[Life-style of medical personnel dwelling and working in agroindustrial area].

PubMed

Sorokina, M G; Kamaev, I A

2005-01-01

Results of sociological survey of medical personnel of typical agroindustrial area of Novgorod Oblast are presented. Data of self-registration of acute and chronic diseases and self-appraisal of one's health testify higher morbidity and health deterioration during last 3 years. Analysis of demographic characteristics, life-styles and labor conditions revealed complex of major factors impacting individual health and flow-out of professional medical personnel. Both amount of average monthly wage of physicians and paramedics, levels of their family income and welfare and as well degree of their inconsistence with cost of living of able-bodied population are established. Conditions of living and social maintenance, labor and off-labor activity, attitude to one's own health and spread of risk factors were analyzed. Management weaknesses of district and rural patient care institutions were established, including considerable exceeding of hygienic regulations established for medical personnel working load and higher spread of physical, chemical and biological risk factors of working environment harmful for health. Need in further enhancement of management of working process, occupational safety, labor remuneration and in increasing social safety, hygienic and curative activity of medical personnel is justified.

Facilitating LGBT Medical, Health and Social Care Content in Higher Education Teaching

ERIC Educational Resources Information Center

Davy, Zowie; Amsler, Sarah; Duncombe, Karen

2015-01-01

Increasingly, Lesbian, Gay, Bisexual, and Transgender (LGBT) health care is becoming an important quality assurance feature of primary, secondary and tertiary healthcare in Britain. While acknowledging these very positive developments, teaching LGBT curricula content is contingent upon having educators understand the complexity of LGBT lives. The…

Observing the onset of disability in older adults.

PubMed

Reynolds, Sandra L; Silverstein, Merril

2003-11-01

One of the greatest threats to the ability of older adults to live independently is the onset of disability in activities adults perform in their daily lives, such as dressing, eating, toileting, managing one's money, preparing meals and so on. This article examines the onset of disability in older adult Americans using three waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (1993, 1995, 1998; n=4228). We use medical/demographic factors (arthritis, heart disease, diabetes; age, gender, race/ethnicity, wealth), baseline characteristics (affect, cognition, health behaviors, medical insurance), and time-varying covariates (changes in chronic conditions and baseline characteristics) to predict the onset of activities of daily living (ADLs) and instrumental activities of daily living (IADLs) disability, individually and in the aggregate, over time. We find the onset of ADL and IADL disability is a complex process, suggesting important roles for medical, demographic, social, psychological, and behavioral triggers, specifically negative affect, higher body weight, and by the lack of vigorous exercise. We also find that individual ADL and IADL impairments are predicted by a variety of different factors, suggesting that summary measures of disability may be masking a wealth of potentially useful interventions. In general, public health efforts in the area of controlling obesity and treating depressive symptoms should be supported.

Value-Based Insurance Design Benefit Offsets Reductions In Medication Adherence Associated With Switch To Deductible Plan.

PubMed

Reed, Mary E; Warton, E Margaret; Kim, Eileen; Solomon, Matthew D; Karter, Andrew J

2017-03-01

Enrollment in high-deductible health plans is increasing out-of-pocket spending. But innovative plans that pair deductibles with value-based insurance designs can help preserve low-cost access to high-value treatments for patients by aligning coverage with clinical value. Among adults in high-deductible health plans who were prescribed medications for chronic conditions, we examined what impact a value-based pharmacy benefit that offered free chronic disease medications had on medication adherence. Overall, we found that the value-based plan offset reductions in medication adherence associated with switching to a deductible plan. The value-based plan appeared particularly beneficial for patients who started with low levels of medication adherence. Patients with additional clinical complexity or vulnerable populations living in neighborhoods with lower socioeconomic status, however, did not show adherence improvements and might not be taking advantage of value-based insurance design provisions. Additional efforts may be needed to educate patients about their nuanced benefit plans to help overcome initial confusion about these complex plans. Project HOPE—The People-to-People Health Foundation, Inc.

[The medical history of Edgar Allan Poe].

PubMed

Miranda C, Marcelo

2007-09-01

Edgar Allan Poe, one of the best American storytellers and poets, suffered an episodic behaviour disorder partially triggered by alcohol and opiate use. Much confusion still exists about the last days of his turbulent life and the cause of his death at an early age. Different etiologies have been proposed to explain his main medical problem, however, complex partial seizures triggered by alcohol, poorly recognized at the time when Poe lived, seems to be one of the most acceptable hypothesis, among others discussed.

Exploring the experiences of older Chinese adults with comorbidities including diabetes: surmounting these challenges in order to live a normal life.

PubMed

Ho, Hsiu-Yu; Chen, Mei-Hui; Lou, Meei-Fang

2018-01-01

Many people with diabetes have comorbidities, even multimorbidities, which have a far-reaching impact on the older adults, their family, and society. However, little is known of the experience of older adults living with comorbidities that include diabetes. The aim of this study was to explore the experience of older adults living with comorbidities including diabetes. A qualitative approach was employed. Data were collected from a selected field of 12 patients with diabetes mellitus in a medical center in northern Taiwan. The data were analyzed by Colaizzi's phenomenological methodology, and four criteria of Lincoln and Guba were used to evaluate the rigor of the study. The following 5 themes and 14 subthemes were derived: 1) expecting to heal or reduce the symptoms of the disease (trying to alleviate the distress of symptoms and trusting in health practitioners combining the use of Chinese and Western medicines); 2) comparing complex medical treatments (differences in physician practices and presentation, conditionally adhering to medical treatment, and partnering with medical professionals); 3) inconsistent information (inconsistent health information and inconsistent medical advice); 4) impacting on daily life (activities are limited and hobbies cannot be maintained and psychological distress); and 5) weighing the pros and cons (taking the initiative to deal with issues, limiting activity, adjusting mental outlook and pace of life, developing strategies for individual health regimens, and seeking support). Surmounting these challenges in order to live a normal life was explored. This study found that the experience of older adults living with comorbidities including diabetes was similar to that of a single disease, but the extent was greater than a single disease. The biggest difference is that the elderly think that their most serious problem is not diabetes, but rather, the comorbidities causing life limitations. Therefore, compared to the elderly suffering from a single disease of diabetes, medical professionals not only care about physiological data of the elderly but also pay attention to the impact of comorbidity on their lives.

Exploring the experiences of older Chinese adults with comorbidities including diabetes: surmounting these challenges in order to live a normal life

PubMed Central

Ho, Hsiu-Yu; Chen, Mei-Hui

2018-01-01

Background Many people with diabetes have comorbidities, even multimorbidities, which have a far-reaching impact on the older adults, their family, and society. However, little is known of the experience of older adults living with comorbidities that include diabetes. Aim The aim of this study was to explore the experience of older adults living with comorbidities including diabetes. Methods A qualitative approach was employed. Data were collected from a selected field of 12 patients with diabetes mellitus in a medical center in northern Taiwan. The data were analyzed by Colaizzi’s phenomenological methodology, and four criteria of Lincoln and Guba were used to evaluate the rigor of the study. Results The following 5 themes and 14 subthemes were derived: 1) expecting to heal or reduce the symptoms of the disease (trying to alleviate the distress of symptoms and trusting in health practitioners combining the use of Chinese and Western medicines); 2) comparing complex medical treatments (differences in physician practices and presentation, conditionally adhering to medical treatment, and partnering with medical professionals); 3) inconsistent information (inconsistent health information and inconsistent medical advice); 4) impacting on daily life (activities are limited and hobbies cannot be maintained and psychological distress); and 5) weighing the pros and cons (taking the initiative to deal with issues, limiting activity, adjusting mental outlook and pace of life, developing strategies for individual health regimens, and seeking support). Surmounting these challenges in order to live a normal life was explored. Conclusion This study found that the experience of older adults living with comorbidities including diabetes was similar to that of a single disease, but the extent was greater than a single disease. The biggest difference is that the elderly think that their most serious problem is not diabetes, but rather, the comorbidities causing life limitations. Therefore, compared to the elderly suffering from a single disease of diabetes, medical professionals not only care about physiological data of the elderly but also pay attention to the impact of comorbidity on their lives. PMID:29430173

Health and Functional Status of Adults with Intellectual Disability Referred to the Specialist Health Care Setting: A Five-Year Experience

PubMed Central

Lee, L.; Rianto, J.; Raykar, V.; Creasey, H.; Waite, L.; Berry, A.; Xu, J.; Chenoweth, B.; Kavanagh, S.; Naganathan, V.

2011-01-01

Aims and Method. The Developmental Disability Database in the Department of Rehabilitation Medicine at a metropolitan hospital was audited for observations on adults with Intellectual Disability living in the local region (total population 180,000) who were seen in an identified multidisciplinary specialist clinic, during 2006–2010. Results. There were 162 people (representing half the known number of adults with Intellectual Disability living in the region): 77 females, 85 males, age range 16–86 years. The most common complex disabilities referred to the specialists in this clinic were epilepsy (52%), challenging or changing behavior (42%) and movement disorders (34%). Early onset dementia was a feature of the group (7%). The prevalence of prescription of medications for gastro-oesophageal reflux was high (36%) and similar to the numbers of people taking psychotropic medications. The rates of chronic cardiovascular disease (2%), chronic respiratory disease (10%) and generalised arthritis (11%) were low overall, but did rise with increasing age. Conclusions. Complex neurological disabilities are common, and chronic medical illnesses are uncommon in adults with Intellectual Disability referred to specialist clinicians in this region. A combined, coordinated, multidisciplinary clinic model addresses some of the barriers experienced by adults with Intellectual Disability in the secondary health system. PMID:22295183

Medication adherence and persistence in type 2 diabetes mellitus: perspectives of patients, physicians and pharmacists on the Spanish health care system.

PubMed

Labrador Barba, Elena; Rodríguez de Miguel, Marta; Hernández-Mijares, Antonio; Alonso-Moreno, Francisco Javier; Orera Peña, Maria Luisa; Aceituno, Susana; Faus Dader, María José

2017-01-01

A good relationship between diabetes patients and their health care team is crucial to ensure patients' medication adherence and self-management. To this end, we aimed to identify and compare the views of type 2 diabetes mellitus (T2DM) patients, physicians and pharmacists concerning the factors and strategies that may be associated with, or could improve, medication adherence and persistence. An observational, cross-sectional study was conducted using an electronic self-administered questionnaire comprising 11 questions (5-point Likert scale) concerning factors and strategies related to medication adherence. The survey was designed for T2DM patients and Spanish National Health System professionals. A total of 963 T2DM patients, 998 physicians and 419 pharmacists participated in the study. Overall, a lower proportion of pharmacists considered the proposed factors associated with medication adherence important as compared to patients and physicians. It should be noted that a higher percentage of physicians in comparison to pharmacists perceived that "complexity of medication" (97% vs 76.6%, respectively) and "adverse events" (97.5% vs 72.2%, respectively) were important medication-related factors affecting adherence. In addition, both patients (80.8%) and physicians (80.8%) agreed on the importance of "cost and co-payment" for adherence, whereas only 48.6% of pharmacists considered this factor important. It is also noteworthy that nearly half of patients (43%) agreed that "to adjust medication to activities of daily living" was the best strategy to reduce therapeutic complexity, whereas physicians believed that "reducing the frequency of administration" (47.9%) followed by "reducing the number of tablets" (28.5%) was the most effective strategy to improve patients' adherence. Our results highlight the need for pharmacists to build a stronger relationship with physicians in order to improve patients monitoring and adherence rates. Additionally, these findings may help to incorporate greater patient-centeredness when developing management strategies, focusing on adjusting medication regimens to patients' daily lives.

After the Visit: An Overview of Government and Community Programs Supporting Children with Medical Complexity.

PubMed

Olson, Kaitlyn B

2017-05-04

The optimal care of children with medical complexity (CMC) requires involvement from a network of professionals that includes physicians, nurses, ancillary service providers, and educators. Pediatric health care providers typically have early and frequent contact with the families of CMC. Therefore, they are in a unique position to connect families to developmental, educational, and psychosocial supports. This article reviews important government and community programs that support CMC living in the United States. It outlines the educational rights of children with disabilities and offers practical tips for collaborating with Early Intervention and the public school system. The article also provides an overview of financial assistance programs, respite care services, and support groups that are beneficial to CMC and their families.

[Sexually transmitted diseases: the impact of stigma and taboo on current medical care].

PubMed

Badura-Lotter, G

2014-04-01

Sexually transmitted diseases (STD) are probably the most tabooed diseases we know. The many taboos and the related stigmata shape patients' lives and significantly influence health care policies, medical research, and current problems in medical ethics. To better understand these complex influences, the still powerful taboos and related metaphors associated with illness and disease are analyzed within their cultural and historical background and concerning the actual impact on patient care and research. It becomes obvious that research and health care policies cannot be satisfyingly successful in helping people affected by STDs as long as these "nonscientific" factors are not taken into account.

Perspectives Regarding Adherence to Prescribed Treatment in Highly Adherent HIV-Infected Gay Men.

PubMed

Brion, John M; Menke, Edna M

2008-01-01

Focus group methodology was used to describe the medication adherence experience of 24 HIV-infected gay men who reported being adherent to their medication regimens. A conceptualization of medication adherence as an evolving process consisted of challenges to adherence (learning the diagnosis, starting the medications, struggling with the medications, dealing with side effects, coping with stigma) as well as those factors supportive of adherence (believing in medications, finding motivating factors, using reminders, depending on others, owning the disease). Themes associated with challenges to adherence focused on diagnosis and the physical and emotional adjustments individuals made to incorporate antiretroviral medications into their daily lives and move toward medication adherence. The factors supportive of adherence were related to the ongoing behaviors identified with establishing and maintaining adherence behaviors. What can be taken from the study is that adherence is a complex and dynamic process rather than a static behavior.

Optimizing the health impacts of civil legal aid interventions: the public health framework of medical-legal partnerships.

PubMed

Lawton, Ellen; Tyler, Elizabeth Tobin

2013-07-01

Research documents the significance of the social determinants of health - the social and environmental conditions in which people live, work and play. A critical foundation of these social and environmental conditions are laws and regulations, which construct the environments in which individuals and populations live, influencing how and when people face disease. Increasingly, healthcare providers, public health professionals and lawyers concerned with social determinants are joining forces to form Medical-Legal Partnerships (MLPs) which offer a preventive approach to address the complex social, legal and systemic problems that affect the health of vulnerable populations. Now in more than 500 health and legal institutions across the country, including Rhode Island, MLP is a healthcare delivery model that integrates legal assistance as a vital component of healthcare. This article explores the many benefits of the MLP model for improving patient health, transforming medical and legal practice and institutions and generating policy changes that specifically address health disparities and social determinants.

Resident and Staff Satisfaction of Pediatric Graduate Medical Education Training on Transition to Adult Care of Medically Complex Patients.

PubMed

Weeks, Matthew; Cole, Brandon; Flake, Eric; Roy, Daniel

2018-04-11

This study aims to describe the quantity and satisfaction current residents and experienced pediatricians have with graduate medical education on transitioning medically complex patients to adult care. There is an increasing need for transitioning medically complex adolescents to adult care. Over 90% now live into adulthood and require transition to adult healthcare providers. The 2010 National Survey of Children with Special Health Care Needs found that only 40% of youth 12-17 yr receive the necessary services to appropriately transition to adult care. Prospective, descriptive, anonymous, web-based survey of pediatric residents and staff pediatricians at Army pediatric residency training programs was sent in March 2017. Questions focused on assessing knowledge of transition of care, satisfaction with transition training, and amount of education on transition received during graduate medical education training. Of the 145 responders (310 potential responders, 47% response rate), transition was deemed important with a score of 4.3 out of 5. The comfort level with transition was rated 2.6/5 with only 4.2% of participants receiving formal education during residency. The most commonly perceived barriers to implementing a curriculum were time constraints and available resources. Of the five knowledge assessment questions, three had a correct response rate of less than 1/3. The findings show the disparity between the presence of and perceived need for a formal curriculum on transitioning complex pediatric patients to adult care. This study also highlighted the knowledge gap of the transition process for novice and experienced pediatricians alike.

Factors associated with medication hassles experienced by family caregivers of older adults.

PubMed

Travis, Shirley S; McAuley, William J; Dmochowski, Jacek; Bernard, Marie A; Kao, Hsueh-Fen S; Greene, Ruth

2007-04-01

We wished to identify potential factors associated with medication administration hassles, daily irritants, among informal caregivers who provide long-term medication assistance to persons aged 55 or older. A sample of 156 informal caregivers were recruited from seven states and several types of settings. The dependent variable was scores on the Family Caregiver Medication Administration Hassles Scale (FCMAHS). Independent variables included in the analyses were medication complexity; caregiver's gender, ethnicity, relationship to recipient, length of time in caregiving, education, and employment outside the home; care recipient's physical capacity and mental capacity; and whether the caregiver and care recipient live together. After preliminary analysis to reduce the number of independent variables, the remaining variables were included in a linear model (GLM procedure). Possible interactions and residuals were considered. Whites and Hispanics experience greater medication administration hassles than other groups, and perceived hassle intensity increases with medication complexity. Medication administration hassle scores increase with increasing education levels up to a high school degree, after which they remain consistently high. Caregivers whose care recipients have moderate levels of cognitive functioning have higher medication administration hassles scores than those whose care recipients have very high or very low cognitive functioning. The preliminary set of significant variables can be used to identify caregivers who may be at risk of experiencing medication administration hassles, increased stress, and potentially harmful events for their care recipients. Family caregivers are accepting complex caregiving responsibility for family members while receiving little or no support or assistance with caregiving hassles associated with this duty. The FCMAHS offers the means to monitor how caregivers are handling the daily irritants involved with medication administration so that educational interventions can be provided before hassles lead to more serious stress and strain.

Factors of interpersonal communication and behavioral health on medication self-efficacy and medication adherence.

PubMed

Archiopoli, Ashley; Ginossar, Tamar; Wilcox, Bryan; Avila, Magdalena; Hill, Ricky; Oetzel, John

2016-12-01

Despite devastating effects on health outcomes and disease progression, many people living with HIV (PLWH) are non-adherent to their medications. Medication self-efficacy is a pivotal factor in medication adherence, yet its formation and relationship with other factors are understudied. This study examines a model that considers the role of three communicative factors (patient-provider communication, social support, and social undermining) and two behavioral health factors (depression and alcohol abuse) and medication self-efficacy impacting medication adherence. Methods included a cross-sectional design using a survey questionnaire of 344 PLWH. Findings indicated that 25% of variance in medication adherence can be explained by a mediation model where depression (B = -.18) and provider-patient communication (B = .21) affect medication self-efficacy, which in turn impacts medication adherence (B = .64). Other variables, including demographics, did not add any explanatory power. These findings demonstrate the complex nature of medication adherence and the formation of medication self-efficacy.

Lifestyle and Self-Management by Those Who Live It: Patients Engaging Patients in a Chronic Disease Model.

PubMed

Jesse, Michelle T; Rubinstein, Elizabeth; Eshelman, Anne; Wee, Corinne; Tankasala, Mrunalini; Li, Jia; Abouljoud, Marwan

Patients pursuing organ transplantation have complex medical needs, undergo comprehensive evaluation for possible listing, and require extensive education. However, transplant patients and their supports frequently report the need for more lifestyle and self-management strategies for living with organ transplantation. First, to explore feasibility of a successful, patient-run transplant lifestyle educational group (Transplant Living Community), designed to complement medical care and integrated into the clinical setting; and second, to report the major themes of patients' and supports' qualitative and quantitative feedback regarding the group. Informal programmatic review and patient satisfaction surveys. A total of 1862 patient satisfaction surveys were disseminated and 823 were returned (response rate, 44.2%). Patients and their supports reported positive feedback regarding the group, including appreciation that the volunteer was a transplant recipient and gratitude for the lifestyle information. Five areas were associated with the success of Transplant Living Community: 1) a "champion" dedicated to the program and its successful integration into a multidisciplinary team; 2) a health care environment receptive to integration of a patient-led group with ongoing community development; 3) a high level of visibility to physicians and staff, patients, and supports; 4) a clearly presented and manageable lifestyle plan ("Play Your ACES"(a) [Attitude, Compliance, Exercise, and Support]), and 5) a strong volunteer structure with thoughtful training with the ultimate objective of volunteers taking ownership of the program. It is feasible to integrate a sustainable patient-led lifestyle and self-management educational group into a busy tertiary care clinic for patients with complex chronic illnesses.

Law and medical ethics in organ transplantation surgery

PubMed Central

Woodcock, Tom; Wheeler, Robert

2010-01-01

This article in the series describes how UK law and medical ethics have evolved to accommodate developments in organ transplantation surgery. August committees have formulated definitions of the point of death of the person which are compatible with the lawful procurement of functioning vital organs from cadavers. Some of the complexities of dead donor rules are examined. Live donors are a major source of kidneys and the laws that protect them are considered. Financial inducements and other incentives to donate erode the noble concept of altruism, but should they be unlawful? PMID:20501013

Two Futures: Financial and Practical Realities for Parents of Living With a Life Limited Child.

PubMed

Randall, Duncan C

2017-12-01

Today more and more children are living with complex health care needs, many of these children are living with life limiting and/or threatening conditions, some are medically fragile. To live a childhood these children must live in communities and with their families. In most cases this means the child's carers, their parents, most often their mothers, are required to undertake a great deal of the child's care. During a project on parental coping I became aware of the ways in which parents were restructuring their working lives in order to meet the demands of the nursing and medical care needs of their children. In this paper I relate the stories we discovered in this qualitative study and discuss the tensions between parental and state's responsibility for children, carers and the political and cultural rights and responsibilities pertaining to children's care. I use Margret Urban Walker's ideas of expressive collaborative morality to argue that the care of life limited and life threatened children should be framed in a negotiation between the state and the carers, both informal and professional. That such an agreement should include a covenant to assist parents and siblings when a child dies to recover and adjust to their loss, in recognition of the work they have performed in caring for the child during their child's life and their death.

Gaming science innovations to integrate health systems science into medical education and practice

PubMed Central

White, Earla J; Lewis, Joy H; McCoy, Lise

2018-01-01

Health systems science (HSS) is an emerging discipline addressing multiple, complex, interdependent variables that affect providers’ abilities to deliver patient care and influence population health. New perspectives and innovations are required as physician leaders and medical educators strive to accelerate changes in medical education and practice to meet the needs of evolving populations and systems. The purpose of this paper is to introduce gaming science as a lens to magnify HSS integration opportunities in the scope of medical education and practice. Evidence supports gaming science innovations as effective teaching and learning tools to promote learner engagement in scientific and systems thinking for decision making in complex scenarios. Valuable insights and lessons gained through the history of war games have resulted in strategic thinking to minimize risk and save lives. In health care, where decisions can affect patient and population outcomes, gaming science innovations have the potential to provide safe learning environments to practice crucial decision-making skills. Research of gaming science limitations, gaps, and strategies to maximize innovations to further advance HSS in medical education and practice is required. Gaming science holds promise to equip health care teams with HSS knowledge and skills required for transformative practice. The ultimate goals are to empower providers to work in complex systems to improve patient and population health outcomes and experiences, and to reduce costs and improve care team well-being.

Gaming science innovations to integrate health systems science into medical education and practice.

PubMed

White, Earla J; Lewis, Joy H; McCoy, Lise

2018-01-01

Health systems science (HSS) is an emerging discipline addressing multiple, complex, interdependent variables that affect providers' abilities to deliver patient care and influence population health. New perspectives and innovations are required as physician leaders and medical educators strive to accelerate changes in medical education and practice to meet the needs of evolving populations and systems. The purpose of this paper is to introduce gaming science as a lens to magnify HSS integration opportunities in the scope of medical education and practice. Evidence supports gaming science innovations as effective teaching and learning tools to promote learner engagement in scientific and systems thinking for decision making in complex scenarios. Valuable insights and lessons gained through the history of war games have resulted in strategic thinking to minimize risk and save lives. In health care, where decisions can affect patient and population outcomes, gaming science innovations have the potential to provide safe learning environments to practice crucial decision-making skills. Research of gaming science limitations, gaps, and strategies to maximize innovations to further advance HSS in medical education and practice is required. Gaming science holds promise to equip health care teams with HSS knowledge and skills required for transformative practice. The ultimate goals are to empower providers to work in complex systems to improve patient and population health outcomes and experiences, and to reduce costs and improve care team well-being.

The Role of the Primary Romantic Relationship in HIV Care Engagement Outcomes Among Young HIV-Positive Black Men Who Have Sex with Men

PubMed Central

Pollack, Lance; Rebchook, Greg; Peterson, John; Huebner, David; Eke, Agatha; Johnson, Wayne; Kegeles, Susan

2018-01-01

The primary romantic relationship plays a fundamental role in health maintenance, but little is known about its role in HIV care engagement among young Black men who have sex with men (MSM) living with HIV. We examined how HIV care engagement outcomes (i.e., having a primary healthcare provider, receiving HIV treatment, taking antiretroviral medication, and medication adherence) vary by partnership status (single vs. concordant-positive vs. discordant) in a sample of young Black MSM living with HIV. Results showed mixed findings. Partnership status was significantly associated with HIV care engagement, even after adjusting for individual, social, and structural factors. While partnered men were consistently more likely than their single counterparts to have a regular healthcare provider, to receive recent treatment, and to have ever taken antiretroviral medication, they were less likely to report currently receiving antiretroviral therapy. Moreover, men with a discordant partner reported better adherence compared to men with a concordant or no partner. The association between partnership status and HIV care engagement outcomes was not consistent across the stages of the HIV Care Continuum, highlighting the complexity in how and why young Black men living with HIV engage in HIV healthcare. Given the social context of HIV disease management, more research is needed to explicate underlying mechanisms involved in HIV care and treatment that differ by relational factors for young Black MSM living with HIV. PMID:27844296

Implementation of a Transdisciplinary Team for the Transition Support of Medically and Socially Complex Youth.

PubMed

Ciccarelli, Mary R; Gladstone, Erin B; Armstrong Richardson, Eprise A J

2015-01-01

This article reports the ongoing work of a statewide transition support program which serves youth ages 11 to 22 with medically complex conditions and socially complex lives. Seven years of transition support services have led to program evolution demonstrated via a descriptive summary of the patients along with both families' and primary care providers' responses to satisfaction surveys. An illustrative case is used to highlight the types of expertise needed in specialized transition service delivery for patients with significant complexity. The team's analysis of their transdisciplinary work processes further explains the work. Nearly three hundred youth with complex needs are served yearly. Families and primary care providers express high satisfaction with the support of the services. The case example shows the broad array of transition-specific services engaged beyond the usual skill set of pediatric or adult care coordination teams. Transdisciplinary team uses skills in collaboration, support, learning, and compromise within a trusting and respectful environment. They describe the shared responsibility and continuous learning of the whole team. Youth with complex medical conditions and complex social situations are at higher risk for problems during transition. Serving this population with a transdisciplinary model is time consuming and requires advanced expertise but, with those investments, we can meet the expectations of the youth, their families and primary care providers. Successful transdisciplinary teamwork requires sustained and focused investment. Further work is needed to describe the complexity of this service delivery along with distinct transition outcomes and costs comparisons. Copyright © 2015 Elsevier Inc. All rights reserved.

Pathological basis of symptoms and crises in sickle cell disorder: implications for counseling and psychotherapy

PubMed Central

Ilesanmi, Oluwatoyin Olatundun

2010-01-01

Sickle Cell Disorder (SCD) is a congenital hemoglobinopathy. There is little in literature regarding the psychological variables affecting individuals living with SCD and all of the significant people around them. There are also limited numbers of trained clinical psychologists and genetic counselors to cater for the psychotherapeutic needs of individuals living with SCD. Even among those who have been trained, only a few might have fully grasped the complexities of the disease pathology. Early understanding of its pathological nature, sources, types, complications, pathophysiological basis, and clinical severity of symptoms among clinical psychologists, genetic counselors and psychotherapists, as well as general medical practitioners, could guide them in providing holistic care for dealing with and reducing pain among individuals living with SCD. It could allow risk-based counseling for families and individuals. It could also justify the early use of disease-modifying or curative interventions, such as hydroxyurea (HU), chronic transfusions (CTs), or stem-cell transplantation (SCT) by general medical practitioners. Hence, the need for this paper on the pathophysiology of SCD. PMID:22184515

Children With Medical Complexity: An Emerging Population for Clinical and Research Initiatives

PubMed Central

Kuo, Dennis Z.; Agrawal, Rishi; Berry, Jay G.; Bhagat, Santi K. M.; Simon, Tamara D.; Srivastava, Rajendu

2011-01-01

Children with medical complexity (CMC) have medical fragility and intensive care needs that are not easily met by existing health care models. CMC may have a congenital or acquired multisystem disease, a severe neurologic condition with marked functional impairment, and/or technology dependence for activities of daily living. Although these children are at risk of poor health and family outcomes, there are few well-characterized clinical initiatives and research efforts devoted to improving their care. In this article, we present a definitional framework of CMC that consists of substantial family-identified service needs, characteristic chronic and severe conditions, functional limitations, and high health care use. We explore the diversity of existing care models and apply the principles of the chronic care model to address the clinical needs of CMC. Finally, we suggest a research agenda that uses a uniform definition to accurately describe the population and to evaluate outcomes from the perspectives of the child, the family, and the broader health care system. PMID:21339266

[The virtuous doctor in cinema: the final examination].

PubMed

Figueroa, Gustavo

2014-10-01

The virtuous doctor has subscribed an oath and by subscribing to this solemn promise, he is committed to live in accordance with the purposes, obligations and virtues established in the medical profession. Cinematic art has shown only a superficial interest in complex aspects of medical profession. An exception is Ingmar Bergman's film "Wild Strawberries", where Professor Isak Borg, a widowed 76-year-old physician, is to be awarded the Doctor Jubilaris degree, 50 years after he received his doctorate at Lund University. During the trip, Isak is forced by a nightmare to reevaluate his professional life as not being a virtuous doctor.

Convolving engineering and medical pedagogies for training of tomorrow's health care professionals.

PubMed

Lee, Raphael C

2013-03-01

Several fundamental benefits justify why biomedical engineering and medicine should form a more convergent alliance, especially for the training of tomorrow's physicians and biomedical engineers. Herein, we review the rationale underlying the benefits. Biological discovery has advanced beyond the era of molecular biology well into today's era of molecular systems biology, which focuses on understanding the rules that govern the behavior of complex living systems. This has important medical implications. To realize cost-effective personalized medicine, it is necessary to translate the advances in molecular systems biology to higher levels of biological organization (organ, system, and organismal levels) and then to develop new medical therapeutics based on simulation and medical informatics analysis. Higher education in biological and medical sciences must adapt to a new set of training objectives. This will involve a shifting away from reductionist problem solving toward more integrative, continuum, and predictive modeling approaches which traditionally have been more associated with engineering science. Future biomedical engineers and MDs must be able to predict clinical response to therapeutic intervention. Medical education will involve engineering pedagogies, wherein basic governing rules of complex system behavior and skill sets in manipulating these systems to achieve a practical desired outcome are taught. Similarly, graduate biomedical engineering programs will include more practical exposure to clinical problem solving.

The inflammatory bowel disease live interinstitutional and interdisciplinary videoconference education (IBD LIVE) series.

PubMed

Regueiro, Miguel D; Greer, Julia B; Binion, David G; Schraut, Wolfgang H; Goyal, Alka; Keljo, David J; Cross, Raymond K; Williams, Emmanuelle D; Herfarth, Hans H; Siegel, Corey A; Oikonomou, Ioannis; Brand, Myron H; Hartman, Douglas J; Tublin, Mitchell E; Davis, Peter L; Baidoo, Leonard; Szigethy, Eva; Watson, Andrew R

2014-10-01

Managing patients with inflammatory bowel disease requires multidisciplinary coordination. Technological advances have enhanced access to care for patients and improved physician interactions. The primary aim of our project was to convene diverse institutions and specialties through a multisite virtual conferencing platform to discuss complex patient management. The case conference is designed to include multiple institutions to exchange ideas, review evidence-based data, and provide input on the management of patients with Crohn's disease and ulcerative colitis. Technology is supplied and coordinated by an information technology specialist and Chorus Call, Inc., an international teleconferencing service provider. The Inflammatory Bowel Disease Live Interinstitutional Interdisciplinary Videoconference Education (IBD LIVE) initiative is accredited by the University of Pittsburgh Medical Center (UPMC) Center for Continuing Education in the Health Sciences for 1 AMA PRA Category 1 Credit per weekly session. IBD LIVE began in 2009 comprising only adult gastroenterology and pediatric gastroenterology from UPMC Presbyterian and Children's Hospitals. Participation steadily increased from 5 sites in 2010 to 11 sites in 2014. Maximum attendance for a single conference was 73 participants with a median of 48. The Continuing Medical Education scores (1 = worst to 5 = best) have a high median overall score (4.6, range 3.2-5.0) with positive responses with regard to the degree to which the conference changed practice. IBD LIVE has been successful and continues to grow. Implementation of the Crohn's and Colitis Foundation of America Virtual Preceptor Program using the IBD LIVE platform will provide expanded national physician access to this professional education activity.

Talking with caregivers of children living in the community with ventricular assist devices.

PubMed

Petruik, Courtney; Mack, Cheryl; Conway, Jennifer; Buchholz, Holger; van Manen, Michael

2017-11-01

A VAD is a mechanical pump used to support the functioning of a failing heart. As a pediatric therapy, a VAD is used as a temporary solution for poor heart function, a bridge to transplantation or recovery, or a destination therapy. The goal of this qualitative study was to explore the perspectives of family and professional caregivers of children who are supported by VADs in outpatient settings. Semi-structured interviews were conducted with 22 caregivers of school-aged children discharged home on VAD support. Interviews were transcribed, and data were analyzed using qualitative content analysis. Caregivers identified issues facing children on VAD support in the contexts of home, school, and other childhood places including being physically connected to a device; experiencing changes; living a medical life; negotiating restrictions; cost of care; family, kinship, and community; and, present and future living. While a child with a VAD may have much in common with other medically complex children, the technological complications and risks of living with a VAD are uniquely identified by caregivers as an issue, especially when considering the way that children with a VAD are connected to their device-implanted yet exterior, mobile yet restricted, and autonomous yet dependent. © 2017 The Authors. Pediatric Transplantation Published by Wiley Periodicals, Inc.

Effects of Environmental Air Pollution on Pulmonary Function Level of Residents in Korean Industrial Complexes.

PubMed

Hong, Eunju; Lee, Seokwon; Kim, Geun-Bae; Kim, Tae-Jong; Kim, Hyoung-Wook; Lee, Kyoungho; Son, Bu-Soon

2018-04-24

This study aims to identify environmental air pollution adversely affecting pulmonary function among a community-based general population living in Korean industrial complexes. A total of 1963 residents participated in a pulmonary function test (PFT). The sample population consisted of an exposed group ( n = 1487) living within a radius of 5 km of industrial complexes and a control group ( n = 476) living over a radius of 10 km from the industrial complexes in Gwangyang and Yeosu cities. PFT results were calculated for each resident of the study population. On-site questionnaire surveys with face-to-face interviews were also conducted to collect more detailed information on personal lifestyles, medical history, exposure to air pollution, and respiratory disease and related symptoms. A total of 486 measured samples were collected by eight automated air-monitoring stations installed in four counties of Gwangyang and four counties of Yeosu in South Korea from January 2006 to February 2007. Mean levels of SO₂ (0.012 ppm), CO (0.648 ppm), NO₂ (0.02 ppm), O₃ (0.034 ppm), and PM 10 (43.07 μg/m³), collected within a radius of 5 km, were significantly higher than those collected over a radius of 10 km from Gwangyang and Yeosu industrial complexes. Prevalence odds ratio (OR) of abnormal pulmonary function in the exposed group of residents (<5 km) was elevated at 1.24 (95% CI 0.71⁻1.96), but not statistically significant ( p > 0.05). In multiple linear regression analysis, forced expiratory volume in one second (FEV₁) and forced vital capacity (FVC) levels significantly declined as SO₂, CO, and O₃ levels increased when adjusting for age, sex, body mass index (BMI), alcohol, smoking, secondhand smoke, and respiratory disease and related symptoms ( n = 1963) ( p < 0.05). These results suggest that exposure to air pollution affects pulmonary function levels of residents living in Korean industrial complexes.

Sympathetic blocks for the treatment of complex regional pain syndrome: A case series.

PubMed

Gungor, Semih; Aiyer, Rohit; Baykoca, Buse

2018-05-01

To present the successful treatment of complex regional pain syndrome type -1 utilizing sympathetic blocks. Severe pain interfering with activities of daily living and temporary disability secondary to complex regional pain syndrome. Complex regional pain syndrome type-1 with involvement of lower extremity (2 patients), and upper extremity (1 patient). We report the management of 3 patients with diagnosis of complex regional pain syndrome type-1 by early institution of sympathetic blocks for diagnostic and therapeutic purposes. All 3 patients were able to tolerate physical therapy only after adequate pain relief had been achieved with institution of sympathetic blocks. All 3 patients responded very favorably to sympathetic blocks with dramatic reversal of pathology. All patients reported almost complete resolution of pain, symptoms, and signs within 6 months duration after diagnosis of complex regional pain syndrome. All 3 patients were able to wean their pain medications and achieve normal activities of daily living without any significant limitations. All patients were able to return to full-time employment. Treatment options are limited and there is lack of high quality research regarding the efficacy of sympathetic blocks in the treatment of complex regional pain syndrome. As presented in this case series, sympathetic blocks maybe very effective in the treatment of complex regional pain syndrome in a subset of patients. Thus, early institution of sympathetic blocks should be considered in complex regional pain syndrome prior to physical therapy and consideration of more invasive pain management interventions.

Differential Vocational Rehabilitation Service Patterns Related to the Job Retention and Job-Seeking Needs of Individuals with Multiple Sclerosis

ERIC Educational Resources Information Center

Tansey, Timothy N.; Strauser, David; Frain, Michael P.; Bishop, Malachy; Chiu, Chung-Yi; Kaya, Cahit; Chan, Fong

2015-01-01

The experience of living with multiple sclerosis (MS) can have a profound effect on employment. The impact of MS is a complex interaction of personal, medical, functional, financial, and psychosocial variables that ultimately results in up to 80% of persons with MS leaving their jobs within 10 years of their diagnosis. The aim of this study was to…

End-of-life mental health assessments for older aged, medically ill persons with expressed desire to die.

PubMed

Weinberger, Linda E; Sreenivasan, Shoba; Garrick, Thomas

2014-01-01

In recent years, assisted suicide has been legalized in four states for those who are terminally ill and wish to end their lives with the assistance of lethal doses of medications prescribed by a physician. The ethics-related and legal questions raised by end-of-life suicide and decisional capacity to refuse treatment assessments are complex. In treating patients with end-stage medical conditions or disorders that severely affect the future quality of their lives, clinicians tend to engage in suicide prevention at all costs. Overriding the patient's expressed desire to die conflicts with another value, however, that of the individual's right to autonomy. We provide a framework for understanding these difficult decisions, by providing a review of the epidemiology of suicide in later life; reviewing findings from a unique dataset of suicides among the elderly obtained from the Los Angeles County Coroner's Office, as well as data from states with legalized assisted suicide; presenting a discussion of the two frameworks of suicidal ideation as a pathological versus an existential reaction; and giving a case example that highlights the dilemmas faced by clinicians addressing decisional capacity to refuse treatment in an elderly, medically ill patient who has expressed the wish to die. © 2014 American Academy of Psychiatry and the Law.

Communication challenges in complex medical environments.

PubMed

Lee, Jessica D; Hohler, Anna

2014-06-01

The provision of health care is becoming increasingly complex and can involve multiple providers and care setting transitions, particularly as the population is living longer, and often with chronic disease. The Electronic Health Record (EHR) was intended to provide a comprehensive documentation of a patient's health-related information; however, health care systems often function in isolation with EHRs that are unique only to that system. The EHR may also limit face-to-face communication between treating physicians within the same system. It is only with diligent effort that changes in medical management plans are conveyed among providers. When multiple providers are involved in a patient's care, physician-to-patient communication may also suffer, which can impact patient satisfaction and outcome. This article describes a scenario in which several lapses in communication occurred, and it outlines other common pitfalls while providing possible solutions for improving communication across the health care spectrum.

Understanding the health care utilization of children who require medical technology: A descriptive study of children who require tracheostomies.

PubMed

Spratling, Regena

2017-04-01

Children who require medical technology have complex chronic illnesses. This medical technology, including ventilators, oximeters, tracheostomy tubes, and feeding tubes, allows children and their families to live at home; however, the management of the children's care by informal caregivers is complex with the need for intensive, specialized care. The purpose of this study was to examine the sociodemographic and clinical characteristics that affect health care utilization in a population of children who require medical technology. A retrospective electronic health record (EHR) review was completed on the EHR records on 171 children who require medical technology, specifically tracheostomies, at an outpatient technology dependent pulmonary clinic over a three year period (January 2010-December 2012). Descriptive statistics were used to analyze sociodemographic and clinical characteristics, including medical diagnoses, and emergency department (ED) visits and hospitalizations. Of the 171 children requiring medical technology studied, there were numerous medical diagnoses (n=791), 99% had chronic illnesses affecting two or more body systems, and 88% required two or more technologies, including a tracheostomy and a feeding tube. In addition, 91% of the children had at least one ED visit or hospitalization and were treated in the ED approximately three times over the three year period. The findings from this study noted an increased utilization of health care by these children, and identified common symptoms and medical technologies for which caregivers may need interventions, focusing on education in managing symptoms and medical technology prior to presentation to the ED or hospital. Copyright © 2017 Elsevier Inc. All rights reserved.

Surgical Management of Neurogenic Lower Urinary Tract Dysfunction.

PubMed

Gor, Ronak A; Elliott, Sean P

2017-08-01

Surgery for patients with neurogenic urinary tract dysfunction (nLUTD) is indicated when medical therapy fails, to correct conditions affecting patient safety, or when surgery can enhance the quality of life better than nonoperative management. Examples include failure of maximal medical therapy, inability to perform or aversion to clean intermittent catheterization, refractory incontinence, and complications from chronic, indwelling catheters. Adults with nLUTD have competing risk factors, including previous operations, obesity, poor nutritional status, complex living arrangements, impaired dexterity/paralysis, and impaired executive and cognitive function. Complications are common in this subgroup of patients requiring enduring commitments from surgeons, patients, and their caretakers. Copyright © 2017 Elsevier Inc. All rights reserved.

Zolpidem ingestion, automatisms, and sleep driving: a clinical and legal case series.

PubMed

Poceta, J Steven

2011-12-15

To describe zolpidem-associated complex behaviors, including both daytime automatisms and sleep-related parasomnias. A case series of eight clinical patients and six legal defendants is presented. Patients presented to the author after an episode of confusion, amnesia, or somnambulism. Legal defendants were being prosecuted for driving under the influence, and the author reviewed the cases as expert witness for the defense. Potential predisposing factors including comorbidities, social situation, physician instruction, concomitant medications, and patterns of medication management were considered. Patients and defendants exhibited abnormal behavior characterized by poor motor control and confusion. Although remaining apparently interactive with the environment, all reported amnesia for 3 to 5 hours. In some cases, the episodes began during daytime wakefulness because of accidental or purposeful ingestion of the zolpidem and are considered automatisms. Other cases began after ingestion of zolpidem at the time of going to bed and are considered parasomnias. Risk factors for both wake and sleep-related automatic complex behaviors include the concomitant ingestion of other sedating drugs, a higher dose of zolpidem, a history of parasomnia, ingestion at times other than bedtime or when sleep is unlikely, poor management of pill bottles, and living alone. In addition, similar size and shape of two medications contributed to accidental ingestion in at least one case. Sleep driving and other complex behaviors can occur after zolpidem ingestion. Physicians should assess patients for potential risk factors and inquire about parasomnias. Serious legal and medical complications can occur as a result of these forms of automatic complex behaviors.

[Living wills under close scrutiny: Medical consultation is indispensable].

PubMed

Schöffner, M; Schmidt, K W; Benzenhöfer, U; Sahm, S

2012-03-01

Since September 2009 the handling of living wills has been regulated by law. Even though a medical consultation is not imperative for the drawing up of a living will, first surveys have shown that medical information about clinical pictures and treatment options lead to an important specification of living wills. For the first time in Germany, a questionnaire has been developed to investigate the impact of medical consultations on the content of living wills. It revealed that nearly all the people surveyed who had already drawn up a living will wished to change the content of their completed will after attending the seminar because the previous version was no longer in accordance with their wishes. In the light of the frequent difficulties in hospitals concerning how to apply a living will to an actual clinical situation, we believe structured medical consultations to be indispensable. © Georg Thieme Verlag KG Stuttgart · New York.

Donor recruitment and selection for adult-to-adult living donor liver transplantation in urgent and elective circumstances.

PubMed

Ben-Haim, Menahem; Carmiel, Michal; Lubezky, Nir; Keidar, Rivka; Katz, Paulina; Blachar, Arye; Nimrod, Adi; Sorkine, Patrick; Oren, Ran; Klausner, Joseph M; Nakache, Richard

2005-03-01

Adult-to-adult living donor liver transplantation is becoming an alternative to cadaveric transplantation in urgent and elective settings. Donor selection crucially affects donor safety and recipient outcome. To present our algorithm of urgent and elective donor selection. Urgent selection is expeditious and protocol-based. Elective selection permits a comprehensive process. Both include medical, psychosocial and surgical-anatomic evaluations. Liver volumes and vascular anatomy are evaluated with computerized tomographic angiography. Informed consent is obtained after painstaking explanations. Independent institutional committees review and approve all cases. Between July 2003 and June 2004 we evaluated 43 potential live donors for 12 potential recipients (fulminant hepatic failure, n = 5; chronic end-stage liver disease, n = 6; primary graft non-function, n = 1). Thirty-three candidates (76%) were excluded due to blood type incompatibility (n = 14, 42%), incompatible anatomy (n = 8, 24%)--including problematic volume distribution (n = 2) or vascular anatomy (n = 6)--psychosocial issues (n = 4, 12%), or medical co-morbidity (n = 7, 22%). Five recipients (FHF, n = 4; chronic ESLD, n = 1) were successfully transplanted from living donors. In the acute setting, two patients (FHF, PGNF) died in the absence of an appropriate donor (cadaveric or living donor). In the elective group, one patient died of unexpected variceal bleeding and one received a cadaveric graft just before the planned living donor transplantation was performed. One candidate was transplanted overseas and two cases are scheduled. The ratio of compatibility for donation was 34% (10/29) for blood type-compatible candidates. Donor selection for living donor liver transplantation is a complex, labor-intensive multidisciplinary process. Most exclusions are due to blood type incompatibility or anatomic details. Psychosocial aspects of these donations warrant special attention.

3D printing of bacteria into functional complex materials.

PubMed

Schaffner, Manuel; Rühs, Patrick A; Coulter, Fergal; Kilcher, Samuel; Studart, André R

2017-12-01

Despite recent advances to control the spatial composition and dynamic functionalities of bacteria embedded in materials, bacterial localization into complex three-dimensional (3D) geometries remains a major challenge. We demonstrate a 3D printing approach to create bacteria-derived functional materials by combining the natural diverse metabolism of bacteria with the shape design freedom of additive manufacturing. To achieve this, we embedded bacteria in a biocompatible and functionalized 3D printing ink and printed two types of "living materials" capable of degrading pollutants and of producing medically relevant bacterial cellulose. With this versatile bacteria-printing platform, complex materials displaying spatially specific compositions, geometry, and properties not accessed by standard technologies can be assembled from bottom up for new biotechnological and biomedical applications.

3D printing of bacteria into functional complex materials

PubMed Central

Schaffner, Manuel; Rühs, Patrick A.; Coulter, Fergal; Kilcher, Samuel; Studart, André R.

2017-01-01

Despite recent advances to control the spatial composition and dynamic functionalities of bacteria embedded in materials, bacterial localization into complex three-dimensional (3D) geometries remains a major challenge. We demonstrate a 3D printing approach to create bacteria-derived functional materials by combining the natural diverse metabolism of bacteria with the shape design freedom of additive manufacturing. To achieve this, we embedded bacteria in a biocompatible and functionalized 3D printing ink and printed two types of “living materials” capable of degrading pollutants and of producing medically relevant bacterial cellulose. With this versatile bacteria-printing platform, complex materials displaying spatially specific compositions, geometry, and properties not accessed by standard technologies can be assembled from bottom up for new biotechnological and biomedical applications. PMID:29214219

Learning by Living: Life-Altering Medical Education through Nursing Home-Based Experiential Learning

ERIC Educational Resources Information Center

Gugliucci, Marilyn R.; Weiner, Audrey

2013-01-01

The University of New England College of Osteopathic Medicine Learning by Living Project (referred to as Learning by Living) was piloted in 2006 as an experiential medical education learning model. Since its inception, medical and other health professions students have been "admitted" into nursing homes to live the life of an older adult nursing…

Computational high-resolution optical imaging of the living human retina

NASA Astrophysics Data System (ADS)

Shemonski, Nathan D.; South, Fredrick A.; Liu, Yuan-Zhi; Adie, Steven G.; Scott Carney, P.; Boppart, Stephen A.

2015-07-01

High-resolution in vivo imaging is of great importance for the fields of biology and medicine. The introduction of hardware-based adaptive optics (HAO) has pushed the limits of optical imaging, enabling high-resolution near diffraction-limited imaging of previously unresolvable structures. In ophthalmology, when combined with optical coherence tomography, HAO has enabled a detailed three-dimensional visualization of photoreceptor distributions and individual nerve fibre bundles in the living human retina. However, the introduction of HAO hardware and supporting software adds considerable complexity and cost to an imaging system, limiting the number of researchers and medical professionals who could benefit from the technology. Here we demonstrate a fully automated computational approach that enables high-resolution in vivo ophthalmic imaging without the need for HAO. The results demonstrate that computational methods in coherent microscopy are applicable in highly dynamic living systems.

A Qualitative Study of Providers’ Perception of Adherence of Women Living with HIV/AIDS in Puerto Rico

PubMed Central

Rivero-Méndez, Marta; Dawson-Rose, Carol S.; Solís-Báez, Solymar S.

2010-01-01

This study examines healthcare providers’ perceptions regarding experiences and factors that contribute to adherent and non-adherent behaviors to HIV treatment among women living with HIV infection in Puerto Rico and describes strategies implemented to improve adherence. Providers’ accounts revealed that women with HIV infection are living “beyond their strengths” attempting to reconcile the burden of the illness and keep adherent. Factors putting women beyond their strengths and influencing non-adherence behavior were: gender-related demands, fear of disclosure, and treatment complexity. Strategies to improve adherence included: ongoing assessment, education, collaborative work, support groups, networking, disguising pills, readiness, and seeking medications outside their towns. Provider-patient interactions are critical for women’s success and must assess all these factors in developing and providing health services. PMID:21243076

Becoming "Undetectable": Longitudinal Narratives of Gay Men's Sex Lives After a Recent HIV Diagnosis.

PubMed

Grace, Daniel; Chown, Sarah A; Kwag, Michael; Steinberg, Malcolm; Lim, Elgin; Gilbert, Mark

2015-08-01

We explore gay men's sex life narratives following their diagnosis with an acute or recent HIV infection. All participants received an acute (n = 13) or recent (n = 12) HIV diagnosis and completed a series of self-administered questionnaires and in-depth qualitative interviews over a one-year period or longer. Over the course of four qualitative interviews, participants frequently spoke of the role of medications (e.g., decisions to start treatment) and changing viral loads (e.g., discourses of becoming "undetectable") in relation to their sex lives since being diagnosed with HIV. Many men talked about milestones relating to initiating medication and viral load as informing their shifting sexual behaviors and identities as HIV-positive--or "undetectable"--gay men. The narratives of our participants provide insight regarding complex negotiations and processes of decision-making over time related to sex, counseling needs, treatment initiation, viral load, and the significance of undetectability as an emergent identity.

Can virtue be taught?

PubMed

Shelton, W

1999-06-01

Applying standards of virtue that define the "good doctor" in a complex and technologically sophisticated health care system is often challenging and sometimes confusing. What are the characteristics of a "good doctor," who wishes to live up to high ethical and professional standards but who also must live and work in a health care system in which moral ambiguity is pervasive? Medical educators are urgently faced with such questions as their schools try to equip students with the skills and capacities required of the virtuous physician. The author describes how Aristotelian concepts of virtue can be used to guide medical educators in defining and teaching virtue. He then discusses how such traits as the ability to tolerate moral differences and ambiguity, the ability to develop thoughtful individual moral positions, and the capacity to respect and understand various cultural traditions may be what might be considered virtues in today's health care system. A "good" doctor, then, would be someone who is thoughtful, fair-minded, respectful of differences, and committed to his or her professional values.

Case Report of Kidney Paired Donation (KPD) with Desensitization: the Strategy and Experience of 3-Way KPD in Samsung Medical Center.

PubMed

Oh, Dongkyu; Kang, Eun Suk; Yu, Shinae; Chun, Kyoungsuk; Huh, Wooseong; Jang, Hye Ryoun; Cho, Chan Woo; Lee, Nuri; Lee, Kyo Won; Park, Hyojun; Park, Jae Berm; Kim, Sung Joo

2018-01-29

As the need for the organ donation increases, strategies to increase kidney transplantation (KT) through expanded living donation have become essential. These include kidney paired donation (KPD) programs and desensitization in incompatible transplantations. KPD enables kidney transplant candidates with incompatible living donors to join a registry with other incompatible pairs in order to find potentially compatible living donor. Positive cross match and ABO incompatible transplantation has been successfully accomplished in selective cases with several pre-conditionings. Patients who are both difficult-to-match due to broad sensitization and hard-to-desensitize because of donor conditions can often be successfully transplanted through a combination of KPD and desensitization. According to the existing data, KPD can increase the number of KTs from living donors with excellent clinical results. This is also a cost-effective treatment as compared with dialysis and desensitization protocols. We carried out 3-way KPD transplantation with one highly sensitized, positive cross match pair and with two ABO incompatible pairs. Herein we report our first successful 3-way KPD transplantation in a single center. To maximize donor-recipient matching and minimize immunologic risk, KPD programs should use proper algorithms with desensitization to identify optimal donor with simultaneous two-, three- or more complex multi-way exchanges. © 2018 The Korean Academy of Medical Sciences.

Exploring staff diabetes medication knowledge and practices in regional residential care: triangulation study.

PubMed

Wellard, Sally Jane; Rasmussen, Bodil; Savage, Sally; Dunning, Trisha

2013-07-01

This study is drawn from a larger project that aimed to identify the staffing and organisational factors influencing the quality of diabetes care for older people living in residential care in regional Victoria, Australia. The focus of the current study is on medication management for residents with diabetes. With a continuous rise in diabetes in the population, there is an associated increase in the prevalence of diabetes in aged care residential settings. However, there is little specific guidance on how to manage diabetes in older people living in institutional settings who experience multiple concurrent chronic conditions. A triangulation strategy consisting of three phases. A one-shot cross-sectional survey (n = 68) focus group interviews and a case file audit (n = 20). Data were collected between May 2009-January 2010. Staff knowledge of diabetes and its contemporary medication management was found to be suboptimal. Challenges to managing residents with diabetes included limited time, resident characteristics and communication systems. Additionally, the variability in medical support available to residents and a high level of polypharmacy added to the complexity of medication management of resident. The current study suggests administering medicine to residents in aged care settings is difficult and has potentially serious medical, professional and economic consequences. Limitations to staff knowledge of contemporary diabetes care and medications potentially place residents with diabetes at risk of receiving less than optimal diabetes care. Providing evidence-based guidelines about diabetes care in residential care settings is essential to achieve acceptable outcomes and increase the quality of life for residents in public aged care. Continuing education programs in diabetes care specifically related to medication must be provided to all health professionals and encompass scope of practice. © 2013 John Wiley & Sons Ltd.

Organ Harvesting and Transplants

ERIC Educational Resources Information Center

Baskette, Kimberly G.; Ritz, John M.

2010-01-01

Humans and animals need healthy organs to live. Due to medical conditions and accidents, some organs fail to function properly. For these reasons, the medical community has experimented and can now perform successful organ transplants, allowing patients to continue to live their lives. Many countries have medical programs where individuals can…

Microorganisms living on macroalgae: diversity, interactions, and biotechnological applications.

PubMed

Martin, Marjolaine; Portetelle, Daniel; Michel, Gurvan; Vandenbol, Micheline

2014-04-01

Marine microorganisms play key roles in every marine ecological process, hence the growing interest in studying their populations and functions. Microbial communities on algae remain underexplored, however, despite their huge biodiversity and the fact that they differ markedly from those living freely in seawater. The study of this microbiota and of its relationships with algal hosts should provide crucial information for ecological investigations on algae and aquatic ecosystems. Furthermore, because these microorganisms interact with algae in multiple, complex ways, they constitute an interesting source of novel bioactive compounds with biotechnological potential, such as dehalogenases, antimicrobials, and alga-specific polysaccharidases (e.g., agarases, carrageenases, and alginate lyases). Here, to demonstrate the huge potential of alga-associated organisms and their metabolites in developing future biotechnological applications, we first describe the immense diversity and density of these microbial biofilms. We further describe their complex interactions with algae, leading to the production of specific bioactive compounds and hydrolytic enzymes of biotechnological interest. We end with a glance at their potential use in medical and industrial applications.

Fostering a "Feeling of Worth" Among Vulnerable HIV Populations: The Role of Linkage to Care Specialists.

PubMed

Broaddus, Michelle R; Owczarzak, Jill; Schumann, Casey; Koester, Kimberly A

2017-10-01

To address barriers to adequate engagement in medical care among people living with HIV, Wisconsin's AIDS/HIV Program created a new position, the Linkage to Care (LTC) Specialist. Specialists provide intensive, short-term case management and patient navigation services for small caseloads of individuals at high risk of disengaging with medical care. Clients are eligible if they are newly diagnosed with HIV or new to medical care, recently released from incarceration, recently out of care, nonadherent to scheduled medical care visits, or have detectable viral load while in care. Interviews with 30 clients of Specialists were conducted to understand experiences with the program and medical care. Common themes included the ability of Specialists to navigate complex systems of care and support services, the unique role Specialists played in their clients' lives, and the challenges of transitioning out of the program. Although the primary goal of Specialists is to address barriers to medical care, they often adopted a holistic approach that also included housing, financial assistance, and other social determinants of health. Descriptions of the Specialist's role in implementation manuals focus on their functional roles and the services provided. However, clients often discussed the emotional support they received, especially for clients without strong social support networks. Many clients also desired an ongoing relationship with their Specialists even after discharge, but had been able to establish independence and self-efficacy. The LTC Specialists are resource-intensive considering their small caseloads, but fill an important gap in existing, often overtaxed case management systems.

Do Medical Students' Narrative Representations of "The Good Doctor" Change Over Time? Comparing Humanism Essays From a National Contest in 1999 and 2013.

PubMed

Rutberg, Pooja C; King, Brandy; Gaufberg, Elizabeth; Brett-MacLean, Pamela; Dinardo, Perry; Frankel, Richard M

2017-04-01

To explore medical students' conceptions of "the good doctor" at two points in time separated by 14 years. The authors conducted qualitative analysis of narrative-based essays. Following a constant comparative method, an emergent relational coding scheme was developed which the authors used to characterize 110 essays submitted to the Arnold P. Gold Foundation Humanism in Medicine Essay Contest in 1999 (n = 50) and 2013 (n = 60) in response to the prompt, "Who is the good doctor?" The authors identified five relational themes as guiding the day-to-day work and lives of physicians: doctor-patient, doctor-self, doctor-learner, doctor-colleague, and doctor-system/society/profession. The authors noted a highly similar distribution of primary and secondary relational themes for essays from 1999 and 2013. The majority of the essays emphasized the centrality of the doctor-patient relationship. Student essays focused little on teamwork, systems innovation, or technology use-all important developments in contemporary medicine. Medical students' narrative reflections are increasingly used as rich sources of information about the lived experience of medical education. The findings reported here suggest that medical students understand the "good doctor" as a relational being, with an enduring emphasis on the doctor-patient relationship. Medical education would benefit from including an emphasis on the relational aspects of medicine. Future research should focus on relational learning as a pedagogical approach that may support the formation of caring, effective physicians embedded in a complex array of relationships within clinical, community, and larger societal contexts.

[Medico-social aspects of AIDS].

PubMed

Rabitti, G; Stati, A; Del Bove Orlandi, G; Gallese, A

1992-01-01

The AIDS crisis has brought us face to face with complex medical and social challenges unparalleled in this century. The magnitude of this tragic epidemic is measured not only in the cost in human lives, but also the enormous financial burdens of health care and lost productivity which each and every one of us, as well as future generations, will ultimately bear. This article presents an opportunity to explore a variety of health, social, economic, juridical and working issues of AIDS.

Benefits of adherence to psychotropic medications on depressive symptoms and antiretroviral medication adherence among men and women living with HIV/AIDS.

PubMed

Cruess, Dean G; Kalichman, Seth C; Amaral, Christine; Swetzes, Connie; Cherry, Chauncey; Kalichman, Moira O

2012-04-01

Psychotropic medications are commonly used for depressive symptoms among people living with HIV/AIDS. We examined the relationships between adherence to psychotropic medications, depressive symptoms, and antiretroviral adherence. We assessed depressive symptoms among 324 people living with HIV/AIDS across a 3-month period (70% men; mean age 45 years; 90% African-American). Psychotropic and antiretroviral adherence was assessed using monthly, unannounced telephone pill counts. Multiple-regression and mediation analyses were utilized to examine associations under investigation. Greater depressive symptoms were associated with lower antiretroviral and psychotropic medication adherence. Greater adherence to psychotropic medications regardless of medication class was positively related to higher antiretroviral adherence. Greater adherence to psychotropic medications also significantly mediated the association between depressive symptoms and antiretroviral adherence. This study demonstrates the benefits of adherence to psychotropic medications on both depressive symptoms and antiretroviral adherence. Future work examining psychotropic medication adherence on disease outcomes in people living with HIV/AIDS is warranted.

Exploring the lived experience of adults using prescription opioids to manage chronic noncancer pain

PubMed Central

Brooks, Erica A; Unruh, Anita; Lynch, Mary E

2015-01-01

BACKGROUND: Chronic noncancer pain (CNCP) and prescription opioid use is a highly complex and growing health care issue in Canada. Many quantitative research studies have investigated the effectiveness of opioids for chronic pain; however, gaps remain in the literature regarding the personal experience of using opioids and their impact on those experiencing CNCP. OBJECTIVE: To explore the lived experience of adults using prescription opioids to manage CNCP, focusing on how opioid medication affected their daily lives. METHODS: In-depth qualitative interviews were conducted with nine adults between 40 and 68 years of age who were using prescription opioids daily for CNCP. Interviews were audiorecorded and transcribed, and subsequently analyzed using interpretive phenomenological analysis. RESULTS: Six major themes identified positive and negative aspects of opioid use associated with social, physical, emotional and psychological dimensions of pain management. These themes included the process of decision making, and physical and psychosocial consequences of using opioids including pharmacological side effects, feeling stigmatized, guilt, fears, ambivalence, self-protection and acceptance. CONCLUSION: Although there were many negative aspects to using opioids daily, the positive effects outweighed the negative for most participants and most of the negative aspects were socioculturally induced rather than caused by the drug itself. The present study highlighted the complexities involved in using prescription opioids daily for management of CNCP for individuals living with pain. PMID:25562838

Worms and the Treatment of Inflammatory Bowel Disease: Are Molecules the Answer?

PubMed Central

Ruyssers, Nathalie E.; De Winter, Benedicte Y.; De Man, Joris G.; Loukas, Alex; Herman, Arnold G.; Pelckmans, Paul A.; Moreels, Tom G.

2008-01-01

The lack of exposure to helminth infections, as a result of improved living standards and medical conditions, may have contributed to the increased incidence of IBD in the developed world. Epidemiological, experimental, and clinical data sustain the idea that helminths could provide protection against IBD. Studies investigating the underlying mechanisms by which helminths might induce such protection have revealed the importance of regulatory pathways, for example, regulatory T-cells. Further investigation on how helminths influence both innate and adaptive immune reactions will shed more light on the complex pathways used by helminths to regulate the hosts immune system. Although therapy with living helminths appears to be effective in several immunological diseases, the disadvantages of a treatment based on living parasites are explicit. Therefore, the identification and characterization of helminth-derived immunomodulatory molecules that contribute to the protective effect could lead to new therapeutic approaches in IBD and other immune diseases. PMID:18509490

Zolpidem Ingestion, Automatisms, and Sleep Driving: A Clinical and Legal Case Series

PubMed Central

Poceta, J. Steven

2011-01-01

Study Objectives: To describe zolpidem-associated complex behaviors, including both daytime automatisms and sleep-related parasomnias. Methods: A case series of eight clinical patients and six legal defendants is presented. Patients presented to the author after an episode of confusion, amnesia, or somnambulism. Legal defendants were being prosecuted for driving under the influence, and the author reviewed the cases as expert witness for the defense. Potential predisposing factors including comorbidities, social situation, physician instruction, concomitant medications, and patterns of medication management were considered. Results: Patients and defendants exhibited abnormal behavior characterized by poor motor control and confusion. Although remaining apparently interactive with the environment, all reported amnesia for 3 to 5 hours. In some cases, the episodes began during daytime wakefulness because of accidental or purposeful ingestion of the zolpidem and are considered automatisms. Other cases began after ingestion of zolpidem at the time of going to bed and are considered parasomnias. Risk factors for both wake and sleep-related automatic complex behaviors include the concomitant ingestion of other sedating drugs, a higher dose of zolpidem, a history of parasomnia, ingestion at times other than bedtime or when sleep is unlikely, poor management of pill bottles, and living alone. In addition, similar size and shape of two medications contributed to accidental ingestion in at least one case. Conclusions: Sleep driving and other complex behaviors can occur after zolpidem ingestion. Physicians should assess patients for potential risk factors and inquire about parasomnias. Serious legal and medical complications can occur as a result of these forms of automatic complex behaviors. Citation: Poceta JS. Zolpidem ingestion, automatisms, and sleep driving: a clinical and legal case series. J Clin Sleep Med 2011;7(6):632-638. PMID:22171202

Multimodal US-gamma imaging using collaborative robotics for cancer staging biopsies.

PubMed

Esposito, Marco; Busam, Benjamin; Hennersperger, Christoph; Rackerseder, Julia; Navab, Nassir; Frisch, Benjamin

2016-09-01

The staging of female breast cancer requires detailed information about the level of cancer spread through the lymphatic system. Common practice to obtain this information for patients with early-stage cancer is sentinel lymph node (SLN) biopsy, where LNs are radioactively identified for surgical removal and subsequent histological analysis. Punch needle biopsy is a less invasive approach but suffers from the lack of combined anatomical and nuclear information. We present and evaluate a system that introduces live collaborative robotic 2D gamma imaging in addition to live 2D ultrasound to identify SLNs in the surrounding anatomy. The system consists of a robotic arm equipped with both a gamma camera and a stereoscopic tracking system that monitors the position of an ultrasound probe operated by the physician. The arm cooperatively places the gamma camera parallel to the ultrasound imaging plane to provide live multimodal visualization and guidance. We validate the system by evaluating the target registration errors between fused nuclear and US image data in a phantom consisting of two spheres, one of which is filled with radioactivity. Medical experts perform punch biopsies on agar-gelatine phantoms with complex configurations of hot and cold lesions to provide a qualitative and quantitative evaluation of the system. The average point registration error for the overlay is [Formula: see text] mm. The time of the entire procedure was reduced by 36 %, with 80v of the biopsies being successful. The users' feedback was very positive, and the system was deemed to be very intuitive, with handling similar to classic US-guided needle biopsy. We present and evaluate the first medical collaborative robotic imaging system. Feedback from potential users for SLN punch needle biopsy is encouraging. Ongoing work investigates the clinical feasibility with more complex and realistic phantoms.

Three-dimensional bio-printing.

PubMed

Gu, Qi; Hao, Jie; Lu, YangJie; Wang, Liu; Wallace, Gordon G; Zhou, Qi

2015-05-01

Three-dimensional (3D) printing technology has been widely used in various manufacturing operations including automotive, defence and space industries. 3D printing has the advantages of personalization, flexibility and high resolution, and is therefore becoming increasingly visible in the high-tech fields. Three-dimensional bio-printing technology also holds promise for future use in medical applications. At present 3D bio-printing is mainly used for simulating and reconstructing some hard tissues or for preparing drug-delivery systems in the medical area. The fabrication of 3D structures with living cells and bioactive moieties spatially distributed throughout will be realisable. Fabrication of complex tissues and organs is still at the exploratory stage. This review summarize the development of 3D bio-printing and its potential in medical applications, as well as discussing the current challenges faced by 3D bio-printing.

Domestic Minor Sex Trafficking Patients: A Retrospective Analysis of Medical Presentation.

PubMed

Goldberg, Amy P; Moore, Jessica L; Houck, Christopher; Kaplan, Dana M; Barron, Christine E

2017-02-01

To describe the clinical characteristics of patients referred for domestic minor sex trafficking (DMST) to improve identification and intervention. Retrospective cohort study. The Lawrence A. Aubin, Sr Child Protection Center at Hasbro Children's Hospital where patients are evaluated by child abuse pediatricians in outpatient, emergency department, and inpatient settings. A total of 41 patients younger than the age of 18 years referred for the evaluation of DMST involvement between August 1, 2013 and March 30, 2015. We collected demographic, social-environmental, medical, and psychiatric variables from the medical records of patients referred for evaluation who have self-disclosed, been reported with evidence, and/or have histories that place them at high risk for DMST involvement. Children had frequent contact with medical providers, with 81% seen in the year before referral for DMST. Childhood maltreatment and family dysfunction were identified (sexual abuse, 21/37 or 57%; parental substance abuse, 22/37 or 60%) in the 41 patients. Children had medical problems (eg, sexually transmitted infection, 13/41 or 32%), psychiatric needs (eg, acute suicidality, 8/41 or 20%; at least 1 previous psychiatric admission, 19/41 or 46%), and substance use (36/41 or 88%). Although 26/41 (63%) had runaway and 17/41 (42%) lived in a group home placement, 28/41 (68%) currently lived at home and 29/41 (71%) presented with a parent/guardian or relative. Children referred for DMST present frequently to physicians and have complex medical and psychiatric needs. Medical providers' increased awareness of this health issue would inform victim identification and intervention. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Proper care for the dying: a critical public issue.

PubMed Central

Crispell, K R; Gomez, C F

1987-01-01

The ability of the medical profession to sustain life, or more appropriately, to prolong dying, in patients with terminal illness, creates a most complex and controversial situation for all involved: the patient, if mentally alert; the patient's family; and the medical care team including physicians, nurses and attendants. This situation is especially complex in large acute care hospitals where medical and nursing students, residents and house officers receive advanced medical training. A major problem, prolonging the dying of the terminally ill, with its medical, legal, ethical and economic complexities now confronts American society. The problem is particularly acute in teaching hospitals, in which one finds a disproportionate number of terminally ill patients. The ability to work at these questions as a community rather than as adversaries will determine much about the ability of the health care system to respect the dignity and autonomy of those who seek aid and comfort when faced with serious illness and impending death. Better communication between the physicians, health care providers, the lawyers and ethicists must be developed in order to solve these problems. Over the next ten years society and our elected representatives will be making very demanding decisions about the use of the health dollar. One possible way to prevent increasing costs is to reach significant agreement on the proper care of the dying. Proper care for the dying is being considered, discussed, and evaluated by very thoughtful people. It is not governments which should decide who is to live or who is to die. There is the serious problem of the 'slippery slope' to euthanasia by omission if cost containment becomes the major force in formulating policy on the proper care of the dying. PMID:3612698

Infection prevention and control standards in assisted living facilities: are residents' needs being met?

PubMed

Kossover, Rachel A; Chi, Carolyn J; Wise, Matthew E; Tran, Alvin H; Chande, Neha D; Perz, Joseph F

2014-01-01

Assisted living facilities (ALFs) provide housing and care to persons unable to live independently, and who often have increasing medical needs. Disease outbreaks illustrate challenges of maintaining adequate resident protections in these facilities. Describe current state laws on assisted living admissions criteria, medical oversight, medication administration, vaccination requirements, and standards for infection control training. We abstracted laws and regulations governing assisted living facilities for the 50 states using a structured abstraction tool. Selected characteristics were compared according to the time period in which the regulation took effect. Selected state health departments were queried regarding outbreaks identified in assisted living facilities. Of the 50 states, 84% specify health-based admissions criteria to assisted living facilities; 60% require licensed health care professionals to oversee medical care; 88% specifically allow subcontracting with outside entities to provide routine medical services onsite; 64% address medication administration by assisted living facility staff; 54% specify requirements for some form of initial infection control training for all staff; 50% require reporting of disease outbreaks to the health department; 18% specify requirements to offer or require vaccines to staff; 30% specify requirements to offer or require vaccines to residents. Twelve states identified approximately 1600 outbreaks from 2010 to 2013, with influenza or norovirus infections predominating. There is wide variation in how assisted living facilities are regulated in the United States. States may wish to consider regulatory changes that ensure safe health care delivery, and minimize risks of infections, outbreaks of disease, and other forms of harm among assisted living residents. Published by Elsevier Inc.

Image-guided tissue engineering of anatomically shaped implants via MRI and micro-CT using injection molding.

PubMed

Ballyns, Jeffery J; Gleghorn, Jason P; Niebrzydowski, Vicki; Rawlinson, Jeremy J; Potter, Hollis G; Maher, Suzanne A; Wright, Timothy M; Bonassar, Lawrence J

2008-07-01

This study demonstrates for the first time the development of engineered tissues based on anatomic geometries derived from widely used medical imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI). Computer-aided design and tissue injection molding techniques have demonstrated the ability to generate living implants of complex geometry. Due to its complex geometry, the meniscus of the knee was used as an example of this technique's capabilities. MRI and microcomputed tomography (microCT) were used to design custom-printed molds that enabled the generation of anatomically shaped constructs that retained shape throughout 8 weeks of culture. Engineered constructs showed progressive tissue formation indicated by increases in extracellular matrix content and mechanical properties. The paradigm of interfacing tissue injection molding technology can be applied to other medical imaging techniques that render 3D models of anatomy, demonstrating the potential to apply the current technique to engineering of many tissues and organs.

Impact of living mulches on the physical properties of Planosol in monocropped maize cultivation

NASA Astrophysics Data System (ADS)

Romaneckas, Kęstutis; Adamavičienė, Aida; Šarauskis, Egidijus; Kriaučiūnienė, Zita; Marks, Marek; Vaitauskienė, Kristina

2018-04-01

The complex mutual interactions between soil properties and plants in high-biodiversity mono-cropping agro ecosystems have not been widely investigated. For this purpose, during 2009-2011, a stationary field experiment was conducted at the Experimental Station of the Aleksandras Stulginskis University to establish the effect of a multi-component agrocenose (maize, living mulch, weeds) on the physical properties of the soil. Spring oilseed rape, white mustard, spring barley, Italian ryegrass, black medic, Persian clover and red clover were sown as living mulch into maize inter-rows. The stability of >1.0 mm aggregates increased between the beginning and end of the maize vegetative period in almost all of the crops containing living mulch. The greatest competition for moisture content between the inter-crops and maize was observed at the beginning of the vegetative period because of living mulches of long growing seasons using the most moisture. In many cases, the shear strength of the soil was significantly reduced by the living mulch in the middle of summer, when it covered the maize inter-rows. These findings show that the monocropping of maize with living mulch stabilises or improves the physical characteristics of the soil, highlighting its potential for sustainable maize growing.

A novel medical image data-based multi-physics simulation platform for computational life sciences.

PubMed

Neufeld, Esra; Szczerba, Dominik; Chavannes, Nicolas; Kuster, Niels

2013-04-06

Simulating and modelling complex biological systems in computational life sciences requires specialized software tools that can perform medical image data-based modelling, jointly visualize the data and computational results, and handle large, complex, realistic and often noisy anatomical models. The required novel solvers must provide the power to model the physics, biology and physiology of living tissue within the full complexity of the human anatomy (e.g. neuronal activity, perfusion and ultrasound propagation). A multi-physics simulation platform satisfying these requirements has been developed for applications including device development and optimization, safety assessment, basic research, and treatment planning. This simulation platform consists of detailed, parametrized anatomical models, a segmentation and meshing tool, a wide range of solvers and optimizers, a framework for the rapid development of specialized and parallelized finite element method solvers, a visualization toolkit-based visualization engine, a Python scripting interface for customized applications, a coupling framework, and more. Core components are cross-platform compatible and use open formats. Several examples of applications are presented: hyperthermia cancer treatment planning, tumour growth modelling, evaluating the magneto-haemodynamic effect as a biomarker and physics-based morphing of anatomical models.

Assessment of older adults' knowledge of and preferences for medication management tools and support systems.

PubMed

Lakey, Susan L; Gray, Shelly L; Borson, Soo

2009-06-01

A variety of strategies are available to assist older adults who have difficulties managing medications. Little is known about older adults' knowledge of or willingness to use these strategies. To assess older adults' current use of, knowledge of, and preferences for medication management tools and supports. A cross-sectional study was conducted at a continuing care retirement community. All 152 independent-living residents were approached for participation. We developed a 6-page survey to gather information about knowledge of and preferences for medication management tools (eg, medi-sets, bubblepacks) and supports (eg, family, caregivers, regimen simplification). Information on demographic variables, medication management capacity, cognition, self-reported difficulty taking medications, and medication use were collected along with survey answers during an in-home interview. chi(2) and t-tests were used to compare knowledge and preferences by complexity and organizer use. Our sample consisted of 109 participants ranging in age from 73 to 98 years (average 85.9). Most of the subjects were well educated (average 15.5 y of education), 98% were white, and 80% were female. The majority (82%) were using a medication tool, mainly simple, self-filled medi-sets (62%) and easy-open vials (55%). Knowledge about, use of, and preferences for other devices, including pharmacist-filled tools and programmable devices, were low. Participants who used medication organizers rated self-filled medi-sets higher than did non-users (4.7 vs 1.6; p < 0.01). Only 18% of participants had asked a provider to simplify their medications, while 40% did not realize that they could do so. Of those who did ask a provider, 80% asked a physician. Educational strategies are needed to increase awareness of the pharmacist's role in facilitating medication management and the option of simplifying complex regimens. It is within the scope of pharmacy to provide this type of medication education.

Technology transfer from havana hospitals to primary care: yamila de armas, MD. Deputy director, provincial health department, havana city province.

PubMed

Giraldo, Gloria

2009-01-01

Dr Yamila de Armas has occupied an array of posts since finishing her residency in family medicine in her home province of Cienfuegos in 1992. She has served as a family doctor; polyclinic, municipal and provincial health director; medical school dean; and twice vice minister of public health. But few would doubt her toughest job is the one she has now: deputy director of the Havana City Provincial Health Department, in charge of medical services for the 2.2 million people living in Cuba's complex, sprawling capital. It was here in 2002-2003 that the program was launched to repair, refurbish and expand the country's nearly 500 community polyclinics. Key to the effort was equipping these facilities with a broader range of new and upgraded medical technology. Dr de Armas offers MEDICC Review her reflections on the results five years later.

Assisted living nursing practice: medication management: part 2 supervision and monitoring of medication administration by unlicensed assistive personnel.

PubMed

Mitty, Ethel; Flores, Sandi

2007-01-01

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.

Differences between paediatric and adult presentation of ESKD in attainment of adult social goals.

PubMed

Lewis, Helen; Marks, Stephen D

2014-12-01

Living with end-stage kidney disease (ESKD) is complex for young adults who experience difficulties with adherence to medications and attainment of social markers of adulthood. We studied adult outcomes (education, employment and accommodation) and evaluated adherence in young adults (age 16-30 years) according to paediatric (<16 years) and adult presentation (16-30 years) of ESKD. Initial questionnaire surveys were undertaken with patients (n = 931) identified from the databases of 12 adult and two paediatric nephrology programmes in England. Young adults (n = 296, 52 % male, 79 % Caucasian and 73 % with functioning renal allograft) with a mean age at first presentation of ESKD and current age of 17 and 25 years, respectively, were surveyed, of whom 5 % still attended paediatric services. Outcomes of patients aged >23 years and in stable health (n = 146) were compared between paediatric and adult presentation, with 30 and 20 % of patients, respectively, registered as disabled (p = 0.02). Educational attainment, based on percentage of those not achieving the General Certificate of Secondary Education (GCSE) level for England, was lower in the paediatric presentation group than in the adult one (7 vs. 18 %, respectively; p = 0.04). Compared to adult presentation patients, paediatric presentation patients were less likely to have full or part time paid work (57 vs. 76 %; p = 0.2). They also tended to be less likely to be living independently, less likely to be living with a partner, and, if living with their parents, more likely to be living in rented accommodation. Only 10 % patients missed taking medication weekly or more often. A higher frequency of missing medication was related to dialysis patients (p = 0.05), who assigned lower importance to taking medication (p < 0.001). However, patients aged <23 years attached less importance to complying with advice about treatment and health (p = 0.02), especially those who presented with ESKD during childhood (p = 0.01). Among our study cohort, young adults who presented with ESKD during childhood have poorer social and educational attainment compared to their counterparts who presented in adulthood. Adherence to medications remains important to ESKD patients. However, young adults wish to have personal control over their own life and health and need additional support and healthcare advice from the multi-disciplinary team. Qualitative work is required to understand the meaning of these outcomes on the quality of life for each individual patient.

Understanding dynamic changes in live cell adhesion with neutron reflectometry

PubMed Central

JUNGHANS, ANN; WALTMAN, MARY JO; SMITH, HILLARY L.; POCIVAVSEK, LUKA; ZEBDA, NOUREDDINE; BIRUKOV, KONSTANTIN; VIAPIANO, MARIANO; MAJEWSKI, JAROSLAW

2015-01-01

Neutron reflectometry (NR) was used to examine various live cells adhesion to quartz substrates under different environmental conditions, including flow stress. To the best of our knowledge, these measurements represent the first successful visualization and quantization of the interface between live cells and a substrate with sub-nanometer resolution. In our first experiments, we examined live mouse fibroblast cells as opposed to past experiments using supported lipids, proteins, or peptide layers with no associated cells. We continued the NR studies of cell adhesion by investigating endothelial monolayers and glioblastoma cells under dynamic flow conditions. We demonstrated that neutron reflectometry is a powerful tool to study the strength of cellular layer adhesion in living tissues, which is a key factor in understanding the physiology of cell interactions and conditions leading to abnormal or disease circumstances. Continuative measurements, such as investigating changes in tumor cell – surface contact of various glioblastomas, could impact advancements in tumor treatments. In principle, this can help us to identify changes that correlate with tumor invasiveness. Pursuit of these studies can have significant medical impact on the understanding of complex biological problems and their effective treatment, e.g. for the development of targeted anti-invasive therapies. PMID:25705067

Cumulative burden of comorbid mental disorders, substance use disorders, chronic medical conditions, and poverty on health among adults in the U.S.A.

PubMed

Walker, Elizabeth Reisinger; Druss, Benjamin G

2017-07-01

The health of individuals in the U.S.A. is increasingly being defined by complexity and multimorbidity. We examined the patterns of co-occurrence of mental illness, substance abuse/dependence, and chronic medical conditions and the cumulative burden of these conditions and living in poverty on self-rated health. We conducted a secondary data analysis using publically-available data from the National Survey on Drug Use and Health (NSDUH), which is an annual nationally-representative survey. Pooled data from the 2010-2012 NSDUH surveys included 115,921 adults 18 years of age or older. The majority of adults (52.2%) had at least one type of condition (mental illness, substance abuse/dependence, or chronic medical conditions), with substantial overlap across the conditions. 1.2%, or 2.2 million people, reported all three conditions. Generally, as the number of conditions increased, the odds of reporting worse health also increased. The likelihood of reporting fair/poor health was greatest for people who reported AMI, chronic medical conditions, and poverty (AOR = 9.41; 95% CI: 7.53-11.76), followed by all three conditions and poverty (AOR = 9.32; 95% CI: 6.67-13.02). For each combination of conditions, the addition of poverty increased the likelihood of reporting fair/poor health. Traditional conceptualizations of multimorbidity should be expanded to take into account the complexities of co-occurrence between mental illnesses, chronic medical conditions, and socioeconomic factors.

My Lived Experiences Are More Important Than Your Probabilities: The Role of Individualized Risk Estimates for Decision Making about Participation in the Study of Tamoxifen and Raloxifene (STAR).

PubMed

Holmberg, Christine; Waters, Erika A; Whitehouse, Katie; Daly, Mary; McCaskill-Stevens, Worta

2015-11-01

Decision-making experts emphasize that understanding and using probabilistic information are important for making informed decisions about medical treatments involving complex risk-benefit tradeoffs. Yet empirical research demonstrates that individuals may not use probabilities when making decisions. To explore decision making and the use of probabilities for decision making from the perspective of women who were risk-eligible to enroll in the Study of Tamoxifen and Raloxifene (STAR). We conducted narrative interviews with 20 women who agreed to participate in STAR and 20 women who declined. The project was based on a narrative approach. Analysis included the development of summaries of each narrative, and thematic analysis with developing a coding scheme inductively to code all transcripts to identify emerging themes. Interviewees explained and embedded their STAR decisions within experiences encountered throughout their lives. Such lived experiences included but were not limited to breast cancer family history, a personal history of breast biopsies, and experiences or assumptions about taking tamoxifen or medicines more generally. Women's explanations of their decisions about participating in a breast cancer chemoprevention trial were more complex than decision strategies that rely solely on a quantitative risk-benefit analysis of probabilities derived from populations In addition to precise risk information, clinicians and risk communicators should recognize the importance and legitimacy of lived experience in individual decision making. © The Author(s) 2015.

The utility of live video capture to enhance debriefing following transcatheter aortic valve replacement.

PubMed

Seamans, David P; Louka, Boshra F; Fortuin, F David; Patel, Bhavesh M; Sweeney, John P; Lanza, Louis A; DeValeria, Patrick A; Ezrre, Kim M; Ramakrishna, Harish

2016-10-01

The surgical and procedural specialties are continually evolving their methods to include more complex and technically difficult cases. These cases can be longer and incorporate multiple teams in a different model of operating room synergy. Patients are frequently older, with comorbidities adding to the complexity of these cases. Recording of this environment has become more feasible recently with advancement in video and audio capture systems often used in the simulation realm. We began using live capture to record a new procedure shortly after starting these cases in our institution. This has provided continued assessment and evaluation of live procedures. The goal of this was to improve human factors and situational challenges by review and debriefing. B-Line Medical's LiveCapture video system was used to record successive transcatheter aortic valve replacement (TAVR) procedures in our cardiac catheterization/laboratory. An illustrative case is used to discuss analysis and debriefing of the case using this system. An illustrative case is presented that resulted in long-term changes to our approach of these cases. The video capture documented rare events during one of our TAVR procedures. Analysis and debriefing led to definitive changes in our practice. While there are hurdles to the use of this technology in every institution, the role for the ongoing use of video capture, analysis, and debriefing may play an important role in the future of patient safety and human factors analysis in the operating environment.

The utility of live video capture to enhance debriefing following transcatheter aortic valve replacement

PubMed Central

Seamans, David P.; Louka, Boshra F.; Fortuin, F. David; Patel, Bhavesh M.; Sweeney, John P.; Lanza, Louis A.; DeValeria, Patrick A.; Ezrre, Kim M.; Ramakrishna, Harish

2016-01-01

Background: The surgical and procedural specialties are continually evolving their methods to include more complex and technically difficult cases. These cases can be longer and incorporate multiple teams in a different model of operating room synergy. Patients are frequently older, with comorbidities adding to the complexity of these cases. Recording of this environment has become more feasible recently with advancement in video and audio capture systems often used in the simulation realm. Aims: We began using live capture to record a new procedure shortly after starting these cases in our institution. This has provided continued assessment and evaluation of live procedures. The goal of this was to improve human factors and situational challenges by review and debriefing. Setting and Design: B-Line Medical's LiveCapture video system was used to record successive transcatheter aortic valve replacement (TAVR) procedures in our cardiac catheterization/laboratory. An illustrative case is used to discuss analysis and debriefing of the case using this system. Results and Conclusions: An illustrative case is presented that resulted in long-term changes to our approach of these cases. The video capture documented rare events during one of our TAVR procedures. Analysis and debriefing led to definitive changes in our practice. While there are hurdles to the use of this technology in every institution, the role for the ongoing use of video capture, analysis, and debriefing may play an important role in the future of patient safety and human factors analysis in the operating environment. PMID:27762242

Self-Reported Goals of Older Patients with Type 2 Diabetes Mellitus

PubMed Central

Huang, Elbert S.; Gorawara-Bhat, Rita; Chin, Marshall H.

2008-01-01

OBJECTIVES New diabetes mellitus guidelines from the American Geriatrics Society promote the individualization of treatment goals and plans for patients aged 65 and older. Communicating with older patients about such complex medical decisions presents new challenges for providers. The self-reported healthcare goals, factors influencing these goals, and self-care practices of older patients with diabetes mellitus were explored. DESIGN Exploratory study involving semistructured interviews. SETTING Four clinics of a midwestern, urban academic medical center. PARTICIPANTS Patients aged 65 and older with type II diabetes mellitus (N = 28). MEASUREMENTS Semistructured, one-on-one interviews were conducted. Interviews were audiotaped, transcribed, and evaluated for recurring themes using a grounded theory approach. RESULTS The majority of patients expressed their health-care goals in a social and functional language, in contrast to the biomedical language of risk factor control and complication prevention, even when specifically asked about goals for diabetes mellitus care. Patient’s predominant healthcare goals centered on maintaining their independence and their activities of daily living (71%). Medical experiences of friends and family (50%), social comparison with peers (7%), and medical professionals (43%) shaped patients’ goals. Self-reported medication adherence and glucose monitoring was high, but more than one-quarter of patients failed to adhere to any dietary recommendations, and one-third failed to adhere to their exercise regimens. CONCLUSION As diabetes mellitus care recommendations for older patients grow more complex, providers could enhance their communication about such medical decisions by exploring patients’ specific circumstances and reframing diabetes mellitus treatment goals in patients’ own language. These may be crucial steps to developing successful individualized care plans PMID:15673357

Self-reported goals of older patients with type 2 diabetes mellitus.

PubMed

Huang, Elbert S; Gorawara-Bhat, Rita; Chin, Marshall H

2005-02-01

New diabetes mellitus guidelines from the American Geriatrics Society promote the individualization of treatment goals and plans for patients aged 65 and older. Communicating with older patients about such complex medical decisions presents new challenges for providers. The self-reported healthcare goals, factors influencing these goals, and self-care practices of older patients with diabetes mellitus were explored. Exploratory study involving semistructured interviews. Four clinics of a midwestern, urban academic medical center. Patients aged 65 and older with type II diabetes mellitus (N=28). Semistructured, one-on-one interviews were conducted. Interviews were audiotaped, transcribed, and evaluated for recurring themes using a grounded theory approach. The majority of patients expressed their healthcare goals in a social and functional language, in contrast to the biomedical language of risk factor control and complication prevention, even when specifically asked about goals for diabetes mellitus care. Patient's predominant healthcare goals centered on maintaining their independence and their activities of daily living (71%). Medical experiences of friends and family (50%), social comparison with peers (7%), and medical professionals (43%) shaped patients' goals. Self-reported medication adherence and glucose monitoring was high, but more than one-quarter of patients failed to adhere to any dietary recommendations, and one-third failed to adhere to their exercise regimens. As diabetes mellitus care recommendations for older patients grow more complex, providers could enhance their communication about such medical decisions by exploring patients' specific circumstances and reframing diabetes mellitus treatment goals in patients' own language. These may be crucial steps to developing successful individualized care plans.

Allocation of scarce resources after a nuclear detonation: setting the context.

PubMed

Knebel, Ann R; Coleman, C Norman; Cliffer, Kenneth D; Murrain-Hill, Paula; McNally, Richard; Oancea, Victor; Jacobs, Jimmie; Buddemeier, Brooke; Hick, John L; Weinstock, David M; Hrdina, Chad M; Taylor, Tammy; Matzo, Marianne; Bader, Judith L; Livinski, Alicia A; Parker, Gerald; Yeskey, Kevin

2011-03-01

The purpose of this article is to set the context for this special issue of Disaster Medicine and Public Health Preparedness on the allocation of scarce resources in an improvised nuclear device incident. A nuclear detonation occurs when a sufficient amount of fissile material is brought suddenly together to reach critical mass and cause an explosion. Although the chance of a nuclear detonation is thought to be small, the consequences are potentially catastrophic, so planning for an effective medical response is necessary, albeit complex. A substantial nuclear detonation will result in physical effects and a great number of casualties that will require an organized medical response to save lives. With this type of incident, the demand for resources to treat casualties will far exceed what is available. To meet the goal of providing medical care (including symptomatic/palliative care) with fairness as the underlying ethical principle, planning for allocation of scarce resources among all involved sectors needs to be integrated and practiced. With thoughtful and realistic planning, the medical response in the chaotic environment may be made more effective and efficient for both victims and medical responders.

The loved ones: families, intimates and patient autonomy.

PubMed

O'Donovan, Katherine; Gilbar, Roy

2003-05-01

Patient autonomy is one of the central values in medical ethics. It is generally understood as recognition of patients' rights as free individuals answerable only to themselves. This emphasis on the individual leaves open the question of the position of the patients' 'loved ones', that is of families and significant others. The authors examine this question in three areas of law and medical ethics. Organ donation offers an example of preference given by medical ethics to family views, notwithstanding an expressed wish of the deceased to donate, and the legal position protecting such a request. Decisions concerning the treatment of incompetent patients illustrate consideration for the family in medical ethics, but hesitations in both law and ethics in accepting family views once expressed. And the tension between the interests of patients and family members over the access to genetic information usually results in respecting the patient's right to confidentiality. This individualistic perception of autonomy, as adopted by medical law, overlooks the patient's relationships with others and is too narrow to face the complexities of human lives.

Nonadherence to Medication Therapy in Haemodialysis Patients: A Systematic Review

PubMed Central

Ghimire, Saurav; Castelino, Ronald L.; Lioufas, Nicole M.; Peterson, Gregory M.; Zaidi, Syed Tabish R.

2015-01-01

Background End-stage kidney disease (ESKD) patients are often prescribed multiple medications. Together with a demanding weekly schedule of dialysis sessions, increased number of medicines and associated regimen complexity pre-dispose them at high risk of medication nonadherence. This review summarizes existing literature on nonadherence and identifies factors associated with nonadherence to medication therapy in patients undergoing haemodialysis. Methods A comprehensive search of PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews covering the period from 1970 through November 2014 was performed following a predefined inclusion and exclusion criteria. Reference lists from relevant materials were reviewed. Data on study characteristics, measures of nonadherence, prevalence rates and factors associated with nonadherence were collected. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was followed in conducting this systematic review. Results Of 920 relevant publications, 44 were included. The prevalence of medication nonadherence varied from 12.5% to 98.6%, with widespread heterogeneity in measures and definitions employed. Most common patient-related factors significantly associated with nonadherence were younger age, non-Caucasian ethnicity, illness interfering family life, being a smoker, and living single and being divorced or widowed. Similarly, disease-related factors include longevity of haemodialysis, recurrent hospitalization, depressive symptoms and having concomitant illness like diabetes and hypertension. Medication-related factors such as daily tablet count, total pill burden, number of phosphate binders prescribed and complexity of medication regimen were also associated with poor adherence. Conclusions A number of patient-, disease-, and medication-related factors are associated with medication nonadherence in haemodialysis patients. Clinicians should be aware of such factors so that adherence to medications can be optimised in haemodialysis patients. Future research should be directed towards well-designed prospective longitudinal studies developing standard definitions and validating available measurement tools, while focusing on the role of additional factors such as psychosocial and behavioural factors in predicting nonadherence to medications. PMID:26636968

Nonadherence to Medication Therapy in Haemodialysis Patients: A Systematic Review.

PubMed

Ghimire, Saurav; Castelino, Ronald L; Lioufas, Nicole M; Peterson, Gregory M; Zaidi, Syed Tabish R

2015-01-01

End-stage kidney disease (ESKD) patients are often prescribed multiple medications. Together with a demanding weekly schedule of dialysis sessions, increased number of medicines and associated regimen complexity pre-dispose them at high risk of medication nonadherence. This review summarizes existing literature on nonadherence and identifies factors associated with nonadherence to medication therapy in patients undergoing haemodialysis. A comprehensive search of PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews covering the period from 1970 through November 2014 was performed following a predefined inclusion and exclusion criteria. Reference lists from relevant materials were reviewed. Data on study characteristics, measures of nonadherence, prevalence rates and factors associated with nonadherence were collected. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was followed in conducting this systematic review. Of 920 relevant publications, 44 were included. The prevalence of medication nonadherence varied from 12.5% to 98.6%, with widespread heterogeneity in measures and definitions employed. Most common patient-related factors significantly associated with nonadherence were younger age, non-Caucasian ethnicity, illness interfering family life, being a smoker, and living single and being divorced or widowed. Similarly, disease-related factors include longevity of haemodialysis, recurrent hospitalization, depressive symptoms and having concomitant illness like diabetes and hypertension. Medication-related factors such as daily tablet count, total pill burden, number of phosphate binders prescribed and complexity of medication regimen were also associated with poor adherence. A number of patient-, disease-, and medication-related factors are associated with medication nonadherence in haemodialysis patients. Clinicians should be aware of such factors so that adherence to medications can be optimised in haemodialysis patients. Future research should be directed towards well-designed prospective longitudinal studies developing standard definitions and validating available measurement tools, while focusing on the role of additional factors such as psychosocial and behavioural factors in predicting nonadherence to medications.

Use of standardized patients to teach medical students about living organ donation.

PubMed

Bramstedt, Katrina A; Moolla, Ariff; Rehfield, Patricia L

2012-03-01

Educators routinely use standardized patients to teach medical students a variety of clinical concepts. Standardized patients have also been used to teach students about medical ethics and deceased organ donation. Not reported before, however, is the use of standardized patients to educate medical students about the ethical issues in living organ donation. It seems important to fill this gap because in the United States, roughly 45% of organ donors are living donors, and these patients will visit physicians throughout their lifespan, not just with the occurrence of donation. This article reports an experience teaching concepts in living donation and transplant ethics to second-year osteopathic medicine students using a standardized patient and supplementary instructional materials (eg, film, panel discussion, reading list). Specifically, a transplant ethics module was created that included an actor portraying a living donor candidate who had a number of case variables pertaining to medical and psychosocial matters. Instructional themes included informed consent, altruism, patient selection criteria, organ vending, and post-donation support systems.

Vertical nanopillars for highly localized fluorescence imaging

PubMed Central

Xie, Chong; Hanson, Lindsey; Cui, Yi; Cui, Bianxiao

2011-01-01

Observing individual molecules in a complex environment by fluorescence microscopy is becoming increasingly important in biological and medical research, for which critical reduction of observation volume is required. Here, we demonstrate the use of vertically aligned silicon dioxide nanopillars to achieve below-the-diffraction-limit observation volume in vitro and inside live cells. With a diameter much smaller than the wavelength of visible light, a transparent silicon dioxide nanopillar embedded in a nontransparent substrate restricts the propagation of light and affords evanescence wave excitation along its vertical surface. This effect creates highly confined illumination volume that selectively excites fluorescence molecules in the vicinity of the nanopillar. We show that this nanopillar illumination can be used for in vitro single-molecule detection at high fluorophore concentrations. In addition, we demonstrate that vertical nanopillars interface tightly with live cells and function as highly localized light sources inside the cell. Furthermore, specific chemical modification of the nanopillar surface makes it possible to locally recruit proteins of interest and simultaneously observe their behavior within the complex, crowded environment of the cell. PMID:21368157

Is animal experimentation fundamental?

PubMed

d'Acampora, Armando José; Rossi, Lucas Félix; Ely, Jorge Bins; de Vasconcellos, Zulmar Acciolli

2009-01-01

The understanding about the utilization of experimental animals in scientific research and in teaching is many times a complex issue. Special attention needs to be paid to attain the understanding by the general public of the importance of animal experimentation in experimental research and in undergraduate medical teaching. Experimental teaching and research based on the availability of animals for experimentation is important and necessary for the personal and scientific development of the physician-to-be. The technological arsenal which intends to mimic experimentation animals and thus fully replace their use many times does not prove to be compatible with the reality of the living animal. The purpose of this paper is to discuss aspects concerning this topic, bringing up an issue which is complex and likely to arouse in-depth reflections.

Attitudes toward live and postmortem kidney donation: a survey of Chinese medical students.

PubMed

Ge, Fangmin; Kaczmarczyk, Gabriele; Biller-Andorno, Nikola

2014-12-01

As the gap between supply and demand for donor organs is increasing, we sought to clarify the knowledge and attitudes regarding living-organ donation among Chinese medical students and analyze their incentives and influencing factors. Data were collected from Chinese medical students using a standardized questionnaire. Of 320 surveyed participants, 261 participants (81.6%) said they would consider donating their live kidney organ, and 262 participants (81.9%) were willing to donate posthumously. Although 177 participants (55.7%) confirmed current regulations on posthumous organ donation, only 85 participants (26.7%) could correctly identify the regulations on live organ donation in China. Gender differences were not significantly associated with willingness to donate a kidney, whereas religion and socioeconomic status of the respondents were significantly associated with willingness to donate a live or posthumous kidney. Among well-informed, young, healthy, and economically well-off Chinese male and female medical students, most were willing to be live kidney donors. Religion and socioeconomic status may affect the decision-making process for organ disposition.

Clinical relevance of voltage-gated potassium channel–complex antibodies in children.

PubMed

Hacohen, Yael; Singh, Rahul; Rossi, Meghan; Lang, Bethan; Hemingway, Cheryl; Lim, Ming; Vincent, Angela

2015-09-15

To assess the clinical and immunologic findings in children with voltage-gated potassium channel (VGKC)-complex antibodies (Abs). Thirty-nine of 363 sera, referred from 2 pediatric centers from 2007 to 2013, had been reported positive (.100 pM) for VGKC-complex Abs. Medical records were reviewed retrospectively and the patients’ condition was independently classified as inflammatory (n 5 159) or noninflammatory (n 5 204). Positive sera (.100 pM) were tested/retested for the VGKC complex Ab–positive complex proteins LGI1 and CASPR2, screened for binding to live hippocampal neurons, and 12 high-titer sera (.400 pM) tested by radioimmunoassay for binding to VGKC Kv1 subunits with or without intracellular postsynaptic density proteins. VGKC-complex Abs were found in 39 children, including 20% of encephalopathies and 7.6% of other conditions (p 5 0.001). Thirty children had inflammatory conditions and 9 had noninflammatory etiologies but titers.400 pM (n512) were found only in inflammatory diseases (p , 0.0001). Four sera, including from 2 children with coexisting NMDA receptor Abs and one with Guillain-Barré syndrome and Abs to both LGI1 and CASPR2, bound to hippocampal neurons. None of the sera bound detectably to VGKC Kv1 subunits on live HEK cells, but 4 of 12 .400 pM sera immunoprecipitated VGKC Kv1 subunits, with or without postsynaptic densities, extracted from transfected cells. Positive VGKC-complex Abs cannot be taken to indicate a specific clinical syndrome in children, but appear to be a nonspecific biomarker of inflammatory neurologic diseases, particularly of encephalopathy. Some of the Abs may bind to intracellular epitopes on the VGKC subunits, or to the intracellular interacting proteins, but in many the targets remain undefined.

Clinical relevance of voltage-gated potassium channel–complex antibodies in children

PubMed Central

Hacohen, Yael; Singh, Rahul; Rossi, Meghan; Lang, Bethan; Hemingway, Cheryl; Lim, Ming

2015-01-01

Objective: To assess the clinical and immunologic findings in children with voltage-gated potassium channel (VGKC)-complex antibodies (Abs). Methods: Thirty-nine of 363 sera, referred from 2 pediatric centers from 2007 to 2013, had been reported positive (>100 pM) for VGKC-complex Abs. Medical records were reviewed retrospectively and the patients' condition was independently classified as inflammatory (n = 159) or noninflammatory (n = 204). Positive sera (>100 pM) were tested/retested for the VGKC-complex Ab–positive complex proteins LGI1 and CASPR2, screened for binding to live hippocampal neurons, and 12 high-titer sera (>400 pM) tested by radioimmunoassay for binding to VGKC Kv1 subunits with or without intracellular postsynaptic density proteins. Results: VGKC-complex Abs were found in 39 children, including 20% of encephalopathies and 7.6% of other conditions (p = 0.001). Thirty children had inflammatory conditions and 9 had noninflammatory etiologies but titers >400 pM (n = 12) were found only in inflammatory diseases (p < 0.0001). Four sera, including from 2 children with coexisting NMDA receptor Abs and one with Guillain-Barré syndrome and Abs to both LGI1 and CASPR2, bound to hippocampal neurons. None of the sera bound detectably to VGKC Kv1 subunits on live HEK cells, but 4 of 12 >400 pM sera immunoprecipitated VGKC Kv1 subunits, with or without postsynaptic densities, extracted from transfected cells. Conclusion: Positive VGKC-complex Abs cannot be taken to indicate a specific clinical syndrome in children, but appear to be a nonspecific biomarker of inflammatory neurologic diseases, particularly of encephalopathy. Some of the Abs may bind to intracellular epitopes on the VGKC subunits, or to the intracellular interacting proteins, but in many the targets remain undefined. PMID:26296514

'Everyone has a secret they keep close to their hearts': challenges faced by adolescents living with HIV infection at the Kenyan coast.

PubMed

Abubakar, Amina; Van de Vijver, Fons J R; Fischer, Ronald; Hassan, Amin S; K Gona, Joseph; Dzombo, Judith Tumaini; Bomu, Grace; Katana, Khamis; Newton, Charles R

2016-02-29

The upsurge in the uptake of antiretroviral therapy (ART) has led to a significant increase in the survival of vertically acquired HIV infected children, many of whom are currently living into adolescence and early adulthood. However little if anything is known of the lived experiences and the challenges faced by HIV positive adolescents in the African context. We set out to investigate psychosocial challenges faced by HIV infected adolescents on the Kenyan coast. A total of 44 participants (12 HIV-infected adolescents, 7 HIV uninfected adolescents, and 25 key informants) took part in this qualitative study, using individually administered in-depth interviews. A framework approach was used to analyze the data using NVIVO software. We observed that the challenges faced by adolescents in rural Kenya could be placed into six major themes: poverty, poor mental and physical health, the lack of a school system that is responsive to their needs, challenges in how to disclose to peers and family members, high levels of stigma in its various forms, and challenges of medical adherence leading to the need for close monitoring. In this African community, vertically acquired HIV-infected adolescents face a complex set of social, economic and medical challenges. Our study points to the urgent need to develop multisectorial intervention support programmes to fully address these challenges.

Consumer Health Informatics: Empowering Healthy-Living-Seekers Through mHealth.

PubMed

Faiola, Anthony; Holden, Richard J

People are at risk from noncommunicable diseases (NCD) and poor health habits, with interventions like medications and surgery carrying further risk of adverse effects. This paper addresses ways people are increasingly moving to healthy living medicine (HLM) to mitigate such health threats. HLM-seekers increasingly leverage mobile technologies that enable control of personal health information, collaboration with clinicians/other agents to establish healthy living practices. For example, outcomes from consumer health informatics research include empowering users to take charge of their health through active participation in decision-making about healthcare delivery. Because the success of health technology depends on its alignment/integration with a person's sociotechnical system, we introduce SEIPS 2.0 as a useful conceptual model and analytic tool. SEIPS 2.0 approaches human work (i.e., life's effortful activities) within the complexity of the design and implementation of mHealth technologies and their potential to emerge as consumer-facing NLM products that support NCDs like diabetes. Copyright © 2016 Elsevier Inc. All rights reserved.

Human body may produce bacteria.

PubMed

Salerian, Alen J

2017-06-01

"Human body may produce bacteria" proposes that human body may produce bacteria and represent an independent source of infections contrary to the current paradigm of infectious disorders proposed by Louis Pasteur in 1880. The following observations are consistent with this hypothesis: A. Bidirectional transformations of both living and nonliving things have been commonly observed in nature. B. Complex multicellular organisms harbor the necessary properties to produce bacteria (water, nitrogen and oxygen). C. Physical laws suggest any previously observed phenomenon or action will occur again (life began on earth; a non living thing). D. Animal muscle cells may generate energy (fermentation). E. Sterilized food products (i.e. boiled eggs), may produce bacteria and fungus under special conditions and without any exposure to foreign living cells. "Human body may produce bacteria" may challenge the current medical paradigm that views human infectious disorders as the exclusive causative byproducts of invading foreign cells. It may also introduce new avenues to treat infectious disorders. Copyright © 2017 Elsevier Ltd. All rights reserved.

Caregivers Create a Veteran-Centric Community in VHA Medical Foster Homes.

PubMed

Haverhals, Leah M; Manheim, Chelsea E; Gilman, Carrie V; Jones, Jacqueline; Levy, Cari

2016-01-01

The Veteran's Health Administration's Medical Foster Home program offers a unique long-term care option for veterans who require nursing-home- or assisted-living-level care. Veterans in a medical foster home reside with community-based caregivers who provide 24-hr-a-day care and monitoring. The veterans often remain in the medical foster home until end of life. Support and oversight is provided to the caregiver from the Veteran's Health Administration's community-based medical team. This qualitative descriptive study is based on secondary analysis of interviews with 20 medical foster home caregivers from 7 programs across the United States. The study's research aims are to describe and explain (a) the type of care backgrounds and skills these caregivers possess, (b) caregivers' primary motivations to open their homes to veterans who often have complex medical and social needs, and (c) how caregivers function in their role as primary caregiver for veterans. Findings indicated that caregivers interviewed had worked in long-term care settings and/or cared for family members. A strong desire to serve veterans was a primary motivation for caregivers, rather than financial gain. The caregivers' long-term care skills aided them in building and sustaining the unique medical foster home family-like community.

How children and young people construct and negotiate living with medical technology.

PubMed

Kirk, Susan

2010-11-01

Increasing numbers of children need the support of medical technology for their survival and wellbeing, yet little is known about their experiences of living technology-assisted lives. This study aimed to explore how this group of children experience and construct medical technology and its influence on their identity and social relationships. Using a Grounded Theory approach, 28 children/young people aged between 8 and 19 years old and using different types of medical devices were recruited via nursing services in England. Data were collected by in-depth interviews conducted in children's homes. The medical technology occupied an ambivalent position in children's lives being seen as having both an enabling and disabling presence. Children actively engaged in work to incorporate the technology into their lives and bodies by developing strategies to manage their condition, the technology and their identities. This body work appeared to be driven by a desire to 'normalise' their bodies and their lives. Technologies were shaped to integrate them into everyday life and children managed their self-presentation and controlled information about their condition. This work was ongoing, responding to changing social contexts and relationships. For these children the process of 'growing up' involves incorporating disability, illness and technology. This study contributes to knowledge by examining how medical technology is constructed by children whose lives are dependent on it and illuminating the resources and strategies they use to manage their identity and negotiate peer culture interactions and norms. Copyright © 2010 Elsevier Ltd. All rights reserved.

Why shared decision making is not good enough: lessons from patients.

PubMed

Olthuis, Gert; Leget, Carlo; Grypdonck, Mieke

2014-07-01

A closer look at the lived illness experiences of medical professionals themselves shows that shared decision making is in need of a logic of care. This paper underlines that medical decision making inevitably takes place in a messy and uncertain context in which sharing responsibilities may impose a considerable burden on patients. A better understanding of patients' lived experiences enables healthcare professionals to attune to what individual patients deem important in their lives.This will contribute to making medical decisions in a good and caring manner, taking into account the lived experience of being ill.

Environmental and Body Concentrations of Heavy Metals at Sites Near and Distant from Industrial Complexes in Ulsan, Korea

PubMed Central

2017-01-01

Background Industrial pollution may affect the heavy metal body burden of people living near industrial complexes. We determined the average concentrations of atmospheric heavy metals in areas close to and distant from industrial complexes in Korea, and the body concentrations of these heavy metals in residents living near and distant from these facilities. Methods The atmospheric data of heavy metals (lead and cadmium) were from the Regional Air Monitoring Network in Ulsan. We recruited 1,148 participants, 872 who lived near an industrial complex (“exposed” group) and 276 who lived distant from industrial complexes (“non-exposed” group), and measured their concentrations of blood lead, urinary cadmium, and urinary total mercury. Results The results showed that atmospheric and human concentrations of heavy metals were higher in areas near industrial complexes. In addition, residents living near industrial complexes had higher individual and combined concentrations (cadmium + lead + mercury) of heavy metals. Conclusion We conclude that residents living near industrial complexes are exposed to high concentrations of heavy metals, and should be carefully monitored. PMID:29349943

Live and non-live pregnancy outcomes among women with depression and anxiety: a population-based study.

PubMed

Ban, Lu; Tata, Laila J; West, Joe; Fiaschi, Linda; Gibson, Jack E

2012-01-01

Women taking antidepressant or anti-anxiety medications during early pregnancy have high risks of non-live pregnancy outcomes, although the contribution of the underlying illnesses to these risks remains unclear. We examined the impacts of antenatal depression and anxiety and of commonly prescribed treatments on the risks of non-live pregnancy outcomes. We identified all pregnancies and their outcome (live birth, perinatal death, miscarriage or termination) among women aged 15-45 years between 1990 and 2009 from a large primary care database in the United Kingdom. Women were grouped according to whether they had no history of depression and anxiety, a diagnosis of such illness prior to pregnancy, illness during pregnancy and illness during pregnancy with use of medication (stratified by medication type). Multinomial logistic regression models were used to compare risks of non-live outcomes among these groups, adjusting for major socio-demographic and lifestyle characteristics. Among 512,574 pregnancies in 331,414 women, those with antenatal drug exposure showed the greatest increased risks for all non-live pregnancy outcomes, relative to those with no history of depression or anxiety, although women with prior (but not currently medicated) illness also showed modest increased risks. Compared with un-medicated antenatal morbidity, there was weak evidence of an excess risk in women taking tricyclic antidepressants, and stronger evidence for other medications. Women with depression or anxiety have higher risks of miscarriage, perinatal death and decisions to terminate a pregnancy if prescribed psychotropic medication during early pregnancy than if not. Although underlying disease severity could also play a role, avoiding or reducing use of these drugs during early pregnancy may be advisable.

Falls, a fear of falling and related factors in older adults with complex chronic disease.

PubMed

Lee, JuHee; Choi, MoonKi; Kim, Chang Oh

2017-12-01

To identify factors influencing falls and the fear of falling among older adults with chronic diseases in Korea. The fear of falling and falls in older adults are significant health problems towards which healthcare providers should direct their attention. Further investigation is needed to improve nursing practice specifically decreasing risk of falls and the fear of falling in Korea. Descriptive, cross-sectional survey. A convenience sample of 108 patients was recruited at the geriatric outpatient department of a tertiary hospital in Seoul, Korea. Demographic characteristics, comorbidities, medication use, fall history, level of physical activity, activities of daily living, mobility, muscle strength, and a fear of falling were investigated. Student's t tests, chi-square tests and multiple linear regressions were used in statistical analysis. Thirty-six participants (33.3%) among 108 subjects reported experiencing ≥1 falls in the past year. Marital status and the use of antipsychotics were associated with falls, while other factors were not significantly related to falls. Only benign prostatic hypertrophy and polypharmacy were significantly related to the fear of falling in the analysis of the relationships between chronic disease, medication use and fear of falling. In the regression model, the number of comorbidities, level of physical activity, activities of daily living and mobility were predictors of a fear of falling. Medication use was marginally significant, in the model. Increasing physical activity, functional fitness and physical independence is important to decrease the fear of falling, and to encourage active and healthy lives in older adults. The findings from this study provide evidence for the development of nursing interventions for older adults. We recommend early screening for a fear of falling and nursing interventions to decrease the fear of falling through enhancing physical activity level and function. © 2017 John Wiley & Sons Ltd.

Key concepts relevant to quality of complex and shared decision-making in health care: a literature review.

PubMed

Dy, Sydney M; Purnell, Tanjala S

2012-02-01

High-quality provider-patient decision-making is key to quality care for complex conditions. We performed an analysis of key elements relevant to quality and complex, shared medical decision-making. Based on a search of electronic databases, including Medline and the Cochrane Library, as well as relevant articles' reference lists, reviews of tools, and annotated bibliographies, we developed a list of key concepts and applied them to a decision-making example. Key concepts identified included provider competence, trustworthiness, and cultural competence; communication with patients and families; information quality; patient/surrogate competence; and roles and involvement. We applied this concept list to a case example, shared decision-making for live donor kidney transplantation, and identified the likely most important concepts as provider and cultural competence, information quality, and communication with patients and families. This concept list may be useful for conceptualizing the quality of complex shared decision-making and in guiding research in this area. Copyright © 2011 Elsevier Ltd. All rights reserved.

Revalidating Sherlock Holmes for a role in medical education.

PubMed

Levine, David

2012-04-01

Sir Arthur Conan Doyle endowed Sherlock Holmes with extraordinary skills that Dr Watson and others found incomprehensible until Holmes gave explanations, often in the form of memorable maxims and short monologues. Intentionally or not, Doyle left us crime-solving precepts that still inform aspects of medical practice. Experienced clinicians share with Holmes the dilemma of how to make complex, often unconscious, capability accessible to novices. Doctors still invoke Holmes's methods in clinical contexts, but the validity of some of the parallels has been challenged and quoting the more popular sayings has been equated with conceit. This paper examines how the use of selected maxims and monologues can help to link abstract principles and live context in a credible way in order to make aspects of clinical reasoning and professional behaviour more accessible and memorable.

Cohort Profile: HAART Observational Medical Evaluation and Research (HOMER) Cohort

PubMed Central

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 SG; Shannon, Kate; Wood, Evan; Hogg, Robert S

2015-01-01

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 (robert_hogg@sfu.ca). PMID:24639444

[Progress in imaging techniques].

PubMed

Mishima, Kazuaki; Otsuka, Tsukasa

2013-05-01

Today it is common to perform real-time diagnosis and treatment via live broadcast as a method of education and to spread new technology for diagnosis and therapy in medical fields. Live medical broadcasts have developed along with broadcast technology. In the early days, live video feeds were sent from operating rooms to classrooms and lecture halls in universities and hospitals. However, the development of imaging techniques and communication networks enabled live broadcasts that bi-directionally link operating rooms and meeting halls during scientific meetings and live demonstration courses. Live broadcasts therefore became an important method for education and the dissemination of new medical technologies. The development of imaging techniques has contributed to more realistic live broadcasts through such innovative techniques as three-dimensional viewing and higher-definition 4K technology. In the future, live broadcasts will be transmitted on personal computers using regular Internet connections. In addition to the enhancement of image delivery technology, it will also be necessary to examine the entire image delivery environment carefully, including issues of security and privacy of personal information.

Perceived Strengths and Weaknesses of Highly Realistic Training and Live Tissue Training for Navy Corpsmen

DTIC Science & Technology

2015-04-08

raises about the proper use and care of animals .10–12 For three decades, activists have tried to end the practice of Highly Realistic and Live Tissue...Training 4 using live animals for medical training. Although live tissue training continues to be widely used in the training of military medical...compared. It was concluded that “modern simulation is reaching parity with live animal training models.”14 Similarly, Hall and colleagues found that

42 CFR 482.90 - Condition of participation: Patient and living donor selection.

Code of Federal Regulations, 2011 CFR

2011-10-01

... principles of medical ethics. Transplant centers must: (1) Ensure that a prospective living donor receives a... candidate on its waiting list, the candidate's medical record must contain documentation that the candidate... selected to receive a transplant, the center must document in the patient's medical record the patient...

Translating weight loss into agency: Men's experiences 5 years after bariatric surgery

PubMed Central

Natvik, Eli; Gjengedal, Eva; Moltu, Christian; Råheim, Målfrid

2015-01-01

Fewer men than women with severe obesity undergo bariatric surgery for weight loss, and knowledge about men's situation after surgery, beyond medical status, is lacking. Our aim was to explore men's experiences with life after bariatric surgery from a long-term perspective. We conducted in-depth interviews with 13 men, aged 28–60 years, between 5 and 7 years after surgery. The analysis was inspired by Giorgi's phenomenological method. We found that agency was pivotal for how the men understood themselves and their lives after surgery. Weight loss meant regaining opportunities for living and acting in unrestricted and independent daily lives, yet surgery remained a radical treatment with complex consequences. Turning to surgery had involved conceptualizing their own body size as illness, which the men had resisted doing for years. After surgery, the rapid and major weight loss and the feelings of being exhausted, weak, and helpless were intertwined. The profound intensity of the weight loss process took the men by surprise. Embodying weight loss and change involved an inevitable renegotiating of experiences connected to the large body. Having bariatric surgery was a long-term process that seemed unfinished 5 years after surgery. Restrictions and insecurity connected to health and illness persist, despite successful weight loss and embodied change. Bariatric surgery initiated a complex and long-lasting life-changing process, involving both increased capacity for agency and illness-like experiences. PMID:26066518

Managing medications for individuals living with a dementia: Evaluating a web-based information resource for informal carers.

PubMed

Horne, Frances; Burns, Pippa; Traynor, Victoria; Gillespie, Robyn; Mullan, Judy; Baker, Amanda; Harrison, Lindsey; Win, Khin Than

2018-05-10

The purpose of the study was to evaluate the usefulness of the "Managing Medicines for People with Dementia" (www.dementiameds.com) website for informal carers. The management of medications for individuals living with a dementia by informal carers is a neglected area of care. We know that informal carers find it difficult accessing reliable and comprehensive information about medications. We also know that the Internet is a contemporary and growing medium through which consumers access health information. This study was unique in that it brought these two elements together through an interdisciplinary study about the usefulness of a new website providing information on medication management. Data collection consisted of focus groups with informal carers of individuals living with a dementia. Data were analysed through content analysis. Four themes were generated from the data to explain the evaluation of the website by informal carers: (1) Suitability of the website; (2) Presentation of the website; (3) Unexpected benefits of the website content; (4) Future enhancements for website. Participants overwhelmingly agreed the content of the website filled a gap in information needs about medication management for individuals living with a dementia. This qualitative evaluation demonstrated the value of the website as a resource for informal carers of individuals living with a dementia. The resource could also be used by community nurses and other healthcare practitioners to help informal carers better manage the medication regimes of individuals living with a dementia. The resource has the potential to reduce complications associated with mismanagement of medications and contribute to new policies for implementing safe medication practices. © 2018 John Wiley & Sons Ltd.

On the road to personalised and precision geomedicine: medical geology and a renewed call for interdisciplinarity.

PubMed

Kamel Boulos, Maged N; Le Blond, Jennifer

2016-01-28

Our health depends on where we currently live, as well as on where we have lived in the past and for how long in each place. An individual's place history is particularly relevant in conditions with long latency between exposures and clinical manifestations, as is the case in many types of cancer and chronic conditions. A patient's geographic history should routinely be considered by physicians when diagnosing and treating individual patients. It can provide useful contextual environmental information (and the corresponding health risks) about the patient, and should thus form an essential part of every electronic patient/health record. Medical geology investigations, in their attempt to document the complex relationships between the environment and human health, typically involve a multitude of disciplines and expertise. Arguably, the spatial component is the one factor that ties in all these disciplines together in medical geology studies. In a general sense, epidemiology, statistical genetics, geoscience, geomedical engineering and public and environmental health informatics tend to study data in terms of populations, whereas medicine (including personalised and precision geomedicine, and lifestyle medicine), genetics, genomics, toxicology and biomedical/health informatics more likely work on individuals or some individual mechanism describing disease. This article introduces with examples the core concepts of medical geology and geomedicine. The ultimate goals of prediction, prevention and personalised treatment in the case of geology-dependent disease can only be realised through an intensive multiple-disciplinary approach, where the various relevant disciplines collaborate together and complement each other in additive (multidisciplinary), interactive (interdisciplinary) and holistic (transdisciplinary and cross-disciplinary) manners.

Understanding dynamic changes in live cell adhesion with neutron reflectometry

DOE PAGES

Junghans, Ann; Waltman, Mary Jo; Smith, Hillary L.; ...

2014-12-10

In this study, neutron reflectometry (NR) was used to examine various live cells' adhesion to quartz substrates under different environmental conditions, including flow stress. To the best of our knowledge, these measurements represent the first successful visualization and quantization of the interface between live cells and a substrate with sub-nanometer resolution. In our first experiments, we examined live mouse fibroblast cells as opposed to past experiments using supported lipids, proteins, or peptide layers with no associated cells. We continued the NR studies of cell adhesion by investigating endothelial monolayers and glioblastoma cells under dynamic flow conditions. We demonstrated that neutronmore » reflectometry is a powerful tool to study the strength of cellular layer adhesion in living tissues, which is a key factor in understanding the physiology of cell interactions and conditions leading to abnormal or disease circumstances. Continuative measurements, such as investigating changes in tumor cell — surface contact of various glioblastomas, could impact advancements in tumor treatments. In principle, this can help us to identify changes that correlate with tumor invasiveness. Pursuit of these studies can have significant medical impact on the understanding of complex biological problems and their effective treatment, e.g. for the development of targeted anti-invasive therapies.« less

The effects of indoor environmental exposures on pediatric asthma: a discrete event simulation model.

PubMed

Fabian, M Patricia; Stout, Natasha K; Adamkiewicz, Gary; Geggel, Amelia; Ren, Cizao; Sandel, Megan; Levy, Jonathan I

2012-09-18

In the United States, asthma is the most common chronic disease of childhood across all socioeconomic classes and is the most frequent cause of hospitalization among children. Asthma exacerbations have been associated with exposure to residential indoor environmental stressors such as allergens and air pollutants as well as numerous additional factors. Simulation modeling is a valuable tool that can be used to evaluate interventions for complex multifactorial diseases such as asthma but in spite of its flexibility and applicability, modeling applications in either environmental exposures or asthma have been limited to date. We designed a discrete event simulation model to study the effect of environmental factors on asthma exacerbations in school-age children living in low-income multi-family housing. Model outcomes include asthma symptoms, medication use, hospitalizations, and emergency room visits. Environmental factors were linked to percent predicted forced expiratory volume in 1 second (FEV1%), which in turn was linked to risk equations for each outcome. Exposures affecting FEV1% included indoor and outdoor sources of NO2 and PM2.5, cockroach allergen, and dampness as a proxy for mold. Model design parameters and equations are described in detail. We evaluated the model by simulating 50,000 children over 10 years and showed that pollutant concentrations and health outcome rates are comparable to values reported in the literature. In an application example, we simulated what would happen if the kitchen and bathroom exhaust fans were improved for the entire cohort, and showed reductions in pollutant concentrations and healthcare utilization rates. We describe the design and evaluation of a discrete event simulation model of pediatric asthma for children living in low-income multi-family housing. Our model simulates the effect of environmental factors (combustion pollutants and allergens), medication compliance, seasonality, and medical history on asthma outcomes (symptom-days, medication use, hospitalizations, and emergency room visits). The model can be used to evaluate building interventions and green building construction practices on pollutant concentrations, energy savings, and asthma healthcare utilization costs, and demonstrates the value of a simulation approach for studying complex diseases such as asthma.

The effects of indoor environmental exposures on pediatric asthma: a discrete event simulation model

PubMed Central

2012-01-01

Background In the United States, asthma is the most common chronic disease of childhood across all socioeconomic classes and is the most frequent cause of hospitalization among children. Asthma exacerbations have been associated with exposure to residential indoor environmental stressors such as allergens and air pollutants as well as numerous additional factors. Simulation modeling is a valuable tool that can be used to evaluate interventions for complex multifactorial diseases such as asthma but in spite of its flexibility and applicability, modeling applications in either environmental exposures or asthma have been limited to date. Methods We designed a discrete event simulation model to study the effect of environmental factors on asthma exacerbations in school-age children living in low-income multi-family housing. Model outcomes include asthma symptoms, medication use, hospitalizations, and emergency room visits. Environmental factors were linked to percent predicted forced expiratory volume in 1 second (FEV1%), which in turn was linked to risk equations for each outcome. Exposures affecting FEV1% included indoor and outdoor sources of NO2 and PM2.5, cockroach allergen, and dampness as a proxy for mold. Results Model design parameters and equations are described in detail. We evaluated the model by simulating 50,000 children over 10 years and showed that pollutant concentrations and health outcome rates are comparable to values reported in the literature. In an application example, we simulated what would happen if the kitchen and bathroom exhaust fans were improved for the entire cohort, and showed reductions in pollutant concentrations and healthcare utilization rates. Conclusions We describe the design and evaluation of a discrete event simulation model of pediatric asthma for children living in low-income multi-family housing. Our model simulates the effect of environmental factors (combustion pollutants and allergens), medication compliance, seasonality, and medical history on asthma outcomes (symptom-days, medication use, hospitalizations, and emergency room visits). The model can be used to evaluate building interventions and green building construction practices on pollutant concentrations, energy savings, and asthma healthcare utilization costs, and demonstrates the value of a simulation approach for studying complex diseases such as asthma. PMID:22989068

Barriers to HIV Medication Adherence as a Function of Regimen Simplification.

PubMed

Chen, Yiyun; Chen, Kun; Kalichman, Seth C

2017-02-01

Barriers to HIV medication adherence may differ by levels of dosing schedules. The current study examined adherence barriers associated with medication regimen complexity and simplification. A total of 755 people living with HIV currently taking anti-retroviral therapy were recruited from community services in Atlanta, Georgia. Participants completed audio-computer-assisted self-interviews that assessed demographic and behavioral characteristics, provided their HIV viral load obtained from their health care provider, and completed unannounced phone-based pill counts to monitor medication adherence over 1 month. Participants taking a single-tablet regimen (STR) were more likely to be adherent than those taking multi-tablets in a single-dose regimen (single-dose MTR) and those taking multi-tablets in a multi-dose regimen (multi-dose MTR), with no difference between the latter two. Regarding barriers to adherence, individuals taking STR were least likely to report scheduling issues and confusion as reasons for missing doses, but they were equally likely to report multiple lifestyle and logistical barriers to adherence. Adherence interventions may need tailoring to address barriers that are specific to dosing regimens.

Race-Based Medical Mistrust, Medication Beliefs and HIV Treatment Adherence: Test of a Mediation Model in People Living with HIV/AIDS

PubMed Central

Kalichman, Seth C.; Eaton, Lisa; Kalichman, Moira O.; Grebler, Tama; Merely, Cynthia; Welles, Brandi

2016-01-01

Race-based medical mistrust significantly predicts non-adherence to antiretroviral therapy (ART) in people living with HIV. The current study builds on previous research that shows beliefs about medication necessity (i.e., “My medicines protect me from becoming worse”) and concerns (i.e., Having to take my medicines worries me) mediate the association between race-based medical mistrust and medication adherence. Racial and ethnic minority men and women living with HIV and receiving ART (N=178) in a southern US city completed computerized measures of demographic and health characteristics, telephone interviews of race-based medical mistrust and medication beliefs, and unannounced phone-based pill counts for ART adherence. Multiple mediation modeling showed that medical mistrust is related to medication necessity and concerns beliefs and ART adherence. Furthermore, medication necessity beliefs predicted ART adherence. The indirect effect of medical mistrust on adherence through medication necessity beliefs was also significant. Results confirm that medication necessity beliefs, although not concerns beliefs, mediate the association between medical mistrust and ART adherence. Medication necessity beliefs offer a viable target for interventions to improve ART adherence in the context of mistrust that patients may have for medical providers and health care systems. PMID:27392477

Interior, living room, looking west U.S. Veterans Hospital, Jefferson ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Interior, living room, looking west - U.S. Veterans Hospital, Jefferson Barracks, Medical Officer in Charge Residence, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

Complexity and Health Coaching: Synergies in Nursing

PubMed Central

Mitchell, Gail J.; Wong, Winnie; Rush, Danica

2013-01-01

Health care professionals are increasingly aware that persons are complex and live in relation with other complex human communities and broader systems. Complex beings and systems are living and evolving in nonlinear ways through a process of mutual influence. Traditional standardized approaches in chronic disease management do not address these non-linear linkages and the meaning and changes that impact day-to-day life and caring for self and family. The RN health coach role described in this paper addresses the complexities and ambiguities for persons living with chronic illness in order to provide person-centered care and support that are unique and responsive to the context of persons' lives. Informed by complexity thinking and relational inquiry, the RN health coach is an emergent innovation of creative action with community and groups that support persons as they shape their health and patterns of living. PMID:24102025

Promoting interprofessional learning with medical students in home care settings.

PubMed

Solomon, Patricia; Risdon, Cathy

2011-01-01

The home care setting is ideal for medical students to learn about the importance of interprofessional collaboration in the community. This project examined the impact of a unique program designed to facilitate medical students' knowledge and awareness of the challenges of interprofessional care in the home. In pairs, medical students participated in two community visits with preceptors from different professions. Students completed a structured personal reflection after their first visit. Students and preceptors participated in focus groups or interviews to identify strengths and challenges of the experiences. The structured reflections and the focus group and interview transcripts were analyzed qualitatively. 164 medical students and 36 preceptors participated in 326 visits. There were high ratings of satisfaction from students and preceptors. Students developed unexpected insights into peoples' lives, developed a greater understanding of the patient's perspective and determinants of health, learned about others' scope of practice, and developed an appreciation of the limitations of their own scope of practice. Preceptors had high expectations for student performance and engagement and enjoyed the opportunity to impart their knowledge to future physicians. Although organizationally complex, the program evaluation suggestions that students and preceptors benefit from interprofessional experiences in the home.

Living into the imagined body: how the diagnostic image confronts the lived body.

PubMed

Stahl, Devan

2013-06-01

In this paper I will show how the medical image, presented to the patient by the physician, participates in medicine's cold culture of abstraction, objectification and mandated normativity. I begin by giving a brief account of the use of anatomical imaging since the Renaissance to show how images have historically functioned in contrast to how they are currently used in medical practice. Next, I examine how contemporary medical imaging techniques participate in a kind of knowledge production that objectifies the human body. Finally, I elucidate how physicians ought to place the medical image within the context of the lived body so as to create a healing relationship with the patient. In all this I hope to show that the medical image, far from a piece of objective data, testifies to the interplay of particular beliefs, practices and doctrines contemporary medicine holds dear. To best treat her patient, the physician must appreciate the influence of these images and appropriately place them within the context of the patient's lived experience.

Patient Narratives as a Teaching Tool: A Pilot Study of First-Year Medical Students and Patient Educators Affected by Intellectual/Developmental Disabilities.

PubMed

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

2017-12-28

People with intellectual and developmental disabilities (IDD) face complex biopsychosocial challenges and are medically underserved. This is in part due to insufficient resources and supports but can also be attributed to a lack of adequate physician training in addressing the unique needs of this population. This study aimed to introduce 1st-year medical students to the IDD population using a blended educational experience that included video narratives of and direct interactions with people affected by IDD. The goal of this intervention was to promote person-centered attitudes and communication among early medical trainees. The study recruited 27 first-year medical students and randomly assigned each to 1 of 2 groups. The control group received an introductory video lecture about IDD healthcare, followed by a quiz. The narrative group received the same lecture, followed by reflective discussion of videos featuring people living with IDD sharing their perspectives and stories. All students then participated in 4 simulated clinical encounters with patient educators (PEs) who have lived experiences of IDD. Focus groups were conducted with students following the simulated encounters to explore their experiences and perceptions of this blended learning activity. Moreover, secondary quantitative data were collected to assess students' performance in the clinical encounters, along with self-reports of comfort, confidence, and competence of interacting with people with IDD (pre- and postparticipation). All students thought that the blended educational experience was valuable and enjoyable, commenting on the importance of adaptable language and engagement of people with IDD, as well as the merits of reflecting on patient narratives. Students also discussed feelings of discomfort stemming from a lack of knowledge and previous exposure to IDD and how this discomfort might motivate them to learn more and develop their skills further. In addition, descriptive analyses revealed that students in the narrative group showed greater self-rated measures of comfort, confidence, and competence compared to control; they also had higher mean performance scores across all PE interview stations. PEs add a powerful real-life dimension to communication skills teaching and have been shown to be a valuable educational modality. Moreover, exposure to and reflection on video-based patient narratives are useful ways of teaching medical students about patients' lived experiences and promoting person-centered communication, both within and beyond IDD.

Why do people consult the doctor?

PubMed

Campbell, S M; Roland, M O

1996-02-01

Symptoms are an everyday part of most peoples' lives and many people with illness do not consult their doctor. The decision to consult is not based simply on the presence or absence of medical problems. Rather it is based on a complex mix of social and psychological factors. This literature review seeks to explore some of the pathways to care and those factors associated with low and high rates of consultation. The paper examines the impact of socioeconomic and demographic factors on consultation rates and, using a revised version of the Health Belief Model, it highlights the psychological factors which influence decisions to seek medical care. Barriers which can inhibit consultation are discussed, as the decision to seek care will only result in a consultation if there is adequate access to care. Whilst poor health status and social disadvantage increase both "objective" medical need and in turn, consultation rates, a range of other social and psychological factors have been shown to influence consulting behaviour.

Health Needs Instrument for hospitalized single-living Taiwanese elders with heart disease: triangulation research design.

PubMed

Shih, Shaw-Nin; Gau, Meei-Ling; Kao Lo, Chi-Hui; Shih, Fu-Jin

2005-11-01

The aims of this study were (a) to explore the health needs of hospitalized Taiwanese older people with heart disease who live alone in the community; (b) to develop an instrument to assess their health needs and (c) to examine relationships among their health needs. Three phases were involved in this between-method triangulation design. The first phase explored the contextual content of the health needs from the perspectives of a purposive sampling of 34 subjects by the use of an explorative qualitative method. The second phase developed the Health Needs Instrument (HNI) and established its reliability and validity. The last phase implemented the instrument in a cohort and examined their appraisals of each type of health need as well as the relationships among different types of health needs. The HNI encompasses the following five types of health needs: help in managing tangible things, psychological support, medical support, obtaining health information and participation in decision-making. In the last phase, a purposive sample of 54 subjects (48 men and 6 women) with an average age of 75.3 years was obtained. Subjects' health needs were ranked as obtaining health information (100%), participation in decision-making (96%), managing tangible issues (87%), medical support (86%) and psychological support (67%). Detailed items for each type of health need were revealed. By examining the relationship between their health needs, the psychological needs in confronting the subjects' physical discomfort had a significant correlation with medical support (r = 0.469, P < 0.01), with tangible needs after surgery or an invasive examination (r = 0.460, P < 0.01), with informational needs (r = 0.393, P = 0.034) and with tangible needs of maintaining daily living activities during the hospitalization period (r = 0.290, P = 0.034). The need for tangible help in maintaining daily living activities during the hospitalization period was significantly correlated with the need for medical support (r = 0.341, P = 0.012), with help in managing admissions and discharge procedures (r = 0.374, P = 0.05) and with help after an invasive examination or in the postsurgery period (r = 0.334, P = 0.013). Finally, a conceptual framework was developed to depict this phenomenon. With the help of this HNI, both Eastern and Western health care providers can be empowered to detect the complex health needs of this particular population earlier and more accurately in order to promote their well-being as well as their health-related quality of life. Empowering nurse clinicians to assess health needs of hospitalized single-living Taiwanese elders with heart disease.

Medical education for equity in health: a participatory action research involving persons living in poverty and healthcare professionals.

PubMed

Hudon, Catherine; Loignon, Christine; Grabovschi, Cristina; Bush, Paula; Lambert, Mireille; Goulet, Émilie; Boyer, Sophie; De Laat, Marianne; Fournier, Nathalie

2016-04-12

Improving the knowledge and competencies of healthcare professionals is crucial to better address the specific needs of persons living in poverty and avoid stigmatization. This study aimed to explore the needs and expectations of persons living in poverty and healthcare professionals in terms of medical training regarding poverty and its effects on health and healthcare. We conducted a participatory action research study using photovoice, a method using photography, together with merging of knowledge and practice, an approach promoting dialogue between different sources of knowledge. Nineteen healthcare professionals and persons from an international community organization against poverty participated in the study. The first phase included 60 meetings and group sessions to identify the perceived barriers between persons living in poverty and healthcare teams. In the second phase, sub-committees deployed action plans in academic teaching units to overcome barriers identified in the first phase. Data were analysed through thematic analysis, using NVivo, in collaboration with five non-academic co-researchers. Four themes in regard to medical training were highlighted: improving medical students' and residents' knowledge on poverty and the living conditions of persons living in poverty; improving their understanding of the reality of those people; improving their relational skills pertaining to communication and interaction with persons living in poverty; improving their awareness and capacity for self-reflection. At the end of the second phase, actions were undertaken such as improving knowledge of the living conditions of persons living in poverty by posting social assistance rates, and tailoring interventions to patients' reality by including sociodemographic information in electronic medical records. Our findings also led to a participatory research project aiming to improve the skills and competency of residents and health professionals in regard to the quality of healthcare provided to persons living in poverty. Medical training and residency programs should aim to improve students' and residents' relational skills, more specifically their communication skills, as well as their awareness and capacity for self-reflection, by helping them to identify and recognize their biases, and limitations.

WE-D-303-00: Computational Phantoms

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

Lewis, John; Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, MA

2015-06-15

Modern medical physics deals with complex problems such as 4D radiation therapy and imaging quality optimization. Such problems involve a large number of radiological parameters, and anatomical and physiological breathing patterns. A major challenge is how to develop, test, evaluate and compare various new imaging and treatment techniques, which often involves testing over a large range of radiological parameters as well as varying patient anatomies and motions. It would be extremely challenging, if not impossible, both ethically and practically, to test every combination of parameters and every task on every type of patient under clinical conditions. Computer-based simulation using computationalmore » phantoms offers a practical technique with which to evaluate, optimize, and compare imaging technologies and methods. Within simulation, the computerized phantom provides a virtual model of the patient’s anatomy and physiology. Imaging data can be generated from it as if it was a live patient using accurate models of the physics of the imaging and treatment process. With sophisticated simulation algorithms, it is possible to perform virtual experiments entirely on the computer. By serving as virtual patients, computational phantoms hold great promise in solving some of the most complex problems in modern medical physics. In this proposed symposium, we will present the history and recent developments of computational phantom models, share experiences in their application to advanced imaging and radiation applications, and discuss their promises and limitations. Learning Objectives: Understand the need and requirements of computational phantoms in medical physics research Discuss the developments and applications of computational phantoms Know the promises and limitations of computational phantoms in solving complex problems.« less

Narratives of health and illness: Arts-based research capturing the lived experience of dementia.

PubMed

Moss, Hilary; O'Neill, Desmond

2017-01-01

Introduction This paper presents three artists' residencies in a geriatric medicine unit in a teaching hospital. The aim of the residencies was creation of new work of high artistic quality reflecting the lived experience of the person with dementia and greater understanding of service user experience of living with dementia. This paper also explores arts-based research methodologies in a medical setting. Method Arts-based research and narrative enquiry were the method used in this study. Artists had extensive access to service users with dementia, family carers and clinical team. Projects were created through collaboration between clinical staff, arts and health director, artist, patients and family carers. Each performance was accompanied by a public seminar discussing dementia. Evaluations were undertaken following each residency. The process of creating artistic responses to dementia is outlined, presented and discussed. Results The artworks were well received with repeat performances and exhibitions requested. Evaluations of each residency indicated increased understanding of dementia. The narratives within the artworks aided learning about dementia. The results are a new chamber music composition, a series of visual artworks created collaboratively between visual artist and patients and family carers and a dance film inspired by a dancer's residency, all created through narrative enquiry. These projects support the role of arts-based research as creative process and qualitative research method which contributes to illuminating and exploring the lived experience of dementia. The arts act as a reflective tool for learning and understanding a complex health condition, as well as creating opportunities for increased understanding and public awareness of dementia. Issues arising in arts-based research in medical settings are highlighted, including ethical issues, the importance of service user narrative and multidisciplinary collaboration in arts and health practice and research.

Providing care to vulnerable populations: a qualitative study among GPs working in deprived areas in Montreal, Canada

PubMed Central

Loignon, Christine; Fortin, Martin; Bedos, Christophe; Barbeau, David; Boudreault-Fournier, Alexandrine; Gottin, Thomas; Goulet, Émilie; Laprise, Elisha; Haggerty, Jeannie L

2015-01-01

Background. Communication barriers between persons living in poverty and healthcare professionals reduce care effectiveness. Little is known about the strategies general practitioners (GPs) use to enhance the effectiveness of care for their patients living in poverty. Objective. The aim of this study was to identify strategies adopted by GPs to deliver appropriate care to patients living in poverty. Methods. We conducted in-depth semi-structured interviews with 35 GPs practising in Montreal, Canada, who regularly provide care to underprivileged patients in primary care clinics located in deprived urban areas. Analysis consisted of interview debriefing, transcript coding, thematic analysis and data interpretation. Results. GPs develop specific skills for caring for these patients that are responsive to their complex medical needs and challenging social context. Our respondents used three main strategies in working with their patients: building a personal connection to overcome social distance, aligning medical expectations with patients’ social vulnerability and working collaboratively to empower patients. With these strategies, the physicians were able to enhance the patient–physician relationship and to take into account the impact of poverty on illness self-management. Conclusions. Our results may help GPs improve the health and care experience of their vulnerable patients by adopting these strategies. The strategies’ impacts on patients’ experience of care and health outcomes should be evaluated as a prelude to integrating them into primary care practice and the training of future physicians. PMID:25670205

Costs of medically assisted reproduction treatment at specialized fertility clinics in the Danish public health care system: results from a 5-year follow-up cohort study.

PubMed

Christiansen, Terkel; Erb, Karin; Rizvanovic, Amra; Ziebe, Søren; Mikkelsen Englund, Anne L; Hald, Finn; Boivin, Jacky; Schmidt, Lone

2014-01-01

To examine the costs to the public health care system of couples in medically assisted reproduction. Longitudinal cohort study of infertile couples initiating medically assisted reproduction treatment. Specialized public fertility clinics in Denmark. Seven hundred and thirty-nine couples having no child at study entry and with data on kind of treatment and live birth (yes/no) for each treatment attempt at the specialized public fertility clinic. Treatment data for medically assisted reproduction attempts conducted at the public fertility clinics were abstracted from medical records. Flow diagrams were drawn for different standard treatment cycles and direct costs at each stage in the flow charts were measured and valued by a bottom-up procedure. Indirect costs were distributed to each treatment cycle on the basis of number of visits as basis. Costs were adjusted to 2012 prices using a constructed medical price index. Live birth, costs. Total costs per live birth in 2012 prices were estimated to 10,755€. Costs per treated couple - irrespective of whether the treatment was terminated by a live birth or not - were estimated at 6607€. Costs per live birth of women <35 years at treatment initiation were 9338€ and 15,040€ for women ≥35 years. The public costs for live births after conception with medically assisted reproduction treatment are relatively modest. The results can be generalized to public fertility treatment in Denmark and to other public treatment settings with similar limitations in numbers of public treatment cycles offered. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

Reducing Medical Students' Stigmatization of People with Chronic Mental Illness: A Field Intervention at the "Living Museum" State Hospital Art Studio

ERIC Educational Resources Information Center

Cutler, Janis L.; Harding, Kelli J.; Hutner, Lucy A.; Cortland, Clarissa; Graham, Mark J.

2012-01-01

Objective: The authors designed an intervention to reduce beginning medical students' stigmatization of people with chronic mental illness (CMI). Methods: Pre-clinical medical students visited a state psychiatric facility's "Living Museum," a combination patient art studio/display space, as the intervention. During the visit, students interacted…

The Mayo Clinic Author Catalog: A Living Repository of Medical Knowledge

PubMed Central

Key, Jack D.; Sholtz, Katherine J.

1973-01-01

Since 1907 records have been kept of publications by staff members of the Mayo Clinic, and this information has been invaluable. The Author Catalog has proved itself such a useful tool for the Mayo Clinic that other libraries, large and small, may wish to consider adopting such a service. The Mayo medical complex is a large institution with more than 500 staff and faculty members engaged in the publication of clinical, educational, and research findings. The great amount of cross-disciplinary cooperation and interdepartmental research makes essential an up-to-date record of what is going on. The Mayo Clinic Library developed a comprehensive computerized method for identifying research and for identifying and indexing publications of Mayo staff members. At the end of 1971 more than 25,000 citations had been stored on computer tape. Images PMID:4122094

Effects of a nutrition plus exercise programme on physical function in sarcopenic obese elderly people: study protocol for a randomised controlled trial.

PubMed

Shen, Shan-Shan; Chu, Jiao-Jiao; Cheng, Lei; Zeng, Xing-Kun; He, Ting; Xu, Li-Yu; Li, Jiang-Ru; Chen, Xu-Jiao

2016-09-30

With a rapidly ageing population, sarcopenic obesity, defined as decreased muscle mass and function combined with increased body fat, is a complex health problem. Although sarcopenic obesity contributes to a decline in physical function and exacerbates frailty in older adults, evidence from clinical trials about the effect of exercise and nutrition on this complex syndrome in Chinese older adults is lacking. We devised a study protocol for a single-blind randomised controlled trial. Sarcopenia is described as age-related decline in muscle mass plus low muscle strength and/or low physical performance. Obesity is defined as a percentage of body fat above the 60th centile. Ninety-two eligible participants will be randomly assigned to a control group, nutrition group, exercise group and nutrition plus exercise group to receive an 8-week intervention and 12-week follow-up. The primary outcomes will be the change in short physical performance battery scores, grip strength and 6 m usual gait speed. The secondary outcomes will include basic activities of daily living scores, instrumental activity daily living scores, body composition and body anthropometric indexes. For all main analyses, the principle of intention-to-treat will be used. This study was approved by the medical ethics committee of Zhejiang Hospital on 25 November 2015. The study will present data targeting the clinical effects of nutrition and exercise on physical function and body composition in a Chinese older population with sarcopenic obesity. The results will help to provide important clinical evidence of the role of complex non-pharmaceutical interventions for sarcopenic obese older people. The findings of this study will be submitted to peer-reviewed medical journals for publication and presented at relevant academic conferences. ChiCTR-IOR-15007501; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Medication-related issues associated with adherence to long-term tyrosine kinase inhibitors for controlling chronic myeloid leukemia: a qualitative study

PubMed Central

Tan, Bee Kim; Tan, Seng Beng; Chen, Li-Chia; Chang, Kian Meng; Chua, Siew Siang; Balashanker, Sharmini; Kamarul Jaman, Habiba Nazeera Begum; Edmund, Syed Carlo; Bee, Ping Chong

2017-01-01

Purpose Poor adherence to tyrosine kinase inhibitors (TKIs) could compromise the control of chronic myeloid leukemia (CML) and contributes to poorer survival. Little is known about how medication-related issues affect CML patients’ adherence to TKI therapy in Malaysia. This qualitative study aimed to explore these issues. Patients and methods Individual face-to-face, semistructured interviews were conducted at the hematology outpatient clinics of two medical centers in Malaysia from August 2015 to January 2016. CML patients aged ≥18 years who were prescribed a TKI were invited to participate in the study. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. Results Four themes were identified from 18 interviews: 1) concerns about adverse reactions to TKIs, 2) personal beliefs regarding the use of TKIs, 3) mismanagement of TKIs in daily lives, and 4) financial burden in accessing treatment. Participants skipped their TKIs due to ineffective emesis control measures and perceived wastage of medication from vomiting. Participants also modified their TKI therapy due to fear of potential harm from long-term use, and stopped taking their TKIs based on belief in curative claims of traditional medicines and misconception about therapeutic effects of TKIs. Difficulty in integrating the dosing requirements of TKIs into daily lives led to unintentional skipping of doses, as well as the risk of toxicities from inappropriate dosing intervals or food interactions. Furthermore, financial constraints also resulted in delayed initiation of TKIs, missed clinic appointments, and treatment interruptions. Conclusion Malaysian CML patients encountered a range of medication-related issues leading to a complex pattern of nonadherence to TKI therapy. Further studies should investigate whether regular contact with patients to improve understanding of treatment rationale, to elicit and address patients’ concerns about adverse reactions, and to empower patients with skills to self-manage their medications might promote better adherence to TKIs and improve CML patients’ outcome. PMID:28652712

Psychotropic Medication Burden and Factors Associated with Antipsychotic Use: An Analysis of a Population-Based Sample of Community-Dwelling Older Persons with Dementia

PubMed Central

Rhee, YongJoo; Csernansky, John G.; Emanuel, Linda L.; Chang, Chang-Gok; Shega, Joseph W.

2011-01-01

Objectives To estimate the proportion of community dwelling older adults with dementia being prescribed a psychotropic and identify patient and caregiver factors associated with antipsychotics use. Methods Retrospective cohort study of The Aging, Demographics, and Memory Study (ADAMS) from 2002 to 2004 designed to assess dementia severity and service use among community-dwelling older adults. The frequency of psychotropic medication (antipsychotics, antidepressants, anticonvulsants and benzodiazepines) use was tabulated and weighted to the US population by dementia diagnosis. Logistic regression analysis identified factors associated with antipsychotic use. Results The 307 participants of ADAMS had the following dementia diagnosis: Alzheimer’s disease (69.29%), vascular dementia (17.74%) and other dementia (12.39%). The proportion of participants prescribed a psychotropic medication broken down by therapeutic class was as 19.07% antipsychotics, 29.08% antidepressants, 9.84% benzodiazepines, and 8.85% anticonvulsants. Older adults with dementia were significantly more likely to receive an antipsychotic if they had moderate dementia (OR =7.4, p<0.05), or severe dementia (OR=5.80, p<0.05), compared to mild dementia or were diagnosed with Alzheimer (OR =6.7, p<0.05) dementia compared to vascular dementia. Older adults with dementia who lived with their caregivers in were significantly less likely to be medicated with antipsychotics (OR= 0.19, p<0.05) compared to those who lived alone. Also, persons with dementia were significantly less likely to be prescribed an antipsychotic if the caregivers were clinically depressed (OR=0.03, p<0.05) compared to those who were not depressed. Conclusion We found psychotropic medication use is common among community-dwelling older adults with dementia. Caregivers appear to have a substantial impact on whether or not an antipsychotic is prescribed, which adds additional complexity to conversations discussing the risk-benefit ratio of this medication class. PMID:22092099

Towards non-reductionistic medical anthropology, medical education and practitioner-patient-interaction: the example of Anthroposophic Medicine.

PubMed

Heusser, Peter; Scheffer, Christian; Neumann, Melanie; Tauschel, Diethart; Edelhäuser, Friedrich

2012-12-01

To develop the hypothesis that reductionism in medical anthropology, professional education and health care influences empathy development, communication and patient satisfaction. We identified relevant literature and reviewed the material in a structured essay. We reflected our hypothesis by applying it to Anthroposophic Medicine (AM), an example of holistic theory and practice. Reductionism in medical anthropology such as in conventional medicine seems to lead to a less empathetic and less communicative health care culture than holism such as in CAM disciplines. However, reductionism can be transformed into a systemic, multi-perspective holistic view, when the emergent properties of the physical, living, psychic, spiritual and social levels of human existence and the causal relations between them are more carefully accounted for in epistemology, medical anthropology and professional education. This is shown by the example of AM and its possible benefits for communication with and satisfaction of patients. A non-reductionistic understanding of the human being may improve communication with patients and enhance patient benefit and satisfaction. Interdisciplinary qualitative and quantitative studies are warranted to test this hypothesis and to understand the complex relations between epistemology, medical anthropology, education, health care delivery and benefit for patients. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Interior, central sunporch behind living room, looking northeast U.S. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Interior, central sunporch behind living room, looking northeast - U.S. Veterans Hospital, Jefferson Barracks, Medical Officer in Charge Residence, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

Medication Regimen Complexity Measured by MRCI: A Systematic Review to Identify Health Outcomes.

PubMed

Alves-Conceição, Vanessa; Rocha, Kérilin Stancine Santos; Silva, Fernanda Vilanova Nascimento; Silva, Rafaella Oliveira Santos; Silva, Daniel Tenório da; Lyra-Jr, Divaldo Pereira de

2018-05-01

To perform a systematic review to identify health outcomes related to medication regimen complexity as measured by the Medication Regimen Complexity Index (MRCI) instrument. Cochrane Library, LILACS, PubMed, Scopus, EMBASE, Open Thesis, and Web of Science were searched from January 1, 2004, until April 02, 2018, using the following search terms: outcome assessment, drug therapy, and Medication Regimen Complexity Index and their synonyms in different combinations. Studies that used the MRCI instrument to measure medication regimen complexity and related it to clinical, humanistic, and/or economic outcomes were evaluated. Two reviewers independently carried out the analysis of the titles, abstracts, and complete texts according to the eligibility criteria, performed data extraction, and evaluated study quality. A total of 23 studies met the inclusion criteria; 18 health outcomes related to medication regimen complexity were found. The health outcomes most influenced by medication regimen complexity were hospital readmission, medication adherence, hospitalization, adverse drug events, and emergency sector visit. Only one study related medication regimen complexity with humanistic outcomes, and no study related medication regimen complexity to economic outcomes. Most of the studies were of good methodological quality. Relevance to Patient Care and Clinical Practice: Health care professionals should pay attention to medication regimen complexity of the patients because this may influence health outcomes. This study identified some health outcomes that may be influenced by medication regimen complexity: hospitalization, hospital readmission, and medication adherence were more prevalent, showing a significant association between MRCI increase and these health outcomes.

Wireless sleep measurement: sensing sleep and breathing patterns using radio-frequency sensors.

PubMed

Heneghan, Conor

2014-01-01

Despite the fact that we spend nearly one third of our lives asleep, surprisingly little was known about sleep until the 20th century. Now, sleep medicine is firmly established as a significant branch of medical practice, taking its roots strongly from the work of Nathaniel Kleitman and colleagues at the University of Chicago in the 1950s. They were the first to show the existence of rapid eye movement (REM) sleep?commonly associated with ?dreaming?and began the process of opening our eyes to the complex physiological processes that occur during sleep.

[Autogenic training within the therapeutic scope of schizophrenic patients].

PubMed

Starke, H

1976-06-01

The author calls the reader's attention to the rather strange fact that autogenic training, in spite of worldwide recognition and extensive uses of the method in various disciplines of medicine and spheres of live, has not so far been finding wide application in the medical specialty dealing with mental disorders. After discussing some possible causes of this situation and commenting on first signs of a necessary change in attitude toward autogenic training, he reports his own experience in the treatment of schizophrenic patients with this psychotherapeutic method, emphasizing the need for including psychotherapy in a complex concept of the treatment of psychoses.

TRIAD IV: Nationwide Survey of Medical Students' Understanding of Living Wills and DNR Orders.

PubMed

Mirarchi, Ferdinando L; Ray, Matthew; Cooney, Timothy

2016-12-01

Living wills are a form of advance directives that help to protect patient autonomy. They are frequently encountered in the conduct of medicine. Because of their impact on care, it is important to understand the adequacy of current medical school training in the preparation of physicians to interpret these directives. Between April and August 2011 of third and fourth year medical students participated in an internet survey involving the interpretation of living wills. The survey presented a standard living will as a "stand-alone," a standard living will with the addition an emergent clinical scenario and then variations of the standard living will that included a code status designation ("DNR," "Full Code," or "Comfort Care"). For each version/ scenario, respondents were asked to assign a code status and choose interventions based on the cases presented. Four hundred twenty-five students from medical schools throughout the country responded. The majority indicated they had received some form of advance directive training and understood the concept of code status and the term "DNR." Based on a stand-alone document, 15% of respondents correctly denoted "full code" as the appropriate code status; adding a clinical scenario yielded negligible improvement. When a code designation was added to the living will, correct code status responses ranged from 68% to 93%, whereas correct treatment decisions ranged from 18% to 78%. Previous training in advance directives had no impact on these results. Our data indicate that the majority of students failed to understand the key elements of a living will; adding a code status designations improved correct responses with the exception of the term DNR. Misunderstanding of advance directives is a nationwide problem and jeopardizes patient safety. Medical School ethics curricula need to be improved to ensure competency with respect to understanding advance directives.

A Scoping Review of Physical Rehabilitation in Long-Term Care: Interventions, Outcomes, Tools.

PubMed

McArthur, Caitlin; Gibbs, Jenna C; Patel, Ruchit; Papaioannou, Alexandra; Neves, Paula; Killingbeck, Jaimie; Hirdes, John; Milligan, James; Berg, Katherine; Giangregorio, Lora

2017-12-01

Residents in long-term care (LTC) often require physical rehabilitation (PR) to maintain/improve physical function. This scoping review described the breadth of literature regarding PR in LTC to date, synthesizing PR interventions that have been evaluated, outcomes used, and tools for determining service eligibility. A structured search, conducted in six licensed databases and grey literature, identified 381 articles for inclusion. Most interventions were delivered and evaluated at the resident level and typically were multicomponent exercise programs. Performance-based measures, activities of daily living, and mood were the most frequently reported outcomes. A key knowledge gap was PR in relation to goals, such as quality of life. Future studies should reflect medically complex residents who live in LTC, and length of residents' stay should be differentiated. Intervention studies should also explore realistic delivery methods; moreover, tool development for determining service eligibility is necessary to ensure equality in rehabilitative care across the LTC sector.

Empathy, justice, and moral behavior

PubMed Central

Decety, Jean; Cowell, Jason M.

2015-01-01

Empathy shapes the landscape of our social lives. It motivates prosocial and caregiving behaviors, plays a role in inhibiting aggression, and facilitates cooperation between members of a similar social group. Thus, empathy is often conceived as a driving motivation of moral behavior and justice, and as such, everyone would think that it should be cultivated. However, the relationships between empathy, morality, and justice are complex. We begin by explaining what the notion of empathy encompasses and then argue how sensitivity to others’ needs has evolved in the context of parental care and group living. Next, we examine the multiple physiological, hormonal, and neural systems supporting empathy and its functions. One troubling but important corollary of this neuro-evolutionary model is that empathy produces social preferences that can conflict with fairness and justice. An understanding of the factors that mold our emotional response and caring motivation for others helps provide organizational principles and ultimately guides decision-making in medical ethics. PMID:26877887

Cohort Profile: HAART Observational Medical Evaluation and Research (HOMER) cohort.

PubMed

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

2015-02-01

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 (robert_hogg@sfu.ca). © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Living well: an intervention to improve self-management of medical illness for individuals with serious mental illness.

PubMed

Goldberg, Richard W; Dickerson, Faith; Lucksted, Alicia; Brown, Clayton H; Weber, Elyssa; Tenhula, Wendy N; Kreyenbuhl, Julie; Dixon, Lisa B

2013-01-01

Individuals with serious mental illness have elevated rates of comorbid chronic general medical conditions and may benefit from interventions designed to support illness self-management. This study examined the effectiveness of a modified version of the Chronic Disease Self-Management Program called Living Well for individuals with serious mental illness. A total of 63 mental health consumers with serious mental illness and at least one concurrent chronic general medical condition were randomly assigned to receive the 13-session peer-cofacilitated Living Well intervention or usual care. Participants were evaluated on attitudinal, behavioral, and functional outcomes at baseline, at the end of the intervention, and at a two-month follow-up. Living Well participants showed significant postintervention improvements across a range of attitudinal (self-efficacy and patient activation), behavioral (illness self-management techniques), and functional (physical and emotional well-being and general health functioning) outcomes. Although attenuation of effect was observed for most outcomes at two months postintervention, evidence was found of continued improvement in general self-management behaviors (use of action planning, brainstorming, and problem-solving). Continued advantage was found for the Living Well group in other areas, such as health-related locus of control and reports of healthy eating and physical activity. Receipt of Living Well was associated with a notable decrease in use of the emergency room for medical care, although the between-group difference was not statistically significant. Living Well shows promise in helping mental health consumers more effectively manage chronic general medical conditions and experience improved functioning and well-being.

Sleep disturbance in family caregivers of children who depend on medical technology: A systematic review.

PubMed

Keilty, Krista; Cohen, Eyal; Ho, Michelle; Spalding, Karen; Stremler, Robyn

2015-01-01

Society relies on family caregivers of children who depend on medical technology (e.g. mechanical ventilation), to provide highly skilled and vigilant care in their homes 24 hours per day. Sleep disturbance is among the most common complaints of these caregivers. The purpose of this review is to systematically examine studies reporting on sleep outcomes in family caregivers of technology dependent children. All relevant databases were systematically searched: MEDLINE, EMBASE, PsycINFO and CINAHL. Given the heterogeneity of the studies, a qualitative analysis was completed and thus results of this review are presented as a narrative. Thirteen studies were retrieved that met eligibility criteria for inclusion. All of the studies reported on family caregivers of children with medical complexity living at home. Moreover, all of the studies relied entirely on self-report, not objective sleep measures. No intervention studies were found. Sleep disturbance was found to be common (51-100%) along with caregiver reports of poor sleep quality. Sleep quantity was seldom measured, but was found in the few studies that did, to be approximately 6 hours, or less than recommendations for optimal health and daytime function. Multiple caregiver, child and environmental factors were also identified that may negatively influence caregiver sleep, health and daytime function. Findings of this review suggest that family caregivers of children with medical complexity who depend on medical technology achieve poor sleep quality and quantity that may place them at risk of the negative consequences of sleep deprivation. Recommendations for practice include that health care providers routinely assess for sleep disturbance in this vulnerable population. The review also suggests that studies using objective sleep measurement are needed to more fully characterize sleep and inform the development of targeted interventions to promote sleep in family caregivers of technology dependent children.

Balancing your personal and professional lives: help for busy medical practice employees.

PubMed

Hills, Laura Sachs

2008-01-01

It is extremely difficult for most people to balance work and home life. This is especially true of employees who work in fast-paced medical practices where they are on the go all day. Each medical practice employee must find his or her own way to balance work and life, but fortunately, the process can usually be boiled down to some basics. This article outlines a strategy for establishing the top five priorities in the medical practice employee's life. It suggests that medical practice personnel can develop and use a personal mission statement as a life guide. This article also suggests specific strategies medical practice employees can use to protect and make the best use of their private time. It provides examples of how medical practice personnel have changed their lives by dropping unnecessary activities from their daily schedules. Finally, this article offers guidance about getting children to help working parents balance their work and private lives, 10 additional tips for work/life balance, a work/life balance self-assessment quiz, and a template the medical practice employee can use to create a customized personal mission statement.

78 FR 45589 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Notice of Designation of a Longer Period for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-29

... on Proposed Rule Change Relating To Which Complex Orders Can Initiate a Complex Order Live Auction... Exchange to determine by order sender which complex orders can initiate a Complex Order Live Auction...

[Quality assurance and quality management in intensive care].

PubMed

Notz, K; Dubb, R; Kaltwasser, A; Hermes, C; Pfeffer, S

2015-11-01

Treatment success in hospitals, particularly in intensive care units, is directly tied to quality of structure, process, and outcomes. Technological and medical advancements lead to ever more complex treatment situations with highly specialized tasks in intensive care nursing. Quality criteria that can be used to describe and correctly measure those highly complex multiprofessional situations have only been recently developed and put into practice.In this article, it will be shown how quality in multiprofessional teams can be definded and assessed in daily clinical practice. Core aspects are the choice of a nursing theory, quality assurance measures, and quality management. One possible option of quality assurance is the use of standard operating procedures (SOPs). Quality can ultimately only be achieved if professional groups think beyond their boundaries, minimize errors, and establish and live out instructions and SOPs.

Negotiating the Relationship Between Addiction, Ethics, and Brain Science

PubMed Central

Buchman, Daniel Z.; Skinner, Wayne; Illes, Judy

2010-01-01

Advances in neuroscience are changing how mental health issues such as addiction are understood and addressed as a brain disease. Although a brain disease model legitimizes addiction as a medical condition, it promotes neuro-essentialist thinking, categorical ideas of responsibility and free choice, and undermines the complexity involved in its emergence. We propose a ‘biopsychosocial systems’ model where psycho-social factors complement and interact with neurogenetics. A systems approach addresses the complexity of addiction and approaches free choice and moral responsibility within the biological, lived experience and socio-historical context of the individual. We examine heroin-assisted treatment as an applied case example within our framework. We conclude with a discussion of the model and its implications for drug policy, research, addiction health care systems and delivery, and treatment of substance use problems. PMID:20676352

Understanding treatment non-adherence in schizophrenia and bipolar disorder: a survey of what service users do and why

PubMed Central

2013-01-01

Background Approximately half of service users with schizophrenia or bipolar disorder do not fully follow treatment recommendations. Studies of adherence have not adequately explored the frequency, consequences and meanings of non-adherence behaviours from service users’ perspectives. This study contributes to a more fine-grained understanding of treatment choices and the support service users require in order to maximise benefit from their medications. Methods This was a mixed-methods questionnaire study, employing quantitative and thematic qualitative analyses. Thirty-five individuals with a diagnosis of, and receiving psycho-pharmaceutical treatment for, schizophrenia or bipolar disorder answered online or telephone questions about whether, how, and why they deviated from their treatment recommendations, and what support they currently and would like to receive. Results Over half of participants identified themselves as being non-adherent, however when asked in detail about intentional and unintentional adherence, 77% reported deviating from treatment recommendations. Critically, 29% were non-adherent and satisfied with being so. Service users’ satisfaction with their support was positively correlated with satisfaction with their medication. Participants’ made treatment choices in order to live well. Both side-effects and symptoms could be obstacles to adherence, but feeling well also impacted on participants’ treatment choices. Treatment choices were often made in the context of living well day-to-day, and did not necessarily take into account longer-term effects of non-adherence. Participants wanted more information about their medications, better emotional support (including better access to psychological therapies) and stability in their relationships with health professionals. Conclusions This study suggests that non-adherence, both intentional and unintentional, is common amongst individuals with diagnoses of schizophrenia and bipolar disorder, and that this often occurs without health professionals’ knowledge or support. Treatment choices reflect a desire to live well, but are often driven by short-term needs. Given access to more information, and importantly to emotional support, service users could be helped to make treatment choices that adequately reflect the long-term risks of non-adherence, as well as allowing them to live well day-to-day. More research is required better to understand the meanings and complexities of service users’ treatment choices. PMID:23714262

Medications for Sexually Transmitted Infections

MedlinePlus

... Healthy Living Healthy Living Healthy Living Nutrition Fitness Sports Oral Health Emotional Wellness Growing Healthy Sleep Safety & Prevention Safety & Prevention Safety and Prevention Immunizations ...

Ernest Hemingway: a psychological autopsy of a suicide.

PubMed

Martin, Christopher D

2006-01-01

Much has been written about Ernest Hemingway, including discussion of his well-documented mood disorder, alcoholism, and suicide. However, a thorough biopsychosocial approach capable of integrating the various threads of the author's complex psychiatric picture has yet to be applied. Application of such a psychiatric view to the case of Ernest Hemingway in an effort toward better understanding of the author's experience with illness and the tragic outcome is the aim of this investigation. Thus, Hemingway's life is examined through a review and discussion of biographies, psychiatric literature, personal correspondence, photography, and medical records. Significant evidence exists to support the diagnoses of bipolar disorder, alcohol dependence, traumatic brain injury, and probable borderline and narcissistic personality traits. Late in life, Hemingway also developed symptoms of psychosis likely related to his underlying affective illness and superimposed alcoholism and traumatic brain injury. Hemingway utilized a variety of defense mechanisms, including self-medication with alcohol, a lifestyle of aggressive, risk-taking sportsmanship, and writing, in order to cope with the suffering caused by the complex comorbidity of his interrelated psychiatric disorders. Ultimately, Hemingway's defense mechanisms failed, overwhelmed by the burden of his complex comorbid illness, resulting in his suicide. However, despite suffering from multiple psychiatric disorders, Hemingway was able to live a vibrant life until the age of 61 and within that time contribute immortal works of fiction to the literary canon.

Measuring the Impact of the Home Health Nursing Shortage on Family Caregivers of Children Receiving Palliative Care.

PubMed

Weaver, Meaghann S; Wichman, Brittany; Bace, Sue; Schroeder, Denice; Vail, Catherine; Wichman, Chris; Macfadyen, Andrew

2018-06-01

The national nursing shortage translates into a gap in home nursing care available to children with complex, chronic medical conditions and their family caregivers receiving palliative care consultations. A total of 38 home health nursing surveys were completed by families receiving pediatric palliative care consultation services at a freestanding children's hospital in the Midwest. The gap in the average number of nursing hours allotted versus received was 40 h/wk per family, primarily during evening hours. Parents missed an average of 23 hours of employment per week to provide hands-on nursing care at home, ranking stress regarding personal employment due to nursing shortage at 6.2/10. Families invested an average of 10 h/mo searching for additional nursing coverage and often resorted to utilizing more than 6 different home nurse coverage personnel per month. Families reported multiple delays to hospital discharges (mean, 15 days per delay) due to inability to find home nursing coverage. Respiratory technology and lack of Medicaid coverage ( P < .02) correlated with the gap in home nursing access. This study examines how the pediatric home nursing shortage translates into a lived experience for families with children with complex medical conditions receiving palliative care.

Anthropology, organ transplantation and the immune system: resituating commodity and gift exchange.

PubMed

Kierans, Ciara

2011-11-01

This article reflects on contributions from medical anthropology to our understanding of the bio-social and bio-political implications of renal transplantation. Taking up the idea of transplantation as a 'complex', a vast assemblage of people, places, practices and procedures which intersect medical, social and cultural domains, I point to a reliance in the anthropological literature on overly pre-determined conceptual frameworks, organised around a distinct polarisation between organ giving and receiving, where one side (supply) takes analytical, and indeed moral, precedence over the other (receipt). These frameworks tend to fail us when it comes to thinking about the wider social, cultural and political implications of transplant technologies. In an attempt to offer a less polarised view, I draw attention to the material and symbolic role of the immune system in transplantation and the ways in which it simultaneously shapes opportunities for procurement and the lived realities of recipiency. This helps us see the many complex ways in which suffering and inequality are constituted all along the variegated chains of supply and demand that are internal to, and made possible by, transplantation practices themselves. Copyright © 2011 Elsevier Ltd. All rights reserved.

Making choices about medical interventions: the experience of disabled young people with degenerative conditions.

PubMed

Mitchell, Wendy A

2014-04-01

Current western policy, including the UK, advocates choice for service users and their families, taking greater control and being more involved in decision making. However, children's role in health decision making, especially from their own perspective, has received less research attention compared to doctors and parents' perspectives. To explore the perspective and experiences of disabled young people with degenerative conditions as they face significant medical interventions and engage in decision-making processes. Findings from a longitudinal qualitative study of 10 young people (13-22 years) with degenerative conditions are reported. Individual semi-structured interviews were conducted with participants over 3 years (2007-2010); the paper reports data from all three interview rounds. Interviews focused on medical intervention choices the young people identified as significant. Although the young people in this study felt involved in the medical intervention choices discussed, findings demonstrate a complex and diverse picture of decision making. Results highlighted different decisional roles adopted by the young people, the importance of information heuristics and working with other people whilst engaging in complex processes weighing up different decisional factors. Young people's experiences demonstrate the importance of moving beyond viewing health choices as technical or rational decisions. How each young person framed their decision was important. Recognizing this diversity and the importance of emerging themes, such as living a normal life, independence, fear of decisions viewed as 'irreversible' and the role of parents and peers in decision making highlights that, there are clear practice implications including, active practitioner listening, sensitivity and continued holistic family working. © 2012 John Wiley & Sons Ltd.

Cannabis Use, Medication Management and Adherence Among Persons Living with HIV.

PubMed

Vidot, Denise C; Lerner, Brenda; Gonzalez, Raul

2017-07-01

Cannabis is used to relieve nausea, trigger weight gain, and reduce pain among adults living with HIV; however, the relationship between its use and medication adherence and management is unclear. Participants (N = 107) were from an ongoing cohort study of community-dwelling HIV+ adults, stratified by cannabis (CB) use: HIV+/CB+ (n = 41) and HIV+/CB- (n = 66). CB+ participants either tested positive in a urine toxicology screen for THC or had a self-reported history of regular and recent use. HIV-status was provided by physician results and/or biomarker assessment. Adherence was measured via the Morisky scale and medication management was assessed via the Medication Management Test-Revised. After adjusting for gender, we found no association between cannabis use group and adherence nor medication management. The amount of cannabis used was also not associated with measures of adherence and management. Preliminary findings suggest that cannabis use may not adversely influence medication adherence/management among adults living with HIV.

Loss of Military Performance due to Individual NBC Protection in a Tropic Environment (belasting en prestatieverlies door individuele nbc-beschermin gin de tropen)

DTIC Science & Technology

2006-08-01

SMP) 1 Trg Area 1330-1430 SMP 2 Trg Area 16 nov 0800-0900 SMP 3 Trg Area 0930-1200 Offensive Fire - LIVE FIRE Range 1 Range Complex 1300-1530 Command...Control Evaluation (C2) 1 Range Complex 1600-1700 SMP 4 Trg Area 17 nov 0930-1200 Defensive Fire - LIVE FIRE Range 2 Range Complex 1300-1530 Command...Control Evaluation (C2) 2 Range Complex 18 nov 0800-0900 SMP 5 Trg Area 0930-1200 Offensive Fire - LIVE FIRE Range 2 Range Complex 1300-1530

[Thyroid cancer after Chernobyl: is iodine 131 the only culprit ? Impact on clinical practice].

PubMed

Guiraud-Vitaux, Françoise; Elbast, Mouhamad; Colas-Linhart, Nicole; Hindie, Elif

2008-02-01

The large increase in the incidence of thyroid cancer among children who were mainly less than five years old at the time of the Chernobyl accident is still a major preoccupation for endocrinologists and nuclear physicians. Epidemiological studies have focused solely on iodine 131. However, past knowledge on thyroid irradiation (medical use of iodine 131, radioactive fallout on Marshall islands and the Nevada, and Hanford site releases) as well as number of recent works (about low-dose irradiation), raise question on the role of other factors. It is here shown that post-Chernobyl thyroid irradiation is complex and that all factors (iodine 131, but also short lived isotopes of iodine and external irradiation) should be considered. Finally, one need to think about some of the present medical uses of iodine 131, and especially to the treatment of hyperthyroidism in young subjects.

Medication use in people with late stage Parkinson's disease and parkinsonism living at home and in institutional care in north-east England: A balance of symptoms and side-effects?

PubMed

Hand, Annette; Gray, William K; Oates, Lloyd L; Woolford, Megan; Todd, Anna; Bale, Elizabeth; Jones, Catherine; Wood, Brian H; Walker, Richard W

2016-11-01

People with Parkinson's disease (PD) and parkinsonism living in care homes (residential or nursing care) in the UK represent around 10-15% of all people with PD and 3-5% of all care home residents. There are few previous data on medication use in those living in care homes with PD. In this study we aimed to compare medication use in a representative cohort of people with PD living in care homes in north-east England with those living in their own homes. All people with late stage (Hoehn and Yahr III-V) idiopathic PD, PD dementia, or atypical parkinsonian syndromes under the care of the Northumbria Healthcare NHS Foundation Trust PD service on 1st January 2015 were identified. Demographic, disease characteristics and medication use data were collected from an audit of medical notes of all those identified. We identified 377 people who met the inclusion criteria, 91 (24.1%) of whom were living in a care home. Disease stage, age and age at disease onset were all significantly higher and levodopa equivalent dose significantly lower in those living in care homes, although disease duration and levodopa dose were not. Greater age, lower levodopa equivalent dose and higher disease stage were independently associated with being in a care home. Although people in care homes had more advanced disease, they were on a significantly lower levodopa equivalent dose. This is likely to be due to the requirement to balance symptom management with drug side-effects. Copyright © 2016 Elsevier Ltd. All rights reserved.

Consumerism, reflexivity and the medical encounter.

PubMed

Lupton, D

1997-08-01

Much emphasis has been placed recently in sociological, policy and popular discourses on changes in lay people's attitudes towards the medical profession that have been labelled by some as a move towards the embracing of "consumerism". Notions of consumerism tend to assume that lay people act as "rational" actors in the context of the medical encounter. They align with broader sociological concepts of the "reflexive self" as a product of late modernity; that is, the self who acts in a calculated manner to engage in self-improvement and who is sceptical about expert knowledges. To explore the ways that people think and feel about medicine and the medical profession, this article draws on findings from a study involving in-depth interviews with 60 lay people from a wide range of backgrounds living in Sydney. These data suggest that, in their interactions with doctors and other health care workers, lay people may pursue both the ideal-type "consumerist" and the "passive patient" subject position simultaneously or variously, depending on the context. The article concludes that late modernist notions of reflexivity as applied to issues of consumerism fail to recognize the complexity and changeable nature of the desires, emotions and needs that characterize the patient-doctor relationship.

Collaboratively reframing mental health for integration of HIV care in Ethiopia†

PubMed Central

Wissow, Lawrence S.; Tegegn, Teketel; Asheber, Kassahun; McNabb, Marion; Weldegebreal, Teklu; Jerene, Degu; Ruff, Andrea

2015-01-01

Background Integrating mental health with general medical care can increase access to mental health services, but requires helping generalists acquire a range of unfamiliar knowledge and master potentially complex diagnostic and treatment processes. Method We describe a model for integrating complex specialty care with generalist/primary care, using as an illustration the integration of mental health into hospital-based HIV treatment services in Ethiopia. Generalists and specialists collaboratively developed mental health treatments to fit the knowledge, skills and resources of the generalists. The model recognizes commonalities between mental health and general medical care, focusing on practical interventions acceptable to patients. It was developed through a process of literature review, interviews, observing clinical practice, pilot trainings and expert consultation. Preliminary evaluation results were obtained by debriefing generalist trainees after their return to their clinical sites. Results In planning interviews, generalists reported discomfort making mental health diagnoses but recognition of symptom groups including low mood, anxiety, thought problems, poor child behaviour, seizures and substance use. Diagnostic and treatment algorithms were developed for these groups and tailored to the setting by including possible medical causes and burdens of living with HIV. First-line treatment included modalities familiar to generalists: empathetic patient–provider interactions, psychoeducation, cognitive reframing, referral to community supports and elements of symptom-specific evidence-informed counselling. Training introduced basic skills, with evolving expertise supported by job aides and ongoing support from mental health nurses cross-trained in HIV testing. Feedback from trainees suggested the programme fit well with generalists’ settings and clinical goals. Conclusions An integration model based on collaboratively developing processes that fit the generalist setting shows promise as a method for incorporating complex, multi-faceted interventions into general medical settings. Formal evaluations will be needed to compare the quality of care provided with more traditional approaches and to determine the resources required to sustain quality over time. PMID:25012090

Collaboratively reframing mental health for integration of HIV care in Ethiopia.

PubMed

Wissow, Lawrence S; Tegegn, Teketel; Asheber, Kassahun; McNabb, Marion; Weldegebreal, Teklu; Jerene, Degu; Ruff, Andrea

2015-07-01

Integrating mental health with general medical care can increase access to mental health services, but requires helping generalists acquire a range of unfamiliar knowledge and master potentially complex diagnostic and treatment processes. We describe a model for integrating complex specialty care with generalist/primary care, using as an illustration the integration of mental health into hospital-based HIV treatment services in Ethiopia. Generalists and specialists collaboratively developed mental health treatments to fit the knowledge, skills and resources of the generalists. The model recognizes commonalities between mental health and general medical care, focusing on practical interventions acceptable to patients. It was developed through a process of literature review, interviews, observing clinical practice, pilot trainings and expert consultation. Preliminary evaluation results were obtained by debriefing generalist trainees after their return to their clinical sites. In planning interviews, generalists reported discomfort making mental health diagnoses but recognition of symptom groups including low mood, anxiety, thought problems, poor child behaviour, seizures and substance use. Diagnostic and treatment algorithms were developed for these groups and tailored to the setting by including possible medical causes and burdens of living with HIV. First-line treatment included modalities familiar to generalists: empathetic patient-provider interactions, psychoeducation, cognitive reframing, referral to community supports and elements of symptom-specific evidence-informed counselling. Training introduced basic skills, with evolving expertise supported by job aides and ongoing support from mental health nurses cross-trained in HIV testing. Feedback from trainees suggested the programme fit well with generalists' settings and clinical goals. An integration model based on collaboratively developing processes that fit the generalist setting shows promise as a method for incorporating complex, multi-faceted interventions into general medical settings. Formal evaluations will be needed to compare the quality of care provided with more traditional approaches and to determine the resources required to sustain quality over time. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Behavior medicine specialist.

PubMed

Tuso, Phillip

2014-01-01

Total Health is a vision for the future and a strategy to prevent preventable disease, save lives, and make health care more affordable. Total Health means health of mind (behavior health) and health of body (physical health). To achieve Total Health we need healthy people in healthy communities. A behavior medicine specialist is a psychologist who works in the medical home with the primary care physician instead of in the Mental Health Department with a psychiatrist. The key to achieving Total Health will be to transform our current health care system from a focus on treating disease to a focus on preventing disease. This transformation will require complex behavior change interventions and services not usually provided in the medical home. The behavior medicine specialist will bring the knowledge and experience used to treat mental illness into the medical home to help the primary care physician improve the care of all patients in the medical home. The behavior medicine specialist will help improve outcomes in synergy with the primary care physician by universal screening of high-risk diseases, stepped care protocols, and efficient use of all resources available to care for patients in the medical home (health education classes, wellness coaches, and online social networking lifestyle management programs). These interventions should increase patient satisfaction, increase access to specialty care (psychiatry), and help us achieve Total Health.

To Prescribe or Not to Prescribe? Consumer Access to Life-Enhancing Products

PubMed Central

Marinova, Detelina; Kozlenkova, Irina V; Cuttler, Leona; Silvers, J B

2017-01-01

Abstract With rapid biotechnological advances in specialty drugs and direct-to-consumer advertising, consumers are under tremendous pressure to look, perform, feel, and live better. This is often accomplished through the use of life-enhancing products, sometimes referred to as performance-enhancing products, which can be accessed only through a gatekeeper, such as a physician. Integrating consumer and medical research, this article investigates how physicians make trade-offs between objective medical and nonmedical factors to determine consumers’ access to life-enhancing products by examining US pediatric endocrinologists’ prescription decisions for growth hormone (GH) for healthy but short children. The results of a conjoint study indicate that consumer medical criteria have less impact on a physician’s decision to prescribe GH if the consumer requests a prescription or the physician believes in the intangible product benefits, and more impact when the product is more expensive. A physician’s length of experience increases the impact of consumer medical criteria and decreases the influence of a consumer’s preference for a prescription on the decision to prescribe. Overall, this research shows that not all consumers have equal access to life-enhancing products; their access depends on a complex combination of medical and nonmedical factors related to the consumer, product, and the physician. PMID:29928069

Interventional cardiology live case presentations: regulatory considerations.

PubMed

Farb, Andrew; Brown, Sheila A; Wolf, Deborah A; Zuckerman, Bram

2010-10-01

Live case presentations are increasingly common at interventional cardiology conferences. Taking advantage of significant advances in communication technology, broadcasts of procedures can be viewed as an extension of traditional medical education targeted to large groups of practitioners. However, there are important ethical, commercial, and patient safety issues associated with live cases that deserve attention. Use of investigational devices in live case demonstrations is subject to review and approval by FDA's Center for Devices and Radiological Health (CDRH), and the outcomes of patients participating in live cases are considered in the overall clinical study results. This article discusses CDRH's regulatory view of live case presentations with a focus on patient safety, clinical trial integrity, and concerns regarding improper medical device promotion. © 2010 Wiley-Liss, Inc.

Interventional cardiology live case presentations regulatory considerations.

PubMed

Farb, Andrew; Brown, Sheila A; Wolf, Deborah A; Zuckerman, Bram

2010-10-01

Live case presentations are increasingly common at interventional cardiology conferences. Taking advantage of significant advances in communication technology, broadcasts of procedures can be viewed as an extension of traditional medical education targeted to large groups of practitioners. However, there are important ethical, commercial, and patient safety issues associated with live cases that deserve attention. Use of investigational devices in live case demonstrations is subject to review and approval by FDA's Center for Devices and Radiological Health (CDRH), and the outcomes of patients participating in live cases are considered in the overall clinical study results. This article discusses CDRH's regulatory view of live case presentations with a focus on patient safety, clinical trial integrity, and concerns regarding improper medical device promotion. Copyright © 2010. Published by Elsevier Inc.

New Technology Provides Urgent Medical Information and Protects Privacy: Providing Important Information in Medical Situations for the Developmentally Disabled

ERIC Educational Resources Information Center

Seelig, Richard

2006-01-01

Fernando Viesca has a 24-year-old son who suffers from Angelman Syndrome, a little known chromosomal disorder that has left him with significant functional deficiencies. When Nando lived at home, his father took care of him full time, thus alleviating any worries about medical care. However, now that Nando lives in a group home, his father is no…

WE-D-303-01: Development and Application of Digital Human Phantoms

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

Segars, P.

2015-06-15

Modern medical physics deals with complex problems such as 4D radiation therapy and imaging quality optimization. Such problems involve a large number of radiological parameters, and anatomical and physiological breathing patterns. A major challenge is how to develop, test, evaluate and compare various new imaging and treatment techniques, which often involves testing over a large range of radiological parameters as well as varying patient anatomies and motions. It would be extremely challenging, if not impossible, both ethically and practically, to test every combination of parameters and every task on every type of patient under clinical conditions. Computer-based simulation using computationalmore » phantoms offers a practical technique with which to evaluate, optimize, and compare imaging technologies and methods. Within simulation, the computerized phantom provides a virtual model of the patient’s anatomy and physiology. Imaging data can be generated from it as if it was a live patient using accurate models of the physics of the imaging and treatment process. With sophisticated simulation algorithms, it is possible to perform virtual experiments entirely on the computer. By serving as virtual patients, computational phantoms hold great promise in solving some of the most complex problems in modern medical physics. In this proposed symposium, we will present the history and recent developments of computational phantom models, share experiences in their application to advanced imaging and radiation applications, and discuss their promises and limitations. Learning Objectives: Understand the need and requirements of computational phantoms in medical physics research Discuss the developments and applications of computational phantoms Know the promises and limitations of computational phantoms in solving complex problems.« less

The impact of complex chronic diseases on care utilization among assisted living residents

PubMed Central

McNabney, Matthew K.; Onyike, Chiadi; Johnston, Deirdre; Mayer, Lawrence; Lyketsos, Constantine; Brandt, Jason; Rosenblatt, Adam; Samus, Quincy

2014-01-01

Purpose Many residents of assisted living (AL) have chronic diseases that are difficult to manage, including congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM). We estimated the amount and intensity of care delivered by the staff for residents with these conditions. Methods We performed a secondary data analysis from the Maryland Assisted Living (MDAL) Study (399 residents, 29 facilities). In-person assessments included measures of cognition, function, depression, and general medical health. Diagnosis of CHF, COPD, and DM, as well as current medications was abstracted from AL medical charts. Measures of care utilization were operationalized at the resident level as: 1) minutes per day of direct care (caregiver activity scale [CAS]), 2) subjective staff ratings of care burden, and 3) assigned AL “level of care” (based on state regulatory criteria). Results In best fit regression models, CHF and DM were not significant predictors of the evaluated care utilization measures; however, COPD was independently associated with increased minutes per day of direct care – 34% of the variance in the caregiver activity scale was explained by degree of functional dependency, cognitive impairment, age, and presence of COPD. Functional dependency, depressive symptoms, and age explained almost a quarter (23%) of the variance of staff care burden rating. For the AL level of care intensity rating, degree of functional dependency, level of cognition, and age were significant correlates, together explaining about 28% of the variance. Conclusion The presence of COPD was a significant predictor of time per day of direct care. However, CHF and DM were not correlates of care utilization measures. Functional and cognitive impairment was associated with measures of care utilization, reiterating the importance of these characteristics in the utilization and intensity of care consumed by AL residents. Further study of this population could reveal other forms and amounts of care utilization. PMID:24139207

Medication-Taking Practices of Patients on Antiretroviral HIV Therapy: Control, Power, and Intentionality

PubMed Central

Panter, Abigail T.; Mouw, Mary S.; Amola, Kemi; Stein, Kathryn E.; Murphy, Joseph S.; Maiese, Eric M.; Wohl, David A.

2015-01-01

Abstract Among people living with HIV (PLWH), adherence to antiretroviral therapy (ART) is crucial for health, but patients face numerous challenges achieving sustained lifetime adherence. We conducted six focus groups with 56 PLWH regarding ART adherence barriers and collected sociodemographics and ART histories. Participants were recruited through clinics and AIDS service organizations in North Carolina. Dedoose software was used to support thematic analysis. Participants were 59% male, 77% black, aged 23–67 years, and living with HIV 4–20 years. Discussions reflected the fluid, complex nature of ART adherence. Maintaining adherence required participants to indefinitely assert consistent control across multiple areas including: their HIV disease, their own bodies, health care providers, and social systems (e.g., criminal justice, hospitals, drug assistance programs). Participants described limited control over treatment options, ART's impact on their body, and inconsistent access to ART and subsequent inability to take ART as prescribed. When participants felt they had more decision-making power, intentionally choosing whether and how to take ART was not exclusively a decision about best treating HIV. Instead, through these decisions, participants tried to regain some amount of power and control in their lives. Supportive provider relationships assuaged these struggles, while perceived side-effects and multiple co-morbidities further complicated adherence. Adherence interventions need to better convey adherence as a continuous, changing process, not a fixed state. A perspective shift among care providers could also help address negative consequences of the perceived power struggles and pressures that may drive patients to exert control via intentional medication taking practices. PMID:26505969

Medication-Taking Practices of Patients on Antiretroviral HIV Therapy: Control, Power, and Intentionality.

PubMed

Muessig, Kathryn E; Panter, Abigail T; Mouw, Mary S; Amola, Kemi; Stein, Kathryn E; Murphy, Joseph S; Maiese, Eric M; Wohl, David A

2015-11-01

Among people living with HIV (PLWH), adherence to antiretroviral therapy (ART) is crucial for health, but patients face numerous challenges achieving sustained lifetime adherence. We conducted six focus groups with 56 PLWH regarding ART adherence barriers and collected sociodemographics and ART histories. Participants were recruited through clinics and AIDS service organizations in North Carolina. Dedoose software was used to support thematic analysis. Participants were 59% male, 77% black, aged 23-67 years, and living with HIV 4-20 years. Discussions reflected the fluid, complex nature of ART adherence. Maintaining adherence required participants to indefinitely assert consistent control across multiple areas including: their HIV disease, their own bodies, health care providers, and social systems (e.g., criminal justice, hospitals, drug assistance programs). Participants described limited control over treatment options, ART's impact on their body, and inconsistent access to ART and subsequent inability to take ART as prescribed. When participants felt they had more decision-making power, intentionally choosing whether and how to take ART was not exclusively a decision about best treating HIV. Instead, through these decisions, participants tried to regain some amount of power and control in their lives. Supportive provider relationships assuaged these struggles, while perceived side-effects and multiple co-morbidities further complicated adherence. Adherence interventions need to better convey adherence as a continuous, changing process, not a fixed state. A perspective shift among care providers could also help address negative consequences of the perceived power struggles and pressures that may drive patients to exert control via intentional medication taking practices.

A probabilistic framework for identifying biosignatures using Pathway Complexity

NASA Astrophysics Data System (ADS)

Marshall, Stuart M.; Murray, Alastair R. G.; Cronin, Leroy

2017-11-01

One thing that discriminates living things from inanimate matter is their ability to generate similarly complex or non-random structures in a large abundance. From DNA sequences to folded protein structures, living cells, microbial communities and multicellular structures, the material configurations in biology can easily be distinguished from non-living material assemblies. Many complex artefacts, from ordinary bioproducts to human tools, though they are not living things, are ultimately produced by biological processes-whether those processes occur at the scale of cells or societies, they are the consequences of living systems. While these objects are not living, they cannot randomly form, as they are the product of a biological organism and hence are either technological or cultural biosignatures. A generalized approach that aims to evaluate complex objects as possible biosignatures could be useful to explore the cosmos for new life forms. However, it is not obvious how it might be possible to create such a self-contained approach. This would require us to prove rigorously that a given artefact is too complex to have formed by chance. In this paper, we present a new type of complexity measure, which we call `Pathway Complexity', that allows us not only to threshold the abiotic-biotic divide, but also to demonstrate a probabilistic approach based on object abundance and complexity which can be used to unambiguously assign complex objects as biosignatures. We hope that this approach will not only open up the search for biosignatures beyond the Earth, but also allow us to explore the Earth for new types of biology, and to determine when a complex chemical system discovered in the laboratory could be considered alive. This article is part of the themed issue 'Reconceptualizing the origins of life'.

Developing a complex systems perspective for medical education to facilitate the integration of basic science and clinical medicine.

PubMed

Aron, David C

2017-04-01

The purpose of medical education is to produce competent and capable professional practitioners who can combine the art and science of medicine. Moreover, this process must prepare individuals to practise in a field in which knowledge is increasing and the contexts in which that knowledge is applied are changing in unpredictable ways. The 'basic sciences' are important in the training of a physician. The goal of basic science training is to learn it in a way that the material can be applied in practice. Much effort has been expended to integrate basic science and clinical training, while adding many other topics to the medical curriculum. This effort has been challenging. The aims of the paper are (1) to propose a unifying conceptual framework that facilitates knowledge integration among all levels of living systems from cell to society and (2) illustrate the organizing principles with two examples of the framework in action - cybernetic systems (with feedback) and distributed robustness. Literature related to hierarchical and holarchical frameworks was reviewed. An organizing framework derived from living systems theory and spanning the range from molecular biology to health systems management was developed. The application of cybernetic systems to three levels (regulation of pancreatic beta cell production of insulin, physician adjustment of medication for glycaemic control and development and action of performance measures for diabetes care) was illustrated. Similarly distributed robustness was illustrated by the DNA damage response system and principles underlying patient safety. Each of the illustrated organizing principles offers a means to facilitate the weaving of basic science and clinical medicine throughout the course of study. The use of such an approach may promote systems thinking, which is a core competency for effective and capable medical practice. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Living Well? Strategies Used by Women Living With Metastatic Breast Cancer.

PubMed

Lewis, Sophie; Willis, Karen; Yee, Jasmine; Kilbreath, Sharon

2016-07-01

Metastatic breast cancer is a disease of changing status-once an imminent death sentence, now a chronic (albeit incurable) disease. Medical intervention advances mean women with metastatic breast cancer now have symptoms alleviated and, potentially, life extended. Living with this disease, however, requires more than a medical approach to symptoms. We were interested to know whether women manage, and if so, how, to "live well" with metastatic cancer. We conducted interviews with 18 women. Women differed in the approaches they used. Most common was the attempt to reestablish a sense of normality in their lives. However, a second group reevaluated and reprioritized their lives; and a third group was restricted in their capacity to live well because of symptoms. The findings provide the foundation for future research exploring normalization of experiences of metastatic cancer, and other chronic illnesses, where people are living with knowledge that they have contracted time. © The Author(s) 2015.

42 CFR 421.505 - Termination and extension of non-random prepayment complex medical review.

Code of Federal Regulations, 2010 CFR

2010-10-01

... prepayment complex medical review for that provider or supplier may be extended. However, if the number of... complex medical review. 421.505 Section 421.505 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... § 421.505 Termination and extension of non-random prepayment complex medical review. (a) Timeframe that...

Reducing medical students' stigmatization of people with chronic mental illness: a field intervention at the "living museum" state hospital art studio.

PubMed

Cutler, Janis L; Harding, Kelli J; Hutner, Lucy A; Cortland, Clarissa; Graham, Mark J

2012-05-01

The authors designed an intervention to reduce beginning medical students' stigmatization of people with chronic mental illness (CMI). Pre-clinical medical students visited a state psychiatric facility's "Living Museum," a combination patient art studio/display space, as the intervention. During the visit, students interacted with artist-guides who showed their work and discussed their experiences creating art. Students completed a self-assessment survey developed to measure attitudes and feelings toward people with CMI after half of the class visited the Living Museum, constituting a Visit/No-Visit cross-sectional comparison. Students who visited the Living Museum (N=64), as compared with those who did not visit (N=110), endorsed more positive attitudes toward people with CMI. Among the students who visited, however, those who reported having spoken individually with a patient-artist (N=44), paradoxically, indicated less-positive feelings toward people with CMI. An intervention in which pre-clinical medical students visited patient-artist guides in an art-studio setting generally improved students' attitudes toward people with CMI. Thus, nontraditional psychiatric settings offer a valuable adjunct to more traditional clinical settings to reduce stigma when introducing medical students to the field of psychiatry.

Inequities In Health Care Needs For Children With Medical Complexity

PubMed Central

Kuo, Dennis; Goudie, Anthony; Cohen, Eyal; Houtrow, Amy; Agrawal, Rishi; Carle, Adam C.; Wells, Nora

2015-01-01

Children with special health care needs are believed to be susceptible to inequities in health and health care access. Within the group with special needs, there is a smaller group of children with medical complexity: children who require medical services beyond what is typically required by children with special health care needs. We describe health care inequities for the children with medical complexity compared to children with special health care needs but without medical complexity, based on a secondary analysis of the 2005–06 and 2009–10 National Survey of Children with Special Health Care Needs. The survey examines the prevalence, health care service use, and needs of children and youth with special care needs, as reported by their families. The inequities we examined were those based on race or ethnicity, primary language in the household, insurance type, and poverty status. We found that children with medical complexity were twice as likely to have at least one unmet need, compared to children without medical complexity. Among the children with medical complexity, uninsured status was associated with more unmet needs than privately insured status. We conclude that medical complexity itself can be a primary determinant of unmet needs. PMID:25489038

[Development in the National Hospice Care Service in Korea].

PubMed

Lee, S W; Lee, E O; Ahn, H S; Heo, D S; Kim, D S; Kim, H S; Lee, H J

1997-01-01

The urgent needs to establish hospice care systems in Korea arise from the following reasons: (1) a drastic increase in chronically ill patients with the increase of aged population: (2) rapid changes in living environment from the traditional habitation (e.g., Many Koreans living in apartment complexes, which is the most popular form of modern residence in recent years, prefer to die in the hospital.): the overall increase in patients with advanced cancer: (4) recent trends in early discharge of terminally ill patients from the limited hospital facilities to accommodate other medical insurance beneficiaries: (5) easy acceptance of euthanasia owing to the recent social atmosphere that belittles the dignity of human life: (6) medical and nursing care of AIDS patient in terminal stage: (7) and the problem associated with inhumane medical care system, overtreatment, and groundless fears against narcotics. Terminally ill patients were used to be treated in the hospital in the past. In these days, however, they are forced to have home cares with little assistance from the qualified medical personnel because of insufficient hospital facilities, which are even short for the need of emergency patients and provide priority cares to medical insurance beneficiaries with other acute problems. And yet, neither are there any administrative organizations nor systematic medical studies that deal with the level of terminally ill patient's need, their family's problems and resources of hospice care systems in Korea. Thus, most patients are not able to get appropriate medical care at the terminal stage of their lives. The objective of this study is to make comprehensive database for various hospice care organization currently in operation, link them through medical information system, and develop an easily accessible hospice care model that meets the need of most Korean people. Our survey results may be summarized as follows: Nationally there are 40 organizations that provide partial or full hospice care. However, these organizations are not linked to any formal medical service network. Furthermore, the objective of hospice care, care principles, personnel with appropriate training, educational programs, standard for care, costs, consulting service to patients' family members, the extent of medical care from professional staff members, status of hospice facility, and management of those institutions are neither clearly defined nor organized compared to the international hospice care standards. The surveys on patients of terminal stage, grouped in hospice and non-hospice care patients, reveal what they want visiting nursing care to help their pain control, psychological, social and spiritual demands. While the more than 90% of hospice care patients want to reduce their pains, the non-hospice care patients, in addition to their desire for pain control, demanded more psychological, social and spiritual helps as well. The results of this research could be utilized to (1) define the standard of hospice care, (2) provide the guidance for hospice medical care costs, (3) establish the database of hospice care systems, (4) develop softwares, (5) build communication network through Medinet, and (6) provide an organized visiting home nursing care system. These information should be a valuable resource to many medical staffs who are involved in cancer therapy, nursing care, and social welfare programs.

School Safety: Saving Lives with AEDs

ERIC Educational Resources Information Center

Slusser, Greg

2012-01-01

Automated external defibrillators (AEDs) on school and university campuses have saved many lives. Students, teachers and community members have been among the fortunate ones pulled from the brink of death. Medical studies validating the effectiveness of AEDs in schools and other public settings have been published in numerous medical journals.…

The role of multiple identities in adherence to medical appointments among gay/bisexual male adolescents living with HIV.

PubMed

Harper, Gary W; Fernandez, Isabel M; Bruce, Douglas; Hosek, Sybil G; Jacobs, Robin J

2013-01-01

Adolescents living with HIV require engagement with care providers in order to access the critical medical and psychosocial services they need. The current study sought to explore developmental determinants of adherence to medical appointments as one aspect of engagement in care among a geographically diverse sample of 200 gay/bisexual male adolescents (16-24 years) living with HIV, with a specific focus on ethnic identity, sexual orientation identity, and identity as a young man living with HIV. Ethnic identity affirmation (OR = 0.6; 95% CI: 0.3, 0.9), morality of homosexuality (OR = 1.7; 95% CI: 1.2, 2.5), and HIV-positive identity salience (OR = 1.5; 95% CI: 0.9, 2.4) were associated with significantly higher risk for missed appointments in the past 3 months. These findings highlight the importance of attending to developmental factors, such as the development of multiple identities, when attempting to increase engagement in care for gay/bisexual male adolescents living with HIV.

The Role of Multiple Identities in Adherence to Medical Appointments among Gay/Bisexual Male Adolescents Living with HIV

PubMed Central

Harper, Gary W.; Fernandez, M. Isabel; Bruce, Douglas; Hosek, Sybil G.; Jacobs, Robin J.

2012-01-01

Adolescents living with HIV require engagement with care providers in order to access the critical medical and psychosocial services they need. The current study sought to explore developmental determinants of adherence to medical appointments as one aspect of engagement in care among a geographically diverse sample of 200 gay/bisexual male adolescents (16–24 years) living with HIV, with a specific focus on ethnic identity, sexual orientation identity, and identity as a young man living with HIV. Ethnic identity affirmation (OR = 0.6; 95% CI: 0.3, 0.9), morality of homosexuality (OR = 1.7; 95% CI: 1.2, 2.5), and HIV-positive identity salience (OR = 1.5; 95% CI: 0.9, 2.4) were associated with significantly higher risk for missed appointments in the past three months. These findings highlight the importance of attending to developmental factors, such as the development of multiple identities, when attempting to increase engagement in care for gay/bisexual male adolescents living with HIV. PMID:22041930

Say their names.

PubMed

Wijayaratne, Sandhira

2018-03-01

Many of us pursue medical careers for the direct impact we have on patients' lives. Complicating those ideals is a mosaic of extraclinical factors-economic, social, cultural, political, historical-that more immediately affect patient health than medical care, especially for countless communities of color. As a medical student witnessing the excessive rates of black lives lost to police brutality, I am reminded of the limits of medicine. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Use of an electronic medical record for the identification of research subjects with diabetes mellitus.

PubMed

Wilke, Russell A; Berg, Richard L; Peissig, Peggy; Kitchner, Terrie; Sijercic, Bozana; McCarty, Catherine A; McCarty, Daniel J

2007-03-01

Diabetes mellitus is a rapidly increasing and costly public health problem. Large studies are needed to understand the complex gene-environment interactions that lead to diabetes and its complications. The Marshfield Clinic Personalized Medicine Research Project (PMRP) represents one of the largest population-based DNA biobanks in the United States. As part of an effort to begin phenotyping common diseases within the PMRP, we now report on the construction of a diabetes case-finding algorithm using electronic medical record data from adult subjects aged > or =50 years living in one of the target PMRP ZIP codes. Based upon diabetic diagnostic codes alone, we observed a false positive case rate ranging from 3.0% (in subjects with the highest glycosylated hemoglobin values) to 44.4% (in subjects with the lowest glycosylated hemoglobin values). We therefore developed an improved case finding algorithm that utilizes diabetic diagnostic codes in combination with clinical laboratory data and medication history. This algorithm yielded an estimated prevalence of 24.2% for diabetes mellitus in adult subjects aged > or =50 years.

Marketing HPV vaccine: implications for adolescent health and medical professionalism.

PubMed

Rothman, Sheila M; Rothman, David J

2009-08-19

The new vaccine against 4 types of human papillomavirus (HPV), Gardasil, like other immunizations appears to be a cost-effective intervention with the potential to enhance both adolescent health and the quality of their adult lives. However, the messages and the methods by which the vaccine was marketed present important challenges to physician practice and medical professionalism. By making the vaccine's target disease cervical cancer, the sexual transmission of HPV was minimized, the threat of cervical cancer to adolescents was maximized, and the subpopulations most at risk practically ignored. The vaccine manufacturer also provided educational grants to professional medical associations (PMAs) concerned with adolescent and women's health and oncology. The funding encouraged many PMAs to create educational programs and product-specific speakers' bureaus to promote vaccine use. However, much of the material did not address the full complexity of the issues surrounding the vaccine and did not provide balanced recommendations on risks and benefits. As important and appropriate as it is for PMAs to advocate for vaccination as a public good, their recommendations must be consistent with appropriate and cost-effective use.

Examining Burnout, Depression, and Attitudes Regarding Drug Use Among Lebanese Medical Students During the 4 Years of Medical School.

PubMed

Talih, Farid; Daher, Michel; Daou, Dayane; Ajaltouni, Jean

2018-04-01

This study aims to evaluate the prevalence of burnout, depressive symptoms, and anxiety symptoms and attitudes toward substance use in medical students as well as their evolution during the 4 years of medical school. A cross-sectional study was carried out at the American University of Beirut Medical Center (AUBMC) between September and December 2016. In total, 176 out of 412 eligible medical students responded. The survey was anonymous and administered via e-mail link to an electronic form. The study included general socio-demographic questions and standardized validated tools to measure depressive symptomatology (PHQ-9), burnout (Burnout Measure), anxiety (GAD-7), alcohol use (AUDIT), and substance abuse (DAST-10) as well as questions pertaining to attitudes toward recreational substance use. Overall, 23.8% of medical students reported depressive symptomatology, with 14.5% having suicidal ideations. Forty-three percent were found to have burnout. Those who screened positive for burnout were more likely to be males, to be living away from their parents, and to have experienced a stressful life event during the last year. With the exception of burnout, there was no significant difference in the prevalence of depression or anxiety among the 4 years of medical school. There was a significant difference in alcohol use, illicit substance use, and marijuana use during the four medical school years. The results of this study show high rates of depression, burnout, and suicidal ideation among medical students from the Middle East region. Increased rates of substance use were detected as well as a more tolerant attitude toward substance use in general, specifically cannabis. It is crucial that medical educators and policymakers keep tackling the complex multifactorial mental health issues affecting medical students and design effective solutions and support systems.

Overt Primary Hypothyroidism in an Industrial Area in São Paulo, Brazil: The Impact of Public Disclosure.

PubMed

Zaccarelli-Marino, Maria Angela; Saldiva André, Carmen Diva; Singer, Julio M

2016-11-22

Background : Primary hypothyroidism (PH) is the most common thyroid pathology. Purpose : to evaluate the impact of public disclosure of an unexpected number of PH cases on the frequency of patients seeking medical evaluation for endocrinological diseases. Methods : data on 6306 subjects (3356 living in the surroundings of a petrochemical complex and 2950 in a control region) were collected over a 15-year time span. Thyroid function was determined by serum levels of triiodothyronine, thyroxine, free thyroxine and thyrotrophin. Antithyroglobulin and antithyroperoxidase antibodies and sonographic scans of the thyroid were performed in all patients. The data were analyzed via log-linear models to compute odds and odds ratios. Results : An increasing trend in the odds of PH was detected along the observation period with greater slope in the study region than in the control region. The odds of PH in the post-disclosure period (2002 to 2004) are greater than the corresponding ones in the pre-disclosure period (1989 to 2001). Conclusions : This study shows that living in the surroundings of a petrochemical complex may be an important risk factor for PH for both adults and children. Furthermore, public disclosure of such risk factor contributes to the awareness of the problem and to the possibility of an early diagnosis.

Household exposure to secondhand smoke is associated with decreased physical and mental health of mothers in the USA

PubMed Central

Sobotova, L.; Liu, Y-H; Burakoff, A.; Sevcikova, L.; Weitzman, M.

2014-01-01

Background Secondhand smoke is one of the most common toxic environmental exposures to children, and maternal health problems also have substantial negative effects on children. We are unaware of any studies examining the association of living with smokers and maternal health. Objective To investigate whether non-smoking mothers who live with smokers have worse physical and mental health than non-smoking mothers who live in homes without smokers. Methods Nationally representative data from the 2000–2004 Medical Expenditure Panel Survey were used. The health of non-smoking mothers with children <18 years (n=18,810) was assessed, comparing those living with one or more smokers (n=3,344) to those living in households with no adult smokers (n=14,836). Associations between maternal health, household smoking, and maternal age, race/ethnicity, and marital, educational, poverty and employment status were examined in bivariable and multivariable analyses using SUDAAN software to adjust for the complex sampling design. Scores on the Medical Outcomes Short Form-12 (SF-12) Physical Component Scale (PCS) and Mental Component Scale (MCS) were used to assess maternal health. Results 79.2% of mothers in the USA are non-smokers and 17.4% of them live with ≥1 adult smokers: 14.2% with 1 and 3.2% with ≥ 2 smokers. Among non-smoking mothers, the mean MCS score is 50.5 and mean PCS is 52.9. The presence of an adult smoker and increasing number of smokers in the home are both negatively associated with MCS and PCS scores in bivariable analyses (p<0.001 for each). Non-smoking mothers with at least one smoker in the household had an 11 % (95% CI=0.80–0.99) lower odds of scoring at or above the mean MCS score and a 19 % (95%CI=0.73–0.90) lower odds of scoring at or above the mean PCS score_compared to non-smoking mothers with no smokers in the household. There is an evidence of a dose response relationship with increasing number of smokers in the household for PCS (p<0.001). Conclusions These findings demonstrate a previously unrecognized child health risk: living with smokers is independently associated with worse physical and mental health among non-smoking mothers. PMID:20012677

"You Know the Medicine, I Know My Kid": How Parents Advocate for Their Children Living With Complex Chronic Conditions.

PubMed

Rafferty, Katherine A; Sullivan, Shelbie L

2017-09-01

Caring for a child with a chronic condition has received considerable attention in the pediatric health literature. Today, approximately 1 out of 5 North American children are diagnosed with a chronic condition that requires parents to become caregivers and advocates. Although advocacy is regarded as a significant aspect to parental caregiving, more research is needed to better define this oversimplified and misrepresented concept in clinical practice and research. Subsequently, we interviewed 35 parents of children diagnosed with complex chronic conditions. Within our analysis, we identified three themes that elaborate upon how parental advocacy is socially constructed through communication behaviors and partnerships with other people (e.g., medical professionals, family, school educators). We also discuss the emotional side of advocacy, and proffer suggestions to practitioners who work with parents to form collaborative care teams.

Medication adherence and persistence in type 2 diabetes mellitus: perspectives of patients, physicians and pharmacists on the Spanish health care system

PubMed Central

Labrador Barba, Elena; Rodríguez de Miguel, Marta; Hernández-Mijares, Antonio; Alonso-Moreno, Francisco Javier; Orera Peña, Maria Luisa; Aceituno, Susana; Faus Dader, María José

2017-01-01

Objective A good relationship between diabetes patients and their health care team is crucial to ensure patients’ medication adherence and self-management. To this end, we aimed to identify and compare the views of type 2 diabetes mellitus (T2DM) patients, physicians and pharmacists concerning the factors and strategies that may be associated with, or could improve, medication adherence and persistence. Methods An observational, cross-sectional study was conducted using an electronic self-administered questionnaire comprising 11 questions (5-point Likert scale) concerning factors and strategies related to medication adherence. The survey was designed for T2DM patients and Spanish National Health System professionals. Results A total of 963 T2DM patients, 998 physicians and 419 pharmacists participated in the study. Overall, a lower proportion of pharmacists considered the proposed factors associated with medication adherence important as compared to patients and physicians. It should be noted that a higher percentage of physicians in comparison to pharmacists perceived that “complexity of medication” (97% vs 76.6%, respectively) and “adverse events” (97.5% vs 72.2%, respectively) were important medication-related factors affecting adherence. In addition, both patients (80.8%) and physicians (80.8%) agreed on the importance of “cost and co-payment” for adherence, whereas only 48.6% of pharmacists considered this factor important. It is also noteworthy that nearly half of patients (43%) agreed that “to adjust medication to activities of daily living” was the best strategy to reduce therapeutic complexity, whereas physicians believed that “reducing the frequency of administration” (47.9%) followed by “reducing the number of tablets” (28.5%) was the most effective strategy to improve patients’ adherence. Conclusion Our results highlight the need for pharmacists to build a stronger relationship with physicians in order to improve patients monitoring and adherence rates. Additionally, these findings may help to incorporate greater patient-centeredness when developing management strategies, focusing on adjusting medication regimens to patients’ daily lives. PMID:28435229

Reversed-polarity regions

NASA Technical Reports Server (NTRS)

Tang, F.

1980-01-01

The 58 RPRS studied have a lifespan comparable to normal active regions and have no tendency to rotate toward a more normal alignment. They seem to have stable configurations with no apparent evidence suggesting stress due to their anomalous magnetic alignment. Magnetic complexity in RPRs is the key to flare productivity just as it is in normal regions - weak field RPRs produced no flares and regions with complex spots produced more flares than regions with noncomplex spots by a factor of 5. The RPRs however, differ from normal regions in the frequency of having complex spots, particularly the long lived complex spots, in them. Less than 17 percent of normal ARs have complex spots; less than 1.8 percent have long lived complex spots. In contrast, 41 percent of RPRs have complex spots and 24 percent have long lived complex spots.

Mammography screening in single older African-American women: a study of related factors.

PubMed

Zhu, K; Hunter, S; Bernard, L J; Payne-Wilks, K; Roland, C L; Levine, R S

2000-01-01

Using baseline data from an intervention study, we examined cognitive, psychological, social and medical care factors in relation to the use of a mammogram in the preceding year among single African-American women aged 65 and older. Study subjects were 325 African-American women aged 65 and older who were divorced, widowed, separated or never-married, and lived in ten public housing complexes in Nashville, Tennessee. In-person interviews were conducted to collect information on breast screening behavior, knowledge and attitude, social network and activities, emotional and psychological symptoms and signs, and medical care use. Compared with those who had not had a mammogram in the preceding year, women who had had a mammogram in the preceding year were three times more likely to have a regular doctor (95% confidence interval [CI] 1.4-5.0) and about six times more likely to have a doctor's recommendation for a mammogram (95%CI 3.4-11.1). In addition, they were more likely to: (a) have attended a meeting on breast health or received educational materials on breast cancer; (b) agree that a woman needs a mammogram even though she has no breast problem; (c) agree that a woman can have breast cancer without having symptoms; (d) have living children and grandchildren; and (e) attend social activities more frequently. While access to regular medical care and receiving a physician's recommendation are strongly associated with mammography among these older, single African-American women, education on breast health and social networks also appear to be influential.

Cognitive and Physical Demands of Activities of Daily Living in Older Adults: Validation of Expert Panel Ratings.

PubMed

Fong, Tamara G; Gleason, Lauren J; Wong, Bonnie; Habtemariam, Daniel; Jones, Richard N; Schmitt, Eva M; de Rooij, Sophia E; Saczynski, Jane S; Gross, Alden L; Bean, Jonathan F; Brown, Cynthia J; Fick, Donna M; Gruber-Baldini, Ann L; O'Connor, Margaret; Tabloski, Patrica A; Marcantonio, Edward R; Inouye, Sharon K

2015-07-01

Difficulties with performance of functional activities may result from cognitive and/or physical impairments. To date, there has not been a clear delineation of the physical and cognitive demands of activities of daily living. To quantify the relative physical and cognitive demands required to complete typical functional activities in older adults. Expert panel survey. Web-based platform. Eleven experts from 8 academic medical centers and 300 community-dwelling elderly adults age 70 and older scheduled for elective noncardiac surgery from 2 academic medical centers. Sum scores of expert ratings were calculated and then validated against objective data collected from a prospective longitudinal study. Correlation between expert ratings and objective neuropsychologic tests (memory, language, complex attention) and physical measures (gait speed and grip strength) for performance-based tasks. Managing money, self-administering medications, using the telephone, and preparing meals were rated as requiring significantly more cognitive demand, whereas walking and transferring, moderately strenuous activities, and climbing stairs were assessed as more physically demanding. Largely cognitive activities correlated with objective neuropsychologic performance (r = 0.13-0.23, P < .05) and largely physical activities correlated with physical performance (r = 0.15-0.46, P < .05). Quantifying the degree of cognitive and/or physical demand for completing a specific task adds an additional dimension to standard measures of functional assessment. This additional information may significantly influence decisions about rehabilitation, postacute care needs, treatment plans, and caregiver education. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

The Daily Relationship Between Aspects of Food Insecurity and Medication Adherence Among People Living with HIV with Recent Experiences of Hunger.

PubMed

Pellowski, Jennifer A; Kalichman, Seth C; Cherry, Sabrina; Conway-Washington, Christopher; Cherry, Chauncey; Grebler, Tamar; Krug, Larissa

2016-12-01

Limited access to resources can significantly impact health behaviors. Previous research on food insecurity and HIV has focused on establishing the relationship between lacking access to nutritious food and antiretroviral (ARV) medication non-adherence in a variety of social contexts. This study aims to determine if several aspects of food insecurity co-occur with missed doses of medication on a daily basis among a sample of people living with HIV who have recently experienced hunger. The current study utilized a prospective, observational design to test the daily relationship between food insecurity and medication non-adherence. Participants were followed for 45 days and completed daily assessments of food insecurity and alcohol use via interactive text message surveys and electronic medication adherence monitoring using the Wisepill. Fifty-nine men and women living with HIV contributed a total of 2,655 days of data. Results showed that severe food insecurity (i.e., hunger), but not less severe food insecurity (i.e., worrying about having food), significantly predicted missed doses of medication on a daily level. Daily alcohol use moderated this relationship in an unexpected way; when individuals were hungry and drank alcohol on a given day, they were less likely to miss a dose of medication. Among people living with HIV with recent experiences of hunger, this study demonstrates that there is a daily relationship between hunger and non-adherence to antiretroviral therapy. Future research is needed to test interventions designed to directly address the daily relationship between food insecurity and medication non-adherence.

Perspectives concerning living wills in medical staff of a main regional hospital in Japan.

PubMed

Maeda, Yoshitaka; Shintani, Shuzo

2015-01-01

Living wills, written types of advanced directives, are now widespread in western countries, but in Japan, their recognition still remains restricted to a small part of the population. As an initial step to introduction of such patient-oriented medicine, we surveyed present recognition and acceptance patterns concerning living wills in a main regional hospital located in a suburban area of Tokyo. Without any preceding guidance on living wills, the questionnaire on living wills was distributed to all the staff working at JA Toride Medical Center in September 2013, and their responses were collected for analysis within one month. Questionnaires were distributed to all hospital staff, 843 in total, and 674 responses (80.0% of distributed) were obtained. The term of living will was known by 304 (45.1%) of the respondents, and introduction of living wills to patients was accepted in 373 (55.3%) of the respondents, meanwhile, 286 (42.4%) respondents did not indicate their attitude toward living wills. As to styles of document form, 332 respondents (49.3%) supported selection of wanted or unwanted medical treatments and care from a prepared list, and 102 respondents (15.1%) supported description of living wills in free form. As preferred treatment options that should be provided as a checklist, cardiac massage (chest compression) and a ventilator were selected by more than half of the respondents. Based on their responses, we developed an original type of living wills available to patients visiting the hospital. Although not all the respondents were aware of living wills even in this main regional hospital, introduction of living wills to patients was accepted by many of the hospital staff. Awareness programs or information campaigns are needed to introduce living wills to support patient-centered medicine.

Inequities in health care needs for children with medical complexity.

PubMed

Kuo, Dennis Z; Goudie, Anthony; Cohen, Eyal; Houtrow, Amy; Agrawal, Rishi; Carle, Adam C; Wells, Nora

2014-12-01

Children with special health care needs are believed to be susceptible to inequities in health and health care access. Within the group with special needs, there is a smaller group of children with medical complexity: children who require medical services beyond what is typically required by children with special health care needs. We describe health care inequities for the children with medical complexity compared to children with special health care needs but without medical complexity, based on a secondary analysis of data from the 2005-06 and 2009-10 National Survey of Children with Special Health Care Needs. The survey examines the prevalence, health care service use, and needs of children and youth with special care needs, as reported by their families. The inequities we examined were those based on race/ethnicity, primary language in the household, insurance type, and poverty status. We found that children with medical complexity were twice as likely to have at least one unmet need, compared to children without medical complexity. Among the children with medical complexity, unmet need was not associated with primary language, income level, or having Medicaid. We conclude that medical complexity itself can be a primary determinant of unmet needs. Project HOPE—The People-to-People Health Foundation, Inc.

31 CFR 538.523 - Commercial sales, exportation, and reexportation of agricultural commodities, medicine, and...

Code of Federal Regulations, 2010 CFR

2010-07-01

... drinking water) or animals (including animal feeds); (B) Seeds for food crops; (C) Fertilizers or organic fertilizers; or (D) Reproductive materials (such as live animals, fertilized eggs, embryos, and semen) for the... fertilizers, live horses, western red cedar, and medical devices other than basic medical supplies, such as...

Awareness of pharmaceutical cost-assistance programs among inner-city seniors.

PubMed

Federman, Alex D; Safran, Dana Gelb; Keyhani, Salomeh; Cole, Helen; Halm, Ethan A; Siu, Albert L

2009-04-01

Lack of awareness may be a significant barrier to participation by low- and middle-income seniors in pharmaceutical cost-assistance programs. The goal of this study was to determine whether older adults' awareness of 2 major state and federal pharmaceutical cost-assistance programs was associated with the seniors' ability to access and process information about assistance programs. Data were gathered from a cross-sectional study of independently living, English- or Spanish-speaking adults aged > or =60 years. Participants were interviewed in 30 community-based settings (19 apartment complexes and 11 senior centers) in New York, New York. The analysis focused on adults aged > or =65 years who lacked Medicaid coverage. Multivariable logistic regression was used to model program awareness as a function of information access (family/social support, attendance at senior or community centers and places of worship, viewing of live health insurance presentations, instrumental activities of daily living, site of medical care, computer use, and having a proxy decision maker for health insurance matters) and information-processing ability (education level, English proficiency, health literacy, and cognitive function). The main outcome measure was awareness of New York's state pharmaceutical assistance program (Elderly Pharmaceutical Insurance Coverage [EPIC

Increasing trend of wearables and multimodal interface for human activity monitoring: A review.

PubMed

Kumari, Preeti; Mathew, Lini; Syal, Poonam

2017-04-15

Activity recognition technology is one of the most important technologies for life-logging and for the care of elderly persons. Elderly people prefer to live in their own houses, within their own locality. If, they are capable to do so, several benefits can follow in terms of society and economy. However, living alone may have high risks. Wearable sensors have been developed to overcome these risks and these sensors are supposed to be ready for medical uses. It can help in monitoring the wellness of elderly persons living alone by unobtrusively monitoring their daily activities. The study aims to review the increasing trends of wearable devices and need of multimodal recognition for continuous or discontinuous monitoring of human activity, biological signals such as Electroencephalogram (EEG), Electrooculogram (EOG), Electromyogram (EMG), Electrocardiogram (ECG) and parameters along with other symptoms. This can provide necessary assistance in times of ominous need, which is crucial for the advancement of disease-diagnosis and treatment. Shared control architecture with multimodal interface can be used for application in more complex environment where more number of commands is to be used to control with better results in terms of controlling. Copyright © 2016 Elsevier B.V. All rights reserved.

[Being cared for and caring: living with multiple chronic diseases (Leila)-a qualitative study about APN contributions to integrated care].

PubMed

Müller-Staub, Maria; Zigan, Nicole; Händler-Schuster, Daniela; Probst, Sebastian; Monego, Renate; Imhof, Lorenz

2015-04-01

Living with multiple chronic diseases is complex and leads to enhanced care needs. To foster integrated care a project called "Living with chronic disease" (Leila) was initiated. The aim was to develop an Advanced Practice Nursing (APN) service in collaboration with medical centers for persons who are living with multiple chronic diseases. The following research questions were addressed: 1. What are patients' experiences, referring physicians and APNs with the Leila-Service? 2. How are referral processes performed? 3. How do the involved groups experience collaboration and APN role development? A qualitative approach according grounded theory of Corbin and Strauss was used to explore the experiences with the Leila project and the interaction of the persons involved. 38 interviews were conducted with patients who are living with multiple chronic diseases, their APN's and the referring physicians. The findings revealed "Being cared for and caring" as main category. The data demonstrated how patients responded to their involvement into care and that they were taken as serious partners in the care process. The category "organizing everyday life" describes how patients learned to cope with the consequences of living with multiple chronic diseases. "Using all resources" as another category demonstrates how capabilities and strengths were adopted. The results of the cooperation- and allocation processes showed that the APN recognition and APN role performance have to be negotiated. Prospective APN-services for this patient population should be integrated along with physician networks and other service providers including community health nursing.

Costs of achieving live birth from assisted reproductive technology: a comparison of sequential single and double embryo transfer approaches.

PubMed

Crawford, Sara; Boulet, Sheree L; Mneimneh, Allison S; Perkins, Kiran M; Jamieson, Denise J; Zhang, Yujia; Kissin, Dmitry M

2016-02-01

To assess treatment and pregnancy/infant-associated medical costs and birth outcomes for assisted reproductive technology (ART) cycles in a subset of patients using elective double embryo (ET) and to project the difference in costs and outcomes had the cycles instead been sequential single ETs (fresh followed by frozen if the fresh ET did not result in live birth). Retrospective cohort study using 2012 and 2013 data from the National ART Surveillance System. Infertility treatment centers. Fresh, autologous double ETs performed in 2012 among ART patients younger than 35 years of age with no prior ART use who cryopreserved at least one embryo. Sequential single and double ETs. Actual live birth rates and estimated ART treatment and pregnancy/infant-associated medical costs for double ET cycles started in 2012 and projected ART treatment and pregnancy/infant-associated medical costs if the double ET cycles had been performed as sequential single ETs. The estimated total ART treatment and pregnancy/infant-associated medical costs were $580.9 million for 10,001 double ETs started in 2012. If performed as sequential single ETs, estimated costs would have decreased by $195.0 million to $386.0 million, and live birth rates would have increased from 57.7%-68.0%. Sequential single ETs, when clinically appropriate, can reduce total ART treatment and pregnancy/infant-associated medical costs by reducing multiple births without lowering live birth rates. Published by Elsevier Inc.

Making choices about medical interventions: the experience of disabled young people with degenerative conditions

PubMed Central

Mitchell, Wendy A.

2012-01-01

Abstract Background  Current western policy, including the UK, advocates choice for service users and their families, taking greater control and being more involved in decision making. However, children’s role in health decision making, especially from their own perspective, has received less research attention compared to doctors and parents’ perspectives. Objective  To explore the perspective and experiences of disabled young people with degenerative conditions as they face significant medical interventions and engage in decision‐making processes. Design and methods  Findings from a longitudinal qualitative study of 10 young people (13–22 years) with degenerative conditions are reported. Individual semi‐structured interviews were conducted with participants over 3 years (2007–2010); the paper reports data from all three interview rounds. Interviews focused on medical intervention choices the young people identified as significant. Results  Although the young people in this study felt involved in the medical intervention choices discussed, findings demonstrate a complex and diverse picture of decision making. Results highlighted different decisional roles adopted by the young people, the importance of information heuristics and working with other people whilst engaging in complex processes weighing up different decisional factors. Discussion  Young people’s experiences demonstrate the importance of moving beyond viewing health choices as technical or rational decisions. How each young person framed their decision was important. Recognizing this diversity and the importance of emerging themes, such as living a normal life, independence, fear of decisions viewed as ‘irreversible’ and the role of parents and peers in decision making highlights that, there are clear practice implications including, active practitioner listening, sensitivity and continued holistic family working. PMID:22296527

NASA/DARPA advanced communications technology satellite project for evaluation of telemedicine outreach using next-generation communications satellite technology: Mayo Foundation participation.

PubMed

Gilbert, B K; Mitchell, M P; Bengali, A R; Khandheria, B K

1999-08-01

To describe the development of telemedicine capabilities-application of remote consultation and diagnostic techniques-and to evaluate the feasibility and practicality of such clinical outreach to rural and underserved communities with limited telecommunications infrastructures. In 1992, Mayo Foundation (Rochester, Minn, Jacksonville, Fla, and Scottsdale, Ariz), the National Aeronautics and Space Administration, and the Defense Advanced Research Projects Agency collaborated to create a complex network of fiberoptic landlines, video recording systems, satellite terminals, and specially developed data translators linking Mayo sites with other locations in the continental United States on an on-demand basis. The purpose was to transmit data via the asynchronous transfer mode (ATM) digital communications protocol over the Advanced Communications Technology Satellite. The links were intended to provide a conduit for transmission of data for patient-specific consultations between physicians, evaluation of medical imagery, and medical education for clinical staffs at remote sites. Low-data-rate (LDR) experiments went live late in 1993. Mayo Clinic Rochester successfully provided medical consultation and services to 2 small regional medical facilities. High-data-rate (HDR) experiments included studies of remote digital echocardiography, store-and-forward telemedicine, cardiac catheterization, and teleconsultation for congenital heart disease. These studies combined landline data transmission with use of the satellite. The complexity of the routing paths and network components, immaturity of available software, and inexperience with existing telecommunications caused significant study delays. These experiments demonstrated that next-generation satellite technology can provide batch and real-time imagery for telemedicine. The first-generation of the ATM and satellite network technology used in these experiments created several technical problems and inconveniences that should be overcome as the network infrastructure matures.

Gender differences in medical students' motives and career choice.

PubMed

Heiligers, Phil J M

2012-08-23

The main subject is the influence of gender and the stage of life on the choice of specialty in medical education. In particular we looked at the influence of intrinsic and external motives on this relationship. The choice of specialty was divided into two moments: the choice between medical specialties and general practice; and the preference within medical specialties. In earlier studies the topic of motivation was explored, mostly related to gender. In this study stage of life in terms of living with a partner -or not- and stage of education was added. A questionnaire concerning career preferences was used. The online questionnaire was sent to all student members of the KNMG (Royal Dutch Medical Association). 58% of these students responded (N = 2397). Only 1478 responses could be used for analyses (36%). For stipulating the motives that played a role, principal components factor analysis has been carried out. For testing the mediation effect a set of regression analyses was performed: logistic regressions and multiple regressions. Although basic findings about gender differences in motivations for preferred careers are consistent with earlier research, we found that whether or not living with a partner is determinant for differences in profession-related motives and external motives (lifestyle and social situation). Furthermore living with a partner is not a specific female argument anymore, since no interactions are found between gender and living with a partner. Another issue is that motives are mediating the relationship between, living with a partner, and the choice of GP or medical specialty. For more clarity in the mediating effect of motives a longitudinal study is needed to find out about motives and changing circumstances. The present study provides a contribution to the knowledge of career aspirations of medical students, especially the impact of motivation. Gender and living with a partner influence both choices, but they are not interacting, so living with a partner is similarly important for male and female students in choosing their preferences. Moreover, external and intrinsic motives mediate this relationship to a greater of lesser degree. First stage students are influenced by life-style and intrinsic motives in their choice of general practice. For second stage students, the results show influences of life-style motives next to profession-related motives on both moments of choice.

Gender differences in medical students’ motives and career choice

PubMed Central

2012-01-01

Background The main subject is the influence of gender and the stage of life on the choice of specialty in medical education. In particular we looked at the influence of intrinsic and external motives on this relationship. The choice of specialty was divided into two moments: the choice between medical specialties and general practice; and the preference within medical specialties. In earlier studies the topic of motivation was explored, mostly related to gender. In this study stage of life in terms of living with a partner -or not- and stage of education was added. Methods A questionnaire concerning career preferences was used. The online questionnaire was sent to all student members of the KNMG (Royal Dutch Medical Association). 58% of these students responded (N = 2397). Only 1478 responses could be used for analyses (36%). For stipulating the motives that played a role, principal components factor analysis has been carried out. For testing the mediation effect a set of regression analyses was performed: logistic regressions and multiple regressions. Results Although basic findings about gender differences in motivations for preferred careers are consistent with earlier research, we found that whether or not living with a partner is determinant for differences in profession-related motives and external motives (lifestyle and social situation). Furthermore living with a partner is not a specific female argument anymore, since no interactions are found between gender and living with a partner. Another issue is that motives are mediating the relationship between, living with a partner, and the choice of GP or medical specialty. For more clarity in the mediating effect of motives a longitudinal study is needed to find out about motives and changing circumstances. Conclusions The present study provides a contribution to the knowledge of career aspirations of medical students, especially the impact of motivation. Gender and living with a partner influence both choices, but they are not interacting, so living with a partner is similarly important for male and female students in choosing their preferences. Moreover, external and intrinsic motives mediate this relationship to a greater of lesser degree. First stage students are influenced by life-style and intrinsic motives in their choice of general practice. For second stage students, the results show influences of life-style motives next to profession-related motives on both moments of choice. PMID:22913471

A pilot study of new approaches to teaching anatomy and pathology.

PubMed

Park, A; Schwartz, R W; Witzke, D B; Roth, J S; Mastrangelo, M; Birch, D W; Jennings, C D; Lee, E Y; Hoskins, J

2001-03-01

Minimally Invasive Surgery (MIS) has impacted patient care as well as medical training. New medical education opportunities have emerged with MIS. In this pilot study we explore the role of live, interactive MIS to augment and strengthen specific segments of the undergraduate medical curriculum. Laparoscopic cholecystectomy (LC) was selected to demonstrate upper abdominal anatomy and pathology. Second year medical students (n=100) in the course of their GI pathology classes attended live LC telesurgery-the telesurgery student group (TSG). Because of technical difficulties, a second class of medical students (n=90) was shown the tape of the MIS procedure one year later instead of the live surgery-the videotape surgery group (VSG). Background clinical information was provided by the program director and the durgeon. During the live and taped LC broadcast living anatomy was demonstrated and a diseased gallbladder was resected. TSG students were able to ask questions of the program director and the surgeon and vice versa using telesurgery technology. After the procedure, the surgeon met with the students for further discussion. VSG students were able to ask questions of the program director during and after the program. Both groups of students completed a pre- and posttest using remote audience responders. Students' responses from the two groups were compared for selected test and evaluation items. Pre-test (Cronbach's alpha=.10) and post-test (Cronbach's alpha =.28) data were obtained from 73 students in the TSG and.22 and.54 respectively from 69 students in the VSG. A significant increase in laparoscopic anatomy knowledge was observed from pretest to posttest for the VSG (31-55%) and from the TSG (30-61%). The majority of VSG students (68%) indicated the method used to teach was outstanding, and 87% indicated that the program was outstanding in keeping their interest. This is contrasted with only 24% of the TSG group responding that the teaching method was outstanding, and 41% indicated that the program was outstanding in keeping their interest. Medical students can productively be exposed to surgical methods and living anatomy using telesurgery. The high regard the TSG students had for this program suggests that it can be used effectively to teach and inspire medical students. The positive results have encouraged us to have a backup instructional method such as a tape of the MIS procedure, it apparently does not have the positive impact of live surgery.

Determination of Death: A Scientific Perspective on Biological Integration

PubMed Central

Condic, Maureen L.

2016-01-01

Human life is operationally defined by the onset and cessation of organismal function. At postnatal stages of life, organismal integration critically and uniquely requires a functioning brain. In this article, a distinction is drawn between integrated and coordinated biologic activities. While communication between cells can provide a coordinated biologic response to specific signals, it does not support the integrated function that is characteristic of a living human being. Determining the loss of integrated function can be complicated by medical interventions (i.e., “life support”) that uncouple elements of the natural biologic hierarchy underlying our intuitive understanding of death. Such medical interventions can allow living human beings who are no longer able to function in an integrated manner to be maintained in a living state. In contrast, medical intervention can also allow the cells and tissues of an individual who has died to be maintained in a living state. To distinguish between a living human being and living human cells, two criteria are proposed: either the persistence of any form of brain function or the persistence of autonomous integration of vital functions. Either of these criteria is sufficient to determine a human being is alive. PMID:27075193

Rhenium tetrazolato complexes coordinated to thioalkyl-functionalised phenanthroline ligands: synthesis, photophysical characterisation, and incubation in live HeLa cells.

PubMed

Werrett, Melissa V; Wright, Phillip J; Simpson, Peter V; Raiteri, Paolo; Skelton, Brian W; Stagni, Stefano; Buckley, Alysia G; Rigby, Paul J; Massi, Massimiliano

2015-12-21

Three new complexes of formulation fac-[Re(CO)3(diim)L], where diim is either 1,10-phenanthroline or 1,10-phenanthroline functionalised at position 5 by a thioalkyl chain, and L is either a chloro or aryltetrazolato ancillary ligand, were synthesised and photophysically characterised. The complexes exhibit phosphorescent emission with maxima around 600 nm, originating from triplet metal-to-ligand charge transfer states with partially mixed ligand-to-ligand charge transfer character. The emission is relatively long-lived, within the 200-400 ns range, and with quantum yields of 2-4%. The complexes were trialed as cellular markers in live HeLa cells, along with two previously reported rhenium tetrazolato complexes bound to unsubstituted 1,10-phenanthroline. All five complexes exhibit good cellular uptake and non-specific perinuclear localisation. Upon excitation at 405 nm, the emission from the rhenium complexes could be clearly distinguished from autofluorescence, as demonstrated by spectral detection within the live cells. Four of the complexes did not appear to be toxic, however prolonged excitation could result in membrane blebbing. No major sign of photobleaching was detected upon multiple imaging on the same cell sample.

Living-Cell Microarrays

PubMed Central

Yarmush, Martin L.; King, Kevin R.

2011-01-01

Living cells are remarkably complex. To unravel this complexity, living-cell assays have been developed that allow delivery of experimental stimuli and measurement of the resulting cellular responses. High-throughput adaptations of these assays, known as living-cell microarrays, which are based on microtiter plates, high-density spotting, microfabrication, and microfluidics technologies, are being developed for two general applications: (a) to screen large-scale chemical and genomic libraries and (b) to systematically investigate the local cellular microenvironment. These emerging experimental platforms offer exciting opportunities to rapidly identify genetic determinants of disease, to discover modulators of cellular function, and to probe the complex and dynamic relationships between cells and their local environment. PMID:19413510

Being a Living Donor: Risks

MedlinePlus

... bowel Fluid on the lungs Lung, Intestine, and Pancreas Pancreas, intestine, and lung living-donor transplants are very ... care of the live organ donor: lung, liver, pancreas, and intestine data and medical guidelines. Transplantation. 2006 ...

Maternal Perspectives of Well Siblings' Adjustment to Family Life With a Technology-Dependent Child.

PubMed

Toly, Valerie Boebel; Blanchette, Julia E; Sikorski, Shannon; Musil, Carol M; Al-Hamed, Arwa

2017-08-01

Technology-dependent (TD) children require complex care and are dependent on medical technology. Approximately 75% of families, in the United States, who are caring for a TD child, also care for a well child. Well siblings are likely to be affected by the experience of living with a TD sibling as the process of family normalization is described as a family affair. The experiences of well siblings are not well described. The purpose of this qualitative analysis was to describe the experiences of well siblings who are living in a family with a TD child. Mothers were interviewed about the experiences of their well children and were digitally audio recorded. The interviews were transcribed, and content analysis was conducted. Content analysis from the interviews revealed the major themes of well sibling adjustment within the family unit, upside (altruistic, prosocial behaviors) and downside (negative internal and external processing behaviors). These results can be applied to advance the delivery of family nursing care offered to these families.

Irinotecan Lipid Complex Injection

MedlinePlus

Irinotecan lipid complex is used in combination with other medications to treat pancreatic cancer that has spread to other ... worsened after treatment with other chemotherapy medications. Irinotecan lipid complex is in a class of antineoplastic medications ...

[Research on medical works of Yuan dynasty quoted by Yong le da dian (The Great classic of Yongle reign)].

PubMed

Du, Yong

2003-01-01

The medical works quoted by Yong le da dian (The Great Classic of Yongle reign) are rather numerous, most of them were lost, and the lives of most of the authors were unknown. By careful investigation, the authors and their lives, circulation of these works, are still pursuable.

Senior aviation medical examiners conducting FAA first-class medical examinations.

DOT National Transportation Integrated Search

1971-07-01

Airline medical departments have provided a system of preventive health maintenance for their crews that has economically effected rehabilitation of experienced crewmembers who otherwise would have lost their medical licenses and thereby their liveli...

A novel laparoscopic grasper with two parallel jaws capable of extracting the mechanical behaviour of soft tissues.

PubMed

Nazarynasab, Dariush; Farahmand, Farzam; Mirbagheri, Alireza; Afshari, Elnaz

2017-07-01

Data related to force-deformation behaviour of soft tissue plays an important role in medical/surgical applications such as realistically modelling mechanical behaviour of soft tissue as well as minimally invasive surgery (MIS) and medical diagnosis. While the mechanical behaviour of soft tissue is very complex due to its different constitutive components, some issues increase its complexity like behavioural changes between the live and dead tissues. Indeed, an adequate quantitative description of mechanical behaviour of soft tissues requires high quality in vivo experimental data to be obtained and analysed. This paper describes a novel laparoscopic grasper with two parallel jaws capable of obtaining compressive force-deformation data related to mechanical behaviour of soft tissues. This new laparoscopic grasper includes four sections as mechanical hardware, sensory part, electrical/electronical part and data storage part. By considering a unique design for mechanical hardware, data recording conditions will be close to unconfined-compression-test conditions; so obtained data can be properly used in extracting the mechanical behaviour of soft tissues. Also, the other distinguishing feature of this new system is its applicability during different laparoscopic surgeries and subsequently obtaining in vivo data. However, more preclinical examinations are needed to evaluate the practicality of the novel laparoscopic grasper with two parallel jaws.

The Geriatric ICF Core Set reflecting health-related problems in community-living older adults aged 75 years and older without dementia: development and validation.

PubMed

Spoorenberg, Sophie L W; Reijneveld, Sijmen A; Middel, Berrie; Uittenbroek, Ronald J; Kremer, Hubertus P H; Wynia, Klaske

2015-01-01

The aim of the present study was to develop a valid Geriatric ICF Core Set reflecting relevant health-related problems of community-living older adults without dementia. A Delphi study was performed in order to reach consensus (≥70% agreement) on second-level categories from the International Classification of Functioning, Disability and Health (ICF). The Delphi panel comprised 41 older adults, medical and non-medical experts. Content validity of the set was tested in a cross-sectional study including 267 older adults identified as frail or having complex care needs. Consensus was reached for 30 ICF categories in the Delphi study (fourteen Body functions, ten Activities and Participation and six Environmental Factors categories). Content validity of the set was high: the prevalence of all the problems was >10%, except for d530 Toileting. The most frequently reported problems were b710 Mobility of joint functions (70%), b152 Emotional functions (65%) and b455 Exercise tolerance functions (62%). No categories had missing values. The final Geriatric ICF Core Set is a comprehensive and valid set of 29 ICF categories, reflecting the most relevant health-related problems among community-living older adults without dementia. This Core Set may contribute to optimal care provision and support of the older population. Implications for Rehabilitation The Geriatric ICF Core Set may provide a practical tool for gaining an understanding of the relevant health-related problems of community-living older adults without dementia. The Geriatric ICF Core Set may be used in primary care practice as an assessment tool in order to tailor care and support to the needs of older adults. The Geriatric ICF Core Set may be suitable for use in multidisciplinary teams in integrated care settings, since it is based on a broad range of problems in functioning. Professionals should pay special attention to health problems related to mobility and emotional functioning since these are the most prevalent problems in community-living older adults.

Live lecture versus video podcast in undergraduate medical education: A randomised controlled trial.

PubMed

Schreiber, Benjamin E; Fukuta, Junaid; Gordon, Fabiana

2010-10-08

Information technology is finding an increasing role in the training of medical students. We compared information recall and student experience and preference after live lectures and video podcasts in undergraduate medical education. We performed a crossover randomised controlled trial. 100 students were randomised to live lecture or video podcast for one clinical topic. Live lectures were given by the same instructor as the narrator of the video podcasts. The video podcasts comprised Powerpoint™ slides narrated using the same script as the lecture. They were then switched to the other group for a second clinical topic. Knowledge was assessed using multiple choice questions and qualitative information was collected using a questionnaire. No significant difference was found on multiple choice questioning immediately after the session. The subjects enjoyed the convenience of the video podcast and the ability to stop, review and repeat it, but found it less engaging as a teaching method. They expressed a clear preference for the live lecture format. We suggest that video podcasts are not ready to replace traditional teaching methods, but may have an important role in reinforcing learning and aiding revision.

Analysis of biosurfaces by neutron reflectometry: From simple to complex interfaces

DOE PAGES

Junghans, Ann; Watkins, Erik B.; Barker, Robert D.; ...

2015-03-16

Because of its high sensitivity for light elements and the scattering contrast manipulation via isotopic substitutions, neutron reflectometry (NR) is an excellent tool for studying the structure of soft-condensed material. These materials include model biophysical systems as well as in situ living tissue at the solid–liquid interface. The penetrability of neutrons makes NR suitable for probing thin films with thicknesses of 5–5000 Å at various buried, for example, solid–liquid, interfaces [J. Daillant and A. Gibaud, Lect. Notes Phys. 770, 133 (2009); G. Fragneto-Cusani, J. Phys.: Condens. Matter 13, 4973 (2001); J. Penfold, Curr. Opin. Colloid Interface Sci. 7, 139 (2002)].more » Over the past two decades, NR has evolved to become a key tool in the characterization of biological and biomimetic thin films. Highlighted In the current report are some of the authors' recent accomplishments in utilizing NR to study highly complex systems, including in-situ experiments. Such studies will result in a much better understanding of complex biological problems, have significant medical impact by suggesting innovative treatment, and advance the development of highly functionalized biomimetic materials.« less

Combining clinical and genomics queries using i2b2 – Three methods

PubMed Central

Murphy, Shawn N.; Avillach, Paul; Bellazzi, Riccardo; Phillips, Lori; Gabetta, Matteo; Eran, Alal; McDuffie, Michael T.; Kohane, Isaac S.

2017-01-01

We are fortunate to be living in an era of twin biomedical data surges: a burgeoning representation of human phenotypes in the medical records of our healthcare systems, and high-throughput sequencing making rapid technological advances. The difficulty representing genomic data and its annotations has almost by itself led to the recognition of a biomedical “Big Data” challenge, and the complexity of healthcare data only compounds the problem to the point that coherent representation of both systems on the same platform seems insuperably difficult. We investigated the capability for complex, integrative genomic and clinical queries to be supported in the Informatics for Integrating Biology and the Bedside (i2b2) translational software package. Three different data integration approaches were developed: The first is based on Sequence Ontology, the second is based on the tranSMART engine, and the third on CouchDB. These novel methods for representing and querying complex genomic and clinical data on the i2b2 platform are available today for advancing precision medicine. PMID:28388645

Can a Healthcare "Lean Sweep" Deliver on What Matters to Patients? Comment on "Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping".

PubMed

Verma, Jennifer Y; Amar, Claudia

2015-07-28

Disconnects and defects in care - such as duplication, poor integration between services or avoidable adverse events - are costly to the health system and potentially harmful to patients and families. For patients living with multiple chronic conditions, such disconnects can be particularly detrimental. Lean is an approach to optimizing value by reducing waste (eg, duplication and defects) and containing costs (eg, improving integration of services) as well as focusing on what matters to patients. Lean works particularly well to optimize existing processes and services. However, as the burden of chronic illness and frailty overtake episodic care needs, health systems require far greater complex, adaptive change. Such change ought to take into account outcomes in population health in addition to care experiences and costs (together, comprising the Triple Aim); and involve patients and families in co-designing new models of care that better address complex, longer-term health needs. © 2015 by Kerman University of Medical Sciences.

A clinical decision support system for integrating tuberculosis and HIV care in Kenya: a human-centered design approach.

PubMed

Catalani, Caricia; Green, Eric; Owiti, Philip; Keny, Aggrey; Diero, Lameck; Yeung, Ada; Israelski, Dennis; Biondich, Paul

2014-01-01

With the aim of integrating HIV and tuberculosis care in rural Kenya, a team of researchers, clinicians, and technologists used the human-centered design approach to facilitate design, development, and deployment processes of new patient-specific TB clinical decision support system for medical providers. In Kenya, approximately 1.6 million people are living with HIV and have a 20-times higher risk of dying of tuberculosis. Although tuberculosis prevention and treatment medication is widely available, proven to save lives, and prioritized by the World Health Organization, ensuring that it reaches the most vulnerable communities remains challenging. Human-centered design, used in the fields of industrial design and information technology for decades, is an approach to improving the effectiveness and impact of innovations that has been scarcely used in the health field. Using this approach, our team followed a 3-step process, involving mixed methods assessment to (1) understand the situation through the collection and analysis of site observation sessions and key informant interviews; (2) develop a new clinical decision support system through iterative prototyping, end-user engagement, and usability testing; and, (3) implement and evaluate the system across 24 clinics in rural West Kenya. Through the application of this approach, we found that human-centered design facilitated the process of digital innovation in a complex and resource-constrained context.

A Clinical Decision Support System for Integrating Tuberculosis and HIV Care in Kenya: A Human-Centered Design Approach

PubMed Central

Catalani, Caricia; Green, Eric; Owiti, Philip; Keny, Aggrey; Diero, Lameck; Yeung, Ada; Israelski, Dennis; Biondich, Paul

2014-01-01

With the aim of integrating HIV and tuberculosis care in rural Kenya, a team of researchers, clinicians, and technologists used the human-centered design approach to facilitate design, development, and deployment processes of new patient-specific TB clinical decision support system for medical providers. In Kenya, approximately 1.6 million people are living with HIV and have a 20-times higher risk of dying of tuberculosis. Although tuberculosis prevention and treatment medication is widely available, proven to save lives, and prioritized by the World Health Organization, ensuring that it reaches the most vulnerable communities remains challenging. Human-centered design, used in the fields of industrial design and information technology for decades, is an approach to improving the effectiveness and impact of innovations that has been scarcely used in the health field. Using this approach, our team followed a 3-step process, involving mixed methods assessment to (1) understand the situation through the collection and analysis of site observation sessions and key informant interviews; (2) develop a new clinical decision support system through iterative prototyping, end-user engagement, and usability testing; and, (3) implement and evaluate the system across 24 clinics in rural West Kenya. Through the application of this approach, we found that human-centered design facilitated the process of digital innovation in a complex and resource-constrained context. PMID:25170939

"I Want to Listen to My Students' Lives": Developing an Ecological Perspective in Learning to Teach

ERIC Educational Resources Information Center

Cook-Sather, Alison; Curl, Heather

2014-01-01

Preparing teachers who want to "listen to their students' lives"requires creating opportunities for prospective teachers to perceive and learn about their students' lives and how those unfold within and as part of complex systems. That means supporting prospective teachers not only in understanding students as complex beings who have to…

Experiences of living with motor neurone disease: a review of qualitative research.

PubMed

Sakellariou, Dikaios; Boniface, Gail; Brown, Paul

2013-10-01

This review sought to answer the question "what is known about people's experiences of living with MND?". The review followed the guidelines of the Centre of Reviews and Dissemination. Twenty articles met the inclusion criteria and their results were analysed thematically. Data were managed and coded using the software package NVIVO and the analysis was performed in two stages, with the first stage aiming to develop descriptive themes offering an overview of the included data. During the second stage, analytical themes were developed with the explicit aim to answer the review question. The themes that emerged point to the following: (a) people with motor neurone disease (MND) develop experiential knowledge that helps them to live with the disease and (b) while people with MND believe they do not have any control over the disease, they try to have control over their lives through active choices, e.g. how and when to use adaptive equipment. This review highlights the decision-making and knowledge generating processes used by people with MND. Further research is required to explore these processes and their implications for the care of people with MND. Decision-making process by MND patients regarding their care is complex and takes into account the social elements of the disease as well as the medical. Exploring the practical knowledge that patients develop can offer insights on appropriate care for MND patients.

[Creation of a complete organised care network allowing facilitated access to ophthalmological care for patients living in socially "at-risk" situations, feasibility study].

PubMed

Terrier de la Chaise, S; Criton, A; Berrod, J-P; Boivin, J-M

2017-09-01

Currently, renouncement to healthcare by socially "at-risk" patients continues to increase and access to ophthalmological care is complex. The main objective of this study is to test the feasibility of a complete organised care network allowing facilitated access to ophthalmological care for patients living in socially "at-risk" situations. A prospective interventional study was conducted within four social housing infrastructures to screen for vision problems in the "at-risk" socially population in question. Partnering with the ophthalmological department of the CHRU de Nancy, an interventional and supportive care trial for the affected population was conducted with the assistance of social workers, nursing aides, opticians, and the author. Ten screening sessions were conducted between December 2015 and April 2016 allowing a vision exam of sixty-five patients living in social housing. Twenty-five patients benefited from specialised care within a three-month time frame provided by the ophthalmological department, of which nineteen patients received corrective lenses. The remaining six patients received other types of ophthalmological care. The study allowed to demonstrate that the cooperation of willing actors makes it possible to improve access to visual healthcare for patients living in socially "at-risk" situations, in particular in the frame of ophthalmological care, often taking second place in a general medical consultation. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Redesigning the MCAT exam: balancing multiple perspectives.

PubMed

Schwartzstein, Richard M; Rosenfeld, Gary C; Hilborn, Robert; Oyewole, Saundra Herndon; Mitchell, Karen

2013-05-01

The authors of this commentary discuss the recently completed review of the current Medical College Admission Test (MCAT), which has been used since 1991, and describe the blueprint for the new test that will be introduced in 2015. The design of the MCAT exam reflects changes in medical education, medical science, health care delivery, and the needs of the populations served by graduates of U.S. and Canadian medical schools. The authors describe how balancing the ambitious goals for the new exam and the varying priorities of the testing program's many stakeholders made blueprint design complex. They discuss the tensions and trade-offs that characterized the design process as well as the deliberations and data that shaped the blueprint.The blueprint for the MCAT exam balances the assessment of a broad range of competencies in the natural, social, and behavioral sciences and critical analysis and reasoning skills that are essential to entering students' success in medical school. The exam will include four sections: Biological and Biochemical Foundations of Living Systems; Chemical and Physical Foundations of Biological Systems; Psychological, Social, and Biological Foundations of Behavior; and Critical Analysis and Reasoning Skills.The authors also offer recommendations for admission committees, advising them to review applicants' test scores, course work, and other academic, personal, and experiential credentials as part of a holistic admission process and in relation to their institutions' educational, scientific, clinical, and service-oriented goals.

Sync and swim: the impact of medication consolidation on adherence in Medicaid patients.

PubMed

Ross, Alexander; Jami, Humaira; Young, Heather A; Katz, Richard

2013-10-01

Medication nonadherence is associated with higher cost of care and poor outcomes. Medication refill consolidation (synchronization of refill dates for patients on multiple drugs) is an important component of regimen complexity. We presumed that Medicaid patients with a 30-day medication supply limit would have significant difficulty with refill consolidation. We evaluated regimen complexity and refill consolidation in relation to medication adherence in the Medicaid population. A survey was administered to 50 Medicaid patients taking 2 or more daily medications in the outpatient setting. The survey included demographics, 13 items related to medication and pharmacy history, and 10 items related to medication regimen complexity and refill consolidation. Chi-square analysis was used to assess the relationship between adherence and missed medication doses due to regimen complexity. Wilcoxon rank sum test was used to determine association between total number of prescribing providers and number of daily medications with various aspects of regimen complexity. 52% were required to go to the pharmacy more than once per month to keep all of their medications filled and 46% missed a day or more of medication because their medications must be refilled on different dates. Those who missed a day or more of medication because of need to refill prescriptions on different days had higher number of prescriptions (P = .03) and higher number of prescribers (P = .03). Medicaid patients had low medication adherence in the context of high regimen complexity and poor refill consolidation. This population would benefit from interventions focused on improving synchronization of medication refills.

Risk factors of falls among elderly living in Urban Suez - Egypt

PubMed Central

Kamel, Mohammed Hany; Abdulmajeed, Abdulmajeed Ahmed; Ismail, Sally El-Sayed

2013-01-01

Introduction Falling is one of the most common geriatric syndromes threatening the independence of older persons. Falls result from a complex and interactive mix of biological or medical, behavioral and environmental factors, many of which are preventable. Studying these diverse risk factors would aid early detection and management of them at the primary care level. Methods This is a cross sectional study about risk factors of falls was conducted to 340 elders in Urban Suez. Those are all patients over 60 who attended two family practice centers in Urban Suez. Results When asked about falling during the past 12 months, 205 elders recalled at least one incident of falling. Of them, 36% had their falls outdoors and 24% mentioned that stairs was the most prevalent site for indoor falls. Falls were also reported more among dependant than independent elderly. Using univariate regression analysis, almost all tested risk factors were significantly associated with falls in the studied population. These risk factors include: living alone, having chronic diseases, using medications, having a physical deficit, being in active, and having a high nutritional risk. However, the multivariate regression analysis proved that the strongest risk factors are low level of physical activity with OR 0.6 and P value 0.03, using a cane or walker (OR 1.69 and P value 0.001) and Impairment of daily living activities (OR 1.7 and P value 0.001). Conclusion Although falls is a serious problem among elderly with many consequences, it has many preventable risk factors. Health care providers should advice people to remain active and more research is needed in such an important area of Family Practice. PMID:23504298

Through the Looking Glass: Real-Time Video Using 'Smart' Technology Provides Enhanced Intraoperative Logistics.

PubMed

Baldwin, Andrew C W; Mallidi, Hari R; Baldwin, John C; Sandoval, Elena; Cohn, William E; Frazier, O H; Singh, Steve K

2016-01-01

In the setting of increasingly complex medical therapies and limited physician resources, the recent emergence of 'smart' technology offers tremendous potential for improved logistics, efficiency, and communication between medical team members. In an effort to harness these capabilities, we sought to evaluate the utility of this technology in surgical practice through the employment of a wearable camera device during cardiothoracic organ recovery. A single procurement surgeon was trained for use of an Explorer Edition Google Glass (Google Inc., Mountain View, CA) during the recovery process. Live video feed of each procedure was securely broadcast to allow for members of the home transplant team to remotely participate in organ assessment. Primary outcomes involved demonstration of technological feasibility and validation of quality assurance through group assessment. The device was employed for the recovery of four organs: a right single lung, a left single lung, and two bilateral lung harvests. Live video of the visualization process was remotely accessed by the home transplant team, and supplemented final verification of organ quality. In each case, the organs were accepted for transplant without disruption of standard procurement protocols. Media files generated during the procedures were stored in a secure drive for future documentation, evaluation, and education purposes without preservation of patient identifiers. Live video streaming can improve quality assurance measures by allowing off-site members of the transplant team to participate in the final assessment of donor organ quality. While further studies are needed, this project suggests that the application of mobile 'smart' technology offers not just immediate value, but the potential to transform our approach to the practice of medicine.

Risk factors of falls among elderly living in urban Suez--Egypt.

PubMed

Kamel, Mohammed Hany; Abdulmajeed, Abdulmajeed Ahmed; Ismail, Sally El-Sayed

2013-01-01

Falling is one of the most common geriatric syndromes threatening the independence of older persons. Falls result from a complex and interactive mix of biological or medical, behavioral and environmental factors, many of which are preventable. Studying these diverse risk factors would aid early detection and management of them at the primary care level. This is a cross sectional study about risk factors of falls was conducted to 340 elders in Urban Suez. Those are all patients over 60 who attended two family practice centers in Urban Suez. When asked about falling during the past 12 months, 205 elders recalled at least one incident of falling. Of them, 36% had their falls outdoors and 24% mentioned that stairs was the most prevalent site for indoor falls. Falls were also reported more among dependant than independent elderly. Using univariate regression analysis, almost all tested risk factors were significantly associated with falls in the studied population. These risk factors include: living alone, having chronic diseases, using medications, having a physical deficit, being in active, and having a high nutritional risk. However, the multivariate regression analysis proved that the strongest risk factors are low level of physical activity with OR 0.6 and P value 0.03, using a cane or walker (OR 1.69 and P value 0.001) and Impairment of daily living activities (OR 1.7 and P value 0.001). Although falls is a serious problem among elderly with many consequences, it has many preventable risk factors. Health care providers should advice people to remain active and more research is needed in such an important area of Family Practice.

The time has come to eliminate the gaps in the under-recognized burden of elder mistreatment: A community-based, cross-sectional study from rural eastern Nepal.

PubMed

Yadav, Uday Narayan; Tamang, Man Kumar; Paudel, Grish; Kafle, Bharat; Mehta, Suresh; Chandra Sekaran, Varalakshmi; Gruiskens, Jeroen R J H

2018-01-01

Elder mistreatment is a well-recognized public health issue with complex underlying factors. The current study hypothesized that there is no effect of any of the following factors on any type of elder mistreatment: ethnicity, age group, education status, gender, living arrangement, concentration problems, medication for any disease, income level of caregiver, use of alcohol and tobacco products, and dependence on family or caregivers for daily activities. We conducted a cross-sectional study of 339 elders adults aged 60 or above residing in a rural part of eastern Nepal between August and November 2016. Multi-stage cluster sampling was adopted to select the study subjects. Information was collected using semi-structured questionnaires administered to elderly people by a designated interviewer. Factors associated with elder mistreatment were analyzed using logistic regression. Our findings revealed that 61.7% of 60+-year-olds experienced some form of mistreatment (physical 2.4%, psychological 22.4%, caregiver neglect 57.5%, financial 12.1% and stranger-inflicted 8.3%). Elder mistreatment was associated with the following characteristics of elders: dependent on family for daily living activities, illiterate, experiencing concentration problems, residing in a living arrangement with their son(s)/daughter(s)-in-law, taking regular medications, belonging to the Dalit community according to the Hindu traditional caste system, and residing with a caregiver having a monthly family income of less than NRs. 20,000 (193USD). Our data show that elder mistreatment is prevalent in a rural community of Nepal. Addressing the lower socio-economic or socio-cultural classes of caregivers and elders via community-focused development programs might have significant implications for improving the well-being of elders.

Nanomolar pyrophosphate detection and nucleus staining in living cells with simple terpyridine-Zn(II) complexes.

PubMed

Chao, Duobin; Ni, Shitan

2016-05-20

Great efforts have been made to develop fluorescent probes for pyrophosphate (PPi) detection. Nucleus staining with fluorescence microscopy has been also widely investigated. But fluorescent probes for PPi detection with high sensitivity in water medium and nucleus staining with low-cost non-precious metal complexes in living cells are still challenging. Herein, we report simple terpyridine-Zn(II) complexes for selective nanomolar PPi detection over ATP and ADP in water based on aggregation induced emission (AIE) and intramolecular charge transfer (ICT). In addition, these terpyridine-Zn(II) complexes were successfully employed for nucleus staining in living cells. These results demonstrated simply obtained terpyridine-Zn(II) complexes are powerful tool for PPi detection and the development of PPi-related studies.

A System for Multi-Domain Contextualization of Personal Health Data.

PubMed

Pustišek, Matevž

2017-01-01

Current telehealth systems are used to improve the treatment of chronic diseases by collecting medical data at the patient and transferring them to a remote medical institution. Research shows that such medical practice can be substantially improved if the measured parameters are greater in number and of more diverse nature. Emerging consumer solutions for monitoring personal health and wellness, as well as various resources from domains like internet, telecommunications and smart living, can be used as possible sources for exploration of an individual's wider health context. It was our aim to design an internet of things solutions, which would combine these sources of information into context information, complementary to health data. An internet of things platform was designed and implemented and integration with an established e-health system was provided to enrich telehealth data with context information by aggregating and processing cross-domain inputs from various sources. The approach was validated on a use case scenario. The concept was tried in a scenario related to prevention and management of heart disease. The system's advanced graphic correlation features are expected to help physicians and patients identify true roots of health problems. Medical researchers are also expected to benefit from a deeper insight into complex cross-domain parameter dependencies that determine an individual's health.

Medication therapy management and complex patients with disability: a randomized controlled trial.

PubMed

Chrischilles, Elizabeth A; Doucette, William; Farris, Karen; Lindgren, Scott; Gryzlak, Brian; Rubenstein, Linda; Youland, Kelly; Wallace, Robert B

2014-02-01

Drug therapy problems, adverse drug events (ADEs), and symptom burden are high among adults with disabilities. To compare the effects of a modified medication therapy management (MTM) program within a self-efficacy workshop versus the workshop alone or usual care on symptom burden among adults with activity limitations. Three-group randomized controlled trial among adults (age 40 and older) with self-reported activity limitations in community practice. 8 weekly Living Well With a Disability (LWD) 2-hour workshop sessions with and without a collaborative medication management (CMM) module. mean number of moderate to very severe symptoms from a list of 11 physical and mental symptoms. Process measures: changes in medication regimens and self-reported ADEs. general linear mixed models (continuous outcomes) and generalized estimating equations (categorical outcomes). Participants had high symptom burden, low physical health, and took many medications. There was a significant increase in ADE reporting in the LWD + CMM group relative to the other 2 groups (Study group × Time P = .014), and there were significantly more changes in medication regimens in the LWD + CMM group (P = .013 LWD only vs LWD + CMM). The oldest third of participants had significantly fewer mean symptoms but received more intense CMM. There was no difference between the LWD-only, LWD + CMM, and usual care groups in symptom burden over time. Pharmacist MTM practices and MTM guidelines may need to be modified to affect symptom burden in a population with physical activity limitations.

Surviving Surveillance: How Pregnant Women and Mothers Living With HIV Respond to Medical and Social Surveillance.

PubMed

Greene, Saara; Ion, Allyson; Kwaramba, Gladys; Lazarus, Lisa; Loutfy, Mona

2017-12-01

Pregnant women and mothers living with HIV are under surveillance of service providers, family members, and the community at large. Surveillance occurs throughout the medical management of their HIV during pregnancy, preventing HIV transmission to their baby, infant feeding practices, and as part of assessments related to their ability to mother. Enacted and anticipatory HIV-related stigma can exacerbate the negative impact that being under surveillance has on mothers living with HIV as they move through their pregnancy, birthing, and mothering experiences. In response, women living with HIV find ways to manage their experiences of surveillance through engaging in acts of distancing, planning, and resisting at different points in time, and sometimes enacting all three practices at once. Positioning the narratives of pregnant women and mothers living with HIV in relation to their experiences of surveillance illuminates the relationship between the surveillance of mothers living with HIV and HIV-related stigma.

Making sense of change: patients' views of diabetes and GP-led integrated diabetes care.

PubMed

Burridge, Letitia H; Foster, Michele M; Donald, Maria; Zhang, Jianzhen; Russell, Anthony W; Jackson, Claire L

2016-02-01

Health system reform is directed towards better management of diabetes. However, change can be difficult, and patients' perspectives are a key aspect of implementing change. This study investigated patients' perceptions and experiences of type 2 diabetes (T2DM), self-care and engagement with GP-led integrated diabetes care. Qualitative interviews were conducted with purposively selected patients with T2DM following their initial medical appointment in the new model of care. Normalization process theory was used to orientate the thematic analysis, to explain the work of implementing change. Two specialist GP-based complex diabetes services in primary care in Brisbane, Australia. Intervention group patients (n = 30) in a randomized controlled trial to evaluate a model of GP-led integrated care for complex T2DM. Participants' experiences and perceptions of diabetes management and a GP-led model of care. Three themes were identified: sensibility of change, 'diabetic life' and diabetes care alliance. The imperative of change made sense, but some participants experienced dissonance between this rational view and their lived reality. Diabetes invaded life, revealing incongruities between participants' values and living with diabetes. They appreciated a flexible and personalized approach to care. Participants responded to advice in ways that seemed rational within the complexities of their life context. Their diabetes partnerships with health professionals coupled providers' biomedical expertise with patients' contextual expertise. Learning to manage relationships with various health professionals adds to patients' diabetes-related work. Providers need to adopt a flexible, interactive approach and foster trust, to enable better diabetes care. © 2015 John Wiley & Sons Ltd.

[Huxianweng (The Old man of Bottle Immortal) is not a famous doctor in the Eastern Han Dynasty].

PubMed

Li, B

2017-01-28

The name Huxianweng appeared in the Ming yi lei an ( Classified Medical Records of Famous Physicians ) did not live in the Eastern Han. Moreover, all medical cases it collected were not belonged to him alone but the accumulation of many people in several periods. By textual investigation, the prototype of Huxianweng is Yin Fu who lived in Yizheng County, Jiangsu Province in the end of the Ming Dynasty. He had expertise in medical skills and high medical ethics, and was therefore loved by the residents deeply. Besides, people alleged many mysterious cases to be cured by him which actually is not true.

Relationships between Lifestyle, Living Environments, and Incidence of Hypertension in Japan (in Men): Based on Participant’s Data from the Nationwide Medical Check-Up

PubMed Central

Oka, Mayumi; Yamamoto, Mio; Mure, Kanae; Takeshita, Tatsuya; Arita, Mikio

2016-01-01

This study aims to investigate factors that contribute to the differences in incidence of hypertension between different regions in Japan, by accounting for not only individual lifestyles, but also their living environments. The target participants of this survey were individuals who received medical treatment for hypertension, as well as hypertension patients who have not received any treatment. The objective variable for analysis was the incidence of hypertension as data aggregated per prefecture. We used data (in men) including obesity, salt intake, vegetable intake, habitual alcohol consumption, habitual smoking, and number of steps walked per day. The variables within living environment included number of rail stations, standard/light vehicle usage, and slope of habitable land. In addition, we analyzed data for the variables related to medical environment including, participation rate in medical check-ups and number of hospitals. We performed multiple stepwise regression analyses to elucidate the correlation of these variables by using hypertension incidence as the objective variable. Hypertension incidence showed a significant negative correlation with walking and medical check-ups, and a significant positive correlation with light-vehicle usage and slope. Between the number of steps and variables related to the living environment, number of rail stations showed a significant positive correlation, while, standard- and light-vehicle usage showed significant negative correlation. Moreover, with stepwise multiple regression analysis, walking showed the strongest effect. The differences in daily walking based on living environment were associated with the disparities in the hypertension incidence in Japan. PMID:27788198

Accessing VA Healthcare During Large-Scale Natural Disasters.

PubMed

Der-Martirosian, Claudia; Pinnock, Laura; Dobalian, Aram

2017-01-01

Natural disasters can lead to the closure of medical facilities including the Veterans Affairs (VA), thus impacting access to healthcare for U.S. military veteran VA users. We examined the characteristics of VA patients who reported having difficulty accessing care if their usual source of VA care was closed because of natural disasters. A total of 2,264 veteran VA users living in the U.S. northeast region participated in a 2015 cross-sectional representative survey. The study used VA administrative data in a complex stratified survey design with a multimode approach. A total of 36% of veteran VA users reported having difficulty accessing care elsewhere, negatively impacting the functionally impaired and lower income VA patients.

Taking care of business: self-help and sleep medicine in american corporate culture.

PubMed

Brown, Megan

2004-01-01

This article argues that corporate management in the United States has expanded its scope beyond office walls and encompasses many aspects of workers' daily lives. One new element of corporate training is the micromanagement of sleep; self-help books, newspaper reports, magazine articles, and consulting firms currently advise workers and supervisors on optimizing productivity by cultivating certain sleep habits. Although consultants and self-help books make specific recommendations about sleep, most medical research is inconclusive about sleep's benefits for human performance. Using the ideas of Michel Foucault and Gilles Deleuze as a philosophical backdrop, this article examines the complex and often contradictory links between self-help, medicine, and corporate governance.

Health: The No-Man's-Land Between Physics and Biology.

PubMed

Mansfield, Peter J

2015-10-01

Health as a positive attribute is poorly understood because understanding requires concepts from physics, of which physicians and other life scientists have a very poor grasp. This paper reviews the physics that bears on biology, in particular complex quaternions and scalar fields, relates these to the morphogenetic fields proposed by biologists, and defines health as an attribute of living action within these fields. The distinction of quality, as juxtaposed with quantity, proves essential. Its basic properties are set out, but a science and mathematics of quality are awaited. The implications of this model are discussed, particularly as proper health enhancement could set a natural limit to demand for, and therefore the cost of, medical services.

Mothers' health and babies' weights: the biology of poverty at the Melbourne Lying-in Hospital, 1857-83.

PubMed

Mccalman, Janet; Morley, Ruth

2003-04-01

Birth weight remains a major focus of medical research into the relationship between pre-natal growth and life course health, and historians have used mean birth weight to assess women's standard of living. However, there are intrinsic difficulties in inferring maternal health and nutritional status from birth weight, and some of the known data sets produce puzzling results. One rich data set comes from the Melbourne Lying-in Hospital, 1857-83, and the article discusses the complex institutional, social, and economic causes that may underlie its apparently counter-intuitive anthropometric results. This data set reveals the biological effects differential social conditions can inflict, even within an otherwise affluent society.

Interactive effects of live coral and structural complexity on the recruitment of reef fishes

NASA Astrophysics Data System (ADS)

Coker, D. J.; Graham, N. A. J.; Pratchett, M. S.

2012-12-01

Corals reefs are subjected to multiple disturbances that modify levels of coral cover and structural complexity of the reef matrix, and in turn influence the structure of associated fish communities. With disturbances predicted to increase, insight into how changes in substrate condition will influence the recruitment of many fishes is essential for understanding the recovery of reef fish populations following biological and physical disturbances. While studies have revealed that both live coral cover and structural complexity are important for many fishes, there is a lack of understanding regarding how a combination of these changes will impact the recruitment of fishes. This study used experimentally constructed patch reefs consisting of six different habitat treatments; three levels of live coral cover (high, medium, low) crossed with two levels of structural complexity (high, low), to test the independent and combined effects of live coral cover and structural complexity on the recruitment and recovery of fish communities. The abundance and species diversity of fishes varied significantly among the six habitat treatments, but differences were not clearly associated with either coral cover or structural complexity and varied through time. More striking, however, was a significant difference in the composition of fish assemblages among treatments, due mostly to disproportionate abundance of coral-dwelling fishes on high coral cover, high complexity reefs. Overall, it appears that coral cover had a more important influence than structural complexity, at least for the contrasting levels of structural complexity achieved on experimental patch reefs. Furthermore, we found that live coral cover is important for the recruitment of some non-coral-dependent fishes. This study confirms that live coral cover is critical for the maintenance of high biodiversity on tropical coral reefs, and that sustained and ongoing declines in coral cover will adversely affect recruitment for many different species of reef fishes.

Mail-order pharmacy experience of veterans living with AIDS/HIV.

PubMed

Desai, Karishma Rohanraj; Chewning, Betty; Wilcox, Andrew; Safdar, Nasia

2018-02-01

The VA system is the largest single provider of healthcare in the United States and to individuals infected with HIV specifically. High quality medication management is particularly important since HIV is a chronic infectious condition which requires taking multiple medications with strict requirements for adherence to medication regimens. Veterans Administration (VA) patients are required to obtain all chronic medications using the VA mail-order pharmacy system. Drawing on Donabedian's Quality Improvement framework, this study sought to examine experiences that Veterans with HIV have with the Veterans Administration medication mail-order system, and to explore opportunities for quality improvement. A sequential, explanatory mixed-methods design was used to interview Veterans receiving care at a Midwestern Veterans Administration Hospital using a mail-order experience survey followed by in-depth interviews. All 57 Veterans, out of 72, who were successfully contacted consented to participate. Overall, Veterans evaluated the mail-order service positively and valued the accuracy (correct medication delivery). However, a notable problem emerged with respect to assuring access to HIV medications with about half (47%) indicating running out of HIV medication. Respondents identified structural issues with respect to days covered by mailed medications (90 versus current 30 days) and process issues with scheduling new refills. Veterans also indicated the information sheets were too long, complex and not helpful for their queries. Patients were open to pharmacists playing an active role during clinic visits and felt this would help manage their conditions better. Veterans generally reported that the VA Mail-order service was of high quality. However, some findings indicate there are opportunities to improve this service to be more patient-centered particularly for vulnerable HIV patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparison of self-efficacy and its improvement after artificial simulator or live animal model emergency procedure training.

PubMed

Hall, Andrew B; Riojas, Ramon; Sharon, Danny

2014-03-01

The objective of this study is to compare post-training self-efficacy between artificial simulators and live animal training for the performance of emergency medical procedures. Volunteer airmen of the 81st Medical Group, without prior medical procedure training, were randomly assigned to two experimental arms consisting of identical lectures and training of diagnostic peritoneal lavage, thoracostomy (chest tube), and cricothyroidotomy on either the TraumaMan (Simulab Corp., Seattle, Washington) artificial simulator or a live pig (Sus scrofa domestica) model. Volunteers were given a postlecture and postskills training assessment of self-efficacy. Twenty-seven volunteers that initially performed artificial simulator training subsequently underwent live animal training and provided assessments comparing both modalities. The results were first, postskills training self-efficacy scores were significantly higher than postlecture scores for either training mode and for all procedures (p < 0.0001). Second, post-training self-efficacy scores were not statistically different between live animal and artificial simulator training for diagnostic peritoneal lavage (p = 0.555), chest tube (p = 0.486), and cricothyroidotomy (p = 0.329). Finally, volunteers undergoing both training modalities indicated preference for live animal training (p < 0.0001). We conclude that artificial simulator and live animal training produce equivalent levels of self-efficacy after initial training, but there is a preference in using a live animal model to achieve those skills. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

The Impact of Living in Rural and Urban Areas: Vitamin D and Medical Costs in Veterans

ERIC Educational Resources Information Center

Bailey, Beth A.; Manning, Todd; Peiris, Alan N.

2012-01-01

Purpose: Living in a rural region is associated with significant health disparities and increased medical costs. Vitamin D deficiency, which is increasingly common, is also associated with many adverse health outcomes. The purpose of this study was to determine whether rural-urban residence status of veterans was related to vitamin D levels, and…

Medical Conditions and Healthcare Utilization among Adults with Intellectual Disabilities Living in Group Homes in New York City

ERIC Educational Resources Information Center

Levy, Joel M.; Botuck, Shelly; Damiani, Marco R.; Levy, Philip H.; Dern, Thomas A.; Freeman, Stephen E.

2006-01-01

The shift in living situations for adults with intellectual and other developmental disabilities (IDDD) from family homes to group homes has raised questions about their healthcare needs and access to appropriate healthcare services. This study was undertaken to describe the disability characteristics and medical conditions in a sample of adults…

The interrupted learner: How distractions during live and video lectures influence learning outcomes.

PubMed

Zureick, Andrew H; Burk-Rafel, Jesse; Purkiss, Joel A; Hortsch, Michael

2017-11-27

New instructional technologies have been increasingly incorporated into the medical school learning environment, including lecture video recordings as a substitute for live lecture attendance. The literature presents varying conclusions regarding how this alternative experience impacts students' academic success. Previously, a multi-year study of the first-year medical histology component at the University of Michigan found that live lecture attendance was positively correlated with learning success, while lecture video use was negatively correlated. Here, three cohorts of first-year medical students (N = 439 respondents, 86.6% response rate) were surveyed in greater detail regarding lecture attendance and video usage, focusing on study behaviors that may influence histology learning outcomes. Students who reported always attending lectures or viewing lecture videos had higher average histology scores than students who employed an inconsistent strategy (i.e., mixing live attendance and video lectures). Several behaviors were negatively associated with histology performance. Students who engaged in "non-lecture activities" (e.g., social media use), students who reported being interrupted while watching the lecture video, or feeling sleepy/losing focus had lower scores than their counterparts not engaging in these behaviors. This study suggests that interruptions and distractions during medical learning activities-whether live or recorded-can have an important impact on learning outcomes. Anat Sci Educ 00: 000-000. © 2017 American Association of Anatomists. © 2017 American Association of Anatomists.

The Social Living Complex: A New, All Day, Yearlong Intervention Model for Individuals with Autism Spectrum Disorder and Their Parents

ERIC Educational Resources Information Center

Doenyas, Ceymi

2016-01-01

We propose an unprecedented intervention for individuals with autism spectrum disorder (ASD) and their parents: the social living complex. Unlike existing social skills interventions, peer-mediated interventions here are not limited to the school/experiment duration and setting. Whereas other supported living services house adults with ASD only,…

Medical Readers' Theater: Relevance to Geriatrics Medical Education

ERIC Educational Resources Information Center

Shapiro, Johanna; Cho, Beverly

2011-01-01

Medical Readers' Theater (MRT) is an innovative and simple way of helping medical students to reflect on difficult-to-discuss topics in geriatrics medical education, such as aging stereotypes, disability and loss of independence, sexuality, assisted living, relationships with adult children, and end-of-life issues. The authors describe a required…

When a Mother Changes Her Mind About a DNR.

PubMed

Higginson, Jason; Lang, Kellie R; Ransom, Hellen; Parker, Clint; Ledoux, Matthew; Hester, D Micah; Lantos, John D

2018-06-21

Generally, wide latitude is granted to parents when making decisions for their child on the basis of the wide acceptance of the special relationship between parent and child and the important role played by parents in the lives of children. However, when high-risk decisions are made, health care teams serve as an important societal safeguard that questions whether a parent is an appropriate decision-maker for their child. Child advocacy is an essential function of the pediatric health care team. In this ethics rounds, we examine a case of an infant with a complex medical condition requiring prolonged hospitalization that results in a clash of understanding between a mother and medical team when the mother abruptly requests removal of life-sustaining treatment. We present an ethical decision-making framework for such cases and examine the impact of barriers and unconscious bias that can exclude parents from their rightful role in directing care for their child. Copyright © 2018 by the American Academy of Pediatrics.

A simple and low-cost Internet-based teleconsultation system that could effectively solve the health care access problems in underserved areas of developing countries.

PubMed

Kuntalp, Mehmet; Akar, Orkun

2004-08-01

In many developing countries including Turkey, telemedicine systems are not in wide use due to the high cost and complexity of the required technology. Lack of these systems however has serious implications on patients who live in rural areas. The objective of this paper is to present a simple and economically affordable alternative to the current systems that would allow experts to easily access the medical data of their remote patients over the Internet. The system is developed in client-server architecture with a user-friendly graphical interface and various services are implemented as dynamic web pages based on PHP. The other key features of the system are its powerful security features and platform independency. An academic prototype is implemented and presented to the evaluation of a group of physicians. The results reveal that the system could find acceptance from the medical community and it could be an effective means of providing quality health care in developing countries.

Black Lives Matter, but What About Our Health?

PubMed

Negbenebor, Nicole A; Garza, Eduardo Wayo

2018-02-01

In the setting of the current social and political climate, the focus on protection of Black lives in America has come to the forefront. We evaluate how health in the Black community should be a paramount concern that can be addressed in three ways: 1. Connecting the medical community to the Black community, empowering patients with knowledge, and diversifying the medical workforce. These three initiatives will help to decrease the health disparities seen in Black health. Copyright © 2018 National Medical Association. Published by Elsevier Inc. All rights reserved.

Medication-related cognitive artifacts used by older adults with heart failure

PubMed Central

Mickelson, Robin S.; Willis, Matt; Holden, Richard J.

2015-01-01

Objective To use a human factors perspective to examine how older adult patients with heart failure use cognitive artifacts for medication management. Methods We performed a secondary analysis of data collected from 30 patients and 14 informal caregivers enrolled in a larger study of heart failure self-care. Data included photographs, observation notes, interviews, video recordings, medical record data, and surveys. These data were analyzed using an iterative content analysis. Results Findings revealed that medication management was complex, inseparable from other patient activities, distributed across people, time, and place, and complicated by knowledge gaps. We identified fifteen types of cognitive artifacts including medical devices, pillboxes, medication lists, and electronic personal health records used for: 1) measurement/evaluation; 2) tracking/communication; 3) organization/administration; and 4) information/sensemaking. These artifacts were characterized by fit and misfit with the patient’s sociotechnical system and demonstrated both advantages and disadvantages. We found that patients often modified or “finished the design” of existing artifacts and relied on “assemblages” of artifacts, routines, and actors to accomplish their self-care goals. Conclusions Cognitive artifacts are useful but sometimes are poorly designed or are not used optimally. If appropriately designed for usability and acceptance, paper-based and computer-based information technologies can improve medication management for individuals living with chronic illness. These technologies can be designed for use by patients, caregivers, and clinicians; should support collaboration and communication between these individuals; can be coupled with home-based and wearable sensor technology; and must fit their users’ needs, limitations, abilities, tasks, routines, and contexts of use. PMID:26855882

Improving Post-Discharge Medication Adherence in Patients with CVD: A Pilot Randomized Trial

PubMed Central

Oliveira-Filho, Alfredo D.; Morisky, Donald E.; Costa, Francisco A.; Pacheco, Sara T.; Neves, Sabrina F.; Lyra-Jr, Divaldo P.

2014-01-01

Background Effective interventions to improve medication adherence are usually complex and expensive. Objective To assess the impact of a low-cost intervention designed to improve medication adherence and clinical outcomes in post-discharge patients with CVD. Method A pilot RCT was conducted at a teaching hospital. Intervention was based on the four-item Morisky Medication Adherence Scale (MMAS-4). The primary outcome measure was medication adherence assessed using the eight-item MMAS at baseline, at 1 month post hospital discharge and re-assessed 1 year after hospital discharge. Other outcomes included readmission and mortality rates. Results 61 patients were randomized to intervention (n = 30) and control (n = 31) groups. The mean age of the patients was 61 years (SD 12.73), 52.5% were males, and 57.4% were married or living with a partner. Mean number of prescribed medications per patient was 4.5 (SD 3.3). Medication adherence was correlated to intervention (p = 0.04) and after 1 month, 48.4% of patients in the control group and 83.3% in the intervention group were considered adherent. However, this difference decreased after 1 year, when adherence was 34.8% and 60.9%, respectively. Readmission and mortality rates were related to low adherence in both groups. Conclusion The intervention based on a validated patient self-report instrument for assessing adherence is a potentially effective method to improve adherent behavior and can be successfully used as a tool to guide adherence counseling in the clinical visit. However, a larger study is required to assess the real impact of intervention on these outcomes. PMID:25590930

What is the evidence of impaired motor skills and motor control among children with attention deficit hyperactivity disorder (ADHD)? Systematic review of the literature.

PubMed

Kaiser, M-L; Schoemaker, M M; Albaret, J-M; Geuze, R H

2014-11-06

This article presents a review of the studies that have analysed the motor skills of ADHD children without medication and the influence of medication on their motor skills. The following two questions guided the study: What is the evidence of impairment of motor skills and aspects of motor control among children with ADHD aged between 6 and 16 years? What are the effects of ADHD medication on motor skills and motor control? The following keywords were introduced in the main databases: attention disorder and/or ADHD, motor skills and/or handwriting, children, medication. Of the 45 articles retrieved, 30 described motor skills of children with ADHD and 15 articles analysed the influence of ADHD medication on motor skills and motor control. More than half of the children with ADHD have difficulties with gross and fine motor skills. The children with ADHD inattentive subtype seem to present more impairment of fine motor skills, slow reaction time, and online motor control during complex tasks. The proportion of children with ADHD who improved their motor skills to the normal range by using medication varied from 28% to 67% between studies. The children who still show motor deficit while on medication might meet the diagnostic criteria of developmental coordination disorder (DCD). It is important to assess motor skills among children with ADHD because of the risk of reduced participation in activities of daily living that require motor coordination and attention. Copyright © 2014 Elsevier Ltd. All rights reserved.

Use of dietary supplements among people living with HIV/AIDS is associated with vulnerability to medical misinformation on the internet

PubMed Central

2012-01-01

Background Use of dietary supplements is common among people living with HIV/AIDS. Because dietary supplements are used in the context of other health behaviors, they may have direct and indirect health benefits. However, supplements may also be associated with vulnerability to medical misinformation and unfounded health claims. We examined use of dietary supplements among people living with HIV/AIDS (PLWH) and the association between use of dietary supplements and believing medical misinformation. Methods A convenience sample of 268 men and 76 women living with HIV was recruited from AIDS services and clinics in Atlanta, GA. Participants completed measures of demographic and health characteristics, dietary supplement use, beliefs about dietary supplements, internet use, and an internet evaluation task designed to assess vulnerability to medical misinformation. Results One out of four PLWH currently used at least one dietary supplement product excluding vitamins. Dietary supplement use was associated with higher education and greater use of the internet for health-related information. Dietary supplement users also endorsed greater believability and trust in unfounded claims for HIV cures. Conclusions Dietary supplement use is common among PLWH and is associated with a broad array of health information seeking behaviors. Interventions are needed to reduce the vulnerability of PLWH, particularly dietary supplement users, to medical misinformation propagated on the internet. PMID:22233928

Factors affecting self-reported medication adherence and hypertension knowledge: A cross-sectional study in rural villages, Yogyakarta Province, Indonesia.

PubMed

Rahmawati, Riana; Bajorek, Beata

2017-01-01

Objectives This study assessed medication adherence and hypertension knowledge, and their predictive factors, in people with hypertension, living in rural communities in Indonesia. Methods Data were acquired from 384 people living in eight rural villages via a researcher-administered questionnaire, a validated adherence scale, and a standardized hypertension knowledge survey. Multivariate analysis was used to identify the predictors of adherence and knowledge. Results Fifty-nine (15%) participants had good hypertension knowledge (score ≥ 8 out of 10). Compared to participants with poor knowledge, these participants had higher formal education (odds ratio = 2.7, 95% confidence interval = 1.5-4.7), and lived closer to a community health center (odds ratio = 1.8, 95% confidence interval = 1.0-3.3). Knowledge gaps about the need for long-term medication, hypertension complications, and the target blood pressure were identified. Good hypertension knowledge predicted good adherence to medication (odds ratio = 7.1, 95% confidence interval = 3.3-15.2). Only 42 (11%) participants were considered to have good adherence. Reasons for intentional nonadherence were beliefs that medicines should be taken only when symptoms are evident, limited access to healthcare services, and a preference using traditional medicines. Conclusion Strategies for addressing knowledge gaps and misconceptions about hypertension medication are needed, particularly for people with a low educational level and those living some distances from healthcare facilities.

Predictive Analytics In Healthcare: Medications as a Predictor of Medical Complexity.

PubMed

Higdon, Roger; Stewart, Elizabeth; Roach, Jared C; Dombrowski, Caroline; Stanberry, Larissa; Clifton, Holly; Kolker, Natali; van Belle, Gerald; Del Beccaro, Mark A; Kolker, Eugene

2013-12-01

Children with special healthcare needs (CSHCN) require health and related services that exceed those required by most hospitalized children. A small but growing and important subset of the CSHCN group includes medically complex children (MCCs). MCCs typically have comorbidities and disproportionately consume healthcare resources. To enable strategic planning for the needs of MCCs, simple screens to identify potential MCCs rapidly in a hospital setting are needed. We assessed whether the number of medications used and the class of those medications correlated with MCC status. Retrospective analysis of medication data from the inpatients at Seattle Children's Hospital found that the numbers of inpatient and outpatient medications significantly correlated with MCC status. Numerous variables based on counts of medications, use of individual medications, and use of combinations of medications were considered, resulting in a simple model based on three different counts of medications: outpatient and inpatient drug classes and individual inpatient drug names. The combined model was used to rank the patient population for medical complexity. As a result, simple, objective admission screens for predicting the complexity of patients based on the number and type of medications were implemented.

Cd(II)-terpyridine-based complex as a ratiometric fluorescent probe for pyrophosphate detection in solution and as an imaging agent in living cells.

PubMed

Jiao, Shu-Yan; Li, Kun; Zhang, Wei; Liu, Yan-Hong; Huang, Zeng; Yu, Xiao-Qi

2015-01-21

The terpyridine anthracene ligand was synthesized and characterized. is a ratiometric fluorescent probe for Cd(2+) with a recognition mechanism based on intramolecular charge transfer (ICT). An complex was isolated, and its structure was established using single-crystal XRD. The complex was able to serve as a novel reversible chemosensing ensemble to allow ratiometric response to pyrophosphate (PPi) in aqueous media. Moreover, the fluorescence imaging in living cells from these two emission channels suggested that was a ratiometric probe for Cd(2+), and the in situ generated complex was also a ratiometric ensemble for PPi detection in living cells.

Physical and biological mechanisms of nanosecond- and microsecond-pulsed FE-DBD plasma interaction with biological objects

NASA Astrophysics Data System (ADS)

Dobrynin, Danil

2013-09-01

Mechanisms of plasma interaction with living tissues and cells can be quite complex, owing to the complexity of both the plasma and the tissue. Thus, unification of all the mechanisms under one umbrella might not be possible. Here, analysis of interaction of floating electrode dielectric barrier discharge (FE-DBD) with living tissues and cells is presented and biological and physical mechanisms are discussed. In physical mechanisms, charged species are identified as the major contributors to the desired effect and a mechanism of this interaction is proposed. Biological mechanisms are also addressed and a hypothesis of plasma selectivity and its effects is offered. Spatially uniform nanosecond and sub-nanosecond short-pulsed dielectric barrier discharge plasmas are gaining popularity in biological and medical applications due to their increased uniformity, lower plasma temperature, lower surface power density, and higher concentration of the active species produced. In this presentation we will compare microsecond pulsed plasmas with nanosecond driven systems and their applications in biology and medicine with specific focus on wound healing and tissue regeneration. Transition from negative to positive streamer will be discussed with proposed hypothesis of uniformity mechanisms of positive streamer and the reduced dependence on morphology and surface chemistry of the second electrode (human body) being treated. Uniform plasma offers a more uniform delivery of active species to the tissue/surface being treated thus leading to better control over the biological results.

Case management by nurses in primary care: analysis of 73 'success stories'.

PubMed

Elwyn, Glyn; Williams, Meryl; Roberts, Catherine; Newcombe, Robert G; Vincent, Judith

2008-01-01

There is interest as to whether case management reduces unplanned patient admission to hospital. However, very little is known about how the intervention is delivered and what the most salient outcome measures are. Qualitative study embedded in a wider evaluation. Primary health care. Analysis of case manager case reports in a service innovation evaluation study. Case management provides home-based care to frail elderly patients using a process of assessment and medication review. This often leads to new diagnoses, to the co-ordination of further care and the tailoring of services to suit the needs of individuals. The benefits reported are complex and relate to improving a patient's quality of life more than the prevention or otherwise of admission to hospital. The type of attention provided by these roles seems to be absent from current NHS arrangements. The role enables time to be spent assessing the individual needs of patients who live at the margins of independent living. The case managers describe having the time and the skills to assess a mix of clinical and social problems, and then accessing the correct networks to help elderly people with multiple illnesses navigate a complex system of providers. More weight should be given to the ability of this intervention to result in improved quality of life for patients, and to the investigation of costs and benefits.

Creating 21st-Century Laboratories and Classrooms for Improving Population Health: A Call to Action for Academic Medical Centers.

PubMed

DeVoe, Jennifer E; Likumahuwa-Ackman, Sonja; Shannon, Jackilen; Steiner Hayward, Elizabeth

2017-04-01

Academic medical centers (AMCs) in the United States built world-class infrastructure to successfully combat disease in the 20th century, which is inadequate for the complexity of sustaining and improving population health. AMCs must now build first-rate 21st-century infrastructure to connect combating disease and promoting health. This infrastructure must acknowledge the bio-psycho-social-environmental factors impacting health and will need to reach far beyond the AMC walls to foster community "laboratories" that support the "science of health," complementary to those supporting the "science of medicine"; cultivate community "classrooms" to stimulate learning and discovery in the places where people live, work, and play; and strengthen bridges between academic centers and these community laboratories and classrooms to facilitate bidirectional teaching, learning, innovation, and discovery.Private and public entities made deep financial investments that contributed to the AMC disease-centered approach to clinical care, education, and research in the 20th century. Many of these same funders now recognize the need to transform U.S. health care into a system that is accountable for population health and the need for a medical workforce equipped with the skills to measure and improve health. Innovative ideas about communities as centers of learning, the importance of social factors as major determinants of health, and the need for multidisciplinary perspectives to solve complex problems are not new; many are 20th-century ideas still waiting to be fully implemented. The window of opportunity is now. The authors articulate how AMCs must take bigger and bolder steps to become leaders in population health.

The Affordable Care Act and the Burden of High Cost Sharing and Utilization Management Restrictions on Access to HIV Medications for People Living with HIV/AIDS.

PubMed

Zamani-Hank, Yasamean

2016-08-01

The HIV/AIDS epidemic continues to be a critical public health issue in the United States, where an estimated 1.2 million individuals live with HIV infection. Viral suppression is one of the primary public health goals for People Living with HIV/AIDS (PLWHA). A crucial component of this goal involves adequate access to health care, specifically anti-retroviral HIV medications. The enactment of the Affordable Care Act (ACA) in 2010 raised hopes for millions of PLWHA without access to health care coverage. High cost-sharing requirements enacted by health plans place a financial burden on PLWHA who need ongoing access to these life-saving medications. Plighted with poverty, Detroit, Michigan, is a center of attention for examining the financial burden of HIV medications on PLWHA under the new health plans. From November 2014 to January 2015, monthly out-of-pocket costs and medication utilization requirements for 31 HIV medications were examined for the top 12 insurance carriers offering Qualified Health Plans on Michigan's Health Insurance Marketplace Exchange. The percentage of medications requiring quantity limits and prior authorization were calculated. The average monthly out-of-pocket cost per person ranged from $12 to $667 per medication. Three insurance carriers placed all 31 HIV medications on the highest cost-sharing tier, charging 50% coinsurance. High out-of-pocket costs and medication utilization restrictions discourage PLWHA from enrolling in health plans and threaten interrupted medication adherence, drug resistance, and increased risk of viral transmission. Health plans inflicting high costs and medication restrictions violate provisions of the ACA and undermine health care quality for PLWHA. (Population Health Management 2016;19:272-278).

A Novel Integrated Cognitive-Behavioral Therapy for Anxiety and Medication Adherence Among Persons Living With HIV/AIDS.

PubMed

Brandt, Charles P; Paulus, Daniel J; Garza, Monica; Lemaire, Chad; Norton, Peter J; Zvolensky, Michael J

2018-02-01

Persons living with HIV/AIDS (PLHIV) are able to live full lifespans after infection, however, rates of anxiety disorders among this population are elevated compared to national samples. Importantly, these anxiety symptoms and disorders have a negative effect on medication adherence, quality of life and other psychological disorders, such as depression. In order to reduce the impact of anxiety among PLHIV, a six-session transdiagnostic CBT-based treatment manual for anxiety among PLHIV named the HIV/Anxiety Management-Reduction Treatment (HAMRT) was developed and implemented. The current manuscript discusses the content of this manual as well as results from three cases examining the impact of HAMRT. Results indicated that HAMRT was effective in reducing symptoms of anxiety, anxiety sensitivity, depression, and negative affect among our sample. Additionally, results indicated that HAMRT was effective in increasing HIV medication adherence as well as quality of life. Results are discussed in terms of the potential utility of an anxiety-reduction therapy program aimed at increasing medication adherence among PLHIV.

Live lecture versus video podcast in undergraduate medical education: A randomised controlled trial

PubMed Central

2010-01-01

Background Information technology is finding an increasing role in the training of medical students. We compared information recall and student experience and preference after live lectures and video podcasts in undergraduate medical education. Methods We performed a crossover randomised controlled trial. 100 students were randomised to live lecture or video podcast for one clinical topic. Live lectures were given by the same instructor as the narrator of the video podcasts. The video podcasts comprised Powerpoint™ slides narrated using the same script as the lecture. They were then switched to the other group for a second clinical topic. Knowledge was assessed using multiple choice questions and qualitative information was collected using a questionnaire. Results No significant difference was found on multiple choice questioning immediately after the session. The subjects enjoyed the convenience of the video podcast and the ability to stop, review and repeat it, but found it less engaging as a teaching method. They expressed a clear preference for the live lecture format. Conclusions We suggest that video podcasts are not ready to replace traditional teaching methods, but may have an important role in reinforcing learning and aiding revision. PMID:20932302

38 CFR 21.35 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., diagnostic, medical, social, psychological, and educational services determined by the Department of Veterans..., diagnostic, medical, social, psychological, independent living, economic, educational, vocational, and.... 99-576) (j) Program of employment services. This term includes the counseling, medical, social, and...

38 CFR 21.35 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., diagnostic, medical, social, psychological, and educational services determined by the Department of Veterans..., diagnostic, medical, social, psychological, independent living, economic, educational, vocational, and.... 99-576) (j) Program of employment services. This term includes the counseling, medical, social, and...

38 CFR 21.35 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., diagnostic, medical, social, psychological, and educational services determined by the Department of Veterans..., diagnostic, medical, social, psychological, independent living, economic, educational, vocational, and.... 99-576) (j) Program of employment services. This term includes the counseling, medical, social, and...

38 CFR 21.35 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., diagnostic, medical, social, psychological, and educational services determined by the Department of Veterans..., diagnostic, medical, social, psychological, independent living, economic, educational, vocational, and.... 99-576) (j) Program of employment services. This term includes the counseling, medical, social, and...

38 CFR 21.35 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., diagnostic, medical, social, psychological, and educational services determined by the Department of Veterans..., diagnostic, medical, social, psychological, independent living, economic, educational, vocational, and.... 99-576) (j) Program of employment services. This term includes the counseling, medical, social, and...

[Realities and professional expectations of medical students attending Guinea Bissau's medical school in 2007 school year].

PubMed

Fronteira, Inês; Rodrigues, Amabélia; Pereira, Camilo; Silva, Augusto P; Mercer, Hugo; Dussault, Guilles; Ferrinho, Paulo

2011-01-01

In Guinea Bissau, the majority of university level professionals are still being trained abroad and most of them do not return to their country. This was a major incentive for creating Guinea Bissau's Medical School. An observational, cross-sectional, analytic study was conducted on the second trimester of 2007 to characterize the socio-demographic, familial and educational profile of medical students, their satisfaction levels, difficulties and expectations concerning the medicine course. A questionnaire was used and a response rate of 63% achieved (81 students). Data was analyzed using SPSS v.17 for descriptive statistics. Students are very committed to their education. They tend to decide to take the medicine course early in their lives and are influenced by their relatives. They choose to be medical doctors because they like it but also for altruistic reasons and the desire to save lives. Although many face financial and material difficulties, they tend to have success in their academic live. They live with their parents, do not have children and some have side jobs to provide for extra income to help with their education. They expect their education to make them good doctors in any part of the world and want to work simultaneously in the public (to serve their country and pay their debt to the State) and in the private sector (to enhance their income). The large majority wants to work in a hospital, in Bissau, and to be a pediatrician or obstetrician. They have unreasonably high expectations concerning their future income as medical doctors.

Variation Across U.S. Assisted Living Facilities: Admissions, Resident Care Needs, and Staffing.

PubMed

Han, Kihye; Trinkoff, Alison M; Storr, Carla L; Lerner, Nancy; Yang, Bo Kyum

2017-01-01

Though more people in the United States currently reside in assisted living facilities (ALFs) than nursing homes, little is known about ALF admission policies, resident care needs, and staffing characteristics. We therefore conducted this study using a nationwide sample of ALFs to examine these factors, along with comparison of ALFs by size. Cross-sectional secondary data analysis using data from the 2010 National Survey of Residential Care Facilities. Measures included nine admission policy items, seven items on the proportion of residents with selected conditions or care needs, and six items on staffing characteristics (e.g., access to licensed nurse, aide training). Facilities (n = 2,301) were divided into three categories by size: small, 4 to 10 beds; medium, 11 to 25 beds; and large, 26 or more beds. Analyses took complex sampling design effects into account to project national U.S. estimates. More than half of ALFs admitted residents with considerable healthcare needs and served populations that required nursing care, such as for transfers, medications, and eating or dressing. Staffing was largely composed of patient care aides, and fewer than half of ALFs had licensed care provider (registered nurse, licensed practical nurse) hours. Smaller facilities tended to have more inclusive admission policies and residents with more complex care needs (more mobility, eating and medication assistance required, short-term memory issues, p < .01) and less access to licensed nurses than larger ALFs (p < .01). This study suggests ALFs are caring for and admitting residents with considerable care needs, indicating potential overlap with nursing home populations. Despite this finding, ALF regulations lag far behind those in effect for nursing homes. In addition, measurement of care outcomes is critically needed to ensure appropriate ALF care quality. As more people choose ALFs, outcome measures for ALFs, which are now unavailable, should be developed to allow for oversight and monitoring of care quality. © 2016 Sigma Theta Tau International.

Medical Care Tasks among Spousal Dementia Caregivers: Links to Care-Related Sleep Disturbances.

PubMed

Polenick, Courtney A; Leggett, Amanda N; Maust, Donovan T; Kales, Helen C

2018-05-01

Medical care tasks are commonly provided by spouses caring for persons living with dementia (PLWDs). These tasks reflect complex care demands that may interfere with sleep, yet their implications for caregivers' sleep outcomes are unknown. The authors evaluated the association between caregivers' medical/nursing tasks (keeping track of medications; managing tasks such as ostomy care, intravenous lines, or blood testing; giving shots/injections; and caring for skin wounds/sores) and care-related sleep disturbances. A retrospective analysis of cross-sectional data from the 2011 National Health and Aging Trends Study and National Study of Caregiving was conducted. Spousal caregivers and PLWDs/proxies were interviewed by telephone at home. The U.S. sample included 104 community-dwelling spousal caregivers and PLWDs. Caregivers reported on their sociodemographic and health characteristics, caregiving stressors, negative caregiving relationship quality, and sleep disturbances. PLWDs (or proxies) reported on their health conditions and sleep problems. Caregivers who performed a higher number of medical/nursing tasks reported significantly more frequent care-related sleep disturbances, controlling for sociodemographic and health characteristics, caregiving stressors, negative caregiving relationship quality, and PLWDs' sleep problems and health conditions. Post hoc tests showed that wound care was independently associated with more frequent care-related sleep disturbances after accounting for the other medical/nursing tasks and covariates. Spousal caregivers of PLWDs who perform medical/nursing tasks may be at heightened risk for sleep disturbances and associated adverse health consequences. Interventions to promote the well-being of both care partners may benefit from directly addressing caregivers' needs and concerns about their provision of medical/nursing care. Copyright © 2018 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Nursing care needs and services utilised by home-dwelling elderly with complex health problems: observational study.

PubMed

Næss, Gro; Kirkevold, Marit; Hammer, Wenche; Straand, Jørund; Wyller, Torgeir Bruun

2017-09-12

In Norway, as in many Western countries, a shift from institutional care to home care is taking place. Our knowledge is limited regarding which needs for nursing interventions patients being cared for in their home have, and how they are met. We aimed at assessing aspects of health and function in a representative sample of the most vulnerable home-dwelling elderly, to identify their needs for nursing interventions and how these needs were met. In this observational study we included patients aged 75+ living in their own homes in Oslo, who received daily home care, had three or more chronic diagnoses, received daily medication, and had been hospitalized during the last year. Focused attention and cognitive processing speed were assessed with the Trail Making Test A (TMT-A), handgrip strength was used as a measure of sarcopenia, mobility was assessed with the "Timed Up-and-Go" test, and independence in primary activities of daily living by the Barthel Index. Diagnoses and medication were collected from electronic medical records. For each diagnosis, medication and functional impairment, a consensus group defined which nursing service that the particular condition necessitated. We then assessed whether these needs were fulfilled for each participant. Of 150 eligible patients, 83 were included (mean age 87 years, 25% men). They had on average 6 diagnoses and used 9 daily medications. Of the 83 patients, 61 (75%) had grip strength indicating sarcopenia, 27 (33%) impaired mobility, and 69 (83%) an impaired TMT-A score. Median amount of home nursing per week was 3.6 h (interquartile range 2.6 to 23.4). Fulfilment of pre-specified needs was >60% for skin and wound care in patients with skin diseases, observation of blood glucose in patients taking antidiabetic drugs, and in supporting food intake in patients with eating difficulties. Most other needs as defined by the consensus group were fulfilled in <10% of the patients. We identified a very frail group of home-dwelling patients. For this group, resources for home nursing should probably be used in a more flexible and pro-active way to aim for preserving functional status, minimize symptom burden, and prevent avoidable hospitalisations.

Family Structure and Child Well-Being: Integrating Family Complexity

PubMed Central

Brown, Susan L.; Manning, Wendy D.; Stykes, J. Bart

2014-01-01

Although children’s family lives are diverse, the measurement of children’s living arrangements has lagged, focusing on the relationships of children to parents while largely ignoring sibling composition. Using data from the 2008 Survey of Income and Program Participation (N = 23,985) the authors documented patterns of family complexity among a nationally representative sample of children ages 0–17 living in a range of family structures. They also examined the independent and joint associations of family structure and family complexity on child economic well-being. Family complexity was independently related to economic disadvantage, namely, a lower income-to-needs ratio and a higher likelihood of public assistance receipt. The role of family complexity was partially contingent on family structure, with the positive association between family complexity and receipt of public assistance more pronounced for children in families with 2 married biological parents. This study demonstrates the utility of integrating family structure and family complexity in studies of children’s well-being. PMID:25620810

Ethical reasoning through simulation: a phenomenological analysis of student experience.

PubMed

Lewis, Gareth; McCullough, Melissa; Maxwell, Alexander P; Gormley, Gerard J

2016-01-01

Medical students transitioning into professional practice feel underprepared to deal with the emotional complexities of real-life ethical situations. Simulation-based learning (SBL) may provide a safe environment for students to probe the boundaries of ethical encounters. Published studies of ethics simulation have not generated sufficiently deep accounts of student experience to inform pedagogy. The aim of this study was to understand students' lived experiences as they engaged with the emotional challenges of managing clinical ethical dilemmas within a SBL environment. This qualitative study was underpinned by an interpretivist epistemology. Eight senior medical students participated in an interprofessional ward-based SBL activity incorporating a series of ethically challenging encounters. Each student wore digital video glasses to capture point-of-view (PoV) film footage. Students were interviewed immediately after the simulation and the PoV footage played back to them. Interviews were transcribed verbatim. An interpretative phenomenological approach, using an established template analysis approach, was used to iteratively analyse the data. Four main themes emerged from the analysis: (1) 'Authentic on all levels?', (2)'Letting the emotions flow', (3) 'Ethical alarm bells' and (4) 'Voices of children and ghosts'. Students recognised many explicit ethical dilemmas during the SBL activity but had difficulty navigating more subtle ethical and professional boundaries. In emotionally complex situations, instances of moral compromise were observed (such as telling an untruth). Some participants felt unable to raise concerns or challenge unethical behaviour within the scenarios due to prior negative undergraduate experiences. This study provided deep insights into medical students' immersive and embodied experiences of ethical reasoning during an authentic SBL activity. By layering on the human dimensions of ethical decision-making, students can understand their personal responses to emotion, complexity and interprofessional working. This could assist them in framing and observing appropriate ethical and professional boundaries and help smooth the transition into clinical practice.

The effects of housing status on health-related outcomes in people living with HIV: a systematic review of the literature.

PubMed

Leaver, Chad A; Bargh, Gordon; Dunn, James R; Hwang, Stephen W

2007-11-01

HIV infection is increasingly characterized as a chronic condition that can be managed through adherence to a healthy lifestyle, complex drug regimens, and regular treatment and monitoring. The location, quality, and/or affordability of a person's housing can be a significant determinant of his or her ability to meet these requirements. The objective of this systematic review is to inform program and policy development and future research by examining the available empirical evidence on the effects of housing status on health-related outcomes in people living with HIV/AIDS. Electronic databases were searched from dates of inception through November 2005. A total of 29 studies met inclusion criteria for this review. Seventeen studies received a "good" or "fair" quality rating based on defined criteria. A significant positive association between increased housing stability and better health-related outcomes was noted in all studies examining housing status with outcomes of medication adherence (n = 9), utilization of health and social services (n = 5), and studies examining health status (n = 2) and HIV risk behaviours (n = 1). Healthcare, support workers and public health policy should recognize the important impact of affordable and sustainable housing on the health of persons living with HIV.

Statistical analysis of dimer formation in supersaturated metal vapor based on molecular dynamics simulation

NASA Astrophysics Data System (ADS)

Korenchenko, Anna E.; Vorontsov, Alexander G.; Gelchinski, Boris R.; Sannikov, Grigorii P.

2018-04-01

We discuss the problem of dimer formation during the homogeneous nucleation of atomic metal vapor in an inert gas environment. We simulated nucleation with molecular dynamics and carried out the statistical analysis of double- and triple-atomic collisions as the two ways of long-lived diatomic complex formation. Close pair of atoms with lifetime greater than the mean time interval between atom-atom collisions is called a long-lived diatomic complex. We found that double- and triple-atomic collisions gave approximately the same probabilities of long-lived diatomic complex formation, but internal energy of the resulted state was essentially lower in the second case. Some diatomic complexes formed in three-particle collisions are stable enough to be a critical nucleus.

Partnering Urban Academic Medical Centers And Rural Primary Care Clinicians To Provide Complex Chronic Disease Care

PubMed Central

Arora, Sanjeev; Kalishman, Summers; Dion, Denise; Som, Dara; Thornton, Karla; Bankhurst, Arthur; Boyle, Jeanne; Harkins, Michelle; Moseley, Kathleen; Murata, Glen; Komaramy, Miriam; Katzman, Joanna; Colleran, Kathleen; Deming, Paulina; Yutzy, Sean

2013-01-01

Many of the estimated thirty-two million Americans expected to gain coverage under the Affordable Care Act are likely to have high levels of unmet need for various chronic illnesses and to live in areas that are already underserved. In New Mexico an innovative new model of health care education and delivery known as Project ECHO (Extension for Community Healthcare Outcomes) provides high-quality primary and specialty care to a comparable population. Using state-of-the-art telehealth technology and case-based learning, Project ECHO enables specialists at the University of New Mexico Health Sciences Center to partner with primary care clinicians in underserved areas to deliver complex specialty care to patients with hepatitis C, asthma, diabetes, HIV/AIDS, pediatric obesity and mental illness. As of March 2011, 298 Project ECHO teams across New Mexico have delivered more than 10,000 specialty care consultations for hepatitis C and other chronic diseases. PMID:21596757

Detection of protease activity in cells and animals.

PubMed

Verdoes, Martijn; Verhelst, Steven H L

2016-01-01

Proteases are involved in a wide variety of biologically and medically important events. They are entangled in a complex network of processes that regulate their activity, which makes their study intriguing, but challenging. For comprehensive understanding of protease biology and effective drug discovery, it is therefore essential to study proteases in models that are close to their complex native environments such as live cells or whole organisms. Protease activity can be detected by reporter substrates and activity-based probes, but not all of these reagents are suitable for intracellular or in vivo use. This review focuses on the detection of proteases in cells and in vivo. We summarize the use of probes and substrates as molecular tools, discuss strategies to deliver these tools inside cells, and describe sophisticated read-out techniques such as mass spectrometry and various imaging applications. This article is part of a Special Issue entitled: Physiological Enzymology and Protein Functions. Copyright © 2015 Elsevier B.V. All rights reserved.

Health insurance and payment systems for severe acute pancreatitis.

PubMed

Yoshida, Masahiro; Takada, Tadahiro; Hirata, Koichi; Mayumi, Toshihiko; Shikata, Satoru; Shirai, Kunihiro; Kimura, Yasutoshi; Wada, Keita; Amano, Hodaka; Arata, Shinju; Hirota, Masahiko; Takeda, Kazunori; Gabata, Toshifumi; Hirota, Morihisa; Yokoe, Masamichi; Kiriyama, Seiki; Sekimoto, Miho

2010-01-01

The medical insurance system of Japan is based on the Universal Medical Care System guaranteed by the provision of the Article 25 of the Constitution of Japan, which states that "All the people shall have the right to live a healthy, cultural and minimum standard of life." The health insurance system of Japan comprises the medical insurance system and the health care system for the long-lived. Medical care insurance includes the employees' health insurance (Social Insurance) that covers employees of private companies and their families and community insurance (National Health Insurance) that covers the self-employed. Each medical insurance system has its own medical care system for the retired and their families. The health care system for the long-lived covers people of over 75 years of age (over 65 years in people with a certain handicap). There is also a system under which all or part of the medical expenses is reimbursed by public expenditure or the cost of medical care not covered by health insurance is paid by the government. This system is referred to collectively as the "the public payment system of medical expenses." To support the realization of the purpose of this system, there is a treatment research enterprise for specified diseases (intractable diseases). Because of the high mortality rate, acute pancreatitis is specified as an intractable disease for the purpose of reducing its mortality rate, and treatment expenses of patients are paid in full by the government dating back to the day when the application was made for a certificate verifying that he or she has severe acute pancreatitis.

The effect of live classical piano music on the vital signs of patients undergoing ophthalmic surgery.

PubMed

Camara, Jorge G; Ruszkowski, Joseph M; Worak, Sandra R

2008-06-25

Music and surgery. To determine the effect of live classical piano music on vital signs of patients undergoing ophthalmic surgery. Retrospective case series. 203 patients who underwent various ophthalmologic procedures in a period during which a piano was present in the operating room of St. Francis Medical Center. [Note: St. Francis Medical Center has recently been renamed Hawaii Medical Center East.] Demographic data, surgical procedures, and the vital signs of 203 patients who underwent ophthalmic procedures were obtained from patient records. Blood pressure, heart rate, and respiratory rate measured in the preoperative holding area were compared with the same parameters taken in the operating room, with and without exposure to live piano music. A paired t-test was used for statistical analysis. Mean arterial pressure, heart rate, and respiratory rate. 115 patients who were exposed to live piano music showed a statistically significant decrease in mean arterial blood pressure, heart rate, and respiratory rate in the operating room compared with their vital signs measured in the preoperative holding area (P < .0001). The control group of 88 patients not exposed to live piano music showed a statistically significant increase in mean arterial blood pressure (P < .0002) and heart rate and respiratory rate (P < .0001). Live classical piano music lowered the blood pressure, heart rate, and respiratory rate in patients undergoing ophthalmic surgery.

Limitations of Western Medicine and Models of Integration Between Medical Systems.

PubMed

Attena, Francesco

2016-05-01

This article analyzes two major limitations of Western medicine: maturity and incompleteness. From this viewpoint, Western medicine is considered an incomplete system for the explanation of living matter. Therefore, through appropriate integration with other medical systems, in particular nonconventional approaches, its knowledge base and interpretations may be widened. This article presents possible models of integration of Western medicine with homeopathy, the latter being viewed as representative of all complementary and alternative medicine. To compare the two, a medical system was classified into three levels through which it is possible to distinguish between different medical systems: epistemological (first level), theoretical (second level), and operational (third level). These levels are based on the characterization of any medical system according to, respectively, a reference paradigm, a theory on the functioning of living matter, and clinical practice. The three levels are consistent and closely consequential in the sense that from epistemology derives theory, and from theory derives clinical practice. Within operational integration, four models were identified: contemporary, alternative, sequential, and opportunistic. Theoretical integration involves an explanation of living systems covering simultaneously the molecular and physical mechanisms of functioning living matter. Epistemological integration provides a more thorough and comprehensive explanation of the epistemic concepts of indeterminism, holism, and vitalism to complement the reductionist approach of Western medicine; concepts much discussed by Western medicine while lacking the epistemologic basis for their emplacement. Epistemologic integration could be reached with or without a true paradigm shift and, in the latter, through a model of fusion or subsumption.

Using the autonomic standards to assess orthostatic hypotension in persons with SCI: a case series.

PubMed

Wecht, Jill M; Wilson, James; Previnaire, Jean-Gabriel

2017-01-01

Spinal cord injury (SCI) creates a complex and unique syndrome of medical issues related to disruption of somatic and autonomic pathways. Among these impaired control of blood pressure (BP) can significantly impede patients' activities of daily living. The International Standards for the Assessment of Autonomic Function after SCI (ISAFSCI) is used to document the impact of SCI on resting BP (abnormal if below 90 mmHg) and the presence or absence of orthostatic hypotension (OH), defined as a symptomatic or asymptomatic decrease in BP (>/=20/10 mmHg) upon moving to an upright position. Case 1 documents the adverse influence of prescribed medications (antidepressants for neuropathic pain) on OH; case 2 describes the influence of bladder management on cardiovascular instability (autonomic dysreflexia and subsequent OH); case 3 describes the association between spasticity and OH; case 4 describes OH associated with a Valsalva maneuver. Impaired control of BP can stem from a combination of medical issues and autonomic dysfunction in persons with SCI. Management strategies for OH will vary depending on the stage of the SCI, the root cause of the OH and other confounding medical conditions. Non-pharmacological treatment should be considered as a first line of intervention and consideration should be given to cessation of potentially contributory medications prior to implementing pharmaceutical interventions. The systematic use of ISAFSCI by clinicians is recommended to document BP irregularities and to describe the effects of treatment strategies aimed at improving BP control in the SCI population.

Wellness, Perceived Stress, Mattering, and Marital Satisfaction among Medical Residents and Their Spouses: Implications for Education and Counseling

ERIC Educational Resources Information Center

Powers, Anne S.; Myers, Jane E.; Tingle, Lynne R.; Powers, John C.

2004-01-01

Numerous studies document that medical education is demanding and stressful, yet few studies have examined the effects of medical training on spouses and medical marriages. Eighty-three individuals (42 couples) living in medical marriages completed questionnaires measuring marital satisfaction, perceived stress, general mattering, and wellness.…

Notions of HIV and Medication among Multiethnic People Living with HIV.

ERIC Educational Resources Information Center

Oggins, Jean

2003-01-01

Examines why people of ethnic minority groups tend to be less likely to take medication for HIV. Respondents viewed HIV/AIDS and medication in terms of other illnesses and drugs, including colds, cancer, and street drugs. Some also thought antiretroviral medications were toxic. Others thought they should wait to take medication to prevent…

[Generation Y : recruitment, retention and development].

PubMed

Schmidt, C E; Möller, J; Schmidt, K; Gerbershagen, M U; Wappler, F; Limmroth, V; Padosch, S A; Bauer, M

2011-06-01

There is a significant shortage of highly qualified personnel in medicine, especially skilled doctors and nurses. This shortage of qualified labor has led to competition between hospitals. Analyzing the circumstances of the competition, nurses and doctors of the so-called generation Y are of importance. Recruitment and retention of these staff members will become a critical success factor for hospitals in the future. An internet search was conducted using the key words "generation Y and medicine, demography, personnel and hospitals". A search in Medline/pubmed for scientific studies on the topics of labor shortage was performed using the key words "personnel, shortage doctors, generation X, baby boomer, personnel and demographic changes, staff". Finally, sources from public institutions and academic medical societies were analyzed. The data were sorted by main categories and relevance for hospitals. Statistical analysis was done using descriptive measures. The analysis confirmed the heterogeneous and complex flood of information on the topic demography and generation. A comparison of the generations showed that they can be separated into baby boomers (born 1946-1964 live to work), generation X (born 1965-1980 work to live) and generation Y (born 1981 and after, live while working). Members of generation Y "live while working" are oriented to competence and less with hierarchies. They exchange information using modern communication methods and within networks. Internet and computers are part of their daily routine. Employees of generation Y challenge leadership in hospitals by increasing the demands. However, generation Y can significantly increase professionalization and competitiveness for hospitals.

Discharge summary for medically complex infants transitioning to primary care.

PubMed

Peacock, Jennifer J

2014-01-01

Improvements in the care of the premature infant and advancements in technology are increasing life expectancy of infants with medical conditions once considered lethal; these infants are at risk of becoming a medically complex infant. Complex infants have a significant existing problem list, are on several medications, and receive medical care by several specialists. Deficits in communication and information transfer at the time of discharge remain problematic for this population. A questionnaire was developed for primary care providers (PCPs) to explore the effectiveness of the current discharge summary because it is related to effective communication when assuming the care of a new patient with medical complexity. PCPs assuming the care of these infants agree that an evidence-based tool, in the form of a specialized summary for this population, would be of value.

Intracellular processing of poly(ethylene imine)/ribozyme complexes can be observed in living cells by using confocal laser scanning microscopy and inhibitor experiments.

PubMed

Merdan, Thomas; Kunath, Klaus; Fischer, Dagmar; Kopecek, Jindrich; Kissel, Thomas

2002-02-01

Critical steps in the subcellular processing of poly(ethylene imine)/nucleic acid complexes, especially endosomal/lysosomal escape, were visualized by using living cell confocal laser scanning microscopy (CSLM) to obtain an insight into their mechanism. Living cell confocal microscopy was used to examine the intracellular fate of poly(ethylene imine)/ribozyme and poly(L-lysine)/ribozyme complexes over time, in the presence of and without bafilomycin Al, a selective inhibitor of endosomal/lysosomal acidification. The compartment of complex accumulation was identified by confocal microscopy with a fluorescent acidotropic dye. To confirm microscopic data, luciferase reporter gene expression was determined under similar experimental conditions. Poly(ethylene imine)/ribozyme complexes accumulate in acidic vesicles, most probably lysosomes. Release of complexes occurs in a sudden event, very likely due to bursting of these organelles. After release, poly(ethylene imine) and ribozyme spread throughout the cell, during which slight differences in distribution between cytosol and nucleus are visible. No lysosomal escape was observed with poly(L-lysine)/ribozyme complexes or when poly(ethylene imine)/ ribozyme complexes were applied together with bafilomycin A1. Poly(ethylene imine)/plasmid complexes exhibited a high luciferase expression, which was reduced approximately 200-fold when lysosomal acidification was suppressed with bafilomycin A1. Our data provide, for the first time, direct experimental evidence for the escape of poly(ethylene imine)/nucleic acid complexes from the endosomal/lysosomal compartment. CLSM, in conjunction with living cell microscopy, is a promising tool for studying the subcellular fate of polyplexes in nucleic acid/gene delivery.

Design and Evaluation of a Medication Adherence Application with Communication for Seniors in Independent Living Communities.

PubMed

Dasgupta, Dipanwita; Johnson, Reid A; Chaudhry, Beenish; Reeves, Kimberly G; Willaert, Patty; Chawla, Nitesh V

2016-01-01

Medication non-adherence is a pressing concern among seniors, leading to a lower quality of life and higher healthcare costs. While mobile applications provide a viable medium for medication management, their utility can be limited without tackling the specific needs of seniors and facilitating the active involvement of care providers. To address these limitations, we are developing a tablet-based application designed specifically for seniors to track their medications and a web portal for their care providers to track medication adherence. In collaboration with a local Aging in Place program, we conducted a three-month study with sixteen participants from an independent living facility. Our study found that the application helped participants to effectively track their medications and improved their sense of wellbeing. Our findings highlight the importance of catering to the needs of seniors and of involving care providers in this process, with specific recommendations for the development of future medication management applications.

Confrontation of the cybernetic definition of a living individual with the real world.

PubMed

Korzeniewski, Bernard

2005-01-01

The cybernetic definition of a living individual proposed previously (Korzeniewski, 2001) is very abstract and therefore describes the essence of life in a very formal and general way. In the present article this definition is reformulated in order to determine clearly the relation between life in general and a living individual in particular, and it is further explained and defended. Next, the cybernetic definition of a living individual is confronted with the real world. It is demonstrated that numerous restrictions imposed on the cybernetic definition of life by physical reality imply a number of particular properties of life that characterize present life on Earth, namely: (1) a living individual must be a dissipative structure (and therefore a low-entropy thermodynamic system out of the state of equilibrium); (2) spontaneously-originated life must be based on organic compounds; (3) evolutionarily stable self-dependent, free-living individuals must have some minimal level of complexity of structure and function; (4) a living individual must have a record of identity separated from an executive machinery; (5) the identity of living individuals must mutate and may evolve; (6) living individuals may collect and accumulate information in subsequent generations over very long periods of time; (7) the degree of complexity of a living individual reflects the degree of complexity of its environment (ecological niche) and (8) living individuals are capable of supple adaptation to varying environmental conditions. Thus, the cybernetic definition of a living individual, when confronted with the real physical world, generates most of the general properties of the present life on Earth.

Creating Physical 3D Stereolithograph Models of Brain and Skull

PubMed Central

Kelley, Daniel J.; Farhoud, Mohammed; Meyerand, M. Elizabeth; Nelson, David L.; Ramirez, Lincoln F.; Dempsey, Robert J.; Wolf, Alan J.; Alexander, Andrew L.; Davidson, Richard J.

2007-01-01

The human brain and skull are three dimensional (3D) anatomical structures with complex surfaces. However, medical images are often two dimensional (2D) and provide incomplete visualization of structural morphology. To overcome this loss in dimension, we developed and validated a freely available, semi-automated pathway to build 3D virtual reality (VR) and hand-held, stereolithograph models. To evaluate whether surface visualization in 3D was more informative than in 2D, undergraduate students (n = 50) used the Gillespie scale to rate 3D VR and physical models of both a living patient-volunteer's brain and the skull of Phineas Gage, a historically famous railroad worker whose misfortune with a projectile tamping iron provided the first evidence of a structure-function relationship in brain. Using our processing pathway, we successfully fabricated human brain and skull replicas and validated that the stereolithograph model preserved the scale of the VR model. Based on the Gillespie ratings, students indicated that the biological utility and quality of visual information at the surface of VR and stereolithograph models were greater than the 2D images from which they were derived. The method we developed is useful to create VR and stereolithograph 3D models from medical images and can be used to model hard or soft tissue in living or preserved specimens. Compared to 2D images, VR and stereolithograph models provide an extra dimension that enhances both the quality of visual information and utility of surface visualization in neuroscience and medicine. PMID:17971879

“This is Our Last Stop”: Negotiating End of Life Transitions in Assisted Living

PubMed Central

Ball, Mary M.; Kemp, Candace L.; Hollingsworth, Carole; Perkins, Molly M.

2014-01-01

Where people die has important implications for end-of-life (EOL) care. Assisted living (AL) increasingly is becoming a site of EOL care and a place where people die. AL residents are moving in older and sicker and with more complex care needs, yet AL remains largely a non-medical care setting that subscribes to a social rather than medical model of care. The aims of this paper are to add to the limited knowledge of how EOL is perceived, experienced, and managed in AL and to learn how individual, facility, and community factors influence these perceptions and experiences. Using qualitative methods and a grounded theory approach to study eight diverse AL settings, we present a preliminary model for how EOL care transitions are negotiated in AL that depicts the range of multilevel intersecting factors that shape EOL processes and events in AL. Facilities developed what we refer to as an EOL presence, which varied across and within settings depending on multiple influences, including, notably, the dying trajectories and care arrangements of residents at EOL, the prevalence of death and dying in a facility, and the attitudes and responses of individuals and facilities towards EOL processes and events, including how deaths were communicated and formally acknowledged and the impact of death and dying on residents and staff. Our findings indicate that in the majority of cases, EOL care must be supported by collaborative arrangements of care partners and that hospice care is a critical component. PMID:24984903

Asthma disparities in urban environments.

PubMed

Bryant-Stephens, Tyra

2009-06-01

Asthma continues to disproportionately affect minority and low-income groups, with African American and Latino children who live in low-socioeconomic-status urban environments experiencing higher asthma morbidity and mortality than white children. This uneven burden in asthma morbidity has been ever increasing despite medical advancement. Many factors have contributed to these disparities in the areas of health care inequities, which result in inadequate treatment; poor housing, which leads to increased exposure to asthma allergens; and social and psychosocial stressors, which are often unappreciated. Interventions to reduce individual areas of disparities have had varying successes. Because asthma is a complex disease that affects millions of persons, multifaceted comprehensive interventions that combine all evidence-based successful strategies are essential to finally closing the gap in asthma morbidity.

Immobilization of bacterial proteases on water-solved polymer by means of electron beam

NASA Astrophysics Data System (ADS)

Gonchar, A. M.; Auslender, V. L.

1996-12-01

Possibility of electron beam usage for proteases' immobilization on 1,4-polyalkylene oxide (1,4-PAO) was studied to obtain biologically active complex for multi-purpose usage. It is shown that immobilization of Bacillus Subtilis protease takes place due to free-radical linking of enzyme and carrier with formation of mycellium-like structures. Immobilization improves heat resistance of enzyme up to 60°C without substrate and up to 80°C in presence of substrate, widens range of pH activity in comparison with non-immobilized forms. Immobilized proteases do not contain peroxides or long-live radicals. Our results permitted to create technologies for production of medical and veterinary preparations, active components for wool washing agents and leather fabrication technology.

Nemours Foundation

MedlinePlus

... Trials Find a Researcher Collaboration Opportunities View All Research Professional Education Continuing Medical Education Graduate Medical Education Pediatric Residency Pharmacy Residency Psychology Programs Fellowships View All Professional Education Healthy Living ...

Experiences of contemplating returning to work for people living with HIV/AIDS.

PubMed

Nixon, Stephanie; Renwick, Rebecca

2003-11-01

In the mid-1990s, medical advances dramatically altered the experience of living with HIV/AIDS. The shifting medical climate spurred new social and financial questions, such as the possibility of returning to work. In this qualitative study, the authors examine how people living with HIV/AIDS perceive, attach meaning to, and approach the experience of returning to work. Findings demonstrate that the participants are influenced by, and wrestle with, both the dominant societal perspective that "people should return to work," and the oppositional perspective that people living with HIV/AIDS "should not return to work." Theoretical understanding of the results is enhanced using the concepts of the "sick role" and the "hierarchy of identities." Findings have conceptual and methodological implications for literature in HIV/AIDS, return to work, and identity.

Exploring medical student decisions regarding attending live lectures and using recorded lectures.

PubMed

Gupta, Anmol; Saks, Norma Susswein

2013-09-01

Student decisions about lecture attendance are based on anticipated effect on learning. Factors involved in decision-making, the use of recorded lectures and their effect on lecture attendance, all warrant investigation. This study was designed to identify factors in student decisions to attend live lectures, ways in which students use recorded lectures, and if their use affects live lecture attendance. A total of 213 first (M1) and second year (M2) medical students completed a survey about lecture attendance, and rated factors related to decisions to attend live lectures and to utilize recorded lectures. Responses were analyzed overall and by class year and gender. M1 attended a higher percentage of live lectures than M2, while both classes used the same percentage of recorded lectures. Females attended more live lectures, and used a smaller percentage of recorded lectures. The lecturer was a key in attendance decisions. Also considered were the subject and availability of other learning materials. Students use recorded lectures as replacement for live lectures and as supplement to them. Lectures, both live and recorded, are important for student learning. Decisions about lecture placement in the curriculum need to be based on course content and lecturer quality.

Vulnerable populations in healthcare.

PubMed

Waisel, David B

2013-04-01

This review is designed to update readers on recent discussions and research regarding vulnerable populations in medicine, including patients who are socioeconomically disadvantaged, queer, in prison or labeled with a stigmatizing complex medical disease. Recent studies have more closely examined the effects of being part of a vulnerable population. Greater societal income inequality impacts those at the lower end of the income curve by increasing mortality and heightening the importance of individual personal situations. Recommendations from an extensive WHO report on the social determinants of health may affect social policy and use of public resources in Europe. Clinicians are undereducated about the lives and concerns of vulnerable populations, including LGBTQI persons, immigrants, physicians, prisoners, and families of patients with diseases considered 'incompatible with life'. Greater understanding of the cause of the health effects of being socioeconomically disadvantaged or being a member of a vulnerable population may be the first steps toward specific policy recommendations. Professional medical organizations and advocacy groups should raise awareness, provide education, publish guidelines and define the goals for the medical care for certain vulnerable populations.Vulnerable populations are at risk for disparate healthcare access and outcomes because of economic, cultural, ethnic or health characteristics. Vulnerable populations include patients who are racial or ethnic minorities, children, elderly, socioeconomically disadvantaged, underinsured or those with certain medical conditions. Members of vulnerable populations often have health conditions that are exacerbated by unnecessarily inadequate healthcare.

Towards a new system of health: the challenge of Western disease.

PubMed

Temple, N J; Burkitt, D P

1993-02-01

Over the last three decades, the concept of Western disease has become well established. Medicine has approached this group of diseases by searching for new cures but has achieved relatively little success. We argue that medicine should now accept the failure of this strategy and place a major emphasis on prevention. The key objective is to change the climate of opinion so that prevention is taken seriously by the general population. The chief activity should be a wide ranging public education campaign so as to persuade people to live a healthier lifestyle. Medicine will require restructuring in order to carry out this work. Medical education needs to be reformed so that medical students receive the necessary training. This must be done as part of an integrated approach in which government, industry and medical research all play a major role. Governments should use taxation and subsidies in areas such as food and tobacco so as to shift consumption patterns towards healthier products. Governments must also tighten laws on tobacco sales and advertising, support health education, and improve food labelling. Industry must be made far more responsive to the health needs of the population. This should be done both by public education, so as to alter demand, and by government action. Medical research should change its emphasis from studying the detailed mechanisms of disease ("complex research") to studying the role of lifestyle factors ("simple research").

A practical approach to ichthyoses with systemic manifestations.

PubMed

Saral, S; Vural, A; Wollenberg, A; Ruzicka, T

2017-06-01

Inherited ichthyoses are rare disorders in terms of patient numbers, but abundant in terms of clinical-genetic subtypes. These disorders are often associated with severe systemic manifestations, in addition to significant medical, cosmetic and social problems. There are 17 subtypes of syndromic ichthyosis identified so far and most patients with these syndromes are living in countries with high consanguinity rates. Frequently, clinicians cannot make a definitive diagnosis and patients are not managed properly owing to the rarity and complexity of these disorders. These difficulties make this group of ichthyosis and the patients living with them 'orphan'. After skin and skin appendages, nervous system is the most frequently involved system in ichthyosis syndromes. Thus, association of ichthyosis with neurological symptoms provides an important clue for diagnosis. In this article, we aim to increase clinicians' comprehension of ichthyosis syndromes by providing a symptomatology-based approach based on this observation. Additionally, we provide a review of ichthyosis syndromes, with special emphasis on neurological symptoms, hoping to attract interest to this complicated field. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Street music or the blues? The lived experience and social environment of depression.

PubMed

Poslusny, S M

2000-01-01

Life's complexity is a haunting melody of continuously interacting variables .... Professional practice in nursing seeks to promote symphonic interaction between man [sic] and environment. . . (Rogers, 1970, pp. 41, 122). The purpose of this phenomenological study was to explore the lived experience of clinical depression for women in the context of their social relations and environment. Twelve ethnically diverse female friend dyads were interviewed and completed the Beck Depression Inventory (BDI). Seventeen of these women had experienced a major depression in the past or were in treatment for clinical depression at the time of the study. This depression was characterized by dissonance experienced in childhood abuse and incest, uncontrollable moods despite self-medication, abusive or negligent therapy, failed social relationships in adulthood, and a lack of resources in the environment. In contrast, seven healthy women described their social environment as generally resonant and connected. Prevention of childhood abuse and racism, relief from economic hardships, early diagnosis, and safe, effective treatment are essential in helping women to survive clinical depression. Nurses in the community are in a unique position to affect this public health problem.

Second-Year Pharmacy Students’ Perceptions of Adhering to a Complex Simulated Medication Regimen

PubMed Central

Hamer, David; Lehotsky, Kristin

2012-01-01

Objective. To conduct a simulated medication regimen with second-year pharmacy students to determine their anticipated versus actual difficulty in adhering to it. Methods. Second-year pharmacy students were given 6 fictitious medications (jellybeans) and a drug regimen to adhere to for 6 days. Pre- and post-intervention surveys were conducted to compare participants anticipated vs. actual difficulty with adherence and changes in empathy toward patients. Results. The 69 (96%) students who participated in the study missed on average 16% of all simulated medication doses and noted that adhering to the complex medication regimen was more difficult than they had anticipated. Eighty-nine percent of students agreed or strongly agreed the project was valuable in developing empathy towards patients taking complex medication regimens. Conclusions. Pharmacy students participating in a simulated medication regimen missed a notable number of doses and reported a greater level of empathy for patients taking complex medication regiments. Finding meaningful ways to integrate adherence into the curriculum is essential. PMID:22412210

Redefining medicine from an anticipatory perspective.

PubMed

Nadin, Mihai

2018-04-13

The meaning of the concept of anticipation escapes the majority of those concerned with change, in particular those who study health. To characterize only genetic disorders, such as conditions with progressively earlier symptoms and higher intensity of disease from generation to generation, in terms of anticipatory expression is rather limited and limiting. Practitioners of medical care could benefit from understanding anticipation as definitory of the living. This view explains why diminished anticipatory expression, in all forms of the living, results in conditions calling for medical attention. So far, medicine has opted for a deterministic-reductionist perspective that reduces the living to a machine. Medical care, stuck in the grey zone between success and failure, should overcome its reactive obsession. From an almost exclusively mechanistic activity, it should evolve into a holistic proactive practice of well-being that reflects awareness of anticipation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Tuberculosis Treatment Completion Rates in Southern New Mexico Colonias.

PubMed

Holden, Maria Arroyo; Huttlinger, Kathleen; Schultz, Pamela; Mullins, Iris; Forster-Cox, Sue

2016-04-01

TB medication completion treatment rates for active TB patients living in impoverished US-Mexico border communities called colonias in southern New Mexico counties are unknown. It might be suspected that residents of colonias have lower completion rates than those living in incorporated and medically more accessible areas. A retrospective record review of closed TB case records from 1993 to 2010 of southern New Mexico border counties, was conducted using a modified version of the New Mexico Department of Health Tuberculosis Targeted Health Assessment/History form (Appendix 1). Study findings reveal that despite their unincorporated status, poorer living conditions and questionable legal status, colonia TB patients had a higher medication completion rate than their non-colonia counterparts. A robust New Mexico TB treatment program contributed to high completion rates with death being the number-one reason for treatment non-completion in both colonia and non-colonias.

Xerostomia and medication: a cross-sectional study in long-term geriatric wards.

PubMed

Desoutter, A; Soudain-Pineau, M; Munsch, F; Mauprivez, C; Dufour, T; Coeuriot, J-L

2012-01-01

The purpose of this study was to determine the prevalence of xerostomia in old people living in long-term geriatric wards, and to measure the relationship between xerostomia and etiologic factors such as age and medication (total number of medications, xerogenic medications, anticholinergic medications and medications that induce hypersialorrhea). An observational retrospective, comparative, multicentre epidemiological study. Long-term geriatric wards, in Reims, France. 769 old people living in long-term geriatric wards. Prevalence of xerostomia assessed from age, total number of medications, xerogenic medications, anticholinergic medications and those that induce hypersialorrhea. Multivariable logistic regression was used to calculate Odds Ratios (OR) and their 95% Confidence Intervals (95% CI). Among 769 old people (average age 84.6±8.4 years old), 287 residents suffered from xerostomia (37.3%). Significant predictors of xerostomia were: resident's age OR=1.56, 95% CI (1.30-1.88), p<0.0001 and anticholinergic medications OR=1.35, 95% CI (1.05-1.73), p=0.02. The only protective factor against xerostomia identified was medications that induce hypersialorrhea OR=0.81, 95% CI (0.67-0.98), p=0.03. The total number of medications and xerogenic medications did not play a significant role in xerostomia. Increasing Age and anticholinergic medications induce a dry mouth. Conversely, the total number of medications and xerogenic medications do not influence xerostomia. Medications that induce hypersialorrhea protect against the occurrence of dry mouth.

Establishing Relationships and Navigating Boundaries When Caring for Children With Medical Complexity at Home.

PubMed

Nageswaran, Savithri; Golden, Shannon L

Children with medical complexity receive care from many healthcare providers including home healthcare nurses. The objective of our study, based on a conceptual framework, was to describe the relationships between parents/caregivers of children with medical complexity and home healthcare nurses caring for these children. We collected qualitative data in 20 semistructured in-depth interviews (15 English, 5 Spanish) with 26 primary caregivers of children with medical complexity, and 4 focus groups of 18 home healthcare nurses inquiring about their experiences about home healthcare nursing services for children with medical complexity. During an iterative analysis process, we identified recurrent themes related to caregiver-nurse relationships. Our study showed that: (1) caregiver-nurse relationships evolved over time and were determined by multiple factors; (2) communication and trust were essential to the establishment of caregiver-nurse relationships; (3) both caregivers and nurses described difficulties of navigating physical, professional, personal, and emotional boundaries, and identified strategies to maintain these boundaries; and (4) good caregiver-nurse relationships helped in the care of children with medical complexity, reduced caregiver burden, resulted in less stress for nurses, and was a factor in nurse retention. We conclude that trusted relationships between caregivers and nurses are important to the home care of children with medical complexity. Interventions to develop and maintain good caregiver-nurse relationships are necessary.

Treatment acceptance and adherence in HIV disease: patient identity and the perceived impact of physician–patient communication

PubMed Central

Laws, M Barton; Rose, Gary S; Bezreh, Tanya; Beach, Mary Catherine; Taubin, Tatiana; Kogelman, Laura; Gethers, Marcia; Wilson, Ira B

2012-01-01

Studies have found that physician–patient relationships and communication quality are related to medication adherence and outcomes in HIV care. Few qualitative studies exist of how people living with HIV experience clinical communication about their self-care behavior. Eight focus groups with people living with HIV in two US cities were conducted. Participants responded to a detailed discussion guide and to reenactments of actual physician–patient dialogue about antiretroviral adherence. The 82 participants were diverse in age, sex, and ethnicity. Most had been living with HIV for many years and had stable relationships with providers. They appreciated providers who knew and cared about their personal lives, who were clear and direct about instructions, and who were accessible. Most had struggled to overcome addiction, emotional turmoil, and/or denial before gaining control over their lives and becoming adherent to medications. They made little or no causal attribution for their transformation to any outside agency, including their providers. They generally saw medication adherence as a function of autonomous motivation. Successful coping with HIV with its prevalent behavioral comorbidities, stigma, and other challenges requires a transformation of identity and internalization of motivation to maintain health. Effective methods for clinicians to support such development are needed. PMID:23271898

The limits of narrative: provocations for the medical humanities.

PubMed

Woods, Angela

2011-12-01

This paper aims to (re)ignite debate about the role of narrative in the medical humanities. It begins with a critical review of the ways in which narrative has been mobilised by humanities and social science scholars to understand the experience of health and illness. I highlight seven dangers or blind spots in the dominant medical humanities approach to narrative, including the frequently unexamined assumption that all human beings are 'naturally narrative'. I then explore this assumption further through an analysis of philosopher Galen Strawson's influential article 'Against Narrativity'. Strawson rejects the descriptive claim that "human beings typically see or live or experience their lives as a narrative" and the normative claim that "a richly Narrative outlook is essential to a well-lived life, to true or full personhood". His work has been taken up across a range of disciplines, but its implications in the context of health and illness have not yet been sufficiently discussed. This article argues that 'Against Narrativity' can and should stimulate robust debate within the medical humanities regarding the limits of narrative, and concludes by discussing a range of possibilities for venturing 'beyond narrative'.

Doxorubicin Lipid Complex Injection

MedlinePlus

... has not improved or that has worsened after treatment with other medications. Doxorubicin lipid complex is also ... has not improved or that has worsened after treatment with other medications. Doxorubicin lipid complex is also ...

Perspective: Does medical education promote professional alexithymia? A call for attending to the emotions of patients and self in medical training.

PubMed

Shapiro, Johanna

2011-03-01

Emotions--one's own and others'--play a large role in the lives of medical students. Students must deal with their emotional reactions to intellectual and physical stress, the demanding clinical situations to which they are witness, as well as patients' and patients' family members' often intense feelings. Yet, currently few components in formal medical training--in either direct curricular instruction or physician role modeling--focus on the emotional lives of students. In this article, the author examines patients', medical students', and physician role models' emotions in the clinical context, highlighting challenges in all three of these arenas. Next, the author asserts that the preponderance of medical education continues to address the emotional realm through ignoring, detaching from, and distancing from emotions. Finally, she presents not only possible theoretical and conceptual models for developing ways of understanding, attending to, and ultimately "working with" emotions in medical education but also examples of innovative curricular efforts to incorporate emotional awareness into medical student training. The author concludes with the hope that medical educators will consider making a concerted effort to acknowledge emotions and their importance in medicine and medical training.

Music and Health. Phenomenological Investigation of a Medical Humanity

ERIC Educational Resources Information Center

McLellan, Lucy; McLachlan, Emma; Perkins, Laurence; Dornan, Tim

2013-01-01

In response to the tendency for music to be under-represented in the discourse of medical humanities, we framed the question "how can music heal?" We answered it by exploring the lived experiences of musicians with lay or professional interests in health. Two medical students and a medically qualified educationalist, all musicians, conducted a…

Reflecting on complexity of biological systems: Kant and beyond?

PubMed

Van de Vijver, Gertrudis; Van Speybroeck, Linda; Vandevyvere, Windy

2003-01-01

Living organisms are currently most often seen as complex dynamical systems that develop and evolve in relation to complex environments. Reflections on the meaning of the complex dynamical nature of living systems show an overwhelming multiplicity in approaches, descriptions, definitions and methodologies. Instead of sustaining an epistemic pluralism, which often functions as a philosophical armistice in which tolerance and so-called neutrality discharge proponents of the burden to clarify the sources and conditions of agreement and disagreement, this paper aims at analysing: (i) what has been Kant's original conceptualisation of living organisms as natural purposes; (ii) how the current perspectives are to be related to Kant's viewpoint; (iii) what are the main trends in current complexity thinking. One of the basic ideas is that the attention for structure and its epistemological consequences witness to a great extent of Kant's viewpoint, and that the idea of organisational stratification today constitutes a different breeding ground within which complexity issues are raised. The various approaches of complexity in biological systems are captured in terms of two different styles, universalism and (weak and strong) constructivism, between which hybrid forms exist.

Genetics Home Reference: familial idiopathic basal ganglia calcification

MedlinePlus

... Children Living with Inherited Metabolic Diseases Dystonia Medical Research Foundation Family Caregiver Alliance National Ataxia Foundation National Organization for Rare Disorders (NORD) University of Kansas Medical ...

Orai1 as New Therapeutic Target for Inhibiting Breast Tumor Metastasis

DTIC Science & Technology

2009-09-01

includes focal adhesion assembly (formation of focal complex) and focal adhesion disassembly, we used live - cell imaging to quantify the rates of assembly...A and B) Live cell imaging of paxillin-GFP transfected MEF cells in the absence (A) or presence (B) of SKF96365. Scale bar: 10 µm. (C and D...includes focal adhesion assembly (formation of focal complexes) and focal adhesion disassembly, we used live - cell imaging to quantify the rates of focal

Symptoms and Quality of Life for People Living with HIV Infection in Puerto Rico

PubMed Central

Rivero-Mendez, Marta; Portillo, Carmen; Solis-Baez, Solymar S.; Wantland, Dean; Holzemer, William L.

2009-01-01

Background People living with HIV infection are confronted with physical and psychological symptoms that impact their quality of life. This study explored the symptom experience of people living with HIV infection in Puerto Rico and its correlation with quality of life. Methods A cross-sectional descriptive design was used to survey 44 men, women, and transgender people living with HIV infection. Measures included a demographic questionnaire, sign and symptom checklist, and a quality of life instrument. Results The sample was 50% male with a mean age of 42.1 years; the participants had been living with HIV infection on average for 9.8 years. The top five symptoms reported by the sample included: muscle aches (81.8%), depression (77.2%), weakness (70.5%), fear/worries (70.5), and difficulty with concentration (65.9%). Symptom frequency was significantly related to four dimensions of quality of life: overall function (r=−0.58), life satisfaction (r=−0.59), health worries (r=0.32) and HIV medication worries (r=0.59). The symptom experience was not related to financial worries, disclosure worries, or sexual functioning. Individuals who reported taking HIV medications reported significantly fewer symptoms than those not taking HIV medications (t=3.061, df=42, p<0.01). Conclusions These results suggest that people living with HIV infection in Puerto Rico experience a wide array of physical and psychological symptoms and that these symptoms have a correlation with their perceived quality of life. Better management of symptoms may have an impact on perceived quality of life for people living with HIV infection. PMID:19266741

From early detection to rehabilitation in the community: reading beyond the blog testimonies of survivors' quality of life and prostate cancer representation.

PubMed

Zanchetta, Margareth Santos; Cognet, Marguerite; Lam-Kin-Teng, Mary Rachel; Dumitriu, Marie Elisabeth; Renaud, Lise; Rhéaume, Jacques

2016-12-16

Survivors' testimonies can reveal much about men's experiences of prostate cancer and impacts on their quality of life (QOL) during the clinical trajectory of the disease. These survivors' shared thoughts and views were hypothesized to reflect salient features of their lived social representation of prostate cancer. We explored the content of testimonies posted by men to a public blog hosted by a French national prostate cancer patients' association. The study question, "What do French bloggers' testimonies reveal about their lived experiences with prostate cancer, especially regarding their quality of life in community settings, that underpin their social representation of prostate cancer?" guided the exploration and analysis of the textual data. The aims were to better understand men's experiences and predominant thoughts and views, to elucidate patients' behaviours, and to enlighten medical policy and practice. Explore issues of QOL as reported by French prostate cancer survivors in a public blog by: (a) identifying the salient aspects and issues of the experience of living with prostate cancer from the perspective of survivors; and (b) analyzing the content in the posted testimonies regarding perceived and lived impacts of prostate cancer on QOL. A critical ethnographic study guided the selection of textual data from 196 male bloggers' testimonies about prostate cancer posted in the period from 2008 to 2013. Media content analysis method was undertaken on blog testimonies, framed by a multidimensional conceptual framework of QOL. Testimonies focused mainly on medical care and rehabilitation, recovery, health education and self-care, as well as on a global vision of prostate cancer and its impacts on personal views of manhood and masculinity. The language used indicated that political, educative and compassionate discourses were intertwined to create a complex representation of the experience and effects of prostate cancer; this multi-faceted representation can inform the public and professional debate about men's capacity to provide emotional support and problem-solve within a community of interest. Findings, while based on data limited to mostly one-time entries to a French blog, contribute to understanding a unique, collective expression of men's lived experiences of prostate cancer. These anonymous survivors shared their varied reactions, ways of coping, and thoughts on needed change.

Modeling travel impedance to medical care for children with birth defects using Geographic Information Systems.

PubMed

Delmelle, Eric M; Cassell, Cynthia H; Dony, Coline; Radcliff, Elizabeth; Tanner, Jean Paul; Siffel, Csaba; Kirby, Russell S

2013-10-01

Children with birth defects may face significant geographic barriers accessing medical care and specialized services. Using a Geographic Information Systems-based approach, one-way travel time and distance to access medical care for children born with spina bifida was estimated. Using 2007 road information from the Florida Department of Transportation, we built a topological network of Florida roads. Live-born Florida infants with spina bifida during 1998 to 2007 were identified by the Florida Birth Defects Registry and linked to hospital discharge records. Maternal residence at delivery and hospitalization locations were identified during the first year of life. Of 668 infants with spina bifida, 8.1% (n = 54) could not be linked to inpatient data, resulting in 614 infants. Of those 614 infants, 99.7% (n = 612) of the maternal residential addresses at delivery were successfully geocoded. Infants with spina bifida living in rural areas in Florida experienced travel times almost twice as high compared with those living in urban areas. When aggregated at county levels, one-way network travel times exhibited statistically significant spatial autocorrelation, indicating that families living in some clusters of counties experienced substantially greater travel times compared with families living in other areas of Florida. This analysis demonstrates the usefulness of linking birth defects registry and hospital discharge data to examine geographic differences in access to medical care. Geographic Information Systems methods are important in evaluating accessibility and geographic barriers to care and could be used among children with special health care needs, including children with birth defects. Copyright © 2013 Wiley Periodicals, Inc.

Improving the Quality of Home Health Care for Children With Medical Complexity.

PubMed

Nageswaran, Savithri; Golden, Shannon L

2017-08-01

The objectives of this study are to describe the quality of home health care services for children with medical complexity, identify barriers to delivering optimal home health care, and discuss potential solutions to improve home health care delivery. In this qualitative study, we conducted 20 semistructured in-depth interviews with primary caregivers of children with medical complexity, and 4 focus groups with 18 home health nurses. During an iterative analysis process, we identified themes related to quality of home health care. There is substantial variability between home health nurses in the delivery of home health care to children. Lack of skills in nurses is common and has serious negative health consequences for children with medical complexity, including hospitalizations, emergency room visits, and need for medical procedures. Inadequate home health care also contributes to caregiver burden. A major barrier to delivering optimal home health care is the lack of training of home health nurses in pediatric care and technology use. Potential solutions for improving care include home health agencies training nurses in the care of children with medical complexity, support for nurses in clinical problem solving, and reimbursement for training nurses in pediatric home care. Caregiver-level interventions includes preparation of caregivers about: providing medical care for their children at home and addressing problems with home health care services. There are problems in the quality of home health care delivered to children with medical complexity. Training nurses in the care of children with medical complexity and preparing caregivers about home care could improve home health care quality. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

38 CFR 3.328 - lndependent medical opinions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Connection § 3.328 lndependent medical opinions. (a) General. When warranted by the medical complexity or... of such obscurity or complexity, or has generated such controversy in the medical community at large... would be harmful to the physical or mental health of the claimant, disclosure shall be subject to the...

Women Living Together Have a Higher Frequency of Menstrual Migraine.

PubMed

Ferreira, Karen S; Guilherme, Gisela; Faria, Viviane R; Borges, Larissa M; Uchiyama, Angel A T

2017-01-01

Menstrual migraine is a highly prevalent disorder among adult women, resulting in disability and loss of quality of life. Some studies have reported menstrual cycle synchrony among women living together. No study has reported whether there may also be a higher prevalence of menstrual migraine among these women. Thus, they reported here the prevalence of menstrual migraine in a group of women living together compared with a control group of women living alone, and discussed the possible factors involved. The study was conducted on female university students aged 18-30 years with a diagnosis of migraine according to the criteria of the International Classification of Headache Disorders III, beta appendix criteria. The subjects were divided into a group of women who lived together with two or more other students and a control group of age-matched students who lived alone, interviewed with a specific questionnaire and assessed for 3 months by means of a paper pain diary. The data evaluated included frequency of headache, presence of menstrual migraine, intensity of headache, medications used including contraceptives, and triggering factors such as diet, sleep deprivation, and stress. The menstrual data and data related to migraine were also investigated in the roommates. A higher occurrence of menstrual migraine among women living together (9, 50%) compared with women living alone (3, 16.7%) (P = .03) was detected. After binary logistic regression analysis, this finding was not related to the main influencing factors detected, that is, use of a contraceptive, test stress, or sleep deprivation (P = .03, adjusted odds ratio: 7.87; 1.23-50.36). These women also showed menstrual cycle synchrony with their roommates (8, 44.4%) and the presence of headache crises during the menstruation of their colleagues (11, 61.1%). The present study detected a higher occurrence of menstrual migraine among women who lived together. Since there was no previous description of this topic in the literature, it was believed that the present study could represent a step toward more elaborate investigations of this complex topic. © 2016 American Headache Society.

The role of a therapeutic team and The Pol-Ilko Association in readaptation of patients with a stoma to the life in a family and society in the 21st century.

PubMed

Snarska, J; Lapuc, K; Puchalski, Z; Hend, M

2005-01-01

Patients who crossed operation where exteriorization stoma was integral her part the aside from of cause, location and far-gone of illness which hereinto brought require special care. In moment of entry we to European Union should advert on introduction by us the surgeons of new operating techniques not only, but to attach importance to quality of sick's life after operations also, particularly these which violate beauty of our body. They are of the patients' groups the nation from stoma, particularly if cause the exteriorization stoma the state the neoplasmic disease of alimentary canal or arrangement urinary. The stay in Clinic whether the surgical squad, perspective of operation which is final effect producing artificial accompanying urinary content tract intestinal or fecal it joins with high-level of phobia. The Information Bureau for Stoma in year 1993 at Medical University was created and on the basis of this the information bureau the therapeutic complex worked out own model of these patients' care over group. The model of care over sick from stomy hugs three periods: preoperative, early and late surgical period (ambulant). On the basis of The Information Bureau from Stoma in 1994 year The Department was created of Podlasie the Society of Care over Patients from Stoma in Bialystok--association of working on thing sick's good. Organization this assembles from stomy the men, their family and guardians, workers of medical service and different men of good will. Meetings are forms of working, which performance of bothering patient's problems connected with nurturing and supply stomy is aim, and also psychical and help support in readaptation to life in family, company and society. The volunteers' training is to help different form of working this sick's group. Volunteer in this case--then living from stomy over year happily, adopted to life in every respect, person which exemplifies for sick prepared to operation positive (exteriorization stoma) or beginning one's "path stoma". Both the analysis and opinion of work of therapeutic complex, as and the workings The Association be made by only patients, their family and guardians, and also the workers of medical service. The elaborate model of care over sick from stoma on the basis of Information Bureau is accepted universally and resoluteness improves quality of life of this patients' group. Patient in XXI age from stomia on Podlasie it can appropriately living in family, work professionally, grow sport and hobby not only thanks to work therapeutic complex, but also and men who earlier found oneself in similar situation, as he alone.

Medication regimen complexity in ambulatory older adults with heart failure.

PubMed

Cobretti, Michael R; Page, Robert L; Linnebur, Sunny A; Deininger, Kimberly M; Ambardekar, Amrut V; Lindenfeld, JoAnn; Aquilante, Christina L

2017-01-01

Heart failure prevalence is increasing in older adults, and polypharmacy is a major problem in this population. We compared medication regimen complexity using the validated patient-level Medication Regimen Complexity Index (pMRCI) tool in "young-old" (60-74 years) versus "old-old" (75-89 years) patients with heart failure. We also compared pMRCI between patients with ischemic cardiomyopathy (ISCM) versus nonischemic cardiomyopathy (NISCM). Medication lists were retrospectively abstracted from the electronic medical records of ambulatory patients aged 60-89 years with heart failure. Medications were categorized into three types - heart failure prescription medications, other prescription medications, and over-the-counter (OTC) medications - and scored using the pMRCI tool. The study evaluated 145 patients (n=80 young-old, n=65 old-old, n=85 ISCM, n=60 NISCM, mean age 73±7 years, 64% men, 81% Caucasian). Mean total pMRCI scores (32.1±14.4, range 3-84) and total medication counts (13.3±4.8, range 2-30) were high for the entire cohort, of which 72% of patients were taking eleven or more total medications. Total and subtype pMRCI scores and medication counts did not differ significantly between the young-old and old-old groups, with the exception of OTC medication pMRCI score (6.2±4 young-old versus 7.8±5.8 old-old, P =0.04). With regard to heart failure etiology, total pMRCI scores and medication counts were significantly higher in patients with ISCM versus NISCM (pMRCI score 34.5±15.2 versus 28.8±12.7, P =0.009; medication count 14.1±4.9 versus 12.2±4.5, P =0.008), which was largely driven by other prescription medications. Medication regimen complexity is high in older adults with heart failure, and differs based on heart failure etiology. Additional work is needed to address polypharmacy and to determine if medication regimen complexity influences adherence and clinical outcomes in this population.

Influenza Vaccine, Live Intranasal

MedlinePlus

... have gotten any other vaccines in the past 4 weeks. Live vaccines given too close together might not work as well. have taken influenza antiviral medication in the past 48 hours. have a very stuffy nose.

Parkinson's Disease: Diagnosis and Treatment

MedlinePlus

... of this page please turn JavaScript on. Feature: Parkinson's Disease Parkinson's Disease: Diagnosis and Treatment Past Issues / Winter 2014 Table of Contents Medications for Parkinson's disease can help many patients live productive lives and ...

42 CFR 482.90 - Condition of participation: Patient and living donor selection.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION... principles of medical ethics. Transplant centers must: (1) Ensure that a prospective living donor receives a...

42 CFR 482.90 - Condition of participation: Patient and living donor selection.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION... principles of medical ethics. Transplant centers must: (1) Ensure that a prospective living donor receives a...

Contraceptive options for women living with HIV.

PubMed

Phillips, Sharon; Steyn, Petrus; Temmerman, Marleen

2014-08-01

Women living with HIV are often of reproductive age, and many desire effective contraceptive options to delay or prevent pregnancy. We review the safety of various hormonal and non-hormonal contraceptive methods for women living with human immunodeficiency virus (HIV). Additionally, we discuss drug interactions between contraceptive methods and antiretrovirals and the safety of methods with respect to onward transmission to HIV-negative partners for women in sero-discordant partnerships. In general, most methods are safe for most women living with HIV. An understanding of the reproductive goals of each individual patient, as well as her medical condition and medication, should be taken into account when counselling women on their contraceptive options. Further research is needed to understand drug interactions between contraceptives and antiretrovirals better and how to fulfil the contraceptive needs of HIV-positive women. Copyright © 2014. Published by Elsevier Ltd.

The Effect of Live Classical Piano Music on the Vital Signs of Patients Undergoing Ophthalmic Surgery

PubMed Central

Camara, Jorge G.; Ruszkowski, Joseph M.; Worak, Sandra R.

2008-01-01

Context Music and surgery. Objective To determine the effect of live classical piano music on vital signs of patients undergoing ophthalmic surgery. Design Retrospective case series. Setting and Patients 203 patients who underwent various ophthalmologic procedures in a period during which a piano was present in the operating room of St. Francis Medical Center. [Note: St. Francis Medical Center has recently been renamed Hawaii Medical Center East.] Intervention Demographic data, surgical procedures, and the vital signs of 203 patients who underwent ophthalmic procedures were obtained from patient records. Blood pressure, heart rate, and respiratory rate measured in the preoperative holding area were compared with the same parameters taken in the operating room, with and without exposure to live piano music. A paired t-test was used for statistical analysis. Main outcome measure Mean arterial pressure, heart rate, and respiratory rate. Results 115 patients who were exposed to live piano music showed a statistically significant decrease in mean arterial blood pressure, heart rate, and respiratory rate in the operating room compared with their vital signs measured in the preoperative holding area (P < .0001). The control group of 88 patients not exposed to live piano music showed a statistically significant increase in mean arterial blood pressure (P < .0002) and heart rate and respiratory rate (P < .0001). Conclusion Live classical piano music lowered the blood pressure, heart rate, and respiratory rate in patients undergoing ophthalmic surgery. PMID:18679538

Education Experiences and Training for People Living with HIV

ERIC Educational Resources Information Center

Coleman, Gary

2017-01-01

Prior to the development of new medications, the effects of the HIV/AIDS epidemic have taken many lives. Despite the introduction of protocols that can prolong and stabilize their lives, many patients do not conform to treatment requirements due to a lack of health literacy. This three-article dissertation examined relevant literature in Article…

Infected Lives: Lived Experiences of Young African American HIV-Positive Women.

PubMed

Peltzer, Jill N; Domian, Elaine W; Teel, Cynthia S

2016-02-01

This hermeneutic phenomenological study explored the lived experiences of young African American HIV-infected women. Eleven women between the ages of 21 and 35 participated. One pattern, Infected Lives, and three themes--Living Alone With HIV, Living With Unresolved Conflicts, and Living With Multiple Layers of Betrayal--emerged. The pattern and themes portray the very complex and challenging experiences faced by these young women living with HIV infection. They have experienced isolation, abandonment, betrayal, and discrimination in their interpersonal and social systems. They often dealt with conflicts of hope and anguish in the relationships with their children, and portraying strength, while feeling fragile. These complexities negatively influence the ability to fully engage in self-care activities. Implications for future research include further investigation about the experiences of psychological distress experienced post-diagnosis, development and evaluation of holistic nursing interventions, and evaluative research on mass media educational campaigns to reduce HIV-related stigma. © The Author(s) 2014.

Medical mistrust, perceived discrimination, and satisfaction with health care among young-adult rural latinos.

PubMed

López-Cevallos, Daniel F; Harvey, S Marie; Warren, Jocelyn T

2014-01-01

Little research has analyzed mistrust and discrimination influencing receipt of health care services among Latinos, particularly those living in rural areas. This study examined the associations between medical mistrust, perceived discrimination, and satisfaction with health care among young-adult rural Latinos. This cross-sectional study analyzed data from 387 young-adult Latinos (ages 18-25) living in rural Oregon. The Behavioral Model of Vulnerable Populations was utilized as the theoretical framework. Correlations were run to assess bivariate associations among variables included in the study. Ordered logistic regression models evaluated the associations between medical mistrust, perceived discrimination, and satisfaction with health care. On average, participants used health services 4 times in the past year. Almost half of the participants had health insurance (46%). The majority reported that they were moderately (32%) or very satisfied (41%) with health care services used in the previous year. In multivariable models, medical mistrust and perceived discrimination were significantly associated with satisfaction with health care. Medical mistrust and perceived discrimination were significant contributors to lower satisfaction with health care among young-adult Latinos living in rural Oregon. Health care reform implementation, currently under way, provides a unique opportunity for developing evaluation systems and interventions toward monitoring and reducing rural Latino health care disparities. © 2014 National Rural Health Association.

Visual analytics in medical education: impacting analytical reasoning and decision making for quality improvement.

PubMed

Vaitsis, Christos; Nilsson, Gunnar; Zary, Nabil

2015-01-01

The medical curriculum is the main tool representing the entire undergraduate medical education. Due to its complexity and multilayered structure it is of limited use to teachers in medical education for quality improvement purposes. In this study we evaluated three visualizations of curriculum data from a pilot course, using teachers from an undergraduate medical program and applying visual analytics methods. We found that visual analytics can be used to positively impacting analytical reasoning and decision making in medical education through the realization of variables capable to enhance human perception and cognition on complex curriculum data. The positive results derived from our evaluation of a medical curriculum and in a small scale, signify the need to expand this method to an entire medical curriculum. As our approach sustains low levels of complexity it opens a new promising direction in medical education informatics research.

Medical Issues: Equipment

MedlinePlus

... support & care > living with sma > medical issues > equipment Equipment Individuals with SMA often require a range of ... you can submit an equipment pool request. Helpful Equipment The following is a list of equipment that ...

"You think it's hard now … It gets much harder for our children": Youth with autism and their caregiver's perspectives of health care transition services.

PubMed

Cheak-Zamora, Nancy C; Teti, Michelle

2015-11-01

Adolescents with Autism Spectrum Disorder diagnosis often have complex comorbid physical and mental health conditions. These youth rely heavily on their medical providers and struggle through the often rocky transition out of pediatric care into adulthood and adult-centered care. This study is among the first to qualitatively examine the health care transition experiences of youth with Autism Spectrum Disorder and their caregivers. We conducted four focus groups with youth with Autism Spectrum Disorder (n = 13) and their caregivers (n = 19) and used thematic analysis strategies to identify key themes. Parents' discussions emphasized (a) loss of relationship with provider and lack of support transitioning from pediatric to adult care, (b) providers' lack of knowledge about Autism Spectrum Disorder, and (c) concerns about losing guardianship. Youth emphasized their confusion and anxiety around (a) medical providers' role, especially in the transition to adulthood; and (b) managing their medical lives independently. Our findings are important because they not only improve our understanding of health care transition needs among youth with Autism Spectrum Disorder and their caregivers but demonstrate a sound methodological procedure to facilitate input from youth with Autism Spectrum Disorder. © The Author(s) 2014.

Outcomes of an Interdisciplinary Transitional Care Quality Improvement Project on Self-Management and Health Care Use in Patients With Heart Failure.

PubMed

Hoover, Carrie; Plamann, Joy; Beckel, Jean

2017-01-01

Heart failure (HF) accounts for most U.S. Medicare hospital admissions. The purpose of the current study was to evaluate the effectiveness of a care transitions quality improvement (QI) intervention on self-management and readmission rates in older adults with HF. A quasi-experimental, descriptive study was conducted with 66 patients with HF in three medical units in a 489-bed Midwestern acute care hospital. The intervention included a nurse coach visit and follow up, pharmacy medication education and reconciliation, and HF clinic referral. Outcomes were assessed within 48 hours of admission and 30 days after discharge using the Self-Care of Heart Failure Index and medical record review. Following implementation, readmission rates decreased from 24% to 13%. Participants demonstrated a greater improvement in use of self-management strategies to control symptoms than the non-intervention group (p < 0.02) and more readily identified their symptoms of HF (p < 0.04). The evolution of population health, with increasing numbers of older adults living at home with complex chronic conditions, will require establishment of active partnerships among pharmacists, physicians, nurse specialists, home care nurses, and patients. [Journal of Gerontological Nursing, 43(1), 23-31.]. Copyright 2016, SLACK Incorporated.

Implementation of Epic Beaker Anatomic Pathology at an Academic Medical Center.

PubMed

Blau, John Larry; Wilford, Joseph D; Dane, Susan K; Karandikar, Nitin J; Fuller, Emily S; Jacobsmeier, Debbie J; Jans, Melissa A; Horning, Elisabeth A; Krasowski, Matthew D; Ford, Bradley A; Becker, Kent R; Beranek, Jeanine M; Robinson, Robert A

2017-01-01

Beaker is a relatively new laboratory information system (LIS) offered by Epic Systems Corporation as part of its suite of health-care software and bundled with its electronic medical record, EpicCare. It is divided into two modules, Beaker anatomic pathology (Beaker AP) and Beaker Clinical Pathology. In this report, we describe our experience implementing Beaker AP version 2014 at an academic medical center with a go-live date of October 2015. This report covers preimplementation preparations and challenges beginning in September 2014, issues discovered soon after go-live in October 2015, and some post go-live optimizations using data from meetings, debriefings, and the project closure document. We share specific issues that we encountered during implementation, including difficulties with the proposed frozen section workflow, developing a shared specimen source dictionary, and implementation of the standard Beaker workflow in large institution with trainees. We share specific strategies that we used to overcome these issues for a successful Beaker AP implementation. Several areas of the laboratory-required adaptation of the default Beaker build parameters to meet the needs of the workflow in a busy academic medical center. In a few areas, our laboratory was unable to use the Beaker functionality to support our workflow, and we have continued to use paper or have altered our workflow. In spite of several difficulties that required creative solutions before go-live, the implementation has been successful based on satisfaction surveys completed by pathologists and others who use the software. However, optimization of Beaker workflows has continued to be an ongoing process after go-live to the present time. The Beaker AP LIS can be successfully implemented at an academic medical center but requires significant forethought, creative adaptation, and continued shared management of the ongoing product by institutional and departmental information technology staff as well as laboratory managers to meet the needs of the laboratory.

A bioaccumulative cyclometalated platinum(II) complex with two-photon-induced emission for live cell imaging.

PubMed

Koo, Chi-Kin; Wong, Ka-Leung; Man, Cornelia Wing-Yin; Lam, Yun-Wah; So, Leo King-Yan; Tam, Hoi-Lam; Tsao, Sai-Wah; Cheah, Kok-Wai; Lau, Kai-Chung; Yang, Yang-Yi; Chen, Jin-Can; Lam, Michael Hon-Wah

2009-02-02

The cyclometalated platinum(II) complex [Pt(L)Cl], where HL is a new cyclometalating ligand 2-phenyl-6-(1H-pyrazol-3-yl)pyridine containing C(phenyl), N(pyridyl), and N(pyrazolyl) donor moieties, was found to possess two-photon-induced luminescent properties. The two-photon-absorption cross section of the complex in N,N-dimethylformamide at room temperature was measured to be 20.8 GM. Upon two-photon excitation at 730 nm from a Ti:sapphire laser, bright-green emission was observed. Besides its two-photon-induced luminescent properties, [Pt(L)Cl] was able to be rapidly accumulated in live HeLa and NIH3T3 cells. The two-photon-induced luminescence of the complex was retained after live cell internalization and can be observed by two-photon confocal microscopy. Its bioaccumulation properties enabled time-lapse imaging of the internalization process of the dye into living cells. Cytotoxicity of [Pt(L)Cl] to both tested cell lines was low, according to MTT assays, even at loadings as high as 20 times the dose concentration for imaging for 6 h.

Use of medication and psychological counselling among Canadians with mood and/or anxiety disorders

PubMed Central

Siobhan, O’Donnell; Maria, Syoufi; Wayne, Jones; Kathryn, Bennett; Louise, Pelletier

2017-01-01

Introduction: This study describes the use of prescription medications and psychological counselling in the past 12 months among Canadian adults with a self-reported mood and/or anxiety disorder diagnosis; the sociodemographic and clinical characteristics associated with their use; and reasons for not using them. Methods: We used data from the 2014 Survey on Living with Chronic Diseases in Canada—Mood and Anxiety Disorders Component. The study sample (n = 2916) was divided into four treatment subgroups: (1) taking medication only; (2) having received counselling only; (3) both; or (4) neither. We combined the first three subgroups and carried out descriptive and multivariate logistic regression analyses comparing those who are taking medication and/or have received counselling in the past 12 months, versus those doing neither. Estimates were weighted to represent the Canadian adult household population living in the 10 provinces with diagnosed mood and/or anxiety disorders. Results: The majority (81.8%) of Canadians with a mood and/or an anxiety disorder diagnosis reported they are taking medications and/or have received counselling (47.6% taking medications only; 6.9% received counselling only; and 27.3% taking/having received both). Upon controlling for individual characteristics, taking medications and/or having received counselling was significantly associated with older age; higher household income; living in the Atlantic region or Quebec versus Ontario; and having concurrent disorders or mood disorders only. Symptoms controlled without medication was the most common reason for not taking medications, while preferring to manage on their own and taking medications were among the common reasons for not having received counselling. Conclusion: The majority of Canadian adults with a mood and/or an anxiety disorder diagnosis are taking medications, while few have received counselling. Insights gained regarding the factors associated with these treatments, and reasons for not using them, emphasize the importance of discussing treatment options and perceived barriers with patients to ensure they receive the best treatment according to their needs and preference. PMID:28493660

Use of medication and psychological counselling among Canadians with mood and/or anxiety disorders.

PubMed

O'Donnell, Siobhan; Syoufi, Maria; Jones, Wayne; Bennett, Kathryn; Pelletier, Louise

2017-05-01

This study describes the use of prescription medications and psychological counselling in the past 12 months among Canadian adults with a self-reported mood and/or anxiety disorder diagnosis; the sociodemographic and clinical characteristics associated with their use; and reasons for not using them. We used data from the 2014 Survey on Living with Chronic Diseases in Canada-Mood and Anxiety Disorders Component. The study sample (n = 2916) was divided into four treatment subgroups: (1) taking medication only; (2) having received counselling only; (3) both; or (4) neither. We combined the first three subgroups and carried out descriptive and multivariate logistic regression analyses comparing those who are taking medication and/or have received counselling in the past 12 months, versus those doing neither. Estimates were weighted to represent the Canadian adult household population living in the 10 provinces with diagnosed mood and/or anxiety disorders. The majority (81.8%) of Canadians with a mood and/or an anxiety disorder diagnosis reported they are taking medications and/or have received counselling (47.6% taking medications only; 6.9% received counselling only; and 27.3% taking/having received both). Upon controlling for individual characteristics, taking medications and/or having received counselling was significantly associated with older age; higher household income; living in the Atlantic region or Quebec versus Ontario; and having concurrent disorders or mood disorders only. Symptoms controlled without medication was the most common reason for not taking medications, while preferring to manage on their own and taking medications were among the common reasons for not having received counselling. The majority of Canadian adults with a mood and/or an anxiety disorder diagnosis are taking medications, while few have received counselling. Insights gained regarding the factors associated with these treatments, and reasons for not using them, emphasize the importance of discussing treatment options and perceived barriers with patients to ensure they receive the best treatment according to their needs and preference.

[Self-medication with vitamins, minerals and food supplements in Germany : Results of nationwide health surveys].

PubMed

Knopf, Hildtraud

2017-03-01

Vitamins, minerals and food supplements (FSs) are often used without medical prescription. Valid data on the magnitude of use are rare in Germany. The aim of the present analysis is to describe the prevalence and trends of self-medication and the associations between health-related factors and self-medication with these substances. The data base consisted of the results of nationwide health surveys (GNHIES98: 1997-1999 and DEGS1: 2008-2001) in which adults aged 18-79 years were interviewed on health-related themes and were examined. The use of drugs and FSs was recorded in standardized personal interviews. Data of 7099 (GNHIES98) and 7091 (DEGS1) individuals were available for analysis. The dependent variable was self-medication with vitamins, minerals and FS. Analysis was conducted in SPSS Version 20 with the complex sample method. Statistical significance was tested with 95% confidence intervals (95% CI) and verified via p-values. Of all DEGS1 participants, 18.1% (95% CI: 17.0-19.2%) consumed vitamins, minerals and FSs in self-medication. Significantly higher prevalence was found among women, older people (60-79 years), those with a higher social status, people living alone, ex- and non-smokers, and those doing more sports. In comparison to the GNHIES98 study the prevalence in DEGS1 has increased by about 6 percentage points (5.8 percentage points, 95% CI 4.1-7.5%, p < 0.001). This increase remained significant when socio-demographic and health-relevant factors were considered simultaneously (odds ratio (OR): 1.49, 95% CI 1.27-1.75). In Germany self-medication with vitamins, minerals or FSs shows a high user prevalence which has increased significantly over time. In light of potential interactions with prescribed medicines the results show the importance of ascertaining self-medication with vitamins, minerals and FSs in medical practice.

3D printing for clinical application in otorhinolaryngology.

PubMed

Zhong, Nongping; Zhao, Xia

2017-12-01

Three-dimensional (3D) printing is a promising technology that can use a patient's image data to create complex and personalized constructs precisely. It has made great progress over the past few decades and has been widely used in medicine including medical modeling, surgical planning, medical education and training, prosthesis and implants. Three-dimensional (3D) bioprinting is a powerful tool that has the potential to fabricate bioengineered constructs of the desired shape layer-by-layer using computer-aided deposition of living cells and biomaterials. Advances in 3D printed implants and future tissue-engineered constructs will bring great progress to the field of otolaryngology. By integrating 3D printing into tissue engineering and materials, it may be possible for otolaryngologists to implant 3D printed functional grafts into patients for reconstruction of a variety of tissue defects in the foreseeable future. In this review, we will introduce the current state of 3D printing technology and highlight the applications of 3D printed prosthesis and implants, 3D printing technology combined with tissue engineering and future directions of bioprinting in the field of otolaryngology.

Justice in the context of family balancing

PubMed Central

Sharp, Richard R.

2013-01-01

Bioethics and feminist scholarship has explored various justice implications of non-medical sex selection and family balancing. However, prospective users’ viewpoints have been absent from the debate over the socially acceptable bounds of non-medical sex selection. This qualitative study provides a set of empirically-grounded perspectives on the moral values that underpin prospective users’ conceptualizations of justice in the context of a family balancing program in the United States. The results indicate that couples pursuing family balancing understand justice primarily in individualist and familial terms rather than in terms of social justice for women and girls or for children resulting from sex selection. Study participants indicated that an individual’s desire for gender balance in their family is ethically complex and may not be inherently sexist, immoral or socially consequential, particularly given the social context in which they live. Our findings suggest that the social conditions that contribute to prospective users’ desires for gender balance in their families may direct them away from recognizing or engaging broader social justice concerns relating to sexism and stratified reproduction. PMID:24371364

[THE EFFECT OF CLAIMS ABOUT MEDICAL ADVERSE EVENTS ON PATIENTS' SAFETY].

PubMed

Niv, Yaron

2018-04-01

In 1999 the Institute of Medicine (ION) declared that "to err in human" and that our goal is not to "blame and shame" but to investigate and establish processes that will prevent future mistakes. Shortage in manpower, physicians and nurses, may cause a disproportional burden of work and increase mistakes and adverse events. The complexity of patients requires a multidisciplinary team with many participants for achieving goals and saving lives. In the last 2 decades there was an exponential increase in the number of medical negligence claims and a similar increase in the sums given to the plaintiffs, in verdicts, mediation or compromises. The judges see before them the victims of these mistakes and their suffering, and look at the health system as a "deep pocket" for plaintiffs' compensation. Health institutes invest a lot of money and personnel to protect against claims instead of investing in systemic learning, manpower and equipment for preventing future adverse events. Fear of claims may cause excellent physicians to leave their profession leading to a possible shortage in experts in some important fields.

[Marital status and the severity of perinatal depression among pregnant women].

PubMed

Podolska, Magdalena; Sipak-Szmigiel, Olimpia

2010-01-01

Cohabitation existing for ages in all human cultures is becoming more common since the 1960s due to complex changes in postmodern societies. These societies have made the phenomenon of cohabitation the object of adequate theoretical reflection. The aim of this work was to determine whether the marital status of pregnant women affects the severity of perinatal depression. We enrolled 117 gravida hospitalized in 2006 and 2007 at the Department of Maternal-Fetal Medicine, Pomeranian Medical University. The gestational age ranged from week 32 to 40. The clinical condition of each gravida was assessed during routine obstetric history taking. The Edinburgh Postnatal Depression Scale by Cox, Holden, and Sagovski was used as the screening test for perinatal depression. 1. The marital status of the gravida with emphasis on cohabitation is a significant correlate of perinatal depression and its risk. 2. Clinical examination should concentrate not only on the physical and medical condition but also on the psychosocial status of the patient as the predictor of perinatal depression. 3. All pregnant women living in informal partnerships should be offered psychological support.

Indoor location-aware medical systems for smart homecare and telehealth monitoring: state-of-the-art.

PubMed

Santoso, Fendy; Redmond, Stephen J

2015-10-01

This paper presents a comprehensive literature review of current progress in the application of state-of-the-art indoor positioning systems for telecare and telehealth monitoring. This review is the first in the literature that provides a comprehensive discussion on how existing wireless indoor positioning systems can benefit the development of home-based care systems. More specifically, this review provides an in-depth comparative study of how both system users and medical practitioners can get benefit from indoor positioning technologies; e.g. for real-time monitoring of patients suffering chronic cardiovascular conditions, general monitoring of activities of daily living (ADLs), fall detection systems for the elderly as well as indoor navigation systems for those suffering from visual impairments. Furthermore, it also details various aspects worth considering when choosing a certain technology for a specific healthcare application; e.g. the spatial precision demanded by the application, trade-offs between unobtrusiveness and complexity, and issues surrounding compliance and adherence with the use of wearable tags. Beyond the current state-of-the-art, this review also rigorously discusses several research opportunities and the challenges associated with each.

A pilot randomized controlled trial of deprescribing.

PubMed

Beer, Christopher; Loh, Poh-Kooi; Peng, Yan Gee; Potter, Kathleen; Millar, Alasdair

2011-04-01

Polypharmacy and adverse drug reactions are frequent and important among older people. Few clinical trials have evaluated systematic withdrawal of medications among older people. This small, open, study was conducted to determine the feasibility of a randomized controlled deprescribing trial. Ten volunteers living in the community (recruited by media advertising) and 25 volunteers living in residential aged-care facilities (RCFs) were randomized to intervention or control groups. The intervention was gradual withdrawal of one target medication. The primary outcome was the number of intervention participants in whom medication withdrawal could be achieved. Other outcomes measures were quality of life, medication adherence, sleep quality, and cognitive impairment. Participants were aged 80 ± 11 years and were taking 9 ± 2 medications. Fifteen participants commenced medication withdrawal and all ceased or reduced the dose of their target medication. Two subjects withdrew; one was referred for clinical review, and one participant declined further dose reductions. A randomized controlled trial of deprescribing was acceptable to participants. Recruitment in RCFs is feasible. Definitive trials of deprescribing are required.

A multisite audit to assess how women with complex social factors access and engage with maternity services.

PubMed

Rayment-Jones, Hannah; Butler, Eleanor; Miller, Chelsie; Nay, Christine; O'Dowd, Jennifer

2017-09-01

to audit women with socially complex lives' documented access to and engagement with antenatal care provided by three inner city, UK maternity services in relation to birth and neonatal outcomes, and referral processes. women living socially complex lives, including young mothers, recently arrived immigrants, non-English speaking, and those experiencing domestic violence, poor mental health, drug and alcohol abuse, and poverty experience high rates of morbidity, mortality and poor birth outcomes. This is associated with late access to and poor engagement with antenatal care. data was collected from three separate NHS trusts data management systems for a total of 182 women living socially complex lives, between January and December 2015. Data was presented by individual trust and compared to standards derived from NICE guidelines, local trust policy and national statistic using Excel and SPSS Version 22. Tests of correlation were carried out to minimise risks of confounding factors in characteristic differences. non-English speaking women were much less likely to have accessed care within the recommended timeframes, with over 70% of the sample not booked for maternity care by 12 weeks gestation. On average 89% primiparous women across all samples had less than the recommended number of antenatal appointments. No sample met the audit criteria in terms of number of antenatal appointments attended. Data held on the perinatal data management systems for a number of outcomes and processes was largely incomplete and appeared unreliable. this data forms a baseline against which to assess the impact of future service developments aimed at improving access and engagement with services for women living with complex social factors. The audit identified issues with the completeness and reliability of data on the perinatal data management system. Copyright © 2017 Elsevier Ltd. All rights reserved.

How Do Young Children Deal with Hybrids of Living and Non-Living Things: The Case of Humanoid Robots

ERIC Educational Resources Information Center

Saylor, Megan M.; Somanader, Mark; Levin, Daniel T.; Kawamura, Kazuhiko

2010-01-01

In this experiment, we tested children's intuitions about entities that bridge the contrast between living and non-living things. Three- and four-year-olds were asked to attribute a range of properties associated with living things and machines to novel category-defying complex artifacts (humanoid robots), a familiar living thing (a girl), and a…

Tutor-led teaching of procedural skills in the skills lab: Complexity, relevance and teaching competence from the medical teacher, tutor and student perspective.

PubMed

Lauter, Jan; Branchereau, Sylvie; Herzog, Wolfgang; Bugaj, Till Johannes; Nikendei, Christoph

2017-05-01

In current medical curricula, the transfer of procedural skills has received increasing attention. Skills lab learning and tutor-led teaching have become an inherent part of all medical curricula at German medical faculties. In 2011, the initial basis for the classification of clinical skills in medical school was created by the German Association for Medical Education (GMA) Committee's consensus statement on procedural skills. As a recommendation for medical curricula, the National Competency-based Catalogue of Learning Objectives (NKLM, 2015) lists procedural skills according to their curriculum integration and competency level. However, classification in regard to the perceived complexity, relevance, or teaching competency is still lacking. The present study aimed to investigate procedural skills taught at the Medical Faculty of Heidelberg in regard to their complexity, relevance, and required teaching skills. To achieve this aim (1) the specific procedural skills in terms of complexity, that is, the degree of difficulty, and (2) the perceived relevance of taught procedural skills for studying and subsequent medical profession as well as (3) the personal preparation and required teaching skills were assessed in medical teachers, tutors and students. During the winter semester 2014/2015, the evaluations of all medical teachers, student tutors, and medical students in the skills lab teaching departments of internal medicine, surgery, pediatrics, gynecology, and otorhinolaryngology at the Medical Faculty of Heidelberg were assessed via a quantitative cross-sectional questionnaire survey using 7-point Likert scales. The questionnaire comprised four item sets concerning 1) demographic details, 2) procedural skill complexity, 3) practical relevance, and 4) required preparation and teaching skills. Descriptive, quantitative analysis was used for questionnaire data. The survey included the data from 17 of 20 physicians (return rate: 85 %), 10 of 10 student tutors (return rate: 100 %) and a total of 406 of 691 students (return rate: 58.8 %). In terms of complexity and relevance, no major differences between medical teachers, tutors, and students were found. Procedural skills, assigned to the competence level of final year medical education in the NKLM, were also perceived as more complex than other skills. All skills were considered equally relevant, and student tutors were seen to have equally competent teaching skills as experienced medical teachers. This study largely underpins the NKLM's classification of procedural skills. The complexity assessment allows for conclusions to be drawn as to which skills are perceived to require particularly intensive training. Finally, our study corroborates extant findings that student tutors are apt at teaching procedural skills if they have been properly trained. Copyright © 2017. Published by Elsevier GmbH.

Unreliable Bodies: A Follow-up Twenty Years Later by a Mother and Daughter about the Impact of Illness and Disability on their Lives.

PubMed

Weingarten, Kaethe; Worthen, Miranda

2017-03-01

We are a mother and daughter, both health care professionals, who offer a follow-up to an article we published twenty years ago about the impact of each other's ongoing, serious medical problems on our relationship. In this article, we contribute a long-term perspective on the differences between having an illness that is well or poorly understood by medical professionals and the lay community. We also discuss health in the context of identity formation and life stage, as during this interval the daughter left home, graduated college, married, and had two children. Also in this period, the mother survived a third breast cancer and other life-threatening illnesses. We discuss the impact of these experiences on each other and in other important relationships in our lives. Current discourses on daughters of breast cancer survivors do not fit our experience and we speculate about why our story differs. We find that although we continue to contend with serious medical issues that impact our own, each other's, and our families' lives, nonetheless, our lives are rich, rewarding, and "appropriate" for our life stage. That is the news. © 2015 Family Process Institute.

Topology and Oligomerization of Mono- and Oligomeric Proteins Regulate Their Half-Lives in the Cell.

PubMed

Mallik, Saurav; Kundu, Sudip

2018-06-05

To find additional structural constraints (besides disordered segments) that regulate protein half-life in the cell, we herein assess the influence of native topology of monomeric and sequestration of oligomeric proteins into multimeric complexes in yeast, human, and mouse. Native topology acts as a molecular marker of globular protein's mechanical resistance and consequently captures their half-life variations on genome scale. Sequestration into multimeric complexes elongates oligomeric protein half-life in the cell, presumably by burying ubiquitinoylation sites and disordered segments required for proteasomal recognition. The latter effect is stronger for proteins associated with multiple complexes and for those binding early during complex self-assembly, including proteins that oligomerize with large proportions of surface buried. After gene duplication, diversification of topology and sequestration into non-identical sets of complexes alter half-lives of paralogous proteins during the course of evolution. Thus, native topology and sequestration into multimeric complexes reflect designing principles of proteins to regulate their half-lives. Copyright © 2018 Elsevier Ltd. All rights reserved.

Lived Experiences of "Illness Uncertainty" of Iranian Cancer Patients: A Phenomenological Hermeneutic Study.

PubMed

Sajjadi, Moosa; Rassouli, Maryam; Abbaszadeh, Abbas; Brant, Jeannine; Majd, Hamid Alavi

2016-01-01

For cancer patients, uncertainty is a pervasive experience and a major psychological stressor that affects many aspects of their lives. Uncertainty is a multifaceted concept, and its understanding for patients depends on many factors, including factors associated with various sociocultural contexts. Unfortunately, little is known about the concept of uncertainty in Iranian society and culture. This study aimed to clarify the concept and explain lived experiences of illness uncertainty in Iranian cancer patients. In this hermeneutic phenomenological study, 8 cancer patients participated in semistructured in-depth interviews about their experiences of uncertainty in illness. Interviews continued until data saturation was reached. All interviews were recorded, transcribed, analyzed, and interpreted using 6 stages of the van Manen phenomenological approach. Seven main themes emerged from patients' experiences of illness uncertainty of cancer. Four themes contributed to uncertainty including "Complexity of Cancer," "Confusion About Cancer," "Contradictory Information," and "Unknown Future." Two themes facilitated coping with uncertainty including "Seeking Knowledge" and "Need for Spiritual Peace." One theme, "Knowledge Ambivalence," revealed the struggle between wanting to know and not wanting to know, especially if bad news was delivered. Uncertainty experience for cancer patients in different societies is largely similar. However, some experiences (eg, ambiguity in access to medical resources) seemed unique to Iranian patients. This study provided an outlook of cancer patients' experiences of illness uncertainty in Iran. Cancer patients' coping ability to deal with uncertainty can be improved.

Evaluation of pharmacotherapy complexity in residents of long-term care facilities: a cross-sectional descriptive study.

PubMed

Alves-Conceição, Vanessa; Silva, Daniel Tenório da; Santana, Vanessa Lima de; Santos, Edileide Guimarães Dos; Santos, Lincoln Marques Cavalcante; Lyra, Divaldo Pereira de

2017-07-25

Polypharmacy is a reality in long-term care facilities. However, number of medications used by the patient should not be the only predictor of a complex pharmacotherapy. Although the level of complexity of pharmacotherapy is considered an important factor that may lead to side effects, there are few studies in this field. The aim of this study was to evaluate the complexity of pharmacotherapy in residents of three long-term care facilities. A cross-sectional study was performed to evaluate the complexity of pharmacotherapy using the protocols laid out in the Medication Regimen Complexity Index instrument in three long-term care facilities in northeastern Brazil. As a secondary result, potential drug interactions, potentially inappropriate medications, medication duplication, and polypharmacy were evaluated. After the assessment, the association among these variables and the Medication Regimen Complexity Index was performed. In this study, there was a higher prevalence of women (64.4%) with a high mean age among the study population of 81.8 (±9.7) years. The complexity of pharmacotherapy obtained a mean of 15.1 points (±9.8), with a minimum of 2 and a maximum of 59. The highest levels of complexity were associated with dose frequency, with a mean of 5.5 (±3.6), followed by additional instructions of use averaging 4.9 (±3.7) and by the dosage forms averaging 4.6 (±3.0). The present study evaluated some factors that complicate the pharmacotherapy of geriatric patients. Although polypharmacy was implicated as a factor directly related to complexity, other indicators such as drug interactions, potentially inappropriate medications, and therapeutic duplication can also make the use of pharmacotherapy in such patients more difficult.

Impact of live medication therapy management on cholesterol values in patients with cardiovascular disease.

PubMed

Thumar, Ricky; Zaiken, Kathy

2014-01-01

To compare the impact of clinical pharmacist (CP) recommendations through a live, primary care-based, medication therapy management (MTM) protocol on low-density-lipoprotein (LDL) cholesterol in patients who have cardiovascular disease (CVD) with standard, chart-review MTM. Patients with established CVD who were not at their LDL goal were identified and analyzed by either a chart-review MTM service or a live, one-on-one pharmacist-physician MTM service over a 6-month timeframe. For the chart-review MTM service, recommendations were communicated through an electronic medical record (EMR) that the physician and pharmacist had access to. Primary outcomes included mean LDL reduction from baseline, number of patients achieving their LDL goal, and percent of implemented CP recommendations. Mean LDL reduction from baseline in the chart-review MTM group and the live MTM group was 36 mg/dL ± 23.2 mg/dL (P = 0.001) and 62 mg/dL ± 28.3 mg/dL (P = 0.001), respectively. The difference between these two groups was statistically significant (P = 0.001). The chart-review MTM group had 30% of patients reach their LDL goal with 66.3% of CP recommendations implemented compared to 51.3% and 86.3% for the same parameters in the live MTM group (P = 0.006 and P = 0.003, respectively). Although both MTM services provide a significant LDL reduction from baseline in patients with CVD, live MTM provides significantly greater LDL reductions, implemented CP recommendations, and goal attainment than chart-review MTM. Thus, live MTM services are more effective than chart-review MTM services, at least within the clinics that these protocols were assessed for the purposes of this study.

Medical Issues: Orthopedics

MedlinePlus

... Cure SMA Store Volunteer Donate Learn About SMA Research Support & Care Get Involved Donate About Us News www.curesma.org > support & care > living with sma > medical issues > orthopedics Orthopedics In SMA, muscle weakness can cause several ...

Association of cardiovascular system medications with cognitive function and dementia in older adults living in nursing homes in Australia.

PubMed

Liu, Enwu; Dyer, Suzanne M; O'Donnell, Lisa Kouladjian; Milte, Rachel; Bradley, Clare; Harrison, Stephanie L; Gnanamanickam, Emmanuel; Whitehead, Craig; Crotty, Maria

2017-06-01

To examine associations between cardiovascular system medication use with cognition function and diagnosis of dementia in older adults living in nursing homes in Australia. As part of a cross-sectional study of 17 Australian nursing homes examining quality of life and resource use, we examined the association between cognitive impairment and cardiovascular medication use (identified using the Anatomical Therapeutic Classification System) using general linear regression and logistic regression models. People who were receiving end of life care were excluded. Participants included 541 residents with a mean age of 85.5 years (± 8.5), a mean Psychogeriatric Assessment Scale-Cognitive Impairment (PAS-Cog) score of 13.3 (± 7.7), a prevalence of cardiovascular diseases of 44% and of hypertension of 47%. Sixty-four percent of participants had been diagnosed with dementia and 72% had received cardiovascular system medications within the previous 12 months. Regression models demonstrated the use of cardiovascular medications was associated with lower (better) PAS-Cog scores [Coefficient (β) = -3.7; 95% CI: -5.2 to -2.2; P < 0.0001] and a lower probability of a dementia diagnosis (OR = 0.44; 95% CI: 0.26 to 0.75, P = 0.0022). Analysis by subgroups of medications showed cardiac therapy medications (C01), beta blocking agents (C07), and renin-angiotensin system agents (C09) were associated with lower PAS-Cog scores (better cognition) and lower dementia diagnosis probability. This analysis has demonstrated an association between greater cardiovascular system medication use and better cognitive status among older adults living in nursing homes. In this population, there may be differential access to health care and treatment of cardiovascular risk factors. This association warrants further investigation in large cohort studies.

Utility of an Interactive Voice Response System to Assess Antiretroviral Pharmacotherapy Adherence Among Substance Users Living with HIV/AIDS in the Rural South

PubMed Central

Simpson, Cathy A.; Huang, Jin; Roth, David L.; Stewart, Katharine E.

2013-01-01

Abstract Promoting HIV medication adherence is basic to HIV/AIDS clinical care and reducing transmission risk and requires sound assessment of adherence and risk behaviors such as substance use that may interfere with adherence. The present study evaluated the utility of a telephone-based Interactive Voice Response self-monitoring (IVR SM) system to assess prospectively daily HIV medication adherence and its correlates among rural substance users living with HIV/AIDS. Community-dwelling patients (27 men, 17 women) recruited from a non-profit HIV medical clinic in rural Alabama reported daily medication adherence, substance use, and sexual practices for up to 10 weeks. Daily IVR reports of adherence were compared with short-term IVR-based recall reports over 4- and 7-day intervals. Daily IVR reports were positively correlated with both recall measures over matched intervals. However, 7-day recall yielded higher adherence claims compared to the more contemporaneous daily IVR and 4-day recall measures suggestive of a social desirability bias over the longer reporting period. Nearly one-third of participants (32%) reported adherence rates below the optimal rate of 95% (range=0–100%). Higher IVR-reported daily medication adherence was associated with lower baseline substance use, shorter duration of HIV/AIDS medical care, and higher IVR utilization. IVR SM appears to be a useful telehealth tool for monitoring medication adherence and identifying patients with suboptimal adherence between clinic visits and can help address geographic barriers to care among disadvantaged, rural adults living with HIV/AIDS. PMID:23651105

Family structure and the treatment of childhood asthma.

PubMed

Chen, Alex Y; Escarce, José J

2008-02-01

Family structure is known to influence children's behavioral, educational, and cognitive outcomes, and recent studies suggest that family structure affects children's access to health care as well. However, no study has addressed whether family structure is associated with the care children receive for particular conditions or with their physical health outcomes. To assess the effects of family structure on the treatment and outcomes of children with asthma. Our data sources were the 1996-2003 Medical Expenditure Panel Survey (MEPS) and the 2003 National Survey of Children's Health (NSCH). The study samples consisted of children 2-17 years of age with asthma who lived in single-mother or 2-parent families. We assessed the effect of number of parents and number of other children in the household on office visits for asthma and use of asthma medications using negative binomial regression, and we assessed the effect of family structure on the severity of asthma symptoms using binary and ordinal logistic regression. Our regression models adjusted for sociodemographic characteristics, parental experience in child-rearing and in caring for an asthmatic child and, when appropriate, measures of children's health status. Asthmatic children in single-mother families had fewer office visits for asthma and filled fewer prescriptions for controller medications than children with 2 parents. In addition, children living in families with 3 or more other children had fewer office visits and filled fewer prescriptions for reliever and controller medications than children living with no other children. Children from single-mother families had more health difficulties from asthma than children with 2 parents, and children living with 2 or more other children were more likely to have an asthma attack in the past 12 months than children living with no other children. For children with asthma, living with a single mother and the presence of additional children in the household are associated with less treatment for asthma and worse asthma outcomes.

Preconception lifestyle advice for people with subfertility.

PubMed

Anderson, Kirsty; Norman, Robert J; Middleton, Philippa

2010-04-14

Infertility is a prevalent problem and has significant consequences for individuals, families and the wider community. People's chance of having a healthy, live birth may be impacted upon by factors such as weight, diet, smoking, other substance abuse, environmental pollutants, infections, medical conditions, medications and family medical history. However, there is no current guideline about what preconception advice should be offered to people presenting for infertility treatment. It is important to determine what preconception advice should be given about these types of factors to such people in order to help them to make positive changes and hopefully improve their chances of conception and delivering a healthy, live baby. To assess the effects of preconception advice on the chances of a live birth for people who perceive that they may be infertile and are investigating the possibility of medical treatment to address subfertility. All published and unpublished randomised controlled trials addressing preconception advice to influence lifestyle factors in people who perceived that they may be infertile and investigated the possibility of medical treatment to address subfertility were sought from the Cochrane Menstrual Disorders and Subfertility Review Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library, MEDLINE, PubMed, EMBASE, PsycINFO, AMED, Cumulative Index to Nursing and Allied Health Literature (CINAHL), LILACS, trial registers for ongoing and registered trials, citation indexes, ISI Web of Knowledge, Clinical Study Results database, OpenSIGLE database, China National Knowledge Infrastructure (CNKI) Periodical Index and Google (inception to 5 October 2009). Only randomised controlled trials (RCTs), including cluster-randomised (group-randomised) trials, that considered preconception advice given to individuals who perceived that they may be infertile and were investigating the possibility of medical treatment from subfertility specialist services were eligible for inclusion. The primary outcome was live birth, defined as delivery of a live fetus after 20 completed weeks of gestation. Two review authors independently applied eligibility criteria to, extracted data from and assessed the risk of bias in the single included trial. One trial assessing smoking cessation advice for 94 infertile women smokers fulfilled the criteria for this review, but the trial did not report on the review's primary outcome of live birth or any other fertility-related outcomes. This trial of women attending a fertility clinic showed that smoking cessation advice tailored to a woman's "stage-of-change" (readiness to stop smoking) did not show significant evidence of a difference in stage (including smoking cessation rates) compared with standard clinical advice. No RCTs were located that assessed the effects of preconception advice on the chance of a live birth or other fertility outcomes in people who perceived that they may be infertile and were investigating the possibility of medical treatment to address subfertility. Given the lack of RCTs evaluating the effectiveness of preconception lifestyle advice for people in the afore-mentioned population, this review cannot provide guidance for clinical practice in this area. However, it does highlight the need for further research into this important subject.

Exploring the evidence base for how people with dementia and their informal carers manage their medication in the community: a mixed studies review.

PubMed

Aston, Lydia; Hilton, Andrea; Moutela, Tiago; Shaw, Rachel; Maidment, Ian

2017-10-18

Little is known about the general medicines management issues for people with dementia living in the community. This review has three aims: firstly to explore and evaluate the international literature on how people with dementia manage medication; assess understanding of medicines management from an informal carers perspective; and lastly to understand the role that healthcare professionals play in assisting this population with medicines management. A mixed studies review was conducted. Web of Knowledge, PubMed and Cochrane Library were searched post-1999 for studies that explored medicines management in people with dementia dwelling in the community, and the role healthcare professionals play in supporting medicines management in people with dementia. Following screening, nine articles were included. Data from included studies were synthesised using a convergent synthesis approach and analysed thematically to combine findings from studies using a range of methods (qualitative, quantitative and mixed methods). Four themes were generated from the synthesis: The nature of the disease and the effects this had on medicines management; the additional responsibilities informal carers have; informal caregivers' knowledge of the importance of managing medication and healthcare professionals' understanding of medicines management in people with dementia. Consequently, these were found to affect management of medication, in particular adherence to medication. This review has identified that managing medication for people with dementia dwelling in the community is a complex task with a frequently associated burden on their informal caregivers. Healthcare professionals can be unaware of this burden. The findings warrant the need for healthcare professionals to undergo further training in supporting medicines management for people with dementia in their own homes.

Distributed Network, Wireless and Cloud Computing Enabled 3-D Ultrasound; a New Medical Technology Paradigm

PubMed Central

Meir, Arie; Rubinsky, Boris

2009-01-01

Medical technologies are indispensable to modern medicine. However, they have become exceedingly expensive and complex and are not available to the economically disadvantaged majority of the world population in underdeveloped as well as developed parts of the world. For example, according to the World Health Organization about two thirds of the world population does not have access to medical imaging. In this paper we introduce a new medical technology paradigm centered on wireless technology and cloud computing that was designed to overcome the problems of increasing health technology costs. We demonstrate the value of the concept with an example; the design of a wireless, distributed network and central (cloud) computing enabled three-dimensional (3-D) ultrasound system. Specifically, we demonstrate the feasibility of producing a 3-D high end ultrasound scan at a central computing facility using the raw data acquired at the remote patient site with an inexpensive low end ultrasound transducer designed for 2-D, through a mobile device and wireless connection link between them. Producing high-end 3D ultrasound images with simple low-end transducers reduces the cost of imaging by orders of magnitude. It also removes the requirement of having a highly trained imaging expert at the patient site, since the need for hand-eye coordination and the ability to reconstruct a 3-D mental image from 2-D scans, which is a necessity for high quality ultrasound imaging, is eliminated. This could enable relatively untrained medical workers in developing nations to administer imaging and a more accurate diagnosis, effectively saving the lives of people. PMID:19936236

Distributed network, wireless and cloud computing enabled 3-D ultrasound; a new medical technology paradigm.

PubMed

Meir, Arie; Rubinsky, Boris

2009-11-19

Medical technologies are indispensable to modern medicine. However, they have become exceedingly expensive and complex and are not available to the economically disadvantaged majority of the world population in underdeveloped as well as developed parts of the world. For example, according to the World Health Organization about two thirds of the world population does not have access to medical imaging. In this paper we introduce a new medical technology paradigm centered on wireless technology and cloud computing that was designed to overcome the problems of increasing health technology costs. We demonstrate the value of the concept with an example; the design of a wireless, distributed network and central (cloud) computing enabled three-dimensional (3-D) ultrasound system. Specifically, we demonstrate the feasibility of producing a 3-D high end ultrasound scan at a central computing facility using the raw data acquired at the remote patient site with an inexpensive low end ultrasound transducer designed for 2-D, through a mobile device and wireless connection link between them. Producing high-end 3D ultrasound images with simple low-end transducers reduces the cost of imaging by orders of magnitude. It also removes the requirement of having a highly trained imaging expert at the patient site, since the need for hand-eye coordination and the ability to reconstruct a 3-D mental image from 2-D scans, which is a necessity for high quality ultrasound imaging, is eliminated. This could enable relatively untrained medical workers in developing nations to administer imaging and a more accurate diagnosis, effectively saving the lives of people.

[Informed consent and parental refusal to medical treatment in childhood. The threshold of medical and social tolerance. Part I].

PubMed

Guadarrama-Orozco, Jessica H; Garduño Espinosa, Juan; Vargas López, Guillermo; Viesca Treviño, Carlos

Informed consent is a right of all individuals and no one can force anyone to receive treatment against their wishes. The right to accept or refuse treatment persists in individuals who are incompetent from a legal point of view; this is exercised on their behalf by a third party. Children are considered incompetent to make medical decisions about their own health and their parents or legal guardians are empowered to make those decisions. However, parental authority is not absolute and there are situations where their decisions are not the best, sometimes leading to jeopardizing the well-being and even the lives of their children, forcing the state to intervene on behalf of the best interests of the child. This is the reason why it is necessary to ask the following questions: is it really the child's best interest that moves us to legally intervene when a parent refuses to accept the proposed medical treatment or is the damage done to make this decision? What kind of parental decisions are those that should not be tolerated? After a review of the theme, we conclude that if the decision of the parents regarding a medical decision is considered to be made with maleficence that is harmful to the child, it is justified that the State intervenes. Finally, we exposed four criteria that can be used in making decisions in complex cases where parents refuse treatment for their children. Copyright © 2015. Publicado por Masson Doyma México S.A.

Living AnatoME: Teaching and Learning Musculoskeletal Anatomy through Yoga and Pilates

ERIC Educational Resources Information Center

McCulloch, Carrie; Marango, Stephanie Pieczenik; Friedman, Erica S.; Laitman, Jeffrey T.

2010-01-01

Living AnatoME, a program designed in 2004 by two medical students in conjunction with the Director of Anatomy, teaches musculoskeletal anatomy through yoga and Pilates. Previously offered as an adjunct to the Gross Anatomy course in 2007, Living AnatoME became an official part of the curriculum. Previous research conducted on the program…

3 CFR 8383 - Proclamation 8383 of May 20, 2009. Emergency Medical Services Week, 2009

Code of Federal Regulations, 2010 CFR

2010-01-01

... establish order and calm—and save lives in the process. They include educators, 911 dispatchers, first... unexpected life-threatening situations, emergency medical services (EMS) providers provide rapid help. Quality emergency medical care dramatically improves the survival and recovery prospects for those who...

Comparative Testing of Hemostatic Dressing in a Large Animal Model (Sus Scorofa) with Severe hepatic Injuries

DTIC Science & Technology

2013-12-02

applicable terms in EACH column) ___ Training: Live Animal ___ Medical Readiness ___ Prolonged Restraint ___ Training: non-Live Animal ... Health Promotion ___ Multiple Survival Surgery ___ Research: Survival (chronic) ___ Prevention ___ Behavioral Study _X__ Research

[Significance of occupational and interpersonal relationships among residents during the specialization training course].

PubMed

Cumplido-Hernández, Gustavo; Campos-Arciniega, María Faustina; Chávez-López, Arturo

2007-01-01

Medical specialty training courses have peculiar characteristics that probably influence the learning process of the residents. These training courses take place in large hospitals; the residents are subjected to a rigorous selection process, and at the same time they are affiliated employees of the institution. They work long shifts and are immersed in complex academic and occupational relationships. This study aims to ascertain the significance that these future specialists give to the environment where the training course takes place in relation with their learning process. We used the social anthropology narrative analysis method. A theoretical social perspective was used to emphasize on the context to explain the reality in which the residents live. Discipline, workload, conflictive relationships and strength of family ties were the most significant elements.

Domestic violence in Australia: definition, prevalence and nature of presentation in clinical practice.

PubMed

Hegarty, K; Hindmarsh, E D; Gilles, M T

2000-10-02

Domestic violence is a complex pattern of behaviours that may include, in addition to physical acts of violence, sexual abuse and emotional abuse. Women experience domestic violence at far greater rates than men do, and women and children often live in fear as a result of the abuse that is used by men to maintain control over their partners. Domestic violence is a major public health problem and is very common in women attending clinical practice. Women present most commonly with a range of chronic symptoms to unsuspecting general practitioners, emergency department doctors or medical specialists. Women who have experienced partner abuse want to be asked about it and are more likely to disclose if asked in an empathic, non-judgemental way. Doctors can make a difference.

Analyzing Activity Behavior and Movement in a Naturalistic Environment using Smart Home Techniques

PubMed Central

Cook, Diane J.; Schmitter-Edgecombe, Maureen; Dawadi, Prafulla

2015-01-01

One of the many services that intelligent systems can provide is the ability to analyze the impact of different medical conditions on daily behavior. In this study we use smart home and wearable sensors to collect data while (n=84) older adults perform complex activities of daily living. We analyze the data using machine learning techniques and reveal that differences between healthy older adults and adults with Parkinson disease not only exist in their activity patterns, but that these differences can be automatically recognized. Our machine learning classifiers reach an accuracy of 0.97 with an AUC value of 0.97 in distinguishing these groups. Our permutation-based testing confirms that the sensor-based differences between these groups are statistically significant. PMID:26259225

Analyzing Activity Behavior and Movement in a Naturalistic Environment Using Smart Home Techniques.

PubMed

Cook, Diane J; Schmitter-Edgecombe, Maureen; Dawadi, Prafulla

2015-11-01

One of the many services that intelligent systems can provide is the ability to analyze the impact of different medical conditions on daily behavior. In this study, we use smart home and wearable sensors to collect data, while ( n = 84) older adults perform complex activities of daily living. We analyze the data using machine learning techniques and reveal that differences between healthy older adults and adults with Parkinson disease not only exist in their activity patterns, but that these differences can be automatically recognized. Our machine learning classifiers reach an accuracy of 0.97 with an area under the ROC curve value of 0.97 in distinguishing these groups. Our permutation-based testing confirms that the sensor-based differences between these groups are statistically significant.

Social and health care needs of elderly people living in the countryside in Poland.

PubMed

Dziechciaż, Małgorzata; Guty, Edyta; Wojtowicz, Agata; Filip, Rafał

2012-01-01

The needs of elderly people living in the countryside constitute serious health, social, financial and organizational problems. To define the needs of elderly people living in the countryside regarding complex living actions. DATA COLLECTED AND METHODOLOGY: The study was carried out among 89 village citizens from the Podkarpackie Voivodeship (N=55; 61.8% women; N=34; 38.2% men) aged 61-2. Average age in the group was 76.3 (+/ -7.9 years). Research methods were 3 different questionnaires, applied to evaluate: socio-demographic data, occurrence of diseases and rehabilitation usage, mental and intellectual status, as well as the Lawton scale (IADL) assessing complex life activities. 18 subjects (20.2%) were fully functional in the scope of complex everyday activities. The highest number were independent in their financial affairs (N=52; 58.4%), preparation and taking of medicine (N=45; 50.6%), and using the telephone (N=39; 43.8%). Lack of self-reliance was most commonly observed with difficult housework (N=62; 69.7%), shopping (N=55; 61.8%), and walking distances exceeding regular walks (N=46; 51.7%). No relation was observed between gender, usage of social welfare, and self-reliance in complex everyday activities. Deterioration in efficiency in the scope of complex everyday activities was observed which progressed with age, and was worse among the unmarried subjects. A relation between material situation and independence, based on the IADL scale, was confirmed, with the exception of using the telephone. 1). People of old age living in the countryside most often need help with complex everyday housework, shopping, and walking distances exceeding regular walks. 2). With the advancement of age, the subjects need help with all IADL activities increased.

Effects of combined fine motor skill and cognitive therapy to cognition, degree of dementia, depression, and activities of daily living in the elderly with Alzheimer's disease.

PubMed

Lee, Jin; Lee, ByoungHee; Park, YuHyung; Kim, Yumi

2015-10-01

[Purpose] This study evaluated the effects of combined fine motor skill and cognitive therapies on cognition, depression, and activities of daily living in elderly patients with Alzheimer's disease (AD). [Subjects and Methods] Twenty-six participants comprised 2 groups. The experimental group (n=13) received combined fine motor skill and cognitive therapy, and the control group (n=13) received only general medical care. [Results] The experimental group showed improvements in cognition, degree of dementia, depression, and activities of daily living compared to the control group. However, there were no significant differences between the two groups. [Conclusion] These results suggest that combined fine motor skill and cognitive therapy improves cognition, degree of dementia, depression, and daily living in elderly patients with AD. These therapies would therefore be effective as general medical care strategies.

Anxiety, depression, and cognitive impairment in dementia-specific and traditional assisted living.

PubMed

Kang, Hyunwook; Smith, Marianne; Buckwalter, Kathleen C; Ellingrod, Vicki; Schultz, Susan K

2010-01-01

With the rapid growth of the assisted living (AL) industry, the number of AL residences providing dementia care continues to increase. The purpose of this article is to describe and compare demographic characteristics; frequency and type of psychiatric diagnoses; level of cognition, depression, and anxiety symptoms; and use of psychotropic medication among older adults in dementia-specific assisted living (DSAL) and traditional assisted living (TAL) residences. Secondary analysis of screening data collected during a cross-sectional, descriptive pilot project compared 18 participants from two DSAL facilities and 28 participants from three TAL facilities. DSAL participants with dementia were more cognitively impaired than TAL participants with dementia (p < 0.001) and used more antipsychotic (67%), anxiolytic (60%), antidepressant (53%), and cognitive-enhancing (87%) medications. No statistically significant differences in demographic factors or levels of anxiety or depression were observed among residents in either setting. Copyright 2010, SLACK Incorporated.

Anxiety, Depression, and Cognitive Impairment in Dementia-Specific and Traditional Assisted Living

PubMed Central

Kang, Hyunwook; Smith, Marianne; Buckwalter, Kathleen C.; Ellingrod, Vicki; Schultz, Susan K.

2010-01-01

With the rapid growth of the assisted living (AL) industry, the number of AL residences providing dementia care continues to increase. The purpose of this article is to describe and compare demographic characteristics; frequency and type of psychiatric diagnoses; level of cognition, depression, and anxiety symptoms; and use of psychotropic medication among older adults in dementia-specific assisted living (DSAL) and traditional assisted living (TAL) residences. Secondary analysis of screening data collected during a cross-sectional, descriptive pilot project compared 18 participants from two DSAL facilities and 28 participants from three TAL facilities. DSAL participants with dementia were more cognitively impaired than TAL participants with dementia (p < 0.001) and used more antipsychotic (67%), anxiolytic (60%), antidepressant (53%), and cognitive-enhancing (87%) medications. No statistically significant differences in demographic factors or levels of anxiety or depression were observed among residents in either setting. PMID:20047249

Organ transplantation: legal, ethical and islamic perspective in Nigeria.

PubMed

Bakari, Abubakar A; Abbo Jimeta, Umar S; Abubakar, Mohammed A; Alhassan, Sani U; Nwankwo, Emeka A

2012-07-01

Organ transplantation dates back to the ancient times and since then it has become one of the important developments in modern medicine; saving the lives, as well as improving the quality of life of many patients. As the demand for organ transplantation far exceeds the organ availability, the transplant program is often saddled with complex legal and ethical issues. This review article highlights the legal and ethical issues that might arise regarding organ transplantation and appraises the existing legal frame work governing organ transplantation in Nigeria. Information on legal, cultural, religious and medical ethical issues regarding organ transplantation in Nigeria was obtained by searching the PubMed and Google Scholar, conference proceedings, seminar paper presentations, law library and other related publications were collated and analyzed. In decision making for organ transplantation, the bioethical principles like autonomy, beneficence and justice must be employed. It was believed by Catholic theologians that to mutilate one living person to benefit another violates the principle of Totality. Among Muslim scholars and researchers, there are those who throw legal support as to its permissibility while the other group sees it as illegal. Organ/tissues transplantation is considered a medical intervention that touches on the fundamental rights of the donor or the recipient. Where there is an unlawful infringement of the right of such persons in any way may be regarded as against Section 34 of the 1999 Nigerian Constitution dealing with right to dignity of the human person. Worldwide, the researchers and government bodies have agreed on informed consent for organ/tissue donation and for recipient should be obtained without coercion before embarking on such medical treatment Worldwide organ transplantation has become the best medical treatment for patients with end stage organ failure. However, there is no law/legislation backing organ/tissues transplantation in Nigeria. The government should take measures to combat transplantation tourism and the problem of national and international trafficking in human tissues and organs, ethics commission and National Transplant registry should be established in order to monitor and regulate the programme in the country.

Organ Transplantation: Legal, Ethical and Islamic Perspective in Nigeria

PubMed Central

Bakari, Abubakar A; Abbo Jimeta, Umar S; Abubakar, Mohammed A; Alhassan, Sani U; Nwankwo, Emeka A

2012-01-01

Organ transplantation dates back to the ancient times and since then it has become one of the important developments in modern medicine; saving the lives, as well as improving the quality of life of many patients. As the demand for organ transplantation far exceeds the organ availability, the transplant program is often saddled with complex legal and ethical issues. This review article highlights the legal and ethical issues that might arise regarding organ transplantation and appraises the existing legal frame work governing organ transplantation in Nigeria. Information on legal, cultural, religious and medical ethical issues regarding organ transplantation in Nigeria was obtained by searching the PubMed and Google Scholar, conference proceedings, seminar paper presentations, law library and other related publications were collated and analyzed. In decision making for organ transplantation, the bioethical principles like autonomy, beneficence and justice must be employed. It was believed by Catholic theologians that to mutilate one living person to benefit another violates the principle of Totality. Among Muslim scholars and researchers, there are those who throw legal support as to its permissibility while the other group sees it as illegal. Organ/tissues transplantation is considered a medical intervention that touches on the fundamental rights of the donor or the recipient. Where there is an unlawful infringement of the right of such persons in any way may be regarded as against Section 34 of the 1999 Nigerian Constitution dealing with right to dignity of the human person. Worldwide, the researchers and government bodies have agreed on informed consent for organ/tissue donation and for recipient should be obtained without coercion before embarking on such medical treatment Worldwide organ transplantation has become the best medical treatment for patients with end stage organ failure. However, there is no law/legislation backing organ/tissues transplantation in Nigeria. The government should take measures to combat transplantation tourism and the problem of national and international trafficking in human tissues and organs, ethics commission and National Transplant registry should be established in order to monitor and regulate the programme in the country. PMID:24027394

Complexity perplexity: a systematic review to describe the measurement of medication regimen complexity.

PubMed

Paquin, Allison M; Zimmerman, Kristin M; Kostas, Tia R; Pelletier, Lindsey; Hwang, Angela; Simone, Mark; Skarf, Lara M; Rudolph, James L

2013-11-01

Complex medication regimens are error prone and challenging for patients, which may impact medication adherence and safety. No universal method to assess the complexity of medication regimens (CMRx) exists. The authors aim to review literature for CMRx measurements to establish consistencies and, secondarily, describe CMRx impact on healthcare outcomes. A search of EMBASE and PubMed for studies analyzing at least two medications and complexity components, among those self-managing medications, was conducted. Out of 1204 abstracts, 38 studies were included in the final sample. The majority (74%) of studies used one of five validated CMRx scales; their components and scoring were compared. Universal CMRx assessment is needed to identify and reduce complex regimens, and, thus, improve safety. The authors highlight commonalities among five scales to help build consensus. Common components (i.e., regimen factors) included dosing frequency, units per dose, and non-oral routes. Elements (e.g., twice daily) of these components (e.g., dosing frequency) and scoring varied. Patient-specific factors (e.g., dexterity, cognition) were not addressed, which is a shortcoming of current scales and a challenge for future scales. As CMRx has important outcomes, notably adherence and healthcare utilization, a standardized tool has potential for far-reaching clinical, research, and patient-safety impact.

Effect of air quality on assisted human reproduction.

PubMed

Legro, Richard S; Sauer, Mark V; Mottla, Gilbert L; Richter, Kevin S; Li, Xian; Dodson, William C; Liao, Duanping

2010-05-01

Air pollution has been associated with reproductive complications. We hypothesized that declining air quality during in vitro fertilization (IVF) would adversely affect live birth rates. Data from US Environmental Protection Agency air quality monitors and an established national-scale, log-normal kriging method were used to spatially estimate daily mean concentrations of criteria pollutants at addresses of 7403 females undergoing their first IVF cycle and at the their IVF labs from 2000 to 2007 in the Northeastern USA. These data were related to pregnancy outcomes. Increases in nitrogen dioxide (NO(2)) concentration both at the patient's address and at the IVF lab were significantly associated with a lower chance of pregnancy and live birth during all phases of an IVF cycle from medication start to pregnancy test [most significantly after embryo transfer, odds ratio (OR) 0.76, 95% confidence interval (CI) 0.66-0.86, per 0.01 ppm increase]. Increasing ozone (O(3)) concentration at the patient's address was significantly associated with an increased chance of live birth during ovulation induction (OR 1.26, 95% CI 1.10-1.44, per 0.02 ppm increase), but with decreased odds of live birth when exposed from embryo transfer to live birth (OR 0.62, 95% CI 0.48-0.81, per 0.02 ppm increase). After modeling for interactions of NO(2) and O(3) at the IVF lab, NO(2) remained negatively and significantly associated with live birth (OR 0.86, 95% CI 0.78-0.96), whereas O(3) was non-significant. Fine particulate matter (PM(2.5)) at the IVF lab during embryo culture was associated with decreased conception rates (OR 0.90, 95% CI 0.82-0.99, per 8 microg/m(3) increase), but not with live birth rates. No associations were noted with sulfur dioxide or larger particulate matter (PM(10)). The effects of declining air quality on reproductive outcomes after IVF are variable, cycle-dependent and complex, though increased NO(2) is consistently associated with lower live birth rates. Our findings are limited by the lack of direct measure of pollutants at homes and lab sites.

Medical Issues: Breathing

MedlinePlus

... Funding Opportunities Research Conference Recruit for Clinical Trials Research Publications Spinraza Support & Care For Newly Diagnosed Care Packages Information Packets Equipment Pool Living With SMA Medical Issues Palliative Breathing Orthopedics Nutrition Equipment Daily Life At School At Home ...

Medical Issues: Nutrition

MedlinePlus

... Funding Opportunities Research Conference Recruit for Clinical Trials Research Publications Spinraza Support & Care For Newly Diagnosed Care Packages Information Packets Equipment Pool Living With SMA Medical Issues Palliative Breathing Orthopedics Nutrition Equipment Daily Life At School At Home ...

GERD: Can Certain Medications Increase Severity?

MedlinePlus

... com/home. Accessed Dec. 31, 2014. Bisphosphonates. Facts & Comparisons. http://www.factsandcomparisons.com. Accessed Dec. 31, 2014. ... Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education ...

[Internet-based continuing medical education: as effective as live continuing medical education].

PubMed

Maisonneuve, Hervé; Chabot, Olivier

2009-10-01

E-learning consists in using new multimedia and Internet technologies to improve the quality of learning activities by facilitating access to resources and services, as well as exchanges and remote collaboration. The Internet is used for adult education in most professional domains, but its use for continuing medical education is less developed. Advantages are observed for teachers (e.g., permanent updating, interactive links, illustrations, archiving, and collective intelligence) and for the learners (e.g., accessibility, autonomy, flexibility, and adaptable pace). Research and meta-analyses have shown that e-CME is as effective as live events for immediate and retained learning. English-language educational medical websites that grant CME credits are numerous; few such French-language sites can currently grant credits. Accreditation of websites for CME, in its infancy in Europe, is common in North America.

Medication education and consultation at a senior dining program for independently living seniors.

PubMed

Schmiedt, Dean; Ellingson, Jody

2010-08-01

To determine if pharmacist involvement within a senior dining program benefits diners by addressing their medication-related questions, using educational sessions, and providing individual consultations. Catholic Charities Senior Dining sites in central Minnesota. Pharmacists went to three senior dining sites, providing educational sessions and individual consultations to independently living senior diners. Pharmacists developed a program, in a nontraditional setting, that used educational sessions and individual consultations to assist seniors with their medication-related questions. The number of diner questions, significant issues raised, issues addressed, and level of diner satisfaction. Pharmacists made 36 visits from January to December 2009. During those visits they presented educational talks to 3,089 diners, and 12.4% of all diners spoke individually with pharmacists. Pharmacists addressed 581 questions or concerns from 384 diners. Significant issues were noted in 25.8% of individual consultations (144 questions). The most common significant issues included: adverse drug reactions (59), indications without treatment (27), and drug interactions (23). Nonopioid analgesics, antilipemics, and antihypertensive medications were most commonly involved in significant issues. Satisfaction surveys were strongly positive, with 97% indicating pharmacists had addressed their medication-related concern; only 3% did not reply. Almost half (42.7%) of satisfaction surveys indicated the diner would change something as a result of meeting with the pharmacist. Pharmacist availability in a nontraditional setting can assist seniors with addressing potentially significant medication-related issues. Independently living seniors will seek out information from a pharmacist in a convenient setting.

Influence of medical care in the quality of life (WHOQOL-100) of women living with systemic lupus erythematosus.

PubMed

da Silva, Juliana Passos; Amadei, Janete Lane

2016-01-01

Lupus requires careful treatment by medical specialists. This study aimed to evaluate the quality of life of patients living with Systemic Lupus Erythematosus (SLE). The method approached women with a confirmed diagnosis of SLE under medical supervision in a University hospital outpatient clinic or in a private clinic. We used an instrument containing relevant information of the patient and also the Portuguese version of the World Health Organization Quality of Life Group (WHOQOL-100) questionnaire. The study population consisted of 39 women, married in their majority (56.4%); prevalently aged 37-60 years old; prevalence of diagnosis time over five years (66.7%); and in use of less than 5 medications (69.2%). 92.3% had the disease inactive with higher means in mobility (p=0.0463) and quality of life (p=0.0199) facets; on the other hand, the physical safety and security facet (p=0.0093) showed higher mean for people with active disease. Health and social care analysis showed availability and quality (p=0.0434), even when with other associated diseases (33.3%); and the highest means were Dependence on medicinal substances and medical aids (p=0.0143). The negative results for associated diseases were higher in sexual activity (p=0.0431) and transportation (p=0.0319) facets. if women living with SLE receive continuous medical attention, they will enjoy good quality of life, while minimizing the complications inherent in this condition. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

The Limits of Narrative: Provocations for the Medical Humanities

PubMed Central

Woods, Angela

2014-01-01

This paper aims to (re)ignite debate about the role of narrative in the medical humanities. It begins with a critical review of the ways in which narrative has been mobilised by humanities and social science scholars to understand the experience of health and illness. I highlight seven dangers or blind spots in the dominant medical humanities approach to narrative, including the frequently unexamined assumption that all human beings are “naturally narrative.” I then explore this assumption further through an analysis of philosopher Galen Strawson’s influential article “Against Narrativity.” Strawson rejects the descriptive claim that “human beings typically see or live or experience their lives as a narrative” and the normative claim that “a richly Narrative outlook is essential to a well-lived life, to true or full personhood.” His work has been taken up across a range of disciplines but its implications in the context of health and illness have not yet been sufficiently discussed. This article argues that “Against Narrativity” can and should stimulate robust debate within the medical humanities regarding the limits of narrative, and concludes by discussing a range of possibilities for venturing “beyond narrative.” PMID:22038696

Health and aging in elderly farmers: the AMI cohort

PubMed Central

2012-01-01

Background The health of the agricultural population has been previously explored, particularly in relation to the farming exposures and among professionally active individuals. However, few studies specifically focused on health and aging among elders retired from agriculture. Yet, this population faces the long-term effects of occupational exposures and multiple difficulties related to living and aging in rural area (limited access to shops, services, and practitioners). However, these difficulties may be counter-balanced by advantages related to healthier lifestyle, richer social support and better living environment. The general aim of the AMI cohort was to study health and aging in elderly farmers living in rural area through a multidisciplinary approach, with a main focus on dementia. Methods/design The study initially included 1 002 participants, randomly selected from the Farmer Health Insurance rolls. Selection criteria were: being 65 years and older; living in rural area in Gironde (South-Western France); being retired from agriculture after at least 20 years of activity and being affiliated to the Health Insurance under own name. The study started in 2007, with two follow-up visits over 5 years. Baseline visits were conducted at home by a neuropsychologist then by a geriatrician for all cases suspected of dementia, Parkinson’s disease and depression (to confirm the diagnosis), and by a nurse for others. A large panel of data were collected through standardised questionnaires: complete neuropsychological assessment, material and social living environment, psychological transition to retirement, lifestyle (smoking, alcohol and diet), medications, disability in daily living, sensory impairments and some clinical measures (blood pressure, depression symptomatology, anxiety, visual test, anthropometry…). A blood sampling was performed with biological measurements and constitution of a biological bank, including DNA. Brain MRI were also performed on 316 of the participants. Finally, the three-year data on health-related reimbursements were extracted from the Health System database (medications, medical and paramedical consultations, biological examinations and medical devices), and the registered Long-Term Diseases (30 chronic diseases 100% covered by the Insurance System). Discussion AMI is the first French longitudinal study on health and aging set up in a population of elderly farmers living in rural area through a multidisciplinary approach. PMID:22839764

The doctor-patient relationship in living donor kidney transplantation.

PubMed

Danovitch, Gabriel M

2007-11-01

A therapeutic and effective doctor-patient relationship and patient-doctor relationship is at the core of all successful medical care. The medical and psychological evaluation of a potential kidney donor serves to protect the long-term health of both the donor and the potential recipient. Careful assessment of risk and donor education is at the core of donor evaluation and the decision to progress with donation requires refined clinical judgment by the medical team and critical thinking by the donor. Increasing pressure to increase the numbers of living donor transplants and suggestions by some that the process should be commercialized make it timely to consider the nature of the relationship between the doctor and the patient in the unusual circumstance of living donation. A high rate of complications in recipients of purchased kidneys and a lack of knowledge of the fate of paid donors have been reported. Commercialization of transplantation undermines the therapeutic doctor-patient relationship and threatens the healthy development of the international transplant endeavor.

76 FR 33015 - Self-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-07

..., specifically a Complex Order Live Auction (``COLA'').\\5\\ The Exchange is not amending the Rebate for Adding... (collectively ``Other Auctions''). \\5\\ COLA is the automated Complex Order Live Auction process. A COLA may take place upon identification of the existence of a COLA- eligible order either: (1) Following a COOP, or (2...

Educational Debt in the Context of Career Planning: A Qualitative Exploration of Medical Student Perceptions.

PubMed

Phillips, Julie P; Wilbanks, Deana M; Salinas, Diana F; Doberneck, Diane M

2016-01-01

Phenomenon: Medical students in the United States face increasing educational debt because medical education costs have risen while public investment in higher education has declined. Contemporary students borrow more money and accumulate debt far surpassing that of previous generations of physicians, and both interest rates and terms of loan repayment have changed significantly in the last decade. As a result, the experiences of medical students differ from the experiences of physician educators. Little is known about how contemporary medical students view their debt in the context of career planning. Understanding contemporary U.S. medical students' lived experiences of educational debt is important, because high debt levels may affect medical students' well-being and professional development. The study's purpose was to explore contemporary students' views of their debt in the context of career planning. In 2012, 2nd-year medical students enrolled in a health policy course at one medical school were invited to write an essay about how debt influences their career choices. The authors analyzed 132 essays using immersion and crystallization and iterative, team-based coding. Code-recode strategies, member checking, and reflexivity ensured validity and rigor. Three themes emerged about the meaning of debt: debt symbolizes lack of social investment, debt reinforces a sense of entitlement, and debt is a collective experience. Four approaches to debt management emerged: anticipation, avoidance, acceptance, and disempowerment. Insights: Medical students' views of debt are more complex than previously reported. Medical educators should recognize that many students experience debt as a stressor, acknowledge students' emotions about debt, and invite discussion about the culture of entitlement in medical education and how this culture affects students' professionalism. At the same time, educators should emphasize that students have many repayment options and that regardless of specialty choice, most physicians repay their debts without significant difficulty. Further exploration is needed of the relationships between the amount of debt owed, students' attitudes toward their debt, and other student characteristics. Because students experience debt in a range of ways, more nuanced approaches to understanding and reframing student perceptions of debt are necessary.

Nursing delegation and medication administration in assisted living.

PubMed

Mitty, Ethel; Resnick, Barbara; Allen, Josh; Bakerjian, Debra; Hertz, Judith; Gardner, Wendi; Rapp, Mary Pat; Reinhard, Susan; Young, Heather; Mezey, Mathy

2010-01-01

Assisted living (AL) residences are residential long-term care settings that provide housing, 24-hour oversight, personal care services, health-related services, or a combination of these on an as-needed basis. Most residents require some assistance with activities of daily living and instrumental activities of daily living, such as medication management. A resident plan of care (ie, service agreement) is developed to address the health and psychosocial needs of the resident. The amount and type of care provided, and the individual who provides that care, vary on the basis of state regulations and what services are provided within the facility. Some states require that an RN hold a leadership position to oversee medication management and other aspects of care within the facility. A licensed practical nurse/licensed vocational nurse can supervise the day-to-day direct care within the facility. The majority of direct care in AL settings is provided by direct care workers (DCWs), including certified nursing assistants or unlicensed providers. The scope of practice of a DCW varies by state and the legal structure within that state. In some states, the DCW is exempt from the nurse practice act, and in some states, the DCW may practice within a specific scope such as being a medication aide. In most states, however, the DCW scope of practice is conscribed, in part, by the delegation of responsibilities (such as medication administration) by a supervising RN. The issue of RN delegation has become the subject of ongoing discussion for AL residents, facilities, and regulators and for the nursing profession. The purpose of this article is to review delegation in AL and to provide recommendations for future practice and research in this area.

Concordance of Advance Care Plans With Inpatient Directives in the Electronic Medical Record for Older Patients Admitted From the Emergency Department.

PubMed

Grudzen, Corita R; Buonocore, Philip; Steinberg, Jonathan; Ortiz, Joanna M; Richardson, Lynne D

2016-04-01

Measuring What Matters identified quality indicators to examine the percentage of patients with documentation of a surrogate decision maker and preferences for life-sustaining treatments. To determine the rate of advance care planning in older adults presenting to the emergency department (ED) and translation into medical directives in the electronic medical record (EMR). A convenience sample of adults 65 years or older was recruited from a large urban ED beginning in January 2012. We administered a baseline interview and survey in English or Spanish, including questions about whether patients had a documented health care proxy or living will. For patients admitted to the hospital who had a health care proxy or living will, chart abstraction was performed to determine whether their advance care preferences were documented in the EMR. From February 2012 to May 2013, 53.8% (367 of 682) of older adults who completed the survey in the ED reported having a health care proxy, and 40.2% (274 of 682) had a living will. Of those admitted to the hospital, only 4% (4 of 94) of patients who said they had a living will had medical directives documented in the EMR. Similarly, only 4% (5 of 115) of patients who had a health care proxy had the person's name or contact information documented in their medical record. About half of the patients 65 years or older arriving in the ED have done significant advance care planning, but most plans are not recorded in the EMR. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Virtual reality and live simulation: a comparison between two simulation tools for assessing mass casualty triage skills.

PubMed

Luigi Ingrassia, Pier; Ragazzoni, Luca; Carenzo, Luca; Colombo, Davide; Ripoll Gallardo, Alba; Della Corte, Francesco

2015-04-01

This study tested the hypothesis that virtual reality simulation is equivalent to live simulation for testing naive medical students' abilities to perform mass casualty triage using the Simple Triage and Rapid Treatment (START) algorithm in a simulated disaster scenario and to detect the improvement in these skills after a teaching session. Fifty-six students in their last year of medical school were randomized into two groups (A and B). The same scenario, a car accident, was developed identically on the two simulation methodologies: virtual reality and live simulation. On day 1, group A was exposed to the live scenario and group B was exposed to the virtual reality scenario, aiming to triage 10 victims. On day 2, all students attended a 2-h lecture on mass casualty triage, specifically the START triage method. On day 3, groups A and B were crossed over. The groups' abilities to perform mass casualty triage in terms of triage accuracy, intervention correctness, and speed in the scenarios were assessed. Triage and lifesaving treatment scores were assessed equally by virtual reality and live simulation on day 1 and on day 3. Both simulation methodologies detected an improvement in triage accuracy and treatment correctness from day 1 to day 3 (P<0.001). The time to complete each scenario and its decrease from day 1 to day 3 were detected equally in the two groups (P<0.05). Virtual reality simulation proved to be a valuable tool, equivalent to live simulation, to test medical students' abilities to perform mass casualty triage and to detect improvement in such skills.

Moving Beyond Routines in Teaching and Learning: Releasing the Educative Potential of Published Eating Disorder Memoirs.

PubMed

Lee Brien, Donna; McAllister, Margaret

2017-05-01

Learning from the lived experience of disordered eating is vital for contemporary mental health practitioners. While mental health practitioners need to understand the psycho-biological issues that impact the person and family with an eating disorder, there is much about this complex condition that eludes and escapes a bio-medical perspective. Use of an aesthetic lens on the issue can illuminate various challenges, tensions and insights that people with disordered eating experience along the journey of their ill-health and on to their recovery, but which often remain unstated in the clinical context. Scholars within the creative arts discipline are experts in making judgements about the quality of artworks they encounter and have highly developed aesthetic knowing. Yet, the central skills and knowledges embodied in creative arts activity are not widely utilized outside that sphere. This article reports on how aesthetics can be applied to sensitize mental health practitioners to appreciate the lived experience of a mental health challenge such as an eating disorder. Such mental health practitioners play an important role in the health service, yet the widespread diffusion of the bio-medical model into mental health, once characterized for its equal emphasis on the psycho-social-cultural, has led to criticisms of an over-focus on illness identification, at the expense of accommodating the meanings of subjective and unique experiences of mental health, struggle and recovery. Using Kate Grenville's typology of the elements of effective creative writing, we show how these elements contribute to the aesthetic power and impact of particular eating disorder memoirs.

[Physical therapy for parkinson's disease].

PubMed

Hubert, M

2011-09-01

Parkinson's disease is a complex neurologic and progressive incapacitating disease. Parkinson's disease severely threatens the quality of live and the number of patients worldwide is expected to rise considerably in the coming decade due to aging of the population. Even with optimal medical management using drugs or neurosurgery, patients are faced with progressively increasing impairments (e.g. in speech, mental and movement related functions), and restrictions in participation (e.g. domestic life and social activities). Physical therapy is often prescribed next to medical treatment but there is a lack of uniform treatment. A systematic literature search for guidelines, systematic reviews, trials, and expert opinions lead to a better understanding. The key question: Is physiotherapy able to optimally treat the Parkinson's disease symptoms? In which way, how and on which scientific bases can the physiotherapist participate to improve autonomy and to help them living independently and avoid, as long as possible, institutionalization? This article has integrated clinical research findings to provide clinicians with an overview to physical therapist management of disorders in people with Parkinson's disease. An Evidence-Based Physical Therapy Guideline providing practice recommendations was developed by the Royal Dutch Society for Physical Therapy (KNGF). Evidence from research was supplemented with clinical expertise and patients values. Randomized clinical trials reflect specific core areas of physical therapy, that is, transfer, posture, balance, reaching and grasping, gait and physical condition. Another aspect is that of educating patients (as well as their partners and family) about the disease process and the benefits of exercise therapy. Alternative therapies can be helpful like Tai Chi, virtual games, dancing, yoga, ball games for example.

Entropy for the Complexity of Physiological Signal Dynamics.

PubMed

Zhang, Xiaohua Douglas

2017-01-01

Recently, the rapid development of large data storage technologies, mobile network technology, and portable medical devices makes it possible to measure, record, store, and track analysis of biological dynamics. Portable noninvasive medical devices are crucial to capture individual characteristics of biological dynamics. The wearable noninvasive medical devices and the analysis/management of related digital medical data will revolutionize the management and treatment of diseases, subsequently resulting in the establishment of a new healthcare system. One of the key features that can be extracted from the data obtained by wearable noninvasive medical device is the complexity of physiological signals, which can be represented by entropy of biological dynamics contained in the physiological signals measured by these continuous monitoring medical devices. Thus, in this chapter I present the major concepts of entropy that are commonly used to measure the complexity of biological dynamics. The concepts include Shannon entropy, Kolmogorov entropy, Renyi entropy, approximate entropy, sample entropy, and multiscale entropy. I also demonstrate an example of using entropy for the complexity of glucose dynamics.

A virtual reality patient simulation system for teaching emergency response skills to U.S. Navy medical providers.

PubMed

Freeman, K M; Thompson, S F; Allely, E B; Sobel, A L; Stansfield, S A; Pugh, W M

2001-01-01

Rapid and effective medical intervention in response to civil and military-related disasters is crucial for saving lives and limiting long-term disability. Inexperienced providers may suffer in performance when faced with limited supplies and the demands of stabilizing casualties not generally encountered in the comparatively resource-rich hospital setting. Head trauma and multiple injury cases are particularly complex to diagnose and treat, requiring the integration and processing of complex multimodal data. In this project, collaborators adapted and merged existing technologies to produce a flexible, modular patient simulation system with both three-dimensional virtual reality and two-dimensional flat screen user interfaces for teaching cognitive assessment and treatment skills. This experiential, problem-based training approach engages the user in a stress-filled, high fidelity world, providing multiple learning opportunities within a compressed period of time and without risk. The system simulates both the dynamic state of the patient and the results of user intervention, enabling trainees to watch the virtual patient deteriorate or stabilize as a result of their decision-making speed and accuracy. Systems can be deployed to the field enabling trainees to practice repeatedly until their skills are mastered and to maintain those skills once acquired. This paper describes the technologies and the process used to develop the trainers, the clinical algorithms, and the incorporation of teaching points. We also characterize aspects of the actual simulation exercise through the lens of the trainee.

Towards the systematic development of medical networking technology.

PubMed

Faust, Oliver; Shetty, Ravindra; Sree, S Vinitha; Acharya, Sripathi; Acharya U, Rajendra; Ng, E Y K; Poo, Chua Kok; Suri, Jasjit

2011-12-01

Currently, there is a disparity in the availability of doctors between urban and rural areas of developing countries. Most experienced doctors and specialists, as well as advanced diagnostic technologies, are available in urban areas. People living in rural areas have less or sometimes even no access to affordable healthcare facilities. Increasing the number of doctors and charitable medical hospitals or deploying advanced medical technologies in these areas might not be economically feasible, especially in developing countries. We need to mobilize science and technology to master this complex, large scale problem in an objective, logical, and professional way. This can only be achieved with a collaborative effort where a team of experts works on both technical and non-technical aspects of this health care divide. In this paper we use a systems engineering framework to discuss hospital networks which might be solution for the problem. We argue that with the advancement in communication and networking technologies, economically middle class people and even some rural poor have access to internet and mobile communication systems. Thus, Hospital Digital Networking Technologies (HDNT), such as telemedicine, can be developed to utilize internet, mobile and satellite communication systems to connect primitive rural healthcare centers to well advanced modern urban setups and thereby provide better consultation and diagnostic care to the needy people. This paper describes requirements and limitations of the HDNTs. It also presents the features of telemedicine, the implementation issues and the application of wireless technologies in the field of medical networking.

Making Medical Decisions for a Loved One at the End of Life

MedlinePlus

... use a living will or durable power of attorney for health care? Do you have these papers ... Helpful Words Living wills and durable powers of attorney are written advance directives and follow state law. ...

Living in Latvia after stroke: the association between functional, social and personal factors and the level of self-perceived disability-a cross-sectional study.

PubMed

Bērziņa, Guna; Smilškalne, Baiba; Vētra, Anita; Sunnerhagen, Katharina S

2016-06-24

To investigate how functional, social and personal factors are associated with self-perceived level of disability in the chronic phase of stroke in a Latvian stroke population. The consequences of stroke can vary greatly and often leads to long-term disability that, according to the WHO definitions, depends on the interaction between the person and his/her context. Cross-sectional study with retrospective data gathering. Community-dwelling persons who received specialised in-patient rehabilitation after stroke in Latvia. Of 600 persons after stroke who were identified through hospital register and selected for the study, 255 were included in the analysis. The medical information and discharge data of the Functional Independence Measure (FIM) was extracted from medical records. Participants filled out a questionnaire on sociodemographic information and the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), either in Latvian or Russian, depending on their wish when contacted for their oral agreement to participate. Stepwise multiple regression analysis was conducted to find a model that best explains the variance in WHODAS 2.0 scores. The models explained 23-43.5% of variance in outcomes. The best explained WHODAS 2.0 domains were 'mobility' and 'self-care'. The significant factors were level of independence in 'self-care', 'locomotion' and 'communication' according to FIM, as well as working status, time since rehabilitation, age, gender, living alone or in family and preferred language. Functional, social and personal factors are of similar importance when explaining self-perceived disability in the chronic phase of stroke. Some, but not all, of the factors are modifiable by the healthcare system. Therefore, a complex approach and involvement of medical, social and political systems is needed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Integrating care for individuals with FASD: results from a multi-stakeholder symposium.

PubMed

Masotti, Paul; Longstaffe, Sally; Gammon, Holly; Isbister, Jill; Maxwell, Breann; Hanlon-Dearman, Ana

2015-10-05

Fetal Alcohol Spectrum Disorder (FASD) has a significant impact on communities and systems such as health, education, justice and social services. FASD is a complex neurodevelopmental disorder that results in permanent disabilities and associated service needs that change across affected individuals' lifespans. There is a degree of interdependency among medical and non-medical providers across these systems that do not frequently meet or plan a coordinated continuum of care. Improving overall care integration will increase provider-specific and system capacity, satisfaction, quality of life and outcomes. We conducted a consensus generating symposium comprised of 60 experts from different stakeholder groups: Allied & Mental Health, Education, First Nations & Métis Health, Advocates, Primary Care, Government Health Policy, Regional FASD Coordinators, Social Services, and Youth Justice. Research questions addressed barriers and solutions to integration across systems and group-specific and system-wide research priorities. Solutions and consensus on prioritized lists were generated by combining the Electronic Meeting System approach with a modified 'Nominal Group Technique'. FASD capacity (e.g., training, education, awareness) needs to be increased in both medical and non-medical providers. Outcomes and integration will be improved by implementing: multidisciplinary primary care group practice models, FASD system navigators/advocates, and patient centred medical homes. Electronic medical records that are accessible to multiple medical and non-medical providers are a key tool to enhancing integration and quality. Eligibility criteria for services are a main barrier to integration across systems. There is a need for culturally and community-specific approaches for First Nations communities. There is a need to better integrate care for individuals and families living with FASD. Primary Care is well positioned to play a central and important role in facilitating and supporting increased integration. Research is needed to better address best practices (e.g., interventions, supports and programs) and long-term individual and family outcomes following a diagnosis of FASD.

Type, number or both? A population-based matched case-control study on the risk of fall injuries among older people and number of medications beyond fall-inducing drugs.

PubMed

Laflamme, Lucie; Monárrez-Espino, Joel; Johnell, Kristina; Elling, Berty; Möller, Jette

2015-01-01

Drug use is a modifiable risk factor for fall-related injuries in older people. Whereas the injurious effect of polypharmacy is established, that of low numbers of medications has not been fully ascertained. Neither do we know whether it is the number per se or the type of medications that actually matters. We assessed this question for fall injuries leading to hospitalization. National register-based, population-based, matched case-control study. Community dwellers aged 65+ years living in Sweden between March 2006 and December 2009. Cases (n = 64,399) were identified in the national inpatient register and four controls per case were randomly matched by gender, date of birth and residential area. The association between number of prescribed medications, assessed through linkage with the Swedish prescribed drug register, and the risk of injurious falls was estimated with odds ratios with 95% confidence intervals using conditional logistic regression, adjusted for demographic and health status. The number of medications was associated with an increased risk of fall injury in a dose-response fashion, even after adjustment for marital status, comorbidity and number of fall-risk-inducing drugs (FRIDs). Using ten or more medications was associated with an almost two-fold higher risk (adjusted OR: 1.76, 95% CI: 1.66 to 1.88). When stratified by use (or not) of at least one FRID, the association weakened slightly among both non-users (adjusted OR: 1.50, 95% CI: 1.34 to 1.67) and users (adjusted OR: 1.67, 95% CI: 1.58 to 1.77). In older people, not only large but also small numbers of medications may affect the risk for them to sustain injurious falls. Although the mechanisms lying behind this are complex, the finding challenges the prevention strategies targeting either specific types of medications (FRIDs) or high numbers of them.

Chromatin Computation

PubMed Central

Bryant, Barbara

2012-01-01

In living cells, DNA is packaged along with protein and RNA into chromatin. Chemical modifications to nucleotides and histone proteins are added, removed and recognized by multi-functional molecular complexes. Here I define a new computational model, in which chromatin modifications are information units that can be written onto a one-dimensional string of nucleosomes, analogous to the symbols written onto cells of a Turing machine tape, and chromatin-modifying complexes are modeled as read-write rules that operate on a finite set of adjacent nucleosomes. I illustrate the use of this “chromatin computer” to solve an instance of the Hamiltonian path problem. I prove that chromatin computers are computationally universal – and therefore more powerful than the logic circuits often used to model transcription factor control of gene expression. Features of biological chromatin provide a rich instruction set for efficient computation of nontrivial algorithms in biological time scales. Modeling chromatin as a computer shifts how we think about chromatin function, suggests new approaches to medical intervention, and lays the groundwork for the engineering of a new class of biological computing machines. PMID:22567109

Measuring interdependence in ambulatory care.

PubMed

Katerndahl, David; Wood, Robert; Jaen, Carlos R

2017-04-01

Complex systems differ from complicated systems in that they are nonlinear, unpredictable and lacking clear cause-and-effect relationships, largely due to the interdependence of their components (effects of interconnectedness on system behaviour and consequences). The purpose of this study was to demonstrate the potential for network density to serve as a measure of interdependence, assess its concurrent validity and test whether the use of valued or binary ties yields better results. This secondary analysis used the 2010 National Ambulatory Care Medical Survey to assess interdependence of 'top 20' diagnoses seen and medications prescribed for 14 specialties. The degree of interdependence was measured as the level of association between diagnoses and drug interactions among medications. Both valued and binary network densities were computed for each specialty. To assess concurrent validity, these measures were correlated with previously-derived valid measures of complexity of care using the same database, adjusting for diagnosis and medication diversity. Partial correlations between diagnosis density, and both diagnosis and total input complexity, were significant, as were those between medication density and both medication and total output complexity; for both diagnosis and medication densities, adjusted correlations were higher for binary rather than valued densities. This study demonstrated the feasibility and validity of using network density as a measure of interdependence. When adjusted for measure diversity, density-complexity correlations were significant and higher for binary than valued density. This approach complements other methods of estimating complexity of care and may be applicable to unique settings. © 2015 John Wiley & Sons, Ltd.

Proceedings of the Canadian Frailty Network Summit: Medication Optimization for Frail Older Canadians, Toronto, Monday April 24, 2017

PubMed Central

Muscedere, John; Kim, Perry; Aitken, Peter; Gaucher, Michael; Osborn, Robin; Farrell, Barbara; Holroyd-Leduc, Jayna; Mallery, Laurie; Siu, Henry; Downar, James; Lee, Todd C.; McDonald, Emily; Burry, Lisa

2017-01-01

Appropriate and optimal use of medication and polypharmacy are especially relevant to the care of older Canadians living with frailty, often impacting their health outcomes and quality of life. A majority (two thirds) of older adults (65 or older) are prescribed five or more drug classes and over one-quarter are prescribed 10 or more drugs. The risk of adverse drug-induced events is even greater for those aged 85 or older where 40% are estimated to take drugs from 10 or more drug classes. The Canadian Frailty Network (CFN), a pan-Canadian non-for-profit organization funded by the Government of Canada through the Networks of Centres of Excellence Program (NCE), is dedicated to improving the care of older Canadian living with frailty and, as part of its mandate, convened a meeting of stakeholders from across Canada to seek their perspectives on appropriate medication prescription. The CFN Medication Optimization Summit identified priorities to help inform the design of future research and knowledge mobilization efforts to facilitate optimal medication prescribing in older adults living with frailty. The priorities were developed and selected through a modified Delphi process commencing before and concluding during the summit. Herein we describe the overall approach/process to the summit, a summary of all the presentations and discussions, and the top ten priorities selected by the participants. PMID:29296132

Interprofessional communication and medical error: a reframing of research questions and approaches.

PubMed

Varpio, Lara; Hall, Pippa; Lingard, Lorelei; Schryer, Catherine F

2008-10-01

Progress toward understanding the links between interprofessional communication and issues of medical error has been slow. Recent research proposes that this delay may result from overlooking the complexities involved in interprofessional care. Medical education initiatives in this domain tend to simplify the complexities of team membership fluidity, rotation, and use of communication tools. A new theoretically informed research approach is required to take into account these complexities. To generate such an approach, we review two theories from the social sciences: Activity Theory and Knotworking. Using these perspectives, we propose that research into interprofessional communication and medical error can develop better understandings of (1) how and why medical errors are generated and (2) how and why gaps in team defenses occur. Such complexities will have to be investigated if students and practicing clinicians are to be adequately prepared to work safely in interprofessional teams.

Morbidity and Mortality of Live Lung Donation: Results from the RELIVE study

PubMed Central

Yusen, R.D.; Hong, B.A.; Messersmith, E.E.; Gillespie, B.W.; Lopez, B.M.; Brown, K.L.; Odim, J.; Merion, R.M.; Barr, M.L.

2014-01-01

The Renal and Lung Living Donors Evaluation Study (RELIVE) assesses outcomes of live lung (lobectomy) donors. This is a retrospective cohort study at University of Southern California (USC) and Washington University (WASHU) Medical Centers (1993–2006), using medical records to assess morbidity and national databases to ascertain post-donation survival and lung transplantation. Serious complications were those requiring significant treatment, potentially life-threatening, or leading to prolonged hospitalization. The 369 live lung donors (287 USC, 82 WASHU) were predominantly white, non-Hispanic, and male; 72% had a biological relationship to the recipient, and 30% were recipient parents. Serious complications occurred in 18% of donors; 2.2% underwent reoperation, and 6.5% had an early rehospitalization. The two centers had significantly different incidences of serious complications (p<0.001). No deaths occurred and no donors underwent lung transplantation during 4,000+ person-years of follow-up (death: minimum 4, maximum 17 years; transplant: minimum 5, maximum 19). Live lung donation remains a potential option for recipients when using deceased donor lungs lacks feasibility. However, the use of two live donors for each recipient and the risk of morbidity associated with live lung donation do not justify this approach when deceased lung donors remain available. Center effects and long-term outcomes require further evaluation. PMID:25039865

Patient Power: Complex Issues Need Complex Answers.

ERIC Educational Resources Information Center

Wiener, Carolyn; And Others

1980-01-01

Discusses ethical and practical questions that arise in physician/patient interactions as a result of the rising prevalence of chronic illness, the growth of medical technology, and the increased differentiation of medical specialization. Issues considered include patients' rights, medical malpractice, informed consent, and the patient self-help…

Assisted-living spaces for end-users with complex needs: a proposed implementation and delivery model.

PubMed

Linskell, Jeremy; Bouamrane, Matt-Mouley

2012-09-01

An assisted living space (ALS) is a technology-enabled environment designed to allow people with complex health or social care needs to remain, and live independently, in their own home for longer. However, many challenges remain in order to deliver usable systems acceptable to a diverse range of stakeholders, including end-users, and their families and carers, as well as health and social care services. ALSs need to support activities of daily-living while allowing end-users to maintain important social connections. They must be dynamic, flexible and adaptable living environments. In this article, we provide an overview of the technological landscape of assisted-living technology (ALT) and recent policies to promote an increased adoption of ALT in Scotland. We discuss our experiences in implementing technology-supported ALSs and emphasise key lessons. Finally, we propose an iterative and pragmatic user-centred implementation model for delivering ALSs in complex-needs scenarios. This empirical model is derived from our past ALS implementations. The proposed model allows project stakeholders to identify requirements, allocate tasks and responsibilities, and identify appropriate technological solutions for the delivery of functional ALS systems. The model is generic and makes no assumptions on needs or technology solutions, nor on the technical knowledge, skills and experience of the stakeholders involved in the ALS design process.

76 FR 35950 - Agency Information Collection Activity (Living Will and Durable Power of Attorney for Health Care...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-20

... (Living Will and Durable Power of Attorney for Health Care) Under OMB Review AGENCY: Department of... INFORMATION Title: Living Will and Durable Power of Attorney for Health Care, VA Form 10-0137. OMB Control... admitted to a VA medical facility complete VA Form 10-0137 to appoint a health care agent to make decision...

The tyranny of the gift: sacrificial violence in living donor transplants.

PubMed

Scheper-Hughes, N

2007-03-01

Medical anthropology can bring to living donor transplant useful insights on the nature of gifting, family obligations, reciprocity and invisible sacrifice. Whereas, ethical reflections and debates on the marketing of tissues and organs, especially sales by living strangers, have proliferated to the point of saturation, the larger issue of the ethics of "altruistic" donation by and among family members is more rarely the focus of bio-ethical scrutiny and discussion today, though of course it was much debated in the early decades of kidney transplant. As the proportion of living over deceased donors (especially of kidneys) has increased markedly in the past decade, the time is ripe to revisit the topic, which I shall do via three vignettes, all of them informed by my 10 years as founding Director of Organs Watch, an independent, university-based, anthropological and ethnographic field-research and medical human rights project. Whereas living-related (altruistic) and living-unrelated (commercial) donation are often treated as very different phenomena, I will illustrate what social elements are shared. In both instances, paid kidney sellers and related donors, are often responding to family pressures and to a call to "sacrifice".

Frequency of Cannabis Use and Medical Cannabis Use Among Persons Living With HIV in the United States: Findings From a Nationally Representative Sample.

PubMed

Pacek, Lauren R; Towe, Sheri L; Hobkirk, Andrea L; Nash, Denis; Goodwin, Renee D

2018-04-01

Little is known about cannabis use frequency, medical cannabis use, or correlates of use among persons living with HIV (PLWH) in United States nationally representative samples. Data came from 626 PLWH from the 2005-2015 National Survey on Drug Use and Health. Logistic regression identified characteristics associated with frequency of cannabis use. Chi-squares identified characteristics associated with medial cannabis use. Non-daily and daily cannabis use was reported by 26.9% and 8.0%. Greater perceived risk of cannabis use was negatively associated with daily and non-daily use. Younger age, substance use, and binge drinking were positively associated with non-daily cannabis use. Smoking and depression were associated with non-daily and daily use. One-quarter reported medical cannabis use. Medical users were more likely to be White, married, and nondrinkers. Cannabis use was common among PLWH. Findings help to differentiate between cannabis users based on frequency of use and medical versus recreational use.

Characterizing complexity in socio-technical systems: a case study of a SAMU Medical Regulation Center.

PubMed

Righi, Angela Weber; Wachs, Priscila; Saurin, Tarcísio Abreu

2012-01-01

Complexity theory has been adopted by a number of studies as a benchmark to investigate the performance of socio-technical systems, especially those that are characterized by relevant cognitive work. However, there is little guidance on how to assess, systematically, the extent to which a system is complex. The main objective of this study is to carry out a systematic analysis of a SAMU (Mobile Emergency Medical Service) Medical Regulation Center in Brazil, based on the core characteristics of complex systems presented by previous studies. The assessment was based on direct observations and nine interviews: three of them with regulator of emergencies medical doctor, three with radio operators and three with telephone attendants. The results indicated that, to a great extent, the core characteristics of complexity are magnified) due to basic shortcomings in the design of the work system. Thus, some recommendations are put forward with a view to reducing unnecessary complexity that hinders the performance of the socio-technical system.

Diva

ERIC Educational Resources Information Center

Walsh, Kieran

2005-01-01

We live in a celebrity-obsessed world and our medical students are no more immune to the glamour of celebrity than anyone else. When teaching medical students about a certain medical illness I used to tell them about a celebrity who suffers from this illness. I did this to get their attention and to stimulate their interest but even though the…

Staff Knowledge of the Side Effects of Anti-Psychotic Medication

ERIC Educational Resources Information Center

Fretwell, Christine; Felce, David

2007-01-01

Background: Anti-psychotic medications are widely prescribed to people with intellectual disabilities and have a range of negative side effects. The aim was to identify the level of knowledge of anti-psychotic medications and their side effects among key carers or home managers of adults with intellectual disabilities living in residential group…

Antipsychotics side effects' influence on stigma of mental illness: focus group study results.

PubMed

Novak, Lan; Svab, Vesna

2009-03-01

Little research was done on the influence of antipsychotics' side effects on stigma of mental illness. An overview of studies shows that people with mental illness state that because of medication side effects they feel discriminated in the field of employment, observe worsening of family relations and tend to skip or discontinue their regular medication. It is difficult to discriminate between stigmatizing effects of antipsychotics and other stigma related factors such as illness symptoms. A focus group of ten patients with schizophrenia or schizoaffective disorder with severe and remitting mental illness treated with antipsychotic medication was conducted to obtain their personal views on how side effects of antipsychotic drugs affect their everyday lives and contribute to the stigmatization because of mental illness. The patients felt most stigmatized in areas of employment and occupation. They repeatedly skipped or discontinued regular medication due to side effects. Their families supported them throughout treatment and recovery despite problems associated with psychotropic medication. Medication induced stigma affects patients' lives in substantial ways and therefore merits further research, part of which is the patients' personal experience.

The role of traditional healers in the provision of health care and family planning services: Ayurveda and Sidda.

PubMed

Bin Mohammed, A; Abdul Raheem, K P; Kaivalyam, K

1985-01-01

The Ayurvedic manuscript was first composed in Sanskrit by Agnivesha, an individual who lived sometime before 750 B.C. The Ayurveda contains instructions on how to live in order to prevent the occurrence of sickness and how to cure it, if illness arises. The medical work of Ayurveda is comprised of elements of Physiology, Pathology, Pharmacology, Materia Medica, and Surgery, among others. It originally consisted of 100 sections each with 1000 stanzas comprising up to 100,000 verses in eight books. All recent medical works on Ayurveda are based upon the writings of Charaka and Sushruta, who rearranged the books into chapters on surgery, nosology, anatomy, therapeutics, toxicology, and local diseases. The authors explain the use of traditional medicine for health and family planning, and the extent of self-medication in sections on the role of Ayurvedic medicine for health, clinics and medical centers on Ayurveda in Malaysia, oleo-therapy/massage through the application of medicated oil and liniment, institutions and laboratories, research, the extent of self-medication, family planning, and Malaysian Ayurvedic or the Siddha practice of contraception.

Medication Management: The Macrocognitive Workflow of Older Adults With Heart Failure

PubMed Central

2016-01-01

Background Older adults with chronic disease struggle to manage complex medication regimens. Health information technology has the potential to improve medication management, but only if it is based on a thorough understanding of the complexity of medication management workflow as it occurs in natural settings. Prior research reveals that patient work related to medication management is complex, cognitive, and collaborative. Macrocognitive processes are theorized as how people individually and collaboratively think in complex, adaptive, and messy nonlaboratory settings supported by artifacts. Objective The objective of this research was to describe and analyze the work of medication management by older adults with heart failure, using a macrocognitive workflow framework. Methods We interviewed and observed 61 older patients along with 30 informal caregivers about self-care practices including medication management. Descriptive qualitative content analysis methods were used to develop categories, subcategories, and themes about macrocognitive processes used in medication management workflow. Results We identified 5 high-level macrocognitive processes affecting medication management—sensemaking, planning, coordination, monitoring, and decision making—and 15 subprocesses. Data revealed workflow as occurring in a highly collaborative, fragile system of interacting people, artifacts, time, and space. Process breakdowns were common and patients had little support for macrocognitive workflow from current tools. Conclusions Macrocognitive processes affected medication management performance. Describing and analyzing this performance produced recommendations for technology supporting collaboration and sensemaking, decision making and problem detection, and planning and implementation. PMID:27733331

Medication Management: The Macrocognitive Workflow of Older Adults With Heart Failure.

PubMed

Mickelson, Robin S; Unertl, Kim M; Holden, Richard J

2016-10-12

Older adults with chronic disease struggle to manage complex medication regimens. Health information technology has the potential to improve medication management, but only if it is based on a thorough understanding of the complexity of medication management workflow as it occurs in natural settings. Prior research reveals that patient work related to medication management is complex, cognitive, and collaborative. Macrocognitive processes are theorized as how people individually and collaboratively think in complex, adaptive, and messy nonlaboratory settings supported by artifacts. The objective of this research was to describe and analyze the work of medication management by older adults with heart failure, using a macrocognitive workflow framework. We interviewed and observed 61 older patients along with 30 informal caregivers about self-care practices including medication management. Descriptive qualitative content analysis methods were used to develop categories, subcategories, and themes about macrocognitive processes used in medication management workflow. We identified 5 high-level macrocognitive processes affecting medication management-sensemaking, planning, coordination, monitoring, and decision making-and 15 subprocesses. Data revealed workflow as occurring in a highly collaborative, fragile system of interacting people, artifacts, time, and space. Process breakdowns were common and patients had little support for macrocognitive workflow from current tools. Macrocognitive processes affected medication management performance. Describing and analyzing this performance produced recommendations for technology supporting collaboration and sensemaking, decision making and problem detection, and planning and implementation.

Outcome Measures in Rheumatology - Interventions for medication Adherence (OMERACT-Adherence) Core Domain Set for Trials of Interventions for Medication Adherence in Rheumatology: 5 Phase Study Protocol.

PubMed

Kelly, Ayano; Tong, Allison; Tymms, Kathleen; March, Lyn; Craig, Jonathan C; De Vera, Mary; Evans, Vicki; Hassett, Geraldine; Toupin-April, Karine; van den Bemt, Bart; Teixeira-Pinto, Armando; Alten, Rieke; Bartlett, Susan J; Campbell, Willemina; Dawson, Therese; Gill, Michael; Hebing, Renske; Meara, Alexa; Nieuwlaat, Robby; Shaw, Yomei; Singh, Jasvinder A; Suarez-Almazor, Maria; Sumpton, Daniel; Wong, Peter; Christensen, Robin; Beaton, Dorcas; de Wit, Maarten; Tugwell, Peter

2018-03-27

Over the last 20 years, there have been marked improvements in the availability of effective medications for rheumatic conditions such as gout, osteoporosis and rheumatoid arthritis (RA), which have led to a reduction in disease flares and the risk of re-fracture in osteoporosis, and the slowing of disease progression in RA. However, medication adherence remains suboptimal, as treatment regimens can be complex and difficult to continue long term. Many trials have been conducted to improve adherence to medication. Core domains, which are the outcomes of most relevance to patients and clinicians, are a pivotal component of any trial. These core domains should be measured consistently, so that all relevant trials can be combined in systematic reviews and meta-analyses to reach conclusions that are more valid. Failure to do this severely limits the potential for trial-based evidence to inform decisions on how to support medication adherence. The Outcome Measures in Rheumatology (OMERACT) - Interventions for Medication Adherence study by the OMERACT-Adherence Group aims to develop a core domain set for interventions that aim to support medication adherence in rheumatology. This OMERACT-Adherence study has five phases: (1) a systematic review to identify outcome domains that have been reported in interventions focused on supporting medication adherence in rheumatology; (2) semi-structured stakeholder interviews with patients and caregivers to determine their views on the core domains; (3) focus groups using the nominal group technique with patients and caregivers to identify and rank domains that are relevant to them, including the reasons for their choices; (4) an international three-round modified Delphi survey involving patients with diverse rheumatic conditions, caregivers, health professionals, researchers and other stakeholders to develop a preliminary core domain set; and (5) a stakeholder workshop with OMERACT members to review, vote on and reach a consensus on the core domain set for interventions to support medication adherence in rheumatology. Establishing a core domain set to be reported in all intervention studies undertaken to support patients with medication adherence will enhance the relevance and the impact of these results and improve the lives of people with rheumatic conditions.

The naming impairment of living and nonliving items in Alzheimer's disease.

PubMed

Montanes, P; Goldblum, M C; Boller, F

1995-01-01

Several studies of semantic abilities in Dementia of the Alzheimer Type (DAT) suggest that their semantic disorders may affect specific categories of knowledge. In particular, the existence of a category-specific semantic impairment affecting, selectively, living things has frequently been reported in association with DAT. We report here results from two naming tasks of 25 DAT patients and two subgroups within this population. The first naming task used 48 black and white line drawings from Snodgrass and Vanderwart (1980) which controlled the visual complexity of stimuli from living and nonliving categories. The second task used 44 colored pictures (to assess the influence of word frequency in living vs. nonliving categories). Within the set of black and white pictures, both DAT patients and controls obtained significantly lower scores on high visual complexity stimuli than on stimuli of low visual complexity. A clear effect of semantic category emerged for DAT patients and controls, with a lower performance on the living category. Within the colored set, pictures corresponding to high frequency words gave rise to significantly higher scores than pictures corresponding to low frequency words. No significant difference emerged between living versus nonliving categories, either in DAT patients or in controls. In the two tasks, the two subgroups of DAT patients presented a different profile of performance and error type. As color constitutes the main difference between the two sets of pictures, our results point to the relevance of this cue in the processing of semantic information, with visual complexity and frequency also being very relevant.

Bronco Junction Proves Asthmatic Kids Can Live Active Lives.

ERIC Educational Resources Information Center

Foster, Scarlett Lee

1980-01-01

Camp Bronco Junction combines physical development, medical self-care knowledge, and fun in its eight-week program for asthmatic youngsters. In this environment, children are able to undertake activities that were formerly thought beyond their physical or emotional capabilities. (CJ)

Influenza (Flu) vaccine (Live, Intranasal): What you need to know

MedlinePlus

... Have gotten any other vaccines in the past 4 weeks. Live vaccines given too close together might not work as well. Have taken influenza antiviral medication in the past 48 hours. Have a very stuffy nose. 4. Risks of ...

5 CFR 870.1103 - Election procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... require a medical examination before making a decision. In these cases, OFEGLI is financially responsible... (CONTINUED) FEDERAL EMPLOYEES' GROUP LIFE INSURANCE PROGRAM Living Benefits § 870.1103 Election procedures. (a) The insured individual must request information on Living Benefits and an application form...

From microscopic to macroscopic sports injuries. Applying the complex dynamic systems approach to sports medicine: a narrative review.

PubMed

Pol, Rafel; Hristovski, Robert; Medina, Daniel; Balague, Natalia

2018-04-19

A better understanding of how sports injuries occur in order to improve their prevention is needed for medical, economic, scientific and sports success reasons. This narrative review aims to explain the mechanisms that underlie the occurrence of sports injuries, and an innovative approach for their prevention on the basis of complex dynamic systems approach. First, we explain the multilevel organisation of living systems and how function of the musculoskeletal system may be impaired. Second, we use both, a constraints approach and a connectivity hypothesis to explain why and how the susceptibility to sports injuries may suddenly increase. Constraints acting at multiple levels and timescales replace the static and linear concept of risk factors, and the connectivity hypothesis brings an understanding of how the accumulation of microinjuries creates a macroscopic non-linear effect, that is, how a common motor action may trigger a severe injury. Finally, a recap of practical examples and challenges for the future illustrates how the complex dynamic systems standpoint, changing the way of thinking about sports injuries, offers innovative ideas for improving sports injury prevention. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Vibrational spectroscopy for imaging single microbial cells in complex biological samples

DOE PAGES

Harrison, Jesse P.; Berry, David

2017-04-13

Here, vibrational spectroscopy is increasingly used for the rapid and non-destructive imaging of environmental and medical samples. Both Raman and Fourier-transform infrared (FT-IR) imaging have been applied to obtain detailed information on the chemical composition of biological materials, ranging from single microbial cells to tissues. Due to its compatibility with methods such as stable isotope labeling for the monitoring of cellular activities, vibrational spectroscopy also holds considerable power as a tool in microbial ecology. Chemical imaging of undisturbed biological systems (such as live cells in their native habitats) presents unique challenges due to the physical and chemical complexity of themore » samples, potential for spectral interference, and frequent need for real-time measurements. This Mini Review provides a critical synthesis of recent applications of Raman and FT-IR spectroscopy for characterizing complex biological samples, with a focus on developments in single-cell imaging. We also discuss how new spectroscopic methods could be used to overcome current limitations of singlecell analyses. Given the inherent complementarity of Raman and FT-IR spectroscopic methods, we discuss how combining these approaches could enable us to obtain new insights into biological activities either in situ or under conditions that simulate selected properties of the natural environment.« less

Vibrational spectroscopy for imaging single microbial cells in complex biological samples

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

Harrison, Jesse P.; Berry, David

Here, vibrational spectroscopy is increasingly used for the rapid and non-destructive imaging of environmental and medical samples. Both Raman and Fourier-transform infrared (FT-IR) imaging have been applied to obtain detailed information on the chemical composition of biological materials, ranging from single microbial cells to tissues. Due to its compatibility with methods such as stable isotope labeling for the monitoring of cellular activities, vibrational spectroscopy also holds considerable power as a tool in microbial ecology. Chemical imaging of undisturbed biological systems (such as live cells in their native habitats) presents unique challenges due to the physical and chemical complexity of themore » samples, potential for spectral interference, and frequent need for real-time measurements. This Mini Review provides a critical synthesis of recent applications of Raman and FT-IR spectroscopy for characterizing complex biological samples, with a focus on developments in single-cell imaging. We also discuss how new spectroscopic methods could be used to overcome current limitations of singlecell analyses. Given the inherent complementarity of Raman and FT-IR spectroscopic methods, we discuss how combining these approaches could enable us to obtain new insights into biological activities either in situ or under conditions that simulate selected properties of the natural environment.« less

[Medicine behind bars. Illness is usual not grounds for modifying imprisonment].

PubMed

Schwarzkopf, A; Zenker, M

2002-05-16

The article describes the possibilities of medical care in prison as exemplified by the Kassel 1 prison with its attached central hospital facility. The main areas of medical care covered there are the treatment of wounds, conservative treatment of fractures, ophthalmology, ENT, urology, dentistry and, via external consultant physicians, also internal medicine, pneumology, dermatology and gynecology. Such infections as hepatitis B and C, syphilis, and tuberculosis have a greater prevalence among prisoners--in contrast to other infections afflicting people housed under similar living conditions, such as in communal living facilities, which show no such increased prevalence. Furthermore, there is a relatively high percentage of injuries, including those that are self-inflicted. The problem of certifying a prisoner medically unfit to tolerate imprisonment is discussed.

Development of the ultrasonography learning model for undergraduate medical students: A case study of the Faculty of Medicine, Burapha University.

PubMed

Limchareon, Sornsupha; Asawaworarit, Nattawat; Klinwichit, Wethaka; Dinchuthai, Pakaphun

2016-08-01

Ultrasound technology is generally considered to be reliable and widely used by physicians today. Therefore, given the efficacy and popularity of the technology, the need for quality ultrasound education is evident. Ultrasound training for undergraduate medical students has been increasingly incorporated into school curriculums, but the teaching methods can vary significantly among medical schools. Among many different choices, one effective teaching model was proposed which added hands-on ultrasound experience on live patients that was supervised by radiologists in the last clinical year. A 2-week radiology elective course was offered for 6(th)-year medical students at Burapha University Hospital, Chonburi, Thailand in the academic year 2014. Fourteen medical students participated in the elective course. Additionally, students who chose radiology as their elective were provided an ultrasound experience on live patients in real-life clinical settings. All 6(th)-year medical students then completed a 25-ultrasound image quiz, and completed a questionnaire at the end of the academic year. The ultrasound test scores were compared between the elective and nonelective students. The students' background characteristics were determined by a grade point average and the ultrasound experience was determined by the number of scans. These were collected, and analyzed to establish their relationship with the ultrasound test scores. The students' opinions were also surveyed. Fourteen medical students participated in the elective course. The ultrasound test scores in the elective group were significantly higher than those in the nonelective group (p=0.013). The students' background characteristics and ultrasound experience had no significant relationship with the ultrasound test scores. By adding hands-on ultrasound experience using live patients proctored by radiologists for final year medical students, in the space of 2 weeks, an effective ultrasound learning model for undergraduate medical students can be provided. This model should be considered in the curricular design. Copyright © 2016. Published by Elsevier Taiwan LLC.

Formerly Homeless People Had Lower Overall Health Care Expenditures After Moving Into Supportive Housing.

PubMed

Wright, Bill J; Vartanian, Keri B; Li, Hsin-Fang; Royal, Natalie; Matson, Jennifer K

2016-01-01

The provision of supportive housing is often recognized as important public policy, but it also plays a role in health care reform. Health care costs for the homeless reflect both their medical complexity and psychosocial risk factors. Supportive housing attempts to moderate both by providing stable places to live along with on-site integrated health services. In this pilot study we used a mixture of survey and administrative claims data to evaluate outcomes for formerly homeless people who were living in a supportive housing facility in Oregon between 2010 and 2014. Results from the claims analysis showed significantly lower overall health care expenditures for the people after they moved into supportive housing. Expenditure changes were driven primarily by reductions in emergency and inpatient care. Survey data suggest that the savings were not at the expense of quality: Respondents reported improved access to care, stronger primary care connections, and better subjective health outcomes. Together, these results indicate a potential association between supportive housing and reduced health care costs that warrants deeper consideration as part of ongoing health care reforms. Project HOPE—The People-to-People Health Foundation, Inc.

Exploring the role of religiosity and spirituality in amniocentesis decision-making among Latinas.

PubMed

Seth, Sarah Guerra; Goka, Thomas; Harbison, Andrea; Hollier, Lisa; Peterson, Susan; Ramondetta, Lois; Noblin, Sarah Jane

2011-12-01

Given the complex array of emotional and medical issues that may arise when making a decision about amniocentesis, women may find that their spiritual and/or religious beliefs can comfort and assist their decision-making process. Prior research has suggested that Latinas' spiritual and/or religious beliefs directly influence their amniocentesis decision. A more intimate look into whether Latinas utilize their beliefs during amniocentesis decision-making may provide an opportunity to better understand their experience. The overall goal of this study was to describe the role structured religion and spirituality plays in Latinas' daily lives and to evaluate how religiosity and spirituality influences health care decisions, specifically in prenatal diagnosis. Semi-structured interviews were conducted with eleven women who were invited to describe their religious beliefs and thoughts while considering the option of amniocentesis. All participants acknowledged the influence of religious and/or spiritual beliefs in their everyday lives. Although the women sought comfort and found validation in their beliefs and in their faith in God's will during their amniocentesis decision-making process, results suggest the risk of procedure-related complications played more of a concrete role than their beliefs.

Does activity limitation predict discharge destination for postacute care patients?

PubMed

Chang, Feng-Hang; Ni, Pengsheng; Jette, Alan M

2014-09-01

This study aimed to examine the ability of different domains of activity limitation to predict discharge destination (home vs. nonhome settings) 1 mo after hospital discharge for postacute rehabilitation patients. A secondary analysis was conducted using a data set of 518 adults with neurologic, lower extremity orthopedic, and complex medical conditions followed after discharge from a hospital into postacute care. Variables collected at baseline include activity limitations (basic mobility, daily activity, and applied cognitive function, measured by the Activity Measure for Post-Acute Care), demographics, diagnosis, and cognitive status. The discharge destination was recorded at 1 mo after being discharged from the hospital. Correlational analyses revealed that the 1-mo discharge destination was correlated with two domains of activity (basic mobility and daily activity) and cognitive status. However, multiple logistic regression and receiver operating characteristic curve analyses showed that basic mobility functioning performed the best in discriminating home vs. nonhome living. This study supported the evidence that basic mobility functioning is a critical determinant of discharge home for postacute rehabilitation patients. The Activity Measure for Post-Acute Care-basic mobility showed good usability in discriminating home vs. nonhome living. The findings shed light on the importance of basic mobility functioning in the discharge planning process.

Asymmetric rhenium tricarbonyl complexes show superior luminescence properties in live cell imaging.

PubMed

Raszeja, Lukasz J; Siegmund, Daniel; Cordes, Anna L; Güldenhaupt, Jörn; Gerwert, Klaus; Hahn, Stephan; Metzler-Nolte, Nils

2017-01-16

The synthesis and photophysical properties of a novel series of rhenium tricarbonyl complexes based on tridentate phenanthridinyl-containing ligands are described. Photophysical data reveal beneficial luminescence behaviour especially for compounds with an asymmetric ligand set. These advantageous properties are not limited to organic solvents, but indeed also improved in aqueous solutions. The suitability of our new rhenium complexes as potent imaging agents has been confirmed by fluorescence microscopy on living cancer cells, which also confirms superior long-time stability under fluorescence microscopy conditions. Colocalisation studies with commercial organelle stains reveal an accumulation of the complexes in the endoplasmic reticulum for all tested cell lines.

Cost Effectiveness of Falls and Injury Prevention Strategies for Older Adults Living in Residential Aged Care Facilities.

PubMed

Church, Jody L; Haas, Marion R; Goodall, Stephen

2015-12-01

To evaluate the cost effectiveness of interventions designed to prevent falls and fall-related injuries among older people living in residential aged care facilities (RACFs) from an Australian health care perspective. A decision analytic Markov model was developed that stratified individuals according to their risk of falling and accounted for the risk of injury following a fall. The effectiveness of the interventions was derived from two Cochrane reviews of randomized controlled trials for falls/fall-related injury prevention in RACFs. Interventions were considered effective if they reduced the risk of falling or reduced the risk of injury following a fall. The interventions that were modelled included vitamin D supplementation, annual medication review, multifactorial intervention (a combination of risk assessment, medication review, vision assessment and exercise) and hip protectors. The cost effectiveness was calculated as the incremental cost relative to the incremental benefit, in which the benefit was estimated using quality-adjusted life-years (QALYs). Uncertainty was explored using univariate and probabilistic sensitivity analysis. Vitamin D supplementation and medication review both dominated 'no intervention', as these interventions were both more effective and cost saving (because of healthcare costs avoided). Hip protectors are dominated (less effective and more costly) by vitamin D and medication review. The incremental cost-effectiveness ratio (ICER) for medication review relative to vitamin D supplementation is AU$2442 per QALY gained, and the ICER for multifactorial intervention relative to medication review is AU$1,112,500 per QALY gained. The model is most sensitive to the fear of falling and the cost of the interventions. The model suggests that vitamin D supplementation and medication review are cost-effective interventions that reduce falls, provide health benefits and reduce health care costs in older adults living in RACFs.

Highly luminescent, biocompatible ytterbium(iii) complexes as near-infrared fluorophores for living cell imaging.

PubMed

Ning, Yingying; Tang, Juan; Liu, Yi-Wei; Jing, Jing; Sun, Yuansheng; Zhang, Jun-Long

2018-04-21

Herein, we report the design and synthesis of biocompatible Yb 3+ complexes for near-infrared (NIR) living cell imaging. Upon excitation at either the visible (Soret band) or red region (Q band), these β-fluorinated Yb 3+ complexes display high NIR luminescence (quantum yields up to 23% and 13% in dimethyl sulfoxide and water, respectively) and have higher stabilities and prolonged decay lifetimes (up to 249 μs) compared to the β-non-fluorinated counterparts. This renders the β-fluorinated Yb 3+ complexes as a new class of biological optical probes in both steady-state imaging and time-resolved fluorescence lifetime imaging (FLIM). NIR confocal fluorescence images showed strong and specific intracellular Yb 3+ luminescence signals when the biocompatible Yb 3+ complexes were uptaken into the living cells. Importantly, FLIM measurements showed an intracellular lifetime distribution between 100 and 200 μs, allowing an effective discrimination from cell autofluorescence, and afforded high signal-to-noise ratios as firstly demonstrated in the NIR region. These results demonstrated the prospects of NIR lanthanide complexes as biological probes for NIR steady-state fluorescence and time-resolved fluorescence lifetime imaging.

Home Health Nurse Collaboration in the Medical Neighborhood of Children with Medical Complexity.

PubMed

Nageswaran, Savithri; Golden, Shannon L

2016-10-01

The objectives of this study were to describe how home healthcare nurses collaborate with other clinicians caring for children with medical complexity, and identify barriers to collaboration within the medical neighborhood. Using qualitative data obtained from 20 semistructured interviews (15 English, 5 Spanish) with primary caregivers of children with medical complexity and 18 home healthcare nurses, researchers inquired about experiences with home healthcare nursing services for these children. During an iterative analysis process, recurrent themes were identified by their prevalence and salience in the data. Home healthcare nurses collaborate with many providers within the medical neighborhood of children with medical complexity and perform many different collaborative tasks. This collaboration is valued by caregivers and nurses, but is inconsistent. Home healthcare nurses' communication with other clinicians is important to the delivery of good-quality care to children with medical complexity at home, but is not always present. Home healthcare nurses reported inability to share clinical information with other clinicians, not receiving child-specific information, and lack of support for clinical problem-solving as concerns. Barriers for optimal collaboration included lack of preparedness of parents, availability of physicians for clinical support, reimbursement for collaborative tasks, variability in home healthcare nurses' tasks, and problems at nursing agency level. Home healthcare nurses' collaboration with other clinicians is important, but problems exist in the current system of care. Optimizing collaboration between home healthcare nurses and other clinicians will likely have a positive impact on these children and their families.

Development of a Hospital-based Massage Therapy Course at an Academic Medical Center.

PubMed

Dion, Liza J; Cutshall, Susanne M; Rodgers, Nancy J; Hauschulz, Jennifer L; Dreyer, Nikol E; Thomley, Barbara S; Bauer, Brent

2015-03-01

Massage therapy is offered increasingly in US medical facilities. Although the United States has many massage schools, their education differs, along with licensure and standards. As massage therapy in hospitals expands and proves its value, massage therapists need increased training and skills in working with patients who have various complex medical concerns, to provide safe and effective treatment. These services for hospitalized patients can impact patient experience substantially and provide additional treatment options for pain and anxiety, among other symptoms. The present article summarizes the initial development and description of a hospital-based massage therapy course at a Midwest medical center. A hospital-based massage therapy course was developed on the basis of clinical experience and knowledge from massage therapists working in the complex medical environment. This massage therapy course had three components in its educational experience: online learning, classroom study, and a 25-hr shadowing experience. The in-classroom study portion included an entire day in the simulation center. The hospital-based massage therapy course addressed the educational needs of therapists transitioning to work with interdisciplinary medical teams and with patients who have complicated medical conditions. Feedback from students in the course indicated key learning opportunities and additional content that are needed to address the knowledge and skills necessary when providing massage therapy in a complex medical environment. The complexity of care in medical settings is increasing while the length of hospital stay is decreasing. For this reason, massage provided in the hospital requires more specialized training to work in these environments. This course provides an example initial step in how to address some of the educational needs of therapists who are transitioning to working in the complex medical environment.

Development of a Hospital-based Massage Therapy Course at an Academic Medical Center

PubMed Central

Dion, Liza J.; Cutshall, Susanne M.; Rodgers, Nancy J.; Hauschulz, Jennifer L.; Dreyer, Nikol E.; Thomley, Barbara S.; Bauer, Brent

2015-01-01

Background: Massage therapy is offered increasingly in US medical facilities. Although the United States has many massage schools, their education differs, along with licensure and standards. As massage therapy in hospitals expands and proves its value, massage therapists need increased training and skills in working with patients who have various complex medical concerns, to provide safe and effective treatment. These services for hospitalized patients can impact patient experience substantially and provide additional treatment options for pain and anxiety, among other symptoms. The present article summarizes the initial development and description of a hospital-based massage therapy course at a Midwest medical center. Methods: A hospital-based massage therapy course was developed on the basis of clinical experience and knowledge from massage therapists working in the complex medical environment. This massage therapy course had three components in its educational experience: online learning, classroom study, and a 25-hr shadowing experience. The in-classroom study portion included an entire day in the simulation center. Results: The hospital-based massage therapy course addressed the educational needs of therapists transitioning to work with interdisciplinary medical teams and with patients who have complicated medical conditions. Feedback from students in the course indicated key learning opportunities and additional content that are needed to address the knowledge and skills necessary when providing massage therapy in a complex medical environment. Conclusions: The complexity of care in medical settings is increasing while the length of hospital stay is decreasing. For this reason, massage provided in the hospital requires more specialized training to work in these environments. This course provides an example initial step in how to address some of the educational needs of therapists who are transitioning to working in the complex medical environment. PMID:25780472

Cohort profile: The Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS)

PubMed Central

de Pokomandy, Alexandra; Kennedy, V. Logan; Carter, Allison; O’Brien, Nadia; Proulx-Boucher, Karène; Ding, Erin; Lewis, Johanna; Nicholson, Valerie; Beaver, Kerrigan; Greene, Saara; Tharao, Wangari; Benoit, Anita; Dubuc, Danièle; Thomas-Pavanel, Jamie; Sereda, Paul; Jabbari, Shahab; Shurgold, Jayson H.; Colley, Guillaume; Hogg, Robert S.; Kaida, Angela

2017-01-01

Globally, women are at increased vulnerability to HIV due to biological, social, structural, and political reasons. Women living with HIV also experience unique issues related to their medical and social healthcare, which makes a clinical care model specific to their needs worthy of exploration. Furthermore, there is a dearth of research specific to women living with HIV. Research for this population has often been narrowly focused on pregnancy-related issues without considering their complex structural inequalities, social roles, and healthcare and biological needs. For these reasons, we have come together, as researchers, clinicians and community members in Canada, to develop the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) to investigate the concept of women-centred HIV care (WCHC) and its impact on the overall, HIV, women’s, mental, sexual, and reproductive health outcomes of women living with HIV. Here, we present the CHIWOS cohort profile, which describes the cohort and presents preliminary findings related to perceived WCHC. CHIWOS is a prospective, observational cohort study of women living with HIV in British Columbia (BC), Ontario, and Quebec. Two additional Canadian provinces, Saskatchewan and Manitoba, will join the cohort in 2018. Using community-based research principles, CHIWOS engages women living with HIV throughout the entire research process meeting the requirements of the ‘Greater Involvement of People living with HIV/AIDS’. Study data are collected through an interviewer-administered questionnaire that uses a web-based platform. From August 2013 to May 2015, a total of 1422 women living with HIV in BC, Ontario, and Quebec were enrolled and completed the baseline visit. Follow-up interviews are being conducted at 18-month intervals. Of the 1422 participants at baseline, 356 were from BC (25%), 713 from Ontario (50%), 353 from Quebec (25%). The median age of the participants at baseline was 43 years (range, 16–74). 22% identified as Indigenous, 30% as African, Caribbean or Black, 41% as Caucasian/White, and 7% as other ethnicities. Overall, 83% of women were taking antiretroviral therapy at the time of the baseline interview and of them, 87% reported an undetectable viral load. Of the 1326 women who received HIV medical care in the previous year and responded to corresponding questions, 57% (95% CI: 54%-60%) perceived that the care they received from their primary HIV doctor had been women-centred. There were provincial and age differences among women who indicated that they received WCHC versus not; women from BC or Ontario were more likely to report WCHC compared to participants in Quebec. They were also more likely to be younger. CHIWOS will be an important tool to develop care models specific for women living with HIV. Moreover, CHIWOS is collecting extensive information on socio-demographics, social determinants of health, psychological factors, and sexual and reproductive health and offers an important platform to answer many relevant research questions for and with women living with HIV. Information on the cohort can be found on the study website (http://www.chiwos.ca). PMID:28957412

Cohort profile: The Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS).

PubMed

Loutfy, Mona; de Pokomandy, Alexandra; Kennedy, V Logan; Carter, Allison; O'Brien, Nadia; Proulx-Boucher, Karène; Ding, Erin; Lewis, Johanna; Nicholson, Valerie; Beaver, Kerrigan; Greene, Saara; Tharao, Wangari; Benoit, Anita; Dubuc, Danièle; Thomas-Pavanel, Jamie; Sereda, Paul; Jabbari, Shahab; Shurgold, Jayson H; Colley, Guillaume; Hogg, Robert S; Kaida, Angela

2017-01-01

Globally, women are at increased vulnerability to HIV due to biological, social, structural, and political reasons. Women living with HIV also experience unique issues related to their medical and social healthcare, which makes a clinical care model specific to their needs worthy of exploration. Furthermore, there is a dearth of research specific to women living with HIV. Research for this population has often been narrowly focused on pregnancy-related issues without considering their complex structural inequalities, social roles, and healthcare and biological needs. For these reasons, we have come together, as researchers, clinicians and community members in Canada, to develop the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) to investigate the concept of women-centred HIV care (WCHC) and its impact on the overall, HIV, women's, mental, sexual, and reproductive health outcomes of women living with HIV. Here, we present the CHIWOS cohort profile, which describes the cohort and presents preliminary findings related to perceived WCHC. CHIWOS is a prospective, observational cohort study of women living with HIV in British Columbia (BC), Ontario, and Quebec. Two additional Canadian provinces, Saskatchewan and Manitoba, will join the cohort in 2018. Using community-based research principles, CHIWOS engages women living with HIV throughout the entire research process meeting the requirements of the 'Greater Involvement of People living with HIV/AIDS'. Study data are collected through an interviewer-administered questionnaire that uses a web-based platform. From August 2013 to May 2015, a total of 1422 women living with HIV in BC, Ontario, and Quebec were enrolled and completed the baseline visit. Follow-up interviews are being conducted at 18-month intervals. Of the 1422 participants at baseline, 356 were from BC (25%), 713 from Ontario (50%), 353 from Quebec (25%). The median age of the participants at baseline was 43 years (range, 16-74). 22% identified as Indigenous, 30% as African, Caribbean or Black, 41% as Caucasian/White, and 7% as other ethnicities. Overall, 83% of women were taking antiretroviral therapy at the time of the baseline interview and of them, 87% reported an undetectable viral load. Of the 1326 women who received HIV medical care in the previous year and responded to corresponding questions, 57% (95% CI: 54%-60%) perceived that the care they received from their primary HIV doctor had been women-centred. There were provincial and age differences among women who indicated that they received WCHC versus not; women from BC or Ontario were more likely to report WCHC compared to participants in Quebec. They were also more likely to be younger. CHIWOS will be an important tool to develop care models specific for women living with HIV. Moreover, CHIWOS is collecting extensive information on socio-demographics, social determinants of health, psychological factors, and sexual and reproductive health and offers an important platform to answer many relevant research questions for and with women living with HIV. Information on the cohort can be found on the study website (http://www.chiwos.ca).

Illuminating cellular structure and function in the early secretory pathway by multispectral 3D imaging in living cells

NASA Astrophysics Data System (ADS)

Rietdorf, Jens; Stephens, David J.; Squire, Anthony; Simpson, Jeremy; Shima, David T.; Paccaud, Jean-Pierre; Bastiaens, Philippe I.; Pepperkok, Rainer

2000-04-01

Membrane traffic between the endoplasmic reticulum (ER) and the Golgi complex is regulated by two vesicular coat complexes, COPII and COPI. COPII has been implicated in selective packaging of anterograde cargo into coated transport vesicles budding from the ER. COPI-coated vesicles are proposed to mediate recycling of proteins from the Golgi complex to the ER. We have used multi spectral 3D imaging to visualize COPI and COPII behavior simultaneously with various GFP-tagged secretory markers in living cells. This shows that COPII and COPI act sequentially whereby COPI association with anterograde transport complexes is involved in microtubule-based transport and the en route segregation of ER recycling molecules from secretory cargo within TCS in transit to the Golgi complex. We have also investigated the possibility to discriminate spectrally GFP fusion proteins by fluorescence lifetime imaging. This shows that at least two, and possibly up to three GFP fusion proteins can be discriminated and localized in living cells using a single excitation wavelength and a single broad band emission filter.

Financial Neutrality for Living Organ Donors: Reasoning, Rationale, Definitions, and Implementation Strategies.

PubMed

Hays, R; Rodrigue, J R; Cohen, D; Danovitch, G; Matas, A; Schold, J; LaPointe Rudow, D

2016-07-01

In the United States, live organ donation can be a costly and burdensome undertaking for donors. While most donation-related medical expenses are covered, many donors still face lost wages, travel expenses, incidentals, and potential for future insurability problems. Despite widespread consensus that live donors (LD) should not be responsible for the costs associated with donation, little has changed to alleviate financial burdens for LDs in the last decade. To achieve this goal, the transplant community must actively pursue strategies and policies to eliminate unreimbursed out-of-pocket costs to LDs. Costs should be more appropriately distributed across all stakeholders; this will also make live donation possible for people who, in the current system, cannot afford to proceed. We propose the goal of LD "financial neutrality," offer an operational definition to include the coverage/reimbursement of all medical, travel, and lodging costs, along with lost wages, related to the act of donating an organ, and guidance for consideration of medical care coverage, and wage and other expense reimbursement. The intent of this report is to provide a foundation to inform discussion within the transplant community and to advance initiatives for policy and resource allocation. © Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

Current Canadian initiatives to reimburse live organ donors for their non-medical expenses.

PubMed

Vlaicu, Sorina; Klarenbach, Scott; Yang, Robert C; Dempster, Todd; Garg, Amit X

2007-01-01

Living organ donors frequently incur non-medical expenses for travel, accommodation, prescription drugs, loss of income, and child care in conjunction with organ donation. Despite international precedent and widespread public support, Canada currently lacks a unified strategy to reimburse donors for these expenses. In 2005, we communicated with 78 individuals within the field of Canadian transplantation to identify which initiatives for reimbursement of living donors existed in each province. Saskatchewan was the only province in which public employees were granted paid leave for organ donation. Six provincial governments partially reimbursed travel and accommodation. At the federal level, other expenses could be partially reimbursed through an income tax credit, while the Employment Insurance program and the Canada Pension Plan provided funding for donors who become unemployed or develop long-term disability as a result of donation. Charities helped a limited number of patients in financial need through grants and no-interest loans, but funding was generally limited by contributions received. While reimbursing living donors for their non-medical expenses is considered just, existing programs only partially reimburse expenses and are not available in all provinces. Developing future reimbursement policies will remove a disincentive faced by some potential donors, and may increase rates of transplantation in Canada.

The effectiveness of group visits for patients with heart failure on knowledge, quality of life, self-care, and readmissions: a systematic review protocol.

PubMed

Slyer, Jason T; Ferrara, Lucille R

The objective of this review is to identify the effectiveness of group visits for patients with heart failure (HF) on knowledge, quality of life, self-care behaviors, and hospital readmissions. BACKGROUND: Heart failure (HF) continues to be a major health burden throughout the world. There are currently over 5.7 million Americans, 15 million Europeans, and 277,800 Australians living with HF. These numbers are expected to double by 2040. Patients and caregivers perform the majority of HF care in the home. Patients with HF need to learn to be successful in self-managing their condition to lessen the burden of symptoms such as fatigue, dyspnea, and edema.Patient education is the primary process used to increase knowledge of self-care practices for patients with HF. Patients with HF need to follow a complex medical regimen while adhering to a low sodium diet and prescribed fluid restrictions. In addition patients monitor their physical condition daily for exacerbation of symptoms or signs of fluid overload. Education, behavior modification, and skill development are necessary for a patient with HF to be successful in self-managing their condition.Most HF education occurs during one-on-one visits between the patient and the health care provider in an examination room during a regular clinic visit. However, there is usually limited time to address all of the needed education topics in an in-depth, meaningful manner with information the patient can take home and utilize in their daily routines.Group visits provide an alternative venue to provide care for this complex patient population. A group visit is an interactive process between a health care provider and a small group of patients and their caregivers who usually share a common medical concern. The participants of group visits can benefit from the knowledge and experiences of the other participants while providing support and encouragement to each other as they learn to cope with living with a chronic condition.The process of the group visit was first developed in 1991 by Dr. John C. Scott at the Kaiser Permanente system in Colorado, United States. Dr. Scott and a nurse held monthly group visits lasting 60 minutes with a group of 15 to 20 patients to manage their complex medical conditions. The group visit model can vary across settings, including from 6-20 patients over a 1-2 hour period with varying times devoted to education and discussion of health concerns. The group visit typically incorporates a one-on-one physical examination with a physician or nurse practitioner in conjunction with a group discussion and medical management. Group visits have shown to be beneficial in improving patient outcomes for conditions such as diabetes, hypertension, and other chronic illness.The goal of group visits for patients with HF is to increase patient knowledge and self-care abilities, while improving self-efficacy. Self-care incorporates the decision making process a patient undergoes when deciding on a course of action to maintain stability as a result of a change in symptoms. Improved self-care can improve symptoms, which will likely result in an increase in quality of life and a reduction in hospitalizations related to decompensation. Quality of life (QOL) refers to a patient's perception of the impact of a health condition and treatment on the patient's health status and can be measured with valid and reliable tools such as the Minnesota Living with Heart Failure Questionnaire (MLHFQ) or the Kansas City Cardiomyopathy Questionnaire (KCCQ). Self-care abilities can be measured using an instrument such as the Self-Care Heart Failure Index (SCHFI). HF knowledge can be measured using an instrument such as the Atlanta Heart Failure Knowledge Test. Group visits can be used to continue to optimize medication therapy while providing a forum for knowledge acquisition and fostering support.A search of the Cochrane Library of Systematic Reviews, the Joanna Briggs Library of Systematic Reviews, MEDLINE, and CINAHL did not identify any previously conducted systematic reviews on the effectiveness of group visits on outcomes for patients with heart failure. Therefore, this review seeks to identify studies evaluating the effectiveness of group visits for patients with heart failure on patient knowledge, quality of life, self-care behaviors, and hospital readmissions.

New NIH-funded Ultrasound Technology is Changing Lives around the World | NIH MedlinePlus the Magazine

MedlinePlus

... please turn Javascript on. New NIH-funded Ultrasound Technology is Changing Lives around the World Past Issues / ... to high-quality medical images. Vscan uses advanced technology to produce high-quality images of internal organs. ...

The impact of taking or not taking ARVs on HIV stigma as reported by persons living with HIV infection in five African countries.

PubMed

Makoae, Lucy N; Portillo, Carmen J; Uys, Leana R; Dlamini, Priscilla S; Greeff, Minrie; Chirwa, Maureen; Kohi, Thecla W; Naidoo, Joanne; Mullan, Joseph; Wantland, Dean; Durrheim, Kevin; Holzemer, William L

2009-11-01

This study examined the impact of taking or not taking antiretroviral (ARV) medications on stigma, as reported by people living with HIV infection in five African countries. A two group (taking or not taking ARVs) by three (time) repeated measures analysis of variance examined change in reported stigma in a cohort sample of 1454 persons living with HIV infection in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Participants self-reported taking ARV medications and completed a standardized stigma scale validated in the African context. Data were collected at three points in time, from January 2006 to March 2007. Participants taking ARV medications self-reported a mean CD4 count of 273 and those not taking ARVs self-reported a mean CD4 count of 418. Both groups reported significant decreases in total HIV stigma over time; however, people taking ARVs reported significantly higher stigma at Time 3 compared to those not taking ARVs. This study documents that this sample of 1454 HIV infected persons in five countries in Africa reported significantly less HIV stigma over time. In addition, those participants taking ARV medications experienced significantly higher HIV stigma over time compared to those not taking ARVs. This finding contradicts some authors' opinions that when clients enroll in ARV medication treatment it signifies that they are experiencing less stigma. This work provides caution to health care providers to alert clients new to ARV treatment that they may experience more stigma from their families and communities when they learn they are taking ARV medications.

Medical condition and care of undocumented migrants in ambulatory clinics in Tel Aviv, Israel: assessing unmet needs.

PubMed

Mor, Zohar; Raveh, Yuval; Lurie, Ido; Leventhal, Alex; Gamzu, Roni; Davidovitch, Nadav; Benari, Orel; Grotto, Itamar

2017-07-14

Approximately 150,000 undocumented migrants (UM) who are medically uninsured reside in Israel, including ~50,000 originating from the horn of Africa (MHA). Free medical-care is provided by two walk-in clinics in Tel-Aviv. This study aims to compare the medical complaints of UM from different origins, define their community health needs and assess gaps between medical needs and available services. This cross-sectional study included a random sample of 610 UM aged 18-64 years, who were treated in these community clinics between 2008 and 2011. The study compared UM who had complex medical conditions which necessitated referral to more equipped medical settings with UM having mild/simple medical conditions, who were treated at the clinics. MHA were younger, unemployed and more commonly males compared with UM originating from other countries. MHA also had longer referral-delays and visited the clinics less frequently. UM with complex medical conditions were more commonly females, had chronic diseases and demonstrated longer referral-delays than those who had mild/simple medical conditions. The latter more commonly presented with complained of respiratory, muscular and skeletal discomfort. In multivariate analysis, the variables which predicted complex medical conditions included female gender, chronic illnes and self-referral to the clinics. The ambulatory clinics were capable of responding to mild/simple medical conditions. Yet, the health needs of women and migrants suffering from complex medical conditions and chronic diseases necessitated referrals to secondary/tertiary medical settings, while jeopardizing the continuity of care. The health gaps can be addressed by a more holistic social approach, which includes integration of UM in universal health insurance.

[Medical treatment support to tuberculous patients--from the standpoint of community support].

PubMed

2001-11-01

A symposium with "Medical Treatment Support to Tuberculous Patients--From the standpoint of community support" as its theme was held at the 76th Annual Meeting of the Japanese Society for Tuberculosis (April 20, 2001). "Once, It is infected with tuberculosis, one have to complete medication with a sensitive antituberculosis drug by observing the prescribed dose and duration for successful treatment". For this to be promoted community, it is necessary that (1) to manage patient's medication by medical facilities, (2) to support patient's medication by health center and (3) to support patient's living by welfare offices. Not that each facilities takes such responsibilities alone, but various community must fulfill them continuously in liaison with one another. On what measures should be taken to that end, reports based on practical examples from Nagoya City, Yokohama City and Kanagawa Prefecture have been compiled as follows. 1. It was in-office liaison by conference that supported the DOTS activities of health nurses. 2. It is cooperating, without health, medical treatment, and welfare going out, as follows. (1) A system for hospitals and clinics to carry out DOTS treatment consistently has been kept in good condition. (2) For a patient to take a drug in front of a nurse has become common, causing the patients to be motivated. (3) Assignment of MSW and nurses in charge of DOTS sent from hospitals has make it possible to offer or exchange information smoothly among those concerned. (4) A system for many persons concerned to support patients timely has been kept in good condition. This resulted in an increase in the cure rate of tuberculosis in the areas which have day laborers' lodgings. 3. By DOTS for in-patients, the number of self-discharges has decreased by 1/3, and the treatment completion rate was 94%. 4. In promotion of DOTS for the patients who have health problems other than tuberculosis, the role MSW plays is great. 5. As conditions for supporting DOTS promotion, it is necessary to create a system by which to stabilize the living of the patient himself, guarantee earnings to support it and dissolve the living problem faced by the patient. 6. Introduction of the "early guidance system for the patients in whom the treatment of tuberculosis" was discontinued has strengthened the liaison between health offices and medical facilities, has led to early detection in persons yet to receive medical treatment and resumption of medical treatment, making it possible to deal with problem cases effectively on a priority basis. It has been confirmed that liaison between health, medical service and welfare for community support of the treatment of tuberculous patients who live in that community resulted in improvement of clinical results of tuberculous patients. In this connection, Dr. Shirai advised "For a tuberculous patient to form a habit of taking a drug wherever he lives needs to be recognized as a major subject". He presented the forcible yell. "Any local government office has the homeless. I want you to make efforts so that DOTS be given to all the tuberculous persons. If there is any problem, I am ready to give advice."

Unpredictable, unpreventable and impersonal medicine: global disaster response in the 21st century.

PubMed

Andrews, Russell J; Quintana, Leonidas M

2015-01-01

The United Nations has recognized the devastating consequences of "unpredictable, unpreventable and impersonal" disasters-at least US $2 trillion in economic damage and more than 1.3 million lives lost from natural disasters in the last two decades alone. In many disasters (both natural and man-made) hundreds-and in major earthquakes, thousands-of lives are lost in the first days following the event because of the lack of medical/surgical facilities to treat those with potentially survivable injuries. Disasters disrupt and destroy not only medical facilities in the disaster zone but also infrastructure (roads, airports, electricity) and potentially local healthcare personnel as well. To minimize morbidity and mortality from disasters, medical treatment must begin immediately, within minutes ideally, but certainly within 24 h (not the days to weeks currently seen in medical response to disasters). This requires that all resources-medical equipment and support, and healthcare personnel-be portable and readily available; transport to the disaster site will usually require helicopters, as military medical response teams in developed countries have demonstrated. Some of the resources available and in development for immediate medical response for disasters-from portable CT scanners to telesurgical capabilities-are described. For immediate deployment, these resources-medical equipment and personnel-must be ready for deployment on a moment's notice and not require administrative approvals or bureaucratic authorizations from numerous national and international agencies, as is presently the case. Following the "trauma center/stroke center" model, disaster response incorporating "disaster response centers" would be seamlessly integrated into the ongoing daily healthcare delivery systems worldwide, from medical education and specialty training (resident/registrar) to acute and subacute intensive care to long-term rehabilitation. The benefits of such a global disaster response network extend far beyond the lives saved: universal standards for medical education and healthcare delivery, as well as the global development of medical equipment and infrastructure, would follow. Capitalizing on the humanitarian nature of disaster response-with its suspension of the cultural, socioeconomic and political barriers that often paralyze international cooperation and development-disaster response can be predictable, loss of life can be preventable and benefits can be both personal and societal.

Daily Living Skills at Your Fingertips. Daily Living Skills for 0-4 Level Adult Basic Education Students. Curriculum and Teacher Guide.

ERIC Educational Resources Information Center

Greene, Margret

A curriculum and teacher guide are provided for a program to teach daily living skills to 0-4 level adult basic education students. The guide presents a method of instruction and lists the materials provided. Teaching plans (content outlines) are provided for these areas: cooking, housekeeping, laundry, leisure skills, and medication awareness. A…

The Possible Impact of Teachers and School Nurses on the Lives of Children Living with Sickle Cell Disease

ERIC Educational Resources Information Center

Knight-Madden, Jennifer M.; Lewis, Norma; Tyson, Esther; Reid, Marvin E.; MooSang, Michelle

2011-01-01

It is well recognized that for people living with a chronic disease, the largest impact on preserved health may come from persons other than medical professionals. This may be especially true for children for whom the actions of parents and school professionals have significant importance. Sickle cell disease (SCD) is one such disease. Although…

An experimental predeployment training program improves self-reported patient treatment confidence and preparedness of Army combat medics.

PubMed

Gerhardt, Robert T; Hermstad, Erik L; Oakes, Michael; Wiegert, Richard S; Oliver, Jeffrey

2008-01-01

To develop and assess impact of a focused review of International Trauma Life Support (ITLS) and combat casualty care with hands-on procedure training for U.S. Army medics deploying to Iraq. The setting was a U.S. Army Medical Department Center and School and Camp Eagle, Iraq. Investigators developed and implemented a command-approved prospective educational intervention with a post hoc survey. Subjects completed a three-day course with simulator and live-tissue procedure laboratories. At deployment's end, medics were surveyed for experience, confidence, and preparedness in treating various casualty severity levels. Investigators used two-tailed t-test with unequal variance for continuous data and chi-square for categorical data. Twenty-nine medics deployed. Eight completed the experimental program. Twenty-one of 25 (84%) available medics completed the survey including six of the eight (75%) experimental medics. The experimental group reported significantly greater levels of preparedness and confidence treating "minimal," "delayed," and "immediate" casualties at arrival in Iraq. These differences dissipated progressively over the time course of the deployment. This experimental program increased combat medic confidence and perceived level of preparedness in treating several patient severity levels. Further research is warranted to determine if the experimental intervention objectively improves patient care quality and translates into lives saved early in deployment.

Medical pluralism on Mfangano Island: use of medicinal plants among persons living with HIV/AIDS in Suba District, Kenya.

PubMed

Nagata, Jason M; Jew, Alan R; Kimeu, John M; Salmen, Charles R; Bukusi, Elizabeth A; Cohen, Craig R

2011-05-17

Given the increasing coverage of antiretroviral therapy (ART) for HIV/AIDS treatment as well as the high utilization of herbal medicine, many persons living with HIV/AIDS in sub-Saharan Africa are thought to practice medical pluralism, or the adoption of more than one medical system for their care and treatment. Using a cross-sectional study we sought to document and identify the herbal medicines used by persons living with HIV/AIDS on Mfangano Island, Suba District, Nyanza Province, Kenya. We interviewed herbalists and knowledgeable mothers to obtain information regarding medicinal plants, particularly for HIV/AIDS-related symptoms, HIV/AIDS, and chira (an illness concept with similarities to HIV/AIDS regarding sexual transmission and wasting symptoms). Using systematic sampling, 67 persons living with HIV/AIDS (49 of whom were receiving ART) were selected from an Mfangano Island health clinic and participated in semi-structured interviews. Interviews with herbalists and mothers identified 40 plant species in 37 genera and 29 families that a person with HIV/AIDS or chira could use for herbal remedies. Overall, 70.1% of persons living with HIV/AIDS had used medicinal plants after HIV diagnosis, most commonly to treat symptoms related to HIV/AIDS. In addition to common vegetables and fruits that can serve medicinal purposes, Azadirachta indica A. Juss. (Meliaceae), Carissa edulis (Forssk.) Vahl (Apocynaceae), and Ximenia americana L. (Olacaceae) were the most frequently cited medicinal plants used by persons living with HIV/AIDS. Collaboration and communication between biomedical clinicians and herbalists should be encouraged given high rates of concomitant ART-herb usage. Pharmacological, toxicological, and ART-herb interaction studies based on the plants identified in this study and their constituent ingredients should be considered. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Medical pluralism on Mfangano Island: Use of medicinal plants among persons living with HIV/AIDS in Suba District, Kenya

PubMed Central

Nagata, Jason M.; Jew, Alan R.; Kimeu, John M.; Salmen, Charles R.; Bukusi, Elizabeth A.; Cohen, Craig R.

2011-01-01

Ethnopharmacological relevance Given the increasing coverage of antiretroviral therapy (ART) for HIV/AIDS treatment as well as the high utilization of herbal medicine, many persons living with HIV/AIDS in sub-Saharan Africa are thought to practice medical pluralism, or the adoption of more than one medical system for their care and treatment. Using a cross-sectional study we sought to document and identify the herbal medicines used by persons living with HIV/AIDS on Mfangano Island, Suba District, Nyanza Province, Kenya. Materials and Methods We interviewed herbalists and knowledgeable mothers to obtain information regarding medicinal plants, particularly for HIV/AIDS-related symptoms, HIV/AIDS, and chira (an illness concept with similarities to HIV/AIDS regarding sexual transmission and wasting symptoms). Using systematic sampling, 67 persons living with HIV/AIDS (49 of whom were receiving ART) were selected from an Mfangano Island health clinic and participated in semi-structured interviews. Results Interviews with herbalists and mothers identified 40 plant species in 37 genera and 29 families that a person with HIV/AIDS or chira could use for herbal remedies. Overall, 70.1% of persons living with HIV/AIDS had used medicinal plants after HIV diagnosis, most commonly to treat symptoms related to HIV/AIDS. In addition to common vegetables and fruits that can serve medicinal purposes, Azadirachta indica A.Juss. (Meliaceae), Carissa edulis (Forssk.) Vahl (Apocynaceae), and Ximenia americana L. (Olacaceae) were the most frequently cited medicinal plants used by persons living with HIV/AIDS. Conclusions Collaboration and communication between biomedical clinicians and herbalists should be encouraged given high rates of concomitant ART-herb usage. Pharmacological, toxicological, and ART-herb interaction studies based on the plants identified in this study and their constituent ingredients should be considered. PMID:21458556

Effects of live music therapy sessions on quality of life indicators, medications administered and hospital length of stay for patients undergoing elective surgical procedures for brain.

PubMed

Walworth, Darcy; Rumana, Christopher S; Nguyen, Judy; Jarred, Jennifer

2008-01-01

The physiological and psychological stress that brain tumor patients undergo during the entire surgical experience can considerably affect several aspects of their hospitalization. The purpose of this study was to examine the effects of live music therapy on quality of life indicators, amount of medications administered and length of stay for persons receiving elective surgical procedures of the brain. Subjects (N = 27) were patients admitted for some type of surgical procedure of the brain. Subjects were randomly assigned to either the control group receiving no music intervention (n = 13) or the experimental group receiving pre and postoperative live music therapy sessions (n = 14). Anxiety, mood, pain, perception of hospitalization or procedure, relaxation, and stress were measured using a self-report Visual Analog Scale (VAS) for each of the variables. The documented administration of postoperative pain medications; the frequency, dosage, type, and how it was given was also compared between groups. Experimental subjects live and interactive music therapy sessions, including a pre-operative session and continuing with daily sessions until the patient was discharged home. Control subjects received routine hospital care without any music therapy intervention. Differences in experimental pretest and posttest scores were analyzed using a Wilcoxon Matched-Pairs Signed-Rank test. Results indicated statistically significant differences for 4 of the 6 quality of life measures: anxiety (p = .03), perception of hospitalization (p = .03), relaxation (p = .001), and stress (p = .001). No statistically significant differences were found for mood (p > .05) or pain (p > .05) levels. Administration amounts of nausea and pain medications were compared with a Two-Way ANOVA with One Repeated Measure resulting in no significant differences between groups and medications, F(1, 51) = 0.03; p > .05. Results indicate no significant differences between groups for length of stay (t = .97, df = 25, p > .05). This research study indicates that live music therapy using patient-preferred music can be beneficial in improving quality of life indicators such as anxiety, perception of the hospitalization or procedure, relaxation, and stress in patients undergoing surgical procedures of the brain.

A normal' category-specific advantage for naming living things.

PubMed

Laws, K R; Neve, C

1999-10-01

'Artefactual' accounts of category-specific disorders for living things have highlighted that compared to nonliving things, living things have lower name frequency, lower concept familiarity and greater visual complexity and greater within-category structural similarity or 'visual crowding' [7]. These hypotheses imply that deficits for living things are an exaggeration of some 'normal tendency'. Contrary to these notions, we found that normal subjects were consistently worse at naming nonliving than living things in a speeded presentation paradigm. Moreover, their naming was not predicted by concept familiarity, name frequency or visual complexity; however, a novel measure of visual familiarity (i.e. for the appearance of things) did significantly predict naming. We propose that under speeded conditions, normal subjects find nonliving things harder to name because their representations are less visually predictable than for living things (i.e. nonliving things show greater within-item structural variability). Finally, because nonliving things have multiple representations in the real world, this may lower the probability of finding impaired naming and recognition in this category.

Interplay of Prior Knowledge, Self-Regulation and Motivation in Complex Multimedia Learning Environments

ERIC Educational Resources Information Center

Song, H. S.; Kalet, A. L.; Plass, J. L.

2016-01-01

This study examined the direct and indirect effects of medical clerkship students' prior knowledge, self-regulation and motivation on learning performance in complex multimedia learning environments. The data from 386 medical clerkship students from six medical schools were analysed using structural equation modeling. The structural model revealed…

Medication Management Assessment for Older Adults in the Community

ERIC Educational Resources Information Center

Orwig, Denise; Brandt, Nicole; Gruber-Baldini, Ann L.

2006-01-01

Purpose: The purpose of this study was to describe the Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE) and to provide results of reliability and validity testing. Design and Methods: Participants were 50 older adults, aged 65 and older, who lived in the community, took at least one prescription medication, and were then…

Children with medical complexity in Canada

PubMed Central

Dewan, Tammie; Cohen, Eyal

2013-01-01

The burden of chronic disease is placing pressure on the Canadian health care system. A small but important chronic disease population is children with medical complexity, defined as individuals with: high family-identified needs; complex chronic disease necessitating specialized care; functional disability; and high health care utilization. These patients present a challenge to community providers who are expected to provide holistic care and manage complex issues, often with a paucity of services and supports. Alternative models of care may address the complex needs of this population. In addition, strategies can be implemented in community practices that may assist with the care of children with medical complexity such as collaborative care, engagement of key workers, focus on goal-directed care and use of care plans. The paediatric community should engage in health care reform discussions focused on chronic disease to ensure that the complex needs of these children are met. PMID:24497777

Adult living liver donors have excellent long-term medical outcomes: the University of Toronto liver transplant experience.

PubMed

Adcock, L; Macleod, C; Dubay, D; Greig, P D; Cattral, M S; McGilvray, I; Lilly, L; Girgrah, N; Renner, E L; Selzner, M; Selzner, N; Kashfi, A; Smith, R; Holtzman, S; Abbey, S; Grant, D R; Levy, G A; Therapondos, G

2010-02-01

Right lobe living donor liver transplantation is an effective treatment for selected individuals with end-stage liver disease. Although 1 year donor morbidity and mortality have been reported, little is known about outcomes beyond 1 year. Our objective was to analyze the outcomes of the first 202 consecutive donors performed at our center with a minimum follow-up of 12 months (range 12-96 months). All physical complications were prospectively recorded and categorized according to the modified Clavien classification system. Donors were seen by a dedicated family physician at 2 weeks, 1, 3 and 12 months postoperatively and yearly thereafter. The cohort included 108 males and 94 females (mean age 37.3 +/- 11.5 years). Donor survival was 100%. A total of 39.6% of donors experienced a medical complication during the first year after surgery (21 Grade 1, 27 Grade 2, 32 Grade 3). After 1 year, three donors experienced a medical complication (1 Grade 1, 1 Grade 2, 1 Grade 3). All donors returned to predonation employment or studies although four donors (2%) experienced a psychiatric complication. This prospective study suggests that living liver donation can be performed safely without any serious late medical complications and suggests that long-term follow-up may contribute to favorable donor outcomes.

Living with an adult family member using advanced medical technology at home.

PubMed

Fex, Angelika; Flensner, Gullvi; Ek, Anna-Christina; Söderhamn, Olle

2011-12-01

Living with an adult family member using advanced medical technology at home An increased number of chronically ill adults perform self-care while using different sorts of advanced medical technology at home. This hermeneutical study aimed to gain a deeper understanding of the meaning of living with an adult family member using advanced medical technology at home. Eleven next of kin to adults performing self-care at home, either using long-term oxygen from a cylinder or ventilator, or performing peritoneal or haemodialysis, were interviewed. The qualitative interviews were analysed using a Gadamerian methodology. The main interpretation explained the meaning as rhythmical patterns of connectedness versus separation, and of sorrow versus reconciliation. Dependence on others was shown in the need for support from healthcare professionals and significant others. In conclusion, next of kin took considerable responsibility for dependent-care. All next of kin were positive to the idea of bringing the technology home, even though their own needs receded into the background, while focusing on the best for the patient. The results were discussed in relation to dependent-care and transition, which may have an influence on the self-care of next of kin and patients. The study revealed a need for further nursing attention to next of kin in this context. © 2011 Blackwell Publishing Ltd.

Retention of Habitat Complexity Minimizes Disassembly of Reef Fish Communities following Disturbance: A Large-Scale Natural Experiment

PubMed Central

Emslie, Michael J.; Cheal, Alistair J.; Johns, Kerryn A.

2014-01-01

High biodiversity ecosystems are commonly associated with complex habitats. Coral reefs are highly diverse ecosystems, but are under increasing pressure from numerous stressors, many of which reduce live coral cover and habitat complexity with concomitant effects on other organisms such as reef fishes. While previous studies have highlighted the importance of habitat complexity in structuring reef fish communities, they employed gradient or meta-analyses which lacked a controlled experimental design over broad spatial scales to explicitly separate the influence of live coral cover from overall habitat complexity. Here a natural experiment using a long term (20 year), spatially extensive (∼115,000 kms2) dataset from the Great Barrier Reef revealed the fundamental importance of overall habitat complexity for reef fishes. Reductions of both live coral cover and habitat complexity had substantial impacts on fish communities compared to relatively minor impacts after major reductions in coral cover but not habitat complexity. Where habitat complexity was substantially reduced, species abundances broadly declined and a far greater number of fish species were locally extirpated, including economically important fishes. This resulted in decreased species richness and a loss of diversity within functional groups. Our results suggest that the retention of habitat complexity following disturbances can ameliorate the impacts of coral declines on reef fishes, so preserving their capacity to perform important functional roles essential to reef resilience. These results add to a growing body of evidence about the importance of habitat complexity for reef fishes, and represent the first large-scale examination of this question on the Great Barrier Reef. PMID:25140801

Retention of habitat complexity minimizes disassembly of reef fish communities following disturbance: a large-scale natural experiment.

PubMed

Emslie, Michael J; Cheal, Alistair J; Johns, Kerryn A

2014-01-01

High biodiversity ecosystems are commonly associated with complex habitats. Coral reefs are highly diverse ecosystems, but are under increasing pressure from numerous stressors, many of which reduce live coral cover and habitat complexity with concomitant effects on other organisms such as reef fishes. While previous studies have highlighted the importance of habitat complexity in structuring reef fish communities, they employed gradient or meta-analyses which lacked a controlled experimental design over broad spatial scales to explicitly separate the influence of live coral cover from overall habitat complexity. Here a natural experiment using a long term (20 year), spatially extensive (∼ 115,000 kms(2)) dataset from the Great Barrier Reef revealed the fundamental importance of overall habitat complexity for reef fishes. Reductions of both live coral cover and habitat complexity had substantial impacts on fish communities compared to relatively minor impacts after major reductions in coral cover but not habitat complexity. Where habitat complexity was substantially reduced, species abundances broadly declined and a far greater number of fish species were locally extirpated, including economically important fishes. This resulted in decreased species richness and a loss of diversity within functional groups. Our results suggest that the retention of habitat complexity following disturbances can ameliorate the impacts of coral declines on reef fishes, so preserving their capacity to perform important functional roles essential to reef resilience. These results add to a growing body of evidence about the importance of habitat complexity for reef fishes, and represent the first large-scale examination of this question on the Great Barrier Reef.

Fourth-Year Medical Student Charting of Older Persons' Cognitive and Functional Status.

PubMed

Agens, John; Appelbaum, Jonathan S; Baker, Suzanne; Brummel-Smith, Kenneth; Friedman, Eli; Harrison, Suzanne L; Kutner, Mitchell; McKenzie, Jonathan

2016-01-01

Functional and cognitive impairment correlates with medical outcomes in older persons, yet documentation in the medical record is often inadequate. The purpose of this pilot study was to evaluate fourth year (M4) medical students' charting performance of cognition and functional status in older persons during non-geriatric clerkships using an audit tool. The research assistants used a chart abstracting tool to retrospectively review patients' charts. The abstracting tool contained keywords and phrases to prompt the research assistants to look for any documentation of patient status in four domains: (1) delirium or acute confusional state, (2) chronic cognitive impairment, (3) activities of daily living, and (4) instrumental activities of daily living. The threshold was any mention of keywords in these domains. On non-geriatrics M4 clerkships in the hospital, students documented acute cognitive status (ACS) and presence or absence of chronic cognitive impairment (CCI) in 57% and 68% of cases respectively, with physicians and/or nurses doing it more often at 63% and 84%. Both students and other care providers documented ACS and CCI in the same charts 41% and 59% of the time, respectively. Students documented activities of daily living (ADLs) and instrumental activities of daily living (IADLs) 31% and 3% respectively, physicians and/or nurses 59% and 0%. Documentation of cognitive status in hospital charts for students and physicians was somewhat higher than in the literature. This may be because geriatrics is integrated into our 4-year curriculum. Documentation by both students and physicians was better for ADLs than IADLs and poor for IADLs overall.

Ambient Information Systems to Support the Elderly in Carrying Out Their Activities of Daily Living

NASA Astrophysics Data System (ADS)

García-Vázquez, Juan Pablo; Rodríguez, Marcela D.

As they age, older adult's present losses in their functional capabilities which cause them can't continue performing their activities of daily living (ADL) independently at home. We propose Ambient Information Systems (AIS) as appropriate pervasive devices to promote their independent living. Therefore our aim is to determine the utility and usability of AIS to support the independent life of older adults by helping them to perform their activities. In this paper we present preliminary results of a case study that we carried out for understanding the problems and needs that older adults face in doing some of their activities of daily living. In particular, we present results regarding the elderly problems to adhere to their medication prescription. Based on these results we propose AIS to support older adults to medicate. Finally, we present the design attributes incorporated into this AIS, which were identified from the design taxonomies of AIS reported in the literature.

Strategies to expand the living donor pool for kidney transplantation.

PubMed

de Klerk, Marry; Zuidema, Willij C; Ijzermans, Jan N M; Weimar, Willem

2008-05-01

Structural shortage of deceased donor kidneys for transplantation has resulted in the expansion of living donation programs. A number of possibilities are now being explored, since it became clear that donors do not need to be genetically related to their recipients. Apart from classical direct donation we now conduct paired exchange, list exchange, altruistic donation and domino paired exchange programs. Other alternative programs are desensitization and transplantation across the blood type barrier. The purpose of this article is to give a general view of all optimizing living donation programs by reviewing the literature. First we describe logistic solutions, thereafter the more intensive medical treatments. We observed a wide variation in clinical experiences with living donation dependent on local jurisdiction, culture and customs. Professionals disagree on various ethical issues inherent to alternative programs. In our opinion logistic solutions like paired exchange, list exchange and altruistic donation programs are to be preferred over the more medical demanding programs e.g. desensitization and transplantation across the blood type barrier.

Aelius Aristides as Informed Patient and Physician.

PubMed

Petridou, Georgia

2016-01-01

Aelius Aristides, one of the most renowned orators of the so-called second sophistic, has often been thought of as the paradigmatic patient who surrendered his physical and psychological health to Asclepius, and spent a large part of his life in the temple of the god at Pergamum blindly following divine orders on diet and regimen. This study looks at the Hieroi Logoi as an illness narrative and argues against such a simplistic view and in favour of a more complex picture: Aristides is a far cry far from the submissive patient, who idly resided in the Pergamene Asclepieion relying exclusively on the therapeutic powers of the god and his human helpers. In fact, through a close reading of a selection of passages from the Hieroi Logoi a whole new image of Aristides emerges: the informed patient who is not only in possession of the basics of the medical discourse but who also functions as a physician of sorts, taking both his own life and the lives of others into his hands. This new type of patient, the knowledgeable patient, who is well-versed in medical matters and envisages himself as an active agent of the healing process and an equally important partner in the medical encounter, ties well with other testimonies we have about knowledgeable patients mostly to be found amongst the members of the socio-political elite of the time.

Sounding Narrative Medicine: Studying Students’ Professional Identity Development at Columbia University College of Physicians and Surgeons

PubMed Central

Miller, Eliza; Balmer, Dorene; Hermann, Nellie; Graham, Gillian; Charon, Rita

2014-01-01

Purpose To learn what medical students derive from training in humanities, social sciences, and the arts in a narrative medicine curriculum and to explore narrative medicine’s framework as it relates to students’ professional development. Method On completion of required intensive, half-semester narrative medicine seminars in 2010, 130 second-year medical students at Columbia University College of Physicians and Surgeons participated in focus group discussions of their experiences. Focus group transcriptions were submitted to close iterative reading by a team who performed a grounded-theory-guided content analysis, generating a list of codes into which statements were sorted to develop overarching themes. Provisional interpretations emerged from the close and repeated readings, suggesting a fresh conceptual understanding of how and through what avenues such education achieves its goals in clinical training. Results Students’ comments articulated the known features of narrative medicine—attention, representation, and affiliation—and endorsed all three as being valuable to professional identity development. They spoke of the salience of their work in narrative medicine to medicine and medical education and its dividends of critical thinking, reflection, and pleasure. Critiques constituted a small percentage of the statements in each category. Conclusions Students report that narrative medicine seminars support complex interior, interpersonal, perceptual, and expressive capacities. Students’ lived experiences confirm some expectations of narrative medicine curricular planners while exposing fresh effects of such work to view. PMID:24362390

Modulating biological events by biophysics: an innovative molecular methodology using ion cyclotron resonance--a pilot study.

PubMed

Corbellini, Ezio; Corbellini, Monica; Licciardello, Orazio; Marotta, Francesco

2014-04-01

The QUEC PHISIS(™) technology, based on the theory of coherence domains of water, is the most advanced application of quantum electrodynamics coherence suitable for transferring highly targeted and personalized electromagnetic signals to the living cells. Several experimental studies in aged rats confirm its beneficial action on vital cellular parameters while also optimizing the bioavailability and absorption of fundamental elements in cellular metabolism. Clinical observations have followed and have strengthened its applicability in healthy volunteers and in patients with complex diseases such as cardiovascular, neuromuscular, and metabolic disorders. Our pilot study on severely compromised, frail subjects corroborates its relevance. The delivery of correct frequencies has the potential to become a safe, very affordable, and effective therapeutic modality that is amenable to being integrated with pharmacological drugs, thus representing a substantial innovation in medical practice.

Endodontics and the ageing patient.

PubMed

Johnstone, M; Parashos, P

2015-03-01

Patients are living longer and the rate of edentulism is decreasing. Endodontic treatment is an essential part of maintaining the health and well-being of the elderly. Retention of natural teeth improves the quality of life and the overall health and longevity of ageing patients. Also, teeth that might be otherwise extracted may be strategically valuable to retain a prosthesis, and elderly patients are more likely to have medical complications that may prevent dental extractions from being safely performed. The technical goals of endodontic treatment in the elderly are the same as those for younger patients. However, the pulpo-dentinal complex undergoes calcific changes over time, which may pose challenges for the clinician. The purposes of this review are to discuss age changes in the pulp and the challenges posed by diagnosing, treatment planning and treating the elderly endodontic patient. © 2015 Australian Dental Association.

Welfare reform: advocacy and intervention in the health care setting.

PubMed Central

Lawton, E; Leiter, K; Todd, J; Smith, L

1999-01-01

Welfare reform has drastically altered the lives of poor families in the US. In its wake, many former recipients are not receiving whatever transitional benefits and other safeguards to which they remain entitled under federal and state laws. Families are losing access to Medicaid and are not receiving the child care assistance or Food Stamps for which they continue to be eligible. Ill-served by stringent time limits and work requirements, lack of child care assistance, and lack of training and educational opportunities for the development of skills that will lead to better jobs, families need help to navigate the complexities of the new welfare system. Boston Medical Center's Department of Pediatrics has instituted a welfare screening project to educate families about their rights under welfare reform and assist them in advocating for themselves and their children. PMID:10670622

A Review of the Pathophysiology and Treatment of Psychosis in Parkinson’s Disease

PubMed Central

Zahodne, Laura B.; Fernandez, Hubert H.

2011-01-01

Psychotic symptoms in Parkinson’s disease (PD) are relatively common, and in addition to being a disturbance to patients’ daily lives, they have consistently been shown to be associated with poor outcome. Our understanding of the pathophysiology of psychosis in PD has expanded dramatically over the past fifteen years, from an initial interpretation of symptoms as dopaminergic drug side effects to the current view of a complex interplay of extrinsic and disease-related factors. The present article reviews the unique clinical features of psychosis as expressed in PD, associated risk factors, and current theories behind its pathogenesis, including medications, visual processing deficits, sleep disturbances, genetics, and neurochemical and structural abnormalities. Finally, we review both traditional and emergent management strategies for PD psychosis, including antipsychotic agents, cholinesterase inhibitors, electroconvulsive therapy (ECT), and other pharmacological and psychological interventions. PMID:18665659

Medical and health risks associated with communicable diseases of Rohingya refugees in Bangladesh 2017.

PubMed

Chan, Emily Y Y; Chiu, Cheuk Pong; Chan, Gloria K W

2018-03-01

Complex emergencies remain major threats to human well-being in the 21st century. More than 300000 Rohingya people from Myanmar, one of the most forgotten minorities globally, have fled to neighboring countries over the past decades. In the recent crisis, the sudden influx of Rohingya people over a 3-month period almost tripled the accumulated displaced population in Bangladesh. Using the Rohingya people in Bangladesh as a case context, this perspective article synthesizes evidence in the published literature regarding the possible key health risks associated with the five main health and survival supporting domains, namely water and sanitation, food and nutrition, shelter and non-food items, access to health services, and information, for the displaced living in camp settlements in Asia. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Ascribing emotion to reasonable use in accelerated cancer services.

PubMed

Obling, Anne Roelsgaard

2013-01-01

A recurrent theme in medical sociology has been the juxtaposition of emotion with scientific rationality in the delivery of health care services. However, apart from addressing this juxtaposition very little is said about the complex intertwinement of "emotional" and "rational" practices which makes up professionals' own day-to-day work experiences - and how these experiences are influenced by present ways of organising health care. This paper aims to explore the ways that hospital doctors relate emotions to their understanding of professional medical work and how they respond to recent organisational changes within the field. Drawing upon a small series of semi-structured interviews (n = 14) with doctors from a public teaching hospital in Denmark, the paper adopts a constructivist framework to analyse personal biographies of health professionals' working lives. The doctors represented rich accounts of professional medical work, which includes an understanding of what a doctor should feel and how he/she should make him/herself emotionally available to others. However, the impetus for making this appearance was not left unaffected by recent new public management reforms and attempts to accelerate the delivery of services. The organisation of cancer services into a work system, which consists of a set of tasks broken down into narrow jobs, underestimates the emotional components of patient-doctor encounters. This makes the creation and maintenance of a genuine patient-doctor relationship difficult and the result is feelings of a failed encounter on behalf of the doctor. The paper suggests that recent rearrangements of cancer services complicate doctors' ability to incorporate emotion into a stream of medical care in a "rational" way. This is shown to challenge their professional ethos and the forms emotional engagement takes in medical practice.

[Exponential use of social media in medicine: example of the interest of Twitter(©) in urology].

PubMed

Rouprêt, M; Misraï, V

2015-01-01

Social media (#SoMe) has changed the face of modern medicine. Our purpose was to asses the potential interest of Twitter in the field of urology. A systematic review of the literature has been performed using PubMed without timeline restriction with the following keywords (MeSH): social media; Web 2.0; Twitter; Internet; network; urology; journal club; education. There were 3 categories of interest of Twitter in the field of urology: spread of scientific knowledge, scientific interaction during medical conferences and medical education and international medical debates. The unique spread of evidence-based-medecine through traditional scientific journals in paper version is over. Main scientific journals in urology and scientific societies are now using a Twitter account and became virtual. They use new bibliometrics available on #SoMe to estimate the social impact. Twitter allows for a better interactivity of doctors attending scientific conferences. Exponential use of Twitter is in the interest of speakers and leaders, audience and scientific societies. Lastly, medical academic education and continuing medical education can be achieved through #SoMe. Twitter became a lively virtual platform for scientific debates for complex oncological cases (dematerialized tumor board). Twitter is also a place for intense scientific discussion during virtual journal club without geographic or timeline restriction. Physicians need to respect the rules for a wise use of #SoMe in order not to break the Hippocratic Oath. There is a revolution around #SoMe and Twitter in the spread of scientific knowledge and academic teaching. International urologists are already committed in this evolution and France should also get involved. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Healthcare provider perspectives on barriers to HIV-care access and utilisation among Latinos living with HIV in the US-Mexico border.

PubMed

Servin, Argentina E; Muñoz, Fátima A; Zúñiga, María Luisa

2014-01-01

Latinos living with HIV residing in the US-Mexico border region frequently seek care on both sides of the border. Given this fact, a border health perspective to understanding barriers to care is imperative to improve patient health outcomes. This qualitative study describes and compares experiences and perceptions of Mexican and US HIV care providers regarding barriers to HIV care access for Latino patients living in the US-Mexico border region. In 2010, we conducted in-depth qualitative interviews with HIV care providers in Tijuana (n = 10) and San Diego (n = 9). We identified important similarities and differences between Mexican and US healthcare provider perspectives on HIV care access and barriers to service utilisation. Similarities included the fact that HIV-positive Latino patients struggle with access to ART medication, mental health illness, substance abuse and HIV-related stigma. Differences included Mexican provider perceptions of medication shortages and US providers feeling that insurance gaps influenced medication access. Differences and similarities have important implications for cross-border efforts to coordinate health services for patients who seek care in both countries.

Prevalence of medication adherence and its associated factors among community-dwelling Chinese older adults in Hong Kong.

PubMed

Leung, Doris Y P; Bai, Xue; Leung, Angela Y M; Liu, Ben C P; Chi, Iris

2015-06-01

The aim of present study was to describe the prevalence of medication adherence, and to examine its risk factors among Chinese community-dwelling older adults with chronic diseases. Secondary analysis was carried out on the data collected from 3167 Hong Kong adults aged ≥60 years who lived in their private home, had at least one type of chronic disease and had completed a screening instrument for long-term care services for the first time in 2006. The outcome variable was the self- or caregiver-reported medication adherence. Among the respondents, 90.8% reported having good medication adherence in the past 7 days. More dependence on activities of daily living (P < 0.001), stroke (P = 0.003) or diabetes (P = 0.036), had medication review by physicians (P < 0.001) and received more informal care support (P = 0.005) were positively associated with medication adherence, whereas more cognitive impaired (P = 0.008), more negative mood (P = 0.071) and perceived poor health (P < 0.001) were negatively associated with medication adherence. The prevalence of self-reported medication adherence was high in Hong Kong Chinese community-dwelling older adults. A number of modifiable factors associated with medication adherence were identified, which provides specific targets for interventions. © 2014 Japan Geriatrics Society.

Internalization of subcellular-scale microfabricated chips by healthy and cancer cells

PubMed Central

Wong, H.-S. Philip

2018-01-01

Continuous monitoring of physiological parameters inside a living cell will lead to major advances in our understanding of biology and complex diseases, such as cancer. It also enables the development of new medical diagnostics and therapeutics. Progress in nanofabrication and wireless communication has opened up the potential of making a wireless chip small enough that it can be wholly inserted into a living cell. To investigate how such chips could be internalized into various types of living single cells and how this process might affect cells’ physiology, we designed and fabricated a series of multilayered micron-scale tag structures with different sizes as potential RFID (Radio Frequency IDentification) cell trackers. While the present structures are test structures that do not resonate, the tags that do resonate have similar structure from device fabrication, material properties, and device size point of view. The structures are in four different sizes, the largest with the lateral dimension of 9 μm × 21 μm. The thickness for these structures is kept constant at 1.5 μm. We demonstrate successful delivery of our fabricated chips into various types of living cells, such as melanoma skin cancer, breast cancer, colon cancer and healthy/normal fibroblast skin cells. To our surprise, we observed a remarkable internalization rate difference between each cell type; the uptake rate was faster for more aggressive cancer cells than the normal/healthy cells. Cell viability before and after tag cellular internalization and persistence of the internalized tags have also been recorded over the course of five days of incubation. These results establish the foundations of the possibility of long term, wireless, intracellular physiological signal monitoring. PMID:29601607

Uptake of erythromycin by first-feeding sockeye salmon, Oncorhynchus nerka (Walbaum), fed live or freeze-dried enriched adult Artemia or medicated pellets.

PubMed

Cook, M A; Rust, M B; Massee, K; Majack, T; Peterson, M E

2003-05-01

The potential to use adult Artemia to deliver erythromycin to first-feeding sockeye salmon, Oncorhynchus nerka (Walbaum), was investigated in three trials. In the first trial, first-feeding sockeye were fed live erythromycin enriched adult Artemia or pellets containing equal amounts of erythromycin for 35 days. At the end of the trial, tissue erythromycin concentration of the fish fed the live Artemia was significantly greater (P < 0.05, 25.52 +/- 1.29 microg mL(-1); mean +/- SEM), than the tissue concentration of the fish fed the pellets (0.72 +/- 0.01 microg mL(-1)). In the second trial, first-feeding sockeye were fed either live or freeze-dried bioencapsulated erythromycin (adult Artemia) or pellets containing erythromycin daily for 21 days. Mean daily erythromycin concentration in fish fed the freeze-dried Artemia, live Artemia, or pellets did not differ significantly. In the third trial, apparent erythromycin digestibility was determined. Significantly more (P < 0.05) erythromycin was retained by juvenile sockeye fed freeze-dried bioencapsulated erythromycin (98.3 +/- 1.0%) compared with medicated pellets (89.2 +/- 1.7%). Uptake of bioencapsulated erythromycin from adult Artemia (live or freeze-dried) appears to be greater than uptake from pellets. Freeze-dried and live Artemia were equally effective at delivery suggesting enriched freeze-dried adult Artemia could be produced into a highly palatable, consistent, off-the-shelf product.

Impact of live interactive teledermatology on diagnosis, disease management, and clinical outcomes.

PubMed

Lamel, Sonia; Chambers, Cindy J; Ratnarathorn, Mondhipa; Armstrong, April W

2012-01-01

To assess the impact of live interactive teledermatology consultations on changes in diagnosis, disease management, and clinical outcomes. We conducted a retrospective analysis of 1500 patients evaluated via live interactive teledermatology between 2003 and 2005 at the University of California, Davis. We compared diagnoses and treatment plans between the referring physicians and the teledermatologists. Patients with 2 or more teledermatology visits within a 1-year period were assessed for changes in clinical outcomes. Academic medical center with an established teledermatology program since 1996. Medical records were evaluated for 1500 patients who underwent live interactive teledermatology consultation. Patients seen for more than 1 teledermatology visit were included in the clinical outcome assessment. Live interactive teledermatology consultation. Changes in diagnosis, disease management, and clinical outcome. Compared with diagnoses and treatment plans from referring physicians, the 1500 live interactive teledermatology consultations resulted in changes in diagnosis in 69.9% of patients and changes in disease management in 97.7% of patients. Among 313 patients with at least 2 teledermatology visits within 1 year, clinical improvement was observed in 68.7% of patients. Multivariate analysis showed that changes in diagnosis (P = .01), changes in disease management (P < .001), and the number of teledermatology visits (P < .001) were significantly associated with improved clinical outcomes. Live interactive teledermatology consultations result in changes in diagnosis and disease management in most consultations. The numbers of live interactive teledermatology visits and changes in diagnosis and disease management are significantly associated with improved clinical outcomes.

Illustrating the (in)visible: Understanding the impact of loss in adults living with secondary lymphedema after cancer

PubMed Central

Thomas, Roanne; Hamilton, Ryan

2014-01-01

Life with a disability is often riddled with paradoxes, one of which is being visibly marked, while personal experiences, losses, and challenges remain hidden. Our article draws attention to this paradox among people who live with secondary lymphedema after cancer (SLC). SLC is a relatively unfamiliar chronic condition within medical and lay discourses of cancer, which proves challenging for the many cancer survivors who are in search of information and understanding. Thirteen men and women with SLC were recruited from two research sites (Fredericton, NB, and Ottawa, ON, Canada) to participate in semi-structured interviews about the physical and psychosocial aspects of SLC. Using a methodology of interpretive description, our analysis of participant interviews reveals the complex ways in which men and women felt both visible and invisible within various contexts. We discuss three majors themes: (in)visibility and appearance related to material losses; (in)visibility and action connected to visible losses in function, as well as invisible struggles to care for oneself; and the loss of present and future well-being, as SLC renders some limitations visible while potentially obscuring a hopeful future indefinitely. Our research indicates that timely diagnosis of SLC would be an immediate first step in recognizing the physical and emotional dimensions of the condition. To accomplish this, increased awareness is needed. To enhance quality of life for those living with SLC, the development of new resources and psychosocial supports is also required. PMID:25148936

Hospital nurses' lived experiences of intelligent resilience: A phenomenological study.

PubMed

Imani, Behzad; Kermanshahi, Sima Mohamad Khan; Vanaki, Zohreh; Kazemnejad Lili, Anoshiravan

2018-05-01

To explore Iranian hospital nurses' lived experiences of intelligent resilience. Nurses do high levels of emotional work when fulfilling patients' and their family members' complex needs. Intelligent resilience can alleviate nurses' stress and enhance their endurance. This study was based on the Husserlian descriptive phenomenology. A purposive sample of ten hospital nurses was drawn from hospitals affiliated with Hamadan University of Medical Sciences, Hamadan, Iran. In-depth semi-structured interviews were held to collect data. The seven-step data analysis approach proposed by Colaizzi was used for the data analysis. In this study, the adherence to consolidated criteria for reporting qualitative guidelines has been followed. The participating hospital nurses' lived experiences of intelligent resilience came into four main themes of patience and wisdom, reverence, situational self-control and appealing to religiosity. Each of the four main themes included two subthemes which were having peace and wise quietness, reverence for the patients, physicians and nurses, distancing themselves from stressful situations and displacing staff who cause stress, and the nurse's trust in God as well as the patient and his family`s trust in God, respectively. Nurses with intelligent resilience are able to bring peace, reverence for others and situational self-control to stressors thereby providing higher quality of care to their patients. Nurses work in unstable and stressful conditions. The findings of this study provide better understanding about the concept of nurses' intelligent resilience and its indicators and attributes. © 2018 John Wiley & Sons Ltd.

Biomimetic silica encapsultation of living cells

NASA Astrophysics Data System (ADS)

Jaroch, David Benjamin

Living cells perform complex chemical processes on size and time scales that artificial systems cannot match. Cells respond dynamically to their environment, acting as biological sensors, factories, and drug delivery devices. To facilitate the use of living systems in engineered constructs, we have developed several new approaches to create stable protective microenvironments by forming bioinspired cell-membrane-specific silica-based encapsulants. These include vapor phase deposition of silica gels, use of endogenous membrane proteins and polysaccharides as a site for silica nucleation and polycondensation in a saturated environment, and protein templated ordered silica shell formation. We demonstrate silica layer formation at the surface of pluripotent stem-like cells, bacterial biofilms, and primary murine and human pancreatic islets. Materials are characterized by AFM, SEM and EDS. Viability assays confirm cell survival, and metabolite flux measurements demonstrate normal function and no major diffusion limitations. Real time PCR mRNA analysis indicates encapsulated islets express normal levels of genetic markers for β-cells and insulin production. The silica glass encapsulant produces a secondary bone like calcium phosphate mineral layer upon exposure to media. Such bioactive materials can improve device integration with surrounding tissue upon implantation. Given the favorable insulin response, bioactivity, and long-term viability observed in silica-coated islets, we are currently testing the encapsulant's ability to prevent immune system recognition of foreign transplants for the treatment of diabetes. Such hybrid silica-cellular constructs have a wide range of industrial, environmental, and medical applications.

Influencing factors of alexithymia in Chinese medical students: a cross-sectional study.

PubMed

Zhu, Yaxin; Luo, Ting; Liu, Jie; Qu, Bo

2017-04-04

A much higher prevalence of alexithymia has been reported in medical students compared with the general population, and alexithymia is a risk factor that increases vulnerability to mental disorders. Our aim was to evaluate the level of alexithymia in Chinese medical students and to explore its influencing factors. A cross-sectional study of 1,950 medical students at Shenyang Medical College was conducted in May 2014 to evaluate alexithymia in medical students using the Chinese version of the 20-item Toronto Alexithymia Scale (TAS-20). The reliability of the questionnaire was assessed by Cronbach's α coefficient and mean inter-item correlations. Confirmatory factor analysis (CFA) was used to evaluate construct validity. The relationships between alexithymia and influencing factors were examined using Student's t-test, analysis of variance, and multiple linear regression analysis. Statistical analysis was performed using SPSS 21.0. Of the 1,950 medical students, 1,886 (96.7%) completed questionnaires. Overall, Cronbach's α coefficient of the TAS-20 questionnaire was 0.868. The results of CFA showed that the original three-factor structure produced an acceptable fit to the data. By univariate analysis, gender, grade (academic year of study), smoking behavior, alcohol use, physical activity, history of living with parents during childhood, and childhood trauma were influencing factors of TAS-20 scores (p < 0.05). Multiple linear regression analysis showed that gender, physical activity, grade, living with parents, and childhood trauma also had statistically significant association with total TAS-20 score (p < 0.05). Gender, physical activity, grade, history of living with parents during childhood, and childhood trauma were all factors determining the level of alexithymia. To prevent alexithymia, it will be advisable to promote adequate physical activity and pay greater attention to male medical students and those who are in the final year of training.

HIV prevalence, sexual behaviors, and engagement in HIV medical care among an online sample of sexually active MSM in Venezuela

PubMed Central

Perez-Brumer, Amaya G.; Oldenburg, Catherine E.; Biello, Katie B.; Novak, David S.; Rosenberger, Joshua G.; Mimiaga, Matthew J.

2016-01-01

In Venezuela, members of a social and sexual partner-networking site for MSM completed an online survey regarding sexual behaviors and HIV medical care. Among the 3,175 respondents, self-reported HIV prevalence was 7.8%. Of participants living with HIV, 73.2% reported taking antiretroviral medication and, 56.6% reported complete adherence within the past month. Participants living with HIV were more likely to be older (aOR=1.04 per one-year increase in age, 95% CI: 1.02, 1.06) and diagnosed with an STI in the previous year (aOR=32.35,10.2). These data provide further understanding of the HIV epidemic among MSM in Venezuela, and potential targets for HIV prevention interventions. PMID:26378188

Effects of acculturation, coping strategies, locus of control, and self-efficacy on chronic pain: study of Chinese immigrant women in Italy - insights from a thematic field analysis.

PubMed

Re, Tania Simona; Bragazzi, Nicola Luigi; Siri, Anna; Cisneros Puebla, César; Friese, Susanne; Simões, Mário; Candau, Joël; Khabbache, Hicham

2017-01-01

Chronic pain represents a common public health concern worldwide. It is a complex phenomenon, owing to the interaction of different factors, including biological, physiological, psychological, environmental, and social variables. Some groups, such as women and immigrants, are particularly vulnerable. However, little is known about how Chinese women in Italy live with and face chronic pain. The present study aimed at filling this knowledge gap by examining the burden of chronic pain in Chinese immigrants in Italy in terms of acculturation processes, perceived control over disease, social networks, and coping strategies. A qualitative approach was used, performing a thematic field analysis. We interviewed 82 Chinese women from different Italian towns (Genoa, Milan, Turin, Bologna, Florence, and Prato) in depth. The sense of belonging to the host culture was strong in our sample. However, this did not simply reflect or translate into a linear engagement with medical systems, as health care pathways were more complex and dual (both Chinese and Western). Chinese women who felt deeply rooted in the Italian environment did not discontinue the use of traditional Chinese medicine. Chronic pain extensively and adversely affected daily life, particularly interfering with work. Coping strategies were mainly adaptive behaviors, being problem focused or maladaptive, relying upon "cope and avoid" mechanisms. Chinese women preferred to use traditional Chinese remedies rather than conventional medicine, while using the Italian system in emergencies. Perceived control over chronic pain was usually external. Finally, Chinese women with chronic pain benefit from social networks and support, which were mainly composed of Chinese peers. In conclusion, our findings underline the tremendous burden of chronic pain affecting all aspects of Chinese women's lives. Health care workers and providers should be aware of the complexity of chronic pain Therefore, a holistic approach, involving different stakeholders, should be adopted when managing chronic pain and approaching immigrant patients.

Medical College of Georgia Complex figures in repeated memory testing: a preliminary study of healthy young adults.

PubMed

Yasugi, Mina; Yamashita, Hikari

2010-02-01

The Medical College of Georgia Complex Figures developed as an alternate version of the Rey-Osterrieth Complex Figure for repeated assessments. The aim of this study was to examine whether serial assessment with different figures of the Medical College of Georgia Complex Figures could attenuate the practice effects. 64 volunteers (M age = 20.0 yr., SD = 1.9) from a Japanese university were randomly assigned to Same or Different figure conditions. Participants in the Same figure condition underwent repeated assessment using Figure 1 of the Medical College of Georgia Complex Figures on both trials, whereas participants in the Different figure condition received Figure 1 on first trials and the Figure 2 on second trials over a 1-mo. test-retest interval. While the Same figure condition showed significant improvements at recall, no practice effect was observed in the Different figure condition. The findings indicated that use of different figures may help attenuate practice effects in repeated testing.

[A quantitative analysis of information-seeking behaviors regarding medical institutions with Spanish language support among South American Spanish-speaking migrants in Aichi Prefecture, Japan].

PubMed

Takaku, Michiko; Ichikawa, Seiichi; Kaneko, Noriyo

2015-01-01

This study aimed to explore the factors associated with information-seeking behaviors regarding medical institutions with Spanish language support among South American Spanish-speaking migrants living in Aichi Prefecture, Japan. The survey targeted South American Spanish-speaking migrants aged 18 years and older currently residing in Aichi Prefecture who had lived in Japan for at least three months and who had previously seen a doctor in Japan. The questionnaire was written in Spanish and the survey was conducted from April to July, 2010. Wilson's information behavior model was used to study information-seeking behavior regarding medical institutions with Spanish language support among 245 respondents who completed the questionnaires (response rate: 58.9%). Experience seeking medical institutions with Spanish language support in the Tokai area was set as the dependent variable and a chi-square test was conducted to examine relationships with language support needs, recognition of and access to medical institutions with Spanish language support, living situation in Japan, and Japanese language skills. Among the 245 respondents, 106 were male (43.3%) and 139 were female (56.7%). The average age was 39.6±11.2 years old and 84.5% were Peruvian. The average length of residency in Japan was 11.0±5.7 years, and 34.3% of respondents had lived in Aichi for 5-9 years. A total of 165 respondents (67.3%) had searched for medical institutions with Spanish language support, while 80 (32.7%) had not. Information-seeking behavior regarding medical institutions with Spanish language support was associated with having previously experienced a need for Spanish language support when seeing doctors in Japan, finding and attending medical institutions with Spanish language support in the Tokai area, length of residency in Japan, Japanese language skills, and the language used in daily life. Experience in requiring Spanish support when sick or injured in Japan motivated respondents to seek medical institutions with Spanish language support. Communication difficulties in Japanese, speaking Spanish in daily life, and length of residency in Japan were relevant factors in their information-seeking behaviors. Respondents were likely to obtain information from family, friends, co-workers, and Spanish media, but not from public institutions that distribute Spanish material. Finding an effective way to disseminate health-related information was a fundamental health issue for South American Spanish-speaking migrants.