Schindler, Debra L.; Chibnall, John T.
Medical education can have significant negative effects on the well-being of medical students. To date, efforts to improve student mental health have focused largely on improving access to mental health providers, reducing the stigma and other barriers to mental health treatment, and implementing ancillary wellness programs. Still, new and innovative models that build on these efforts by directly addressing the root causes of stress that lie within the curriculum itself are needed to properly promote student wellness. In this article, the authors present a new paradigm for improving medical student mental health, by describing an integrated, multifaceted, preclinical curricular change program implemented through the Office of Curricular Affairs at the Saint Louis University School of Medicine starting in the 2009–2010 academic year. The authors found that significant but efficient changes to course content, contact hours, scheduling, grading, electives, learning communities, and required resilience/mindfulness experiences were associated with significantly lower levels of depression symptoms, anxiety symptoms, and stress, and significantly higher levels of community cohesion, in medical students who participated in the expanded wellness program compared with those who preceded its implementation. The authors discuss the utility and relevance of such curricular changes as an overlooked component of change models for improving medical student mental health. PMID:24556765
Slavin, Stuart J; Schindler, Debra L; Chibnall, John T
Medical education can have significant negative effects on the well-being of medical students. To date, efforts to improve student mental health have focused largely on improving access to mental health providers, reducing the stigma and other barriers to mental health treatment, and implementing ancillary wellness programs. Still, new and innovative models that build on these efforts by directly addressing the root causes of stress that lie within the curriculum itself are needed to properly promote student wellness. In this article, the authors present a new paradigm for improving medical student mental health, by describing an integrated, multifaceted, preclinical curricular change program implemented through the Office of Curricular Affairs at the Saint Louis University School of Medicine starting in the 2009-2010 academic year. The authors found that significant but efficient changes to course content, contact hours, scheduling, grading, electives, learning communities, and required resilience/mindfulness experiences were associated with significantly lower levels of depression symptoms, anxiety symptoms, and stress, and significantly higher levels of community cohesion, in medical students who participated in the expanded wellness program compared with those who preceded its implementation. The authors discuss the utility and relevance of such curricular changes as an overlooked component of change models for improving medical student mental health.
Uchegbu, B O
The ideal operational curriculum is dynamic. It is alive, constantly responding to changes within the social milieu served by its programmes. The medical curriculum of the University of the West Indies (UWI) has not been readily responsive to its catchment society's changing needs. This lack of resilience has created both curricular and administrative problems that have remained unsolved. Now, at the threshold of the twenty-first century, many more fundamental curricular changes are imperative in the UWI medical programme if the Faculty of Medical Sciences (FMS) is to be able to withstand the territorial invasions imminent from the global digital institutions of the new age. The new changes that will place the medical curriculum in line with the demands of the new Information Age will also remove the obnoxious effects of the 'dual curriculum' question and related issues. The Change Formula (Ch = V x P x D > C) that has worked the corporate transformations and realignments of the late twentieth century is applied to the thoughts of a reformed management of the UWI medical curriculum, and its ability to break down walls of resistance to change and liberate the curriculum to full dynamism is discussed.
Vanderbilt, Allison A; Baugh, Reginald F; Hogue, Patricia A; Brennan, Julie A; Ali, Imran I
In the United States, the health of a community falls on a continuum ranging from healthy to unhealthy and fluctuates based on several variables. Research policy and public health practice literature report substantial disparities in life expectancy, morbidity, risk factors, and quality of life, as well as persistence of these disparities among segments of the population. One such way to close this gap is to streamline medical education to better prepare our future physicians for our patients in underserved communities. Medical schools have the potential to close the gap when training future physicians by providing them with the principles of social medicine that can contribute to the reduction of health disparities. Curriculum reform and systematic formative assessment and evaluative measures can be developed to match social medicine and health disparities curricula for individual medical schools, thus assuring that future physicians are being properly prepared for residency and the workforce to decrease health inequities in the United States. We propose that curriculum reform includes an ongoing social medicine component for medical students. Continued exposure, practice, and education related to social medicine across medical school will enhance the awareness and knowledge for our students. This will result in better preparation for the zero mile stone residency set forth by the Accreditation Council of Graduate Medical Education and will eventually lead to the outcome of higher quality physicians in the United States to treat diverse populations.
Prince, Lisa K; Little, Dustin J; Schexneider, Katherine I; Yuan, Christina M
The Accreditation Council for Graduate Medical Education requires that trainees show progressive milestone attainment in the practice-based learning and systems-based practice competencies. As part of the Clinical Learning Environment Review, sponsoring hospitals must educate trainees in health care quality improvement, provide them with specialty-specific quality data, and ensure trainee participation in quality improvement activities and committees. Subspecialty-specific quality improvement curricula in nephrology training programs have not been reported, although considerable curricular and assessment material exists for specialty residencies, including tools for assessing trainee and faculty competence. Nephrology-specific didactic material exists to assist nephrology fellows and faculty mentors in designing and implementing quality improvement projects. Nephrology is notable among internal medicine subspecialties for the emphasis placed on adherence to quality thresholds-specifically for chronic RRT shown by the Centers for Medicare and Medicaid Services Quality Incentive Program. We have developed a nephrology-specific curriculum that meets Accreditation Council for Graduate Medical Education and Clinical Learning Environment Review requirements, acknowledges regulatory quality improvement requirements, integrates with ongoing divisional quality improvement activities, and has improved clinical care and the training program. In addition to didactic training in quality improvement, we track trainee compliance with Kidney Disease Improving Global Outcomes CKD and ESRD quality indicators (emphasizing Quality Improvement Program indicators), and fellows collaborate on a yearly multidisciplinary quality improvement project. Over the past 6 years, each fellowship class has, on the basis of a successful quality improvement project, shown milestone achievement in Systems-Based Practice and Practice-Based Learning. Fellow quality improvement projects have improved
Wohlauer, Max V; Arora, Vineet M; Horwitz, Leora I; Bass, Ellen J; Mahar, Sean E; Philibert, Ingrid
In 2010, the Accreditation Council for Graduate Medical Education released its resident duty hours restrictions, requiring that faculty monitor their residents' patient handoffs to ensure that residents are competent in handoff communications. Although studies have reported the need to improve the effectiveness of the handoff and a variety of curricula have been suggested and implemented, a common method for teaching and evaluating handoff skills has not been developed. Also in 2010, engineers, informaticians, and physicians interested in patient handoffs attended a symposium in Savannah, Georgia, hosted by the Association for Computing Machinery, entitled Handovers and Handoffs: Collaborating in Turns. As a result of this symposium, a workgroup formed to develop practical and readily implementable educational materials for medical educators involved in teaching patient handoffs to residents. In this article, the result of that yearlong collaboration, the authors aim to provide clarity on the definition of the patient handoff, to review the barriers to performing effective handoffs in academic health centers, to identify available solutions to improve handoffs, and to provide a structured approach to educating residents on handoffs via a curricular blueprint. The authors' blueprint was developed to guide educators in customizing handoff education programs to fit their specific, local needs. Hopefully, it also will provide a starting point for future research into improving the patient handoff. Increasingly complex patient care environments require both innovations in handoff education and improvements in patient care systems to improve continuity of care.
Wohlauer, Max V.; Arora, Vineet M.; Horwitz, Leora I.; Bass, Ellen J.; Mahar, Sean E.; Philibert, Ingrid
In 2010, the Accreditation Council for Graduate Medical Education released its resident duty hours restrictions, requiring that faculty monitor their residents’ patient handoffs to ensure that residents are competent in handoff communications. Although studies have reported the need to improve the effectiveness of the handoff and a variety of curricula have been suggested and implemented, a common method for teaching and evaluating handoff skills has not been developed. Also in 2010, engineers, informaticians, and physicians interested in patient handoffs attended a symposium in Savannah, Georgia, hosted by the Association for Computing Machinery, entitled Handovers and Handoffs: Collaborating in Turns. As a result of this symposium, a workgroup formed to develop practical and readily implementable educational materials for medical educators involved in teaching patient handoffs to residents. In this article, the result of that yearlong collaboration, the authors aim to provide clarity on the definition of the patient handoff, to review the barriers to performing effective handoffs in academic health centers, to identify available solutions to improve handoffs, and to provide a structured approach to educating residents on handoffs via a curricular blueprint. The authors’ blueprint was developed to guide educators in customizing handoff education programs to fit their specific, local needs. Hopefully, it also will provide a starting point for future research into improving the patient handoff. Increasingly complex patient care environments require both innovations in handoff education and improvements in patient care systems to improve continuity of care. PMID:22361791
Kanter, S L; Miller, R A; Tan, M; Schwartz, J
Recognition of the biomedical concepts in a document is prerequisite to further processing of the document: medical educators examine curricular documents to discover the coverage of certain topics, detect unwanted redundancies, integrate new content, and delete old content; and clinicians are concerned with terms in patient medical records for purposes ranging from creation of an electronic medical record to identification of medical literature relevant to a particular case. POSTDOC (POSTprocessor of DOCuments) is a computer application that (1) accepts as input a free-text, ASCII-formatted document and uses the Unified Medical Language System (UMLS) Metathesaurus to recognize relevant main concept terms; (2) provides term co-occurrence data and thus is able to identify potentially increasing correlations among concepts within the document; and (3) retrieves references from MEDLINE files based on user identification of relevant subjects. This paper describes a formative evaluation of POSTDOC's ability to recognize UMLS Metathesaurus biomedical concepts in medical school lecture outlines. The "precision" and "recall" varied over a wide range and were deemed not yet acceptable for automated creation of a database of concepts from curricular documents. However, results were good enough to warrant further study and continued system development.
Hylton, Ann C.; Justice, Michael
Objective. To identify and address areas for curricular improvement by evaluating student achievement of expected learning outcomes and competencies on annual milestone examinations. Design. Students were tested each professional year with a comprehensive milestone examination designed to evaluate student achievement of learning outcomes and professional competencies using a combination of multiple-choice questions, standardized patient assessments (SPAs), and objective structured clinical examination (OSCE) questions. Assessment. Based on student performance on milestone examinations, curricular changes were instituted, including an increased emphasis on graded comprehensive cases, OSCE skills days, and use of patient simulation in lecture and laboratory courses. After making these changes, significant improvements were observed in second and third-year pharmacy students’ grades for the therapeutic case and physician interaction/errors and omissions components of the milestone examinations. Conclusion. Results from milestone examinations can be used to identify specific areas in which curricular improvements are needed to foster student achievement of learning outcomes and professional competencies. PMID:28090108
Nazha, Bassel; Salloum, Rony H.; Fahed, Akl C.; Nabulsi, Mona
Early integration of research education into medical curricula is crucial for evidence-based practice. Yet, many medical students are graduating with no research experience due to the lack of such integration in their medical school programs. The purpose of this study was to explore the impact of a peer-organized, extra-curricular research methodology course on the attitudes of medical students towards research and future academic careers. Twenty one medical students who participated in a peer-organized research course were enrolled in three focus group discussions to explore their experiences, perceptions and attitudes towards research after the course. Discussions were conducted using a semi-structured interview guide, and were transcribed and thematically analyzed for major and minor themes identification. Our findings indicate that students’ perceptions of research changed after the course from being difficult initially to becoming possible. Participants felt that their research skills and critical thinking were enhanced and that they would develop research proposals and abstracts successfully. Students praised the peer-assisted teaching approach as being successful in enhancing the learning environment and filling the curricular gap. In conclusion, peer-organized extra-curricular research courses may be a useful option to promote research interest and skills of medical students when gaps in research education in medical curricula exist. PMID:25764441
Nazha, Bassel; Salloum, Rony H; Fahed, Akl C; Nabulsi, Mona
Early integration of research education into medical curricula is crucial for evidence-based practice. Yet, many medical students are graduating with no research experience due to the lack of such integration in their medical school programs. The purpose of this study was to explore the impact of a peer-organized, extra-curricular research methodology course on the attitudes of medical students towards research and future academic careers. Twenty one medical students who participated in a peer-organized research course were enrolled in three focus group discussions to explore their experiences, perceptions and attitudes towards research after the course. Discussions were conducted using a semi-structured interview guide, and were transcribed and thematically analyzed for major and minor themes identification. Our findings indicate that students' perceptions of research changed after the course from being difficult initially to becoming possible. Participants felt that their research skills and critical thinking were enhanced and that they would develop research proposals and abstracts successfully. Students praised the peer-assisted teaching approach as being successful in enhancing the learning environment and filling the curricular gap. In conclusion, peer-organized extra-curricular research courses may be a useful option to promote research interest and skills of medical students when gaps in research education in medical curricula exist.
Chin, Eliza L; Hoggatt, Marley; McGregor, Alyson J; Rojek, Mary K; Templeton, Kimberly; Casanova, Robert; Klein, Wendy S; Miller, Virginia M; Jenkins, Marjorie
The Sex and Gender Medical Education Summit: a roadmap for curricular innovation was a collaborative initiative of the American Medical Women's Association, Laura W. Bush Institute for Women's Health, Mayo Clinic, and Society for Women's Health Research (www.sgbmeducationsummit.com). It was held on October 18-19, 2015 to provide a unique venue for collaboration among nationally and internationally renowned experts in developing a roadmap for the incorporation of sex and gender based concepts into medical education curricula. The Summit engaged 148 in-person attendees for the 1 1/2-day program. Pre- and post-Summit surveys assessed the impact of the Summit, and workshop discussions provided a framework for informal consensus building. Sixty-one percent of attendees indicated that the Summit had increased their awareness of the importance of sex and gender specific medicine. Other comments indicate that the Summit had a significant impact for motivating a call to action among attendees and provided resources to initiate change in curricula within their home institutions. These educational efforts will help to ensure a sex and gender basis for delivery of health care in the future.
Dowers, Kristy L; Schoenfeld-Tacher, Regina M; Hellyer, Peter W; Kogan, Lori R
The ethics document of the Association of American Veterinary Medical Colleges provides guiding principles for veterinary schools to develop conflict of interest policies. These policies regulate faculty and student interactions with industry, potentially reducing the influence companies have on students' perceptions and future prescribing practices. This paper examines the implementation of a conflict of interest policy and related instructional activities at one veterinary college in the US. To inform policy and curricular development, survey data were collected regarding veterinary students' attitudes toward pharmaceutical marketing, including their perceptions of their own susceptibility to bias in therapeutic decisions. Responses from this group of students later served as control data for assessing the effectiveness of educational programs in the content area. A conflict of interest policy was then implemented and presented to subsequent classes of entering students. Classroom instruction and relevant readings were provided on ethics, ethical decision making, corporate influences, and the issue of corporate influence in medical student training. Within seven days of completing a learning program on conflict of interest issues, another cohort of veterinary students (the treatment group) were administered the same survey that had been administered to the control group. When compared with the control group who received no instruction, survey results for the treatment group showed moderate shifts in opinion, with more students questioning the practice of industry-sponsored events and use of corporate funds to reduce tuition. However, many veterinary students in the treatment group still reported they would not be personally influenced by corporate gifts.
Pinciroli, Francesco; Bonacina, Stefano; Marceglia, Sara; Ferrante, Simona; Mazzola, Luca
Curricular recommendations coming from highly respectable associations are highly useful. Nevertheless, they show fatigue in keeping the pace of any fast evolution, as in the ICT happens. So we do the attempt to disclose the emerging challenges affecting e-Health curricular education.
Ahmed, Rami A; Frey, Jennifer; Gardner, Aimee K; Gordon, James A; Yudkowsky, Rachel; Tekian, Ara
Background In the past few years, there has been rapid growth in the number of simulation fellowships for physicians in the United States and Canada, with the objective of producing faculty with expertise and leadership training in medical simulation. Relatively little is known about the collective content and structure of these new fellowship opportunities. Objective We sought to identify a common set of core curricular elements among existing simulation fellowships and to obtain demographic background information on participants and leadership. Methods We designed a web-based survey and circulated it to simulation fellowship directors in the United States and Canada. The questions explored aspects of the fellowship curriculum. A grounded theory approach was used to qualitatively analyze fellowship goals and objectives. Results Of the 29 program directors surveyed, 23 responded (79%). The most commonly listed goals and objectives were to increase skills in simulation curriculum development, simulation operations and training environment setup, research, educational theory, administration, and debriefing. The majority of the responding fellowship directors (17 of 22, 77%) indicated that a set of consensus national guidelines would benefit their fellowship program. Conclusions Simulation fellowships are experiencing a period of rapid growth. Development of a common set of program guidelines is a widely shared objective among fellowship directors.
Gandy, Robyn A.; Herial, Nabeel A.; Khuder, Sadik A.; Metting, Patricia J.
This paper studies student performance predictions based on the United States Medical Licensure Exam (USMLE) Step 1. Subjects were second-year medical students from academic years of 2002 through 2006 (n = 711). Three measures of basic science knowledge (two curricular and one extracurricular) were evaluated as predictors of USMLE Step 1 scores.…
Meder, A; Lammerding-Köppel, M; Zundel, S; Stöckle, U; Bahrs, C; Gonser, C
Background: There is a serious lack of young doctors in trauma surgery, which has intensified in recent years. The reasons are complex. Studies have shown that the interest in starting a career in surgery significantly decreases during medical school. To counteract the lack of young talent in the clinic, interest in the subject should be aroused in medical school. The aim of the present study was to evaluate current teaching at our university, where trauma surgery is a curricular subject with mandatory attendance for all medical students. Material and Methods: The current curriculum is intended for medicine students in their fifth year. The curriculum comprises lectures, practical courses and observation modules held in small groups. Students are provided with an experienced surgeon as teacher and mentor for the whole week. A teaching and training centre is available for the practical courses. In an anonymised questionnaire, students were asked about their overall assessment and the training success of practical and theory-oriented modules, as well as their specific interest in traumatology. Results: The evaluated curriculum gave very good results, with an overall rating of 1.53 (average) on a 6-point Likert scale in the overall assessment. It could be shown that students previously not interested in starting a career in trauma surgery showed significantly more interest in the subject after the curriculum. The practical parts scored best in the individual assessment. Conclusion: We showed that intensive teaching can arouse interest in traumatology in students who had been indifferent to orthopaedics and traumatology.
Laufs, U; Böhm, M; Kroemer, H K; Schüssel, K; Griese, N; Schulz, M
Up to 50 % of patients with chronic diseases do not take their medication regularly. Poor adherence to drug therapy is associated with higher morbidity and mortality. A selective literature search using the terms adherence, compliance, concordance, persistence, medication management, and pharmaceutical care was performed. Evidence for improving adherence has been provided for the following principles: individual counselling of patients and care givers, medication management including simplifying dosing and use of combination tablets as well as the use of individual unit doses, e. g. blister cards. The effectiveness has only been shown for the duration of the interventions. The improvement of medication adherence represents an area of research with high impact on outcomes and cost. Measures to improve adherence may be as important as the development of novel therapies. However, prospective clinical evaluations with clinical endpoints are missing especially for the German health care system in order to develop recommendations for clinical practice. Joint efforts of physicians and pharmacists are needed.
The GMC states that "Trainees in hospital posts must have well organised handover arrangements, ensuring continuity of patient care". In the Belfast City Hospital throughout the day there can be multiple new medical admissions. These can be via the GP Unit, transfers for tertiary care, and transfers due to bed shortages in other hospitals. Over the course of 24 hours there can be up to four medical SHOs and three registrars that fill in the take sheet. Due to the variety of admission routes and number of doctors looking after the medical take information can be lost during handover between SHOs. In the current format there is little room to write and key and relevant information on the medical take sheet about new and transferring patients. I felt that this handover sheet could be improved. An initial questionnaire demonstrated that 47% found the old proforma easy to use and 28.2% felt that it allowed them to identify sick patients. 100% of SHOs and Registrars surveyed felt that it could be improved from its current form. From feedback from my colleagues I created a new template and trialled it in the hospital. A repeat questionnaire demonstrated that 92.3% of responders felt the new format had improved medical handover and that 92.6% felt that it allowed safe handover most of the time/always. The success of this new proforma resulted in it being implemented on a permanent basis for new medical admissions and transfers to the hospital.
Shoemaker, Joy R; Chavez, Ruth A; Keane, Patricia; Butz, Susan; Yowler, Susan K
Achieving satisfactory first-time pass rates on the national nursing licensure examination represents a challenge for nursing programs across the United States. The consequences of examination failure for first-time test takers can be devastating, both emotionally and financially. Nursing programs are evaluated by national higher-education credentialing bodies and state boards of nursing based on the first-time pass rate of their students. One Midwestern nursing program faced unsatisfactory first-time pass rates and developed strategies for improving first-time pass rates over a 3-year period. The nursing program utilized several strategies documented in the literature but found implementing computerized curricular assistive tools that complemented the nursing program's curriculum to be most effective. In addition, changing faculty and student culture on preparation for the national licensure examination was beneficial to all involved in the process.
Jagadeesan, Vikrant S.; Raleigh, David R.; Koshy, Matthew; Howard, Andrew R.; Chmura, Steven J.; Golden, Daniel W.
Purpose: Students applying to radiation oncology residency programs complete 1 or more radiation oncology clerkships. This study assesses student experiences and perspectives during radiation oncology clerkships. The impact of didactic components and number of clerkship experiences in relation to confidence in clinical competency and preparation to function as a first-year radiation oncology resident are evaluated. Methods and Materials: An anonymous, Internet-based survey was sent via direct e-mail to all applicants to a single radiation oncology residency program during the 2012-2013 academic year. The survey was composed of 3 main sections including questions regarding baseline demographic information and prior radiation oncology experience, rotation experiences, and ideal clerkship curriculum content. Results: The survey response rate was 37% (70 of 188). Respondents reported 191 unique clerkship experiences. Of the respondents, 27% (19 of 70) completed at least 1 clerkship with a didactic component geared towards their level of training. Completing a clerkship with a didactic component was significantly associated with a respondent's confidence to function as a first-year radiation oncology resident (Wilcoxon rank–sum P=.03). However, the total number of clerkships completed did not correlate with confidence to pursue radiation oncology as a specialty (Spearman ρ P=.48) or confidence to function as a first year resident (Spearman ρ P=.43). Conclusions: Based on responses to this survey, rotating students perceive that the majority of radiation oncology clerkships do not have formal didactic curricula. Survey respondents who completed a clerkship with a didactic curriculum reported feeling more prepared to function as a radiation oncology resident. However, completing an increasing number of clerkships does not appear to improve confidence in the decision to pursue radiation oncology as a career or to function as a radiation oncology resident. These results
The Association Between Premedical Curricular and Admission Requirements and Medical School Performance and Residency Placement: A Study of Two Admission Routes at The Warren Alpert Medical School of Brown University
George, Paul; Park, Yoon Soo; Ip, Julianne; Gruppuso, Philip A.; Adashi, Eli Y.
Purpose The curricular elements of undergraduate premedical education are the subject of an ongoing debate. The Warren Alpert Medical School of Brown University (AMS) matriculates students via the traditional premedical route (TPM) and an eight-year baccalaureate/MD program—the Program in Liberal Medical Education (PLME)—which provides students with a broad and liberal education. Using the juxtaposition of these two admission routes, the authors aimed to determine whether there is an association between highly distinct premedical curricular and admission requirements and medical school performance and residency placement. Method The cohorts studied included all of the PLME (n = 295) and TPM (n = 215) students who graduated from the AMS between 2010 and 2015. Outcome variables consisted of multiple measures of medical school performance, including standardized multiple-choice examination scores and honors grades, and residency placement. The authors employed unadjusted tests of averages and proportions (independent t tests and chi-squared tests) to compare variables. Results The TPM students attained marginally, but statistically significantly, higher average scores on standardized multiple-choice examinations than their PLME counterparts. The number of undergraduate premedical science courses completed by PLME students accounted for less than 4% of the variance in key metrics of medical school performance. The residency placement record of the PLME and TPM cohorts proved comparable. Conclusions These findings suggest that the association between medical school performance and residency placement and undergraduate premedical curricular and admission requirements is weak. Further study is needed to determine the optimal premedical preparation of students. PMID:26422591
McCaffery, Fergal; Donnelly, Peter; McFall, Donald; Wilkie, Frederick George
This chapter describes a software process improvement framework, structured to ensure regulatory compliance for the software developed in medical devices. Software is becoming an increasingly important aspect of medical devices and medical device regulation. Medical devices can only be marketed if compliance and approval from the appropriate regulatory bodies of the Food and Drug Administration (US requirement), and the European Commission under its Medical Device Directives (CE marking requirement) is achieved.
The guide is designed for physicians and other medical practitioners who need to work with medical interpreters to improve communication with patients. Special attention is given to the Australian context. An introductory section discusses the need for medical interpreters and explains the guide's organization. Subsequent sections address these…
Ham, Sandra; Doolittle, Fred C.; Holton, Glee Ivory; Ventura, Ana Maria; Jackson, Rochanda
This report is the first in a series on Project GRAD (Graduation Really Achieves Dreams) in the Newark, New Jersey Public Schools. Project GRAD is an education initiative that combines several proven or promising reforms with the goals of increasing reading and math achievement test scores, improving classroom behavior, reducing dropout rates, and…
Reed, Deborah K.; Groth, Cori
The middle school team project described in this article was part of a larger district initiative, started in 2001 by the Southwest Educational Development Laboratory (SEDL) to create a systemic model of school improvement for increasing student achievement in low-performing schools. Academic teams were established as the conduit for ensuring that…
Purpose: College of Medicine, Gulf Medical University, United Arab Emirates, underwent a major curriculum change from a discipline-based to an organ system-based integrated curriculum. However, it was not known how the faculty perceived the changes in the educational environment as experienced by the students. In this context, we aimed to compare the faculty perceptions of the student experiences in the discipline-based curriculum with those in the organ system-based integrated curriculum. Methods: The Dundee Ready Education Environment Measure (DREEM) questionnaire was modified to assess faculty perceptions of the student experiences, pilot-tested, and administered to all faculty members (n=28) involved in the discipline-based curriculum (FDC) in January 2009. In the subsequent year, data were collected from the same faculty involved in the new integrated curriculum (FIC). Collected data were transferred to Predictive Analytics Software version 18. Total, domain, and individual statement scores were assessed with the Wilcoxon signed rank test. Percentage agreement, disagreement, and uncertainty were assessed by the McNemar’s test for proportion. Results: The mean total DREEM score was significantly higher (P<0.001) for FIC (139/200) as compared to FDC (119/200). The FIC perceived significantly more positive student experiences with the educational environment as indicated by the domain scores and statement scores. The differences in proportions of agreement between FIC and FDC also reinforced that the FIC perceived more positive student experiences with the educational environment. Conclusion: The study showed that the faculty perceived the organ system-based integrated curriculum as providing a better educational environment for the students than the discipline based curriculum. PMID:24781357
Yuan, Christina M; Prince, Lisa K; Oliver, James D; Abbott, Kevin C; Nee, Robert
Beginning in the 2014-2015 training year, the US Accreditation Council for Graduate Medical Education (ACGME) required that nephrology Clinical Competency Committees assess fellows' progress toward 23 subcompetency "context nonspecific" internal medicine subspecialty milestones. Fellows' advancement toward the "ready for unsupervised practice" target milestone now is tracked in each of the 6 competencies: Patient Care, Medical Knowledge, Professionalism, Interpersonal Communication Skills, Practice-Based Learning and Improvement, and Systems-Based Practice. Nephrology program directors and subspecialty societies must define nephrology-specific "curricular milestones," mapped to the nonspecific ACGME milestones. Although the ACGME goal is to produce data that can discriminate between successful and underperforming training programs, the approach is at risk to produce biased, inaccurate, and unhelpful information. We map the ACGME internal medicine subspecialty milestones to our previously published nephrology-specific milestone schema and describe entrustable professional activities and other objective assessment tools that inform milestone decisions. Mapping our schema onto the ACGME subspecialty milestone reporting form allows comparison with the ACGME subspecialty milestones and the curricular milestones developed by the American Society of Nephrology Program Directors. Clinical Competency Committees may easily adapt and directly translate milestone decisions reached using our schema onto the ACGME internal medicine subspecialty competency milestone-reporting format.
The GMC states that “Trainees in hospital posts must have well organised handover arrangements, ensuring continuity of patient care”. In the Belfast City Hospital throughout the day there can be multiple new medical admissions. These can be via the GP Unit, transfers for tertiary care, and transfers due to bed shortages in other hospitals. Over the course of 24 hours there can be up to four medical SHOs and three registrars that fill in the take sheet. Due to the variety of admission routes and number of doctors looking after the medical take information can be lost during handover between SHOs. In the current format there is little room to write and key and relevant information on the medical take sheet about new and transferring patients. I felt that this handover sheet could be improved. An initial questionnaire demonstrated that 47% found the old proforma easy to use and 28.2% felt that it allowed them to identify sick patients. 100% of SHOs and Registrars surveyed felt that it could be improved from its current form. From feedback from my colleagues I created a new template and trialled it in the hospital. A repeat questionnaire demonstrated that 92.3% of responders felt the new format had improved medical handover and that 92.6% felt that it allowed safe handover most of the time/always. The success of this new proforma resulted in it being implemented on a permanent basis for new medical admissions and transfers to the hospital. PMID:26734303
Conners, Michael S; Money, Samuel R
Intermittent claudication is a common disabling condition that affects approximately 5% to 15% of patients with atherosclerotic disease. Recommended treatment involves lifestyle modification and physical conditioning through the adoption of a regular exercise program. These methods of treatment often have been unsuccessful in the past because of noncompliance, in large part related to the relatively minor degree of improvement experienced by the patient. However, some recent trials have resulted in greater relative improvements in both pain-free and maximal walking distances in some patients treated with medication. Surgical and endovascular options offer greater degrees of improvement but also greater morbidity and should be reserved as treatment for severe claudication. The efficacies, as well as common adverse reactions associated with current medications used to treat patients with intermittent claudication are reviewed.
Kaminski, Gerry M; Schoettker, Pamela J; Alessandrini, Evaline A; Luzader, Carolyn; Kotagal, Uma
Cincinnati Children's Hospital Medical Center developed a comprehensive model to build quality improvement (QI) capability to support its goal to transform its delivery system through a series of training courses. Two online modules orient staff to basic concepts and terminology and prepare them to participate more effectively in QI teams. The basic program (Rapid Cycle Improvement Collaborative, RCIC) is focused on developing the capability to use basic QI tools and complete a narrow-scoped project in approximately 120 days. The Intermediate Improvement Science Series (I(2)S(2)) program is a leadership course focusing on improvement skills and developing a broader and deeper understanding of QI in the context of the organization and external environment. The Advanced Improvement Methods (AIM) course and Quality Scholars Program stimulate the use of more sophisticated methods and prepare Cincinnati Children's Hospital Medical Center (CCHMC) and external faculty to undertake QI research. The Advanced Improvement Leadership Systems (AILS) sessions enable interprofessional care delivery system leadership teams to effectively lead a system of care, manage a portfolio of projects, and to deliver on CCHMC's strategic plan. Implementing these programs has shown us that 1) a multilevel curricular approach to building improvement capability is pragmatic and effective, 2) an interprofessional learning environment is critical to shifting mental models, 3) repetition of project experience with coaching and feedback solidifies critical skills, knowledge and behaviors, and 4) focusing first on developing capable interprofessional improvement leaders, versus engaging in broad general QI training across the whole organization, is effective.
Continued Variation Amid Standardization: The Effects of School Program Improvement Status and of Participation in the South Coast Writing Project (SCWriP) on Teachers' Curricular Sensemaking and Enactment
Null, Suzanne Y.
Recent school reforms such as NCLB have focused on standardizing learning outcomes, and in the process have stimulated many schools to standardize curricular content, particularly if those schools are in Program Improvement (PI) status as a result of not meeting testing targets. But these attempts at standardization have ignored the fact that…
English for Specific Purposes: Building a Curricular Bridge between English as a Second Language and Vocational/Business Office Systems. A Carl D. Perkins Vocational and Applied Technology Education Program Improvement Grant. Final Report.
Austin Community Coll., TX.
This 11-page report describes a project wherein a Carl D. Perkins Vocational and Applied Technology Program Improvement Grant was used to develop a curricular bridge between the academic English-as-a-Second-Language (ESL) area and the vocational-technical business/office systems area of Austin Community College (ACC). The following project…
Ram, Anita; Chisolm, Margaret S
This commentary highlights the growing demand for substance abuse prevention and treatment, summarizes the literature regarding the current insufficiencies in substance abuse training in medical schools, and suggests strategies to address this gap in physician education. The authors describe how the combination of mandated coverage for substance abuse services and expanding treatment needs means that more physicians, regardless of their patient populations, will be faced with addressing the problem of substance use. The authors review the literature on substance abuse training in medical schools, which indicates insufficient exposure to this topic. The authors describe how current substance abuse training at medical schools is focused on transmitting scientific knowledge with relatively little education or training in attitudes and skills central to effective prevention and treatment. Given the gap between clinical need and physician education, the authors suggest several strategies for medical schools to increase training in substance abuse knowledge, attitudes, and skills, which will enhance the practice of evidence-based care. The authors posit that medical curricular reform, combined with initiatives to change clinical culture around substance abuse, will translate into improved rates of screening, shorter overall length of treatment, effective referrals for continued treatment, and increased access to care for individuals who use substances and so reduce the morbidity and mortality associated with substance use.
Ross, Muriel D.; Twombly, Ian A.; Senger, Steven
An improved computational-simulation system for interactive medical imaging has been invented. The system displays high-resolution, three-dimensional-appearing images of anatomical objects based on data acquired by such techniques as computed tomography (CT) and magnetic-resonance imaging (MRI). The system enables users to manipulate the data to obtain a variety of views for example, to display cross sections in specified planes or to rotate images about specified axes. Relative to prior such systems, this system offers enhanced capabilities for synthesizing images of surgical cuts and for collaboration by users at multiple, remote computing sites.
Michael, Emma; Patel, Chandni
In recent years medical handover has been identified as an increasingly important area for hospitals to improve upon, in light of the changes in shift patterns for doctors. Significant changes to weekday handover had recently been successfully introduced at Broomfield hospital. Weekend handover remained a concern, with an electronic and paper system being used simultaneously. Our objectives were to introduce a new electronic handover system for weekend handover at Broomfield Hospital and improve the organisation of the weekend handover meeting to promote patient safety. Doctors involved in weekend handover were surveyed using a questionnaire, to establish insufficiencies in the weekend handover process; where both the electronic ExtraMed system and paper were being used inconsistently. A new weekend handover system was introduced together with a new user-friendly electronic handover database, addressing the identified difficulties in the current system. These changes met the medical handover guidelines set by the Royal College of Physicians. Three months after the launch of the new system, doctors were re-surveyed using a modified questionnaire to assess the impact our changes had made. Before changes were implemented only 12% of doctors surveyed used the electronic system for weekend. Eighty-nine percent found sorting through jobs time consuming and 67% were handed jobs to them meant for a different grade of doctor. Only 41% were aware who to hand weekend discharges to. Subjective assessment of safety was 3.18 out of 5. The electronic system was felt to be time consuming and complicated. After execution of the new weekend handover process, 100% of doctors reported using the electronic system for weekend handover. Only 47% of doctors felt sorting through jobs was time consuming and 89% of doctors were aware who to handover weekend discharges to. Subjective assessment of the safety of weekend handover improved to 3.84 out of 5. Informal interviews on the ward
Afrin, Lawrence B; Arana, George W; Medio, Franklin J; Ybarra, Angela F N; Clarke, Harry S
Accreditation organizations, financial stakeholders, legal systems, and regulatory agencies have increased the need for accountability in educational processes and curricular outcomes of graduate medical education. This demand for greater programmatic monitoring has placed pressure on institutions with graduate medical education (GME) programs to develop greater oversight of these programs. Meeting these challenges requires development of new GME management strategies and tools for institutional GME administrators to scrutinize programs, while still allowing these programs the autonomy to develop and implement educational methods to meet their unique training needs. At the Medical University of South Carolina (MUSC), senior administrators in the college of medicine felt electronic information management was a critical strategy for success and thus proceeded to carefully select an electronic residency management system (ERMS) to provide functionality for both individual programs and the GME enterprise as a whole. Initial plans in 2002 for a phased deployment had to be changed to a much more rapid deployment due to regulatory issues. Extensive communication and cooperation among MUSC's GME leaders resulted in a successful deployment in 2003. Evaluation completion rates have substantially improved, duty hours are carefully monitored, patient safety has improved through more careful oversight of residents' procedural privileges, regulators have been pleased, and central GME administrative visibility of program performance has dramatically improved. The system is now being expanded to MUSC's medical school and other health professions colleges. The authors discuss lessons learned and opportunities and challenges ahead, which include improving tracking of development of procedural competency, establishing and monitoring program performance standards, and integrating the ERMS with GME reimbursement systems.
... of controller medications Share | Inhaler reminders significantly improve asthma patients’ use of controller medications Published Online: July ... effective in reducing the burden and risk of asthma, but many patients do not use them regularly. ...
Mohan, Arun; Riley, Brian; Boyington, Dane; Kripalani, Sunil
Although illustrated medication instructions may improve medication management among vulnerable populations, little prior research has evaluated their use among Latinos. We conducted focus groups and interviews with Latino patients with diabetes at two safety net clinics in Tennessee to understand medication taking practices and perceptions of illustrated medication instructions. Patients reported confidence in being able to take medications, but demonstrated a lack of understanding of medication instructions. On further probing, they described several barriers to effective medication management rooted in poor communication. Patients expressed preference for illustrated medication instructions which could address several of the challenges raised by patients. PMID:22453163
Newman-Casey, Paula Anne; Weizer, Jennifer S.; Heisler, Michele; Lee, Paul P.; Stein, Joshua D.
Adherence to prescribed glaucoma medications is often poor, and proper adherence can be challenging for patients. We systematically reviewed the literature and identified eight studies using educational interventions to improve glaucoma medication adherence. Overall, five of the eight studies found that educational interventions lead to a significant improvement in medication adherence, and the remaining studies found a trend towards improvement. Using information from this systematic review and Health Behavior Theory, we constructed a conceptual framework to illustrate how counseling and education can improve glaucoma medication adherence. More rigorous studies grounded in Health Behavior Theory with adequately powered samples and longer follow-up are needed. PMID:23697623
Curricular goals that traditionally focused on the delivery of the teaching rather than the outcomes of the learning are in a state of major transition. Implementation of academic standards requires the application of content and not merely its delivery. As a result, colleges of education must prepare anew genre of teacher leaders equipped to…
Journal of Dental Education, 1981
Presented are the curricular guidelines for Neuroanatomy developed by the Section on Anatomical Sciences of the American Association of Dental Schools for use by individual educational institutions as curriculum development aids. Included are recommendations for primary educational goals, prerequisites, scope, content, behavioral objectives,…
Adams, A. Birk; And Others
Curricular guidelines for biochemistry are presented, developed by the Section on Biochemistry and Nutrition and the Section on Oral Diagnosis and Oral Medicine of the American Association of Dental Schools for use by individual educational institutions as curriculum development aids. (MLW)
Frank, Erica; Smith, Donna; Fitzmaurice, Dorothy
Background To test whether promoting medical student health could efficiently improve patient counseling, we developed and implemented a 4-year-long curricular and extracurricular intervention to promote healthy behaviors among students in the Class of 2003 at Emory University School of Medicine, Atlanta, Georgia. Methods We asked students: (1) “What did you think about these [listed intervention components]”; (2) “did any of these interventions influence your personal health habits/attitudes toward your personal health”; and (3) “did any of these interventions influence your behavior or attitudes regarding current or future clinical practices, including history taking or counseling? If so, how? If not, why not?” Students evaluated the effectiveness of these formats and proposed changes in our intervention. The focus groups were transcribed and analyzed with QSR N5. Results Several major themes emerged from the focus groups: Listen to the students early, often, substantively, and noticeably;Incorporate many faculty and student leaders;Quietly integrate the curricular activities into the regular curriculum;Provide a strong, science-based, pragmatic prevention curriculum to complement the personal health promotion;Don't just use lectures to teach;Offer plentiful, nonrequired, fun extracurriculars;Don't nag;Have achievable interventions and recommendations;Provide collective data, but don't overexpose the students to it, and don't assume that collective data apply to every student, especially if it's unpleasant news;Provide personalized data where possible; andUncouple evaluations from the intervention, and keep evaluations brief. Conclusions Some students seemed pleased to have their medical school be attentive to their health, and believed that the project positively influenced their personal health practices and clinical practices (which was our goal). The students enjoyed many components of the intervention, especially the extracurricular activities
Kumar, G. N. Sunith; Arockiasamy, S.
Co-curricular activities provide prospects for better youth development and growth experiences. These activities are particularly good at providing opportunities for students to work in teams, to exercise leadership, and to take the initiative themselves. The active participation of the students is required to reap out maximum benefits out of such…
Neufeld, Karin J.; Schuckit, Marc A.; Hernandez-Avila, Carlos A.
The Alcohol Medical Scholars Program (AMSP) is designed to improve medical education related to substance use disorders (SUDs) through mentorship of junior, full-time academic faculty from medical schools across the United States. Scholarship focuses on literature review and synthesis, lecture development and delivery, increasing SUD education in…
Both good communication and presentation skills on the part of an academic teacher are crucial when trying to generate students' interest in the subject of a lecture. More generally, our task is to share knowledge in the most effective way possible. It is also worth teaching students presentation skills, as today's students are tomorrow's teachers. An engaging presentation is a powerful tool. There are some rules for presenting which I consider worthy of being discussed and taught at a medical university.
Do standards exist to improve communication in a medical setting? What are the minimal requirements to make our communication with patients and their family clear and simple? International literature, as well as psychology, philosophy, and even our brain structure offer ways to improve communication. We reflected about what is preventing effective communication in the medical setting and how/from where should we set about improving it. PMID:23295153
O'Quin, K. E.; Semalulu, T.; Orom, H.
Medication mismanagement is a growing public health concern, especially among elders. Annually, it is a major contributor to emergency hospitalization and nursing home placement. Elders and their caregivers, as healthcare consumers and stakeholders in this issue, are uniquely qualified to inform strategies to improve medication adherence. We…
Costa, Elísio; Giardini, Anna; Savin, Magda; Menditto, Enrica; Lehane, Elaine; Laosa, Olga; Pecorelli, Sergio; Monaco, Alessandro; Marengoni, Alessandra
Medication adherence and persistence is recognized as a worldwide public health problem, particularly important in the management of chronic diseases. Nonadherence to medical plans affects every level of the population, but particularly older adults due to the high number of coexisting diseases they are affected by and the consequent polypharmacy. Chronic disease management requires a continuous psychological adaptation and behavioral reorganization. In literature, many interventions to improve medication adherence have been described for different clinical conditions, however, most interventions seem to fail in their aims. Moreover, most interventions associated with adherence improvements are not associated with improvements in other outcomes. Indeed, in the last decades, the degree of nonadherence remained unchanged. In this work, we review the most frequent interventions employed to increase the degree of medication adherence, the measured outcomes, and the improvements achieved, as well as the main limitations of the available studies on adherence, with a particular focus on older persons. PMID:26396502
Reeve, Doug; Evans, Greg; Simpson, Annie; Sacks, Robin; Olivia-Fisher, Estelle; Rottmann, Cindy; Sheridan, Patricia
In recent years engineering educators have been encouraged to blend technical and professional learning in their curricular and co-curricular programming (Engineers Canada, 2009; National Academy of Engineering [NAE], 2004). Our paper describes a multifaceted leadership learning program developed to achieve this goal by infusing reflective,…
Housen, Alex; Beardsmore, Hugo Baetens
Analysis of multilingual acquisition processes among children at the European School of Brussels reveals how both curricular and extra-curricular factors combine to account for these students' high levels of proficiency in three or four languages. Schumann's (1979) Acculturation Model applied to one case study allows examination of how the…
Tong, Monica; Oh, Hye Young; Thomas, Jennifer; Patel, Sheila; Hardesty, Jennifer L; Brandt, Nicole J
The current quality improvement initiative evaluated the medication reconciliation process within select nursing homes in Washington, DC. The identification of common types of medication discrepancies through monthly retrospective chart reviews of newly admitted patients in two different nursing homes were described. The use of high-risk medications, namely antidiabetic, anticoagulant, and opioid agents, was also recorded. A standardized spreadsheet tool based on multiple medication reconciliation implementation tool kits was created to record the information. The five most common medication discrepancies were incorrect indication (21%), no monitoring parameters (17%), medication name omitted (11%), incorrect dose (10%), and incorrect frequency (8%). Antidiabetic agents in both sites were the most used high-risk medication. This initiative highlights that medication discrepancies on admission are common in nursing homes and may be clinically impactful. More attention needs to be given to work flow processes to improve medication reconciliation considering the increased risk for adverse drug events and hospitalizations. [Journal of Gerontological Nursing and Mental Health Services, 43(4), 9-14.].
Miroshnichenko, Yu V; Goryachev, A B; Popov, A A; Rodionov, E O
One of the priorities of the military health care is to improve the system of rationing medical equipment for the hospital unit of the medical service of the Armed Forces in wartime. This is determined the fact that the effectiveness of measures to provide military field hospitals with medical supplies depends on the quality of medical care for the wounded and sick, as well as the level of their return to duty. The article presents the characteristics of modern standards medical supplies procurement of military field hospitals included in the new regulatory legal act of the Russian Federation Ministry of Defence--"Standards of supplies medical supplies medical and pharmaceutical organizations (units) of the Russian Federation on the wartime armed forces", approved and put into effect in 2015 by order of the Minister of Defence of the Russian Federation.
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.
Insel, Kathie C.; Einstein, Gilles O.; Morrow, Daniel G.; Koerner, Kari M.; Hepworth, Joseph T.
Background/Objectives Older adults do not take medication as prescribed, diminishing the benefits of treatment and increasing costs to individuals and society. A multifaceted prospective memory intervention for improving adherence to antihypertensive medication was tested and assessed if executive function/working memory processes moderated intervention effects. Design A two group longitudinal randomized control trial was used. Setting and Participants and Measurements The sample consisted of community-based older adults (≥ 65 years of age) without signs of dementia or symptoms of severe depression who were self-managing prescribed medication. Following four weeks of initial adherence monitoring using a medication event monitoring system (MEMS®), individuals with 90% or less adherence were randomly assigned to groups. Intervention The prospective memory intervention was designed to provide strategies that switch older adults from relying on executive function/working memory processes (that show effects of cognitive aging) to mostly automatic associative processes (that are relatively spared with normal aging) for remembering to take one’s medications. Strategies included establishing a routine, establishing cues strongly associated with medication taking actions, performing the action immediately upon thinking about it, using a medication organizer, and imagining medication taking to enhance encoding and improve cuing. Results There was significant improvement in adherence for the intervention group (57% at baseline to 78% post intervention), but most of these gains were lost after 5 months. The control condition started at 68%, was stable during the intervention, but dropped to 62%. Executive function/working memory moderated the intervention effect, with the intervention producing greater benefit for those with lower executive function/working memory. Conclusion The intervention improved adherence, but the benefits were not sustained. Further research is
Zhao, Yaqian; Zhao, Qinping; Hao, Aimin
Multimodal medical image fusion is a method of integrating information from multiple image formats. Its aim is to provide useful and accurate information for doctors. Multi-channel pulse coupled neural network (m-PCNN) is a recently proposed fusion model. Compared with previous methods, this network can effectively manage various types of medical images. However, it has two drawbacks: lack of control to feed function and low-level automation. The improved multi-channel PCNN proposed in this paper can adjust the impact of feed function by linking strength and adaptively compute the weighting coefficients for each pixel. Experimental results demonstrated the effectiveness of the improved m-PCNN fusion model.
Zhou, Ningning; Yang, Tingting; Zhang, Shaobai
Image segmentation plays an important role in medical image processing. Fuzzy c-means (FCM) is one of the popular clustering algorithms for medical image segmentation. But FCM is highly vulnerable to noise due to not considering the spatial information in image segmentation. This paper introduces medium mathematics system which is employed to process fuzzy information for image segmentation. It establishes the medium similarity measure based on the measure of medium truth degree (MMTD) and uses the correlation of the pixel and its neighbors to define the medium membership function. An improved FCM medical image segmentation algorithm based on MMTD which takes some spatial features into account is proposed in this paper. The experimental results show that the proposed algorithm is more antinoise than the standard FCM, with more certainty and less fuzziness. This will lead to its practicable and effective applications in medical image segmentation.
Linley, Jodi L.; Nguyen, David J.
This chapter examines curricula as important microsystems for LGBTQ college students. The authors explore sociocultural influences on curricula and discuss strategies for creating positive curricular experiences for LGBTQ students.
Tartaglia, Kimberly M; Walker, Curt
Introduction As health systems find ways to improve quality of care, medical training programs are finding opportunities to prepare learners on principles of quality improvement (QI). The impact of QI curricula for medical students as measured by student learning is not well delineated. The aim of this study is to evaluate the effectiveness of a QI curriculum for senior medical students as measured by student knowledge and skills. Methods This study was an observational study that involved a self-assessment and post-test Quality Improvement Knowledge Application Tool (QIKAT) for intervention and control students. A QI curriculum consisting of online modules, live discussions, independent readings and reflective writing, and participation in a mentored QI project was offered to fourth-year medical students completing an honor's elective (intervention group). Senior medical students who received the standard QI curriculum only were recruited as controls. Results A total of 22 intervention students and 12 control students completed the self-assessment and QIKAT. At baseline, there was no difference between groups in self-reported prior exposure to QI principles. Students in the intervention group reported more comfort with their skills in QI overall and in 9 of the 12 domains (p<0.05). Additionally, intervention students performed better in each of the three case scenarios (p<0.01). Discussion A brief QI curriculum for senior medical students results in improved comfort and knowledge with QI principles. The strengths of our curriculum include effective use of classroom time and faculty mentorship with reliance on pre-existing online modules and written resources. Additionally, the curriculum is easily expandable to larger groups of students and transferable to other institutions.
Putnam, Dana E.; And Others
Evaluated commitment-based intervention for improvement of adherence to 10-day antibiotic regimen. Subjects were 60 college students. Experimental subjects made verbal and written commitments for adherence and completed tasks designed to increase their investment in medication regimen. Controls performed similarly structured tasks unrelated to…
Dullabh, Prashila M.; Sondheimer, Norman K.; Katsh, Ethan; Evans, Michael A.
Objectives: Assess (1) if patients can improve their medical records’ accuracy if effectively engaged using a networked Personal Health Record; (2) workflow efficiency and reliability for receiving and processing patient feedback; and (3) patient feedback’s impact on medical record accuracy. Background: Improving medical record’ accuracy and associated challenges have been documented extensively. Providing patients with useful access to their records through information technology gives them new opportunities to improve their records’ accuracy and completeness. A new approach supporting online contributions to their medication lists by patients of Geisinger Health Systems, an online patient-engagement advocate, revealed this can be done successfully. In late 2011, Geisinger launched an online process for patients to provide electronic feedback on their medication lists’ accuracy before a doctor visit. Patient feedback was routed to a Geisinger pharmacist, who reviewed it and followed up with the patient before changing the medication list shared by the patient and the clinicians. Methods: The evaluation employed mixed methods and consisted of patient focus groups (users, nonusers, and partial users of the feedback form), semi structured interviews with providers and pharmacists, user observations with patients, and quantitative analysis of patient feedback data and pharmacists’ medication reconciliation logs. Findings/Discussion: (1) Patients were eager to provide feedback on their medications and saw numerous advantages. Thirty percent of patient feedback forms (457 of 1,500) were completed and submitted to Geisinger. Patients requested changes to the shared medication lists in 89 percent of cases (369 of 414 forms). These included frequency—or dosage changes to existing prescriptions and requests for new medications (prescriptions and over-the counter). (2) Patients provided useful and accurate online feedback. In a subsample of 107 forms
Prasad, A; Datta, P P; Pattanayak, C; Panda, P
Pharmacology is a subject taught in the medical curriculum in India over a period of one and half years along with pathology, microbiology and forensic medicine. The present study was planned to know the opinion of medical students regarding pharmacology and to assess the proposed teaching schedule and methods of teaching pharmacology. The study was conducted in a private medical college in eastern India among the medical undergraduate students in 5th semester. Total 74 students participated in the study. A pre-designed, pre-tested, semi-structured questionnaire was given to the students and data was collected after one hour. Collected data was compiled, tabulated and analyzed in SPSS (version 16.0). The subject was perceived as interesting and useful by majority of students and most of them were in opinion to integrate pharmacology with the clinical subjects. Lecture in whole class was the most preferred teaching method according to the students and teaching with chalk and board they preferred most. Rational use of medicine, clinical trial, pediatric and geriatric pharmacology are the important topics the students felt to be included in the curriculum. Regular assessment of teaching methods by the students and taking suggestions from the students about improving the teaching method and redesigning the curriculum can help a lot in improving the learning capacity of the medical students and that will give benefit for the society as a whole.
Doshi, Jalpa A; Lim, Raymond; Li, Pengxiang; Young, Peinie P; Lawnicki, Victor F; State, Joseph J; Troxel, Andrea B; Volpp, Kevin G
Synchronizing medication refills-renewing all medications at the same time from the same pharmacy-is an increasingly popular strategy to improve adherence to medication regimens, but there has been little research regarding its effectiveness. In light of increasing policy interest, we evaluated the impact of a pilot refill synchronization program implemented by a large national insurer. A random sample of Medicare Advantage patients receiving mail-order refills for common maintenance medications (antihypertensive, lipid-lowering, or antidiabetic agents) were invited to join the program and followed for twelve months. On average, the absolute increase in the proportion of patients deemed adherent during follow-up was 3-10 percentage points for the intervention group, compared to 1-5 percentage points for the control group. Patients with poorer baseline adherence showed larger increases in the absolute proportion deemed adherent in intervention (23-26 percentage points) compared to a control group (13-15 percentage points). Synchronizing refills might be a promising intervention to improve adherence to maintenance medications, especially among Medicare patients with low baseline adherence.
Bauer, David T.; Guerlain, Stephanie
Medication label design is frequently a contributing factor to medication errors. Design regulations and recommendations have been predominantly aimed at manufacturers’ product labels. Pharmacy-generated labels have received less scrutiny despite being an integral artifact throughout the medication use process. This article is an account of our efforts to improve the design of a hospital’s intravenous (IV) medication labels. Our analysis revealed a set of interrelated processes and stakeholders that restrict the range of feasible label designs. The technological and system constraints likely vary among hospitals and represent significant barriers to developing and implementing specific design standards. We propose both an ideal IV label design and one that adheres to the current constraints of the hospital under study. PMID:21731156
Bauer, David T; Guerlain, Stephanie
Medication label design is frequently a contributing factor to medication errors. Design regulations and recommendations have been predominantly aimed at manufacturers' product labels. Pharmacy-generated labels have received less scrutiny despite being an integral artifact throughout the medication use process. This article is an account of our efforts to improve the design of a hospital's intravenous (IV) medication labels. Our analysis revealed a set of interrelated processes and stakeholders that restrict the range of feasible label designs. The technological and system constraints likely vary among hospitals and represent significant barriers to developing and implementing specific design standards. We propose both an ideal IV label design and one that adheres to the current constraints of the hospital under study.
Tarrant, Marie; Dodgson, Joan E; Law, Beatrice V K K
In today's environment of rapidly changing health care and information technology, nurses require a broad range of skills. One of the key skills required of all health professionals in this environment is information literacy. For registered nurses returning to a university setting to study for their baccalaureate degree, becoming information literate is one of many challenges they face. Also key to students' ability to use and communicate information in an appropriate and effective manner is their writing skills. This article describes a curricular intervention designed to develop and strengthen post-registration nurses' information literacy and academic writing competencies. An introductory information management module was developed and provided to three successive cohorts of students (n=159). Students were predominantly female (85.4%) with a mean age of 34.2 years (SD=6.8). Prior to commencing the program, students reported low information literacy and writing skills, especially in accessing and searching electronic databases and using referencing formats. The post-test evaluation of skills showed substantial and statistically significant increases in all assessed competencies. This intervention demonstrated that with structured but flexible learning activities early in the curriculum, post-registration nursing students can quickly become information literate.
This paper describes a partnership between the University of Nairobi College of Health Sciences (CHS) Library and the University of Maryland Health Sciences and Human Services Library (HS/HSL). The libraries are collaborating to develop best practices for the CHS Library as it meets the challenge of changing medical education information needs in a digital environment. The collaboration is part of a Medical Education Partnership Initiative. The library project has several components: an assessment of the CHS Library, learning visits in the United States and Kenya, development of recommendations to enhance the CHS Library, and ongoing evaluation of the program's progress. Development of new services and expertise at the CHS Library is critical to the project's success. A productive collaboration between the HS/HSL and CHS Library is ongoing. A successful program to improve the quality of medical education will have a beneficial impact on health outcomes in Kenya.
This paper describes a partnership between the University of Nairobi College of Health Sciences (CHS) Library and the University of Maryland Health Sciences and Human Services Library (HS/HSL). The libraries are collaborating to develop best practices for the CHS Library as it meets the challenge of changing medical education information needs in a digital environment. The collaboration is part of a Medical Education Partnership Initiative. The library project has several components: an assessment of the CHS Library, learning visits in the United States and Kenya, development of recommendations to enhance the CHS Library, and ongoing evaluation of the program's progress. Development of new services and expertise at the CHS Library is critical to the project's success. A productive collaboration between the HS/HSL and CHS Library is ongoing. A successful program to improve the quality of medical education will have a beneficial impact on health outcomes in Kenya. PMID:24860265
Leguelinel-Blache, Géraldine; Dubois, Florent; Bouvet, Sophie; Roux-Marson, Clarisse; Arnaud, Fabrice; Castelli, Christel; Ray, Valérie; Kinowski, Jean-Marie; Sotto, Albert
Quality of transitions of care is one of the first concerns in patient safety. Redesigning the discharge process to incorporate clinical pharmacy activities could reduce the incidence of postdischarge adverse events by improving medication adherence. The present study investigated the value of pharmacist counseling sessions on primary medication adherence after hospital discharge.This study was conducted in a 1844-bed hospital in France. It was divided in an observational period and an interventional period of 3 months each. In both periods, ward-based clinical pharmacists performed medication reconciliation and inpatient follow-up. In interventional period, initial counseling and discharge counseling sessions were added to pharmaceutical care. The primary medication adherence was assessed by calling community pharmacists 7 days after patient discharge.We compared the measure of adherence between the patients from the observational period (n = 201) and the interventional period (n = 193). The rate of patients who were adherent increased from 51.0% to 66.7% between both periods (P < 0.01). When discharge counseling was performed (n = 78), this rate rose to 79.7% (P < 0.001). The multivariate regression performed on data from both periods showed that age of at least 78 years old, and 3 or less new medications on discharge order were predictive factors of adherence. New medications ordered at discharge represented 42.0% (n = 1018/2426) of all medications on discharge order. The rate of unfilled new medications decreased from 50.2% in the observational period to 32.5% in the interventional period (P < 10). However, patients included in the observational period were not significantly more often readmitted or visited the emergency department than the patients who experienced discharge counseling during the interventional period (45.3% vs. 46.2%; P = 0.89).This study highlights that discharge counseling sessions are essential to improve
Payne, B C; Lyons, T F; Neuhaus, E; Kolton, M; Dwarshius, L
The usefulness of an action-research model is demonstrated in the evaluation and improvement of ambulatory medical care in a variety of settings: solo office practice, prepaid capitation multiple-specialty group practice, and medical school hospital-based outpatient clinic practice. Improvements in the process of medical care are found to relate directly to the intensity and duration of planned interventions by the study group and are demonstrated to follow organizational changes in the participating sites--primarily managerial and support services initiated by policy decisions in each study site. Improvement in performance approaching one standard deviation results from the most intense intervention, about one-half standard deviation at the next level of intervention, and virtually no change from a simple feedback of performance measures. On the basis of these findings and other operational and research efforts to improve physician performance, it is unlikely that simple feedback of performance measures will elicit a change in behavior. However, noncoercive methods involving health care providers in problem identification, problem solving, and solution implementation are demonstrated to be effective. PMID:6735736
The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.
Kumar, Ashok; Cariappa, M.P.; Marwaha, Vishal; Sharma, Mukti; Arora, Manu
Background Medical stores management in hospitals is a tedious and time consuming chore with limited resources tasked for the purpose and poor penetration of Information Technology. The process of automation is slow paced due to various inherent factors and is being challenged by the increasing inventory loads and escalating budgets for procurement of drugs. Methods We carried out an indepth case study at the Medical Stores of a tertiary care health care facility. An iterative six step Quality Improvement (QI) process was implemented based on the Plan–Do–Study–Act (PDSA) cycle. The QI process was modified as per requirement to fit the medical stores management model. The results were evaluated after six months. Results After the implementation of QI process, 55 drugs of the medical store inventory which had expired since 2009 onwards were replaced with fresh stock by the suppliers as a result of effective communication through upgraded database management. Various pending audit objections were dropped due to the streamlined documentation and processes. Inventory management improved drastically due to automation, with disposal orders being initiated four months prior to the expiry of drugs and correct demands being generated two months prior to depletion of stocks. The monthly expense summary of drugs was now being done within ten days of the closing month. Conclusion Improving communication systems within the hospital with vendor database management and reaching out to clinicians is important. Automation of inventory management requires to be simple and user-friendly, utilizing existing hardware. Physical stores monitoring is indispensable, especially due to the scattered nature of stores. Staff training and standardized documentation protocols are the other keystones for optimal medical store management. PMID:26900225
Zink, Brian J; Hammoud, Maya M; Middleton, Eric; Moroney, Donney; Schigelone, Amy
In 1999, the University of Michigan Medical School (UMMS) initiated a new career development program (CDP). The CDP incorporates the 4-phase career development model described by the Association of American Medical Colleges (AAMC) Careers in Medicine (CiM). The CDP offers self-assessment exercises with guidance from trained counselors for 1st- and 2nd-year medical students. Career exploration experiences include Career Seminar Series luncheons, shadow experiences with faculty, and a shadow program with second-year (M2) and fourth-year (M4) medical students. During the decision-making phase, students work with trained faculty career advisors (FCA). Mandatory sessions are held on career selection, preparing the residency application, interviewing, and program evaluation. During the implementation phase, students meet with deans or counselors to discuss residency application and matching. An "at-risk plan" assists students who may have difficulty matching. The CiM Web site is extensively used during the 4 stages. Data from the AAMC and UMMS Graduation Questionnaires (GQ) show significant improvements for UMMS students in overall satisfaction with career planning services and with faculty mentoring, career assessment activities, career information, and personnel availability. By 2003, UMMS students had significantly higher satisfaction in all measured areas of career planning services when compared with all other U.S. medical students.
Murakami, Manabu; Olga, Amengual; Iguchi, Kaori; Otaki, Junji
In the past, we made several efforts making curriculum changes to Medical English Practice, however, these changes did not improve motivation effectively. We have completely modified the curriculum in 2012, and performed a questionnaire survey to 112 sophomore medical students. In the final exam, students answered a questionnaire assessing all classes of the course by scoring 3 points (no change required), 2 points (minor change required), and 1 point (major change required or discontinue). In addition, students could write free comments about potential contents they would like to add to the curriculum. Each class was assessed as more than or equal to 2.5 points on average (range: 2.50-2.96). Potential contents students want to add are: 1. Speaking (45 students [55%]), 2. Listening (30 students [37%]), 3. Reading (6 students [7%]), 4. Writing (1 student [1%]). The most frequent suggestion was to include group discussions in speaking (27 students [33%]), followed by listening on topics of healthcare systems (11 students [13%]). Many students suggested to include conversation classes in small groups, or classes in which international students introduce the structure of healthcare systems of their home countries to the curriculum. Increasing the participation of international faculty, staff and students in the Medical English Practice might contribute to the improvement of medical students' motivation.
Awosogba, Temitope; Betancourt, Joseph R.; Conyers, F. Garrett; Estapé, Estela S.; Francois, Fritz; Gard, Sabrina J.; Kaufman, Arthur; Lunn, Mitchell R.; Nivet, Marc A.; Oppenheim, Joel D.; Pomeroy, Claire; Yeung, Howa
Despite yearly advances in life-saving and preventive medicine, as well as strategic approaches by governmental and social agencies and groups, significant disparities remain in health, health quality, and access to health care within the United States. The determinants of these disparities include baseline health status, race and ethnicity, culture, gender identity and expression, socioeconomic status, region or geography, sexual orientation, and age. In order to renew the commitment of the medical community to address health disparities, particularly at the medical school level, we must remind ourselves of the roles of doctors and medical schools as the gatekeepers and the value setters for medicine. Within those roles are responsibilities toward the social mission of working to eliminate health disparities. This effort will require partnerships with communities as well as with academic centers to actively develop and to implement diversity and inclusion strategies. Besides improving the diversity of trainees in the pipeline, access to health care can be improved, and awareness can be raised regarding population-based health inequalities. PMID:23659676
Moroshek, Jacob G
Background Physician dispensing, different from pharmacist dispensing, is a way for practitioners to supply their patients with medications, at the point of care. The InstyMeds dispenser and logistics system can automate much of the dispensing, insurance adjudication, inventory management, and regulatory reporting that is required of physician dispensing. Objective To understand the percentage of patients that exhibit primary adherence to medication in the outpatient setting when choosing InstyMeds. Method The InstyMeds dispensing database was de-identified and analyzed for primary adherence. This is the ratio of patients who dispensed their medication to those who received an eligible prescription. Results The average InstyMeds emergency department installation has a primary adherence rate of 91.7%. The maximum rate for an installed device was 98.5%. Conclusion Although national rates of primary adherence have been found to be in the range of 70%, automated physician dispensing vastly improves the rate of adherence. Improved adherence should lead to better patient outcomes, fewer return visits, and lower healthcare costs. PMID:28115860
Oaks, D'Arcy J.
This chapter will discuss how institutional research professionals might integrate co-curricular learning outcomes into larger measures of institutional effectiveness. By mapping co-curricular learning outcomes to align with curricular and institutional goals, linkages can be made that demonstrate mission-congruent activities and outcomes across…
Biran, Roy; Pond, Daniel
Blood contact with biomaterials triggers activation of multiple reactive mechanisms that can impair the performance of implantable medical devices and potentially cause serious adverse clinical events. This includes thrombosis and thromboembolic complications due to activation of platelets and the coagulation cascade, activation of the complement system, and inflammation. Numerous surface coatings have been developed to improve blood compatibility of biomaterials. For more than thirty years, the anticoagulant drug heparin has been employed as a covalently immobilized surface coating on a variety of medical devices. This review describes the fundamental principles of non-eluting heparin coatings, mechanisms of action, and clinical applications with focus on those technologies which have been commercialized. Because of its extensive publication history, there is emphasis on the CARMEDA(®) BioActive Surface (CBAS(®) Heparin Surface), a widely used commercialized technology for the covalent bonding of heparin.
Wyatt, Stephen A; Dekker, Michael A
Medical and psychosocial problems related to substance use disorders (SUDs) remain a major source of national morbidity and mortality. This situation exists despite greater understanding of genetic, neurobiologic, and social underpinnings of the development of these illnesses that has resulted in many advances in addiction medicine. The value of assessment and brief intervention of this disease is well documented. Patients need to be identified and engaged in order for them to be treated. A variety of evidence-based pharmacologic and psychotherapeutic treatments are now available. Strong evidence exists that treatment of patients for SUDs produces results similar to or better than those obtained from treatment for other chronic illnesses. It is also clear that physicians can play a pivotal role in helping to reduce the burden of disease related to SUDs However, to do this, physicians need to be better educated. Through such education comes greater confidence in identification and providing treatment. Also, the discomfort and stigma often associated with this disease are reduced. The federal government-through the Office of National Drug Control Policy, the Surgeon General, the Center for Substance Abuse Treatment, the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and the National Highway Traffic Safety Administration of the Department of Transportation (DOT)-is expending concerted efforts to improve physician education in addiction medicine. These efforts culminated in the Second Leadership Conference on Medical Education in Substance Abuse in December 2006. The osteopathic medical profession was represented at this conference. This article reviews not only the recommendations from this meeting, but also the nature of the problem, how members of the osteopathic medical profession are currently addressing it, and a strategy for improvement endorsed by the American Osteopathic Academy of Addiction Medicine.
The considerable debate in recent years on the aims of citizenship education has not been accompanied by an equally substantial discussion on the educational processes involved. This article puts forward a theoretical framework, referred to as "curricular transposition", for understanding the complex task of realizing normative ideals of…
King, Clement T.
Two psychological theories which seem to have had a great impact on compensatory education programs are Skinnerian reinforcement theory and the cognitive developmental theory derived in part from Jean Piaget. The Englemann-Becker program is a typical example of the Programmed Curricular kind of program; the Florida Project, an Open Framework; and…
Rulison, Sheila R.
The purpose of this study was to examine teachers' perceptions of curricular change and how teachers in one high school in the southwestern United States viewed the potential effects of the implementation of Common Core State Standards. Surveys, focus group sessions, one-on-one interviews, and various observational techniques were used to…
Valera, Luca; Russo, María Teresa; Curcio, Giuseppe
More and more seems to be necessary to find new ways of communication between medical doctors and bioethicists in order to build a shared vocabulary and to prevent conflicts: many bioethical problems seem to be caused by the lack of dialogue between them, which both seem to speak two different languages. Improving this dialogue means searching new languages and innovative forms of communication: the narration could be a really effective tool to enhance the physicians' and bioethicist's moral conscience, since it facilitates reasoning on someone's particular experience, and, ultimately, on our experience. Starting from the results of a questionnaire administered to a group of students of the Faculty of Medicine and Surgery of the University Campus Bio-Medico we present a theoretical discussion about the need for more dialogue and for a shared vocabulary in medical experiences. In this regard, we suggest as a possible solution to the conflicts among medical doctors and bioethicists, an educational strategy, i.e., humanities courses for medical students, which may help them to deeply describe their practical present (and future) experience.
Bliznakov, Z; Pappous, G; Bliznakova, K; Pallikarakis, N
The evolution of biomedical technology has led to an extraordinary use of medical devices in health care delivery. During the last decade, clinical engineering departments (CEDs) turned toward computerization and application of specific software systems for medical equipment management in order to improve their services and monitor outcomes. Recently, much emphasis has been given to patient safety. Through its Medical Device Directives, the European Union has required all member nations to use a vigilance system to prevent the reoccurrence of adverse events that could lead to injuries or death of patients or personnel as a result of equipment malfunction or improper use. The World Health Organization also has made this issue a high priority and has prepared a number of actions and recommendations. In the present workplace, a new integrated, Windows-oriented system is proposed, addressing all tasks of CEDs but also offering a global approach to their management needs, including vigilance. The system architecture is based on a star model, consisting of a central core module and peripheral units. Its development has been based on the integration of 3 software modules, each one addressing specific predefined tasks. The main features of this system include equipment acquisition and replacement management, inventory archiving and monitoring, follow up on scheduled maintenance, corrective maintenance, user training, data analysis, and reports. It also incorporates vigilance monitoring and information exchange for adverse events, together with a specific application for quality-control procedures. The system offers clinical engineers the ability to monitor and evaluate the quality and cost-effectiveness of the service provided by means of quality and cost indicators. Particular emphasis has been placed on the use of harmonized standards with regard to medical device nomenclature and classification. The system's practical applications have been demonstrated through a pilot
Ajami, Sima; Ketabi, Saeedeh; Sadeghian, Akram; Saghaeinnejad-Isfahani, Sakine
Background: Lean management is a process improvement technique to identify waste actions and processes to eliminate them. The benefits of Lean for healthcare organizations are that first, the quality of the outcomes in terms of mistakes and errors improves. The second is that the amount of time taken through the whole process significantly improves. Aims: The purpose of this paper is to improve the Medical Records Department (MRD) processes at Ayatolah-Kashani Hospital in Isfahan, Iran by utilizing Lean management. Materials and Methods: This research was applied and an interventional study. The data have been collected by brainstorming, observation, interview, and workflow review. The study population included MRD staff and other expert staff within the hospital who were stakeholders and users of the MRD. Statistical Analysis Used: The MRD were initially taught the concepts of Lean management and then formed into the MRD Lean team. The team then identified and reviewed the current processes subsequently; they identified wastes and values, and proposed solutions. Results: The findings showed that the MRD units (Archive, Coding, Statistics, and Admission) had 17 current processes, 28 wastes, and 11 values were identified. In addition, they offered 27 comments for eliminating the wastes. Conclusion: The MRD is the critical department for the hospital information system and, therefore, the continuous improvement of its services and processes, through scientific methods such as Lean management, are essential. Originality/Value: The study represents one of the few attempts trying to eliminate wastes in the MRD. PMID:26097862
Shipp, Melvin D.
The author argues that any new curricular model for optometric education must be responsive to evolving scientific and societal trends and consistent with the long-term goals of the profession. Some of these trends are outlined, including advancing technology and related improvement in health care and health care reform. (MSE)
Stratton, Terry D; Rudy, David W; Sauer, Marlene J; Perman, Jay A; Jennings, C Darrell
As medical education grapples with organizational calls for centralized curricular oversight, programs may be compelled to respond by establishing highly vertical, stacked governance structures. Although these models offer discrete advantages over the horizontal, compartmentalized structures they are designed to replace, they pose new challenges to ensuring curricular quality and the educational innovations that drive the curricula. The authors describe a hybrid quality-assurance (QA) governance structure introduced in 2003 at the University of Kentucky College of Medicine (UKCOM) that ensures centralized curricular oversight of the educational product while allowing individualized creative control over the educational process. Based on a Lean production model, this approach draws on industry experiences that strategically separate institutional accountability (management) for a quality curriculum from the decision-making processes required to ensure it (production). In so doing, the authors acknowledge general similarities and key differences between overseeing the manufacture of a complex product versus the education of a physician-emphasizing the structured, sequential, and measurable nature of each process. Further, the authors briefly trace the emergence of quality approaches in manufacturing and discuss the philosophical changes that accompany transition to an institutional governance system that relies on vigorous, robust performance measures to offer continuous feedback on curricular quality.
Zanaty, E A; Afifi, Ashraf
In this paper, a novel watershed approach based on seed region growing and image entropy is presented which could improve the medical image segmentation. The proposed algorithm enables the prior information of seed region growing and image entropy in its calculation. The algorithm starts by partitioning the image into several levels of intensity using watershed multi-degree immersion process. The levels of intensity are the input to a computationally efficient seed region segmentation process which produces the initial partitioning of the image regions. These regions are fed to entropy procedure to carry out a suitable merging which produces the final segmentation. The latter process uses a region-based similarity representation of the image regions to decide whether regions can be merged. The region is isolated from the level and the residual pixels are uploaded to the next level and so on, we recall this process as multi-level process and the watershed is called multi-level watershed. The proposed algorithm is applied to challenging applications: grey matter-white matter segmentation in magnetic resonance images (MRIs). The established methods and the proposed approach are experimented by these applications to a variety of simulating immersion, multi-degree, multi-level seed region growing and multi-level seed region growing with entropy. It is shown that the proposed method achieves more accurate results for medical image oversegmentation.
Geist, Shin-Mey Rose Y; Geist, James R
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.
Background. This research aims to investigate the quantitative relationship between telemedicine and online continuing medical education (CME) and to find the optimal CME lectures to be delivered via telemedicine to improve the population's health status. Objective. This study examines the following: (1) What factors foster learning processes in CME via telemedicine? (2) What is the possible role of online CME in health improvement? And (3) How optimal learning processes can be integrated with various health services? Methods. By applying telemedicine experiences in Taiwan over the period 1995–2004, this study uses panel data and the method of ordinary least squares to embed an adequate set of phenomena affecting the provision of online CME lectures versus health status. Results. Analytical results find that a nonlinear online CME-health nexus exists. Increases in the provision of online CME lectures are associated with health improvements. However, after the optimum has been reached, greater provision of online CME lectures may be associated with decreasing population health. Conclusion. Health attainment could be partially viewed as being determined by the achievement of the appropriately providing online CME lectures. This study has evaluated the population's health outcomes and responded to the currently inadequate provision of online CME lectures via telemedicine. PMID:27660637
Leung, Chun H S; Chong, Carol; Lim, Wen K
Approximately 40% of patients are non-adherent to their medications. A prospective study of 80 patients evaluated the effectiveness of medical student-led pre-discharge medication education sessions. A significantly greater proportion of patients in the intervention group were adherent to their regular medications at 1 month compared with the control group (76.3% compared to 60.3%, P = 0.037). Medical student-led patient education significantly improved medication adherence rates.
Wertheimer, Albert I; Santella, Thomas M; Finestone, Albert J; Levy, Richard A
Innovations in dosage forms and dose delivery systems across a wide range of medications offer substantial clinical advantages, including reduced dosing frequency and improved patient adherence; minimized fluctuation of drug concentrations and maintenance of blood levels within a desired range; localized drug delivery; and the potential for reduced adverse effects and increased safety. The advent of new large-molecule drugs for previously untreatable or only partially treatable diseases is stimulating the development of suitable delivery systems for these agents. Although advanced formulations may be more expensive than conventional dosage forms, they often have a more favorable pharmacologic profile and can be cost-effective. Inclusion of these dosage forms on drug formulary lists may help patients remain on therapy and reduce the economic and social burden of care.
Sajjad, Madiha; Mahboob, Usman
Workplace-based learning is considered as one of the most effective way of translating medical theory into clinical practice. Although employed traditionally at postgraduate level, this strategy can be used in undergraduate students coming for clerkships in clinical departments. There are many challenges to workplace learning such as, unfavorable physical environment, lack of interest by clinical staff and teachers, and lack of student motivation. Clinical teachers can help bridge this gap and improve workplace learning through individual and collaborative team effort. Knowledge of various educational theories and principles and their application at workplace can enhance student learning and motivation, for which faculty development is much needed. Different teaching and learning activities can be used and tailored according to the clinical setting. Active reflection by students and constructive feedback from the clinicians forms the backbone of effective workplace learning.
Presser, Ashley Lewis; Vahey, Philip; Dominguez, Ximena
This paper describes findings from a blocked randomized design (BRD) field study conducted to examine the "Next Generation Preschool Math" (NGPM) program's implementation in preschool classrooms and promise in improving young children's mathematic learning. NGPM integrates traditional preschool activities with developmentally appropriate…
Nurses can protect patients receiving intravenous (IV) medication by using medication safety software to program "smart" pumps to administer IV medications. After a patient safety event identified inconsistent use of medication safety software by nurses, a performance improvement team implemented the Deming Cycle performance improvement methodology. The combined use of improved direct care nurse communication, programming strategies, staff education, medication safety champions, adherence monitoring, and technology acquisition resulted in a statistically significant (p < .001) increase in nurse adherence to using medication safety software from 28% to above 85%, exceeding national benchmark adherence rates (Cohen, Cooke, Husch & Woodley, 2007; Carefusion, 2011).
... of the review process, the annuitant will be asked about any medical or vocational therapy that he or... evidence shows that the annuitant is the beneficiary of advances in medical or vocational therapy or technology (related to his or her ability to work). Advances in medical or vocational therapy or...
... of the review process, the annuitant will be asked about any medical or vocational therapy that he or... evidence shows that the annuitant is the beneficiary of advances in medical or vocational therapy or technology (related to his or her ability to work). Advances in medical or vocational therapy or...
... of the review process, the annuitant will be asked about any medical or vocational therapy that he or... evidence shows that the annuitant is the beneficiary of advances in medical or vocational therapy or technology (related to his or her ability to work). Advances in medical or vocational therapy or...
FAGHIHI, SEYED ALIAKBAR; KHANKEH, HAMID REZA; HOSSEINI, SEYED JALIL; SOLTANI ARABSHAHI, SEYED KAMRAN; FAGHIH, ZAHRA; PARIKH, SAGAR V.; SHIRAZI, MANDANA
Introduction Continuing Medical Education (CME) has been considered as a lifelong commitment for doctors to provide the optimal care for patients. Despite a long history of creating CME programs, outcomes are far from ideal. The present qualitative study aims to clarify the barriers affecting effectiveness of the CME programs in Iran based on the experiences of general practitioners. Methods Sixteen general practitioners were recruited to participate in in-depth interviews and field observations concerning experiences with CME. The study was performed using a qualitative content analysis method. The codes, categories and themes were explored through an inductive process in which the researchers moved from specific to general. Results The participants’ experiences identified a number of barriers, particularly insufficient interaction with the instructors; additional problems included the teachers’ use of an undifferentiated approach; unreal and abstract CME; and ignorance of the diverse reasons to participate in CME. Conclusion Based on the study results, there are multiple barriers to effective implementation of CME in Iran. The key barriers include insufficient interaction between the trainees and providers, which must be considered by other stakeholders and program designers. Such interactions would facilitate improved program design, invite more specific tailoring of the education to the participants, allow for more effective educational methods and set the stage for outcome evaluation from the learners actually applying their new knowledge in practice. Replication of these findings with another sample would improve confidence in these recommendations, but these findings are broadly consistent with findings in the educational literature on improving the efficacy of CME. PMID:27104199
... HUMAN SERVICES Food and Drug Administration Campaign To Improve Poor Medication Adherence (U18) AGENCY... ] importance of good medication adherence, a vital first step toward improved adherence behavior and better...' awareness of the importance of good medication adherence and provide tools to prescribers to help...
Tregunno, Deborah; Ginsburg, Liane; Clarke, Beth; Norton, Peter
Background As efforts to integrate patient safety into health professional curricula increase, there is growing recognition that the rate of curricular change is very slow, and there is a shortage of research that addresses critical perspectives of faculty who are on the ‘front-lines’ of curricular innovation. This study reports on medical, nursing and pharmacy teaching faculty perspectives about factors that influence curricular integration and the preparation of safe practitioners. Methods Qualitative methods were used to collect data from 20 faculty members (n=6 medical from three universities; n=6 pharmacy from two universities; n=8 nursing from four universities) engaged in medical, nursing and pharmacy education. Thematic analysis generated a comprehensive account of faculty perspectives. Results Faculty perspectives on key challenges to safe practice vary across the three disciplines, and these different perspectives lead to different priorities for curricular innovation. Additionally, accreditation and regulatory requirements are driving curricular change in medicine and pharmacy. Key challenges exist for health professional students in clinical teaching environments where the culture of patient safety may thwart the preparation of safe practitioners. Conclusions Patient safety curricular innovation depends on the interests of individual faculty members and the leveraging of accreditation and regulatory requirements. Building on existing curricular frameworks, opportunities now need to be created for faculty members to act as champions of curricular change, and patient safety educational opportunities need to be harmonises across all health professional training programmes. Faculty champions and practice setting leaders can collaborate to improve the culture of patient safety in clinical teaching and learning settings. PMID:24299734
Goldman, Ellen F; Swayze, Susan S; Swinehart, Sarah E; Schroth, W Scott
Effective curriculum oversight requires periodic assessment and continuous improvement of individual course offerings as well as their overall integration. The literature indicates that most course review processes do not use the breadth of information available or sufficiently encourage faculty feedback and reflection, limiting the value derived. Suggestions for which data to include in the course evaluations are available in the literature; however, there is little guidance on effective course review structures and processes. In this article, the authors discuss a course review process revised as part of a comprehensive reform of the George Washington University School of Medicine and Health Sciences undergraduate medical school curriculum management structure. The process improvements incorporated evaluation practices grounded in the medical and higher education literatures and included changes to the data reviewed as well as the review timing, participants, and structure. The revised process uses a broad array of information, requires significant faculty participation, and uses questioning, writing, and dialogue to encourage faculty reflection and learning. Course directors indicate that the process helps them focus, and the information and the perspectives of others lead to reflection and new ideas. Through the process, course directors have changed course content and teaching methods, improved assessments of learning, and expanded course integration across the curriculum. The procedural and content elements of the process can be easily transferred to other medical schools and are applicable to other curricular reform projects across the continuum of medical education.
This project was designed to catalyze curricular changes to better prepare students for the workplace. Industrial managers provided a list of 16 characteristics valued in the workplace: most were NOT related to science course content. The project formed 5 teams each including 3M professionals and students. Each team developed curricular changes in one of the 16 areas. Team goals were to improve skills in communication, data analysis, business/economics, team problem solving, and culture competency. Curricular changes realized include communication skill activities embodied in science courses and faculty communication teaching skill seminars, self learning tools in data analysis, statistics and model building, a new course developed with assistance from 3M personnel focussing on topics directly related to technological industries, high performance team problem solving training/coaching for faculty and workshops for students and faculty relative to importance of cultural competencies in the workplace, and a new course focusing on culture, team problem solving and conflict resolution in the technical workplace. Process for developing and content of curricular changes will be reported.
Artz, Jerry L.
This project was designed to catalyze curricular changes to better prepare students for the workplace. Industrial managers provided a list of 16 characteristics valued in the workplace; most were NOT related to science course content. The project formed 5 teams each including 3M professionals and students. Each team developed curricular changes in one of the 16 areas. Team goals were to improve skills in communication, data analysis, business/economics, team problem solving, and cultural competency. Curricular changes realized include communication skill activities embodied in science courses and faculty communication teaching skill seminars; self learning tools in data analysis, statistics and model building; a new course developed with assistance from 3M personnel focusing on topics directly related to technological industries; high performance team problem solving training/coaching for faculty; workshops for students and faculty relative to importance of cultural competencies in the workplace; and a new course focusing on culture, team problem solving and conflict resolution in the technical workplace. Process for developing and content of curricular changes will be reported. *Thanks to: NSF GOALI CHE-99010782
A lot of healthcare professionals experienced annoyance with biased mass media news regarding medical and health issues. In this paper, I propose "news profiling method" and "media guideline" to improve the medical and health journalism.
Fisun, A Ia
In 2013 the main efforts of the Medical Service were aimed at the following tasks: optimization of management system of military medical service, improvement of medical evacuation system, medical service security for military contingents, assigned according to territory principle to military-medical facilities of the Ministry of Defence of the Russian Federation, implementation of innovations at all stages of medical evacuation in peace- and wartime, security of combat and mobilization readiness of regulatory bodies of the Medical Service, medical military units and military medical facilities, medical service of troops battle training, improvement of material and technical resources, security of regular pharmacy and equipment supply, activation of research work in the Medical Service interests. Lines of military medicine development in 2014 are: transfer of treatment facilities that are not used by the Ministry of Defence into the Federal Biomedical Agency till the end of 2014, prevention of pneumonia and meningitis in military personnel, improvement of early diagnosis system, medical service for military contingents according to territory principle, improvement of diagnostic and treatment work in military-medical units and subunits and military-medical facilities by means of development of material and technical resources, monitor the implementation of innovative diagnostic and treatment technologies, completion of construction projects of central military hospitals and etc.
Okafor, Nnaemeka G.; Doshi, Pratik B.; Miller, Sara K.; McCarthy, James J.; Hoot, Nathan R.; Darger, Bryan F.; Benitez, Roberto C.; Chathampally, Yashwant G.
Introduction Medical errors are frequently under-reported, yet their appropriate analysis, coupled with remediation, is essential for continuous quality improvement. The emergency department (ED) is recognized as a complex and chaotic environment prone to errors. In this paper, we describe the design and implementation of a web-based ED-specific incident reporting system using an iterative process. Methods A web-based, password-protected tool was developed by members of a quality assurance committee for ED providers to report incidents that they believe could impact patient safety. Results The utilization of this system in one residency program with two academic sites resulted in an increase from 81 reported incidents in 2009, the first year of use, to 561 reported incidents in 2012. This is an increase in rate of reported events from 0.07% of all ED visits to 0.44% of all ED visits. In 2012, faculty reported 60% of all incidents, while residents and midlevel providers reported 24% and 16% respectively. The most commonly reported incidents were delays in care and management concerns. Conclusion Error reporting frequency can be dramatically improved by using a web-based, user-friendly, voluntary, and non-punitive reporting system. PMID:26759657
Ahrens, Susan L; Wirges, Ashley M
Patient satisfaction is viewed as a significant indicator of quality of care. More specifically, improving patient satisfaction related to communication about medications and potential side effects can improve healthcare outcomes. Patient satisfaction scores related to medication side effects on a neuro-medical surgical unit were monitored following a quality improvement program. These patients frequently experience cognitive impairment and functional difficulties that can affect the way they understand and handle medications. The purpose of this quality improvement practice change was to (a) develop an educational approach for post acute neurosurgical patients and (b) evaluate whether the use of the approach is successful in improving patient satisfaction scores related to medication education on side effects. The quality improvement program interventions included (a) patient informational handouts inserted into admission folders, (b) nurse education about the importance of providing education on side effects to patient and discussion of their involvement with the program, (c) unit flyers with nurse education, and (d) various communications with bedside nurses through personal work mail and emails. The primary focus was for nurses to employ the "teach back" method to review and reinforce the medication side-effect teaching with patients. Evaluation of the data showed an increase in patient satisfaction after the implementation of the "Always Ask" program.
Naghshineh, Sheila; Hafler, Janet P.; Miller, Alexa R.; Blanco, Maria A.; Lipsitz, Stuart R.; Dubroff, Rachel P.; Khoshbin, Shahram
Background Despite evidence of inadequate physical examination skills among medical students, teaching these skills has declined. One method of enhancing inspection skills is teaching “visual literacy,” the ability to reason physiology and pathophysiology from careful and unbiased observation. Objective To improve students’ visual acumen through structured observation of artworks, understanding of fine arts concepts and applying these skills to patient care. Design Prospective, partially randomized pre- vs. post-course evaluation using mixed-methods data analysis. Participants Twenty-four pre-clinical student participants were compared to 34 classmates at a similar stage of training. Intervention Training the Eye: Improving the Art of Physical Diagnosis consists of eight paired sessions of art observation exercises with didactics that integrate fine arts concepts with physical diagnosis topics and an elective life drawing session. Measurements The frequency of accurate observations on a 1-h visual skills examination was used to evaluate pre- vs. post-course descriptions of patient photographs and art imagery. Content analysis was used to identify thematic categories. All assessments were blinded to study group and pre- vs. post-course evaluation. Results Following the course, class participants increased their total mean number of observations compared to controls (5.41 ± 0.63 vs. 0.36 ± 0.53, p < 0.0001) and had increased sophistication in their descriptions of artistic and clinical imagery. A ‘dose-response’ was found for those who attended eight or more sessions, compared to participants who attended seven or fewer sessions (6.31 + 0.81 and 2.76 + 1.2, respectively, p = 0.03). Conclusions This interdisciplinary course improved participants’ capacity to make accurate observations of art and physical findings. Electronic supplementary material The online version of this article (doi:10.1007/s11606-008-0667-0) contains
Describes a workshop that presented both implementation strategies and a working model for education programs seeking to infuse environmental education (EE) in the classroom. Reviews possible obstacles to cross-curricular EE in the school setting and includes a list of factors useful in selecting cross-curricular program themes. (MCO)
Sinclair, Susan M; Miller, Richard K; Chambers, Christina; Cooper, Elizabeth M
Nearly 90% of women in the United States have taken medications during pregnancy. Medication exposures during pregnancy can result in adverse pregnancy and neonatal outcomes including birth defects, fetal loss, intrauterine growth restriction, prematurity, and longer-term neurodevelopmental outcomes. Advising pregnant women about the safety of medication use during pregnancy is complicated by a lack of data necessary to engage the woman in an informed discussion. Routinely, health care providers turn to the package insert, yet this information can be incomplete and can be based entirely on animal studies. Often, adequate safety data are not available. In a busy clinical setting, health care providers need to be able to quickly locate the most up-to-date information in order to counsel pregnant women concerned about medication exposure. Deciding where to locate the best available information is difficult, particularly when the needed information does not exist. Pregnancy registries are initiated to obtain more data about the safety of specific medication exposures during pregnancy; however, these studies are slow to produce meaningful information, and when they do, the information may not be readily available in a published form. Health care providers have valuable data in their everyday practice that can expand the knowledge base about medication safety during pregnancy. This review aims to discuss the limitations of the package insert regarding medication safety during pregnancy, highlight additional resources available to health care providers to inform practice, and communicate the importance of pregnancy registries for expanding knowledge about medication safety during pregnancy.
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…
Larimore, W L; Jordan, E V
Not since the development of the SOAP note in the problem-oriented medical record has there been a significant need to alter the format of medical record documentation. With the intrusion of third-party audits, malpractice attorney subpoenas, medical guidelines, and reimbursement code criteria into the practice of medicine, there is a need to expand the traditional SOAP note. This article proposes a new acronym, "SNOCAMP," for medical record documentation. SNOCAMP retains the SOAP format, which includes subjective, objective, assessment, and plan of treatment, with the addition of nature of the presenting complaint, counseling, and medical decision-making. It is hoped that this new, more explicit format will prove successful in meeting the divergent needs of practicing physicians, the patients they serve, and the inquiring minds that look over their shoulders.
Tarricone, Rosanna; Callea, Giuditta; Ogorevc, Marko; Prevolnik Rupel, Valentina
Medical devices (MDs) have distinctive features, such as incremental innovation, dynamic pricing, the learning curve and organisational impact, that need to be considered when they are evaluated. This paper investigates how MDs have been assessed in practice, in order to identify methodological gaps that need to be addressed to improve the decision-making process for their adoption. We used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist supplemented by some additional categories to assess the quality of reporting and consideration of the distinctive features of MDs. Two case studies were considered: transcatheter aortic valve implantation (TAVI) representing an emerging technology and implantable cardioverter defibrillators (ICDs) representing a mature technology. Economic evaluation studies published as journal articles or within Health Technology Assessment reports were identified through a systematic literature review. A total of 19 studies on TAVI and 41 studies on ICDs were analysed. Learning curve was considered in only 16% of studies on TAVI. Incremental innovation was more frequently mentioned in the studies of ICDs, but its impact was considered in only 34% of the cases. Dynamic pricing was the most recognised feature but was empirically tested in less than half of studies of TAVI and only 32% of studies on ICDs. Finally, organisational impact was considered in only one study of ICDs and in almost all studies on TAVI, but none of them estimated its impact. By their very nature, most of the distinctive features of MDs cannot be fully assessed at market entry. However, their potential impact could be modelled, based on the experience with previous MDs, in order to make a preliminary recommendation. Then, well-designed post-market studies could help in reducing uncertainties and make policymakers more confident to achieve conclusive recommendations. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.
Shevchenko, Iu L
The Military Medical Academy is a military educational institution which carries out the primary profile training of physicians for the Armed Services and all types of post-graduation training and advanced training of the scientific-pedagogical and medical specialists. Internship as a first stage of the post-graduation training is intended to improve practical medical training of the graduates of the Russian Military Medical Academy and other medico-military educational institutions by means of their primary specialization in one of the clinical or profile branches of medicine. The reforming of the post-graduation training rest system in the Military Medical Academy aims at its further development and putting specialists' training system into accordance with the Armed Forces reorganizations. This will make it possible to ensure high professional qualification of military doctors at the level of national and international standards.
Bock, Allison; Chintamaneni, Kathan; Rein, Lisa; Frazer, Tifany; Kayastha, Gyan; MacKinney, Theodore
Streptococcus pneumoniae infection is associated with high morbidity and mortality in low income countries. In Nepal, there is a high lung disease burden and incidence of pneumonia due to multiple factors including indoor air pollution, dust exposure, recurrent infections, and cigarette smoking. Despite the ready availability of effective pneumococcal vaccines (PNV), vaccine coverage rates remain suboptimal globally. Quality Improvement (QI) principles could be applied to improve compliance, but it is a virtually new technology in Nepal. This QI study for Patan Hospital sought to introduce the concept of QI there, to measure the baseline pneumococcal vaccination rate of qualifying adult patients discharged from the medical wards and to assess reasons for non-vaccination. QI interventions were instituted to improve this rate, measuring the effectiveness of QI methods to produce the desired outcomes using the Model for Improvement, Plan-Do-Study-Change (PDSA) methodology. In the three week baseline assessment, 2 out of 81 (2%) eligible patients recalled ever receiving a prior pneumococcal vaccine; 68 (84%) unvaccinated patients responded that they were not asked or were unaware of the PNV. After the QI interventions, the pneumococcal vaccination rate significantly increased to 42% (23/56, p<0.001). Post-intervention, the leading reason for non-vaccination was cost (20%, 11/56). Only 5 (9%) unvaccinated patients were not asked or were unaware of the PNV, a significant change in that process outcome from baseline (p<0.001). Quality improvement measures were effective in increasing pneumococcal vaccination rates, despite the limited familiarity with QI methods at this major teaching hospital. QI techniques may be useful in this and other efforts to improve quality in resource-limited settings, without great cost. PMID:27933153
Engel, Lisa; Henderson, Courtney; Fergenbaum, Jennifer; Colantonio, Angela
Medical record review (MRR) is often used in clinical research and evaluation, yet there is limited literature regarding best practices in conducting a MRR, and there are few studies reporting interrater reliability (IRR) from MRR data. The aim of this research was twofold: (a) to develop a MRR abstraction tool and standardize the MRR process and (b) to examine the IRR from MRR data. This study introduces the MRR-Conduction Model, which was used to implement a MRR, and examines the IRR between two abstractors who collected preinjury medical and psychiatric, incident-related medical and postinjury head symptom information from the medical records of 47 neurologically injured workers. Results showed that the percentage agreement was > or =85% and the unweighted kappa statistic was > or =.60 for most variables, indicating substantial IRR. An effective and reliable MRR to abstract medical-related information requires planning and time. The MRR-Conduction Model is proposed to guide the process of creating a MRR.
Over the last five years several scholarly publishing associations have been launched in Africa - the Forum for African Medical Editors (FAME), the Society of African Journals (SAJE), the Consortium of African Scholarly Publishers (CASP), the Africa Journals Partnership Project and the African Association of Science Editors (AASE). What, if any, has been the impact of these initiatives? This paper reviews the most notable of these associations, FAME, which was established in 2003 with the support of the World Association of Medical Editors, the Council of Science Editors and the Special Program for Research and Training in Tropical Diseases (TDR). FAME is evaluated in relation to two other international scholarly publishing associations - the Scientific Electronic Library Online (SciELO) in South America and the Eastern Mediterranean Association of Medical Editors (EMAME). The article also discusses the future of FAME with regards to new developments in open access publishing through African Journals Online.
Thase, Michael E
Medical comorbidities contribute to poor antidepressant response, treatment resistance, and poor outcomes in many patients with depression. Depression can co-occur with thyroid conditions, chronic pain conditions, central nervous system disorders, and more. Inflammatory conditions such as diabetes and obesity are also associated with depression, and the connection between inflammation and depression may lead to testing that could better match patients to specific antidepressant treatment. Interventions for patients with depression and a comorbid medical condition include careful selection of antidepressant therapy as well as psychotherapy and adjunctive agents.
Hofer, Rebecca; Choi, Hwajung; Mase, Rebecca; Fagerlin, Angela; Spencer, Michael; Heisler, Michele
Objective In a randomized controlled trial we compared two models of community health worker-led diabetes medication decision support for low-income Latino and African American adults with diabetes. Most outcomes were improved when community health workers used either an interactive e-Health tool or print materials. This article investigates mediators and moderators of improved medication adherence in these two models. Method Because both programs significantly improved satisfaction with medication information, medication knowledge, and decisional conflict, we examined whether improvements in each of these outcomes in turn were associated with improvements in self-reported medication adherence, and if so, whether these improvements were mediated by improvements in diabetes self-efficacy or diabetes distress. Potential moderators of improvement included gender, race/ethnicity, age, education, insulin use, health literacy, and baseline self-efficacy, diabetes distress, and A1c. Results A total of 176 participants (94%) completed all assessments. After adjusting for potential confounders, only increased satisfaction with medication information was correlated with improved medication adherence (p = .024). Improved self-efficacy, but not diabetes distress, was associated with improvements in both satisfaction with medication information and medication adherence. However, the Sobel-Goodman Mediation test did not support improvements in self-efficacy as a mechanism by which improved satisfaction led to better adherence. None of the examined variables achieved statistical significance as moderators. Conclusions Improvements in satisfaction with medication information but not in medication knowledge or decision conflict were associated with improvements in medication adherence. Interventions that target low-income ethnic and racial minorities may need to focus on increasing participants' satisfaction with information provided on diabetes medications and not just improving
Stillman, Gloria A.; Alison, Justine; Croker, Felicity
Describes the development of a computer-assisted learning package at James Cook University (Australia) that uses the World Wide Web to provide accessible practice in medication calculations for undergraduate nursing students and inservice education for nurses in isolated areas. Highlights include design features, constraints, cost effectiveness,…
Wen, Fengtong; Guo, Dianli
Telecare medical information system (TMIS) constructs an efficient and convenient connection between patients and the medical server. The patients can enjoy medical services through public networks, and hence the protection of patients' privacy is very significant. Very recently, Wu et al. identified Jiang et al.'s authentication scheme had some security drawbacks and proposed an enhanced authentication scheme for TMIS. However, we analyze Wu et al.'s scheme and show that their scheme suffers from server spoofing attack, off-line password guessing attack, impersonation attack. Moreover, Wu et al.'s scheme fails to preserve the claimed patient anonymity and its password change phase is unfriendly and inefficient. Thereby, we present a novel anonymous authentication scheme for telecare medical information systems to eliminate the aforementioned faults. Besides, We demonstrate the completeness of the proposed scheme through the BAN logic. Furthermore, the security of our proposed scheme is proven through Bellare and Rogaways model. Compared with the related existing schemes, our scheme is more secure.
approach for supporting its RC members in meeting IMR requirements, getting vaccinations , and obtain- ing medical and dental treatment as needed. IMR... HPV ), screening for cervical cancer, and testing for chlamydia. Focus on demineralization (“fix and prevent”) rather than cavities (“drill, fill
... diabetes mellitus which the prior adjudicator believed was medically disabling. The prior record shows that the annuitant has “brittle” diabetes for which he was taking insulin. The annuitant's urine was 3+ for sugar, and he alleged occasional hypoglycemic attacks caused by exertion. His doctor felt the...
... diabetes mellitus which the prior adjudicator believed was medically disabling. The prior record shows that the annuitant has “brittle” diabetes for which he was taking insulin. The annuitant's urine was 3+ for sugar, and he alleged occasional hypoglycemic attacks caused by exertion. His doctor felt the...
According to Hopkins and colleagues, integration of basic science and clinical practice in the medical curriculum has been "incremental" at best, rather than transformative, in part because of a lack of focus on the individuals central to the integration--basic science educators. These authors maintain that those who lead change in education should not only address the systemic structure but also understand the meaning of integration for individual basic scientists at different levels of change. Their view has merit, and this Commentary author suggests three concrete steps that institutions should undertake to engage basic scientists who are interested in becoming "educationally literate" and assuming leadership roles in curriculum integration: (1) Offer opportunities to help interested basic science teaching faculty gain the necessary expertise to become skilled educators; (2) establish institutional programs and structures that foster a community of medical educators across departments and schools; and (3) align institutional priorities and incentives to promote, rather than hinder, integration in medical education. In essence, curricular integration cannot succeed if the participants do not understand the "language of education." Furthermore, faculty who opt for an education-focused career path should be brought together from across departments, centers, and schools to create a community of educators within the academic health center. Finally, institutional leaders should place high value and proper incentives in terms of recognition and opportunities for faculty advancement to ensure that those opting to gain additional training as skilled educators will drive innovation and help move curricular reform from incremental change to transformation.
This chapter describes how assessment of co-curricular student learning outcomes can be used as part of the institutional accreditation process and the opportunities institutional researchers and student affairs educators have to collaborate in those efforts.
Leitzman, David F.; And Others
Reports research that utilized multidimensional scaling and related analytic procedures to validate the curricular goals of a graduate therapeutic recreation program. Data analysis includes the use of the two-dimensional KYST and PREFMAP spaces. (Author/JD)
Hurtubise, Larry; Roman, Brenda
Most significant learning (SL) experiences produce long-lasting learning experiences that meaningfully change the learner's thinking, feeling, and/or behavior. Most significant teaching experiences involve strong connections with the learner and recognition that the learner felt changed by the teaching effort. L. Dee Fink in Creating Significant Learning Experiences: An Integrated Approach to Designing College Course defines six kinds of learning goals: Foundational Knowledge, Application, Integration, Human Dimension, Caring, and Learning to Learn. SL occurs when learning experiences promote interaction between the different kinds of goals, for example, acquiring knowledge alone is not enough, but when paired with a learning experience, such as an effective patient experience as in Caring, then significant (and lasting) learning occurs. To promote SL, backward design principles that start with clearly defined learning goals and the context of the situation of the learner are particularly effective. Emphasis on defining assessment methods prior to developing teaching/learning activities is the key: this ensures that assessment (where the learner should be at the end of the educational activity/process) drives instruction and that assessment and learning/instruction are tightly linked so that assessment measures a defined outcome (competency) of the learner. Employing backward design and the AAMC's MedBiquitous standard vocabulary for medical education can help to ensure that curricular design and redesign efforts effectively enhance educational program quality and efficacy, leading to improved patient care. Such methods can promote successful careers in health care for learners through development of self-directed learning skills and active learning, in ways that help learners become fully committed to lifelong learning and continuous professional development.
O'Shea, Brian; Terry, Laura; Benenson, Walter
We present outcomes from curricular changes made to an introductory calculus-based physics course whose audience is primarily life sciences majors, the majority of whom plan to pursue postbaccalaureate studies in medical and scientific fields. During the 2011-2012 academic year, we implemented a Physics of the Life Sciences curriculum centered on…
Bell, Cathy K.; Guerrero, Anthony; Matsu, Courtenay; Takeshita, Junji; Haning, William; Schultz, Karen
Objective: The authors describe curricular modifications created in response to the changing culture of medical education, health care systems, academic medicine, and generational differences. The authors propose a model child psychiatry inpatient curriculum that is sustainable within a community teaching hospital in the 21st century. Methods: The…
Staker, Larry V.
Practicing physicians generally are not engaged in either the methods of performance improvement for health care or the measurement and reporting of clinical outcomes. The principal reasons are lack of compensation for such work, the perception that the work of performance improvement adds no value and is a waste of time, the lack of knowledge and…
It is incredibly easy to ignore the medical practice team that is doing a good job. However, when we allow good performers to continue as they are, they probably won't improve. Their performance may even worsen. This is unfortunate because with a little bit of effort and support, good performers can often learn to excel. This article offers 12 techniques medical practice managers can use to bring their team members from good performance to excellent. It describes how to use goal-setting, work assignments, modeling, confidence building, team retreats, rewards, incentives, and reinforcement to ratchet up a good medical practice team's performance. This article also identifies the signs of medical employee mediocrity. It describes why setting higher expectations of your medical practice employees will ultimately improve their performance. Finally, this article suggests 10 practical and affordable strategies that medical practice managers can use to reinforce excellent performance in their good employees.
Ens, Konstantin; Schumacher, Hanno; Franz, Astrid; Fischer, Bernd
One of the future-oriented areas of medical image processing is to develop fast and exact algorithms for image registration. By joining multi-modal images we are able to compensate the disadvantages of one imaging modality with the advantages of another modality. For instance, a Computed Tomography (CT) image containing the anatomy can be combined with metabolic information of a Positron Emission Tomography (PET) image. It is quite conceivable that a patient will not have the same position in both imaging systems. Furthermore some regions for instance in the abdomen can vary in shape and position due to different filling of the rectum. So a multi-modal image registration is needed to calculate a deformation field for one image in order to maximize the similarity between the two images, described by a so-called distance measure. In this work, we present a method to adapt a multi-modal distance measure, here mutual information (MI), with weighting masks. These masks are used to enhance relevant image structures and suppress image regions which otherwise would disturb the registration process. The performance of our method is tested on phantom data and real medical images.
Vattanavanit, Veerapong; Kawla-ied, Jarernporn; Bhurayanontachai, Rungsun
Background Septic shock resuscitation bundles have poor compliance worldwide partly due to a lack of knowledge and clinical skills. High-fidelity simulation-based training is a new teaching technology in our faculty which may improve the performance of medical students in the resuscitation process. However, since the efficacy of this training method in our institute is limited, we organized an extra class for this evaluation. Purpose The aim was to evaluate the effect on medical students’ knowledge and confidence levels after the high-fidelity medical simulation training in septic shock management. Methods A retrospective study was performed in sixth year medical students during an internal medicine rotation between November 2015 and March 2016. The simulation class was a 2-hour session of a septic shock management scenario and post-training debriefing. Knowledge assessment was determined by a five-question pre-test and post-test examination. At the end of the class, the students completed their confidence evaluation questionnaire. Results Of the 79 medical students, the mean percentage score ± standard deviation (SD) of the post-test examination was statistically significantly higher than the pre-test (66.83%±19.7% vs 47.59%±19.7%, p<0.001). In addition, the student mean percentage confidence level ± SD in management of septic shock was significantly better after the simulation class (68.10%±12.2% vs 51.64%±13.1%, p<0.001). They also strongly suggested applying this simulation class to the current curriculum. Conclusion High-fidelity medical simulation improved the students’ knowledge and confidence in septic shock resuscitation. This simulation class should be included in the curriculum of the sixth year medical students in our institute. PMID:28053558
Background Unresolved medication discrepancies during hospitalization can contribute to adverse drug events, resulting in patient harm. Discrepancies can be reduced by performing medication reconciliation; however, effective implementation of medication reconciliation has proven to be challenging. The goals of the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) are to operationalize best practices for inpatient medication reconciliation, test their effect on potentially harmful unintentional medication discrepancies, and understand barriers and facilitators of successful implementation. Methods Six U.S. hospitals are participating in this quality improvement mentored implementation study. Each hospital has collected baseline data on the primary outcome: the number of potentially harmful unintentional medication discrepancies per patient, as determined by a trained on-site pharmacist taking a “gold standard” medication history. With the guidance of their mentors, each site has also begun to implement one or more of 11 best practices to improve medication reconciliation. To understand the effect of the implemented interventions on hospital staff and culture, we are performing mixed methods program evaluation including surveys, interviews, and focus groups of front line staff and hospital leaders. Discussion At baseline the number of unintentional medication discrepancies in admission and discharge orders per patient varies by site from 2.35 to 4.67 (mean=3.35). Most discrepancies are due to history errors (mean 2.12 per patient) as opposed to reconciliation errors (mean 1.23 per patient). Potentially harmful medication discrepancies averages 0.45 per patient and varies by site from 0.13 to 0.82 per patient. We discuss several barriers to implementation encountered thus far. In the end, we anticipate that MARQUIS tools and lessons learned have the potential to decrease medication discrepancies and improve patient outcomes. Trial
Martínez Castuera-Gómez, Carla; Talavera, Juan O
The increased quality in medical care may be immediately accomplished if clinical research is integrated into daily clinical practice. In the generation of medical knowledge are four steps: an unanswered question awakened from clinical practice, the critical analysis of specialized literature, the development of a research protocol, and, finally, the publication of outcomes. Decision making and continuous training are becoming part of an effective strategy of medical attention improvement.
Monroe, Heidi; Plylar, Peggy; Krugman, Mary
Higher patient acuities and more novice nurses on medical-surgical units have Educators focused on achieving positive outcomes with changes in patient condition. An educational program was developed to enhance nurses' knowledge, skill, and confidence in assessing hemodynamics, recognizing early signs of instability, and administering vasoactive medications. The program was successful with significant knowledge improvement as well as an increased use of the Medical Emergency Team while maintaining a low number of code calls.
Newman-Casey, Paula Anne; Dayno, Megan; Robin, Alan L.
Purpose To evaluate the current state of the research on educational interventions whose aim is to improve glaucoma medication adherence. Methods A systematic review of Pubmed, Embase and CINAHL was conducted to identify research studies evaluating educational interventions to improve glaucoma medication adherence. Studies were included if the intervention was described, the outcomes assessed glaucoma medication adherence, and the focus of the research was on adults with glaucoma. The search was conducted on June 2, 2015. Results Seventeen studies were identified that met the inclusion criteria. These included nine randomized controlled trials and eight observational studies. Eight of the studies demonstrated an impact on glaucoma medication adherence, though their outcome measures were too heterogeneous to estimate a pooled effect size.. Conclusion The interventions that successfully improved glaucoma medication adherence used an adequate dose of face-to-face counseling to overcome barriers to health behavior change alongside education about glaucoma. PMID:27134639
Chen, Lu; Xu, YingJun; Zhang, Fengxia; Yang, Qingfeng; Yuan, Juxiang
Dirty medical lead clothes, contaminated with blood or other infected material, may carry ongoing bioburden, which increase the risk of hospital-acquired infection. In this study, we investigated medical lead clothes contamination levels and assessed the effectiveness of the intervention that was constructed to improve the cleanliness of lead clothes.
Schnelle, John F.; Osterweil, Dan; Simmons, Sandra F.
Nursing home medical-record documentation of daily-care occurrence may be inaccurate, and information is not documented about important quality-of-life domains. The inadequacy of medical record data creates a barrier to improving care quality, because it supports an illusion of care consistent with regulations, which reduces the motivation and…
Jagosh, Justin J.
In 2004, members of the McGill University Faculty of Medicine began implementing a new curriculum for undergraduate medical education entitled, Physicianship: The Physician as Professional and Healer. The initiative underscores the idea that physician training entails cultivating not only scientific knowledge and technical skill, but a mindset guided by intrinsic principles of doctoring. Although the McGill case exemplifies a wide-spread paradigm shift in medical teaching, there is a dearth of analysis concerning the degree of congruency between the objectives of formal undergraduate curricular revision and the so-called 'hidden curriculum' of the hospital training environment. With Physicianship as a point of departure, this dissertation maps evolutionary patterns in clinical medicine and, using qualitative methods, analyzes the perspectives of twenty physician-educators on curricular reform and the transforming clinical training environment. Physicians interviewed were generally supportive of the new curricular initiative. Concerns were raised, however, that many recent changes within the teaching hospital environment interfere with students' cultivation of professional and healer attributes. These changes were organized into three main themes: scientific, institutional, and social. Physicians expressed concern that what is often considered beneficial for patients is often detrimental for medical training. For example, increased use of diagnostic technologies has improved patient care but reduces opportunities for trainees' clinical skill development. Concern was raised that the concept of selfless service has been undermined through recent shift-work regulations and a culture gap between older and younger generation physicians. Alternatively, some perceived new policies of the clinical environment to be more conducive to physicians' self-care and quality of life. Younger trainees were often described as more competent in managing medical information, more open
Weiss, Barry D.; Brega, Angela G.; LeBlanc, William G.; Mabachi, Natabhona M.; Barnard, Juliana; Albright, Karen; Cifuentes, Maribel; Brach, Cindy; West, David R.
Background Although routine medication reviews in primary care practice are recommended to identify drug therapy problems, it is often difficult to get patients to bring all their medications to office visits. The objective of this study was to determine whether the medication review tool in the Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit can help to improve medication reviews in primary care practices. Methods The toolkit's “Brown Bag Medication Review” was implemented in a rural private practice in Missouri and an urban teaching practice in California. Practices recorded outcomes of medication reviews with 45 patients before toolkit implementation and then changed their medication review processes based on guidance in the toolkit. Six months later we conducted interviews with practice staff to identify changes made as a result of implementing the tool, and practices recorded outcomes of medication reviews with 41 additional patients. Data analyses compared differences in whether all medications were brought to visits, the number of medications reviewed, drug therapy problems identified, and changes in medication regimens before and after implementation. Results Interviews revealed that practices made the changes recommended in the toolkit to encourage patients to bring medications to office visits. Evaluation before and after implementation revealed a 3-fold increase in the percentage of patients who brought all their prescription medications and a 6-fold increase in the number of prescription medications brought to office visits. The percentage of reviews in which drug therapy problems were identified doubled, as did the percentage of medication regimens revised. Conclusions Use of the Health Literacy Universal Precautions Toolkit can help to identify drug therapy problems. PMID:26769873
Uomo, Paul Dell; Schwieters, Jill
Hospitals that want to improve their recruitment efforts should: Make recruitment a priority within the organization. Take steps to reduce high vacancy rates and turnover among first-year employees. Develop a recruitment marketing plan for key positions. Establish human resources metrics to track costs and effectiveness of recruiting efforts. Enhance the recruitment process for hiring managers and job candidates.
Frese, Richard C
Healthcare organizations can improve their year-end malpractice insurance accruals by taking the following steps: Maintain productive communication. Match accrual and accounting policies. Adjust amount of credit to own historical loss experience. Request more frequent analysis. Obtain a second opinion.
Timofeev, I V
The paper considers the legal and organizational issues of the activity of pathology services in improving medical care. It shows the main (diagnostic and medico-organizational) areas of pathology work to improve the quality of medical care.
Pollock, George P.
The basic curricular structure and courses deemed necessary to podiatric medical education are outlined and their rationale explained. Specialties appropriate to podiatric practice, such as electrophysiology and cardiovascular physiology, are noted, and the sequence of coursework suggested. (MSE)
Poeggel, Sven; Duraibabu, Dineshbabu; Kalli, Kyriacos; Leen, Gabriel; Dooly, Gerard; Lewis, Elfed; Kelly, Jimmy; Munroe, Maria
This investigation describes a detailed analysis of the fabrication and testing of optical fibre pressure and temperature sensors (OFPTS). The optical sensor of this research is based on an extrinsic Fabry-Perot interferometer (EFPI) with integrated fibre Bragg grating (FBG) for simultaneous pressure and temperature measurements. The sensor is fabricated exclusively in glass and with a small diameter of 0.2 mm, making it suitable for volume-restricted bio-medical applications. Diaphragm shrinking techniques based on polishing, hydrofluoric (HF) acid and femtosecond (FS) laser micro-machining are described and analysed. The presented sensors were examined carefully and demonstrated a pressure sensitivity in the range of sp = 2-10 nm/kPa and a resolution of better than ΔP = 10 Pa protect (0.1 cm H2O). A static pressure test in 38 cm H2O shows no drift of the sensor in a six-day period. Additionally, a dynamic pressure analysis demonstrated that the OFPTS never exceeded a drift of more than 130 Pa (1.3 cm H2O) in a 12-h measurement, carried out in a cardiovascular simulator. The temperature sensitivity is given by k = 10.7 pm/K, which results in a temperature resolution of better than ΔT = 0.1 K. Since the temperature sensing element is placed close to the pressure sensing element, the pressure sensor is insensitive to temperature changes.
Gold, Jonathan; Reyes-Gastelum, David; Turner, Jane; Davies, H Dele
Despite expert guidelines, gaps persist in quality of care for children with asthma. This study sought to identify barriers and potential interventions to improve compliance to national asthma prevention guidelines at a single academic pediatric primary care clinic. Using the plan-do-check-act (PDCA) quality improvement framework and fishbone analysis, several barriers to consistent asthma processes and possible interventions were identified by a group of key stakeholders. Two interventions were implemented using the electronic medical record (EMR). Physician documentation of asthma quality measures were analyzed before intervention and during 2 subsequent time points over 16 months. Documentation of asthma action plans (core group P < .001, noncore group P = .004) and medication counseling (core group P < .001, noncore group P < .001) improved substantially by the third time point. A systematic approach to quality improvement using PDCA and fishbone analysis in conjunction with embedded EMR tools can improve asthma care in a pediatric primary care setting.
Xakellis, George; Brangman, Sharon A; Hinton, W Ladson; Jones, Vida Y; Masterman, Donna; Pan, Cynthia X; Rivero, Jorge; Wallhagen, Margaret; Yeo, Gwen
Strategies to reduce the documented disparities in health and health care for the rapidly growing numbers of older patients from diverse ethnic populations include increased cultural competence of providers. To assist geriatric faculty in medical and other health professional schools develop cultural competence training for their ethnogeriatric programs, the University of California Academic Geriatric Resource Program partnered with the Ethnogeriatric Committee of the American Geriatrics Society to develop a curricular framework. The framework includes core competencies based on the format of the Core Competencies for the Care of Older Patients developed by the Education Committee of the American Geriatrics Society. Competencies in attitudes, knowledge, and skills for medical providers caring for elders from diverse populations are specified. Also included are recommended teaching strategies and resources for faculty to pursue the development of full curricula.
Pandolfe, Frank; Crotty, Bradley H; Safran, Charles
Incompletely reconciled medication lists contribute to prescribing errors and adverse drug events. Providers expend time and effort at every point of patient contact attempting to curate a best possible medication list, and yet often the list is incomplete or inaccurate. We propose a framework that builds upon the existing infrastructure of a health information exchange (HIE), centralizes data and encourages patient activation. The solution is a constantly accessible, singular, patient-adjudicated medication list that incorporates useful information and features into the list itself. We aim to decrease medication errors across transitions of care, increase awareness of potential drug-drug interactions, improve patient knowledge and self-efficacy regarding medications, decrease polypharmacy, improve prescribing safety and ultimately decrease cost to the health-care system. PMID:28269955
Pandolfe, Frank; Crotty, Bradley H; Safran, Charles
Incompletely reconciled medication lists contribute to prescribing errors and adverse drug events. Providers expend time and effort at every point of patient contact attempting to curate a best possible medication list, and yet often the list is incomplete or inaccurate. We propose a framework that builds upon the existing infrastructure of a health information exchange (HIE), centralizes data and encourages patient activation. The solution is a constantly accessible, singular, patient-adjudicated medication list that incorporates useful information and features into the list itself. We aim to decrease medication errors across transitions of care, increase awareness of potential drug-drug interactions, improve patient knowledge and self-efficacy regarding medications, decrease polypharmacy, improve prescribing safety and ultimately decrease cost to the health-care system.
Liu, Long; Shuai, Ma; Wang, Zhu; Li, Ping
In order to effectively analyze and control use-related risk of medical devices, quantitative methodologies must be applied. Failure Mode and Effects Analysis (FMEA) is a proactive technique for error detection and risk reduction. In this article, an improved FMEA based on Fuzzy Mathematics and Grey Relational Theory is developed to better carry out user-related risk analysis for medical devices. As an example, the analysis process using this improved FMEA method for a certain medical device (C-arm X-ray machine) is described.
Kaneko, Sakae; Masuda, Koji; Hiragun, Takaaki; Inomata, Naoko; Furue, Masutaka; Onozuka, Daisuke; Takeuchi, Satoshi; Murota, Hiroyuki; Sugaya, Makoto; Saeki, Hidehisa; Shintani, Yoichi; Tsunemi, Yuichiro; Abe, Shinya; Kobayashi, Miwa; Kitami, Yuki; Tanioka, Miki; Imafuku, Shinichi; Abe, Masatoshi; Hagihara, Akihito; Morisky, Donald E; Katoh, Norito
Poor adherence to medication is a major public health challenge. Here, we aimed to determine the adherence to oral and topical medications and to analyze underlying associated factors using the translated Japanese version of Morisky Medication Adherence Scale-8 regarding urticaria treatment. Web-based questionnaires were performed for 3096 registered dermatological patients, along with a subanalysis of 751 registered urticaria patients in this study. The adherence to oral medication was significantly associated with the frequency of hospital visits. Variables that affected the adherence to topical medication included age and experience of drug effectiveness. The rate of responses that "It felt like the symptoms had improved" varied significantly among the dermatological diseases treated with oral medications. Dermatologists should be aware that adherence to the treatment of urticaria is quite low. Regular visits and active education for patients with urticaria are mandatory in order to achieve a good therapeutic outcome by increasing the adherence.
Newell, Terry L; Steinmetz-Malato, Laura L; Van Dyke, Deborah L
The inpatient medication delivery system used at a large regional acute care hospital in the Midwest had become antiquated and inefficient. The existing 24-hr medication cart-fill exchange process with delivery to the patients' bedside did not always provide ordered medications to the nursing units when they were needed. In 2007 the principles of the Toyota Production System (TPS) were applied to the system. Project objectives were to improve medication safety and reduce the time needed for nurses to retrieve patient medications. A multidisciplinary team was formed that included representatives from nursing, pharmacy, informatics, quality, and various operational support departments. Team members were educated and trained in the tools and techniques of TPS, and then designed and implemented a new pull system benchmarking the TPS Ideal State model. The newly installed process, providing just-in-time medication availability, has measurably improved delivery processes as well as patient safety and satisfaction. Other positive outcomes have included improved nursing satisfaction, reduced nursing wait time for delivered medications, and improved efficiency in the pharmacy. After a successful pilot on two nursing units, the system is being extended to the rest of the hospital.
Olson, Brandon D.
Institutions of higher education are facing increasing pressure to improve the effectiveness and quality of academic programs (Association of Governing Boards, Top public policy issues 2011-2012, 2011). These institutions apply curricular assessment processes as a means to evaluate and improve academic effectiveness and quality. Knowledge…
Fratto, Victoria A.
This study was designed to determine if the use of online curricular tools as a pedagogical supplement to an introductory accounting course would improve student accounting knowledge as compared to traditional teaching methodology. The curricular model employed course-embedded online assessments and tools that were designed to assist an accounting…
Margotti, Ana E; Ferreira, Filipa B; Santos, Francisco A; Garcia, Renato
Health technology assessment (HTA) is a tool to support decision making that is intended to assist healthcare managers in their strategic decisions. The use of HTA as a tool for clinical engineering is especially relevant in the domain of the medical equipment once it could improve the performance of the medical equipment. It would be done by their systematically evaluation in several aspects, in their life cycle. In Brazil, the Institute of Biomedical Engineering (IEB-UFSC) through the clinical engineering area has been working on the development of methodologies and improvements on HTA for medical equipment. Therefore, this paper presents the effort to create specific methodologies that will improve the dissemination of HTA, focusing on incorporation and utilization phase of the medical equipment life cycle. This will give a better support to the decision makers in the management of the health care system.
Brannan, Grace D; Russ, Ronald; Winemiller, Terry R; Mast, Eric
Quality improvement (QI) continues to be a health care challenge, and the literature indicates that osteopathic medical students need more training. To qualify for portions of managed care reimbursement, hospitals are required to meet measures intended to improve quality of care and patient satisfaction, which may be challenging for small community hospitals with limited resources. Because osteopathic medical training is grounded on community hospital experiences, an opportunity exists to align the outcomes needs of hospitals and QI training needs of students. In this pilot program, 3 sponsoring hospitals recruited and mentored 1 osteopathic medical student each through a QI project. A mentor at each hospital identified a project that was important to the hospital's patient care QI goals. This pilot program provided osteopathic medical students with hands-on QI training, created opportunities for interprofessional collaboration, and contributed to hospital initiatives to improve patient outcomes.
Virtually all health care organizations have goals of improving patient safety, but despite clear goals and considerable investments, gains have been limited. This article explores a community hospital's resounding success using Lean methodology to improve medication administration safety with process changes designed by engaged employees and leaders with the knowledge and skill to effect improvements. This article inspires an interdisciplinary approach to quality improvement using reproducible strategies.
Mousa, Aseel; Yusof, Yuhanis
A metric or distance function is a function which defines a distance between elements of a set. In clustering, measuring the similarity between objects has become an important issue. In practice, there are various similarity measures used and this includes the Euclidean, Manhattan and Minkowski. In this paper, an improved Chebyshev similarity measure is introduced to replace existing metrics (such as Euclidean and standard Chebyshev) in clustering analysis. The proposed measure is later realized in analyzing blood cancer images. Results demonstrate that the proposed measure produces the smallest objective function value and converge at the lowest number of iteration. Hence, it can be concluded that the proposed distance metric contribute in producing better clusters.
Pitkänen, Anneli; Teuho, Susanna; Uusitalo, Marjo; Kaunonen, Marja
In recent years, patient safety has been a serious concern internationally. Medication in particular is a significant area in improving patient safety because medication errors are a crucial clinical problem. This study aimed to explore suggestions to improve medication safety reported via computerized patient safety systems in hospitals. The research data were retrospectively collected from the computerized patient safety incident reporting systems in one university hospital and two regional hospitals in Finland. Open-ended records concerning prescribing medicines (n = 136), dispensing medicines (n = 362), administering medicines to patients (n = 538), and documenting medication (n = 434) were included in the analysis. The data were analyzed by using inductive content analysis. Based on the study findings, there is a need to develop and standardize procedures related to all four parts of medication management process. Moreover, working environment, multiprofessional collaboration, and knowledge and skills of the professionals should be developed. Promoting medication safety in hospitals is an urgent challenge. The study results indicated that computerized patient safety incident reporting systems can provide important qualitative information to improve medication process to be safer.
Cross-curricular objectives serve as a kind of "safety net" for core objectives. Firstly, cross-curricular objectives refer to competencies that do not pertain to the content of one or more subjects, but that can be taught, practised and applied in it, such as learning to learn and social skills. Secondly, certain cross-curricular final…
Kloeppel, Tiffany; Kulinna, Pamela Hodges; Stylianou, Michalis; van der Mars, Hans
This study addressed teachers' fidelity to one Physical Education curricular model. The theoretical framework guiding this study included professional development and fidelity to curricular models. In this study, teachers' fidelity to the Dynamic Physical Education (DPE) curricular model was measured for high and nonsupport district groups.…
Sneider, Richard M.
A Medical Information System (MIS) impacts virtually every department in a hospital. Technicon's MATRIX MIS is designed to improve patient care while reducing the cost of delivering that care. This paper discusses several of the features designed to improve the quality of patient care at user hospitals.
Sung, Wen-Tsai; Chiang, Yen-Chun
This study examines wireless sensor network with real-time remote identification using the Android study of things (HCIOT) platform in community healthcare. An improved particle swarm optimization (PSO) method is proposed to efficiently enhance physiological multi-sensors data fusion measurement precision in the Internet of Things (IOT) system. Improved PSO (IPSO) includes: inertia weight factor design, shrinkage factor adjustment to allow improved PSO algorithm data fusion performance. The Android platform is employed to build multi-physiological signal processing and timely medical care of things analysis. Wireless sensor network signal transmission and Internet links allow community or family members to have timely medical care network services.
Kuqi, Kushtrim; Eveleigh, Tim; Holzer, Thomas; Sarkani, Shahryar; Levin, James E; Crowley, Rebecca S
This study examines a new approach of using the Design Structure Matrix (DSM) modeling technique to improve the design of Electronic Medical Record (EMR) user interfaces. The usability of an EMR medication dosage calculator used for placing orders in an academic hospital setting was investigated. The proposed method captures and analyzes the interactions between user interface elements of the EMR system and groups elements based on information exchange, spatial adjacency, and similarity to improve screen density and time-on-task. Medication dose adjustment task time was recorded for the existing and new designs using a cognitive simulation model that predicts user performance. We estimate that the design improvement could reduce time-on-task by saving an average of 21 hours of hospital physicians' time over the course of a month. The study suggests that the application of DSM can improve the usability of an EMR user interface.
Hauer, Karen E.; Carney, Patricia A.; Chang, Anna; Satterfield, Jason
Purpose Unhealthy behaviors contribute to half of U.S. deaths. However, physicians lack sufficient skill in counseling patients to change behaviors. Characterizing effective published curricular interventions for behavior-change counseling for medical trainees would inform educators toward improved training. Method The authors conducted a systematic literature search of studies published 1965–2011 evaluating curricula on behavior change counseling for medical trainees. Included studies described: (1) behavior change counseling, (2) teaching interventions for medical trainees, and (3) assessment of interventions. The authors extracted eligible articles, rated outcomes for learners and patients using Kirkpatrick’s hierarchy, and determined study quality. Results Of 2,788 identified citations, 109 met inclusion criteria. Most studies were performed in the United States (98), 93 at a single institution, and 81 in primary care settings. Curricular topics for counseling included smoking (67 studies), nutrition (30), alcohol/drug use (26), and exercise (22). Although most studies did not include theoretical frameworks, 39 used the Transtheoretical Model of Change. Sixty-two studies involved eight or fewer hours of curricular time, and 51 spanned four or fewer weeks. The studies with highest-level outcomes and quality employed multiple curricular techniques and included practice of counseling techniques in either simulated or actual clinical settings. Conclusions Existing literature suggests that trainees learn behavior change counseling through active, realistic practice and implementation of reminder and feedback systems within actual clinical practice settings. Multi-institutional medical education research on methods of teaching behavior-change counseling that influence patients’ health outcomes are needed to ensure trainees’ clinical competence and improve patient care. PMID:22622220
Klemetsen, O; Birkelund, Y; Jacobsen, S K; Maccarini, P F; Stauffer, P R
(amplifiers and power meter). For the configuration with a low noise amplifier up front, damage would occur to the active components of the radiometer if used in presence of the microwave heating antenna. Nevertheless, this design showed significantly improved sensitivity of measured temperatures and merits further investigation to determine methods of protecting the radiometer for amplifier first front ends.
Eisenstein, Eric L.; Ortiz, Maqui; Anstrom, Kevin J.; Crosslin, David R.; Lobach, David F.
Medical information systems are being recognized for their ability to improve patient outcomes. While standards for the economic evaluation of medical technologies were instituted in the mid-1990s, little is known about their application in medical information technology studies. In a review of medical information technology evaluation studies published between 1982 and 2002, we found that the volume and variety of economic evaluations had increased; however, investigators routinely omitted key cost or effectiveness elements in their designs, resulting in publications with incomplete, and potentially biased, economic findings. Of the studies that made economic claims, 23% did not report any economic data, 40% failed to include any effectiveness measures, and more than 50% used a case study or pre- post- test design. Thus, during a time when health economic study methods in general have experienced significant development, there is little evidence of similar progress in medical information technology economic evaluations. PMID:17238338
Kivekäs, Eija; Luukkonen, Irmeli; Mykkänen, Juha; Saranto, Kaija
In this paper, we present an overview of activities and results from a regional development project in Finland. The aim in this project was to analyze how healthcare providers produce and receive information on a patient's medication, and to identify opportunities to improve the quality, effectiveness, availability and collaboration of social and healthcare services in relation to medication information. The project focused on the most important points in patients' medication management such as home care and care transitions. In a regional development project, data was gathered by interviews and a multi professional workshop. The study revealed that medication information reached only some professionals and lay caregivers despite electronic patient record (EPR) systems and tools. Differences in work processes related to medication reconciliation and information management were discussed in the group meeting and were regarded as a considerable risk for patient safety.
Journal of Dental Education, 1981
AADS curricular guidelines suggest objectives for these areas of dental auxiliary radiology: physical principles of X-radiation in dentistry, related radiobiological concepts, principles of radiologic health, radiographic technique, x-ray films and intensifying screens, factors contributing to film quality, darkroom, and normal variations in…
York County School District 3, Rock Hill, SC.
This curricular guide focuses on life science and is designed for use with seventh grade students. Life science was chosen as the course of study based on the rationale that, as pupils enter junior high school, they are in early adolescence and find it difficult to understand themselves so that the study of living things with a thorough…
Ebadi, Seyed Hossein; Keshtiaray, Narges; Aghaei, Asghar; Yousefy, Alireza
Present-day curricular designs have to take the pupils' psychological needs in account, thus becoming melodies of mental health and happiness for the next generation. Emphasizing the findings from previous investigations using the research synthesis methodology, the present study has been conducted aiming at achieving some integrative knowledge…
George, Deborah A.
With the motivation for career advancement, many adult learners have chosen to return to graduate education or professional programs. The bridge program is one relatively new alternative curricular model available for adult learners who wish to build on their education within their chosen profession. Evidence on the effectiveness of such programs…
Prescott, Lauren S.; Dickens, Andrea S.; Guerra, Sandra L.; Tanha, Jila M.; Phillips, Desiree G.; Patel, Katherine T.; Umberson, Katie M.; Lozano, Miguel A.; Lowe, Kathryn B.; Brown, Alaina J.; Taylor, Jolyn S.; Soliman, Pamela T.; Garcia, Elizabeth A.; Levenback, Charles F.; Bodurka, Diane C.
Objective Shared medical appointments offer a novel approach to improve efficiency and quality of care consistent with the goals of the Institute of Medicine. Our objective was to develop and implement a shared medical appointment for gynecologic cancer patients initiating chemotherapy. Methods We first assessed the level of interest in shared medical appointments among our patients and providers through qualitative interviews. Both patients and providers identified pre-chemotherapy as an optimal area to pilot shared medical appointments. We subsequently created a multidisciplinary team comprised of physicians, advanced practice providers, nurses, pharmacists, administrators, health education specialists and members of the Quality Improvement Department to establish a Shared Medical Appointment and Readiness Teaching (SMART) program for all gynecologic oncology patients initiating chemotherapy with platinum- and/or taxane-based regimens. We developed a standardized chemotherapy education presentation and provided patients with a tool kit that consisted of chemotherapy drug education, a guide to managing side effects, advance directives, and center contact information. Results From May 9, 2014 to June 26, 2015, 144 patients participated in 51 SMART visits. The majority of patients had ovarian cancer and were treated with carboplatin/paclitaxel. Surveyed patients reported being highly satisfied with the group visit and would recommend shared medical appointments to other patients. Conclusions This model of care provides patient education within a framework of social support that empowers patients. Shared medical appointments for oncology patients initiating chemotherapy are both feasible and well accepted. PMID:26549108
Awdishu, Linda; Namba, Jennifer
Objective. To evaluate first-year pharmacy students’ ability to identify medication errors involving the top 100 prescription medications. Design. In the first quarter of a 3-quarter pharmacy self-care course, a didactic lecture on the most common prescribing and dispensing prescription errors was presented to first-year pharmacy students (P1) in preparation for a prescription review simulation done individually and as a group. In the following quarter, they were given a formal prescription review workshop before a second simulation involving individual and group review of a different set of prescriptions. Students were evaluated based on the number of correctly checked prescriptions and a self-assessment of their confidence in reviewing prescriptions. Assessment. All 63 P1 students completed the prescription review simulations. The individual scores did not significantly change, but group scores improved from 79 (16.2%) in the fall quarter to 98.6 (4.7%) in the winter quarter. Students perceived improvement of their prescription checking skills, specifically in their ability to fill a prescription on their own, identify prescribing and dispensing errors, and perform pharmaceutical calculations. Conclusion. A prescription review module consisting of a didactic lecture, workshop and simulation-based methods to teach prescription analysis was successful at improving first year pharmacy students’ knowledge, confidence, and application of these skills. PMID:27402989
Atayee, Rabia S; Awdishu, Linda; Namba, Jennifer
Objective. To evaluate first-year pharmacy students' ability to identify medication errors involving the top 100 prescription medications. Design. In the first quarter of a 3-quarter pharmacy self-care course, a didactic lecture on the most common prescribing and dispensing prescription errors was presented to first-year pharmacy students (P1) in preparation for a prescription review simulation done individually and as a group. In the following quarter, they were given a formal prescription review workshop before a second simulation involving individual and group review of a different set of prescriptions. Students were evaluated based on the number of correctly checked prescriptions and a self-assessment of their confidence in reviewing prescriptions. Assessment. All 63 P1 students completed the prescription review simulations. The individual scores did not significantly change, but group scores improved from 79 (16.2%) in the fall quarter to 98.6 (4.7%) in the winter quarter. Students perceived improvement of their prescription checking skills, specifically in their ability to fill a prescription on their own, identify prescribing and dispensing errors, and perform pharmaceutical calculations. Conclusion. A prescription review module consisting of a didactic lecture, workshop and simulation-based methods to teach prescription analysis was successful at improving first year pharmacy students' knowledge, confidence, and application of these skills.
de Saunière, Anne; Bonneau, Laetitia; Donio, Valérie; Godinot, Valérie; Flouzat, Jean-Philippe; Bensasson, Géraldine; Code, Christelle; Galay, Guillaume; Pige, Dominique
The institutions expressed great interest in medication administration systems and tools designed to monitor all stages of medication administration. A dozen simple and pragmatic improvement actions were identified and listed in the Ile-de-France Regional Health Agency action plan to improve medication administration management of in EHPAD..
The author takes a look into the benefits that dinosaurs may bring to the classroom. He discusses how he used dinosaurs as a cross-curricular theme to improve children's understanding and knowledge of science concepts. To investigate what a child might learn from dinosaurs, he started by comparing the many non-fiction dinosaur books using the…
Stanford Univ., CA. Stanford Program on International and Cross Cultural Education.
This guide is for educators who wish to improve existing curricular frameworks for teaching about world cultures. The guide is anchored by six goal statements for student learning: (1) to begin to understand that cultures are complex and are made up of many components (values, behavior, habitat, aesthetics, etc.); (2) to recognize the part…
Coleman, Daniel R.; Bolte, John R.
The quest for excellence in American higher education has been accompanied by the implementation of basic skills requirements and the corresponding assessment programs. Assessment results could provide feedback for curricular improvement, although they are frequently used as indicators of institutional quality. A study is presented that compared…
Liu, Xiaoqiu; Lewis, James J.; Zhang, Hui; Lu, Wei; Zhang, Shun; Zheng, Guilan; Bai, Liqiong; Li, Jun; Li, Xue; Chen, Hongguang; Liu, Mingming; Chen, Rong; Chi, Junying; Lu, Jian; Huan, Shitong; Cheng, Shiming; Wang, Lixia; Jiang, Shiwen; Chin, Daniel P.; Fielding, Katherine L.
Background Mobile text messaging and medication monitors (medication monitor boxes) have the potential to improve adherence to tuberculosis (TB) treatment and reduce the need for directly observed treatment (DOT), but to our knowledge they have not been properly evaluated in TB patients. We assessed the effectiveness of text messaging and medication monitors to improve medication adherence in TB patients. Methods and Findings In a pragmatic cluster-randomised trial, 36 districts/counties (each with at least 300 active pulmonary TB patients registered in 2009) within the provinces of Heilongjiang, Jiangsu, Hunan, and Chongqing, China, were randomised using stratification and restriction to one of four case-management approaches in which patients received reminders via text messages, a medication monitor, combined, or neither (control). Patients in the intervention arms received reminders to take their drugs and reminders for monthly follow-up visits, and the managing doctor was recommended to switch patients with adherence problems to more intensive management or DOT. In all arms, patients took medications out of a medication monitor box, which recorded when the box was opened, but the box gave reminders only in the medication monitor and combined arms. Patients were followed up for 6 mo. The primary endpoint was the percentage of patient-months on TB treatment where at least 20% of doses were missed as measured by pill count and failure to open the medication monitor box. Secondary endpoints included additional adherence and standard treatment outcome measures. Interventions were not masked to study staff and patients. From 1 June 2011 to 7 March 2012, 4,292 new pulmonary TB patients were enrolled across the 36 clusters. A total of 119 patients (by arm: 33 control, 33 text messaging, 23 medication monitor, 30 combined) withdrew from the study in the first month because they were reassessed as not having TB by their managing doctor (61 patients) or were switched to
Context: A FAIMER (Foundation for Advancement in International Medical Education and Research) fellow organized a comprehensive faculty development program to improve faculty awareness resulting in changed teaching practices and better teacher student relationships using Transactional Analysis (TA). Practicing TA tools help development of ‘awareness’ about intrapersonal and interpersonal processes. Objectives: To improve self-awareness among medical educators.To bring about self-directed change in practices among medical educators.To assess usefulness of TA tools for the same. Methods: An experienced trainer conducted a basic course (12 hours) in TA for faculty members. The PAC model of personality structure, functional fluency model of personal functioning, stroke theory on motivation, passivity and script theories of adult functional styles were taught experientially with examples from the Medical Education Scenario. Self-reported improvement in awareness and changes in practices were assessed immediately after, at three months, and one year after training. Findings: The mean improvement in self-'awareness' is 13.3% (95% C.I 9.3-17.2) among nineteen participants. This persists one year after training. Changes in practices within a year include, collecting feedback, new teaching styles and better relationship with students. Discussion and Conclusions: These findings demonstrate sustainable and measurable improvement in self-awareness by practice of TA tools. Improvement in self-'awareness' of faculty resulted in self-directed changes in teaching practices. Medical faculty has judged the TA tools effective for improving self-awareness leading to self-directed changes. PMID:24358808
Blaginin, A A; Grebeniuk, A N; Lizogub, I N
Blaginin A.A., Grebenyuk A.N., Lizogub LN. - The main ways of improvement of medical support of the Air Forces in modern conditions. Aircrew conducting active hostilities suffers from the whole spectrum of factors and conditions of the combat situation. The main task for the medical service of the Air Force is to carry out preventive and curative action for aviation specialists who are responsible for the combat capability of aircraft formations. The medical service of the Air Force must have forces and facilities for planning, organization and implementation of the treatment of lightly wounded and sick aviation professionals with short periods of recovery, medical rehabilitation of aircrew qfter suffering injuries, diseases, sanatorium therapy of aircrew with partial failure of health, outpatient and inpatient medical examination aircrew - flight commissions, preventive rest of aviation specialists with symptoms of chronic fatigue. Should be trained aviation physicians, including both basic military medical education and in-depth study of the medical aspects of various fields of personnel of the Air Force.
Artinian, Nancy T; Schwiebert, Loren; Yarandi, Hossein; Levy, Phillip D
Background Hypertension (HTN) is a major public health concern in the United States, with almost 78 million Americans age 20 years and over suffering from the condition. Moreover, HTN is a key risk factor for health disease and stroke. African Americans disproportionately shoulder the burdens of HTN, with greater prevalence, disease severity, earlier onset, and more HTN-related complications than age-matched whites. Medication adherence for the treatment of HTN is poor, with estimates indicating that only about half of hypertensive patients are adherent to prescribed medication regimens. Although no single intervention for improving medication adherence has emerged as superior to others, text message medication reminders have the potential to help improve medication adherence in African Americans with uncontrolled HTN as mobile phone adoption is very high in this population. Objective The purpose of this two-phased study was to develop (Phase I) and test in a randomized controlled trial (RCT) (Phase II) a text message system, BPMED, to improve the quality of medication management through increasing medication adherence in African Americans with uncontrolled HTN. Methods In Phase I, we recruited 16 target end-users from a primary care clinic, to assist in the development of BPMED through participating in one of three focus groups. Focus groups sought to gain patient perspectives on HTN, medication adherence, mobile phone use, and the use of text messaging to support medication adherence. Potential intervention designs were presented to participants, and feedback on the designs was solicited. In Phase II, we conducted two pilot RCTs to determine the feasibility, acceptability, and preliminary efficacy of BPMED in primary care and emergency department settings. Both pilot studies recruited approximately 60 participants, who were randomized equally between usual care and the BPMED intervention. Results Although data collection is now complete, data analysis from the
Gabbay, Robert A.; Friedberg, Mark W.; Miller-Day, Michelle; Cronholm, Peter F.; Adelman, Alan; Schneider, Eric C.
PURPOSE The medical home has gained national attention as a model to reorganize primary care to improve health outcomes. Pennsylvania has undertaken one of the largest state-based, multipayer medical home pilot projects. We used a positive deviance approach to identify and compare factors driving the care models of practices showing the greatest and least improvement in diabetes care in a sample of 25 primary care practices in southeast Pennsylvania. METHODS We ranked practices into improvement quintiles on the basis of the average absolute percentage point improvement from baseline to 18 months in 3 registry-based measures of performance related to diabetes care: glycated hemoglobin concentration, blood pressure, and low-density lipoprotein cholesterol level. We then conducted surveys and key informant interviews with leaders and staff in the 5 most and least improved practices, and compared their responses. RESULTS The most improved/higher-performing practices tended to have greater structural capabilities (eg, electronic health records) than the least improved/lower-performing practices at baseline. Interviews revealed striking differences between the groups in terms of leadership styles and shared vision; sense, use, and development of teams; processes for monitoring progress and obtaining feedback; and presence of technologic and financial distractions. CONCLUSIONS Positive deviance analysis suggests that primary care practices’ baseline structural capabilities and abilities to buffer the stresses of change may be key facilitators of performance improvement in medical home transformations. Attention to the practices’ structural capabilities and factors shaping successful change, especially early in the process, will be necessary to improve the likelihood of successful medical home transformation and better care. PMID:23690393
Ajami, Sima; Ketabi, Saedeh; Torabiyan, Fatemeh
Medical Record Department (MRD) has a vital role in making short and long term plans to improve health system services. The aim of this study was to describe performance improvement indicators of hospital MRD and information technology (IT). Collection of Data: A search was conducted in various databases, through related keywords in articles, books, and abstracts of conferences from 2001 to 2009. About 58 articles and books were available which were evaluated and finally 15 of them were selected based on their relevance to the study. MRD must be capable of supporting tasks such as patient care and continuity, institute management processes, medical education programs, medical research, communication between different wards of a hospital and administrative and medical staff. The use of IT in MRD can facilitate access to department, expedite communication within and outside department, reduce space with electronic medical records, reduce costs, accelerate activities such as coding by use of coding guide software and facilitate retrieval of records that will ultimately improve the performance of MRD. PMID:26150874
Westmoreland, Glenda R; Counsell, Steven R; Sennour, Youcef; Schubert, Cathy C; Frank, Kathryn I; Wu, Jingwei; Frankel, Richard M; Litzelman, Debra K; Bogdewic, Stephen P; Inui, Thomas S
In an effort to reduce "agism" which is prevalent among medical trainees, a new geriatrics educational experience for medical students aimed at improving attitudes toward older patients was developed. Each 90-minute Older Adult Session included four components: initial reflective writing exercise; introduction to the session; 75-minute dialogue with the "Council of Elders," a group of active, "well" older adults; and final reflective writing exercise. The new session was provided to 237 first- and second-year medical students during the 2006/07 academic year at Indiana University School of Medicine. Session evaluation included comparing scores on the 14-item Geriatrics Attitude Scale administered before and after the session, identifying attitude changes in the reflective writing exercises, and a student satisfaction survey. Student responses on the Geriatrics Attitude Scale after the session were significantly improved in seven of 14 items, demonstrating better attitudes toward being with and listening to older people and caring for older patients. Analysis of the reflective writings revealed changing of negative to positive or reinforced positive attitudes in 27% of medical students, with attitudes not discernable in the remaining 73% (except one student, in whom positive attitudes changed to negative). Learner satisfaction with the Older Adult Session was high, with 98% agreeing that the session had a positive effect on insight into the care of older adults. A Council of Elders coupled with a reflective writing exercise is a promising new approach to improving attitudes of medical students toward their geriatric patients.
Head, Barbara A; Schapmire, Tara J; Earnshaw, Lori; Chenault, John; Pfeifer, Mark; Sawning, Susan; Shaw, Monica A
The needs of an aging population and advancements in the treatment of both chronic and life-threatening diseases have resulted in increased demand for quality palliative care. The doctors of the future will need to be well prepared to provide expert symptom management and address the holistic needs (physical, psychosocial, and spiritual) of patients dealing with serious illness and the end of life. Such preparation begins with general medical education. It has been recommended that teaching and clinical experiences in palliative care be integrated throughout the medical school curriculum, yet such education has not become the norm in medical schools across the world. This article explores the current status of undergraduate medical education in palliative care as published in the English literature and makes recommendations for educational improvements which will prepare doctors to address the needs of seriously ill and dying patients. PMID:26955298
Head, Barbara A; Schapmire, Tara J; Earnshaw, Lori; Chenault, John; Pfeifer, Mark; Sawning, Susan; Shaw, Monica A
The needs of an aging population and advancements in the treatment of both chronic and life-threatening diseases have resulted in increased demand for quality palliative care. The doctors of the future will need to be well prepared to provide expert symptom management and address the holistic needs (physical, psychosocial, and spiritual) of patients dealing with serious illness and the end of life. Such preparation begins with general medical education. It has been recommended that teaching and clinical experiences in palliative care be integrated throughout the medical school curriculum, yet such education has not become the norm in medical schools across the world. This article explores the current status of undergraduate medical education in palliative care as published in the English literature and makes recommendations for educational improvements which will prepare doctors to address the needs of seriously ill and dying patients.
Rukavishnikov, Ilya; Bogomolov, Valery; Polyakov, Alexey
The crew members are delivered to ISS and return back to the Earth on the space craft "Soyuz TMA" at present time. The technical means providing the safe landing of space crews are reliable enough. In spite of that the complex of negative factors (long lasting alternating and shock overloads, effects of landing apparatus rotation on vestibular system) affects the crew during landing and can reach the extreme values under the certain conditions. According to this fact there is a possibility of appearance of bodily damages of different weight besides the traditional functional disturbances. The group of search and rescue on the landing site includes the medical specialists appropriately equipped to stop the symptoms of medical contingency (strong vestibule-vegetative reactions, traumas of different weight, etc.) Medical evacuation complex which provides the acceptable conditions for the cosmonauts including the conditions for medical care is delivered to the landing site as well. The long term experience of search and rescue assurance at the landing site have shown that the specialists successfully cope with this task. In some cases it was required to give the medical help which allowed to improve the general condition and physical capacity of crewmembers and provide their evacuation to the places of postflight rehabilitation. At the same time the solution of some of the problems from our point of view could increase the efficacy of medical care for the landing crew. The organization of the training on emergency under the field conditions for medical specialists on the regular basis (not less that once a year) is extremely important. The equipment of medical specialists requires the regular improvement and modernization due to the fast changing medical technologies and standards. Wearable medical sets must provide the first aid performing in accordance to the modern medical requirements. It is also necessary to include in the list of equipment the textbook of
Polisena, Julie; Jutai, Jeffrey; Chreyh, Rana
Purpose Medical devices are used to monitor, replace, or modify anatomy or physiological processes. They are important health care innovations that enable effective treatment using less invasive techniques, and they improve health care delivery and patient outcomes. Devices can also introduce risk of harm to patients. Our objective was to propose a surveillance system framework to improve the safety associated with the use of medical devices in a hospital. Materials and methods The proposed medical device surveillance system incorporates multiple components to accurately document and assess the appropriate actions to reduce the risk of incidents, adverse events, and patient harm. The assumptions on which the framework is based are highlighted. The surveillance system was designed from the perspective of a tertiary teaching hospital that includes dedicated hospital staff whose mandate is to provide safe patient care to inpatients and outpatients and biomedical engineering services. Results The main components of the surveillance system would include an adverse medical device events database, a medical device/equipment library, education and training, and an open communication and feedback strategy. Close linkages among these components and with external medical device/equipment networks to the hospital must be established and maintained. A feedback mechanism on medical device-related incidents, as well as implementation and evaluation strategies for the surveillance system are described to ensure a seamless transition and a high satisfactory level among the hospital staff. The direct cost items of the proposed surveillance system for consideration, and its potential benefits are outlined. Conclusion The effectiveness of the proposed medical device surveillance system framework can be measured after it has been implemented in a Canadian hospital facility. PMID:24876796
Kreyenbuhl, Julie; Record, Elizabeth J; Palmer-Bacon, Jessica
Nonadherence to psychopharmacological treatments poses a significant challenge to treatment success in individuals with serious mental illness, with upwards of 60% of people not taking their psychiatric medications as prescribed. Nonadherence is associated with adverse outcomes, including exacerbation of psychiatric symptoms, impaired functioning, increased hospitalizations and emergency room use, and increased health care costs. Whereas interventions using psychoeducation or cognitive approaches, such as motivational interviewing, have largely proven ineffective in improving adherence, approaches employing behavioral tailoring that incorporate medication taking into the daily routine and/or use environmental supports have shown promise. Recently, adherence-enhancing behavioral tailoring interventions that utilize novel technologies, such as electronic monitors and mobile phones, have been developed. Although interventions utilizing these platforms have the potential for widespread dissemination to a broad range of individuals, most require further empirical testing. This paper reviews selected behavioral tailoring strategies that aim to improve medication adherence and other functional outcomes among individuals with serious mental illness.
Lawrence, David B; Allison, Wanda; Chen, Joyce C; Demand, Michael
Treatment adherence is critical in managing chronic disease, but achieving it remains an elusive goal across many prevalent conditions. As part of its care management strategy, BlueCross BlueShield of South Carolina (BCBSSC) implemented the Longitudinal Adherence Treatment Evaluation program, a behavioral intervention to improve medication adherence among members with cardiovascular disease and/or diabetes. The objectives of this study were to 1) assess the effectiveness of telephonic intervention in influencing reinitiation of medication therapy, and 2) evaluate the rate and timing of medication reinitiation. BCBSSC applied algorithms against pharmacy claims data to identify patients prescribed targeted medications who were 60 or more days overdue for refills. This information was provided to care managers to address during their next patient contact. Care managers received focused training on techniques for medication behavior change, readiness to change, motivational interviewing, and active listening. Training also addressed common barriers to adherence and available resources, including side effect management, mail order benefits, drug assistance programs, medication organizers, and reminder systems. Overdue refills were tracked for 12 months, with medication reinitiation followed for an additional 3 months. In the intervention group, 94 patients were identified with 123 instances of late medication refills. In the age- and gender-matched comparison group, 61 patients were identified with 76 late refills. The intervention group had a significantly higher rate of medication reinitiation (59.3%) than the control group (42.1%; P < 0.05). Time to reinitiation was significantly shorter in the intervention group, 59.5 (+/- 69.0) days vs. 107.4 (+/- 109) days for the control group (P < 0.05). This initiative demonstrated that a targeted disease management intervention promoting patient behavior change increased the number of patients who reinitiated therapy after a
Wallack, Madeline Carpinelli; Loafman, Mark; Sorensen, Todd D
The Patient Safety and Clinical Pharmacy Services Collaborative (PSPC) is demonstrating improvements in the quality of care delivered by safety-net organizations through integration of clinical pharmacy services. This article describes how the PSPC is leading meaningful change in the arena of medication use in management of chronic disease.
Harrison, R. Van; Standiford, Connie J.; Green, Lee A.; Bernstein, Steven J.
Introduction: In 1996 the University of Michigan Health System created the Guidelines Utilization, Implementation, Development, and Evaluation Studies (GUIDES) unit to improve the quality and cost-effectiveness of primary care for common medical problems. GUIDES's primary functions are to oversee the development of evidence-based, practical…
Scheifes, Arlette; Egberts, Toine C. G.; Stolker, Joost Jan; Nijman, Henk. L. I.; Heerdink, Eibert R.
Background: Polypharmacy and chronic drug use are common in people with intellectual disability and behavioural problems, although evidence of effectiveness and safety in this population is lacking. This study examined the effects of a structured medication review and aimed to improve pharmacotherapy in inpatients with intellectual disability.…
Thornhill, Joshua T., IV; Tong, Lowell
Objective: The authors discuss approaches to curricular goals, methods, and assessments in the education of medical students in psychiatry. Methods: Using current educational principles and opinions on curricular reform in medical student education, an outline for a core curriculum and an individualized approach to medical student education were…
Zartman, Rosemarie R; McWhorter, Alton G; Seale, N Sue; Boone, William John
The Objective Structured Clinical Examination (OSCE) is becoming more widely used for performance assessment in dentistry. The department of pediatric dentistry at Baylor College of Dentistry (BCD) began incorporating the OSCE into its curriculum in 1995. This article describes the evolution of the department's use of the OSCE and its impact on teaching and the curriculum. The discussion focuses on logistics and station design, curricular content and order, student anxiety, writing and scoring exams, and curriculum assessment. BCD has found that using an OSCE-based testing format is time-consuming and labor-intensive, but provides unprecedented feedback about students' understanding and pinpoints areas of confusion. The demands of an OSCE-based testing format reveal that students can master, to the level of competency, only a finite amount of information in a given time period. The timed, interactive aspects of the OSCE create high levels of student anxiety that must be addressed. Writing and scoring OSCE items are different from traditional test items. The OSCE is a valuable mechanism to assess the students' progress toward competency. This review of the process of incorporating OSCEs into a curriculum is the foundation for future assessment of the OSCE and its use for curricular improvement.
Herbstreit, Frank; Kehren, Clemens; Chittamadathil, Jilson; Wolfertz, Sandra; Dirkmann, Daniel; Kluge, Annette; Peters, Jürgen
Objectives The purpose of this study is to evaluate the effects of a tailor-made, non-technical skills seminar on medical student’s behaviour, attitudes, and performance during simulated patient treatment. Methods Seventy-seven students were randomized to either a non-technical skills seminar (NTS group, n=43) or a medical seminar (control group, n=34). The human patient simulation was used as an evaluation tool. Before the seminars, all students performed the same simulated emergency scenario to provide baseline measurements. After the seminars, all students were exposed to a second scenario, and behavioural markers for evaluating their non-technical skills were rated. Furthermore, teamwork-relevant attitudes were measured before and after the scenarios, and perceived stress was measured following each simulation. All simulations were also evaluated for various medical endpoints. Results Non-technical skills concerning situation awareness (p<.01, r=0.5) and teamwork (p<.01, r=0.45) improved from simulation I to II in the NTS group. Decision making improved in both groups (NTS: p<.01, r=0.39; control: p<.01, r=0.46). The attitude ‘handling errors’ improved significantly in the NTS group (p<.05, r=0.34). Perceived stress decreased from simulation I to II in both groups. Medical endpoints and patients´ outcome did not differ significantly between the groups in simulation II. Conclusions This study highlights the effectiveness of a single brief seminar on non-technical skills to improve student’s non-technical skills. In a next step, to improve student’s handling of emergencies and patient outcomes, non-technical skills seminars should be accompanied by exercises and more broadly embedded in the medical school curriculum. PMID:28355594
Birckhead, Brandon J; Mullikin, Trey C; Zubair, Adeel S; Alniemi, Dema; Franz, Walter B; Bachman, John W
Many incoming medical and undergraduate students seek out international medical mission trips to supplement their education and training. However, few have the necessary skills to perform simple clinical tasks such as taking vital signs or conducting an initial patient interview. We conducted a small pilot study to assess the impact of simulation exercises on teaching incoming first-year medical students and undergraduate students basic clinical skills and teamwork. Our study population consisted of nine incoming medical students and 11 undergraduate students who participated in a training session involving simulated tasks prior to taking a medical mission trip to Nicaragua. Participants completed a survey before and after the simulation and at the end of the trip. All 20 indicated the simulation was effective in teaching clinical and team-building skills. In addition, the simulation exercise improved participants' confidence in their ability to perform certain clinical tasks and work as a team prior to the mission trip. We concluded that simulation is effective for incoming medical and undergraduate students and can be used prior to global health trips to increase their confidence in performing tasks required for a successful experience.
Elden, Nesreen Mohamed Kamal; Ismail, Amira
Introduction: Medication errors have significant implications on patient safety. Error detection through an active management and effective reporting system discloses medication errors and encourages safe practices. Objectives: To improve patient safety through determining and reducing the major causes of medication errors (MEs), after applying tailored preventive strategies. Methodology: A pre-test, post-test study was conducted on all inpatients at a 177 bed hospital where all medication procedures in each ward were monitored by a clinical pharmacist. The patient files were reviewed, as well. Error reports were submitted to a hospital multidisciplinary committee to identify major causes of errors. Accordingly, corrective interventions that consisted of targeted training programs for nurses and physicians were conducted. Results: Medication errors were higher during ordering/prescription stage (38.1%), followed by administration phase (20.9%). About 45% of errors reached the patients: 43.5% were harmless and 1.4% harmful. 7.7% were potential errors and more than 47% could be prevented. After the intervention, error rates decreased from (6.7%) to (3.6%) (P≤0.001). Conclusion: The role of a ward based clinical pharmacist with a hospital multidisciplinary committee was effective in recognizing, designing and implementing tailored interventions for reduction of medication errors. A systematic approach is urgently needed to decrease organizational susceptibility to errors, through providing required resources to monitor, analyze and implement effective interventions. PMID:27045415
Medication administration is an important and essential nursing function with the potential for dangerous consequences if errors occur. Not only must nurses understand the use and outcomes of administering medications they must be able to calculate correct dosages. Medication administration and dosage calculation education occurs across the undergraduate program for student nurses. Research highlights inconsistencies in the approaches used by academics to enhance the student nurse's medication calculation abilities. The aim of this integrative review was to examine the literature available on effective education strategies for undergraduate student nurses on medication dosage calculations. A literature search of five health care databases: Sciencedirect, Cinahl, Pubmed, Proquest, Medline to identify journal articles between 1990 and 2012 was conducted. Research articles on medication calculation educational strategies were considered for inclusion in this review. The search yielded 266 papers of which 20 meet the inclusion criteria. A total of 5206 student nurse were included in the final review. The review revealed educational strategies fell into four types of strategies; traditional pedagogy, technology, psychomotor skills and blended learning. The results suggested student nurses showed some benefit from the different strategies; however more improvements could be made. More rigorous research into this area is needed.
Bauer, Brooke; Rebel, Annette; Dilorenzo, Amy; Schell, Randall M.; Dority, Jeremy S.; Lukens, Faith; Sloan, Paul A.
Background Residents are expected to have transition of care (ToC) skills upon entering graduate medical education. It is unclear whether experience and training during medical school is adequate. Objective The aim of the project was to assess: 1) graduating medical students’ ability to perform ToC in a crisis situation, and 2) whether using a cognitive aid improves the ToC quality. Methods The authors developed simulation scenarios for rapid response teams and a cognitive aid to assist in the ToC during crisis situations. Graduating medical students were enrolled and randomly divided into teams of three students, randomly assigned into one of two groups: teams using a cognitive aid for ToC (CA), or not using a cognitive aid (nCA). In the scenario, teams respond to a deteriorating patient and then transfer care to the next provider after stabilization. Three faculty reviewed the recording to assess completeness of the ToC and the overall quality. A completeness score was expressed as a fraction of the maximum score. Statistical analysis was performed using a t-test and Mann-Whitney U test. Results A total of 112 senior medical students participated: CA n=19, nCA n=17. The completeness score of the ToC and overall quality improved when using the cognitive aid (completeness score: CA 0.80±0.06 vs. nCA 0.52±0.07, p<0.01; ToC quality: CA 3.16±0.65 vs. nCA 1.92±0.56, p<0.01). Participants’ rating of knowledge and comfort with the ToC process increased after the simulation. Conclusion The completeness of information transfer during the ToC process by graduating medical students improved by using a cognitive aid in a simulated patient crisis. PMID:27435838
de la Cruz, Leonardo
The document is intended to assist educators in Nepal in implementing curriculum reform or improvement by using population education as a means. Procedural designs that can be followed are described. First, the goals of population education must be defined. Second, a decision has to be made as to which body of knowledge or population concepts are…
Uribe Elías, Roberto
The 2010 undergraduate medical degree curriculum at the National Autonomous University of Mexico (UNAM) faculty of medicine is based on the reality of the operating structure of the medical care units qualified for teaching. The clinical teaching/learning is based on the cooperative work of the professor and student; this means, it is based on the institutional physician responsible for medical care in a professor/assistant action together with the student being brought up. Therefore, the permanent education and training of all medical teams in the institutions offering teaching is essential. Teaching must be one distinctive characteristic of excellence for the units of the Health Ministry as it is teaching the central factor that raises the quality of medical care. The clinical evaluation must be permanent, improving the value of the daily action in front of a patient at the formative level and as a means to allow the assessment for its development, as it is the clinical aspect that is the essence of medicine.
Abdekhoda, Mohammadhiwa; Dehnad, Afsaneh; Yousefi, Mahmood
This study aimed to assess the efficiency of delivering a 4-month course of "effective literature search" among medical postgraduate students for improving information literacy skills. This was a cross-sectional study in which 90 postgraduate students were randomly selected and participated in 12 training sessions. Effective search strategies were presented and the students' attitude and competency concerning online search were measured by a pre- and post-questionnaires and skill tests. Data were analyzed by SPSS version 16 using t-test. There was a significant improvement (p=0.00), in student's attitude. The mean (standard deviation [SD]) was 2.9 (0.8) before intervention versus the mean (SD) 3.9 (0.7) after intervention. Students' familiarity with medical resources and databases improved significantly. The data showed a significant increase (p=0.03), in students' competency score concerning search strategy design and conducting a search. The mean (SD) was 2.04 (0.7) before intervention versus the mean (SD) 3.07 (0.8) after intervention. Also, students' ability in applying search and meta search engine improved significantly. This study clearly acknowledges that the training intervention provides considerable opportunity to improve medical student's information literacy skills.
This study aimed to assess the efficiency of delivering a 4-month course of “effective literature search” among medical postgraduate students for improving information literacy skills. This was a cross-sectional study in which 90 postgraduate students were randomly selected and participated in 12 training sessions. Effective search strategies were presented and the students’ attitude and competency concerning online search were measured by a pre- and post-questionnaires and skill tests. Data were analyzed by SPSS version 16 using t-test. There was a significant improvement (p=0.00), in student’s attitude. The mean (standard deviation [SD]) was 2.9 (0.8) before intervention versus the mean (SD) 3.9 (0.7) after intervention. Students’ familiarity with medical resources and databases improved significantly. The data showed a significant increase (p=0.03), in students’ competency score concerning search strategy design and conducting a search. The mean (SD) was 2.04 (0.7) before intervention versus the mean (SD) 3.07 (0.8) after intervention. Also, students’ ability in applying search and meta search engine improved significantly. This study clearly acknowledges that the training intervention provides considerable opportunity to improve medical student’s information literacy skills. PMID:27907985
Jain, Mamta; Kumar, Anil; Choudhary, Rishabh Charan
In this article, we have proposed an improved diagonal queue medical image steganography for patient secret medical data transmission using chaotic standard map, linear feedback shift register, and Rabin cryptosystem, for improvement of previous technique (Jain and Lenka in Springer Brain Inform 3:39-51, 2016). The proposed algorithm comprises four stages, generation of pseudo-random sequences (pseudo-random sequences are generated by linear feedback shift register and standard chaotic map), permutation and XORing using pseudo-random sequences, encryption using Rabin cryptosystem, and steganography using the improved diagonal queues. Security analysis has been carried out. Performance analysis is observed using MSE, PSNR, maximum embedding capacity, as well as by histogram analysis between various Brain disease stego and cover images.
Fan, Jingyang; Nieto, Marcelo J.
Objective. To identify ways in which curricular integration is addressed in US pharmacy schools, the structure of therapeutics and foundational science courses, and perceptions of the effects current curricular integration methods have on student learning. Methods. An electronic survey was sent to academic leaders representing 131 pharmacy schools in the United States. Frequency data was tabulated and demographic analysis was performed. Results. Respondent data represents 94 schools of pharmacy. Arranging similar content from various disciplines in a course, a skills laboratory and pharmacy practice experiences were the most common methods for achieving curricular integration. More than one half of the schools indicated that foundational sciences were integrated with therapeutics. The most common reported challenge to curricular integration was logistics. Conclusion. Pharmacy education in the United States has evolved in addressing curricular integration in the curricula, which is consistent with changes in accreditation standards. Most pharmacy schools reported a variety of methods for achieving the intent of curricular integration. PMID:27667833
Poirier, Therese I; Fan, Jingyang; Nieto, Marcelo J
Objective. To identify ways in which curricular integration is addressed in US pharmacy schools, the structure of therapeutics and foundational science courses, and perceptions of the effects current curricular integration methods have on student learning. Methods. An electronic survey was sent to academic leaders representing 131 pharmacy schools in the United States. Frequency data was tabulated and demographic analysis was performed. Results. Respondent data represents 94 schools of pharmacy. Arranging similar content from various disciplines in a course, a skills laboratory and pharmacy practice experiences were the most common methods for achieving curricular integration. More than one half of the schools indicated that foundational sciences were integrated with therapeutics. The most common reported challenge to curricular integration was logistics. Conclusion. Pharmacy education in the United States has evolved in addressing curricular integration in the curricula, which is consistent with changes in accreditation standards. Most pharmacy schools reported a variety of methods for achieving the intent of curricular integration.
Dhulkhed, Vithal Krishna; Kurdi, Madhuri S; Dhulkhed, Pavan V; Ramaswamy, Ashwini H
Research publications are desirable for academic promotion in medical colleges as per the current rules of the Medical Council of India (MCI). These rules reflect an endeavour to improve the academic standards. We strongly believe that every medical college teacher should conduct true research and contribute to good peer-reviewed publications. However, it is felt that the MCI rule has the potential to lead to undesirable consequences, and the quality of teaching and learning could take a back-seat. There is an urgent need to adopt more objective criteria and better guidelines as followed by well-known global institutes. In our own country, the University Grants Commission has formulated specific guidelines for this purpose in the form of Academic Performance Indicators which, it appears, are not taken into consideration by the MCI. This article discusses the adverse impact of the rule and suggests ways for the adoption of a more scientific assessment system for faculty appointment and promotion. PMID:27942051
Dhulkhed, Vithal Krishna; Kurdi, Madhuri S; Dhulkhed, Pavan V; Ramaswamy, Ashwini H
Research publications are desirable for academic promotion in medical colleges as per the current rules of the Medical Council of India (MCI). These rules reflect an endeavour to improve the academic standards. We strongly believe that every medical college teacher should conduct true research and contribute to good peer-reviewed publications. However, it is felt that the MCI rule has the potential to lead to undesirable consequences, and the quality of teaching and learning could take a back-seat. There is an urgent need to adopt more objective criteria and better guidelines as followed by well-known global institutes. In our own country, the University Grants Commission has formulated specific guidelines for this purpose in the form of Academic Performance Indicators which, it appears, are not taken into consideration by the MCI. This article discusses the adverse impact of the rule and suggests ways for the adoption of a more scientific assessment system for faculty appointment and promotion.
Noguchi, Yoshinori; Matsui, Kunihiko; Imura, Hiroshi; Kiyota, Masatomo; Fukui, Tsuguya
BACKGROUND Quite often medical students or novice residents have difficulty in ruling out diseases even though they are quite unlikely and, due to this difficulty, such students and novice residents unnecessarily repeat laboratory or imaging tests. OBJECTIVE To explore whether or not a carefully designed short training course teaching Bayesian probabilistic thinking improves the diagnostic ability of medical students. PARTICIPANTS AND METHODS Ninety students at 2 medical schools were presented with clinical scenarios of coronary artery disease corresponding to high, low, and intermediate pretest probabilities. The students’ estimates of test characteristics of exercise stress test, and pretest and posttest probability for each scenario were evaluated before and after the short course. RESULTS The pretest probability estimates by the students, as well as their proficiency in applying Bayes's theorem, were improved in the high pretest probability scenario after the short course. However, estimates of pretest probability in the low pretest probability scenario, and their proficiency in applying Bayes's theorem in the intermediate and low pretest probability scenarios, showed essentially no improvement. CONCLUSION A carefully designed, but traditionally administered, short course could not improve the students’ abilities in estimating pretest probability in a low pretest probability setting, and subsequently students remained incompetent in ruling out disease. We need to develop educational methods that cultivate a well-balanced clinical sense to enable students to choose a suitable diagnostic strategy as needed in a clinical setting without being one-sided to the “rule-in conscious paradigm.” PMID:15109340
Arellano, John; Young, M.; Boley, L.; Garcia, Y.; Saile, L.; Walton, M.; Kerstman, E.; Reyes, D.; Goodenow, D. A.; Myers, J. G.
The IMMs ability to assess mission outcome risk levels relative to available resources provides a unique capability to provide guidance on optimal operational medical kit and vehicle resources. Post-processing optimization allows IMM to optimize essential resources to improve a specific model outcome such as maximization of the Crew Health Index (CHI), or minimization of the probability of evacuation (EVAC) or the loss of crew life (LOCL). Mass and or volume constrain the optimized resource set. The IMMs probabilistic simulation uses input data on one hundred medical conditions to simulate medical events that may occur in spaceflight, the resources required to treat those events, and the resulting impact to the mission based on specific crew and mission characteristics. Because IMM version 4.0 provides for partial treatment for medical events, IMM Optimization 4.0 scores resources at the individual resource unit increment level as opposed to the full condition-specific treatment set level, as done in version 3.0. This allows the inclusion of as many resources as possible in the event that an entire set of resources called out for treatment cannot satisfy the constraints. IMM Optimization version 4.0 adds capabilities that increase efficiency by creating multiple resource sets based on differing constraints and priorities, CHI, EVAC, or LOCL. It also provides sets of resources that improve mission-related IMM v4.0 outputs with improved performance compared to the prior optimization. The new optimization represents much improved fidelity that will improve the utility of the IMM 4.0 for decision support.
Supiano, Mark A; Fitzgerald, James T; Hall, Karen E; Halter, Jeffrey B
The objective of this study was to determine the effect of a vertically integrated curriculum intervention on the geriatric knowledge and performance in clinical skills of third-year medical students. This observational cohort study conducted at the University of Michigan Medical School evaluates the performance of 622 third-year medical students from the graduating class years of 2004 through 2007. An integrated curriculum intervention was developed and implemented for the class of 2006. Its elements included identification and tracking of geriatric learning outcomes in an individualized Web-based student portfolio, integration of geriatric content into preclinical courses, development of a geriatric functional assessment standardized patient instructor, and an experience in a geriatrics clinic during the ambulatory component of the third-year internal medicine clerkship. Medical student performance was assessed on a geriatric knowledge test and during a geriatric functional assessment station administered during an Observed Structured Clinical Examination (OSCE) at the beginning of the fourth year. Student performance on the geriatric functional assessment OSCE station progressively improved from pre-intervention performance (mean performance+/-standard deviation 43+/-15% class of 2005, 62 + 15% class of 2006, 78+/-10% class of 2007; analysis of variance, P<.001). Similarly, student performance on the geriatric knowledge test was significantly better for the classes of 2006 and 2007 than for the class of 2005 (model F ratio=4.72; P<.001). In conclusion, an integrated approach to incorporating new educational geriatric objectives into the medical school curriculum leads to significant improvements in medical student knowledge and in important clinical skills in the functional assessment of older patients.
Kilbourne, Amy M; Irmiter, Cheryl; Capobianco, Jeff; Reynolds, Kathleen; Milner, Karen; Barry, Kristen; Blow, Frederic C
The historical fragmentation of physical and mental health services has impeded efforts to improve quality and outcomes of care for persons with mental disorders. However, there is little information on effective strategies that might reduce fragmentation and improve integrated services within non-academic, community-based healthcare settings. Twenty-three practices from across the U.S. participated in a learning community meeting designed to identify barriers to integrated care and strategies for reducing such barriers. Barriers were initially identified based on a quantitative survey of organizational factors. Focus groups were used to elaborate on barriers to integrated care and to identify strategies for reducing barriers that are feasible in community-based settings. Participants identified key barriers, including administrative (e.g., lack of common medical records for mental health and general medical conditions), financial (e.g., lack of reimbursement codes to bill for mental health and general medical care in the same setting), and clinical (e.g., lack of an integrated care protocol). Top strategies recommended by participants included templates (i.e., for memoranda of understanding) to allow providers to work across practice settings, increased medical record security to enable a common medical record between mental health and general medical care, working with state Medicaid agencies to establish integrated care reimbursement codes, and guidance in establishing workflows between different providers (i.e., avoid duplication of tasks). Strategies to overcome barriers to integrated care may require cooperation across different organizational levels, including administrators, providers, and health care payers in order for integrated care to be established and sustained over time.
Sorensen, James L; Haug, Nancy A; Delucchi, Kevin L; Gruber, Valerie; Kletter, Evan; Batki, Steven L; Tulsky, Jacqueline P; Barnett, Paul; Hall, Sharon
This clinical trial evaluated a contingency management intervention designed to improve medication adherence among HIV-positive methadone maintenance patients. After a 4-week baseline observation phase, eligible participants (N=66) were randomly assigned to: (a) medication coaching sessions every other week to assist with adherence strategies (comparison group) or (b) medication coaching plus voucher reinforcement for opening electronic medication caps on time (voucher group). Baseline adherence (percent doses taken/percent total possible doses) was 51% using electronic measurement, 75% using self-report and 75% using pill count. The intervention was provided for 12 weeks, with a 4-week follow-up. The primary outcome results of the clinical trial indicated effectiveness during the intervention, with significant mean adherence differences between voucher and comparison groups using electronic measurement (78% versus 56%), pill count (86% versus 75%), and self-report (87% versus 69%). Differences between groups faded after vouchers were discontinued. Contingency management shows promise as a strategy to promote antiretroviral medication adherence in this population.
Wu, Fan; Xu, Lili
Nowadays, patients can gain many kinds of medical service on line via Telecare Medical Information Systems(TMIS) due to the fast development of computer technology. So security of communication through network between the users and the server is very significant. Authentication plays an important part to protect information from being attacked by malicious attackers. Recently, Jiang et al. proposed a privacy enhanced scheme for TMIS using smart cards and claimed their scheme was better than Chen et al.'s. However, we have showed that Jiang et al.'s scheme has the weakness of ID uselessness and is vulnerable to off-line password guessing attack and user impersonation attack if an attacker compromises the legal user's smart card. Also, it can't resist DoS attack in two cases: after a successful impersonation attack and wrong password input in Password change phase. Then we propose an improved mutual authentication scheme used for a telecare medical information system. Remote monitoring, checking patients' past medical history record and medical consultant can be applied in the system where information transmits via Internet. Finally, our analysis indicates that the suggested scheme overcomes the disadvantages of Jiang et al.'s scheme and is practical for TMIS.
Bryant, Jamie; McDonald, Vanessa M; Boyes, Allison; Sanson-Fisher, Rob; Paul, Christine; Melville, Jessica
Adherence to medication among individuals with chronic obstructive pulmonary disease (COPD) is suboptimal and has negative impacts on survival and health care costs. No systematic review has examined the effectiveness of interventions designed to improve medication adherence. Electronic databases Medline and Cochrane were searched using a combination of MeSH and keywords. Eligible studies were interventions with a primary or secondary aim to improve medication adherence among individuals with COPD published in English. Included studies were assessed for methodological quality using the Effective Practice and Organisation of Care (EPOC) criteria. Of the 1,186 papers identified, seven studies met inclusion criteria. Methodological quality of the studies was variable. Five studies identified effective interventions. Strategies included: brief counselling; monitoring and feedback about inhaler use through electronic medication delivery devices; and multi-component interventions consisting of self-management and care co-ordination delivered by pharmacists and primary care teams. Further research is needed to establish the most effective and cost effective interventions. Special attention should be given to increasing patient sample size and using a common measure of adherence to overcome methodological limitations. Interventions that involve caregivers and target the healthcare provider as well as the patient should be further explored.
Farooq, Saeed; Choudry, Abid
Aims and method To investigate whether medication adherence is monitored during follow-up in out-patient reviews. A retrospective audit was carried out with a sample of 50 follow-up patients with a diagnosis of schizophrenia or schizoaffective disorder. Following this, interventions were made prior to the re-audit (including text messaging clinicians and prompt sheets in the out-patient department to encourage adherence discussions). Results There was an improvement on all the standards set for this audit following the interventions. More doctors had discussed medication adherence (62% second cycle v. 50% first cycle) with their patient and there was increased discussion and documentation regarding medication side-effects (60% second cycle v. 30% first cycle). More clinicians discussed the response to medication (60% second cycle v. 46% first cycle). Clinical implications Treatment adherence is not regularly monitored or recorded in clinical notes in routine psychiatric out-patient appointments. This highlights the need for regular training to improve practice. PMID:28184317
Lakatos, Peter Laszlo
Inflammatory bowel diseases (IBD) are chronic diseases with a relapsing-remitting disease course necessitating lifelong treatment. However, non-adherence has been reported in over 40% of patients, especially those in remission taking maintenance therapies for IBD. The economical impact of non-adherence to medical therapy including absenteeism, hospitalization risk, and the health care costs in chronic conditions, is enormous. The causes of medication non-adherence are complex, where the patient-doctor relationship, treatment regimen, and other disease-related factors play key roles. Moreover, subjective assessment might underestimate adherence. Poor adherence may result in more frequent relapses, a disabling disease course, in ulcerative colitis, and an increased risk for colorectal cancer. Improving medication adherence in patients is an important challenge for physicians. Understanding the different patient types, the reasons given by patients for non-adherence, simpler and more convenient dosage regimens, dynamic communication within the health care team, a self-management package incorporating enhanced patient education and physician-patient interaction, and identifying the predictors of non-adherence will help devise suitable plans to optimize patient adherence. This editorial summarizes the available literature on frequency, predictors, clinical consequences, and strategies for improving medical adherence in patients with IBD.
Moore, Brooke M.; Laguna, Theresa A.; Liu, Meixia; McNamara, John J.
BACKGROUND CFF practice guidelines recommend patients ≥ age 6 use dornasealfa and hypertonic saline daily, and those ≥ age 6 colonized with P. aeruginosa use inhaled tobramycin and oral azithromycin to improve lung function and reduce pulmonary exacerbations. A decline in FEV1 was noted in our 2008 CF Center Report. We hypothesized that increasing adherence to prescribing guidelines for these pulmonary medications would improve mean FEV1. METHODS This was a quality improvement project completed at a US CF center. CFF practice guidelines were reviewed with the center physicians. Patients were identified that were eligible to receive recommended therapies and it was determined whether they were prescribed the therapies. Baseline FEV1 data was collected. Adherence rates and FEV1 were followed quarterly for 1 year. Providers received a quarterly report card with adherence rates, mean FEV1 compared to colleagues, and a list of eligible patients that were not prescribed recommended therapies. RESULTS 92 patients were included. At baseline, the overall adherence rate was 59%. Overall adherence increased quarterly (p=<0.001). Each quarter there was improvement in adherence to prescribing for each medication (p<0.001). Except in quarter 1, FEV1 increased quarterly (p=0.092). There was moderate correlation (r=0.533) between improved adherence and improved FEV1. CONCLUSIONS Educating clinicians about guidelines, providing feedback on adherence to guidelines, and monitoring prescribing patterns improves prescribing adherence. FEV1 showed improvement after months of sustained adherence, trending towards significance. Longer follow-up is necessary to determine if improved prescribing adherence translates into improved FEV1 or slows rate of decline in FEV1. PMID:22997186
Alpert, Jonathan E.; Schlozman, Steve; Badaracco, Mary Anne; Burke, Jay; Borus, Jonathan F.
Objective: The authors summarize efforts to revitalize psychiatry teaching to medical students at Harvard Medical School (HMS) in advance of a major overhaul of the medical school curriculum. Methods: This preliminary report chronicles key challenges and the organization of the reform effort within the departments of psychiatry affiliated with the…
Rokicki, Ryszard; Hryniewicz, Tadeusz; Pulletikurthi, Chandan; Rokosz, Krzysztof; Munroe, Norman
Haemocompatibility of Nitinol implantable devices and their corrosion resistance as well as resistance to fracture are very important features of advanced medical implants. The authors of the paper present some novel methods capable to improve Nitinol implantable devices to some marked degree beyond currently used electropolishing (EP) processes. Instead, a magnetoelectropolishing process should be advised. The polarization study shows that magnetoelectropolished Nitinol surface is more corrosion resistant than that obtained after a standard EP and has a unique ability to repassivate the surface. Currently used sterilization processes of Nitinol implantable devices can dramatically change physicochemical properties of medical device and by this influence its biocompatibility. The Authors' experimental results clearly show the way to improve biocompatibility of NiTi alloy surface. The final sodium hypochlorite treatment should replace currently used Nitinol implantable devices sterilization methods which rationale was also given in our previous study.
SORENSON, CORINNA; DRUMMOND, MICHAEL
Context: Recent debates and events have brought into question the effectiveness of existing regulatory frameworks for medical devices in the United States and Europe to ensure their performance, safety, and quality. This article provides a comparative analysis of medical device regulation in the two jurisdictions, explores current reforms to improve the existing systems, and discusses additional actions that should be considered to fully meet this aim. Medical device regulation must be improved to safeguard public health and ensure that high-quality and effective technologies reach patients. Methods: We explored and analyzed medical device regulatory systems in the United States and Europe in accordance with the available gray and peer-reviewed literature and legislative documents. Findings: The two regulatory systems differ in their mandate and orientation, organization, pre-and postmarket evidence requirements, and transparency of process. Despite these differences, both jurisdictions face similar challenges for ensuring that only safe and effective devices reach the market, monitoring real-world use, and exchanging pertinent information on devices with key users such as clinicians and patients. To address these issues, reforms have recently been introduced or debated in the United States and Europe that are principally focused on strengthening regulatory processes, enhancing postmarket regulation through more robust surveillance systems, and improving the traceability and monitoring of devices. Some changes in premarket requirements for devices are being considered. Conclusions: Although the current reforms address some of the outstanding challenges in device regulation, additional steps are needed to improve existing policy. We examine a number of actions to be considered, such as requiring high-quality evidence of benefit for medium-and high-risk devices; moving toward greater centralization and coordination of regulatory approval in Europe; creating
Ito, Kouta; Shrank, William H; Avorn, Jerry; Patrick, Amanda R; Brennan, Troyen A; Antman, Elliot M; Choudhry, Niteesh K
Objective To evaluate the comparative cost-effectiveness of interventions to improve adherence to evidence-based medications among postmyocardial infarction (MI) patients. Data Sources/Study Setting Cost-effectiveness analysis. Study Design We developed a Markov model simulating a hypothetical cohort of 65-year-old post-MI patients who were prescribed secondary prevention medications. We evaluated mailed education, disease management, polypill use, and combinations of these interventions. The analysis was performed from a societal perspective over a lifetime horizon. The main outcome was an incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life year (QALY) gained. Data Collection/Extraction Methods Model inputs were extracted from published literature. Principal Findings Compared with usual care, only mailed education had both improved health outcomes and reduced spending. Mailed education plus disease management, disease management, polypill use, polypill use plus mailed education, and polypill use plus disease management cost were $74,600, $69,200, $133,000, $113,000, and $142,900 per QALY gained, respectively. In an incremental analysis, only mailed education had an ICER of less than $100,000 per QALY and was therefore the optimal strategy. Polypill use, particularly when combined with mailed education, could be cost effective, and potentially cost saving if its price decreased to less than $100 per month. Conclusions Mailed education and a polypill, once available, may be the cost-saving strategies for improving post-MI medication adherence. PMID:22998129
Pearce, Jacob; Edwards, Daniel; Fraillon, Julian; Coates, Hamish; Canny, Benedict J; Wilkinson, David
An assessment framework provides a structured conceptual map of the learning outcomes of a programme of study along with details of how achievement of the outcomes can be measured. The rationale for using frameworks to underpin the targeting of essential content components is especially relevant for the medical education community. Frameworks have the capacity to improve validity and reliability in assessment, allowing test developers to more easily create robust assessment instruments. The framework used by the Australian Medical Assessment Collaboration (AMAC) is an interesting and relevant case study for the international community as it draws and builds on established processes in higher education assessment. The AMAC experience offers an insight into important considerations for designing assessment frameworks and implementing frameworks in differing contexts. There are lessons which have the potential to improve assessment and reporting practice and quality in not only medical education, but in other domains of assessment. Prior to implementing any programme of assessment, the framework considerations outlined here will hopefully improve the quality of assessment and reporting practice by making implicit assumptions explicit, and allowing more critical reflection and evaluation throughout assessment processes.
Heard, C; Blackburn, J L; Thompson, M S; Wallace, S M
Computer-generated refill reminder notices were mailed to patients receiving continual medication for cardiovascular diseases to measure improved compliance and to discover whether a computer-assisted program was economically viable. Guidelines were established to define compliance. A computer-assisted compliance intervention program did not significantly improve the rate at which patients had their prescriptions filled "on time" and the mean compliance rate for both experimental and control groups was greater than 79%. Also discussed were cost and compliance strategy implications and the receptiveness of patients to the reminder program.
Aims and methods It is now well established that antipsychotic medications are associated with adverse effects such as metabolic dysfunction, hyperprolactinaemia and cardiac arrhythmias. We completed an audit cycle between 2008 and 2010 to assess whether the implementation of a high-visibility prompt and an educational programme would improve monitoring rates among patients prescribed regular antipsychotics admitted to a 59-bedded psychiatric hospital in West Sussex. Results There was an improvement in monitoring rates for most audit standards. The greatest improvement was seen in measurement of random plasma glucose and cholesterol levels. Rates improved irrespective of the risk of metabolic dysfunction. However, prolactin measurement remained static and the ECG recording deteriorated. Clinical implications There appears to be a growing awareness of the need to screen for metabolic dysfunction among patients prescribed regular antipsychotic medication. A high-visibility prompt and educational programme helps to increase monitoring rates. However, more needs to be done to improve the mortality and morbidity rates among this patient subpopulation. PMID:24381652
Sokouti, Massoud; Zakerolhosseini, Ali; Sokouti, Babak
Medical images are regarded as important and sensitive data in the medical informatics systems. For transferring medical images over an insecure network, developing a secure encryption algorithm is necessary. Among the three main properties of security services ( i.e. , confidentiality, integrity, and availability), the confidentiality is the most essential feature for exchanging medical images among physicians. The Goldreich Goldwasser Halevi (GGH) algorithm can be a good choice for encrypting medical images as both the algorithm and sensitive data are represented by numeric matrices. Additionally, the GGH algorithm does not increase the size of the image and hence, its complexity will remain as simple as O(n(2) ). However, one of the disadvantages of using the GGH algorithm is the Chosen Cipher Text attack. In our strategy, this shortcoming of GGH algorithm has been taken in to consideration and has been improved by applying the padding (i.e., snail tour XORing), before the GGH encryption process. For evaluating their performances, three measurement criteria are considered including (i) Number of Pixels Change Rate (NPCR), (ii) Unified Average Changing Intensity (UACI), and (iii) Avalanche effect. The results on three different sizes of images showed that padding GGH approach has improved UACI, NPCR, and Avalanche by almost 100%, 35%, and 45%, respectively, in comparison to the standard GGH algorithm. Also, the outcomes will make the padding GGH resist against the cipher text, the chosen cipher text, and the statistical attacks. Furthermore, increasing the avalanche effect of more than 50% is a promising achievement in comparison to the increased complexities of the proposed method in terms of encryption and decryption processes.
Sokouti, Massoud; Zakerolhosseini, Ali; Sokouti, Babak
Medical images are regarded as important and sensitive data in the medical informatics systems. For transferring medical images over an insecure network, developing a secure encryption algorithm is necessary. Among the three main properties of security services (i.e., confidentiality, integrity, and availability), the confidentiality is the most essential feature for exchanging medical images among physicians. The Goldreich Goldwasser Halevi (GGH) algorithm can be a good choice for encrypting medical images as both the algorithm and sensitive data are represented by numeric matrices. Additionally, the GGH algorithm does not increase the size of the image and hence, its complexity will remain as simple as O(n2). However, one of the disadvantages of using the GGH algorithm is the Chosen Cipher Text attack. In our strategy, this shortcoming of GGH algorithm has been taken in to consideration and has been improved by applying the padding (i.e., snail tour XORing), before the GGH encryption process. For evaluating their performances, three measurement criteria are considered including (i) Number of Pixels Change Rate (NPCR), (ii) Unified Average Changing Intensity (UACI), and (iii) Avalanche effect. The results on three different sizes of images showed that padding GGH approach has improved UACI, NPCR, and Avalanche by almost 100%, 35%, and 45%, respectively, in comparison to the standard GGH algorithm. Also, the outcomes will make the padding GGH resist against the cipher text, the chosen cipher text, and the statistical attacks. Furthermore, increasing the avalanche effect of more than 50% is a promising achievement in comparison to the increased complexities of the proposed method in terms of encryption and decryption processes. PMID:27857824
Abdallah, Nihad; Conn, Rory; Latif Marini, Abdel
Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement. The project aimed at improving the physical health monitoring among patients with SMI who are receiving antipsychotic medications. The improvement process focused on ensuring there is a good communication with general practitioners (GPs) as well as patient's education and education of care home staff. GP letters requesting physical health monitoring were updated; care home staff and patients were given more information about the value of regular physical health monitoring. There was an improvement in patients' engagement with the monitoring and the monitoring done by GPs was more adherent to local and national guidelines and was communicated with the mental health service.
Kobokovich, L J
Accelerating clinical improvement is a unique strategic method for accelerating the rate and effectiveness of improvements in strategically important clinical services. It promotes real reduction in the cost of service while preserving the quality and value within the system. Based on the components of process, value, benchmarking, change, and learning, the method can be used in any system or setting to produce value-driven change. Accelerating clinical improvement is being used within the Obstetrical Department of Dartmouth-Hitchcock Medical Center to decrease postpartum length of stay for families with spontaneous vaginal delivery. Familiarity with the method led to additional and ongoing improvements in the system. This method is important for nurses because it is continuous, multidisciplinary, addresses values of concern to families and providers, and is easily incorporated by nurse providers in any clinical setting.
Dreyfus, Benjamin W.; Ewell, Mary; Moore, Kimberly
When curricular materials are disseminated to new sites, there can be a tension between fidelity to the original intent of the developers and adaptation to local needs. In this case study we look at a lab activity that was initially developed for an introductory physics for the life sciences (IPLS) course at the University of Maryland, then implemented at George Mason University with significant adaptations. The goals of the two implementations were overlapping, but also differed in ways that are reflected in the two versions of the lab. We compare student lab report data from the two sites to examine the impacts of the adaptation on how students engaged with the lab.
Background Many countries have devoted considerable efforts in an attempt to improve the performance of their health care systems. National Medical Associations (NMAs), along with other stakeholders, play a part in the promotion of such activities. The purpose of this paper is to explore the nature and level of participation of NMAs in activities of quality improvement in medicine, with a specific emphasis on Israel. Methods The authors conducted a survey among NMAs around the world inquiring as to their involvement in three central aspects of quality improvement: clinical guidelines, quality measurement and continuing medical education (CME). In addition, they conducted a review of the literature in order to gather more information and complete the data collected in the survey. The findings were processed and analyzed comparatively. Results Most of the NMAs surveyed participate in quality improvement activities at least to some extent. NMAs' main involvement is in the regulation of CME and they are involved to a much lesser extent in the preparation of clinical guidelines and in quality measurement. In Israel, the Israeli Medical Association (IMA) has a dominant role in both the preparation of clinical guidelines and the regulation of CME credits. Discussion It is possible that the expertise maintained by the profession, coupled with the organizational power of the NMA as a union, is viewed as beneficial for regulating educational activities in medicine such as CME. Conversely, the issuing of clinical guidelines is usually regarded as a typical scientific activity, and therefore often rests in the hands of professional medical societies. Quality measurement is regarded as a distinctive administrative tool and is usually found in the province of governments. Based on the typology that we introduced in our previous paper, we discovered that the extent of NMAs’ involvement in quality improvement coincides with the mode of governance of the health care system
Miller, Robert H; Bovbjerg, Randall R
Medical care should be safer. Inpatient problems and solutions have received the most attention; this outpatient qualitative case study addresses a gap in knowledge. We describe safety improvements among large physician groups, model the key influences on their behavior, and identify beneficial public and private policies. All groups were trying to reduce medical injury, which was part of the sample design. The most commonly targeted problems are those that are similar across groups: shortcomings in diagnosis, abnormal tests follow-up, scope of practice and referral patterns, and continuity of care. Medical group innovators vary greatly, however, in implementation of improvements, that is, in the extent to which they implement process changes that identify events/problems, analyze and track incidents, decide how to change clinical and administrative practices, and monitor impacts of the changes. Our conceptual model identifies key determinants: (1) demand for safety comes from external factors: legal, market, and professional; (2) organizational responses depend on internal factors: group size, scope, and integration; leadership and governance; professional culture; information-system assets; and financial and intellectual capital. Further, safety is an aspect of quality (the same tools, decision making, interventions, and monitoring apply), and safety management benefits from prior efficiency management (similar skills and culture of innovation). Observed variation in even simple safeguards shows that existing safety incentives are too weak. Our model suggests that the biggest improvement would come from boosting the demand for quality and safety from both private and public larger group purchasers. Current policy relies too much on litigation and discipline, which have sometimes helped, but not solved, problems because they are inefficient, tend to drive needed information underground, and complicate needed cultural change. Patients' safety demand is also weak
Curtis, Jeffrey R; Xi, Juan; Westfall, Andrew O; Cheng, Hong; Lyles, Kenneth; Saag, Kenneth G; Delzell, Elizabeth
Introduction Administrative claims data have a limited ability to identify persons with high compliance to oral bisphosphonates. We tested whether adding information on compliance with other drugs used to treat chronic, asymptomatic conditions would improve the predictive ability of administrative data to identify adherent individuals. Methods Using data from a large, U.S. healthcare organization, we identified new bisphosphonate users and their 1 year compliance to oral bisphosphonates, quantified by the Medication Possession Ratio (MPR). Multivariable logistic regression models evaluated the relationship between high bisphosphonate compliance (MPR >= 80%) and patient demographics, comorbidities, and health services utilization. To these logistic regression models, we evaluated the incremental change in the area under the receiver operator curve (AUC) after adding information regarding compliance with other drug classes. These included anti-hyperlipidemics (statins), anti-hypertensives, anti-depressants, oral diabetes agents, and glaucoma medications. Results from the logistic regression models were evaluated in parallel using recursive partitioning trees with 10-fold cross-validation. Results Among 101,038 new bisphosphonate users, administrative data identified numerous non-medication factors (e.g. age, gender, use of preventive services) significantly associated with high bisphosphonate compliance at 1 year. However, all these factors in aggregate had low discriminant ability to identify persons highly adherent with bisphosphonates (AUC = 0.62). For persons who were new users of ≥ 1 of the other asymptomatic condition drugs, MPR data on the other drugs substantially improved the prediction of high bisphosphonate compliance. The impact on prediction was largest for concomitant statin users (AUC = 0.70). Conclusions Information on compliance with drugs used to treat chronic asymptomatic conditions improves the prediction of compliance with oral bisphosphonates
Laba, Tracey-Lea; Bleasel, Jonathan; Brien, Jo-Anne; Cass, Alan; Howard, Kirsten; Peiris, David; Redfern, Julie; Salam, Abdul; Usherwood, Tim; Jan, Stephen
Medication non-adherence poses a major barrier to reducing cardiovascular disease (CVD) burden globally, and is increasingly recognised as a socioeconomically determined problem. Strategies promoting CVD medication adherence appear of moderate effectiveness and cost-effectiveness. Potentially, 'one-size-fits-all' measures are ill-equipped to address heterogeneous adherence behaviour between social groups. This review aims to determine the effects of strategies to improve adherence to CVD-related medications in socioeconomically disadvantaged groups. Randomised/quasi-randomised controlled trials (1996-June 2012, English), testing strategies to increase adherence to CVD-related medications prescribed to adult patients who may experience health inequity (place of residence, occupation, education, or socioeconomic position) were reviewed. 772 abstracts were screened, 111 full-text articles retrieved, and 16 full-text articles reporting on 14 studies, involving 7739 patients (age range 41-66 years), were included. Methodological and clinical heterogeneity precluded quantitative data synthesis. Studies were thematically grouped by targeted outcomes; underlying interventions and policies were classified using Michie et al.'s Behaviour Change Wheel. Contrasting with patient or physician/practice strategies, those simultaneously directed at patients and physicians/practices resulted in statistically significant improvements in relative adherence (16-169%). Comparative cost and cost-effectiveness analyses from three studies did not find cost-saving or cost-effective strategies. Unlike much current evidence in general populations, promising evidence exists about what strategies improve adherence in disadvantaged groups. These strategies were generally complex: simultaneously targeting patients and physicians; addressing social, financial, and treatment-related adherence barriers; and supported by broader guidelines, regulatory and communication-based policies. Given their
Venous thromboembolism (VTE), comprising life-threatening pulmonary embolism (PE) and its precursor deep-vein thrombosis (DVT), is commonly encountered problem. Although most patients survive DVT, they often develop serious and costly long-term complications. Both unfractionated heparin and low molecular weight heparins significantly reduce the incidence of VTE and its associated complications. Despite the evidence demonstrating significant benefit of VTE prophylaxis in acutely ill medical patients, several registries have shown significant underutilization. This underutilization indicates the need for educational and audit programs in order to increase the number of medical patients receiving appropriate prophylaxis. Many health advocacy groups and policy makers are paying more attention to VTE prophylaxis; the National Quality Forum and the Joint Commission recently endorsed strict VTE risk assessment evaluation for each patient upon admission and regularly thereafter. In the article, all major studies addressing this issue in medical patients have been reviewed from the PubMed. The current status of VTE prophylaxis in hospitalized medical patients is addressed and some improvement strategies are discussed. PMID:20981179
Ting, Jacky S L; Tsang, Albert H C; Ip, Andrew W H; Ho, George T S
This paper presents an innovative electronic medical records (EMR) system, RF-MediSys, which can perform medical information sharing and retrieval effectively and which is accessible via a 'smart' medical card. With such a system, medical diagnoses and treatment decisions can be significantly improved when compared with the conventional practice of using paper medical records systems. Furthermore, the entire healthcare delivery process, from registration to the dispensing or administration of medicines, can be visualised holistically to facilitate performance review. To examine the feasibility of implementing RF-MediSys and to determine its usefulness to users of the system, a survey was conducted within a multi-disciplinary medical service organisation that operates a network of medical clinics and paramedical service centres throughout Hong Kong Island, the Kowloon Peninsula and the New Territories. Questionnaires were distributed to 300 system users, including nurses, physicians and patients, to collect feedback on the operation and performance of RF-MediSys in comparison with conventional paper-based medical record systems. The response rate to the survey was 67%. Results showed a medium to high level of user satisfaction with the radiofrequency identification (RFID)-based EMR system. In particular, respondents provided high ratings on both 'user-friendliness' and 'system performance'. Findings of the survey highlight the potential of RF-MediSys as a tool to enhance quality of medical services and patient safety.
Fontaine, Sherry J.; Cook, Shawn M.
Engagement in co-curricular activities is a means of educating the whole student, providing an opportunity for the integration of academic, professional, and personal development. Residential programs offer students campus-based, co-curricular experiences that foster the development of student knowledge and personal development outside of the…
Domina, Thurston; Penner, Andrew M.; Penner, Emily K.; Conley, AnneMarie
In this paper, the authors investigate the consequences of curricular intensification by examining changes in the social organization of schooling and student achievement in one California school district. The authors' analyses consider the following three research questions: (1) What effect did 8th grade curricular intensification have on…
Karrow, Douglas D.; Fazio, Xavier
This paper provides a curricular critique of an environmental education policy framework called "Acting Today, Shaping Tomorrow" (Ontario Ministry of Education, 2009). Answers to the following two curricular questions: "What should be taught?" and "How it should be taught?" frame the critique. Scrutiny of the latter…
Siegel, Judith Susan
This study attempts to clarify and exploit Joseph Schwab's recent and current work on "practical" and "eclectic" curriculums in a simulated deliberation about a concrete curricular question, How might "Hamlet" be taught to one group of high school juniors? By exemplifying curricular deliberation, it aims to clarify…
... 49 Transportation 1 2013-10-01 2013-10-01 false Textbooks and curricular material. 25.455 Section 25.455 Transportation Office of the Secretary of Transportation NONDISCRIMINATION ON THE BASIS OF SEX... Basis of Sex in Education Programs or Activities Prohibited § 25.455 Textbooks and curricular...
Sobottka, Stephan B; Töpfer, Armin; Eberlein-Gonska, Maria; Schackert, Gabriele; Albrecht, D Michael
Six Sigma is an innovative management- approach to reach practicable zero- defect quality in medical service processes. The Six Sigma principle utilizes strategies, which are based on quantitative measurements and which seek to optimize processes, limit deviations or dispersion from the target process. Hence, Six Sigma aims to eliminate errors or quality problems of all kinds. A pilot project to optimize the preparation for neurosurgery could now show that the Six Sigma method enhanced patient safety in medical care, while at the same time disturbances in the hospital processes and failure costs could be avoided. All six defined safety relevant quality indicators were significantly improved by changes in the workflow by using a standardized process- and patient- oriented approach. Certain defined quality standards such as a 100% complete surgical preparation at start of surgery and the required initial contact of the surgeon with the patient/ surgical record on the eve of surgery could be fulfilled within the range of practical zero- defect quality. Likewise, the degree of completion of the surgical record by 4 p.m. on the eve of surgery and their quality could be improved by a factor of 170 and 16, respectively, at sigma values of 4.43 and 4.38. The other two safety quality indicators "non-communicated changes in the OR- schedule" and the "completeness of the OR- schedule by 12:30 a.m. on the day before surgery" also show an impressive improvement by a factor of 2.8 and 7.7, respectively, corresponding with sigma values of 3.34 and 3.51. The results of this pilot project demonstrate that the Six Sigma method is eminently suitable for improving quality of medical processes. In our experience this methodology is suitable, even for complex clinical processes with a variety of stakeholders. In particular, in processes in which patient safety plays a key role, the objective of achieving a zero- defect quality is reasonable and should definitely be aspirated.
Physicians have been required to possess high ethical standards, as medical practice is directly involved with patients' lives. Although ethics arise out of an individual's consciousness, ethical regulations imposed by the nation/government together with self-regulation by physician groups are important in the practice of ethics, for which reason countries around the world undertake various initiatives. This paper investigates physician licensure, organizations governing physician status, the role of physician groups, and the actual conditions of lifelong learning and ethics education in developed countries worldwide, in contrast with which it throws problems in the situation in Japan into relief. Organizations governing physician status, the form of medical associations, and the improvement of lifelong learning are pointed out as critical issues especially in Japan. PMID:22498978
Carney, Brian T; West, Priscilla; Neily, Julia B; Mills, Peter D; Bagian, James P
There are differences between nurse and physician perceptions of teamwork. The purpose of this study was to determine whether these differences would be reduced with medical team training (MTT). The Safety Attitudes Questionnaire was administered to nurses and physicians working in the operating rooms of 101 consecutive hospitals before and at the completion of an MTT program. Responses to the 6 teamwork climate items on the Safety Attitudes Questionnaire were analyzed using nonparametric testing. At baseline, physicians had more favorable perceptions on teamwork climate items than nurses. Physicians demonstrated improvement on all 6 teamwork climate items. Nurses demonstrated improvement in perceptions on all teamwork climate items except "Nurse input is well received." Physicians still had a more favorable perception than nurses on all 6 teamwork climate items at follow-up. Despite an improvement in perceptions by physicians and nurses, baseline nurse-physician differences persisted at completion of the Veterans Health Administration MTT Program.
Frigerio, Roberta; Kazmi, Nazia; Meyers, Steven L.; Sefa, Meredith; Walters, Shaun A.; Silverstein, Jonathan C.
Abstract We describe quality improvement and practice-based research using the electronic medical record (EMR) in a community health system–based department of neurology. Our care transformation initiative targets 10 neurologic disorders (brain tumors, epilepsy, migraine, memory disorders, mild traumatic brain injury, multiple sclerosis, neuropathy, Parkinson disease, restless legs syndrome, and stroke) and brain health (risk assessments and interventions to prevent Alzheimer disease and related disorders in targeted populations). Our informatics methods include building and implementing structured clinical documentation support tools in the EMR; electronic data capture; enrollment, data quality, and descriptive reports; quality improvement projects; clinical decision support tools; subgroup-based adaptive assignments and pragmatic trials; and DNA biobanking. We are sharing EMR tools and deidentified data with other departments toward the creation of a Neurology Practice-Based Research Network. We discuss practical points to assist other clinical practices to make quality improvements and practice-based research in neurology using the EMR a reality. PMID:26576324
Khabaz Mafinejad, Mahboobeh; Aghili, Rokhsareh; Emami, Zahra; Malek, Mojtaba; Baradaran, Hamidreza; Taghavinia, Mansoureh; Khamseh, Mohammad E
In medicine, there is a rapid development of a knowledge base. Medical professionals need to sustain and advance their competence to practice in response to these varieties. So, there is increased interest in self-directed learning methods. Study guides can make a major contribution to self-directed learning. This study was carried out to evaluate the effect of study guides on improving self-learning skills of medical students in the Iran University of Medical Sciences (IUMS). In this quasi-experimental study, 46 medical students were randomly assigned into two groups; the intervention group and the control group. Both groups participated in a diagnostic test at the beginning of the course (pre-test). The same test was taken at the end of the course (post-test). The intervention group was provided with study guides on thyroid disorders and diabetes. Meanwhile, they continued their routine clinical training. The control group was only involved in the conventional training program. Students in the intervention group were also asked to complete a designed questionnaire in regard to their attitude toward the study guides. At enrollment, there was no statistically significant difference between the two groups. The mean scores of the pre-test for the control group and the intervention group were 6.18 and 6.13 respectively (P=0.9). In the post-test, the mean score of the students in the intervention group was considerably higher: 9.25 vs. 12 (P=0.002). The students in the intervention group found the study guides useful. The study guides were potentially effective in motivating self-learning in this group of medical students and had a remarkable effect on their final score.
Kniga, V V; Pitsyk, S P
Examined and analyzed was dynamics of morbidity, losses in man-hours, medical discharge and attrition of the flying personnel in various types and branches of aviation of the Russian Federation Military Forces over the recent 10 years (1991-2000). Results of the review of the RF MF medical flight certification process (MCP) laid the ground for developing guidelines and scientifically substantiated proposals for MCP improvement in line with the present-day reform of the RF MF aviation.
Byrne, Eleanor; Brodie, Marilyn
This book brings together ongoing debates about personalised learning, creativity and ICT in education, with a cross-curricular focus, and establishes a principled framework for cross-curricular teaching and learning in Science. It identifies a range of key issues and aims to strengthen in-school science practices by introducing ways of teaching…
Milic, Natasa M.; Trajkovic, Goran Z.; Bukumiric, Zoran M.; Cirkovic, Andja; Nikolic, Ivan M.; Milin, Jelena S.; Milic, Nikola V.; Savic, Marko D.; Corac, Aleksandar M.; Marinkovic, Jelena M.; Stanisavljevic, Dejana M.
Background Although recent studies report on the benefits of blended learning in improving medical student education, there is still no empirical evidence on the relative effectiveness of blended over traditional learning approaches in medical statistics. We implemented blended along with on-site (i.e. face-to-face) learning to further assess the potential value of web-based learning in medical statistics. Methods This was a prospective study conducted with third year medical undergraduate students attending the Faculty of Medicine, University of Belgrade, who passed (440 of 545) the final exam of the obligatory introductory statistics course during 2013–14. Student statistics achievements were stratified based on the two methods of education delivery: blended learning and on-site learning. Blended learning included a combination of face-to-face and distance learning methodologies integrated into a single course. Results Mean exam scores for the blended learning student group were higher than for the on-site student group for both final statistics score (89.36±6.60 vs. 86.06±8.48; p = 0.001) and knowledge test score (7.88±1.30 vs. 7.51±1.36; p = 0.023) with a medium effect size. There were no differences in sex or study duration between the groups. Current grade point average (GPA) was higher in the blended group. In a multivariable regression model, current GPA and knowledge test scores were associated with the final statistics score after adjusting for study duration and learning modality (p<0.001). Conclusion This study provides empirical evidence to support educator decisions to implement different learning environments for teaching medical statistics to undergraduate medical students. Blended and on-site training formats led to similar knowledge acquisition; however, students with higher GPA preferred the technology assisted learning format. Implementation of blended learning approaches can be considered an attractive, cost-effective, and efficient
External quality assessment (EQA) programs have been conducted by the Japanese Association of Medical Technologists (JAMT) since 1989. The nationwide EQA programs have provided feedback for improving clinical tests quality in individual laboratories. The participating laboratories have been expected to process the survey samples according to their usual practice for patient specimens. However, many problems relating to the EQA programs in clinical microbiology have been raised. Dishonesty in the responses, survey samples being handled in a manner that improves assessment results, surveys depending on volunteers because of time and cost limitations were some of the initial problems. In addition, the criteria used to evaluate the results were poorly understood, so that neither examiners not participants were clear as to how the evaluation worked. And finally, the nationwide EQA programs can detect only gross errors and use invalid methods for evaluating routine performances. They have been measuring only a few steps in specimens processing. To assess overall laboratory competence, other methods are needed. It is time to reform the JAMT nationwide EQA program to initiate real proficiency testing and to this end it is necessary to increase collaboration between JAMT and the regional associations of medical technologists, so that the improved testing program can be properly administered.
Zheng, W H; Wakim, R J; Geary, R C; Lander, L R; Wen, S J; Xiao, M C; Sullivan, C R
This is a prospective, naturalistic study to evaluate patient's report on sleep and depression in early recovery while receiving buprenorphine in Medication Assisted Treatment (MAT). 40 Subjects entering into MAT with buprenorphine/naloxonefor opioid dependence disorder were recruited. No change of concurrent treatment was made. Subjects were administered Sleep Scale from the Medical Outcomes Study (MOS-Sleep), a 5-item Supplemental Sleep Scale (SSS), and the Beck Depression Inventory II (BDI-II). The measures were administered at day 0 (baseline), 30, 60 and 90 days. The result showed that patients reported significant progressive improvements in three MOS-Sleep subscales: sleep disturbance, sleep indices I and II. The mean scores of SLPD4 (Sleep disturbance) at day 0, 30, 60, 90 were 62.4, 53.2, 53.3, and 48.4 respectively (p=0.0029). Similarly, subscores of SLP6 (Sleep Problem Index I) and SLP 9 (Sleep Problem Index II) were also significantly decreased over time (P=0.038 for SLP6 and p=0.007 for SLP9). BDI-II depression scores improved from "Moderate depression" at baseline to "Mild depression". The mean BDI score decreased from 24.2 to 17.0 after 90 days of treatment. Findings suggest that subjects reported improvement in both sleep and depression after initiating MAT with buprenorphine/naloxone.
Zheng, WH; Wakim, RJ; Geary, RC; Lander, LR; Wen, SJ; Xiao, MC; Sullivan, CR
This is a prospective, naturalistic study to evaluate patient’s report on sleep and depression in early recovery while receiving buprenorphine in Medication Assisted Treatment (MAT). 40 Subjects entering into MAT with buprenorphine/naloxonefor opioid dependence disorder were recruited. No change of concurrent treatment was made. Subjects were administered Sleep Scale from the Medical Outcomes Study (MOS-Sleep), a 5-item Supplemental Sleep Scale (SSS), and the Beck Depression Inventory II (BDI-II). The measures were administered at day 0 (baseline), 30, 60 and 90 days. The result showed that patients reported significant progressive improvements in three MOS-Sleep subscales: sleep disturbance, sleep indices I and II. The mean scores of SLPD4 (Sleep disturbance) at day 0, 30, 60, 90 were 62.4, 53.2, 53.3, and 48.4 respectively (p=0.0029). Similarly, subscores of SLP6 (Sleep Problem Index I) and SLP 9 (Sleep Problem Index II) were also significantly decreased over time (P=0.038 for SLP6 and p=0.007 for SLP9). BDI-II depression scores improved from “Moderate depression” at baseline to “Mild depression”. The mean BDI score decreased from 24.2 to 17.0 after 90 days of treatment. Findings suggest that subjects reported improvement in both sleep and depression after initiating MAT with buprenorphine/naloxone. PMID:28133635
Holbrook, Anne; Bowen, James M; Patel, Harsit; O'Brien, Chris; You, John J; Tahavori, Roshan; Doleweerd, Jeff; Berezny, Tim; Perri, Dan; Nieuwstraten, Carmine; Troyan, Sue; Patel, Ameen
Background Medication reconciliation (MedRec) has been a mandated or recommended activity in Canada, the USA and the UK for nearly 10 years. Accreditation bodies in North America will soon require MedRec for every admission, transfer and discharge of every patient. Studies of MedRec have revealed unintentional discrepancies in prescriptions but no clear evidence that clinically important outcomes are improved, leading to widely variable practices. Our objective was to apply process mapping methodology to MedRec to clarify current processes and resource usage, identify potential efficiencies and gaps in care, and make recommendations for improvement in the light of current literature evidence of effectiveness. Methods Process engineers observed and recorded all MedRec activities at 3 academic teaching hospitals, from initial emergency department triage to patient discharge, for general internal medicine patients. Process maps were validated with frontline staff, then with the study team, managers and patient safety leads to summarise current problems and discuss solutions. Results Across all of the 3 hospitals, 5 general problem themes were identified: lack of use of all available medication sources, duplication of effort creating inefficiency, lack of timeliness of completion of the Best Possible Medication History, lack of standardisation of the MedRec process, and suboptimal communication of MedRec issues between physicians, pharmacists and nurses. Discussion MedRec as practised in this environment requires improvements in quality, timeliness, consistency and dissemination. Further research exploring efficient use of resources, in terms of personnel and costs, is required. PMID:28039294
Al-Talib, Mohammed; Leslie, Isla
Many hospitals deploy Medical Emergency (MET) and Cardiac Arrest teams to improve the management and treatment of patients who become critically ill. In many cases, blood results are key in allowing the clinicians involved in these teams to make definitive management decisions for these patients. Following anecdotal reports that these results were often delayed, we assessed the process of blood tests being reported in emergency calls, identified the key factors causing delays and sought to make improvements. The initial intervention involved implementing a new blood form that specified the nature of the call, the tests required and a contact number for laboratory staff to contact the clinical team with results. We also developed a streamlined process within the laboratory for these samples to be fast-tracked. Successive improvement cycles sought to increase awareness of the project, improve accessibility to the new forms and embed spontaneous practices that contributed to improvement. Results demonstrated an overall reduction in the time taken for blood samples in emergencies to be reported from 130 minutes to 97 minutes. This project demonstrates that using a specific blood request form for emergency calls, and tying this to a specified laboratory process, improves the time taken for these tests to be reported. In addition, the project provides some insight into challenges faced when implementing change in new departments. PMID:28243442
Deichmann, Richard E.; Morledge, Michael D.; Ulep, Robin; Shaffer, Johnathon P.; Davies, Philippa; van Driel, Mieke L.
Background: Inadequate patient adherence to a medication regimen is a major factor in the lack of success in treating hyperlipidemia. Improved adherence rates may result in significantly improved cardiovascular outcomes in populations treated with lipid-lowering therapy. The purpose of this metaanalysis was to evaluate the effectiveness of interventions aimed at improving adherence to lipid-lowering drugs, focusing on measures of adherence and clinical outcomes. Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature databases through January 14, 2015, and also used the results from previous Cochrane reviews of this title. Randomized controlled trials of adherence-enhancing interventions for lipid-lowering medication in adults in an ambulatory setting with measurable outcomes were evaluated with criteria outlined by the Cochrane Handbook for Systematic Reviews of Interventions. Results: Twenty-seven studies randomly assigning 899,068 participants to a variety of interventions were analyzed. One group of interventions categorized as intensified patient care showed significant improvement in adherence rates when compared to usual care (odds ratio 1.93; 95% confidence interval [CI] 1.29-2.88). Additionally, after <6 months of follow-up, total cholesterol decreased by a mean of 17.15 mg/dL (95% CI 1.17-33.14), while after >6 months total cholesterol decreased by a mean of 17.57 mg/dL (95% CI 14.95-20.19). Conclusion: Healthcare systems that can implement team-based intensified patient care interventions, such as electronic reminders, pharmacist-led interventions, and healthcare professional education of patients, may be successful in improving adherence rates to lipid-lowering medicines. PMID:27660570
Clark, Douglas Burton
The three interconnected levels of this research characterize how students develop deeper understanding in a complex science topic. The first investigation analyzes the impact of progressively more streamlined versions of the Computer as Learning Partner (CLP) curriculum. This cross-semester investigation analyzes subject matter posttest data for 3000 students who studied one of four versions of the CLP curriculum. The second investigation follows 50 students across their 8th grade CLP semester and into high school. This within-semester analysis maps the knowledge integration of two fairly successful and two less successful students in addition to focusing on the entire cohort. The third investigation analyzes student learning across a novel five-day laboratory/simulation project. Together, these cross-semester, within-semester, and project-level analyses clarify the paths through which students integrate their ideas in response to instruction that emphasizes knowledge integration. To facilitate these analyses, this research develops three new ways to represent connections among student ideas. Summary Tables present accessible overviews of case study students' progress in core topic areas across each interview. Distilled Interview Tables enumerate ideas held at each level of sophistication, displaying trends in sophistication and integration of ideas, clarifying contradictions, and identifying appearance of new ideas. Conceptual Element Maps chart connections and level of integration in further detail, highlighting the paths through which students reorganize and connect the elements within their conceptual ecologies and highlighting areas of strength and weakness. These new representations aid in the identification of appropriate targeted curricular interventions. In addition to the methodological contributions, this work makes theoretical contributions to the conceptual change literature and the depth of coverage literature. Contributions to the conceptual change
Background Informed consent talks are mandatory before invasive interventions. However, the patients’ information recall has been shown to be rather poor. We investigated, whether medical laypersons recalled more information items from a simulated informed consent talk after advanced medical students participated in a communication training aiming to reduce a layperson’s cognitive load. Methods Using a randomized, controlled, prospective cross-over-design, 30 5th and 6th year medical students were randomized into two groups. One group received communication training, followed by a comparison intervention (early intervention group, EI); the other group first received the comparison intervention and then communication training (late intervention group, LI). Before and after the interventions, the 30 medical students performed simulated informed consent talks with 30 blinded medical laypersons using a standardized set of information. We then recorded the number of information items the medical laypersons recalled. Results After the communication training both groups of medical laypersons recalled significantly more information items (EI: 41 ± 9% vs. 23 ± 9%, p < .0001, LI 49 ± 10% vs. 35 ± 6%, p < .0001). After the comparison intervention the improvement was modest and significant only in the LI (EI: 42 ± 9% vs. 40 ± 9%, p = .41, LI 35 ± 6% vs. 29 ± 9%, p = .016). Conclusion Short communication training for advanced medical students improves information recall of medical laypersons in simulated informed consent talks. PMID:23374907
Toker, Asaf; Urkin, Jacob; Bloch, Yuval
The Joyce and Irving Goldman School of Medicine, Faculty of Health Sciences at the Ben Gurion University of the Negev encourages students to take part in the development and evaluation of the teaching experience. These special relations between the school and the students contribute not only to changes in the curriculum but also to increased involvement of faculty and students in the community. This article reviews the special relationship between the Faculty of Health Sciences and its medical students through the Medical Students Association (ASRN). During the last decade, BGU medical students have initiated innovative programmes some of which have recently become integrated into the curriculum. These include: prevention of sexual violence among youth, decreasing white-coat fear in small children ('Teddy Bear hospital') and participation in home-hospice activities. By encouraging students to become equal partners in faculty development and rejecting the traditional paternalistic mode of teacher-student relationships, the faculty has created an improved learning experience, and increased student motivation and levels of communication between the teachers and the future clinicians.
Cook, Royer F.; Billings, Douglas W.; Kaplan, Seth; Murray, David; Safren, Steven; Goforth, Justin; Spencer, Joy
We evaluated the effectiveness of a web-based version of the Life-Steps intervention combined with modules for stress reduction and mood management, designed to improve medication adherence among HIV infected individuals. 168 HIV+ adults were randomized into either the Life-Steps program or a waitlist control condition. All participants completed a baseline assessment and provided a 2-week electronic pill (MEMS) cap baseline reading. Follow up data collection was conducted at 3, 6 and 9 months. Patients in the web-based Life-Steps condition had significantly higher antiretroviral medication adherence rates than patients in the control group over the nine-month period as measured by the MEMS cap. In addition, analysis of viral load data indicated that the program also resulted in a significant decrease in viral load. These findings indicate that a web-based Life-Steps program can be a useful and implementable tool for helping patients living with HIV maintain medication adherence. PMID:23760634
Guimarães, Fabiana Costa; Amorim, Paulo Roberto dos Santos; Reis, Fernando Fonseca dos; Bonoto, Robson Teixeira; Oliveira, Wederson Candido de; Moura, Tiago Augusto da Silva; Assis, Cláudia Loures de; Palotás, András; Lima, Luciana Moreira
In addition to hypertension, dyslipidemia, atherosclerosis, and diabetes, a sedentary lifestyle plays a pivotal role in cerebro- and cardiovascular disease and progressive cognitive decline, including vascular dementia and Alzheimer's disease. The present study investigated whether controlling the key risks and participating in physical activity have a beneficial impact on these disorders. Elderly volunteers were enrolled in a 3-month program that consisted of structured exercise three times per week. The daily routine, medical treatment, and vital parameters were evaluated and correlated with the subjects' neuropsychiatric status. High blood pressure was found in 40% of the participants, with no significant differences between the sexes. A higher proportion of females (55%) than males (18%) forgot to take their medication during the observation period. Significant negative correlations were found between Mini-Mental State Examination (MMSE) scores and age, lack of a caregiver, and increased pulse rate before or after exercise. These results suggest that the presence of home assistance and subsequent improvement in medication compliance, vital parameter optimization, and regular physical activity may yield better MMSE results and a lower risk for cerebro- and cardiovascular disease.
Young physicians in Germany often criticize the advanced training programme, especially the lack of structure and the insufficient rotations. The Medical Association in each Bundesland/federal state require to include a proposal for advanced training and rotation in a trainer's aplication for an educational license. However, there is no systematic scrutiny of these concepts and therefore the criteria stated outcomes are often only incompletely met. Trainers engage too little in training methods and medical didactics. They rarely evaluate learning outcomes, and structured assessments based on workplace are exceptions. The reasons are deeply rooted in Germany's education system: Resources for specialist training are not provided, and there is no funding for a commitment in continued medical education. In addition, teaching is not assigned a quantifiable value. However, during the last decade awareness has arisen that good training programmes are an important part of quality assurance and the validation of a hospital. Better planning, structuring and evaluation of training programmes is necessary. New learning methods should be incorporated in training programmes. The German Respiratory Society (DGP) wishes to contribute to the improvement of advanced training: for example with "train the trainer" seminars for teachers, with a structured educational course programme for the trainees, with assessments such as the HERMES (Harmonized Education in Respiratory Medicine for European Specialists) exam and with support for the accreditation as a Respiratory Training Centre of the ERS (European Respiratory Society) and EBAP (European Board for Accreditation in Pneumology).
Leat, Susan J.; Krishnamoorthy, Abinaya; Carbonara, Antonio; Gold, Deborah; Rojas-Fernandez, Carlos
Objectives: Most current prescription labels fail to meet print guidelines, especially in print size. We therefore compared the legibility of current prescription medication labels against the legibility of prototype labels, based on current guidelines for legibility. Method: Sample medication labels were obtained from pharmacies, and prototype medication labels were developed according to legibility guidelines from nongovernmental organizations and pharmacy organizations. Three groups of participants, consisting of older adults with normal vision, older adults with visual impairment and younger adults with visual impairment (total N = 71) took part. Participants were asked to read and rank the labels. Reading speed and accuracy were determined. Results: Accuracies were high (75%–100%), and there were no significant differences between samples or prototypes or between groups. Prototypes, however, were read faster than samples (p < 0.001). Subjectively, participants preferred the largest print option (p < 0.001) and instructions with the numbers written in highlighted uppercase words (p < 0.001). Discussion: The results indicate that improvements to the label would include larger print size, a consistent layout with left justification and using upper case with highlighting for emphasis of the numbers in the instructions. PMID:27212968
Pettit, Amy R; Marcus, Steven C
Medication nonadherence is a widespread problem that compromises treatment outcomes, particularly in schizophrenia. Weersink et al. (Soc Psychiatry Psychiatr Epidemiol, 2015) describe telephone calls to a national medicines information line, with a focus on queries related to antipsychotic medications. Their analysis of callers' questions and concerns offers a valuable window into patient and caregiver perspectives. Given that many callers reported that they had not shared these concerns with a health care provider, this study also highlights the capacity of medication hotlines to address unmet needs. Establishing and maintaining long-term treatment regimens is a complex task, and truly patient-centered care requires a variety of creative and accessible support resources. Medication lines have the potential to serve as a resource and to provide proactive and timely adherence support.
Purpose Medication management is a complex process, at high risk of error with life threatening consequences. The focus should be on devising strategies to avoid errors and make the process self-reliable by ensuring prevention of errors and/or error detection at subsequent stages. The purpose of this paper is to use failure mode effect analysis (FMEA), a systematic proactive tool, to identify the likelihood and the causes for the process to fail at various steps and prioritise them to devise risk reduction strategies to improve patient safety. Design/methodology/approach The study was designed as an observational analytical study of medication management process in the inpatient area of a multi-speciality hospital in Gurgaon, Haryana, India. A team was made to study the complex process of medication management in the hospital. FMEA tool was used. Corrective actions were developed based on the prioritised failure modes which were implemented and monitored. Findings The percentage distribution of medication errors as per the observation made by the team was found to be maximum of transcription errors (37 per cent) followed by administration errors (29 per cent) indicating the need to identify the causes and effects of their occurrence. In all, 11 failure modes were identified out of which major five were prioritised based on the risk priority number (RPN). The process was repeated after corrective actions were taken which resulted in about 40 per cent (average) and around 60 per cent reduction in the RPN of prioritised failure modes. Research limitations/implications FMEA is a time consuming process and requires a multidisciplinary team which has good understanding of the process being analysed. FMEA only helps in identifying the possibilities of a process to fail, it does not eliminate them, additional efforts are required to develop action plans and implement them. Frank discussion and agreement among the team members is required not only for successfully conducing
Nelson, Lyndsay A; Bethune, Magaela C; Lagotte, Andrea E
Background Web-delivered interventions are a feasible approach to health promotion. However, if a website is poorly designed, difficult to navigate, and has technical bugs, it will not be used as intended. Usability testing prior to evaluating a website’s benefits can identify barriers to user engagement and maximize future use. Objective We developed a Web-delivered intervention called Diabetes Medication Adherence Promotion (Diabetes MAP) and used a mixed-methods approach to test its usability prior to evaluating its efficacy on medication adherence and glycemic control in a randomized controlled trial. Methods We recruited English-speaking adults with type 2 diabetes mellitus (T2DM) from an academic medical center who were prescribed diabetes medications. A trained research assistant administered a baseline survey, collected medical record information, and instructed participants on how to access Diabetes MAP. Participants were asked to use the site independently for 2 weeks and to provide survey and/or focus group feedback on their experience. We analyzed survey data descriptively and qualitative data thematically to identify participants’ favorable and unfavorable experiences, characterize usability concerns, and solicit recommendations for improving Diabetes MAP. Results Enrolled participants (N=32) were an average of 51.7 ± 11.8 years old, 66% (21/32) female, 60% (19/32) non-Hispanic White, 88% (28/32) had more than 12 years of education, half had household incomes over $50,000, and 78% (25/32) were privately insured. Average duration of diagnosed diabetes was 7.8 ± 6.3 years, average A1c was 7.4 ± 2.0, and 38% (12/32) were prescribed insulin. Of enrolled participants, 91% (29/32) provided survey and/or focus group feedback about Diabetes MAP. On the survey, participants agreed website information was clear and easy to understand, but in focus groups they reported navigational challenges and difficulty overcoming user errors (eg, entering data in an
Ekin, Ahmet; Jasinschi, Radu; Turan, Erman; Engbers, Rene; van der Grond, Jeroen; van Buchem, Mark A.
In the medical world, the accuracy of diagnosis is mainly affected by either lack of sufficient understanding of some diseases or the inter-, and/or intra-observer variability of the diagnoses. The former requires understanding the progress of diseases at much earlier stages, extraction of important information from ever growing amounts of data, and finally finding correlations with certain features and complications that will illuminate the disease progression. The latter (inter-, and intra- observer variability) is caused by the differences in the experience levels of different medical experts (inter-observer variability) or by mental and physical tiredness of one expert (intra-observer variability). We believe that the use of large databases can help improve the current status of disease understanding and decision making. By comparing large number of patients, some of the otherwise hidden relations can be revealed that results in better understanding, patients with similar complications can be found, the diagnosis and treatment can be compared so that the medical expert can make a better diagnosis. To this effect, this paper introduces a search and retrieval system for brain MR databases and shows that brain iron accumulation shape provides additional information to the shape-insensitive features, such as the total brain iron load, that are commonly used in the clinics. We propose to use Kendall's correlation value to automatically compare various returns to a query. We also describe a fully automated and fast brain MR image analysis system to detect degenerative iron accumulation in brain, as it is the case in Alzheimer's and Parkinson's. The system is composed of several novel image processing algorithms and has been extensively tested in Leiden University Medical Center over so far more than 600 patients.
Afek, Arnon; Meilik, Ahuva; Rotstein, Zeev
Today, medical organizations have to contend with a highly competitive environment, an atmosphere saturated with a multitude of innovative new technologies and ever-increasing costs. The ability of these organizations to survive and to develop and expand their services mandates adoption of management guidelines based on the world of finance/commerce, adapted to make them relevant to the world of medical service. In this article the authors chose to present a management administration assessment which is a process that ensures that the management will effectively administer the organization's resources, and meet the goals set by the organization. The system demands that hospital "centers of responsibility" be defined, a management information system be set up, activities be priced, budget be defined and the expenses assessed. These processes make it possible to formulate a budget and assess any possible deviation between the budget and the actual running costs. An assessment of deviations will reveal any possible deviation of the most significant factor--efficiency. Medical organization managers, with the cooperation of the directors of the "centers of responsibility", can assess subunit activities and gain an understanding of the significance of management decisions and thus improve the quality of management, and the medical organization. The goal of this management system is not only to Lower costs and to meet the financial goals that were set; it is a tool that ensures quality. Decreasing expenditure is important in this case, but is only secondary in importance and will be a result of reducing the costs incurred by services lacking in quality.
Postal, S N
The above application of the quality improvement cycle provides insight into the use of the Deming method to address one of several identified customer needs and expectations obtained during the managing phase of product-line administration. Implementation of the quality improvement method requires a major commitment from all team members. Process improvement requires a willingness to be detail oriented. Gathering of statistics--such as analysis turn-around time--and evaluation are critical. This objective view of processes requires accountability and a commitment to change. Improvements focus on long-term problem resolution, not the quick fixes that result from addressing symptoms of problems. True problem resolution occurs by solving the root causes of variations. Medical record departments must move from being outcome oriented to being process focused. It is no longer feasible to be constantly putting out fires in an environment that demands well-planned and well-designed products that meet customers' expectations. The long-term management of product lines requires a systematic method of planning, doing, checking, and acting. The Deming quality improvement method provides a framework for positive change that focuses on quality processes resulting in a quality product that meets consumers' needs.
Lindberg, Sara M; Anderson, Cynthie K
The purpose of this study was to test the effectiveness of an intervention to improve the consistency and accuracy of antenatal gestational weight gain counseling through introduction of a "best practice alert" into an electronic medical record (EMR) system. A best practice alert was designed and implemented in the EMR. Based on each patient's pre-gravid body mass index (BMI), fetal number, and 2009 Institute of Medicine (IOM) guidelines, the alert provides an individualized total gestational weight gain goal, the weight gain goal per week of gestation, a template for scripted provider counseling and documentation, and a patient handout containing personalized gestational weight gain information. Retrospective chart reviews of 388 pre-intervention patients and 345 post-intervention patients were used to evaluate effectiveness. Introduction of a gestational weight gain best practice alert into the EMR improved the rate of antenatal gestational weight gain counseling that was consistent with current IOM guidelines (p < 0.001). Improvement in IOM-consistent gestational weight gain counseling was seen across all provider types, including obstetricians, family practice physicians, and certified nurse midwives. The intervention also resulted in significant improvement in documentation of pre-gravid weights and BMIs within the EMR. The EMR is an effective tool for improving the consistency and accuracy of antenatal gestational weight gain counseling in accord with 2009 IOM guidelines.
Selter, Jessica H; Turner, Zahava; Doerrer, Sarah C; Kossoff, Eric H
Unlike anticonvulsant drugs and vagus nerve stimulation, there are no guidelines regarding adjustments to ketogenic diet regimens to improve seizure efficacy once the diet has been started. A retrospective chart review was performed of 200 consecutive patients treated with the ketogenic diet at Johns Hopkins Hospital from 2007 to 2013. Ten dietary and supplement changes were identified, along with anticonvulsant adjustments. A total of 391 distinct interventions occurred, of which 265 were made specifically to improve seizure control. Adjustments led to >50% further seizure reduction in 18%, but only 3% became seizure-free. The benefits of interventions did not decrease over time. There was a trend towards medication adjustments being more successful than dietary modifications (24% vs 15%, P = .08). No single dietary change stood out as the most effective, but calorie changes were largely unhelpful (10% with additional benefit).
Frey, Bernhard; Argent, Andrew
Neonatal and paediatric intensive care has improved the prognosis for seriously sick infants and children. This has happened because of a pragmatic approach focused on stabilisation of vital functions and immense technological advances in diagnostic and therapeutic procedures. However, the belief that more medical care must inevitably lead to improved health is increasingly being questioned. This issue is especially relevant in developing countries where the introduction of highly specialised paediatric intensive care may not lead to an overall fall in child mortality. Even in developed countries, the complexity and availability of therapeutics and invasive procedures may put seriously ill children at additional risk. In both developing and industrialised countries the use of safe and simple procedures for appropriate periods, particular attention to drug prescription patterns and selection of appropriate aims and modes of therapy, including non-invasive methods, may minimise the risks of paediatric intensive care.
Cao, Tianjie; Zhai, Jingxuan
In order to protect users' identity privacy, Chen et al. proposed an efficient dynamic ID-based authentication scheme for telecare medical information systems. However, Chen et al.'s scheme has some weaknesses. In Chen et al.'s scheme, an attacker can track a user by a linkability attack or an off-line identity guessing attack. Chen et al.'s scheme is also vulnerable to an off-line password guessing attack and an undetectable on-line password guessing attack when user's smart card is stolen. In server side, Chen et al.'s scheme needs large computational load to authentication a legal user or reject an illegal user. To remedy the weaknesses in Chen et al.'s scheme, we propose an improved smart card based password authentication scheme. Our analysis shows that the improved scheme can overcome the weaknesses in Chen et al.'s scheme.
Duff, Jed; Walker, Kim; Omari, Abdullah; Middleton, Sandy; McInnes, Elizabeth
Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in hospitalized medical patients. Evidence-based guidelines exist for preventing VTE; unfortunately, these guidelines are not always adhered to by clinicians. The aim of this study was to evaluate the acceptability, utility and clinical impact of an educational outreach visit (EOV) on nurses' provision of mechanical prophylaxis to hospitalized medical patients using a prospective, uncontrolled, before-and-after design. Nurses received a 1-to-1 educational session on mechanical VTE prevention by a trained nurse facilitator. The EOV intervention was designed by a multidisciplinary group of healthcare professionals using social marketing theory. Eighty-five of the 120 eligible nurses (71%) attended the EOV. The median length of each visit was 11.5 minutes (interquartile range [IQR], 10-15) and the median time spent arranging and conducting each visit was 63 minutes (IQR, 49-85). Eighty-four (99%) of the 85 participants gave a verbal commitment to trial the new evidence-based mechanical VTE prevention practices. However, there were no measurable improvements in the proportion of patients risk assessed (-1.7% improvement; 95% confidence interval [CI], -7.0 to 10.3; P = .68) or provided appropriate mechanical prophylaxis (-0.3% improvement; 95% CI, -13.4 to 14; P = .96). Researchers conclude that EOV should not be used to improve nurses' use of mechanical VTE prevention because it has no measurable impact on clinical practice and is resource intensive, requiring 4.5 minutes of preparation for every minute spent face to face with participants. Further research into the specific mechanism of action is required to explain the variability in clinical effect seen with this intervention.
Sadeghi, Anahita; Aghaei Meybodi, Hamidreza; Navabakhsh, Behrouz; Soroush, Ahmadreza; Malekzadeh, Masoud Mohammad; Khorgami, Zhamak
Quality of clinical education for medical students has always been a concern in academic medicine. This concern has increased in today's time-squeeze while faculty members have to fulfill their complementary roles as a teacher, researcher, and practitioner. One of the strategies for program evaluation is obtaining trainees' feedbacks since they are the main customers of educational programs; however, there are debates about the efficacy of student feedback as a reliable source for reforms. We gathered Likert scores on a 16-item questionnaire from 2,771 medical students participating in all clerkship programs in a multidisciplinary teaching hospital. An expert panel consisting of 8 attending physicians established content validity of the questionnaire while a high Cronbach's Alpha (0.93) proved its reliability. Summary reports of these feedbacks were presented to heads of departments, clerkship program directors, and hospital administrators, at the end of each semester. Analysis of variance was used for comparing hospital scores across different time periods and different departments. Significant changes (P<0.001) were observed in mean scores between different semesters (partial η2=0.090), different departments (partial η2=0.149) as well as the interaction term between departments and semesters (partial η2=0.111). A significant improvement in mean clinical education score is noticeable after three semesters from the beginning of the survey. Periodic, systematic trainee's feedback to program directors can lead to an improved educational performance in teaching hospitals.
Insel, Kathleen C; Einstein, Gilles O; Morrow, Daniel G; Hepworth, Joseph T
Adherence to prescribed antihypertensive agents is critical because control of elevated blood pressure is the single most important way to prevent stroke and other end organ damage. Unfortunately, nonadherence remains a significant problem. Previous interventions designed to improve adherence have demonstrated only small benefits of strategies that target single facets such as understanding medication directions. The intervention described here is informed by prospective memory theory and performance of older adults in laboratory-based paradigms and uses a comprehensive, multifaceted approach to improve adherence. It incorporates multiple strategies designed to support key components of prospective remembering involved in taking medication. The intervention is delivered by nurses in the home with an education control group for comparison. Differences between groups in overall adherence following the intervention and 6 months later will be tested. Systolic and diastolic blood pressure levels also will be examined between groups and as they relate to adherence. Intra-individual regression is planned to examine change in adherence over time and its predictors. Finally, we will examine the association between executive function/working memory and adherence, predicting that adherence will be related to executive/working memory in the control group but not in the intervention group.
Cranwell, K; Polacsek, M; McCann, T V
WHAT IS KNOWN ON THE SUBJECT?: Mental health service users with medical co-morbidity frequently experience difficulties accessing and receiving appropriate treatment in emergency departments. Service users frequently experience fragmented care planning and coordinating between tertiary medical and primary care services. Little is known about mental health nurses' perspectives about how to address these problems. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Emergency department clinicians' poor communication and negative attitudes have adverse effects on service users and the quality of care they receive. The findings contribute to the international evidence about mental health nurses' perspectives of service users feeling confused and frustrated in this situation, and improving coordination and continuity of care, facilitating transitions and increasing family and caregiver participation. Intervention studies are needed to evaluate if adoption of these measures leads to sustainable improvements in care planning and coordination, and how service users with medical co-morbidity are treated in emergency departments in particular. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Effective planning and coordination of care are essential to enable smooth transitions between tertiary medical (emergency departments in particular) and primary care services for service users with medical co-morbidity. Ongoing professional development education and support is needed for emergency department clinicians. There is also a need to develop an organized and systemic approach to improving service users' experience in emergency departments.
Medical librarians supporting information systems project lifecycles toward improved patient safety. Medical librarians possess expertise to navigate various search resources and can investigate inquiries during IS project lifecycles.
Saimbert, Marie K; Zhang, Yingting; Pierce, Jenny; Moncrief, Erica S; O'Hagan, Keydi Boss; Cole, Peter
Health information systems (HIS) have progressed from being used to manage billing to impacting patient safety and health professionals' job satisfaction. Many decisions are made during project management and the information system lifecycle of a HIS. Medical librarians are underutilized in HIS lifecycles; it may not be clear to stakeholders what they can provide and where their services fit. Medical librarians possess expertise to navigate various search resources and can investigate inquiries during information systems project lifecycles. Librarians can market specific skills to project lifecycle teams such as those involved in computerized provider order entry (CPOE), electronic medication administration record (eMAR) and root cause analysis (RCA). HIS project personnel, including patient safety team members, should make use of medical librarians in phases of health information systems project management. This will help them meet institutional and global objectives for evidence-based use of technology towards improved patient safety.
Kiguli-Malwadde, Elsie; Olapade-Olaopa, E Oluwabunmi; Kiguli, Sarah; Chen, Candice; Sewankambo, Nelson K; Ogunniyi, Adesola O; Mukwaya, Solome; Omaswa, Francis
Background Relatively little has been written on Medical Education in Sub-Saharan Africa, although there are over 170 medical schools in the region. A number of initiatives have been started to support medical education in the region to improve quality and quantity of medical graduates. These initiatives have led to curricular changes in the region, one of which is the introduction of Competency-Based Medical Education (CBME). Institutional reviews This paper presents two medical schools, Makerere University College of Health Sciences and College of Medicine, University of Ibadan, which successfully implemented CBME. The processes of curriculum revision are described and common themes are highlighted. Both schools used similar processes in developing their CBME curricula, with early and significant stakeholder involvement. Competencies were determined taking into consideration each country’s health and education systems. Final competency domains were similar between the two schools. Both schools established medical education departments to support their new curricula. New teaching methodologies and assessment methods were needed to support CBME, requiring investments in faculty training. Both schools received external funding to support CBME development and implementation. Conclusion CBME has emerged as an important change in medical education in Sub-Saharan Africa with schools adopting it as an approach to transformative medical education. Makerere University and the University of Ibadan have successfully adopted CBME and show that CBME can be implemented even for the low-resourced countries in Africa, supported by external investments to address the human resources gap. PMID:25525404
Casella, Erica; Capozzi, Donna; McGettigan, Suzanne; Gangadhar, Tara C.; Schuchter, Lynn; Myers, Jennifer S.
Purpose: Over the last decade, the use of oral chemotherapy (OC) for the treatment of cancer has dramatically increased. Despite their route of administration, OCs pose many of the same risks as intravenous agents. In this quality improvement project, we sought to examine our current process for the prescription of OC at the Abramson Cancer Center of the University of Pennsylvania and to improve on its safety. Methods: A multidisciplinary team that included oncologists, advanced-practice providers, and pharmacists was formed to analyze the current state of our OC practice. Using Lean Six Sigma quality improvement tools, we identified a lack of pharmacist review of the OC prescription as an area for improvement. To address these deficiencies, we used our electronic medical system to route OC orders placed by treating providers to an oncology-specific outpatient pharmacist at the Abramson Cancer Center for review. Results: Over 7 months, 63 orders for OC were placed for 45 individual patients. Of the 63 orders, all were reviewed by pharmacists, and, as a result, 22 interventions were made (35%). Types of interventions included dosage adjustment (one of 22), identification of an interacting drug (nine of 22), and recommendations for additional drug monitoring (12 of 22). Conclusion: OC poses many of the same risks as intravenous chemotherapy and should be prescribed and reviewed with the same oversight. At our institution, involvement of an oncology-trained pharmacist in the review of OC led to meaningful interventions in one third of the orders. PMID:26733627
Caballero, Joshua; Ownby, Raymond L; Rey, Jose A; Clauson, Kevin A
Use of neuroenhancers has been studied in groups ranging from students to surgeons; however, use of cognitive and performance enhancing medications (CPEMs) to improve performance in poker has remained largely overlooked. To assess the use of CPEMs to improve poker performance, a survey of poker players was conducted. Participants were recruited via Internet poker forums; 198 completed the online survey. Approximately 28 % of respondents used prescription CPEMs, with the most commonly used including: amphetamine/dextroamphetamine (62 %), benzodiazepines (20 %), and methylphenidate (20 %). CPEMs were used in poker to focus (73 %), calm nerves (11 %), and stay awake (11 %). Caffeine (71 %), as well as conventionally counter-intuitive substances like marijuana (35 %) and alcohol (30 %) were also reported to enhance poker performance. Non-users of CPEMs were dissuaded from use due to not knowing where to get them (29 %), apprehension about trying them (26 %), and legal or ethical concerns (16 %). Respondents most frequently acquired CPEMs via friends/fellow poker players (52 %), or prescription from physician (38 %). Additionally, greater use of CPEMs was associated with living outside the United States (p = 0.042), prior use of prescription medications for improving non-poker related performance (p < 0.001), and amateur and semi-professional player status (p = 0.035). Unmonitored use of pharmacologically active agents and their methods of acquisition highlight safety concerns in this cohort of poker players, especially among non-professional players. The current state of guidance from national organizations on CPEM use in healthy individuals could impact prescribing patterns.
... SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 54.455 Textbooks and curricular...
Wilson, Christopher James
We describe specific curricular decisions employed at Butler University that have resulted in student achievement in the actuarial science major. The paper includes a discussion of how these decisions might be applied in the context of a new actuarial program.
... SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 54.455 Textbooks and curricular...
... SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 229.455 Textbooks and curricular...
... SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 229.455 Textbooks and curricular...
Ma, Lina; Zhao, Xiaoling; Liu, Huizhen; Zhu, Hong; Yang, Wei; Qian, Yuying; Wang, Jieyu; Feng, Ming; Li, Yun
We aim to explore the influence of an antidepression medication on symptom scores and quality of life in elderly patients with benign prostatic hyperplasia accompanied by depression. We conducted a randomized controlled clinical trial which included 94 elderly patients with benign prostatic hyperplasia accompanied by depression in Xuan Wu Hospital and Beijing Boai Hospital during August 2008 to May 2012. The study was designed to compare outcomes related to patient quality of life (QoL). The patients were randomly assigned to one of two groups, consisting of a control group (n = 47) and a therapy group (n = 47), and were followed up for 3 months. The pre-treatment and post-treatment changes among patients in the two groups were compared using their respective IPSS symptom scores, HAM-D scores, and scores on the Short Form 36 Health Survey. Following treatment, the patient IPSS symptom scores in the therapy group were significantly lower than those in the control group (10.74 ± 4.72 vs. 16.42 ± 8.09, respectively; t = 4.157, P < 0.05). Additionally, each measured dimension of QoL was significantly higher in the therapy group [total score (69.12 ± 3.92) vs. (61.30 ± 3.51), P < 0.05]. The results show antidepression medication can improve the symptoms and quality of life among elderly patients with benign prostatic hyperplasia accompanied by depression. Our findings suggest that an antidepression medication should be included when treating elderly patients with benign prostatic hyperplasia.
Hoelzer, Simon; Schweiger, Ralf Kurt; Boettcher, Hanno; Rieger, Joerg; Dudeck, Joachim
Due to the information overload and the unstructured access to (medical) information of the internet, it isn't hardly possible to find problem-relevant medical information in an appropriate time (e.g. during a consultation). The web offers a mixture of web pages, forums, newsgroups and databases. The search for problem-relevant information for a certain knowledge area encounters on two basic problems. On the one hand, you have to find in the jungle of the information, relevant resources for your individual clinical case (treatment, diagnosis, therapeutic option etc..). The second problem consists of being able to judge the quality of individual contents of inteernet pages. On the basis of the different informational needs of health care professionals and patients a catalog with inteernet resources was created to tumor diseases such as lung cancer (small cell and non-small cell carcinoma), colorectal cancer and thyroid cancer. Explicit and implicit metainformation, if available, such as the title of the document, language, date or keywords are stored in the database. The database entries are editorially revised, so that further specific metainformation is available for the information retrieval. Our pragmatic approach of searching, editing, and archiving of internet content is still necessary since most of the web documents are based on HTML, which doesn't allow for structuring (medical) information and assigning metainformation sufficiently. The use of specific metainformation is crucial in order to improve the recall and precision of internet searches. In the future, XML and related technologies (RDF) will meet these requirements.
Hodgson, M; Brodt, W; Henderson, D; Loftness, V; Rosenfeld, A; Woods, J; Wright, R
Medical research facilities, indeed all the nation's constructed facilities, must be designed, operated, and maintained in a manner that supports the health, safety, and productivity of the occupants. The National Construction Goals, established by the National Science and Technology Council, envision substantial improvements in occupant health and worker productivity. The existing research and best practices case studies support this conclusion, but too frequently building industry professionals lack the knowledge to design, construct, operate, and maintain facilities at these optimum levels. There is a need for more research and more collaborative efforts between medical and facilities engineering researchers and practitioners in order to attain the National Construction Goals. Such collaborative efforts will simultaneously support attainment of the National Health Goals. This article is the summary report of the Healthy Buildings Committee for the Leadership Conference: Biomedical Facilities and the Environment sponsored by the National Institutes of Health, the National Association of Physicians for the Environment, and the Association of Higher Education Facilities Officers on 1--2 November 1999 in Bethesda, Maryland, USA. PMID:11124125
English is the most important language used in international communication. Nurses today have significantly more opportunities to come into contact with clients of different nationalities. Therefore, English communication abilities are a critical to the effective care of foreign clients. Miscommunication due to language barriers can endanger the health and safety of foreign clients and hinder their access to healthcare resources. Basic English communicate skills allow nurses to better understand the feelings of foreign clients and to affect their satisfaction with healthcare services provided. The majority of clinical nurses in Taiwan are inadequately prepared to communicate with foreign clients or use English when delivering nursing care services. Although English is not an official language in Taiwan, strengthening English communication skills is necessary for Taiwan's healthcare service system. Faced with increasing numbers of foreign clients in their daily work, first-line nursing staffs need more training to improve English proficiency. In order to do so, support from the hospital director is the first priority. The second priority is to motivate nursing staffs to learn English; the third is to incorporate different English classes into the medical system and schedule class times to meet nurse scheduling needs; and the fourth is to establish international medical wards, with appropriate incentives in pay designed to attract and retain nursing staff proficient in English communication.
Bartley, Kelly Bauer; Haney, Rebecca
Improving access to care, health outcomes, and patient satisfaction are primary objectives for healthcare practices. This article outlines benefits, concerns, and possible challenges of shared medical appointments (SMAs) for patients and providers. The SMA model was designed to support providers' demanding schedules by allowing patients with the same chronic condition to be seen in a group setting. By concentrating on patient education and disease management, interactive meetings provide an opportunity for patients to share both successes and struggles with others experiencing similar challenges. Studies demonstrated that SMAs improved patient access, enhanced outcomes, and promoted patient satisfaction. This article describes the potential benefits of SMAs for patients with chronic heart disease, which consumes a large number of healthcare dollars related to hospital admissions, acute exacerbations, and symptom management. Education for self-management of chronic disease can become repetitive and time consuming. The SMA model introduces a fresh and unique style of healthcare visits, allowing providers to devote more time and attention to patients and improve productivity. The SMA model provides an outstanding method for nurse practitioners to demonstrate their role as a primary care provider, by leading patients in group discussions and evaluating their current health status. Patient selection, preparation, and facilitation of an SMA are discussed to demonstrate the complementary nature of an SMA approach in a healthcare practice.
Maruo, Katsuichiro; Singh, Kamleshwar; Shibata, Sadahiko; Sugiura, Go; Kumagai, Takashi; Tamaki, Katsushi; Jain, Jyoti
Background: Study comparing the improvement of implant maintenance is limited. Clinicians must be aware of implant maintenance to improve long-term success of implant. Aims: The aim of this retrospective study was to evaluate whether the Medical Treatment Model (MTM), which is a comprehensive treatment, includes initial risk assessment, lifestyle instructions, such as diet and habits, and a customized maintenance program to improve implant prognosis. Materials and Methods: Patients who were comprehensively treated were included and divided into two groups, test and control groups. The test group included patients who started treatment with MTM, whereas control group included patients who started treatment without MTM introduction. Moreover, subsequently, compliance with maintenance, occurrence of biological complications, and implant failure were evaluated. Results: About 199 patients with 515 implants were analyzed in the control group and 38 patients with 59 implants in the test group. In the control and test groups, the percentages of patients in the four compliance categories were, respectively, 73.9% and 89.5% for excellent compliance, 7.0% and 7.9% for good compliance, 14.6% and 0% for fair compliance, and 4.5% and 2.6% for poor compliance. There was a statistically significant difference in the compliance with periodontal and implant maintenance between the test and control groups (P = 0.029). Conclusions: Within the limitation of this study, MTM significantly enhanced the compliance of patients treated with implants. PMID:27994406
Song, Zirui; Safran, Dana Gelb; Landon, Bruce E; Landrum, Mary Beth; He, Yulei; Mechanic, Robert E; Day, Matthew P; Chernew, Michael E
Seven provider organizations in Massachusetts entered the Blue Cross Blue Shield Alternative Quality Contract in 2009, followed by four more organizations in 2010. This contract, based on a global budget and pay-for-performance for achieving certain quality benchmarks, places providers at risk for excessive spending and rewards them for quality, similar to the new Pioneer Accountable Care Organizations in Medicare. We analyzed changes in spending and quality associated with the Alternative Quality Contract and found that the rate of increase in spending slowed compared to control groups, more so in the second year than in the first. Overall, participation in the contract over two years led to savings of 2.8 percent (1.9 percent in year 1 and 3.3 percent in year 2) compared to spending in nonparticipating groups. Savings were accounted for by lower prices achieved through shifting procedures, imaging, and tests to facilities with lower fees, as well as reduced utilization among some groups. Quality of care also improved compared to control organizations, with chronic care management, adult preventive care, and pediatric care within the contracting groups improving more in year 2 than in year 1. These results suggest that global budgets with pay-for-performance can begin to slow underlying growth in medical spending while improving quality of care.
O'Leary, Kevin J; Creden, Amanda J; Slade, Maureen E; Landler, Matthew P; Kulkarni, Nita; Lee, Jungwha; Vozenilek, John A; Pfeifer, Pamela; Eller, Susan; Wayne, Diane B; Williams, Mark V
In a prior study involving 2 medical units, Structured Interdisciplinary Rounds (SIDRs) improved teamwork and reduced adverse events (AEs). SIDR was implemented on 5 additional units, and a pre- versus postintervention comparison was performed. SIDR combined a structured format for communication with daily interprofessional meetings. Teamwork was assessed using the Safety Attitudes Questionnaire (score range = 0-100), and AEs were identified using queries of information systems confirmed by 2 physician researchers. Paired analyses for 82 professionals completing surveys both pre and post implementation revealed improved teamwork (mean 76.8 ± 14.3 vs 80.5 ± 11.6; P = .02), which was driven mainly by nurses (76.4 ± 14.1 vs 80.8 ± 10.4; P = .009). The AE rate was similar across study periods (3.90 vs 4.07 per 100 patient days; adjusted IRR = 1.08; P = .60). SIDR improved teamwork yet did not reduce AEs. Higher baseline teamwork scores and lower AE rates than the prior study may reflect a positive cultural shift that began prior to the current study.
Sechel, Teodora Daniela
In all European countries, the eighteenth century was characterised by efforts to improve the vernaculars. The Transylvanian case study shows how both codified medical language and ordinary language were constructed and enriched by a large number of medical books and brochures. The publication of medical literature in Central European vernacular languages in order to popularise new medical knowledge was a comprehensive programme, designed on the one hand by intellectual, political and religious elites who urged the improvement of the fatherland and the promotion of the common good by perfecting the arts and sciences. On the other hand, the imperial administration’s initiatives affected local forms of medical knowledge and the construction of vernacular languages. In the eighteenth century, the construction of vernacular languages in the Habsburg Monarchy took on a significant political character. However, in the process of building of the scientific and medical vocabulary, the main preoccupation was precision, clarity and accessibility of the neologisms being invented to encompass the medical phenomena being described. In spite of political conflicts among the ‘nations’ living in Transylvania, physicians borrowed words from German, Hungarian and Romanian. Thus they elevated several words used in everyday language to the upper social stratum of language use, leading to the invention of new terms to describe particular medical practices or phenomena. PMID:22595134
The purpose of this study was to describe the development, implementation, and evaluation of an educational program in family medicine for general practitioners in Saudi Arabia from 2009 to 2011. A continuing medical education program called Family Medicine Education (FAME) was developed with 7 modules each consisting of 12-14 hours of teaching to be delivered in 3 day blocks, over 45 days. Twenty percent (2,761) of all general practitioners participated in the FAME program. Initial assessment of the program showed significant improvement of knowledge from scores of 49% on a pre-test to 89% on post-tests. FAME program in Saudi Arabia facilitated primary care physicians’ knowledge. PMID:24250833
Dunn-Lombard, Donisha; Harden-Barrios, Jewel; Lefante, John J.
Abstract Little is known about how to integrate primary care with mental/behavioral services outside of clinical trials. The authors implemented a collaborative care model (CCM) for depression in a safety net patient-centered medical home. The model focused on universal screening for symptoms, risk stratification based on symptom severity, care management for intensive follow-up, and psychiatry consultation. CCM increased rates of primary care physician encounters, timely follow-up for monitoring symptoms of depression, and documentation of treatment response. Contextual factors that facilitated or hindered practice redesign included clinic leadership, quality improvement culture, staffing, technology infrastructure, and external incentives/disincentives for organizational change. (Population Health Management 2016;19:46–55) PMID:26087153
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Global Quality Systems--An Integrated Approach To Improving... ``Global Quality Systems--An Integrated Approach to Improving Medical Product Safety.'' This 2-day...
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Perry, Lora; Malkin, Robert
It is often said that most of the medical equipment in the developing world is broken with estimates ranging up to 96% out of service. But there is little documented evidence to support these statements. We wanted to quantify the amount of medical equipment that was out of service in resource poor health settings and identify possible causes. Inventory reports were analyzed from 1986 to 2010, from hospitals in sixteen countries across four continents. The UN Human Development Index was used to determine which countries should be considered developing nations. Non-medical hospital equipment was excluded. This study examined 112,040 pieces of equipment. An average of 38.3% (42,925, range across countries: 0.83-47%) in developing countries was out of service. The three main causes were lack of training, health technology management, and infrastructure. We hope that the findings will help biomedical engineers with their efforts toward effective designs for the developing world and NGO's with efforts to design effective healthcare interventions.
Kim, H C; Pandolfino, J E; Komanduri, S; Hirano, I; Cohen, E R; Wayne, D B
Advanced esophageal endoscopic procedures such as stricture dilation, hemostasis tools, and stent placement as well as high-resolution manometry (HRM) interpretation are necessary skills for gastroenterology fellows to obtain during their training. Becoming proficient in these skills may be challenging in light of higher complication rates compared with diagnostic procedures and infrequent opportunities to practice these skills. Our aim was to determine if intensive training during a continuing medical education (CME) course boosts the knowledge and skills of gastroenterology fellows in esophageal diagnostic test interpretation and performance of therapeutic procedures. This was a pretest-posttest design without a control group of a simulation-based, educational intervention in esophageal stricture balloon dilation and HRM interpretation. The participants were 24 gastroenterology fellows from 21 accredited US training programs. This was an intensive CME course held in Las Vegas, Nevada from August 7 to August 9, 2009. The research procedure had two phases. First, the subjects were measured at baseline (pretest) for their knowledge and procedural skill. Second, the fellows received 6 hours of education sessions featuring didactic content, instruction in HRM indications and interpretation, and deliberate practice using an esophageal stricture dilation model. After the intervention, all of the fellows were retested (posttest). A 17-item checklist was developed for the esophageal balloon dilation procedure using relevant sources, expert opinion, and rigorous step-by-step procedures. Nineteen representative HRM swallow studies were obtained from Northwestern's motility lab and formed the pretest and posttest in HRM interpretation. Mean scores on the dilation checklist improved 81% from 39.4% (standard deviation [SD]= 33.4%) at pretest to 71.3% (SD = 29.5%) after simulation training (P < 0.001). HRM mean examination scores increased from 27.2% (SD = 16.4%) to 46.5% (SD
Chun, Kyung Hee; Lee, Young Hwan
Purpose: Academic debate is an effective method to enhance the competences of critical thinking, problem solving, communication skills and cooperation skills. The present study examined the improvement of debate competence which is an outcome of debate-based flipped learning. Methods: A questionnaire was administrated to second-year premedical school students at Yeungnam University. In total 45 students participated in the survey. The survey questionnaire was composed of 60 items of eight subfactors on debate competence. To investigate the homogeneous of low and high achievement groups, 18 items on empathy and 75 items on critical thinking scales were used. To compare the pretest with posttest scores, data was analyzed using paired sample t-test. Results: There were no significant differences between low and high achievement groups by average grade at the beginning of the semester. There was a significant improvement in high achievers on the logical argumentation (p<0.001), proficiency in inquiry (p<0.01), active participation (p<0.001), ability to investigate and analyze (p<0.001), observance of debate rules (p<0.05), and acceptability (p<0.05). Even in low achievers, active participation (p<0.05) and ability to investigate and analyze (p<0.01) were significantly improved. Conclusion: Results showed that students could improve their debate competence by the debate-based flipped learning. A prospective and comparative study on the communication and teamwork competences needs to be conducted in the future. It is suggested that in-depth discussion for the curriculum design and teaching will be needed in terms of the effectiveness and the outcomes of the medical humanities. PMID:26838572
Simon, Steven R; Rodriguez, Hector P; Majumdar, Sumit R; Kleinman, Ken; Warner, Cheryl; Salem-Schatz, Susanne; Miroshnik, Irina; Soumerai, Stephen B; Prosser, Lisa A
The authors estimated the costs and cost savings of implementing a program of mailed practice guidelines and single-visit individual and group academic detailing interventions in a randomized controlled trial to improve the use of antihypertensive medications. Analyses took the perspective of the payer. The total costs of the mailed guideline, group detailing, and individual detailing interventions were estimated at 1000 dollars, 5500 dollars, and 7200 dollars, respectively, corresponding to changes in the average daily per person drug costs of -0.0558 dollars (95% confidence interval, -0.1365 dollars to 0.0250 dollars) in the individual detailing intervention and -0.0001 dollars (95% confidence interval, -0.0803 dollars to 0.0801 dollars) in the group detailing intervention, compared with the mailed intervention. For all patients with incident hypertension in the individual detailing arm, the annual total drug cost savings were estimated at 21,711 dollars (95% confidence interval, 53,131 dollars savings to 9709 dollars cost increase). Information on costs of academic detailing could assist with health plan decision making in developing interventions to improve prescribing.
Zhu, Min; Xia, Jing; Yan, Molei; Cai, Guolong; Yan, Jing; Ning, Gangmin
With the development of medical technology, more and more parameters are produced to describe the human physiological condition, forming high-dimensional clinical datasets. In clinical analysis, data are commonly utilized to establish mathematical models and carry out classification. High-dimensional clinical data will increase the complexity of classification, which is often utilized in the models, and thus reduce efficiency. The Niche Genetic Algorithm (NGA) is an excellent algorithm for dimensionality reduction. However, in the conventional NGA, the niche distance parameter is set in advance, which prevents it from adjusting to the environment. In this paper, an Improved Niche Genetic Algorithm (INGA) is introduced. It employs a self-adaptive niche-culling operation in the construction of the niche environment to improve the population diversity and prevent local optimal solutions. The INGA was verified in a stratification model for sepsis patients. The results show that, by applying INGA, the feature dimensionality of datasets was reduced from 77 to 10 and that the model achieved an accuracy of 92% in predicting 28-day death in sepsis patients, which is significantly higher than other methods.
Zhu, Min; Xia, Jing; Yan, Molei; Cai, Guolong; Yan, Jing; Ning, Gangmin
With the development of medical technology, more and more parameters are produced to describe the human physiological condition, forming high-dimensional clinical datasets. In clinical analysis, data are commonly utilized to establish mathematical models and carry out classification. High-dimensional clinical data will increase the complexity of classification, which is often utilized in the models, and thus reduce efficiency. The Niche Genetic Algorithm (NGA) is an excellent algorithm for dimensionality reduction. However, in the conventional NGA, the niche distance parameter is set in advance, which prevents it from adjusting to the environment. In this paper, an Improved Niche Genetic Algorithm (INGA) is introduced. It employs a self-adaptive niche-culling operation in the construction of the niche environment to improve the population diversity and prevent local optimal solutions. The INGA was verified in a stratification model for sepsis patients. The results show that, by applying INGA, the feature dimensionality of datasets was reduced from 77 to 10 and that the model achieved an accuracy of 92% in predicting 28-day death in sepsis patients, which is significantly higher than other methods. PMID:26649071
Vagena, E.; Stoulos, S.; Manolopoulou, M.
An improved neutron activation technique is analyzed that can be used for the characterization of the neutron field in low neutron flux environments, such as medical Linacs. Due to the much lower neutron fluence rates, thick materials instead of thin have been used. The study is focused on the calculations of basic components of the neutron activation analysis that are required for accurate results, such as the efficiency of the gamma detector used for γ-spectrometry as well as crucial correction factors that are required when dealing with thick samples in different geometries and forms. A Monte Carlo detector model, implemented by Geant4 MC Code was adjusted in accordance to results from various measurements performed. Moreover, regarding to estimate the self-shielding correction factors a new approach using both Monte Carlo and analytical approach was presented. This improvement gives more accurate results, which are important for both activation and shielding studies that take place in many facilities. A quite good agreement between the neutron fluxes is achieved; according to the data obtained a mean value of (2.13±0.34)×105 ncm-2 s-1 is representative for the isocenter of the specific Linac that corresponds to fluence of (5.53±0.94)×106 ncm-2 Gy-1. Comparable fluencies reported in the literature for similar Linacs operating with photon beams at 15 MeV.
Gan, Hong-Seng; Swee, Tan Tian; Abdul Karim, Ahmad Helmy; Sayuti, Khairil Amir; Abdul Kadir, Mohammed Rafiq; Tham, Weng-Kit; Wong, Liang-Xuan; Chaudhary, Kashif T; Ali, Jalil; Yupapin, Preecha P
Well-defined image can assist user to identify region of interest during segmentation. However, complex medical image is usually characterized by poor tissue contrast and low background luminance. The contrast improvement can lift image visual quality, but the fundamental contrast enhancement methods often overlook the sudden jump problem. In this work, the proposed bihistogram Bezier curve contrast enhancement introduces the concept of "adequate contrast enhancement" to overcome sudden jump problem in knee magnetic resonance image. Since every image produces its own intensity distribution, the adequate contrast enhancement checks on the image's maximum intensity distortion and uses intensity discrepancy reduction to generate Bezier transform curve. The proposed method improves tissue contrast and preserves pertinent knee features without compromising natural image appearance. Besides, statistical results from Fisher's Least Significant Difference test and the Duncan test have consistently indicated that the proposed method outperforms fundamental contrast enhancement methods to exalt image visual quality. As the study is limited to relatively small image database, future works will include a larger dataset with osteoarthritic images to assess the clinical effectiveness of the proposed method to facilitate the image inspection.
Kehe, Kai; Balszuweit, Frank; Emmler, Judith; Kreppel, Helmut; Jochum, Marianne; Thiermann, Horst
Objective: Sulfur mustard (SM) is a bifunctional alkylating substance being used as chemical warfare agent (vesicant). It is still regarded as a significant threat in chemical warfare and terrorism. Exposure to SM produces cutaneous blisters, respiratory and gastrointestinal tract injury, eye lesions, and bone marrow depression. Victims of World War I as well as those of the Iran-Iraq war have suffered from devastating chronic health impairment. Even decades after exposure, severe long-term effects like chronic obstructive lung disease, lung fibrosis, recurrent corneal ulcer disease, chronic conjunctivitis, abnormal pigmentation of the skin, and different forms of cancer have been diagnosed. Methods: This review briefly summarizes the scientific literature and own results concerning detection, organ toxicity of SM, its proposed toxicodynamic actions, and strategies for the development of improved medical therapy. Results: Despite extensive research efforts during the last century, efficient antidotes against SM have not yet been generated because its mechanism of action is not fully understood. However, deeper insights into these mechanisms gained in the last decade and promising developments of new drugs now offer new chances to minimize SM-induced organ damage and late effects. Conclusion: Polymerase inhibitors, anti-inflammatory drugs, antioxidants, matrix metalloproteinase inhibitors, and probably regulators of DNA damage repair are identified as promising approaches to improve treatment. PMID:18615149
Obstructive sleep apnoea is characterized by repeated periods of breathing cessation during sleep. Obstructive sleep apnoea is both common and underdiagnosed in the obese. A recent study found that as many as 86% of older obese type 2 diabetics had obstructive sleep apnoea. Obesity is independently associated with developing obstructive sleep apnoea, and the reverse may also occur. The prevalence of obstructive sleep apnoea is therefore expected to rise in the wake of the obesity epidemic. The number of partial (hypopnoea) or complete (apnoea) airway obstructions per hour (apnoea-hypopnoea index) is used to classify obstructive sleep apnoea as mild (5-14 events per hour), moderate (15-30) or severe (>30). Severe obstructive sleep apnoea is associated with a two to sixfold increase in all-cause mortality; the impact of mild and moderate obstructive sleep apnoea is less clear. Until recently, the evidence supporting a beneficial effect of weight loss on obstructive sleep apnoea has been limited by a lack of randomized trials. In 2009, at least three randomized controlled trials evaluated whether medically induced weight loss improves obstructive sleep apnoea. The treatment effect ranged from 42% to 62% improvement, although the highest estimate was seen in a very short duration study (9 weeks). Patients who either lost 10-15 kg or more, or had severe obstructive sleep apnoea at baseline, benefited most from treatment.
Navas, H; Graffi Moltrasio, L; Ares, F; Strumia, G; Dourado, E; Alvarez, M
Within preventable medical errors, those related to medications are frequent in every stage of the prescribing cycle. Nursing is responsible for maintaining each patients safety and care quality. Moreover, nurses are the last people who can detect an error in medication before its administration. Medication administration is one of the riskiest tasks in nursing. The use of information and communication technologies is related to a decrease in these errors. Including mobile devices related to 2D code reading of patients and medication will decrease the possibility of error when preparing and administering medication by nurses. A cross-platform software (iOS and Android) was developed to ensure the five Rights of the medication administration process (patient, medication, dose, route and schedule). Deployment in November showed 39% use.
Liu, Xiang; Ge, Bin; Liu, Jinchu
In this paper, we interpret the new YY/T 0841-2011 standard and contrast the difference between it and GB9706.1-2007 standard. Then, we improved the current preventive maintenance work. After the improvement, we not only have more effective detection of the electrical safety performance of all kinds of medical electrical equipment, but also reduce the workload of clinical engineers, improve efficiency, and reduce the risk of electrical shock.
Fetterman, David M; Deitz, Jennifer; Gesundheit, Neil
Medical schools continually evolve their curricula to keep students abreast of advances in basic, translational, and clinical sciences. To provide feedback to educators, critical evaluation of the effectiveness of these curricular changes is necessary. This article describes a method of curriculum evaluation, called "empowerment evaluation," that is new to medical education. It mirrors the increasingly collaborative culture of medical education and offers tools to enhance the faculty's teaching experience and students' learning environments. Empowerment evaluation provides a method for gathering, analyzing, and sharing data about a program and its outcomes and encourages faculty, students, and support personnel to actively participate in system changes. It assumes that the more closely stakeholders are involved in reflecting on evaluation findings, the more likely they are to take ownership of the results and to guide curricular decision making and reform. The steps of empowerment evaluation include collecting evaluation data, designating a "critical friend" to communicate areas of potential improvement, establishing a culture of evidence, encouraging a cycle of reflection and action, cultivating a community of learners, and developing reflective educational practitioners. This article illustrates how stakeholders used the principles of empowerment evaluation to facilitate yearly cycles of improvement at the Stanford University School of Medicine, which implemented a major curriculum reform in 2003-2004. The use of empowerment evaluation concepts and tools fostered greater institutional self-reflection, led to an evidence-based model of decision making, and expanded opportunities for students, faculty, and support staff to work collaboratively to improve and refine the medical school's curriculum.
Oberlin, Shelley R; Parente, Stephen T; Pruett, Timothy L
The immune system is a powerful barrier to successful organ transplantation, but one that has been routinely thwarted through modern pharmacotherapeutics. Despite the benefits of immunosuppressive therapy, medication non-adherence leads to an increased risk of graft rejection, higher hospital utilization and costs, and poor outcomes. We conduct a scoping review following Arksey and O’Malley’s five-stage framework methodology to identify established or novel interventions that could be applied to kidney transplant recipients to improve medication adherence. As the desired outcome is a behavior (taking a pill), we assess three areas: behavioral-focused interventions in other industries, patient engagement theories, and behavioral economic principles. Search strategies included mining business, social sciences, and medical literature with additional guidance from six consultative interviews. Our review suggests that no intervention stands out as superior or likely to be more effective than any other intervention; yet promising strategies and interventions were identified across all three areas examined. Based on our findings, we believe there are five strategies that transplant centers and other organizations can implement to improve medication adherence: (1) Build a foundation of trust; (2) Employ multiple interventions; (3) Stratify the population; (4) Develop collaborative partnerships; and (5) Embed medication adherence into the organization’s culture. The effectiveness of these interventions will need to be investigated further, but we believe they are a step in the right direction for organizations to consider in their efforts to improve medication adherence. PMID:26835016
Ershad Sarabi, Roghayeh; Sadoughi, Farahnaz; Jamshidi Orak, Roohangiz; Bahaadinbeigy, Kambiz
Context Medication non-adherence is a commonly observed problem in the self-administration of treatment, regardless of the disease type. Text messaging reminders, as electronic reminders, provide an opportunity to improve medication adherence. In this study, we aimed to provide evidence addressing the question of whether text message reminders were effective in improving patients’ adherence to medication. Evidence Acquisition We carried out a systematic literature search, using the five electronic bibliographic databases: PubMed, Embase, PsycINFO, CINAHL, and the Cochrane central register of controlled trials. Studies were included on the basis of whether they examined the benefits and effects of short-message service (SMS) interventions on medication adherence. Results The results of this systematic review indicated that text messaging interventions have improved patients’ medication adherence rate (85%, 29.34). Included in the review, those who had problems with adherence, or those whom text messaging was most helpful had HIV, asthma, diabetes, schizophrenia and heart disease (73.5%). The period of intervention varied from 1 week to 14 months. The most common study design was randomized controlled trials (RCTs) (66%) carried out in the developed countries. Conclusions This study demonstrated the potential of mobile phone text messaging for medication non-adherence problem solving. PMID:27437126
Fox, Geraldine S.; Stock, Saundra; Briscoe, Gregory W.; Beck, Gary L.; Horton, Rita; Hunt, Jeffrey I.; Liu, Howard Y.; Rutter, Ashley Partner; Sexson, Sandra; Schlozman, Steven C.; Stubbe, Dorothy E.; Stuber, Margaret L.
Objective: A new Child and Adolescent Psychiatry in Medical Education (CAPME) Task Force, sponsored by the Association for Directors of Medical Student Education in Psychiatry (ADMSEP), has created an inter-organizational partnership between child and adolescent psychiatry (CAP) educators and medical student educators in psychiatry. This paper…
Díez-Goñi, N; Rodríguez-Díez, M C
Empathy is a basic skill in the exercise of medicine and increases patient and physician satisfaction and improves clinical results. However, the teaching of empathy is poorly covered in the teaching plans. A number of studies have observed a reduction in empathy during the final training courses. The reasons for this decline include, the students' excessive academic workload, the prioritisation of acquiring medical expertise over humanistic knowledge, the patient load in hospitals and health centres and the physicians' need to distance themselves from their patients. Nevertheless, intervention studies through simulation with standardised patients have shown an increase in empathy in students, which can be evaluated through the Jefferson scales: JSE-S and JSPPPE. The teaching of empathy to medical students is an important commitment in the curricular programs of medical schools.
Kelly, Narcie A A; Brandom, Kevin G; Mattick, Karen L
Objective New medical graduates are the front-line staff in many hospital settings and manage patients with diabetes frequently. Prescribing is an area of concern for junior doctors, however, with insulin prescribing reported as a particular weakness. This study aimed to produce an educational intervention which aimed to improve preparedness to manage patients with diabetes and evaluate it using a mixed methods approach. Research design and methods An e-resource (http://www.diabetesscenariosforjuniordoctors.co.uk) was created to contain commonplace and authentic diabetes decision-making scenarios. –32 junior doctors (n=20) and year 5 students (n=12) in South West England worked through the scenarios while ‘thinking aloud’ and then undertook a semistructured interview. Qualitative data were transcribed verbatim and analyzed thematically. Participant confidence to manage patients with diabetes before, immediately after, and 6 weeks after the educational intervention was also measured using a self-rating scale. Results Participants reported that patients with diabetes were daunting to manage because of the wide array of insulin products, their lack of confidence with chronic disease management and the difficulty of applying theory to practice. The e-resource was described as authentic, practical, and appropriate for the target audience. Junior doctors’ self-rated confidence to manage patients with diabetes increased from 4.7 (of 10) before using the e-resource, to 6.4 immediately afterwards, and 6.8 6 weeks later. Medical students’ confidence increased from 5.1 before, to 6.4 immediately afterwards, and 6.4 6 weeks later. Conclusions Providing opportunities to work with authentic scenarios in a safe environment can help to ameliorate junior doctors’ lack of confidence to manage patients with diabetes. PMID:26435838
Cheng, Xin; Ka Ho Lee, Kenneth; Chang, Eric Y; Yang, Xuesong
Traditional medical education methodologies have been dramatically impacted by the introduction of new teaching approaches over the past few decades. In particular, the "flipped classroom" format has drawn a great deal of attention. However, evidence regarding the effectiveness of the flipped model remains limited due to a lack of outcome-based studies. In the present study, a pilot histology curriculum of the organ systems was implemented among 24 Traditional Chinese Medicine (TCM) students in a flipped classroom format at Jinan University. As a control, another 87 TCM students followed a conventional histology curriculum. The academic performance of the two groups was compared. In addition, a questionnaire was administered to the flipped classroom group. The test scores for the flipped classroom participants were found to be significantly higher compared to non-participants in the control group. These results suggest that students may benefit from using the flipped classroom format. Follow-up questionnaires also revealed that most of the flipped classroom participants undertook relatively more earnest preparations before class and were actively involved in classroom learning activities. The teachers were also found to have more class time for leading discussions and delivering quizzes rather than repeating rote didactics. Consequently, the increased teaching and learning activities contributed to a better performance among the flipped classroom group. This pilot study suggests that a flipped classroom approach can be used to improve histology education among medical students. However, future studies employing randomization, larger numbers of students, and more precise tracking methods are needed before definitive conclusions can be drawn. Anat Sci Educ. © 2016 American Association of Anatomists.
Korniushko, I G; Shelepov, A M; Zhidik, V V; Berezin, A I
Frequent changes in tactical, rear and medical situations cause the medical service officials of airborne division (ABD) to obtain and transmit the data characterizing the medical service forces and means for a lot of times. It decreases the effectiveness of the control process. Equipping of ABD medical service staff with programming-and-technical systems (PTS), development of algorithm of official interaction, creation of report forms and selection of materials necessary for PTS database input will contribute to the effectiveness of ABD medical service control.
Beigy, Maani; Pishgahi, Ghasem; Moghaddas, Fateme; Maghbouli, Nastaran; Shirbache, Kamran; Asghari, Fariba; Abolfat-H Zadeh, Navid
It has long been a common goal for both medical educators and ethicists to develop effective methods or programs for medical ethics education. The current lecture-based courses of medical ethics programs in medical schools are demonstrated as insufficient models for training "good doctors''. In this study, we introduce an innovative program for medical ethics education in an extra-curricular student-based design named Students' Medical Ethics Rounds (SMER). In SMER, a combination of educational methods, including theater-based case presentation, large group discussion, expert opinions, role playing and role modeling were employed. The pretest-posttest experimental design was used to assess the impact of interventions on the participants' knowledge and attitude regarding selected ethical topics. A total of 335 students participated in this study and 86.57% of them filled the pretest and posttest forms. We observed significant improvements in the knowledge (P < 0.0500) and attitude (P < 0.0001) of participants. Interestingly, 89.8% of participants declared that their confidence regarding how to deal with the ethical problems outlined in the sessions was increased. All of the applied educational methods were reported as helpful. We found that SMER might be an effective method of teaching medical ethics. We highly recommend the investigation of the advantages of SMER in larger studies and interdisciplinary settings.
Beigy, Maani; Pishgahi, Ghasem; Moghaddas, Fateme; Maghbouli, Nastaran; Shirbache, Kamran; Asghari, Fariba; Abolfat-h Zadeh, Navid
It has long been a common goal for both medical educators and ethicists to develop effective methods or programs for medical ethics education. The current lecture-based courses of medical ethics programs in medical schools are demonstrated as insufficient models for training “good doctors’’. In this study, we introduce an innovative program for medical ethics education in an extra-curricular student-based design named Students’ Medical Ethics Rounds (SMER). In SMER, a combination of educational methods, including theater-based case presentation, large group discussion, expert opinions, role playing and role modeling were employed. The pretest-posttest experimental design was used to assess the impact of interventions on the participants’ knowledge and attitude regarding selected ethical topics. A total of 335 students participated in this study and 86.57% of them filled the pretest and posttest forms. We observed significant improvements in the knowledge (P < 0.0500) and attitude (P < 0.0001) of participants. Interestingly, 89.8% of participants declared that their confidence regarding how to deal with the ethical problems outlined in the sessions was increased. All of the applied educational methods were reported as helpful. We found that SMER might be an effective method of teaching medical ethics. We highly recommend the investigation of the advantages of SMER in larger studies and interdisciplinary settings. PMID:27471586
Granger, Bradi B.; Rusincovitch, Shelley A.; Avery, Suzanne; Batch, Bryan C.; Dunham, Ashley A.; Feinglos, Mark N.; Kelly, Katherine; Pierre-Louis, Marjorie; Spratt, Susan E.; Califf, Robert M.
Purpose: Poor adherence to prescribed medicines is associated with increased rates of poor outcomes, including hospitalization, serious adverse events, and death, and is also associated with increased healthcare costs. However, current approaches to evaluation of medication adherence using real-world electronic health records (EHRs) or claims data may miss critical opportunities for data capture and fall short in modeling and representing the full complexity of the healthcare environment. We sought to explore a framework for understanding and improving data capture for medication adherence in a population-based intervention in four U.S. counties. Approach: We posited that application of a data model and a process matrix when designing data collection for medication adherence would improve identification of variables and data accessibility, and could support future research on medication-taking behaviors. We then constructed a use case in which data related to medication adherence would be leveraged to support improved healthcare quality, clinical outcomes, and efficiency of healthcare delivery in a population-based intervention for persons with diabetes. Because EHRs in use at participating sites were deemed incapable of supplying the needed data, we applied a taxonomic approach to identify and define variables of interest. We then applied a process matrix methodology, in which we identified key research goals and chose optimal data domains and their respective data elements, to instantiate the resulting data model. Conclusions: Combining a taxonomic approach with a process matrix methodology may afford significant benefits when designing data collection for clinical and population-based research in the arena of medication adherence. Such an approach can effectively depict complex real-world concepts and domains by “mapping” the relationships between disparate contributors to medication adherence and describing their relative contributions to the shared goals
Ferren, Ann S.; Slavings, Rick
This monograph describes a variety of approaches to understanding how cost and quality are related and offers analytical tools. The analyses focus on the direct cost of instruction for a course, a course of study, or an academic program and do not include related support services such as the library or academic computing. Following an introductory…
Jelinek, James John, Ed.
The handbook examines issues facing the increasingly interdependent world and suggests areas of knowledge which educators must consider as they develop and implement curriculum to help students deal effectively with the future. The document contains eight articles. The first article identifies problems facing society as rapid change, economic…
Khan, Fazeel; Singh, Kumar
Engineers often need to predict how a part, mechanism or machine will perform in service, and this insight is typically achieved thorough computer simulations. Therefore, instruction in the creation and application of simulation models is essential for aspiring engineers. The purpose of this project was to develop a unified approach to teaching…
Marcum, Zachary A.; Murray, Michael D.
Background Poor medication adherence is a major public health problem in older adults often resulting in negative health outcomes. Objective The objective of this review was to provide an updated summary of evidence from randomized controlled studies to determine whether interventions aimed at improving medication adherence also improve the health outcomes of older adults residing in community-based settings. Methods Articles that assessed medication adherence interventions and related health outcomes in elderly individuals were identified through searches of MEDLINE (1970–June 2016), the Cochrane Database of Systematic Reviews (through to June 2016), and Google Scholar. Across the 12 included studies, interventions were grouped into three main categories: behavioral/educational (n = 3), pharmacist-led (n = 7), and reminder/simplification (n = 2). Results Among the behavioral/educational intervention studies, two showed improvements in both adherence and related health outcomes, whereas one found no changes in adherence or health outcomes. Among the pharmacist-led studies, three showed improvements in both adherence and related health outcomes, while three reported no changes in adherence or health outcomes. One found an improvement in adherence but not health outcomes. Among the reminder/simplification studies, both studies reported improvements in adherence without a significant impact on related health outcomes. Conclusion This evidence-based review of medication adherence interventions in older adults revealed promising strategies in the larger context of a largely mixed body of literature. Future patient-centered and multidisciplinary interventions should be developed and tested using evidence-based principles to improve medication adherence and health outcomes in older adults. PMID:28074410
Oda, Yasutomo; Onishi, Hirotaka; Sakemi, Takanobu; Fujimoto, Kazuma; Koizumi, Shunzo
Fifteen years of undergraduate medical education curriculum reform at Saga Medical School was evaluated by measuring medical students' communication and interpersonal skills with a patient satisfaction questionnaire developed by the American Board of Internal Medicine. A multiphase cross-sectional study was conducted at the General Medicine Clinic of Saga Medical School Hospital in phase I (1998-1999), phase II (2001-2002), and phase III (2009-2010). A total of 1,963 patient ratings for 437 medical students' performance was analyzed. The average scores of phases II and III were significantly higher than for phase I. The average score of female students showed a significant difference between phases I and II, but no difference between phases II and III. The average score of male students showed no difference between phases I and II, but significant difference between phases II and III. The phase II curriculum introduced basic clinical skills and examination and improved female students' performance. The phase III curriculum was effective for male students because it emphasized the clinical skill program more and introduced problem-based learning. Curriculum reform at Saga Medical School is considered to have made good progress in improving students' clinical competence and patient-centered attitudes.
Ownby, Raymond L; Hertzog, Christopher; Czaja, Sara J
Medication adherence is recognized as an issue of critical importance within health care, as many patients do not take their medications as prescribed. This study evaluated two interventions targeted at improving adherence in elderly patients being treated for memory impairments. Twenty-seven participants were randomly assigned to control (n = 11), automated reminding (n = 8), or tailored information conditions (n = 8). Medication adherence was evaluated with an electronic pill bottle. Generalized estimating equation (GEE) models assessed the effects of the interventions on electronically monitored medication adherence after controlling for covariates. Results showed that individuals in both intervention groups had higher levels of medication adherence than those in the control group. The presence of a caregiver was associated with substantially higher levels of adherence. Verbal memory, but not general cognitive status, predicted better adherence. Mood, health literacy, and executive functions were not associated with adherence. Results thus suggest that both automated reminding and tailored information interventions may improve medication adherence in elders, even among those with memory impairments.
Dimitrovski, Ivica; Kocev, Dragi; Kitanovski, Ivan; Loskovska, Suzana; Džeroski, Sašo
In this paper, we present the approach that we applied to the medical modality classification tasks at the ImageCLEF evaluation forum. More specifically, we used the modality classification databases from the ImageCLEF competitions in 2011, 2012 and 2013, described by four visual and one textual types of features, and combinations thereof. We used local binary patterns, color and edge directivity descriptors, fuzzy color and texture histogram and scale-invariant feature transform (and its variant opponentSIFT) as visual features and the standard bag-of-words textual representation coupled with TF-IDF weighting. The results from the extensive experimental evaluation identify the SIFT and opponentSIFT features as the best performing features for modality classification. Next, the low-level fusion of the visual features improves the predictive performance of the classifiers. This is because the different features are able to capture different aspects of an image, their combination offering a more complete representation of the visual content in an image. Moreover, adding textual features further increases the predictive performance. Finally, the results obtained with our approach are the best results reported on these databases so far.
Montgomery, James B; Linville, Beth A; Slonim, Anthony D
Because the economic crisis in the United States continues to have an impact on healthcare organizations, industry leaders must optimize their decision making. Discrete-event computer simulation is a quality tool with a demonstrated track record of improving the precision of analysis for process redesign. However, the use of simulation to consolidate practices and design efficiencies into an unfinished medical office building was a unique task. A discrete-event computer simulation package was used to model the operations and forecast future results for four orthopedic surgery practices. The scenarios were created to allow an evaluation of the impact of process change on the output variables of exam room utilization, patient queue size, and staff utilization. The model helped with decisions regarding space allocation and efficient exam room use by demonstrating the impact of process changes in patient queues at check-in/out, x-ray, and cast room locations when compared to the status quo model. The analysis impacted decisions on facility layout, patient flow, and staff functions in this newly consolidated practice. Simulation was found to be a useful tool for process redesign and decision making even prior to building occupancy.
Muir, Kelly W.; Ventura, Alice; Stinnett, Sandra S.; Enfiedjian, Abraham; Allingham, R. Rand; Lee, Paul P.
Objective To test an educational intervention targeted to health literacy level with the goal of improving glaucoma medication adherence. Methods One hundred and twenty-seven veterans with glaucoma were randomized to glaucoma education or standard care. The intervention included a video scripted at a 4th, 7th, or 10th grade level, depending on the subject’s literacy level. After six months, the number of days without glaucoma medicine (DWM) according to pharmacy records for the intervention and control groups was compared. Results The number of DWM in the six months following enrollment was similar for control and intervention groups (intervention, n = 67, DWM = 63 ± 198; standard care, n = 60, DWM = 65 ± 198; p = 0.708). For each subgroup of literacy (adequate, marginal, inadequate), subjects in the intervention group experienced less mean DWM than subjects in the control group and the effect size (ES) increased as literacy decreased: adequate literacy, ES 0.069; marginal, ES 0.183, inadequate, ES 0.363. Decreasing health literacy skills were associated with decreasing self-reported satisfaction with care (slope = 0.017, SE = 0.005, p = 0.002). Conclusions Patients with decreased health literacy skills may benefit from educational efforts tailored to address their health literacy level and learning style. Practice implications Providers should consider health literacy skills when engaging in glaucoma education. PMID:22000272
Ohashi, Kumiko; Dykes, Patricia; Mcintosh, Kathleen; Buckley, Elizabeth; Yoon, Catherine; Luppi, Carol; Bane, Anne; Bates, David W
Patient controlled analgesia (PCA) and Patient-controlled epidural analgesia (PCEA) pumps are methods of pain control with complex smart infusion devices and are widely used in hospitals. Smart PCA/PCEA pumps can be programmed with the dose and rate of medications within pre-set ranges. However, adverse effects have been reported associated with these pumps' use. In this paper, we describe a prevalence observational study where observers used an electronic data collection tool to record pump settings and medications with PCA pumps, corresponding medication orders to identify errors. The results showed that there were many labeling and tubing change tag errors, which were a violation of hospital policy. A few potential harmful medication errors were identified but no critical errors. Study results suggest the importance of a standard process of PCA pump use. Next steps include implementing a safety bundle for improving PCA practice to support safe and effective pain management.
Chiou, Shin-Yan; Ying, Zhaoqin; Liu, Junqiang
Medical systems allow patients to receive care at different hospitals. However, this entails considerable inconvenience through the need to transport patients and their medical records between hospitals. The development of Telecare Medicine Information Systems (TMIS) makes it easier for patients to seek medical treatment and to store and access medical records. However, medical data stored in TMIS is not encrypted, leaving patients' private data vulnerable to external leaks. In 2014, scholars proposed a new cloud-based medical information model and authentication scheme which would not only allow patients to remotely access medical services but also protects patient privacy. However, this scheme still fails to provide patient anonymity and message authentication. Furthermore, this scheme only stores patient medical data, without allowing patients to directly access medical advice. Therefore, we propose a new authentication scheme, which provides anonymity, unlinkability, and message authentication, and allows patients to directly and remotely consult with doctors. In addition, our proposed scheme is more efficient in terms of computation cost. The proposed system was implemented in Android system to demonstrate its workability.
Dall'Oglio, Immacolata; Fiori, Martina; Di Ciommo, Vincenzo; Tiozzo, Emanuela; Mascolo, Rachele; Bianchi, Natalia; Ciofi Degli Atti, Marta Luisa; Ferracci, Antonella; Gawronski, Orsola; Pomponi, Manuel; Raponi, Massimiliano
Objective To assess the effectiveness of an improvement programme to reduce the number of interruptions during the medication administration process in a paediatric hospital. Design and methods A prestudy–post study design was used to monitor nursing interruptions during medication cycles in a paediatric hospital. Interruptions were reported on an observation sheet (MADOS-P) adapted to the paediatric context. Setting A 600-bed tertiary paediatric research hospital in Italy. Intervention The interventions included a yellow sash worn by nurses during medication cycles, a yellow-taped floor area indicating the ‘No interruption area’, visual notices in the medication areas, education sessions for healthcare providers and families, patient and parent information material. Results 225 medication cycles were observed before the intervention (T0) and 261 after the intervention (T1). The median of interruptions occurring in each cycle decreased significantly from baseline to postintervention (8.0 vs 2.0, p=0.002), as the rate ratios (interruptions/patient post–pre ratio: 0.34; interruptions/medication post–pre ratio: 0.37; interruptions/hour of medication cycle post–pre ratio: 0.53, p<0.001). During preintervention, the main causes of interruptions were ‘other patients’ (19.9%), ‘other nurses’ (17.2%) and ‘conversation’ (15.7%); during postintervention, they were ‘other nurses’ (26.1%), ‘conversation’ (18.2%) and ‘other patients’ (17.4%). Conclusions This bundle of interventions proved to be an effective improvement programme to prevent interruptions during medication administration in a paediatric context. PMID:28062470
Perlini, Stefano; Salinaro, Francesco; Santalucia, Paola; Musca, Francesco
Clinical evaluation is the cornerstone of any cardiac diagnosis, although excessive over-specialisation often leads students to disregard the value of clinical skills, and to overemphasize the approach to instrumental cardiac diagnosis. Time restraints, low availability of "typical" cardiac patients on whom to perform effective bedside teaching, patients' respect and the underscoring of the value of clinical skills all lead to a progressive decay in teaching. Simulation-guided cardiac auscultation may improve clinical training in medical students and residents. Harvey(©) is a mannequin encompassing more than 50 cardiac diagnoses that was designed and developed at the University of Miami (Florida, USA). One of the advantages of Harvey(©) simulation resides in the possibility of listening, comparing and discussing "real" murmurs. To objectively assess its teaching performance, the capability to identify five different cardiac diagnoses (atrial septal defect, normal young subject, mitral stenosis with tricuspid regurgitation, chronic mitral regurgitation, and pericarditis) out of more than 50 diagnostic possibilities was assessed in 523 III-year medical students (i.e. at the very beginning of their clinical experience), in 92 VI-year students, and in 42 residents before and after a formal 10-h teaching session with Harvey(©). None of them had previously experienced simulation-based cardiac auscultation in addition to formal lecturing (all three groups) and bedside teaching (VI-year students and residents). In order to assess the "persistence" of the acquired knowledge over time, the test was repeated after 3 years in 85 students, who did not repeat the formal 10-h teaching session with Harvey(©) after the III year. As expected, the overall response was poor in the "beginners" who correctly identified 11.0 % of the administered cardiac murmurs. After simulation-guided training, the ability to recognise the correct cardiac diagnoses was much better (72.0 %; p < 0
Conn, Vicki S.; Hafdahl, Adam R.; Cooper, Pamela S.; Ruppar, Todd M.; Mehr, David R.; Russell, Cynthia L.
Purpose: This study investigated the effectiveness of interventions to improve medication adherence (MA) in older adults. Design and Methods: Meta-analysis was used to synthesize results of 33 published and unpublished randomized controlled trials. Random-effects models were used to estimate overall mean effect sizes (ESs) for MA, knowledge,…
Sattar, Kamran; Ahmad, Tauseef; Khalil, Mahmoud Salah; Soliman, Mona Mohamed; Punnamperuma, Gominda Giatry; Abdulghani, Hamza Mohammad
Progress test's distinguishing characteristics make it pertinent worldwide. We explored medical students' perceptions and opinions about Progress Test (PT) with a view to identifying areas concomitant with it's execution. This cross-sectional study took place at College of Medicine, Saudi Arabia, during the academic year 2015-16. A questionnaire (14 items) was administered. Reason for majority n=96 (89.7%) of the total participants to take the PT was their keenness to compare their academic standing with their peers from other participating medical colleges. The majority of students were highly satisfied with PT implementation; i.e. its orientation (58.9%) and allocated time (90.7%). Students (76.6%) considered PT to offer academic support as future physicians. Students (75.7%) also agreed to participate in the future PT. Students being highly satisfied with the organization of PT. They found it to be a tool helping them to focus on improving the knowledge domain.
Newton, Warren; Wouk, Noah; Spero, Julie C
The National Academy of Medicine has called for fundamental reform in the governance and accountability of graduate medical education, but how to implement this change is unclear. We describe the North Carolina graduate medical education system, and we propose tracking outcomes and aligning residency stipends with outcomes such as specialty choice, practice in North Carolina, and acceptance of new Medicaid and Medicare patients.
Karon, Bertram P.
That two-thirds of depressed adults are resistant to medication has led to the addition of psychotherapy to treatment, but is medication necessary? Results are at least as good with psychotherapy alone, and the relapse rate is less. Handling of suicidal danger, sleep disorders, and common depressing issues in college students are discussed along…
Zhong, Jianping; Ge, Yi
Based on the managerial deficiencies of Implantable medical device, using the RFID technology, the automatically comparison of data, Intelligent logistics, this article has established three conceptional methods of the original system of increment and iterative development. And details are included in aspect of principle, framework and etc. Meanwhile, advices have been given in the scientific and effective management of the medical instrument.
Jiang, Guanchao; Chen, Hong; Wang, Qiming; Chi, Baorong; He, Qingnan; Xiao, Haipeng; Zhou, Qinghuan; Liu, Jing; Wang, Shan
Background The National Clinical Skills Competition has been held in China for 5 consecutive years since 2010 to promote undergraduate education reform and improve the teaching quality. The effects of the simulation-based competition will be analyzed in this study. Methods Participation in the competitions and the compilation of the questions used in the competition finals are summarized, and the influence and guidance quality are further analyzed. Through the nationwide distribution of questionnaires in medical colleges, the effects of the simulation-based competition on promoting undergraduate medical education reform were evaluated. Results The results show that approximately 450 students from more than 110 colleges (accounting for 81% of colleges providing undergraduate clinical medical education in China) participated in the competition each year. The knowledge, skills, and attitudes were comprehensively evaluated by simulation-based assessment. Eight hundred and eighty copies of the questionnaires were distributed to 110 participating medical schools in 2015. In total, 752 valid responses were received across 95 schools. The majority of the interviewees agreed or strongly agreed that competition promoted the adoption of advanced educational principles (76.8%), updated the curriculum model and instructional methods (79.8%), strengthened faculty development (84.0%), improved educational resources (82.1%), and benefited all students (53.4%). Conclusions The National Clinical Skills Competition is widely accepted in China. It has effectively promoted the reform and development of undergraduate medical education in China.
Gupta, Sonal; MacLean, Diana L; Heer, Jeffrey; Manning, Christopher D
Objective To reliably extract two entity types, symptoms and conditions (SCs), and drugs and treatments (DTs), from patient-authored text (PAT) by learning lexico-syntactic patterns from data annotated with seed dictionaries. Background and significance Despite the increasing quantity of PAT (eg, online discussion threads), tools for identifying medical entities in PAT are limited. When applied to PAT, existing tools either fail to identify specific entity types or perform poorly. Identification of SC and DT terms in PAT would enable exploration of efficacy and side effects for not only pharmaceutical drugs, but also for home remedies and components of daily care. Materials and methods We use SC and DT term dictionaries compiled from online sources to label several discussion forums from MedHelp (http://www.medhelp.org). We then iteratively induce lexico-syntactic patterns corresponding strongly to each entity type to extract new SC and DT terms. Results Our system is able to extract symptom descriptions and treatments absent from our original dictionaries, such as ‘LADA’, ‘stabbing pain’, and ‘cinnamon pills’. Our system extracts DT terms with 58–70% F1 score and SC terms with 66–76% F1 score on two forums from MedHelp. We show improvements over MetaMap, OBA, a conditional random field-based classifier, and a previous pattern learning approach. Conclusions Our entity extractor based on lexico-syntactic patterns is a successful and preferable technique for identifying specific entity types in PAT. To the best of our knowledge, this is the first paper to extract SC and DT entities from PAT. We exhibit learning of informal terms often used in PAT but missing from typical dictionaries. PMID:24970840
Heinssen, Robert K
Introduction by the column editors: Numerous factors influence a patient's decision to accept or reject prescribed medications, including the patient's personal values, environmental conditions, and the quality of the patient-physician relationship (1). Guidelines for evaluating and managing noncompliance with medication regimens by patients with schizophrenia take this multidimensional perspective into account, emphasizing functional assessment of nonadherence behaviors and individualized behavior-change strategies to secure and maintain the patient's cooperation (2). Moreover, a collaborative approach to planning pharmacotherapy is required to ensure medication compliance, with a particular emphasis on linking the positive effects of medications with the patient's personal goals and desires for better functioning and quality of life (3). The following case study illustrates the application of principles for enhancing medication compliance in the treatment of a woman diagnosed as having schizophrenia, paranoid type. Strategies presented by Dr. Heinssen include collaborative treatment contracts, analysis of adherence behaviors, and techniques for boosting medication cues and reinforcers in the patient's home. The therapy described was provided in the Life Skills partial hospitalization and psychiatric rehabilitation program, a multidisciplinary, multilevel outpatient service of the now-closed Chestnut Lodge Hospital in Rockville, Maryland. The program integrated medical, social-learning, and cognitive-behavioral interventions for psychosis within a psychiatric rehabilitation framework.
Jordan, Mark; Caesar, Jenny
Hypokalaemia is prevalent in 20% of hospitalised patients. Furthermore, inadequate management of hypokalemia was identified in 24% of these patients. Associated with significant patient morbidity and mortality, the identification, investigation, and treatment of hypokalaemia was identified as an area for improvement in the management of medical inpatients. The project aims to measure the assessment, management, and therapeutic monitoring of medical inpatients with hypokalaemia in a district general hospital. All medical inpatients over a one week period who met the criteria for hypokalaemia (serum potassium <3.5 mmol/L on standard biochemical sample) were included in the audit. Patient's notes were located and evaluated to identify if they had mild, moderate, or severe hypokalaemia. Further data on ECG requests, repeat U&Es, serum magnesium analysis, treatment prescribed, and medication review dates was collated. A re-audit was completed after the introduction of a set of interventions which included a hypokalaemia treatment algorithm. Pre-intervention analysis of all medical inpatients, who met our inclusion criteria for hypokalaemia, identified 32 patients. 25 of these patients met the criteria for mild hypokalaemia (3.1-3.4 mmol/L) and 7 met the criteria for moderate hypokalaemia (2.5-3.0 mmol/L). Only 7/32 (22 %) patients were receiving adequate treatment based on trust guidelines. Post intervention results showed marked improvement in the management of patients with hypokalaemia. A total of 30 patients were identified in this post-intervention group. There were 16/30 patients who qualified as mild hypokalaemia (3.1-3.4 mmol/L) and 14/30 with moderate hypokalaemia (2.5-3.0 mmol/L). 19/30 (63%) patients in the post-intervention group were correctly prescribed appropriate medication doses consistent with the treatment algorithm. Following the initial success of the project, analysis at 3 months showed a positive trend for sustained improvement when compared to
private and public medical text can be used to accurately classify PHI. The data and algorithms reported here are made freely available for evaluation and improvement. PMID:24083569
Carrizales, Gwen; Clark, Kevin R
Patient safety is a focal point in healthcare because of recent changes issued by CMS. Hospital reimbursement rates have fallen, and these reimbursement rates are governed by CMS mandates regarding patient safety procedures. Reimbursement changes are reflected in the National Patient Safety Goals (NPSGs) administered annually by The Joint Commission. Medical imaging departments have multiple areas of patient safety concerns including effective handoff communication, proper patient identification, and safe medication/contrast administration. This literature review examines those areas of patient safety within the medical imaging department and reveals the need for continued protocol and policy changes to keep patients safe.
Meeker, William C.; Watkins, R.W.; Kranz, Karl C.; Munsterman, Scott D.; Johnson, Claire
Objective This report summarizes the closing plenary session of the Association of Chiropractic Colleges Educational Conference—Research Agenda Conference 2014. The purpose of this session was to examine patient-centered medical homes and accountable care organizations from various speakers’ viewpoints and to discuss how chiropractic could possibly work within, and successfully contribute to, the changing health care environment. Discussion The speakers addressed the complex topic of patient-centered medical homes and accountable care organizations and provided suggestions for what leadership strategies the chiropractic profession may need to enhance chiropractic participation and contribution to improving our nation’s health. Conclusion There are many factors involved in the complex topic of chiropractic inclusion in health care models. Major themes resulting from this panel included the importance of building relationships with other professionals, demonstrating data and evidence for what is done in chiropractic practice, improving quality of care, improving health of populations, and reducing costs of health care. PMID:25431542
Suh, Chang-Ok; Oh, Se Jeong; Hong, Sung-Tae
The article overviews some achievements and problems of Korean medical journals published in the highly competitive journal environment. Activities of Korean Association of Medical Journal Editors (KAMJE) are viewed as instrumental for improving the quality of Korean articles, indexing large number of local journals in prestigious bibliographic databases and launching new abstract and citation tracking databases or platforms (eg KoreaMed, KoreaMed Synapse, the Western Pacific Regional Index Medicus [WPRIM]). KAMJE encourages its member journals to upgrade science editing standards and to legitimately increase citation rates, primarily by publishing more great articles with global influence. Experience gained by KAMJE and problems faced by Korean editors may have global implications.
Marks, Steven K.; Vitek, John D.; Giardino, John R.; McQueen, Kay C.
The realization that we do not control nature is often associated with devastating loss of life and property. Apparently, humans do not learn from their mistakes, because human tragedies seem to happen repeatedly and minimal modification of human behavior appears to transpire. Because people do not understand the dynamic nature of Earth and Earth processes, specific education to understand and to comprehend the cause and effect of a dynamic earth is needed. The strong economic base and a high literacy rate within the USA should contribute to the ability of the K-12 educational system to create more appropriate human behavior and response to processes shaping Earth. Today major efforts are underway in government agencies, professional societies, universities and by individuals to change what and how students learn about the environment. Curricular reform has been established as new national standards for what students should learn in science in grades K-12. Just having standards, however, does not guarantee implementation, improved teaching by teachers, or increased understanding by students. Science faculties must accept the challenge to provide the pedagogical education for K-12 teachers; teachers must be trained and empowered to implement change; this change must ripple throughout the entire K-12 system. Workshops and innovative materials to support renovations in the curricula are essential to affect change. The World Wide Web will be a major help in information dissemination. However, for success to be achieved, local involvement is fundamental. People with expertise about Earth can have the greatest impact on effecting change by helping neighbors acquire knowledge of the dynamic environment of Earth. The same people (namely you) must become pro-active in K-12 education.
Simon, Christian; Hassler, Sylvain; Beuscart-Zephir, Marie-Catherine; Favre, Madeleine; Venot, Alain; Duclos, Catherine; Lamy, Jean-Baptiste
Physicians have difficulties to access and analyse information in a medical record. In a previous work on drug databanks, we have shown that with an iconic language as VCM, an icon-based presentation can help physicians to access medical information. Our objective, herein, is to study whether VCM can be used in an electronic medical record for facilitating physician access in general practice. We identify the data and the functionalities of an electronic medical record that could benefit from VCM icons representing clinical findings, patient history, etc. We also present a preliminary evaluation of this new icon-focused interface. We conclude by discussing the results like the assessment of the user's satisfaction and pointing out the importance of coding data.
El-Mallakh, Peggy; Findlay, Jan
The purpose of this review is to describe research over the past 10 years on the role of support services in promoting medication adherence in mental health consumers diagnosed with schizophrenia. A literature search was conducted using the terms “medication adherence,” “schizophrenia,” and “support services,” using Medline, PubMed, and CINAHL. Reference lists from published studies were also reviewed to identify additional research studies. Twenty-two articles focused on support-service intervention studies, and these were selected for review. Available support-service interventions include adherence therapy, electronic reminders via text messages and telephones, cognitive–behavioral and motivational strategies, and financial incentives. Support-service intervention strategies need to be tailored to the specific needs of mental health consumers with schizophrenia. More research is needed to investigate effective support services to enhance long-term adherence and adherence to medications for medical illnesses in this population. PMID:25931823
commanders and AFMS senior leadership; • Set a single PME standard for AFMS officers; • Shift provider billets to patient care roles and establish...single PME standard, and by realigning human resources to increase clinical currency, medical readiness and resource efficiency. Some structural...organizational entity. Like running a surgical service or a medical service. . . . It’s much bigger than that, because you’re dealing with finance and
Goiania , Brazil in 1987 when two men brought home some glowing, blue pieces of metal they had taken out of a discarded Cesium-137 radiotherapy machine...Medicine 13 (January 2004): 5. 51 University of Cincinnati, “The Radiological Accident in Goiania : An Overview of Dosimetric and Medical Aspects...University of Cincinnati. “The Radiological Accident in Goiania : An Overview of Dosimetric and Medical Aspects.” Briefing slides available from <http
Danzer, Graham; Rieger, Sarah M
Severe mental illnesses, mainly schizophrenia and bipolar disorders, often go untreated until the afflicted persons become dangerous to themselves or others. In such states, they must be hospitalized and medicated, often involuntarily due to the stigma and low insight into need for treatment that can be considered characteristic of severe illnesses. Hospitalization and medications can help the mentally ill stabilize. But these options also can have a demoralizing effect on future engagement with providers. Accordingly, the process of involuntary hospitalization and medication treatment must be maximally dignified and respectful of patient autonomy, within the limits of manifest illnesses. Literature that was reviewed and synthesized suggests best practice strategies for helping involuntary mentally ill patients grow into voluntary consumers of medication. In turn, risk of relapse is lowered and quality of life is enhanced. Best practice strategies included decreasing usage of coercive tactics, helping patients cope with medication side effects, and emphasizing the necessity of family involvement. The authors conclude with a review of the limitations of arguing for involuntary hospitalization and treatment as restoring patient autonomy, along with implications for future practice focusing on increasing the medication adherence of severely mentally ill populations.
Gill, Christopher J.; Le Ngoc, Bao; Halim, Nafisa; Nguyen Viet, Ha; Larson Williams, Anna; Nguyen Van, Tan; McNabb, Marion; Tran Thi Ngoc, Lien; Falconer, Ariel; An Phan Ha, Hai; Rohr, Julia; Hoang, Hai; Michiel, James; Nguyen Thi Thanh, Tam; Bird, Liat; Pham Vu, Hoang; Yeshitla, Mahlet; Ha Van, Nhu; Sabin, Lora
Background Community health workers (CHWs) provide critical services to underserved populations in low and middle-income countries, but maintaining CHW’s clinical knowledge through formal continuing medical education (CME) activities is challenging and rarely occurs. We tested whether a Short Message Service (SMS)-based mobile CME (mCME) intervention could improve medical knowledge among a cadre of Vietnamese CHWs (Community Based Physician’s Assistants–CBPAs) who are the leading providers of primary medical care for rural underserved populations. Methods The mCME Project was a three arm randomized controlled trial. Group 1 served as controls while Groups 2 and 3 experienced two models of the mCME intervention. Group 2 (passive model) participants received a daily SMS bullet point, and were required to reply to the text to acknowledge receipt; Group 3 (interactive model) participants received an SMS in multiple choice question format addressing the same thematic area as Group 2, entering an answer (A, B, C or D) in their response. The server provided feedback immediately informing the participant whether the answer was correct. Effectiveness was based on standardized examination scores measured at baseline and endline (six months later). Secondary outcomes included job satisfaction and self-efficacy. Results 638 CBPAs were enrolled, randomized, and tested at baseline, with 592 returning at endline (93.7%). Baseline scores were similar across all three groups. Over the next six months, participation of Groups 2 and 3 remained high; they responded to >75% of messages. Group 3 participants answered 43% of the daily SMS questions correctly, but their performance did not improve over time. At endline, the CBPAs reported high satisfaction with the mCME intervention, and deemed the SMS messages highly relevant. However, endline exam scores did not increase over baseline, and did not differ between the three groups. Job satisfaction and self-efficacy scores also did
... 29 Labor 1 2014-07-01 2013-07-01 true Textbooks and curricular material. 36.455 Section 36.455 Labor Office of the Secretary of Labor NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs...
... 10 Energy 4 2013-01-01 2013-01-01 false Textbooks and curricular material. 1042.455 Section 1042.455 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of...
Phelps, Margaret S.; Peach, Larry E.; Reddick, Thomas L.
Principals of 62 elementary and secondary rural schools in a 20-county area of the upper Cumberland region of Tennessee were surveyed about the status of rural school facilities and their accommodation of various curricular and extracurricular offerings. Small class size was reported by 58 percent. The high incidence of Internet-operable schools…
Andrade, Maureen Snow
Institutions of higher education are widening access to meet demand and to realize the benefits of an educated citizenry. Widened access has resulted in increased learner diversity, and consequently, differing expectations for teaching and learning. Achieving desired learning outcomes in this context suggests the need to examine curricular design,…
This commentary explores theoretical alternatives for viewing the problem identified by Volny Fages and Virginie Albe in their article entitled Social issues in nanoscience and nanotechnology Master's degrees: The socio-political stakes of curricular choices. An approach to social research is suggested that would render visible the associations…
Sutton Trust, 2014
This Research Briefing analyses Office for National Statistics data and finds children from the most advantaged households benefit from significantly more spending on extra-curricular activities and private tutoring than their poorer peers. The brief also includes the Trust's annual polling on private tuition and new polling on parents and…
Booyse, Celia; Chetty, Rajendra
Evidence of the value of constructivist theory in the classroom is especially important for educational practice in areas of poverty and social challenge. Research was undertaken in 2010 into the application of constructivist theory on instructional design. The findings of this research are particularly relevant to the current curricular crisis in…
Phillips, Paul; Godwin, Michael
Described is the use of the Bible as a source of information on the availability and use of metals in ancient societies. The use of the Bible in cross-curricular work between science, technology, and religious studies is discussed. (Author/CW)
McGowen, K. Ramsey; Miller, Merry Noel; Floyd, Michael; Miller, Barney; Coyle, Brent
Objective: The authors discuss the curricular implications of a research project originally designed to evaluate the instructional strategy of using standardized patients in a psychotherapy training seminar. Methods: The original project included second-year residents enrolled in an introductory psychotherapy seminar that employed sequential…
This document contains a cross-curricular cooperative learning experience that is designed to give high school students career and technical educational experiences in the areas of forensic sciences and criminalistics by doing the forensic work to "solve" a fictitious murder. The activities included in the cooperative learning experience…
The Rose Review has been published to sort out all those nasty curriculum and pedagogical problems that have bewildered, frustrated and exhausted so many primary teachers over the recent past! This article addresses one aspect of the recommendations, namely, the role of cross-curricular approaches to strengthen teaching and learning. Perhaps this…
... 18 Conservation of Power and Water Resources 2 2014-04-01 2014-04-01 false Textbooks and curricular material. 1317.455 Section 1317.455 Conservation of Power and Water Resources TENNESSEE VALLEY AUTHORITY NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING...
... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Textbooks and curricular material. 1317.455 Section 1317.455 Conservation of Power and Water Resources TENNESSEE VALLEY AUTHORITY NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL...
... 7 Agriculture 1 2013-01-01 2013-01-01 false Textbooks and curricular material. 15a.42 Section 15a.42 Agriculture Office of the Secretary of Agriculture EDUCATION PROGRAMS OR ACTIVITIES RECEIVING OR BENEFITTING FROM FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs...
... 7 Agriculture 1 2014-01-01 2014-01-01 false Textbooks and curricular material. 15a.42 Section 15a.42 Agriculture Office of the Secretary of Agriculture EDUCATION PROGRAMS OR ACTIVITIES RECEIVING OR BENEFITTING FROM FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs...
... 7 Agriculture 1 2011-01-01 2011-01-01 false Textbooks and curricular material. 15a.42 Section 15a.42 Agriculture Office of the Secretary of Agriculture EDUCATION PROGRAMS OR ACTIVITIES RECEIVING OR BENEFITTING FROM FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs...
... 7 Agriculture 1 2010-01-01 2010-01-01 false Textbooks and curricular material. 15a.42 Section 15a.42 Agriculture Office of the Secretary of Agriculture EDUCATION PROGRAMS OR ACTIVITIES RECEIVING OR BENEFITTING FROM FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs...
Humphrey, James H.
Noting that unilateral definitions of motor learning as separate from ideational learning are inadequate, this book identifies and explores certain branches of specific aspects of motor learning. The book is divided into three parts, dealing with curricular motor learning, compensatory motor learning, and cognitive motor learning. Part I is…
Working (with) Deleuzo-Guattarian philosophical imaginaries opens (to) a multiplicity of possibilities for thinking differently about curriculum, young children and how they perform their curricular understandings. In this article I work (as) rhizome, bringing the imaginaries "becoming" and "milieu" into an early childhood curriculum conversation…
This description of a curricular adaptation decision-making process focuses on tenets of reflective practice as teachers design instruction for students in heterogeneous classrooms. A case example illustrates how an elementary teaching team transformed lessons to accommodate a wide range of learners in a multiage first- and second-grade classroom.…
Bensimon, Estela Mara
This paper examines the effect of organizational culture and power on the meaning and practice of multicultural curricular change. A case study is presented of an urban academic institution that had adopted a university-wide undergraduate diversity requirement in 1991 after considerable debate and negotiation among various constituencies. The…
The American Council of Learned Societies (ACLS) humanities model in the Cambridge (Massachusetts) public schools has significantly affected curricular reform and teacher development. The endeavor is in its third year at the Pilot School, a program within the Cambridge Rindge and Latin School. The article describes progressive reform experiences…
James Woodcock continues his theme from "Teaching History 138" about the difference between superficial, thematic cross-curricularity and much more rigorous interdisciplinarity. His concern is to retain rather than compromise the integrity of the subject disciplines. Woodcock argues that interdisciplinary working adds value to learning…
Lenski, Susan Davis
Considers how many educators believe that teaching an integrated curriculum should help students develop cross-curricular connections. Notes that students often do not make connections between subject areas even when they are in classrooms with integrated units. Presents a strategy called Brain Surfing that teachers can use to facilitate…
Maryland State Dept. of Education, Baltimore. Div. of Career Technology and Adult Learning.
This curricular framework is designed to assist administrators and teachers in planning, developing, and implementing family and consumer sciences programs in Maryland. It provides a philosophical foundation and a broad outline from which educators may construct comprehensive family and consumer sciences programs. The materials will aid local…
Haugh, Rita; And Others
A new curricular router created to be more flexible, more user-oriented, and use less computer memory was developed in 1979. Although initially called the "Indiana Routing System" (TIRS), it has been renamed the "Indiana Manager of PLATO-Assisted Curricula." This new router permits any mixture of the instructional strategies of…
Journal of Dental Education, 1980
Oral radiology curricular guidelines developed by the American Association of Dental Schools are provided. The guidelines describe minimal conditions under which a satisfactory educational experience can be offered. Principles of x-radiation, radiobiological concepts, radiological health, radiographic technique, radiographic quality, and darkroom…
... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Textbooks and curricular material. 5.455 Section 5.455 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL...
... 40 Protection of Environment 1 2012-07-01 2012-07-01 false Textbooks and curricular material. 5.455 Section 5.455 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL...
... 40 Protection of Environment 1 2014-07-01 2014-07-01 false Textbooks and curricular material. 5.455 Section 5.455 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL...
Marzano, Robert J.
Advances in cognitive science have greatly increased our knowledge of how the human mind stores and uses information. That knowledge can be used to decompose curricular objectives so as to increase the specificity of instruction to a level of precision that should greatly enhance student writing. This article identifies some major types of…
Land, Tonia J.; Drake, Corey
In this study, we examined how curricular resources supported three expert teachers in their enactment of progressions. Using a video-stimulated interview process, we documented the multiple types of progressions identified, described, and enacted by the teachers. Results indicate that the teachers used four different types of…
Moriana, Juan Antonio; Alos, Francisco; Alcala, Rocio; Pino, Maria-Jose; Herruzo, Javier; Ruiz, Rosario
Introduction: In this paper we study the possible influence of extra-curricular activities (study-related and/or sports) on academic performance of first- and second-year pupils in "Educacion Secundaria Obligatoria (ESO)" [N.T. seventh- and eighth-graders]. Method: We randomly selected 12 schools in the city (9 public and 3 private), and…
... 29 Labor 1 2011-07-01 2011-07-01 false Textbooks and curricular material. 36.455 Section 36.455 Labor Office of the Secretary of Labor NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs...
... 10 Energy 4 2011-01-01 2011-01-01 false Textbooks and curricular material. 1042.455 Section 1042.455 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of...
... 29 Labor 1 2012-07-01 2012-07-01 false Textbooks and curricular material. 36.455 Section 36.455 Labor Office of the Secretary of Labor NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs...
Clarke, Lillian W.; Franklin, Carl M.
The Cross-Curricular Sequencing (CCS) approach to teaching business communications is explored. Its uses in word processing, principles of management, and business policy courses are discussed. Techniques for integrating materials from these courses into business communication classes are described. The implications of CCS for business…
Tarabochia, Sandra Lynn
In this dissertation, I use qualitative research methods to study relationships between compositionists and faculty in other disciplines in the context of cross-curricular literacy (CCL) work. Drawing on a two-year CCL project in the biology department, for which I was a participant observer, I argue that compositionists need to attend more…
Tange, Hanne; Millar, Sharon
Inspired by Bourdieu's ("Homo Academicus, Polity," Cambridge, 1988; "The Logic of Practice, Polity," Cambridge, 1990) ideas of knowledge reproduction, the article presents an empirical mapping of knowledge geographies, as manifest in the curricular practices found within a single international MA programme in Denmark. Following…
Burn, Helen E.
This multiple case study explores factors that shaped the curricular reasoning of mathematics faculty engaged in college algebra reform in community colleges. Overall, the study found that although proposed reform of college algebra is broad in scope and influenced by the student audience, competing influences emerge that can enable or constrain…
Maryland State Dept. of Education, Baltimore. Div. of Library Development and Services.
This publication provides guidelines designed to assist Maryland library media administrators and specialists in planning, developing, and implementing kindergarten through twelfth grade library media programs. It provides a broad outline from which local systems may construct library media programs integrated with other curricular units. The…
Johnson, Daniel K. N.; Lybecker, Kristina M.; Taylor, Corrine H.
The authors investigated whether the curricular structure of an economics course (semester, trimester, or compressed block schedule) has an effect on an undergraduate's subsequent retention of course material, while controlling for other relevant differences. They tested separately for theoretical or process comprehension and for graphical…
... Section 146.455 Foreign Relations DEPARTMENT OF STATE CIVIL RIGHTS NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 146.455 Textbooks and curricular...
... Section 146.455 Foreign Relations DEPARTMENT OF STATE CIVIL RIGHTS NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 146.455 Textbooks and curricular...
Ferris, Helena; Joyce, Pauline
There are various influences and obstacles when planning an educational curriculum. The imprint of globalisation on the landscape of Irish medicine highlights the importance of delivering a diverse curriculum with international dimensions so that knowledge and skills can transfer across borders. It is also clear that medical emigration has a…
Piecuch, Anna; Makarewicz-Wujec, Magdalena; Kozłowska-Wojciechowska, Małgorzata
Background An informed or shared decision-making model is desirable to support the choice of over-the-counter (OTC) medications in pharmacies: it respects patient empowerment in self-medication. Such a model is achievable provided that pharmacists are a credible, competent information source open to patient needs. Objective To study the dependencies among selected factors that may influence the provision of OTC medication information. The study was conducted from the perspective of a community pharmacist. Method The study consisted of an auditorium survey with a self-administered questionnaire. We attempted to determine the relationships among three selected constructs: patient centredness (four items), competence (four items), and provision of OTC medication information (six items) as latent variables. We analysed hypothetical relationships among the observable variables and latent variables using structural equation modelling. Main outcome measure Selected factors that may influence the provision of OTC medication information. Results In all, 1496 pharmacists took part in the study. The model demonstrated adequate fit (χ(2) = 198.39, df = 64). The patient-centredness construct was demonstrated to have a strong direct positive impact on the provision of OTC medication information construct (β = 0.77, P < 0.05). Provision of OTC medication information was also shown to have a strong direct effect on the competence variable (β = 0.90, P < 0.05). Conclusion If a pharmacist is patient centred, there is a greater possibility that they will provide information about OTC medicines; that may influence the pharmacist's feelings about their ability to cope with patient initiatives and enhance the pharmacist's selfperceived competence.
Kwan, Jennifer Y.Y.; Nyhof-Young, Joyce; Catton, Pamela; Giuliani, Meredith E.
Purpose: To evaluate (1) the quantity and quality of current undergraduate oncology teaching at a major Canadian medical school; and (2) curricular changes over the past decade, to enhance local oncology education and provide insight for other educators. Methods and Materials: Relevant 2011-2012 undergraduate curricular sessions were extracted from the University of Toronto curriculum mapping database using keywords and database identifiers. Educational sessions were analyzed according to Medical Council of Canada objectives, discussion topics, instructor qualifications, teaching format, program year, and course subject. Course-related oncology research projects performed by students during 2000 to 2012 were extracted from another internal database. Elective choices of clerks during 2008-2014 were retrieved from the institution. The 2011-2012 and 2000-2001 curricula were compared using common criteria. Results: The 2011-2012 curriculum covers 5 major themes (public health, cancer biology, diagnosis, principles of care, and therapy), which highlight 286 oncology teaching topics within 80 sessions. Genitourinary (10, 12.5%), gynecologic (8, 10.0%), and gastrointestinal cancers (7.9, 9.8%) were the most commonly taught cancers. A minority of sessions were taught by surgical oncologists (6.5, 8.1%), medical oncologists (2.5, 3.1%), and radiation oncologists (1, 1.2%). During 2000-2012, 9.0% of students (233 of 2578) opted to complete an oncology research project. During 2008-2014, oncology electives constituted 2.2% of all clerkship elective choices (209 of 9596). Compared with pre-2001 curricula, the 2012 oncology curriculum shows notable expansion in the coverage of epidemiology (6:1 increase), prevention (4:1), screening (3:1), and molecular biology (6:1). Conclusions: The scope of the oncology curriculum has grown over the past decade. Nevertheless, further work is needed to improve medical student knowledge of cancers, particularly those relevant to public health
Report No. DODIG-2012-106 June 27, 2012 DoD Needs to Improve the Billing System for Health Care Provided to Contractors at Medical Treatment ...Billing System for Health Care Provided to Contractors at Medical Treatment Facilities in Southwest Asia 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c...General MTF Medical Treatment Facility SPOT Synchronized Predeployment and Operational Tracker TMDS Theater Medical Data Store USD(AT&L) Under
Beach, Mary Catherine; Roter, Debra L.; Saha, Somnath; Korthuis, P. Todd; Eggly, Susan; Cohn, Jonathan; Sharp, Victoria; Moore, Richard D.; Wilson, Ira B.
Introduction Medication adherence is essential in HIV care, yet provider communication about adherence is often suboptimal. We designed this study to improve patient-provider communication about HIV medication adherence. Methods We randomized 26 providers at three HIV care sites to receive or not receive a one-hour communication skills training based on motivational interviewing principles applied to medication adherence. Prior to routine office visits, non-adherent patients of providers who received the training were coached to discuss adherence with their providers. Patients of providers who did not receive the training providers were not coached. We audio-recorded and coded patient-provider interactions using the Roter Interaction Analysis System (RIAS). Results There was more dialogue about therapeutic regimen in visits with intervention patients and providers (167 vs 128, respectively, p=.004), with the majority of statements coming from providers. These visits also included more brainstorming solutions to nonadherence (41% vs. 22%, p=0.026). Intervention compared with control visit providers engaged in more positive talk (44 vs. 38 statements, p=0.039), emotional talk (26 vs. 18 statements, p<0.001), and probing of patient opinion (3 vs. 2 statements, p=0.009). Conclusion A brief provider training combined with patient coaching sessions, improved provider communication behaviors and increased dialogue regarding medication adherence. PMID:26021185
Saadat, Seyed Hassan; Izadi, Morteza; Aslani, Jafar; Ghanei, Mostafa
Background: As a developing country, Iran has not had a substantial share in global science production activities; however, this country has recently been the forth country in the world regarding research output publications, and biomedical research has played a crucial role in achieving this honorable position. Objectives: In this paper, we aimed to introduce the strategies employed at Baqiyatallah University of Medical Sciences of Iran, to enhance scientific research output of this university. Patients and Methods: The present study used the qualitative content analysis technique. The Research deputies and the head of research centers of Baqiyatallah University of Medical Sciences were the research subjects. The main researcher conducted all the interviews. The participants were all authorities of the university. Sampling continued until data saturation. After speaking with 16 participants, the interviews yielded no new information, and no new categories or subcategories were added to the previous ones. Deep and semi-structured interviews with open-ended questions were used to collect data. Results: Diplomacies employed to promote research, organizing educational classes, and foundation of infrastructural organizations for research and true surveillance of research programs were the main characteristics of Baqiyatallah University of Medical Sciences research strategies. Conclusions: Baqiyatallah University of Medical Sciences is a military university of limited resources that has won several awards in the recent years, and has been categorized as one of the leading first ranked medical universities in Iran; a position quite higher than several other larger universities of the country. We recommend more enhanced strategies for other universities. PMID:25793114
Guo, Dianli; Wen, Qiaoyan; Li, Wenmin; Zhang, Hua; Jin, Zhengping
Telecare medical information system (TMIS) offers healthcare delivery services and patients can acquire their desired medical services conveniently through public networks. The protection of patients' privacy and data confidentiality are significant. Very recently, Mishra et al. proposed a biometrics-based authentication scheme for telecare medical information system. Their scheme can protect user privacy and is believed to resist a range of network attacks. In this paper, we analyze Mishra et al.'s scheme and identify that their scheme is insecure to against known session key attack and impersonation attack. Thereby, we present a modified biometrics-based authentication scheme for TMIS to eliminate the aforementioned faults. Besides, we demonstrate the completeness of the proposed scheme through BAN-logic. Compared to the related schemes, our protocol can provide stronger security and it is more practical.
Rose, J S; Fisch, B J; Hogan, W R; Levy, B; Marshal, P; Thomas, D R; Kirkley, D
It has become abundantly clear that standards of recording clinical terms in human-readable, computer-processable format are indispensable. Controlled medical terminology is the missing link in health information standards (in fact, medical terminology can be viewed as the mother of all standards); its absence interferes with the business of healthcare and impedes the core processes of healing and maintaining health. Medicine has lacked the controlled common medical vocabulary that would enable universal sharing of data at the point of care and ensure reliable information for determining health intervention effectiveness. Simple clinical and code content alone has proven insufficient for healthcare enterprises to successfully manage the terminology problem; the "lexical runtime engine," formerly called a vocabulary server (VOSER), which manages the vocabulary ontology and serves up the relevant vocabulary to users of applications in the clinical environment, has recently become a reality.
34 ! JUL01 THE DEVELOPMENT AND IMPLEMENTATION Lf OF AN IMPROVED INFORMATION FEEDBACK SYSTEM AT USAF MEDICAL CENTER WRIGHT-PATTERSON WRIGHT-PATTERSON...Code) 7b. ADDRESS (City, State, and ZIP Code) U.S. Medical Center AHS Wright-Patterson AFB, OHIO 45433-5300 SAN ANTONIO, TEXAS 78234-6100 8a. NAME OF...USAF Medical Center Wright-Patterson. Unfortunately, the information gathered was not always analyzed, interpreted, and used to improve the services
Pitts, Stephanie E
Extra-curricular activities have for many years been a prominent and valuable feature of UK university music departments, but the current political and economic climate poses several significant threats to their survival, including uncertain funding, demands on students’ time (including the need to undertake paid employment), and, potentially, the…
... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true Does maximum medical improvement always have to be reached for an impairment to be included in the impairment rating? 30.911 Section 30.911... Ratable Impairments § 30.911 Does maximum medical improvement always have to be reached for an...
... 20 Employees' Benefits 1 2014-04-01 2012-04-01 true Does maximum medical improvement always have to be reached for an impairment to be included in the impairment rating? 30.911 Section 30.911... Ratable Impairments § 30.911 Does maximum medical improvement always have to be reached for an...
... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Does maximum medical improvement always have to be reached for an impairment to be included in the impairment rating? 30.911 Section 30.911... Ratable Impairments § 30.911 Does maximum medical improvement always have to be reached for an...
... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false Does maximum medical improvement always have to be reached for an impairment to be included in the impairment rating? 30.911 Section 30.911... Ratable Impairments § 30.911 Does maximum medical improvement always have to be reached for an...
... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Does maximum medical improvement always have to be reached for an impairment to be included in the impairment rating? 30.911 Section 30.911... Ratable Impairments § 30.911 Does maximum medical improvement always have to be reached for an...
Acosta, Cheila Valera
This document describes primary, secondary and teacher training curricular policy relating to education for citizenship in Cuba, Haiti and the Dominican Republic in order to make practical recommendations for improved design, quality and implementation of these initiatives in the three countries selected. The first chapter describes the Caribbean…
Nierenberg, David W; Carney, Patricia A
In recent years, Dartmouth Medical School has increased its commitment to educational research within the school, and in collaboration with other schools across the country. Passionate faculty members with ideas and expertise in particular curricular areas are one critical component needed for a successful educational research program. Other components include an atmosphere that fosters research collaborations and mentoring, and various types of institutional support structures. This same model has effectively supported basic science and clinical research for decades. Because of the complexities involved in studying medical education, Dartmouth Medical School has invested in support structures for educational grant and manuscript development, financial support for pilot projects and partial salary support for investigators and key staff members, and other support targeted toward specific research projects. Ultimately, the goal is to use the results of the school's educational research projects to improve the curriculum through cycles of hypothesis development and testing, providing evidence for subsequent curricular change. When some research findings are relevant and applicable for use in other medical schools, that is an additional benefit of the educational research process. In this report, the authors describe the development of Dartmouth Medical School's infrastructure for supporting educational research, which has helped to accelerate the educational research productivity teaching faculty now enjoy. The authors also address some of the challenges that they anticipate in the near future.
Martelli, Nicolas; van den Brink, Hélène; Borget, Isabelle
We describe here recent modifications to the French Coverage with Evidence Development (CED) scheme for innovative medical devices. CED can be defined as temporary coverage for a novel health product during collection of the additional evidence required to determine whether definitive coverage is possible. The principle refinements to the scheme include a more precise definition of what may be considered an innovative product, the possibility for device manufacturers to request CED either independently or in partnership with hospitals, and the establishment of processing deadlines for health authorities. In the long term, these modifications may increase the number of applications to the CED scheme, which could lead to unsustainable funding for future projects. It will also be necessary to ensure that the study conditions required by national health authorities are suitable for medical devices and that processing deadlines are met for the scheme to be fully operational. Overall, the modifications recently applied to the French CED scheme for innovative medical devices should increase the transparency of the process, and therefore be more appealing to medical device manufacturers.
Duke, Pamela; Cohen, Diane; Novack, Dennis
This study examined first-year medical student attitudes concerning the elderly before and after instituting a geriatric mentoring program. The program began and ended with a survey designed to assess students' attitudes toward the elderly. During the mentoring program, students visited the same senior for four visits throughout the academic year.…
Wolyniak, Michael J; Bemis, Lynne T; Prunuske, Amy J
Genetics is an essential subject to be mastered by health professional students of all types. However, technological advances in genomics and recent pedagogical research have changed the way in which many medical training programs teach genetics to their students. These advances favor a more experience-based education focused primarily on developing student’s critical thinking skills. In this review, we examine the current state of genetics education at both the preclinical and clinical levels and the ways in which medical and pedagogical research have guided reforms to current and emerging teaching practices in genetics. We discover exciting trends taking place in which genetics is integrated with other scientific disciplines both horizontally and vertically across medical curricula to emphasize training in scientific critical thinking skills among students via the evaluation of clinical evidence and consultation of online databases. These trends will produce future health professionals with the skills and confidence necessary to embrace the new tools of medical practice that have emerged from scientific advances in genetics, genomics, and bioinformatics. PMID:26604852
Dali, Keren; Dilevko, Juris
Although fiction plays a prominent role in the interdisciplinary field of medical humanities (MH), it is physically and intellectually isolated from non-fiction in academic health sciences libraries. Using the Literature, Arts, and Medicine Database (LAMD) as a tool for selection and subject analysis, we suggest a method of integrating fiction…
Ruedrich, S. L.; Swales, T. P.; Rossvanes, C.; Diana, L.; Arkadiev, V.; Lim, K.
Objective: Atypical antipsychotic medications have largely supplanted their typical counterparts, both for psychosis and for the treatment of aggression and/or self-injurious behaviour (SIB), in persons with intellectual disabilities (ID). However, with the exception of risperidone, little systematic research supports their use in such persons.…
dentists, medical service corps, and veterinarians , to name a few, at the work center level across Army fixed military treatment facilities. The model uses...1072 - 896 903 Hematology /Oncology 41 40 43 - 12 17 - 18 14 Infectious Disease 63 59 62 - 29 34 - 16 17 Internal Medicine 315 e 254 e 277 e
Richtering, Sarah S; Chalmers, John; Thiagalingam, Aravinda; Chow, Clara K; Redfern, Julie
Background There are a growing number of mobile phone apps available to support people in taking their medications and to improve medication adherence. However, little is known about how these apps differ in terms of features, quality, and effectiveness. Objective We aimed to systematically review the medication reminder apps available in the Australian iTunes store and Google Play to assess their features and their quality in order to identify high-quality apps. Methods This review was conducted in a similar manner to a systematic review by using a stepwise approach that included (1) a search strategy; (2) eligibility assessment; (3) app selection process through an initial screening of all retrieved apps and full app review of the included apps; (4) data extraction using a predefined set of features considered important or desirable in medication reminder apps; (5) analysis by classifying the apps as basic and advanced medication reminder apps and scoring and ranking them; and (6) a quality assessment by using the Mobile App Rating Scale (MARS), a reliable tool to assess mobile health apps. Results We identified 272 medication reminder apps, of which 152 were found only in Google Play, 87 only in iTunes, and 33 in both app stores. Apps found in Google Play had more customer reviews, higher star ratings, and lower cost compared with apps in iTunes. Only 109 apps were available for free and 124 were recently updated in 2015 or 2016. Overall, the median number of features per app was 3.0 (interquartile range 4.0) and only 18 apps had ≥9 of the 17 desirable features. The most common features were flexible scheduling that was present in 56.3% (153/272) of the included apps, medication tracking history in 54.8% (149/272), snooze option in 34.9% (95/272), and visual aids in 32.4% (88/272). We classified 54.8% (149/272) of the included apps as advanced medication reminder apps and 45.2% (123/272) as basic medication reminder apps. The advanced apps had a higher number
Cushing, Anna; Manice, Melissa P; Ting, Andrew; Parides, Michael K
Purpose Currently, 7.1 million children in the United States have asthma. Nonadherence to daily controller asthma medication is common, leading to more severe symptoms, overuse of rescue medication, and increased hospitalizations. The purpose of this study was to develop and evaluate the feasibility and acceptability of a novel mHealth management system composed of a sensored device, which is connected to mobile phone app that is designed to monitor and improve asthma medication adherence. Patients and methods The asthma management system was designed using well-established behavioral theory. Seven adolescents aged 11–18 years were enrolled and given an adherence sensor, and four of those also received a mobile phone app with game features and reminders. Five patients completed the study, and one was lost to follow-up in each group. Mobile app users and their parents participated in focus groups to assess patient preferences. Feasibility was assessed by the ability of sensors to capture real-time medication data. Acceptability was assessed by patient questionnaire and focus group analysis. Results Successful upload of real-time data from six of seven inhaler sensors to the HIPAA-compliant server demonstrates the feasibility of at-home patient monitoring using the sensor device. All three mobile app users who completed the study reported interest in continued use of the management system and would recommend the app to friends. Unstructured interviews and focus groups revealed that patients felt that the intervention helped their sense of asthma control. Conclusion This study demonstrates the feasibility of using the sensor device to remotely monitor real-time medication usage, and user feedback demonstrates the acceptability of the intervention for patient use. The findings provide guidance for the improvement of study design and technology development. Further research is needed to assess the efficacy of the intervention. PMID:27853357
Polk, James D.; Duncan, James M.; Davis, Jeffrey R.; Williams, Richard S.; Lindgren, Kjell N.; Mathes, Karen L.; Gillis, David B.; Scheuring, Richard A.
From May of 1973 to February of 1974, the National Aeronautics and Space Administration conducted a series of three manned missions to the Skylab space station, a voluminous vehicle largely descendant of Apollo hardware, and America s first space station. The crewmembers of these three manned missions spent record breaking durations of time in microgravity (28 days, 59 days and 84 days, respectively) and gave the U.S. space program its first experiences with long-duration space flight. The program overcame a number of obstacles (including a significant crippling of the Skylab vehicle) to conduct a lauded scientific program that encompassed life sciences, astronomy, solar physics, materials sciences and Earth observation. Skylab has more to offer than the results of its scientific efforts. The operations conducted by the Skylab crews and ground personnel represent a rich legacy of operational experience. As we plan for our return to the moon and the subsequent manned exploration of Mars, it is essential to utilize the experiences and insights of those involved in previous programs. Skylab and SMEAT (Skylab Medical Experiments Altitude Test) personnel have unique insight into operations being planned for the Constellation Program, such as umbilical extra-vehicular activity and water landing/recovery of long-duration crewmembers. Skylab was also well known for its habitability and extensive medical suite; topics which deserve further reflection as we prepare for lunar habitation and missions beyond Earth s immediate sphere of influence. The Skylab Medical Operations Summit was held in January 2008. Crewmembers and medical personnel from the Skylab missions and SMEAT were invited to participate in a two day summit with representatives from the Constellation Program medical operations community. The purpose of the summit was to discuss issues pertinent to future Constellation operations. The purpose of this document is to formally present the recommendations of the
Akinbosoye, Osayi E.; Grana, James; Hill, Jerrold; Wade, Rolin L
Abstract The aim was to evaluate the impact of a multifaceted set of medication management interventions offered by a community pharmacy on adherence, health care utilization, and costs within a commercial population. Patients initiating therapy within 16 drug classes from February 7, 2013, to October 6, 2013, were offered various adherence interventions by Walgreens pharmacy. Patients were linked deterministically to IMS medical and prescription databases for 6-month pre- and post-index data analysis. Walgreens patients (intervention) were matched to patients using other pharmacies (control) on drug class, index date, baseline demographics, clinical factors, utilization, and costs. Outcomes were evaluated at the intent-to-treat level using post-index differences and generalized estimating equations (GEE) regression model. Paired t tests (continuous variables) and McNemar's test (dichotomous variables) were used to determine the significance of estimated model coefficients at α = 0.05. The groups (n = 72,410 each) had similar age (47.1 vs. 45.7 years), sex (41.2% vs. 40.2% male), and disease burden (0.52 vs. 0.40 mean Charlson comorbidity index). In the 6-month post-index period, the intervention group had 3.0% greater medication adherence, 1.8% fewer hospital admissions, 2.7% fewer emergency room (ER) visits, and 0.53 fewer mean outpatient visits compared to the control group (all P < 0.0001). The intervention group incurred significantly lower GEE-adjusted pharmacy costs (−$92), outpatient costs (−$120), ER costs (−$38), and total health care costs (−$226.07) (all P < 0.0001), and higher inpatient costs ($86, P < 0.004) per patient. A multifaceted set of medication management interventions offered by a community pharmacy were associated with patients in a commercial population having significantly higher medication adherence and lower health care utilization and costs. PMID:27035728
Wang, Candice; Huang, Chin-Chou; Lin, Shing-Jong; Chen, Jaw-Wen
Objectives The goal of our study was to shed light on educational methods to strengthen medical students' cardiopulmonary resuscitation (CPR) leadership and team skills in order to optimise CPR understanding and success using didactic videos and high-fidelity simulations. Design An observational study. Setting A tertiary medical centre in Northern Taiwan. Participants A total of 104 5–7th year medical students, including 72 men and 32 women. Interventions We provided the medical students with a 2-hour training session on advanced CPR. During each class, we divided the students into 1–2 groups; each group consisted of 4–6 team members. Medical student teams were trained by using either method A or B. Method A started with an instructional CPR video followed by a first CPR simulation. Method B started with a first CPR simulation followed by an instructional CPR video. All students then participated in a second CPR simulation. Outcome measures Student teams were assessed with checklist rating scores in leadership, teamwork and team member skills, global rating scores by an attending physician and video-recording evaluation by 2 independent individuals. Results The 104 medical students were divided into 22 teams. We trained 11 teams using method A and 11 using method B. Total second CPR simulation scores were significantly higher than first CPR simulation scores in leadership (p<0.001), teamwork (p<0.001) and team member skills (p<0.001). For methods A and B students' first CPR simulation scores were similar, but method A students' second CPR simulation scores were significantly higher than those of method B in leadership skills (p=0.034), specifically in the support subcategory (p=0.049). Conclusions Although both teaching strategies improved leadership, teamwork and team member performance, video exposure followed by CPR simulation further increased students' leadership skills compared with CPR simulation followed by video exposure. PMID:27678539
Peltz, Alon; Ladner, Travis R.; Reddy, India; Miller, Bonnie M.; Miller, Robert F.; Fowler, Michael J.
Purpose Student-run free clinics (SRFCs) provide service–learning opportunities for medical students and care to underserved patients. Few published studies, however, support that they provide high-quality care. In this study, the authors examined the clinical impact of a medical student health educator program for diabetic patients at an SRFC. Method In 2012, the authors retrospectively reviewed the electronic medical records of diabetic patients who established care at Shade Tree Clinic in Nashville, Tennessee, between 2008 and 2011. They compared clinical outcomes at initial presentation to the clinic and 12 months later. They analyzed the relationship between the number of patient–student interactions (touchpoints) and change in hemoglobin A1c values between these two time points and compared the quality of care provided to best-practice benchmarks (process and outcomes measures). Results The authors studied data from 45 patients. Mean hemoglobin A1c values improved significantly from 9.6 to 7.9, after a mean of 12.5 ± 1.5 months (P < .0001). A trend emerged between increased number of touchpoints and improvement in A1c values (r2 = 0.06, P = .10). A high percentage of patients were screened during clinic visits, whereas a low to moderate percentage met benchmarks for A1c, LDL, and blood pressure levels. Conclusions These findings demonstrate that a medical student health educator program at an SRFC can provide high-quality diabetes care and facilitate clinical improvement one year after enrollment, despite inherent difficulties in caring for underserved patients. Future studies should examine the educational and clinical value of care provided at SRFCs. PMID:24556762
Osorio, Carlos Agustin Muniz
A general consensus exists that the present worldwide state of the natural environment is in crisis. Tied to this crisis, the social dimension presents a discouraging picture in aspects like violence and poverty. The predominant neoliberal economic system---ecocidal and genocidal---just as the production system that sustains it, affects this crisis. Puerto Rico, in its political and economic relationship with the United States of America, is not exempt of this situation. Education arises as an alternative to transform this reality. Science education has the potential to address these socio-environmental problems in a creative way. From a scientific educational framework, we conceptualized, designed and disseminated diverse approaches and tools that integrate socio-ecological and environmental aspects, as well as issues related to violence, conflict and peace. The central research questions were: At present, what are some of the main characteristics of the social-ecological and environmental global and local (glocal) issues and what relation do they have with formal education?; What is the ethical responsibility of science education when, facing social-ecological and environmental situations and issues concerning peace?; What educational foundations justify the "Praxis Educativa Ecopacifista de Enriquecimiento Curricular" as an alternative to the situations and issues considered?; What didactic tools do we propose?; What curricular design and revision processes do we propose? What dissemination processes do we propose? The nature of our methodology is qualitative and is centered around curricular design. It includes a research-theoretical dimension, a practical-research dimension, and systematizing of learning elements. We emphasize the conceptualization of the theoretical-philosophical and methodological dimensions of the ecopacifist approach and its fundamental principles. We highlight the praxis, integrating creativity, intelligence and talent development
Gupta, Vipin; Vajinepalli, Pallavi; Venkatesan, Shankar; Seth, Subhendu; Keswarpu, Payal; Nalam, Asish; Sathpathy, Akash
Medical images taken from camera based devices (e.g. laparoscope, colposcope, retinoscope, etc) are greatly affected by numerous bright reflection spots (called glare or specular reflections). This may affect the visibility of the abnormal features (if present in the glare locations). We have developed a novel solution to overcome this problem by incorporating a multi-LED lighting solution. This will intelligently and rapidly switch on and off the LED's in a pattern that dynamically and geometrically shifts/shuffles these glare spots back and forth in the image such that every glare-affected area of a single image frame can be reconstructed from a few adjacent time-frame images. We have built the prototype that successfully demonstrates how the glare problem in the medical video/image can be satisfactorily solved, significantly enhancing the accuracy of this vital procedure in the diagnosis of diseases. We achieve 65-95% reduction in specularity on phantom model using the proposed approach.
Fünger, S. M.; Lesevic, H.; Rosner, S.; Ott, I.; Berberat, P.; Nikendei, C.; Sonne, C.
Background: Bedside courses are of outstanding importance when training medical students. The fact that less and less teaching is taking place nowadays at the patient's bedside makes it all the more important that the available time be put to effective use. The aim of this study was to check whether structured improvement measures in the course (scripts, lecturer briefing, e-learning cases) would improve the abilities of the students on the basis of a subjective self-assessment as well as an external assessment by the lecturers with respect to clinical abilities. Methods: Bedside teaching takes place in the fourth study year in the Medical Clinics of the TU Munich. Both students and lecturers had the chance to hand in an anonymous, quantitative self- and external assessment of the clinical abilities of the students (German grading system) after every course date. This assessment took place online in the three categories "Medical history & examination", "Diagnosis" and "Therapy". An overall period of four semesters, each with 6 course dates, was investigated. After two of the total of four semesters in the study, the course was changed by introducing scripts, lecturer briefing as well as interactive e-learning cases. The self- and external assessment was compared both within the semester (date 1-3: A; date 4-6: B), during the course as well as before and after introducing the improvement measures ("before" (T0): SS 2012, SS 2013, "after" (T1): WS 2013/2014, SS 2014). Results: There was a significant improvement in one's own abilities on the basis of the self-assessment within each semester when comparing the first (A) and the last (B) course dates. Moreover, there was a significant improvement in the performances in all three categories when T0 was compared with T1, from both the point of view of the students ("Medical history & examination": T0 =2.5±0.9, T1=2.2±0.7, pp<0.001; "Diagnosis" T0=3.1±1.0, T1=2.8 ±0.9, pp<0.001; "Therapy": T0=3.8±1.3, T1=3.5±1.2, pp
customers would be the inclusion of NMCP’s capabilities to diagnose and treat ADHD more effectively than network providers into existing marketing efforts...the selection of a primary care or psychiatrist provider, is significantly different between direct care and network providers, given similar...Pediatric Patients Managed by Providers at Naval Medical Center Portsmouth and Network Providers Introduction Attention-deficit hyperactivity disorder (ADHD
Akinci, Fevzi; Patel, Poonam M
Despite the fact that the United States dedicates so much of its resources to healthcare, the current healthcare delivery system still faces significant quality challenges. The lack of effective communication and coordination of care services across the continuum of care poses disadvantages for those requiring long-term management of their chronic conditions. This is why the new transformation in healthcare known as the patient-centered medical home (PCMH) can help restore confidence in our population that the healthcare services they receive is of the utmost quality and will effectively enhance their quality of life. Healthcare using the PCMH model is delivered with the patient at the center of the transformation and by reinvigorating primary care. The PCMH model strives to deliver effective quality care while attempting to reduce costs. In order to relieve some of our healthcare system distresses, organizations can modify their delivery of care to be patient centered. Enhanced coordination of services, better provider access, self-management, and a team-based approach to care represent some of the key principles of the PCMH model. Patients that can most benefit are those that require long-term management of their conditions such as chronic disease and behavioral health patient populations. The PCMH is a feasible option for delivery reform as pilot studies have documented successful outcomes. Controversy about the lack of a medical neighborhood has created concern about the overall sustainability of the medical home. The medical home can stand independently and continuously provide enhanced care services as a movement toward higher quality care while organizations and government policy assess what types of incentives to put into place for the full collaboration and coordination of care in the healthcare system.
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
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.
Implementation pearls from a new guidebook on improving medication use and outcomes with clinical decision support. Effective CDS is essential for addressing healthcare performance improvement imperatives.
Sirajuddin, Anwar M; Osheroff, Jerome A; Sittig, Dean F; Chuo, John; Velasco, Ferdinand; Collins, David A
Effective clinical decision support (CDS) is essential for addressing healthcare performance improvement imperatives, but care delivery organizations (CDO) typically struggle with CDS deployment. Ensuring safe and effective medication delivery to patients is a central focus of CDO performance improvement efforts, and this article provides an overview of best-practice strategies for applying CDS to these goals. The strategies discussed are drawn from a new guidebook, co-published and co-sponsored by more than a dozen leading organizations. Developed by scores of CDS implementers and experts, the guidebook outlines key steps and success factors for applying CDS to medication management. A central thesis is that improving outcomes with CDS interventions requires that the CDS five rights be addressed successfully. That is, the interventions must deliver the right information, to the right person, in the right format, through the right channel, at the right point in workflow. This paper provides further details about these CDS five rights, and highlights other important strategies for successful CDS programs.
Yousefichaijan, Parsa; Jafari, Farshad; Kahbazi, Manijeh; Rafiei, Mohammad; Pakniyat, AbdolGhader
Background: Clinical reasoning process leads clinician to get purposeful steps from signs and symptoms toward diagnosis and treatment. This research intends to investigate the effect of teaching clinical reasoning on problem-solving skills of medical students. Methods: This research is a semi-experimental study. Nineteen Medical student of the pediatric ward as case group participated in a two-day workshop for training clinical reasoning. Before the workshop, they filled out Diagnostic Thinking Inventory (DTI) questionnaires. Fifteen days after the workshop the DTI questionnaire completed and "key feature" (KF) test and "clinical reasoning problem" (CRP) test was held. 23 Medical student as the control group, without passing the clinical reasoning workshop DTI questionnaire completed, and KF test and CRP test was held. Results: The average score of the DTI questionnaire in the control group was 162.04 and in the case group before the workshop was 153.26 and after the workshop was 181.68. Compare the average score of the DTI questionnaire before and after the workshop there is a significant difference. The difference between average KF test scores in the control and the case group was not significant but between average CRP test scores was significant. Conclusion: Clinical reasoning workshop is effectiveness in promoting problem-solving skills of students. PMID:27579286
Bass, Kristin M.; Stark, Louisa A.
How can researchers in K–12 contexts stay true to the principles of rigorous evaluation designs within the constraints of classroom settings and limited funding? This paper explores this question by presenting a small-scale randomized controlled trial (RCT) designed to test the efficacy of curricular supplemental materials on epigenetics. The researchers asked whether the curricular materials improved students’ understanding of the content more than an alternative set of activities. The field test was conducted in a diverse public high school setting with 145 students who were randomly assigned to a treatment or comparison condition. Findings indicate that students in the treatment condition scored significantly higher on the posttest than did students in the comparison group (effect size: Cohen's d = 0.40). The paper discusses the strengths and limitations of the RCT, the contextual factors that influenced its enactment, and recommendations for others wishing to conduct small-scale rigorous evaluations in educational settings. Our intention is for this paper to serve as a case study for university science faculty members who wish to employ scientifically rigorous evaluations in K–12 settings while limiting the scope and budget of their work. PMID:25452482
Hollinger, Charlotte; Libarkin, Julie C; Stickle, Julia E; Hauptman, Joe G; Henry, Rebecca; Scott, Michael A
A mixed-methods evaluation was conducted to study learner attitudes and knowledge about clinical pathology across a curricular change that instituted a stand-alone clinical pathology course in place of content within a previously integrated pathology course structure. Groups of pre- and post-change students were assessed three times across the two semesters leading up to graduation. At each time, rank-ordered and open-ended response items probed attitudes, and multiple-choice items assessed knowledge. Data about student clinical pathology performance were also collected from clinical pathology instructors and supervising clinicians. Student rank-ordered items were evaluated by factor analysis; resulting factor-scale scores, multiple-choice scores, and rank responses from study cohorts were statistically assessed between groups and within each group over time. Intraclass correlations were calculated for the coding of student open-ended responses, and all coded responses were compared among groups. Analysis revealed that students in the revised curriculum had greater satisfaction with their training and greater confidence in data interpretation compared to students without exposure to an independent clinical pathology course. Although differences in knowledge of clinical pathology were not detected, it was also apparent that the independent clinical pathology course filled a student-perceived curricular need without raising criticisms related to diminished integration with anatomic pathology. Secondary study outcomes included formative feedback for course improvement, evidence of clerkship efficacy, and baseline data for further studies.
Herrinton, Lisa J; Liu, Liyan; Altschuler, Andrea; Dell, Richard; Rabrenovich, Violeta; Compton-Phillips, Amy L
Context: Disease registries enable priority setting and batching of clinical tasks, such as reaching out to patients who have missed a routine laboratory test. Building disease registries requires collaboration among professionals in medicine, population science, and information technology. Specialty care addresses many complex, uncommon conditions, and these conditions are diverse. The cost to build and maintain traditional registries for many diverse, complex, low-frequency conditions is prohibitive. Objective: To develop and to test the Specialty Miniregistries platform, a collaborative interface designed to streamline the medical specialist’s contributions to the science and management of population health. Design: We used accessible technology to develop a platform that would generate miniregistries (small, routinely updated datasets) for surveillance, to identify patients who were missing expected utilization, and to influence clinicians and others to change practices to improve care. The platform was composed of staff, technology, and structured collaborations, organized into a workflow. The platform was tested in five medical specialty departments. Main Outcome Measure: Proof of concept. Results: The platform enabled medical specialists to rapidly and effectively communicate clinical questions, knowledge of disease, clinical workflows, and improvement opportunities. Their knowledge was used to build and to deploy the miniregistries. Each miniregistry required 1 to 2 hours of collaboration by a medical specialist. Turnaround was 1 to 14 days. Conclusions: The Specialty Miniregistries platform is useful for low-volume questions that often occur in specialty care, and it requires low levels of investment. The efficient organization of information workers to support accountable care is an emerging question. PMID:25785640
Bai, Guan-nan; Wang, Yu-feng; Yang, Li; Niu, Wen-yi
Objective To evaluate the efficacy of a psychoeducation program for parents of children with ADHD in enhancing adherence to pharmacological treatment and improving clinical symptoms. Methods We developed a psychoeducation program based on the theory of planned behavior (TPB). Eighty-nine children with ADHD were cluster randomly assigned for their families to receive 3 months of well-structured psychoeducation (intervention group, n=44) or only general clinical counseling (control group, n=45). Parents in the intervention group were given an expert lecture (with slides and a parent manual), attended two expert-guided parent group sessions, and were invited to join a professional-guided online community. Measurement of parents’ knowledge about ADHD, components of the TPB model, and child ADHD symptoms were taken before and after intervention. Medication adherence was assessed thoroughly at the end of the first and third months. Satisfaction with the psychoeducation program was assessed only in the intervention group. Two-independent-samples t-test, ANOVA, and chi-square test were employed to compare differences between groups. Results Compared to the control group, medication adherence in the intervention group was significantly higher after 1 and 3 months (97.7% intervention vs 75.6% control, P=0.002, and 86.4% intervention vs 53.3% control, P=0.001, respectively). Accordingly, the ADHD rating scale scores were lower in the intervention group than the control group after intervention (33.7±5.4 vs 45.1±7.9, P=0.008). Greater improvements in parents’ knowledge about ADHD and many components of the TPB model were observed in the intervention group, especially increased intention to adhere to medication, compared to the control group (P<0.001). Conclusion This psychoeducation program had a positive impact on both medication adherence and clinical symptoms of ADHD children. It could be considered as a potential beneficial supplement to clinical practice. PMID
Pinto, Sharrel L; Kumar, Jinender; Partha, Gautam; Bechtol, Robert A
Background The purpose of this study was to determine the cost savings of a pharmacist-led, employer-sponsored medication therapy management (MTM) program for diabetic patients and to assess for any changes in patient satisfaction and self-reported medication adherence for enrollees. Methods Participants in this study were enrollees of an employer-sponsored MTM program. They were included if their primary medical insurance and prescription coverage was from the City of Toledo, they had a diagnosis of type 2 diabetes, and whether or not they had been on medication or had been given a new prescription for diabetes treatment. The data were analyzed on a prospective, pre-post longitudinal basis, and tracked for one year following enrollment. Outcomes included economic costs, patient satisfaction, and self-reported patient adherence. Descriptive statistics were used to characterize the population, calculate the number of visits, and determine the mean costs for each visit. Friedman’s test was used to determine changes in outcomes due to the nonparametric nature of the data. Results The mean number of visits to a physician’s office decreased from 10.22 to 7.07. The mean cost of these visits for patients increased from $47.70 to $66.41, but use of the emergency room and inpatient visits decreased by at least 50%. Employer spending on emergency room visits decreased by $24,214.17 and inpatient visit costs decreased by $166,610.84. Office visit spending increased by $11,776.41. A total cost savings of $179,047.80 was realized by the employer at the end of the program. Significant improvements in patient satisfaction and adherence were observed. Conclusion Pharmacist interventions provided through the employer-sponsored MTM program led to substantial cost savings to the employer with improved patient satisfaction and adherence on the part of employees at the conclusion of the program. PMID:23610526
Pagesy, R; Soula, G; Fieschi, M
The World Wide Web (web) provides the same type of information to widely different users and these users must then find the information suitable for their use in the package offered. The authors present the DI2ADEM project designed to take the user into account and intended to provide this user with appropriate medical information. To do that, DI2ADEM is suggesting an adaptive hypermedia based on the management of a meta-knowledge of the user and a knowledge of the information that can be circulated. An adaptive hypermedia prototype devoted to paediatric oncology was implemented on the intranet network of a university hospital.
semantic barrier 17 , synonymy and polysemy . It also has some interesting w xproblems of its own 12,14,15 . The community of medical information users is...terms Ž .to seek identical information polysemy . Furnas et w xal. 10 , showed that the probability of two people using the same term to classify an...object was less than 20%. ( )A.L. Houston et al.rDecision Support Systems 30 2000 171–186 173 Because of these discrepancies, an exact match between
Mavis, Brian E; Wagner, Dianne P; Henry, Rebecca C; Carravallah, Laura; Gold, Jon; Maurer, Joel; Mohmand, Asad; Osuch, Janet; Roskos, Steven; Saxe, Andrew; Sousa, Aron; Prins, Vince Winkler
Introduction We operationalized the taxonomy developed by Hauer and colleagues describing common clinical performance problems. Faculty raters pilot tested the resulting worksheet by observing recordings of problematic simulated clinical encounters involving third-year medical students. This approach provided a framework for structured feedback to guide learner improvement and curricular enhancement. Methods Eighty-two problematic clinical encounters from M3 students who failed their clinical competency examination were independently rated by paired clinical faculty members to identify common problems related to the medical interview, physical examination, and professionalism. Results Eleven out of 26 target performance problems were present in 25% or more encounters. Overall, 37% had unsatisfactory medical interviews, with 'inadequate history to rule out other diagnoses' most prevalent (60%). Seventy percent failed because of physical examination deficiencies, with missing elements (69%) and inadequate data gathering (69%) most common. One-third of the students did not introduce themselves to their patients. Among students failing based on standardized patient (SP) ratings, 93% also failed to demonstrate competency based on the faculty ratings. Conclusions Our review form allowed clinical faculty to validate pass/fail decisions based on standardized patient ratings. Detailed information about performance problems contributes to learner feedback and curricular enhancement to guide remediation planning and faculty development.
Stoneking, LR; Waterbrook, AL; Garst Orozco, J; Johnston, D; Bellafiore, A; Davies, C; Nuño, T; Fatás-Cabeza, J; Beita, O; Ng, V; Grall, KH; Adamas-Rappaport, W
Background After emergency department (ED) discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit. Objectives To determine if integrating a longitudinal medical Spanish and cultural competency curriculum into emergency medicine residency didactics improves patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency. Methods Our ED has two Emergency Medicine Residency Programs, University Campus (UC) and South Campus (SC). SC program incorporates a medical Spanish and cultural competency curriculum into their didactics. Real-time Spanish surveys were collected at SC ED on patients who self-identified as primarily Spanish-speaking during registration and who were treated by resident physicians from both residency programs. Surveys assessed whether the treating resident physician communicated in the patient’s native Spanish language. Follow-up phone calls assessed patient satisfaction and adherence to discharge instructions. Results Sixty-three patients self-identified as primarily Spanish-speaking from August 2014 to July 2015 and were initially included in this pilot study. Complete outcome data were available for 55 patients. Overall, resident physicians spoke Spanish 58% of the time. SC resident physicians spoke Spanish with 66% of the patients versus 45% for UC resident physicians. Patients rated resident physician Spanish ability as very good in 13% of encounters – 17% for SC versus 5% for UC. Patient satisfaction with their ED visit was rated as very good in 35% of encounters – 40% for SC resident physicians versus 25% for UC resident physicians. Of the 13 patients for whom Spanish was the language used during the medical encounter who followed medical recommendations, ten (77%) of these encounters were with SC resident physicians
Priebe, Stefan; Bremner, Stephen A; Lauber, Christoph; Henderson, Catherine; Burns, Tom
BACKGROUND: Poor adherence to long-term antipsychotic injectable (LAI) medication in patients with psychotic disorders is associated with a range of negative outcomes. No psychosocial intervention has been found to be consistently effective in improving adherence. OBJECTIVES: To test whether or not offering financial incentives is effective and cost-effective in improving adherence and to explore patient and clinician experiences with such incentives. DESIGN: A cluster randomised controlled trial with economic and nested qualitative evaluation. The intervention period lasted for 12 months with 24 months' follow-up. The unit of randomisation was mental health teams in the community. SETTING: Community teams in secondary mental health care. PARTICIPANTS: Patients with a diagnosis of schizophrenia, schizoaffective psychosis or bipolar illness, receiving ≤ 75% of their prescribed LAI medication. In total, 73 teams with 141 patients (intervention n = 78 and control n = 63) were included. INTERVENTIONS: Participants in the intervention group received £15 for each LAI medication. Patients in the control group received treatment as usual. MAIN OUTCOME MEASURES: PRIMARY OUTCOME: adherence to LAI medication (the percentage of received out of those prescribed). SECONDARY OUTCOMES: percentage of patients with at least 95% adherence; clinical global improvement; subjective quality of life; satisfaction with medication; hospitalisation; adverse events; and costs. Qualitative evaluation: semistructured interviews with patients in the intervention group and their clinicians. RESULTS: PRIMARY OUTCOME: outcome data were available for 131 patients. Baseline adherence was 69% in the intervention group and 67% in the control group. During the intervention period, adherence was significantly higher in the intervention group than in the control group (85% vs. 71%) [adjusted mean difference 11.5%, 95% confidence interval (CI) 3.9% to 19.0%; p = 0.003]. Secondary outcome
Kahn, Laura H; von Hippel, Frank
Highly enriched uranium (HEU) is used to manufacture technetium-99m, the most widely used medical radioisotope in the world. Highly enriched uranium is also used to make nuclear bombs; 50 kg of HEU is enough to make a Hiroshima-type bomb. It is generally agreed that this technology is within the reach of a terrorist group; the main obstacle is acquiring HEU. Currently, as a legacy of the US and Soviet Atoms for Peace Program, there are civilian users of HEU in 40 countries, and about 1,000 kg are still being shipped each year. Unfortunately, the major international manufacturers of technetium-99m have been refusing to convert their production facilities to use low-enriched uranium (LEU), which cannot be used to make a nuclear bomb. Only 1% to 2% of the HEU is consumed in the process of producing technetium-99m. The remainder is accumulating in radioactive waste storage facilities. The radiologic and nuclear medical communities could make a tremendous contribution to a safer world by supporting the replacement of HEU with LEU in the production of technetium-99m. Low-enriched uranium is just as cost effective as HEU for the manufacture of technetium-99m and does not contribute to the risk for nuclear terrorism.
Landesman, Linda Young; Markowitz, Forest; Conde, Nelson
The limitation of medical intern and resident work hours, known as the Bell 405 regulations, was initiated in New York State in 1989 with a modification to the state hospital code. The Bell 405 regulations were strengthened in 2000, and facilities would now be fined for noncompliance. Monitoring systems in place at that time were insufficient to provide an adequate level of review for the New York City Health and Hospitals Corporation (HHC) with more than 7,000 medical residents whose training is based at or who rotate through these public hospitals. A "simple to use," yet comprehensive, method of monitoring compliance needed to be developed to ensure that residents and interns complied with laws regulating working hours. The subsequent development of national accreditation standards increased the stakes for reliable scrutiny. HHC developed and implemented a Web-based Structured Query Language (SQL) application that facilitated easy access to work hour surveys captured through electronic time sheets. The time sheet data automatically entered a database that provided instant analysis of conformance to state law. The development of an electronic on-line application accessible from anywhere allowed HHC to efficiently identify nonconformance and pinpoint corrective action. Since the inception of the application and its expansion allowing access through the intranet, 26,000 individual time sheets have been submitted for evaluation. With the national movement regulating work hours, other hospitals still at the pencil and manual computation stage would greatly benefit by developing a similar application.
Yin, Lim Khai; Rajeswari, Mandava
To segment an image using the random walks algorithm; users are often required to initialize the approximate locations of the objects and background in the image. Due to its segmenting model that is mainly reflected by the relationship among the neighborhood pixels and its boundary conditions, random walks algorithm has made itself sensitive to the inputs of the seeds. Instead of considering the relationship between the neighborhood pixels solely, an attempt has been made to modify the weighting function that accounts for the intensity changes between the neighborhood nodes. Local affiliation within the defined neighborhood region of the two nodes is taken into consideration by incorporating an extra penalty term into the weighting function. Besides that, to better segment images, particularly medical images with texture features, GLCM variance is incorporated into the weighting function through kernel density estimation (KDE). The probability density of each pixel belonging to the initialized seeds is estimated and integrated into the weighting function. To test the performance of the proposed weighting model, several medical images that mainly made up of 174-brain tumor images are experimented. These experiments establish that the proposed method produces better segmentation results than the original random walks.
Allen, Molly; Garman, Andrew; Johnson, Tricia; Hohmann, Samuel; Meurer, Steve
President Obama announced the National Export Initiative in his 2010 State of the Union address and set the ambitious goal of doubling US exports by the end of 2014 to support millions of domestic jobs. Understanding the competitive position of US health care in the global market for international patients, University Health System Consortium (UHC), an alliance of 116 academic medical centers and 272 of their affiliated hospitals, representing 90 percent of the nation's non-profit academic medical centers partnered with Rush University, a private University in Chicago, IL and the International Trade Administration of the US Department of Commerce International Trade Administration (ITA) to participate in the Market Development Cooperator Program. The goal of this private-public partnership is to increase the global competitiveness of the US health care industry, which represents over 16 percent of the GDP, amongst foreign health care providers. This article provides an overview of the US health care market and outlines the aims of the US Cooperative for International Patient Programs, the end result of the partnership between UHC, ITA and Rush University.
Schultz, Karen; Scott, Abigail; Pollock, Emily; Kotecha, Jyoti; Martin, Danyal
Problem An emerging priority in medical education is the need to facilitate learners’ acquisition of quality improvement (QI) competencies. Accreditation bodies in both Canada and the United States have included QI and patient safety in their core competencies. Approach In 2010, the Department of Family Medicine at Queen’s University designed a graduate medical education curriculum to engage residents in a clinical QI program that would meet accreditation requirements. Monthly didactic sessions were combined with an experiential, team-based QI project that aligned with existing clinic priorities. The curriculum spans the first year of residency and is divided into three stages: (1) Engaging, (2) Understanding, and (3) Improving and translating. In Stage 1, teams of residents select a clinical QI topic, engage stakeholders, and collect baseline data related to their topic. In Stage 2, they focus on understanding their problem, interpreting their results, and applying QI tools. In Stage 3, they develop change ideas, translate their knowledge, and prepare to hand over their project. Outcomes This QI curriculum aided residents in effectively acquiring QI competencies and allowed them to experience real-world challenges, such as securing project buy-in, negotiating with peers, and developing solutions to problems. Unlike in many QI programs, residents learned how to improve quality rather than about QI; thus, they formed the necessary foundation to carry out QI work in the future. Next Steps The curriculum will be evaluated using a knowledge assessment and satisfaction tool and postproject resident interviews. Facilitators will focus more on improving faculty develop ment in QI. PMID:26200583
Golemboski, Karen; Otto, Catherine N; Morris, Susan
In order to contribute to improved healthcare quality through patient-centered care, laboratory professionals at all levels of practice must be able to recognize the connection between non-analytical factors and laboratory analysis, in the context of patient outcomes and quality improvement. These practices require qualities such as critical thinking (CT), teamwork skills, and familiarity with the quality improvement process, which will be essential for the development of evidence-based laboratory science practice. Performance tasks (PT) are an educational strategy which can be used to teach and assess CT and teamwork, while introducing Medical Laboratory Science (MLS) students at both baccalaureate and advanced-practice levels to the concepts of quality improvement processes and patient outcomes research. PT presents students with complex, realistic scenarios which require the incorporation of subject-specific knowledge with competencies such as effective team communication, patient-centered care, and successful use of information technology. A PT with assessment rubric was designed for use in a baccalaureate-level MLS program to teach and assess CT and teamwork competency. The results indicated that, even when students were able to integrate subject-specific knowledge in creative ways, their understanding of teamwork and quality improvement was limited. This indicates the need to intentionally teach skills such as collaboration and quality system design. PT represent one of many strategies that may be used in MLS education to develop essential professional competencies, encourage expert practice, and facilitate quality improvement.
Duda, Catherine; Rajaram, Kumar; Barz, Christiane; Rosenthal, J Thomas
There has been an increasing emphasis on health care efficiency and costs and on improving quality in health care settings such as hospitals or clinics. However, there has not been sufficient work on methods of improving access and customer service times in health care settings. The study develops a framework for improving access and customer service time for health care settings. In the framework, the operational concept of the bottleneck is synthesized with queuing theory to improve access and reduce customer service times without reduction in clinical quality. The framework is applied at the Ronald Reagan UCLA Medical Center to determine the drivers for access and customer service times and then provides guidelines on how to improve these drivers. Validation using simulation techniques shows significant potential for reducing customer service times and increasing access at this institution. Finally, the study provides several practice implications that could be used to improve access and customer service times without reduction in clinical quality across a range of health care settings from large hospitals to small community clinics.
Noonan, John; Walters, Dean; Virgo, Matt; Lewellen, John
A method and isotope linac system are provided for producing radio-isotopes and for recovering isotopes. The isotope linac is an energy recovery linac (ERL) with an electron beam being transmitted through an isotope-producing target. The electron beam energy is recollected and re-injected into an accelerating structure. The ERL provides improved efficiency with reduced power requirements and provides improved thermal management of an isotope target and an electron-to-x-ray converter.
We describe the discovery of the trigemino-cardiac reflex by Schaller in 1999 and the continued improvement of the knowledge about the trigemino-cardiac reflex involved in neurosurgery, especially in skull base surgery, during the past several years. The achieved medical progress could be gained only by the practical experience described by different case reports and later case series that have been published in several principal scientific journals. Additionally, we explain the scientific as well as clinical importance of the communication of the case reports on TCR. Special reference has been given to the validity of the case reports for new phenomena in clinical medicine. PMID:21496216
Harris, Mary Sadama
This research sought to determine whether and how current local and national curricular mandates affect the science instruction of two exemplary Alabama elementary teachers. The study provides a description of the contextual backdrop of elementary teaching in Alabama and the curricular mandates resulting from federal legislation entitled The No Child Left Behind Act of 2001 that have been enacted across the state of Alabama. This study centers on the evolution of reform initiatives that impact the teaching of science in elementary schools. These reforms focus on student achievement, teacher accountability, subject matter testing, and federal legislation. The emphasis on accountability has created situations where teachers are, in any given year, faced with multiple program innovations focused on subject matter tested leaving other subjects areas such as science excluded from the curricula. Reform initiatives influential to this research were the Alabama Reading Initiative and Alabama's State Department of Education's mandated testing and progress monitoring of the Dynamic Indicators of Basic Early Literacy Skills (DIBELS) and how these reforms impact the elementary day and science instruction. The purpose of this research, which utilized a qualitative multiple case study design, was to understand how exemplary elementary science teachers in Alabama teach science given the curricular mandates that marginalize science instructional time. The central phenomenon centered on the curricular adaptations and negotiations teachers made in order to teach science. Data collected included classroom observations, semi-structured interviews, and artifacts. An inductive, interpretative approach to data analysis was used to allow for exploration of the sociocultural and sociopolitical influences on science teaching of these exemplary elementary teachers. Findings were constructed as narrative portraitures of each teacher and their science teaching bounded within their unique
Crandall, Sonia J. S.; Reboussin, Beth A.; Michielutte, Robert; Anthony, Jennie E.; Naughton, Michelle J.
Medical education has been shown to negatively influence student attitudes toward certain types of patient populations. Past research does not inform current educational practice because today's medical school environment is different from when most of the published research was conducted. There are more female students, curricular innovations…
Dadkhah, Mehdi; Seno, Seyed Amin Hosseini; Borchardt, Glenn
At the moment, scholarly publishing is faced with much academic misconduct and threats such as predatory journals, hijacked journals, phishing, and other scams. In response, we have been discussing this misconduct and trying to increase the awareness of researchers, but it seems that there is a lack of research that presents guidelines for editors to help them protect themselves against these threats. It seems that information security is missing in some parts of scholarly publishing that particularly involves medical journals. In this paper, we explain different types of cyber-attacks that especially threaten editors and academic journals. We then explain the details involved in each type of attack. Finally, we present general guidelines for detection and prevention of the attacks. In some cases, we use small experiments to show that our claim is true. Finally, we conclude the paper with a prioritization of these attacks.
Khanna, Vivek; Gao, Robert X.
Ultrasonic transducers having curved radiating surfaces may offer a simple solution to maintaining good lateral resolution over the large depth of field required in medical imaging. In this paper the design considerations for such a transducer that consists of a cylindrical metal housing and an ultrasonic wave generating piezoceramic disc is presented. The mechanism of focusing the radiated ultrasonic wave is studied by changing the geometry of the front surface of the metal housing. The propagation of ultrasonic wave in the surrounding medium is analyzed using the impulse response approach for the near field region and Fraunhofer's approximation for the far field. In addition, modal analysis of the transducer structure is conducted using the finite element method. The results obtained show that the geometry of the transducer housing has significant effects on the radiation characteristics of the transducer.
Bishop, Tara F.; Federman, Alex D.; Ross, Joseph S.
Objective To determine the prevalence of physician incentives for quality and to test the hypothesis that quality of ambulatory medical care is better by physicians with these incentives. Study Design Cross-sectional study using data from the National Ambulatory Medical Care Survey Method We examined the association between physician compensation based on quality, physician compensation based on satisfaction, and public reporting of practice measures and twelve measures of high quality ambulatory care. Results Overall, 20.8% of visits were to physicians whose compensation was partially based on quality, 17.7% of visits were to physicians whose compensation was partially based on patient satisfaction, and 10.0% of visits were to physicians who publicly reported performance measures. Quality of ambulatory care varied: weight reduction counseling occurred in 12.0% of preventative care visits by obese patients whereas urinalysis was not performed in 93.0% of preventative care visits. In multivariable analyses, there were no statistically significant associations between compensation for quality and delivery of any of the 12 measures, nor between compensation for satisfaction and 11 of the 12 measures; the exception was BMI screening in preventative visits (47.8% vs. 56.2%, adjusted p=0.004). There was also no statistically significant association between public reporting and delivery of 11 of 12 measures; the exception was weight reduction counseling for overweight patients (10.0% vs. 25.5%, adjusted p=0.01). Conclusions We found no consistent association between incentives for quality and 12 measures of high quality ambulatory care. PMID:22554038
Neuner-Jehle, Stefan; Schmid, Margareta; Grüninger, Ueli
Health related behaviour is a main determinant of chronic disease. Family physicians have an important role in the support of patients to improve their health behaviour, but relevant barriers should be addressed. In the new "Health Coaching KHM" program, patients and physicians are working as a team in four steps (sensitize - create motivation - plan - act). In this process, physicians' communication skills (which are trained within the program) are of utmost importance. In a pilot study with 20 family physicians and 1045 patients acceptance and feasibility were excellent: Every second participant improved her or his behaviour in the area of choice by at least one (of two possible) categories. For dissemination improving framework is crucial.
Blayney, Douglas W
The Donabedian definition of quality—structure, process, and outcome—provides a useful framework. A relentless focus on measuring process adherence and outcome is critical. Systemic improvements usually require teams to plan and to implement them. The lean or Toyota production system for process improvement is one useful method of organizing work, although different approaches are often necessary at the physician, practice unit, and statewide level. Challenges include scalability of the change (ie, rolling them out across the institution or system), tailoring the information technology tools, and building systems for sustainability.
Ouslander, Joseph G.; Bonner, Alice; Herndon, Laurie; Shutes, Jill
INTERACT is a publicly available quality improvement program that focuses on improving the identification, evaluation, and management of acute changes in condition of nursing home residents. Effective implementation has been associated with substantial reductions in hospitalization of nursing home residents. Familiarity with and support of program implementation by medical directors and primary care clinicians in the nursing home setting are essential to effectiveness and sustainability of the program over time. In addition to helping nursing homes prevent unnecessary hospitalizations and their related complications and costs, and thereby continuing to be or becoming attractive partners for hospitals, health care systems, managed care plans, and ACOs, effective INTERACT implementation will assist nursing homes in meeting the new requirement for a robust QAPI program which is being rolled out by the federal government over the next year. PMID:24513226
Stults, Cheryl D; McCuistion, Mary H; Frosch, Dominick L; Hung, Dorothy Y; Cheng, Peter H; Tai-Seale, Ming
The Affordable Care Act has extended coverage for uninsured and underinsured Americans, but it could exacerbate existing problems of access to primary care. Shared medical appointments (SMAs) are one way to improve access and increase practice productivity, but few studies have examined the patient's perspective on participation in SMAs. To understand patient experiences, 5 focus group sessions were conducted with a total of 30 people in the San Francisco Bay Area. The sessions revealed that most participants felt that they received numerous tangible and intangible benefits from SMAs, particularly enhanced engagement with other patients and physicians, learning, and motivation for health behavior change. Most importantly, participants noted changes in the power dynamic during SMA visits as they increasingly saw themselves empowered to impart information to the physician. Although SMAs improve access, engagement with physicians and other patients, and knowledge of patients' health, they also help to ease the workload for physicians.
Technical, February 1991. 5. " Poka - Yoke , Improving Product Quality by Preventing Defects," English Trans-ation, 1988, Productivity, Inc., Edited by NKS...Source Inspection and the Poka - Yoke System, English Translation, Productiv- ity, Inc., p. v (preface), 1986. 58 INITIAL DISTRIBUTION LIST No. of
Krasowski, Matthew D.; Schriever, Andy; Mathur, Gagan; Blau, John L.; Stauffer, Stephanie L.; Ford, Bradley A.
Background: Pathology data contained within the electronic health record (EHR), and laboratory information system (LIS) of hospitals represents a potentially powerful resource to improve clinical care. However, existing reporting tools within commercial EHR and LIS software may not be able to efficiently and rapidly mine data for quality improvement and research applications. Materials and Methods: We present experience using a data warehouse produced collaboratively between an academic medical center and a private company. The data warehouse contains data from the EHR, LIS, admission/discharge/transfer system, and billing records and can be accessed using a self-service data access tool known as Starmaker. The Starmaker software allows users to use complex Boolean logic, include and exclude rules, unit conversion and reference scaling, and value aggregation using a straightforward visual interface. More complex queries can be achieved by users with experience with Structured Query Language. Queries can use biomedical ontologies such as Logical Observation Identifiers Names and Codes and Systematized Nomenclature of Medicine. Result: We present examples of successful searches using Starmaker, falling mostly in the realm of microbiology and clinical chemistry/toxicology. The searches were ones that were either very difficult or basically infeasible using reporting tools within the EHR and LIS used in the medical center. One of the main strengths of Starmaker searches is rapid results, with typical searches covering 5 years taking only 1–2 min. A “Run Count” feature quickly outputs the number of cases meeting criteria, allowing for refinement of searches before downloading patient-identifiable data. The Starmaker tool is available to pathology residents and fellows, with some using this tool for quality improvement and scholarly projects. Conclusion: A data warehouse has significant potential for improving utilization of clinical pathology testing. Software
Hina-Syeda, Hussaini; Kimbrough, Christina; Murdoch, William; Markova, Tsveti
Background Quality improvement education and work in interdisciplinary teams is a healthcare priority. Healthcare systems are trying to meet core measures and provide excellent patient care, thus improving their Hospital Consumer Assessment of Healthcare Providers & Systems scores. Crittenton Hospital Medical Center in Rochester Hills, MI, aligned educational and clinical objectives, focusing on improving immunization rates against pneumonia and influenza prior to the rates being implemented as core measures. Improving immunization rates prevents infections, minimizes hospitalizations, and results in overall improved patient care. Teaching hospitals offer an effective way to work on clinical projects by bringing together the skill sets of residents, faculty, and hospital staff to achieve superior results. Methods We designed and implemented a structured curriculum in which interdisciplinary teams acquired knowledge on quality improvement and teamwork, while focusing on a specific clinical project: improving global immunization rates. We used the Lean Six Sigma process tools to quantify the initial process capability to immunize against pneumococcus and influenza. Results The hospital's process to vaccinate against pneumonia overall was operating at a Z score of 3.13, and the influenza vaccination Z score was 2.53. However, the process to vaccinate high-risk patients against pneumonia operated at a Z score of 1.96. Improvement in immunization rates of high-risk patients became the focus of the project. After the implementation of solutions, the process to vaccinate high-risk patients against pneumonia operated at a Z score of 3.9 with a defects/million opportunities rate of 9,346 and a yield of 93.5%. Revisions to the adult assessment form fixed 80% of the problems identified. Conclusions This process improvement project was not only beneficial in terms of improved quality of patient care but was also a positive learning experience for the interdisciplinary team
Zhang, Xiaoli; Zou, Jie; Le, Daniel X.; Thoma, George R.
Investigators are people who are listed as members of corporate organizations but not entered as authors in an article. Beginning with journals published in 2008, investigator names are required to be included in a new bibliographic field in MEDLINE citations. Automatic extraction of investigator names is necessary due to the increase in collaborative biomedical research and consequently the large number of such names. We implemented two discriminative SVM models, i.e., SVM and structural SVM, to identify named entities such as the first and last names of investigators from online medical journal articles. Both approaches achieve good performance at the word and name chunk levels. We further conducted an error analysis and found that SVM and structural SVM can offer complementary information about the patterns to be classified. Hence, we combined the two independently trained classifiers where the SVM is chosen as a base learner with its outputs enhanced by the predictions from the structural SVM. The overall performance especially the recall rate of investigator name retrieval exceeds that of the standalone SVM model.
Jester; Wittgrove; Clark
BACKGROUND: Patients who undergo bariatric surgery sometimes experience late onset or weight gain, when they lapse into negative eating patterns, which adversely affect weight management. Long-term weight management is a process, with a surgical foundation, and requiring adjunctive strategies for best results. We sought to determine if appetite suppressant medications could be safely incorporated into a comprehensive program of weight management. METHODS: Subjects were at least 18 months postoperative, were accessible for weekly follow-up, and weighed at least 9 kg more than their ideal body weight. Phentermine and fenfluramine were prescribed in combination, at the lowest dose necessary to achieve comfortable appetite suppression. RESULTS: Weight losses ranged from 4.5 to 22.7 kg, over a 12-week course of treatment, corresponding to 8-65% of excess body weight. Most side-effects were minor, and did not require cessation of treatment. Two patients discontinued treatment due to side-effects which were unacceptable to them. CONCLUSION: Phentermine and fenfluramine are a safe and useful adjunct to a comprehensive program of weight management.
Selvi, Eşref; Selver, M. Alper; Güzeliş, Cüneyt; Dicle, Oǧuz
Segmentation of anatomical structures from medical image series is an ongoing field of research. Although, organs of interest are three-dimensional in nature, slice-by-slice approaches are widely used in clinical applications because of their ease of integration with the current manual segmentation scheme. To be able to use slice-by-slice techniques effectively, adjacent slice information, which represents likelihood of a region to be the structure of interest, plays critical role. Recent studies focus on using distance transform directly as a feature or to increase the feature values at the vicinity of the search area. This study presents a novel approach by constructing a higher order neural network, the input layer of which receives features together with their multiplications with the distance transform. This allows higher-order interactions between features through the non-linearity introduced by the multiplication. The application of the proposed method to 9 CT datasets for segmentation of the liver shows higher performance than well-known higher order classification neural networks.
O'Hare, Dennis; Kudrle, Venetia
Comments on the 2004 survey identified that physicians thought it was too early to judge whether the new structure itself was successful. This year, the survey will be repeated to measure the effectiveness of the new structure and to help administrators set goals to further improve physician engagement levels. Meanwhile, Mercy & Unity is using the tenets of the physician compact, elements of physician culture, and elements of administrative culture to inform new process-improvement activities. More study is needed to identify whether Mercy & Unity's techniques of reorganization contributed to the higher rates of physician satisfaction and engagement, but it is our belief that incorporating physician cultural norms into the process helped prevent the change process from turning the horse into the proverbial camel.
Hall, Ian; Shah, Amar; Thomson, Helen
Adherence with antipsychotic monitoring guidelines is notoriously low nationally. Without active monitoring and measures to improve metabolic abnormalities, more patients may develop related morbidity and mortality. An audit highlighted antipsychotic monitoring in this learning disability service in London did not match guideline recommendations. People with intellectual disability also experience health inequalities. Psychiatrists are well placed to provide advice and assistance that is suitable for those with complex communication, behaviour, and social needs. The QI team tested ideas to increase rates of antipsychotic reviews. The focus was the follow up monitoring of all universal measures recommended by NICE 2014, collected at 2-weekly intervals. We trialled interventions in four broad categories; Intervention 1: to make monitoring more structured and planned; Intervention 2: to increase staff and patient awareness of healthy eating and exercise programs; Intervention 3: to increase the collection of diet and exercise histories from patients; Intervention 4: to improve the uptake of blood tests. The interventions created an improvement in monitoring. There are lessons in the methodology for others carrying out similar projects. PMID:27335645
Southwick, Frederick; Katona, Peter; Kauffman, Carol; Monroe, Sara; Pirofski, Liise-anne; del Rio, Carlos; Gallis, Harry; Dismukes, William
Preclinical microbiology and infectious diseases courses too often primarily depend on PowerPoint lectures and notes, combined with multiple-choice tests, as their primary teaching tools. This strategy sets low expectations for students, encouraging short-term memory and discouraging understanding and long-term memory. These methods also fail to stimulate active participation, collaborative learning, and two-way communication with the professor, and they do not respect the students' diverse talents and ways of learning. The Infectious Diseases Society of America Preclinical Curriculum Committee proposes a new approach that emphasizes active learning and understanding and that addresses all of these failures. It consists of five components: (1) "Just-in-time" teaching that requires students to e-mail the answers to two general questions as well as any areas of misunderstanding to the instructor several hours before each lecture, (2) peer instruction or large-group sessions consisting of student teams of four who electronically answer a conceptual question before each major section of the lecture, (3) teaching from edited textbooks and Internet sources, (4) small-group discussions that emphasize pathogenesis and differential diagnosis, and (5) essay questions that encourage and test understanding in addition to recognition. A national consensus on factual content is proposed, with the goals of reducing information overload and minimizing requirements for excessive memorization. These strategies promise to enhance learning and rekindle interest in the field of infectious diseases. Other subspecialty organizations should create similar teaching guidelines that will encourage future medical students to bring a richer understanding of clinical and basic science to the bedside.
NASA's vision for space exploration (February 2004) calls for development of a new crew exploration vehicle, sustained lunar operations, and human exploration of Mars. To meet the challenges of planned sustained operations as well as the limited communications between Earth and the crew (e.g., Mars exploration), many systems will require crews to operate in an autonomous environment. It has been estimated that once every 2.4 years a major medical issue will occur while in space. NASA's future travels, especially to Mars, will begin to push this timeframe. Therefore, now is the time for investigating technologies and systems that will support crews in these environments. Therefore, this summer two studies were conducted to evaluate the technology and systems that may be used by crews in future missions. The first study evaluated three commercial Indoor Positioning Systems (IPS) (Versus, Ekahau, and Radianse) that can track equipment and people within a facility. While similar to Global Positioning Systems (GPS), the specific technology used is different. Several conclusions can be drawn from the evaluation conducted, but in summary it is clear that none of the systems provides a complete solution in meeting the tracking and technology integration requirements of NASA. From a functional performance (e.g., system meets user needs) evaluation perspective, Versus performed fairly well on all performance measures as compared to Ekahau and Radianse. However, the system only provides tracking at the room level. Thus, Versus does not provide the level of fidelity required for tracking assets or people for NASA requirements. From an engineering implementation perspective, Ekahau is far simpler to implement that the other two systems because of its wi-fi design (e.g., no required runs of cable). By looking at these two perspectives, one finds there was no clear system that met NASA requirements. Thus it would be premature to suggest that any of these systems are ready for
Cunningham, David D; Lowery, Michael G
Attachment of a small, medical device to the human body for an extended period of time in an ambulatory setting requires the careful consideration of the physical form of the device and the physiological constraints limiting the time a device will stay on the skin. Factors such as the size of the device, the area of the device available for attachment to the skin, and the occlusive nature of the materials in the device are likely to affect adhesion. Here, plastic acrylic disks, 25 mm in diameter, containing a crisscross pattern of air-filled channels were tested on the forearm and abdomen using a moderately aggressive, unsupported, pressure-sensitive transfer adhesive in a pilot human clinical study. After vigorous exercise, droplets of moisture were observed in the channels followed by evaporation of the droplets over time. Disks without channels remained attached to the skin for about a day and a half, while disks containing 450 microm deep channels remained on the skin about three times longer. Little difference was found when the channel-to-channel spacing was increased from 1.3 to 1.6 mm, however 230 microm deep channels were less effective than 450 microm deep channels. Overall, the moisture vapor transport channels appear capable of reducing the moisture content of the outermost stratum corneum layer of the skin, increasing the strength of the stratum corneum, and increasing the time a device remains attached to the skin. The median trial-to-trial relative standard deviation of 45% observed in the pilot study can be used to design appropriately powered studies for the comparison of different device designs.
Background Preparing medical students for the takeover or the start-up of a medical practice is an important challenge in Germany today. Therefore, this paper presents a computer-aided serious game (eMedOffice) developed and currently in use at the RWTH Aachen University Medical School. The game is part of the attempt to teach medical students the organizational and conceptual basics of the medical practice of a general practitioner in a problem-based learning environment. This paper introduces methods and concepts used to develop the serious game and describes the results of an evaluation of the game's application in curricular courses at the Medical School. Results Results of the conducted evaluation gave evidence of a positive learning effect of the serious game. Educational supervisors observed strong collaboration among the players inspired by the competitive gaming aspects. In addition, an increase in willingness to learn and the exploration of new self-invented ideas were observed and valuable proposals for further prospective enhancements were elicited. A statistical analysis of the results of an evaluation provided a clear indication of the positive learning effect of the game. A usability questionnaire survey revealed a very good overall score of 4.07 (5=best, 1=worst). Conclusions We consider web-based, collaborative serious games to be a promising means of improving medical education. The insights gained by the implementation of eMedOffice will promote the future development of more effective serious games for integration into curricular courses of the RWTH Aachen University Medical School. PMID:23110606
Gual, Arcadi; Escaneroi, Jesus; Tomás, Inmaculada; Rodríguez de Castro, Felipe; Elorudy, Marta; Virumbrales, Montserrat; Rodríguez, Gerardo; Arce, Victor
Objectives The purpose of this study was to investigate student's perceptions of Educational Climate (EC) in Spanish medical schools, comparing various aspects of EC between the 2nd (preclinical) and the 4th (clinical) years to detect strengths and weaknesses in the on-going curricular reform. Methods This study utilized a cross-sectional design and employed the Spanish version of the "Dundee Ready Education Environment Measure" (DREEM). The survey involved 894 2nd year students and 619 4th year students from five Spanish medical schools. Results The global average score of 2nd year students from the five medical schools was found to be significantly higher (116.2±24.9, 58.2% of maximum score) than that observed in 4th year students (104.8±29.5, 52.4% of maximum score). When the results in each medical school were analysed separately, the scores obtained in the 2nd year were almost always significantly higher than in the 4th year for all medical schools, in both the global scales and the different subscales. Conclusions The perception of the EC by 2nd and 4th year students from five Spanish medical schools is more positive than negative although it is significantly lower in the 4th year. In both years, although more evident in the 4th year, students point out the existence of several important "problematic educational areas" associated with the persistence of traditional curricula and teaching methodologies. Our findings of this study should lead medical schools to make a serious reflection and drive the implementation of the necessary changes required to improve teaching, especially during the clinical period. PMID:26057355
Maldiney, Thomas; Lecointre, Aurélie; Viana, Bruno; Bessière, Aurélie; Gourier, Didier; Bessodes, Michel; Richard, Cyrille; Scherman, Daniel
Regarding its ability to circumvent the autofluorescence signal, persistent luminescence was recently shown to be a powerful tool for in vivo imaging and diagnosis applications in living animal. The concept was introduced with lanthanide-doped persistent luminescence nanoparticles (PLNP), from a lanthanide-doped silicate host Ca0.2Zn0.9Mg0.9Si2O6:Eu2+, Mn2+, Dy3+ emitting in the near-infrared window. In order to improve the behaviour of these probes in vivo and favour diagnosis applications, we showed that biodistribution could be controlled by varying the hydrodynamic diameter, but also the surface charges and functional groups. Stealth PLNP, with neutral surface charge obtained by polyethylene glycol (PEG) coating, can circulate for longer time inside the mice body before being uptaken by the reticulo-endothelial system. However, the main drawback of this first generation of PLNP was the inability to witness long-term monitoring, mainly due to the decay kinetic after several decades of minutes, unveiling the need to work on new materials with improved optical characteristics. We investigated a modified silicate host, diopside CaMgSi2O6, and increased its persistent luminescence properties by studying various Ln3+ dopants (for instance Ce, Pr, Nd, Tm, Ho). Such dopants create electron traps that control the long lasting phosphorescence (LLP). We showed that Pr3+ was the most suitable Ln3+ electron trap in diopside lattice, providing optimal trap depth, and resulting in the most intense luminescence decay curve after UV irradiation. A novel composition CaMgSi2O6:Eu2+,Mn2+,Pr3+ was obtained for in vivo imaging, displaying a strong near-infrared persistent luminescence centred on 685 nm, allowing improved and sensitive detection through living tissues.
Linn, Annemiek J; van Weert, Julia C M; de Bakker, Dinny H; Bouvy, Marcel L; van Dijk, Liset
Background Many patients experience difficulties in adhering to long-term treatment. Although patients' reasons for not being adherent are diverse, one of the most commonly reported barriers is forgetfulness. Reminding patients to take their medication may provide a solution. Electronic reminders (automatically sent reminders without personal contact between the healthcare provider and patient) are now increasingly being used in the effort to improve adherence. Objective To examine the effectiveness of interventions using electronic reminders in improving patients' adherence to chronic medication. Methods A comprehensive literature search was conducted in PubMed, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials. Electronic searches were supplemented by manual searching of reference lists and reviews. Two reviewers independently screened all citations. Full text was obtained from selected citations and screened for final inclusion. The methodological quality of studies was assessed. Results Thirteen studies met the inclusion criteria. Four studies evaluated short message service (SMS) reminders, seven audiovisual reminders from electronic reminder devices (ERD), and two pager messages. Best evidence synthesis revealed evidence for the effectiveness of electronic reminders, provided by eight (four high, four low quality) studies showing significant effects on patients' adherence, seven of which measured short-term effects (follow-up period <6 months). Improved adherence was found in all but one study using SMS reminders, four studies using ERD and one pager intervention. In addition, one high quality study using an ERD found subgroup effects. Conclusion This review provides evidence for the short-term effectiveness of electronic reminders, especially SMS reminders. However, long-term effects remain unclear. PMID:22534082
Padderatz, A Y
As military treatment facility leaders become more knowledgeable regarding apportionment of resources, decision making involving primary family member support services must be clear and concise. Continuing in its effort to meet the maternal and child health care expectations of its patients, a large military treatment facility command instituted several changes to consolidate its maternal and newborn services. This article presents findings and outcomes of actions taken in support of quality improvement and efficient use of budgetary resources to maximize patient satisfaction and bring about cost savings.
International learning mobility is a strategic and operational priority for both the federal government and the majority of universities in Australia. Dating back over a decade, successive governments have stressed the public good to be derived from having an increased proportion of students participating in mobility programs. It is seen as…
Amedee, Ronald G.; Maronge, Genevieve F.; Pinsky, William W.
Background Patient transfers from other hospitals within the Ochsner Health System to the main campus are coordinated through a Transfer Center that was established in fall 2008. We analyzed the transfer process to assess distinct opportunities to enhance the overall transition of patient care. Methods We surveyed internal medicine residents and nocturnists to determine their satisfaction with transfers in terms of safety, efficiency, and usefulness of information provided at the time of transfer. After a kaizen event at which complementary goals for the institution and members of the study team were recognized and implemented, we resurveyed the group to evaluate improvement in the transfer process. Results The preintervention average satisfaction score was 1.18 (SD=0.46), while the postintervention score was 3.7 (SD=1.01). A t test showed a significant difference in the average scores between the preintervention and postintervention surveys (P<0.0001). Conclusions By including residents in the transfer calls (a result of the kaizen event), data were collected that facilitated fewer and higher quality handoffs that were performed in less time. In addition, the process resulted in increased awareness of the value of resident participation in institutional quality improvement projects. PMID:23267257
Wang, Amy T.; Sandhu, Nicole P.; Wittich, Christopher M.; Mandrekar, Jayawant N.; Beckman, Thomas J.
Objective To determine continuing medical education (CME) course participants' use of social media (SM) and their attitudes about the value of SM for enhancing CME education and to examine associations between participants' characteristics and attitudes toward SM. Participants and Methods We conducted a cross-sectional survey and validation study of 539 participants at a Mayo Clinic Internal Medicine CME course in November 2011. The Social Media Use and Perception Instrument (SMUPI) consisted of 10 items (5-point Likert scales) and categorical response options. The main outcome measures were psychometric characteristics of the SMUPI scale, course participants' use of SM, and their attitudes regarding the importance of SM for enhancing CME. Results Of 539 CME course participants, 327 (61%) responded to the SMUPI survey. Most respondents (291 [89%]) reported using SM, with the most common types being YouTube (189 of the 327 participants [58%]) and Facebook (163 of 327 [50%]). Factor analysis revealed a 2-dimensional assessment of course participants' attitudes. Internal consistency reliability (Cronbach α) was excellent for factor 1 (0.94), factor 2 (0.89), and overall (0.94). The CME course participants' favorable attitudes toward SM were associated with younger age (20-29 years, mean score 3.13; 30-39 years, 3.40; 40-49 years, 3.39; 50-59 years, 3.18; 60-69 years, 2.93; and ≥70 years, 2.92; P=.02), using SM frequently (never, mean score 2.49; less than once monthly, 2.75; once monthly, 3.21; weekly, 3.31; and daily, 3.81; P<.0001), and professional degree (PhD, mean score 3.00; MD, 3.05; DO, 3.35; PA, 3.42; and NP, 3.50; P=.01). Conclusion We describe the first validated measure of CME course participants' use of and attitudes toward SM. Our results suggest that CME course directors should guide SM strategies toward more youthful, technology-savvy CME participants and that SM will become increasingly worthwhile in CME as younger learners continue to enter the
Keijsers, Carolina J P W; Segers, Wieke S; de Wildt, Dick J; Brouwers, Jacobus R B J; Keijsers, Loes; Jansen, Paul A F
Aim The only validated tool for pharmacotherapy education for medical students is the 6-step method of the World Health Organization. It has proven effective in experimental studies with short term interventions. The generalizability of this effect after implementation in a contextual-rich medical curriculum was investigated. Methods The pharmacology knowledge and pharmacotherapy skills of cohorts of students, from years before, during and after implementation of a WHO-6-step-based integrated learning programme were tested using a standardized assessment containing 50 items covering knowledge of basic (n = 25) and clinical (n = 24) pharmacology, and pharmacotherapy skills (n = 1 open question). All scores are expressed as a percentage of the maximum score possible per (sub)domain. Results In total, 1652 students were included between September 2010 and July 2014 (participation rate 89%). The WHO-6-step-based learning programme improved students’ knowledge of basic pharmacology (mean score ± SD, 60.6 ± 10.5% vs. 63.4 ± 10.9%, P < 0.01) and clinical or applied pharmacology (63.7 ± 10.4% vs. 67.4 ± 10.3%, P < 0.01), and improved their pharmacotherapy skills (68.8 ± 26.1% vs. 74.6% ± 22.9%, P 0.02). Moreover, satisfaction with education increased (5.7 ± 1.3 vs. 6.3 ± 1.0 on a 10-point scale, P < 0.01) and as did students’ confidence in daily practice (from −0.81 ± 0.72 to −0.50 ± 0.79 on a −2 to +2 scale, P < 0.01). Conclusions The WHO-6-step method was successfully implemented in a medical curriculum. In this observational study, the integrated learning programme had positive effects on students’ knowledge of basic and applied pharmacology, improved their pharmacotherapy skills, and increased satisfaction with education and self-confidence in prescribing. Whether this training method leads to better patient care remains to be established. PMID:25556708
Background Distinguishing cases from non-cases in free-text electronic medical records is an important initial step in observational epidemiological studies, but manual record validation is time-consuming and cumbersome. We compared different approaches to develop an automatic case identification system with high sensitivity to assist manual annotators. Methods We used four different machine-learning algorithms to build case identification systems for two data sets, one comprising hepatobiliary disease patients, the other acute renal failure patients. To improve the sensitivity of the systems, we varied the imbalance ratio between positive cases and negative cases using under- and over-sampling techniques, and applied cost-sensitive learning with various misclassification costs. Results For the hepatobiliary data set, we obtained a high sensitivity of 0.95 (on a par with manual annotators, as compared to 0.91 for a baseline classifier) with specificity 0.56. For the acute renal failure data set, sensitivity increased from 0.69 to 0.89, with specificity 0.59. Performance differences between the various machine-learning algorithms were not large. Classifiers performed best when trained on data sets with imbalance ratio below 10. Conclusions We were able to achieve high sensitivity with moderate specificity for automatic case identification on two data sets of electronic medical records. Such a high-sensitive case identification system can be used as a pre-filter to significantly reduce the burden of manual record validation. PMID:23452306
An organization's mission, vision, and values are just words-intangible concepts, unactionable directives, and inconsequential thoughts. Without the emphasis, energy, and a defined process and framework, the words have little meaning to the organization. Task Force 62 created this organizational vision and communications strategy through a tested model based on Kaplan and Norton's continuing studies on organizational strategy. The task force accomplished its strategy only by overcoming the most difficult hurdle in changing organizational culture-accepting change. Over time, the staff evolved from compliance to commitment to the culture of process improvement and organizational introspection. We could do this because the climate during our weekly reviews was not punitive or defensive, but collaborative and challenging. We also saw the value added to our unit and task force growth and development and, in the process, learning and development as individuals. Future medical task forces will have the ability to gain ground and develop this model for conclusion. As the Army Medical Department (AMEDD) continues to develop and refine lessons learned, the CHSS model presented here can be the foundation for the AMEDD and DoD's vision in the creation and modification of schoolhouse programs of instructions and doctrine to be relevant to the maturing combat theater of operations.
Kraus, Carl N; Baldwin, Alan T; McAllister, R G
The US Food and Drug Administration (FDA) requires risk communication as an element of Risk Evaluation and Mitigation Strategies (REMS) to alert and educate healthcare providers about severe toxicities associated with approved drugs. The educational effectiveness of this approach has not been evaluated. To support the communication plan element of the ipilimumab REMS, a Medscape Safe Use Alert (SUA) letter was distributed by Medscape via email and mobile device distribution to clinicians specified in the REMS. This alert contained the FDA-approved Dear Healthcare Provider (DHCP) letter mandated for distribution. A continuing medical education (CME) activity describing ipilimumab toxicities and the appropriate management was simultaneously posted on the website and distributed to Medscape members. Data were collected over a 6-month period regarding the handling of the letter and the responses to pre- and post-test questions for those who participated in the CME activity. Analysis of the answers to the pre- and posttest questions showed that participation in the CME activity resulted in an improvement in correct answer responses of 47%. Our experience shows that there are likely distinct information sources that are utilized by different HCP groups. The ready availability of a brief CME activity was utilized by 24,063 individuals, the majority of whom showed enhanced understanding of ipilimumab toxicity by improvement in post-test scores, educational data that are not available via implementation of standard safety alert communications. These results demonstrate that improvement in understanding of specific drug toxicities is enhanced by a CME intervention.
Song, Zirui; Safran, Dana Gelb; Landon, Bruce E.; Landrum, Mary Beth; He, Yulei; Mechanic, Robert E.; Day, Matthew P.; Chernew, Michael E.
Seven provider organizations in Massachusetts entered the Blue Cross Blue Shield Alternative Quality Contract in 2009, followed by four more organizations in 2010. This contract, based on a global budget and pay-for-performance for achieving certain quality benchmarks, places providers at risk for excessive spending and rewards them for quality, similar to the new Pioneer Accountable Care Organizations in Medicare. We analyzed changes in spending and quality associated with the Alternative Quality Contract and found that the rate of increase in spending slowed compared to control groups. Overall, participation in the contract over two years led to a savings of 3.3% (1.9% in year-1, 3.3% in year-2) compared to spending in groups not participating in the contract. The savings were even higher for groups whose previous experience had been only in fee-for-service contracting. Such groups’ quarterly savings over two years averaged 8.2% (6.3% in year-1, 9.9% in year-2). Quality of care also improved within organizations participating in the Alternative Quality Contract compared to control organizations in both years. Chronic care management, adult preventive care, and pediatric care improved from year 1 to year 2 within the contracting groups. These results suggest that global budgets coupled with pay-for-performance can begin to slow the underlying growth in medical spending while improving quality. PMID:22786651
Based on the multidisciplinary field of multimodality, this paper offers a theoretical perspective on the construct of a curricular concept which is commonly used in a school curriculum and applies it to an analysis of a typical curricular text and classroom instruction that exposit the physics concept of work-energy. Theorizing a concept as a…
Professional discussion of curricular change and innovation is essential for maintaining and increasing the positive effects that music education can have on schoolchildren. Much recent discourse about curricular change has focused on critiques of the traditional large-ensemble model of music education, technological innovation applied to teaching…
Kloeppel, Tiffany; Stylianou, Michalis; Kulinna, Pamela Hodges
Relatively little is known about the use of standardized physical education curricular models and teachers perceptions of and fidelity to such curricula. The purpose of this study was to examine teachers perceptions of and fidelity to a standardized physical education curricular model (i.e., Dynamic Physical Education [DPE]). Participants for this…
Merton, Prudence; Froyd, Jeffrey E.; Clark, M. Carolyn; Richardson, Jim
We examined two curricular change efforts at a small, midwestern engineering and science college in order to explore how organizational culture influences curricular change processes. We found that the failure of one effort (measured by inability to sustain the curriculum over time) and the success of the other (the curriculum continues to be…
Cross-curricular work in schools across the United Kingdom generally involves the use of a cross-curricular dimension or theme that spans the work of several subject teachers. The limitations of this type of curriculum planning have been noted in the research literature both within the United Kingdom and across Europe. The research reported here…
Beattie, Irenee R.
Theories suggest curricular tracking is linked to racial/ethnic inequality. However, prior studies largely examine cognitive outcomes like standardized test scores and neglect behavioral outcomes. They also overlook potential racial/ethnic differences "within" curricular tracks. This study asks the following questions: (a) Is curricular…