... HUMAN SERVICES Food and Drug Administration Use of International Standard ISO-10993, ``Biological Evaluation of Medical Devices Part 1: Evaluation and Testing''; Draft Guidance for Industry and Food and Drug Administration Staff; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The...
Becker, Daniel E
A thorough assessment of a patient's medical status is standard practice when dental care is provided. Although this is true for procedures performed under local anesthesia alone, the information gathered may be viewed somewhat differently if the dentist is planning to provide sedation or general anesthesia as an adjunct to dental treatment. This article, the second of a 2-part sequence on preoperative assessment, will address pulmonary and other noncardiovascular disorders. PMID:20020794
Part 1 of this paper explored the origins of process activity mapping, one of the major tools currently being used to modernize patient pathways in the National Health Service in Great Britain. Within medical photography the current notion of modernization is inextricably linked to the development of digital technology. Whilst the core principle of capturing light on a sensitive medium remains as clear and relevant as ever, the mechanisms by which the image is processed and presented to the client have changed profoundly. Part 2 shows how the principles of lean thinking and process activity mapping can be utilized to harness the advantages of digital technology to provide a modern and appropriate medical photography service in a large disparate teaching hospital.
Elliot, Diane L.; Linz, Douglas H.; Kane, Joseph A.
Surgical outcome can be optimized by anticipation and prevention of medical complications. General considerations that apply to all patients include evaluation for coagulation disorders, prior anesthetic complications and drug history. Evaluation for organ-specific risk factors allows identification of patients at high surgical risk, minimization of risk and anticipation of postoperative complications. Review of the recent literature and a practical guide to therapy is presented for the major medical considerations before surgical procedures: cardiac disease, hypertension, pulmonary disease, endocrine considerations and hepatic disease. Attention to these areas and communication among internists, anesthesiologists and surgeons should provide optimal treatment of surgical patients with medical disease. PMID:7179956
Pangalos, G J
Users of medical information systems need confidence in the security of the system they are using. They also need a method to evaluate and compare its security capabilities. Every system has its own requirements for maintaining confidentiality, integrity and availability. In order to meet these requirements a number of security functions must be specified covering areas such as access control, auditing, error recovery, etc. Appropriate confidence in these functions is also required. The 'trust' in trusted computer systems rests on their ability to prove that their secure mechanisms work as advertised and cannot be disabled or diverted. The general framework and requirements for medical database security and a number of parameters of the evaluation problem are presented and discussed. The problem of database security evaluation is then discussed, and a number of specific proposals are presented, based on a number of existing medical database security systems.
In this presentation, as a member of the Harmonization by Doing (HBD) project, I discuss the significance of regulatory science in global medical device development and our experience in the international collaboration process for medical devices. In Japan, most innovative medical therapeutic devices were previously developed and exported by foreign-based companies. Due to this device lag, Japanese had minimal opportunities for receiving treatment with innovative medical devices. To address this issue, the Japanese government has actively accepted foreign clinical trial results and promoted global clinical trials in projects such as HBD. HBD is a project with stakeholders from academia, regulatory authorities, and industry in the US and Japan to promote global clinical trials and reduce device lags. When the project started, medical device clinical trials were not actively conducted in Japan at not just hospitals but also at medical device companies. We started to identify issues under the concept of HBD. After 10 years, we have now become key members in global clinical trials and able to obtain approvals without delay. Recently, HBD has started promoting international convergence. Physicians and regulatory authorities play central roles in compiling guidelines for the clinical evaluation of medical device development, which will be a more active field in the near future. The guidelines compiled will be confirmed with members of academia and regulatory authorities in the United Sates.
Robinson, M B
OBJECTIVE--To review current knowledge of the effectiveness of medical audit programmes as a whole and of specific interventions within these programmes, as a means of changing clinical behaviour. CRITERIA FOR INCLUSION AND EXCLUSION OF PUBLISHED REPORTS--Articles listed on Medline from 1985-92 with key words "quality assurance" or "medical audit", and "evaluation" and relevant references from these articles, and from recently published reviews and reports on medical audit, were included. Excluded were simple descriptions of audit activity, replications of previous work, and publication in a language other than English. RESULTS--Evaluation of entire programmes of medical audit is unusual. Most reports concern specific interventions and focus particularly on the scientific and technical aspects of quality. These interventions may be classified by the means through which they attempt to achieve desired changes: patient characteristics; physician characteristics; administrative and organisational structures; and financial incentives. CONCLUSIONS--Knowledge about effective methods of bringing about specific changes in clinical behaviour is rudimentary. Impact is highly dependent on local factors, so generalisation of results to other settings is difficult. More qualitative research is needed to define the local factors which influence results. PMID:7964351
Tanji, Jeffrey L.
Discusses the differences between exercise alone and exercise with medication (e.g., diuretics, beta blockers, and ACE inhibitors) for treating hypertensive patients. Guidelines are presented for physicians wanting to change the therapeutic regimen or to step down from medical therapy, noting exercise must always be part of the program. (SM)
Taitel, Michael S; Mu, Ying; Gooptu, Angshuman; Lou, Youbei
Objectives This study evaluates a nationwide pharmacy chain’s late-to-refill (LTR) reminder program that entails local pharmacists placing reminder calls to Medicare Part D patients. Methods We conducted a randomized controlled study among 735,218 patients who exhibited nonadherent behavior by not refilling a maintenance medication 3 days from an expected refill date. Patients were randomly assigned to an intervention group who received LTR reminder calls or to a control group. We used Walgreens pharmaceutical claims data from 2015 to estimate the impact of LTR calls on short-term and annual adherence. Results The initial refill rate within the first 14 days of the expected refill date significantly increased in the intervention group by 22.8% (6.09 percentage points) compared to the control group (P<0.001). The proportion of days covered (PDC) in the intervention group increased significantly by 1.5% (0.856 percentage points) relative to the control group (P<0.001) over 365 days. Patients in the intervention group were significantly more adherent (PDC ≥80%) by 3% (0.97 percentage points) compared to the control group (P<0.001). Over a 270-day follow-up period, persistence significantly increased by 2.15 days in the intervention group (P<0.001). Conclusion Results from this study suggest that LTR reminder calls increased adherence for Medicare Part D patients who are late in refilling their medications and therefore have the potential to reduce their risk for hospitalization and health care costs. Additionally, the intervention increased the number of patients with PDC ≥80% by ~3%, positively impacting Medicare Part D plan quality rating. PMID:28280310
Collett, T J; McLachlan, J C
This study aimed at evaluating how doing poetry could affect students' understanding of medical practice and at assessing the effectiveness of the evaluation method used. Qualitative research was carried out on the experiences of medical students participating in a poetry workshop, followed by some quantitative analysis. The study was conducted at Peninsula Medical School and St Ives, Cornwall, UK, with three medical students, a poet and a pathologist as participants. Data were collected by interviews, observation and web access. "Doing poetry" with a professional poet was found to assist communication between doctors and patients as it enhanced skills of observation, heightened awareness of the effect of language and fostered deep reflection. Poetry was also found to offer an outlet for medics and patients. The voluntary workshop attracted three participants; however, it might have had an effect on the wider student community because the poetry website received 493 hits in four months. Qualitative methods worked well as a tool for evaluation. "Doing poetry for poetry's sake" seemed to foster the development of skills related to empathy. The opportunity to do poetry should be made available to medical students as part of a wider arts and humanities programme.
Srivastava, M; Sharma, D K
1. Medical audit is a philosophy in the field of medical science which has reached to an advanced stage of practice in Western World, but yet to reach and percolate into Indian medical community. 2. Of late, community is getting increasingly aware of its health rights, gradually community participation in health matters including quantum and quality of case, has started increasing. Thus community leaders have started demanding for quality of medical care and accountability of those, responsible for delivery of medical care at various levels. 3. Medical audit or Evaluation of medical care is an answer to ensure the quality of care. But there are misgivings and distrust about medical audit due to its terminology. 4. There is need to education the medical, nursing and paramedical staff regarding medical audit and its sole purpose of self education and improvement of patient care activity. The present paper spells out fundamentals of medical audit, its scope and limitations.
The recent implementation of medical care evaluation (medical audit) systems in the nation's hospitals is a phenomenon of major consequence. The systematic measurement of the quality of patient care based on outcome data is becoming a part of the delivery of that care. Sixty years ago Dr. E. A. Codman developed and crusaded for a similar idea that seemed at one point to be on the threshold of widespread acceptance in U. S. hospitals, but for reasons other than lack of conceptual soundness the effort failed. In this article the author reviews the history of this early approach to the evaluation of patient care quality and suggests some lessons this historical episode holds for today's health care professionals.
Hoyt, E M
For thousands of years physicians have recorded clinical observations as private notes to document the clinical course, findings, and treatment of their patients. The medical record was generated exclusively for the physician's use in treating the patient. Physicians and hospitals are now under extraordinary pressure to reveal patient information. During the past 20 years, the role of the medical record has changed and it now has become a multipurpose document. Health care records are the topic of reports, interviews and depositions. Controlled disclosure of the sensitive information contained in the record is essential in today's society yet, when such information is released, various considerations must be carefully evaluated and weighed. From his vantage point as a physician and attorney, the author shares his insight and his concerns about privacy, confidentiality and privilege as related to health records in this two part article.
Tollan, A; Magnus, J H
The curriculum at the Medical School, University of Tromsø reserves 23 weeks for optional studies, including a period of 12 weeks at the end of the fifth year when the students carry out an independent study and write a short thesis. Of the first 417 doctors (graduation year 1979-89) from Tromsø 84.6% answered a postal questionnaire asking them to evaluate this part of the curriculum. These postgraduates report high levels of satisfaction with and benefit from this part of the curriculum. A total of 26.8% started working on their thesis before the final 12-week period, 32.6% had also published their study, half of these in international journals, and 75.6% found that the skills acquired during the final optional period had been useful in their subsequent work, irrespective of specialty. In conclusion, postgraduates consider their work in preparing a scientific paper as an important and integral part of medical studies.
The lure of land and gold, the hope for better health and an overcrowded profession in Britain led to an increasing number of doctors migrating to Australia. This migration was even more marked after the goldrush, especially in Victoria. The fifth article in this series looks at the way in which medical practice was controlled by excluding many of those doctors who were from non-British origins.
Casanova, J M; Sanmartín, V; Martí, R M; Morales, J L; Soler, J; Purroy, F; Pujol, R
The acquisition of competences (the set of knowledge, skills and attitudes required to perform a job to a professional level) is considered a fundamental part of medical training. Dermatology competences should include, in addition to effective clinical interviewing and detailed descriptions of skin lesions, appropriate management (diagnosis, differentiation, and treatment) of common skin disorders and tumors. Such competences can only be acquired during hospital clerkships. As a way of certifying these competences, we propose evaluating the different components as follows: knowledge, via clinical examinations or critical incident discussions; communication and certain instrumental skills, via structured workplace observation and scoring using a set of indicators; and attitudes, via joint evaluation by staff familiar with the student.
Densen, Paul M.; And Others
The increasing number of medical centers involved in collaborative and innovative health services in the community is but one reflection of social concerns and pressures for change in the health care system. Medical schools and their affiliated teaching hospitals are trying in various ways to adapt their teaching, research, and service functions…
Agapitov, A A; Aleĭnikov, S I; Bolekhan, V N; Ivchenko, E V; Krassiĭ, A B; Nagibovich, O A; Petrov, S V; Rezvantsev, M V; Soldatov, E A; Shalakhin, R A; Sheppli, E V
The present article is the fourth part of the review dedicated to organization and management of medical research in the US Armed Forces. The first, second and the third parts were published in the previous issues of the journal. Specifically this article is dedicated to organization and management of medical research in the US Navy. It is shown that in the US Navy the fundamental and a part of applied investigations are conducted in the Office of Naval Research while more practical research is carried out at the Naval Medical Research Center. The latter includes the Naval Health Research Center, the Naval Submarine Medical Research Laboratory and seven Naval Medical Research Units which are successively presented. The particular research programs conducted in the above mentioned organizations are discussed.
Astronaut Jack R. Lousma, Skylab 3 pilot, reaches into a medical kit, part of the Inflight Medical Support System (IMSS), during training for the second manned Skylab Earth-orbital mission. This activity took place in the Orbital Workshop (OWS) trainer in the Mission Simulation and Training Facility at JSC.
Dee, Cheryl R
An increasing number of medical school libraries offer chat service to provide immediate, high quality information at the time and point of need to students, faculty, staff, and health care professionals. Part 2 of Chat Reference Service in Medical Libraries presents a snapshot of the current trends in chat reference service in medical school libraries. In late 2002, 25 (21%) medical school libraries provided chat reference. Trends in chat reference services in medical school libraries were compiled from an exploration of medical school library Web sites and informal correspondence from medical school library personnel. Many medical libraries are actively investigating and planning new chat reference services, while others have decided not to pursue chat reference at this time. Anecdotal comments from medical school library staff provide insights into chat reference service.
Dee, Cheryl R
Chat reference services offer the opportunity to provide immediate access to quality information to meet the medical information needs of students, faculty, staff, physicians, nurses, and allied health care professionals. Part 1 of this two-part article on chat reference service in medical libraries is an introduction to the management of chat reference services and to features available for chat reference. The management of chat reference services raises issues of planning, staffing, selecting, and marketing. Planning issues focus on the identification of the users, the users' medical information needs, and the users' information-seeking behavior. Staffing issues relate to the selection of chat hours, the location of the chat service, and participation in collaborative agreements. Selecting chat software weighs the sophistication of the chat features against the related cost. Marketing uses techniques similar to traditional reference services and often begins slowly as chat expertise develops. Part 2 of the article discusses trends in chat reference services in medical libraries.
Del Rosso, James Q; Harper, Julie C; Graber, Emmy M; Thiboutot, Diane; Silverberg, Nanette B; Eichenfield, Dawn Zhang; Eichenfield, Lawrence F
Acne presenting in adult women is commonly encountered in clinical practice. Many affected women have had acne during their teenaged years, have tried several therapies in the past, and are seeking effective treatment. Others are frustrated by the inexplicable emergence of acne as an adult when they never had it as a teenager. Both groups seek an explanation of why they have acne, are often psychosocially affected by its effects on appearance and self-esteem, and all are wanting effective and safe treatment. Clinicians are encouraged to connect favorably with each patient through careful history and physical examination and to consider underlying causes of androgen excess. Practical approaches to examination and laboratory evaluation are discussed.
Sandlow, L. J.; And Others
The educational contribution of medical care evaluation (MCE) has been portrayed as the identification of physicians' educational needs. A study of 13 MCE committees was undertaken to document the learning that occurs in these committees and to discover the conditions affecting their educational value. (Author/MLW)
Zhang, Rui; Pakhomov, Serguei; Gladding, Sophia; Aylward, Michael; Borman-Shoap, Emily; Melton, Genevieve B.
Medical post-graduate residency training and medical student training increasingly utilize electronic systems to evaluate trainee performance based on defined training competencies with quantitative and qualitative data, the later of which typically consists of text comments. Medical education is concomitantly becoming a growing area of clinical research. While electronic systems have proliferated in number, little work has been done to help manage and analyze qualitative data from these evaluations. We explored the use of text-mining techniques to assist medical education researchers in sentiment analysis and topic analysis of residency evaluations with a sample of 812 evaluation statements. While comments were predominantly positive, sentiment analysis improved the ability to discriminate statements with 93% accuracy. Similar to other domains, Latent Dirichlet Analysis and Information Gain revealed groups of core subjects and appear to be useful for identifying topics from this data. PMID:23304426
Malacara, J M
The peer review process for manuscripts submitted for publication to scientific journals and for the evaluation of grant research proposals is unsatisfactory in several respects. We examine here some of the problems related with evaluation of scientific merit. Some criteria for rejection are proposed, i.e. a poor preparation of the manuscript, a lack of a distinct hypothesis, a disagreement between hypothesis and methodology, and a deficient methodology. Other important criteria causes of rejection would be lack of originality of the hypothesis, scarce relevance of the work, and inconsistency in the results. Conversely, interesting work are rejected for invalid objections such as "less than optimal design", "lack of experience of the group" and some conceptual objections which are controversial. In order to improve the peer review process, we propose a larger role of editorial committees in final editorial decisions, an improved mechanism for selection of reviewers, and more explicit criteria for causes of rejection for reviewers and authors.
Ferris, Helena A.; Collins, Mary E.
The landscape of medical education is continuously evolving, as are the needs of the learner. The appropriate use of research and evaluation is key when assessing the need for change and instituting one's innovative endeavours. This paper demonstrates how research seeks to generate new knowledge, whereas evaluation uses information acquired from…
Holloway, D C; Wiczai, L J; Carlson, E T
The purpose of this study was to evaluate a computerized information system, the Professional Activity Study-Medical Audit Program (PAS-MAP), when used by the medical staff of a hospital to conduct medical care evaluation studies. PAS-MAP was compared to a manual system for collecting data not contained on the face sheets of medical records. The results indicated that, compared to the manual system, PAS-MAP: was less costly if more than 41 per cent of hospitalized patients were included in medical care evaluation studies; was as timely as the manual system for data it could provide but provided fewer clinical data elements than physicians requested; and was less protective against human error. Three decision makers assigned weights indicating the relative importance of these results. The weights were combined in an additive model to arrive at a score for each system. Based on these scores, the manual system was recommended for implementation.
Webb, B W
Family physicians are often consulted to evaluate medically a patient for various dental procedures. The majority of the referrals are for diseases of the cardiovascular system. General guidelines have been established at the University of Maryland Family Health Center for the evaluation of these patients. These guidelines pertain to the use of local anesthetics and prophylaxis for endocarditis, as well as to the evaluation of patients with cardiac disease, hypertension, pulmonary disease, endocrine disease, neurological disease, hepatic disease, pregnancy, and anticoagulant therapy.
UNCLASSIFIED Defense Technical Information Center Compilation Part Notice ADPO 11055 TITLE: Losartan Potassium: Evaluating the Treated Aviator for...thru ADP011058 UNCLASSIFIED 145 Losartan Potassium: Evaluating the Treated Aviator for Medical Waiver Jeb S. Pickard, M.D. USAFSAM/FECI 2507 Kennedy... losartan has Furthermore, there is some data suggesting a shown it to be a potential candidate for use in diastolic antihypertensive effect lingering
Kirisits, Andreas; Redekop, W Ken
The economic evaluation of medical technology has evolved as a key element in supporting health budget allocation decisions. Among suppliers of innovation, the medical device industry is one of the most dynamic fields of medical progress with thousands of new products marketed every year. Accordingly, the broad variety of technologies covered by the umbrella term 'medical devices' have come under increasing scrutiny regarding their cost effectiveness. In the process, a number of device-specific factors have become apparent, each of which can complicate a thorough economic evaluation and limit its informative value. Some of these factors relate to specific characteristics of device functioning. Examples of such factors include the fact that most technologies require, or form part of, a procedure and that many devices have multiple indications or purposes. Others in turn reflect external conditions and are more general in character, such as the regulatory framework that a medical device manufacturer faces prior to market approval and the structure of the medical device industry. Drawing on the available literature, these complicating factors and their practical implications are discussed and used as a basis to elaborate on the emerging challenges for the economic evaluation of medical devices.
Belden, J.; Williams, J.; Richardson, B.; Schuster, K.
Summary Background Federated medical search engines are health information systems that provide a single access point to different types of information. Their efficiency as clinical decision support tools has been demonstrated through numerous evaluations. Despite their rigor, very few of these studies report holistic evaluations of medical search engines and even fewer base their evaluations on existing evaluation frameworks. Objectives To evaluate a federated medical search engine, MedSocket, for its potential net benefits in an established clinical setting. Methods This study applied the Human, Organization, and Technology (HOT-fit) evaluation framework in order to evaluate MedSocket. The hierarchical structure of the HOT-factors allowed for identification of a combination of efficiency metrics. Human fit was evaluated through user satisfaction and patterns of system use; technology fit was evaluated through the measurements of time-on-task and the accuracy of the found answers; and organization fit was evaluated from the perspective of system fit to the existing organizational structure. Results Evaluations produced mixed results and suggested several opportunities for system improvement. On average, participants were satisfied with MedSocket searches and confident in the accuracy of retrieved answers. However, MedSocket did not meet participants’ expectations in terms of download speed, access to information, and relevance of the search results. These mixed results made it necessary to conclude that in the case of MedSocket, technology fit had a significant influence on the human and organization fit. Hence, improving technological capabilities of the system is critical before its net benefits can become noticeable. Conclusions The HOT-fit evaluation framework was instrumental in tailoring the methodology for conducting a comprehensive evaluation of the search engine. Such multidimensional evaluation of the search engine resulted in recommendations for
Dean, Gary S., And Others
This set of guidelines was written to provide a systematic explanation of the process of evaluation applied to Regional Medical Programs, as required by Public Law 89-239. Goals of the programs are the improvement of health care of patients suffering from heart disease, cancer, stroke and related diseases and improvement in the practice of health…
Morgan, Melissa; Montagne, Michael
Antidepressant medications have been the fastest growing category of use of pharmaceutical products over the past decade. Selected Internet web sites providing information on antidepressant medications were identified and assessed using code of conduct criteria for posting health information on the Internet as developed by the Health on the Internet Foundation. Thirteen representative web sites were evaluated. Degree of compliance with each of the eight criterion varied by site, though all 13 sites met the criterion for legality of content and conduct on their web site. WebMD and FamilyDoctor.org met most of the criteria, while pharmaceutical company sites tended to meet the fewest criteria.
Buhimschi, Catalin S; Weiner, Carl P
One of the least-developed areas of clinical pharmacology and drug research is the use of medication during pregnancy and lactation. This article is the first in a two-part series designed to familiarize physicians with many aspects of the drugs they commonly prescribe for pregnant and breast-feeding women. Almost every pregnant woman is exposed to some type of medication during pregnancy. Although the majority of pregnant and breast-feeding women consume clinically indicated or over-the-counter drug preparation regularly, only few medications have specifically been tested for safety and efficacy during pregnancy. There is scant information on the effect of common pregnancy complications on drug clearance and efficacy. Often, the safety of a drug for mothers, their fetuses, and nursing infants cannot be determined until it has been widely used. Absent this crucial information, many women are either refused medically important agents or experience potentially harmful delays in receiving drug treatment. Conversely, many drugs deemed "safe" are prescribed despite evidence of possible teratogenicity. Novel research and diagnostic applications evolving from the opportunities presented by the advances in genomics and proteomics are now beginning to affect clinical diagnosis, vaccine development, drug discovery, and unique therapies in a modern diagnostic-therapeutic framework-part of the new scientific field of theranostics. This review critically explores a number of recently raised issues in regard to the use of several classes of medications during gestation and seeks to provide a general and concise resource on drugs commonly used during pregnancy and lactation. It also seeks to make clinicians more aware of the controversies surrounding some drugs in an effort to encourage safer prescribing practices through consultation with a maternal-fetal medicine specialist and through references and Web sites that list up-to-date information.
Kongmunee, Chalermkwan; Chutima, Parames
This research investigates the problem of the part supplier performance evaluation in a major Japanese automotive plant in Thailand. Its current evaluation scheme is based on experiences and self-opinion of the evaluators. As a result, many poor performance suppliers are still considered as good suppliers and allow to supply parts to the plant without further improvement obligation. To alleviate this problem, the brainstorming session among stakeholders and evaluators are formally conducted. The result of which is the appropriate evaluation criteria and sub-criteria. The analytical hierarchy process is also used to find suitable weights for each criteria and sub-criteria. The results show that a newly developed evaluation method is significantly better than the previous one in segregating between good and poor suppliers.
... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental..., and social evaluations. (a) Before admission to a mental hospital or before authorization for payment... medical findings; (3) Medical history; (4) Mental and physical functional capacity; (5) Prognoses; and...
This is the first of two articles reviewing the history of medical symbols. In this first article I have briefly reviewed the evolution of the Greek god, Asclepius, (and his Roman counterpart Aesculapius) with the single serpent entwined around a wooden rod as a symbol of western medicine and have alluded to the misplaced adoption of the Caduceus of the Greek god Hermes (and his Roman counterpart Mercury) with its double entwined serpents as an alternative symbol. In the second part of this article (to be published later), I have made a tentative suggestion of why the Simorgh might be adopted as an Eastern or an Asian symbol for medicine.
... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Medical evaluation programs. 339.205 Section 339.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS MEDICAL QUALIFICATION DETERMINATIONS Physical and Medical Qualifications § 339.205 Medical evaluation programs....
Silvent, Anne-Sophie; Moreau-Gaudry, Alexandre; Cinquin, Philippe
Quality evaluation in the field of Augmented Surgery is strategic for public health policies. It implies to be able to effectively perform evaluation of Quality in term of Expected Medical Benefit (EMB). The notion of EMB is complex and not standardized in this field. To define and to evaluate EMB, it is necessary to discover the knowledge on the domain targeted by the device and to structure it. This paper presents first parts of this work. Focused on navigated knee surgery, it led us to obtain two main results: the identification of a new criterion for evaluating EMB obtained thanks to the formalization of a new kind of metadata. These encouraging results seem to offer new perspectives for the evaluation of devices from the field of augmented surgery.
Gebicki, Marek; Mooney, Ed; Chen, Shi-Jie Gary; Mazur, Lukasz M
As supply chain costs constitute a large portion of hospitals' operating expenses and with $27.7 billion spent by the US hospitals on drugs alone in 2009, improving medication inventory management provides a great opportunity to decrease the cost of healthcare. This study investigates different management approaches for a system consisting of one central storage location, the main pharmacy, and multiple dispensing machines located in each department. Each medication has a specific unit cost, availability from suppliers, criticality level, and expiration date. Event-driven simulation is used to evaluate the performance of several inventory policies based on the total cost and patient safety (service level) under various arrangements of the system defined by the number of drugs and departments, and drugs' criticality, availability, and expiration levels. Our results show that policies that incorporate drug characteristics in ordering decisions can address the tradeoff between patient safety and cost. Indeed, this study shows that such policies can result in higher patient safety and lower overall cost when compared to traditional approaches. Additional insights from this study allow for better understanding of the medication inventory system's dynamics and suggest several directions for future research in this topic. Findings of this study can be applied to help hospital pharmacies with managing their inventory.
... 42 Public Health 4 2011-10-01 2011-10-01 false Medical, psychological, and social evaluations. 456...: Intermediate Care Facilities Medical, Psychological, and Social Evaluations and Admission Review § 456.370 Medical, psychological, and social evaluations. (a) Before admission to an ICF or before authorization...
Majewska, Anna; Mlynarczyk-Bonikowska, Beata; Malejczyk, Magdalena; Mlynarczyk, Grazyna; Majewski, Slawomir
This is a second part of a review under a main title Antiviral medication in sexually transmitted diseases. In the part we published in Mini Rev Med Chem. 2013,13(13):1837-45, we have described mechanisms of action and mechanism of resistance to antiviral agents used in genital herpes and genital HPV infection. The Part II review focuses on therapeutic options in HIV infection. In 1987, 6 years after the recognition of AIDS, the FDA approved the first drug against HIV--zidovudine. Since then a lot of antiretroviral drugs are available. The most effective treatment for HIV is highly active antiretroviral therapy--a combination of several antiretroviral medicines that cause a reduction of HIV blood concentration and often results in substantial recovery of impaired immunologic function. At present, there are over 20 drugs licensed and used for the treatment of HIV/AIDS, and these drugs are divided into one of six classes. Investigational agents include GS-7340, the prodrug of tenofovir and BMS-663068--the first in a novel class of drugs that blocks the binding of the HIV gp120 to the CD4 receptor.
Kamali, Farahnaz; Yamani, Nikoo; Changiz, Tahereh
Introduction: To achieve a valid evaluation of faculty members, it is necessary to develop an inclusive and dynamic system of evaluation addressing all the activities and responsibilities of faculty members. Among these responsibilities, educational activities comprise an important part which needs to be investigated. This study aimed to investigate the current system of evaluating the faculty members’ educational duties. Methods: In this descriptive cross-sectional study, a checklist for investigating the current evaluation system and was developed confirmed by a focus group. The data for checklist were collected through a researcher-made questionnaire and interview with eight experts of faculty evaluation that worked in different Iranian Medical Universities. For completion of information, the available documents and records were studied. Finally, the current evaluation system of different universities was depicted. Results: The developed checklist had six themes and 123 subthemes. The extracted themes included: Tools, evaluators, processes, appropriateness of faculty field of work with evaluation, feedback status, and university status regarding decisions made based on faculty evaluation results. As for comprehensiveness, all evaluation items except for evaluation and assessment skills and religiosity from personality traits subtheme were fully investigated. The evaluation tools were not enough for different types of education such as clinical education. In six universities, the feedbacks provided were only for making inter/intra department comparison, and no scientific suggestions were included. The results of evaluations were used only for the faculties’ promotions. Discussion: Suitability between evaluation and performance components is a necessity in every evaluation system. The study showed this does not exist in Iranian Universities. For instance, there was no appropriate tool for the evaluation of clinical education. Also, the results of the faculty
... medical fitness determinations for issuance of merchant mariners' documents. The Coast Guard will accept... Coast Guard in making medical fitness determinations for issuance of merchant mariners' documents; and... maintains an ``open'' system of medical evaluation. While the ultimate determination of medical...
... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Medical evaluation programs. 339.205... QUALIFICATION DETERMINATIONS Physical and Medical Qualifications § 339.205 Medical evaluation programs. Agencies may establish periodic examination or immunization programs by written policies or directives...
... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Medical evaluation programs. 339.205... QUALIFICATION DETERMINATIONS Physical and Medical Qualifications § 339.205 Medical evaluation programs. Agencies may establish periodic examination or immunization programs by written policies or directives...
... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Medical evaluation programs. 339.205... QUALIFICATION DETERMINATIONS Physical and Medical Qualifications § 339.205 Medical evaluation programs. Agencies may establish periodic examination or immunization programs by written policies or directives...
... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Medical evaluation programs. 339.205... QUALIFICATION DETERMINATIONS Physical and Medical Qualifications § 339.205 Medical evaluation programs. Agencies may establish periodic examination or immunization programs by written policies or directives...
... 42 Public Health 4 2012-10-01 2012-10-01 false Medical, psychiatric, and social evaluations. 456... Hospitals Medical, Psychiatric, and Social Evaluations and Admission Review § 456.170 Medical, psychiatric... beneficiary's need for care in the hospital; and appropriate professional personnel must make a...
... 42 Public Health 4 2013-10-01 2013-10-01 false Medical, psychiatric, and social evaluations. 456... Hospitals Medical, Psychiatric, and Social Evaluations and Admission Review § 456.170 Medical, psychiatric... beneficiary's need for care in the hospital; and appropriate professional personnel must make a...
... 42 Public Health 4 2014-10-01 2014-10-01 false Medical, psychiatric, and social evaluations. 456... Hospitals Medical, Psychiatric, and Social Evaluations and Admission Review § 456.170 Medical, psychiatric... beneficiary's need for care in the hospital; and appropriate professional personnel must make a...
REZAEE, RITA; SHOKRPOUR, NASRIN; BOROUMAND, MARYAM
Introduction: In e-learning, people get involved in a process and create the content (product) and make it available for virtual learners. The present study was carried out in order to evaluate the first virtual master program in medical education at Shiraz University of Medical Sciences according to P3 Model. Methods: This is an evaluation research study with post single group design used to determine how effective this program was. All students 60 who participated more than one year in this virtual program and 21 experts including teachers and directors participated in this evaluation project. Based on the P3 e-learning model, an evaluation tool with 5-point Likert rating scale was designed and applied to collect the descriptive data. Results: Students reported storyboard and course design as the most desirable element of learning environment (2.30±0.76), but they declared technical support as the less desirable part (1.17±1.23). Conclusion: Presence of such framework in this regard and using it within the format of appropriate tools for evaluation of e-learning in universities and higher education institutes, which present e-learning curricula in the country, may contribute to implementation of the present and future e-learning curricula efficiently and guarantee its implementation in an appropriate way. PMID:27795971
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.
Shield, Renee R.; Farrell, Timothy W.; Nanda, Aman; Campbell, Susan E.; Wetle, Terrie
Purpose of the study: The Alpert Medical School of Brown University began to integrate geriatrics content into all preclerkship courses and key clerkship cases as part of a major medical school curriculum redesign in 2006. This study evaluates students' responses to geriatrics integration within the curriculum using journals kept by volunteer…
Schnurman, Zane; Kondziolka, Douglas
OBJECT Patients, practitioners, payers, and regulators are advocating for reform in how medical advances are evaluated. Because surgery does not adhere to a standardized developmental pathway, how the medical community accepts a procedure remains unclear. The authors developed a new model, using publication data and patterns, that quantifies this process. Using this technique, the authors identified common archetypes and influences on neurosurgical progress from idea inception to acceptance. METHODS Seven neurosurgical procedures developed in the past 15-25 years were used as developmental case studies (endovascular coil, deep brain stimulation, vagus nerve stimulation, 1,3-bis(2-chloroethyl)-l-nitrosourea wafer, and 3 radiosurgery procedures), and the literature on each topic was evaluated. A new metric the authors termed "progressive scholarly acceptance" (PSA) was used as an end point for community acceptance. PSA was reached when the number of investigations that refine or improve a procedure eclipsed the total number of reports assessing initial efficacy. Report characteristics, including the number of patients studied, study design, and number of authoring groups from the first report to the point of PSA, were assessed. RESULTS Publication data implicated factors that had an outsized influence on acceptance. First, procedural accessibility to investigators was found to influence the number of reports, number of patients studied, and number of authoring groups contributing. Barriers to accessibility included target disease rarity, regulatory restrictions, and cost. Second, the ease or difficulty in applying a randomized controlled trial had an impact on study design. Based on these 2 factors, 3 developmental archetypes were characterized to generally describe the development of surgery. CONCLUSIONS Common surgical development archetypes can be described based on factors that impact investigative methods, data accumulation, and ultimate acceptance by society
Lloyd, Charles W.; Guess, Terrell M.; Whiting, Charles W.; Doarn, Charles R.
The medical investigations completed on the KC-135 during FY 1990 in support of the development of the Health Maintenance Facility and Medical Operations are discussed. The experiments are comprised of engineering evaluations of medical hardware and medical procedures. The investigating teams are made up of both medical and engineering personnel responsible for the development of medical hardware and medical operations. The hardware evaluated includes dental equipment, a coagulation analyzer, selected pharmaceutical aerosol devices, a prototype air/fluid separator, a prototype packaging and stowage system for medical supplies, a microliter metering system, and a workstation for minor surgical procedures. The results of these engineering evaluations will be used in the design of fleet hardware as well as to identify hardware specific training requirements.
Addresses three issues: (1) how children respond to the medical evaluation for sexual abuse; (2) how the trauma of the evaluation experienced by some children can be minimized and the benefits maximized; and (3) how children's responses to the medical evaluation for sexual abuse can be interpreted. (DB)
Lloyd, Charles W.
The medical investigations completed on the KC-135 during FY 1991 in support of the development of the Health Maintenance Facility and Medical Operations are presented. The experiments consisted of medical and engineering evaluations of medical hardware and procedures and were conducted by medical and engineering personnel. The hardware evaluated included prototypes of a crew medical restraint system and advanced life support pack, a shuttle orbiter medical system, an airway medical accessory kit, a supplementary extended duration orbiter medical kit, and a surgical overhead canopy. The evaluations will be used to design flight hardware and identify hardware-specific training requirements. The following procedures were evaluated: transport of an ill or injured crewmember at man-tended capability, surgical technique in microgravity, transfer of liquids in microgravity, advanced cardiac life support using man-tended capability Health Maintenance Facility hardware, medical transport using a model of the assured crew return vehicle, and evaluation of delivery mechanisms for aerosolized medications in microgravity. The results of these evaluation flights allow for a better understanding of the types of procedures that can be performed in a microgravity environment.
Cole, Leonard A.; Wagner, Katherine; Scott, Sandra; Connell, Nancy D.; Cooper, Arthur; Kennedy, Cheryl Ann; Natal, Brenda; Lamba, Sangeeta
Terror medicine, a field related to emergency and disaster medicine, focuses on medical issues ranging from preparedness to psychological manifestations specifically associated with terrorist attacks. Calls to teach aspects of the subject in American medical schools surged after the 2001 jetliner and anthrax attacks. Although the threat of terrorism persists, terror medicine is still addressed erratically if at all in most medical schools. This paper suggests a template for incorporating the subject throughout a 4-year medical curriculum. The instructional framework culminates in a short course for fourth year students, such as one recently introduced at Rutgers New Jersey Medical School, Newark, NJ, USA. The proposed 4-year Rutgers curriculum serves as a model that could assist other medical schools contemplating the inclusion of terror medicine in pre-clerkship and clerkship training. PMID:25309891
Cole, Leonard A; Wagner, Katherine; Scott, Sandra; Connell, Nancy D; Cooper, Arthur; Kennedy, Cheryl Ann; Natal, Brenda; Lamba, Sangeeta
Terror medicine, a field related to emergency and disaster medicine, focuses on medical issues ranging from preparedness to psychological manifestations specifically associated with terrorist attacks. Calls to teach aspects of the subject in American medical schools surged after the 2001 jetliner and anthrax attacks. Although the threat of terrorism persists, terror medicine is still addressed erratically if at all in most medical schools. This paper suggests a template for incorporating the subject throughout a 4-year medical curriculum. The instructional framework culminates in a short course for fourth year students, such as one recently introduced at Rutgers New Jersey Medical School, Newark, NJ, USA. The proposed 4-year Rutgers curriculum serves as a model that could assist other medical schools contemplating the inclusion of terror medicine in pre-clerkship and clerkship training.
Forsbach, G; Lozano, P; Pinto, E; González, O; Calderón, L; Martínez, R; Martínez, G
A pilot program with primary care physicians was established in Clinica Cuauhtémoc y Famosa, focused to evaluate women older than 35 years with climateric symptoms. This program included a survey, a complete gynecological examination with Pap smears, ultrasound pelvic examination and mamography. Also, blood samples were collected for cholesterol, tryglycerides, calcium, phosphorus and alkaline phosphatase. An ECG, bone densitometry of the radius and X-rays of the vertebral column were obtained. This group was formed by 69 women with an age media of 50 years (SD 7.6 years, median 49 years). The survey disclosed that 34/65 women had been hysterectomized, and only 34/64 had received antitetanic immunization in the last 10 years. A preexistent chronic disease occurred in 36/59 women, these were diabetes mellitus, arterial hypertension or degenerative osteoarthritis. Alcohol consumption was recorded in 5/66 women and tabac consumption in 9/66 women, and 32/68 women accepted to be sedentary. Laboratory examinations disclosed hypercholesterolemia in 19/66 women and hypertryglyceridemia in 8/64 women. Osteopenia was detected in 33/60 women. This findings support a systematic plan to provide medical assistance for women in this age, specially if previous epidemiologycal studies have disclosed that coronary disease is the main cause of death for women older than 50 years in this region, that also belongs to the area of highest incidence of diabetes.
Zhang, Hongkui; Wang, Bo; Zhang, Longlu
Explorating reform of the teaching evaluation method for vocational competency-based education (CBE) curricula for medical students is a very important process in following international medical education standards, intensify ing education and teaching reforms, enhancing teaching management, and improving the quality of medical education. This…
Das, Mandira; And Others
This study sought to evaluate faculty opinion of existing medical curricula in two medical schools in different countries in terms of six educational strategies using the "SPICES continuum." Significant differences between existing educational plans of the two medical schools were identified. (LZ)
Saxon, David S.
The aloofness of those in the medical schools from general faculty and students and the still narrow education of medical students are considered to be among the causes of the deep problems facing modern medicine. The current state of American medicine is assessed in this regard. (Author/LBH)
Maidlow, Kristin; Schulz, John M.; Lloyd, Charles W.; Breeding, Tiffany
The effectivity was evaluated in zero gravity of several medical equipment and supply items flown in the Shuttle Orbiter Medical System (SOMS). Several procedures listed in Medical Operations Medical Checklist, JSC 1732 were also evaluated. Several items were drawn out of the kits and tested on the KC-135. In two different flights, the following elements were examined: (1) measuring IV flow (drip chamber, one way flow valve, and air/fluid separator); (2) chemstrip protocol for urine analysis in zero-gravity; and (3) tamper resistant seals for injectable medications.
... by the Military Medical Departments to DoDDS Students on IEPs C Appendix C to Part 57 National... Appendix C to Part 57—Procedures for the Provision of Related Services by the Military Medical Departments to DoDDS Students on IEPs A. Evaluation Procedures (1) Upon request by a DoDDS CSC, the...
... by the Military Medical Departments to DoDDS Students on IEPs C Appendix C to Part 57 National... Appendix C to Part 57—Procedures for the Provision of Related Services by the Military Medical Departments to DoDDS Students on IEPs A. Evaluation Procedures (1) Upon request by a DoDDS CSC, the...
... 42 Public Health 4 2010-10-01 2010-10-01 false Medical, psychological, and social evaluations. 456.370 Section 456.370 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...: Intermediate Care Facilities Medical, Psychological, and Social Evaluations and Admission Review §...
... 42 Public Health 4 2012-10-01 2012-10-01 false Medical, psychiatric, and social evaluations. 456... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inpatient Psychiatric..., psychiatric, and social evaluations. If a facility provides inpatient psychiatric services to a...
... 42 Public Health 4 2011-10-01 2011-10-01 false Medical, psychiatric, and social evaluations. 456... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inpatient Psychiatric..., psychiatric, and social evaluations. If a facility provides inpatient psychiatric services to a...
... 42 Public Health 4 2014-10-01 2014-10-01 false Medical, psychiatric, and social evaluations. 456... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inpatient Psychiatric..., psychiatric, and social evaluations. If a facility provides inpatient psychiatric services to a...
... 42 Public Health 4 2013-10-01 2013-10-01 false Medical, psychiatric, and social evaluations. 456... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inpatient Psychiatric..., psychiatric, and social evaluations. If a facility provides inpatient psychiatric services to a...
... 42 Public Health 4 2010-10-01 2010-10-01 false Medical, psychiatric, and social evaluations. 456... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inpatient Psychiatric..., psychiatric, and social evaluations. If a facility provides inpatient psychiatric services to a...
Shah, Hemal; Pozo-Garcia, Lucia; Koulouroudias, Marinos
Dermatological conditions form a significant number of consultations seen by general practitioners on a daily basis. There is a lack of training and formal assessment of dermatology during medical school and we propose that there should be a mandatory component in OSCEs for dermatology during medical school to enhance one's diagnostic and clinical reasoning skills which will ultimately lead to better care for the patient and efficacious use of NHS resources.
This is part I of a two-part annotated bibliography of selected references on medical education in the People's Republic of China. The references date from 1925 to 1983. Most of the references are from the 1970's. (RH)
... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false First Aid Kits and Emergency Medical Kits A... REQUIREMENTS: DOMESTIC, FLAG, AND SUPPLEMENTAL OPERATIONS Pt. 121, App. A Appendix A to Part 121—First Aid Kits and Emergency Medical Kits Approved first-aid kits, at least one approved emergency medical kit,...
... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false First Aid Kits and Emergency Medical Kits A... REQUIREMENTS: DOMESTIC, FLAG, AND SUPPLEMENTAL OPERATIONS Pt. 121, App. A Appendix A to Part 121—First Aid Kits and Emergency Medical Kits Approved first-aid kits, at least one approved emergency medical kit,...
Kleinsorge, Christy A; Roberts, Michael C; Roy, Kimberlee M; Rapoff, Michael A
A program evaluation of a pediatric primary care training clinic was conducted using the criteria of a "medical home" set forth by the American Academy of Pediatrics (AAP). A total of 107 parents completed questionnaires regarding demographics, satisfaction with care, and questions related to the definition of medical home. Medical providers completed questionnaires regarding demographics, job satisfaction, and community resources. Parents reported acceptable levels of satisfaction with the quality of care provided, and the essential parts of the medical home definition were met. There were several areas that were designated as having room for improvement, including shortening clinic wait times and instructing the medical providers to be more sensitive to cultural differences in beliefs about health and wellness. The concepts of medical home set forth by the AAP are attainable for pediatric primary care clinics, but routine evaluations may be needed to ensure that goals continue to be met.
Henderson, M M; Meinert, C L
There is an expanding need for quantitative information to evaluate health and medical care procedures. Existing methods for designing and carrying out evaluation studies need to be improved to provide better techniques for answering questions on efficacy of health and medical procedures, and in providing a more adequate information base on which to set healthy policy. This paper reviews some of the problems in the design and conduct of evaluation research, and makes a plea for creation of a special discipline to support and develop the field of health and medical care evaluation.
Linn, M W; Linn, S B
Some of the problems facing evaluators of medical care have been dealt with by individuals examining mental health programs. Mental health research has focused more on outcome studies that include a multidimensional approach in evaluation. Techniques have been devised in that field that make the evaluative process patient specific and goal oriented. Borrowing some of these methods to make medical care evaluation include a problem-oriented outcome, which incorporates patient satisfaction, compliance with medical therapy, and relief of symptoms, could lead to more accurate data on the health delivery system.
... Medicare Program; Medicare Hospital Insurance (Part A) and Medicare Supplementary Medical Insurance (Part B... Insurance; and Program No. 93.774, Medicare-- Supplementary Medical Insurance Program) Dated: March 13, 2013..., Utilization and Quality Control Peer Review, private health insurance, and related matters. They are...
... 23 Highways 1 2010-04-01 2010-04-01 false Determination of Federal Medical Savings E Appendix E to Part 1240 Highways NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION AND FEDERAL HIGHWAY ADMINISTRATION... SEAT BELT USE RATES Pt. 1240, App. E Appendix E to Part 1240—Determination of Federal Medical Savings...
Hyman, W A
The provision of automatic alarm systems on medical equipment is generally designed to supplement the user's ability to monitor a variety of device and patient variables simultaneously. The potential value of such systems in improving the safety and efficacy of medical care is accompanied by the potential for false reliance on or other misuse of the alarm systems. Therefore the alarm provisions become an important aspect of clinical engineering assessment of equipment with respect to selection, user training, hazard analysis, and the provision of effective and appropriate preventive maintenance programs.
Andrews, Hans A.
Stresses the importance of faculty evaluation in continuing education and community service programs. Discusses the shortcomings of student evaluations. Identifies key steps in evaluation (i.e., establishing minimum qualifications, providing orientation to teaching, conducting in-class observations and evaluations, and taking follow-up action).…
Borges, Nicole J.; Hartung, Paul J.
Although medical education has long recognized the importance of community service, most medical schools have not formally nor fully incorporated service learning into their curricula. To address this problem, we describe the initial design, development, implementation, and evaluation of a service-learning project within a first-year medical…
Carroll, Jean; Becker, Selwyn
In view of the current emphasis on measurement of the quality of health care services, reflected in regulatory provisions and accreditation requirements, an inquiry was made as to the extent to which medical schools are offering formal training in the techniques of medical care evaluation. (Editor)
... MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.63 Initial medical evaluation and management. (a... hunger strike: (1) Measure and record height and weight; (2) Take and record vital signs; (3) Urinalysis... weight and vital signs at least once every 24 hours while the inmate is on a hunger strike....
... MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.63 Initial medical evaluation and management. (a... hunger strike: (1) Measure and record height and weight; (2) Take and record vital signs; (3) Urinalysis... weight and vital signs at least once every 24 hours while the inmate is on a hunger strike....
And Others; Crandall, Lee A.
Medical students, nursing students, and residents from the University of Florida College of Medicine live and work for several weeks in a rural county health center, providing a wide range of primary care and emergency medical services. Retrospective evaluations by participants are reported. (LBH)
BAZRAFKAN, LEILA; HAYAT, ALI ASGHAR; ABBASI, KARIM; BAZRAFKAN, AGHDAS; ROHALAMINI, AZADEH; FARDID, MOZHGAN
Introduction: The information literacy status and the use of information technology among students in the globalization age of course plans are very momentous. This study aimed to evaluate the information literacy status and use of information technology among medical students of Shiraz University of Medical Sciences in 2013. Methods: This was a descriptive-analytical study with cross-sectional method. The study population consisted of all medical students (physiopathology, externship and internship) studying at Shiraz University of Medical Sciences. The sample size (n=310) was selected by systematic random sampling. The tool of data gathering was LASSI questionnaire (assigned by America research association) with 48 closed items in five-point LIKERT scale. The questionnaire included two distinct parts of demographic questions and the information literacy skills based on the standards of information literacy capacities for academic education. The content validity was acquired by professors’ and experts’ comments. The reliability was also calculated by Cronbach’salpha (0.85). Data were analyzed in both descriptive (frequency- mean) and analytical level (t-test, analysis of variance) using SPSS 14 software. Results: 60.3% of the participants were females, and the remaining (29.7%) were males. The mean score of information literacy and its five subgroups among the students weren’t at a desirable level. The mean scores of information literacy for educational grades from the highest to lowest belonged to the internship, physiopathology and externship. The results showed that the highest average was related to the effective access ability to information among interns (9.27±3.57) and the lowest one was related to the ability of understanding legal and economical cases related with using information among externs (3.11±1.32).The results of ANOVA showed that there wasn’t a significant difference between educational grades and information literacy. Finally, the
All anatomical departments of German universities used bodies of the executed and other victims of the National Socialist (NS) regime for their work. Many of these victims had been executed in prisons and were members of the German political opposition; others had perished in camps for prisoners of war or forced laborers and concentration camps, and were of various European and other descent. Anatomists generally welcomed the increased influx of "fresh material" for purposes of research and education of the growing numbers of medical students. No anatomist is known to have refused work with the bodies of NS victims. Other medical disciplines also made use of these bodies, among them were racial hygienists and neuropathologists. In the late 19th and early 20th century, the fields of anatomy, physical anthropology, and racial hygiene (eugenics) were closely related in their subject matter. Anatomists were involved in the biological foundation of racial hygiene, most prominently among them Eugen Fischer. The discipline was established as part of the medical curriculum after 1920. Racial hygiene became the scientific justification for NS policies that led to racial discrimination, involuntary sterilization and ultimately mass murder. Anatomists taught racial hygiene throughout the Third Reich and did research in this area. Some were actively involved in NS policies through propaganda and evaluations for the so-called Genetic Health Courts, whereas others became victims of their own science in that they were dismissed for racial reasons.
... From the Federal Register Online via the Government Publishing Office SOCIAL SECURITY ADMINISTRATION Revised Medical Criteria for Evaluating Visual Disorders AGENCY: Social Security Administration. ACTION: Final rules; Correction. SUMMARY: The Social Security Administration published a document in...
Fernández Moyano, A; García Garmendia, J L; Palmero Palmero, C; García Vargas-Machuca, B; Páez Pinto, J M; Alvarez Alcina, M; Aparicio Santos, R; Benticuaga Martines, M; Delgado de la Cuesta, J; de la Rosa Morales, R; Escorial Moya, C; Espinosa Calleja, R; Fernández Rivera, J; González-Becerra, C; López Herrero, E; Marín Fernández, Y; Mata Martín, A M; Ramos Guerrero, A; Romero Rivero, M J; Sánchez-Dalp, M; Vallejo Maroto, I
The patients being treated in our health care system are becoming increasingly older and have a greater prevalence of chronic diseases. Due to these factors, these patients require greater and easier accessibility to the system as well as continuity of medical care. Collaboration between the different levels of health care has been instrumental in the success of the system and has produced changes in the hospital medical care protocol. Our hospital has developed a care model oriented towards the patient's needs, resulting in a higher grade of satisfaction among the medical professionals. In this paper, we have given a detailed description of part of our medical model, illustrating its different components and indicating several parameters of its evaluation. We have also reviewed the current state of the various models published on this topic. In summary, we believe that this medical care model presents a different approach to management that benefits patients, medical professionals and the health system alike.
Visser, Benjamin J; Huiskes, Florian; Korevaar, Daniel A
Increasing numbers of medical practitioners and medical students are using online social and business-related networking websites such as Facebook, Doc2doc and LinkedIn. These rapidly evolving and growing social media have potential to promote public health by providing powerful instruments for communication and education. However, evidence is emerging from studies, legal cases, and media reports that the use of these new technologies is creating several ethical problems for medical practitioners as well as medical students. Improper online activities may harm not only individual reputations and careers, but also the medical profession as a whole, for example by breach of patient confidentiality, defamation of colleagues and employers, undisclosed conflict of interests that bias the medical practitioner's medical advice, posting of advice/information without an evidence base, and infringement of copyright. We developed a self-evaluation checklist for medical practitioners using social media. The checklist addresses three key elements in the use of social media: personal information and accessibility, connections, and postings. It contains questions specifically formulated to evaluate a medical practitioner's social media profile, to prevent unintended, improper online activities and to promote professional online behaviour.
The systematic measurement of the quality of patient care based on outcome data is becoming a part of the delivery of that care. The author reviews the history of an early approach developed and crusaded by Dr. E. A. Codman 60 years ago and suggests some lessons it holds for today's health care professionals. (Editor/JT)
Mitty, Ethel; Flores, Sandi
More than half the states permit assistance with or administration of medications by unlicensed assistive personnel or med techs. Authorization of this nursing activity (or task) is more likely because of state assisted living regulation than by support and approval of the state Board of Nursing. In many states, the definition of "assistance with" reads exactly like "administration of" thereby raising concern with regard to delegation, accountability, and liability for practice. It is, as well, a hazardous path for the assisted living nurse who must monitor and evaluate the performance of the individual performing this nursing task. This article, the second in a series on medication management, addresses delegation, standards of practice of medication administration, types of medication errors, the components of a performance evaluation tool, and a culture of safety. Maintaining professional standards of assisted living nursing practice courses throughout the suggested recommendations.
Nicoletta, Julie A; Lande, Marc B
Nephrolithiasis is responsible for 1 in 1000 to 1 in 7600 pediatric hospital admissions annually throughout the United States. Seventy-five percent of children with nephrolithiasis have an identifiable predisposition to stone formation. This article reviews the different causes and disease states associated with nephrolithiasis in the pediatric population. The initial evaluation and the metabolic evaluation of children with nephrolithiasis are reviewed. Treatment modalities for the different stone types are also described.
Waller, Stephen G; Powell, Clydette; Ward, Jane B; Riley, Kevin
Non-military government agencies and non-governmental organizations (NGOs) have made great strides in the evaluation of humanitarian medical work, and have learned valuable lessons regarding monitoring and evaluation (M&E) that may be equally as valuable to military medical personnel. We reviewed the recent literature by the worldwide humanitarian community regarding the art and science of M&E, with focus toward military applications. The successes and failures of past humanitarian efforts have resulted in prolific analyses. Alliances of NGOs set the standard for humanitarian quality and M&E standards. Military medical personnel can apply some of these standards to military humanitarian M&E in complex and stability operations. The authors believe that the NGO community?s M&E standards should be applied to improve evaluation of U.S. military medical humanitarian operations.
Carroll, J; Becker, S
In view of the current emphasis on measurement of the quality of health care services, reflected in regulatory provisions and accreditation requirements, an inquiry was made as to the extent to which medical schools are presently offering formal training in the techniques of medical care evaluation. Of 118 medical schools surveyed, 24 responded with the information that they are actually providing such training. The training reported ranged from a one-hour lecture to five elective courses. The implications of the findings are discussed with reference to the need of physicians to become familiar with the principles and methods of scientific evaluation of medical care. Some of the areas that might be covered in courses on evaluation are discussed, and examples of two current programs are given.
van der Putten, W J
The National University of Ireland in Galway established a Master in Science (MSc.) program in medical physics in 2002. The course was designed to be 90 ECTS(1) credits and of one calendar year duration. From the outset the MSc. was designed to be part of an overall medical physics training program. MSc. programs are now widely used as part of the training and education of medical physicists. There is however paucity of data on the effectiveness of such courses and the purpose of the study reported here is to provide information on one particular MSc. course in medical physics. This is relevant to medical physicists who are involved in the development and running of medical physics training programs. The study used as methodology the Kirkpatrick levels of professional training. It was conducted through an online survey, both from students who graduated from the course and from students who were in the process of completing the course. The survey proved to be an effective way to determine attributes of modules such as learning outcomes, knowledge imparted, quality of teaching materials and others. The survey proved to be remarkably able to demonstrate interventions in the individual course modules. Although the course was shown to be effective in the imparting of the knowledge required to become a qualified medical physicist several areas for improvement were identified. These are mainly in the areas of increased practical experience and in course delivery.
Wakefield, Jerome C
Christopher Boorse's biostatistical theory of medical disorder claims that biological part-dysfunction (i.e., failure of an internal mechanism to perform its biological function), a factual criterion, is both necessary and sufficient for disorder. Jerome Wakefield's harmful dysfunction analysis of medical disorder agrees that part-dysfunction is necessary but rejects the sufficiency claim, maintaining that disorder also requires that the part-dysfunction causes harm to the individual, a value criterion. In this paper, I present two considerations against the sufficiency claim. First, I analyze Boorse's central argument for the sufficiency claim, the "pathologist argument," which takes pathologists' intuitions about pathology as determinative of medical disorder and conclude that it begs the question and fails to support the sufficiency claim. Second, I present four counterexamples from the medical literature in which salient part-dysfunctions are considered nondisorders, including healthy disease carriers, HIV-positive status, benign mutations, and situs inversus totalis, thus falsifying the sufficiency claim and supporting the harm criterion.
... 42 Public Health 4 2010-10-01 2010-10-01 false Content of medical care evaluation studies. 456.143...: Medical Care Evaluation Studies § 456.143 Content of medical care evaluation studies. Each medical care evaluation study must— (a) Identify and analyze medical or administrative factors related to the...
... 42 Public Health 4 2010-10-01 2010-10-01 false Content of medical care evaluation studies. 456.243... Ur Plan: Medical Care Evaluation Studies § 456.243 Content of medical care evaluation studies. Each medical care evaluation study must— (a) Identify and analyze medical or administrative factors related...
A Report on the Feasibility and Design of a Longitudinal Tracking System for Evaluating the Effects of Medical Student Preceptorships on Career Development Processes and Dispositions. Final Report-Part I.
The Career Development and Information System (CDIS) is a longitudinal tracking system addressing itself to the distribution of new physicians in underserved areas, and in the field of primary health care as opposed to a specialty. It is comprised of several computerized modules. The Comprehensive Research, Evaluation and Assessment Module (CREAM)…
... 42 Public Health 4 2010-10-01 2010-10-01 false Medical, psychiatric, and social evaluations. 456.170 Section 456.170 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND..., and social evaluations. (a) Before admission to a mental hospital or before authorization for...
... ADMINISTRATION RIN 0960-AF58 Medical Criteria for Evaluating Cystic Fibrosis AGENCY: Social Security....04 to evaluate claims involving cystic fibrosis in adults and children under titles II and XVI of the... information on the disability program. 2. Information for individuals with cystic fibrosis who apply...
Bauer, Elizabeth K.
Traces the development, since its founding in 1863, of the American Veterinary Medical Association (AVMA) influence over the standards of training required in the veterinary profession. Attention is focused on the roles of the U.S. Department of Agriculture, the military, and the land-grant colleges in that development. (JT)
Sugawara, Shinya; Wu, Tianyi; Yamanishi, Kenji
This study proposes a novel statistical methodology to analyze expenditure on multiple medical sectors using consumer data. Conventionally, medical expenditure has been analyzed by two-part models, which separately consider purchase decision and amount of expenditure. We extend the traditional two-part models by adding the step of basket analysis for dimension reduction. This new step enables us to analyze complicated interdependence between multiple sectors without an identification problem. As an empirical application for the proposed method, we analyze data of 13 medical sectors from the Medical Expenditure Panel Survey. In comparison with the results of previous studies that analyzed the multiple sector independently, our method provides more detailed implications of the impacts of individual socioeconomic status on the composition of joint purchases from multiple medical sectors; our method has a better prediction performance.
Tregubova, E S; Nekhoroshev, A S
Complex sanitary hygienic and sociologic evaluation of high school factors enabled to assign work conditions of medical institute lecturers according to P 2.2.2006 - to 05 for jeopardy and to 2 degree 3 class for hardiness and intensity of work, to define psychosocial risks as main hazards. The authors specified and suggested prophylactic system aimed to increase work efficiency of medical institute lecturers.
Lichty, Richard W.; Peterson, Jerrold M.
The use of peer evaluation in assessing teaching effectiveness is discussed and two techniques that utilize peer evaluation are explained in this paper. Peer evaluation is viewed as a comprehensive measure of teaching effectiveness and a necessary supplement to student evaluation of teacher performance. It is suggested that this method be carried…
North Carolina State Dept. of Public Instruction, Raleigh. Div. of Accountability Services/Research.
In North Carolina, Alternative Learning Programs (ALP) is a designation applied to a variety of activities, locations, and student characteristics. This report focuses on descriptive information about the state's ALP efforts, teachers, and the students they serve. Two hundred and fifteen schools and programs met the evaluation criteria as ALPs.…
Petty, Janet L
This article explores the influence of health literacy on medication adherence. With health literacy skills nearly flat for over a decade and an aging population receiving multiple and complex medication regimens, literacy is becoming a more important factor in nursing assessment and intervention. Concrete tools are provided to help the clinical nurse specialist (CNS) assess literacy and evaluate written resources for patient education and to improve medication adherence.
This is Part II of a two-part annotated bibliography of selected references on medical education in the People's Republic of China. The references date from 1913 to 1982. Most of the references are from the 1960's and 1970's. (RH)
Dudnyk, V M; Popov, V P; Skakyn, Z A; Gumynska, G S; Vinnichuk, L L; Marchuk, O I
Provided evaluation of the medical and social inspection of the dcotrors-consultative commission of Vinnytsya regional childrens hospital in children with juvenile rheumatoid arthritis (JRA). Patients with JRA that got position of the child-invalid are given individual program of the rehabilitation that includes medical, professional, sport and physical, social adaptation that gives ability control recommendations for both--physicians and parents.
Stewart, Michael R.; Fogg, Sarah M.; Schminke, Brandon C.; Zackula, Rosalee E.; Nester, Tina M.; Eidem, Leslie A.; Rosendale, James C.; Ragan, Robert H.; Bond, Jack A.; Goertzen, Kreg W.
Abstract Background/Objective: Medication reconciliation at transitions of care decreases medication errors, hospitalizations, and adverse drug events. We compared inpatient medication histories and reconciliation across disciplines and evaluated the nature of discrepancies. Methods: We conducted a prospective cohort study of patients admitted from the emergency department at our 760-bed hospital. Eligible patients had their medication histories conducted and reconciled in order by the admitting nurse (RN), certified pharmacy technician (CPhT), and pharmacist (RPh). Discharge medication reconciliation was not altered. Admission and discharge discrepancies were categorized by discipline, error type, and drug class and were assigned a criticality index score. A discrepancy rating system systematically measured discrepancies. Results: Of 175 consented patients, 153 were evaluated. Total admission and discharge discrepancies were 1,461 and 369, respectively. The average number of medications per participant at admission was 8.59 (1,314) with 9.41 (1,374) at discharge. Most discrepancies were committed by RNs: 53.2% (777) at admission and 56.1% (207) at discharge. The majority were omitted or incorrect. RNs had significantly higher admission discrepancy rates per medication (0.59) compared with CPhTs (0.36) and RPhs (0.16) (P < .001). RPhs corrected significantly more discrepancies per participant than RNs (6.39 vs 0.48; P < .001); average criticality index reduction was 79.0%. Estimated prevented adverse drug events (pADEs) cost savings were $589,744. Conclusions: RPhs committed the fewest discrepancies compared with RNs and CPhTs, resulting in more accurate medication histories and reconciliation. RPh involvement also prevented the greatest number of medication errors, contributing to considerable pADE-related cost savings. PMID:25477614
Williams, James P.
For the past 13 years, the Verde Valley Campus of Yavapai College, in Arizona, has used the same system to evaluate part-time faculty in an effort to both maintain quality control and provide feedback to part-time faculty and address their concerns. The system utilizes two instruments to gather evaluative data. The first is used to determine…
Wagholikar, Kavishwar; Mangrulkar, Sanjeev; Deshpande, Ashok; Sundararajan, Vijayraghavan
The potential of computer based tools to assist physicians in medical decision making, was envisaged five decades ago. Apart from factors like usability, integration with work-flow and natural language processing, lack of decision accuracy of the tools has hindered their utility. Hence, research to develop accurate algorithms for medical decision support tools, is required. Pioneering research in last two decades, has demonstrated the utility of fuzzy set theory for medical domain. Recently, Wagholikar and Deshpande proposed a fuzzy relation based method (FR) for medical diagnosis. In their case studies for heart and infectious diseases, the FR method was found to be better than naive bayes (NB). However, the datasets in their studies were small and included only categorical symptoms. Hence, more evaluative studies are required for drawing general conclusions. In the present paper, we compare the classification performance of FR with NB, for a variety of medical datasets. Our results indicate that the FR method is useful for classification problems in the medical domain, and that FR is marginally better than NB. However, the performance of FR is significantly better for datasets having high proportion of unknown attribute values. Such datasets occur in problems involving linguistic information, where FR can be particularly useful. Our empirical study will benefit medical researchers in the choice of algorithms for decision support tools.
Panlilio, Leigh V.; Justinova, Zuzana; Trigo, Jose M.; Le Foll, Bernard
Cannabis use has been increasingly accepted legally and in public opinion. However, cannabis has the potential to produce adverse physical and mental health effects and can result in cannabis use disorder (CUD) in a substantial percentage of both occasional and daily cannabis users. Many people have difficulty discontinuing use. Therefore, it would be beneficial to develop safe and effective medications for treating CUD. To achieve this, methods have been developed for screening and evaluating potential medications using animal models and controlled experimental protocols in human volunteers. In this chapter we describe: 1) animal models available for assessing the effect of potential medications on specific aspects of CUD; 2) the main findings obtained so far with these animal models; 3) the approaches used to assess potential medications in humans in laboratory experiments and clinical trials; and 4) the effectiveness of several potential pharmacotherapies on the particular aspects of CUD modeled in these human studies. PMID:27055612
Santos, Beatriz S.; Dillenseger, Jean-Louis
Among the several medical imaging stages (acquisition, reconstruction, etc.), visualization is the latest stage on which decision is generally taken. Scientific visualization tools allow to process complex data into a graphical visible and understandable form, the goal being to provide new insight. If the evaluation of procedures is a crucial issue and a main concern in medicine, paradoxically visualization techniques, predominantly in tri-dimensional imaging, have not been the subject of many evaluation studies. This is perhaps due to the fact that the visualization process integrates the Human Visual and Cognitive Systems, which makes evaluation especially difficult. However, as in medical imaging, the question of quality evaluation of a specific visualization remains a main challenge. While a few studies concerning specific cases have already been published, there is still a great need for definition and systemization of evaluation methodologies. The goal of our study is to propose such a framework, which makes it possible to take into account all the parameters taking part in the evaluation of a visualization technique. Concerning the problem of quality evaluation in data visualization in general, and in medical data visualization in particular, three different concepts appear to be fundamental: the type and level of components used to convey to the user the information contained in the data, the type and level at which evaluation can be performed, and the methodologies used to perform such evaluation. We propose a taxonomy involving types of methods that can be used to perform evaluation at different levels.
Grad, Roland; Macaulay, Ann C.; Warner, Michelle
Describes and evaluates a teaching initiative in evidence-based medical care in McGill University's family practice residency program. Discusses results of pre- and post-course self-assessments by students, which indicated significant increases in skill at formulating clinical questions and searching for evidence-based answers, appraising reviews,…
Frazier, William H.; Cannon, Joseph F.
An evaluation was conducted of the diagnostic accuracy and treatment appropriateness of emergency medical technicians (EMTs) in caring for 4,455 consecutive patients during a four-and-one-half month period. Data on EMT diagnosis and treatment and physician diagnosis were collected, and EMT data validated by observers. There were fifty-eight…
Silk, Larry; Watt, Jackie; Pilon, Nancy; Draper, Chad
This article describes a psychotropic PRN Evaluative Tool developed by interprofessional clinicians to address inconsistent reporting and assessment of the effectiveness of PRN medications used for people who are developmentally disabled. Fifty-nine participants (37 males, 22 females), ages 16 to 60 years, were included in the review, all…
Li Wang, Virginia; And Others
A continuing medical education program is discussed that addresses chronic obstructive pulmonary disease and that links primary care physicians to a source of needed clinical knowledge at a relatively low cost. The educational methods, evaluation design, diagnosis of educational needs, selection of program content and behavioral outcomes are…
Friedman, Charles P.; And Others
The Josiah Macy Jr. Foundation sponsored a conference to consider designs for evaluation studies and the potential distinctive outcomes of the innovative medical curricula that might be foci of these studies. Differences between graduates of innovative and traditional curricula which might be expected were identified. (Author/MLW)
Bodenreider, Oliver; Burgun, Anita; Botti, Geneviève; Fieschi, Marius; Beux, Pierre Le; Kohler, François
Abstract Objective: The authors evaluated the use of the Unified Medical Language System (UMLS) as a medical knowledge source for the representation of medical procedures in the MAOUSSC system. Design: MAOUSSC, a multiaxial coding system, was used for the representation of 1500 procedures from 15 clinical specialties, using UMLS concepts (augmented by full sources for three new vocabularies being added to the UMLS) and relationships whenever possible. Evaluation criteria for the UMLS included (1) completeness of representation of concepts and of inter-concept relationships, (2) consistency in the categorization of both concepts and inter-concept relationships, and (3) usability, including adaptability of the UMLS to a foreign language (French), its suitability to a geographic region with different medical practices than the USA, and issues relative to the annual update changes in the test vocabularies. Results: During the MAOUSSC trial, the number of missing concepts or relationships identified in the augmented UMLS sources was deemed to be inconsequential relative to overall project goals. “Missing” UMLS inter-concept relationships were identified, although they were small in number. Some inconsistencies in the UMLS were noted, especially in the area of hierarchic relationships. Conclusion: After UMLS was used for five years as a knowledge source for representing 1500 complex medical procedures in MAOUSSC, its value is considered significant. Future editions of the UMLS are expected to improve representation of inter-concept relationships and global consistency. PMID:9452987
Mellado, J M
Legal recognition of patient's rights aspired to change clinical relationship and medical lex artis. However, its implementation has been hampered by the scarcity of resources and the abundance of regulations. For several years, autonomy, consent, and responsibility have formed one of the backbones of the medical profession. However, they have sparked controversy and professional discomfort. In the first part of this article, we examine the conceptual and regulatory limitations of the principle of autonomy as the basis of informed consent. We approach the subject from philosophical, historical, legal, bioethical, deontological, and professional standpoints. In the second part, we cover the viability of informed consent in health care and its relationship with legal responsibility.
Staggers, Nancy; Iribarren, Sarah; Guo, Jia-Wen; Weir, Charlene
Barcode medication administration (BCMA) systems can reduce medication errors, but sociotechnical issues are quite common. Although crucial to nurses’ work, few usability evaluations are available for electronic medication administration record screens (eMARs). The purpose of this research was to identify current usability problems in the VA’s eMAR/BCMA system and explore how these might impact nurses’ situation awareness. Three expert evaluators used 10 tasks/elements, heuristic evaluation techniques and explored potential impacts using a situation awareness perspective. The results yielded 99 usability problems categorized into 440 heuristic violations with the largest volume in the category of Match with the Real World. Fifteen usability issues were rated as catastrophic with the Administer/Chart medications task having the most. Situational awareness was impacted at all levels, especially at Level 2, Comprehension. Usability problems point to important areas for improvement because these issues have the potential to impact nurses’ situation awareness, “at a glance” information, nurse productivity and patient safety. PMID:25601936
Nathanson, Andrew T; Young, Justin Mark J; Young, Craig
A request for a preparticipation medical evaluation for wilderness watersports may be made by guiding agencies, instructional camps, or by patients presenting for an annual visit. Although guidelines have been published regarding preparticipation physical evaluation for traditional competitive high school and collegiate sports, little has been written about medical evaluations for those wishing to engage in wilderness and adventure watersports. in this article, we offer guidance based on literature review and expert opinion. Watersports are among the most common recreational activities in the United states and are generally safe. Drowning, however, is a significant risk, particularly in small, self-propelled craft, and among children. Medical counseling before participation in watersports should include screening for medical conditions which may impair swimming ability, including a history of seizures, heart disease, and lung disease. Physicians should also promote preventive health measures such as use of lifejackets and sun protection, as well as alcohol avoidance. Swim testing tailored to specific activities should be strongly considered for children and those with questionable swimming ability.
Rotter, Jason S; Foerster, Douglas; Bridges, John Fp
Economic evaluation is established within health-technology assessment but is challenged by those wanting to use economic evaluation to inform pricing and/or incorporate nontraditional sources of value and the views of diverse stakeholders. The changing role of economic evaluation in (formally or informally) assessing prices/values in four jurisdictions (UK, Australia, Germany and USA) is detailed and the authors propose a taxonomy of factors impacting the value of medical technology spanning clinical utility (effectiveness, safety/tolerability and quality of evidence), consumer demand (consumer preferences, process utility and unmet need), economic incentives (innovation, option value and market competition) and the societal perspective (social justice, social values and national interest). The authors suggest that multicriteria decision analysis methods grounded in hedonic-pricing theory can facilitate the valuing/pricing of medical technologies. The use of such an approach is hindered by a paucity of relevant educational opportunities, vested interests and aversion to placing prices/values on health.
Dubowitz, Howard; Christian, Cindy W; Hymel, Kent; Kellogg, Nancy D
Physicians play an important role in the forensic evaluation of suspected child abuse and neglect. There has been considerable progress in the medical field, helping distinguish findings related to maltreatment from other conditions or circumstances. Nevertheless, important questions remain. This article covers several of these questions and proposes a research agenda concerning five main topics: sexual abuse, neglect, fractures, abusive head trauma, and physicians work in interdisciplinary settings. The suggestions are hardly inclusive, but offer suggestions the authors think are priorities, and ones that research could reasonably address. By providing some background to gaps in our knowledge, this paper should be of interest to a broader audience than just medical professionals.
Schiekirka, Sarah; Feufel, Markus A.; Herrmann-Lingen, Christoph; Raupach, Tobias
Background and objective: Evaluation is an integral part of education in German medical schools. According to the quality standards set by the German Society for Evaluation, evaluation tools must provide an accurate and fair appraisal of teaching quality. Thus, data collection tools must be highly reliable and valid. This review summarises the current literature on evaluation of medical education with regard to the possible dimensions of teaching quality, the psychometric properties of survey instruments and potential confounding factors. Methods: We searched Pubmed, PsycINFO and PSYNDEX for literature on evaluation in medical education and included studies published up until June 30, 2011 as well as articles identified in the “grey literature”. Results are presented as a narrative review. Results: We identified four dimensions of teaching quality: structure, process, teacher characteristics, and outcome. Student ratings are predominantly used to address the first three dimensions, and a number of reliable tools are available for this purpose. However, potential confounders of student ratings pose a threat to the validity of these instruments. Outcome is usually operationalised in terms of student performance on examinations, but methodological problems may limit the usability of these data for evaluation purposes. In addition, not all examinations at German medical schools meet current quality standards. Conclusion: The choice of tools for evaluating medical education should be guided by the dimension that is targeted by the evaluation. Likewise, evaluation results can only be interpreted within the context of the construct addressed by the data collection tool that was used as well as its specific confounding factors. PMID:26421003
... 34 Education 2 2011-07-01 2010-07-01 true Evaluation Standards A Appendix A to Part 379 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION PROJECTS WITH INDUSTRY Pt. 379, App. A Appendix A to Part...
... 34 Education 2 2012-07-01 2012-07-01 false Evaluation Standards A Appendix A to Part 379 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION PROJECTS WITH INDUSTRY Pt. 379, App. A Appendix A to Part...
... 34 Education 2 2010-07-01 2010-07-01 false Evaluation Standards A Appendix A to Part 379 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION PROJECTS WITH INDUSTRY Pt. 379, App. A Appendix A to Part...
... 34 Education 2 2013-07-01 2013-07-01 false Evaluation Standards A Appendix A to Part 379 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION PROJECTS WITH INDUSTRY Pt. 379, App. A Appendix A to Part...
... 34 Education 2 2014-07-01 2013-07-01 true Evaluation Standards A Appendix A to Part 379 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION PROJECTS WITH INDUSTRY Pt. 379, App. A Appendix A to Part...
Huntzinger, Paul Evan
Nonprescription medication (i.e., "over-the-counter") programs have historically been popular at many military treatment facilities. These programs were developed to provide a mechanism through which active duty members could obtain certain nonprescription medications without seeing a health care provider. The goal of such programs was to reduce demand on health care provider appointments and operational costs associated with such visits. Coast Guard military treatment facilities are encouraged to provide the service. The purpose of this paper was to evaluate whether the nonprescription medication program offered at the Coast Guard Alameda pharmacy reduced demand on health care provider appointments for self-limiting conditions and reduced costs associated with such visits.
... 42 Public Health 4 2010-10-01 2010-10-01 false UR plan requirements for medical care evaluation...: Hospitals Ur Plan: Medical Care Evaluation Studies § 456.142 UR plan requirements for medical care... medical care evaluation studies under paragraph (b)(1) of this section. (b) The UR plan must provide...
Walsh., Kim; Schwartz., Barbara
Background: In most health care facilities, problems related to delays in STAT medication order processing time are of common concern. Objective: The purpose of this study was to evaluate processing time for STAT orders at Kimball Medical Center. Methods: All STAT orders were reviewed to determine processing time; order processing time was also stratified by physician order entry (physician entered (PE) orders vs. non-physician entered (NPE) orders). Collected data included medication ordered, indication, time ordered, time verified by pharmacist, time sent from pharmacy, and time charted as given to the patient. Results: A total of 502 STAT orders were reviewed and 389 orders were included for analysis. Overall, median time was 29 minutes, IQR 16–63; p<0.0001.). The time needed to process NPE orders was significantly less than that needed for PE orders (median 27 vs. 34 minutes; p=0.026). In terms of NPE orders, the median total time required to process STAT orders for medications available in the Automated Dispensing Devices (ADM) was within 30 minutes, while that required to process orders for medications not available in the ADM was significantly greater than 30 minutes. For PE orders, the median total time required to process orders for medications available in the ADM (i.e., not requiring pharmacy involvement) was significantly greater than 30 minutes. [Median time = 34 minutes (p<0.001)]. Conclusion: We conclude that STAT order processing time may be improved by increasing the availability of medications in ADM, and pharmacy involvement in the verification process. PMID:27382418
Zakaria, Adel; Labib, Osama
The emissions from medical waste incinerators might perform a threat to the environment and the Public Health, the aim of the present work is to evaluate the emissions of six medical waste incinerators in six hospitals in Alexandria, Namely; Gamal Abd El-Naser, Sharq El-Madina, Central Blood Bank, Fever, Medical Research Institute, and Al-Mo'asat, ordered serially from 1 to 6. Five air pollutants were sampled and analyzed in the emissions comprising smoke, lead, carbon monoxide, sulphur dioxide and nitrogen oxides. The results of the present study have revealed that all the average values of gases in the six incinerators were within the limits stated in Egyptian environmental law, where as carbonaceous particulate (smoke) averages of the six incinerators have exceeded the maximum allowable limit in the law. On the other hand, lead concentration in emissions were far below the maximum allowable limit in the law. Al-Mo'asat incinerator emissions have been significantly higher in CO, NO2, SO2 and smoke concentration than the other five incinerators P < 0.001, P < 0.0006, P < 0.0001, and P < 0.002 respectively. The main recommendations of the present work are to reassess the limits of emissions in the Egyptian law and to state specific limits for medical wast incinerators and to relocate the medical waste incinerators away from residential areas or to substitute them all by a central incinerator in a proper place out of the city.
Young, S; Bellamy, K
Medical illustrators have long been involved in the research projects of other workers, by providing photographic and other visual records. These illustrations may be used for measurement purposes, in which case it is important that medical illustrators understand the requirements for using tested protocols, which ensure that all variables of the recording medium are controlled. Now that there are degree courses in medical illustration an increasing number of medical illustrators in the UK are instigating their own research projects, making it all the more important that they understand the research process. In this second of a two-part article, consideration is given to: the design of experiments and research trials; the production of research protocols; data analysis and interpretation; the writing of the research report or dissertation; and the role of the supervisor or mentor.
Masters, Ken; Ellaway, Rachel
With e-learning now part of the medical education mainstream, both educational and practical technical and informatics skills have become an essential part of the medical teacher's portfolio. The Guide is intended to help teachers develop their skills in working in the new online educational environments, and to ensure that they appreciate the wider changes and developments that accompany this 'information revolution'. The Guide is divided into two parts, of which this is the second. The first part introduced the basic concepts of e-learning, e-teaching, and e-assessment, the day-to-day issues of e-learning, looking both at theoretical concepts and practical implementation issues. This second part covers topics such as practical knowledge of the forms of technology used in e-learning, the behaviours of teachers and learners in online environments and the design of e-learning content and activities. It also deals with broader concepts of the politics and psychology of e-learning, as well as many of its ethical, legal and economical dimensions, and it ends with a review of emerging forms and directions in e-learning in medical education.
Moreira, H; Magalhães, T; Dinis-Oliveira, Rj; Taveira-Gomes, A
Although medical liability (disciplinary, civil and criminal) is increasingly becoming an issue, few studies exist, particularly from the perspective of forensic science, which demonstrate the extent to which medical malpractice occurs, or when it does, the reasons for it. Our aims were to evaluate the current situation concerning medical liability in general surgery (GS) in Portugal, the reasons for claims, and the forensic evaluations and conclusions, as well as the association between these issues and the judicial outcomes. We analysed the Medico-Legal Council (CML) reports of the National Institute of Legal Medicine and Forensic Sciences of Portugal related to GS during 2001-2010. The judicial outcomes of each case were requested from the Public Prosecutor Office (PPO) and the court. Alleged cases of medical liability in GS represented 11.2% of the total cases analysed by the CML. We estimated that in Portugal, 4:100,000 surgeries are subject to litigation. The majority of complaints were due to the patient's death (75.4%), with laparoscopic cholecystectomy surgeries representing 55.2% of cases. In 76.1% of the cases, the CML believed that there was no violation of legesartis and in 55.2% of cases, no causal nexus was found between the medical practice and the alleged harm. The PPO prosecuted physicians in 6.4% of the cases and resulted in one conviction. Finally, the importance of the CML reports as a relevant technical-scientific tool for judicial decision was evident because these reports significantly (p < 0.05) influenced the prosecutor's decision, whether to prosecute or not.
Becker, Gary J
In recent years, formal professionalism education, training, and assessment have been introduced to medical schools and accredited residency training programs. Current constructs of medical professionalism characterize it as a multidimensional competency rather than a trait. Medical professionalism is a belief system for organizing and delivering care, in which group members (medical professionals) promise patients and the public that they will self-regulate (ie, ensure that medical professionals live up to standards of competence and ethical values). Physicians who are good professionals have lapses in professionalism. Responses to professional lapses should focus on remediation. Failure of groups of professionals to enforce the standards and values can convey to patients and the public a lack of trustworthiness and thereby undermine the foundation of professionalism, the social contract. The Physician Charter sets forth the 3 fundamental principles and 10 commitments that offer guidance in some of the most challenging situations. One example is illustrated herein and is continued from Part 1 of this two-part series.
Baral, Nirmal; Paudel, Bishnu Hari; Das, Binod Kumar Lal; Aryal, Madhukar; Das, Balbhadra Prasad; Jha, Nilambar; Lamsal, Madhab
Effective teaching is a concern of all teachers. Therefore, regular teachers' training is emphasized globally. B. P. Koirala Institute of Health Sciences (BPKIHS), a health science deemed university situated in eastern region of Nepal has an established Medical Education unit which attempts to improve teaching-learning skills by training faculty members through organizing regular medical education training programs. The aim of the present study was to assess the effectiveness of 3-day training workshop on "Teaching-learning methodology and Evaluation" held in four different medical colleges of Nepal. The workshop was targeted at middle and entry level of health profession teachers who had not been previously exposed to any teacher's training program. The various components, such as teaching-learning principles, writing educational objectives, organizing and sequencing education materials, teaching-learning methods, microteaching and assessment techniques, were incorporated in the workshop. A team of resource persons from BPKIHS were involved in all the four medical institutions. The collection data had two categories of responses: (1) a questionnaire survey of participants at the beginning and end of the workshop to determine their gain in knowledge and (2) a semi-structured questionnaire survey of participants at the end of workshop to evaluate their perception on usefulness of the workshop. The later category had items with three-point likert scale (very useful, useful and not useful) and responses to open-ended questions/ statements to document participants general views. The response was entered into a spreadsheet and analyzed using SPSS. The result showed that all participants (n = 92) improved their scores after attending the workshop (p < 0.001). Majority of respondents expressed that the teaching-learning methods, media, microteaching and evaluation techniques were useful in teaching-learning. The workshop was perceived as an acceptable way of acquiring
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.
The objective of this evaluation study is to assess a method for standard based medical data visualization. The method allows flexible and customizable visualization for ISO 13606 archetype based medical data. The chosen evaluation concept is based the Guideline for Good Evaluation Practice in Health Informatics (GEP-HI). The stages of the study were identified. Each stage got a detailed description. We also identified the participants and their required qualifications and responsibilities. The evaluation location was described in details. The evaluation metrics were defined. The questionnaires for doctors, patients and experts were developed to fulfill the requirements of the evaluation study. The study was performed in Tomsk, Russia. 30 patients and 5 doctors participated in the study. The overall performance of the users reached the expert level by the end of the study. Patients as well as medical staff stated in their comments that the usability of the system was high, and they preferred it to the previously used paper-based and computer based systems. This was also shown by the high level of satisfaction measured within our study. The visualization approach, integrated into the electronic health record, was well accepted in our pilot setting with high usability scores from patients and doctors alike. The results showed the efficiency for both modeling and visualization part of the system.
O'Hara, Nancy F; Duvanich, Mary; Foss, Julie; Wells, Nancy
Developing a performance-based advancement system requires evaluation tools that capture essential behaviors and outcomes reflective of key nursing functions. To ensure relevance to clinical practice and enhance buy-in from nursing staff, the behaviors and outcomes were defined by a broad cross-section of nursing staff and administrators. The first article (September 2003) in this 3-part series described the foundation for and the philosophical background of the Vanderbilt Professional Nursing Practice Program (VPNPP), the career advancement program under way at Vanderbilt University Medical Center. This second article describes the development of the evaluation tools used in the VPNPP, the implementation and management of this new system, program evaluation, and improvements since the inception of the program. Additionally, the authors present the challenges and lessons we learned in development and implementation of a dynamic evaluation system that supports our career advancement program. The process of advancing within the program will be described in part 3.
Cohen, Peter J
Whether "medical marijuana" (Cannabis sativa used to treat a wide variety of pathologic states) should be accorded the status of a legitimate pharmaceutical agent has long been a contentious issue. Is it a truly effective drug that is arbitrarily stigmatized by many and criminalized by the federal government? Or is it without any medical utility, its advocates hiding behind a screen of misplaced (or deliberately misleading) compassion for the ill? Should Congress repeal its declaration that smoked marijuana is without "current medical benefit"? Should cannabis be approved for medical use by a vote of the people as already has been done in 13 states? Or should medical marijuana be scientifically evaluated for safety and efficacy as any other new investigational drug? How do the competing--and sometimes antagonistic--roles of science, politics and prejudice affect society's attempts to answer this question? This article examines the legal, political, policy, and ethical problems raised by the recognition of medical marijuana by over one-fourth of our states although its use remains illegal under federal law. Although draconian punishment can be imposed for the "recreational" use of marijuana, I will not address the contentious question of whether to legalize or decriminalize the use of marijuana solely for its psychotropic effects, a fascinating and important area of law and policy that is outside the scope of this paper. Instead, the specific focus of this article will be on the conflict between the development of policies based on evidence obtained through the use of scientific methods and those grounded on ideological and political considerations that have repeatedly entered the longstanding debate regarding the legal status of medical marijuana. I will address a basic question: Should the approval of medical marijuana be governed by the same statute that applies to all other drugs or pharmaceutical agents, the Food, Drug, and Cosmetic Act (FD&C Act), after the
Anderson, Eric L.; Nordstrom, Kimberly; Wilson, Michael P.; Peltzer-Jones, Jennifer M.; Zun, Leslie; Ng, Anthony; Allen, Michael H.
Introduction In the United States, the number of patients presenting to the emergency department (ED) for a mental health concern is significant and expected to grow. The breadth of the medical evaluation of these patients is controversial. Attempts have been made to establish a standard evaluation for these patients, but to date no nationally accepted standards exist. A task force of the American Association of Emergency Psychiatry, consisting of physicians from emergency medicine and psychiatry, and a psychologist was convened to form consensus recommendations on the medical evaluation of psychiatric patients presenting to EDs. Methods The task force reviewed existing literature on the topic of medical evaluation of psychiatric patients in the ED (Part I) and then combined this with expert consensus (Part II). Results In Part I, we discuss terminological issues and existing evidence on medical exams and laboratory studies of psychiatric patients in the ED. Conclusion Emergency physicians should work cooperatively with psychiatric receiving facilities to decrease unnecessary testing while increasing the quality of medical screening exams for psychiatric patients who present to EDs. PMID:28210358
...: Mental Hospitals Ur Plan: Medical Care Evaluation Studies § 456.242 UR plan requirements for medical care... medical care evaluation studies under paragraph (b)(1) of this section. (b) The UR plan must provide that... 42 Public Health 4 2010-10-01 2010-10-01 false UR plan requirements for medical care...
Nanji, Karen C.; Patel, Amit; Shaikh, Sofia; Seger, Diane L.; Bates, David W.
Background The purpose of this study is to assess the rates of perioperative medication errors (MEs) and adverse drug events (ADEs) as percentages of medication administrations, evaluate their root causes, and formulate targeted solutions to prevent them. Methods In this prospective observational study, anesthesia-trained study staff (anesthesiologists/nurse anesthetists) observed randomly selected operations at a 1,046 bed tertiary care academic medical center to identify MEs and ADEs over eight months. Retrospective chart abstraction was performed to flag events that were missed by observation. All events subsequently underwent review by two independent reviewers. Primary outcomes were the incidence of MEs and ADEs. Results A total of 277 operations were observed with 3,671 medication administrations of which 193 (5.3%, 95% CI 4.5 to 6.0) involved a ME and/or ADE. Of these, 153 (79.3%) were preventable and 40 (20.7%) were non-preventable. The events included 153 (79.3%) errors and 91 (47.2%) ADEs. While 32 (20.9%) of the errors had little potential for harm, 51 (33.3%) led to an observed ADE and an additional 70 (45.8%) had the potential for patient harm. Of the 153 errors, 99 (64.7%) were serious, 51 (33.3%) were significant and 3 (2.0%) were life-threatening. Conclusions One in twenty perioperative medication administrations included an ME and/or ADE. More than one third of the MEs led to observed ADEs, and the remaining two thirds had the potential for harm. These rates are markedly higher than those reported by retrospective surveys. Specific solutions exist which have the potential to decrease the incidence of perioperative MEs. PMID:26501385
Smith, A E; Nugent, C D; McClean, S I
The application of artificial intelligence systems is still not widespread in the medical field, however there is an increasing necessity for these to handle the surfeit of information available. One drawback to their implementation is the lack of criteria or guidelines for the evaluation of these systems. This is the primary issue in their acceptability to clinicians, who require them for decision support and therefore need evidence that these systems meet the special safety-critical requirements of the domain. This paper shows evidence that the most prevalent form of intelligent system, neural networks, is generally not being evaluated rigorously regarding classification precision. A taxonomy of the types of evaluation tests that can be carried out, to gauge inherent performance of the outputs of intelligent systems has been assembled, and the results of this presented in a clear and concise form, which should be applicable to all intelligent classifiers for medicine.
Carlson, Joanne S
This study helps to quantify and describe orientation, evaluation, and integration practices pertaining to part-time clinical nursing faculty teaching in prelicensure nursing education programs. A researcher designed Web-based survey was used to collect information from a convenience sample of part-time clinical nursing faculty teaching in prelicensure nursing programs. Survey questions focused on the amount and type of orientation, evaluation, and integration practices. Descriptive statistics were used to analyze results. Respondents reported on average four hours of orientation, with close to half reporting no more than two hours. Evaluative feedback was received much more often from students than from full-time faculty. Most respondents reported receiving some degree of mentoring and that it was easy to get help from full-time faculty. Respondents reported being most informed about student evaluation procedures, grading, and the steps to take when students are not meeting course objectives, and less informed about changes to ongoing curriculum and policy.
... AFFAIRS Agency Information Collection (Report of Medical Examination for Disability Evaluation) Activity.... 2900-0052.'' SUPPLEMENTARY INFORMATION: Title: Report of Medical Examination for Disability Evaluation... submit the collection of information abstracted below to the Office of Management and Budget (OMB)...
Zimmer, J G
This report describes the selection, design, conduct, analysis, and application of medical care evaluation studies in long-term care facilities (skilled nursing homes) in a regional program in the Rochester region of upstate New York. Eight examples are presented to highlight methodologic approaches and problems. They are classified under four general headings: Administration Audits, Diagnosis-specific Studies, Care Modality-specific Studies, and General Outcome Indicators. The implementation of results and recommendations from the studies is discussed and an application of "tracer" methodology for assessing the components of care activities in long-term facilities is described. Problems and challenges in long-term quality care are outlined.
Cooper, Cathy; Walker, Connie
This is Part I of a final evaluation of a program designed to reduce the incidence of destructive risk-taking behavior (e.g. drug-alcohol abuse, and juvenile delinquency) among school-age youth. Background research indicates that peer group pressure is the single most important factor in dictating the presence or absence of juvenile delinquency…
Batista, Almária Mariz; Carvalho, Maria Cleide Ribeiro Dantas de
The scope of this paper was to evaluate advertising for medication broadcast on radio stations in Natal, State of Rio Grande do Norte, Brazil, from April to September 2008 and from April to September 2010. The advertising was recorded and transcribed in order to conduct legal analysis and content analysis based on the precepts of Laurence Bardin. Both the advertising recorded during the first stage (regulated by RDC 102/00) and the second stage (regulated by RDC 96/08) contained some form of legal violation. Content analysis detected practically the same violations in both stages, namely the lack of information regarding adverse effects of the medication, appeal to consumption, exaggeration of efficiency/effectiveness and abusive exploitation of illness. Despite the inclusion of more modern and restrictive legislation, radio advertising continues to violate the law blatantly, committing abuse and disrespecting the population's entitlement to good health. The study reveals the need for medication advertising to be dealt with in a broader context, in other words to be treated as a public health concern. It must take into consideration the socio-historical scenario in which it evolved, since the legislation alone is insufficient to combat abuse committed to the detriment of public health.
As hospital medical device managers obtain more data, opportunities exist for using the data to improve medical device management, enhance patient safety, and evaluate costs of decisions. As a demonstration of the ability to use data analytics, this article applies survival analysis statistical techniques to assist in making decisions on medical equipment maintenance. The analysis was performed on a large amount of data related to failures of an infusion pump manufacturer's lithium battery and two aftermarket replacement lithium batteries from one hospital facility. The survival analysis resulted in statistical evidence showing that one of the third-party batteries had a lower survival curve than the infusion pump manufacturer's battery. This lower survival curve translates to a shorter expected life before replacement is needed. The data suggested that to limit unexpected failures, replacing batteries at a two-year interval, rather than the current industry recommendation of three years, may be warranted. For less than $5,400 in additional annual cost, the risk of unexpected battery failures can be reduced from an estimated 28% to an estimated 7%.
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
... 42 Public Health 4 2014-10-01 2014-10-01 false UR plan requirements for medical care evaluation...: Mental Hospitals Ur Plan: Medical Care Evaluation Studies § 456.242 UR plan requirements for medical care evaluation studies. (a) The UR plan must describe the methods that the committee uses to select and...
Sajadi, Haniye Sadat; Maleki, Mohammadreza; Ravaghi, Hamid; Farzan, Homayoun; Aminlou, Hasan; Hadi, Mohammad
Background: The critical role that the board plays in governance of universities clarifies the necessity of evaluating its performance. This study was aimed to evaluate the performance of the boards of medical universities and provide solutions to enhance its performance. Methods: The first phase of present study was a qualitative research in which data were collected through face-to-face semi-structured interviews. Data were analyzed by thematic approach. The second phase was a mixed qualitative and quantitative study, with quantitative part in cross-sectional format and qualitative part in content analysis format. In the quantitative part, data were collected through Ministry of Health and Medical Education (MoHME). In the qualitative part, the content of 2,148 resolutions that were selected by using stratified sampling method were analyzed. Results: Participants believed that the boards had no acceptable performance for a long time.Results also indicated the increasing number of meetings and resolutions of the boards in these 21 years. The boards’ resolutions were mostly operational in domain and administrative in nature. The share of specific resolutions was more than the general ones. Conclusion: Given the current pace of change and development and the need to timely respond them, it is recommended to accelerate the slow pace of improvement process of the boards. It appears that more delegation and strengthening the position of the boards are the effective strategies to speed up this process. PMID:25337597
There is not a perfect agree in the definition of medical image quality from the physician and physicist point of view. The present conference analyzes the standard techniques used to grade image quality. In the first place, an analysis about how viewing conditions related to environment, monitor used or physician experience determines the subjective evaluation is done. After that, the physics point of view is analyzed including the advantage and disadvantage of the main published methods like: Quality Control Tests, Mathematical metrics, Modulation Transfer Function, Noise Power Spectrum, System Response Curve and Mathematical observers. Each method is exemplified with the results of updated papers. We concluded that the most successful methods up to the present have been those which include simulations of the Human Visual System. They have good correlation between the results of the objective metrics and the subjective evaluation made by the observers.
ALTINTAŞ, Ebru; KARAKURUM GÖKSEL, Başak; SARITÜRK, Çağla; TAŞKINTUNA, Nilgün
Introduction We aimed to evaluate the prevalence and relationship between childhood maltreatment (CMT) among patients with medication overuse headache (MOH) and to investigate whether CMT is associated with medication overuse in patients having headaches or with headaches that become chronic. Epidemiological studies report a relationship between childhood abuse and headache. There is growing knowledge about the evidence that childhood maltreatment leads to neurobiological sequel. Medication overuse is the most important problem for migraine to become chronic. But in the literature, there was no information about the role of childhood abuse in MOH and for migraine to become chronic. Methods A total of 116 patients with headache, aged from 15 to 65 years, were included in the study. Patients having chronic migraine (CM), MOH and episodic migraine (EM) were selected out of patients presented to the headache outpatient clinic. Types of headache were determined according to the revised International Headache Society (IHS) criteria published in 2004. The Childhood Trauma Questionnaire, Beck Depression Inventory and Beck Anxiety Inventory were performed. Presence of psychiatric co-morbidities was evaluated by a clinician using Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, the Fourth Edition. Results A total of 116 patients with headache were included in the study. Of patients, 64 had MOH, 25 had CM and 27 had EM. The prevalence of CMT, particularly emotional neglect (62%), physical neglect (44%) and emotional abuse (36.2%), was determined higher in all headache groups. There was no statistically significant difference in prevalence of childhood maltreatment between MOH, CM and EM groups. No statistically significant difference was detected between educational status, psychiatric co-morbidities and childhood trauma, except for physical neglect. Conclusion Childhood maltreatment was observed in MOH as in other forms of migraine and
Alshreef, Abualbishr; Jenks, Michelle; Green, William; Dixon, Simon
The economic evaluation of medical devices is increasingly used to inform decision making on adopting new or novel technologies; however, challenges are inevitable due to the unique characteristics of devices. Cost-consequence analyses are recommended and employed by the English National Institute for Health and Care Excellence (NICE) Medical Technologies Evaluation Programme (MTEP) to help address these challenges. The aim of this work was to review the critiques raised for previous MTEP submissions and explore if there were common problems across submissions. We reviewed a sample of 12 economic submissions to MTEP representing 50 % of 24 sets of guidance issued to July 2015. For each submission, we reviewed the External Assessment Centre's (EAC) report and the guidance document produced by NICE. We identified the main problems raised by the EAC's assessments and the committee's considerations for each submission, and explored strategies for improvement. We found that the identification and measurement of costs and consequences are the main shortcomings within economic submissions to MTEP. Together, these shortcomings accounted for 42 % of criticisms by the EACs among the reviewed submissions. In certain circumstances problems with these shortcomings may be unavoidable, for example, if there is a limited evidence base for the device being appraised. Nevertheless, strategies can often be adopted to improve submissions, including the use of more appropriate time horizons, whilst cost and resource use information should be taken, where possible, from nationally representative sources.
Kang, Ran; Li, Haisheng; Lysdahl, Helle; Quang Svend Le, Dang; Chen, Menglin; Xie, Lin; Bünger, Cody
In an attempt to find an ideal closure method during annulus defect repair, we evaluate the use of medical glue by mechanical and biocompatible test. Cyanoacrylate medical glue was applied together with a multilayer microfiber/nanofiber polycaprolactone scaffold and suture in annulus repair. Continuous axial loading and fatigue mechanical test was performed. Furthermore, the in vitro response of mesenchymal stem cell (MSC) to the glue was evaluated by cell viability assay. The in vivo response of annulus tissue to the glue and scaffold was also studied in porcine lumbar spine; histological sections were evaluated after 3 months. Cyanoacrylate glue significantly improved the closure effect in the experimental group with failure load 2825.7 ± 941.6 N, compared to 774.1 ± 281.3 N in the control group without glue application (p < 0.01). The experimental group also withstood the fatigue test. No toxic effect was observed by in vitro cell culture and in vivo implantation. On the basis of this initial evaluation, the use of cyanoacrylate medical glue improves closure effect with no toxicity in annulus defect repair. This method of annulus repair merits further effectiveness study in vivo. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 14-20, 2017.
The paper covers the performed evaluation of frequency with which the statistical methods were applied in analyzed works having been published in six selected, national medical journals in the years 1988-1992. For analysis the following journals were chosen, namely: Klinika Oczna, Medycyna Pracy, Pediatria Polska, Polski Tygodnik Lekarski, Roczniki Państwowego Zakładu Higieny, Zdrowie Publiczne. Appropriate number of works up to the average in the remaining medical journals was randomly selected from respective volumes of Pol. Tyg. Lek. The studies did not include works wherein the statistical analysis was not implemented, which referred both to national and international publications. That exemption was also extended to review papers, casuistic ones, reviews of books, handbooks, monographies, reports from scientific congresses, as well as papers on historical topics. The number of works was defined in each volume. Next, analysis was performed to establish the mode of finding out a suitable sample in respective studies, differentiating two categories: random and target selections. Attention was also paid to the presence of control sample in the individual works. In the analysis attention was also focussed on the existence of sample characteristics, setting up three categories: complete, partial and lacking. In evaluating the analyzed works an effort was made to present the results of studies in tables and figures (Tab. 1, 3). Analysis was accomplished with regard to the rate of employing statistical methods in analyzed works in relevant volumes of six selected, national medical journals for the years 1988-1992, simultaneously determining the number of works, in which no statistical methods were used. Concurrently the frequency of applying the individual statistical methods was analyzed in the scrutinized works. Prominence was given to fundamental statistical methods in the field of descriptive statistics (measures of position, measures of dispersion) as well as
Sörensdotter, Renita; Siwe, Karin
Gynaecologists are in a position to challenge norms about gender and sexuality in relation to female genitals. Through their work they have the opportunity to educate patients, which is why teaching medical students to perform examinations in a gender sensitive way is significant. Medical students performing their first pelvic examination often experience the examination as uncomfortable because it is a body part that is connected to sex and to something private. This paper uses medical students' interpretations of performing their first pelvic examination as a means to discuss how cultural norms for gender, sexuality and female genitals affect these examinations. Issues raised include how cultural connotations of female genitals affect the pelvic examination, how female and male students relate differently to examining female genitals and the interpretations they make in relation to themselves. Findings show that the female genitals are perceived as a special body part connected to sexuality and intimacy. Students' gender also affects the interpretations they make during pelvic examinations. Norms of gender, sexuality and female genitals need to be challenged in the teaching and performance of pelvic examination in order to demystify this experience.
Naci, Huseyin; Soumerai, Stephen B; Ross-Degnan, Dennis; Zhang, Fang; Briesacher, Becky A; Gurwitz, Jerry H; Madden, Jeanne M
Elderly Americans, especially those with multiple chronic conditions, face difficulties paying for prescriptions, resulting in worse adherence and discontinuation of therapy (“cost-related medication nonadherence” or CRN). We investigated whether the gains in medication affordability attributable to Medicare Part D implementation in January 2006 persisted during the six years that followed. Overall, we found continued incremental improvements in medication affordability in the early years of Part D (2007–2009), which then eroded during more recent years (2009–2011). Among elderly beneficiaries with four or more chronic conditions, we observed an increase in the prevalence of CRN from 14.4% in 2009 to 17.0% in 2011, reversing previous downward trends. Similarly, the prevalence of forgoing basic needs in order to purchase medicines among the sickest elderly decreased from 8.7% in 2007 to 6.8% in 2009, then rose to 10.2% in 2011. Our findings highlight the need for targeted policy efforts to alleviate the persistent burden of drug treatment costs in this vulnerable population. PMID:25092846
Bachrach, D J
While physicians have historically held positions of leadership in academic medical centers, there is an increasing trend that physicians will not only guide the clinical, curriculum and scientific direction of the institution, but its business direction as well. Physicians are assuming a greater role in business decision making and are found at the negotiating table with leaders from business, insurance and other integrated health care delivery systems. Physicians who lead "strategic business units" within the academic medical center are expected to acquire and demonstrate enhanced business acumen. There is an increasing demand for formal and informal training programs for physicians in academic medical centers in order to better prepare them for their evolving roles and responsibilities. These may include the pursuit of a second degree in business or health care management, intramurally conducted courses in leadership skill development; management, business and finance; or involvement in extramurally prepared and delivered training programs specifically geared toward physicians as conducted at major universities, often in their schools of business or public health. This article article was prepared by the author from research into and presentation of a thesis entitled. "The Importance of Leadership Training And Development For Physicians In Academic Medical Centers In An Increasingly Complex Healthcare Environment, " prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in the College (ACHE). Part 2 will appear in the next issue of the Journal.
Utsunomiya, Junpei; Hirano, Shigeki; Fukui, Aiko; Funabashi, Kazuaki; Deguchi, Yuko; Yamada, Susumu; Naito, Kazuyuki
At Komaki City Hospital, the drug cost in connection with cancer chemotherapy was re-examined as part of improved management along with the introduction of DPC in July 2008. With due attention to the 5-HT3 receptor antagonists, both the change from injections to oral drugs and the change from brand-name drugs to generic drugs were tried between July 2008 and June 2009. After that, in order to examine the economic impact of these changes, we investigated and analyzed the number of medications, the cost of medicine purchased, and the average drug cost per medication of the 5-HT3 receptor antagonists between April 2008 and September 2009. As a result, the cost of 5-HT3 receptor antagonists purchased decreased greatly, and the impact of the improvement was mainly due to the change to oral drugs, and partially to the change to generic drugs. Therefore, from the viewpoint of hospital economic improvement in DPC, it was thought that the change to oral drugs(5-HT3 receptor antagonists)is given top priority.
Phillips, Jennifer; Demaris, Kendra
Objective. To determine how medical literature evaluation (MLE) is being taught across the United States and to summarize methods for teaching and assessing MLE. Methods. An 18-question survey was administered to faculty members whose primary responsibility was teaching MLE at schools and colleges of pharmacy. Results. Responses were received from 90 (71%) US schools of pharmacy. The most common method of integrating MLE into the curriculum was as a stand-alone course (49%). The most common placement was during the second professional year (43%) or integrated throughout the curriculum (25%). The majority (77%) of schools used a team-based approach. The use of active-learning strategies was common as was the use of multiple methods of evaluation. Responses varied regarding what role the course director played in incorporating MLE into advanced pharmacy practice experiences (APPEs). Conclusion. There is a trend toward incorporating MLE education components throughout the pre-APPE curriculum and placement of literature review/evaluation exercises into therapeutics practice skills laboratories to help students see how this skill integrates into other patient care skills. Several pre-APPE educational standards for MLE education exist, including journal club activities, a team-based approach to teaching and evaluation, and use of active-learning techniques. PMID:26941431
Tan, Ngiap Chuan; Mitesh, Shah; Koh, Yi Ling Eileen; Ang, Seng Bin; Chan, Hian Hui Vincent; How, Choon How; Tay, Ee Guan; Hwang, Siew Wai
INTRODUCTION It is uncommon for medical students to deliver public health talks as part of their medical education curriculum. This study evaluated the effectiveness of a novel training programme that required medical students to deliver public health talks during their family medicine (FM) clerkship in a Singapore primary care institution. METHODS The FM faculty staff guided teams of third-year medical students to select appropriate topics for health talks that were to be conducted at designated polyclinics. The talks were video-recorded and appraised for clarity, content and delivery. The appraisal was done by the student’s peers and assigned faculty staff. The audience was surveyed to determine their satisfaction level and understanding of the talks. The students also self-rated the effectiveness of this new teaching activity. RESULTS A total of 120 medical students completed a questionnaire to rate the effectiveness of the new teaching activity. 85.8% of the students felt confident about the delivery of their talks, 95.8% reported having learnt how to deliver talks and 92.5% perceived this new training modality as useful in their medical education. Based on the results of the audience survey, the speakers were perceived as knowledgeable (53.1%), confident (51.3%) and professional (39.0%). Assessment of 15 video-recorded talks showed satisfactory delivery of the talks by the students. CONCLUSION The majority of the students reported a favourable overall learning experience under this new training programme. This finding is supported by the positive feedback garnered from the audience, peers of the medical students and the faculty staff. PMID:26891745
Lin, Dan; Liu, Jialin; Zhang, Rui; Li, Yong; Huang, Tingting
In order to provide a reference and theoretical guidance of the evaluation of electronic medical record (EMR) and establishment of evaluation system in China, we applied a bibliometric analysis to assess the application of methodologies used at home and abroad, as well as to summarize the advantages and disadvantages of them. We systematically searched international medical databases of Ovid-MEDLINE, EBSCOhost, EI, EMBASE, PubMed, IEEE, and China's medical databases of CBM and CNKI between Jan. 1997 and Dec. 2012. We also reviewed the reference lists of articles for relevant articles. We selected some qualified papers according to the pre-established inclusion and exclusion criteria, and did information extraction and analysis to the papers. Eventually, 1 736 papers were obtained from online database and other 16 articles from manual retrieval. Thirty-five articles met the inclusion and exclusion criteria and were retrieved and assessed. In the evaluation of EMR, US counted for 54.28% in the leading place, and Canada and Japan stood side by side and ranked second with 8.58%, respectively. For the application of evaluation methodology, Information System Success Model, Technology Acceptance Model (TAM), Innovation Diffusion Model and Cost-Benefit Access Model were widely applied with 25%, 20%, 12.5% and 10%, respectively. In this paper, we summarize our study on the application of methodologies of EMR evaluation, which can provide a reference to EMR evaluation in China.
Cooke, Suzette; Lemay, Jean-Francois
In an age where practicing physicians have access to an overwhelming volume of clinical information and are faced with increasingly complex medical decisions, the ability to execute sound clinical reasoning is essential to optimal patient care. The authors propose two concepts that are philosophically paramount to the future assessment of clinical reasoning in medicine: assessment in the context of "uncertainty" (when, despite all of the information that is available, there is still significant doubt as to the best diagnosis, investigation, or treatment), and acknowledging that it is entirely possible (and reasonable) to have more than "one correct answer." The purpose of this article is to highlight key elements related to these two core concepts and discuss genuine barriers that currently exist on the pathway to creating such assessments. These include acknowledging situations of uncertainty, creating clear frameworks that define progressive levels of clinical reasoning skills, providing validity evidence to increase the defensibility of such assessments, considering the comparative feasibility with other forms of assessment, and developing strategies to evaluate the impact of these assessment methods on future learning and practice. The authors recommend that concerted efforts be directed toward these key areas to help advance the field of clinical reasoning assessment, improve the clinical care decisions made by current and future physicians, and have positive outcomes for patients. It is anticipated that these and subsequent efforts will aid in reaching the goal of making future assessment in medical education more representative of current-day clinical reasoning and decision making.
Kern, Donna H.; Shrader, Sarah P.
Objective. To evaluate the impact of an Interprofessional Communication Skills Workshop on pharmacy student confidence and proficiency in disclosing medical errors to patients. Pharmacy student behavior was also compared to that of other health professions’ students on the team. Design. Students from up to four different health professions participated in a simulation as part of an interprofessional team. Teams were evaluated with a validated rubric postsimulation on how well they handled the disclosure of an error to the patient. Individually, each student provided anonymous feedback and self-reflected on their abilities via a Likert-scale evaluation tool. A comparison of pharmacy students who completed the workshop (active group) vs all others who did not (control group) was completed and analyzed. Assessment. The majority of students felt they had adequate training related to communication issues that cause medication errors. However, fewer students believed that they knew how to report such an error to a patient or within a health system. Pharmacy students who completed the workshop were significantly more comfortable explicitly stating the error disclosure to a patient and/or caregiver and were more likely to apologize and respond to questions forthrightly (p<0.05). Conclusions. This data affirms the need to devote more time to training students on communicating with patients about the occurrence of medical errors and how to report these errors. Educators should be encouraged to incorporate such training within interprofessional education curricula. PMID:27899834
Patterson, Sophie; Cescon, Angela; Samji, Hasina; Cui, Zishan; Yip, Benita; Lepik, Katherine J; Moore, David; Lima, Viviane D; Nosyk, Bohdan; Harrigan, P Richard; Montaner, Julio S G; Shannon, Kate; Wood, Evan; Hogg, Robert S
Since 1986, antiretroviral therapy (ART) has been available free of charge to individuals living with HIV in British Columbia (BC), Canada, through the BC Centre of Excellence in HIV/AIDS (BC-CfE) Drug Treatment Program (DTP). The Highly Active Antiretroviral Therapy (HAART) Observational Medical Evaluation and Research (HOMER) cohort was established in 1996 to maintain a prospective record of clinical measurements and medication profiles of a subset of DTP participants initiating HAART in BC. This unique cohort provides a comprehensive data source to investigate mortality, prognostic factors and treatment response among people living with HIV in BC from the inception of HAART. Currently over 5000 individuals are enrolled in the HOMER cohort. Data captured include socio-demographic characteristics (e.g. sex, age, ethnicity, health authority), clinical variables (e.g. CD4 cell count, plasma HIV viral load, AIDS-defining illness, hepatitis C co-infection, mortality) and treatment variables (e.g. HAART regimens, date of treatment initiation, treatment interruptions, adherence data, resistance testing). Research findings from the HOMER cohort have featured in numerous high-impact peer-reviewed journals. The HOMER cohort collaborates with other HIV cohorts on both national and international scales to answer complex HIV-specific research questions, and welcomes input from external investigators regarding potential research proposals or future collaborations. For further information please contact the principal investigator, Dr Robert Hogg (email@example.com).
The commonest practical model used in contemporary medical ethics is Principlism. Yet, while Principlism is a widely accepted consensus statement for ethics, the moral theory that underpins it faces serious challenges in its attempt to provide a coherent and accepted system of moral analysis. This inevitably challenges the stability of such a consensus statement and makes it vulnerable to attack by competitors such as preference consequentialism. This two-part paper proposes an inclusive version of virtue theory as a more grounded system of moral analysis.
Ellaway, Rachel; Masters, Ken
In just a few years, e-learning has become part of the mainstream in medical education. While e-learning means many things to many people, at its heart it is concerned with the educational uses of technology. For the purposes of this guide, we consider the many ways that the information revolution has affected and remediated the practice of healthcare teaching and learning. Deploying new technologies usually introduces tensions, and e-learning is no exception. Some wish to use it merely to perform pre-existing activities more efficiently or faster. Others pursue new ways of thinking and working that the use of such technology affords them. Simultaneously, while education, not technology, is the prime goal (and for healthcare, better patient outcomes), we are also aware that we cannot always predict outcomes. Sometimes, we have to take risks, and 'see what happens.' Serendipity often adds to the excitement of teaching. It certainly adds to the excitement of learning. The use of technology in support of education is not, therefore, a causal or engineered set of practices; rather, it requires creativity and adaptability in response to the specific and changing contexts in which it is used. Medical Education, as with most fields, is grappling with these tensions; the AMEE Guide to e-Learning in Medical Education hopes to help the reader, whether novice or expert, navigate them. This Guide is presented both as an introduction to the novice, and as a resource to more experienced practitioners. It covers a wide range of topics, some in broad outline, and others in more detail. Each section is concluded with a brief 'Take Home Message' which serves as a short summary of the section. The Guide is divided into two parts. The first part introduces the basic concepts of e-learning, e-teaching, and e-assessment, and then focuses on the day-to-day issues of e-learning, looking both at theoretical concepts and practical implementation issues. The second part examines technical
... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan: Medical Care Evaluation Studies § 456.242 UR plan requirements for medical care... evaluation studies in the mental hospital; (2) Documents for each study— (i) Its results; and (ii) How...
... HUMAN SERVICES Food and Drug Administration Center for Drug Evaluation and Research Medical Policy... interested organizations, on medical policy issues that may be considered by the CDER Medical Policy Council (Council) in FDA's Center for Drug Evaluation and Research (CDER). These comments will help the...
Malamed, S F
It was assumed that dentists employ a complete system of physical evaluation for all new patients in their dental practices. Results of a survey of 1,588 dentists demonstrated that the use of a written medical history questionnaire was commonplace; however, recording of blood pressure and heart rate and rhythm on all new patients was quite limited. A greater percentage of dentists monitored blood pressure when there was a history of cardiovascular disease or high blood pressure. Monitoring of the heart rate and rhythm, even in patients with cardiovascular disease or high blood pressure, was severely limited in scope. A significant number of dentists still employ racemic epinephrine impregnated gingival retraction cord, and of these, 40% had observed "epinephrine-reactions."
Freimuth, Robert R.; Wix, Kelly; Zhu, Qian; Siska, Mark; Chute, Christopher G.
We evaluated the potential use of RxNorm to provide standardized representations of generic drug name and route of administration to facilitate management of drug lists for clinical decision support (CDS) rules. We found a clear representation of generic drug name but not route of administration. We identified several issues related to data quality, including erroneous or missing defined relationships, and the use of different concept hierarchies to represent the same drug. More importantly, we found extensive semantic precoordination of orthogonal concepts related to route and dose form, which would complicate the use of RxNorm for drug-based CDS. This study demonstrated that while RxNorm is a valuable resource for the standardization of medications used in clinical practice, additional work is required to enhance the terminology so that it can support expanded use cases, such as managing drug lists for CDS. PMID:25954360
Freimuth, Robert R; Wix, Kelly; Zhu, Qian; Siska, Mark; Chute, Christopher G
We evaluated the potential use of RxNorm to provide standardized representations of generic drug name and route of administration to facilitate management of drug lists for clinical decision support (CDS) rules. We found a clear representation of generic drug name but not route of administration. We identified several issues related to data quality, including erroneous or missing defined relationships, and the use of different concept hierarchies to represent the same drug. More importantly, we found extensive semantic precoordination of orthogonal concepts related to route and dose form, which would complicate the use of RxNorm for drug-based CDS. This study demonstrated that while RxNorm is a valuable resource for the standardization of medications used in clinical practice, additional work is required to enhance the terminology so that it can support expanded use cases, such as managing drug lists for CDS.
Petersen, Amy J.; Karliner, Leah S.; Tice, Jeffrey A.
Introduction The global medical technology industry brings thousands of devices to market every year. However, significant gaps persist in the scientific literature, in the medical device approval process, and in the realm of postmarketing surveillance. Although thousands of drugs obtain approval only after review in randomized controlled trials, relatively few new medical devices are subject to comparable scrutiny. Objective To improve health outcomes, we must enhance our scrutiny of medical devices, and, without simply deferring to the Food and Drug Administration, we must ask ourselves: Who is responsible for evaluating the safety and effectiveness of medical devices? Conclusions Technology assessments by independent organizations are a part of the solution to this challenge and may motivate further research focused on patient outcomes. PMID:18095046
Ilgner, Justus F. R.; Kawai, Takashi; Shibata, Takashi; Yamazoe, Takashi; Westhofen, Martin
Introduction: An increasing number of surgical procedures are performed in a microsurgical and minimally-invasive fashion. However, the performance of surgery, its possibilities and limitations become difficult to teach. Stereoscopic video has evolved from a complex production process and expensive hardware towards rapid editing of video streams with standard and HDTV resolution which can be displayed on portable equipment. This study evaluates the usefulness of stereoscopic video in teaching undergraduate medical students. Material and methods: From an earlier study we chose two clips each of three different microsurgical operations (tympanoplasty type III of the ear, endonasal operation of the paranasal sinuses and laser chordectomy for carcinoma of the larynx). This material was added by 23 clips of a cochlear implantation, which was specifically edited for a portable computer with an autostereoscopic display (PC-RD1-3D, SHARP Corp., Japan). The recording and synchronization of left and right image was performed at the University Hospital Aachen. The footage was edited stereoscopically at the Waseda University by means of our original software for non-linear editing of stereoscopic 3-D movies. Then the material was converted into the streaming 3-D video format. The purpose of the conversion was to present the video clips by a file type that does not depend on a television signal such as PAL or NTSC. 25 4th year medical students who participated in the general ENT course at Aachen University Hospital were asked to estimate depth clues within the six video clips plus cochlear implantation clips. Another 25 4th year students who were shown the material monoscopically on a conventional laptop served as control. Results: All participants noted that the additional depth information helped with understanding the relation of anatomical structures, even though none had hands-on experience with Ear, Nose and Throat operations before or during the course. The monoscopic
Owen, Michael C; Chang, Nancy M; Chong, David H; Vawdrey, David K
Clinical documents frequently contain a list of a patient's medications. Missing information about the dosage, route, or frequency of a medication impairs clinical communication and may harm patients. We examined 253 medication lists. There were 181 lists (72%) with at least one medication missing a dose, route, or frequency. Missing information was judged to be potentially harmful in 47 of the lists (19% of 253) by three physician reviewers (kappa=0.69). We also observed that many lists contained additional information included as annotations, prompting a secondary thematic analysis of the annotations. Fifty-five of the 253 lists (22%) contained one or more annotations. The most frequent types of annotations were comments about the patient's medical history, the clinician's treatment plan changes, and the patient's adherence to a medication. Future development of electronic medication reconciliation tools to improve medication list completeness should also support annotating the medication list in a flexible manner.
Sotile, W M; Sotile, M O
Managing workplace conflict is one of the most important, stressful, and time-consuming tasks faced by today's physician leaders. In Part 1 of this article series, the authors describe how to assess an organization's interpersonal dynamics. True change comes from interventions that help an organization to become a positive interpersonal culture, one that fosters cooperation and collaboration. Part 2 offers seven steps to solving the disruptive physician problem: (1) provide protection to complainants; (2) listen, empathize, and avoid communication triangles; (3) confront offenders with data, authority, and compassion; (4) if needed, get outside help; (5) offer workplace training and experiences that foster positive relationships; (6) follow-up; and (7) practice what you preach. The self-assessment and intervention guidelines discussed in this series of articles can help physician executive move beyond struggling with episodes of conflict to shaping stress-resilient medical organizations.
Litzinger, Marcia J.; Welker, Weston J.
An academic affairs committee submitted a questionnaire to the 116 U. S. medical schools to obtain specific information concerning the existence of National Board of Medical Examiners' part 1 preparatory review programs and the organization and methods of such courses. Only 25 percent of the respondents indicated an organized program of board…
Feng, David X; McCauley, Joseph P; Morgan–Curtis, Fea K; Salam, Redoan A; Pennell, David R; Loveless, Mary E
Objective: With increased signal to noise ratios, 7.0-T MRI has the potential to contribute unique information regarding anatomy and pathophysiology of a disease. However, concerns for the safety of subjects with metallic medical implants have hindered advancement in this field. The purpose of the present research was to evaluate the MRI safety for 39 commonly used medical implants at 7.0 T. Methods: Selected metallic implants were tested for magnetic field interactions, radiofrequency-induced heating and artefacts using standardized testing techniques. Results: 5 of the 39 implants tested may be unsafe for subjects undergoing MRI at 7.0 T. Conclusion: Implants were deemed either “MR Conditional” or “MR Unsafe” for the 7.0-T MRI environment. Further research is needed to expand the existing database categorizing implants that are acceptable for patients referred for MRI examinations at 7.0 T. Advances in knowledge: Lack of MRI testing for common metallic medical implants limits the translational potential of 7.0-T MRI. For safety reasons, patients with metallic implants are not allowed to undergo a 7.0-T MRI scan, precluding part of the population that can benefit from the detailed resolution of ultra-high-field MRIs. This investigation provides necessary MRI testing of common medical implants at 7.0 T. PMID:26481696
Heydarpour, Pouria; Hafezi-Nejad, Nima; Khodabakhsh, Ali; Khosravi, Mohsen; Khoshkis, Shayan; Sadeghian, Majid; Samavat, Bijan; Faturechi, Ali; Pasalar, Parvin; Dehpour, Ahmad Reza
Podcasting has become a popular means of transferring knowledge in higher education through making lecture contents available to students at their convenience. Accessing courses on media players provides students with enhanced learning opportunities. Development of teaching methods able to cope with ever-changing nature of medicine is crucial to train the millennium students. Pharmacology education in Tehran University of Medical Sciences has been based on lectures so far; our aim was to implement a pilot study to evaluate the advantages and disadvantages of offering the course contents as podcasts as well as evaluating whether such program can be feasible in our educational program. 46% of students downloaded the podcast according to our download center. 48% favored usage of both internet and DVD-ROM concurrently. Overall 96% of students perceived that podcasting had a positive impact on their learning in pharmacology course. Our results indicate that most of attendants proposed the positive yields of podcasting despite low usage of it, mainly as a pre-class preparing tool.
GAO General Accounting Office GME Graduate Medical Education GMO General Medical Officer GPA Grade Point Average xiv HPLRP Health...supersede, or automatically promote, to O-3. At this juncture, a student will begin internship training, followed by a General Medical Officer ( GMO ) or...medical students will not complete a GMO or FS tour, and they will instead continue on through residency and fellowship training. This is commonly
Alepis, Efthymios; Virvou, Maria
Mobile computing facilities may provide many assets to the educational process. Mobile technology provides software access from anywhere and at any time, as well as computer equipment independence. The need for time and place independence is even greater for medical instructors and medical students. Medical instructors are usually doctors that…
Herrmann-Lingen, Christoph; Brunner, Edgar; Hildenbrand, Sibylle; Loew, Thomas H.; Raupach, Tobias; Spies, Claudia; Treede, Rolf-Detlef; Vahl, Christian-Friedrich; Wenz, Hans-Jürgen
Objective: The evaluation of medical research performance is a key prerequisite for the systematic advancement of medical faculties, research foci, academic departments, and individual scientists’ careers. However, it is often based on vaguely defined aims and questionable methods and can thereby lead to unwanted regulatory effects. The current paper aims at defining the position of German academic medicine toward the aims, methods, and consequences of its evaluation. Methods: During the Berlin Forum of the Association of the Scientific Medical Societies in Germany (AWMF) held on 18 October 2013, international experts presented data on methods for evaluating medical research performance. Subsequent discussions among representatives of relevant scientific organizations and within three ad-hoc writing groups led to a first draft of this article. Further discussions within the AWMF Committee for Evaluation of Performance in Research and Teaching and the AWMF Executive Board resulted in the final consented version presented here. Results: The AWMF recommends modifications to the current system of evaluating medical research performance. Evaluations should follow clearly defined and communicated aims and consist of both summative and formative components. Informed peer reviews are valuable but feasible in longer time intervals only. They can be complemented by objective indicators. However, the Journal Impact Factor is not an appropriate measure for evaluating individual publications or their authors. The scientific “impact” rather requires multidimensional evaluation. Indicators of potential relevance in this context may include, e.g., normalized citation rates of scientific publications, other forms of reception by the scientific community and the public, and activities in scientific organizations, research synthesis and science communication. In addition, differentiated recommendations are made for evaluating the acquisition of third-party funds and the
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.
Breeden, J O
The Union's decision to treat medicines and medical supplies as contraband of war meant, for the Confederacy, the specter of medical shortages. The Confederate medical department significantly lessened the subsequent suffering through an energetic and resourceful program to supply its physicians' needs. Medicines and medical supplies were purchased abroad and smuggled through the Union blockade, obtained in an illicit trade with the North, captured from the enemy, and manufactured in the Confederacy. The search for home remedies, enthusiastically endorsed by Surgeon General Samuel P. Moore, was one of the most prominent features of the southern program. This paper surveys and analyzes medical shortages and Confederate medicine.
Hamilton, Douglas R; Gavagan, Thomas F; Smart, Kieran T; Upton, Lori A; Havron, Douglas A; Weller, Nancy F; Shah, Umair A; Fishkind, Avrim; Persse, David; Shank, Paul; Mattox, Kenneth
After Hurricane Katrina hit the Gulf Coast on August 29, 2005, thousands of ill and injured evacuees were transported to Houston, TX. Houston's regional disaster plan was quickly implemented, leading to the activation of the Regional Hospital Preparedness Council's Catastrophic Medical Operations Center and the rapid construction of a 65-examination-room medical facility within the Reliant Center. A plan for triage of arriving evacuees was quickly developed and the Astrodome/Reliant Center Complex mega-shelter was created. Herein, we discuss major elements of the regional disaster response, including regional coordination, triage and emergency medical service transfers into the region's medical centers, medical care in population shelters, and community health challenges.
... qualification requirements must retain a paper copy of the medical examiner's certificate. Interstate motor... are able to post the medical self-certification and medical examiner's certificate data on the... driver record data from a CDL holder's medical self- certification and medical examiner's...
Káplár, Zoltán; Lǐ, Yáo T.
Background The professional moral and job satisfaction of medical profession remain highly disputed in media in China. On the other hand, there is wide disaffection of patients toward doctors in China. This survey aims to obtain a better understanding of the motivation of Chinese medical professionals. Methods An anonymous online cross-sectional survey, AME survey III, was conducted using the platform provided by DXY (www.dxy.cn) during the period of September 10-23, 2015. In total 2,356 DXY users completed the survey, including 1,740 males and 617 females, with a mean age of 31.96±7.03 yrs. Results The reasons (multiple choices) for career disaffection included poor patient/doctor relationship (88.6%), imbalance between workload and pay (79.5%), could not enter the preferred specialty (14.14%), and working in small clinics with no career progress (11.17%). If given the choice to enter the specialty as well as the hospital grade of their choice, 73.8% dissatisfied respondents replied they would like to be a doctor. For the dis-satisfied respondents, university teacher appeared to be the most popular career choice. The cited high workload was considered to be due to (I) imbalance in geographical allocation of doctors and insufficient training of doctors; (II) many red-tapism formalities; (III) Chinese patients often have unreasonable requests; (IV) over-examination and over-treatment; (V) high pressure to publish papers. One hundred and twelve respondents have their child/children attending university or graduated from university, 25.0% of them are pursuing a career in medicine. Nine hundred and ninety respondents have child/children while did not reach university age yet, among them 23.62% would like their child/children to study medicine. 64.87% of the 2,356 participants favor China to open up medical market to qualified foreign medical organizations to take part in fair competition, and 57.91% favor the government supporting regulated private hospitals
Sabzevari, Alireza; Kiani, Mohammad Ali; Saeidi, Masumeh; Jafari, Seyed Ali; Kianifar, Hamidreza; Ahanchian, Hamid; Jarahi, Lida; Zakerian, Mohsen
Introduction To supply quality services and healthcare, it is evident that medical ethics and patients’ rights, while providing medical and healthcare services need to be observed. This study was conducted to evaluate observance of the Patients’ Rights Charter among medical staff of educational hospitals affiliated to Mashhad University of Medical Sciences. Methods This cross-sectional study was conducted in four educational hospitals in Mashhad on eighty physicians, nurses, nurse aids and medical students. Data were collected using a two-part inventory of patients’ rights, including demographic data and inventory of patients’ rights observance. Data analysis was conducted using SPSS-16 as well as descriptive statistics, independent t-test, chi-square, Spearman correlation coefficient and Pearson correlation. Results Mean age of subjects was 36.3±8.3. Observance of human rights was perfect by 84.4 percent of subjects. The highest amount of observance of patients’ rights was related to the area of respecting patients’ privacy and observing the principle of confidentiality, which was evaluated to be perfect by all subjects (100%). The lowest value of patients’ rights observance was related to presenting appropriate and adequate information for patients, which was perfect among 48.1% of subjects. There was no significant relation between personal details (age, gender, education and career) and observance of patients’ rights (p>0.05). Conclusion Although in this study, the observance of patients’ rights by medical staff is optimal in most areas, the area of providing appropriate and adequate information needs to be promoted. Therefore, it is suggested that more stringent regulatory policies be compiled and implemented to the items of Patients’ Rights Charter along with training courses, to strengthen medical staff’s awareness in this regard. PMID:27957310
Hummel, J M; van Rossum, W; Verkerke, G J; Rakhorst, G
Most types of medical technology assessment are performed only after the technology has been developed. Consequently, they have only minor effects on changes in clinical practice. Our study introduces a new method of constructive medical technology assessment that can change the development and diffusion of a medical device to improve its later clinical effectiveness. The method, based on Saaty's Analytic Hierarchy Process, quantitatively supports discussions between various parties involved in technological development and diffusion. We applied this method in comparing a new blood pump with two competitors based on technical, medical and social requirements. These discussions changed the evaluators' perspectives, reduced diasagreements, and ended in a reliable evaluation of the pump's performance. On the basis of these results, adaptations were derived which improved the design and diffusion of the blood pump. This application shows the adequate potential of our method to steer technological development and diffusion of artificial organs.
Warburton, Rebecca N.; Fisher, Paul D.; Nosil, Josip
The 422-bed Victoria General Hospital (VGH) and Siemens Electric Limited have since 1983 been piloting the implementation of comprehensive computerized medical imaging, including digital acquisition of diagnostic images, in British Columbia. Although full PACS is not yet in place at VGH, experience to date habeen used to project annual cost figures (including capital replacement) for a fully-computerized department. The resulting economic evaluation has been labelled hypothetical to emphasize that some key cost components were estimated rather than observed; this paper presents updated cost figures based on recent revisions to proposed departmental equipment configuration which raised the cost of conventional imaging equipment by 0.3 million* and lowered the cost of computerized imaging equipment by 0.8 million. Compared with conventional diagnostic imaging, computerized imaging appears to raise overall annual costs at VGH by nearly 0.7 million, or 11.6%; this is more favourable than the previous results, which indicated extra annual costs of 1 million (16.9%). Sensitivity analysis still indicates that all reasonable changes in the underlying assumptions result in higher costs for computerized imaging than for conventional imaging. Computerized imaging offers lower radiation exposure to patients, shorter waiting times, and other potential advantages, but as yet the price of obtaining these benefits remains substantial.
Lloyd, Charles W.; Martin, William J.; Gosbee, John
The goal was to visually evaluate the effect gravity has on delivery of medications by the use of various aerosol devices. During parabolic flight the same four aerosols were retested as performed in studio ground tests. It appears that the Cetacaine spray and the Ventolin inhaler function without failure during all test. The pump spray (Nostril) appeared to function normally when the container was full, however it appeared to begin to fail to deliver a full mist with larger droplet size when the container was nearly empty. The simple hand spray bottle appeared to work when the container was full and performed progressively worse as the container was emptied. During Apollo flights, it was reported that standard spray bottles did not work well, however, they did not indicate why. It appears that we would also conclude that standard spray bottles do not function as well in zero gravity by failing to produce a normal mist spray. The standard spray bottle allowed the fluid to come out in a narrow fluid stream when held with the nozzle either level or slightly tilted upward.
Sagi, Sreedhar; Wendt-Nordahl, Gunnar; Alken, Peter; Knoll, Thomas
Medical treatment for cystinuria aims to decrease the concentration of cystine in the urine, increase its solubility and therefore prevent stone formation. Ascorbic acid and captopril have been recommended as alternatives to thiol drugs, though conflicting data undermining their efficacy has been widely reported, too. The aim of this study was to verify the effects of ascorbic acid and captopril on cystine stone formation in the cystinuria mouse model. A total of 28 male homozygous pebbles mice were used for characterizing the mice on normal diet, ascorbic acid and captopril supplemented diets. The baseline physiological parameters of the mice were determined initially. The normal diet was then replaced with the supplemented diet (ascorbic acid/captopril) for the next 48 weeks and various biochemical parameters in urine and plasma were analyzed. All homozygous mice developed urinary cystine stones during the first year of life. No reduction in the urinary cystine concentration was seen with either of the supplemented diets. The stone mass varied widely in the study and a beneficial effect of ascorbic acid in some of the animals was possible though an overall statistical significance was not seen. Conclusions: The cystinuria mouse model provides an ideal tool for evaluation of stone preventive measures in a standardized environment. This study confirms that ascorbic acid and captopril are not effective in cystinuria.
Hordinsky, J. R.
The Skylab program established the opportunity for the first time to perform extensive medical experimentation on man in a long-term zero-g environment. This experimentation involved metabolic studies, cardiovascular systems, nutrition and mineral balance, hematology, vestibular function, and many other related investigations. This report presents an overview of the significant results of the medical experiments performed during the program and a summary of the medical observations gathered by the team of life scientists.
Kravchenko, O K
The medical personnel operating currently available medical equipment can be exposed to physical factors. To prevent the adverse consequences of these exposures, medical equipment undergoes sanitary-and-epidemiological examination, resulting in the drawing up of a sanitary-and-epidemiological report. For regulation of this procedure, a management directive has been worked out, which determines an examination procedure, a hygienic classification of medical equipment, allowable values for controlled safety indices during operation, etc. Introduction of the directive makes it possible to upgrade the quality of sanitary-and-epidemiological equipment audit, to improve working conditions, and to keep health in the personnel operating the present-day high-technology equipment.
Management Information System (TAMMIS) and the division level version of the system, TAMMIS-D. TAMMIS/ TAMMIS-D are automated, on-line, interactive, microcomputer systems designed to manage combat medical information but capable of performing peacetime functions as well. The systems were developed to meet the needs of medical commanders by providing timely, accurate, and relevant information on the status of patients, medical units, and medical supplies on the battlefield. The IOT&E was conducted at Fort Lewis, WA in tents erected between two-story barracks
Background Medication nonadherence has a significant impact on the health and wellbeing of individuals with chronic disease. Several mobile medication management applications are available to help users track, remember, and read about their medication therapy. Objective The objective of this study was to explore the usability and usefulness of existing medication management applications for older adults. Methods We recruited 35 participants aged 50 and over to participate in a 2-hour usability session. The average age ranged from 52-78 years (mean 67 years) and 71% (25/35) of participants were female. Each participant was provided with an iPad loaded with four medication management applications: MyMedRec, DrugHub, Pillboxie, and PocketPharmacist. These applications were evaluated using the 10 item System Usability Scale (SUS) and visual analog scale. An investigator-moderated 30-minute discussion followed, and was recorded. We used a grounded theory (GT) approach to analyze qualitative data. Results When assessing mobile medication management applications, participants struggled to think of a need for the applications in their own lives. Many were satisfied with their current management system and proposed future use only if cognition and health declined. Most participants felt capable of using the applications after a period of time and training, but were frustrated by their initial experiences with the applications. The early experiences of participants highlighted the benefits of linear navigation and clear wording (eg, “undo” vs “cancel”) when designing for older users. While there was no order effect, participants attributed their poor performance to the order in which they tried the applications. They also described being a part of a technology generation that did not encounter the computer until adulthood. Of the four applications, PocketPharmacist was found to be the least usable with a score of 42/100 (P<.0001) though it offered a drug interaction
Kocsis, O; Costaridou, L; Efstathopoulos, E P; Lymberopoulos, D; Panayiotakis, G
Currently, medical digital imaging systems are characterized by the introduction of additional modules such as digital display, image compression and image processing, as well as film printing and digitization. These additional modules require performance evaluation to ensure high image quality. A tool for designing computer-generated test objects applicable to performance evaluation of these modules is presented. The test objects can be directly used as digital images in the case of film printing, display, compression and image processing, or indirectly as images on film in the case of digitization. The performance evaluation approach is quality control protocol based. Digital test object design is user-driven according to specifications related to the requirements of the modules being tested. The available quality control parameters include input/output response curve, high contrast resolution, low contrast discrimination, noise, geometric distortion and field uniformity. The tool has been designed and implemented according to an object oriented approach in Visual C++ 5.0, and its user interface is based on the Microsoft Foundation Class Library version 4.2, which provides interface items such as windows, dialog boxes, lists, buttons, etc. The compatibility with DICOM 3.0 part 10 image formats specifications allows the integration of the tool in the existing software framework for medical digital imaging systems. The capability of the tool is demonstrated by direct use of the test objects in case of image processing, and indirect use of the test objects in case of film digitization.
Daly, M P
Improvements in anesthesia and surgical techniques have greatly reduced the perioperative mortality and morbidity of elderly patients. Mortality is more closely correlated with pathology, type of surgery, and duration of anesthesia rather than with age. Particular attention should be directed toward cardiac and pulmonary status, because operative mortality and morbidity is related, for the most part, to cardiovascular and pulmonary complications. Postoperatively, the occurrence of pulmonary emboli and painless myocardial infarctions is more common in this age group. Elderly patients are more often confused postoperatively owing to the residual effect of anesthetics, analgesics, fever, and electrolyte disturbances. The stress of surgery and unfamiliar surroundings are also frequent precipitating causes. Orthostatic blood pressure and pulse readings should be checked before ambulating elderly patients who have been at bed rest for more than 2 to 3 days because of the frequent occurrence of orthostatic hypotension. Pressure sores, incontinence, and aspiration pneumonia may also occur owing to immobility. The elderly patient's functional status and mental status may be enhanced by simple encouragement, early mobilization, and by social interaction. It is not possible to precisely define the risks of proposed procedure, nor can the physician eliminate all risks from a surgical procedure. The risks a particular patient is subjected to depend on the complex interplay of the preoperative medical condition of the patient, the type of surgery proposed, and the skill and expertise of the anesthesiologist and surgeon. We must strive to achieve the goal of bringing our patient to the operating room in the best possible condition in the time available.
Scholtz, M. T.; Voldner, E.; Van Heyst, B. J.; McMillan, A. C.; Pattey, E.
In the first part of the paper, the development of a numerical pesticide emission model (PEM) is described for predicting the volatilization of pesticides applied to agricultural soils and crops through soil incorporation, surface spraying, or in the furrow at the time of planting. In this paper the results of three steps toward the evaluation of PEM are reported. The evaluation involves: (i) verifying the numerical algorithms and computer code through comparison of PEM simulations with an available analytical solution of the advection/diffusion equation for semi-volatile solutes in soil; (ii) comparing hourly heat, moisture and emission fluxes of trifluralin and triallate modeled by PEM with fluxes measured using the relaxed eddy-accumulation technique; and (iii) comparison of the PEM predictions of persistence half-life for 29 pesticides with the ranges of persistence found in the literature. The overall conclusion from this limited evaluation study is that PEM is a useful model for estimating the volatilization rates of pesticides from agricultural soils and crops. The lack of reliable estimates of chemical and photochemical degradation rates of pesticide on foliage, however, introduces large uncertainties in the estimates from any model of the volatilization of pesticide that impacts the canopy.
Anyaehie, U. S. B.; Nwobodo, E.; Oze, G.; Nwagha, U. I.; Orizu, I.; Okeke, T.; Anyanwu, G. E.
The expansion of biomedical knowledge and the pursuit of more meaningful learning have led to world-wide evidence-based innovative changes in medical education and curricula. The recent emphasis on problem-based learning (PBL) and student-centred learning environments are, however, not being implemented in Nigerian medical schools. Traditional…
A partnership was formed to address the crisis that rural health care facilities in rural Nebraska face in attracting and hiring trained health care workers. The Rural Allied Medical Business Occupations (RAMBO) project trained economically disadvantaged individuals in high technology medical fields. Five objectives were outlined in the project:…
Smithburger, Pamela L.; Buckley, Mitchell S.; Culver, Mark A.; Sokol, Sarah; Lat, Ishaq; Handler, Steven M.; Kirisci, Levent; Kane-Gill, Sandra L.
Objective Prior research indicates off-label use is common in the intensive care unit (ICU); however the safety of off-label use has not been assessed. The study objective was to determine the incidence of adverse drug reactions (ADRs) associated with off-label use and evaluate off-label use as a risk factor for the development of ADRs in an adult ICU population. Setting Medical ICUs at three academic medical centers Patients Adult patients (age ≥ 18 years old) receiving medication therapy Interventions All administered medications were evaluated for Food and Drug Administration (FDA) approved or off-label use. Patients were assessed daily for the development of an ADR through active surveillance. Three ADR assessment instruments were used to determine the probability of an ADR resulting from drug therapy. Severity and harm of the ADR were also assessed. Cox proportional hazard regression was used to identify a set of covariates that influenced the rate of ADRs. Measurements and Main Results Overall, 1654 patient days (327 patients) and 16,391 medications were evaluated, with 43% of medications being used off-label. One hundred and sixteen ADRs were categorized dichotomously (FDA or off-label), with 56% and 44% being associated with FDA approved and off-label use, respectively. The number of ADRs for medications administered and number of harmful and severe ADRs did not differ for medications used for FDA approved or off-label use (0.74% vs 0.67%, p = 0.336; 33 vs. 31 events, p=0.567; 24 vs. 24 events, p = 0.276). Age, sex, number of high-risk medications, number of off-label medications, and severity of illness score were included in the Cox proportional hazard regression. It was found that the rate of ADRs increases by 8% for every one additional off-label medication (HR = 1.08; 95 % CI: 1.018–1.154). Conclusion While ADRs do not occur more frequently with off-label use, ADR risk increases with each additional off-label medication used. PMID:25855897
Cai, Q.; Volk, W.; Düster, A.; Rank, E.
In the automotive industry, surfaces of styling models are shaped very often in physical models. For example, in the styling process of a car body important design work is realized by clay models and the resulting geometry information typically comes from optical scans. The scanned data is given in the form of point clouds which is then utilized in the virtual planning process for engineering work, e.g. to evaluate the load-carrying capacity. This is an important measure for the stiffness of the car body panels. In this contribution, the following two issues are discussed: what is the suitable geometric representation of the stiffness of the car body and how it is computed if only discrete point clouds exist. In the first part, the suitable geometric representation is identified by constructing continuous CAD models with different geometric parameters, e.g. Gaussian curvature and mean curvature. The stiffness of models is then computed in LS-DYNA and the influence of different geometric parameters is presented based on the simulation result. In the second part, the point clouds from scanned data, rather than continuous CAD models, are directly utilized to estimate the Gaussian curvature, which is normally derived from continuous surfaces. The discrete Gauss-Bonnet algorithm is applied to estimate the Gaussian curvature of the point clouds and the sensitivity of the algorithm with respect to the mesh quality is analyzed. In this way, the stiffness evaluation process in an early stage can be accelerated since the transformation from discrete data to continuous CAD data is labor-intensive. The discrete Gauss-Bonnet algorithm is finally applied to a sheet metal model of the BMW 3 series.
Introduction: In recent years, an increasing number of medical students have taken time off during medical school in order to conduct research. Schools and students have invested millions of dollars and thousands of person-years on research projects, but little is known as to why students choose to take this time off. We aim to characterize why students take research years during medical school. Methods: The authors distributed an online survey about research in medical school to students at five medical schools that have highly regarded research programs. Results: 328 students responded to the survey. The most common reasons students take years off for research are: “increase competitiveness for residency application” (32%), “time to pursue other opportunities” (24%), and “academic interest” (23%). Students who would still take a research year even if they were already assured a position in a residency program of their choice were at 65%, while 35% would not take a research year. Responses varied based on whether students intended to go into a competitive specialty. Discussion: Medical students take research years for multiple reasons, although they frequently are not motivated by an interest in the research itself. Many student projects consume a substantial amount of time and money despite having little educational value. Medical schools, residency programs, and policymakers should rethink incentives to increase value and help students better pursue their academic interests. PMID:27672532
Forrest, David V
Techniques developed for teaching more empathic affect recognition and reflection to medical students during their introduction to psychiatric interviewing begin with a concrete grounding in facial muscular movements and facial affect recognition, and proceed to the use of countertransferential affective experience to aid in ascertaining personality types. Observations about the temper of today's medical students by psychoanalysts may be of help in avoiding increasing their already substantial characterological resistance to affective learning and empathy that has recently been reported in the medical education literature.
Newton, Alice Whittier; Vandeven, Andrea Marie
It was only 30 years ago that the medical community began to develop an increased awareness of child sexual abuse, and the role of the medical provider in the evaluation of sexually abused children has evolved significantly. As clinicians worldwide develop a greater understanding of the impact of the sexual abuse evaluation on the child, the roles…
Bashook, P. G.; And Others
A model medical care evaluation (MCE) program was implemented at the Michael Reese Hospital and Medical Center. The program was evaluated by quantitative and qualitative observational techniques, questionnaires, and interviews, and by comparing committees for which the implementation was highly successful with those less successful. (Author/MLW)
... studies. 456.142 Section 456.142 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...: Hospitals Ur Plan: Medical Care Evaluation Studies § 456.142 UR plan requirements for medical care evaluation studies. (a) The UR plan must describe the methods that the committee uses to select and...
... ``Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and Information... HUMAN SERVICES Food and Drug Administration Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and Information on Non-Standardized Allergenic Extracts in the...
Anyaehie, U S B; Nwobodo, E; Oze, G; Nwagha, U I; Orizu, I; Okeke, T; Anyanwu, G E
The expansion of biomedical knowledge and the pursuit of more meaningful learning have led to world-wide evidence-based innovative changes in medical education and curricula. The recent emphasis on problem-based learning (PBL) and student-centred learning environments are, however, not being implemented in Nigerian medical schools. Traditional didactic lectures thus predominate, and learning is further constrained by funding gaps, poor infrastructure, and increasing class sizes. We reviewed medical students' perceptions of their exposed learning environment to determine preferences, shortcomings, and prescriptions for improvements. The results confirm declining interest in didactic lectures and practical sessions with preferences for peer-tutored discussion classes, which were considered more interactive and interesting. This study recommends more emphasis on student-centered learning with alternatives to passive lecture formats and repetitive cookbook practical sessions. The institutionalization of student feedback processes in Nigerian medical schools is also highly recommended.
Romero, Diana; Kwan, Amy; Swearingen, Justin; Nestler, Sue; Cohen, Neal
This community health needs assessment-the first part of a mixed-methods project-sought to qualitatively examine the impact of the closure of St. Vincent's Catholic Medical Center, a large not-for-profit hospital in NYC, on individuals who used its services. Key informant interviews with organizational leaders and focus groups with residents were conducted to understand hospital utilization, unmet health care needs, health care utilization and experiences post closure, perceptions of the most significant effect of the closing, and recommendations for improving health care in the community. Most respondents spoke positively of the hospital's accessibility, comprehensive, high-quality services, and its close relationship with the community. Conversely, experiences post-closure were largely negative, including decreased access, interrupted care, and loss of emergency and specialty care. Lack of information concerning medical records reflected a larger problem of poor planning and community outreach. Another issue was widespread anxiety in a community now lacking a hospital. Further, while the hospital's closure might cause inconveniences, these effects were described as more daunting to vulnerable groups. Our findings provide a consistent picture of a hospital highly regarded by residents, patients, and leaders of several health and social services organizations. Regardless of whether it should have been permitted to close (as raised by many respondents), the lack of advance planning and outreach to community members and patients remains a major criticism. Coordinated efforts to provide the community with information about health and social services in the area will respond to a clear need while reducing some of the complexity encountered with utilizing local health care services.
Fazzio, Lydia; Galanter, Marc; Dermatis, Helen; Levounis, Petros
This is a two-phase study on attitudes of medical students toward Alcoholics Anonymous. The first phase compares views of addiction faculty to third-year medical students on the importance of spirituality in addiction treatment. We administered a questionnaire to assess attitudes toward spiritual, biological, and psychosocial approaches to addiction treatment. The faculty viewed spirituality as relatively more important in addiction treatment than did the students. The second phase was designed to assess whether medical student attitudes toward spiritually based treatments changed over the course of a psychiatry clerkship. At the beginning of the clerkship, students rated a spiritually oriented approach as important in addiction treatment as a biological approach, whereas, at the end of the clerkship, they rated the biological approach as more important. It may be important to educate medical students about the spiritual dimensions of recovery so they can integrate this into their treatment of addiction.
Pankova, V B; Golysheva, G V; Khvastunov, R M; Makarov, A A
The paper reflects the priority role of preliminary and periodic medical examinations in the system of measures implemented by therapeutic-and-prophylactic institutions of the Ministry of Railway of Russia. It gives a comprehensive assessment of the medical, social, and economic aspects of the efficiency of preventive medical examinations. Emphasis is laid on the necessity of elaborating methods to evaluate the economic efficiency of medical measures under the conditions of market economy. At the same time, light is shed on the difficulties available when a full-scale, within the whole industry, economic evaluation of periodic medical examinations is made. The role of a cost-effect analysis is shown as the most flexible existing principle in the evaluation of the efficiency of medical preventive measures.
Tavakol, Mohsen; Sandars, John
Abstract Medical educators need to understand and conduct medical education research in order to make informed decisions based on the best evidence, rather than rely on their own hunches. The purpose of this Guide is to provide medical educators, especially those who are new to medical education research, with a basic understanding of how quantitative and qualitative methods contribute to the medical education evidence base through their different inquiry approaches and also how to select the most appropriate inquiry approach to answer their research questions.
Tavakol, Mohsen; Sandars, John
Medical educators need to understand and conduct medical education research in order to make informed decisions based on the best evidence, rather than rely on their own hunches. The purpose of this Guide is to provide medical educators, especially those who are new to medical education research, with a basic understanding of how quantitative and qualitative methods contribute to the medical education evidence base through their different inquiry approaches and also how to select the most appropriate inquiry approach to answer their research questions.
Hoti, Kreshnik; Forman, Dawn; Hughes, Jeffery
There is lack of literature data reporting an incorporation of medication management reviews in students' interprofessional education (IPE) and practice programs in aged care settings. This pilot study reports how an interprofessional disease state and medication management review program (DSMMR) was established in a residential aged care facility in Perth, Western Australia. Students from the professions of nursing, pharmacy and physiotherapy focused on a wellness check in the areas of cognition, falls and continence while integrating a medication management review. Students' attitudes were explored using a pre- and post-placement questionnaire. Students indicated positive experience with the IPE DSMMR program which also resulted in their positive attitudinal shift towards IPE and practice. These findings indicated that aged care can be a suitable setting for student interprofessional programs focusing on DSMMR.
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
Sund, Patrik; Hakansson, Markus; Lindskog, Lars; Tylen, Ulf; Kheddache, Susanne; Mansson, Lars G.
A physical and clinical evaluation of four different display systems intended for the presentation of medical x-ray images was performed. State-of-the-art b/w display devices were studied as well as a low-cost color display. The systems tested were: a) CRT 21' b/w 1K, b) CRT 21' b/w, 2K, c) CRT 21' color, 1K, d) LCD 20.8' b/w, 1.5K. All displays were, as far as possible, adjusted to conform to DICOM 3.0 part 14. The physical evaluation included quantities such as resolution, flickering and uniformity. The clinical evaluation was performed by 15 radiologists using visual grading analysis of one phantom chest image and 12 clinical images of the chest and small bones. One subtle pathological structure and one anatomical structure were rated. The CRT b/w 1K display was used as the reference display system. All displays were evaluated at two different luminance levels (160 and 320 cd/m2) and viewed under two different ambient light conditions (10 and 40 lux). The LCD 1.5K display was rated best and the color CRT display was rated worst for both luminance levels. The result for the color CRT display - unable to produce more than 120 cd/m2 - at the high ambient light setting was very poor.
Eisenstein, Eric L.; Ortiz, Maqui; Anstrom, Kevin J.; Crosslin, David R.; Lobach, David F.
Standards for the economic evaluation of medical technologies were instituted in the mid-1990s, yet little is known about their application in medical information technology studies. In a review of 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. PMID:17238533
... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false How will the FAB evaluate new medical... Medical Evidence of Impairment § 30.908 How will the FAB evaluate new medical evidence submitted to... impairment evaluation that differs from the impairment evaluation relied upon by the district office, the...
ALIEGIESZ penicillin G-6-PD deficient MEDICjALmisTORY: Appendectomy, age 14. infectious hepatitis, age 19. malaria, age 21; positive ppd, age 25: angina ... pectoris . age 32; hypertension, age 32. peptic ulcer, age 32 PRESENT MEDICATIONS! Hydrochlorothiazide, 50 mg. once a day, propran- olol. 60 mg, once a day
Raddatz, Mikaela M.; Royal, Kenneth D.; Pennington, Jessica
The purpose of this study is to determine if the construct of a medical subspecialty examination, as defined by the hierarchy of item difficulties, is stable across physicians who completed a fellowship and recertifiers as compared to non-fellows. Three comparisons of groups are made: 1) Practice pathway board candidates compared to members of all…
Frese, Richard C
To best project an actuarial estimate for medical malpractice exposure for a merger and acquisition, a organization's leaders should consider the following factors, among others: How to support an unbiased actuarial estimation. Experience of the actuary. The full picture of the organization's malpractice coverage. The potential for future loss development. Frequency and severity trends.
Siegal, Harvey A.; And Others
The Week-end Intervention Program (WIP) used by Wright State University School of Medicine, which assesses the alcohol problems of those convicted of offenses such as drunk driving and then assists in finding treatment, is described. The impact of the program in educating medical students about alcoholism is discussed. (MLW)
Development of the STARPAHC telemedicine system is documented. Using STARPAHC assessment results and monitoring experience, on board and ground based flight medical system monitoring requirements and operational procedures were developed for use with the Space Transportation System during OFT and mature operation phases of the shuttle.
Bacro, Thierry R. H.; Gebregziabher, Mulugeta; Fitzharris, Timothy P.
Recently, the Medical University of South Carolina adopted a lecture recording system (LRS). A retrospective study of LRS was implemented to document the students' perceptions, pattern of usage, and impact on the students' grades in three basic sciences courses (Cell Biology/Histology, Physiology, and Neurosciences). The number of accesses and…
This paper researched on course of registration and administrative licensing for medical device product specification, analyzed the existing demands of review and pre-evaluation, discussed about how to improve and manage pre-evaluation results for testing laboratory and manufacturer in China, based on "Provision of Medical Device Product Specification Standardization", "Provision on Medical Device Registration" and relative documents of States Food & Drug Administration. It suggested that set up and maintain a professional team of review and approval staff, further strengthen standardization of medical device specification, arming at current situations of non-compatibility between documents and inconformity of performance in different provinces. It paid attention to control the quality of medical device to ensure the core of safety and effectiveness for using medical device.
This notice announces a CMS Ruling that establishes a policy that revises the current policy on Part B billing following the denial of a Part A inpatient hospital claim by a Medicare review contractor on the basis that the inpatient admission was determined not reasonable and necessary. This revised policy is intended as an interim measure until CMS can finalize a policy to address the issues raised by the Administrative Law Judge and Medicare Appeals Council decisions going forward. To that end, elsewhere in this issue of the Federal Register, we published a proposed rule entitled, "Medicare Program; Part B Inpatient Billing in Hospitals,'' to propose a permanent policy that would apply on a prospective basis.
Thayer, Erin K.; Rathkey, Daniel; Miller, Marissa Fuqua; Palmer, Ryan; Mejicano, George C.; Pusic, Martin; Kalet, Adina; Gillespie, Colleen; Carney, Patricia A.
Issue Medical educators and educational researchers continue to improve their processes for managing medical student and program evaluation data using sound ethical principles. This is becoming even more important as curricular innovations are occurring across undergraduate and graduate medical education. Dissemination of findings from this work is critical, and peer-reviewed journals often require an institutional review board (IRB) determination. Approach IRB data repositories, originally designed for the longitudinal study of biological specimens, can be applied to medical education research. The benefits of such an approach include obtaining expedited review for multiple related studies within a single IRB application and allowing for more flexibility when conducting complex longitudinal studies involving large datasets from multiple data sources and/or institutions. In this paper, we inform educators and educational researchers on our analysis of the use of the IRB data repository approach to manage ethical considerations as part of best practices for amassing, pooling, and sharing data for educational research, evaluation, and improvement purposes. Implications Fostering multi-institutional studies while following sound ethical principles in the study of medical education is needed, and the IRB data repository approach has many benefits, especially for longitudinal assessment of complex multi-site data. PMID:27443407
Thayer, Erin K; Rathkey, Daniel; Miller, Marissa Fuqua; Palmer, Ryan; Mejicano, George C; Pusic, Martin; Kalet, Adina; Gillespie, Colleen; Carney, Patricia A
Issue Medical educators and educational researchers continue to improve their processes for managing medical student and program evaluation data using sound ethical principles. This is becoming even more important as curricular innovations are occurring across undergraduate and graduate medical education. Dissemination of findings from this work is critical, and peer-reviewed journals often require an institutional review board (IRB) determination. Approach IRB data repositories, originally designed for the longitudinal study of biological specimens, can be applied to medical education research. The benefits of such an approach include obtaining expedited review for multiple related studies within a single IRB application and allowing for more flexibility when conducting complex longitudinal studies involving large datasets from multiple data sources and/or institutions. In this paper, we inform educators and educational researchers on our analysis of the use of the IRB data repository approach to manage ethical considerations as part of best practices for amassing, pooling, and sharing data for educational research, evaluation, and improvement purposes. Implications Fostering multi-institutional studies while following sound ethical principles in the study of medical education is needed, and the IRB data repository approach has many benefits, especially for longitudinal assessment of complex multi-site data.
Keller, James P
Before hospitals embrace new technologies, it's important that medical personnel agree on how best to use them. Likewise, hospitals must provide the support to operate these sophisticated devices safely. With this in mind, it's wise for hospitals to include medical device training in the procurement process. Moreover, purchasing professionals can play a key role in helping to increase the amount of user training for medical devices and systems. What steps should you take to help ensure that new medical devices are implemented safely? Here are some tips.
Mattei, Eugenio; Censi, Federica; Triventi, Michele; Bartolini, Pietro; Calcagnini, Giovanni
The number and the types of electromagnetic emitters to which patients with active implantable medical devices (AIMD) are exposed to in their daily activities have proliferated over the last decade. Radiofrequency identification (RFID) is an example of wireless technology applied in many fields. The interaction between RFID emitters and AIMD is an important issue for patients, industry and regulators, because of the risks associated with such interactions. The different AIMDs refer to different standards that address the electromagnetic immunity issue in different ways. Indeed, different test setups, immunity levels and rationales are used to guarantee that AIMDs are immune to electromagnetic nonionizing radiation. In this article, the regulatory framework concerning electromagnetic compatibility between RFID systems and AIMDs is analyzed to understand whether and how the application of the current AIMD standards allows for the effective control of the possible risks associated with RFID technology.
Rule conclusion BECAUSE "In Accordance With The VA Schedule For Rating Disabilities" RULE N3 !Mandatory rule label IF Problem= Sacroiliac Joint ...Condition OR REFERRAL=MedicalBoard_Slip !Condition AND PROBLEM=Spine_Scapulae.. Sacroiliac !Condition THEN ACTION=Refer-toMEB !Rule conclusion BECAUSE "In...Rules Block RULE N1 !Mandatory rule label IF Problem= Joints !Condition THEN Decision=Narrative !Rule conclusion BECAUSE "In
Crosland, Kimberly A.; Zarcone, Jennifer R.; Lindauer, Steven E.; Valdovinos, Maria G.; Zarcone, Troy J.; Hellings, Jessica A.; Schroeder, Stephen R.
The atypical antipsychotic medication risperidone was evaluated using a double-blind, placebo-controlled design to treat destructive behavior in two males (ages 6 and 24) with autism. Destructive behavior during the demand condition was significantly reduced during the medication phases, whereas it continued to occur to obtain tangible items and…
Krantz-Girod, Catherine; Bonvin, Raphael; Lanares, Jacques; Cueanot, Seagoleine; Feihl, Francois; Bosman, Fred; Waeber, Bernard
The second preclinical year of the medical curriculum at the Medical Faculty of the University of Lausanne in Switzerland includes nine multidisciplinary organ-system-oriented modules consisting of lectures and problem-based-learning tutorials. This study reports the experience accumulated with the evaluation of lectures during the academic years…
... these methods, NHTSA will estimate the fatalities prevented and the non-fatal injuries avoided by... Economic Cost of Motor Vehicle Crashes, 1994,” 2 NHTSA measured both the medical costs and payment sources for motor vehicle crashes. NHTSA will adjust the national medical cost figures from this report...
... these methods, NHTSA will estimate the fatalities prevented and the non-fatal injuries avoided by... Economic Cost of Motor Vehicle Crashes, 1994,” 2 NHTSA measured both the medical costs and payment sources for motor vehicle crashes. NHTSA will adjust the national medical cost figures from this report...
... these methods, NHTSA will estimate the fatalities prevented and the non-fatal injuries avoided by... Economic Cost of Motor Vehicle Crashes, 1994,” 2 NHTSA measured both the medical costs and payment sources for motor vehicle crashes. NHTSA will adjust the national medical cost figures from this report...
Nestel, Debra; Ivkovic, Amelie; Hill, Robyn A.; Warrens, Anthony N.; Paraskevas, Paraskeva A.; McDonnell, Jacqueline A.; Mudarikwa, Ruvimbo S.; Browne, Chris
Programme evaluation is essential for quality assurance in education. In this paper, we describe our evaluation strategy for the first year of a new medical programme. Although we used multiple methods in the evaluation, the use of the focus group method was core. This paper reports our experiences of focus groups for this purpose. We describe the…
Trevino, Fernando M.; Eiland, D. C., Jr.
A peer tutorial program in the basic sciences implemented at the University of Texas Medical Branch at Galveston is evaluated. The grades of students receiving peer tutorials were analyzed and questionnaires were mailed to each participant soliciting their evaluation of services received. Future cost-benefit evaluations are planned. (Author/MLW)
Patel, Vimla L; Yoskowitz, Nicole A; Arocha, Jose F
Health professions education is dealing with major transformations in light of the changing nature of the health care delivery system, including the use of technology for "just in time" delivery of care, evidence-based practice, personalized medical care and learning, as health professionals strive to integrate biomedical advances and clinical practice. This has forced the medical education community to reassess the current teaching and learning practices and more importantly, the evaluation of the medical education process. There have been recent advances in cognitive and learning sciences theories, some of which can inform medical educators about best teaching and learning practices and their impact on the evaluation process. An understanding of these theories provides a sound rationale for choosing specific instructional strategies and choosing evaluation measures that assess the curricular objectives. The review begins with an overview of evaluation and assessment in education, followed by an overview of major theories from the cognitive and learning sciences. Next, the role of cognitive and learning sciences theories in informing the process of medical education evaluation is discussed, including its impact on student learning, performance and professional competence, as well as recommendations for reform of medical curricula based on such theories. The paper continues with the elaboration of current trends in health sciences education, particularly medical education, and available evidence for the impact on student learning and performance as well as areas where more research is needed.
Jha, Vikram; Duffy, Sean
Reports the results of an evaluation of Distance Interactive Learning in Obstetrics and Gynecology (DIALOG) which is an electronic program for continuing education. Presents 10 golden rules for designing software for medical practitioners. (Contains 26 references.) (Author/YDS)
... AFFAIRS Proposed Information Collection (Report of Medical Examination for Disability Evaluation); Comment... opportunity for public comment on the proposed collection of certain information by the agency. Under the... Register concerning each proposed collection of information, including each proposed extension of...
Blewett, Earl L; Kisamore, Jennifer L
Background Oklahoma State University-Center for Health Sciences (OSU-CHS) has replaced its microbiology wet laboratory with a variety of tutorials including a case-based interactive session called Microbial Jeopardy!. The question remains whether the time spent by students and faculty in the interactive case-based tutorial is worthwhile? This study was designed to address this question by analyzing both student performance data and assessing students' perceptions regarding the tutorial. Methods Both quantitative and qualitative data were used in the current study. Part One of the study involved assessing student performance using archival records of seven case-based exam questions used in the 2004, 2005, 2006, and 2007 OSU-CHS Medical Microbiology course. Two sample t-tests for proportions were used to test for significant differences related to tutorial usage. Part Two used both quantitative and qualitative means to assess student's perceptions of the Microbial Jeopardy! session. First, a retrospective survey was administered to students who were enrolled in Medical Microbiology in 2006 or 2007. Second, responses to open-ended items from the 2008 course evaluations were reviewed for comments regarding the Microbial Jeopardy! session. Results Both student performance and student perception data support continued use of the tutorials. Quantitative and qualitative data converge to suggest that students like and learn from the interactive, case-based session. Conclusion The case-based tutorial appears to improve student performance on case-based exam questions. Additionally, students perceived the tutorial as helpful in preparing for exam questions and reviewing the course material. The time commitment for use of the case-based tutorial appears to be justified. PMID:19712473
Chapman, A M; Taylor, C A; Girling, A J
The economic evaluation of medical products and services is increasingly prioritised by healthcare decision makers and plays a key role in informing funding allocation decisions. It is well known that there are a number of methodological difficulties in the health technology assessment of medical devices, particularly in the provision of efficacy evidence. By contrasting devices with pharmaceuticals, the way in which the differing systems of innovation mould the UK's industry landscape is described and substantiated with market statistics. In recognition of the challenges faced by industry, as well as the growing need for cost-effective allocation of National Health Service (NHS) resources, the National Institute for Health and Care Excellence (NICE) led the development of the Medical Technologies Evaluation Programme (MTEP), which launched in 2009/2010. The review of the UK's medical devices market supports the programme's three principal aims: to simplify access to evaluation, speed up the process, and increase evaluative capacity for devices within NICE. However, an analysis of the output of MTEP's first 3 years suggests that it has some way to go to meet each of these aims.
Sansgiry, S S; Cady, P S
Currently, marketed over-the-counter (OTC) medication labels were simulated and tested in a controlled environment to understand consumer evaluation of OTC label information. Two factors, consumers' age (younger and older adults) and label designs (picture-only, verbal-only, congruent picture-verbal, and noncongruent picture-verbal) were controlled and tested to evaluate consumer information processing. The effects exerted by the independent variables, namely, comprehension of label information (understanding) and product evaluations (satisfaction, certainty, and perceived confusion) were evaluated on the dependent variable purchase intention. Intention measured as purchase recommendation was significantly related to product evaluations and affected by the factor label design. Participants' level of perceived confusion was more important than actual understanding of information on OTC medication labels. A Label Evaluation Process Model was developed which could be used for future testing of OTC medication labels.
Rintoul, Mark Daniel; Wilson, Andrew T.
Hospitals have always generated and consumed large amounts of data concerning patients, treatment and outcomes. As computers and networks have permeated the hospital environment it has become feasible to collect and organize all of this data. This raises naturally the question of how to deal with the resulting mountain of information. In this report we detail a proof-of-concept test using two commercially available parallel database systems to analyze a set of real, de-identified medical records. We examine database scalability as data sizes increase as well as responsiveness under load from multiple users.
Lugosi, L; Molnár, I
With the technical improvement of the sensitivity and specificity of the medical diagnostic tests the principles and methods of statistical analysis of the tests are in developing too. The technical development of the diagnostic tests and the exact statistical evaluation of the data will improve the reliability and effectiveness of the decisions for medical interventions. Application, statistical evaluation and interpretation of the Bayes theorem, ROC curve and Kappa test are presented.
Marines What is your present position title? GMO (general medical officer) PMO (preventive medicine officer) EHO (environmental health officer) IDC...NAVAL HEALTH RESEARCH CENTER TEST AND EVALUATION OF MEDICAL DATA SURVEILLANCE SYSTEM AT NAVY AND MARINE CORPS MTFs Test & Evaluation Group T. Melcer...B. Bohannan R. Burr T. Leap C. Reed B. Jeschonek Report No. 03-14 Approved for public release; distribution unlimited. NAVAL HEALTH RESEARCH CENTER
Baker, M S; Ryals, P A
Many military deployments are "military operations other than war" (MOOTW), a spectrum of assignments less than all-out combat. The corresponding medical support requirement differs from conventional military medical combat support and also from customary civilian medical practice. Hence, medical planners will use different doctrine and planning tools than are used in civilian facilities or on field training exercises when tasked for MOOTW activities. The deployment team must be self-sufficient, plan for very large numbers of affected individuals, and arrange for food, water, shelter, sanitation, power, light, security, transportation, communications, and team health care in advance of arrival. Careful and well-thought-out advance liaison with numerous interested parties is required to ensure mission success. The medical department on these missions may represent the lead element, and other warfare specialists and line and staff officers may support the medical mission by providing security, communications, transportation, and logistics. The medical team may find that it represents the foreign policy "point of the spear" during MOOTW deployments.
Foens, Cassandra S; Fairobent, Lynne A; Guiberteau, Milton J
In the spring of 2005, the US Nuclear Regulatory Commission completed its revision of Title 10, Part 35, of the Code of Federal Regulations, its regulatory framework for the medical use of radioisotopes. Because of the complexity of the regulation and the lengthy period over which the revisions were accomplished, many radiologists remain uninformed regarding changes in the rule. This article highlights some of the more important of these changes as they relate to the practice of radiology, radiation oncology, nuclear medicine, and medical physics.
Wild, Katharina; Scholz, Michael; Ropohl, Axel; Bräuer, Lars; Paulsen, Friedrich; Burger, Pascal H M
Burnout and stress-related mental disorders (depression, anxiety) occur in medical students and physicians with a significantly higher prevalence than in the general population. At the same time, the learning of coping mechanisms against stress is still not an integral part of medical education. In this pilot study we developed an elective course for learning relaxation techniques and examined the condition of the students before and after the course. 42 students participated in the semester courses in 2012 and 2013 as well as in a survey at the start and end of each course. The students were instructed in autogenic training (AT) and progressive muscle relaxation according to Jacobsen (PMR) with the goal of independent and regular exercising. At the beginning and the end of the semester/course the students were interviewed using standardized, validated questionnaires on burnout (BOSS-II) and anxiety (STAI-G), depression (BDI), quality of life (SF-12) and sense of coherence (SOC-L9). We compared the results of our students participating in Relacs with results from eight semester medical students (n = 88), assessed with the same questionnaires at similar points of time within their semester. Participating students showed a significant decline in cognitive and emotional burnout stress and in trait anxiety. Furthermore, they showed a reduction in state anxiety and a conspicuous decrease in mean depression. The sense of coherence increased at the same time. A comparative cohort of medical students of 8th semester students, showed lower values for the specified measurement parameters at the beginning, but showed no progressive changes. Our course introducing AT and PMR led to a significant reduction of burnout and anxiety within the participating group of medical students. Even the course attendance for just one semester resulted in significant improvements in the evaluated parameters in contrast to those students who did not attend the course.
Shelvey, Bethany M; Coulman, Sion A; John, Dai N
Background The current literature on undergraduate interprofessional education (IPE) for pharmacy and medical students highlights a range of positive outcomes, although to date IPE has focused predominantly on student views and experiences of IPE sessions with these opinions being sought at the end of the sessions. This study aimed to evaluate medical students’ experiences of therapeutics and prescribing IPE, with pharmacy students, 1 year following the session. Methods Following ethics committee approval, 3rd year medical students at Cardiff University were invited to participate using non-probability sampling. Topic guide development was informed by the literature and research team discussions, including a review of the materials used in the IPE session. Semi-structured one-to-one interviews explored experiences, prior to, during, and after the IPE session. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Results Eighteen medical students were interviewed; 11 were females. Seven themes were identified, namely 1) refinement of pre-session preparation, 2) session value, 3) learning with a pharmacy student, 4) learning about a pharmacist, 5) learning from a pharmacy student, 6) importance and application of what was learnt into practice, and 7) suggestions for change. Conclusion This study provides a valuable insight into medical students’ experiences of a therapeutics and prescribing IPE session and emphasizes the value they placed on interaction with pharmacy students. Medical students were able to recall clear learning experiences from the IPE session that had taken place 12 months earlier, which itself is an indicator of the impact of the session on the students. Furthermore, they were able to describe how knowledge and skills learnt had been applied to subsequent learning activities. Those developing IPE sessions should consider the following: clarify professional roles in the session content, incorporate IPE as a series of
Tariq, Amina; Richardson, Lauren; Byrne, Mary; Robinson, Maureen; Li, Ling; Westbrook, Johanna I; Baysari, Melissa T
Background Medication is the most common intervention in health care, and written medication information can affect consumers’ medication-related behavior. Research has shown that a large proportion of Australians search for medication information on the Internet. Objective To evaluate the medication information content, based on consumer medication information needs, and usability of 4 Australian health websites: Better Health Channel, myDr, healthdirect, and NPS MedicineWise . Methods To assess website content, the most common consumer medication information needs were identified using (1) medication queries to the healthdirect helpline (a telephone helpline available across most of Australia) and (2) the most frequently used medications in Australia. The most frequently used medications were extracted from Australian government statistics on use of subsidized medicines in the community and the National Census of Medicines Use. Each website was assessed to determine whether it covered or partially covered information and advice about these medications. To assess website usability, 16 consumers participated in user testing wherein they were required to locate 2 pieces of medication information on each website. Brief semistructured interviews were also conducted with participants to gauge their opinions of the websites. Results Information on prescription medication was more comprehensively covered on all websites (3 of 4 websites covered 100% of information) than nonprescription medication (websites covered 0%-67% of information). Most websites relied on consumer medicines information leaflets to convey prescription medication information to consumers. Information about prescription medication classes was less comprehensive, with no website providing all information examined about antibiotics and antidepressants. Participants (n=16) were able to locate medication information on websites in most cases (accuracy ranged from 84% to 91%). However, a number of
Kessler, Daniel P
The U.S. medical malpractice liability system has two principal objectives: to compensate patients who are injured through the negligence of healthcare providers and to deter providers from practicing negligently. In practice, however, the system is slow and costly to administer. It both fails to compensate patients who have suffered from bad medical care and compensates those who haven't. According to opinion surveys of physicians, the system creates incentives to undertake cost-ineffective treatments based on fear of legal liability--to practice "defensive medicine." The failures of the liability system and the high cost of health care in the United States have led to an important debate over tort policy. How well does malpractice law achieve its intended goals? How large of a problem is defensive medicine and can reforms to malpractice law reduce its impact on healthcare spending? The flaws of the existing system have led a number of states to change their laws in a way that would reduce malpractice liability--to adopt "tort reforms." Evidence from several studies suggests that wisely chosen reforms have the potential to reduce healthcare spending significantly with no adverse impact on patient health outcomes.
Ho, Chao Chung
Ever since Taiwan's National Health Insurance implemented the diagnosis-related groups payment system in January 2010, hospital income has declined. Therefore, to meet their medical waste disposal needs, hospitals seek suppliers that provide high-quality services at a low cost. The enactment of the Waste Disposal Act in 1974 had facilitated some improvement in the management of waste disposal. However, since the implementation of the National Health Insurance program, the amount of medical waste from disposable medical products has been increasing. Further, of all the hazardous waste types, the amount of infectious medical waste has increased at the fastest rate. This is because of the increase in the number of items considered as infectious waste by the Environmental Protection Administration. The present study used two important findings from previous studies to determine the critical evaluation criteria for selecting infectious medical waste disposal firms. It employed the fuzzy analytic hierarchy process to set the objective weights of the evaluation criteria and select the optimal infectious medical waste disposal firm through calculation and sorting. The aim was to propose a method of evaluation with which medical and health care institutions could objectively and systematically choose appropriate infectious medical waste disposal firms.
Ho, Chao Chung
Ever since Taiwan's National Health Insurance implemented the diagnosis-related groups payment system in January 2010, hospital income has declined. Therefore, to meet their medical waste disposal needs, hospitals seek suppliers that provide high-quality services at a low cost. The enactment of the Waste Disposal Act in 1974 had facilitated some improvement in the management of waste disposal. However, since the implementation of the National Health Insurance program, the amount of medical waste from disposable medical products has been increasing. Further, of all the hazardous waste types, the amount of infectious medical waste has increased at the fastest rate. This is because of the increase in the number of items considered as infectious waste by the Environmental Protection Administration. The present study used two important findings from previous studies to determine the critical evaluation criteria for selecting infectious medical waste disposal firms. It employed the fuzzy analytic hierarchy process to set the objective weights of the evaluation criteria and select the optimal infectious medical waste disposal firm through calculation and sorting. The aim was to propose a method of evaluation with which medical and health care institutions could objectively and systematically choose appropriate infectious medical waste disposal firms.
Falk, Jamie; Dik, Natalia; Bugden, Shawn
Purpose The aim of this study was to evaluate the first initiation, sequence of addition, and appropriate prescribing of COPD medications in Manitoba, Canada. Patients and methods A population-based cohort study of COPD medication use was conducted using administrative health care data (1997–2012). Those aged ≥35 years with COPD based on three or more COPD-related outpatient visits over a rolling 24-month window or at least one COPD-related hospitalization were included. The first medication(s) dispensed on or after the date of COPD diagnosis were determined based on pharmacy claims. The next medication(s) in sequence were determined to be additions or switches to the previous regimen. Evaluation of guideline-based appropriateness to receive inhaled corticosteroids (ICS) was based on exacerbation history and past medication use. Results Of 13,369 patients dispensed COPD medications after diagnosis, 66.0% were dispensed short-acting bronchodilators as first medications. Although long-acting bronchodilators alone were uncommonly used as first or subsequent medications, ICS were dispensed as first medications in 28.2% of patients. Over the study period, use of short-acting bronchodilators as first medications declined from 70.6% to 59.4% (P<0.0001), whereas the use of ICS as a first medication increased from 23.5% to 34.4% (P<0.0001). Dispensation of an ICS plus a long-acting β-agonist increased dramatically from 1.2% to 27.3% (P<0.0001). By the end of the study period, the majority of patients (53.3%) were being initiated on two or more medications. Of 5,823 patients dispensed an ICS, 52.4% met Canadian guideline criteria for initiating an ICS, whereas 0.3% met Global Initiative for Chronic Obstructive Lung Disease guideline criteria. Conclusion The use of first-line medications has declined over time, replaced primarily by combination inhalers prescribed early without prior trials of appropriate next step medications. This, along with an increasingly
Newton, Alice Whittier; Vandeven, Andrea Marie
It was only 30 years ago that the medical community began to develop an increased awareness of child sexual abuse, and the role of the medical provider in the evaluation of sexually abused children has evolved significantly. As clinicians worldwide develop a greater understanding of the impact of the sexual abuse evaluation on the child, the roles of the physician and nurse have changed. In the United States, current practice often uses a multidisciplinary assessment involving skilled forensic interviewing of the child and a medical examination done by a medical provider with specialized training in sexual abuse. In order to minimize child interviews, these assessments are frequently held in settings such as child advocacy centers, where forensic interviewers and medical clinicians, child protective service workers, and police and district attorneys can work jointly to address the legal and protective issues in a coordinated fashion.
Liao, Xing; Xie, Yan-Ming
This article introduced a new clinical research evaluating system, Faculty of 1000 Medicine (F1000M), in which articles are selected, rated, and evaluated by its faculty of over 10 000 expert scientists and clinical researchers engaging in more than 3 000 peer-reviewed journals. It is a kind of post-publication peer review. A few evaluated articles about Chinese medicine were selected and introduced. It is hoped that F1000 could inspire both traditional Chinese medicine researchers and Western medicine researchers to conduct good quality research and write good clinical research reports.
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This paper reviews mechanical-engineering-based medical engineering degrees which are currently provided at undergraduate level in the UK. At present there are 14 undergraduate degree programmes in medical engineering, offered by the University of Bath, University of Birmingham, University of Bradford, Cardiff University, University of Hull, Imperial College London, University of Leeds, University of Nottingham, University of Oxford, Queen Mary University of London, University of Sheffield, University of Southampton, University of Surrey, and Swansea University. All these undergraduate courses are delivered on a full-time basis, both 3 year BEng and 4 year MEng degrees. Half of the 14 degree courses share a core first 2 years with a mechanical engineering stream. The other seven programmes include medical engineering modules earlier in their degrees. Within the courses, a very wide range of medical-engineering-related modules are offered, although more common modules include biomaterials, biomechanics, and anatomy and physiology.
Perdrizet, George A
The purpose of this monograph is to narrow the knowledge gap between current medical practice and hyperbaric oxygen therapy. Graduate medical education has not kept pace with the expanding science and practice of hyperbaric medicine. The number of hyperbaric chambers in the state of Connecticut has increased by >400% during the past five years. A brief overview of the science and practice of hyperbaric oxygen therapy is presented, with additional resources identified where more in-depth coverage can be found. The reader will find the basics of hyperbaric medical practice reviewed and be able to recognize diagnoses that are appropriate for referral to a hyperbaric medical center. The intended audience is practitioners who have had no formal exposure to hyperbaric medicine or chronic wound care.
Ismail, Salwani; Salam, Abdus; Alattraqchi, Ahmed G; Annamalai, Lakshmi; Chockalingam, Annamalai; Elena, Wan Putri; Rahman, Nor Iza A; Abubakar, Abdullahi Rabiu; Haque, Mainul
Background Didactic lecture is the oldest and most commonly used method of teaching. In addition, it is considered one of the most efficient ways to disseminate theories, ideas, and facts. Many critics feel that lectures are an obsolete method to use when students need to perform hands-on activities, which is an everyday need in the study of medicine. This study evaluates students’ perceptions regarding lecture quality in a new medical school. Methods This was a cross-sectional study conducted of the medical students of Universiti Sultan Zainal Abidin. The study population was 468 preclinical medical students from years 1 and 2 of academic year 2012–2013. Data were collected using a validated instrument. There were six different sections of questions using a 5-point Likert scale. The data were then compiled and analyzed, using SPSS version 20. Results The response rate was 73%. Among 341 respondents, 30% were male and 70% were female. Eighty-five percent of respondents agree or strongly agree that the lectures had met the criteria with regard to organization of lecture materials. Similarly, 97% of students agree or strongly agree that lecturers maintained adequate voices and gestures. Conclusion Medical students are quite satisfied with the lecture classes and the lectures. However, further research is required to identify student-centered teaching and learning methods to promote active learning. PMID:25878516
Siegel, John H.
This report summarizes the work done on the contract NAG9-567, which was activated at the New Jersey Medical School-UMDNJ in April 1992 and carried on during the 1992-93 year to the present 1993-94 year which was terminated in May 1994. The initial examination stage was completed of an interactive program for the recording of physical and physiologic injury information obtained from examination of an injured person, who might be an astronaut sustaining traumatic injury, due to a burn or physical trauma, either in space or in an earth bound training environment. In this report three aspects will be discussed: 1) a description of the system of diagnostic examination graphics, 2) a description of the organization of the therapeutic advisory systems with a demonstration of two specific modules, and 3) a brief technical description of the organization of the programming system carried out on a UNIX based work station using a WINDOWS environment.
This series presents guidelines for: electrically isolated inputs and outputs; measuring the performance of hospital biomedical engineering programs; evaluating the risk of electric shock in hospitals; and for isolated power in anesthetizing locations. In Part I, specific recommendations are given for the use of insulated approach, battery-powered monitors in surgery, and for isolation requirements for devices connected to cardiac leads. In Part II, checklists are provided for the self-evaluation of an in-house, biomedical engineering staff. Parts III and IV, in future issues of this Journal, will include discussion of the theoretical electrical hazard potential in reference to the use of isolated power systems. The question of whether isolated power should be required in all anesthetizing locations will be discussed in Part IV.
Schmidmaier, Ralf; Holzer, Matthias; Angstwurm, Matthias; Nouns, Zineb; Reincke, Martin; Fischer, Martin R.
Aims: The Medical Curriculum Munich (MeCuM) has been implemented since 2004 and was completely established in 2007. In this study the clinical part of MeCuM was evaluated with respect to retention of the knowledge in internal medicine (learning objectives of the 6th/7th semester). Methods: In summer of 2009 and winter of 2009/2010 1065 students participated in the Progress Test Medizin (PTM) from Charité Medical School Berlin. Additionally the students answered a questionnaire regarding the acceptance and rating of the progress test and basic demographic data. Results: The knowledge of internal medicine continuously increases during the clinical part of the medical curriculum in Munich. However, significant differences between the sub-disciplines of internal medicine could be observed. The overall acceptance of the PTM was high and increased further with the study progress. Interestingly, practical experiences like clinical clerkships positively influenced the test score. Conclusions: The PTM is a useful tool for the evaluation of knowledge retention in a specific curriculum. PMID:21818215
Del Rosso, James Q; Harper, Julie C; Graber, Emmy M; Thiboutot, Diane; Silverberg, Nanette B; Eichenfield, Lawrence F
Parts 1 and 2 of this 3-part series provided an overview of the epidemiology, visible patterns, and important considerations for clinical and laboratory evaluation of acne vulgaris (AV) in adult women and reviewed the role of proper skin care and topical therapies in this patient population. In Part 3, oral therapies including combination oral contraceptives, spironolactone, antibiotics, and isotretinoin are discussed along with important considerations that clinicians should keep in mind when selecting oral agents for management of AV in adult women.
von Lengerke, Thomas; Kursch, Angelika; Lange, Karin
In the model medical curriculum HannibaL at Hannover Medical School (MHH, Hannover, Germany), communication skills in taking case histories and disclosing diagnoses (breaking bad news) are assessed through an objective structured clinical examination (OSCE). This is part of the examinations which at the MHH represent the equivalent to the First Part of the Medical Examinations. The second year doctor-patient communication course preparing for these examinations was evaluated during the 2009/10 academic year.Using questionnaires specific to the learning objectives, learning needs were assessed, pre-post comparisons of self-assessed competencies were performed and key teaching methods were evaluated (5-point Likert scales, "5"=fully agree). At T0 (start of the course) 267 students participated (response rate: 93.7%), of which 180 filled out the T1 questionnaire during the last session of the course (67.4%). Within-subject analyses of variance and paired t-tests were conducted.The highest learning needs were found for the "to show how"-items regarding history taking and disclosing diagnoses (M=4.4). The T1-T0 comparisons showed the greatest improvements for history taking ("to know how": mean difference = +1.7, "to show how": +1.8, p<.0001 as with all tests) and the "to know how"-item regarding the disclosure of diagnoses (+1.6), followed by the "to show how"-items on disclosing a diagnosis (+1.4), shared decision making (+1.2), self-assessing one's own strengths/weaknesses (+1.0) and confidently approaching new patients (+0.7). Students with T0 values of 1 or 2 on the respective scales improved on average by 2.2 points across all items, students with the value of 3 by 1.1, and from 4 or 5 by 0.1. Methodically, the use of simulated patients was rated the most helpful (M=4.8, 87% with the scale value 5). This doctor-patient communication course is associated with substantial improvements regarding all key learning objectives. Regarding methods, the deployed simulated
von Lengerke, Thomas; Kursch, Angelika; Lange, Karin
In the model medical curriculum HannibaL at Hannover Medical School (MHH, Hannover, Germany), communication skills in taking case histories and disclosing diagnoses (breaking bad news) are assessed through an objective structured clinical examination (OSCE). This is part of the examinations which at the MHH represent the equivalent to the First Part of the Medical Examinations. The second year doctor-patient communication course preparing for these examinations was evaluated during the 2009/10 academic year. Using questionnaires specific to the learning objectives, learning needs were assessed, pre-post comparisons of self-assessed competencies were performed and key teaching methods were evaluated (5-point Likert scales, “5”=fully agree). At T0 (start of the course) 267 students participated (response rate: 93.7%), of which 180 filled out the T1 questionnaire during the last session of the course (67.4%). Within-subject analyses of variance and paired t-tests were conducted. The highest learning needs were found for the “to show how”-items regarding history taking and disclosing diagnoses (M=4.4). The T1-T0 comparisons showed the greatest improvements for history taking (“to know how”: mean difference = +1.7, “to show how”: +1.8, p<.0001 as with all tests) and the “to know how”-item regarding the disclosure of diagnoses (+1.6), followed by the “to show how”-items on disclosing a diagnosis (+1.4), shared decision making (+1.2), self-assessing one’s own strengths/weaknesses (+1.0) and confidently approaching new patients (+0.7). Students with T0 values of 1 or 2 on the respective scales improved on average by 2.2 points across all items, students with the value of 3 by 1.1, and from 4 or 5 by 0.1. Methodically, the use of simulated patients was rated the most helpful (M=4.8, 87% with the scale value 5). This doctor-patient communication course is associated with substantial improvements regarding all key learning objectives. Regarding
Parshuram, Christopher S.; To, Teresa; Seto, Winnie; Trope, Angela; Koren, Gideon; Laupacis, Andreas
Introduction Errors in the concentration of intravenous medications are not uncommon. We evaluated steps in the infusion-preparation process to identify factors associated with preventable medication errors. Methods We included 118 health care professionals who would be involved in the preparation of intravenous medication infusions as part of their regular clinical activities. Participants performed 5 infusion-preparation tasks (drug-volume calculation, rounding, volume measurement, dose-volume calculation, mixing) and prepared 4 morphine infusions to specified concentrations. The primary outcome was the occurrence of error (deviation of > 5% for volume measurement and > 10% for other measures). The secondary outcome was the magnitude of error. Results Participants performed 1180 drug-volume calculations, 1180 rounding calculations and made 1767 syringe-volume measurements, and they prepared 464 morphine infusions. We detected errors in 58 (4.9%, 95% confidence interval [CI] 3.7% to 6.2%) drug-volume calculations, 30 (2.5%, 95% CI 1.6% to 3.4%) rounding calculations and 29 (1.6%, 95% CI 1.1% to 2.2%) volume measurements. We found 7 errors (1.6%, 95% CI 0.4% to 2.7%) in drug mixing. Of the 464 infusion preparations, 161 (34.7%, 95% CI 30.4% to 39%) contained concentration errors. Calculator use was associated with fewer errors in dose-volume calculations (4% v. 10%, p = 0.001). Four factors were positively associated with the occurence of a concentration error: fewer infusions prepared in the previous week (p = 0.007), increased number of years of professional experience (p = 0.01), the use of the more concentrated stock solution (p < 0.001) and the preparation of smaller dose volumes (p < 0.001). Larger magnitude errors were associated with fewer hours of sleep in the previous 24 hours (p = 0.02), the use of more concentrated solutions (p < 0.001) and preparation of smaller infusion doses (p < 0.001). Interpretation Our data suggest that the reduction of provider
In 1986, Planned Parenthood of Greater Northern New Jersey (PPGNNJ) began to evaluate its sex education programs. First PPGNNJ staff evaluated a 1-day, 40-minute lesson designed to help high school students 1) identify risk behavior for unplanned pregnancy, 2) estimate risk, and 3) review basic contraceptive methods. This project showed that a single lesson could substantially increase knowledge about contraception and comfort with the idea of condoms and family planning (FP) clinic use. A second PPGNNJ evaluation project revealed that adding a motivational video to the lesson increased the feeling of comfort expressed about use of an FP clinic and that PPGNNJ staff were more effective than regular teachers in promoting change in attitudes about FP services, but teachers were more effective in promoting longterm knowledge of risk. Evaluation of five popular AIDS prevention videos revealed that all of the videos significantly increased HIV/AIDS knowledge and motivation to seek protection. However, the videos made many viewers feel helpless about their ability to protect themselves and unwilling to support an AIDS home in their neighborhood. PPGNNJ's staff also designed the "Human Sexuality Questionnaire" to determine the impact of a five-session sex education program delivered to high-risk youth. This tool is now used in program evaluation nationwide. Evaluation of two date rape prevention strategies (a single-lesson, interactive date-rape scenario and a video) revealed a significant impact on females and none on males. Testing of a 1994 video and discussion session designed to improve adolescent attitudes towards use of an FP clinic also had positive results. While these evaluation methodologies were not problem-free, evaluation forced PPGNNJ staff to define objectives and lessons, enter a new collaboration with schools, and use results to continually evaluate work.
Adams, Richard C; Tapia, Carl
The medical home and the Individuals With Disabilities Education Act Part C Early Intervention Program share many common purposes for infants and children ages 0 to 3 years, not the least of which is a family-centered focus. Professionals in pediatric medical home practices see substantial numbers of infants and toddlers with developmental delays and/or complex chronic conditions. Economic, health, and family-focused data each underscore the critical role of timely referral for relationship-based, individualized, accessible early intervention services and the need for collaborative partnerships in care. The medical home process and Individuals With Disabilities Education Act Part C policy both support nurturing relationships and family-centered care; both offer clear value in terms of economic and health outcomes. Best practice models for early intervention services incorporate learning in the natural environment and coaching models. Proactive medical homes provide strategies for effective developmental surveillance, family-centered resources, and tools to support high-risk groups, and comanagement of infants with special health care needs, including the monitoring of services provided and outcomes achieved.
Casebeer, Linda; Andolsek, Kathryn; Abdolrasulnia, Maziar; Green, Joseph; Weissman, Norman; Pryor, Erica; Zheng, Shimin; Terndrup, Thomas
Introduction: Much of the international community has an increased awareness of potential biologic, chemical, and nuclear threats and the need for physicians to rapidly acquire new knowledge and skills in order to protect the public's health. The present study evaluated the educational effectiveness of an online bioterrorism continuing medical…
Hekelman, Francine P.; And Others
An instrument to measure the 13 personal characteristics of productive researchers described by C. J. Bland and others (1986, 1990) was developed and evaluated. The total eligible sample was 404 full-time assistant professor faculty members in the tenure track at Case Western Reserve University in Cleveland (Ohio). A random sample of 100…
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... such disorders include chronic glomerulonephritis, hypertensive nephropathy, diabetic nephropathy.... Examples of such disorders include chronic glomerulonephritis, hypertensive nephropathy, diabetic.... treatment? 6.00E What other things do we consider 6.00C What other factors do when we evaluate your...
Rodgers, Nancy J; Cutshall, Susanne M; Dion, Liza J; Dreyer, Nikol E; Hauschulz, Jennifer L; Ristau, Crystal R; Thomley, Barb S; Bauer, Brent A
The use of complementary and integrative medicine therapies is steadily becoming an integral part of health care. Massage therapy is increasingly offered to hospitalized patients for various conditions to assist with the management of common symptoms such as pain, anxiety, and tension. This article summarizes a decade of building the massage therapy service at a large tertiary care medical center, from the early pilot studies and research to the current program offerings, and the hopes and dreams for the future.
This is the second of three articles exploring skill analysis, assisting readers to evaluate a practice skill of their choice. Sometimes evaluations are made against external reference points, the competencies of the registered nurse or a job description for a post eagerly sought after; sometimes they are made with reference to aspirations--an ideal of the skill in use that the nurse and colleagues admire. Nurses may be understandably anxious about the evaluation of practice skills, as they work in a performance-orientated world where they are judged on whether their practice is competent, safe, ethical, cost effective and efficient. Nonetheless, understanding the strengths and weaknesses of a chosen practice skill is central to practice development. If the skill is to be affirmed, improved or adjusted, it is necessary to evaluate the skill in use.
Lexa, Frank James; Lexa, Frank J
The medical field is one of the most exciting in America for entrepreneurs. Radiologists and other medical practitioners are in a unique position to take advantage of opportunities to invent and create innovative products and services. Physicians have led many of the most important revolutionary and evolutionary changes that have occurred in the field in the past 100 years. However, many radiologists find the process of entrepreneurship a daunting one and are often deterred from acting on their ideas. This article addresses the key issues and challenges that entrepreneurs face when embarking on new enterprises. Although most of these issues face all entrepreneurs at this stage, this article focuses on medical innovation and its particular challenges. This article concentrates on the kinds of questions that physician-entrepreneurs need to ask before jumping in, the types of common pitfalls that await those who don't address these issues, and some answers to seek if you are to beat the odds and succeed.
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.
Greenfield, S; Kaplan, S H; Goldberg, G A; Nadler, M A; Deigh-Hewertson, R
This study was designed to determine which of three quality assessment methods most validly identifies deficient care. Process criteria were developed to assess outpatient care for urinary tract infection using each of three methods: a limited "list" of seven criteria, an extensive "list" of 40 criteria, and a criteria map (CM) which uses branching logic to identify applicable criteria according to the specific needs of each case. Defining deficiency as compliance with less than 60 percent of criteria, the extensive list found all 66 cases deficient; the limited list, 27 (41.0 percent); and the CM system, 15 (22.7 percent). After excluding the extensive list because of its nondiscrimination, 23 discrepancies in rating remained between the limited list and the CM. Ten physicians unaware of the results reviewed all 23 cases. In 12 of these 23 cases, at least seven of the ten physicians preferred the rating of one method over another; the CM assessment was preferred in 11 of the 12 cases (P less than .01). Criteria maps, providing a patient-specific approach, offer a more valid assessment of medical care than either the extensive or limited list.
Liddle, Stephanie; Grover, Lata; Zhang, Rachel; Khitrov, Maxim; Brown, Joan C; Cobb, J Perren; Goldman, Julian; Chou, Joseph; Yagoda, Daniel; Westover, Brandon; Reisner, Andrew T
Our hospital became interested in the extraction of electronic data from our bedside monitor network to enrich clinical care, and enable various quality improvement projects, research projects, and future applications involving advanced decision-support. We conducted a range of tests to confirm the safety of deploying BedMaster (Excel Medical Electronics, Jupiter FL, USA), which is third-party software sold expressly to provide electronic data extraction and storage from networked General Electric Healthcare bedside patient monitors. We conducted a series of tests examining the changes in network performance when the BedMaster system was on our isolated patient monitor network. We found that use of BedMaster led to measurable, but trivial increases in network traffic and latency. We did not identify any failure scenarios in our analysis and testing. The major value of this report is to highlight potential challenges inherent in data and electronic device integration within the healthcare setting. In describing our strategy for testing the BedMaster system, it is our intention to present one testing protocol and to generate thought and discussion in the broader community about what types of problems can arise with inter-operability, and what types of testing are necessary to mitigate against these risks. Standards for inter-operability would surely reduce the inherent risks.
Rørbye, Christina; Nørgaard, Mogens; Nilas, Lisbeth
To provide optimal information to women choosing between early medical and surgical abortion, rigorous comparisons of the two methods are warranted. We compared the outcome of 1135 consecutive women with gestational age (GA) < or = 63 days receiving either a medical (600 mg mifepristone and 1 mg gemeprost) or a surgical abortion (vacuum aspiration in general anesthesia). One hundred eleven of these women were randomized for abortion method. Surgical interventions and complications leading to readmission within the following 15 weeks were identified through a computer system. Information about antibiotic treatment, leave of absence and number of contacts to the health care system were obtained from mailed questionnaires. The number of complications was identical after the two methods, but surgical abortion was associated with a higher success rate [97.7% (708/725) vs. 94.1% (386/410), p < .01] and also with a higher risk of antibiotic treatment than medical abortion [7.8% (37/467) vs. 3.7% (13/356), p < .05]. The median leave of absence was shorter in women choosing a medical (1 day) than a surgical termination (2 days), p < .05. On average, one third of all the women requested at least one extra unscheduled consultation apart from a routine follow-up visit. We conclude that the chance of a primary successful termination at GA < or = 63 days is higher after a surgical abortion in general anesthesia compared to a medical abortion induced with 600 mg mifepristone and 1 mg gemeprost. A surgical abortion is associated with an increased risk of antibiotic treatment compared to medical abortion. The women's need for follow-up might be higher than we expect.
A library class was designed and offered to new nurses from the Neonatal Intensive Care Unit at the Children's Hospital of Michigan between 2003 and 2005. The class was intended to increase their knowledge of quality health information resources and to assist them with their smooth transition to a new health care organization. The goal of the library training class was to develop the nurses' awareness and knowledge of the library services and online resources on the organization Intranet and to improve their skills in finding reliable information related to patient care, patient parent education, and research. An evaluation study was conducted to assess the effectiveness of the library class. Although the findings demonstrated strengths of the library class, they also revealed some areas for improvement. The data gathered resulted in a number of recommendations regarding library instruction design and evaluation.
Waghmare, Lalitbhushan S; Rawekar, Alka; Mishra, Ved Prakash
Introduction Medical education can be enormously benefitted from research. Since clinicians/medical teachers are directly involved in teaching learning processes, they should participate in Educational Research (ER) practices to generate evidence and insights about teaching learning. Faculty Development Program (FDP) has a positive influence amongst health professionals and therefore can prove to be of consequence in instilling a strong educational research culture. Aim Present study was undertaken to evaluate the efficacy of a Faculty Development Fellowship Program in Medical Education to foster educational research culture amongst medical teachers. Materials and Methods Study utilized the Kirkpatrick model of program evaluation for evaluating the fellowship program. It aimed to evaluate the third level of the model i.e., “Change in Behaviour” of participants (n=40) after completion of the course. The tool used was a pre-validated survey questionnaire consisting of five items. Results Study population was sparsely aware about educational research and had never attempted the same (100%) before joining the fellowship program. A 32.5% faculty with average professional experience of seven years undertook new educational projects after the fellowship and knowledge gained during fellowship program helped them in guiding educational research (coded into four categories) at their workplaces. Conclusion There is a need, to direct effort towards focused training for educational research through FDPs for medical teachers. This will encourage academicians and clinicians to become active in ER and guide policies in Teaching Learning Practices in Medical Education. PMID:28208883
Aslani, Abolfazl; Ghannadi, Alireza; Rostami, Farnaz
Background: Various ginger compounds improve gastrointestinal problems and motion sickness. The main effects of ginger allocate to some phenolics such as gingerols and shogaols that act as their active agents. Chewing gums are among convenient dosage forms which patients prefer due to their advantages. Hence, this study tried to design, formulate, and evaluate ginger chewing gum of favorable taste and texture to avoid motion sickness and have gastro-protective and anti-oxidant effect. Materials and Methods: Dried ginger rhizomes were percolated to extract ginger compounds. Total phenolics were measured in 70% hydro-alcoholic extract of ginger by gallic and tannic acid standards using Folin–Ciocalteu’s reagent. Chewing gums containing 50 mg of concentrated extract were prepared. Content uniformity, weight variation, release pattern, organoleptic, and mechanical properties were evaluated. Results: Phenolic content was measured 61.50 ± 5.27 mg/g and 76.75 ± 5.45 mg/g of concentrated extract as gallic acid and tannic acid equivalents, respectively. Release pattern of formulations with different gum bases and sweeteners demonstrated almost 100% release of drug. Evaluation of organoleptic properties was on 10 healthy volunteers and later prepared formulations exhibited better characteristics. Formulations without any flavorants have higher acceptability. Evaluation of mechanical properties showed higher stiffness of F15. Conclusion: Ginger chewing gum comprises admissible properties to be used as a modern drug delivery system due to its advantageous results in motion sickness. It passed all the specified tests for an acceptable chewing gum. Thus, it may be successfully produced to help GI problems. PMID:27563640
Dorpema, J. W.
Safety assessment of medical devices includes sterilization and biological evaluation or biocompatibility testing. Sterilization by ETO gas is critised for their carcinogenic potency or even banned. Mutual acceptance of biological evaluation test results is promoted by a laboratory accreditation and qualification program.
Salehi, Hadi; Khadivar, Zahra; Mehrabi, Mahmood
Evaluation is basically a matching process, which concerns matching learners' needs to available solutions. Through analysis and assessment of ESP textbooks, a much more promising and desirable approach to a theory of ESP takes place. To this aim, the purpose of the present study was to evaluate the ESP medical textbook. To gather the necessary…
Salehi, Hadi; Khadivar, Zahra; Babaee, Ruzbeh; Singh, Hardev Kaur Ap Jujar
Textbook evaluation is determining the productivity and value of textbooks with respect to stated objectives, standards, or criteria. This study was an attempt to evaluate the ESP medical textbook, which is taught at some universities in Iran. To gather the necessary data, two researcher-made questionnaires and one interview protocol were used.…
Lim, Russell F.; Wegelin, Jacob; Hua, Lisa L.; Kramer, Elizabeth J.; Servis, Mark E.
Objective: The authors aim to evaluate the effectiveness of a presentation designed to increase cultural competence. Methods: A measure was developed to evaluate the attainment of knowledge and attitude objectives by first-year medical students who watched a presentation on the effect of culture on the doctor-patient relationship and effective…
disease states, and allergies. Evaluation methods The research associates evaluated each prescription for medication errors using a structured ... computer -based system. Using five screens, they progressed in sequence, entering all data, one prescription at a time, into the database (except that
Guo, J.; Iribarren, S.; Kapsandoy, S.; Perri, S.; Staggers, N.
Background Electronic medication administration records (eMARs) have been widely used in recent years. However, formal usability evaluations are not yet available for these vendor applications, especially from the perspective of nurses, the largest group of eMAR users. Objective To conduct a formal usability evaluation of an implemented eMAR. Methods Four evaluators examined a commercial vendor eMAR using heuristic evaluation techniques. The evaluators defined seven tasks typical of eMAR use and independently evaluated the application. Consensus techniques were used to obtain 100% agreement of identified usability problems and severity ratings. Findings were reviewed with 5 clinical staff nurses and the Director of Clinical Informatics who verified findings with a small group of clinical nurses. Results Evaluators found 60 usability problems categorized into 233 heuristic violations. Match, Error, and Visibility heuristics were the most frequently violated. Administer Medication and Order and Modify Medications tasks had the highest number of heuristic violations and usability problems rated as major or catastrophic. Conclusion The high number of usability problems could impact the effectiveness, efficiency and satisfaction of nurses’ medication administration activities and may include concerns about patient safety. Usability is a joint responsibility between sites and vendors. We offer a call to action for usability evaluations at all sites and eMAR application redesign as necessary to improve the user experience and promote patient safety. PMID:23616871
... HUMAN SERVICES Food and Drug Administration Medical Devices Regulated by the Center for Biologics Evaluation and Research; Availability of Summaries of Safety and Effectiveness Data for Premarket Approval... the Center for Biologics Evaluation and Research (CBER). This list is intended to inform the public...
Stratton, Terry D; Witzke, Donald B; Freund, Mary Jane; Wilson, Martha T; Jacob, Robert J
As more students from various health professions are combined into integrated courses, evaluating the teaching quality of individual faculty in these typically large, multi-instructor contexts becomes increasingly difficult. Indeed, students who lack sufficient recall of a given faculty member or are not committed to the evaluation process may respond by marking identical responses to all evaluation items (e.g., 3-3-3-3-3), regardless of the specific content of the items on the faculty evaluation questionnaire. These "straight-lining" behaviors-more formally referred to as monotonic response patterns (MRPs)-often reflect students' inattention to the task at hand or lack of motivation to be discriminating, which may result in invalid data. This study examines the prevalence of MRP ratings in relation to indicators reflective of students' lack of attention to evaluating the quality of faculty teaching. Dental and medical students in a required, second-year (medicine) basic science course conducted by the medical school and taught primarily by medical school faculty completed seven-item faculty evaluation forms, along with an anonymous questionnaire measuring their need to evaluate, attitudes toward faculty evaluation, and recall of instructors. MRP ratings failed to correlate significantly with students' need to evaluate or their attitudes toward faculty evaluation. However, among medical students, MRP "straight-line" responses were more prevalent for raters who recalled faculty members "very well" (p=.04). For dental students, MRPs were associated with less accurate recall (p=.01). As such, the validity of faculty evaluations within integrated, multi-instructor courses may vary when students rate distinct aspects of a teacher's performance identically. In this case-in which medical students' greater recall of instructors coincides with MRPs-ratings may suffice as global, holistic assessments of an instructor's teaching. For dental students, similar ratings may be
Maggi, Lauretta; Conte, Ubaldo; Nhamias, Alain; Grenier, Pascal; Vergnault, Guy
The overall stability of medicated chewing gums is investigated under different storage conditions. Active substances with different chemical stabilities in solid state are chosen as model drugs. The dosage form is a three layer tablet obtained by direct compression. The gum core contains the active ingredient while the external layers are formulated to prevent gum adhesion to the punches of the tableting machine. Two accelerated test conditions (40°C/75% RH and 30°C/65% RH) are performed for 6 months. Furthermore, a long-term stability test at room conditions is conducted to verify the predictability of the results obtained from the stress tests. Some drugs are stable in all the conditions tested, but other drugs, generally considered stable in solid dosage forms, have shown relevant stability problems particularly when stress test conditions are applied to this particular semi-solid dosage forms. For less stable drugs, the stress conditions of 40°C/75% RH are not always predictable of chewing gum stability at room temperature and may produce false negative; intermediate conditions, 30°C/65% RH, are more predictive for this purpose, the results of drug content found after 6 months at intermediate stress conditions and 12 months at room conditions are generally comparable. But the results obtained show that only long-term conditions stability tests gave consistent results. During aging, the semi solid nature of the gum base itself, may also influence the drug delivery rate during chewing and great attention should be given also to the dissolution stability.
Mione, Sylvia; Valcke, Martin; Cornelissen, Maria
Histology stands as a major discipline in the life science curricula, and the practice of teaching it is based on theoretical didactic strategies along with practical training. Traditionally, students achieve practical competence in this subject by learning optical microscopy. Today, students can use newer information and communication technologies in the study of digital microscopic images. A virtual microscopy program was recently introduced at Ghent University. Since little empirical evidence is available concerning the impact of virtual microscopy (VM) versus optical microscopy (OM) on the acquisition of histology knowledge, this study was set up in the Faculty of Medicine and Health Sciences. A pretest-post test and cross-over design was adopted. In the first phase, the experiment yielded two groups in a total population of 199 students, Group 1 performing the practical sessions with OM versus Group 2 performing the same sessions with VM. In the second phase, the research subjects switched conditions. The prior knowledge level of all research subjects was assessed with a pretest. Knowledge acquisition was measured with a post test after each phase (T1 and T2). Analysis of covariance was carried out to study the differential gain in knowledge at T1 and T2, considering the possible differences in prior knowledge at the start of the study. The results pointed to non-significant differences at T1 and at T2. This supports the assumption that the acquisition of the histology knowledge is independent of the microscopy representation mode (VM versus OM) of the learning material. The conclusion that VM is equivalent to OM offers new directions in view of ongoing innovations in medical education technology.
Department of the Army, Washington, DC.
These instructor plans of instruction, lesson plans, and student text and review materials for a secondary-postsecondary-level course for medical laboratory specialist are one of a number of military-developed curriculum packages selected for adaptation to vocational instruction and curriculum development in a civilian setting. It is the first of…
Department of the Army, Washington, DC.
These instructor plans of instruction and lesson plans and student text and review materials for a secondary-postsecondary-level course for medical laboratory specialist are one of a number of military-developed curriculum packages selected for adaptation to vocational instruction and curriculum development in a civilian setting. It is the second…
... increased seat belt use. 1 Blincoe, L.J. Estimating the Benefits of Increased Safety Belt Use. Washington... for inflation, using the most recent annual average Consumer Price Index for medical care, and then... available data found in the same cost report or in other sources, as they may become available. 2 Blincoe,...
... the functional capacity to perform medium work. However, an individual with a marginal education and... medically determinable impairment(s). 203.00Maximum sustained work capability limited to medium work as a... past work. They also reflect the analysis of the various vocational factors (i.e., age, education,...
... the functional capacity to perform medium work. However, an individual with a marginal education and... medically determinable impairment(s). 203.00Maximum sustained work capability limited to medium work as a... past work. They also reflect the analysis of the various vocational factors (i.e., age, education,...
... medically determinable impairment(s). 203.00Maximum sustained work capability limited to medium work as a... his or her maximum sustained work capability for sedentary, light, medium, heavy, or very heavy work... at the various functional levels (sedentary, light, medium, heavy, and very heavy) as supported...
... medically determinable impairment(s). 203.00Maximum sustained work capability limited to medium work as a... his or her maximum sustained work capability for sedentary, light, medium, heavy, or very heavy work... at the various functional levels (sedentary, light, medium, heavy, and very heavy) as supported...
Palmer, Nikolaus O A; Fleming, Pádraig; Randall, Christine
This paper is the seventh in the series on prescribing medicines for child dental patients. Here, the authors aim to describe the medical emergencies that may occur in children presenting for dental treatment and to provide guidelines on their management, with particular reference to the use of emergency drugs.
Findling, Robert L.; Brams, Matthew; Childress, Ann C.; Lopez, Frank A.; Manos, Michael J.; Jensen, Peter S.
ADHD is one of the most common neurobehavioral disorders of childhood, and FDA-approved medications offer an efficacious treatment option. However, case reports and anecdotal sources suggest that children can have emotional responses, both salutary and detrimental, to these agents. We have previously conducted a comprehensive literature review and…
Crosland, Kimberly A; Zarcone, Jennifer R; Lindauer, Steven E; Valdovinos, Maria G; Zarcone, Troy J; Hellings, Jessica A; Schroeder, Stephen R
The atypical antipsychotic medication risperidone was evaluated using a double-blind, placebo-controlled design in the treatment of destructive behavior in two individuals with autism. Pre-medication functional analyses indicated that destructive behavior was maintained by escape from demands, attention, or access to tangible items. For both individuals, destructive behavior during the demand condition was significantly reduced during the medication phases, whereas destructive behavior continued to occur to obtain tangible items (Reggie) and attention (Sean). In addition, there appeared to be a differential effect of the medication on self-injurious behavior (SIB) versus aggression for Sean. Results of the study demonstrate how functional analysis may provide information on those conditions and behaviors that are most likely to be affected by a specific medication.
Sims, Shireen Madani; Lynch, James W.
Introduction The College of Medicine at our institution underwent a major curricular revision in order to develop a patient-centered context for learning. The admission process was revised to reflect this change, adopting a holistic review process, with the hope of attracting students who were particularly well suited to a patient-centered curriculum and learning culture. Methods Patients from a single practitioner, who were accustomed to working with medical students, were asked if they would like to select the next generation of physicians. The patient's experience included a brief didactic presentation related to the patient's diagnosis and treatment. This was followed by an informal session with the applicants and the physician, where they shared their story in a small group setting. They were encouraged to share their experiences with the healthcare system, both positive and negative. The goal was to allow applicants to glean the importance of the human aspects of disease in our institutional culture of learning. Results The response and experience were overwhelmingly positive for the patients who donated their time to participate and for our applicants. Follow-up surveys indicated that our applicants found the experience to be unique and positive. Many of the students who chose to attend our university cited the interview experience and learning culture as factors that influenced their choice of medical schools. In addition, the Liaison Committee on Medical Education cited the favorability of the admission process in their recent site visit. Discussion Now in its fifth year, we can say that the inclusion of patients as part of the interview day is feasible as part of our admission process. We continue to make changes and monitor our progress, and we have added several other faculty members and specialties in order to ensure the program is sustainable. PMID:27520404
Derancourt, C; Devos, P; Moore, N; Rouvillain, J-L
The "système d'interrogation, de gestion et d'analyse des publications scientifiques" (System for Identification, Management and Analysis of Scientific Publications), or SIGAPS, is an innovative tool of French design that enables the identification and analysis of bibliographic references produced by a given researcher or unit using the Medline database (PubMed). This evaluation takes into account the author's rank of signature and the impact factor of the journal of publication within the discipline in question. The limits are those of the impact factor. Analyses produced by SIGAPS enable financial assessment to be made by hospitals.
and aging. Computerized cognitive test batteries, COGSREEN and WOMBAT , were selected as the domain-independent measures. Flitescript and whole task...were assessed. COGSCREEN total composite scores were significantly correlated with evaluator ratings on emergency/abnormal maneuvers. Neither WOMBAT ...B-3 WOMBAT Questionnaire .......................................... B-4 Sim ulator Post-flight Questionnaire
Gould, Madelyn S.; Kalafat, John; HarrisMunfakh, Jimmie Lou; Kleinman, Marjorie
In this study we evaluated the effectiveness of telephone crisis services/hotlines, examining proximal outcomes as measured by changes in callers' suicide state from the beginning to the end of their calls to eight centers in the U.S. and again within 3 weeks of their calls. Between March 2003 and July 2004, 1,085 suicide callers were assessed…
North Carolina State Dept. of Public Instruction, Raleigh. Div. of Accountability Services/Research.
In 1996, North Carolina began a 5-year evaluation of Alternative Learning Programs (ALPs). This report describes selected outcomes for students who participated in ALPs during 1995-96. These outcomes include performance on North Carolina End-of-Grade tests (elementary school) and performance on the End-of-Course(EOC) tests (high school) for…
Patterson, J. E.
The pre-travel medical evaluation of elderly patients and patients with chronic illness requires special assessment and advice. Screening and special precautions are reviewed for traveling patients with respiratory disease, cardiac disease, sinusitis, diabetes mellitus, HIV infection, and other chronic medical conditions. Current guidelines for empiric therapy and prophylaxis of travelers' diarrhea are reviewed, with emphasis on concerns in geriatric or chronically ill travelers. Special considerations such as potential drug-drug interactions and insurance coverage are also discussed. PMID:1290273
Eker, Hasan Hüseyin; Bilgili, Mehmet Sinan; Sekman, Elif; Top, Selin
In this study, a survey containing 28 questions concerning general information about the healthcare services, waste collection, training, waste quantities, storage and general evaluation was applied to 311 healthcare services. The response rate was 82%, which was considered acceptable for the evaluation of the results. The separate collection of medical waste and sharps was completely achieved in all of the healthcare services participating in the survey and 82.6% of the healthcare services used containers for separate collection of medical waste. Only 5% of the containers used for waste collection and temporary storage were inappropriate for collecting medical waste. Almost 33% of healthcare services organized courses monthly, 40% quarterly and 20% at least twice a year. A total of 88% of the hospitals have temporary storage depots for medical waste and all of these depots complied with the Medical Waste Control Regulation. The results of this study showed that the medical waste generation rate was 2.35 kg bed(-1) day(-1). The amount of liquid waste and sharps was determined for the first time in Turkey. The rate of separate collection for recyclables increased to 94%, having been 83% in 2006. The results indicate that in the period 2006-2009, the healthcare services conformed completely to the Medical Waste Control Regulation as it applied. Any deficiencies observed will be satisfied by precautionary actions that will be taken by hospital managers and local administrations.
Brown, Dana A; Brown, Daniel L; Yocum, Christine K
While pharmacy curricula can prepare students for the cognitive domains of pharmacy practice, mastery of the affective aspects can prove to be more challenging. At the Gregory School of Pharmacy, medical mission trips have been highly effective means of impacting student attitudes and beliefs. Specifically, these trips have led to transformational changes in student leadership capacity, turning an act of service into an act of influence. Additionally, building team unity is invaluable to the overall effectiveness of the trip. Pre-trip preparation for teams includes activities such as routine team meetings, team-building activities, and implementation of committees, as a means of promoting positive team dynamics. While in the field, team dynamics can be fostered through activities such as daily debriefing sessions, team disclosure times, and provision of medical services.
Pechère-Bertschi, Antoinette; Herpin, Daniel; Lefebvre, Hervé
Spironolactone, which is a potent mineralocorticoid receptor antagonist, represents the first line medical treatment of primary aldosteronism (PA). As spironolactone is also an antagonist of the androgen and progesterone receptor, it may present side effects, especially in male patients. In case of intolerance to spironolactone, amiloride may be used to control hypokaliemia and we suggest that eplerenone, which is a more selective but less powerful antagonist of the mineralocorticoid receptor, be used in case of intolerance to spironolactone and insufficient control of hypertension by amiloride. Specific calcic inhibitors and thiazide diuretics may be used as second or third line therapy. Medical treatment of bilateral forms of PA seem to be as efficient as surgical treatment of lateralized PA for the control of hypertension and the prevention of cardiovascular and renal morbidities. This allows to propose medical treatment of PA to patients with lateralized forms of PA who refuse surgery or to patients with PA who do not want to be explored by adrenal venous sampling to determine whether they have a bilateral or lateralized form.
Carson, P A; Fairclough, C S; Mauduit, C; Colsell, M
Fabric laundering is now a sophisticated chemical process involving a variety of operations including bleaching. The chemistry of peroxy bleaches is described including the use of novel organic compounds to provide effective bleaching at the lower temperatures of modern wash cycles. The instability of peroxy compounds is illustrated using cameo case histories to relate theory and practice. Techniques available for determining their thermochemistry are summarised. A model is provided for hazard and risk assessment of development projects in general (particularly those involving new molecules, processes or formulations) from ideas phase through exploratory laboratory investigations to pilot plant scale-up and eventual manufacture and commercial exploitation. This paper is a prelude to Part 2, which describes the determination of thermodynamic and kinetic properties of peroxy bleaches and discusses the implication of the results in terms of precautions for their safe storage and incorporation into detergent formulations during processing.
[Experience of medical backup of military parade on Red Square. Authors showed data about medical backup of military personnel taking part in the parade on Red Square dedicating to anniversary of victory in the Great Patriotic War].
Malykh, A B; Iakovlev, S V; Valevskiĭ, V V
Authors showed data about medical backup of military personnel taking part in the parade on Red Square dedicating to anniversary of Victory in the Great Patriotic War. Experience of running such events allowed to work out an algorithm for medical service: preparatory stage, training stage, running of parade, stage of move out to permanent base. During the parade on Red Square for medical care asked 18 people (participants of parade and civilians). Authors came to conclusion that as a result of medical backup of military personnel taking part in the parade no infectious and group diseases were registered.
Wilby, K J; Hazi, H M; Ashour, M A
The objectives of this study were to assess the needs of schoolchildren relating to medication safety and to develop and implement a health promotion programme in Qatar. Semi-structured interviews were completed with teachers, nurses and school administrators at 2 primary schools in Doha. Two main themes were identified from these interviews, namely medication basics and medication safety. Subsequently, a 25-minute health promotion programme was developed and delivered to 11 groups of schoolchildren aged 6-10 years. The student groups contained both expatriate and local Qatari students. The programme was evaluated based on perceptions of site representatives, investigators and peer reviewers using a standardized evaluation form. All the evaluators agreed that the programme was beneficial and should be recommended to other schools in Qatar. This study can serve as a prototype for future programmes in the Eastern Mediterranean Region and elsewhere.
Onofri, E; Salesi, M; Massoni, F; Rosati, M V; Ricci, S
"Seafarer" means person employed with any job on board a ship offshore, whether publicly or privately, excluding ships of war. Day by day a seafarer is forced to confront a reality in constant motion and live in environments that require awkward movements, and restricting the normal mobility of the person. In order to verify the frequency of herniated discs in this particular category of workers, given the recent introduction of INAIL tabulated diseases, a study was conducted on a sample of seafarers. Data analysis showed that 48.3% of the seafarers of the sample has herniated lumbar disc, and 34.5% of these duties in the deck, and 65.5% of the machine. The study of sample, varied as to age and task being performed, supports the assertion that the individual risk factors, especially age and obesity, are not strongly implicated in the genesis of disk herniation suffered by seafarers while the work factors (vibrations) play a more significant role in the onset of this disease. This consideration is part of a context, that of legal medical evaluation and in particular the causal relationship, which currently seems rather lacking in terms of literature and scientific production.
Huesman, Ronald H.; Reutter, Bryan W.; Marshall, Robert C.
Kinetic analysis of dynamic tracer data is performed with the goal of evaluating myocardial radiotracers for cardiac nuclear medicine imaging. Data from experiments utilizing the isolated rabbit heart model are acquired by sampling the venous blood after introduction of a tracer of interest and a reference tracer. We have taken the approach that the kinetics are properly characterized by an impulse response function which describes the difference between the reference molecule (which does not leave the vasculature) and the molecule of interest which is transported across the capillary boundary and is made available to the cell. Using this formalism we can model the appearance of the tracer of interest in the venous output of the heart as a convolution of the appearance of the reference tracer with the impulse response. In this work we parameterize the impulse response function as the sum of a large number of exponential functions whose predetermined decay constants form a spectrum, and each is required only to have a nonnegative coefficient. This approach, called spectral analysis, has the advantage that it allows conventional compartmental analysis without prior knowledge of the number of compartments which the physiology may require or which the data will support.
Margolis, Amanda R.; Martin, Beth A.; Mott, David A.
lists to facilitate MTM sessions in the community pharmacy setting. Evaluating the sustainability of using student pharmacists or trained technicians to collect medication lists is needed. PMID:27000165
Perdrizet, George A
Advances in the treatment of chronic wounds* have steadily occurred over the past decade and include the specialized use of dynamic compression therapy, implementation of moist wound care techniques, chronic lymphedema therapy, negative pressure wound therapy, arterial compression therapy and application of off-loading devices. General medical practitioners should recognize when timely patient referral to a comprehensive wound care center is indicated. The clinical practice of HBOT and its scientific basis has also advanced significantly during this same time period. HBOT is a therapeutic tool with many qualities that are unique to medical care and enable difficult and otherwise untreatable conditions to be safely and effectively managed. Level 1 evidence exists for HBOT and the therapeutic indications are growing. It is the responsibility of all practitioners to become informed about the modern principles and practice of HBOT. Clinicians should take the advice of Mark Twain: "Supposing is good but finding out is better." It is the responsibility of educational institutions and medical societies to become informed and actively engaged in hyperbaric medical care, education and research. This will benefit our patients as well as our systems of medical care. There is now ample access to hyperbaric oxygen facilities and expertise with the state. There is a growing need for HBOT services due to the rising incidence of obesity and diabetes combined with an aging demographic. Appropriate networks and patterns of referral have lagged behind this demand due to a generalized lack of understanding of the true risks, benefits and indications for HBOT. This review will hopefully begin to address this problem. Hyperbaric medicine is in an early phase of development. The current and future demand for clinical services will drive development of research and educational programs. Only through continued efforts for perform high quality research and education will the full potential
Moore, W. J.
Gallium-doped germanium far infrared detectors were evaluated at low temperatures and low background simulating the space environment. Signal and noise characteristics were determined for detector temperatures in the 2K to 4K range. Optimum performance occurs at about 2.5K for all devices tested. The minimum average NEP in the 40-130 micron region was found to be approximately 4 x 10 to the minus 17th power watt Hz(-1/2) at a frequency of 1 Hz.
Rostami, S; Sarmad, A; Mohammadi, M; Cheleie, M; Amiri, S; Zardoei Golanbary, S H
Evaluating hospital information systems leads to the improvement and devotion based on the users' needs, especially the medical records section users in hospitals, which are in contact with this system from the moment the patient enters the hospital until his/ her release and after that. The present research aimed to evaluate the hospital information systems from the point of view of the medical record section employees. Materials and method: The current research was applicative-descriptive analytical and the research society included 70 users of the medical history section in the educational-medical centers of Kermanshah city. The data-gathering tool was the 10th part of 9241/ 10 Isometric standard questionnaire of evaluating hospital information systems, with 75 specific questions in 7 bases, with the five spectra Likertt scale, its conceptual admissibility being confirmed in previous researches. 22 SPSS statistical software analyzed its permanency in the present study, which was also confirmed by Cronbach's's alpha test, which equaled to 0.89, and the data. Findings: The highest level of the employees' satisfaction, based on gained scores median, was respectively the incompatibility with the users' expectations, measuring 3.55, self-description measuring 3.54 and controllability - 3.51, which in total presented the average scores of 3.39, the lowest level of satisfaction being related to useful learning , whose value was 3.19. Discussion and conclusion: Hospital information systems' users believe that it is more desirable that the existing systems are based on the measures and consider them proper for making them non-governmental and useful for undesired learning. Considering the long distance of the existing information systems with the desired performance, it is essential that "these systems pay more attention to a more complete and deeper recognition and awareness of users' opinions and requirements in their road. The movement and development is to increase
Hillen, Jodie B; Vitry, Agnes; Caughey, Gillian E
Given the growing aged care population, the complexity of their medication-related needs and increased risk of adverse drug events, there is a necessity to systematically monitor and manage medication-related quality of care. The aim of this systematic review was to identify and synthesise medication-related quality of care indicators with respect to application to residential aged care. MEDLINE (Ovid), Psychinfo, CINAHL, Embase and Google® were searched from 2001 to 2013 for studies that were in English, focused on older people aged 65+ years and discussed the development, application or validation of original medication-related quality of care indicators. The quality of selected articles was appraised using the Critical Appraisal Skills Program and psychometric qualities extracted and synthesised using content analysis. Indicators were mapped to six medication-related quality of care attributes and a minimum indicator set derived. Thirty three articles describing 25 indicator sets met the inclusion criteria. Thirteen (52%) contained prescribing quality indicators only. Eight (32%) were developed specifically for aged care. Twenty three (92%) were validated and seven (28%) assessed for reliability. The most common attribute addressed was medication appropriateness (n = 24). There were no indicators for evaluating medication use in those with limited life expectancy, which resulted in only five of the six attributes being addressed. The developed minimum indicator set contains 28 indicators representing 22 of 25 identified indicator sets. Whilst a wide variety of validated indicator sets exist, none addressed all aspects of medication-related quality of care pertinent to residential aged care. The minimum indicator set is intended as a foundation for comprehensively evaluating medication-related quality of care in this setting. Future work should focus on bridging identified gaps.
A dynamic evaluation of the Community Multiscale Air Quality (CMAQ) modeling system version 5.0.1 was conducted to evaluate the model's ability to predict changes in ozone levels between 2002 and 2005, a time period characterized by emission reductions associated with the EPA's Nitrogen Oxides State Implementation Plan as well as significant reductions in mobile source emissions. Model results for the summers of 2002 and 2005 were compared to simulations from a previous version of CMAQ to assess the impact of model updates on predicted pollutant response. Changes to the model treatment of emissions, meteorology and chemistry had substantial impacts on the simulated ozone concentrations. While the median bias for high summertime ozone decreased in both years compared to previous simulations, the observed decrease in ozone from 2002 to 2005 in the eastern US continued to be underestimated by the model. Additional “cross” simulations were used to decompose the model predicted change in ozone into the change due to emissions, the change due to meteorology and any remaining change not explained individually by these two components. The decomposition showed that the emission controls led to a decrease in modeled high summertime ozone close to twice as large as the decrease attributable to changes in meteorology alone. Quantifying the impact of retrospective emission controls by removing the impacts of meteorology during the control period can be a valuable approac
Fisher, K.; Walker, R.; Dunleavy, R.; Woodroof, B.; Crabb, H.
Logging tools can now quantify multiple isotopes, including the volume of individual isotopes present and their radial position away from the well bore. In conjunction with those improvements, tracers have been developed that eliminate wash off effects of conventional tracers. By precisely locating the presence and concentration of traced proppant at the well bore, better evaluations can be made of vertical and radial proppant distribution near the well bore and fracture aperture width. A comprehensive study of 98 wells with 136 fracture stages in four different basins has been completed. Each stage was traced and logged. Spectral gamma ray logs were compared with conventional openhole logs, sonic stress logs where available, and cased hole logs such as cement bond and production logs. This data was then compared on a well-by-well basis with the fracture design program, post treatment stimulation reports and production history. Several trends were identified while building this massive stimulation evaluation database. Problems that potentially could be solved using tracer technology are: fracture height greater than design; unstimulated perforation sets within a stage; understimulated pay intervals.
Gould, Madelyn S; Kalafat, John; Harrismunfakh, Jimmie Lou; Kleinman, Marjorie
In this study we evaluated the effectiveness of telephone crisis services/hotlines, examining proximal outcomes as measured by changes in callers' suicide state from the beginning to the end of their calls to eight centers in the U.S. and again within 3 weeks of their calls. Between March 2003 and July 2004, 1,085 suicide callers were assessed during their calls and 380 (35.0%) participated in the follow-up assessment. Several key findings emerged. Seriously suicidal individuals reached out to telephone crisis services. Significant decreases in suicidality were found during the course of the telephone session, with continuing decreases in hopelessness and psychological pain in the following weeks. A caller's intent to die at the end of the call was the most potent predictor of subsequent suicidality. The need to heighten outreach strategies and improve referrals is highlighted.
Kodiyalam, Srinivas; Yuan, Charles; Sobieski, Jaroslaw (Technical Monitor)
A new MDO method, BLISS, and two different variants of the method, BLISS/RS and BLISS/S, have been implemented using iSIGHT's scripting language and evaluated in this report on multidisciplinary problems. All of these methods are based on decomposing a modular system optimization system into several subtasks optimization, that may be executed concurrently, and the system optimization that coordinates the subtasks optimization. The BLISS method and its variants are well suited for exploiting the concurrent processing capabilities in a multiprocessor machine. Several steps, including the local sensitivity analysis, local optimization, response surfaces construction and updates are all ideally suited for concurrent processing. Needless to mention, such algorithms that can effectively exploit the concurrent processing capabilities of the compute servers will be a key requirement for solving large-scale industrial design problems, such as the automotive vehicle problem detailed in Section 3.4.
Ebina, H; Funato, T; Kawamura, T; Ishimori, A; Satoh, K; Terasaki, S; Chiba, M; Yanagiya, T
Recently the risk of ischemic heart disease (IHD) is increasing in young generations. Thus, we evaluated the degree of hyperlipidemia in the students of high school in Miyagi prefecture. At first, we examined the plasma level of total cholesterol in all students as screening. About 10% of all the students showed high level of total cholesterol over 200mg/dl. For second screening, we examined further indexes for hyperlipidemia including lipids, glucose and blood pressure at fasting state and got information about family history, diet and exercise. There was positive correlation between total cholesterol and LDL-cholesterol (LDL-C), but no relation was found among others. Lipoprotein (a) which was an independent factor of IHD showed a broad distribution as described before, and had no relation with other lipid levels. Early education and a familial consultation for protecting from IHD should be followed after the screening of lipids levels.
Rashotte, Judy; Coburn, Geraldine; Harrison, Denise; Stevens, Bonnie J; Yamada, Janet; Abbott, Laura K
BACKGROUND: Although documentation of children’s pain by health care professionals is frequently undertaken, few studies have explored the nature of the language used to describe pain in the medical records of hospitalized children. OBJECTIVES: To describe health care professionals’ use of written language related to the quality and quantity of pain experienced by hospitalized children. METHODS: Free-text pain narratives documented during a 24 h period were collected from the medical records of 3822 children (0 to 18 years of age) hospitalized on 32 inpatient units in eight Canadian pediatric hospitals. A qualitative descriptive exploration using a content analysis approach was used. RESULTS: Pain narratives were documented a total of 5390 times in 1518 of the 3822 children’s medical records (40%). Overall, word choices represented objective and subjective descriptors. Two major categories were identified, with their respective subcategories of word indicators and associated cues: indicators of pain, including behavioural (eg, vocal, motor, facial and activities cues), affective and physiological cues, and children’s descriptors; and word qualifiers, including intensity, comparator and temporal qualifiers. CONCLUSIONS: The richness and complexity of vocabulary used by clinicians to document children’s pain lend support to the concept that the word ‘pain’ is a label that represents a myriad of different experiences. There is potential to refine pediatric pain assessment measures to be inclusive of other cues used to identify children’s pain. The results enhance the discussion concerning the development of standardized nomenclature. Further research is warranted to determine whether there is congruence in interpretation across time, place and individuals. PMID:24093122
Sloan, D A; Donnelly, M B; Schwartz, R W; Felts, J L; Blue, A V; Strodel, W E
This study had two purposes: determining the reliability and validity of the Objective Structured Clinical Examination (OSCE) in assessing performance by trainees at all levels, including medical students and chief residents; and estimating the impact of providing OSCE participants with immediate feedback about their performance. A comprehensive 210-min OSCE was administered to 53 surgical residents and 6 junior medical students. Faculty experts proctored all patient stations and provided immediate feedback to participants after the patient interaction segments (Part A). The participants then answered questions about the patients seen (Part B). The reliability of the OSCE was high (.91), identical to that of a previous resident OSCE with no feedback. The standard error of measurement for both parts was approximately 4%. At the 95% confidence interval, each participant's actual level of clinical performance (Part A) and clinical knowledge (Part B) could be estimated with an error of +/-8%. Participants showed significant differences in clinical performance (Part A, P < 0.01) and knowledge (Part B, P < 0.01) by level of training. Most participants (74%) rated the OSCE as an above average or outstanding educational method. The OSCE is a valid and reliable test of residents' clinical skills. Feedback to participants during the OSCE was positively received and did not perturb test reliability.
Del Rosso, James Q; Harper, Julie C; Graber, Emmy M; Thiboutot, Diane; Silverberg, Nanette B; Eichenfield, Lawrence F
In part 1 of this 3-part series, an overview of the epidemiology, visible patterns, and important considerations for clinical and laboratory evaluation of acne vulgaris (AV) in adult women was provided. Proper selection and integration of skin care products is important in the management of AV in this patient population. Part 2 of this series includes a discussion of over-the-counter and prescription topical therapies for adult women with AV. A summary of key randomized controlled trials also is provided. Further well-designed studies are needed, as data on the use of topical agents in this subpopulation are limited.
Gougelet, Robert M.; Rea, Michael E.; Nicolalde, Roberto J.; Geiling, James A.; Swartz, Harold M.
Few natural disasters or intentional acts of war or terrorism have the potential for such severe impact upon a population and infrastructure as the intentional detonation of a nuclear device within a major U.S. city. In stark contrast to other disasters or even a “dirty bomb,” hundreds of thousands will be affected and potentially exposed to a clinically significant dose of ionizing radiation. This will result in immediate deaths and injuries and subsequently the development of Acute Radiation Syndrome (ARS). Additionally, millions more who are unlikely to develop ARS will seek medical evaluation and treatment, overwhelming the capacity of an already compromised medical system. In this paper, we propose that in vivo electron paramagnetic resonance (EPR) dosimetry be utilized to screen large numbers of potentially exposed victims, and that this screening process be incorporated into the medical-surge framework that is currently being implemented across the nation for other catastrophic public health emergencies. The National Incident Management System (NIMS), the National Response Framework (NRF), the Target Capabilities list (TCL), Homeland Security Presidential Directives (HSPD), as well as additional guidance from multiple federal agencies provides a solid framework for this response. The effective screening of potentially exposed victims directly following a nuclear attack could potentially decrease the number of patients seeking immediate medical care by greater than 90%. PMID:20065673
Jünger, Jana; Fischer, Martin R; Duelli, Roman; Putz, Reinhard; Resch, Franz
The implementation of new medical licensing regulations (AAppO 2003) was the starting point for radical curricular changes in all German medical schools. In 2004, the postgraduate and interfaculty Master of Medical Education (MME) degree programme was established at the University of Heidelberg under the auspices of the Medical Faculty Association (Medizinischer Fakultätentag, MFT) and supported by the Association for the Promotion of Science and Humanities in Germany (Stifterverband für die Deutsche Wissenschaft). This new degree programme is intended to train multipliers and leaders in medical education, to build a German-speaking network and to strengthen educational research. The eight one-week MME modules are organised by seven locations in Germany (Munich, Tuebingen, Muenster/Essen, Berlin, Heidelberg, Cologne, Dresden) and an annually changing international faculty. The instructor teams are composed of national and international experts. Major focal points include: curriculum development, education theory, teaching and exam methods, evaluations, team building and group dynamics, project management, leadership, and faculty development, as well as educational research. The modules are connected with each other longitudinally: each participant conducts a project to improve teaching in his or her own faculty and writes a master's thesis about an educational research project. Overall, the participants earn 60 ECTS (European Credit Transfer System) in the course of two years while working. So far 100 participants (25 per year) from 33 of 34 medical faculties have started the program and 19 participants (50% of the participants from Cohort 1, 29% of the participants from Cohort 2) completed the program. The evaluation of the individual modules showed a very high level of participant satisfaction. In two modules, the evaluation results demonstrated a need for change. In 2006, an external evaluation conducted by international experts positively highlighted the MME
... 391 Motor carriers, Reporting and recordkeeping requirements, Safety. 0 In consideration of the...--COMMERCIAL DRIVER'S LICENSE STANDARDS; REQUIREMENTS AND PENALTIES 0 1. The authority citation for part 383... Pub. L. 109- 59, 119 Stat. 1144, 1726; and 49 CFR 1.73. 0 2. In Sec. 383.71, revise paragraph (a)...
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Mirzazadeh, Azim; Gandomkar, Roghayeh; Hejri, Sara Mortaz; Hassanzadeh, Gholamreza; Koochak, Hamid Emadi; Golestani, Abolfazl; Jafarian, Ali; Jalili, Mohammad; Nayeri, Fatemeh; Saleh, Narges; Shahi, Farhad; Razavi, Seyed Hasan Emami
The purpose of this study was to utilize the Context, Input, Process and Product (CIPP) evaluation model as a comprehensive framework to guide initiating, planning, implementing and evaluating a revised undergraduate medical education programme. The eight-year longitudinal evaluation study consisted of four phases compatible with the four components of the CIPP model. In the first phase, we explored the strengths and weaknesses of the traditional programme as well as contextual needs, assets, and resources. For the second phase, we proposed a model for the programme considering contextual features. During the process phase, we provided formative information for revisions and adjustments. Finally, in the fourth phase, we evaluated the outcomes of the new undergraduate medical education programme in the basic sciences phase. Information was collected from different sources such as medical students, faculty members, administrators, and graduates, using various qualitative and quantitative methods including focus groups, questionnaires, and performance measures. The CIPP model has the potential to guide policy makers to systematically collect evaluation data and to manage stakeholders' reactions at each stage of the reform in order to make informed decisions. However, the model may result in evaluation burden and fail to address some unplanned evaluation questions.
Becker, Michael; Finze, Susanne; Holtherm, Christoph; Hinder, Jens; Lison, Andreas
Occupational health promotion is an effective tool to improve the state of health of employees. As part of occupational health promotion in the German Bundeswehr, top-ranking military executives are offered a medical examination and training programme. Health-related data is collected as a basis for training and lifestyle counselling. This data was subjected to a retrospective evaluation in order to identify occupational risk factors and their correlation with cardiovascular resilience, trunk strength, and the development of orthopaedic and internal disorders. A total of 122 military executives (all male, age 54.6 ± 4.2 years) answered a questionnaire aimed at evaluating private and occupational stress factors. The medical history was followed by a medical and orthopaedic examination involving a lactate performance test (treadmill or bicycle ergometry) and an isometric trunk strength measurement. The data obtained was then statistically evaluated. For military executives, work-related travelling and commuting involve a high risk of medical and orthopaedic conditions. Regular exercise leads to improved fitness levels. In order to prevent medical problems, military executives working long hours should regularly take part in fitness and weight training under professional instructions. PMID:27774505
Asgary, Ramin; Smith, Clyde L
A significant number of asylum seekers who largely survived torture live in the United States. Asylum seekers have complex social and medical problems with significant barriers to health care access. When evaluating and providing care for survivors, health providers face important challenges regarding medical ethics and professional codes. We review ethical concerns in regard to accountability, the patient-physician relationship, and moral responsibilities to offer health care irrespective of patient legal status; competing professional responsibility toward society and the judiciary system; concerns about the consistency of asylum seekers' claims; ethical concerns surrounding involving trainees and researching within the evaluation setting; and the implication of broader societal views towards rights and social justice. We discuss contributing factors, including inadequate and insufficient provider training, varying and inadequate institutional commitment, asylum seekers' significant medical and social problems, and the broader health and social system issues. We review existing resources to address these concerns and offer suggestions.
This paper describes the experiences of staff and students at two UK medical schools, who introduced portable ultrasound (PU) as an imaging technology to deliver clinical anatomy teaching and to aid skill development in interpretation of cross-sectional anatomy (CSA). A sonographer contributed to curriculum design and teaching, but mostly anatomy tutors delivered the teaching. This case study method evaluates staff and student perspectives on the ultrasound-based anatomy teaching. Quantitative data and qualitative data were collected and analysed. Staff were positive about the experience. They described their expectations for students and solutions for practical issues regarding the teaching, but were concerned about their competency in scanning and wanted bespoke training for sonoanatomy teaching. Curriculum development was accelerated through engagement with a sonographer and an ultrasound champion. Students were extremely positive about their experience; they valued the expertise of a sonographer who taught more challenging sonoanatomy, but were equally positive regarding teaching sessions led by well-trained anatomy tutors who taught more simple sonoanatomy. Students affirmed most tutors' expectations that ultrasound could reinforce existing anatomical knowledge, added clinical contextualisation, but not that use of ultrasound (US) assisted in interpreting CSA. Students valued the introduction to the technology and found sonoimage interpretation challenging, but not insurmountable. Students wanted more instruction on ultrasound physics, an expansion of ultrasound curriculum, with smaller groups and opportunities to scan volunteers. These data support the case for the use of PU to deliver anatomy teaching and to prime medical students for later clinical encounters with PU.
Baker, Michael S
Throughout the recorded history of civilization, there has been armed conflict. Warfare has been associated with advances in care for the wounded. Many of these advances when shown effective on the battlefield become incorporated into civilian health care. It is a laboratory where there is unfortunately much clinical material and presents opportunity for the creative, curious, and innovative. This article reviews the medical advances that resulted from the Korean War. There were notable advances in neurosurgery, vascular surgery, and plastic surgery. Tools from prior wars were rediscovered, dusted off, and used to stop combat losses from psychiatric trauma. A treatment was developed for cleft lip by a plastic surgeon, thus giving hope to young lives. War is a disruptive, destructive, and harrowing experience--but can lead to improvements in care for the wounded and these developments can improve the lives of people everywhere.
The practice of evidence-based medicine calls for the creation of "best practice" guidelines, leading to improved clinical outcomes. One of the primary factors limiting evidence-based medicine in radiology today is the relative paucity of standardized databases. The creation of standardized medical imaging databases offer the potential to enhance radiologist workflow and diagnostic accuracy through objective data-driven analytics, which can be categorized in accordance with specific variables relating to the individual examination, patient, provider, and technology being used. In addition to this "global" database analysis, "individual" radiologist workflow can be analyzed through the integration of electronic auditing tools into the PACS. The combination of these individual and global analyses can ultimately identify best practice patterns, which can be adapted to the individual attributes of end users and ultimately used in the creation of automated evidence-based medicine workflow templates.
With continuing efforts to reduce medical reimbursements, many radiology service providers have reacted by increasing productivity to maintain revenue. This continuing push to increase speed carries the risk for diminished quality in the form of diagnostic accuracy. Data mining offers the potential to synergistically improve both productivity and quality, through the combined analysis of examination complexity, interpretation accuracy, and interpretation times specific to each individual radiologist. The resulting technology can in turn be used to create external pacers, which can be customized to the individual needs and preferences of each radiologist. The derived data can also be used to identify best-practice patterns and end-user performance, which can in turn be used by radiologists for individualized education and training.
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.
The current professional reimbursement model within medicine was created more than 20 years ago in response to physician dissatisfaction and health care inflationary pressures. Despite many resulting improvements, several deficiencies currently exist within the current reimbursement model, related to transparency, accountability, and quality. As the tenets of evidence-based medicine and pay for performance become ingrained within health care delivery, it would be beneficial to modify the existing reimbursement model to reflect these principles. The opportunity to accomplish this goal is advanced through the continued evolution of information systems technologies and data mining. The author discusses the existing deficiencies in medical reimbursement and makes a number of recommendations for improvement. The ultimate goal is to incorporate objective and standardized data into a transparent and readily accessible database, which can be used to enhance performance, education, and informed decision making.
Reggia, James A.
A number of methods for critically evaluating the performance of medical expert systems in practice are surveyed. To illustrate the concepts involved, clinical evaluation of the performance of a computer-based decision aid for patients having transient ischemic attacks is discussed in some detail. Two factors are identified as crucial in the rapid development and testing of this system: the availability of a domain-independent expert system generator, and the existence of a database of relevant patient records.
Heman-Ackah, Selena E; Roland, J Thomas; Haynes, David S; Waltzman, Susan B
Since the first cochlear implant approved by the US Food and Drug Administration in the early 1980s, great advances have occurred in cochlear implant technology. With these advances, patient selection, preoperative evaluation, and rehabilitation consideration continue to evolve. This article describes the current practice in pediatric candidacy evaluation, reviews the medical and surgical considerations in pediatric cochlear implantation, and explores the expanding criteria for cochlear implantation within the pediatric population.
Stevens, Ronald H.; And Others
A study to determine the feasibility of creating and administering computer-based problem-solving examinations for evaluating second-year medical students in immunology and to determine how students would perform on these tests relative to their performances on concurrently administered objective and essay examinations is described. (Author/MLW)
Muntinga, M. E.; Krajenbrink, V. Q.; Peerdeman, S. M.; Croiset, G.; Verdonk, P.
Recent years have seen a rise in the efforts to implement diversity topics into medical education, using either a "narrow" or a "broad" definition of culture. These developments urge that outcomes of such efforts are systematically evaluated by mapping the curriculum for diversity-responsive content. This study was aimed at…
Aguirre-Gas, Héctor Gerardo
Evaluation of the quality of medical care began in Mexico in 1956. This was done by reviewing the clinical files of patients. In 1984, Donabedian introduced the Theory of Systems that evaluates structure, process and results, adopted as a base in the IMSS to develop the System of Integral Evaluation and Continuous Improvement of the Quality of the Medical Care, through the identification and solution of the problems that affect quality in medical care as well as the improvements of the inefficient processes or those with low quality. The Joint Commission on Accreditation of Health Care, European Foundation for Quality Management (ETQM) and International Society for Quality in Health Care (ISQua) use a similar methodology in its evaluations. The ISO System (International Organization for Standardization) was created in 1947 to assure and to certify the quality of the production processes and to guarantee the quality of the products that were fabricated. In health institutions the ISO system is useful to certify the structure and organization, and it indicates that they are under conditions to assure the quality of medical care, but it does not guarantee that this must happen. On the other hand, faults in structure and organization may result in poor quality of care. We conclude that both systems are complementary, rather than exclusionary.
Hwang, Jeeseong; Ramella-Roman, Jessica C; Nordstrom, Robert
The editors introduce the Biomedical Optics Express feature issue on "Phantoms for the Performance Evaluation and Validation of Optical Medical Imaging Devices." This topic was the focus of a technical workshop that was held on November 7-8, 2011, in Washington, D.C. The feature issue includes 13 contributions from workshop attendees.
Royal, Kenneth D.; Gonzalez, Liara M.
The purpose of this study was to evaluate the psychometric properties of a newly developed instrument intended to measure faculty competence as it pertains to their role as advisors, particularly in medical and professional programs. A total of 166 students completed the Faculty Advisor's Skills and Behaviors Inventory (FASBI). The psychometric…
Besdine, Richard W.; Shield, Renee R.; McNicoll, Lynn; Campbell, Susan E.; Wetle, Terrie
Brown Medical School developed a comprehensive curriculum in which enriched aging content increased from 22 to 80 hours in preclerkship courses and was also added for clerkships, residencies, and nongeriatrician physicians. Innovative evaluation strategies are also described. Highlights include "treasure hunts" in the anatomy laboratory, a…
Hardy, M C; Yeoh, J W; Crawford, S
Recent federal regulations have minimized the role of the hospital library in contributing to the quality of medical care and in lowering hospital costs. We trace the events that have led to these assumptions and discuss the complex problem of evaluating the impact of library services. Current research on the value and effectiveness of information is outlined. PMID:3978294
Clinical problem solving exercises for preclinical medical education that were developed at Michigan State University School of Osteopathic Medicine are described. Two types of outcomes were set as priorities in the design and implementation of the problem solving sessions: small group peer interactions as instructional and evaluative resources;…
Decker, Jesse; Ronay, Ashley; Telfer, Megan; Becker, Craig M.; Cremeens, Jennifer; Swinker, Marian
A medical school at a Southeastern university implemented a tobacco free policy to promote a healthy environment for its employees, patients, and visitors. Eighteen months post policy implementation, undergraduate students in the Department of Health Education and Promotion evaluated the satisfaction, awareness, and perceived…
This monograph describes the basic physical/neurological examination of children with special needs and how such an exam fits into the multidisciplinary evaluation and development of individualized programming for such children. The first section addresses the importance of the medical history. Next, the basic exam is described, followed by…
Bray, James H.; Kowalchuk, Alicia; Waters, Vicki; Laufman, Larry; Shilling, Elizabeth H.
The Baylor College of Medicine SBIRT Medical Residency Training Program is a multilevel project that trains residents and faculty in evidenced-based screening, brief intervention, and referral to treatment (SBIRT) methods for alcohol and substance use problems. This paper describes the training program and provides initial evaluation after the…
Azer, Samy A.
The aim of the present study was to critically evaluate the accuracy and readability of English Wikipedia articles on the respiratory system and its disorders and whether they can be a suitable resource for medical students. On April 27, 2014, English Wikipedia was searched for articles on respiratory topics. Using a modified DISCERN instrument,…
The need for effective treatments for pediatric overweight is well known. We evaluated the applicability of an evidence-based treatment in an applied clinic setting that includes children with severe obesity and comorbid medical or psychiatric conditions. Forty-eight overweight children and their fa...
Predictive value of grade point average (GPA), Medical College Admission Test (MCAT), internal examinations (Block) and National Board of Medical Examiners (NBME) scores on Medical Council of Canada qualifying examination part I (MCCQE-1) scores
Roy, Banibrata; Ripstein, Ira; Perry, Kyle; Cohen, Barry
Background To determine whether the pre-medical Grade Point Average (GPA), Medical College Admission Test (MCAT), Internal examinations (Block) and National Board of Medical Examiners (NBME) scores are correlated with and predict the Medical Council of Canada Qualifying Examination Part I (MCCQE-1) scores. Methods Data from 392 admitted students in the graduating classes of 2010–2013 at University of Manitoba (UofM), College of Medicine was considered. Pearson’s correlation to assess the strength of the relationship, multiple linear regression to estimate MCCQE-1 score and stepwise linear regression to investigate the amount of variance were employed. Results Complete data from 367 (94%) students were studied. The MCCQE-1 had a moderate-to-large positive correlation with NBME scores and Block scores but a low correlation with GPA and MCAT scores. The multiple linear regression model gives a good estimate of the MCCQE-1 (R2 =0.604). Stepwise regression analysis demonstrated that 59.2% of the variation in the MCCQE-1 was accounted for by the NBME, but only 1.9% by the Block exams, and negligible variation came from the GPA and the MCAT. Conclusions Amongst all the examinations used at UofM, the NBME is most closely correlated with MCCQE-1. PMID:27103953
Das, Rolee Pathak; Mansukhani, Rupal Patel; Cosler, Leon E.
Objective. To evaluate the impact of counseling in a simulated medication adherence activity. Design. Students were randomized into 2 groups: patient medication monograph only (PMMO) and patient medication monograph with counseling (PMMC). Both groups received a fictitious medication and monograph. Additionally, the PMMC group received brief counseling. A multiple-choice, paper-based survey instrument was used to evaluate simulated food-drug interactions, adherence, and perceptions regarding the activity’s value and impact on understanding adherence challenges. Assessment. Ninety-two students participated (PMMC, n=45; and PMMO, n=47). Overall, a significantly higher incidence of simulated food-drug interactions occurred in the PMMO group (30%) vs the PMMC group (22%) (p=0.02). Doses taken without simulated food-drug interactions were comparable: 46.2% (PMCC) vs 41.9% (PMMO) (p=0.19). The average number of missed doses were 3.2 (PMMC) vs 2.8 (PMMO) (p=0.55). Approximately 70% of the students found the activity to be valuable and 89% believed it helped them better understand adherence challenges. Conclusion. This activity demonstrated the challenges and important role of counseling in medication adherence. PMID:26056407
Jang, Seong-wook; Ko, Junho; Yoo, Yon-sik; Kim, Yoonsang
Recent medical virtual reality (VR) applications to minimize re-operations are being studied for improvements in surgical efficiency and reduction of operation error. The CT image acquisition method considering three-dimensional (3D) modeling for medical VR applications is important, because the realistic model is required for the actual human organ. However, the research for medical VR applications has focused on 3D modeling techniques and utilized 3D models. In addition, research on a CT image acquisition method considering 3D modeling has never been reported. The conventional CT image acquisition method involves scanning a limited area of the lesion for the diagnosis of doctors once or twice. However, the medical VR application is required to acquire the CT image considering patients' various postures and a wider area than the lesion. A wider area than the lesion is required because of the necessary process of comparing bilateral sides for dyskinesia diagnosis of the shoulder, pelvis, and leg. Moreover, patients' various postures are required due to the different effects on the musculoskeletal system. Therefore, in this paper, we perform a comparative experiment on the acquired CT images considering image area (unilateral/bilateral) and patients' postures (neutral/abducted). CT images are acquired from 10 patients for the experiments, and the acquired CT images are evaluated based on the length per pixel and the morphological deviation. Finally, by comparing the experiment results, we evaluate the CT image acquisition method for medical VR applications.
Bailey, Rebecca J; Baingana, Rhona K; Couper, Ian D; Deery, Christopher B; Nestel, Debra; Ross, Heather; Sagay, Atiene Solomon; Talib, Zohray M
Background The Medical Education Partnership Initiative (MEPI) supports medical schools in Africa to increase the capacity and quality of medical education, improve retention of graduates, and promote regionally relevant research. Many MEPI programmes include elements of community-based education (CBE) such as: community placements; clinical rotations in underserved locations, community medicine, or primary health; situational analyses; or student-led research. Methods CapacityPlus and the MEPI Coordinating Center conducted a workshop to share good practices for CBE evaluation, identify approaches that can be used for CBE evaluation in the African context, and strengthen a network of CBE collaborators. Expected outcomes of the workshop included draft evaluation plans for each school and plans for continued collaboration among participants. The workshop focused on approaches and resources for evaluation, guiding exploration of programme evaluation including data collection, sampling, analysis, and reporting. Participants developed logic models capturing inputs, activities, outputs, and expected outcomes of their programmes, and used these models to inform development of evaluation plans. This report describes key insights from the workshop, and highlights plans for CBE evaluation among the MEPI institutions. Results Each school left the workshop with a draft evaluation plan. Participants agreed to maintain communication and identified concrete areas for collaboration moving forward. Since the workshop’s conclusion, nine schools have agreed on next steps for the evaluation process and will begin implementation of their plans. Conclusion This workshop clearly demonstrated the widespread interest in improving CBE evaluation efforts and a need to develop, implement, and disseminate rigorous approaches and tools relevant to the African context. PMID:26523230
Meillier, Andrew; Patel, Shyam
Background Gastroparesis is a chronic condition that can be further enhanced with patient understanding. Patients’ education resources on the Internet have become increasingly important in improving healthcare literacy. We evaluated the readability of online resources for gastroparesis and the influence by medical terminology. Methods Google searches were performed for “gastroparesis”, “gastroparesis patient education material” and “gastroparesis patient information”. Following, all medical terminology was determined if included on Taber’s Medical Dictionary 22nd Edition. The medical terminology was replaced independently with “help” and “helping”. Web resources were analyzed with the Readability Studio Professional Edition (Oleander Solutions, Vandalia, OH) using 10 different readability scales. Results The average of the 26 patient education resources was 12.7 ± 1.8 grade levels. The edited “help” group had 6.6 ± 1.0 and “helping” group had 10.4 ± 2.1 reading levels. In comparing the three groups, the “help” and “helping” groups had significantly lower readability levels (P < 0.001). The “help” group was significantly less than the “helping” group (P < 0.001). Conclusions The web resources for gastroparesis were higher than the recommended reading level by the American Medical Association. Medical terminology was shown to be the cause for this elevated readability level with all, but four resources within the recommended grade levels following word replacement. PMID:28270870
Birney, Arden; Charland, Paola; Cole, Mollie; Aslam Arain, Mubashir
Purpose The goal of this evaluation was to understand how four long-term care (LTC) facilities in Alberta have implemented medication reviews for the Appropriate Use of Antipsychotics (AUA) initiative. We aimed to determine how interprofessional (IP) collaboration was incorporated in the antipsychotic medication reviews and how the reviews had been sustained. Methods Four LTC facilities in Alberta participated in this evaluation. We conducted semistructured interviews with 18 facility staff and observed one antipsychotic medication review at each facility. We analyzed data according to the following key components that we identified as relevant to the antipsychotic medication reviews: the structure of the reviews, IP interactions between the staff members, and strategies for sustaining the reviews. Results The duration of antipsychotic medication reviews ranged from 1 to 1.5 hours. The number of professions in attendance ranged from 3 to 9; a pharmacist led the review at two sites, while a registered nurse led the review at one site and a nurse practitioner at the remaining site. The number of residents discussed during the review ranged from 6 to 20. The process at some facilities was highly IP, demonstrating each of the six IP competencies. Other facilities conducted the review in a less IP manner due to challenges of physician involvement and staff workload, particularly of health care aides. Facilities that had an nurse practitioner on site were more efficient with the process of implementing recommendations resulting from the medication reviews. Conclusion The LTC facilities were successful in implementing the medication review process and the process seemed to be sustainable. A few challenges were observed in the implementation process at two facilities. IP practice moved forward the goals of the AUA initiative to reduce the inappropriate use of antipsychotics. PMID:27785044
Barsten, Kristina; Hurst, Victor, IV; Scheuring, Richard; Baumann, David K.; Johnson-Throop, Kathy
Introduction: Analogue environments assist the NASA Human Research Program (HRP) in developing capabilities to mitigate high risk issues to crew health and performance for space exploration. The Habitat Demonstration Unit (HDU) is an analogue habitat used to assess space-related products for planetary missions. The Exploration Medical Capability (ExMC) element at the NASA Johnson Space Center (JSC) was tasked with developing planetary-relevant medical scenarios to evaluate the concept of operations for mitigating medical issues in such an environment. Methods: Two medical scenarios were conducted within the simulated planetary habitat with the crew executing two space flight-relevant procedures: Eye Examination with a corneal injury and Skin Laceration. Remote guidance for the crew was provided by a flight surgeon (FS) stationed at a console outside of the habitat. Audio and video data were collected to capture the communication between the crew and the FS, as well as the movements of the crew executing the procedures. Questionnaire data regarding procedure content and remote guidance performance also were collected from the crew immediately after the sessions. Results: Preliminary review of the audio, video, and questionnaire data from the two scenarios conducted within the HDU indicate that remote guidance techniques from an FS on console can help crew members within a planetary habitat mitigate planetary-relevant medical issues. The content and format of the procedures were considered concise and intuitive, respectively. Discussion: Overall, the preliminary data from the evaluation suggest that use of remote guidance techniques by a FS can help HDU crew execute space exploration-relevant medical procedures within a habitat relevant to planetary missions, however further evaluations will be needed to implement this strategy into the complete concept of operations for conducting general space medicine within similar environments
Banks, Matthew L; Hutsell, Blake A; Schwienteck, Kathryn L; Negus, S Stevens
Drug addiction is a disease that manifests as an inappropriate allocation of behavior towards the procurement and use of the abused substance and away from other behaviors that produce more adaptive reinforcers (e.g. exercise, work, family and social relationships). The goal of treating drug addiction is not only to decrease drug-maintained behaviors, but also to promote a reallocation of behavior towards alternative, nondrug reinforcers. Experimental procedures that offer concurrent access to both a drug reinforcer and an alternative, nondrug reinforcer provide a research tool for assessment of medication effects on drug choice and behavioral allocation. Choice procedures are currently the standard in human laboratory research on medications development. Preclinical choice procedures have been utilized in biomedical research since the early 1940's, and during the last 10-15 years, their use for evaluation of medications to treat drug addiction has increased. We propose here that parallel use of choice procedures in preclinical and clinical studies will facilitate translational research on development of medications to treat cocaine addiction. In support of this proposition, a review of the literature suggests strong concordance between preclinical effectiveness of candidate medications to modify cocaine choice in nonhuman primates and rodents and clinical effectiveness of these medications to modify either cocaine choice in human laboratory studies or metrics of cocaine abuse in patients with cocaine use disorder. The strongest evidence for medication effectiveness in preclinical choice studies has been obtained with maintenance on the monoamine releaser d-amphetamine, a candidate agonist medication for cocaine use analogous to use of methadone to treat heroin abuse or nicotine formulations to treat tobacco dependence.
Banks, Matthew L; Hutsell, Blake A; Schwienteck, Kathryn L; Negus, S. Stevens
Opinion Statement Drug addiction is a disease that manifests as an inappropriate allocation of behavior towards the procurement and use of the abused substance and away from other behaviors that produce more adaptive reinforcers (e.g. exercise, work, family and social relationships). The goal of treating drug addiction is not only to decrease drug-maintained behaviors, but also to promote a reallocation of behavior towards alternative, nondrug reinforcers. Experimental procedures that offer concurrent access to both a drug reinforcer and an alternative, nondrug reinforcer provide a research tool for assessment of medication effects on drug choice and behavioral allocation. Choice procedures are currently the standard in human laboratory research on medications development. Preclinical choice procedures have been utilized in biomedical research since the early 1940’s, and during the last 10–15 years, their use for evaluation of medications to treat drug addiction has increased. We propose here that parallel use of choice procedures in preclinical and clinical studies will facilitate translational research on development of medications to treat cocaine addiction. In support of this proposition, a review of the literature suggests strong concordance between preclinical effectiveness of candidate medications to modify cocaine choice in nonhuman primates and rodents and clinical effectiveness of these medications to modify either cocaine choice in human laboratory studies or metrics of cocaine abuse in patients with cocaine use disorder. The strongest evidence for medication effectiveness in preclinical choice studies has been obtained with maintenance on the monoamine releaser d-amphetamine, a candidate agonist medication for cocaine use analogous to use of methadone to treat heroin abuse or nicotine formulations to treat tobacco dependence. PMID:26009706
Hochberg, M C; Altman, R D; Brandt, K D; Clark, B M; Dieppe, P A; Griffin, M R; Moskowitz, R W; Schnitzer, T J
Treatment of patients with OA of the hip should be individualized and tailored to the severity of the disease. In individuals with mildly symptomatic disease, treatment may be limited to patient education, physical and occupational therapy, other nonpharmacologic modalities, and drug therapy with a non-opioid oral analgesic. In patients who are unresponsive to this treatment regimen, the use of an NSAID in addition to nonpharmacologic therapy is appropriate unless it is medically contraindicated. Patients with severe symptomatic OA of the hip require an aggressive approach to decreasing pain, increasing mobility, and improving function; such patients may benefit from orthopedic consultation and evaluation for osteotomy or total joint arthroplasty.
Moreira, Ana Sofia Linhares; Afonso, Maria da Graça Alves; Dinis, Mónica Ribeiro dos Santos Alves; dos Santos, Maria Cristina Granja Teixeira
Objective To identify and evaluate the correct positioning of the most commonly used medical devices as visualized in thoracic radiograms of patients in the intensive care unit of our center. Methods A literature search was conducted for the criteria used to evaluate the correct positioning of medical devices on thoracic radiograms. All the thoracic radiograms performed in the intensive care unit of our center over an 18-month period were analyzed. All admissions in which at least one thoracic radiogram was performed in the intensive care unit and in which at least one medical device was identifiable in the thoracic radiogram were included. One radiogram per admission was selected for analysis. The radiograms were evaluated by an independent observer. Results Out of the 2,312 thoracic radiograms analyzed, 568 were included in this study. Several medical devices were identified, including monitoring leads, endotracheal and tracheostomy tubes, central venous catheters, pacemakers and prosthetic cardiac valves. Of the central venous catheters that were identified, 33.6% of the subclavian and 23.8% of the jugular were malpositioned. Of the endotracheal tubes, 19.9% were malpositioned, while all the tracheostomy tubes were correctly positioned. Conclusion Malpositioning of central venous catheters and endotracheal tubes is frequently identified in radiograms of patients in an intensive care unit. This is relevant because malpositioned devices may be related to adverse events. In future studies, an association between malpositioning and adverse events should be investigated. PMID:27737432
Meyer, Katie A; Decker, Kathy; Mervis, Cynthia A; Louder, Danielle; Bradshaw, Jay; DeVader, Shannon; Wigand, Debra
Rapid access to medical treatment is a key determinant of outcomes for cardiovascular events. Emergency medical services (EMS) play an important role in delivering early treatment for acute cardiovascular events. Attention has increased on the potential for EMS data to contribute to our understanding of prehospital treatment. Maine recently began to explore the possible role of EMS data in cardiovascular disease surveillance and cardiovascular health program planning and evaluation. We describe the Maine EMS data system, discuss findings on ease of data use and data quality, provide a sample of findings, and share how we plan to use EMS data for program planning and evaluation of community-level interventions and to partner with EMS provider organizations to improve treatment. Our objective is to increase understanding of the promise and limitations of using EMS data for cardiovascular disease surveillance and program planning and evaluation.
Davitian, C; Ducarme, G; Grossetti, A; Desfeux, P; Yver, C; Pejoan, H; Andre, M-C; Levardon, M; Bougeois, B; Luton, D
Continuous medical evaluation (CME) is compulsory which aims to ameliorate and guarantee quality of care. This paper describes the experience of our unit during the different stages of evaluation that permit us to obtain our accreditation. Our evaluation dealt with the "amelioration of women's and newborn's care after scheduled caesarean section". A first retrospective study of files of scheduled caesareans allowed to update possible points of improvement, after application of adapted corrective actions, both at the medical and paramedical level. The second study, made after application of these actions, allowed to appreciate the results of our initiative of CME, to update new possible points of improvement, but also to notice certain limits in the achievement of the objectives.
Polk, James D; Merlino, James I; Kovach, Betty L; Mancuso, Charlene; Fallon, William F
The air medical team has limited options when evaluating the obstetrical patient and assessing fetal health during air transport to a high-risk obstetrical unit. Traditionally, physical examination and a Doppler stethoscope have been used to determine fetal heart rates and movement. However, with the advent of portable ultrasound technology, new information about the mother and child are available to the air medical crew. The Fetal Evaluation for Transport with Ultrasound (FETUS) is a screening examination that consists of an evaluation of the fetal heart rate, position, and movement and general condition of the placenta. The examination can be repeated in flight with no acoustic distortion from rotor noise. The additional information can be advantageous when transport decisions need to be made or when conditions do not allow Doppler stethoscope use.
McCarthy, F M; Malamed, S F
The physical evaluation system allows the practitioner to rapidly classify each patient according to medical risk and thus to provide dental treatment comfortably and safely. The evaluation system serves as a guide to the level of dental therapy, deisions of management, and modification of treatment for the medically compromised patient. Extensive use of the ADA physical status classification system in dentistry would allow meaningful studies of morbidity and mortality that are related to various management protocols and could conceivably have an impact on insurance schedules associated with psychosedation modalities and general anethesia on an out patient basis. A physical evaluation system cannot substitute for knowledge and good judgment. Recommended categories of physical status and modification of treatment should not be considered as absolutes, but as guides. Wheras the guidelines may appear to be inflexible, they should not be considered as such. Deviation from recommendations is often justified and is expected.
Matsumoto, Takehiro; Honda, Masayuki
The Community Medical ICT Network service at the Nagasaki, Japan was established in 2009. Medical information network for sharing patients data was investigated focused on the access log data from April of 2009 and October of 2010. The total number of the access to the medical information was 30,914 of 2,213 patients. And the total number of access of the image including diagnostic imaging report, medical examination, treatment and medical documents was 10,278(33.2%), 8,949(28.9%), 6,896(22.3%) and 4,791(15.5%) respectively. These results showed that these medical information had enough valued for sharing in the regional medicine. In conclusion, many types of medical information should be required for sharing in the community medical ICT network in Japan.
Chien, Wai Tong; Yip, Annie LK
During the last three decades, an increasing understanding of the etiology, psychopathology, and clinical manifestations of schizophrenia spectrum disorders, in addition to the introduction of second-generation antipsychotics, has optimized the potential for recovery from the illness. Continued development of various models of psychosocial intervention promotes the goal of schizophrenia treatment from one of symptom control and social adaptation to an optimal restoration of functioning and/or recovery. However, it is still questionable whether these new treatment approaches can address the patients’ needs for treatment and services and contribute to better patient outcomes. This article provides an overview of different treatment approaches currently used in schizophrenia spectrum disorders to address complex health problems and a wide range of abnormalities and impairments resulting from the illness. There are different treatment strategies and targets for patients at different stages of the illness, ranging from prophylactic antipsychotics and cognitive–behavioral therapy in the premorbid stage to various psychosocial interventions in addition to antipsychotics for relapse prevention and rehabilitation in the later stages of the illness. The use of antipsychotics alone as the main treatment modality may be limited not only in being unable to tackle the frequently occurring negative symptoms and cognitive impairments but also in producing a wide variety of adverse effects to the body or organ functioning. Because of varied pharmacokinetics and treatment responsiveness across agents, the medication regimen should be determined on an individual basis to ensure an optimal effect in its long-term use. This review also highlights that the recent practice guidelines and standards have recommended that a combination of treatment modalities be adopted to meet the complex health needs of people with schizophrenia spectrum disorders. In view of the heterogeneity of the
Marshburn, Thomas; Whitmore, Mihriban; Ortiz, Rosie; Segal, Michele; Smart, Kieran; Hughes, Catherine
Emergency medical capabilities aboard the ISS include a Crew Medical Officer (CMO) (not necessarily a physician), and back-up, resuscitation equipment, and a medical checklist. It is essential that CMOs have reliable, usable and informative medical protocols that can be carried out independently in flight. The study evaluates the existing ISS Medical Checklist layout against a checklist updated to reflect a human factors approach to structure and organization. Method: The ISS Medical checklist was divided into non-emergency and emergency sections, and re-organized based on alphabetical and a body systems approach. A desk-top evaluation examined the ability of subjects to navigate to specific medical problems identified as representative of likely non-emergency events. A second evaluation aims to focus on the emergency section of the Medical Checklist, based on the preliminary findings of the first. The final evaluation will use Astronaut CMOs as subjects comparing the original checklist against the updated layout in the task of caring for a "downed crewmember" using a Human Patient Simulator [Medical Education Technologies, Inc.]. Results: Initial results have demonstrated a clear improvement of the re-organized sections to determine the solution to the medical problems. There was no distinct advantage for either alternative, although subjects stated having a preference for the body systems approach. In the second evaluation, subjects will be asked to identify emergency medical conditions, with measures including correct diagnosis, time to completion and solution strategy. The third evaluation will compare the original and fully updated checklists in clinical situations. Conclusions: Initial findings indicate that the ISS Medical Checklist will benefit from a reorganization. The present structure of the checklist has evolved over recent years without systematic testing of crewmember ability to diagnose medical problems. The improvements are expected to enable ISS
Paneni, Francesco; Beckman, Joshua A; Creager, Mark A; Cosentino, Francesco
Hyperglycemia and insulin resistance are key players in the development of atherosclerosis and its complications. A large body of evidence suggest that metabolic abnormalities cause overproduction of reactive oxygen species (ROS). In turn, ROS, via endothelial dysfunction and inflammation, play a major role in precipitating diabetic vascular disease. A better understanding of ROS-generating pathways may provide the basis to develop novel therapeutic strategies against vascular complications in this setting. Part I of this review will focus on the most current advances in the pathophysiological mechanisms of vascular disease: (i) emerging role of endothelium in obesity-induced insulin resistance; (ii) hyperglycemia-dependent microRNAs deregulation and impairment of vascular repair capacities; (iii) alterations of coagulation, platelet reactivity, and microparticle release; (iv) epigenetic-driven transcription of ROS-generating and proinflammatory genes. Taken together these novel insights point to the development of mechanism-based therapeutic strategies as a promising option to prevent cardiovascular complications in diabetes.
An effective intervention to decrease medication errors related to high-risk, high-alert medications is to implement double checks and second verification using the five rights of medication administration. To evaluate the effectiveness and use of the Personalized Bar-Code Identification card in verifying high-risk, high-alert medications, the High-Risk, High-Alert Medication Verification Audit Tool was used to collect data from the medical records of patients who received high-risk, high-alert medications in four ICUs. Data were collected for administered high-risk, high-alert medication, primary registered nurses who administered the high-risk, high-alert medication, and secondary registered nurses who verified the medication. The percentage of medications that were "not verified," "Personalized Bar-Code Identification verified," and "verified" using a method other than the Personalized Bar-Code Identification was calculated and compared using Z tests for two proportions. The percentage of Personalized Bar-Code Identification-verified medications (83.5%) was significantly higher than the percentage of medications that were not verified (10.9%) (Z = 38.43, P < .05). Also, the difference between the proportion of the Personalized Bar-Code Identification-verified medications and those that were verified using another method (5.6%) was significant (Z = 41.42, P < .05). The results show that nurses generally tend to follow the standardized procedure for verifying high-risk, high-alert medications in the four ICUs.
... 32 National Defense 3 2014-07-01 2014-07-01 false Management Control Evaluation Checklist G Appendix G to Part 505 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY AID OF CIVIL AUTHORITIES AND PUBLIC RELATIONS ARMY PRIVACY ACT PROGRAM Pt. 505, App. G Appendix G to Part...
... 32 National Defense 3 2011-07-01 2009-07-01 true Management Control Evaluation Checklist G Appendix G to Part 505 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY AID OF CIVIL AUTHORITIES AND PUBLIC RELATIONS ARMY PRIVACY ACT PROGRAM Pt. 505, App. G Appendix G to Part...
... 32 National Defense 3 2013-07-01 2013-07-01 false Management Control Evaluation Checklist G Appendix G to Part 505 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY AID OF CIVIL AUTHORITIES AND PUBLIC RELATIONS ARMY PRIVACY ACT PROGRAM Pt. 505, App. G Appendix G to Part...
Dubick, Michael A.
Part 1 of this evaluation of dietary supplements and health aids (SE 533 788) focused on various therapeutic claims made for vitamins and minerals. This part examines health-promoting claims made for selected macronutrients and fiber. Macronutrients examined include selected proteins, amino acids, enzymes, carbohydrates, and lipids. (JN)
... 49 Transportation 5 2013-10-01 2013-10-01 false Explanation of Safety Audit Evaluation Criteria A Appendix A to Part 385 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL... REGULATIONS SAFETY FITNESS PROCEDURES Pt. 385, App. A Appendix A to Part 385—Explanation of Safety...
... 32 National Defense 3 2010-07-01 2010-07-01 true Management Control Evaluation Checklist G Appendix G to Part 505 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY AID OF CIVIL AUTHORITIES AND PUBLIC RELATIONS ARMY PRIVACY ACT PROGRAM Pt. 505, App. G Appendix G to Part...
Butcher, Robyn; MacKinnon, Martin; Gadd, Kathleen; LeBlanc-Duchin, Denise
The rapid development and updates of mobile medical resource applications (apps) highlight the need for an evaluation tool to assess the content of these resources. The purpose of the study was to develop and test a new evaluation rubric for medical resource apps. The evaluation rubric was designed using existing literature and through a collaborative effort between a hospital and an academic librarian. Testing found scores ranging from 23% to 88% for the apps. The evaluation rubric proved able to distinguish levels of quality within each content component of the apps, demonstrating potential for standardization of medical resource app evaluations.
Reducing postoperative morbidity and mortality is important not only for patients' outcome but for reduction of financial burden on society. Precise and accurate preoperative evaluation of surgical risk factors is crucial to plan appropriate postoperative allocation of medical resources. American Society of Anesthesiologists physical status is a traditional measure to describe preoperative risk of patients undergoing surgery. In the last decade, several scoring systems with better sensitivity and specificity were reported and validated. Charlson Age-comorbidity Index, Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) are frequently used scoring systems. Several lines of evidence indicate that negligence of medical caregivers cause substantial numbers of errors to patients and often leads to severe complications or deaths. Full compliances to surgical checklists and implementation of medical team will help reduce these errors and lead to better patients' postoperative outcomes.
Abramowitz, Joelle; O'Hara, Brett
This article uses the 2013 Current Population Survey Annual Social and Economic Supplement to estimate the financial burden of medical out-of-pocket costs by comparing medical out-of-pocket expenditures to income. This measure is important for evaluating the magnitude of burden, better understanding who bears it, and establishing a baseline to assess the impact of the Patient Protection and Affordable Care Act. We examine the distribution of burden and the incidence of high burden across all families and by individuals' health insurance status and demographic and socioeconomic characteristics. We look more closely at one group vulnerable to having high burden: those younger than age 65 with incomes between 138% and 200% of the federal poverty line. We find that 18.5% of these individuals have incomes below the threshold of expansion Medicaid eligibility after accounting for non-over-the-counter medical expenses and examine the characteristics associated with being classified below this threshold.
Haeri Mazanderani, Ahmad F; du Plessis, Nicolette M; Lumb, Janet; Feucht, Ute D; Myburgh, Marcelle; Mayaphi, Simnikiwe H; Lekalakala, Molebogeng R; Swanepoel, De Wet; Georgakis, Hellen; Avenant, Theunis
The current legislative framework in South Africa (SA) supports adoption as the preferred form of care for children with inadequate or no parental or family support. There are an estimated 3.8 million orphans in SA, with approximately 1.5 - 2 million children considered adoptable. As a means of improving services, newly drafted adoption guidelines from the National Department of Social Development will in future require both non-profit and private sector adoption agencies to obtain a medical report on a child prior to placement. However, no local guidelines specify what an appropriate medical examination entails or how it should be reported. For the purposes of proposing and developing such guidelines, an open forum was convened at the Institute of Pathology, University of Pretoria, in March 2013. These 'Recommendations for the medical evaluation of children prior to adoption in South Africa' emanate from this meeting.
Nelson, E C; McHugo, G; Schnurr, P; Devito, C; Roberts, E; Simmons, J; Zubkoff, W
We conducted a trial to evaluate the impact of medical self-care education on 330 elders whose average age was 71. The test group participated in a 13-session educational intervention with training in clinical medicine, life-style, and use of health services. The comparison group received a two-hour lecture-demonstration. Both groups were assessed pre-intervention, post-intervention, and one year after entry. The results indicate medical self-care instruction: produces substantial improvements, that were sustained for one year, in health knowledge, skills performance, and skills confidence; stimulates many attempts to improve life-style; and generates improvements in life quality. The program had little influence on utilization of medical care or health status. PMID:6507688
Mubki, Thamer; Rudnicka, Lidia; Olszewska, Malgorzata; Shapiro, Jerry
Hair loss (alopecia) is a common problem and is often a major source of distress for patients. The differential diagnosis of alopecia includes both scarring and nonscarring alopecias. In addition, many hair shaft disorders can produce hair shaft fragility, resulting in different patterns of alopecia. Therefore, an organized and systematic approach is needed to accurately address patients' complaints to achieve the correct diagnosis. Part 1 of this 2-part continuing medical education article on alopecia describes history taking and the clinical examination of different hair loss disorders. It also provides an algorithmic diagnostic approach based on the most recent knowledge about different types of alopecia.
Dauletkalieva, J A; Kulov, D B
The article demonstrates necessity of implementing principle of solidary responsibility of citizenfore one's own health with purpose of health promotion and development of health care in country and all over the world. The analysis of national and international literature proved that human health in many ways depends on life style. Nowadays, population places the responsibility for one's own health to state, employers and medical personnel. The article presents main results of anonymous questionnaire survey carried out among 723 workers of municipal polyclinics. The software Statisitka was applied to determine relative frequency of occurrence of characteristic in different groups (percentage) and confidence range. The comparative analysis according the Student criterion was applied among physicians and paramedical personnel. The purpose of survey was to evaluate degree of responsibility of population for one's own health from point of view of medical personnel. It is established that 69.5% of physicians and 79.6% of paramedical personnel consider their patients responsible for implementation of prescribed recommendations. The opposite point of view have 30.5% of physicians and 20.4% of paramedical personnel. According opinion of 42.9% Of physicians and 48.9% of paramedical personnel human age has no impact on degree of one's own health caring. The physicians of polyclinics evaluate responsibility of citizenfor one's own health quite low. So, only 11. 6% of physicians and 28.6% of paramedical personnel of polyclinics provide positive reply to the asked question. The majority of physicians (37.4%) and medical nurses (34.2%) are convinced that to increase responsibility for one's own health the activities infield of health education are to be implemented. The application of the mechanism of co-payments for medical services is supported by 34.6% of physicians and 27.4% of medical nurses. The given question caused difficulties with answer among 20.2% of physicians and
Evaluation of the current status of Rehabilitation, Physical Medicine and Naturopathy education 10 years after the reform of the Medical Licensure Act - a nationwide survey of German Medical Universities.
Stock-Schröer, Beate; Huber, Roman; Joos, Stefanie; Klose, Petra
Introduction: After the reform of the German Medical Licensure Act of 2003, Rehabilitation, Naturopathy and Physical Medicine were integrated into one discipline to be taught in Medical University. The aim of this survey is to determine the outcome of this change by evaluating the current status of education of these three disciplines based on the experience and satisfaction reported by lecturers responsible for teaching these subjects to medical students. Methods: A questionnaire-based survey. A paper version of the questionnaire for each discipline was posted to each Medical University in Germany. The first part asked about the current status of teaching; the second part asked about facilities and requirements; the third part asked respondents to give information on their career and teaching experience in this subject Results: The response rate was 51.5% for Rehabilitation, 48.5% for Physical Medicine and 60.6% for Naturopathy. A vast range of people and faculties were involved in the curricula. The percentage of each discipline taught was unevenly distributed: the major proportion being rehabilitation (38%), then naturopathy 34% lastly physical medicine with less than a third (28%). The main delivery of these disciplines was through lectures in plenary sessions. Modern teaching methods were not in evidence. Lecturers were generally pleased to be working with the combination of the three disciplines. Conclusion: Future medical education should improve upon teaching coordination and aim towards a common curriculum for these three disciplines. Expected future changes to medical curricula will provide opportunities to improve the implementation of Rehabilitation, Physical Medicine and Naturopathy in teaching and research.
Evaluation of the current status of Rehabilitation, Physical Medicine and Naturopathy education 10 years after the reform of the Medical Licensure Act – a nationwide survey of German Medical Universities
Stock-Schröer, Beate; Huber, Roman; Joos, Stefanie; Klose, Petra
Introduction: After the reform of the German Medical Licensure Act of 2003, Rehabilitation, Naturopathy and Physical Medicine were integrated into one discipline to be taught in Medical University. The aim of this survey is to determine the outcome of this change by evaluating the current status of education of these three disciplines based on the experience and satisfaction reported by lecturers responsible for teaching these subjects to medical students. Methods: A questionnaire-based survey. A paper version of the questionnaire for each discipline was posted to each Medical University in Germany. The first part asked about the current status of teaching; the second part asked about facilities and requirements; the third part asked respondents to give information on their career and teaching experience in this subject Results: The response rate was 51.5% for Rehabilitation, 48.5% for Physical Medicine and 60.6% for Naturopathy. A vast range of people and faculties were involved in the curricula. The percentage of each discipline taught was unevenly distributed: the major proportion being rehabilitation (38%), then naturopathy 34% lastly physical medicine with less than a third (28%). The main delivery of these disciplines was through lectures in plenary sessions. Modern teaching methods were not in evidence. Lecturers were generally pleased to be working with the combination of the three disciplines. Conclusion: Future medical education should improve upon teaching coordination and aim towards a common curriculum for these three disciplines. Expected future changes to medical curricula will provide opportunities to improve the implementation of Rehabilitation, Physical Medicine and Naturopathy in teaching and research. PMID:28293670
Background There is a relative lack of current research on the effects of specific communication training offered at the beginning of the medical degree program. The newly developed communication training "Basics and Practice in Communication Skills" was pilot tested in 2008 and expanded in the following year at the University Medical Centre Hamburg-Eppendorf in Germany. The goal was to promote and improve the communicative skills of participants and show the usefulness of an early offered intervention on patient-physician communication within the medical curriculum. Methods The students participating in the project and a comparison group of students from the standard degree program were surveyed at the beginning and end of the courses. The survey consisted of a self-assessment of their skills as well as a standardised expert rating and an evaluation of the modules by means of a questionnaire. Results Students who attended the communication skills course exhibited a considerable increase of communication skills in this newly developed training. It was also observed that students in the intervention group had a greater degree of self-assessed competence following training than the medical students in the comparison group. This finding is also reflected in the results from a standardised objective measure. Conclusions The empirical results of the study showed that the training enabled students to acquire specialised competence in communication through the course of a newly developed training program. These findings will be used to establish new communication training at the University Medical Centre Hamburg-Eppendorf. PMID:22443807
Nam, Kyoung Won; Choi, Seong Wook; Kim, In Young; Kim, Kwang Gi; Jo, Yung Ho; Kim, Dae Hyun
Conventional gas-compensated medication reservoirs used for implantable infusion devices require perfect sealing of the gas chamber, because the gases used are generally toxic. In addition, the physical properties of selected gas critically affect the performance of infusion devices and hydraulic performance of the infusion device can be affected by the amount of medication discharged. In this study, we suggest a new medication reservoir that adopts a cerebrospinal fluid (CSF)-compensating mechanism, such that when a medication is released from the reservoir by a mechanical actuator, native CSF enters into the reservoir to minimize the build-up of pressure drop. We evaluated in vitro performance and conducted in vivo feasibility tests by using an intrathecal infusion device developed at the Korean National Cancer Center. Experimental results showed that the proposed CSF-compensated infusion pump was essentially less affected by ambient temperature or pressure conditions compared to the gas-compensated infusion pump. Moreover, it showed moderate implant feasibility and operating stability during an animal experiment performed for 12 days. We believe that the proposed volume-compensating mechanism could be applied in various medical fields that use implantable devices.
Masseroli, Marco; Pinciroli, Francesco
To provide easy retrieval, integration and evaluation of multimodal cardiology images and data in a web browser environment, distributed application technologies and java programming were used to implement a client-server architecture based on software agents. The server side manages secure connections and queries to heterogeneous remote databases and file systems containing patient personal and clinical data. The client side is a Java applet running in a web browser and providing a friendly medical user interface to perform queries on patient and medical test dat and integrate and visualize properly the various query results. A set of tools based on Java Advanced Imaging API enables to process and analyze the retrieved cardiology images, and quantify their features in different regions of interest. The platform-independence Java technology makes the developed prototype easy to be managed in a centralized form and provided in each site where an intranet or internet connection can be located. Giving the healthcare providers effective tools for querying, visualizing and evaluating comprehensively cardiology medical images and records in all locations where they can need them- i.e. emergency, operating theaters, ward, or even outpatient clinics- the developed prototype represents an important aid in providing more efficient diagnoses and medical treatments.
... 32 National Defense 3 2012-07-01 2009-07-01 true Management Control Evaluation Checklist G Appendix G to Part 505 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY AID OF... for evaluating management controls. Submit comments to the Department of Army, Freedom of...
[Experiences and recommendations of the German Federal Institute for Drugs and Medical Devices (BfArM) concerning clinical investigation of medical devices and the evaluation of serious adverse events (SAE)].
Renisch, B; Lauer, W
An integral part of the conformity assessment process for medical devices is a clinical evaluation based on clinical data. Particularly in the case of implantable devices and products of risk class III clinical trials must be performed. Since March 2010 applications for the authorization of clinical trials as well as for the waiver of the authorization requirement must be submitted centrally in Germany to the appropriate federal authority, the Federal Institute for Drugs and Medical Devices (BfArM) or the Paul Ehrlich Institute (PEI). In addition to authorization, approval by the responsible ethics committee is also required under law in order to begin clinical testing of medical devices in Germany. In this paper, the legal framework for the clinical testing of medical devices as well as those involved and possible procedures including evaluation criteria for the initial application of a trial and subsequent amendments are presented in detail. In addition, the reporting requirements for serious adverse events (SAEs) are explained and possible consequences of the evaluation are presented. Finally, a summary of application and registration numbers for all areas of extensive experience of the BfArM as well as requests and guidance for applicants are presented.
This is the first part of a two-part paper which explores methods that can be used to evaluate digital libraries in the health sector. In this first part, some approaches to evaluation that have been proposed for mainstream digital information services are examined for their suitability to provide models for the health sector. The paper summarizes some major national and collaborative initiatives to develop measures for digital libraries, and analyses these approaches in terms of their relationship to traditional measures of library performance, which are focused on inputs and outputs, and their relevance to current debates among health information specialists. The second part* looks more specifically at evaluative models based on outcomes, and models being developed in the health sector.
Lee, Young Hee; Lee, Young-Mee
In recent years, several high-profile cases related with misconduct by doctors and medical students have led to increased media interest and public concern regarding doctors who fail to maintain the expected professional standards. In response to these concerns and the increasing awareness of the social responsibility of medicine, the importance of professionalism in medical school is receiving renewed attention in our medical society. Many studies in other countries have stressed the early detection and intervention of unprofessional behaviors in medical students using an adequate evaluation system. The authors intended to explore strategies that reinforce professionalism education and prevent misconduct in medical students. We conducted an extensive literature review to identify patterns and categorize issues of misconduct and unprofessional behavior by medical students; existing evidence to determine why early detection and intervention of are crucial to prevent future misbehavior and disciplinary action by doctors; and education and evaluation systems to enhance professionalism for medical students.
... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Listing of Medical-Vocational Guidelines in appendix 2 of subpart P of part 404 of this chapter. 416.969 Section 416.969 Employees' Benefits SOCIAL... appendix 2 of subpart P of part 404 of this chapter. The Dictionary of Occupational Titles...
... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Listing of Medical-Vocational Guidelines in appendix 2 of subpart P of part 404 of this chapter. 416.969 Section 416.969 Employees' Benefits SOCIAL... appendix 2 of subpart P of part 404 of this chapter. The Dictionary of Occupational Titles...
Goodin, J; Hanzlick, R
More than 700 physician medical examiner/coroners (ME/Cs) were surveyed to assess differences in manner of death classifications for typical but often controversial death scenarios: 198 physicians participated by choosing the manner of death (homicide, suicide, accident, natural, undetermined) for 23 such scenarios. Sixteen questions related to death certificate training, work location, and manner of death issues were also asked. The classification of manner of death by ME/Cs was highly variable. For some challenging death scenarios, majority agreement was lacking. Agreement was > or = 80% for only 11 of the 23 scenarios and was 100% for only 1. Manner of death classification method was not influenced by forensic pathology board certification status, by whether or not the physician actually completed death certificates, or by previous threats of lawsuits over manner of death classification. However, there were some differences by state. No textbook or individual was widely recognized as authoritative on manner of death issues. Few ME/Cs had formal death certification training in medical school or residency. The data lend credence to the practice of the National Center for Health Statistics (NCHS) of classifying manner of death for statistical purposes by using coding and classification rules and selection criteria rather than solely on the basis of the classification of manner chosen by ME/Cs. The data also indicate that caution is in order when one compares manner of death statistics of one ME/C with those of another Published guidelines and more uniform training are needed so that ME/Cs may become more consistent in their manner of death classifications. Further information is presented in Part I (history of manner of death classification) and in Part III (individual death scenarios and their analysis) companion articles in this issue of the Journal.
Bashook, P G; Maxwell, J A; Sandlow, L J
A model medical care evaluation (MCE) program, designed to increase the educational value of MCE activities, was implemented in three clinical departments at the Michael Reese Hospital and Medical Center. The program was evaluated by means of quantitative and qualitative observational techniques, questionnaires, and interviews and by comparing committees for which the implementation was highly successful with those for which it was less successful. The results confirmed the educational value of the following features of the model program: (a) a focus on the process of care rather than standards of care, (b) prior review of records and their presentation as case problems, (c) educational emphasis by the committee chairperson, and (d) attendance by at least four physicians. Implications for other types of hospital quality assurance or educational activities are discussed.
Knesper, D J
To learn more about the methodological problems inherent in medical care evaluation studies, a quality assurance committee conducted a study of rates of referral failure for potentially suicidal patients seen in the psychiatry division of a university hospital's emergency room. A simple 5-point scale was used to identify for study a similarly ill patient group: 296 patients with moderately to extremely severe suicide potential. The rates of referral failure for the emergency room's psychiatry division were 24 per cent for referrals within the university hospital system and 33 per cent outside the system, which compared favorably with other facilities. Outlier analysis-a statistical procedure that holds promise for medical care evaluation studies-was used to identify clinicians whose rates of referral failure differed significantly from their peer's rates of. As a result, an instance of substandard performance was identified and corrected through the transfer of information about exceptionally good performance.
Peloso, Paul M; Khan, Mahweesh; Gross, Anita R; Carlesso, Lisa; Santaguida, Lina; Lowcock, Janet; MacDermid, Joy C; Walton, Dave; Goldsmith, Charlie H; Langevin, Pierre; Shi, Qiyun
Objectives: To conduct an overview (review-of-reviews) on pharmacological interventions for neck pain. Search Strategy: Computerized databases and grey literature were searched from 2006 to 2012. Selection Criteria: Systematic reviews of randomized controlled trials (RCT) in adults with acute to chronic neck pain reporting effects of pharmacological interventions including injections on pain, function/disability, global perceived effect, quality of life and patient satisfaction. Data Collection & Analysis: Two independent authors selected articles, assessed risk of bias and extracted data The GRADE tool was used to evaluate the body of evidence and an external panel provided critical review. Main Results: We found 26 reviews reporting on 47 RCTs. Most pharmacological interventions had low to very low quality methodologic evidence with three exceptions. For chronic neck pain, there was evidence of: a small immediate benefit for eperison hydrochloride (moderate GRADE, 1 trial, 157 participants);no short-term pain relieving benefit for botulinum toxin-A compared to saline (strong GRADE; 5 trial meta-analysis, 258 participants) nor for subacute/chronic whiplash (moderate GRADE; 4 trial meta-analysis, 183 participants) including reduced pain, disability or global perceived effect; andno long-term benefit for medial branch block of facet joints with steroids (moderate GRADE; 1 trial, 120 participants) over placebo to reduce pain or disability; Reviewers' Conclusions: While in general there is a lack of evidence for most pharmacological interventions, current evidence is against botulinum toxin-A for chronic neck pain or subacute/chronic whiplash; against medial branch block with steroids for chronic facet joint pain; but in favour of the muscle relaxant eperison hydrochloride for chronic neck pain. PMID:24155805
This is the second part of a two-part paper which explores methods that can be used to evaluate digital libraries in the health sector. Part 1 focuses on approaches to evaluation that have been proposed for mainstream digital information services. This paper investigates evaluative models developed for some innovative digital library projects, and some major national and international electronic health information projects. The value of ethnographic methods to provide qualitative data to explore outcomes, adding to quantitative approaches based on inputs and outputs is discussed. The paper concludes that new 'post-positivist' models of evaluation are needed to cover all the dimensions of the digital library in the health sector, and some ways of doing this are outlined.
administered about 1 week after the training . Thus, the time interval between the pretests and posttests was approximately 7–8 weeks. Pretests and...given that the time interval between the pretests and posttests was 7–8 weeks. However, it is likely that the training made a contribution to the...Naval Health Research Center Evaluation of Highly Realistic Training for Navy Corpsmen: Results for Field Medical Training Battalion−West
225 Development of a Multipurpose Dataset to Evaluate Potential Medication Errors in Ambulatory Settings K. Arnold Chan for the HMO Research...Network CERT Patient Safety Investigators Abstract Ten health maintenance organizations ( HMOs ) of the HMO Research Network Center for Education and...through June 30, 2001, were selected from each of the 10 HMOs . The study population included all of the health plan members in a randomly selected
Australia's fabled Royal Flying Doctor Service recently undertook a soul-searching evaluation of its structure, operations and goals. Although there are no plans to stop providing emergency medical services to the residents of the outback, the service may refocus efforts on health promotion and prevention, since 75% of its work involves nonemergency care. Cost efficiency, the key phrase for health care around the globe, will be another goal. Images p746-a p747-a p748-a PMID:7882237
Background There is a great variety in how emergency medical communication centers (EMCC) are organized in different countries and sometimes, even within countries. Organizational changes in the EMCC have often occurred because of outside world changes, limited resources and the need to control costs, but historically there is often a lack of structured evaluation of these organization changes. The aim of this study was to evaluate if the performance in emergency medical dispatching changed in a smaller community outside Helsinki after the emergency medical call centre organization reform in Finland. Methods A retrospective observational study was conducted in the EMCC in southern Finland. The data from the former system, which had municipality-based centers, covered the years 2002-2005 and was collected from several databases. From the new EMCC, data was collected from January 1 to May 31, 2006. Identified performance indicators were used to evaluate and compare the old and new EMCC organizations. Results A total of 67 610 emergency calls were analyzed. Of these, 54 026 were from the municipality-based centers and 13 584 were from the new EMCC. Compared to the old municipality-based centers the new EMCC dispatched the highest priority to 7.4 percent of the calls compared to 3.6 percent in the old system. The high priority cases not detected by dispatchers increased significantly (p < 0.001) in the new EMCC organization, and the identification rate of unexpected deaths in the dispatched ambulance assignments was not significantly (p = 0.270) lower compared to the old municipality-based center data. Conclusion After implementation of a new EMCC organization in Finland the percentage and number of high priority calls increased. There was a trend, but no statistically significant increase in the emergency medical dispatchers' ability to detect patients with life-threatening conditions despite structured education, regular evaluation and standardization of protocols in
Lauridson, J R; Myers, L
The multidisciplinary evaluation of fatal dog bites in the context of a case is discussed. This approach emphasizes detailed examination of the animals including matching of bite marks, autopsy, and canine behavioral analysis. It further provides details such as contributory medical conditions, past animal behavior and physical evidence linking the dogs to the attack. Such information is important in the legal proceedings that usually accompany these events.
Marshall, Nina L; Spooner, Muirne; Galvin, P Leo; Ti, Joanna P; McElvaney, N Gerald; Lee, Michael J
A preliminary audit of orders for computed tomography was performed to evaluate the typical performance of interns ordering radiologic examinations. According to the audit, the interns showed only minimal improvement after 8 months of work experience. The online radiology ordering module (ROM) program included baseline assessment of student performance (part I), online learning with the ROM (part II), and follow-up assessment of performance with simulated ordering with the ROM (part III). A curriculum blueprint determined the content of the ROM program, with an emphasis on practical issues, including provision of logistic information, clinical details, and safety-related information. Appropriate standards were developed by a committee of experts, and detailed scoring systems were devised for assessment. The ROM program was successful in addressing practical issues in a simulated setting. In the part I assessment, the mean score for noting contraindications for contrast media was 24%; this score increased to 59% in the part III assessment (P = .004). Similarly, notification of methicillin-resistant Staphylococcus aureus status and pregnancy status and provision of referring physician contact information improved significantly. The quality of the clinical notes was stable, with good initial scores. Part III testing showed overall improvement, with the mean score increasing from 61% to 76% (P < .0001). In general, medical students lack the core knowledge that is needed for good-quality ordering of radiology services, and the experience typically afforded to interns does not address this lack of knowledge. The ROM program was a successful intervention that resulted in statistically significant improvements in the quality of radiologic examination orders, particularly with regard to logistic and radiation safety issues.
Anselma, Luca; Bottrighi, Alessio; Montani, Stefania; Terenziani, Paolo
The process of keeping up-to-date the medical knowledge stored in relational databases is of paramount importance. Since quality and reliability of medical knowledge are essential, in many cases physicians' proposals of updates must undergo experts' evaluation before possibly becoming effective. However, until now no theoretical framework has been provided in order to cope with this phenomenon in a principled and non-ad hoc way. Indeed, such a framework is important not only in the medical domain, but in all Wikipedia-like contexts in which evaluation of update proposals is required. In this paper we propose GPVM (General Proposal Vetting Model), a general model to cope with update proposal⧹evaluation in relational databases. GPVM extends the current theory of temporal relational databases and, in particular, BCDM - Bitemporal Conceptual Data Model - "consensus" model, providing a new data model, new operations to propose and accept⧹reject updates, and new algebraic operators to query proposals. The properties of GPVM are also studied. In particular, GPVM is a consistent extension of BCDM and it is reducible to it. These properties ensure consistency with most relational temporal database frameworks, facilitating implementation on top of current frameworks and interoperability with previous approaches.
Muntinga, M E; Krajenbrink, V Q E; Peerdeman, S M; Croiset, G; Verdonk, P
Recent years have seen a rise in the efforts to implement diversity topics into medical education, using either a 'narrow' or a 'broad' definition of culture. These developments urge that outcomes of such efforts are systematically evaluated by mapping the curriculum for diversity-responsive content. This study was aimed at using an intersectionality-based approach to define diversity-related learning objectives and to evaluate how biomedical and sociocultural aspects of diversity were integrated into a medical curriculum in the Netherlands. We took a three-phase mixed methods approach. In phase one and two, we defined essential learning objectives based on qualitative interviews with school stakeholders and diversity literature. In phase three, we screened the written curriculum for diversity content (culture, sex/gender and class) and related the results to learning objectives defined in phase two. We identified learning objectives in three areas of education (medical knowledge and skills, patient-physician communication, and reflexivity). Most diversity content pertained to biomedical knowledge and skills. Limited attention was paid to sociocultural issues as determinants of health and healthcare use. Intersections of culture, sex/gender and class remained mostly unaddressed. The curriculum's diversity-responsiveness could be improved by an operationalization of diversity that goes beyond biomedical traits of assumed homogeneous social groups. Future efforts to take an intersectionality-based approach to curriculum evaluations should include categories of difference other than culture, sex/gender and class as separate, equally important patient identities or groups.
Background The internet is increasingly being used worldwide in imparting medical education and improving its delivery. It has become an important tool for healthcare professionals training but the data on its use by medical students in developing countries is lacking with no study on the subject from Pakistan. This study was, therefore, carried out with an aim to evaluate the pattern of internet access and utilization by medical students in Pakistan. Methods A structured pre-tested questionnaire was administered to a group of 750 medical students in clinical years studying at various public and private medical colleges in Lahore. The questions were related to patterns of internet access, purpose of use and self reported confidence in performing various internet related tasks, use of health related websites to supplement learning and the problems faced by students in using internet at the institution. Results A total of 532 medical students (70.9%) returned the questionnaire. The mean age of study participants was 21.04 years (SD 1.96 years). Majority of the respondents (84.0%) reported experience with internet use. About half of the students (42.1%) were using internet occasionally with 23.1%, 20.9% and 13.9% doing so frequently, regularly and rarely respectively. About two third of the students (61.0%) stated that they use internet for both academic and professional activities. Most of the participants preferred to use internet at home (70.5%). Self reported ability to search for required article from PubMed and PakMedinet was reported by only 34.0% of the entire sample. Students were moderately confident in performing various internet related tasks including downloading medical books from internet, searching internet for classification of diseases and downloading full text article. Health related websites were being accessed by 55.1% students to supplement their learning process. Lack of time, inadequate number of available computers and lack of support from
Boysen-Osborn, Megan; Yanuck, Justin; Mattson, James; Toohey, Shannon; Wray, Alisa; Wiechmann, Warren; Lahham, Shadi; Langdorf, Mark I.
Introduction The Medical Student Performance Evaluation (MSPE) appendices provide a program director with comparative performance for a student’s academic and professional attributes, but they are frequently absent or incomplete. Methods We reviewed MSPEs from applicants to our emergency medicine residency program from 134 of 136 (99%) U.S. allopathic medical schools, over two application cycles (2012–13, 2014–15). We determined the degree of compliance with each of the five recommended MSPE appendices. Results Only three (2%) medical schools were compliant with all five appendices. The medical school information page (MSIP, appendix E) was present most commonly (85%), followed by comparative clerkship performance (appendix B, 82%), overall performance (appendix D, 59%), preclinical performance (appendix A, 57%), and professional attributes (appendix C, 18%). Few schools (7%) provided student-specific, comparative professionalism assessments. Conclusion Medical schools inconsistently provide graphic, comparative data for their students in the MSPE. Although program directors (PD) value evidence of an applicant’s professionalism when selecting residents, medical schools rarely provide such useful, comparative professionalism data in their MSPEs. As PDs seek to evaluate applicants based on academic performance and professionalism, rather than standardized testing alone, medical schools must make MSPEs more consistent, objective, and comparative. PMID:28116008
Goldstein, Matthew J; Lunn, Mitchell R; Peng, Lily
Since the publication of the Flexner Report in 1910, the medical education enterprise has undergone many changes to ensure that medical schools meet a minimum standard for the curricula and clinical training they offer students. Although the efforts of the licensing and accrediting bodies have raised the quality of medical education, the educational processes that produce the physicians who provide the best patient care and conduct the best biomedical research have not been identified. Comparative analyses are powerful tools to understand the differences between institutions, but they are challenging to carry out. As a result, the analysis performed by U.S. News & World Report (USN&WR) has become the default tool to compare U.S. medical schools. Medical educators must explore more rigorous and equitable approaches to analyze and understand the performance of medical schools. In particular, a better understanding and more thorough evaluation of the most successful institutions in producing academic physicians with biomedical research careers are needed. In this Perspective, the authors present a new model to evaluate medical schools' production of academic physicians who advance medicine through basic, clinical, translational, and implementation science research. This model is based on relevant and accessible objective criteria that should replace the subjective criteria used in the current USN&WR rankings system. By fostering a national discussion about the most meaningful criteria that should be measured and reported, the authors hope to increase transparency of assessment standards and ultimately improve educational quality.
Lorv, Bailey; Horodyski, Robin; Welton, Cynthia; Vail, John; Simonetto, Luca; Jokanovic, Danilo; Sharma, Richa; Mahoney, Angela Rea; Savoy-Bird, Shay; Bains, Shalu
There is increasing awareness of the importance of medical device reprocessing (MDR) for the provision of safe patient care. Although industry service standards are available to guide MDR practices, there remains a lack of published key performance indicators (KPIs) and targets that are necessary to evaluate MDR quality for feedback and improvement. This article outlines the development of an initial framework that builds on established guidelines and includes service standards, KPIs and targets for evaluating MDR operations. This framework can support healthcare facilities in strengthening existing practices and enables a platform for collaboration towards better MDR performance management.
Brand, Alison H; Harrison, Amanda; Kumar, Koshila
Given our ageing population and the increase in chronic disease, palliative care will become an increasingly important part of doctors' workloads, with implications for palliative care education. This study used a mixed methods strategy to evaluate second-year medical students' learning outcomes and experiences within a palliative care education program. Analysis of pre- and post-test scores showed a significant improvement in students' attitudinal scores, but no change in knowledge as measured by multiple-choice questions. Analysis of qualitative data revealed that students' learning experience was marked by a lack of clear learning objectives and experiential learning opportunities. Students also reported divergent reactions to death and dying and noted that palliative care was different from other areas of clinical medicine. This study revealed that palliative care teaching results in improved attitudes toward palliative care, reflecting the holistic and patient-focused nature of the palliative care curriculum.
Meyer, Lindsay D; Raymond, Colette B; Rodrigue, Christine M J
Background: To create a checklist of the tasks that a pharmacist must perform during medication order review in the hospital setting and to evaluate the utility of and pharmacists’ satisfaction with the checklist. Methods: An evidence-based checklist for medication order review was developed, with items related to order urgency, verification of patients’ identity, therapeutic review, and actionable items. Pharmacists were educated about the checklist, and it was made available at 2 community hospitals in an urban setting. Pharmacists completed a nonvalidated satisfaction survey and participated in focus groups or interviews within 3 months after implementation of the checklist. Qualitative descriptive theory was used to identify themes within the data. Near-miss occurrence reports for the 3 months before and after implementation of the checklist were quantified. Results: Of 16 pharmacists who were involved in the implementation phase, 14 participated in focus groups or an interview, and 11 responded to the survey. All respondents felt that the primary role of the checklist was for training. They felt that the checklist could be useful when reviewing high-alert or unfamiliar medications or therapy for patients with complex medications. The checklist was most helpful when it was used as a reminder, on an as-needed basis. Nine (82%) of the 11 survey respondents indicated that the checklist standardized the process of medication order review, the same number felt that it prevented accidental omission of critical checks, and 8 (73%) felt that it improved patient safety. Education was necessary to reinforce the purpose of the checklist and its self-check nature. There was no difference in the number of near misses in the pharmacy between the 3-month periods before and after implementation of the checklist. Conclusion: Pharmacists participating in the study felt that a checklist for medication order review had a role in training new pharmacists and standardizing
Hochberg, M C; Altman, R D; Brandt, K D; Clark, B M; Dieppe, P A; Griffin, M R; Moskowitz, R W; Schnitzer, T J
Treatment of patients with OA of the knee should be individualized and tailored to the severity of the symptoms. In individuals with mild symptomatic OA, treatment may be limited to patient education, physical and occupational therapy and other nonpharmacologic modalities, and pharmacologic therapy including non-opioid oral and topical analgesics. In patients who are unresponsive to this treatment regimen, the use of NSAIDs in addition to nonpharmacologic therapy is appropriate unless medically contraindicated. Judicious use of intraarticular steroid injections has a role either as monotherapy or an adjunct to systemic therapy in patients with knee OA who have symptomatic effusions. The role of joint lavage and arthroscopic debridement in patients with OA of the knee who are unresponsive to conservative medical therapy needs further study, and these procedures cannot be routinely recommended for all patients at this time. Patients with severe symptomatic OA of the knee require an aggressive approach to decreasing pain, increasing mobility, and decreasing functional impairment; such patients may benefit from orthopedic consultation and evaluation for osteotomy or total joint arthroplasty.
Corriveau, H; Guarna, F; Dutil, E; Riley, E; Arsenault, A B; Drouin, G
A protocol of evaluation of the hemiplegic patient based on the Bobath approach to treatment is presented. Six parameters are evaluated: sensorium, muscle tone, reflex activity, active movement, postural reactions and pain. The first and last of these are included because of their possible effects on the motor recovery process of the hemiplegic patient. The other four are directly borrowed from the Bobath modality of treatment. For each of these parameters, the procedures are given for its evaluation along with its respective rating scales. These scales are of an ordinal nature ranging from 0 to 3. It is suggested that this new evaluation protocol is fully compatible with the therapeutic modality developed by Bobath and as well is adequate to quantify patient progress in the principle aspects treated by this well used rehabilitation approach.
Freisthler, Bridget; Kepple, Nancy J; Sims, Revel; Martin, Scott E
In 1996, California was the first state to pass a Compassionate Use Act allowing for the legal use of marijuana for medical purposes. Here we review several current policy and land use environmental interventions designed to limit problems related to the influx of medical marijuana dispensaries across California cities. Then we discuss the special challenges, solutions, and techniques used for studying the effects of these place-based policies. Finally, we present some of the advanced spatial analytic techniques that can be used to evaluate the effectiveness of environmental interventions, such as those related to reducing problems associated with the proliferation of medical marijuana dispensaries. Further, using data from a premise survey of all the dispensaries in Sacramento, this study will examine what characteristics and practices of these dispensaries are related to crime within varying distances from the dispensaries (e.g., 100, 250, 500, and 1,000 feet). We find that some security measures, such as security cameras and having a door man outside, implemented by medical marijuana dispensary owners might be effective at reducing crime within the immediate vicinity of the dispensaries.
Kirby, Sheila Nataraj; Marsh, Julie A; Thie, Harry J
In calling for the transformation of military medical education and training, the 2005 Base Realignment and Closure Commission recommended relocating basic and specialty enlisted medical training to a single site to take advantage of economies of scale and the opportunity for joint training. As a result, a joint medical education and training campus (METC) has been established at Fort Sam Houston, Texas. Two of METC's primary long-term goals are to become a high-performing learning organization and to seek accreditation as a community college. Such goals require a clear model of organizational improvement with well-defined metrics for measuring its performance and using research and evaluation to assess and improve that performance. Lessons learned from a review of practices at institutions with similar missions-such as community colleges, corporate universities, the UK's Defence Medical Education and Training Agency, and other federal agencies, such as the Veterans Health Administration-establish a clear need for an office of institutional research to help METC attain its organizational goals. They also provide useful recommendations regarding the METC office's structure, scope, and governance.
Sorg, Heiko; Knobloch, Karsten
Background: First quantitative evaluation of the requirements for the promotion as associate professor (AP) at German Medical Faculties Material and methods: Analysis of the AP-regulations of German Medical Faculties according to a validated scoring system, which has been adapted to this study. Results: The overall scoring for the AP-requirements at 35 German Medical Faculties was 13.5±0.6 of 20 possible scoring points (95% confidence interval 12.2-14.7). More than 88% of the AP-regulations demand sufficient performance in teaching and research with adequate scientific publication. Furthermore, 83% of the faculties expect an expert review of the candidate´s performance. Conference presentations required as an assistant professor as well as the reduction of the minimum time as an assistant professor do only play minor roles. Conclusion: The requirements for assistant professors to get nominated as an associate professor at German Medical Faculties are high with an only small range. In detail, however, it can be seen that there still exists large heterogeneity, which hinders equal opportunities and career possibilities. These data might be used for the ongoing objective discussion. PMID:23255964
Kirby, Sheila Nataraj; Marsh, Julie A.; Thie, Harry J.
Abstract In calling for the transformation of military medical education and training, the 2005 Base Realignment and Closure Commission recommended relocating basic and specialty enlisted medical training to a single site to take advantage of economies of scale and the opportunity for joint training. As a result, a joint medical education and training campus (METC) has been established at Fort Sam Houston, Texas. Two of METC's primary long-term goals are to become a high-performing learning organization and to seek accreditation as a community college. Such goals require a clear model of organizational improvement with well-defined metrics for measuring its performance and using research and evaluation to assess and improve that performance. Lessons learned from a review of practices at institutions with similar missions—such as community colleges, corporate universities, the UK's Defence Medical Education and Training Agency, and other federal agencies, such as the Veterans Health Administration—establish a clear need for an office of institutional research to help METC attain its organizational goals. They also provide useful recommendations regarding the METC office's structure, scope, and governance. PMID:28083182
A conceptual benchmark part for guiding manufacturers and users of rapid prototyping technologies is proposed. This is based on a need to have some tool to evaluate the development of this technology and to assist the user in judiciously selecting a process. The benchmark part is designed to have unique product details and features. The extent to which a rapid prototyping process can reproduce these features becomes a measure of the capability of the process. Since rapid prototyping is a dynamic technology, this benchmark part should be used to continuously monitor process capability of existing and developing technologies. Development of this benchmark part is, therefore, based on an understanding of the properties required from prototypes and characteristics of various rapid prototyping processes and measuring equipment that is used for evaluation.
Komattil, Ramnarayan; Hande, Shyamala Handattu; Mohammed, Ciraj Ali; Subramaniam, Barathi
The study aimed at evaluating the personal and professional development (PPD) module in the undergraduate medical curriculum in Melaka Manipal Medical College, India. PPD hours were incorporated in the curriculum. A team of faculty members and a faculty coordinator identified relevant topics and students were introduced to topics such as medical humanities, leadership skills, communication skills, ethics, professional behavior, and patient narratives. The module was evaluated using a prevalidated course feedback questionnaire which was administered to three consecutive batches of students from March 2011 to March 2013. To analyze faculty perspectives, one to one in-depth interviews and focus group discussions were conducted by the coordinators with faculty members who conducted the PPD classes. Analysis of the course feedback form revealed that majority (80%) of students agreed that the module was well prepared and was "highly relevant" to the profession. Faculty found the topics new and interdisciplinary and there was a sense of sharing responsibility and workload by the faculty. PPD modules are necessary components of the curriculum and help to mould students while they are still acquiescent as they assume their roles as doctors of the future. PMID:26838576
Komattil, Ramnarayan; Hande, Shyamala Handattu; Mohammed, Ciraj Ali; Subramaniam, Barathi
The study aimed at evaluating the personal and professional development (PPD) module in the undergraduate medical curriculum in Melaka Manipal Medical College, India. PPD hours were incorporated in the curriculum. A team of faculty members and a faculty coordinator identified relevant topics and students were introduced to topics such as medical humanities, leadership skills, communication skills, ethics, professional behavior, and patient narratives. The module was evaluated using a prevalidated course feedback questionnaire which was administered to three consecutive batches of students from March 2011 to March 2013. To analyze faculty perspectives, one to one in-depth interviews and focus group discussions were conducted by the coordinators with faculty members who conducted the PPD classes. Analysis of the course feedback form revealed that majority (80%) of students agreed that the module was well prepared and was "highly relevant" to the profession. Faculty found the topics new and interdisciplinary and there was a sense of sharing responsibility and workload by the faculty. PPD modules are necessary components of the curriculum and help to mould students while they are still acquiescent as they assume their roles as doctors of the future.
Bodnari, Andreea; Shen, Shuying; Forbush, Tyler; Pestian, John; South, Brett R
Background The fifth i2b2/VA Workshop on Natural Language Processing Challenges for Clinical Records conducted a systematic review on resolution of noun phrase coreference in medical records. Informatics for Integrating Biology and the Bedside (i2b2) and the Veterans Affair (VA) Consortium for Healthcare Informatics Research (CHIR) partnered to organize the coreference challenge. They provided the research community with two corpora of medical records for the development and evaluation of the coreference resolution systems. These corpora contained various record types (ie, discharge summaries, pathology reports) from multiple institutions. Methods The coreference challenge provided the community with two annotated ground truth corpora and evaluated systems on coreference resolution in two ways: first, it evaluated systems for their ability to identify mentions of concepts and to link together those mentions. Second, it evaluated the ability of the systems to link together ground truth mentions that refer to the same entity. Twenty teams representing 29 organizations and nine countries participated in the coreference challenge. Results The teams' system submissions showed that machine-learning and rule-based approaches worked best when augmented with external knowledge sources and coreference clues extracted from document structure. The systems performed better in coreference resolution when provided with ground truth mentions. Overall, the systems struggled in solving coreference resolution for cases that required domain knowledge. PMID:22366294
Pane, Josep; Coloma, Preciosa M; Verhamme, Katia M C; Sturkenboom, Miriam C J M; Rebollo, Irene
Recent safety issues involving non-active implantable medical devices (NAIMDs) have highlighted the need for better pre-market and post-market evaluation. Some stakeholders have argued that certain features of medicine safety evaluation should also be applied to medical devices. Our objectives were to compare the current processes and methodologies for the assessment of NAIMD safety profiles with those for medicines, identify potential gaps, and make recommendations for the adoption of new methodologies for the ongoing benefit-risk monitoring of these devices throughout their entire life cycle. A literature review served to examine the current tools for the safety evaluation of NAIMDs and those for medicines. We searched MEDLINE using these two categories. We supplemented this search with Google searches using the same key terms used in the MEDLINE search. Using a comparative approach, we summarized the new product design, development cycle (preclinical and clinical phases), and post-market phases for NAIMDs and drugs. We also evaluated and compared the respective processes to integrate and assess safety data during the life cycle of the products, including signal detection, signal management, and subsequent potential regulatory actions. The search identified a gap in NAIMD safety signal generation: no global program exists that collects and analyzes adverse events and product quality issues. Data sources in real-world settings, such as electronic health records, need to be effectively identified and explored as additional sources of safety information, particularly in some areas such as the EU and USA where there are plans to implement the unique device identifier (UDI). The UDI and other initiatives will enable more robust follow-up and assessment of long-term patient outcomes. The safety evaluation system for NAIMDs differs in many ways from those for drugs, but both systems face analogous challenges with respect to monitoring real-world usage. Certain features
Jaén, Carlos Roberto; Crabtree, Benjamin F.; Palmer, Raymond F.; Ferrer, Robert L.; Nutting, Paul A.; Miller, William L.; Stewart, Elizabeth E.; Wood, Robert; Davila, Marivel; Stange, Kurt C.
PURPOSE Understanding the transformation of primary care practices to patient-centered medical homes (PCMHs) requires making sense of the change process, multilevel outcomes, and context. We describe the methods used to evaluate the country’s first national demonstration project of the PCMH concept, with an emphasis on the quantitative measures and lessons for multimethod evaluation approaches. METHODS The National Demonstration Project (NDP) was a group-randomized clinical trial of facilitated and self-directed implementation strategies for the PCMH. An independent evaluation team developed an integrated package of quantitative and qualitative methods to evaluate the process and outcomes of the NDP for practices and patients. Data were collected by an ethnographic analyst and a research nurse who visited each practice, and from multiple data sources including a medical record audit, patient and staff surveys, direct observation, interviews, and text review. Analyses aimed to provide real-time feedback to the NDP implementation team and lessons that would be transferable to the larger practice, policy, education, and research communities. RESULTS Real-time analyses and feedback appeared to be helpful to the facilitators. Medical record audits provided data on process-of-care outcomes. Patient surveys contributed important information about patient-rated primary care attributes and patient-centered outcomes. Clinician and staff surveys provided important practice experience and organizational data. Ethnographic observations supplied insights about the process of practice development. Most practices were not able to provide detailed financial information. CONCLUSIONS A multimethod approach is challenging, but feasible and vital to understanding the process and outcome of a practice development process. Additional longitudinal follow-up of NDP practices and their patients is needed. PMID:20530398
Chen, Guowen; Zhang, Xinran; Fan, Zhencheng; Liao, Hongen
Autostereoscopic has long been proposed to fulfill medical display in image-guided surgery and clinical education to provide more intuitive position information of clinical interest zone thus improving surgery safety and accuracy. As one category of flexible autostereoscopic 3D display, computer generated integral photography (CGIP) has been studied in medical application by many researches for its convenience and cost-efficiency. However, IP still suffers from inaccurate light field reconstruction, which limits its practicality in surgery. In this paper, we propose and apply a flexible fish-eye model based micro lens array (MLA) distortion calibration method and pre-distorted retracing rendering algorithm to render elemental image array (EIA) of CGIP. Furthermore, we also evaluate light field of the proposed algorithm in depth cue, and signal noise ratio of IP images by phantom experiment.
Maxwell, J A; Sandlow, L J; Bashook, P G
A model program designed to increase the educational value of medical care evaluation committee meetings was studied to determine its effect on the knowledge and clinical performance of participating physicians. The members of hospital committees in which the program was successfully implemented showed a statistically significant gain in knowledge of the topics discussed by their committees. In addition, several members made substantial changes in their patient care practices. These changes resulted not so much from the acquisition of new medical information as from a rethinking of patient management strategies, stimulated by peer discussion during committee meetings. A structure that encourages such discussions can be incorporated in other types of patient-care-oriented committee activities as well.
Irfan, Syeda Saba; Ahmed, Zunirah; Farooq, Muhammad Zain; Khan, Bilal Ahmed; Khan, Aamir Hameed
The medium of instruction for medical education in Pakistan is English, which results in several words being lost in translation due to the lack of equivalent words in English. "Ghabrahat" is one such commonly used symptom. We conducted a cross sectional descriptive survey of medical students and doctors from four tertiary care hospitals between November 2013 and April 2014 evaluating the term "Ghabrahat". Total 120 participants were interviewed. Of these, 65.8% had heard of "ghabrahat". Among those aware of this terminology, 60.8% believed they had a good understanding of it. Of the total 95% believed "ghabrahat" still needed further investigation. The participants classified, "Ghabrahat "as benign (18.3%), serious (23.3%) and as an indefinable/vague symptom (48.3%).We concluded that "ghabrahat" is a symptom commonly encountered in clinical practice. It has a wide variety of expressed meanings and should not be used as a term expressing a single entity, system or disease.
Alghothani, Nora; Alghothani, Yousef; Atassi, Bassel
BACKGROUND: The escalating political and humanitarian crisis in Syria has left thousands detained, killed or displaced in neighboring countries. Given the permission and co-operation of the Turkish health authorities, a short-term medical mission to the Syrian refugee camps in the Hatay province was arranged. MATERIALS AND METHODS: To assess this mission's impact and potential expansion to serve other more emergently inflicted areas both inside and outside the Syrian borders, an evaluation was conducted via survey questionnaire of participating physicians. RESULTS: While almost all respondents found the experience worthwhile and fulfilling, medical, social and educational challenges as well as possible solutions were outlined. CONCLUSION: The use of several specified principles to further guide efforts towards providing service, education, relief, and awareness would result in greater effect, sustainability and growth of the mission. PMID:23826554
Eisen, Seth A; Karlinsky, Joel; Jackson, Leila W; Blanchard, Melvin; Kang, Han K; Murphy, Frances M; Alpern, Renee; Reda, Domenic J; Toomey, Rosemary; Battistone, Michael J; Parks, Becky J; Klimas, Nancy; Pak, Hon S; Hunter, Joyce; Lyons, Michael J; Henderson, William G
Ten years after the 1991 Persian Gulf War (GW I), a comprehensive evaluation of a national cohort of deployed veterans (DV) demonstrated a higher prevalence of several medical conditions, in comparison to a similarly identified cohort of nondeployed veterans (NDV). The present study determined the prevalence of medical conditions among nonveteran spouses of these GW I DV and NDV. A cohort of 490 spouses of GW I DV and 537 spouses of GW I NDV underwent comprehensive face-to-face examinations. No significant differences in health were detected except that spouses of DV were less likely to have one or more of a group of six common skin conditions. We conclude that, 10 years after GW I, the general physical health of spouses of GW I DV is similar to that of spouses of NDV.
Wise, Christopher G; Bahl, Vinita; Mitchell, Rita; West, Brady T; Carli, Thomas
Reports by the Institute of Medicine and the Health Care Financing Administration have emphasized that the integration of medical care delivery, evidence-based medicine, and chronic care disease management may play a significant role in improving the quality of care and reducing medical care costs. The specific aim of this project is to assess the impact of an integrated set of care coordination tools and chronic disease management interventions on utilization, cost, and quality of care for a population of beneficiaries who have complementary health coverage through a plan designed to apply proactive medical and disease management processes. The utilization of health care services by the study population was compared to another population from the same geographic service area and covered by a traditional fee-for-service indemnity insurance plan that provided few medical or disease management services. Evaluation of the difference in utilization was based on the difference in the cost per-member-per-month (PMPM) in a 1-year measurement period, after adjusting for differences in fee schedules, case-mix and healthcare benefit design. After adjustments for both case-mix and benefit differences, the study group is $63 PMPM less costly than the comparison population for all members. Cost differences are largest in the 55-64 and 65 and above age groups. The study group is $115 PMPM lower than the comparison population for the age category of 65 years and older, after adjustments for case-mix and benefits. Health Plan Employer and Data Information Set (HEDIS)-based quality outcomes are near the 90th percentile for most indications. The cost outcomes of a population served by proactive, population-based disease management and complex care management, compared to an unmanaged population, demonstrates the potential of coordinated medical and disease management programs. Further studies utilizing appropriate methodologies would be beneficial.
Gilard, Martine; Debroucker, Frederique; Dubray, Claude; Allioux, Yves; Aper, Eliane; Barat-Leonhardt, Valérie; Brami, Michèle; Carbonneil, Cédric; Chartier-Kastler, Emmanuel; Coqueblin, Claire; Fare, Sandrine; Giri, Isabelle; Goehrs, Jean-Marie; Levesque, Karine; Maugendre, Philippe; Parquin, François; Sales, Jean-Patrick; Szwarcensztein, Karine
Medical devices are many and various, ranging from tongue spatulas to implantable or invasive devices and imaging machines; their lifetimes are short, between 18 months and 5 years, due to incessant incremental innovation; and they are operator-dependent: in general, the clinical user performs a fitting procedure (hip implant or pacemaker), a therapeutic procedure using a non-implantable invasive device (arrhythmic site ablation probe, angioplasty balloon, extension spondyloplasty system, etc.) or follow-up of an active implanted device (long-term follow-up of an implanted cardiac defibrillator or of a deep brain stimulator in Parkinson's patients). A round-table held during the XXVIII(th) Giens Workshops meeting focused on the methodology of scientific evaluation of medical devices and the associated procedures with a view to their pricing and financing by the French National Health Insurance system. The working hypothesis was that the available data-set was sufficient for and compatible with scientific evaluation with clinical benefit. Post-registration studies, although contributing to the continuity of assessment, were not dealt with. Moreover, the focus was restricted to devices used in health establishments, where the association between devices and technical medical procedures is optimally representative. An update of the multiple regulatory protocols governing medical devices and procedures is provided. Issues more specifically related to procedures as such, to non-implantable devices and to innovative devices are then dealt with, and the proposals and discussion points raised at the round-table for each of these three areas are presented.
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Santonja-Medina, Fernando; García-Sanz, M Paz; Martínez-Martínez, Francisco; Bó, David; García-Estañ, Joaquín
This article investigates whether a reflexive portfolio is instrumental in determining the level of acquisition of clinical competences in traumatology, a subject in the 5th year of the degree of medicine. A total of 131 students used the portfolio during their clinical rotation of traumatology. The students’ portfolios were blind evaluated by four professors who annotated the existence (yes/no) of 23 learning outcomes. The reliability of the portfolio was moderate, according to the kappa index (0.48), but the evaluation scores between evaluators were very similar. Considering the mean percentage, 59.8% of the students obtained all the competences established and only 13 of the 23 learning outcomes (56.5%) were fulfilled by >50% of the students. Our study suggests that the portfolio may be an important tool to quantitatively analyze the acquisition of traumatology competences of medical students, thus allowing the implementation of methods to improve its teaching. PMID:26929675
Santonja-Medina, Fernando; García-Sanz, M Paz; Martínez-Martínez, Francisco; Bó, David; García-Estañ, Joaquín
This article investigates whether a reflexive portfolio is instrumental in determining the level of acquisition of clinical competences in traumatology, a subject in the 5th year of the degree of medicine. A total of 131 students used the portfolio during their clinical rotation of traumatology. The students' portfolios were blind evaluated by four professors who annotated the existence (yes/no) of 23 learning outcomes. The reliability of the portfolio was moderate, according to the kappa index (0.48), but the evaluation scores between evaluators were very similar. Considering the mean percentage, 59.8% of the students obtained all the competences established and only 13 of the 23 learning outcomes (56.5%) were fulfilled by >50% of the students. Our study suggests that the portfolio may be an important tool to quantitatively analyze the acquisition of traumatology competences of medical students, thus allowing the implementation of methods to improve its teaching.
Beer, André-Michael; Fey, Stefan; Siebolds, Marcus; Kiwitt, Paul
Following structured forms of postgraduate training, which are already in use internationally, there are more and more reports on operationalised procedures of postgraduate training in Germany as well. The transparency, which is required by law in order to make medical postgraduate training demonstrable in terms of Sect. 8 of the new regulation on postgraduate training, creates a demand for evaluations. However, only 10 to 20% of the participants in postgraduate training use these evaluations to demonstrate their results scientifically. The aim of the present paper was to show that--with regard to content--the conceptual integration of operationalised programmes for postgraduate training is able to compensate for the given limited time frames and formally tightened structures of postgraduate training in the sense of the quality assurance required by the legislator. The evaluation showed that this can be made possible through ensuring the participants' satisfaction and achieving the goals of postgraduate training.
Purpose: The promotion of educators is challenged by the lack of accepted standards to evaluate the quality and impact of educational activities. Traditionally, promotion is related to research productivity. This study developed an evaluation tool for educational performance of medical school faculty using educator portfolios (EPs). Methods: Design principles and quantitative items for EPs were developed in a consensus workshop. These principles were tested in a simulation and revised based on feedback. The changes of total educational activities following introduction of the system were analyzed. Results: A total of 71% faculty members answered the simulation of the system and the score distributed widely (mean±standard deviation, 65.43±68.64). The introduction of new system significantly increased the total educational activities, especially in assistant professors. Conclusion: The authors offer comprehensive and practical tool for enhancing educational participation of faculty members. Further research for development of qualitative evaluation systems is needed. PMID:27363501
Krugman, Mary; Sanders, Carolyn; Kinney, Lisa J
Based on the work of a TCAB facility design team at an academic hospital (part 1), an evaluation project was implemented to measure RN work environment perceptions, work activity sampling, and steps walked on 6 units moving into a new acute care pavilion. Pre and post data reported significant nurse satisfaction post move with the new work environment. Workflow sampling data did not reflect significant changes; the pedometer device used to measure nurse steps proved unreliable. Project evaluation data are reported.
Johnson-Troop; Pettys, Marianne; Hurst, Victor, IV; Smaka, Todd; Paul, Bonnie; Rosenquist, Kevin; Gast, Karin; Gillis, David; McCulley, Phyllis
International Space Station (ISS) Mission Operations are managed by multiple flight control disciplines located at the lead Mission Control Center (MCC) at NASA-Johnson Space Center (JSC). ISS Medical Operations are supported by the complementary roles of Flight Surgeons (Surgeon) and Biomedical Engineer (BME) flight controllers. The Surgeon, a board certified physician, oversees all medical concerns of the crew and the BME provides operational and engineering support for Medical Operations Crew Health Care System. ISS Medical Operations is currently addressing the coordinated response to a crew call down for an emergent medical event, in particular when the BME is the only Medical Operations representative in MCC. In this case, the console procedure BME Response to Crew Call Down for an Emergency will be used. The procedure instructs the BME to contact a Surgeon as soon as possible, coordinate with other flight disciplines to establish a Private Medical Conference (PMC) for the crew and Surgeon, gather information from the crew if time permits, and provide Surgeon with pertinent console resources. It is paramount that this procedure is clearly written and easily navigated to assist the BME to respond consistently and efficiently. A total of five BME flight controllers participated in the study. Each BME participant sat in a simulated MCC environment at a console configured with resources specific to the BME MCC console and was presented with two scripted emergency call downs from an ISS crew member. Each participant used the procedure while interacting with analog MCC disciplines to respond to the crew call down. Audio and video recordings of the simulations were analyzed and each BME participant's actions were compared to the procedure. Structured debriefs were conducted at the conclusion of both simulations. The procedure was evaluated for its ability to elicit consistent responses from each BME participant. Trials were examined for deviations in procedure task
Olson, Lenora M.; Keenan, Heather T.
BACKGROUND: Previous research has described variability in medical evaluation of suspected abuse. The objective of this study was to identify, through expert consensus, required and highly recommended elements of a child abuse pediatrics (CAP) evaluation for 3 common presentations of suspected physical abuse in children aged 0 to 60 months. METHODS: Twenty-eight CAPs recruited from 2 national organizations formed the expert panel for this modified Delphi Process. An initial survey was developed for each presentation based on demographics, history of present illness, past medical, family and social history, laboratory, radiology, and consultation elements present in at least 10% of CAP consultations collected for a larger study. CAPs ranked each element on a 9-point scale then reviewed and discussed summary results through a project blog over 3 rounds. Required and highly recommended elements were defined as elements ranked as 9 and 8, respectively, by ≥75% of experts after the final round. RESULTS: From 96 elements in the initial surveys, experts identified 30 Required elements and 37 Highly Recommended elements for CAP evaluation of intracranial hemorrhage, 21 Required and 33 Highly Recommended elements for CAP evaluation of long bone fracture, and 18 Required and 16 Highly Recommended elements for CAP evaluation of isolated skull fracture. CONCLUSIONS: This guideline reflects expert consensus and provides a starting point for development of child abuse assessment protocols for quality improvement or research. Additional research is required to determine whether this guideline can reduce variability and/or improve reliability in the evaluation and diagnosis of child physical abuse. PMID:26101359
Pieper, Ina Laura; Friedmann, Yasmin; Jones, Alyssa; Thornton, Catherine
Small affordable automated hematology analyzers that produce rapid and accurate complete blood cell counts are a valuable tool to researchers developing blood-handling medical devices, such as ventricular assist devices, for in vitro safety assessments. In such studies, it is common to use the blood of large animals such as cattle and sheep. However, the commercially available instruments have not been evaluated for their ability to measure the blood counts of these animals. In this study, we compare, for the first time, four veterinary analyzers for blood counts on bovine and ovine blood samples. We look at ease of use, repeatability and agreement with a view to inform researchers of the benefits of these instruments in routine measurement of ovine and bovine bloods during in vitro testing. Complete blood cell counts and a three-part differential (granulocytes, monocytes, and lymphocytes) were measured by each of the instruments, and the results compared to those obtained from two additional analyzers used in a reference laboratory. Repeatability and agreement were evaluated using the Bland-Altman method; bias and 95% limits of agreement between the instruments, and between the instruments and two reference instruments, were used to evaluate instrument performance. In summary, there are advantages and disadvantages with all instruments. Of the four instruments tested, the repeatability and agreement was fairly similar for all instruments except one instrument which cannot be recommended for bovine or ovine blood counts.
Kavan, Michael G.; Malin, Paula Jo; Wilson, Daniel R.
Objectives: This article explores ethical and practical issues associated with the Liaison Committee on Medical Education (LCME) provision that states health professionals who provide psychiatric/psychological care to medical students must have no involvement in the academic evaluation or promotion of students receiving those services. Method: The…
Kromrei, Heidi T.
The Accreditation Council for Graduate Medical Education has charged institutions that sponsor accredited Graduate Medical Education programs (residency and fellowship specialty programs) with overseeing implementation of mandatory annual program evaluation efforts to ensure compliance with regulatory requirements. Physicians receive scant, if…
Alfici, C.; And Others
The purpose of this research is to build a test for the evaluation of the knowledge needed by medical students before entering clinical courses in medical school. The criterion for this was provided by teachers in both the pre-clinical and clinical subjects. The Pilot instrument consisted of 335 items that covered 8 sections. Each one of these…
Soori, Afshin; Haghani, Elham
Textbooks are the instruments that assist both teachers and learners in process of second language learning. With respect to the importance of textbooks in a language course, evaluation of course books is a significant issue for most researchers. The present study investigated and analyzed Listening Comprehension parts in Top Notch 2A & 2B 2nd…
An Integrated Research Agenda to Evaluate Tap Water Disinfection Byproducts and Human Health: Part I
Michele Lynberg1, David Ashley 2, Pauline Mendola3, J. R. Nuckols4, Kenneth Cantor5, Benjamin Blount 2, Philip Singer6, Charles Wilkes7, Lorraine Backer1, and Peter Langlo...
This study examines the perceptions of superintendents regarding the use of multi-source assessment (MSA) as part of superintendent evaluation. Known users of MSA were asked to participate. MSA users are difficult to find and those using it successfully do not understand why more were not interested in using the process. Each superintendent…
Lin, Chao-Cheng; Li, Yu-Chuan; Bai, Ya-Mei; Chen, Jen-Yeu; Hsu, Chien-Yeh; Wang, Chih-Hung; Chiu, Hung-Wen; Wan, Hsu-Tien
Game-Based e-learning (GBeL) was newly designed platform for education of students with higher education, especially for medical students. The purpose of this study was to preliminarily evaluate the attraction of GBeL, the motivation toward GBeL and the learning effect. We found more than 80% of students thought that GBeL was attractive and more interesting than traditional class. However, the percentage of enhancing interest to learn and learning more complete and deep knowledge were less than 50%.
Jessee, W F; Nickerson, C W; Grant, W S
Nine Professional Standards Review Organizations jointly conducted an areawide medical care evaluation study of Cesarean births. Of 5,002 Cesarean births studied in 158 hospitals, only 1.1 per cent were judged to be unjustified procedures by local physician peer review. Although there was substantial geographic variation in rates of Cesarean birth (11.0%-18.3 per cent), no statistically significant pattern of variation was identified. Maternal outcomes and infant outcomes were generally good. This study demonstrates the potential for use of PSRO data in studying major issues in health care, as well as the practical constraints of such studies.
Goldman, Roberta E.; Parker, Donna R.; Brown, Joanna; Walker, Judith; Eaton, Charles B.; Borkan, Jeffrey M.
PURPOSE There is a strong push in the United States to evaluate whether the patient-centered medical home (PCMH) model produces desired results. The explanatory and contextually based questions of how and why PCMH succeeds in different practice settings are often neglected. We report the development of a comprehensive, mixed qualitative-quantitative evaluation set for researchers, policy makers, and clinician groups. METHODS To develop an evaluation set, the Brown Primary Care Transformation Initiative convened a multidisciplinary group of PCMH experts, reviewed the PCMH literature and evaluation strategies, developed key domains for evaluation, and selected or created methods and measures for inclusion. RESULTS The measures and methods in the evaluation set (survey instruments, PCMH meta-measures, patient outcomes, quality measures, qualitative interviews, participant observation, and process evaluation) are meant to be used together. PCMH evaluation must be sufficiently comprehensive to assess and explain both the context of transformation in different primary care practices and the experiences of diverse stakeholders. In addition to commonly assessed patient outcomes, quality, and cost, it is critical to include PCMH components integral to practice culture transformation: patient and family centeredness, authentic patient activation, mutual trust among practice employees and patients, and transparency, joy, and collaboration in delivering and receiving care in a changing environment. CONCLUSIONS This evaluation set offers a comprehensive methodology to enable understanding of how PCMH transformation occurs in different practice settings. This approach can foster insights about how transformation affects critical outcomes to achieve meaningful, patient-centered, high-quality, and cost-effective sustainable change among diverse primary care practices. PMID:25755039
Koppel, Ross; Leonard, Charles E; Localio, A Russell; Cohen, Abigail; Auten, Ruthann; Strom, Brian L
All methods of identifying medication prescribing errors are fraught with inaccuracies and systematic bias. A systematic, efficient, and inexpensive way of measuring and quantifying prescribing errors would be a useful step for reducing them. We ask if rapid discontinuations of prescription-orders--where physicians stop their orders within 2 hours--would be an expedient proxy for prescribing errors? To study this we analyzed CPOE-system medication orders entered and then discontinued within 2 hours. We investigated these phenomena in real time via interviews with corresponding ordering physicians. Each order was also independently reviewed by a clinical pharmacist or physicians. We found that of 114 rapidly discontinued orders by 75 physicians, two-thirds (35 of 53, PPV = 66; 95% CI = 53-77) of medication orders discontinued within 45 minutes were deemed inappropriate (overdose, underdose, etc.). Overall, 55% (63 of 114; 95% CI = 46-64%) of medication orders discontinued within 2 hours were deemed inappropriate. This measure offers a rapid, constant, inexpensive, and objective method to identify medication orders with a high probability of error. It may also serve as a screening and teaching mechanism for physicians-in-training.
Maier, A B; Wächtler, C; Hofmann, W
Considering the large number of elderly patients in acute hospitals who receive medical as well as psychiatric treatment because of relevant comorbidity, adequate interdisciplinary treatment models have to be developed and applied. The Centre for Elderly, a cooperation project between the departments of geriatric and psychogeriatric medicine in a community hospital in Germany, was founded in 2000. In addition to traditionally structured units, the centre consists of interdisciplinary units. Patient-, staff- and hospital-related characteristics influenced by the reformation of both departments were evaluated by comparing hospital-based registry data records containing age, gender, main and minor diagnoses, length of stay and patient transferrals within the centre. Experts working at the centre were asked to take a stand on the development of the treatment quality, allocation of patients, diagnostic procedures, consultation services and information transmission. The number of admissions to the Centre for the Elderly increased within one year. The distribution of the main diagnose groups remained unchanged, with an overlap between the geriatric and psychogeriatric department consisting of the main diagnoses dementia and depression. The length of stay and the number of transferrals decreased significantly in both departments. The majority of the interviewed employees stated that the treatment quality and the allocation of patients were improved. We conclude that interdisciplinary treatment between the departments of psychiatry and geriatric medicine may contribute to the medical needs of subgroups of elderly inpatients suffering from medical-psychiatric comorbidity.
Mache, Stefanie; Scutaru, Cristian; Vitzthum, Karin; Gerber, Alexander; Quarcoo, David; Welte, Tobias; Bauer, Torsten T; Spallek, Michael; Seidler, Andreas; Nienhaus, Albert; Klapp, Burghard F; Groneberg, David A
Background There are several ways to conduct a job task analysis in medical work environments including pencil-paper observations, interviews and questionnaires. However these methods implicate bias problems such as high inter-individual deviations and risks of misjudgement. Computer-based observation helps to reduce these problems. The aim of this paper is to give an overview of the development process of a computer-based job task analysis instrument for real-time observations to quantify the job tasks performed by physicians working in different medical settings. In addition reliability and validity data of this instrument will be demonstrated. Methods This instrument was developed in consequential steps. First, lists comprising tasks performed by physicians in different care settings were classified. Afterwards content validity of task lists was proved. After establishing the final task categories, computer software was programmed and implemented in a mobile personal computer. At least inter-observer reliability was evaluated. Two trained observers recorded simultaneously tasks of the same physician. Results Content validity of the task lists was confirmed by observations and experienced specialists of each medical area. Development process of the job task analysis instrument was completed successfully. Simultaneous records showed adequate interrater reliability. Conclusion Initial results of this analysis supported the validity and reliability of this developed method for assessing physicians' working routines as well as organizational context factors. Based on results using this method, possible improvements for health professionals' work organisation can be identified. PMID:19094213
Sajn, Luka; Kukar, Matjaž
The paper presents results of our long-term study on using image processing and data mining methods in a medical imaging. Since evaluation of modern medical images is becoming increasingly complex, advanced analytical and decision support tools are involved in integration of partial diagnostic results. Such partial results, frequently obtained from tests with substantial imperfections, are integrated into ultimate diagnostic conclusion about the probability of disease for a given patient. We study various topics such as improving the predictive power of clinical tests by utilizing pre-test and post-test probabilities, texture representation, multi-resolution feature extraction, feature construction and data mining algorithms that significantly outperform medical practice. Our long-term study reveals three significant milestones. The first improvement was achieved by significantly increasing post-test diagnostic probabilities with respect to expert physicians. The second, even more significant improvement utilizes multi-resolution image parametrization. Machine learning methods in conjunction with the feature subset selection on these parameters significantly improve diagnostic performance. However, further feature construction with the principle component analysis on these features elevates results to an even higher accuracy level that represents the third milestone. With the proposed approach clinical results are significantly improved throughout the study. The most significant result of our study is improvement in the diagnostic power of the whole diagnostic process. Our compound approach aids, but does not replace, the physician's judgment and may assist in decisions on cost effectiveness of tests.
Mirsadraee, Raheleh; Gharagozlou, Mohammad; Movahedi, Masoud; Behniafard, Nasrin; Nasiri, Rasoul
Asthma is one of the most common chronic inflammatory disorders in children. Nonadherence to medical therapy is a major cause of poor clinical outcome the objective of this study was evaluating factors, which are resulted in nonadherence to medical therapy in children with asthma.In this descriptive study, 150 children with asthma and nonadherent to medication therapy were enrolled. General information and probable causes of nonadherence were recorded in self-report questionnaire and data were analyzed. In our study, 57.3% of children were male. Approximately 43%of children belonged to age group 6-9 years old. Prevalence of probable causes of nonadherence to treatment were concern about treatment expenses(34.7%) ,fear of cardiac complications(34.7%), concern about drug dependency(38.7%), belief to growth inhibition(30.7%) and fear of osteopenia (32%). There was statistically significant reverse association between treatment with multi-drug regimens and concern about bone mineral abnormalities, cardiac complications and drug dependency (p=0.0001, 0.014 and 0.012 respectively). In addition, there was a significant association between mild asthma and fear about drug dependency (p=0.001).According to our results, factors such as prolonged duration of treatment, various therapeutic regimens, and receiving multiple drugs before diagnosis of asthma pose the highest frequencies for nonadherence.
Fresnel, A; Jarno, P; Burgun, A; Delamarre, D; Denier, P; Cleret, M; Courtin, C; Seka, L P; Pouliquen, B; Cléran, L; Riou, C; Leduff, F; Lesaux, H; Duvauferrier, R; Le Beux, P
A pedagogical network has been developed at University Hospital of Rennes from 1996. The challenge is to give medical information and informatics tools to all medical students in the clinical wards of the University Hospital. At first, nine wards were connected to the medical school server which is linked to the Internet. Client software electronic mail and WWW Netscape on Macintosh computers. Sever software is set up on Unix SUN providing a local homepage with selected pedagogical resources. These documents are stored in a DBMS database ORACLE and queries can be provided by specialty, authors or disease. The students can access a set of interactive teaching programs or electronic textbooks and can explore the Internet through the library information system and search engines. The teachers can send URL and indexation of pedagogical documents and can produce clinical cases: the database updating will be done by the users. This experience of using Web tools generated enthusiasm when we first introduced it to students. The evaluation shows that if the students can use this training early on, they will adapt the resources of the Internet to their own needs.
Ishida, Kai; Fujioka, Tomomi; Endo, Tetsuo; Hosokawa, Ren; Fujisaki, Tetsushi; Yoshino, Ryoji; Hirose, Minoru
Establishment of electromagnetic compatibility is important in use of electronic medical equipment in hospitals. To evaluate the electromagnetic environment, the electric field intensity induced by electromagnetic radiation in broadcasting spectra coming from outside the hospital was measured in a new hospital building before any patients visited the hospital and 6 months after the opening of the hospital. Various incoming radio waves were detected on the upper floors, with no significant difference in measured levels before and after opening of the hospital. There were no cellphone terminal signals before the hospital opened, but these signals were strongly detected at 6 months thereafter. Cellphone base stations signals were strongly detected on the upper floors, but there were no signals at most locations in the basement and in the center of the building on the lower floors. A maximum electrical intensity of 0.28 V/m from cellphone base stations (2.1 GHz) was detected at the south end of the 2nd floor before the hospital opened. This value is lower than the EMC marginal value for general electronic medical equipment specified in IEC 60601-1-2 (3 V/m). Therefore, electromagnetic interference with electronic medical equipment is unlikely in this situation. However, cellphone terminal signals were frequently detected in non-base station signal areas. This is a concern, and understanding signal strength from cellphone base stations at a hospital is important for promotion of greater safety.
Journal of Medical Education, 1981
A proposal by the National Board of Medical Examiners and the Federation of State Medical Boards to require all medical graduates to pass a qualifying examination for participation eligibility in patient care in accredited graduate medical education programs is examined by the Association of American Medical Colleges. (MLW)
The marketing approval (AMM) is based on criteria of pharmaceutical quality, efficacy and safety of use. Before marketing, the data are collected by means of double-blind, randomized, prospective clinical trials that compare the study product to a reference product. A post-AMM assessment is needed to define the increase of the medical benefit (ASMR) and the therapeutic value of the new drugs. The quantification of the ASMR is essential for registration on the list of drugs reimbursable for those who benefit from Social Security. The evaluation of the therapeutic value and the nature of the affection treated are the criteria upon which the reimbursement ratio is chosen. After marketing, the reevaluation of the medical benefit and the drugs' usefulness may be compared to the treatment's net medical cost (direct + indirect cost--avoided cost) in cost/utility or cost/benefit studies. The Transparency Commission has worked out a scale of assessment of the ASMR which will orient recommendation, or non-recommendation, of registration on the list of reimbursable drugs as well as price fixing proposals. In the future, the Transparency Commission is to strengthen its position regarding the good use of the drug through a better prescriber information system. Thanks to the pharmaco-epidemiology and the pharmaco-vigilance data, the Transparency Commission will be able to guarantee the post-marketing follow-up of the drugs. The examination of the products' conditions of use, the reevaluation of the treatment's advantages based on the utility studies and the epidemiological surveys, and the cost-benefit studies will contribute to a medical control of health spending linked to drug consumption.
Gilmour, Gregory; McKivigan, James
Introduction Historically, testing medical students’ skills using a handheld ophthalmoscope has been difficult to do objectively. Many programs train students using plastic models of the eye which are a very limited fidelity simulator of a real human eye. This makes it difficult to be sure that actual proficiency is attained given the differences between the various models and actual patients. The purpose of this article is to introduce a method of testing where a medical student must match a patient with his/her fundus photo, ensuring objective evaluation as well as developing skills on real patients which are more likely to transfer into clinical practice directly. Presentation of case Fundus photos from standardized patients (SPs) were obtained using a retinal camera and placed into a grid using proprietary software. Medical students were then asked to examine a SP and attempt to match the patient to his/her fundus photo in the grid. Results Of the 33 medical students tested, only 10 were able to match the SP’s eye to the correct photo in the grid. The average time to correct selection was 175 seconds, and the successful students rated their confidence level at 27.5% (average). The incorrect selection took less time, averaging 118 seconds, yet yielded a higher student-reported confidence level at 34.8% (average). The only noteworthy predictor of success (p<0.05) was the student’s age (p=0.02). Conclusion It may be determined that there is an apparent gap in the ophthalmoscopy training of the students tested. It may also be of concern that students who selected the incorrect photo were more confident in their selections than students who chose the correct photo. More training may be necessary to close this gap, and future studies should attempt to establish continuing protocols in multiple centers. PMID:28096708
Schreier, Gunter; Schwarz, Mark; Modre-Osprian, Robert; Kastner, Peter; Scherr, Daniel; Fruhwald, Friedrich
The intake of prescribed medication presents a challenge, in particular for elderly people and in cases where a variety of medications have to be taken in accordance to a complex schedule. To support patients with this task, an mHealth-concept was developed and evaluated in the course of a clinical trial. The system used a multimodal user interface concept, i.e. both RFID tags and barcodes to identify and document the intake of medications. Results of the clinical study with 20 patients indicate that the multimodal mHealth concept utilizing barcode and RFID tags enabled easy-to-use medication management. Although further clinical evaluation is needed to assess whether such a tool can also enhance adherence, the system shows the potential for targeting the problem of medication management with mHealth methods.
Thomas, Treye; Thomas, Karluss; Sadrieh, Nakissa; Savage, Nora; Adair, Patricia; Bronaugh, Robert
Considerable media attention has recently been given to novel applications for products that contain nanoscale materials. These products could have utility in several industries that market consumer products, including textiles, sporting equipment, cosmetics, consumer electronics, and household cleaners. Some of the purported benefits of these products include improved performance, convenience, lower cost, as well as other desirable features, when compared to the conventional products that do not contain nanoscale materials. Although there are numerous likely consumer advantages from products containing nanoscale materials, there is very little information available regarding consumer exposure to the nanoscale materials in these products or any associated risks from these exposures. This paper seeks to review a limited subset of products that contain nanoscale materials, assess the available data for evaluating the consumer exposures and potential hazards associated with these products, and discuss the capacity of U.S. regulatory agencies to address the potential risks associated with these products.
McCormick, Patrick J; Kaiser, James J; Schoene, Michael J; Shlatz, Deborah L; Norton, Susan E
This study reports the results of a designed experiment to evaluate the use of the o-phthalic dialdehyde (OPA) method for residual protein, with a testsoilderivedfrom blood, dehydrated hog mucin, and egg yolk, and its application in validating the automated cleaning of surgical instruments in a laboratory setting. The ruggedness and robustness of the OPA method was determined by means of a Plackett-Burman experimental design and assessed the automated cleaning of a microkeratome for use in patients undergoing lamellar resection of the cornea during refractive surgery. The outcome of the study indicates that the OPA method for residual protein is rugged and robust for the factors evaluated and is an effective means for validating the cleaning of complex medical devices under controlled laboratory conditions. The components of the microkeratome contaminated with the test soil were successfully cleaned in an automated washer-disinfector using a neutral pH detergent and the procedure as described.
Dy, Sydney Morss
The author conducted a structured literature review of instruments for evaluating shared medical decision making. She included relevant instruments that were generalizable beyond specific situations and had been formally evaluated and organized them by domains of values or preferences, information and communication in decision making, and other aspects of decision making. For values or preferences, the author identified 11 instruments, mostly on preferences for roles and information. For information and communication, she found a systematic review of instruments for observational assessment of decision making, 3 additional observational instruments, and 3 questionnaires. For other aspects of decision making, the author identified 3 instruments in domains such as decision self-efficacy and 4 multidimensional instruments. Although instrument development tended to cluster in several areas and there were clear gaps in the literature, the diversity of instruments demonstrates the broad range of constructs involved in assessing shared decision making.
Tumerman, Marc; Carlson, Leanne M Hedberg
Current national health care issues of affordability, quality, and accessibility have prompted the development of Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs). Components of ACOs and PCMHs call for increased capacities in areas of teamwork, engagement, and physician leadership skills and behaviors. Three hundred sixty degree feedback evaluation processes have been established in corporate environments as effective for increasing capacities in these areas. Recently, health care organizations have begun to adopt the use of such tools with positive outcomes. This article presents a case study of the development and implementation of a 360-degree evaluation process at a family medicine clinic. We also discuss the challenges, successes, and lessons learned along the way.
Golden, Daniel W.; Spektor, Alexander; Rudra, Sonali; Ranck, Mark C.; Krishnan, Monica S.; Jimenez, Rachel B.; Viswanathan, Akila N.; Koshy, Matthew; Howard, Andrew R.; Chmura, Steven J.
Purpose: To develop and evaluate a structured didactic curriculum to complement clinical experiences during radiation oncology clerkships at 2 academic medical centers. Methods and Materials: A structured didactic curriculum was developed to teach fundamentals of radiation oncology and improve confidence in clinical competence. Curriculum lectures included: (1) an overview of radiation oncology (history, types of treatments, and basic clinic flow); (2) fundamentals of radiation biology and physics; and (3) practical aspects of radiation treatment simulation and planning. In addition, a hands-on dosimetry session taught students fundamentals of treatment planning. The curriculum was implemented at 2 academic departments in 2012. Students completed anonymous evaluations using a Likert scale to rate the usefulness of curriculum components (1 = not at all, 5 = extremely). Likert scores are reported as (median [interquartile range]). Results: Eighteen students completed the curriculum during their 4-week rotation (University of Chicago n=13, Harvard Longwood Campus n=5). All curriculum components were rated as extremely useful: introduction to radiation oncology (5 [4-5]); radiation biology and physics (5 [5-5]); practical aspects of radiation oncology (5 [4-5]); and the treatment planning session (5 [5-5]). Students rated the curriculum as “quite useful” to “extremely useful” (1) to help students understand radiation oncology as a specialty; (2) to increase student comfort with their specialty decision; and (3) to help students with their future transition to a radiation oncology residency. Conclusions: A standardized curriculum for medical students completing a 4-week radiation oncology clerkship was successfully implemented at 2 institutions. The curriculum was favorably reviewed. As a result of completing the curriculum, medical students felt more comfortable with their specialty decision and better prepared to begin radiation oncology residency.
Vidi, Venkatesan D.; Matheny, Michael E.; Donnelly, Sharon; Resnic, Frederic S.
Background Post-market medical product safety surveillance is a complex task requiring standardized data collection, prompt adverse event reporting mechanisms and appropriate methodologies to identify low frequency safety threats and risk communication. Purpose To review the design of the DELTA (Data Extraction and Longitudinal Trend Analysis) network study of the medical device safety surveillance. Methods This is a multicenter prospective observational study designed to evaluate the safety of new cardiovascular devices used during percutaneous coronary intervention (PCI) performed through continuous analysis of the routinely collected American College of Cardiology- National Cardiovascular Data Registry (ACC-NCDR) data elements. The primary endpoint of the study is detection of adverse event rates specific to several classes of new medical devices, including drug eluting coronary stents, embolic protection devices, and vascular closure devices in patients undergoing PCI. Secondary endpoints include the time-savings between the DELTA network detection of a true device safety alert and the time taken to detect the same outcome using conventional retrospective data analysis, overall sensitivity, specificity, positive predictive value and negative predictive value of the DELTA network surveillance system. Results The details of the study are described including system design, eligibility criteria, methods and components of data collection, data security and statistical methods. In addition, the methods of adjudication and verification following an adverse event alert, overall study outcomes, end points, limitations and potential advantages are discussed. Conclusion This report describes the first multicenter prospective study of a computerized safety surveillance system to monitor and evaluate the safety of new cardiovascular devices. PMID:21356331
Given, Joanne E.; Loane, Maria; Luteijn, Johannes M.; Morris, Joan K.; de Jong van den Berg, Lolkje T.W.; Garne, Ester; Addor, Marie‐Claude; Barisic, Ingeborg; de Walle, Hermien; Gatt, Miriam; Klungsoyr, Kari; Khoshnood, Babak; Latos‐Bielenska, Anna; Nelen, Vera; Neville, Amanda J.; O'Mahony, Mary; Pierini, Anna; Tucker, David; Wiesel, Awi
Aims To evaluate congenital anomaly (CA)‐medication exposure associations produced by the new EUROmediCAT signal detection system and determine which require further investigation. Methods Data from 15 EUROCAT registries (1995–2011) with medication exposures at the chemical substance (5th level of Anatomic Therapeutic Chemical classification) and chemical subgroup (4th level) were analysed using a 50% false detection rate. After excluding antiepileptics, antidiabetics, antiasthmatics and SSRIs/psycholeptics already under investigation, 27 associations were evaluated. If evidence for a signal persisted after data validation, a literature review was conducted for prior evidence of human teratogenicity. Results Thirteen out of 27 CA‐medication exposure signals, based on 389 exposed cases, passed data validation. There was some prior evidence in the literature to support six signals (gastroschisis and levonorgestrel/ethinylestradiol (OR 4.10, 95% CI 1.70–8.53; congenital heart disease/pulmonary valve stenosis and nucleoside/tide reverse transcriptase inhibitors (OR 5.01, 95% CI 1.99–14.20/OR 28.20, 95% CI 4.63–122.24); complete absence of a limb and pregnen (4) derivatives (OR 6.60, 95% CI 1.70–22.93); hypospadias and pregnadien derivatives (OR 1.40, 95% CI 1.10–1.76); hypospadias and synthetic ovulation stimulants (OR 1.89, 95% CI 1.28–2.70). Antipropulsives produced a signal for syndactyly while the literature revealed a signal for hypospadias. There was no prior evidence to support the remaining six signals involving the ordinary salt combinations, propulsives, bulk‐forming laxatives, hydrazinophthalazine derivatives, gonadotropin releasing hormone analogues and selective serotonin agonists. Conclusion Signals which strengthened prior evidence should be prioritized for further investigation, and independent evidence sought to confirm the remaining signals. Some chance associations are expected and confounding by indication is possible. PMID
Killough, Emily; Spector, Lisa; Moffatt, Mary; Wiebe, Jan; Nielsen-Parker, Monica; Anderst, Jim
Still photo imaging is often used in medical evaluations of child sexual abuse (CSA) but video imaging may be superior. We aimed to compare still images to videos with respect to diagnostic agreement regarding hymenal deep notches and transections in post-pubertal females. Additionally, we evaluated the role of experience and expertise on agreement. We hypothesized that videos would result in improved diagnostic agreement of multiple evaluators as compared to still photos. This was a prospective quasi-experimental study using imaging modality as the quasi-independent variable. The dependent variable was diagnostic agreement of participants regarding presence/absence of findings indicating penetrative trauma on non-acute post-pubertal genital exams. Participants were medical personnel who regularly perform CSA exams. Diagnostic agreement was evaluated utilizing a retrospective selection of videos and still photos obtained directly from the videos. Videos and still photos were embedded into an on-line survey as sixteen cases. One-hundred sixteen participants completed the study. Participant diagnosis was more likely to agree with study center diagnosis when using video (p<0.01). Use of video resulted in statistically significant changes in diagnosis in four of eight cases. In two cases, the diagnosis of the majority of participants changed from no hymenal transection to transection present. No difference in agreement was found based on experience or expertise. Use of video vs. still images resulted in increased agreement with original examiner and changes in diagnostic impressions in review of CSA exams. Further study is warranted, as video imaging may have significant impacts on diagnosis.
Lelario, M; Ciuffreda, P; Lupo, P; Bristogiannis, C; Vinci, R; Stoppino, L P; De Filippo, M; Macarini, L
To evaluate any discrepancy between radiological reports for clinical purposes and for medicolegal purposes and to quantify its economic impact on repayments made by private insurance companies for meniscal injuries of the knee. The medical records obtained pertaining to 108 knee injury patients (mean age 43.3 years) assessed over a period of 12 months were analysed. Clinical medical reports, aimed at assessing the lesion, and medicolegal reports, drawn up with a view to quantifying compensation, were compared. Unlike reports for clinical purposes in reports for medicolegal purposes, in the evaluation of meniscal lesions, in addition to morphological features of lesions, chronological, topographical, severity and exclusion criteria were applied. To estimate the economic impact resulting from the biological damage, we consulted an actuarial table based on the 9-point minor incapacity classification system. Meniscal lesions not compatible with a traumatic event and therefore not eligible for an insurance payout were found in 56 patients. Of these, 37 failed exclusion criteria, while 19 failed to meet chronological criteria. This difference resulted in a reduction in compensation made by private insurance companies with savings estimated with a saving between euro 203,715.41 and euro 622,315.39. The use of a clinical report for medicolegal purposes can be a source of valuation error, as chronological and/or dynamic information regarding the trauma mechanism may be lacking. Therefore, the use of a full radiological appraisal allows a better damage's assessment and an adequate compensation for injuries.
Ersin, Özlem H.; Chen, Yu-Chieh
Objective. To describe and assess student perceptions and performance on a medication use evaluation (MUE) team project. Design. Following a 1-hour MUE lecture in a 62-student patient safety course, student teams (n=14) were assigned a medication safety or quality issue. Teams worked with a mentor to design an MUE to address the issue. The deliverable was a verbal presentation recorded as a webinar. Assessment. Presentations were assessed by 2 reviewers for content and style. Mean score was 45.0 +/- 2.7 of 50 points. Students rated level of agreement that they could perform MUE-related skills pre- and postproject (n=35 and 34, respectively) on a 5-point Likert scale. Students perceived improved ability to design an MUE after project completion (median 3 vs 4; p=0.003). Student comfort with sample determination, data, collaborators, study limitations, and potential project impact also improved. Conclusion. Teams achieved the objective of successfully designing an MUE, and related enabling outcomes (ie, supportive activities that contribute to designing an MUE), as measured by evaluators and student perceptions. PMID:25386020
Helary, Christophe; Abed, Aicha; Mosser, Gervaise; Louedec, Liliane; Letourneur, Didier; Coradin, Thibaud; Giraud-Guille, Marie Madeleine; Meddahi-Pellé, Anne
Cutaneous chronic wounds are characterized by an impaired wound healing which may lead to infection and amputation. When current treatments are not effective enough, the application of wound dressings is required. To date, no ideal biomaterial is available. In this study, highly dense collagen matrices have been evaluated as novel medicated wound dressings for the treatment of chronic wounds. For this purpose, the structure, mechanical properties, swelling ability and in vivo stability of matrices concentrated from 5 to 40 mg mL(-1) were tested. The matrix stiffness increased with the collagen concentration and was associated with the fibril density and thickness. Increased collagen concentration also enhanced the material resistance against accelerated digestion by collagenase. After subcutaneous implantation in rats, dense collagen matrices exhibited high stability without any degradation after 15 days. The absence of macrophages and neutrophils evidenced their biocompatibility. Subsequently, dense matrices at 40 mg mL(-1) were evaluated as drug delivery system for ampicillin release. More concentrated matrices exhibited the best swelling abilities and could absorb 20 times their dry weight in water, allowing for an efficient antibiotic loading from their dried form. They released efficient doses of antibiotics that inhibited the bacterial growth of Staphylococcus Aureus over 3 days. In parallel, they show no cytotoxicity towards human fibroblasts. These results show that dense collagen matrices are promising materials to develop medicated wound dressings for the treatment of chronic wounds.
Matheson, N W; Grefsheim, S F
A comparative study was undertaken to assess the reasons for the low rankings received by George Washington University Medical Center library in the Annual Statistics for Medical School Libraries in the United States and Canada. Although internal studies showed the library was successfully satisfying user needs and meeting its primary objectives, the rankings, which include the traditional measures of quality used by accrediting bodies, indicated the contrary. Three hypotheses were postulated to account for the discrepancy. In a matched group of similar libraries: (1) the rankings of an individual library would differ from the national rankings; (2) clustering the variables would change the rankings; and (3) libraries with similar staff size would tend to rank in the same quartile in service and resource variables. All hypotheses were invalidated. Further tests led to the conclusion that the Annual Statistics and other traditional measures of quality are inappropriate and inaccurate methods for evaluating library programs, since they only measure resource allocations and not the effectiveness of those allocations. Alternative evaluation methods are suggested. PMID:7248592
Lamounier, J A; Pereira, A A; de Oliveira, H N
A project which integrates medical RESIDENCY with medical masters degree has been discussed and is expected to be set up at UFMG Medical School in the near future. Such project is optional for the entering residents and aims those who are interested in becoming researchers. This paper's objective is to raise the residents' opinion on the project as well as their interests in post graduation level. A 240 university hospital residents (HC-UFMG) and a 114 non-university hospital (IPSEMG) were studied through questionnaire application. From the total population of 354 residents we had a 50% questionnaire devolution, 120 (68%) from HC-UFMG and 57 (32%) from IPSEMG. Residents of different clinical and surgical areas were included, 55% male and 45% female. Most of them work exclusively in residency activities, 69% have interest in specialize after residency, 55% in taking medical masters degree, 52% in taking up academic life and 67% in applying for the integrated residency-master degree program. Twelve (7%) are not particularly interested in join the program because they are not sure whether they are able to carry on adequately both residency and research activities at the same time. This study shows that residents are highly receptive to the UFMG's program and that more detailed information concerning its contents should be handed out in order to generate further discussion.
The article deals with the study results related to preventive activities in the primary medical sanitary care system. It is demonstrated that the prevention activities of physicians are lacking of both proper organization and adequate involvement into the process. The medical personnel in the primary medical sanitary system need enhancing of professional qualification especially in the field of health promotion and disease prevention. The study proved the necessity of including the prevention into the actual health policy and health care planning.