could potentially serve as a treatment emergent biomarker, in males only. Furthermore, it could be useful to a priori stratify by gender for future MDD studies.

  19. Speciality preferences in Dutch medical students influenced by their anticipation on family responsibilities.

    PubMed

    Alers, Margret; Pepping, Tess; Bor, Hans; Verdonk, Petra; Hamberg, Katarina; Lagro-Janssen, Antoine

    2014-12-01

    Physician gender is associated with differences in the male-to-female ratio between specialities and with preferred working hours. We explored how graduating students' sex or full-time or part-time preference influences their speciality choice, taking work-life issues into account. Graduating medical students at Radboud University Medical Centre, the Netherlands participated in a survey (2008-2012) on career considerations. Logistic regression tested the influence of sex or working hour preference on speciality choice and whether work-life issues mediate. Of the responding students (N = 1,050, response rate 83, 73.3 % women), men preferred full-time work, whereas women equally opted for part time. More men chose surgery, more women family medicine. A full-time preference was associated with a preference for surgery, internal medicine and neurology, a part-time preference with psychiatry and family medicine. Both male and female students anticipated that foremost the career of women will be negatively influenced by family life. A full-time preference was associated with an expectation of equality in career opportunities or with a less ambitious partner whose career would affect family life. This increased the likelihood of a choice for surgery and reduced the preference for family medicine among female students. Gender specifically plays an important role in female graduates' speciality choice making, through considerations on career prospects and family responsibilities.

  20. Medical response to a radiologic/nuclear event: integrated plan from the Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services.

    PubMed

    Coleman, C Norman; Hrdina, Chad; Bader, Judith L; Norwood, Ann; Hayhurst, Robert; Forsha, Joseph; Yeskey, Kevin; Knebel, Ann

    2009-02-01

    The end of the Cold War led to a reduced concern for a major nuclear event. However, the current threats from terrorism make a radiologic (dispersal or use of radioactive material) or nuclear (improvised nuclear device) event a possibility. The specter and enormousness of the catastrophe resulting from a state-sponsored nuclear attack and a sense of nihilism about the effectiveness of a response were such that there had been limited civilian medical response planning. Although the consequences of a radiologic dispersal device are substantial, and the detonation of a modest-sized (10 kiloton) improvised nuclear device is catastrophic, it is both possible and imperative that a medical response be planned. To meet this need, the Office of the Assistant Secretary for Preparedness and Response in the Department of Health and Human Services, in collaboration within government and with nongovernment partners, has developed a scientifically based comprehensive planning framework and Web-based "just-in-time" medical response information called Radiation Event Medical Management (available at http://www.remm.nlm.gov). The response plan includes (1) underpinnings from basic radiation biology, (2) tailored medical responses, (3) delivery of medical countermeasures for postevent mitigation and treatment, (4) referral to expert centers for acute treatment, and (5) long-term follow-up. Although continuing to evolve and increase in scope and capacity, current response planning is sufficiently mature that planners and responders should be aware of the basic premises, tools, and resources available. An effective response will require coordination, communication, and cooperation at an unprecedented level. The logic behind and components of this response are presented to allow for active collaboration among emergency planners and responders and federal, state, local, and tribal governments.

  1. Checklist of British and Irish Hymenoptera - Platygastroidea

    PubMed Central

    Buhl, Peter N.; Notton, David G.

    2016-01-01

    Abstract Background A revised checklist of the British and Irish Platygastroidea (Platygastridae) substantially updates the previous comprehensive checklist, dating from 1978. Distribution data (i.e. occurrence in England, Scotland, Wales, Ireland and the Isle of Man) is reported where known. New information A total of 381 British and Irish Platygastroidea represents a 47% increase on the number of British and Irish species reported in 1978. PMID:27279762

  2. Incorporating Concomitant Medications into Genome-Wide Analyses for the Study of Complex Disease and Drug Response.

    PubMed

    Graham, Hillary T; Rotroff, Daniel M; Marvel, Skylar W; Buse, John B; Havener, Tammy M; Wilson, Alyson G; Wagner, Michael J; Motsinger-Reif, Alison A

    2016-01-01

    Given the high costs of conducting a drug-response trial, researchers are now aiming to use retrospective analyses to conduct genome-wide association studies (GWAS) to identify underlying genetic contributions to drug-response variation. To prevent confounding results from a GWAS to investigate drug response, it is necessary to account for concomitant medications, defined as any medication taken concurrently with the primary medication being investigated. We use data from the Action to Control Cardiovascular Disease (ACCORD) trial in order to implement a novel scoring procedure for incorporating concomitant medication information into a linear regression model in preparation for GWAS. In order to accomplish this, two primary medications were selected: thiazolidinediones and metformin because of the wide-spread use of these medications and large sample sizes available within the ACCORD trial. A third medication, fenofibrate, along with a known confounding medication, statin, were chosen as a proof-of-principle for the scoring procedure. Previous studies have identified SNP rs7412 as being associated with statin response. Here we hypothesize that including the score for statin as a covariate in the GWAS model will correct for confounding of statin and yield a change in association at rs7412. The response of the confounded signal was successfully diminished from p = 3.19 × 10(-7) to p = 1.76 × 10(-5), by accounting for statin using the scoring procedure presented here. This approach provides the ability for researchers to account for concomitant medications in complex trial designs where monotherapy treatment regimens are not available.

  3. Incorporating Concomitant Medications into Genome-Wide Analyses for the Study of Complex Disease and Drug Response

    PubMed Central

    Graham, Hillary T.; Rotroff, Daniel M.; Marvel, Skylar W.; Buse, John B.; Havener, Tammy M.; Wilson, Alyson G.; Wagner, Michael J.; Motsinger-Reif, Alison A.; Friedewald, W.T.

    2016-01-01

    Given the high costs of conducting a drug-response trial, researchers are now aiming to use retrospective analyses to conduct genome-wide association studies (GWAS) to identify underlying genetic contributions to drug-response variation. To prevent confounding results from a GWAS to investigate drug response, it is necessary to account for concomitant medications, defined as any medication taken concurrently with the primary medication being investigated. We use data from the Action to Control Cardiovascular Disease (ACCORD) trial in order to implement a novel scoring procedure for incorporating concomitant medication information into a linear regression model in preparation for GWAS. In order to accomplish this, two primary medications were selected: thiazolidinediones and metformin because of the wide-spread use of these medications and large sample sizes available within the ACCORD trial. A third medication, fenofibrate, along with a known confounding medication, statin, were chosen as a proof-of-principle for the scoring procedure. Previous studies have identified SNP rs7412 as being associated with statin response. Here we hypothesize that including the score for statin as a covariate in the GWAS model will correct for confounding of statin and yield a change in association at rs7412. The response of the confounded signal was successfully diminished from p = 3.19 × 10−7 to p = 1.76 × 10−5, by accounting for statin using the scoring procedure presented here. This approach provides the ability for researchers to account for concomitant medications in complex trial designs where monotherapy treatment regimens are not available. PMID:27775101

  4. Factors affecting response to medical management in patients of filarial chyluria: A prospective study.

    PubMed

    Goyal, Neeraj Kumar; Goel, Apul; Sankhwar, Satyanarayan; Singh, Vishwajeet; Ali, Wahid; Natu, S M; Singh, Bhupendra Pal; Sinha, Rahul Janak; Dalela, Divakar

    2014-01-01

    Filarial chyluria is a common problem in filarial endemic countries. Its management begins with medical therapy but some patients progress to require surgery. The present study aimed to determine factors affecting response to medical management in patients of filarial chyluria. This prospective study conducted between August 2008 and November 2012, included conservatively managed patients of chyluria. Demographic profile, clinical presentation, treatment history and urinary triglycerides (TGs) and cholesterol levels at baseline were compared between the responders and non-responders. Apart from the clinical grade of chyluria, hematuria was evaluated as an independent risk factor. Out of the 222 patients (mean age, 37.99 ± 13.29 years, 129 males), 31 patients failed to respond while 35 had a recurrence after initial response; the overall success rate being 70.3% at a mean follow-up of 25 months. No difference was observed in demographics, clinical presentation, presence of hematuria, disease duration and mean urinary TGs loss between responders and non-responders. On multivariate analysis, patients with treatment failure were found to have a higher-grade disease (14.3% Grade-I, 36.6% Grades-II and 60% Grade-III), higher number of pretreatment courses (1.59 ± 1.08 vs. 1.02 ± 0.79) and heavier cholesterol (26.54 ± 23.46 vs. 8.81 ± 8.55 mg/dl) loss at baseline compared with responders (P < 0.05). Conservative management has a success rate in excess of 70%, not affected by the disease chronicity, previous episodes and recurrent nature. However, higher-grade disease, extensive pre-treatment with drugs and higher urinary cholesterol loss at baseline are the predictors of poor response. Hematuria is not an independent poor risk factor for conservative management.

  5. Immunization delivery in British Columbia

    PubMed Central

    Omura, John; Buxton, Jane; Kaczorowski, Janusz; Catterson, Jason; Li, Jane; Derban, Andrea; Hasselback, Paul; Machin, Shelagh; Linekin, Michelle; Morgana, Tamsin; O’Briain, Barra; Scheifele, David; Dawar, Meena

    2014-01-01

    Abstract Objective To explore the experiences of family physicians and pediatricians delivering immunizations, including perceived barriers and supports. Design Qualitative study using focus groups. Setting Ten cities throughout British Columbia. Participants A total of 46 family physicians or general practitioners, 10 pediatricians, and 2 residents. Methods A semistructured dialogue guide was used by a trained facilitator to explore participants’ experiences and views related to immunization delivery in British Columbia. Verbatim transcriptions were independently coded by 2 researchers. Key themes were analyzed and identified in an iterative manner using interpretive description. Main findings Physicians highly valued vaccine delivery. Factors facilitating physician-delivered immunizations included strong beliefs in the value of vaccines and having adequate information. Identified barriers included the large time commitment and insufficient communication about program changes, new vaccines, and the adult immunization program in general. Some physicians reported good relationships with local public health, while others reported the opposite experience, and this varied by geographic location. Conclusion These findings suggest that physicians are supportive of delivering vaccines. However, there are opportunities to improve the sustainability of physician-delivered immunizations. While compensation schemes remain under the purview of the provincial governments, local public health authorities can address the information needs of physicians. PMID:24627403

  6. An exploratory study on the elements that might affect medical students' and residents' responsibility during clinical training.

    PubMed

    Asemani, Omid; Iman, Mohammad Taghi; Moattari, Marzieh; Tabei, Seyed Ziaadin; Sharif, Farkhondeh; Khayyer, Mohammad

    2014-01-01

    We are now more or less confronting a "challenge of responsibility" among both undergraduate and postgraduate medical students and some recent alumni from medical schools in Iran. This ethical problem calls for urgent etiologic and pathologic investigations into the problem itself and the issues involved. This study aimed to develop a thematic conceptual framework to study factors that might affect medical trainees' (MTs) observance of responsibility during clinical training. A qualitative descriptive methodology involving fifteen in-depth semi-structured interviews was used to collect the data. Interviews were conducted with both undergraduate and postgraduate MTs as well as clinical experts and experienced nurses. Interviews were audio-recorded and then transcribed. The data was analyzed using thematic content analysis. The framework derived from the data included two main themes, namely "contextual conditions" and "intervening conditions". Within each theme, participants recurrently described "individual" and "non-individual or system" based factors that played a role in medical trainees' observance of responsibility. Overall, contextual conditions provide MTs with a "primary or basic responsibility" which is then transformed into a "secondary or observed responsibility" under the influence of intervening conditions. In conclusion three measures were demonstrated to be very important in enhancing Iranian MTs' observance of responsibility: a) to make and implement stricter and more exact admission policies for medical colleges, b) to improve and revise the education system in its different dimensions such as management, structure, etc. based on regular and systematic evaluations, and c) to establish, apply and sustain higher standards throughout the educational environment.

  7. Development and responsiveness of a scale to measure clinicians' attitudes to people with mental illness (medical student version).

    PubMed

    Kassam, A; Glozier, N; Leese, M; Henderson, C; Thornicroft, G

    2010-08-01

    We report the rationale, reliability, validity and responsiveness studies of the Mental Illness: Clinicians' Attitudes (MICA) Scale, a 16-item scale designed to measure attitudes of health care professionals towards people with mental illness. Items were generated through focus groups with service users, carers, medical students and trainee psychiatrists. Psychometric testing was completed in a number of student samples. The responsiveness of the scale was tested after a 1.5 h mental illness stigma related intervention with medical students. The MICA scale showed good internal consistency, alpha = 0.79. The test-retest reliability (concordance) was 0.80 (95% CI: 0.68-0.91). The standardised response mean for the scale was 0.4 (95% CI 0.02-0.8) after a mental illness related stigma intervention. The MICA scale is a responsive, reliable and valid tool, which can be used in medical education and mental health promotion settings and studies.

  8. Whose responsibility is medication reconciliation: Physicians, pharmacists or nurses? A survey in an academic tertiary care hospital.

    PubMed

    Al-Hashar, Amna; Al-Zakwani, Ibrahim; Eriksson, Tommy; Al Za'abi, Mohammed

    2017-01-01

    Background: Medication errors occur frequently at transitions in care and can result in morbidity and mortality. Medication reconciliation is a recognized hospital accreditation requirement and designed to limit errors in transitions in care. Objectives: To identify beliefs, perceived roles and responsibilities of physicians, pharmacists and nurses prior to the implementation of a standardized medication reconciliation process. Methods: A survey was distributed to the three professions: pharmacists in the pharmacy and physicians and nurses in hospital in-patient units. It contained questions about the current level of medication reconciliation practices, as well as perceived roles and responsibilities of each profession when a standardized process is implemented. Value, barriers to implementing medication reconciliation and the role of information technology were also assessed. Analyses were performed using univariate statistics. Results: There was a lack of clarity of current medication reconciliation practices as well as lack of agreement between the three professions. Physicians and pharmacists considered their professions as the main providers while nurses considered physicians followed by themselves as the main providers with limited roles for pharmacists. The three professions recognize the values and benefits of medication reconciliation yet pharmacists, more than others, stated limited time to implement reconciliation is a major barrier. Obstacles such as unreliable sources of medication history, patient knowledge and lack of coordination and communication between the three professions were expressed. Conclusions: The three health care professions recognize the value of medication reconciliation and want to see it implemented in the hospital, yet there is a lack of agreement with regard to roles and responsibilities of each profession within the process. This needs to be addressed by the hospital administration to design clear procedures and defined roles

  9. Medical Assistants

    MedlinePlus

    ... and sterilize medical instruments. They may have additional responsibilities, such as instructing patients about medication or special ... They Do tab describes the typical duties and responsibilities of workers in the occupation, including what tools ...

  10. Smoking Response to Health and Medical Spending Changes and the Role of Insurance.

    PubMed

    Marti, Joachim; Richards, Michael R

    2017-03-01

    Severe health shocks provide new information about one's personal health and have been shown to influence smoking behaviors. In this paper, we suggest that they may also convey information about the hard to predict financial consequences of illnesses. Relevant financial risk information is idiosyncratic and unavailable to the consumer preceding illness, and the information search costs are high. However, new and salient information about the health as well as financial consequences of smoking after a health shock may impact smoking responses. Using variation in the timing of health shocks and two features of the US health care system (uninsured spells and aging into the Medicare program at 65), we test for heterogeneity in the post-shock smoking decision according to plausibly exogenous changes in financial risk exposure to medical spending. We also explore the relationship between smoking and the evolution of out-of-pocket costs. Individuals experiencing a cardiovascular health shock during an uninsured spell have more than twice the cessation effect of those receiving the illness while insured. For those uninsured prior to age 65 years, experiencing a cardiovascular shock post Medicare eligibility completely offsets the cessation effect. We also find that older adults' medical spending changes separate from health shocks influence their smoking behavior. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  11. The probability of death in road traffic accidents. How important is a quick medical response?

    PubMed

    Sánchez-Mangas, Rocío; García-Ferrrer, Antonio; de Juan, Aranzazu; Arroyo, Antonio Martín

    2010-07-01

    The number of deaths in road traffic accidents in Spain exceeds three thousand people each year. Public authorities have implemented some policies with the aim to reducing this number. Among them, the improvement of road quality standards and some legal changes encouraging careful driving behavior. However, less attention has been focused on one of the issues that may be critical to reducing the number of fatalities caused by traffic accidents: a quick emergency medical care. In this paper, we use a sample of more than 1400 accidents occurred on Spanish roads in May 2004. Our objective is to analyze to which extent a reduction of the time interval between the crash and the arrival of the emergency services to the crash scene is related to a lower probability of death. Our results suggest that a 10 min reduction of the medical response time can be statistically associated with an average decrease of the probability of death by one third, both on motorways and conventional roads. Copyright 2009 Elsevier Ltd. All rights reserved.

  12. Physicians' responses to financial and social incentives: A medically framed real effort experiment.

    PubMed

    Lagarde, Mylène; Blaauw, Duane

    2017-04-01

    Because compensation policies have critical implications for the provision of health care, and evidence of their effects is limited and difficult to study in the real world, laboratory experiments may be a valuable methodology to study the behavioural responses of health care providers. With this experiment undertaken in 2013, we add to this new literature by designing a new medically framed real effort task to test the effects of different remuneration schemes in a multi-tasking context. We assess the impact of different incentives on the quantity (productivity) and quality of outputs of 132 participants. We also test whether the existence of benefits to patients influences effort. The results show that salary yields the lowest quantity of output, and fee-for-service the highest. By contrast, we find that the highest quality is achieved when participants are paid by salary, followed by capitation. We also find a lot of heterogeneity in behaviour, with intrinsically motivated individuals hardly sensitive to financial incentives. Finally, we find that when work quality benefits patients directly, subjects improve the quality of their output, while maintaining the same levels of productivity. This paper adds to a nascent literature by providing a new approach to studying remuneration schemes and modelling the medical decision making environment in the lab.

  13. [Euthanasia and/or medically assisted suicide: Reflection on the new responsibility of the hospital pharmacist].

    PubMed

    Boissinot, L; Benamou, M; Léglise, P; Mancret, R-C; Huchon-Bécel, D

    2014-03-01

    Concern about euthanasia and medically assisted suicide is currently growing around the world and particularly in France. Though not authorized at present in France, the role of hospital pharmacist in this issue needs to be discussed. This article aims to gather medical and legal literature of European Union member states on these issues and particularly in France. To propose a practical thinking on the possible role of hospital pharmacist. Among European Union, euthanasia and/or assisted suicide have already been introduced in some member states' laws. In France, Leonetti law currently sets the legal framework for the management of end of life. To address the society's demand on these issues, French President F. Hollande made two ethics committees responsible for working on it. Both were mainly against euthanasia and assisted suicide. Though a bit forgotten in this debate, hospital pharmacist needs to be associated in the thinking, as the main "drug-keeper". Indeed, guidelines are necessary to outline and ensure a safe drug use, complying with professional ethics, if lethal doses are voluntarily prescribed. Pharmaceutical work is in constant evolution and is addressing new issues still unanswered, including assisted suicide and euthanasia. French pharmaceutical authorities should seize upon them, in order to guarantee pharmaceutical ethics. These practices, if authorized by law, should remain exceptional, and law strictly enforced. The pharmacist could be one of these "lawkeepers". Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  14. Therapeutic Interactive Voice Response (TIVR) to Reduce Analgesic Medication Use for Chronic Pain Management

    PubMed Central

    Naylor, Magdalena R.; Naud, Shelly; Keefe, Francis J.; Helzer, John E.

    2011-01-01

    This paper examines whether a telephone-based, automated maintenance enhancement program can help to reduce opioid and NSAID analgesics use in patients with chronic pain. Following 11 weeks of group CBT, fifty-one subjects with chronic musculoskeletal pain were randomized to one of two study groups. Twenty-six subjects participated in 4 months of a Therapeutic Interactive Voice Response (TIVR) program in addition to standard follow-up care, while a control group of twenty-five subjects received standard follow-up care only. TIVR is an automated, telephone-based tool developed for the maintenance and enhancement of CBT skills. Opioid analgesic use decreased in the experimental group in both follow-ups: 4- and 8-months post-CBT. In addition, at 8-month follow up, 21% of the TIVR subjects had discontinued the use of opioid analgesics, 23% had discontinued NSAIDS, and 10% had discontinued antidepressant medications. In contrast, the control group showed increases in opioid and NSAIDS use. Analysis of covariance (ANCOVA) revealed significant between-group differences in opioid analgesic use at 8-month follow up (p=0.004). We have previously demonstrated the efficacy of Therapeutic IVR to decrease pain and improve coping; this analysis demonstrates that the use of TIVR may also result in concurrent reductions in opioid analgesic and NSAID medications use. PMID:20620119

  15. A 'mixed reality' simulator concept for future Medical Emergency Response Team training.

    PubMed

    Stone, Robert J; Guest, R; Mahoney, P; Lamb, D; Gibson, C

    2017-08-01

    The UK Defence Medical Service's Pre-Hospital Emergency Care (PHEC) capability includes rapid-deployment Medical Emergency Response Teams (MERTs) comprising tri-service trauma consultants, paramedics and specialised nurses, all of whom are qualified to administer emergency care under extreme conditions to improve the survival prospects of combat casualties. The pre-deployment training of MERT personnel is designed to foster individual knowledge, skills and abilities in PHEC and in small team performance and cohesion in 'mission-specific' contexts. Until now, the provision of airborne pre-deployment MERT training had been dependent on either the availability of an operational aircraft (eg, the CH-47 Chinook helicopter) or access to one of only two ground-based facsimiles of the Chinook's rear cargo/passenger cabin. Although MERT training has high priority, there will always be competition with other military taskings for access to helicopter assets (and for other platforms in other branches of the Armed Forces). This paper describes the development of an inexpensive, reconfigurable and transportable MERT training concept based on 'mixed reality' technologies-in effect the 'blending' of real-world objects of training relevance with virtual reality reconstructions of operational contexts. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  16. A web-services architecture designed for intermittent connectivity to support medical response to disasters.

    PubMed

    Brown, Steve; Griswold, William; Lenert, Leslie A

    2005-01-01

    To support mobile computing systems for first responders at mass casualty sites, as part of the WIISARD (Wireless Internet Information System for Medical Response in Disasters) project, we have developed a data architecture to gracefully handle an environment with frequent network failure and, multiple writers that also supports rapid dissemination of updates that could be critical to the safety of responders. This is accomplished by allowing for a subset of the overall information available in a disaster scene to be cached locally on a responder's device and locally modified with or without network access. When the network is available, the local subset of the model is automatically synchronized with a server that contains the full model, and conflicts are resolved. When changes from a device are committed, the changes are instantly sent to any connected devices where the local subset would be modified by the changes.

  17. The discursive construction of competence and responsibility in medical collegial talk.

    PubMed

    Atkinson, Paul

    2004-01-01

    The paper explores the construction of clinical competence in the spoken discourse of physicians. The analysis is derived from transcribed recordings of physicians' talk in the specialty of Haematology in an American teaching hospital. It is argued that current discussions of 'competence' among medical sociologists and anthropologists are not adequately based in the direct observation and recording of physicians' professional, collegial interactions. It is argued that physicians' constructions of case narratives and presentations inscribes the evaluations of the responsibility and competence of other physicians, through the representation of their agency and character in the course of accounts of cases. The paper thus addresses the naturally occurring use of 'evidence' in a clinical setting, and is an invitation to more naturalistic studies of 'evidence-based medicine'.

  18. Caffeine enhances the physiological response to occupational stress in medical students.

    PubMed

    Pincomb, G A; Lovallo, W R; Passey, R B; Brackett, D J; Wilson, M F

    1987-01-01

    Caffeine (3.3 mg/kg) was tested against a placebo in 20 male medical students during periods of low (no exams) versus high (final exams) work stress. On each of 8 test days, heart rate and blood pressure were measured at baseline and over a 40-min postdrug interval; immediately afterward, blood was drawn to test plasma cortisol and serum lipid concentrations. Exams increased heart rate (p less than .005) and systolic blood pressure (p less than .02). Caffeine decreased heart rate (p less than .0001) and increased systolic blood pressure (p less than .005), diastolic blood pressure (p less than .0001), plasma cortisol levels (p less than .01), and serum cholesterol levels (p less than .02). Caffeine effects were additive with those of exams, and together they increased the number of men showing systolic blood pressures in the borderline hypertensive range. Thus, caffeine use during periods of increased occupational stress may enhance the cumulative stress response.

  19. Withholding and withdrawing life-sustaining treatment: criminal responsibility for established medical practice?

    PubMed

    White, Ben; Willmott, Lindy; Allen, John

    2010-05-01

    The law recognises the right of a competent adult to refuse medical treatment even if this will lead to death. Guardianship and other legislation also facilitates the making of decisions to withhold or withdraw life-sustaining treatment in certain circumstances. Despite this apparent endorsement that such decisions can be lawful, doubts have been raised in Queensland about whether decisions to withhold or withdraw life-sustaining treatment would contravene the criminal law, and particularly the duty imposed by the Criminal Code (Qld) to provide the "necessaries of life". This article considers this tension in the law and examines various arguments that might allow for such decisions to be made lawfully. It ultimately concludes, however, that criminal responsibility may still arise and so reform is needed.

  20. Progress Toward Improving the Quality of Cardiac Arrest Medical Team Responses at an Academic Teaching Hospital

    PubMed Central

    Didwania, Aashish; McGaghie, William C.; Cohen, Elaine R.; Butter, John; Barsuk, Jeffrey H.; Wade, Leonard D.; Chester, Rozanna; Wayne, Diane B.

    2011-01-01

    Background Internal medicine (IM) residents who undergo simulation-based advanced cardiac life support (ACLS) training are significantly more likely to manage actual events according to American Heart Association (AHA) standards than nontrained residents. How long ACLS skills are retained is unknown. Methods We conducted a retrospective case-control study of ACLS responses from January to June 2008 and reviewed medical records to assess adherence to AHA standards. Cases and controls are team responses to ACLS events divided into those directed by postgraduate year 2 (PGY-2) IM resident leaders versus those managed by PGY-3 IM resident leaders. Residents in 2008 completed an educational program featuring deliberate practice in ACLS using a human patient simulator during their second year. Medical records of ACLS events were reviewed to assess adherence to AHA guidelines. We evaluated the effects of simulation training on quality of ACLS care during the 2008 period and in comparison with historical 2004 data. Results In 2008, 1 year after simulation training, PGY-3 residents showed the same adherence to AHA standards (88% [SD, 17%]) as that of PGY-2 residents who were newly simulator trained (86% [SD, 18%]) (P  =  .77). Previously, in 2004, PGY-2 simulator-trained residents showed significantly higher adherence to AHA standards (68% [SD, 20%]) than nonsimulator-trained PGY-3 residents (44% [SD, 20%]) (P < .001). All resident groups in 2008 outperformed their 2004 peers. Conclusions Improved quality of ACLS care was maintained by 2008 PGY-3 simulator-trained residents 1 year after training, likely due to skill retention rather than increased clinical experience, as a prior cohort of PGY-3 residents did not perform as well as PGY-2 residents in actual ACLS care. Our results confirm prior work regarding the impact of simulation-based education to improve the quality of actual patient care. PMID:22655144

  1. Progress toward improving the quality of cardiac arrest medical team responses at an academic teaching hospital.

    PubMed

    Didwania, Aashish; McGaghie, William C; Cohen, Elaine R; Butter, John; Barsuk, Jeffrey H; Wade, Leonard D; Chester, Rozanna; Wayne, Diane B

    2011-06-01

    Internal medicine (IM) residents who undergo simulation-based advanced cardiac life support (ACLS) training are significantly more likely to manage actual events according to American Heart Association (AHA) standards than nontrained residents. How long ACLS skills are retained is unknown. We conducted a retrospective case-control study of ACLS responses from January to June 2008 and reviewed medical records to assess adherence to AHA standards. Cases and controls are team responses to ACLS events divided into those directed by postgraduate year 2 (PGY-2) IM resident leaders versus those managed by PGY-3 IM resident leaders. Residents in 2008 completed an educational program featuring deliberate practice in ACLS using a human patient simulator during their second year. Medical records of ACLS events were reviewed to assess adherence to AHA guidelines. We evaluated the effects of simulation training on quality of ACLS care during the 2008 period and in comparison with historical 2004 data. In 2008, 1 year after simulation training, PGY-3 residents showed the same adherence to AHA standards (88% [SD, 17%]) as that of PGY-2 residents who were newly simulator trained (86% [SD, 18%]) (P  =  .77). Previously, in 2004, PGY-2 simulator-trained residents showed significantly higher adherence to AHA standards (68% [SD, 20%]) than nonsimulator-trained PGY-3 residents (44% [SD, 20%]) (P < .001). All resident groups in 2008 outperformed their 2004 peers. Improved quality of ACLS care was maintained by 2008 PGY-3 simulator-trained residents 1 year after training, likely due to skill retention rather than increased clinical experience, as a prior cohort of PGY-3 residents did not perform as well as PGY-2 residents in actual ACLS care. Our results confirm prior work regarding the impact of simulation-based education to improve the quality of actual patient care.

  2. British Pakistani Muslim Masculinity, (In)fertility, and the Clinical Encounter.

    PubMed

    Blell, Mwenza

    2017-08-11

    The experiences of men facing fertility disruptions are understudied. For British Pakistanis, the impact of infertility is heightened for women because of normative pressures to bear children. But what of men? I present data from in-depth interviews in North East England with infertile British Pakistani Muslims and relevant health professionals. British Pakistani men's level of participation in clinical encounters and responses to diagnoses of male factor infertility must be understood in the context of kinship, the construction of Pakistani ethnicity in the UK, and the subordinated forms of masculinity which accompany this identity.

  3. Immune response and immunologic memory in medical personnel vaccinated with hepatitis B vaccine.

    PubMed

    Kevorkyan, Ani K; Teoharov, Pavel B; Petrova, Nedyalka S; Baltadzhiev, Ivan G; Stoilova, Yordanka D; Angelova, Nevena G; Plachkova, Angelina D

    2011-01-01

    The occupation-related nature of Hepatitis B viral infection in medical personnel has been well documented in a lot of studies. The only reliable way of prevention of this infection is immunisation with hepatitis B vaccine. To follow-up the primary immune response after immunisation with recombinant vaccine and its duration in adult immunocompetent subjects. One hundred sixty-five health-care workers working at St. George University Hospital, Plovdiv in 2009/2010 were included in the study and allocated to two groups. Group 1 (N1 = 70) was followed up for the primary immune response after immunization; group 2 (N2 = 95) was with documented immunization in 1998/1999 (n = 81) and in 1994/1995 (n = 14). Tests based on ELISA for quantitative determination of anti-HBs in mIU/ml were used. The measurement were performed at the National Reference Laboratory of Viral Hepatitis at the NCIPD, Sofia. Descriptive statistics, non-parametric and parametric tests, qualitative correlation were used to analyse data. Group 1 mean age was 40.3 +/- 2.6 years; anti-HBs concentration of > or = 10 mIU/ ml was found in 92.8%. No association between the immune response and the commonly involved factors such as gender, age, overweight, smoking, etc., was found. In group 2, anti-HBs concentration of > or = 10 mIU/ml was found in 77.9%: it was in 75.3% in those immunized 10 years before, and in 92.9% in those immunized 15 years before (t = 0.24, p > 0.05). A booster dose of the vaccine was received by 15/21 subjects from group 2 (those immunized 10 years before that) with anti-HBs < 10 mIU/ml. After the booster, 9/15 produced anti-HBs in protective concentrations (anamnestic immune response). The actual level of seroprotection among the immunized more than 10 years ago was 92%. This study and the documentation of the primary postvaccinal immunity in high-risk medical personnel will help specify if additional hepatitis B vaccine shots are needed.

  4. Brain-responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy.

    PubMed

    Geller, Eric B; Skarpaas, Tara L; Gross, Robert E; Goodman, Robert R; Barkley, Gregory L; Bazil, Carl W; Berg, Michael J; Bergey, Gregory K; Cash, Sydney S; Cole, Andrew J; Duckrow, Robert B; Edwards, Jonathan C; Eisenschenk, Stephan; Fessler, James; Fountain, Nathan B; Goldman, Alicia M; Gwinn, Ryder P; Heck, Christianne; Herekar, Aamar; Hirsch, Lawrence J; Jobst, Barbara C; King-Stephens, David; Labar, Douglas R; Leiphart, James W; Marsh, W Richard; Meador, Kimford J; Mizrahi, Eli M; Murro, Anthony M; Nair, Dileep R; Noe, Katherine H; Park, Yong D; Rutecki, Paul A; Salanova, Vicenta; Sheth, Raj D; Shields, Donald C; Skidmore, Christopher; Smith, Michael C; Spencer, David C; Srinivasan, Shraddha; Tatum, William; Van Ness, Paul C; Vossler, David G; Wharen, Robert E; Worrell, Gregory A; Yoshor, Daniel; Zimmerman, Richard S; Cicora, Kathy; Sun, Felice T; Morrell, Martha J

    2017-06-01

    Evaluate the seizure-reduction response and safety of mesial temporal lobe (MTL) brain-responsive stimulation in adults with medically intractable partial-onset seizures of mesial temporal lobe origin. Subjects with mesial temporal lobe epilepsy (MTLE) were identified from prospective clinical trials of a brain-responsive neurostimulator (RNS System, NeuroPace). The seizure reduction over years 2-6 postimplantation was calculated by assessing the seizure frequency compared to a preimplantation baseline. Safety was assessed based on reported adverse events. There were 111 subjects with MTLE; 72% of subjects had bilateral MTL onsets and 28% had unilateral onsets. Subjects had one to four leads placed; only two leads could be connected to the device. Seventy-six subjects had depth leads only, 29 had both depth and strip leads, and 6 had only strip leads. The mean follow-up was 6.1 ± (standard deviation) 2.2 years. The median percent seizure reduction was 70% (last observation carried forward). Twenty-nine percent of subjects experienced at least one seizure-free period of 6 months or longer, and 15% experienced at least one seizure-free period of 1 year or longer. There was no difference in seizure reduction in subjects with and without mesial temporal sclerosis (MTS), bilateral MTL onsets, prior resection, prior intracranial monitoring, and prior vagus nerve stimulation. In addition, seizure reduction was not dependent on the location of depth leads relative to the hippocampus. The most frequent serious device-related adverse event was soft tissue implant-site infection (overall rate, including events categorized as device-related, uncertain, or not device-related: 0.03 per implant year, which is not greater than with other neurostimulation devices). Brain-responsive stimulation represents a safe and effective treatment option for patients with medically intractable epilepsy, including patients with unilateral or bilateral MTLE who are not candidates for

  5. Tobacco dependence treatment teaching by medical school clerkship preceptors: survey responses from more than 1,000 US medical students.

    PubMed

    Geller, Alan C; Hayes, Rashelle B; Leone, Frank; Churchill, Linda C; Leung, Katherine; Reed, George; Jolicoeur, Denise; Okuliar, Catherine; Adams, Michael; Murray, David M; Liu, Qin; Waugh, Jonathan; David, Sean; Ockene, Judith K

    2013-08-01

    To determine factors associated with tobacco cessation counseling in medical school clerkships. Third-year medical students at 10 medical schools across the United States completed a 100-item survey, measuring the frequency with which they experienced their preceptors providing clinical teaching components: clear instruction, feedback, modeling behavior, setting clear objectives, and responding to questions about tobacco dependence counseling as well as frequency of use of tobacco prompts and office systems. Our primary dependent measure was student self-reported skill level for items of tobacco dependence treatment (e.g. "5As"). Surveys were completed by 1213 students. For both family medicine and internal medicine clerkships, modeling and providing clear instruction on ways to provide tobacco counseling were reported most commonly. In contrast, providing feedback and clear objectives for tobacco dependence treatment lagged behind. Overall, students who reported preceptors' provision of optimal clinical teaching components and office system prompts in both family medicine and internal medicine clerkships had higher self-reported skill (P<0.001) than students with no exposure or exposure during only one of the clerkships. Future educational interventions intended to help students adopt effective tobacco dependence treatment techniques should be engineered to facilitate these critical precepting components. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Model Program: The British Schools of America

    ERIC Educational Resources Information Center

    Hall, Gareth

    2007-01-01

    This article features the British Schools of America and describes the curriculum these schools offer. The British Schools of America offer a broad curriculum based on the International Primary Curriculum, the National Curriculum (England) and the International Baccalaureate, and focus on the whole development of the child, aiming to equip every…

  7. The Making of a Moral British Bangladeshi

    ERIC Educational Resources Information Center

    Zeitlyn, Benjamin

    2014-01-01

    This article traces changing notions of a moral upbringing among British Bangladesh families in London. It reviews ideas of the making of a moral person ("manush corano") in Bangladesh and contrasts those with contemporary practices and ideas about the good child in London. It argues that in London, British Bangladeshis have embraced a…

  8. British African Caribbean Women and Depression

    ERIC Educational Resources Information Center

    Adkison-Bradley, Carla; Maynard, Donna; Johnson, Phillip; Carter, Stephaney

    2009-01-01

    Depression is a common condition among women in the United Kingdom. However, little is known about the context of depression among British African Caribbean women. This article offers a preliminary discussion regarding issues and information pertaining to depression among British African Caribbean women. Characteristics and symptoms of depression…

  9. British Columbia Transfer TIPS. Second Edition Revised

    ERIC Educational Resources Information Center

    Finlay, Finola, Ed.; Karlinski, Jean, Ed.

    2005-01-01

    BCTransfer TIPS is a user friendly document outlining how transfer between British Columbia (BC) post-secondary institutions works. It includes tips, student quotes, scenarios, a personal plan and checklist. Information in this document can only be reproduced with permission from the British Columbia Council on Admissions and Transfer (BCCAT.)

  10. The Making of a Moral British Bangladeshi

    ERIC Educational Resources Information Center

    Zeitlyn, Benjamin

    2014-01-01

    This article traces changing notions of a moral upbringing among British Bangladesh families in London. It reviews ideas of the making of a moral person ("manush corano") in Bangladesh and contrasts those with contemporary practices and ideas about the good child in London. It argues that in London, British Bangladeshis have embraced a…

  11. Providing a Background for British Literature.

    ERIC Educational Resources Information Center

    DeLuca, Diana Macintyre

    One consequence of teaching British literature far away from British shores is the loss of intimacy that comes from a shared culture. American teachers can help bring Britain into their classrooms by requesting audiovisual aids from the various museums and galleries in Britain that are willing to supply material. Among such sources are (1) Walton…

  12. Indian Education Programs in British Columbia.

    ERIC Educational Resources Information Center

    Kelly, Reg

    The British North America Act of 1867, the founding constitution of Canada, provides that all matters pertaining to Indians and Indian lands are under Federal jurisdiction. Because of this, the province of British Columbia (BC) has not felt it could do much for native peoples and little attention has been paid to the extension of provincial…

  13. Utilisation of British University Research Reactors.

    ERIC Educational Resources Information Center

    Duncton, P. J.; And Others

    British experience relating to the employment of university research reactors and subcritical assemblies in the education of nuclear scientists and technologists, in the training of reactor operators and for fundamental pure and applied research in this field is reviewed. The facilities available in a number of British universities and the uses…

  14. Request Strategies in British English and Japanese.

    ERIC Educational Resources Information Center

    Fukushima, Saeko

    1996-01-01

    Tests request strategies used by speakers of Japanese and British English in two culturally neutral situations likely to trigger a request. Concludes that the degree of imposition goes on a par with the number of politeness strategies but that there are differences in the types of strategies used: the British use conventional forms and supportive…

  15. British Children's Books in the Twentieth Century.

    ERIC Educational Resources Information Center

    Eyre, Frank

    A revised and expanded version of an earlier study of modern British children's literature (1952), this latest edition begins with an introductory section on the historical development of children's literature and follows with chapters examining the main trends in British children's books from 1900 to the present day. Special attention is given to…

  16. The Current Canon in British Romantics Studies.

    ERIC Educational Resources Information Center

    Linkin, Harriet Kramer

    1991-01-01

    Describes and reports on a survey of 164 U.S. universities to ascertain what is taught as the current canon of British Romantic literature. Asserts that the canon may now include Mary Shelley with the former standard six major male Romantic poets, indicating a significant emergence of a feminist perspective on British Romanticism in the classroom.…

  17. The Contemporaneity of the British Survey.

    ERIC Educational Resources Information Center

    Dodson, Charles Brooks

    The seeming remoteness of material studied in a British literature survey course can be frustrating for the teacher. Students may find little relevance in the story of Beowulf or the descriptions of Gulliver's voyages. However, instructors can highlight the contemporaneity of British literary texts by drawing parallels to modern times. For…

  18. Utilisation of British University Research Reactors.

    ERIC Educational Resources Information Center

    Duncton, P. J.; And Others

    British experience relating to the employment of university research reactors and subcritical assemblies in the education of nuclear scientists and technologists, in the training of reactor operators and for fundamental pure and applied research in this field is reviewed. The facilities available in a number of British universities and the uses…

  19. The Current Canon in British Romantics Studies.

    ERIC Educational Resources Information Center

    Linkin, Harriet Kramer

    1991-01-01

    Describes and reports on a survey of 164 U.S. universities to ascertain what is taught as the current canon of British Romantic literature. Asserts that the canon may now include Mary Shelley with the former standard six major male Romantic poets, indicating a significant emergence of a feminist perspective on British Romanticism in the classroom.…

  20. Providing a Background for British Literature.

    ERIC Educational Resources Information Center

    DeLuca, Diana Macintyre

    One consequence of teaching British literature far away from British shores is the loss of intimacy that comes from a shared culture. American teachers can help bring Britain into their classrooms by requesting audiovisual aids from the various museums and galleries in Britain that are willing to supply material. Among such sources are (1) Walton…

  1. The Contemporaneity of the British Survey.

    ERIC Educational Resources Information Center

    Dodson, Charles Brooks

    The seeming remoteness of material studied in a British literature survey course can be frustrating for the teacher. Students may find little relevance in the story of Beowulf or the descriptions of Gulliver's voyages. However, instructors can highlight the contemporaneity of British literary texts by drawing parallels to modern times. For…

  2. Request Strategies in British English and Japanese.

    ERIC Educational Resources Information Center

    Fukushima, Saeko

    1996-01-01

    Tests request strategies used by speakers of Japanese and British English in two culturally neutral situations likely to trigger a request. Concludes that the degree of imposition goes on a par with the number of politeness strategies but that there are differences in the types of strategies used: the British use conventional forms and supportive…

  3. British African Caribbean Women and Depression

    ERIC Educational Resources Information Center

    Adkison-Bradley, Carla; Maynard, Donna; Johnson, Phillip; Carter, Stephaney

    2009-01-01

    Depression is a common condition among women in the United Kingdom. However, little is known about the context of depression among British African Caribbean women. This article offers a preliminary discussion regarding issues and information pertaining to depression among British African Caribbean women. Characteristics and symptoms of depression…

  4. Indian Education Programs in British Columbia.

    ERIC Educational Resources Information Center

    Kelly, Reg

    The British North America Act of 1867, the founding constitution of Canada, provides that all matters pertaining to Indians and Indian lands are under Federal jurisdiction. Because of this, the province of British Columbia (BC) has not felt it could do much for native peoples and little attention has been paid to the extension of provincial…

  5. Integrated Curriculum Programs in British Columbia

    ERIC Educational Resources Information Center

    Johnston, Julie

    2011-01-01

    In this article, the author discusses British Columbia's integrated curriculum programs (ICPs). In this province of sea and mountains, outdoor adventures figure prominently in its ICPs--with a healthy dose of environmental and sustainability education mixed in. The author presents five examples from British Columbia's ICPs: (1) Earthquest Outdoor…

  6. Condition Self-Management in Pediatric Spina Bifida: A Longitudinal Investigation of Medical Adherence, Responsibility-Sharing, and Independence Skills.

    PubMed

    Psihogios, Alexandra M; Kolbuck, Victoria; Holmbeck, Grayson N

    2015-09-01

    This study aimed to evaluate rates of medical adherence, responsibility, and independence skills across late childhood and adolescence in youth with spina bifida (SB) and to explore associations among these disease self-management variables. 111 youth with SB, their parents, and a health professional participated at two time points. Informants completed questionnaires regarding medical adherence, responsibility-sharing, and child independence skills. Youth gained more responsibility and independence skills across time, although adherence rates did not follow a similar trajectory. Increased child medical responsibility was related to poorer adherence, and father-reported independence skills were associated with increased child responsibility. This study highlights medical domains that are the most difficult for families to manage (e.g., skin checks). Although youth appear to gain more autonomy across time, ongoing parental involvement in medical care may be necessary to achieve optimal adherence across adolescence. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Locating AED Enabled Medical Drones to Enhance Cardiac Arrest Response Times.

    PubMed

    Pulver, Aaron; Wei, Ran; Mann, Clay

    2016-01-01

    Out-of-hospital cardiac arrest (OOHCA) is prevalent in the United States. Each year between 180,000 and 400,000 people die due to cardiac arrest. The automated external defibrillator (AED) has greatly enhanced survival rates for OOHCA. However, one of the important components of successful cardiac arrest treatment is emergency medical services (EMS) response time (i.e., the time from EMS "wheels rolling" until arrival at the OOHCA scene). Unmanned Aerial Vehicles (UAV) have regularly been used for remote sensing and aerial imagery collection, but there are new opportunities to use drones for medical emergencies. The purpose of this study is to develop a geographic approach to the placement of a network of medical drones, equipped with an automated external defibrillator, designed to minimize travel time to victims of out-of-hospital cardiac arrest. Our goal was to have one drone on scene within one minute for at least 90% of demand for AED shock therapy, while minimizing implementation costs. In our study, the current estimated travel times were evaluated in Salt Lake County using geographical information systems (GIS) and compared to the estimated travel times of a network of AED enabled medical drones. We employed a location model, the Maximum Coverage Location Problem (MCLP), to determine the best configuration of drones to increase service coverage within one minute. We found that, using traditional vehicles, only 4.3% of the demand can be reached (travel time) within one minute utilizing current EMS agency locations, while 96.4% of demand can be reached within five minutes using current EMS vehicles and facility locations. Analyses show that using existing EMS stations to launch drones resulted in 80.1% of cardiac arrest demand being reached within one minute Allowing new sites to launch drones resulted in 90.3% of demand being reached within one minute. Finally, using existing EMS and new sites resulted in 90.3% of demand being reached while greatly reducing

  8. Evaluation of interactive teaching for undergraduate medical students using a classroom interactive response system in India.

    PubMed

    Datta, Rakesh; Datta, Karuna; Venkatesh, M D

    2015-07-01

    The classical didactic lecture has been the cornerstone of the theoretical undergraduate medical education. Their efficacy however reduces due to reduced interaction and short attention span of the students. It is hypothesized that the interactive response pad obviates some of these drawbacks. The aim of this study was to evaluate the effectiveness of an interactive response system by comparing it with conventional classroom teaching. A prospective comparative longitudinal study was conducted on 192 students who were exposed to either conventional or interactive teaching over 20 classes. Pre-test, Post-test and retentions test (post 8-12 weeks) scores were collated and statistically analysed. An independent observer measured number of student interactions in each class. Pre-test scores from both groups were similar (p = 0.71). There was significant improvement in both post test scores when compared to pre-test scores in either method (p < 0.001). The interactive post-test score was better than conventional post test score (p < 0.001) by 8-10% (95% CI-difference of means - 8.2%-9.24%-10.3%). The interactive retention test score was better than conventional retention test score (p < 0.001) by 15-18% (95% CI-difference of means - 15.0%-16.64%-18.2%). There were 51 participative events in the interactive group vs 25 in the conventional group. The Interactive Response Pad method was efficacious in teaching. Students taught with the interactive method were likely to score 8-10% higher (statistically significant) in the immediate post class time and 15-18% higher (statistically significant) after 8-12 weeks. The number of student-teacher interactions increases when using the interactive response pads.

  9. British surgical aid to Jordan

    PubMed Central

    Boyd, N. A.; Barry, N. A.; Davies, A. K.

    1971-01-01

    The surgical commitment of No. 2 Field Hospital, R.A.M.C., during its stay in Jordan is presented. The majority of patients that were admitted had sustained war wounds, many of which were infected due to the delay in treatment. The difficulties encountered in their subsequent management are discussed. Special reference is made to the use of ketamine (Ketalar) and mafenide acetate (Sulphamylon) in the treatment of those burns cases under our care. It is the first time for many years that a British field hospital has been employed in an active rôle. ImagesFig. 1Fig. 3Fig. 4Fig. 8Fig. 11Fig. 12Fig. 13Fig. 14Fig. 2Fig. 5Fig. 6Fig. 7Fig. 9Fig. 10 PMID:5114910

  10. Developments in British environmental law

    SciTech Connect

    Williams, D.G.T.

    1984-07-01

    Decisions on whether or not to build nuclear power plants are increasingly settled in the courts because of conflicting interests in the growth of electric power demand and environmental protection that has led to a breakdown in public order. Lawyers share the same sense of bewilderment as lay people over nuclear as well as noise, smoke, and other types of environmental questions. The author reviews British criminal and civil law to see how the courts have dealt with pollution issues in the past. Public inquiry over a proposed development has triggered many of Britain's major law and environment problems, the Windscale inquiry being a notable example. A reluctance to legislate is an underlying factor in the trend toward inquiry and litigation. 139 references.

  11. Houston's medical disaster response to Hurricane Katrina: part 2: transitioning from emergency evacuee care to community health care.

    PubMed

    Hamilton, Douglas R; Gavagan, Thomas; Smart, Kieran; Weller, Nancy; Upton, Lori A; Havron, Douglas A; Fishkind, Avrim; Persse, David; Shank, Paul; Shah, Umair A; Mattox, Kenneth

    2009-04-01

    After Hurricane Katrina hit the Gulf Coast on August 29, 2005, thousands of ill and injured evacuees were transported to Houston, TX. Houston's regional disaster plan was quickly implemented, leading to the activation of the Regional Hospital Preparedness Council's Catastrophic Medical Operations Center and the rapid construction of a 65-examination-room medical facility within the Reliant Center. A plan for triage of arriving evacuees was quickly developed and the Astrodome/Reliant Center Complex mega-shelter was created. Herein, we discuss major elements of the regional disaster response, including regional coordination, triage and emergency medical service transfers into the region's medical centers, medical care in population shelters, and community health challenges.

  12. Who is Responsible for Evaluating the Safety and Effectiveness of Medical Devices? The Role of Independent Technology Assessment

    PubMed Central

    Petersen, Amy J.; Karliner, Leah S.; Tice, Jeffrey A.

    2007-01-01

    Introduction The global medical technology industry brings thousands of devices to market every year. However, significant gaps persist in the scientific literature, in the medical device approval process, and in the realm of postmarketing surveillance. Although thousands of drugs obtain approval only after review in randomized controlled trials, relatively few new medical devices are subject to comparable scrutiny. Objective To improve health outcomes, we must enhance our scrutiny of medical devices, and, without simply deferring to the Food and Drug Administration, we must ask ourselves: Who is responsible for evaluating the safety and effectiveness of medical devices? Conclusions Technology assessments by independent organizations are a part of the solution to this challenge and may motivate further research focused on patient outcomes. PMID:18095046

  13. Assessing the Awareness of Egyptian Medical Students about Responsible Conduct of Research and Research Ethics: Impact of an Educational Campaign.

    PubMed

    El-Shinawi, Mohamed; Mohamed, Karim Osama; Fouad, Yousef Ahmed; Fahmy, Yara Mohamed; Asar, Hadeel Abdulwahed; Khalil, Mohamed Gomaa; Anestidou, Lida; El-Kamary, Samer S; Mohamed, Mona Mostafa

    2016-01-01

    This is a quasi-experimental pre-post assessment study utilizing an anonymous self-administered questionnaire to assess Egyptian medical students' awareness about responsible conduct of research (RCR) and research ethics. Students' were assessed before and after an RCR awareness campaign. Our results showed that most of the pre-campaign respondents were not familiar with the basic principles and terms of RCR. An increase in the awareness about RCR across all discussed topics was noted following the campaign. We concluded that an educational awareness campaign is effective in increasing medical students' awareness about RCR and should be incorporated into current medical school curricula in Egypt.

  14. Roles of Medication Responsibility, Executive and Adaptive Functioning in Adherence for Children and Adolescents With Perinatally Acquired HIV.

    PubMed

    Garvie, Patricia A; Brummel, Sean S; Allison, Susannah M; Malee, Kathleen M; Mellins, Claude A; Wilkins, Megan L; Harris, Lynnette L; Patton, E Doyle; Chernoff, Miriam C; Rutstein, Richard M; Paul, Mary E; Nichols, Sharon L

    2017-08-01

    Medication adherence is a critical but challenging developmental task for children and adolescents with perinatally acquired HIV (PHIV). Understanding how medication responsibility, executive functions (EFs) and adaptive functioning (AF) influence adherence may help prepare adolescents for transition to adulthood. Participants included PHIV children and adolescents 7-16 years of age enrolled in the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol, who were prescribed antiretroviral medications. Measures included caregiver report and child self-report measures of adherence, medication responsibility and EF, caregiver report of child AF, examiner-administered tests of EF and processing speed and demographic and health characteristics. Two hundred fifty-six participants with PHIV (mean age: 12 years old) were 51% female, 80% black and 79% non-Hispanic. Per 7-day recall, 72% were adherent (no missed doses). Children/adolescents self-reported that 22% had sole and 55% had shared medication responsibility. Adjusted logistic models revealed significantly higher odds of adherence with sole caregiver responsibility for medication [odds ratio (OR): 4.10, confidence interval (CI): 1.43-11.8, P = 0.009], child nadir CD4% <15% (OR: 2.26, CI: 1.15-4.43, P = 0.018), better self-reported behavioral regulation (OR: 0.65, CI: 0.44-0.96, P = 0.029) and slower processing speed (OR: 0.54, CI: 0.38-0.77, P < 0.001), adjusting for demographic variables (age, race and caregiver education). Among children and adolescents with PHIV, continued caregiver medication management, especially during adolescence, is essential. Although global EF and AF were not significantly associated with adherence, behavioral regulation was. Given that EF and AF develop throughout adolescence, their relationships to adherence should be evaluated longitudinally, especially as youth transition to adulthood and caregiver responsibility diminishes.

  15. John Gregory (1724-1773) and his lectures on the duties and qualifications of a physician establishing modern medical ethics on the base of the moral philosophy and the theory of science of the empiric British Enlightenment.

    PubMed

    Strätling, M

    1997-01-01

    In 1769/70 the Scottish physician and philosopher John Gregory (1724-1773) published Lectures On the Duties and Qualifications of a Physician. Gregory developed a truely ethical - in the sense of (moral) philosophically based - system of conduct in a physician. His concept of practising and teaching ethics in medicine and science is established on a very broad footing: combining Bacon's (1561-1626) general philosophy of nature and science with both, the general, likewise empirically based moral philosophy of his personal friend David Hume (1711-1776), and with the principles upheld by the so-called Common-Sense Philosophy. His Lectures had - particularly via the famous Code of Medical Ethics of Thomas Percival (1740-1804) - a decisive influence on our contemporary concepts of ethics in medicine and science. John Gregory is, without doubt, one of the most important and certainly the most comprehensive among the founders of what is known today as modern Bioethics.

  16. Response of a hybrid pixel detector (MEDIPIX3) to different radiation sources for medical applications

    SciTech Connect

    Chumacero, E. Miguel; De Celis Alonso, B.; Martínez Hernández, M. I.; Vargas, G.; Moreno Barbosa, E.; Moreno Barbosa, F.

    2014-11-07

    The development in semiconductor CMOS technology has enabled the creation of sensitive detectors for a wide range of ionizing radiation. These devices are suitable for photon counting and can be used in imaging and tomography X-ray diagnostics. The Medipix[1] radiation detection system is a hybrid silicon pixel chip developed for particle tracking applications in High Energy Physics. Its exceptional features (high spatial and energy resolution, embedded ultra fast readout, different operation modes, etc.) make the Medipix an attractive device for applications in medical imaging. In this work the energy characterization of a third-generation Medipix chip (Medipix3) coupled to a silicon sensor is presented. We used different radiation sources (strontium 90, iron 55 and americium 241) to obtain the response curve of the hybrid detector as a function of energy. We also studied the contrast of the Medipix as a measure of pixel noise. Finally we studied the response to fluorescence X rays from different target materials (In, Pd and Cd) for the two data acquisition modes of the chip; single pixel mode and charge summing mode.

  17. [Risk management in health care systems: the new legislative orientations in medical civil responsibility].

    PubMed

    Tomassini, A; Signorelli, C; Colzani, E

    2004-01-01

    The recent radical change in the relationships between physicians and patients has increased the frequency of malpractice. Consequently, on one hand, many physicians got used to avoiding any possible risk of denunciation by applying the so called "defensive medicine", while on the other hand, the insurance companies raised the prices of their premiums for policies concerning civil responsibility of health operators. In order to avoid this "vicious circle", some health structures created Units for the Risk Management related to malpractice, while others took advantage of the collaboration of Associations for Patients' Rights to create database about the most frequent medical mistakes. The need for a legislative change has been accepted by the Parliament which expects with the proposal n.108 (approved in spring 2002 by the Commission for Hygiene and Health of the Senate) to attribute the civil responsibility of the physicians to the hospitals (both private and public) for which they work, to constitute a Register of experts and to accelerate the legal disputes. The problem is complex and still to be solved, but it seems that time for a strong intervention in order to improve the situation has to come.

  18. Cutting Close to the Bone: Student Trauma, Free Speech, and Institutional Responsibility in Medical Education.

    PubMed

    Kumagai, Arno K; Jackson, Brittani; Razack, Saleem

    2017-03-01

    Learning the societal roles and responsibilities of the physician may involve difficult, contentious conversations about topics such as race, gender, sexual orientation, and class, as well as violence, inequities, sexual assault, and child abuse. If not done well, these discussions may be deeply traumatizing to learners for whom these subjects "cut close to the bone." Equally traumatizing is exposure to injustice and mistreatment, as well as to the sights, sounds, and smells of suffering and pain in the clinical years. This potential for iatrogenic educational trauma remains unaddressed, and medical educators must take responsibility for attending to it. Possible solutions include trigger warnings or statements given to students before an educational activity that may cause personal discomfort. The authors of this Perspective assert, however, both that this concept does not distinguish between psychological trauma and discomfort and that well-intentioned trigger warnings target the wrong goal-the avoidance of distress. Exposure to discomfort not only is unavoidable in the practice of medicine but may be crucial to personal and professional moral development. The authors argue that a more appropriate solution is to create safe spaces for dialogues about difficult topics and jarring experiences. This approach places even the notion of free speech under a critical lens-it is not an end in itself but a means to create a professional ethic dedicated to treating all individuals with excellence and justice. Ultimately, this approach aspires to create an inclusive curriculum sensitive to the realities of teaching and learning in increasingly diverse societies.

  19. Response of a hybrid pixel detector (MEDIPIX3) to different radiation sources for medical applications

    NASA Astrophysics Data System (ADS)

    Chumacero, E. Miguel; De Celis Alonso, B.; Martínez Hernández, M. I.; Vargas, G.; Moreno Barbosa, F.; Moreno Barbosa, E.

    2014-11-01

    The development in semiconductor CMOS technology has enabled the creation of sensitive detectors for a wide range of ionizing radiation. These devices are suitable for photon counting and can be used in imaging and tomography X-ray diagnostics. The Medipix[1] radiation detection system is a hybrid silicon pixel chip developed for particle tracking applications in High Energy Physics. Its exceptional features (high spatial and energy resolution, embedded ultra fast readout, different operation modes, etc.) make the Medipix an attractive device for applications in medical imaging. In this work the energy characterization of a third-generation Medipix chip (Medipix3) coupled to a silicon sensor is presented. We used different radiation sources (strontium 90, iron 55 and americium 241) to obtain the response curve of the hybrid detector as a function of energy. We also studied the contrast of the Medipix as a measure of pixel noise. Finally we studied the response to fluorescence X rays from different target materials (In, Pd and Cd) for the two data acquisition modes of the chip; single pixel mode and charge summing mode.

  20. The Current Status of Development and Implementation of Medical Emergency Response Plan in Schools.

    PubMed

    Nishiuchi, Tatsuya; Kinoshita, Rie; Kubota, Yoshie; Paul, Moses; Hiraide, Atsushi

    2016-04-13

    Automated external defibrillators (AEDs) have been widely distributed at schools in Japan. We have demonstrated that ventricular fibrillation accounted for 68% of nontraumatic sudden cardiac arrest (SCA) in schools, suggesting that a well-prepared medical emergency response plan (MERP) for schools would improve the outcomes of SCA patients. However, it is uncertain if the MERP has been well developed or implemented in Japanese schools. We conducted a cross-sectional study of schools in Osaka using a postal questionnaire. Survey items included type of school, number of students, school staff and teaching staff, number of AEDs used and the place of installation, cardiopulmonary resuscitation (CPR) training to school staff, MERP development and implementation, and the number of SCA cases they experienced. The response rate to this survey was 44% (764 of 1728 schools). Every school except for 4 have installed at least 1 AED. Thirty-six percent of schools, however, have not yet developed and implemented a MERP for SCA. Moreover, 49% of schools surveyed have not conducted a rehearsal training session for SCA in the previous 3 years, although 95% of schools provided CPR training courses to school staff. A total of 15 schools have experienced 16 presumed or actual SCA cases in the study period. Of the 15 schools, 6 schools reported that bystanders experienced psychological stress. A MERP for SCA has not yet been fully developed and implemented in the schools surveyed in our study despite widely distributed AEDs and CPR training.

  1. Mass murder in a university setting: analysis of the medical examiner's response.

    PubMed

    Fierro, Marcella F

    2007-09-01

    Seung-Hui Cho, a student at Virginia Polytechnic Institute and State University (Virginia Tech), shot and killed 33 students and faculty, including himself, on the morning of April 16, 2007. A retrospective review of the medical examiner system response to this multiple fatality event was undertaken to identify which procedures were and were not effective. Case records, spreadsheets, telephone call logs, notes, and after-action interviews of staff were reviewed and analyzed. Recommendations were developed to improve the management of the multiple components of a high-profile multiple fatality event. One autopsy took place on Monday, April 16, 12 on Tuesday, April 17, and 20 on Wednesday, April 18. Pathologists archived the biopsies of major organs in formalin. Slides were made of entrance wounds that exhibited residues. Blood for alcohols was collected from victims. Blood for alcohols, acid, base, and neutral drugs was collected from Cho for analysis. Standard forensic pathology procedures worked and timely postmortem examinations were completed. The victim identification component of the family assistance center must be established and staffed at the time of the initial response. Public information officers need training in morgue and medicolegal death management and in ways to effectively communicate with different audiences about multiple fatality management procedures.

  2. A comparison of responses to alcohol expectancy questionnaire (CEOA) of Indian and Malaysian medical students.

    PubMed

    Ganaraja, B; Ramesh, Bhat M; Kotian, M S

    2010-01-01

    Alcohol addiction is a social problem faced by every country worldwide. Young people are more at risk of this menace. In spite of a clear knowledge and message about the effects of alcohol on individual health and social fabric, it is hard to curb the overuse of this beverage. In the present study, we compared the outcome of a survey using Comprehensive effects of Alcohol (CEOA) in two private Medical institutions in two Asian countries, viz. KMC, Mangalore, India (n=180) and AIMST, Kedah, Malaysia (n=170). The study included both males and female students. The result suggested that the negative reinforcement responses were rated higher in both the study groups. But those who have tasted alcohol before had a higher rating that alcohol may cause positive reinforcement. Both groups of respondents showed similar trend suggesting that the alcohol expectancies are similar in Indian students and Malaysian students. From the results we could conclude that the responses of the two sample groups were comparable to each other. While the male respondents were inclined show higher affinity towards acceptance of alcohol females are very much less so. However, the respondents of both groups appeared to be well aware of the negative aspects of alcohol. Importantly previous exposure to alcohol intake dramatically changed the perception and showed increased inclination towards alcoholism. This study thus provides an important clue to the clinician, counselors and parents regarding the importance of guiding the young people about the alcoholism.

  3. Implementing medical revalidation in the United Kingdom: Findings about organisational changes and impacts from a survey of Responsible Officers

    PubMed Central

    Boyd, Alan; Bryce, Marie; Luscombe, Kayleigh; Tazzyman, Abigail; Tredinnick-Rowe, John; Archer, Julian

    2017-01-01

    Objective To describe the implementation of medical revalidation in healthcare organisations in the United Kingdom and to examine reported changes and impacts on the quality of care. Design A cross-sectional online survey gathering both quantitative and qualitative data about structures and processes for medical revalidation and wider quality management in the organisations which employ or contract with doctors (termed ‘designated bodies’) from the senior doctor in each organisation with statutory responsibility for medical revalidation (termed the ‘Responsible Officer’). Setting United Kingdom Participants Responsible Officers in designated bodies in the United Kingdom. Five hundred and ninety-five survey invitations were sent and 374 completed surveys were returned (63%). Main outcome measures The role of Responsible Officers, the development of organisational mechanisms for quality assurance or improvement, decision-making on revalidation recommendations, impact of revalidation and mechanisms for quality assurance or improvement on clinical practice and suggested improvements to revalidation arrangements. Results Responsible Officers report that revalidation has had some impacts on the way medical performance is assured and improved, particularly strengthening appraisal and oversight of quality within organisations and having some impact on clinical practice. They suggest changes to make revalidation less ‘one size fits all’ and more responsive to individual, organisational and professional contexts. Conclusions Revalidation appears primarily to have improved systems for quality improvement and the management of poor performance to date. There is more to be done to ensure it produces wider benefits, particularly in relation to doctors who already perform well. PMID:28084166

  4. [Medical Relief Response by Miyako Public Health Center after the Great East Japan Earthquake and Tsunami, 2011].

    PubMed

    Yanagihara, Hiroki

    2016-01-01

    To improve disaster preparedness, we investigated the response of medical relief activities managed by Iwate Prefectural Miyako Public Health Center during the post-acute phase of the Great East Japan Earthquake and Tsunami on March 11, 2011. The study divided the post-disaster period into three approximate time segments: Period I (time of disaster through late March), Period II (mid-April), and Period III (end of May in Miyako City, early July in Yamada Town). We reviewed records on medical relief activities conducted by medical assistance teams (MATs) in Miyako City and Yamada Town. Miyako Public Health Center had organized a meeting to coordinate medical relief activities from Period I to Period III. According to demand for medical services and recovery from the local medical institutions (LMIs) in the affected area, MATs were deployed and active on evacuation centers in each area assigned. The number of patients examined by MATs in Miyako rose to approximately 250 people per day in Period I and decreased to 100 in Period III. However, in Yamada, the number surged to 700 in Period I, fell to 100 in Period II, and decreased to 50 in Period III. This difference could be partly explained as follows. In Miyako, most evacuees had consulted LMIs which restarted medical services after disaster, and the number of LMIs restarted had already reached 29 (94% of the whole) in Period I. In Yamada, most evacuees who had consulted MATs in Period I had almost moved to LMIs restarted in Period II. During the same time, a division of roles and coordination on medical services provision was conducted, such as MATs mainly in charge of primary emergency triage, in response to the number of LMIs restarted which reached 1 (20%) in Period I and 3 (60%) in Period II. Following Period III, more than 80% of patients in Miyako had been a slight illness, such as need for health guidance, and the number of people who underwent emergency medical transport reached pre-disaster levels in both

  5. Potential application of item-response theory to interpretation of medical codes in electronic patient records

    PubMed Central

    2011-01-01

    Background Electronic patient records are generally coded using extensive sets of codes but the significance of the utilisation of individual codes may be unclear. Item response theory (IRT) models are used to characterise the psychometric properties of items included in tests and questionnaires. This study asked whether the properties of medical codes in electronic patient records may be characterised through the application of item response theory models. Methods Data were provided by a cohort of 47,845 participants from 414 family practices in the UK General Practice Research Database (GPRD) with a first stroke between 1997 and 2006. Each eligible stroke code, out of a set of 202 OXMIS and Read codes, was coded as either recorded or not recorded for each participant. A two parameter IRT model was fitted using marginal maximum likelihood estimation. Estimated parameters from the model were considered to characterise each code with respect to the latent trait of stroke diagnosis. The location parameter is referred to as a calibration parameter, while the slope parameter is referred to as a discrimination parameter. Results There were 79,874 stroke code occurrences available for analysis. Utilisation of codes varied between family practices with intraclass correlation coefficients of up to 0.25 for the most frequently used codes. IRT analyses were restricted to 110 Read codes. Calibration and discrimination parameters were estimated for 77 (70%) codes that were endorsed for 1,942 stroke patients. Parameters were not estimated for the remaining more frequently used codes. Discrimination parameter values ranged from 0.67 to 2.78, while calibration parameters values ranged from 4.47 to 11.58. The two parameter model gave a better fit to the data than either the one- or three-parameter models. However, high chi-square values for about a fifth of the stroke codes were suggestive of poor item fit. Conclusion The application of item response theory models to coded

  6. Transforming family practice in British Columbia

    PubMed Central

    Cavers, William J.R.; Tregillus, Valerie H.F.; Micco, Angela; Hollander, Marcus J.

    2010-01-01

    ABSTRACT OBJECTIVE To describe a new approach to primary care reform developed in British Columbia (BC) under the leadership of the General Practice Services Committee (GPSC). COMPOSITION OF THE COMMITTEE The GPSC is a joint committee of the BC Ministry of Health Services, the BC Medical Association, and the Society of General Practitioners of BC. Representatives of BC’s health authorities also attend as guests. METHOD This paper is based on the 2008–2009 annual report of the GPSC. It summarizes the history and main activities of the GPSC. REPORT The GPSC is currently supporting a number of key activities to transform primary care in BC. These activities include the Full Service Family Practice Incentive Program, which provides incentive payments to promote enhanced primary care; the Practice Support Program, which provides family physicians and their medical office assistants with various practical evidence-based strategies and tools for managing practice enhancement; the Family Physicians for BC Program to develop family practices in areas of identified need; the Shared Care Committee, which supports and enables the determination of appropriate scopes of practice among GPs, specialists, and other health care professionals; the Divisions of Family Practice, which are designed to facilitate interactions among family doctors and between doctors and their respective health authorities; and the Community Healthcare and Resource Directory, a Web-based resource to help health care providers find appropriate mental health resources. CONCLUSION Early results indicate that the GPSC’s initiatives are enhancing the delivery of primary care services in BC. PMID:21156899

  7. British Counterinsurgency Operations in Ireland 1916-1921. A Case Study.

    DTIC Science & Technology

    2007-11-02

    some ineptitude by the British. The principal Irish parties in shaping the rebellion in Ireland were Sinn Fein, the Irish Volunteer Force ( IVF ), and...political scene. The IVF was the Irish Catholic militia force founded in 1913 in 17 response to the formation of the Protestant Ulster Volunteer Force...Having grown to over 100,000 participants by 1914, the IVF ranks were depleted by the Irishmen who volunteered to fight for the British against

  8. Predicting stimulant medication response in ADHD: evidence from an integrated profile of neuropsychological, psychophysiological and clinical factors.

    PubMed

    Hermens, Daniel F; Cooper, Nicholas J; Kohn, Michael; Clarke, Simon; Gordon, Evian

    2005-03-01

    There have been significant advances in understanding the neurobiology of Attention-Deficit/Hyperactivity Disorder (ADHD) and it is timely to examine the ability of biological and psychological markers to predict medication response in this disorder. We evaluated prediction of medication response in adolescent ADHD using neuropsychological testing and psychophysiological measures of central and autonomic function. Fifty ADHD adolescents participated in pre- and post-stimulant medication testing. Separately ranked performance in auditory oddball and visual Working Memory (WM) tasks determined 20 "responders" and 20 "non-responders" with 10 "neutrals" excluded from the discriminant function analyses (DFA). For both oddball and WM performance rankings, the two groups did not differ in age, sex, or handedness. However, responders did have higher levels of symptomatology than non-responders at baseline. Pre-stimulant medication psychophysiology variables were used as predictors in each DFA. Oddball performance correctly classified 85.0% of responders and 95.0% of non-responders. Better response was associated with increased resting beta power (left posteriorly), delayed oddball target N1 (frontally), decreased oddball target P2 (left posteriorly) and decreased WM distractor P3 (right frontally). Working memory performance classified 80.0% of responders and 90.0% of non-responders, with a broadly similar profile of psychophysiological predictors. These finding indicate the value of integrating neuropsychological and psychophysiological data in predicting medication response in ADHD.

  9. Mississippi Medical Reserve Corps: Moving Mississippi From Emergency Planning to Response Ready.

    PubMed

    McCormick, Lisa C; Fifolt, Matthew; Mercer, Caroline; Pevear, Jesse; Wilson, Jonathan

    The purpose of this study was to identify factors that might impact a Medical Reserve Corps (MRC) volunteer's decision to respond to an emergency event. The 2 primary goals of this survey were to (1) establish realistic planning assumptions regarding the use of volunteers in health care emergency responses, and (2) determine whether barriers to volunteer participation could be addressed by MRC units to improve volunteer response rates. An anonymous online survey instrument was made available via Qualtrics through a customized URL. For the purpose of distribution, the Mississippi State Department of Health sent an electronic message that included the survey link to all MRC volunteers who were registered with the Mississippi Responder Management System (MRMS) as of September 2014. Approximately 15% of those surveyed indicated they would be available and able to deploy within 24 hours. The most common factors reported in terms of respondent decisions to deploy included risk to personal health (61.2%), length of deployment (58.8%), and the security of the deployment area (55.3%). In addition, 67% of respondents indicated that extended periods of deployment would have a negative financial impact on their lives. Respondents who have had training or previous deployment experience reported having greater knowledge of potential response roles, increased comfort in their ability to respond with the MRC, and increased confidence in responding to differing public health emergencies. Barriers to MRC volunteers being able to deploy should be addressed by each MRC unit. Issues such as risk to personal safety while on deployment, site security, and length of deployment should be considered by planners and those solutions communicated to MRC members during trainings. Emergency plans utilizing MRC volunteers will require significant evaluation to assess the risk of relying on an expected resource that could be severely limited during an actual emergency.

  10. Medical Surge Capacity in Atlanta-Area Hospitals in Response to Tanker Truck Chemical Releases.

    PubMed

    Harris, Curtis; Bell, William; Rollor, Edward; Waltz, Tawny; Blackwell, Pam; Dallas, Cham

    2015-12-01

    We designed and conducted a regional full-scale exercise in 2007 to test the ability of Atlanta-area hospitals and community partners to respond to a terrorist attack involving the coordinated release of 2 dangerous chemicals (toluene diisocyanate and parathion) that were being transported through the area by tanker truck. The exercise was designed to facilitate the activation of hospital emergency response plans and to test applicable triage, decontamination, and communications protocols. Plume modeling was conducted by using the Defense Threat Reduction Agency's (DTRA) Hazard Prediction and Assessment Capability (HPAC) V4 program. The scenario went through multiple iterations as exercise planners sought to reduce total injuries to a manageable, but stressful, level for Atlanta's health care infrastructure. Atlanta-area hospitals rapidly performed multiple casualty triage and were able to take in a surge of victims from the simulated attack. However, health care facilities were reticent to push the perceived manageable numbers of victims, and scenarios were modified significantly to lower the magnitude of the simulated attack. Additional coordination with community response partners and incident command training is recommended. Security at health care facilities and decontamination of arriving victims are two areas that will require continued review. Atlanta-area hospitals participated in an innovative regional exercise that pushed facilities beyond traditional scopes of practice and brought together numerous health care community response partners. Using lessons learned from this exercise coupled with subsequent real-world events and training exercises, participants have significantly enhanced preparedness levels and increased the metropolitan region's medical surge capacity in the case of a multiple casualty disaster.

  11. Primary scene responses by Helicopter Emergency Medical Services in New South Wales Australia 2008–2009

    PubMed Central

    2012-01-01

    Background Despite numerous studies evaluating the benefits of Helicopter Emergency Medical Services (HEMS) in primary scene responses, little information exists on the scope of HEMS activities in Australia. We describe HEMS primary scene responses with respect to the time taken, the distances travelled relative to the closest designated trauma hospital and the receiving hospital; as well as the clinical characteristics of patients attended. Methods Clinical service data were retrospectively obtained from three HEMS in New South Wales between July 2008 and June 2009. All available primary scene response data were extracted and examined. Geographic Information System (GIS) based network analysis was used to estimate hypothetical ground transport distances from the locality of each primary scene response to firstly the closest designated trauma hospital and secondly the receiving hospital. Predictors of bypassing the closest designated trauma hospital were analysed using logistic regression. Results Analyses included 596 primary missions. Overall the HEMS had a median return trip time of 94min including a median of 9min for activation, 34min travelling to the scene, 30min on-scene and 25min transporting patients to the receiving hospital. 72% of missions were within 100km of the receiving hospital and 87% of missions were in areas classified as ‘major cities’ or ‘inner regional’. The majority of incidents attended by HEMS were trauma-related, with road trauma the predominant cause (44%). The majority of trauma patients (81%) had normal physiology at HEMS arrival (RTS = 7.84). We found 62% of missions bypassed the closest designated trauma hospital. Multivariate predictors of bypass included: age; presence of spinal or burns trauma; the level of the closest designated trauma hospital; the transporting HEMS. Conclusion Our results document the large distances travelled by HEMS in NSW, especially in rural areas. The high proportion of HEMS missions that bypass

  12. Perceptions of the preparedness of medical graduates for internship responsibilities in district hospitals in Kenya: a qualitative study.

    PubMed

    Muthaura, Patricia N; Khamis, Tashmin; Ahmed, Mushtaq; Hussain, Syeda Ra'ana

    2015-10-21

    Aga Khan University is developing its undergraduate medical education curriculum for East Africa. In Kenya, a 1 year internship is mandatory for medical graduates' registration as practitioners. The majority of approved internship training sites are at district hospitals. The purposes of this study were to determine: (1) whether recent Kenyan medical graduates are prepared for their roles as interns in district hospitals upon graduation from medical school; (2) what working and training conditions and social support interns are likely to face in district hospital; and (3) what aspects of the undergraduate curriculum need to be addressed to overcome perceived deficiencies in interns' competencies. Focus group discussions and semi-structured interviews were conducted with current interns and clinical supervisors in seven district hospitals in Kenya. Perceptions of both interns and supervisors regarding interns' responsibilities and skills, working conditions at district hospitals, and improvements required in medical education were obtained. Findings included agreement across informants on deficiencies in interns' practical skills and experience of managing clinical challenges. Supervisors were generally critical regarding interns' competencies, whereas interns were more specific about their weaknesses. Supervisor expectations were higher in relation to surgical procedures than those of interns. There was agreement on the limited learning, clinical facilities and social support available at district hospitals including, according to interns, inadequate supervision. Supervisors felt they provided adequate supervision and that interns lacked the ability to initiate communication with them. Both groups indicated transition challenges from medical school to medical practice attributable to inadequate practical experience. They indicated the need for more direct patient care responsibilities and clinical experience at a district hospital during undergraduate training

  13. Imperatives in medical education and training in response to demands for a sustainable workforce.

    PubMed

    Dowton, S Bruce

    Factors to be considered in planning our medical workforce to meet future needs include: Need for outcomes-based curricular designs in medical schools and postgraduate training. Shortening the length of medical training. Improving career flexibility to permit professional re-invention. Developing awareness within the profession about how innovation happens.

  14. What I actually said about medical ethics: a brief response to Toon.

    PubMed Central

    Seedhouse, D

    1995-01-01

    It has been said that I am against medical philosophy. This is a misrepresentation of my position. I am against conventional medical ethics teaching as it has to be done in medical schools, but very much in favour of philosophy in medicine. PMID:7776348

  15. Audience response technology: engaging and empowering non-medical prescribing students in pharmacology learning.

    PubMed

    Lymn, Joanne S; Mostyn, Alison

    2010-10-27

    Non-medical prescribing (NMP) is a six month course for nurses and certain allied health professionals. It is critical that these students develop a good understanding of pharmacology; however, many students are mature learners with little or no formal biological science knowledge and struggle with the pharmacology component. The implications for patient safety are profound, therefore we encourage students not just to memorise enough pharmacology to pass the exam but to be able to integrate it into clinical practice. Audience response technology (ART), such as the KeePad system (KS) has been shown to promote an active approach to learning and provide instant formative feedback. The aim of this project, therefore, was to incorporate and evaluate the use the KS in promoting pharmacology understanding in NMP students. Questions were incorporated into eight pharmacology lectures, comprising a mix of basic and clinical pharmacology, using TurningPoint software. Student (n = 33) responses to questions were recorded using the KS software and the percentage of students getting the question incorrect and correct was made immediately available in the lecture in graphical form. Survey data collected from these students investigated student perceptions on the use of the system generally and specifically as a learning tool. More in depth discussion of the usefulness of the KS was derived from a focus group comprising 5 students. 100% of students enjoyed using the KS and felt it promoted their understanding of key concepts; 92% stated that it helped identify their learning needs and 87% agreed that the technology was useful in promoting integration of concepts. The most prevalent theme within feedback was that of identifying their own learning needs. Analysis of data from the focus group generated similar themes, with the addition of improving teaching. Repeated questioning produced a significant increase (p < 0.05) in student knowledge of specific pharmacological concepts. The

  16. Audience response technology: Engaging and empowering non-medical prescribing students in pharmacology learning

    PubMed Central

    2010-01-01

    Background Non-medical prescribing (NMP) is a six month course for nurses and certain allied health professionals. It is critical that these students develop a good understanding of pharmacology; however, many students are mature learners with little or no formal biological science knowledge and struggle with the pharmacology component. The implications for patient safety are profound, therefore we encourage students not just to memorise enough pharmacology to pass the exam but to be able to integrate it into clinical practice. Audience response technology (ART), such as the KeePad system (KS) has been shown to promote an active approach to learning and provide instant formative feedback. The aim of this project, therefore, was to incorporate and evaluate the use the KS in promoting pharmacology understanding in NMP students. Methods Questions were incorporated into eight pharmacology lectures, comprising a mix of basic and clinical pharmacology, using TurningPoint software. Student (n = 33) responses to questions were recorded using the KS software and the percentage of students getting the question incorrect and correct was made immediately available in the lecture in graphical form. Survey data collected from these students investigated student perceptions on the use of the system generally and specifically as a learning tool. More in depth discussion of the usefulness of the KS was derived from a focus group comprising 5 students. Results 100% of students enjoyed using the KS and felt it promoted their understanding of key concepts; 92% stated that it helped identify their learning needs and 87% agreed that the technology was useful in promoting integration of concepts. The most prevalent theme within feedback was that of identifying their own learning needs. Analysis of data from the focus group generated similar themes, with the addition of improving teaching. Repeated questioning produced a significant increase (p < 0.05) in student knowledge of specific

  17. Job Location Decisions of Pharmacy Graduates in British Columbia

    PubMed Central

    Andres, Lesley

    2010-01-01

    Objectives To determine the factors influencing pharmacy graduates' selection of their first professional job location. Methods A survey was conducted of the 2007 graduating class of the University of British Columbia, examining hometown location, community and workplace factors, personal relationships, financial factors, and leisure activities. Responses were analyzed to determine whether community size or demographic characteristics affected the degree to which each factor influenced the job location decision. Results The majority of graduates moved from their hometowns to larger communities, mainly to the largest city in British Columbia. Most of those taking jobs in rural and remote communities grew up in or near those communities, and were more influenced by community size and anticipated working conditions, and less influenced by access to cultural and social activities, than their urban counterparts. Conclusions The admission of students from rural and remote communities is modestly effective in ensuring a supply of pharmacists for these areas. PMID:20585436

  18. A study of the motivations of British hospice volunteers.

    PubMed

    Claxton-Oldfield, Stephen; Claxton-Oldfield, Jane; Paulovic, Stefan; Wasylkiw, Louise

    2013-09-01

    In all, 162 British hospice volunteers completed the Inventory of Motivations for Hospice Palliative Care Volunteerism (IMHPCV) of Claxton-Oldfield, Wasylkiw, Mark, and Claxton-Oldfield.(1) The IMHPCV taps into 5 different categories of motives for becoming a hospice palliative care volunteer: altruism, civic responsibility, leisure, self-promotion, and personal gain. Altruistic motives were the most influential reasons for choosing to join hospice; personal gain motives were the least influential reasons for becoming a hospice volunteer. Altruistic motives were found to be a significant predictor of volunteers' length of service to the hospice. Compared to previously collected data from a sample of Canadian hospice palliative care volunteers,(1) the current study's sample of British hospice volunteers scored significantly different on 2 of the 5 categories of motives on the IMHPCV.

  19. Checklist of British and Irish Hymenoptera - Proctotrupoidea

    PubMed Central

    2016-01-01

    Abstract Background A revised checklist of the British and Irish Heloridae and Proctotrupidae (Proctotrupoidea) substantially updates the previous comprehensive checklist, dating from 1978. Country level data (i.e. occurrence in England, Scotland, Wales, Ireland and the Isle of Man) is reported where known. New information A total of three Heloridae and 39 Proctotrupidae (including only certainly recorded species) represents a 27% increase in the British list since 1978. Most species are still poorly known and there has been a dearth of taxonomic and faunistic work on the British and Irish fauna. PMID:27226750

  20. Rural mass casualty preparedness and response: the Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events.

    PubMed

    Viswanathan, Kristin P; Bass, Robert; Wijetunge, Gamunu; Altevogt, Bruce M

    2012-10-01

    The Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events hosted a workshop at the request of the Federal Interagency Committee on Emergency Medical Services (FICEMS) that brought together a range of stakeholders to broadly identify and confront gaps in rural infrastructure that challenge mass casualty incident (MCI) response and potential mechanisms to fill them. This report summarizes the presentations and discussions around 6 major issues specific to rural MCI preparedness and response: (1) improving rural response to MCI through improving daily capacity and capability, (2) leveraging current and emerging technology to overcome infrastructure deficits, (3) sustaining and strengthening relationships, (4) developing and sharing best practices across jurisdictions and sectors, (5) establishing metrics research and development, and (6) fostering the need for federal leadership to expand and integrate EMS into a broader rural response framework.

  1. Predicting the long-term effects of human-robot interaction: a reflection on responsibility in medical robotics.

    PubMed

    Datteri, Edoardo

    2013-03-01

    This article addresses prospective and retrospective responsibility issues connected with medical robotics. It will be suggested that extant conceptual and legal frameworks are sufficient to address and properly settle most retrospective responsibility problems arising in connection with injuries caused by robot behaviours (which will be exemplified here by reference to harms occurred in surgical interventions supported by the Da Vinci robot, reported in the scientific literature and in the press). In addition, it will be pointed out that many prospective responsibility issues connected with medical robotics are nothing but well-known robotics engineering problems in disguise, which are routinely addressed by roboticists as part of their research and development activities: for this reason they do not raise particularly novel ethical issues. In contrast with this, it will be pointed out that novel and challenging prospective responsibility issues may emerge in connection with harmful events caused by normal robot behaviours. This point will be illustrated here in connection with the rehabilitation robot Lokomat.

  2. Obstructive Sleep Apnea Hypopnea and Poor Response to Antidepressant Medication in Patients with Coronary Heart Disease

    PubMed Central

    Roest, Annelieke M.; Carney, Robert M.; Stein, Phyllis K.; Freedland, Kenneth E.; Meyer, Hilary; Steinmeyer, Brian C.; de Jonge, Peter; Rubin, Eugene H.

    2012-01-01

    Objective Evidence from several clinical trials in patients with coronary heart disease (CHD) suggests that depression that does not respond to treatment is associated with a particularly high risk of adverse cardiac outcomes. The purpose of this study was to determine whether obstructive sleep apnea/hypopnea (OSAH) is associated with a poor response to antidepressant medication in patients with CHD. Method This was an ancillary study of a clinical trial of omega-3 fatty acid augmentation of sertraline for depression in patients with CHD. Cyclical heart rate (HR) patterns associated with OSAH were detected via ambulatory electrocardiography prior to treatment. Symptoms of depression were measured at baseline and follow-up with the Beck Depression Inventory-II (BDI-II) and the Hamilton Rating Scale for Depression (HAM-D-17). The primary endpoint was the BDI-II score at 10 weeks. Results Thirty (29%) of the 105 patients were classified as having moderate to severe OSAH, based on HR patterns. Patients with OSAH had significantly higher scores on both the BDI-II (p=0.01) and the HAM-D-17 (p=0.02) at follow-up as compared to the reference group. Adjustment for the baseline depression score, treatment arm (omega-3 versus placebo), body mass index, and inflammatory markers did not change the results. Conclusion OSAH is associated with a relatively poor response to sertraline for depression. Future research should determine the contribution of OSAH to the increased risk of adverse cardiac outcome associated with treatment resistant depression. PMID:21903027

  3. Association of the dopamine receptor interacting protein gene, NEF3, with early response to antipsychotic medication.

    PubMed

    Strous, Rael D; Greenbaum, Lior; Kanyas, Kyra; Merbl, Yifat; Horowitz, Anat; Karni, Osnat; Viglin, Dina; Olender, Tsviya; Deshpande, Smita N; Lancet, Doron; Ben-Asher, Edna; Lerer, Bernard

    2007-06-01

    Genetic variation in antipsychotic drug targets could underlie variability among patients in the time required for antipsychotic effects to be elicited. In a clinical, pharmacogenetic study we focused on the dopamine receptor interacting protein (DRIP) gene family. DRIPs are pivotally involved in regulating dopamine receptor signal transduction. Consecutively hospitalized, acutely psychotic patients with DSM-IV schizophrenia (n=121) were included in the study if they received treatment with typical antipsychotic medication (TYP, n=72) or TYP plus risperidone (TYP-R, n=49) for at least 2 wk. Clinical state and adverse effects were rated at baseline and after 2 wk. Patients improved significantly on both TYP and TYP-R with no significant difference between them. Early responders were defined as patients whose PANSS change scores were greater than the median. Twenty-two single nucleotide polymorphisms (SNPs) were analysed in five DRIP-encoding genes. Two SNPs in NEF3, which encodes the DRIP, neurofilament-medium (NF-M), were associated with early response (rs1457266, p=0.01; rs1379357, p=0.006). A 5 SNP haplotype spanning NEF3 was over-represented in early responders (p=0.015), in the combined patient group and in the TYP group alone. These findings suggest that variation in NEF3, most likely functional variants that are in linkage disequilibrium with the SNPs that we studied, influences rate of response to TYP. Since NEF3 is primarily associated with dopamine D1 receptor function, the evidence for a complementary role of dopamine D1 receptors in antipsychotic effects is considered. The findings reported here open an interesting research avenue in the pharmacogenetics of antipsychotic effects but require replication in larger samples treated in a controlled context.

  4. The Joint Military Medical Executive Skills initiative: an impressive response to changing human resource management rules of engagement.

    PubMed

    Kerr, Bernard J

    2007-01-01

    Confronted with a sudden and substantial change in the rules regarding who could command a military medical treatment facility (MTF), the Military Health System (MHS) responded to the challenge with an impressive human resource management solution-the Joint Medical Executive Skills Program. The history, emergence, and continuing role of this initiative exemplifies the MHS's capacity to fulfill the spirit and intent of an arduous Congressional mandate while enhancing professional development and sustaining the career opportunities of medical officers. The MHS response to the Congressional requirement that candidates for MTF command demonstrate professional administrative skills was decisive, creative, and consistent with the basic principles of human resource management. The Joint Medical Executive Skills Program is a management success story that demonstrates how strategic planning, well-defined skills requirements, and structured training can assure a ready supply of qualified commanders for the military's MTFs.

  5. [Responsibility of the anaesthetist in preoperative risk management. Comments on the legal implications of medical publications in this field].

    PubMed

    Bock, R-W; Dudziak, R; Wilke, H J

    2004-06-01

    There is an increasing number of publications in the medical literature which address the medical and legal obligations of a specialist in a given field. These articles, mostly editorials, seek to delineate the optimal course of treatment based on the current state of the art and science of medicine. However, we believe that the unreflected adoption of these often highly theoretical ideas and suggestions carries its own dangers. For one thing, there is the threatening financial crisis in the public health system. In addition, the feasibility of implementing these suggestions in routine medical and surgical practice is questionable. Last but not least, suggestions and guidelines for preoperative risk management by, for instance, Lingnau and Strohmenger 2002 cross the well established boundaries of the various medical and surgical specialties, which obviously demands careful deliberations among the specialties involved. So far, few specialty boards have seen fit to act on these suggestions. Our article on the medical and legal responsibilities of the anaesthesiologist in perioperative risk management restates the aforementioned concerns. We attempt to point out medical and legal points of controversy. In particular, we caution against the ever present danger of a bona fide adoption of visionary guidelines as the "standard of care" by both medical and legal experts. We feel that it is imperative to carefully evaluate editorial comments and suggestions, however well meaning, in the light of established teaching and practice, lest these comments and suggestions become the basis of an unjustified determination of a physicians innocence or guilt in a court of law.

  6. 802.11 wireless infrastructure to enhance medical response to disasters.

    PubMed

    Arisoylu, Mustafa; Mishra, Rajesh; Rao, Ramesh; Lenert, Leslie A

    2005-01-01

    802.11 (WiFi) is a well established network communications protocol that has wide applicability in civil infrastructure. This paper describes research that explores the design of 802.11 networks enhanced to support data communications in disaster environments. The focus of these efforts is to create network infrastructure to support operations by Metropolitan Medical Response System (MMRS) units and Federally-sponsored regional teams that respond to mass casualty events caused by a terrorist attack with chemical, biological, nuclear or radiological weapons or by a hazardous materials spill. In this paper, we describe an advanced WiFi-based network architecture designed to meet the needs of MMRS operations. This architecture combines a Wireless Distribution Systems for peer-to-peer multihop connectivity between access points with flexible and shared access to multiple cellular backhauls for robust connectivity to the Internet. The architecture offers a high bandwidth data communications infrastructure that can penetrate into buildings and structures while also supporting commercial off-the-shelf end-user equipment such as PDAs. It is self-configuring and is self-healing in the event of a loss of a portion of the infrastructure. Testing of prototype units is ongoing.

  7. Assessment of Biodosimetry Methods for a Mass-Casualty Radiological Incident: Medical Response and Management Considerations

    PubMed Central

    Sullivan, Julie M.; Prasanna, Pataje G. S.; Grace, Marcy B.; Wathen, Lynne; Wallace, Rodney L.; Koerner, John F.; Coleman, C. Norman

    2013-01-01

    Following a mass-casualty nuclear disaster, effective medical triage has the potential to save tens of thousands of lives. In order to best use the available scarce resources, there is an urgent need for biodosimetry tools to determine an individual’s radiation dose. Initial triage for radiation exposure will include location during the incident, symptoms, and physical examination. Stepwise triage will include point of care assessment of less than or greater than 2 Gy, followed by secondary assessment, possibly with high throughput screening, to further define an individual’s dose. Given the multisystem nature of radiation injury, it is unlikely that any single biodosimetry assay can be used as a stand-alone tool to meet the surge in capacity with the timeliness and accuracy needed. As part of the national preparedness and planning for a nuclear or radiological incident, we reviewed the primary literature to determine the capabilities and limitations of a number of biodosimetry assays currently available or under development for use in the initial and secondary triage of patients. Understanding the requirements from a response standpoint and the capability and logistics for the various assays will help inform future biodosimetry technology development and acquisition. Factors considered include: type of sample required, dose detection limit, time interval when the assay is feasible biologically, time for sample preparation and analysis, ease of use, logistical requirements, potential throughput, point-of-care capability, and the ability to support patient diagnosis and treatment within a therapeutically relevant time point. PMID:24162058

  8. Assessment of biodosimetry methods for a mass-casualty radiological incident: medical response and management considerations.

    PubMed

    Sullivan, Julie M; Prasanna, Pataje G S; Grace, Marcy B; Wathen, Lynne K; Wallace, Rodney L; Koerner, John F; Coleman, C Norman

    2013-12-01

    Following a mass-casualty nuclear disaster, effective medical triage has the potential to save tens of thousands of lives. In order to best use the available scarce resources, there is an urgent need for biodosimetry tools to determine an individual's radiation dose. Initial triage for radiation exposure will include location during the incident, symptoms, and physical examination. Stepwise triage will include point of care assessment of less than or greater than 2 Gy, followed by secondary assessment, possibly with high throughput screening, to further define an individual's dose. Given the multisystem nature of radiation injury, it is unlikely that any single biodosimetry assay can be used as a standalone tool to meet the surge in capacity with the timeliness and accuracy needed. As part of the national preparedness and planning for a nuclear or radiological incident, the authors reviewed the primary literature to determine the capabilities and limitations of a number of biodosimetry assays currently available or under development for use in the initial and secondary triage of patients. Understanding the requirements from a response standpoint and the capability and logistics for the various assays will help inform future biodosimetry technology development and acquisition. Factors considered include: type of sample required, dose detection limit, time interval when the assay is feasible biologically, time for sample preparation and analysis, ease of use, logistical requirements, potential throughput, point-of-care capability, and the ability to support patient diagnosis and treatment within a therapeutically relevant time point.

  9. Prediction modeling to determine the adequacy of medical response to urban nuclear attack.

    PubMed

    Dallas, Cham E; Bell, William C

    2007-11-01

    Government reports have persistently indicated the intent of terrorists and hostile nations to acquire and "weaponize" nuclear materials for deliberate attack on a major US metropolitan city. A modeling analysis of the effects of 20- and 550-kiloton nuclear detonations on the 2 major metropolitan centers of Los Angeles and Houston is presented with a focus on thermal casualties. Brode's work as modified by Binninger was used to calculate thermal fluence, using thermal fractions. The EM-1 and WE programs were used to calculate blast effects. Fallout radiation was calculated using the Defense Threat Reduction Agency's Hazard Prediction and Assessment Capability V404SP4 with "urban effects" turned on. The ESRI ArcView program calculated affected populations from 2000 US Census block-level data for areas affected by thermal effects. The population affected by a 550-kiloton nuclear weapon detonated in Los Angeles and Houston is staggering: surviving thermal casualties are estimated at 185,000 and 59,000, respectively. Even the 20-kiloton detonations in Los Angeles and Houston are significant: the numbers of surviving thermal casualties requiring care exceed 28,000 and 10,000, respectively. The surviving health care community postdetonation would be faced with an unprecedented burden of care for thermal casualties. A great expansion of personnel involved in emergency burn care response is critical. Bold, new approaches such as regionalization and predetermined medical air transport need to be considered.

  10. The governments' doctors: the roles and responsibilities of chief medical officers in the European Union.

    PubMed

    Jakubowski, Elke; Martin-Moreno, José M; McKee, Martin

    2010-12-01

    The regular meetings of the chief medical officers (CMOs) from the European Union's (EU's) 27 Member States provide an important forum to address issues of common interest affecting Europe's populations. Yet there is no universally agreed role for a CMO. This article describes the findings of a study, based on interviews with key informants and documentary analysis that sought to describe their diverse roles. For the purpose of this article, CMOs are defined as those sent by their governments to the regular EU meetings of CMOs. Four broad categories of countries were identified: those whose CMO is the most senior doctor in the health ministry, in some cases with responsibility spanning all of government; where they are head of a division within the health ministry; head of a separate body such as a national board of health; and countries where no single individual can be identified. Although the diversity of health systems means that these roles cannot be harmonised, there is scope to explore what can be learnt from the different approaches.

  11. Dissociation between emotional and endocrine responses preceding an academic examination in male medical students.

    PubMed

    Allen, P I; Batty, K A; Dodd, C A; Herbert, J; Hugh, C J; Moore, G F; Seymour, M J; Shiers, H M; Stacey, P M; Young, S K

    1985-11-01

    A study was made in 2 consecutive years of the emotional states and morning and afternoon serum levels of prolactin, cortisol and testosterone of male medical students during a 4- to 5-week period preceding a major university examination. 'Distress', 'anxiety' and, to a lesser degree, 'depression' increased during the 2 weeks immediately preceding the examination and were positively correlated with personality anxiety or neuroticism traits. Group means for hormones showed no consistent change over the same period. Neither was there evidence for a correlation between endocrine and emotional changes within individual students during the pre-examination period. A restricted study showed that there were significant increments in cortisol in samples taken during the examination itself. Changes in emotional state before an examination occurred in the absence of equally dramatic changes in levels of the three hormones studied, though this relationship may have altered during the examination itself. This suggests that the factors controlling the two categories of response may relate differently, in some way, to the imminence of this stressful event.

  12. Incapacity of the Mind Secondary to Medication Misuse as a Not Criminally Responsible Defense.

    PubMed

    Prat, Sebastien S; Losier, Bruno J; Moulden, Heather M; Chaimowitz, Gary A

    2017-01-01

    The manifestations of disorders of the mind may play a role in the occurrence of criminal behavior. In the majority of the cases, the presence of a psychiatric disorder is cited as the reason that an individual was not fully aware of his behavior. However, other conditions, such as seizure disorders or hypoglycemia, have also been linked to an inability to understand the nature and consequences of one's actions. On occasion, these situations can be explained by a state of automatism that may be described as insane or noninsane. In this article, we describe the case of a 77-year-old man, suffering from Parkinson's disease, where the issue of criminal responsibility associated with incapacity of the mind secondary to medication misuse was raised. We elaborate on the thinking behind this opinion and the implications according to Canadian law. Although the legal outcome of this case is specific to our jurisdiction, the clinical implication may be common to any patient suffering from a similar condition and may inform physicians, families, and lawyers. © 2016 American Academy of Forensic Sciences.

  13. 802.11 Wireless Infrastructure To Enhance Medical Response to Disasters

    PubMed Central

    Arisoylu, Mustafa; Mishra, Rajesh; Rao, Ramesh; Lenert, Leslie A.

    2005-01-01

    802.11 (WiFi) is a well established network communications protocol that has wide applicability in civil infrastructure. This paper describes research that explores the design of 802.11 networks enhanced to support data communications in disaster environments. The focus of these efforts is to create network infrastructure to support operations by Metropolitan Medical Response System (MMRS) units and Federally-sponsored regional teams that respond to mass casualty events caused by a terrorist attack with chemical, biological, nuclear or radiological weapons or by a hazardous materials spill. In this paper, we describe an advanced WiFi-based network architecture designed to meet the needs of MMRS operations. This architecture combines a Wireless Distribution Systems for peer-to-peer multihop connectivity between access points with flexible and shared access to multiple cellular backhauls for robust connectivity to the Internet. The architecture offers a high bandwidth data communications infrastructure that can penetrate into buildings and structures while also supporting commercial off-the-shelf end-user equipment such as PDAs. It is self-configuring and is self-healing in the event of a loss of a portion of the infrastructure. Testing of prototype units is ongoing. PMID:16778990

  14. Ambulance response time and emergency medical dispatcher program: a study in Kelantan, Malaysia.

    PubMed

    Shah, C H Mohd Shaharudin; Ismail, I Mohd; Mohsin, S S J Syed

    2008-11-01

    This study provided data by a simple method of acquiring information related to ambulance response time (ART) and determined whether it met the international standards of ART. Additionally, this paper also compared the duration of ART at this hospital before and after the implementation of an Emergency Medical Dispatcher (EMD) program. The ART, which started when details like phone number of the caller, exact location of the incident and the nature of the main complaint were received and ended when the emergency team arrived at the scene of the incident. The parameters recorded include call processing time, time taken to prepare the team and time taken to travel to the scene. The results of the study revealed that the ART for the university hospital (HUSM) was at 913.2 +/- 276.5 seconds (mean +/- SD) and it was far below the international standard of ART as a benchmark of a good ambulance service. However, the study suggested that the EMD program that was recently implemented at the HUSM gave a significantly improvement to the ART score.

  15. Responses of HMO Medical Directors to Trust Building in Managed Care

    PubMed Central

    Mechanic, David; Rosenthal, Marsha

    1999-01-01

    Managed care organizations (MCOs) are facing intense criticism at national, state, and local levels and battling initiatives that would impose stricter regulation. Medical directors of HMOs were surveyed regarding their organizations’ strategies of communication, the programs they have instituted to build trust, and their commitment to sponsoring family and patient support groups. The responses obtained from 252 directors indicate that nonprofit and free-standing organizations are more likely than either for-profitHMOs or organizations that are part of a chain to sponsor community activities and programs and to offer family and patient support groups. Staff- and group-model HMOs are more likely than other organizational configurations to initiate many types of “trust programs.” The results indicate that more dispersed and “virtual-type” organizations must explore ways to respond meaningfully to community concerns–and to public health, prevention, and health promotion needs as well–while continuing to improve their practice patterns. PMID:10526546

  16. The Response of Radiation Portal Monitors to Medical Radionuclides at Border Crossings

    SciTech Connect

    Kouzes, Richard T.; Siciliano, Edward R.

    2006-05-01

    Radio-pharmaceuticals are found at detectable levels in about one in 2600 Americans. Such individuals are thus commonly found at border crossings where equipment exists for radiation detection, and the resulting alarms must be handled by cognizant officials. A total of approximately 14.4 million medical procedures using radionuclides were performed in the U.S. during 2001. Of this total number of procedures during 2001, approximately 14.2 million were diagnostic procedures and 0.2 million were therapeutic procedures. Although there were over 45 different commercially-available products used in over 75 different types of procedures, 17 isotopes comprise the complete set of active ingredients in the commercially available radiopharmaceuticals in the U.S. Of these, 12 are customarily administered to outpatients, and 9 of these produce energetic photons. At 91.5%, the isotope 99mTc is the one most likely administered by an overwhelming margin. This paper reports on various impacts of radiopharmaceuticals observed at border crossings. Calculations were performed to simulate the photon response of portal radiation monitors to these types of sources. It is shown that at any time, about one in 2600 Americans carries a detectable radiation burden. (PIET-43741-TM-326)

  17. Accounting for medical communication: parents' perceptions of communicative roles and responsibilities in the pediatric intensive care unit.

    PubMed

    Gordon, Cynthia; Barton, Ellen; Meert, Kathleen L; Eggly, Susan; Pollacks, Murray; Zimmerman, Jerry; Anand, K J S; Carcillo, Joseph; Newth, Christopher J L; Dean, J Michael; Willson, Douglas F; Nicholson, Carol

    2009-01-01

    Through discourse analysis of transcribed interviews conducted over the phone with parents whose child died in the Pediatric Intensive Care Unit (PICU) (n = 51), this study uncovers parents' perceptions of clinicians' and their own communicative roles and responsibilities in the context of team-based care. We examine parents' descriptions and narratives of communicative experiences they had with PICU clinicians, focusing on how parents use accounts to evaluate the communicative behaviors they report (n = 47). Findings indicate that parental perceptions of communicative responsibilities are more nuanced than assumed in previous research: Parents identified their own responsibilities as participating as part of the team of care, gathering information, interacting with appropriate affect, and working to understand complex and uncertain medical information. Complementarily, parents identified clinician responsibilities as communicating professionally, providing medical information clearly, managing parents' hope responsibly, and communicating with appropriate affect. Through the accounts they provide, parents evaluate both parental and clinician role-responsibilities as fulfilled and unfulfilled. Clinicians' management of prognostic uncertainty and parents' struggles to understand that uncertainty emerged as key, complementary themes with practical implications for incorporating parents into the PICU care team. The study also highlights insights retrospective interview data bring to the examination of medical communication.

  18. Accounting for medical communication: Parents’ perceptions of communicative roles and responsibilities in the pediatric intensive care unit

    PubMed Central

    GORDON, CYNTHIA; BARTON, ELLEN; MEERT, KATHLEEN L.; EGGLY, SUSAN; POLLACK, MURRAY; ZIMMERMAN, JERRY; ANAND, K. J. S.; CARCILLO, JOSEPH; NEWTH, CHRISTOPHER J. L.; DEAN, J. MICHAEL; WILLSON, DOUGLAS F.; NICHOLSON, CAROL

    2012-01-01

    Through discourse analysis of transcribed interviews conducted over the phone with parents whose child died in the Pediatric Intensive Care Unit (PICU) (n = 51), this study uncovers parents’ perceptions of clinicians’ and their own communicative roles and responsibilities in the context of team-based care. We examine parents’ descriptions and narratives of communicative experiences they had with PICU clinicians, focusing on how parents use accounts to evaluate the communicative behaviors they report (n = 47). Findings indicate that parental perceptions of communicative responsibilities are more nuanced than assumed in previous research: Parents identified their own responsibilities as participating as part of the team of care, gathering information, interacting with appropriate affect, and working to understand complex and uncertain medical information. Complementarily, parents identified clinician responsibilities as communicating professionally, providing medical information clearly, managing parents’ hope responsibly, and communicating with appropriate affect. Through the accounts they provide, parents evaluate both parental and clinician role-responsibilities as fulfilled and unfulfilled. Clinicians’ management of prognostic uncertainty and parents’ struggles to understand that uncertainty emerged as key, complementary themes with practical implications for incorporating parents into the PICU care team. The study also highlights insights retrospective interview data bring to the examination of medical communication. PMID:20635554

  19. Treatment of ADHD with Stimulant Medications: Response to Nissen Perspective in the New England Journal of Medicine

    ERIC Educational Resources Information Center

    Biederman, Joseph; Spencer, Thomas J.; Wilens, Timothy E.; Prince, Jefferson B.; Faraone, Stephen V.

    2006-01-01

    This article is a response to Dr. Steven E. Nissen's comments (Nissen, 2006) about attention deficit/hyperactivity disorder (ADHD) and its treatment with stimulant medications. In this article, the authors refute his arguments and provide accurate information. Here, they answer the questions, such as: (1) Do stimulants increase the risk for sudden…

  20. Predictors and Moderators of Response to Cognitive Behavioral Therapy and Medication for the Treatment of Binge Eating Disorder

    ERIC Educational Resources Information Center

    Grilo, Carlos M.; Masheb, Robin M.; Crosby, Ross D.

    2012-01-01

    Objective: To examine predictors and moderators of response to cognitive behavioral therapy (CBT) and medication treatments for binge-eating disorder (BED). Method: 108 BED patients in a randomized double-blind placebo-controlled trial testing CBT and fluoxetine treatments were assessed prior, throughout, and posttreatment. Demographic factors,…

  1. Blister Packaging Medication to Increase Treatment Adherence and Clinical Response: Impact on Suicide-related Morbidity and Mortality

    DTIC Science & Technology

    2014-12-01

    AD _ Award Number: W81XWH-09-1-0723 TITLE: Blister Packaging Medication to Increase Treatment Adherence and Clinical Response: Impact on Suicide...YYYY) , 2. REPORT TYPE December 2014 Final Report 3. DATES COVERED (From - To) 29Sept2009 - 28 Sept2014 4. TITLE AND SUBTITLE Blister Packaging

  2. Treatment of ADHD with Stimulant Medications: Response to Nissen Perspective in the New England Journal of Medicine

    ERIC Educational Resources Information Center

    Biederman, Joseph; Spencer, Thomas J.; Wilens, Timothy E.; Prince, Jefferson B.; Faraone, Stephen V.

    2006-01-01

    This article is a response to Dr. Steven E. Nissen's comments (Nissen, 2006) about attention deficit/hyperactivity disorder (ADHD) and its treatment with stimulant medications. In this article, the authors refute his arguments and provide accurate information. Here, they answer the questions, such as: (1) Do stimulants increase the risk for sudden…

  3. Predictors and Moderators of Response to Cognitive Behavioral Therapy and Medication for the Treatment of Binge Eating Disorder

    ERIC Educational Resources Information Center

    Grilo, Carlos M.; Masheb, Robin M.; Crosby, Ross D.

    2012-01-01

    Objective: To examine predictors and moderators of response to cognitive behavioral therapy (CBT) and medication treatments for binge-eating disorder (BED). Method: 108 BED patients in a randomized double-blind placebo-controlled trial testing CBT and fluoxetine treatments were assessed prior, throughout, and posttreatment. Demographic factors,…

  4. The british military hospitals in macedonia during the first world war.

    PubMed

    Cvetkovski, Vladimir

    The paper focusses its attention to the medical work of the British Military hospitals stationed in Macedonia during the First World War, the surgical work carried out under very heavy conditions in improvised operating theatres as well as the treatment of the wounded and sick solders brought from the battlefields on the Macedonian Front.

  5. From Stress to Distress: Conceptualizing the British Family Farming Patriarchal Way of Life

    ERIC Educational Resources Information Center

    Price, Linda; Evans, Nick

    2009-01-01

    "Rural stress" and "farming stress" are terms that have become commonly appropriated by British health-based academic disciplines, the medical profession and social support networks, especially since the agricultural "crises" of B.S.E. and Foot and Mouth disease. Looking beyond the media headlines, it is apparent that…

  6. From Stress to Distress: Conceptualizing the British Family Farming Patriarchal Way of Life

    ERIC Educational Resources Information Center

    Price, Linda; Evans, Nick

    2009-01-01

    "Rural stress" and "farming stress" are terms that have become commonly appropriated by British health-based academic disciplines, the medical profession and social support networks, especially since the agricultural "crises" of B.S.E. and Foot and Mouth disease. Looking beyond the media headlines, it is apparent that…

  7. British and American attitudes toward credit cards.

    PubMed

    Yang, Bijou; James, Simon; Lester, David

    2006-04-01

    American university students owned more than twice as many credit cards as British university students. However, scores on a credit card attitude scale predicted the number of cards owned by respondents in both countries.

  8. Racial Discrimination in the British Labor Market.

    ERIC Educational Resources Information Center

    Firth, Michael

    1981-01-01

    Contains results of a study of racial discrimination in the British job market for accountants and financial executives. Results show that considerable discrimination remains several years after the adoption of the Race Relations Act of 1968. (CT)

  9. Libraries in British Columbia: MedlinePlus

    MedlinePlus

    ... this page: https://medlineplus.gov/libraries/britishcolumbia.html Libraries in British Columbia To use the sharing features ... George University Hospital of Northern BC Northern Health Library Services / ILL Learning & Development Centre 1475 Edmonton Street ...

  10. [The British Surgeon William Wittman's impression of Istanbul and its neighborhood's health problems surrounding at the beginning of 19th century].

    PubMed

    Görkey, S

    1993-01-01

    British surgeon William Wittman visited the Ottoman Empire between the years 1799 and 1802 as a member of the British Military Mission. The British Military Mission came to the Ottoman Territory in accordance with the alliance which was enacted between the Ottoman and British Empires after Napoleons' invasion of Egypt. William Wittman spent a year in Istanbul. Later on he went to Jaffa with the British Military Mission to join the Ottoman army. They traveled through El-Arish and Belbeis to Cairo with the army. During this time Wittman recorded the health problems and the diseases which were prevalent both in the Ottoman army and the British Military Mission. He also recorded the cases which he tried to cure. William Wittman appended three medical reports to his travel report. This article is on William Wittman's biography and his impressions of the Levant Chiflick in Istanbul; health problems, and diseases prevalent in Istanbul and its neighborhood during the period.

  11. Does the private finance initiative promote innovation in health care? The case of the British National Health Service.

    PubMed

    Petratos, Pythagoras

    2005-12-01

    The Private Finance Initiative (PFI) is a specific example of health care privatization within the British National Health Service. In this essay, I critically assess the ways in which various Private Finance Initiatives have increased health care efficiency and effectiveness, as well as encouraged medical innovation. Indeed, as the analysis will demonstrate, significant empirical evidence supports the conclusion that Private Finance Initiatives are a driving force of innovation within the British Health Care System.

  12. Did Senior British Officers Effectively Lead Change?

    DTIC Science & Technology

    2014-12-12

    environment that defined the changes to the British Army will be assessed against four factors: political, economic, technology, and environmental factors.57...last five years. Financial considerations were paramount as the British Army sought to transform and meet the future operating environment . This...and areas for improvement were always couched in a realistic appreciation of the environment in which change was carried out: non-conducive and

  13. Geographic Discordance Between Patient Residence and Incident Location in Emergency Medical Services Responses.

    PubMed

    Hsia, Renee Y; Dai, Mengtao; Wei, Ran; Sabbagh, Sarah; Mann, N Clay

    2017-01-01

    The location of a patient's residence is often used for emergency medical services (EMS) system planning. Our objective is to evaluate the association between patient residence and emergency incident zip codes for 911 calls. We used data from the 2013 National Emergency Medical Services Information System (NEMSIS) Public-Release Research Dataset. We studied all 911 calls with a valid complaint by dispatch, identifying zip codes for both the residence and incident locations (n=12,376,784). The primary outcomes were geographic and distance discordances between patient residence and incident zip codes. We used a multivariate logistic regression model to determine geographic discordance between residence and incident zip codes by dispatch complaint, age, and sex. We also measured distances between locations with geospatial processing. The overall proportion of geographic discordance for all 911 calls was 27.7% (95% confidence interval [CI] 27.7% to 27.8%) and the median distance discordance was 11.5 miles (95% CI 11.5 to 11.5 miles). Lower geographic discordance rates were found among patients aged 65 to 79 years (20.2%; 95% CI 20.1% to 20.2%) and 80 years and older (14.5%; 95% CI 14.5% to 14.6%). Motor vehicle crashes (63.5%; 95% CI 63.5% to 63.6%), industrial accidents (59.3%; 95% CI 58.0% to 60.6%), and mass casualty incidents (50.6%; 95% CI 49.6% to 51.5%) were more likely to occur outside a patient's residence zip code. Median network distance between home and incident zip centroid codes ranged from 8.6 to 23.5 miles. In NEMSIS, there was geographic discordance between patient residence zip code and call location zip code in slightly more than one quarter of EMS responses records. The geographic discordance rates between residence and incident zip codes were associated with dispatch complaints and age. Although a patient's residence might be a valid proxy for incident location for elderly patients, this relationship holds less true for other age groups and among

  14. Effects of motivation and medication on electrophysiological markers of response inhibition in children with attention-deficit/hyperactivity disorder.

    PubMed

    Groom, Madeleine J; Scerif, Gaia; Liddle, Peter F; Batty, Martin J; Liddle, Elizabeth B; Roberts, Katherine L; Cahill, John D; Liotti, Mario; Hollis, Chris

    2010-04-01

    Theories of attention-deficit/hyperactivity disorder (ADHD) posit either executive deficits and/or alterations in motivational style and reward processing as core to the disorder. Effects of motivational incentives on electrophysiological correlates of inhibitory control and relationships between motivation and stimulant medication have not been explicitly tested. Children (9-15 years) with combined-type ADHD (n = 28) and matched typically developing children (CTRL) (n = 28) performed a go/no-go task. Electroencephalogram data were recorded. Amplitude of two event-related potentials, the N2 and P3 (markers of response conflict and attention), were measured. The ADHD children were all stimulant responders tested on and off their usual dose of methylphenidate; CTRLs were never medicated. All children performed the task under three motivational conditions: reward; response cost; and baseline, in which points awarded/deducted for inhibitory performance varied. There were effects of diagnosis (CTRL > ADHD unmedicated), medication (on > off), and motivation (reward and/or response cost > baseline) on N2 and P3 amplitude, although the N2 diagnosis effect did not reach statistical significance (p = .1). Interactions between motivation and diagnosis/medication were nonsignificant (p > .1). Motivational incentives increased amplitudes of electrophysiological correlates of response conflict and attention in children with ADHD, towards the baseline (low motivation) amplitudes of control subjects. These results suggest that, on these measures, motivational incentives have similar effects in children with ADHD as typically developing CTRLs and have additive effects with stimulant medication, enhancing stimulus salience and allocation of attentional resources during response inhibition. Copyright 2010 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  15. Effects of Motivation and Medication on Electrophysiological Markers of Response Inhibition in Children with Attention-Deficit/Hyperactivity Disorder

    PubMed Central

    Groom, Madeleine J.; Scerif, Gaia; Liddle, Peter F.; Batty, Martin J.; Liddle, Elizabeth B.; Roberts, Katherine L.; Cahill, John D.; Liotti, Mario; Hollis, Chris

    2010-01-01

    Background Theories of attention-deficit/hyperactivity disorder (ADHD) posit either executive deficits and/or alterations in motivational style and reward processing as core to the disorder. Effects of motivational incentives on electrophysiological correlates of inhibitory control and relationships between motivation and stimulant medication have not been explicitly tested. Methods Children (9–15 years) with combined-type ADHD (n = 28) and matched typically developing children (CTRL) (n = 28) performed a go/no-go task. Electroencephalogram data were recorded. Amplitude of two event-related potentials, the N2 and P3 (markers of response conflict and attention), were measured. The ADHD children were all stimulant responders tested on and off their usual dose of methylphenidate; CTRLs were never medicated. All children performed the task under three motivational conditions: reward; response cost; and baseline, in which points awarded/deducted for inhibitory performance varied. Results There were effects of diagnosis (CTRL > ADHD unmedicated), medication (on > off), and motivation (reward and/or response cost > baseline) on N2 and P3 amplitude, although the N2 diagnosis effect did not reach statistical significance (p = .1). Interactions between motivation and diagnosis/medication were nonsignificant (p > .1). Conclusions Motivational incentives increased amplitudes of electrophysiological correlates of response conflict and attention in children with ADHD, towards the baseline (low motivation) amplitudes of control subjects. These results suggest that, on these measures, motivational incentives have similar effects in children with ADHD as typically developing CTRLs and have additive effects with stimulant medication, enhancing stimulus salience and allocation of attentional resources during response inhibition. PMID:19914599

  16. High intensity scenario training of military medical students to increase learning capacity and management of stress response.

    PubMed

    Mueller, Genevieve R; Moloff, Alan L; Wedmore, Ian S; Schoeff, Jonathan E; Laporta, Anthony J

    2012-01-01

    A delicate balance exists between a beneficial stress response that enhances memory and recall performance and a detrimental high stress response that impairs memory and learning. Repetitive training in stressful situations enables people to lower their stress levels from the detrimental range to a more beneficial one.1 This is particularly true for physicians in training as they seek to achieve advanced skills and knowledge in the fields of triage, emergency medicine, and surgery prior to graduation. This need is significant for medical students entering military service after graduation. We theorize that military medical students can advance their proficiencies through an Intensive Skills Week (ISW) prior to entering their third and forth year rotations. To test this theory, Rocky Vista University will hold a week long high-intensity first-responder, emergency medicine and surgical training course, facilitated by military medical physicians, to further students? skills and maximize training using the Human Worn Partial Surgical Task Simulator (Cut Suit). We also see the possible benefit to physician and non-physician military personnel, especially Special Operations Forces (SOF) medical personnel, from developing and implementing similar training programs when live tissue or cadaver models are unavailable or not feasible. Stress, cortisol, medical student, enhanced learning, scenario, high intensity. 2012.

  17. Criminal law as a response to medical malpractice: pluses and minuses--comparing Italian and U.S. experiences.

    PubMed

    Di Landro, Andrea R

    2012-06-01

    The paper is divided into three parts. The first part sets out the comparative differences between the tort of malpractice in common law and the criminal negligence in civil law: while the common law takes for mens rea only the "gross" negligence, and rarely medical negligence, other law systems instead (and particularly Italian law) criminalize also ordinary negligence, frequently in medical malpractice cases. The second part of the paper addresses the pluses of using criminal law as response to medical malpractice: inadequate medical self-policing and "repeat offenders" problems are analysed, in the perspective of the patient, of the doctor, of the insurance company, and of the community. The third part addresses the minuses of the criminal law as response: medical "shame and blame" mentality, criminal stigma and culture of fear are disincentives to incident reporting and to system analysis (the most important means of prevention); "defensive medicine" and "courts-abiding medicine" are managed not yet in the patient's exclusive interest, but in the egoistic/utilitarian aim to avoid denunciations; finally, the uncertainty of the medicine, the accusatory system and the proof "beyond a reasonable doubt" seem hardly compatible with each other.

  18. Cancer incidence in British vegetarians.

    PubMed

    Key, T J; Appleby, P N; Spencer, E A; Travis, R C; Allen, N E; Thorogood, M; Mann, J I

    2009-07-07

    Few prospective studies have examined cancer incidence among vegetarians. We studied 61,566 British men and women, comprising 32,403 meat eaters, 8562 non-meat eaters who did eat fish ('fish eaters') and 20,601 vegetarians. After an average follow-up of 12.2 years, there were 3350 incident cancers of which 2204 were among meat eaters, 317 among fish eaters and 829 among vegetarians. Relative risks (RRs) were estimated by Cox regression, stratified by sex and recruitment protocol and adjusted for age, smoking, alcohol, body mass index, physical activity level and, for women only, parity and oral contraceptive use. There was significant heterogeneity in cancer risk between groups for the following four cancer sites: stomach cancer, RRs (compared with meat eaters) of 0.29 (95% CI: 0.07-1.20) in fish eaters and 0.36 (0.16-0.78) in vegetarians, P for heterogeneity=0.007; ovarian cancer, RRs of 0.37 (0.18-0.77) in fish eaters and 0.69 (0.45-1.07) in vegetarians, P for heterogeneity=0.007; bladder cancer, RRs of 0.81 (0.36-1.81) in fish eaters and 0.47 (0.25-0.89) in vegetarians, P for heterogeneity=0.05; and cancers of the lymphatic and haematopoietic tissues, RRs of 0.85 (0.56-1.29) in fish eaters and 0.55 (0.39-0.78) in vegetarians, P for heterogeneity=0.002. The RRs for all malignant neoplasms were 0.82 (0.73-0.93) in fish eaters and 0.88 (0.81-0.96) in vegetarians (P for heterogeneity=0.001). The incidence of some cancers may be lower in fish eaters and vegetarians than in meat eaters.

  19. British women's attitudes to surrogacy.

    PubMed

    Poote, A E; van den Akker, O B A

    2009-01-01

    There has been little interest in the research literature on public opinions regarding assisted conception and surrogacy, particularly in European countries, despite the growing evidence showing that problems in adaptation and coping may be related to perceived normative values. This study investigated British women's attitudes to surrogacy using components of the theory of planned behaviour (TPB). Questionnaires on attitudes to surrogacy and reasons for parenthood were completed by 187 women from the general public. Significant socio-demographic differences were found between women who were possibly willing (n = 76) and those who were unwilling (n = 111) to become surrogate mothers. General attitudes to surrogacy also differed between groups (P = 0.000). This study supported the predictive utility of components of the TPB, and differentiated adequately between groups on attitudes to recruitment for surrogacy (P = 0.000), the consequences of surrogacy (P = 0.000), factors that induce people to become surrogates (P = 0.000), social support (P = 0.000), having personal control (P = 0.002) and reasons for parenthood (P = 0.000). Age (P = 0.000), attitudes to advertising (P = 0.02) and the consequences of surrogacy (P = 0.05) predicted (un)willingness to become a potential surrogate mother. Further research is needed with larger sample sizes of potential surrogates to determine whether the predictive attitudes reported here translate to actual behaviours. The larger group which was not interested in considering becoming a surrogate scored significantly more negatively on all attitudes towards surrogacy. The negative attitudes reported by the 'unwilling to consider being a surrogate' group may reflect attitudes held by the majority of the population and are likely to be influenced by reports of stigma associated with surrogacy.

  20. Outbound medical tourism from Mongolia: a qualitative examination of proposed domestic health system and policy responses to this trend.

    PubMed

    Snyder, Jeremy; Byambaa, Tsogtbaatar; Johnston, Rory; Crooks, Valorie A; Janes, Craig; Ewan, Melanie

    2015-05-03

    Medical tourism is the practice of traveling across international boundaries in order to access medical care. Residents of low-to-middle income countries with strained or inadequate health systems have long traveled to other countries in order to access procedures not available in their home countries and to take advantage of higher quality care elsewhere. In Mongolia, for example, residents are traveling to China, Japan, Thailand, South Korea, and other countries for care. As a result of this practice, there are concerns that travel abroad from Mongolia and other countries risks impoverishing patients and their families. In this paper, we present findings from 15 interviews with Mongolian medical tourism stakeholders about the impacts of, causes of, and responses to outbound medical tourism. These findings were developed using a case study methodology that also relied on tours of health care facilities and informal discussions with citizens and other stakeholders during April, 2012. Based on these findings, health policy changes are needed to address the outflow of Mongolian medical tourists. Key areas for reform include increasing funding for the Mongolian health system and enhancing the efficient use of these funds, improving training opportunities and incentives for health workers, altering the local culture of care to be more supportive of patients, and addressing concerns of corruption and favouritism in the health system. While these findings are specific to the Mongolian health system, other low-to-middle income countries experiencing outbound medical tourism will benefit from consideration of how these findings apply to their own contexts. As medical tourism is increasing in visibility globally, continued research on its impacts and context-specific policy responses are needed.