Efficient Privacy-Enhancing Techniques for Medical Databases

NASA Astrophysics Data System (ADS)

Schartner, Peter; Schaffer, Martin

In this paper, we introduce an alternative for using linkable unique health identifiers: locally generated system-wide unique digital pseudonyms. The presented techniques are based on a novel technique called collision-free number generation which is discussed in the introductory part of the article. Afterwards, attention is payed onto two specific variants of collision-free number generation: one based on the RSA-Problem and the other one based on the Elliptic Curve Discrete Logarithm Problem. Finally, two applications are sketched: centralized medical records and anonymous medical databases.

Government regulations and other influences on the medical use of computers.

PubMed

Mishelevich, D J; Grams, R R; Mize, S G; Smith, J P

1979-01-01

This paper presents points brought out in a panel discussion held at the 12th Hawaiian International Conference on System Sciences, January 1979. The session was attended by approximately two dozen interested parties from various segments of the academic, government, and health care communities. The broad categories covered include the specific problems of government regulations and their impact on specific clinical information systems installed at The University of Texas Health Science Center at Dallas, opportunities in a regulated environment, problems in a regulated environment, vendor-related issues in the marketing and manufacture of computer-based information systems, rational approaches to government control, and specific issues related to medical computer science.

Do Continuing Medical Education Articles Foster Shared Decision Making?

ERIC Educational Resources Information Center

Labrecque, Michel; Lafortune, Valerie; Lajeunesse, Judith; Lambert-Perrault, Anne-Marie; Manrique, Hermes; Blais, Johanne; Legare, France

2010-01-01

Introduction: Defined as reviews of clinical aspects of a specific health problem published in peer-reviewed and non-peer-reviewed medical journals, offered without charge, continuing medical education (CME) articles form a key strategy for translating knowledge into practice. This study assessed CME articles for mention of evidence-based…

Development and evaluation of a crowdsourcing methodology for knowledge base construction: identifying relationships between clinical problems and medications

PubMed Central

Wright, Adam; Laxmisan, Archana; Ottosen, Madelene J; McCoy, Jacob A; Butten, David; Sittig, Dean F

2012-01-01

Objective We describe a novel, crowdsourcing method for generating a knowledge base of problem–medication pairs that takes advantage of manually asserted links between medications and problems. Methods Through iterative review, we developed metrics to estimate the appropriateness of manually entered problem–medication links for inclusion in a knowledge base that can be used to infer previously unasserted links between problems and medications. Results Clinicians manually linked 231 223 medications (55.30% of prescribed medications) to problems within the electronic health record, generating 41 203 distinct problem–medication pairs, although not all were accurate. We developed methods to evaluate the accuracy of the pairs, and after limiting the pairs to those meeting an estimated 95% appropriateness threshold, 11 166 pairs remained. The pairs in the knowledge base accounted for 183 127 total links asserted (76.47% of all links). Retrospective application of the knowledge base linked 68 316 medications not previously linked by a clinician to an indicated problem (36.53% of unlinked medications). Expert review of the combined knowledge base, including inferred and manually linked problem–medication pairs, found a sensitivity of 65.8% and a specificity of 97.9%. Conclusion Crowdsourcing is an effective, inexpensive method for generating a knowledge base of problem–medication pairs that is automatically mapped to local terminologies, up-to-date, and reflective of local prescribing practices and trends. PMID:22582202

A problem-solving approach to effective insulin injection for patients at either end of the body mass index.

PubMed

Juip, Micki; Fitzner, Karen

2012-06-01

People with diabetes require skills and knowledge to adhere to medication regimens and self-manage this complex disease. Effective self-management is contingent upon effective problem solving and decision making. Gaps existed regarding useful approaches to problem solving by individuals with very low and very high body mass index (BMI) who self-administer insulin injections. This article addresses those gaps by presenting findings from a patient survey, a symposium on the topic of problem solving, and recent interviews with diabetes educators to facilitate problem-solving approaches for people with diabetes with high and low BMI who inject insulin and/or other medications. In practice, problem solving involves problem identification, definition, and specification; goal and barrier identification are a prelude to generating a set of potential strategies for problem resolution and applying these strategies to implement a solution. Teaching techniques, such as site rotation and ensuring that people with diabetes use the appropriate equipment, increase confidence with medication adherence. Medication taking is more effective when people with diabetes are equipped with the knowledge, skills, and problem-solving behaviors to effectively self-manage their injections.

Screening and Diagnostic Procedure for Identification of Adult Learning Problems. 309 Demonstration Project.

ERIC Educational Resources Information Center

International Labour Office, Islamabad (Pakistan). Asian and Pacific Skill Development Programme.

This screening and diagnostic procedure is intended to identify Level 1 adults with specific learning problems. The adults not meeting criteria on the assessments for visual and auditory functions should be referred to proper medical services for full evaluations. A prescriptive teaching program should be specifically designed to meet needs of…

Expected Benefits of Streamlining Undergraduate Medical Education by Early Commitment to Specific Medical Specialties

ERIC Educational Resources Information Center

Benbassat, Jochanan; Baumal, Reuben

2012-01-01

Undergraduate medical education is too long; it does not meet the needs for physicians' workforce; and its content is inconsistent with the job characteristics of some of its graduates. In this paper we attempt to respond to these problems by streamlining medical education along the following three reforms. First, high school graduates would be…

Optimized model tuning in medical systems.

PubMed

Kléma, Jirí; Kubalík, Jirí; Lhotská, Lenka

2005-12-01

In medical systems it is often advantageous to utilize specific problem situations (cases) in addition to or instead of a general model. Decisions are then based on relevant past cases retrieved from a case memory. The reliability of such decisions depends directly on the ability to identify cases of practical relevance to the current situation. This paper discusses issues of automated tuning in order to obtain a proper definition of mutual case similarity in a specific medical domain. The main focus is on a reasonably time-consuming optimization of the parameters that determine case retrieval and further utilization in decision making/ prediction. The two case studies - mortality prediction after cardiological intervention, and resource allocation at a spa - document that the optimization process is influenced by various characteristics of the problem domain.

Technology applications

NASA Technical Reports Server (NTRS)

1972-01-01

A review was made of recent and current efforts to apply aerospace derived solutions to nonaerospace problems. Specific problems discussed include transportation, environmental pollution and abatement, housing and urban construction, firefighter equipment, and mine safety. Medical diseases and equipment are also discussed.

The Medical Response to Sex Trafficking of Minors in Wisconsin.

PubMed

Rabbitt, Angela

2015-04-01

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

Education in the workplace for the physician: clinical management states as an organizing framework.

PubMed

Greenes, R A

2000-01-01

Medical educators are interested in approaches to making selected relevant knowledge available in the context of problem-based care. This is of value both during the process of care and as a means of organizing information for offline self-study. Four trends in health information technology are relevant to achieving the goal and can be expected to play a growing role in the future. First, health care enterprises are developing approaches for access to information resources related to the care of a patient, including clinical data and images but also communication tools, referral and other logistic tools, decision support, and educational materials. Second, information for patients and methods for patient-doctor interaction and decision making are becoming available. Third, computer-based methods for representation of practice guidelines are being developed to support applications that can incorporate their logic. Finally, considering patients as being in particular "clinical management states" (or CMSs) for specific problems, approaches are being developed to use guidelines as a kind of "predictive" framework to enable development of interfaces for problem-based clinical encounters. The guidelines for a CMS can be used to identify the kinds of resources specifically needed for clinical encounters of that type. As the above trends converge to produce problem-specific environments, professional specialty organizations and continuing medical education course designers will need to focus energies on organizing and updating medical knowledge to make it available in CMS-specific contexts.

An Intervention to Maximize Medication Management by Caregivers of Persons with Memory Loss: Intervention Overview and Two-Month Outcomes

PubMed Central

Lingler, Jennifer H.; Arida, Janet; Houze, Martin; Kaufman, Robert; Knox, Melissa; Sereika, Susan M.; Tamres, Lisa; Erlen, Judith; Amspaugh, Carolyn; Tang, Fengyan; Happ, Mary Beth

2016-01-01

Overseeing medication-taking is a critical aspect of dementia caregiving. This randomized controlled trial examined the efficacy of a tailored, problem-solving intervention designed to maximize medication management practices among caregivers of persons with memory loss. Eighty-three community-dwelling dyads (patient + informal caregiver) with a baseline average of 3 medication deficiencies participated. Home- and telephone-based sessions were delivered by nurse or social worker interventionists and addressed basic aspects of managing medications, plus tailored problem solving for specific challenges. The outcome of medication management practices was assessed using the Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE) and an investigator-developed Medication Deficiency Checklist (MDC). Linear mixed modeling showed both the intervention and usual care groups had decreases in medication management problems as measured by the MedMaIDE (F=6.91, p<.01) and MDC (F=9.72, p<.01) at 2 months post-intervention. The phenomenon of reduced medication deficiencies in both groups suggests that when nurses or social workers merely raise awareness of the importance of medication adherence, there may be benefit. PMID:26804450

Learning the facts in medical school is not enough: which factors predict successful application of procedural knowledge in a laboratory setting?

PubMed

Schmidmaier, Ralf; Eiber, Stephan; Ebersbach, Rene; Schiller, Miriam; Hege, Inga; Holzer, Matthias; Fischer, Martin R

2013-02-22

Medical knowledge encompasses both conceptual (facts or "what" information) and procedural knowledge ("how" and "why" information). Conceptual knowledge is known to be an essential prerequisite for clinical problem solving. Primarily, medical students learn from textbooks and often struggle with the process of applying their conceptual knowledge to clinical problems. Recent studies address the question of how to foster the acquisition of procedural knowledge and its application in medical education. However, little is known about the factors which predict performance in procedural knowledge tasks. Which additional factors of the learner predict performance in procedural knowledge? Domain specific conceptual knowledge (facts) in clinical nephrology was provided to 80 medical students (3rd to 5th year) using electronic flashcards in a laboratory setting. Learner characteristics were obtained by questionnaires. Procedural knowledge in clinical nephrology was assessed by key feature problems (KFP) and problem solving tasks (PST) reflecting strategic and conditional knowledge, respectively. Results in procedural knowledge tests (KFP and PST) correlated significantly with each other. In univariate analysis, performance in procedural knowledge (sum of KFP+PST) was significantly correlated with the results in (1) the conceptual knowledge test (CKT), (2) the intended future career as hospital based doctor, (3) the duration of clinical clerkships, and (4) the results in the written German National Medical Examination Part I on preclinical subjects (NME-I). After multiple regression analysis only clinical clerkship experience and NME-I performance remained independent influencing factors. Performance in procedural knowledge tests seems independent from the degree of domain specific conceptual knowledge above a certain level. Procedural knowledge may be fostered by clinical experience. More attention should be paid to the interplay of individual clinical clerkship experiences and structured teaching of procedural knowledge and its assessment in medical education curricula.

The Role of Medication in Supporting Emotional Wellbeing in Young People with Long-Term Needs

PubMed Central

Gray, Nicola J.; Wood, Damian M.

2017-01-01

Young people frequently use and access prescribed medications for a range of health problems. Medications aimed at treating both common health problems and long-term physical and mental health needs in adolescence can have a significant effect on a young person’s emotional well-being. We use a series of case studies to illustrate the challenges for healthcare professionals supporting young people with medication use. The studies illustrate the efficacy and limitations of medication on improving emotional well-being by alleviating illness and distress, and how this efficacy must be balanced against both the adverse effects and the burden of treatment. There are specific challenges for medication management during adolescence including issues of adherence/concordance, facilitating autonomy and participation in decision making, and promoting independence. PMID:29099742

Designing the future of healthcare.

PubMed

Fidsa, Gianfranco Zaccai

2009-01-01

This paper describes the application of a holistic design process to a variety of problems plaguing current healthcare systems. A design process for addressing complex, multifaceted problems is contrasted with the piecemeal application of technological solutions to specific medical or administrative problems. The goal of this design process is the ideal customer experience, specifically the ideal experience for patients, healthcare providers, and caregivers within a healthcare system. Holistic design is shown to be less expensive and wasteful in the long run because it avoids solving one problem within a complex system at the cost of creating other problems within that system. The article applies this approach to the maintenance of good health throughout life; to the creation of an ideal experience when a person does need medical care; to the maintenance of personal independence as one ages; and to the enjoyment of a comfortable and dignified death. Virginia Mason Medical Center is discussed as an example of a healthcare institution attempting to create ideal patient and caregiver experiences, in this case by applying the principles of the Toyota Production System ("lean manufacturing") to healthcare. The article concludes that healthcare is inherently dedicated to an ideal, that science and technology have brought it closer to that ideal, and that design can bring it closer still.

Toward interactive scheduling systems for managing medical resources.

PubMed

Oddi, A; Cesta, A

2000-10-01

Managers of medico-hospital facilities are facing two general problems when allocating resources to activities: (1) to find an agreement between several and contrasting requirements; (2) to manage dynamic and uncertain situations when constraints suddenly change over time due to medical needs. This paper describes the results of a research aimed at applying constraint-based scheduling techniques to the management of medical resources. A mixed-initiative problem solving approach is adopted in which a user and a decision support system interact to incrementally achieve a satisfactory solution to the problem. A running prototype is described called Interactive Scheduler which offers a set of functionalities for a mixed-initiative interaction to cope with the medical resource management. Interactive Scheduler is endowed with a representation schema used for describing the medical environment, a set of algorithms that address the specific problems of the domain, and an innovative interaction module that offers functionalities for the dialogue between the support system and its user. A particular contribution of this work is the explicit representation of constraint violations, and the definition of scheduling algorithms that aim at minimizing the amount of constraint violations in a solution.

Detection of medication-related problems in hospital practice: a review

PubMed Central

Manias, Elizabeth

2013-01-01

This review examines the effectiveness of detection methods in terms of their ability to identify and accurately determine medication-related problems in hospitals. A search was conducted of databases from inception to June 2012. The following keywords were used in combination: medication error or adverse drug event or adverse drug reaction, comparison, detection, hospital and method. Seven detection methods were considered: chart review, claims data review, computer monitoring, direct care observation, interviews, prospective data collection and incident reporting. Forty relevant studies were located. Detection methods that were better able to identify medication-related problems compared with other methods tested in the same study included chart review, computer monitoring, direct care observation and prospective data collection. However, only small numbers of studies were involved in comparisons with direct care observation (n = 5) and prospective data collection (n = 6). There was little focus on detecting medication-related problems during various stages of the medication process, and comparisons associated with the seriousness of medication-related problems were examined in 19 studies. Only 17 studies involved appropriate comparisons with a gold standard, which provided details about sensitivities and specificities. In view of the relatively low identification of medication-related problems with incident reporting, use of this method in tracking trends over time should be met with some scepticism. Greater attention should be placed on combining methods, such as chart review and computer monitoring in examining trends. More research is needed on the use of claims data, direct care observation, interviews and prospective data collection as detection methods. PMID:23194349

Pregnancy during Graduate Medical Training.

ERIC Educational Resources Information Center

Young-Shumate, Linda; And Others

1993-01-01

A discussion of student pregnancy during medical residencies looks at the available literature and discusses related problems and issues. Well-written, specific parental leave policies are advocated. A national survey concerning maternity leave policy in psychiatry programs is cited, and further research in other specialties is recommended.…

76 FR 25725 - Final Regulatory Guide: Issuance, Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-05

....18, Revision 2, ``Information Relevant to Ensuring that Occupational Radiation Exposures at Medical..., techniques that the staff uses in evaluating specific problems or postulated accidents, and data that the..., ``Information Relevant to Ensuring that Occupational Radiation Exposures at Medical Institutions will be As Low...

[Contemporary history of medicine: issues and approaches].

PubMed

Schlich, Thomas

2007-01-01

This paper illuminates specific aspects of writing contemporary history of medicine. The first section deals with specific methodological problems in the historiography of modem medicine. Topics discussed include the specific situation concerning contemporary source material, oral history, the use of theories in historiography, the problem of temporal proximity and the issue of the necessity of medical technical knowledge on part of the historian. In the second section the paper ends with a discussion of the purpose and objectives of contemporary history of medicine.

Medical School Education in Hypertension Management: A National Survey.

ERIC Educational Resources Information Center

Moser, Marvin; And Others

1983-01-01

The management of patients with primary hypertension remains a significant problem for the medical profession. In spite of this, specific programs for education in hypertensive vascular disease have been poorly organized. A survey to determine the level of training in this discipline is discussed. (MLW)

[Medical Devices Law for pain therapists].

PubMed

Regner, M; Sabatowski, R

2016-08-01

Medical Devices Law is a relatively new legal system, which has replaced the Medical Devices Regulations still well-known in Germany. German Medical Devices Law is based on European directives, which are, in turn, incorporated into national law by the Medical Devices Act. The Medical Devices Act is a framework law and covers a number of regulations that address specific topics within Medical Devices Law. In turn, in individual regulations, reference is made to guidelines, recommendations, etc. from other sources that provide detailed technical information on specific topics. Medical Devices Law is a very complex legal system, which needs to be permanently observed due to constant updating and adjustment. In the current article, the design and the structure of the system will be described, but special emphasis will be laid on important problem areas that need to be considered when applying and operating medical products, in this case by pain therapists in particular.

Evaluation of a Constrained Facet Analysis Efficiency Model for Identifying the Efficiency of Medical Treatment Facilities in the Army Medical Department

DTIC Science & Technology

1990-07-31

examples on their use is available with the PASS User Documentation Manual. 2 The data structure of PASS requires a three- lvel organizational...files, and missing control variables. A specific problem noted involved the absence of 8087 mathematical co-processor on the target IBM-XT 21 machine...System, required an operational understanding of the advanced mathematical technique used in the model. Problems with the original release of the PASS

[Medical surveillance in university: organizational difficulties, legal problems, scientific e technical specificities. Experience of University of Milan Bicocca].

PubMed

D'Orso, M I; Giuliani, C; Assini, R; Riva, M A; Cesana, G

2012-01-01

Our research describes activities of Occupational Health carried out during last year in University of Milan Bicocca by Occupational Doctors. We describe results of medical surveillance in 1153 employees or students exposed to occupational risks for health and safety. We report results obtained, technical difficulties, organizational problems, and preventive actions decided to improve functionality of our activity. Students seem to be less protected and consequently seem to have higher professional safety and health risks.

Medications for School-Age Children: Effects on Learning and Behavior.

ERIC Educational Resources Information Center

Brown, Ronald T.; Sawyer, Michael G.

Use of medications that target specific behaviors affecting learning and social development has been the most extensively studied form of intervention available to children with behavioral and learning problems. Drawing from extensive research literature spanning the past 30 years, this guide for psychologists and other professionals who work with…

Conceptualizing a model: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force-2.

PubMed

Roberts, Mark; Russell, Louise B; Paltiel, A David; Chambers, Michael; McEwan, Phil; Krahn, Murray

2012-01-01

The appropriate development of a model begins with understanding the problem that is being represented. The aim of this article is to provide a series of consensus-based best practices regarding the process of model conceptualization. For the purpose of this series of papers, the authors consider the development of models whose purpose is to inform medical decisions and health-related resource allocation questions. They specifically divide the conceptualization process into two distinct components: the conceptualization of the problem, which converts knowledge of the health care process or decision into a representation of the problem, followed by the conceptualization of the model itself, which matches the attributes and characteristics of a particular modeling type to the needs of the problem being represented. Recommendations are made regarding the structure of the modeling team, agreement on the statement of the problem, the structure, perspective and target population of the model, and the interventions and outcomes represented. Best practices relating to the specific characteristics of model structure, and which characteristics of the problem might be most easily represented in a specific modeling method, are presented. Each section contains a number of recommendations that were iterated among the authors, as well as the wider modeling taskforce, jointly set up by the International Society for Pharmacoeconomics and Outcomes Research and the Society for Medical Decision Making.

Medication use in children with asthma: not a child size problem.

PubMed

Grover, Charu; Armour, Carol; Asperen, Peter Paul Van; Moles, Rebekah; Saini, Bandana

2011-12-01

The global burden of pediatric asthma is high. Governments and health-care systems are affected by the increasing costs of childhood asthma--in terms of direct health-care costs and indirect costs due to loss of parental productivity, missed school days, and hospitalizations. Despite the availability of effective treatment, the current use of medications in children with asthma is suboptimal. The purpose of this review is to scope the empirical literature to identify the problems associated with the use of pediatric asthma medications. The findings will help to design interventions aiming to improve the use of asthma medications among children. A literature search using electronic search engines (i.e., Medline, International Pharmaceutical Abstracts (IPA), PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) and the search terms "asthma," "children," and "medicines" (and derivatives of these keywords) was conducted. The search terms were expanded to include emergent themes arising out of search findings. Content themes relating to parents, children themselves, health-care professionals, organizational systems, and specific medications and devices were found. Within these themes, key issues included a lack of parental knowledge about asthma and asthma medications, lack of information provided to parents, parental beliefs and fears, parental behavioral problems, the high costs of medications and devices, the child's self-image, the need for more child responsibility, physician nonadherence to prescribing guidelines, "off-label" prescribing, poor understanding of teachers, lack of access to educational resources, and specific medications. These key issues should be taken into account when modifying the development of educational tools. These tools should focus on targeting the children themselves, the parent/carers, the health-care professionals, and various organizational systems.

The effects of using concept mapping as an artifact to engender metacognitive thinking in first-year medical students' problem-based learning discussions: A mixed-methods investigation

NASA Astrophysics Data System (ADS)

Shoop, Glenda Hostetter

Attention in medical education is turning toward instruction that not only focuses on knowledge acquisition, but on developing the medical students' clinical problem-solving skills, and their ability to critically think through complex diseases. Metacognition is regarded as an important consideration in how we teach medical students these higher-order, critical thinking skills. This study used a mixed-methods research design to investigate if concept mapping as an artifact may engender metacognitive thinking in the medical student population. Specifically the purpose of the study is twofold: (1) to determine if concept mapping, functioning as an artifact during problem-based learning, improves learning as measured by scores on test questions; and (2) to explore if the process of concept mapping alters the problem-based learning intragroup discussion in ways that show medical students are engaged in metacognitive thinking. The results showed that students in the problem-based learning concept-mapping groups used more metacognitive thinking patterns than those in the problem-based learning discussion-only group, particularly in the monitoring component. These groups also engaged in a higher level of cognitive thinking associated with reasoning through mechanisms-of-action and breaking down complex biochemical and physiologic principals. The students disclosed in focus-group interviews that concept mapping was beneficial to help them understand how discrete pieces of information fit together in a bigger structure of knowledge. They also stated that concept mapping gave them some time to think through these concepts in a larger conceptual framework. There was no significant difference in the exam-question scores between the problem-based learning concept-mapping groups and the problem-based learning discussion-only group.

Integrating clinical communication with clinical reasoning and the broader medical curriculum.

PubMed

Cary, Julie; Kurtz, Suzanne

2013-09-01

The objectives of this paper are to discuss the results of a workshop conducted at EACH 2012. Specifically, we will (1) examine the link between communication, clinical reasoning, and medical problem solving, (2) explore strategies for (a) integrating clinical reasoning, medical problem solving, and content from the broader curriculum into clinical communication teaching and (b) integrating communication into the broader curriculum, and (3) discuss benefits gained from such integration. Salient features from the workshop were recorded and will be presented here, as well as a case example to illustrate important connections between clinical communication and clinical reasoning. Potential links between clinical communication, clinical reasoning, and medical problem solving as well as strategies to integrate clinical communication teaching and the broader curricula in human and veterinary medicine are enumerated. Participants expressed enthusiasm and keen interest in integration of clinical communication teaching and clinical reasoning during this workshop, came to the idea of the interdependence of these skills easily, and embraced the rationale immediately. Valuing the importance of communication as clinical skill and embracing the interdependence between communication and thought processes related to clinical reasoning and medical problem solving will be beneficial in teaching programs. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

[Security specifications for electronic medical records on the Internet].

PubMed

Mocanu, Mihai; Mocanu, Carmen

2007-01-01

The extension for the Web applications of the Electronic Medical Record seems both interesting and promising. Correlated with the expansion of Internet in our country, it allows the interconnection of physicians of different specialties and their collaboration for better treatment of patients. In this respect, the ophthalmologic medical applications consider the increased possibilities for monitoring chronic ocular diseases and for the identification of some elements for early diagnosis and risk factors supervision. We emphasize in this survey some possible solutions to the problems of interconnecting medical information systems to the Internet: the achievement of interoperability within medical organizations through the use of open standards, the automated input and processing for ocular imaging, the use of data reduction techniques in order to increase the speed of image retrieval in large databases, and, last but not least, the resolution of security and confidentiality problems in medical databases.

American parents' willingness to prescribe psychoactive drugs to children: a test of cultural mediators.

PubMed

Cohen, David; Dillon, Frank R; Gladwin, Hugh; De La Rosa, Mario

2013-12-01

In the USA, white children receive psychoactive drugs more often than black or Hispanic children. This study investigates whether cultural attitudes statistically mediate differences between American parents' self-identified racial-ethnic group membership and their willingness to medicate children for behavioral problems. Using data from telephone interviews with 1,145 parents in two Florida counties, structural models tested associations between each group compared with the other, in willingness to medicate children exhibiting different problematic behaviors and hypothesized cultural (familism, fatalism, attitude toward corporal punishment, religiosity, concern about treatment stigma, birth abroad, language of interview) and other mediators (views about medications and causes of children's problems). Respondent gender, age, socioeconomic status, parent-type household, taking psychoactive medication, and having a child with behavioral problems were used as covariates. Race-ethnicity was strongly associated with specific cultural attitudes and views about medications and problems, but only Hispanics distinguished themselves significantly from whites in willingness to medicate children. Across groups, parents who viewed medication favorably and endorsed biomedical causes for problems were more willing to medicate. In Hispanic-white and Hispanic-black comparisons, being interviewed in Spanish was the sole but modest cultural mediator of willingness, and in black-white comparisons, only concern about treatment stigma weakly mediated differences in willingness. These findings provide faint support for a parent-centered cultural explanation of reported prescription differences among youths of different racial-ethnic groups in the USA. However, structural and professional components of a broader cultural hypothesis for such differences, within the USA and between different countries, still require evaluation.

American parents’ willingness to prescribe psychoactive drugs to children: a test of cultural mediators

PubMed Central

Dillon, Frank R.; Gladwin, Hugh; Rosa, Mario De La

2013-01-01

Purpose In the USA, white children receive psychoactive drugs more often than black or Hispanic children. This study investigates whether cultural attitudes statistically mediate differences between American parents’ self-identified racial–ethnic group membership and their willingness to medicate children for behavioral problems. Methods Using data from telephone interviews with 1,145 parents in two Florida counties, structural models tested associations between each group compared with the other, in willingness to medicate children exhibiting different problematic behaviors and hypothesized cultural (familism, fatalism, attitude toward corporal punishment, religiosity, concern about treatment stigma, birth abroad, language of interview) and other mediators (views about medications and causes of children’s problems). Respondent gender, age, socioeconomic status, parent-type household, taking psychoactive medication, and having a child with behavioral problems were used as covariates. Results Race–ethnicity was strongly associated with specific cultural attitudes and views about medications and problems, but only Hispanics distinguished themselves significantly from whites in willingness to medicate children. Across groups, parents who viewed medication favorably and endorsed biomedical causes for problems were more willing to medicate. In Hispanic–white and Hispanic–black comparisons, being interviewed in Spanish was the sole but modest cultural mediator of willingness, and in black–white comparisons, only concern about treatment stigma weakly mediated differences in willingness. Conclusions These findings provide faint support for a parent-centered cultural explanation of reported prescription differences among youths of different racial–ethnic groups in the USA. However, structural and professional components of a broader cultural hypothesis for such differences, within the USA and between different countries, still require evaluation. PMID:23715970

Recent Trends in Computerized Medical Information Systems for Hospital Departments

PubMed Central

Maturi, Vincent F.; DuBois, Richard M.

1980-01-01

The authors have re-examined the current state of commercially-available department-specific medical information systems and their relationship to the hospital-wide communications systems. The current state was compared to the state two years ago when the authors made their first survey. The changes in the trend, the number of problems that hospital administrators or department directors are faced with when purchasing or using department-specific systems, and the activity in standardization were studied.

Teaching medical students to discern ethical problems in human clinical research studies.

PubMed

Roberts, Laura Weiss; Warner, Teddy D; Green Hammond, Katherine A; Brody, Janet L; Kaminsky, Alexis; Roberts, Brian B

2005-10-01

Investigators and institutional review boards are entrusted with ensuring the conduct of ethically sound human studies. Assessing ethical aspects of research protocols is a key skill in fulfilling this duty, yet no empirically validated method exists for preparing professionals to attain this skill. The authors performed a randomized controlled educational intervention, comparing a criteria-based learning method, a clinical-research- and experience-based learning method, and a control group. All 300 medical students enrolled at the University of New Mexico School of Medicine in 2001 were invited to participate. After a single half-hour educational session, a written posttest of ability to detect ethical problems in hypothetical protocol vignettes was administered. The authors analyzed responses to ten protocol vignettes that had been evaluated independently by experts. For each vignette, a global assessment of the perceived significance of ethical problems and the identification of specific ethical problems were evaluated. Eighty-three medical students (27%) volunteered: 50 (60%) were women and 55 (66%) were first- and second-year students. On global assessments, the criteria-focused group perceived ethical problems as more significant than did the other two groups (p < .02). Students in the criteria-focused group were better able than students in the control group (p < .03) to discern specific ethical problems, more closely resembling expert assessments. Unexpectedly, the group focused on clinical research participants identified fewer problems than did the control group (p < .05). The criteria-focused intervention produced enhanced ethical evaluation skills. This work supports the potential value of empirically derived methods for preparing professionals to discern ethical aspects of human studies.

[Giving medico-legal opinions in cases with suspicion of medical mistake. part 2. Expert evidence in cases with suspicion of medical mistake - expectations, possibilities, threats…].

PubMed

Chowaniec, Czesław; Chowaniec, Małgorzata; Wilk, Mateusz

Problems of medical mistake and therapeutic failure are inextricably linked with realization of medical services. In recent years, mostly by the media and increasing demanding attitude, a rapid increase of initiated cases opened by judicial body in conjunction with medical mistake made by medical staff is observed. Making medico-legal opinions is not easy task and often face many difficulties. These consist of lacks in medical documentation, time rigor, formal tightening and need to create team that consist of both forensic medicine specialist and clinicians, who together shall write complex medico-legal opinion. This article touches the essence of the opinion-making problem in the aspect of medical mistake. It shows specifics of the role of forensic medicine specialist, his challenges and difficulties in creating opinions. The article confronts real possibilities of court experts with expectations of judicial body, outlining new challenges and dangers which court experts have to face.

Learning the facts in medical school is not enough: which factors predict successful application of procedural knowledge in a laboratory setting?

PubMed Central

2013-01-01

Background Medical knowledge encompasses both conceptual (facts or “what” information) and procedural knowledge (“how” and “why” information). Conceptual knowledge is known to be an essential prerequisite for clinical problem solving. Primarily, medical students learn from textbooks and often struggle with the process of applying their conceptual knowledge to clinical problems. Recent studies address the question of how to foster the acquisition of procedural knowledge and its application in medical education. However, little is known about the factors which predict performance in procedural knowledge tasks. Which additional factors of the learner predict performance in procedural knowledge? Methods Domain specific conceptual knowledge (facts) in clinical nephrology was provided to 80 medical students (3rd to 5th year) using electronic flashcards in a laboratory setting. Learner characteristics were obtained by questionnaires. Procedural knowledge in clinical nephrology was assessed by key feature problems (KFP) and problem solving tasks (PST) reflecting strategic and conditional knowledge, respectively. Results Results in procedural knowledge tests (KFP and PST) correlated significantly with each other. In univariate analysis, performance in procedural knowledge (sum of KFP+PST) was significantly correlated with the results in (1) the conceptual knowledge test (CKT), (2) the intended future career as hospital based doctor, (3) the duration of clinical clerkships, and (4) the results in the written German National Medical Examination Part I on preclinical subjects (NME-I). After multiple regression analysis only clinical clerkship experience and NME-I performance remained independent influencing factors. Conclusions Performance in procedural knowledge tests seems independent from the degree of domain specific conceptual knowledge above a certain level. Procedural knowledge may be fostered by clinical experience. More attention should be paid to the interplay of individual clinical clerkship experiences and structured teaching of procedural knowledge and its assessment in medical education curricula. PMID:23433202

What the Classroom Teacher Needs to Know about Children with Chronic Medical Problems.

ERIC Educational Resources Information Center

Frieman, Barry B.; Settel, Joanne

1994-01-01

Explains the causes and symptoms of four chronic diseases (asthma, diabetes, epilepsy, and sickle cell anemia) that afflict large numbers of children, and discusses specific classroom medical procedures that teachers can use to help children with these diseases. Also provides suggestions for working with parents of chronically ill children and…

Occurrence of Medical Concerns in Psychiatric Outpatients with Intellectual Disabilities

ERIC Educational Resources Information Center

Azimi, Kousha; Modi, Miti; Hurlbut, Janice; Lunsky, Yona

2016-01-01

Despite the fact that adults with both intellectual disabilities (ID) and psychiatric disorders are at increased risk for physical health problems, few studies have described their medical concerns specifically. This study reports on the rates of physical health issues and completion of recommended health screenings among 78 adult outpatients with…

Merging Problem-Based Learning with Simulation-Based Learning in the Medical Undergraduate Curriculum: The PAIRED Framework for Enhancing Lifelong Learning

PubMed Central

Koh, Jansen

2016-01-01

Lifelong learning is an essential trait that is expected of every physician. The CanMeds 2005 Physician Competency Framework emphasizes lifelong learning as a key competency that physicians must achieve in becoming better physicians. However, many physicians are not competent at engaging in lifelong learning. The current medical education system is deficient in preparing medical students to develop and carry out their own lifelong learning curriculum upon graduation. Despite understanding how physicians learn at work, medical students are not trained to learn while working. Similarly, although barriers to lifelong learning are known, medical students are not adequately skilled in overcoming these barriers. Learning to learn is just as important, if not more, as acquiring the skills and knowledge required of a physician. The medical undergraduate curriculum lacks a specific learning strategy to prepare medical students in becoming an adept lifelong learner. In this article, we propose a learning strategy for lifelong learning at the undergraduate level. In developing this novel strategy, we paid particular attention to two parameters. First, this strategy should be grounded on literature describing a physician’s lifelong learning process. Second, the framework for implementing this strategy must be based on existing undergraduate learning strategies to obviate the need for additional resources, learner burden, and faculty time. In this paper, we propose a Problem, Analysis, Independent Research Reporting, Experimentation Debriefing (PAIRED) framework that follows the learning process of a physician and serves to synergize the components of problem-based learning and simulation-based learning in specifically targeting the barriers to lifelong learning. PMID:27446767

Medical care at mass gatherings: emergency medical services at large-scale rave events.

PubMed

Krul, Jan; Sanou, Björn; Swart, Eleonara L; Girbes, Armand R J

2012-02-01

The objective of this study was to develop comprehensive guidelines for medical care during mass gatherings based on the experience of providing medical support during rave parties. Study design was a prospective, observational study of self-referred patients who reported to First Aid Stations (FASs) during Dutch rave parties. All users of medical care were registered on an existing standard questionnaire. Health problems were categorized as medical, trauma, psychological, or miscellaneous. Severity was assessed based on the Emergency Severity Index. Qualified nurses, paramedics, and doctors conducted the study after training in the use of the study questionnaire. Total number of visitors was reported by type of event. During the 2006-2010 study period, 7,089 persons presented to FASs for medical aid during rave parties. Most of the problems (91.1%) were categorized as medical or trauma, and classified as mild. The most common medical complaints were general unwell-being, nausea, dizziness, and vomiting. Contusions, strains and sprains, wounds, lacerations, and blisters were the most common traumas. A small portion (2.4%) of the emergency aid was classified as moderate (professional medical care required), including two cases (0.03%) that were considered life-threatening. Hospital admission occurred in 2.2% of the patients. Fewer than half of all patients presenting for aid were transported by ambulance. More than a quarter of all cases (27.4%) were related to recreational drugs. During a five-year field research period at rave dance parties, most presentations on-site for medical evaluation were for mild conditions. A medical team of six healthcare workers for every 10,000 rave party visitors is recommended. On-site medical staff should consist primarily of first aid providers, along with nurses who have event-specific training on advanced life support, event-specific injuries and incidents, health education related to self-care deficits, interventions for psychological distress, infection control, and disaster medicine. Protocols should be available for treating common injuries and other minor medical problems, and for registration, triage, environmental surveillance and catastrophe management and response.

A cognitive taxonomy of medical errors.

PubMed

Zhang, Jiajie; Patel, Vimla L; Johnson, Todd R; Shortliffe, Edward H

2004-06-01

Propose a cognitive taxonomy of medical errors at the level of individuals and their interactions with technology. Use cognitive theories of human error and human action to develop the theoretical foundations of the taxonomy, develop the structure of the taxonomy, populate the taxonomy with examples of medical error cases, identify cognitive mechanisms for each category of medical error under the taxonomy, and apply the taxonomy to practical problems. Four criteria were used to evaluate the cognitive taxonomy. The taxonomy should be able (1) to categorize major types of errors at the individual level along cognitive dimensions, (2) to associate each type of error with a specific underlying cognitive mechanism, (3) to describe how and explain why a specific error occurs, and (4) to generate intervention strategies for each type of error. The proposed cognitive taxonomy largely satisfies the four criteria at a theoretical and conceptual level. Theoretically, the proposed cognitive taxonomy provides a method to systematically categorize medical errors at the individual level along cognitive dimensions, leads to a better understanding of the underlying cognitive mechanisms of medical errors, and provides a framework that can guide future studies on medical errors. Practically, it provides guidelines for the development of cognitive interventions to decrease medical errors and foundation for the development of medical error reporting system that not only categorizes errors but also identifies problems and helps to generate solutions. To validate this model empirically, we will next be performing systematic experimental studies.

Female boxing in Italy: 2002-2007 report.

PubMed

Bianco, Massimiliano; Massimiliano, Bianco; Sanna, Nicola; Nicola, Sanna; Bucari, Sante; Sante, Bucari; Fabiano, Carmela; Carmela, Fabiano; Palmieri, Vincenzo; Palmieri, V; Zeppilli, Paolo; Paolo, Zeppilli

2011-06-01

To collect medical data on women's boxing. Cross-sectional and longitudinal study. Medical examinations requested by Italian laws. A retrospective study was conducted on all female boxing competitions in Italy from April 2001 to December 2007. Sixty-one amateur female boxers were evaluated longitudinally. (1) Retrospective study: All pre-/postmatch medical reports were analysed. (2) Prospective study: Breast, gynaecologic, brain, eyes, ear, nose and throat examinations were carried out. (1) Retrospective study: Any injury assessed before/after the match. (2) Prospective study: Health problems which could be related to boxing activity. (1) Retrospective study: Data from 5600 examinations were collected. Precompetition, a medical problem was recorded in three athletes (one conjunctiva hyperemia, one zygomatic bruise, one eyelid haematoma). Post competition, 51/2800 medical checks showed mild common injuries, such as soft tissue facial lesions, epistaxis and hand-wrist problems. Only one concussion was recorded with hospitalisation (for a thorough evaluation). Another athlete was hospitalised for a nasal fracture. (2) Prospective study: Two fibroadenomas, three ovarian cysts and one intramural uterine myoma were diagnosed. In four boxers, non-specific electroencephalographic abnormalities were detected, however, with a normal brain MRI in three (the fourth is still waiting for the radiologic procedure). Nasal septum deviation was common (42.6%) and a transmissive hypoacusia was observed in two athletes. No major eye injuries were reported. Female boxing seems to be a safe sport with a very low incidence of events requiring hospitalisation. No specific diseases in female boxers could be observed, in particular regarding the breast and reproductive system.

[Medical errors from positions of mutual relations of patient-lawyer-doctor].

PubMed

Radysh, Ia F; Tsema, Ie V; Mehed', V P

2013-01-01

The basic theoretical and practical aspects of problem of malpractice in the system of health protection Ukraine are presented in the article. On specific examples the essence of the term "malpractice" is expounded. It was considered types of malpractice, conditions of beginning and kinds of responsibility to assumption of malpractice. The special attention to the legal and mental and ethical questions of problem from positions of protection of rights for a patient and medical worker is spared. The necessity of qualification malpractices on intentional and unintentional, possible and impermissible is grounded.

Neurobehavioral Manifestations of HIV/AIDS: Diagnosis and Treatment

PubMed Central

Singer, Elyse J.; Thames, April D.

2015-01-01

Synopsis Behavioral disorders are common in HIV-infected (HIV+) persons. The differential includes pre-existing psychiatric diseases, substance abuse, direct effects of HIV infection, opportunistic infection (OI), and the adverse effects of medical therapies. Many patients have more than one contributing or co-morbid problem to explain these behavioral changes. The differential should always include consideration of psychosocial, genetic, and medical causes of disease. Treatment strategies must take into account the co-administration of antiretroviral therapy and the specific neurological problems common in the HIV+ population. PMID:26613994

Query-oriented evidence extraction to support evidence-based medicine practice.

PubMed

Sarker, Abeed; Mollá, Diego; Paris, Cecile

2016-02-01

Evidence-based medicine practice requires medical practitioners to rely on the best available evidence, in addition to their expertise, when making clinical decisions. The medical domain boasts a large amount of published medical research data, indexed in various medical databases such as MEDLINE. As the size of this data grows, practitioners increasingly face the problem of information overload, and past research has established the time-associated obstacles faced by evidence-based medicine practitioners. In this paper, we focus on the problem of automatic text summarisation to help practitioners quickly find query-focused information from relevant documents. We utilise an annotated corpus that is specialised for the task of evidence-based summarisation of text. In contrast to past summarisation approaches, which mostly rely on surface level features to identify salient pieces of texts that form the summaries, our approach focuses on the use of corpus-based statistics, and domain-specific lexical knowledge for the identification of summary contents. We also apply a target-sentence-specific summarisation technique that reduces the problem of underfitting that persists in generic summarisation models. In automatic evaluations run over a large number of annotated summaries, our extractive summarisation technique statistically outperforms various baseline and benchmark summarisation models with a percentile rank of 96.8%. A manual evaluation shows that our extractive summarisation approach is capable of selecting content with high recall and precision, and may thus be used to generate bottom-line answers to practitioners' queries. Our research shows that the incorporation of specialised data and domain-specific knowledge can significantly improve text summarisation performance in the medical domain. Due to the vast amounts of medical text available, and the high growth of this form of data, we suspect that such summarisation techniques will address the time-related obstacles associated with evidence-based medicine. Copyright © 2015 Elsevier Inc. All rights reserved.

Conceptualizing a model: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--2.

PubMed

Roberts, Mark; Russell, Louise B; Paltiel, A David; Chambers, Michael; McEwan, Phil; Krahn, Murray

2012-01-01

The appropriate development of a model begins with understanding the problem that is being represented. The aim of this article was to provide a series of consensus-based best practices regarding the process of model conceptualization. For the purpose of this series of articles, we consider the development of models whose purpose is to inform medical decisions and health-related resource allocation questions. We specifically divide the conceptualization process into two distinct components: the conceptualization of the problem, which converts knowledge of the health care process or decision into a representation of the problem, followed by the conceptualization of the model itself, which matches the attributes and characteristics of a particular modeling type with the needs of the problem being represented. Recommendations are made regarding the structure of the modeling team, agreement on the statement of the problem, the structure, perspective, and target population of the model, and the interventions and outcomes represented. Best practices relating to the specific characteristics of model structure and which characteristics of the problem might be most easily represented in a specific modeling method are presented. Each section contains a number of recommendations that were iterated among the authors, as well as among the wider modeling taskforce, jointly set up by the International Society for Pharmacoeconomics and Outcomes Research and the Society for Medical Decision Making. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Use abstracted patient-specific features to assist an information-theoretic measurement to assess similarity between medical cases

PubMed Central

Cao, Hui; Melton, Genevieve B.; Markatou, Marianthi; Hripcsak, George

2008-01-01

Inter-case similarity metrics can potentially help find similar cases from a case base for evidence-based practice. While several methods to measure similarity between cases have been proposed, developing an effective means for measuring patient case similarity remains a challenging problem. We were interested in examining how abstracting could potentially assist computing case similarity. In this study, abstracted patient-specific features from medical records were used to improve an existing information-theoretic measurement. The developed metric, using a combination of abstracted disease, finding, procedure and medication features, achieved a correlation between 0.6012 and 0.6940 to experts. PMID:18487093

Psychotropic medication management in persons with co-occurring psychiatric and substance use disorders.

PubMed

Sowers, W; Golden, S

1999-01-01

Persons presenting with concurrent psychiatric and substance problems present unique challenges for diagnosis and for effective and rational treatment planning. This is especially true for psychiatrists attempting to prescribe pharmacologic interventions which will promote recovery from both disorders and improve function. In order to be effective in this endeavor it is important to have a clear understanding of the dynamics of addiction as well as the particular issues and struggles related to mental illness which will affect an individual's attitude toward and use of medication. This article discusses some of the common problems related to diagnostic decision making and initiation of medication in persons with co-occurring disorders. An algorithm for guiding these decisions is presented. Common misconceptions held by these individuals regarding medication, as distinguished from "drugs," are considered. Unique psychodynamic issues that may lead these persons to actively seek medication as a solution to their problems, or which may, conversely, lead them to an outright rejection of medication as a part of their recovery, are discussed. Countertransferential issues influencing the physician's approach to prescribing for this population are also considered. The article concludes with recommendations for pharmacologic approaches to address specific psychiatric syndromes which may present in this population.

The Medically Fragile Child: Caring for Children with Special Healthcare Needs in the School Setting

ERIC Educational Resources Information Center

American Federation of Teachers (NJ), 2009

2009-01-01

This publication is designed to help teachers, nurses and paraprofessionals meet the challenges of dealing with children who have serious medical problems. It contains information on training, health and safety, and legal rights and responsibilities. Specifically, this third edition sets out to accomplish three goals: (1) to educate American…

Instrumentation for Evaluating Medical School Courses in Human Sexuality.

ERIC Educational Resources Information Center

Wiggers, T. Thorne; And Others

A Sex Content Scale was developed to evaluate a series of simulated interviews conducted with 24 second year medical students and an actress who was carefully coached to reveal a specific sexual problem as she felt comfortable with the student and as he/she asked her appropriate questions. A patient response form was also developed to quantify the…

Strategies for addressing adherence problems in patients with serious and persistent mental illness: recommendations from the expert consensus guidelines.

PubMed

Velligan, Dawn I; Weiden, Peter J; Sajatovic, Martha; Scott, Jan; Carpenter, Daniel; Ross, Ruth; Docherty, John P

2010-09-01

Poor adherence to medication can have devastating consequences for patients with serious mental illness. The literature review and recommendations in this article are reprinted from The Expert Consensus Guideline Series: Adherence Problems in Patients with Serious and Persistent Mental Illness, published in 2009. The expert consensus survey (39 questions, 521 options) on adherence problems in schizophrenia and bipolar disorder was completed by 41 experts in 2008. This article first reviews the literature on interventions aimed at improving adherence. It then presents the experts' recommendations for targeting factors that can contribute to nonadherence and relates them to the literature. The following psychosocial/programmatic and pharmacologic interventions were rated first line for specific problems that can lead to nonadherence: ongoing symptom/ side-effect monitoring for persistent symptoms or side effects; services targeting logistic problems; medication monitoring/environmental supports (e.g., Cognitive Adaptation Training, assertive community treatment) for lack of routines or cognitive deficits; and adjusting the dose or switching to a different oral antipsychotic for persistent side effects (also high second-line for persistent symptoms). Among pharmacologic interventions, the experts gave high second-line ratings to switching to a long-acting antipsychotic when lack of insight, substance use, persistent symptoms, logistic problems, lack of routines, or lack of family/ social support interfere with adherence and to simplifying the treatment regimen when logistic problems, lack of routines, cognitive deficits, or lack of family/social support interfere with adherence. Psychosocial/programmatic interventions that received high second-line ratings in a number of situations included medication monitoring/environmental supports, patient psychoeducation, more frequent and/or longer visits if possible, cognitive behavioral therapy (CBT), family-focused therapy, and services targeting logistic problems. It is important to identify specific factors that may be contributing to a patient's adherence problems in order to customize interventions and to consider using a multifaceted approach since multiple problems may be involved.

Pharmacological Issues for Astronauts

NASA Technical Reports Server (NTRS)

Wotring, Virginia E.

2010-01-01

Medication-induced side effects, called untoward effects by pharmacologists, can be a problem with any medication. Few therapies are perfectly specific for the desired physiological activity; rather they act on multiple biological targets and result in multiple physiological effects. There are several strategies that are employed to prevent, alleviate or counteract medication-induced side effects. The administered dose may be optimized to the lowest possible amount that provides the desired therapeutic effect, with the expectation that untoward effects will be minimized by a lower dose. Empirical trials of different therapies for a particular medical problem may be used in the hopes of finding a drug with minimal side effects for a particular patient, or at least of finding a set of side effects that the patient considers tolerable. If these two strategies have been exhausted, it may be possible to administer another medication to block or ameliorate side effects. A recent search of published scientific literature has revealed that there are medications used in spaceflight that seem to be associated with a significant number of reports of untoward effects. To prevent future medical problems and to improve the well-being and productivity of crew members, it would be best to eliminate (or at least reduce) untoward effects. Reports from the literature will be examined, with the aim of identifying a strategy for reducing untoward effects.

[Not enough help for themselves--the risk of physicians to commit suicide].

PubMed

Püschel, Klaus; Schalinski, Sarah

2006-01-01

Physicians seem unwilling to deal with their own suicidal problems professionally. Suicide is a repressed topic. According to international studies, medical students and physicians are clearly over-represented among suicide victims. Committing suicide stands in sharp contrast to the positive image physicians enjoy as competent, strong helpers transmitting positive energy. Various studies and meta-analyses show that physicians use knowledge specific to their profession and are therefore "more successful" than the general population in committing suicide. Moreover, the data reveal a number of risk factors specifically correlating with medical practice. This is confirmed by an increased number of suicides during medical training and professional life in comparison with the general population. Gender-specific analyses show an even higher suicide risk for female physicians. In this context it cannot be excluded that out of "professional respect" cardiovascular causes of death are sometimes falsely documented in death certificates instead of suicide. Despite their special education, physicians are not very good at diagnosing their own emotional disorders and asking colleagues for adequate professional help. They rather tend to camouflage their own psychological problems also because they are afraid of occupational and personal discrimination.

Malnutrition

MedlinePlus

... fats, vitamins, and minerals - you may suffer from malnutrition. Causes of malnutrition include: Lack of specific nutrients in your diet. ... the lack of one vitamin can lead to malnutrition. An unbalanced diet Certain medical problems, such as ...

Elders' nonadherence, its assessment, and computer assisted instruction for medication recall training.

PubMed

Leirer, V O; Morrow, D G; Pariante, G M; Sheikh, J I

1988-10-01

This study investigates three questions related to the problem of medication nonadherence among elders. First, does recall failure play a significant role in nonadherence? Recent research suggests that it may not. Second, can the new portable bar code scanner technology be used to study nonadherence? Other forms of monitoring are obtrusive or inaccurate. Finally, can inexpensive computer assisted instructions (CAI) be used to teach mnemonic techniques specifically designed to improve medication schedule recall? Current research on memory training teaches nonspecific mnemonics and uses the expensive classroom approach. Results of the present study suggest that physically active and cognitively alert elders do have significant nonadherence (control group = 32.0%) problems related to forgetting and that CAI courseware can significantly reduce (medication recall training group = 10.0%) this form of nonadherence. Portable bar code technology proved easy to use by elderly patients and provided detailed information about the type of forgetting underlying nonadherence. Most significant recall failure was in the complete forgetting to take medication rather than delays in medicating or overmedicating.

Do third-party plans really pay for CVS care?

PubMed

Soden, Richard

2002-04-01

Until specific CPT and ICD-9 codes are created and approved for CVS, and until there is uniform agreement that CVS is a true medical anomaly (or not), each practitioner will have to decide on how to bill for the signs and symptoms of Computer Vision Syndrome. If the practitioner chooses to view CVS as a medical problem, then the same guidelines and rules for all other patients should be followed with appropriate documentation using CPT and ICD-9 coding. If the practitioner chooses to consider CVS solely as an optical problem, this is a "noncovered" service and the patient or any applicable optical plan will be responsible for payment. One final note: each practitioner who tests for CVS will also have to determine if there is a separate fee for CVS testing. If the practitioner considers CVS to be a medical problem, it may be applicable to include testing for Computer Vision Syndrome as an incidental test to the medical office visit. If the practitioner chooses to consider CVS to be purely an optical problem, it may be appropriate to add an appropriate charge to the noncovered examination. Whatever the decision is, there must be consistency from patient to patient.

An Analysis of Categorical and Quantitative Methods for Planning Under Uncertainty

PubMed Central

Langlotz, Curtis P.; Shortliffe, Edward H.

1988-01-01

Decision theory and logical reasoning are both methods for representing and solving medical decision problems. We analyze the usefulness of these two approaches to medical therapy planning by establishing a simple correspondence between decision theory and non-monotonic logic, a formalization of categorical logical reasoning. The analysis indicates that categorical approaches to planning can be viewed as comprising two decision-theoretic concepts: probabilities (degrees of belief in planning hypotheses) and utilities (degrees of desirability of planning outcomes). We present and discuss examples of the following lessons from this decision-theoretic view of categorical (nonmonotonic) reasoning: (1) Decision theory and artificial intelligence techniques are intended to solve different components of the planning problem. (2) When considered in the context of planning under uncertainty, nonmonotonic logics do not retain the domain-independent characteristics of classical logical reasoning for planning under certainty. (3) Because certain nonmonotonic programming paradigms (e.g., frame-based inheritance, rule-based planning, protocol-based reminders) are inherently problem-specific, they may be inappropriate to employ in the solution of certain types of planning problems. We discuss how these conclusions affect several current medical informatics research issues, including the construction of “very large” medical knowledge bases.

[Problems in integrative postgraduate medical training of physicians at anthroposophic hospitals in Germany and Switzerland].

PubMed

Heusser, Peter; Eberhard, Sabine; Weinzirl, Johannes; Orlow, Pascale; Berger, Bettina

2014-01-01

Anthroposophic hospitals provide integrative medical care by complementing conventional (CON) with anthroposophic medicine (AM). They teach integrative medicine in postgraduate medical training (PGMT). In a first evaluation of PGMT quality in AM, we analyzed the problems of this training from the perspectives of trainers and trainees. We conducted an anonymous cross-sectional full survey of all trainee and trainer physicians at the 15 AM hospitals in Germany (DE) and Switzerland (CH) with questionnaires of the Swiss Institute of Technology (ETH) Zürich, complemented by a module for AM. We also conducted descriptive statistics for questions with answering scales as well as calculations of group differences (two-tailed Mann-Whitney U test) and a qualitative content analysis (Mayring) of free text answers related to the problem analysis. The response rate in DE embraced 89 out of 215 (41.39%) surveyed trainees and 78 out of 184 (42.39%) trainers; in CH, the response rate comprised 19 out of 25 (76%) trainees and 22 out of 30 (73.33%) trainers. Free text answers related to problem analysis in DE and CH were given by 16 out of 108 (14.8%) trainees and by 20 out of 100 (20%) trainers, overall. Perceived main problems include work overload; shortcomings in work organization; delimitation of competences; interprofessional cooperation; financial resources (trainers); wages (trainees DE); practical relevance of AM (trainees and trainers in DE); professional or didactic competence of trainers; lack of interest in AM (trainees); problems with learning and practicing AM; no curriculum for postgraduate medical training in AM; tensions between AM and CON. Explanations for the differences between DE and CH include larger departments and the DRG system in DE, but also better structural conditions for AM PGMT in CH. Main problems of PGMT in AM include not only non-specific and systemic aspects, but also AM-specific issues. In order to develop a basis for concrete problem solving options, this study will be complemented by an analysis of solution ideas from the perspective of the involved trainers and trainees.

Self-reported difficulty in conceiving as a measure of infertility.

PubMed

Dick, M-L B; Bain, C J; Purdie, D M; Siskind, V; Molloy, D; Green, A C

2003-12-01

This study aimed to explore the meaning and potential use of women's self-reported difficulties in conceiving as a measure of infertility in epidemiological studies, and to compare women's stated reasons for infertility with information in their medical records. Data were available from a population-based case-control study of ovarian cancer involving 1638 women. The sensitivity and specificity of women's self-reported infertility were calculated against their estimated fertility status based on detailed reproductive histories. Self-reported reasons for infertility were compared with diagnoses documented in women's medical records. The sensitivity of women's self-reported difficulty in conceiving was 66 and 69% respectively when compared with calendar-derived and self-reported times taken trying to conceive; its specificity was 95%. Forty-one (23%) of the 179 women for whom medical records were available had their self-reported fertility problem confirmed. Self-reported infertility causes could be compared with diagnoses in medical records for only 22 of these women. Self-reported difficulty conceiving is a useful measure of infertility for quantifying the burden of fertility problems experienced in the community. Validation of reasons for infertility is unlikely to be feasible through examination of medical records. Improved education of the public regarding the availability and success rates of infertility treatments is proposed.

Pain Disrupts Sleep in Children and Youth with Intellectual and Developmental Disabilities

ERIC Educational Resources Information Center

Breau, Lynn M.; Camfield, Carol S.

2011-01-01

Both chronic pain and sleep problems are common for children with intellectual and developmental disabilities (IDD). Although one study has revealed a relationship between having a medical condition and sleep problems in this population, the role of pain was not examined independently. Thus, the goal of this study was to clarify the specific role…

[The medical problems of the aftermath of the accident at the Chernobyl Atomic Electric Power Station].

PubMed

Guda, V; Kozak, R

1993-01-01

The article is devoted to medical problems of Chernobyl accident, specifically to the question of thyroid carcinoma in children who received increased doses of radioactive iodine (mainly of 131I) in the first days of the disaster. Some relevant reports made at the 3rd Congress of the World Federation of Ukrainian Medical Societies are analyzed. The necessity of ultrasonic examination of the thyroid in children is pointed out. Special portable American-made apparatus is recommended for this purpose. Likelihood of leukaemia, lung cancer, gastrointestinal malign tumors as well as genetic disorders in descendants of irradiated people should also be remembered. Question of "clean" products and evacuation of the population residing in the 30-km zone must be solved.

Health hazards and medical treatment of volunteers aged 18-30 years working in international social projects of non-governmental organizations (NGO).

PubMed

Küpper, T; Rieke, B; Neppach, K; Morrison, A; Martin, J

2014-01-01

The specific health risk profile and diversity of treatments sought by young volunteers participating in international social projects should differ from those of their older colleagues. In the absence of any data to identify whether this was correct, a retrospective analysis was performed using a standardized questionnaire. Questions included what diseases occurred, and details of the frequency and types of treatment sought during their stay - (e.g. self-treatment, medical/dental intervention, or local healer). The 153 participants were aged 18-30 years and worked in a non-governmental organization for >6 months. The participants were: 53% female, mean age 20 years, and mean duration of stay was 11.2 months. Their NGO placement abroad was in Latin America 65.4%, 14.4% in Africa, and 9.8% in Asia. 83% of the young volunteers had received some advice regarding travel medicine before their departure. However, they suffered from more injuries compared to private travellers, and febrile infections were more common when compared to older studies. 21.2% suffered from dental problems and 50% of them sought medical treatment. This study highlights a previously unreported higher risk profile of specific health problems occurring in young NGO volunteers, including some potentially life-threatening diagnoses that differed from their older colleagues and normal travellers. It is recommended that young volunteers should receive age specific, comprehensive pre-departure training in health and safety, first aid, and management of common health problems. A medical check-up upon returning home should be mandatory. The provision of a basic first aid kit to each volunteer before departure is also recommended. Copyright © 2013 Elsevier Ltd. All rights reserved.

Paul Polani and the development of medical genetics

PubMed Central

Harper, Peter S.

2007-01-01

Paul Polani (1914-2006) was one of the key figures internationally in the beginnings and development of medical genetics. Best remembered scientifically for his highly original work on the basis of human sex chromosome disorders, notably Turner syndrome, he pioneered the application of basic biological research to clinical genetic problems. The unit that he founded in 1960, at Guys Hospital, London, provided an unparalleled model for combined research and service in medical genetics across a wide range of laboratory areas and helped to establish medical genetics as a specific discipline. PMID:17066298

[Dance, art and top performance sport with specific injuries].

PubMed

Rietveld, Boni; van de Wiel, Albert

2011-01-01

Professional theatre dance has high and specific physical demands, comparable to top sport. Dance injuries are often caused by faulty technique due to compensation for physical limitations. Knowledge of these limitations and professional teaching can prevent many problems. Dance injuries mostly involve the lower limbs, especially the ankles and knees. Dance injuries require that the medical professional has knowledge of dance technique and respects the passion of the dancer. The advice to stop dancing has hardly ever to be given. Scientific, prospective dance medical research is recommended.

A history of medical student debt: observations and implications for the future of medical education.

PubMed

Greysen, S Ryan; Chen, Candice; Mullan, Fitzhugh

2011-07-01

Over the last 50 years, medical student debt has become a problem of national importance, and obtaining medical education in the United States has become a loan-dependent, individual investment. Although this phenomenon must be understood in the general context of U.S. higher education as well as economic and social trends in late-20th-century America, the historical problem of medical student debt requires specific attention for several reasons. First, current mechanisms for students' educational financing may not withstand debt levels above a certain ceiling which is rapidly approaching. Second, there are no standards for costs of medical school attendance, and these can vary dramatically between different schools even within a single city. Third, there is no consensus on the true cost of educating a medical student, which limits accountability to students and society for these costs. Fourth, policy efforts to improve physician workforce diversity and mitigate shortages in the primary care workforce are inhibited by rising levels of medical student indebtedness. Fortunately, the current effort to expand the U.S. physician workforce presents a unique opportunity to confront the unsustainable growth of medical student debt and explore new approaches to the financing of medical students' education.

Medical devices manufactured from latex: European regulatory initiatives.

PubMed

De Jong, W H; Geertsma, R E; Tinkler, J J B

2002-05-01

In Europe the marketing of medical devices manufactured from latex is regulated by directives describing the essential (safety) requirements that products have to fulfill to obtain marketing approval. This paper describes the general requirements for marketing medical devices in Europe and, more specifically, the requirements for products manufactured from natural rubber latex. The requirements for marketing medical devices can be fulfilled by using the relevant harmonized European standards. These standards are regularly under revision to incorporate the latest scientific developments. For certain devices, for example, latex medical (examination and surgical) gloves, specific standards have been published. Medical devices manufactured from latex pose a serious problem because of the risk of induction of allergy both against the latex proteins inherently present (type I or immediate type allergy) and against chemicals added during processing (type IV or delayed type hypersensitivity) present as residues in the latex products. So, besides requirements for product quality in terms of barrier properties, strength, and sterility, the main focus consists of the allergy-inducing properties of the latex products. Recent developments have reopened the discussion on the value of total protein versus allergen determination in latex medical gloves. However, as long as minimal levels needed for both sensitization and elicitation have not been established, a safe maximum level for leachable proteins/allergens in latex products cannot be determined. A European Commission guidance document on the latex allergy problem is currently being drafted by experts from Competent Authorities. Copyright 2002 Elsevier Science (USA).

Can we still stop the migration of physicians from Austria? : An evaluation of clinical internships by students of the Medical University of Vienna.

PubMed

Seitz, Tamara; Turk, Bela R; Löffler-Stastka, Henriette

2017-01-01

The increasing emigration of graduates of the Medical University of Vienna presents a serious problem. This study examined students' evaluation of clinical rotations, their self-rated performance, and where they felt the most deficits exist. Medical students answered an online questionnaire surveying the following aspects: an evaluation of their internship; supervision; integration in the team and improvement of field-specific knowledge; the qualities of taking a patient's medical history by empathy; patient-centeredness; structure; target orientation; and the ability to integrate field-specific knowledge into anamnesis. The data collected indicate that rotations in Austria, especially in Vienna, were evaluated significantly worse than those abroad. Particularly the lack of supervision and integration in the team were criticized. These data stress a dire need for the reform of curricular structures during clinical rotation in the latter years of medical education.

Statistical text classifier to detect specific type of medical incidents.

PubMed

Wong, Zoie Shui-Yee; Akiyama, Masanori

2013-01-01

WHO Patient Safety has put focus to increase the coherence and expressiveness of patient safety classification with the foundation of International Classification for Patient Safety (ICPS). Text classification and statistical approaches has showed to be successful to identifysafety problems in the Aviation industryusing incident text information. It has been challenging to comprehend the taxonomy of medical incidents in a structured manner. Independent reporting mechanisms for patient safety incidents have been established in the UK, Canada, Australia, Japan, Hong Kong etc. This research demonstrates the potential to construct statistical text classifiers to detect specific type of medical incidents using incident text data. An illustrative example for classifying look-alike sound-alike (LASA) medication incidents using structured text from 227 advisories related to medication errors from Global Patient Safety Alerts (GPSA) is shown in this poster presentation. The classifier was built using logistic regression model. ROC curve and the AUC value indicated that this is a satisfactory good model.

Ancient medical texts, modern reading problems.

PubMed

Rosa, Maria Carlota

2006-12-05

The word tradition has a very specific meaning in linguistics: the passing down of a text, which may have been completed or corrected by different copyists at different times, when the concept of authorship was not the same as it is today. When reading an ancient text the word tradition must be in the reader's mind. To discuss one of the problems an ancient text poses to its modern readers, this work deals with one of the first printed medical texts in Portuguese, the Regimento proueytoso contra ha pestenença, and draws a parallel between it and two related texts, A moche profitable treatise against the pestilence, and the Recopilaçam das cousas que conuem guardar se no modo de preseruar à Cidade de Lixboa E os sãos, & curar os que esteuerem enfermos de Peste. The problems which arise out of the textual structure of those books show how difficult is to establish a tradition of another type, the medical tradition. The linguistic study of the innumerable medieval plague treatises may throw light on the continuities and on the disruptions of the so-called hippocratic-galenical medical tradition.

Correlates of specific childhood feeding problems.

PubMed

Field, D; Garland, M; Williams, K

2003-01-01

The correlates of specific childhood feeding problems are described to further examine possible predisposing factors for feeding problems. We report our experience with 349 participants evaluated by an interdisciplinary feeding team. A review of records was conducted and each participant was identified as having one or more of five functionally defined feeding problems: food refusal, food selectivity by type, food selectivity by texture, oral motor delays, or dysphagia. The prevalence of predisposing factors for these feeding problems was examined. Predisposing factors included developmental disabilities, gastrointestinal problems, cardiopulmonary problems, neurological problems, renal disease and anatomical anomalies. The frequencies of predisposing factors varied by feeding problem. Differences were found in the prevalence of the five feeding problems among children with three different developmental disabilities: autism, Down syndrome and cerebral palsy. Gastro-oesophageal reflux was the most prevalent condition found among all children in the sample and was the factor most often associated with food refusal. Neurological conditions and anatomical anomalies were highly associated with skill deficits, such as oral motor delays and dysphagia. Specific medical conditions and developmental disabilities are often associated with certain feeding problems. Information concerning predisposing factors of feeding problems can help providers employ appropriate primary, secondary and tertiary prevention measures to decrease the frequency or severity of some feeding problems.

Mental health first aid training for Australian medical and nursing students: an evaluation study.

PubMed

Bond, Kathy S; Jorm, Anthony F; Kitchener, Betty A; Reavley, Nicola J

2015-01-01

The role and demands of studying nursing and medicine involve specific stressors that may contribute to an increased risk for mental health problems. Stigma is a barrier to help-seeking for mental health problems in nursing and medical students, making these students vulnerable to negative outcomes including higher failure rates and discontinuation of study. Mental Health First Aid (MHFA) is a potential intervention to increase the likelihood that medical and nursing students will support their peers to seek help for mental health problems. This study aimed to evaluate the effectiveness of a tailored MHFA course for nursing and medical students. Nursing and medical students self-selected into either a face-to-face or online tailored MHFA course. Four hundred and thirty-four nursing and medical students completed pre- and post-course surveys measuring mental health first aid intentions, mental health literacy, confidence in providing help, stigmatising attitudes and satisfaction with the course. The results of the study showed that both the online and face-to-face courses improved the quality of first aid intentions towards a person experiencing depression, and increased mental health literacy and confidence in providing help. The training also decreased stigmatizing attitudes and desire for social distance from a person with depression. Both online and face-to-face tailored MHFA courses have the potential to improve outcomes for students with mental health problems, and may benefit the students in their future professional careers.

Towards a cure for food allergy.

PubMed

Skripak, Justin M; Sampson, Hugh A

2008-12-01

Over the past two decades, food allergies have become both more prevalent and long lasting. This burgeoning problem has not been met with any therapeutic options to date, and patients must attempt to avoid known allergenic foods and treat any allergic reactions with 'as-needed' medications. There are a number of promising emerging therapeutic modalities for food allergy, including allergen-specific and allergen non-specific immunotherapeutic approaches. Although the allergen-specific approaches have some distinct differences, they all attempt to induce tolerance by exposing the patient to an allergen via the mucosal route (oral tolerance induction). Allergen non-specific approaches include biologics to suppress free total IgE levels (e.g. anti-IgE antibody) or to induce more general immune suppression (Chinese herbal medication).

Growing up Kennedy: the role of medical ailments in the life of JFK, 1920-1957.

PubMed

Giglio, James N

2006-10-01

As a result of the opening of new materials at the John F Kennedy Library relating to John F Kennedy's medical problems, we have a better understanding of the specific nature of those ailments, how they were treated, and how he responded to them. Most important, this study focuses on how his medical problems affected his relationship with his parents, especially his father, in the context of an older sibling who personified what a Kennedy should be: bright, athletic, and healthy. John Kennedy's response to family expectations produced a sometimes rebellious and detached youth who learned to rely on his charm, wit, intellect, and inner toughness to overcome adversity. In the process of dealing with serious medical issues into adulthood, John Kennedy revealed both courage and fortitude-traits that would eventually carry him to the White House.

System dynamics in medical education: a tool for life.

PubMed

Rubin, David M; Richards, Christopher L; Keene, Penelope A C; Paiker, Janice E; Gray, A Rosemary T; Herron, Robyn F R; Russell, Megan J; Wigdorowitz, Brian

2012-05-01

A course in system dynamics has been included in the first year of our university's six-year medical curriculum. System Dynamics is a discipline that facilitates the modelling, simulation and analysis of a wide range of problems in terms of two fundamental concepts viz. rates and levels. Many topics encountered in the medical school curriculum, from biochemistry to sociology, can be understood in this way. The course was introduced following a curriculum review process in which it was concluded that knowledge of systems would serve to enhance problem-solving skills and clinical reasoning. The specific characteristics of system dynamics, the widespread use of digital computers, and the availability of suitable software made it possible to introduce the course at this level. The syllabus comprises a brief review of relevant mathematics followed by system dynamics topics taught in the context of examples, which are primarily but not exclusively medical. It is anticipated that this will introduce new thought processes to medical students, including holistic thinking and improved graphical visualisation skills.

The secure authorization model for healthcare information system.

PubMed

Hsu, Wen-Shin; Pan, Jiann-I

2013-10-01

Exploring healthcare system for assisting medical services or transmitting patients' personal health information in web application has been widely investigated. Information and communication technologies have been applied to the medical services and healthcare area for a number of years to resolve problems in medical management. In the healthcare system, not all users are allowed to access all the information. Several authorization models for restricting users to access specific information at specific permissions have been proposed. However, as the number of users and the amount of information grows, the difficulties for administrating user authorization will increase. The critical problem limits the widespread usage of the healthcare system. This paper proposes an approach for role-based and extends it to deal with the information for authorizations in the healthcare system. We propose the role-based authorization model which supports authorizations for different kinds of objects, and a new authorization domain. Based on this model, we discuss the issues and requirements of security in the healthcare systems. The security issues for services shared between different healthcare industries will also be discussed.

An approach for access differentiation design in medical distributed applications built on databases.

PubMed

Shoukourian, S K; Vasilyan, A M; Avagyan, A A; Shukurian, A K

1999-01-01

A formalized "top to bottom" design approach was described in [1] for distributed applications built on databases, which were considered as a medium between virtual and real user environments for a specific medical application. Merging different components within a unified distributed application posits new essential problems for software. Particularly protection tools, which are sufficient separately, become deficient during the integration due to specific additional links and relationships not considered formerly. E.g., it is impossible to protect a shared object in the virtual operating room using only DBMS protection tools, if the object is stored as a record in DB tables. The solution of the problem should be found only within the more general application framework. Appropriate tools are absent or unavailable. The present paper suggests a detailed outline of a design and testing toolset for access differentiation systems (ADS) in distributed medical applications which use databases. The appropriate formal model as well as tools for its mapping to a DMBS are suggested. Remote users connected via global networks are considered too.

Designing Medical Tests: The Other Side of Bayes' Theorem

ERIC Educational Resources Information Center

Ross, Andrew M.

2012-01-01

To compute the probability of having a disease, given a positive test result, is a standard probability problem. The sensitivity and specificity of the test must be given and the prevalence of the disease. We ask how a test-maker might determine the tradeoff between sensitivity and specificity. Adding hypothetical costs for detecting or failing to…

Medication review using a Systematic Tool to Reduce Inappropriate Prescribing (STRIP) in adults with an intellectual disability: A pilot study.

PubMed

Zaal, Rianne J; Ebbers, Susan; Borms, Mirka; Koning, Bart de; Mombarg, Erna; Ooms, Piet; Vollaard, Hans; van den Bemt, Patricia M L A; Evenhuis, Heleen M

2016-08-01

A Systematic Tool to Reduce Inappropriate Prescribing (STRIP), which includes the Screening Tool to Alert doctors to Right Treatment (START) and the Screening Tool of Older Peoples' Prescriptions (STOPP), has recently been developed in the Netherlands for older patients with polypharmacy in the general population. Active involvement of the patient is part of this systematic multidisciplinary medication review. Although annual review of pharmacotherapy is recommended for people with an intellectual disability (ID), a specific tool for this population is not yet available. Besides, active involvement can be compromised by ID. Therefore, the objective of this observational pilot study was to evaluate the process of medication review using STRIP in adults with an ID living in a centralized or dependent setting and the identification of drug-related problems using this tool. The study was performed in three residential care organizations for ID. In each organization nine clients with polypharmacy were selected by an investigator (a physician in training to become a specialized physician for individuals with an ID) for a review using STRIP. Clients as well as their legal representatives (usually a family member) and professional caregivers were invited to participate. Reviews were performed by an investigator together with a pharmacist. First, to evaluate the process time-investments of the investigator and the pharmacist were described. Besides, the proportion of reviews in which a client and/or his legal representative participated was calculated as well as the proportion of professional caregivers that participated. Second, to evaluate the identification of drug-related problems using STRIP, the proportion of clients with at least one drug-related problem was calculated. Mean time investment was 130minutes for the investigator and 90minutes for the pharmacist. The client and/or a legal representatives were present during 25 of 27 reviews (93%). All 27 professional caregivers (100%) were involved. For every client included at least one drug-related problem was identified. In total 127 drug-related problems were detected, mainly potentially inappropriate or unnecessary drugs. After six months, 15.7% of the interventions were actually implemented. Medication review using STRIP seems feasible in adults with an ID and identifies drug-related problems. However, in this pilot study the implementation rate of suggested interventions was low. To improve the implementation rate, the treating physician should be involved in the review process. Besides, specific adaptations to STRIP to address drug-related problems specific for this population are required. Copyright © 2016 Elsevier Ltd. All rights reserved.

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.

Introduction to the special issue on personality assessment in medical settings.

PubMed

Porcelli, Piero; McGrath, Robert E

2007-12-01

This special issue of the Journal of Personality Assessment brings together 3 review articles and 5 research studies on personality assessment in medical settings that should help clinicians become more familiar with the current status of this field. In 1 review article, Sirri, Fabbri, Fava, and Sonino (2007/this issue) summarize evidence of a new approach to the assessment of psychological syndromes in somatizing patients based on the Diagnostic Criteria for Psychosomatic Research (Fava et al., 1995). The other reviews focus on 2 personality constructs widely used in investigations with medical patients. Kupper and Denollet (2007/this issue) review the Type D personality, whereas Lumley, Neely, and Burger (2007/this issue) provide an overview of alexithymia. Of the research articles, 2 also focus on alexithymia, specifically on the factor structure of the 20-item Toronto Alexithymia Scale (Bagby, Parker, & Taylor, 1994), which is the best-validated and most commonly used measure of alexithymia (Bagby, Taylor, Quilty, & Parker, 2007/this issue; Gignac, Palmer, & Stough, 2007/this issue). The other 3 research studies examine the relationship between specific personality dimensions (behavioral problems relevant to medicine, resiliency, and interpersonal sensitivity) and medical outcomes (adherence to treatment, coping with injury, and postsurgical sexual functioning) from medical samples of patients with HIV, spinal cord injury, and prostate carcinoma (Berry, Elliott, & Rivera, 2007/this issue; Cruess, Meagher, Antoni, & Millon, 2007/this issue; Siegel et al., 2007/this issue). Each article touches on the role person variables can play in the expression of medical problems.

Millennial medical anthropology: from there to here and beyond, or the problem of global health.

PubMed

Gaines, Atwood D

2011-03-01

While much of Medical Anthropology was and is what we can call "Normal" (following Kuhn) Medical Anthropology, I coined the term Millennial Medical Anthropology for that branch of the discipline that, in the 1990s, was departing from the Normal research paradigms and was deserving of a distinct sobriquet. This paper considers the Strong Program in Medical Anthropology's Millennial Medical Anthropology and its key subdivisions, the Cultural Studies of Science and Cultural Bioethics. Specifically it considers Medical Anthropology's movement from the past into an ethical future wherein Normal Biomedicine, Bioethics and Global Health are problematized. This provides the basis for the construction of a truly anthropological global health (i.e., Global, Global Health or Global Health 2.0).

Perpetuating stigma? Differences between advertisements for psychiatric and non-psychiatric medication in two professional journals.

PubMed

Foster, Juliet L H

2010-02-01

Continuing debates regarding advertising and the pharmaceutical industry, and others detailing the continued stigmatization of mental health problems. To establish whether there are any differences in advertisements for psychiatric and non-psychiatric medication aimed at health professionals. Quantitative (t-tests, Chi-squared) and qualitative analysis of all unique advertisements for medication that appeared in two professional journals (the British Medical Journal and the British Journal of Psychiatry) between October 2005 and September 2006 was undertaken. Close attention was paid to both images and text used in the advertisements. Significant differences were found between advertisements for psychiatric and non-psychiatric medication in both quantitative and qualitative analysis: advertisements for psychiatric medication contain less text and are less likely to include specific information about the actual drug than non-psychiatric medication advertisements; images used in advertisements for psychiatric medication are more negative than those used for non-psychiatric medication, and are less likely to portray people in everyday situations. A distinction between mental health problems and other forms of ill health is clearly being maintained in medication advertisements; this has potentially stigmatizing consequences, both for professional and public perceptions. There are also troubling implications in light of the debates surrounding Direct to Consumer Advertising.

Security and privacy qualities of medical devices: an analysis of FDA postmarket surveillance.

PubMed

Kramer, Daniel B; Baker, Matthew; Ransford, Benjamin; Molina-Markham, Andres; Stewart, Quinn; Fu, Kevin; Reynolds, Matthew R

2012-01-01

Medical devices increasingly depend on computing functions such as wireless communication and Internet connectivity for software-based control of therapies and network-based transmission of patients' stored medical information. These computing capabilities introduce security and privacy risks, yet little is known about the prevalence of such risks within the clinical setting. We used three comprehensive, publicly available databases maintained by the Food and Drug Administration (FDA) to evaluate recalls and adverse events related to security and privacy risks of medical devices. Review of weekly enforcement reports identified 1,845 recalls; 605 (32.8%) of these included computers, 35 (1.9%) stored patient data, and 31 (1.7%) were capable of wireless communication. Searches of databases specific to recalls and adverse events identified only one event with a specific connection to security or privacy. Software-related recalls were relatively common, and most (81.8%) mentioned the possibility of upgrades, though only half of these provided specific instructions for the update mechanism. Our review of recalls and adverse events from federal government databases reveals sharp inconsistencies with databases at individual providers with respect to security and privacy risks. Recalls related to software may increase security risks because of unprotected update and correction mechanisms. To detect signals of security and privacy problems that adversely affect public health, federal postmarket surveillance strategies should rethink how to effectively and efficiently collect data on security and privacy problems in devices that increasingly depend on computing systems susceptible to malware.

Security and Privacy Qualities of Medical Devices: An Analysis of FDA Postmarket Surveillance

PubMed Central

Kramer, Daniel B.; Baker, Matthew; Ransford, Benjamin; Molina-Markham, Andres; Stewart, Quinn; Fu, Kevin; Reynolds, Matthew R.

2012-01-01

Background Medical devices increasingly depend on computing functions such as wireless communication and Internet connectivity for software-based control of therapies and network-based transmission of patients’ stored medical information. These computing capabilities introduce security and privacy risks, yet little is known about the prevalence of such risks within the clinical setting. Methods We used three comprehensive, publicly available databases maintained by the Food and Drug Administration (FDA) to evaluate recalls and adverse events related to security and privacy risks of medical devices. Results Review of weekly enforcement reports identified 1,845 recalls; 605 (32.8%) of these included computers, 35 (1.9%) stored patient data, and 31 (1.7%) were capable of wireless communication. Searches of databases specific to recalls and adverse events identified only one event with a specific connection to security or privacy. Software-related recalls were relatively common, and most (81.8%) mentioned the possibility of upgrades, though only half of these provided specific instructions for the update mechanism. Conclusions Our review of recalls and adverse events from federal government databases reveals sharp inconsistencies with databases at individual providers with respect to security and privacy risks. Recalls related to software may increase security risks because of unprotected update and correction mechanisms. To detect signals of security and privacy problems that adversely affect public health, federal postmarket surveillance strategies should rethink how to effectively and efficiently collect data on security and privacy problems in devices that increasingly depend on computing systems susceptible to malware. PMID:22829874

Mining with Rare Cases

NASA Astrophysics Data System (ADS)

Weiss, Gary M.

Rare cases are often the most interesting cases. For example, in medical diagnosis one is typically interested in identifying relatively rare diseases, such as cancer, rather than more frequently occurring ones, such as the common cold. In this chapter we discuss the role of rare cases in Data Mining. Specific problems associated with mining rare cases are discussed, followed by a description of methods for addressing these problems.

[Proactive screening for rehabilitation need in type 2 diabetics from an AOK Disease Management Programe: which patients will be identified?].

PubMed

Döbler, A; Pollmann, H; Raspe, H; Mittag, O

2014-02-01

Medical rehabilitation seems suitable for implementing multimodal interventions for the treatment of type 2 diabetes. Rehabilitation in Germany on principle requires that insurees file an application. Proactive screening for rehabilitation need has only been explored in pilot projects so far. It seems a promising attempt to assess rehab need by questionnaire especially in patients with type 2 diabetes. We do not know though how patients who have been screened positive for rehab need differ from other patients with type 2 diabetes as to their health and risk profiles. This could provide an indication of the validity of the proactive approach. Members of an Allgemeine Ortskrankenkasse (AOK) Disease Management Program (DMP) for type 2 diabetes were screened for rehab need by questionnaire. 13 diabetes-specific problem areas were assessed. Problems were assigned to 10 specific treatments (problem-treatment-pairs). Rehab need was presumed if patients needed 3 or more treatments. Patients were then compared to regular rehab patients as well as patients with type 2 diabetes from primary care medical offices. From 5500 DMP-patients 829 returned the questionnaire (return rate: 15.5%). From these 94% met the criteria for rehab need; of these 55% needed 6 or more treatments (complex problems). Patients who screened positive for rehab suffered from more health problems and had worse risk profiles as compared to patients from medical offices, and disease burden was comparable or worse as compared to regular rehab patients. This indicates that proactive screening for rehab need in patients with type 2 diabetes leads to reasonable (valid) results. The very low return rate suggests that the sample may be considerably biased, though. Possibly, mainly patients with greater impairment to health responded to the screening. © Georg Thieme Verlag KG Stuttgart · New York.

The Impact of Selected Contextual Factors on Experts' Clinical Reasoning Performance (Does Context Impact Clinical Reasoning Performance in Experts?)

ERIC Educational Resources Information Center

Durning, Steven J.; Artino, Anthony R.; Boulet, John R.; Dorrance, Kevin; van der Vleuten, Cees; Schuwirth, Lambert

2012-01-01

Context specificity, or the variation in a participant's performance from one case, or situation, to the next, is a recognized problem in medical education. However, studies have not explored the potential reasons for context specificity in experts using the lens of situated cognition and cognitive load theories (CLT). Using these theories, we…

Risk factors for pain in children with severe cognitive impairments.

PubMed

Breau, Lynn M; Camfield, Carol S; McGrath, Patrick J; Finley, G Allen

2004-06-01

Diagnosing cause of pain in children with severe cognitive impairments is difficult due to their problems with communication. Identification of risk factors for specific pain etiologies might help professionals in this task. The aim of this study was to determine whether child-related characteristics increase risk for specific types of pain. Participants were the caregivers of 41 females and 53 males with moderate to profound mental retardation, who were aged 3 to 18 years 8 months (mean 10:1, SD 4:4) but who communicated at the level of a typical child of 13.8 months (SD 10 months): 44 of the children had cerebral palsy (CP) and 59 a seizure disorder. Caregivers reported the cause of children's episodes of pain for four 1-week periods over 1 year. Logistic regression analyses were used to predict occurrence of specific types of pain using children's demographic, medical, and physical characteristics. Children had 406 episodes of pain due to accident, gastrointestinal conditions, musculoskeletal problems, infection, recurrent conditions, and common childhood causes. Results indicated that a unique set of risk factors predicted each pain type in this sample. Significant risk factors for pain included: lack of visual impairment and leg impairment (accidental pain); seizures, leg impairment, and greater number of medications (non-accidental pain); being male and tube fed (musculoskeletal pain); age <7 years, absence of CP, visual impairment, and less frequent medical monitoring (infection pain); being female and with arm impairment (gastrointestinal pain); and being tube fed and taking fewer medications (common childhood pains). In most cases, models were more specific than sensitive, indicating that the significant predictors are more useful for eliminating potential pain causes. These results suggest that population risk factors may be helpful in structuring diagnostic investigations for individual children with severe cognitive impairments.

The problem of fuzzy cause-specific death rates in mortality context analysis: the case of Panama City.

PubMed

Bock, S; Gans, P

1993-05-01

In studies of mortality, small and fluctuating numbers of deaths are problems which are caused by infrequent reporting and small spatial unit reporting. To use Panama City as an example, the paper will introduce a Monte Carlo simulation which allows for the analysis of mortality even with small absolute numbers. In addition, Panama City will be used as an example where good medical care is available in every city district, so that social class differences between the districts have a negligible effect on most cause-specific death rates and infant mortality.

Ontological approach for safe and effective polypharmacy prescription

PubMed Central

Grando, Adela; Farrish, Susan; Boyd, Cynthia; Boxwala, Aziz

2012-01-01

The intake of multiple medications in patients with various medical conditions challenges the delivery of medical care. Initial empirical studies and pilot implementations seem to indicate that generic safe and effective multi-drug prescription principles could be defined and reused to reduce adverse drug events and to support compliance with medical guidelines and drug formularies. Given that ontologies are known to provide well-principled, sharable, setting-independent and machine-interpretable declarative specification frameworks for modeling and reasoning on biomedical problems, we explore here their use in the context of multi-drug prescription. We propose an ontology for modeling drug-related knowledge and a repository of safe and effective generic prescription principles. To test the usability and the level of granularity of the developed ontology-based specification models and heuristic we implemented a tool that computes the complexity of multi-drug treatments, and a decision aid to check the safeness and effectiveness of prescribed multi-drug treatments. PMID:23304299

Childhood Abuse and Current Health Problems among Older Adults: The Mediating Role of Self-Efficacy

PubMed Central

Sachs-Ericsson, Natalie; Medley, Amanda N.; Kendall – Tackett, Kathleen; Taylor, John

2011-01-01

Objectives Child abuse has negative consequences on health functioning and the self-concept. Prior studies have garnered support for these relationships in younger adults; yet few studies have looked at the effects of abuse on health in older adults and the psychosocial variables, specifically self-efficacy, that may influence the abuse-health relationship. Methods Data obtained from the Physical Health and Disability Study were used to explore the impact of child abuse on current medical problems among older adults who were screened on physical disability status (N=1396, Mean age = 67, SD = 10.2). The study was conducted in South Florida and employed a multiethnic sample that is representative of the general population in this area. Results Child abuse was associated with the number of current medical problems and disability. Child abuse was also related to lower self-efficacy, and self-efficacy explained the relationship between abuse and the number of health problems. Conclusions There are far reaching effects of child abuse on older adults' health and self-concept. Health care providers and gerontologists need to be aware that child abuse is a life-long risk factor for increased disability and specific health problems, especially among the elderly. Future research should examine treatments designed to increase self-efficacy, especially among those who experienced child abuse, and observe any positive effects on health functioning. PMID:21922052

MO-F-204-00: Preparing for the ABR Diagnostic and Nuclear Medical Physics Exams

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

NONE

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of allmore » aspects of clinical medical physics. All parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those unique aspects of the nuclear exam, and how preparing for a second specialty differs from the first. Medical physicists who recently completed each ABR exam portion will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less

An interactive problem-solving approach to teach traumatology for medical students.

PubMed

Abu-Zidan, Fikri M; Elzubeir, Margaret A

2010-08-13

We aimed to evaluate an interactive problem-solving approach for teaching traumatology from perspectives of students and consider its implications on Faculty development. A two hour problem-solving, interactive tutorial on traumatology was structured to cover main topics in trauma management. The tutorial was based on real cases covering specific topics and objectives. Seven tutorials (5-9 students in each) were given by the same tutor with the same format for fourth and fifth year medical students in Auckland and UAE Universities (n = 50). A 16 item questionnaire, on a 7 point Likert-type scale, focusing on educational tools, tutor-based skills, and student-centered skills were answered by the students followed by open ended comments. The tutorials were highly ranked by the students. The mean values of educational tools was the highest followed by tutor-centered skills and finally student-centered skills. There was a significant increase of the rating of studied attributes over time (F = 3.9, p = 0.004, ANOVA). Students' open ended comments were highly supportive of the interactive problem-solving approach for teaching traumatology. The interactive problem-solving approach for tutorials can be an effective enjoyable alternative or supplement to traditional instruction for teaching traumatology to medical students. Training for this approach should be encouraged for Faculty development.

An Independent Human Factors Analysis and Evaluation of the Emergency Medical Protocol Checklist for the International Space Station

NASA Technical Reports Server (NTRS)

Marshburn, Thomas; Whitmore, Mihriban; Ortiz, Rosie; Segal, Michele; Smart, Kieran; Hughes, Catherine

2003-01-01

Emergency medical capabilities aboard the ISS include a Crew Medical Officer (CMO) (not necessarily a physician), and back-up, resuscitation equipment, and a medical checklist. It is essential that CMOs have reliable, usable and informative medical protocols that can be carried out independently in flight. The study evaluates the existing ISS Medical Checklist layout against a checklist updated to reflect a human factors approach to structure and organization. Method: The ISS Medical checklist was divided into non-emergency and emergency sections, and re-organized based on alphabetical and a body systems approach. A desk-top evaluation examined the ability of subjects to navigate to specific medical problems identified as representative of likely non-emergency events. A second evaluation aims to focus on the emergency section of the Medical Checklist, based on the preliminary findings of the first. The final evaluation will use Astronaut CMOs as subjects comparing the original checklist against the updated layout in the task of caring for a "downed crewmember" using a Human Patient Simulator [Medical Education Technologies, Inc.]. Results: Initial results have demonstrated a clear improvement of the re-organized sections to determine the solution to the medical problems. There was no distinct advantage for either alternative, although subjects stated having a preference for the body systems approach. In the second evaluation, subjects will be asked to identify emergency medical conditions, with measures including correct diagnosis, time to completion and solution strategy. The third evaluation will compare the original and fully updated checklists in clinical situations. Conclusions: Initial findings indicate that the ISS Medical Checklist will benefit from a reorganization. The present structure of the checklist has evolved over recent years without systematic testing of crewmember ability to diagnose medical problems. The improvements are expected to enable ISS Crewmembers to more speedily and accurately respond to medical situations on the ISS.

OSHA medical and workplace surveillance requirements and NIOSH recommendations (for employees exposed to toxic substances and other work hazards)

NASA Technical Reports Server (NTRS)

Cooper, L. P.

1983-01-01

Both OSHA medical and work place surveillance requirements and NIOSH recommendations were prepared as a desk reference to help occupational health professionals to perform their duties. The medical surveillance information focuses on frequency of physical examinations, specific problems that may arise as a result of exposure (e.g., decreased immunocompetence, weight loss, ets.), conditions that intensify the harmful effects of exposure (e.g., medication an exposed employee may be taking, cigarette smoking, etc.), the areas that should be scrutinized in medical and work histories and during the physical exam, and specific clinical tests that should be conducted. Recordkeeping requirements are also specified. The workplace surveillance information consists of monitoring requirements, personal protective equipment requirements, and recordkeeping requirements. Such details as the sampling devices that should be used, the type of respirators that should be worn, and the frequency of inspections are included. This document does not specify the training, labeling and posting, and safe work practice requirements and recommendations due to space considerations.

Management of neurodegenerative disorders: Parkinson's disease and Alzheimer's disease.

PubMed

Pal, P K; Netravathi, M

2005-03-01

Neurodegenerative disorders result from premature progressive degeneration of specific neurons, and manifest as diseases or syndromes with varied combinations of cognitive, motor, sensory and autonomic dysfunctions. The management involves pharmacotherapy as well as non-pharmacological measures and also to lessen the burden of the care-givers. The medications available for medical treatment are: Levodopa, dopamine agonists, amantadine, anticholinergics, enzyme inhibitors, etc. Advanced Parkinson's disease is concerned with management of motor complications and non-motor complications. Recently surgical treatment is a great option for managing motor complication. Orthostatic hypotension, gait distiurbances, emotional and psychiatric problems, sleep disturbances can be managed and had been discussed in brief. Currently there is no medication available for the cure of Alzheimer's disease. The specific medications claimed to improve patient's well being and cognition include cholinesterase inhibitors, N-methyl-D-aspartate receptor antagonist, anti-oxidants, and anti-amyloid therapy. While medical and surgical treatments for Parkinson's disease have revolutionised the management, still drug therapy for Alzheimer's disease is dismal.

Optimal assignment of workers to supporting services in a hospital

NASA Astrophysics Data System (ADS)

Sawik, Bartosz; Mikulik, Jerzy

2008-01-01

Supporting services play an important role in health care institutions such as hospitals. This paper presents an application of operations research model for optimal allocation of workers among supporting services in a public hospital. The services include logistics, inventory management, financial management, operations management, medical analysis, etc. The optimality criterion of the problem is to minimize operations costs of supporting services subject to some specific constraints. The constraints represent specific conditions for resource allocation in a hospital. The overall problem is formulated as an integer program in the literature known as the assignment problem, where the decision variables represent the assignment of people to various jobs. The results of some computational experiments modeled on a real data from a selected Polish hospital are reported.

The geriatric assessment.

PubMed

Elsawy, Bassem; Higgins, Kim E

2011-01-01

The geriatric assessment is a multidimensional, multidisciplinary assessment designed to evaluate an older person's functional ability, physical health, cognition and mental health, and socioenvironmental circumstances. It is usually initiated when the physician identifies a potential problem. Specific elements of physical health that are evaluated include nutrition, vision, hearing, fecal and urinary continence, and balance. The geriatric assessment aids in the diagnosis of medical conditions; development of treatment and follow-up plans; coordination of management of care; and evaluation of long-term care needs and optimal placement. The geriatric assessment differs from a standard medical evaluation by including nonmedical domains; by emphasizing functional capacity and quality of life; and, often, by incorporating a multidisciplinary team. It usually yields a more complete and relevant list of medical problems, functional problems, and psychosocial issues. Well-validated tools and survey instruments for evaluating activities of daily living, hearing, fecal and urinary continence, balance, and cognition are an important part of the geriatric assessment. Because of the demands of a busy clinical practice, most geriatric assessments tend to be less comprehensive and more problem-directed. When multiple concerns are presented, the use of a "rolling" assessment over several visits should be considered. Academy of Family Physicians.

[Work-related medical rehabilitation for patients with rheumatic diseases].

PubMed

Ehlebracht-König, I; Dorn, M

2014-02-01

In recent years work-related rehabilitation has been intensified. Several studies have shown the effectiveness of work-related interventions in medical rehabilitation by improving participation in the work force and reducing sick leave. The German pension insurance fund has developed standardized requirements for medical work-related rehabilitation which include diagnostic procedures to identify patients with specific occupational problems and vocation-related interventions. These requirements address patients across different indications and diagnoses. Rehabilitation centers are assigned to different levels of work-related interventions depending on the intensity and specificity of the profile. Centers providing the complete range of work-related interventions offer differentiated work-related diagnostics, job training and occupational groups in addition to general social advice. In this article four case studies with different priorities regarding vocational interventions are presented.

GENDER ISSUES: Medical Support for Female Soldiers Deployed to Bosnia

DTIC Science & Technology

1999-03-01

indicate how many visits were for health services such as obtaining birth control refill prescriptions or for specific medical problems such as pelvic...as yeast infections and urinary tract infections. They could also test for pregnancy and dispense birth control . The clinics, however, were not...these briefings were (1) birth control and sexually transmitted diseases; (2) female hygiene in 8Not all 234 women taking our survey responded to our

[Economic burden for patients with chronic myelogenous leukemia--healthcare economics and medical governance of cancer].

PubMed

Kodama, Yuko; Kami, Masahiro

2010-04-01

Due to the recent economic downturn, the economic burden of cancer patients has been further worsened. Specifically for chronic myelogenous leukemia patients, their annual income has decreased by 1, 500, 000 yen from 2000 to 2008, while the cost of their medications has increased from 1,000,000 yen to 1,200,000 yen due the advent of the new drug, Glivec, which was approved in 2001. The scores for psychological burden have increased 30% over the past 8 years before Glivec became available. The economic crisis among cancer patients is a consequence of structural problems with many anticancer drugs and cancer treatment. Especially, problems involving the cost of medical care and the system of drug pricing should be resolved by thorough discussion not only with cancer patients but also with the entire population. Discussion on the medical expense burden for CML patients has flourished through patients' spontaneous activities and information disclosure to a wider population through the internet. This methodology will be significant in establishing medical governance in cancer treatment in Japan.

Preliminary investigation into application of problem-based learning in the practical teaching of diagnostics

PubMed Central

Rui, Zeng; Rong-Zheng, Yue; Hong-Yu, Qiu; Jing, Zeng; Xue-Hong, Wan; Chuan, Zuo

2015-01-01

Background Problem-based learning (PBL) is a pedagogical approach based on problems. Specifically, it is a student-centered, problem-oriented teaching method that is conducted through group discussions. The aim of our study is to explore the effects of PBL in diagnostic teaching for Chinese medical students. Methods A prospective, randomized controlled trial was conducted. Eighty junior clinical medical students were randomly divided into two groups. Forty students were allocated to a PBL group and another 40 students were allocated to a control group using the traditional teaching method. Their scores in the practice skills examination, ability to write and analyze medical records, and results on the stage test and behavior observation scale were compared. A questionnaire was administered in the PBL group after class. Results There were no significant differences in scores for writing medical records, content of interviewing, physical examination skills, and stage test between the two groups. However, compared with the control group, the PBL group had significantly higher scores on case analysis, interviewing skills, and behavioral observation scales. Conclusion The questionnaire survey revealed that PBL could improve interest in learning, cultivate an ability to study independently, improve communication and analytical skills, and good team cooperation spirit. However, there were some shortcomings in systematization of imparting knowledge. PBL has an obvious advantage in teaching with regard to diagnostic practice. PMID:25848334

Comprehensive Assessment of Children and Youth with ADHD.

ERIC Educational Resources Information Center

Burcham, Barbara G.; DeMers, Stephen T.

1995-01-01

Principles of comprehensive assessment of students with attention deficit hyperactivity disorder are examined in relation to legal compliance, special considerations for cultural diversity, medical diagnosis versus educational identification, and the problem-solving assessment model. Strengths and weakness of specific strategies are identified as…

Group problems in problem-based learning.

PubMed

Hendry, Graham D; Ryan, Greg; Harris, Jennifer

2003-11-01

Successful small-group learning in problem-based learning (PBL) educational programmes relies on functional group processes. However, there has been limited research on PBL group problems, and no studies have been conducted on problems as perceived by both students and tutors in the same educational context. The authors investigated PBL group problems in a graduate-entry medical programme, and report the most common group problems, and those that hinder students' learning the most. The possible causes of individual quietness and dominant behaviour, and potential influences that group problems may have on the tutorial process are summarized in an exploratory model of PBL group dysfunction that could be used to guide further research. Specifically, there is a need for further evidence on which to base guidelines for tutors and students to effectively manage group problems.

[User's requests (from a practitioner's perspective)].

PubMed

Ohnishi, T

1997-08-01

As a practitioner, I have to rely on outside clinical laboratories and affiliated hospitals to perform laboratory tests. In this abstract, I describe specific problems I have encountered with third-party laboratories, and propose solutions for these problems to optimize use of laboratory tests. BLOOD TESTS: The most frequent problem in ordering blood tests is the lack of detailed information regarding sampling conditions. I often have to call laboratories to check whether the sample should be serum or plasma, what volume is needed, whether the sample should be cooled, etc. I propose that clinical laboratories should provide practitioners' manuals that describe specific sampling information. Most laboratories do not keep the data from ultrasonographic tests. The lack of these is most problematic when test results are interpreted differently by laboratories and by practitioners. Retaining the data would also help private laboratories improve the quality of the test by enabling them to compare their interpretations with others'. ANNUAL MEDICAL SCREENING: Even if an abnormal finding is detected at medical screening clinics, the final diagnosis is usually not sent back to the screening facilities. This is highly recommended to establish an official system that mediates the feedback to screening centers. MRI: Due to miscommunication between practitioners and radiologists, the test is sometimes performed inappropriately. A thorough consultation should occur before the test to clarify specific goals for each patient. PATHOLOGICAL TESTS: Interpretation of results is often inconsistent among laboratories. Independent clinical laboratories tend to report results without indicating sample problems, while pathology departments at affiliated hospitals tend to emphasize sample problems instead of diagnosis or suggesting ways to improve sample quality. Mutual communication among laboratories would help standardize the quality of pathological tests.

MO-F-204-02: Preparing for Part 2 of the ABR Diagnostic Physics Exam

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

Szczykutowicz, T.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of allmore » aspects of clinical medical physics. All parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those unique aspects of the nuclear exam, and how preparing for a second specialty differs from the first. Medical physicists who recently completed each ABR exam portion will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less

MO-F-204-03: Preparing for Part 3 of the ABR Diagnostic Physics Exam

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

Zambelli, J.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of allmore » aspects of clinical medical physics. All parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those unique aspects of the nuclear exam, and how preparing for a second specialty differs from the first. Medical physicists who recently completed each ABR exam portion will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less

MO-F-204-01: Preparing for Part 1 of the ABR Diagnostic Physics Exam

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

McKenney, S.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of allmore » aspects of clinical medical physics. All parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those unique aspects of the nuclear exam, and how preparing for a second specialty differs from the first. Medical physicists who recently completed each ABR exam portion will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less

MO-F-204-04: Preparing for Parts 2 & 3 of the ABR Nuclear Medicine Physics Exam

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

MacDougall, R.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of allmore » aspects of clinical medical physics. All parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those unique aspects of the nuclear exam, and how preparing for a second specialty differs from the first. Medical physicists who recently completed each ABR exam portion will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less

WE-D-213-04: Preparing for Parts 2 & 3 of the ABR Nuclear Medicine Physics Exam

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

MacDougall, R.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance ofmore » all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less

WE-D-213-00: Preparing for the ABR Diagnostic and Nuclear Medicine Physics Exams

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

NONE

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance ofmore » all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less

WE-D-213-01: Preparing for Part 1 of the ABR Diagnostic Physics Exam

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

Simiele, S.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance ofmore » all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less

WE-D-213-03: Preparing for Part 3 of the ABR Diagnostic Physics Exam

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

Bevins, N.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance ofmore » all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less

WE-D-213-02: Preparing for Part 2 of the ABR Diagnostic Physics Exam

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

Zambelli, J.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance ofmore » all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less

Ethical problems in pediatrics: what does the setting of care and education show us?

PubMed

Guedert, Jucélia Maria; Grosseman, Suely

2012-03-16

Pediatrics ethics education should enhance medical students' skills to deal with ethical problems that may arise in the different settings of care. This study aimed to analyze the ethical problems experienced by physicians who have medical education and pediatric care responsibilities, and if those problems are associated to their workplace, medical specialty and area of clinical practice. A self-applied semi-structured questionnaire was answered by 88 physicians with teaching and pediatric care responsibilities. Content analysis was performed to analyze the qualitative data. Poisson regression was used to explore the association of the categories of ethical problems reported with workplace and professional specialty and activity. 210 ethical problems were reported, grouped into five areas: physician-patient relationship, end-of-life care, health professional conducts, socioeconomic issues and health policies, and pediatric teaching. Doctors who worked in hospitals as well as general and subspecialist pediatricians reported fewer ethical problems related to socioeconomic issues and health policies than those who worked in Basic Health Units and who were family doctors. Some ethical problems are specific to certain settings: those related to end-of-life care are more frequent in the hospital settings and those associated with socioeconomic issues and public health policies are more frequent in Basic Health Units. Other problems are present in all the setting of pediatric care and learning and include ethical problems related to physician-patient relationship, health professional conducts and the pediatric education process. These findings should be taken into consideration when planning the teaching of ethics in pediatrics. This research article didn't reports the results of a controlled health care intervention. The study project was approved by the Institutional Ethical Review Committee (Report CEP-HIJG 032/2008).

A discrepancy in objective and subjective measures of knowledge: do some medical students with learning problems delude themselves?

PubMed

Anthoney, T R

1986-01-01

In general, the rankings of first-year medical students on a written test of long-term neuroscience retention (RET) correlated strongly with how many of three neuroscience research presentations given within the following 2 days the students reported understanding. The lowest-ranking sixth of the class on RET, however, reported understanding almost every lecture, even more than the highest-ranking RET students did. Some of these low-ranking students were aware that they had areas of weakness, but simply tolerated more of them without reporting overall lack of understanding. Other low-ranking students, however, seemed genuinely unaware that they had any areas of weakness. This interpretation was further supported by data on small-group problem-solving performance during the first-year neuroscience course, on use of human resources during the final first-year neuroscience take-home examination, and on performance during the third-year clinical clerkships. Persistence of the problem, even after 5 months of instruction specifically designed to improve such information-processing skills, suggests that correction may be difficult to achieve. The need for specific valid evaluative instruments and effective correctional techniques is noted.

The impact of problem-based learning on students' perceptions of preparedness for advanced pharmacy practice experiences.

PubMed

Hogan, Shirley; Lundquist, Lisa M

2006-08-15

To evaluate graduating pharmacy students' perceptions of their preparedness for advanced pharmacy practice experiences and the effectiveness of problem-based learning in their preparation. A survey instrument was administered anonymously in May 2004 and May 2005 to graduating pharmacy students of the University of Mississippi School of Pharmacy. Students reported that the areas in which problem-based learning prepared them most effectively for advanced pharmacy practice experiences were retrieval of medical information (80%), discussion of disease states and drug therapies at the basic science level (56%), and evaluation of the appropriateness of a medication regimen based on patient specific information (50%). Areas in which students reported being inadequately prepared included identifying and utilizing drug assistance programs (42%) and processing prescriptions/hospital orders (40%). Data from 2 consecutive graduating classes supports that problem-based learning is an effective format for preparing pharmacy students for advanced pharmacy practice experiences in a variety of areas.

Substance Use as a Risk Factor for Sleep Problems Among Adolescents Presenting to the Emergency Department.

PubMed

Zhabenko, Olena; Austic, Elizabeth; Conroy, Deirdre A; Ehrlich, Peter; Singh, Vijay; Epstein-Ngo, Quyen; Cunningham, Rebecca M; Walton, Maureen A

2016-01-01

To determine correlates of sleep problems among adolescents. Specifically, to assess the relative strength of associations between sleep problems and dating victimization, reasons for emergency department (ED) visit, depression, unhealthy alcohol use, and other drug use (marijuana, nonmedical use of prescription opioids, stimulants, and tranquilizers). A total of 1852 adolescents aged 14 to 20 years presenting for care to the University of Michigan Emergency Department, Ann Arbor, Michigan, during 2011-2012, self-administered a computerized health survey. Sleep problems were identified if any of the 4 items on the Sleep Problems Questionnaire were rated by a patient as greater than 3 on a 0 to 5 scale. Adolescents who were too sick to be screened in the ED were eligible to participate in the study during their inpatient stay. Exclusion criteria for baseline included insufficient cognitive orientation precluding informed consent, not having parent/guardian present if younger than 18 years, medical severity precluding participation, active suicidal/homicidal ideation, non-English-speaking, deaf/visually impaired, or already participated in this study on a prior visit. 23.5% of adolescents reported clinically significant sleep problems. Female gender, depression, dating victimization, tobacco use, nonmedical use of prescription medication, and an ED visit for medical reasons were each associated with sleep problems among adolescents, even while controlling for age, other types of drug use, receiving public assistance, and dropping out of school. These exploratory findings indicate that ED-based screening and brief intervention approaches addressing substance use and/or dating victimization may need to account for previously undiagnosed sleep problems.

Chronic fatigue in Ehlers-Danlos syndrome-Hypermobile type.

PubMed

Hakim, Alan; De Wandele, Inge; O'Callaghan, Chris; Pocinki, Alan; Rowe, Peter

2017-03-01

Chronic fatigue is an important contributor to impaired health-related quality of life in Ehlers-Danlos syndrome. There is overlap in the symptoms and findings of EDS and chronic fatigue syndrome. A proportion of those with CFS likely have EDS that has not been identified. The evaluation of chronic fatigue in EDS needs to include a careful clinical examination and laboratory testing to exclude common causes of fatigue including anemia, hypothyroidisim, and chronic infection, as well as dysfunction of major physiological or organ systems. Other problems that commonly contribute to fatigue in EDS include sleep disorders, chronic pain, deconditioning, cardiovascular autonomic dysfunction, bowel and bladder dysfunction, psychological issues, and nutritional deficiencies. While there is no specific pharmacological treatment for fatigue, many medications are effective for specific symptoms (such as headache, menstrual dysfunction, or myalgia) and for co-morbid conditions that result in fatigue, including orthostatic intolerance and insomnia. Comprehensive treatment of fatigue needs to also evaluate for biomechanical problems that are common in EDS, and usually involves skilled physical therapy and attention to methods to prevent deconditioning. In addition to managing specific symptoms, treatment of fatigue in EDS also needs to focus on maintaining function and providing social, physical, and nutritional support, as well as providing on-going medical evaluation of new problems and review of new evidence about proposed treatments. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Empowering Physicians with Financial Literacy.

PubMed

Bar-Or, Yuval

2015-01-01

Most doctors complete their medical training without sufficient knowledge of business and finance. This leads to inefficient financial decisions, avoidable losses, and unnecessary anxiety. A big part of the problem is that the existing options for gaining financial knowledge are flawed. The ideal solution is to provide a simple framework of financial literacy to all students: one that can be adapted to their specific circumstances. That framework must be delivered by an objective expert to young physicians before they complete medical training.

Applying established guidelines to team-based learning programs in medical schools: a systematic review.

PubMed

Burgess, Annette W; McGregor, Deborah M; Mellis, Craig M

2014-04-01

Team-based learning (TBL), a structured form of small-group learning, has gained popularity in medical education in recent years. A growing number of medical schools have adopted TBL in a variety of combinations and permutations across a diversity of settings, learners, and content areas. The authors conducted this systematic review to establish the extent, design, and practice of TBL programs within medical schools to inform curriculum planners and education designers. The authors searched the MEDLINE, PubMed, Web of Knowledge, and ERIC databases for articles on TBL in undergraduate medical education published between 2002 and 2012. They selected and reviewed articles that included original research on TBL programs and assessed the articles according to the seven core TBL design elements (team formation, readiness assurance, immediate feedback, sequencing of in-class problem solving, the four S's [significant problem, same problem, specific choice, and simultaneous reporting], incentive structure, and peer review) described in established guidelines. The authors identified 20 articles that satisfied the inclusion criteria. They found significant variability across the articles in terms of the application of the seven core design elements and the depth with which they were described. The majority of the articles, however, reported that TBL provided a positive learning experience for students. In the future, faculty should adhere to a standardized TBL framework to better understand the impact and relative merits of each feature of their program.

Key Data Gaps Regarding the Public Health Issues Associated with Opioid Analgesics

PubMed Central

Schmidt, Teresa D.; Haddox, J. David; Nielsen, Alexandra E.; Wakeland, Wayne; Fitzgerald, John

2014-01-01

Most pharmaceutical opioids are used to treat pain and they have been demonstrated to be effective medications for many. Their abuse and misuse pose significant public health concerns in the United States. Research has provided much insight into the prevalence, scope, and drivers of opioid abuse, but a holistic understanding is limited by a lack of available data regarding key aspects of this public health problem. Twelve data gaps were revealed during the creation of a systems-level computer model of medical use, diversion, nonmedical use, and the adverse outcomes associated with opioid analgesics in the United States. Data specific to these gaps would enhance the validity and real-world applications of systems-level models of this public health problem, and would increase understanding of the complex system in which use and abuse occur. This paper provides an overview of these gaps, argues for the importance of closing them, and provides specific recommendations for future data collection efforts. PMID:24554390

The Japanese national health screening and intervention program aimed at preventing worsening of the metabolic syndrome.

PubMed

Kohro, Takahide; Furui, Yuji; Mitsutake, Naohiro; Fujii, Ryo; Morita, Hiroyuki; Oku, Shinya; Ohe, Kazuhiko; Nagai, Ryozo

2008-03-01

Similar to the healthcare systems in other industrialized countries, the Japanese healthcare system is facing the problem of increasing medical expenditure. In Japan, this situation may be primarily attributed to advanced technological developments, an aging population, and increasing patient demand. Japan also faces the problem of a declining youth population due to a low birth rate. Taken together, these problems present the healthcare system with a very difficult financial situation. Several reforms have been undertaken to contain medical expenditure, such as increasing employee copayment for health insurance from 10% to 20% in 1997 and from 20% to 30% in 2003 in order to curb unnecessary visits to medical institutions. Since the aging of the Japanese population is inevitable, a suitable method to contain medical expenditure may be to screen individuals who are likely to develop lifestyle-related diseases and conduct early intervention programs for them to prevent the development of diseases such as myocardial infarction or stroke that are costly to treat. If this goal is attained, it may contribute to the containment of medical expenditure as well as to improving the quality of life of the elderly. Therefore, the Japanese Ministry of Health, Labor and Welfare has decided to introduce a nationwide health screening and intervention program specifically targeting the metabolic syndrome commencing April 2008. Here, we discuss (1) the background of the Japanese healthcare system and the problems facing it, (2) the underlying objective and details of the new screening program, and (3) the expected impact of the program.

Research on cultivating medical students' self-learning ability using teaching system integrated with learning analysis technology.

PubMed

Luo, Hong; Wu, Cheng; He, Qian; Wang, Shi-Yong; Ma, Xiu-Qiang; Wang, Ri; Li, Bing; He, Jia

2015-01-01

Along with the advancement of information technology and the era of big data education, using learning process data to provide strategic decision-making in cultivating and improving medical students' self-learning ability has become a trend in educational research. Educator Abuwen Toffler said once, the illiterates in the future may not be the people not able to read and write, but not capable to know how to learn. Serving as educational institutions cultivating medical students' learning ability, colleges and universities should not only instruct specific professional knowledge and skills, but also develop medical students' self-learning ability. In this research, we built a teaching system which can help to restore medical students' self-learning processes and analyze their learning outcomes and behaviors. To evaluate the effectiveness of the system in supporting medical students' self-learning, an experiment was conducted in 116 medical students from two grades. The results indicated that problems in self-learning process through this system was consistent with problems raised from traditional classroom teaching. Moreover, the experimental group (using this system) acted better than control group (using traditional classroom teaching) to some extent. Thus, this system can not only help medical students to develop their self-learning ability, but also enhances the ability of teachers to target medical students' questions quickly, improving the efficiency of answering questions in class.

Six ways problem-based learning cases can sabotage patient-centered medical education.

PubMed

MacLeod, Anna

2011-07-01

Problem-based learning (PBL) cases tell a story of a medical encounter; however, the version of the story is typically very biomedical in focus. The patient and her or his experience of the situation are rarely the focus of the case despite a prevalent discourse of patient-centeredness in contemporary medical education. This report describes a qualitative study that explored the question, "How does PBL teach medical students about what matters in medicine?" The qualitative study, culminating in 2008, involved three data collection strategies: (1) a discourse analysis of a set of PBL cases from 2005 to 2006, (2) observation of a PBL tutorial group, and (3) semistructured, in-depth, open-ended interviews with medical educators and medical students. In this report, using data gathered from 67 PBL cases, 26 hours of observation, and 14 interviews, the author describes six specific ways in which PBL cases-if not thoughtfully conceptualized and authored-can serve to overlook social considerations, thereby undermining a patient-centered approach. These comprise the detective case, the shape-shifting patient, the voiceless PBL person, the joke name, the disembodied PBL person, and the stereotypical PBL person. PBL cases constitute an important component of undergraduate medical education. Thoughtful authoring of PBL cases has the potential to reinforce, rather than undermine, principles of patient-centeredness.

Erectile Dysfunction in Brazilian Primary Health Care: Dealing with Medicalization

PubMed Central

Modesto, Antônio Augusto Dall’Agnol; Couto, Marcia Thereza

2017-01-01

Erectile dysfunction (ED) is a common sexual problem and has been attracting growing interest from the field of medicine. The pharmaceutical industry works together with medical associations to popularize the theme, emphasizing individual enhancement and medication, besides reinforcing an idea of a male sexuality defined by the ability to have an erection and penetrate. Patients worried about erection problems search for general practitioners (GPs), frequently without a clear complaint, and a comprehensive primary health care (PHC) must be capable of dealing with these issues considering medicalization and disease mongering. This article discusses how PHC physicians take (and might take) care of men with erection problems, and how users perceive it and search for help in two cities in the State of São Paulo, Brazil. The qualitative research, performed in five PHC services, included semistructured interviews with 16 GPs and 15 adult male users. The adult male users were invited by their doctors during consultations where questions about prostate, ED, or other sexual problems arose. Interviews were transcribed and submitted for content analysis. In addition, the five participating services were observed with help of a specific script. Results indicate that ED is frequently a hidden agenda and that doctors have trouble approaching the problem, usually focusing on the biological aspects. Based on empirical data and literature, this work indicates some measures to qualify the care of men with ED in PHC which includes contemplating users’ questions, respecting their autonomy, avoiding an antidrug stance, and considering drug and nondrug approaches as a continuum of resources. PMID:29076407

Automation and adaptation: Nurses' problem-solving behavior following the implementation of bar coded medication administration technology.

PubMed

Holden, Richard J; Rivera-Rodriguez, A Joy; Faye, Héléne; Scanlon, Matthew C; Karsh, Ben-Tzion

2013-08-01

The most common change facing nurses today is new technology, particularly bar coded medication administration technology (BCMA). However, there is a dearth of knowledge on how BCMA alters nursing work. This study investigated how BCMA technology affected nursing work, particularly nurses' operational problem-solving behavior. Cognitive systems engineering observations and interviews were conducted after the implementation of BCMA in three nursing units of a freestanding pediatric hospital. Problem-solving behavior, associated problems, and goals, were specifically defined and extracted from observed episodes of care. Three broad themes regarding BCMA's impact on problem solving were identified. First, BCMA allowed nurses to invent new problem-solving behavior to deal with pre-existing problems. Second, BCMA made it difficult or impossible to apply some problem-solving behaviors that were commonly used pre-BCMA, often requiring nurses to use potentially risky workarounds to achieve their goals. Third, BCMA created new problems that nurses were either able to solve using familiar or novel problem-solving behaviors, or unable to solve effectively. Results from this study shed light on hidden hazards and suggest three critical design needs: (1) ecologically valid design; (2) anticipatory control; and (3) basic usability. Principled studies of the actual nature of clinicians' work, including problem solving, are necessary to uncover hidden hazards and to inform health information technology design and redesign.

Automation and adaptation: Nurses’ problem-solving behavior following the implementation of bar coded medication administration technology

PubMed Central

Holden, Richard J.; Rivera-Rodriguez, A. Joy; Faye, Héléne; Scanlon, Matthew C.; Karsh, Ben-Tzion

2012-01-01

The most common change facing nurses today is new technology, particularly bar coded medication administration technology (BCMA). However, there is a dearth of knowledge on how BCMA alters nursing work. This study investigated how BCMA technology affected nursing work, particularly nurses’ operational problem-solving behavior. Cognitive systems engineering observations and interviews were conducted after the implementation of BCMA in three nursing units of a freestanding pediatric hospital. Problem-solving behavior, associated problems, and goals, were specifically defined and extracted from observed episodes of care. Three broad themes regarding BCMA’s impact on problem solving were identified. First, BCMA allowed nurses to invent new problem-solving behavior to deal with pre-existing problems. Second, BCMA made it difficult or impossible to apply some problem-solving behaviors that were commonly used pre-BCMA, often requiring nurses to use potentially risky workarounds to achieve their goals. Third, BCMA created new problems that nurses were either able to solve using familiar or novel problem-solving behaviors, or unable to solve effectively. Results from this study shed light on hidden hazards and suggest three critical design needs: (1) ecologically valid design; (2) anticipatory control; and (3) basic usability. Principled studies of the actual nature of clinicians’ work, including problem solving, are necessary to uncover hidden hazards and to inform health information technology design and redesign. PMID:24443642

Attention and material-specific memory in children with lateralized epilepsy.

PubMed

Engle, Jennifer A; Smith, Mary Lou

2010-01-01

Epilepsy is frequently associated with attention and memory problems. In adults, lateralization of seizure focus impacts the type of memory affected (left-sided lesions primarily impact verbal memory, while right-sided lesions primarily impact visual memory), but the relationship between seizure focus and the nature of the memory impairment is less clear in children. The current study examines the correlation between parent-reported attention problems and material-specific memory (verbal or visual-spatial) in 65 children (ages 6-16) with medically intractable lateralized epilepsy. There were no significant differences in attention and memory between those with left-lateralized epilepsy (n=25) and those with right-lateralized epilepsy (n=40). However, in the left-lateralized group attention problems were significantly negatively correlated only with delayed visual memory (r=-.450, p<.05), while the right-lateralized group demonstrated the opposite pattern (attention problems significantly negatively correlated with delayed verbal memory; r=-.331, p<.05). These findings suggest that lateralization of seizure focus may in fact impact children's memory in a material-specific manner, while problems with attention may impact memory more globally. Therefore, interventions designed to improve attention in children with epilepsy may have utility in improving certain aspects of memory, but further suggest that in children with lateralized epilepsy, material-specific memory deficits may not resolve with such interventions.

Menopause, only for women? The social construction of menopause as an exclusively female condition.

PubMed

Oudshoorn, N E

1997-06-01

Over the last three decades the menopause has continued to interest the medical profession, the pharmaceutical industry and the mass media. Although there exist many different views on the menopause, there is one common denominator. Menopause is depicted as an exclusively female condition. The medical discourse on menopause seems to exclude men. However, a closer look at the history of the medical sciences reveals that there have been and still are, attempts to classify symptoms of ageing men as male menopause or climacterium. Despite these attempts to put men on the menopausal agenda, most attention is focused on women. How can we understand this almost exclusive focus on female bodies? Why does there exist such an emphasis on the medicalization of the third age of women rather than of men? Maybe we might be inclined to think of a male conspiracy, as has been suggested by feminists: women take the pills, while men cash the bills. We might consider the enormous profits of the pharmaceutical industry. This paper is concerned with finding an alternative explanation for the almost exclusive attention for the female menopause. Based on historical data and more recent discussions in medical journals, the paper shows that the medicalization of the female menopause and the relative silence around the male climacterium can be understood in terms of the social and cultural processes that underly the classification of health problems as specific diseases. The imbalance in medical treatment of climacteric health problems in women and men is not simply rooted in biological sex differences, but can be ascribed to men's attitudes towards health problems and organizational infrastructures of the medical institutions.

Factors associated with adolescent and caregiver reported problems in using asthma medications.

PubMed

Sleath, Betsy; Carpenter, Delesha M; Walsh, Kathleen E; Davis, Scott A; Watson, Claire Hayes; Lee, Charles; Loughlin, Ceila E; Garcia, Nacire; Reuland, Daniel S; Tudor, Gail

2018-04-18

The purpose of this study was to: (a) describe the types of medication problems/concerns youth with asthma and their caregivers reported and (b) examine the association between socio-demographic characteristics and youth and caregiver reported medication problems/concerns. English-and Spanish-speaking youth ages 11-17 with persistent asthma were recruited at four pediatric clinics. Youth were interviewed and caregivers completed questionnaires about reported asthma medication concerns/problems. Multiple logistic regression was used to analyze the data. Three hundred and fifty-nine youth were recruited. Eighty percent of youth and 70% of caregivers reported one or more problems in using asthma medications. The most commonly reported problems by youth were: (a) hard to remember when to take the asthma medication (54%) and (b) hard to use asthma medication at school (34%). Younger children were significantly more likely to report difficulty in understanding their asthma medication's directions and difficulty reading the print on the medication's package. Caregivers' top-reported problem was that it is hard for their child to remember to take their asthma medications (49%). Caregivers without Medicaid were significantly more likely to express difficulty paying for their child's asthma medications. Difficulty remembering to take asthma medication was a significant problem for youth and their caregivers. Providers should work with youth and their caregivers to identify asthma medication problems and discuss strategies to address those problems.

Estimating costs in the economic evaluation of medical technologies.

PubMed

Luce, B R; Elixhauser, A

1990-01-01

The complexities and nuances of evaluating the costs associated with providing medical technologies are often underestimated by analysts engaged in economic evaluations. This article describes the theoretical underpinnings of cost estimation, emphasizing the importance of accounting for opportunity costs and marginal costs. The various types of costs that should be considered in an analysis are described; a listing of specific cost elements may provide a helpful guide to analysis. The process of identifying and estimating costs is detailed, and practical recommendations for handling the challenges of cost estimation are provided. The roles of sensitivity analysis and discounting are characterized, as are determinants of the types of costs to include in an analysis. Finally, common problems facing the analyst are enumerated with suggestions for managing these problems.

Drug use--problem in pregnancy.

PubMed

Durisova, A; Magulova, L

2004-01-01

The consumption of drugs during pregnancy considered as a specific medical problem. Drug consumption and drug compliance in pregnancy were analysed in our study. Structured questionnaire and data from mothers were used as principal sources for analysis. Consumption of drugs and compliance with therapy were evaluated in 331 pregnant women, 60% city and 40% rural population, of Region Nitra, Slovakia, after their child birth. Drug's use was confirmed in 75% of pregnant women. The consumption was significantly higher in the first and second pregnancy when compared to the females by in their third or further pregnancies. Medical prescription was the reason of drug use in 89% pregnant women. The number of prescribed drugs similarly as the total consumption was higher in the first and second pregnancies. We noted medical prescribing drug compliance in 70% pregnant women. 16% of pregnant women used anagetic drugs, out of whom 57% on the basis of medical prescription. Adverse drug reactions (gastrointestinal problems and)headache were reported by 15% of pregnant women. In the observed group 6% of women gave birth premature infants (once gemini, once trimini). Two newborns overcomed sepsis. One baby suffered from cheilognatopalatoschisis and two newborns from vitium cordis congenitum. We do not suppose any correlation between child abnormalities and drug consumption during pregnacy. (Tab. 1, Ref. 9.).

Priority setting in general practice: health priorities of older patients differ from treatment priorities of their physicians.

PubMed

Voigt, Isabel; Wrede, Jennifer; Diederichs-Egidi, Heike; Dierks, Marie-Luise; Junius-Walker, Ulrike

2010-12-01

To ascertain health priorities of older patients and treatment priorities of their general practitioners (GP) on the basis of a geriatric assessment and to determine the agreement between these priorities. The study included a sample of 9 general practitioners in Hannover, Germany, and a stratified sample of 35 patients (2-5 patients per practice, 18 female, average age 77.7 years). Patients were given a geriatric assessment using the Standardized Assessment for Elderly Patients in Primary Care (STEP) to gain an overview of their health and everyday problems. On the basis of these results, patients and their physicians independently rated the importance of each problem disclosed by the assessment. Whereas patients assessed the importance for their everyday lives, physicians assessed the importance for patients' medical care and patients' everyday lives. Each patient had a mean ± standard deviation of 18 ± 9.2 health problems. Thirty five patients disclosed a total of 634 problems; 537 (85%) were rated by patients and physicians. Of these 537 problems, 332 (62%) were rated by patients and 334 (62%) by physicians as important for patients' everyday lives. In addition, 294 (55%) were rated by physicians as important for patients' medical care. Although these proportions of important problems were similar between patients and physicians, there was little overlap in the specific problems that each group considered important. The chance-corrected agreement (Cohen κ) between patients and physicians on the importance of problems for patients' lives was low (κ=0.23). Likewise, patients and physicians disagreed on the problems that physicians considered important for patients' medical care (κ=0.18, P<0.001 for each). The low agreement on health and treatment priorities between patients and physicians necessitates better communication between the two parties to strengthen mutual understanding.

Factors affecting medication adherence in elderly people

PubMed Central

Jin, Hyekyung; Kim, Yeonhee; Rhie, Sandy Jeong

2016-01-01

Background Little is known about the functional health literacy (FHL) associated with medication adherence in elderly patients. The aim of this study was to examine the FHL among older adults and identify influencing factors that can predict medication adherence. Methods This was a cross-sectional survey. Participants (n=160) aged 65 years and older were selected from outpatient clinics of 3 tertiary care hospitals, 6 community pharmacies, and 2 senior centers between November 1 and 30, 2014. The participants’ FHL was measured using the Korean Functional Health Literacy Test, which consists of 15 items including 8 numeracy and 7 reading comprehension items. Medication adherence was measured by the Adherence to Refills and Medication Scale. Descriptive statistics, chi-square or Fisher’s exact test, and multiple regression analyses were used to analyze the data. Results The mean score of the total FHL was 7.72±3.51 (range 0–15). The percentage of the total number of correct answers for the reading comprehension subtest and numeracy subtest were 48.1% and 54.4%, respectively. Among 160 participants, 52.5% showed low adherence to medication. The factors affecting medication adherence included the patient’s degree of satisfaction with the service (β=−0.215, P=0.022), sufficient explanation of medication counseling (β=−0.335, P=0.000), education level (β=−0.153, P=0.045), health-related problems (β=−0.239, P=0.004), and dosing frequency (β=0.189, P=0.018). Conclusion In this study, we found medication adherence of elderly patients was associated with education level, health-related problems, dosing frequency, satisfaction with patient counseling, and explanation of medication, but no association was found with FHL. Pharmacists should consider elderly patients’ individual characteristics such as educational background and specific patient-related health problems, provide sufficient information and explanation of medication, and ensure patient satisfaction with the counseling. PMID:27799748

[Errors in wound management].

PubMed

Filipović, Marinko; Novinscak, Tomislav

2014-10-01

Chronic ulcers have adverse effects on the patient quality of life and productivity, thus posing financial burden upon the healthcare system. Chronic wound healing is a complex process resulting from the interaction of the patient general health status, wound related factors, medical personnel skill and competence, and therapy related products. In clinical practice, considerable improvement has been made in the treatment of chronic wounds, which is evident in the reduced rate of the severe forms of chronic wounds in outpatient clinics. However, in spite of all the modern approaches, efforts invested by medical personnel and agents available for wound care, numerous problems are still encountered in daily practice. Most frequently, the problems arise from inappropriate education, of young personnel in particular, absence of multidisciplinary approach, and inadequate communication among the personnel directly involved in wound treatment. To perceive them more clearly, the potential problems or complications in the management of chronic wounds can be classified into the following groups: problems mostly related to the use of wound coverage and other etiology related specificities of wound treatment; problems related to incompatibility of the agents used in wound treatment; and problems arising from failure to ensure aseptic and antiseptic performance conditions.

Medical serials control systems by computer--a state of the art review.

PubMed

Brodman, E; Johnson, M F

1976-01-01

A review of the problems encountered in serials control systems is followed by a description of some of the present-day attempts to solve these problems. Specific networks are described, notably PHILSOM (developed at Washington University School of Medicine Library), the UCLA Biomedical Library's system, and OCLC in Columbus, Ohio. Finally, the role of minicomputers in present and future developments is discussed, and some cautious guesses are made on future directions in the field.

Validation of the MedUseQ: A Self-Administered Screener for Older Adults to Assess Medication Use Problems.

PubMed

Berman, Rebecca L; Iris, Madelyn; Conrad, Kendon J; Robinson, Carrie

2018-01-01

Older adults taking multiple prescription and nonprescription drugs are at risk for medication use problems, yet there are few brief, self-administered screening tools designed specifically for them. The study objective was to develop and validate a patient-centered screener for community-dwelling older adults. In phase 1, a convenience sample of 57 stakeholders (older adults, pharmacists, nurses, and physicians) participated in concept mapping, using Concept System® Global MAX TM , to identify items for a questionnaire. In phase 2, a 40-item questionnaire was tested with a convenience sample of 377 adults and a 24-item version was tested with 306 older adults, aged 55 and older, using Rasch methodology. In phase 3, stakeholder focus groups provided feedback on the format of questionnaire materials and recommended strategies for addressing problems. The concept map contained 72 statements organized into 6 conceptual clusters or domains. The 24-item screener was unidimensional. Cronbach's alpha was .87, person reliability was acceptable (.74), and item reliability was high (.96). The MedUseQ is a validated, patient-centered tool targeting older adults that can be used to assess a wide range of medication use problems in clinical and community settings and to identify areas for education, intervention, or further assessment.

Research on history of medicine in China in the last five years.

PubMed

Zhu, Jian-ping

2004-03-01

Since 1999, progress has been made, to varying degrees, in numerous areas of medical history research in China including history of TCM, history of western medicine, history of integrated Chinese and western medicine, history of traditional medicine of Chinese minorities, history of medicine of foreign countries, history of medical exchanges between China and other countries, and history of comparative medical history. Among others, the number of articles on history of diseases, history of specific medical disciplines, modern medical history, medical biographies, medical works, contemporary medical history, and history of medical culture has increased dramatically. In the field of history of diseases, the papers deal with diseases in gynecology and obstetrics, plague, lanhousha (scarlet fever), and nephritis; articles in the field of specific disciplines deal with history of acu-moxibustion, history of prescription-forms, and history of gynecology, endoscopic surgery, and evidence-based medicine. There are even distinguished papers appeared in these aspects. In the aspect of modern medical history, there are papers dealing with the developement of TCM, the introduction of western medicine into China, with some specific researches in these fields. Medical biographies include Tan Yun-xian, Quan Shao-qing, Du Chong-ming etc. Papers on medical works deal with the ancient unearthed literature lost yet spread and extant abroad, medical classics, canons on material medica, cold-pathogenic diseases, and formularies. While papers on history of medical culture discuss basically the influence of Confucianism, Taoism, Buddhism and I-discipline on Chinese medicine. During these five years, 300 original articles have been published in The Chinese journal of Medical History, with another 200 papers published in other Chinese journals. Forty monographs have been published and important ones are A General History of Chinese Medicine, Modern history of TCM, The Historical Development of Acupuncture, A General History of Tiberan Medicine. For the coming years, the stress points should be laid on the research on history of diseases, history of specific medical disciplines, and some specific academic topics. In addition, the weak points in the research fields of theoretical problems in studies of medical history, history of traditional medicine of Chinese minorities, medical history of communication between China and foreign countries, comparative study on medical history, and the study on history of medical also be strengthened continually. In the five years since 1999, progress has been made, more or less, in the research works in medical history in China, including history of TCM, history of western medicine, history of integrated Chinese and western medicine, history of traditional medicine of Chinese minorities, history of medicine of foreign countries, history of medical exchanges between China and other countries, and history of comparative medical history. And the number of articles on history of diseases, history of specific medical disciplines, modern medical history, medical biographies, medical works, contemporary medical history and history of medical culture has increased dramatically. The research work in ancient medical history is still progressing forcefully.

Effects of Methylphenidate on Sleep Functioning in Children with Attention-Deficit/Hyperactivity Disorder.

PubMed

Becker, Stephen P; Froehlich, Tanya E; Epstein, Jeffery N

2016-06-01

To examine the effects of stimulant medication on the sleep functioning of children with attention-deficit/hyperactivity disorder (ADHD) and identify predictors of sleep problems as a side effect of taking stimulant medication. One hundred sixty-three stimulant-naïve children (72% boys) aged 7 to 11 years diagnosed with ADHD (120 with ADHD predominantly inattentive type, 43 with ADHD combined type) participated in a 4-week, randomized, double-blind, placebo-controlled trial of once-daily (long-acting) methylphenidate (MPH). Parents completed weekly side-effect ratings including an item related to sleep problems. Ten percent of patients had parent-rated sleep problems before the initiation of medication. Rates of parent-rated sleep problems during MPH titration generally increased with increasing MPH dose (placebo: 8%; low dose: 18%; medium dose: 15%; high dose: 25%). Differences emerged between children with (n = 16) or without (n = 147) preexisting sleep problems. Although 23% of children without preexisting sleep problems went on to have sleep problems at the highest MPH dose, only 37.5% of children with preexisting sleep problems still had sleep problems at the highest MPH dose. Lower weight and lower body mass index (BMI) were associated with increased sleep problems during MPH titration. This study demonstrated a general association between increased MPH dose and increased sleep problems in children with ADHD, particularly for children of lower weight/BMI. However, a substantial proportion of children with preexisting sleep difficulties no longer had sleep problems on the highest MPH dose, which may help explain mixed findings reported to date in studies examining the impact of MPH on sleep functioning in children with ADHD and suggests that MPH dose titration should not be avoided solely on the basis of a child's premorbid sleep problems. Future research is needed to replicate and extend these findings to more specific domains of sleep functioning and to identify differences between children with persistent or improved sleep functioning as a result of MPH use.

Material selection indices for design of surgical instruments with long tubular shafts.

PubMed

Nelson, Carl A

2013-02-01

In any medical device design process, material selection plays an important role. For devices which sustain mechanical loading, strength and stiffness requirements can be significant drivers of the design. This paper examines the specific case of minimally invasive surgical instruments, including robotic instruments, having long, tubular shafts. Material properties-based selection indices are derived for achieving high performance of these devices in terms of strength and stiffness, and the use of these indices for informing the medical device design problem is illustrated.

The Academic Support Program at the University of Michigan School of Medicine.

PubMed

Segal, S S; Giordani, B; Gillum, L H; Johnson, N

1999-04-01

The University of Michigan has a support program aimed at early identification, remedial plans, and appropriate academic accommodations for at-risk students in under-graduate colleges and graduate and professional schools. Since 1994, the medical school has formally taken part in this program. Medical students at risk for academic failure (e.g., repeated failure in academic course work, licensure examinations, clinical examinations) are automatically referred to their academic counselors in the Student Programs Office of the medical school. Once a referral is made, the student is evaluated at the Office of Services for Students with Disabilities to identify problem areas. The office makes appropriate recommendations for interventions or accommodation. Tutoring, academic assistance, and other services are available through the medical school, specific divisions of the medical center, and the community. The Student Programs Office acts as a liaison between community and university assistance programs and between the student and the medical school. During the first four years of the program, 28 medical students were identified through it; of these, 24 (86%) were underrepresented minorities. Most (21) were referred during the first and third years of the curriculum. After a range of services for a variety of problems, 26 (93%) of the 28 students either graduated or continued to progress in their studies; the other two left the medical school for academic reasons.

[Safety management in pathology laboratory: from specimen handling to confirmation of reports].

PubMed

Minato, Hiroshi; Nojima, Takayuki; Nakano, Mariko; Yamazaki, Michiko

2011-03-01

Medical errors in pathological diagnosis give a huge amount of physical and psychological damage to patients as well as medical staffs. We discussed here how to avoid medical errors in surgical pathology laboratory through our experience. Handling of surgical specimens and diagnosing process requires intensive labor and involves many steps. Each hospital reports many kinds of accidents or incidents, however, many laboratories share common problems and each process has its specific risk for the certain error. We analyzed the problems in each process and concentrated on avoiding misaccessioning, mislabeling, and misreporting. We have made several changes in our system, such as barcode labels, digital images of all specimens, putting specimens in embedding cassettes directly on the endoscopic biopsied specimens, and using a multitissue control block as controls in immunohistochemistry. Some problems are still left behind, but we have reduced the errors by decreasing the number of artificial operation as much as possible. A pathological system recognizing the status of read or unread the pathological reports by clinician are now underconstruction. We also discussed about quality assurance of diagnosis, cooperation with clinicians and other comedical staffs, and organization and method. In order to operate riskless work, it is important for all the medical staffs to have common awareness of the problems, keeping careful observations, and sharing all the information in common. Incorporation of an organizational management tool such as ISO 15189 and utilizing PDCA cycle is also helpful for safety management and quality improvement of the laboratory.

International medical students' expectations and worries at the beginning of their medical education: a qualitative focus group study.

PubMed

Huhn, Daniel; Huber, Julia; Ippen, Franziska M; Eckart, Wolfgang; Junne, Florian; Zipfel, Stephan; Herzog, Wolfgang; Nikendei, Christoph

2016-01-28

The number of international students has increased substantially within the last decade. Due to cultural barriers, this specific group faces diverse challenges. In comparison to German colleagues, international medical students perform significantly lower in clinical examinations and exceed the average duration of study; they suffer from personal distress as well as insufficient support. Within the present study, their individual perspectives, expectations, hopes and fears were examined. Four focus groups with first-year international medical students (N = 16) were conducted in October 2013. Each 60- to 90-min discussion was audiotaped, transcribed and analysed using qualitative methods. International medical students go abroad in search of good study-conditions. For the choice of place of study, affordability, social ties as well as an educational system following the achievement principle are decisive factors. While contact with German-students and other international students is seen as beneficial, international medical students are most concerned to encounter problems and social exclusion due to language deficits and intercultural differences. Facilitating the access to university places, the provision of financial aid and, moreover, social support, nurturing cultural integration, would greatly benefit international medical students. Hereby, the establishment of specific medical language courses as well as programs fostering intercultural-relations could prove to be valuable.

Does a PBL-based medical curriculum predispose training in specific career paths? A systematic review of the literature.

PubMed

Tsigarides, Jordan; Wingfield, Laura R; Kulendran, Myutan

2017-01-07

North American medical schools have used problem-based learning (PBL) structured medical education for more than 60 years. However, it has only recently been introduced in other medical schools outside of North America. Since its inception, there has been the debate on whether the PBL learning process predisposes students to select certain career paths. To review available evidence to determine the predisposition of specific career paths when undertaking a PBL-based medical curriculum. The career path trajectory was determined as measured by official Matching Programs, self-reported questionnaires and surveys, and formally defined career development milestones. A systematic literature review was performed. PubMed, Medline, Cochrane and ERIC databases were analysed in addition to reference lists for appropriate inclusion. Eleven studies fitting the inclusion criteria were identified. The majority of studies showed that PBL did not predispose a student to a career in a specific speciality (n = 7 out of 11 studies, 64%). However, three studies reported a significantly increased number of PBL graduates working in primary care compared to those from a non-PBL curriculum. PBL has been shown not to predispose medical students to a career in General Practice or any other speciality. Furthermore, a greater number of similar studies are required before a definitive conclusion can be made in the future.

Understanding catastrophizing from a misdirected problem-solving perspective.

PubMed

Flink, Ida K; Boersma, Katja; MacDonald, Shane; Linton, Steven J

2012-05-01

The aim is to explore pain catastrophizing from a problem-solving perspective. The links between catastrophizing, problem framing, and problem-solving behaviour are examined through two possible models of mediation as inferred by two contemporary and complementary theoretical models, the misdirected problem solving model (Eccleston & Crombez, 2007) and the fear-anxiety-avoidance model (Asmundson, Norton, & Vlaeyen, 2004). In this prospective study, a general population sample (n= 173) with perceived problems with spinal pain filled out questionnaires twice; catastrophizing and problem framing were assessed on the first occasion and health care seeking (as a proxy for medically oriented problem solving) was assessed 7 months later. Two different approaches were used to explore whether the data supported any of the proposed models of mediation. First, multiple regressions were used according to traditional recommendations for mediation analyses. Second, a bootstrapping method (n= 1000 bootstrap resamples) was used to explore the significance of the indirect effects in both possible models of mediation. The results verified the concepts included in the misdirected problem solving model. However, the direction of the relations was more in line with the fear-anxiety-avoidance model. More specifically, the mediation analyses provided support for viewing catastrophizing as a mediator of the relation between biomedical problem framing and medically oriented problem-solving behaviour. These findings provide support for viewing catastrophizing from a problem-solving perspective and imply a need to examine and address problem framing and catastrophizing in back pain patients. ©2011 The British Psychological Society.

The use of medical care and the prevalence of serious illness in an adult Prader-Willi syndrome cohort.

PubMed

Sinnema, Margje; Maaskant, Marian A; van Schrojenstein Lantman-de Valk, Henny M J; Boer, Harm; Curfs, Leopold M G; Schrander-Stumpel, Constance T R M

2013-08-01

Adults with Prader-Willi syndrome (PWS) have an increased occurrence of several medical conditions. We report on the consequences of high morbidity rates such as prevalence rate of hospital admissions, medication use and surgery in a Dutch cohort of adults with PWS. Special attention is paid to causes and symptoms of serious illness. Participants were contacted via the Dutch Prader-Willi Parent Association and through physicians specializing in persons with ID. The persons with PWS and their main caregivers were visited at home. Information was collected through semi-structured interviews on 102 adults with PWS. The need for medical care in the neonatal period is associated with hypotonia and feeding problems. Hospital admissions for respiratory tract infections are frequent. During childhood most hospital admissions were due to PWS syndrome specific surgery. During adolescence hospital admissions occurred for scoliosis surgery and endocrine evaluations. At adult age, hospitalization was associated with inguinal hernia surgery, diabetes mellitus, psychosis, erysipelas, water and drug intoxications. In the older group, respiratory infections were again the main reason for hospital admissions. Frequently used medications at adult age included psychotropics, laxatives, anti-diabetics and dermatologic preparations. Abnormal drinking patterns, problems with anesthesia, decreased ability to vomit, abnormal pain awareness and unpredictable fever responses were frequent and often lead to delayed diagnoses of serious conditions. People with PWS are frequent users of medical-care. Reasons for hospitalization and medication use are age specific. Knowledge on the different presentation of symptoms in people with PWS is needed. In case of unexplained illness, disturbances of consciousness and behavioral changes in people with PWS, an infection should be ruled out in the first place. Information from this study may help in preventing conditions and recognizing conditions in an early stage. Adequate preventive management and treatment of PWS related morbidity, could reduce medical care use in the long term and could improve quality adjusted life years. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

[Differentiation of coding quality in orthopaedics by special, illustration-oriented case group analysis in the G-DRG System 2005].

PubMed

Schütz, U; Reichel, H; Dreinhöfer, K

2007-01-01

We introduce a grouping system for clinical practice which allows the separation of DRG coding in specific orthopaedic groups based on anatomic regions, operative procedures, therapeutic interventions and morbidity equivalent diagnosis groups. With this, a differentiated aim-oriented analysis of illustrated internal DRG data becomes possible. The group-specific difference of the coding quality between the DRG groups following primary coding by the orthopaedic surgeon and final coding by the medical controlling is analysed. In a consecutive series of 1600 patients parallel documentation and group-specific comparison of the relevant DRG parameters were carried out in every case after primary and final coding. Analysing the group-specific share in the additional CaseMix coding, the group "spine surgery" dominated, closely followed by the groups "arthroplasty" and "surgery due to infection, tumours, diabetes". Altogether, additional cost-weight-relevant coding was necessary most frequently in the latter group (84%), followed by group "spine surgery" (65%). In DRGs representing conservative orthopaedic treatment documented procedures had nearly no influence on the cost weight. The introduced system of case group analysis in internal DRG documentation can lead to the detection of specific problems in primary coding and cost-weight relevant changes of the case mix. As an instrument for internal process control in the orthopaedic field, it can serve as a communicative interface between an economically oriented classification of the hospital performance and a specific problem solution of the medical staff involved in the department management.

The Medical Education and Best Practice in Orthopedic Patient Care in Poland.

NASA Astrophysics Data System (ADS)

Rosiek, Anna; Leksowski, Krzysztof

2012-07-01

The leadership organization focuses on education, teamwork, customer relationship and developing strategy which help in building added value, in managing activities, time and quality. Everyday orthopedic experience shows that medical education is a mixture of: specific knowledge, skills and attitudes of people working together, and that creates effective teamwork in a hospital environment. Apart from the main reason of medical education, teaching about disease treatment and health problem solving, medical education should also concentrate on human factors and behavioral aspects of patient treatment in hospital.Assessment of an organization and medical education process by cultural and teamwork criteria, offers a powerful new way to think about performance at the frontlines of healthcare and in the future it could be gold standard for assessing the success of an organization, and standards in medical education, not only in orthopedics.

EMP: A Diagnostic and Therapeutic Approach.

ERIC Educational Resources Information Center

Stephens, Jill

A 2-year study examined the relevance of English-as-a-second-language instructional materials for students in health care fields. The study gathered specific information on common medical activities requiring the use of English and identified problem areas. A random sample of students of medicine, pharmacy, and research science was surveyed, the…

Psychopharmacology in Fragile X Syndrome--Present and Future

ERIC Educational Resources Information Center

Berry-Kravis, Elizabeth; Potanos, Kristina

2004-01-01

In addition to cognitive disability, fragile X syndrome (FXS) is associated with behavioral problems that are often functionally limiting. There are few controlled trials to guide treatment; however, available information does suggest that medications can be quite helpful for a number of categories of behavioral disturbance in FXS. Specifically,…

The social act of electronic medication prescribing.

PubMed

Aarts, Jos

2013-01-01

Prescribing medication is embedded in social norms and cultures. In modern Western health care professionals and policy makers have attempted to rationalize medicine by addressing cost-effectiveness of diagnostic and therapeutic treatments and the development of guidelines and protocols based on the outcomes of clinical studies. These notions of cost-effectiveness and evidence-based medicine have also been embedded in technology such as electronic prescribing systems. Such constraining systems may clash with the reality of clinical practice, where formal boundaries of responsibility and authorization are often blurred. Such systems may therefore even impede patient care. Medication is seen as the essence of medical practice. Prescribing is a social act. In a hospital medications may be aimed at treating a patient for a specific condition, in primary care the professional often meets the patient with her or his social and cultural notions of a health problem. The author argues that the design and implementation of electronic prescribing systems should address the social and cultural context of prescribing. Especially in primary care, where health problems are often ill defined and evidence-based medicine guidelines do not always work as intended, studies need to take into account the sociotechnical character of electronic prescribing systems.

The Chromosome 18 Clinical Resource Center.

PubMed

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

2018-05-01

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

What is the role of sedating antidepressants, antipsychotics, and anticonvulsants in the management of insomnia?

PubMed

McCall, Catherine; McCall, W Vaughn

2012-10-01

Psychiatric medications such as antidepressants, antipsychotics, and anticonvulsants are commonly prescribed by physicians for the off-label use of improving sleep. Reasons for preferential prescription of these medications over FDA-approved insomnia drugs may include a desire to treat concurrent sleep problems and psychiatric illness with a single medication, and/or an attempt to avoid hypnotic drugs due to their publicized side effects. However, there have been few large studies demonstrating the efficacy and safety of most off-label medications prescribed to treat insomnia. In addition, many of these medications have significant known side effect profiles themselves. Here we review the pertinent research studies published in recent years on antidepressant, antipsychotic, and anticonvulsant medications frequently prescribed for sleep difficulties. Although there have been few large-scale studies for most of these medications, some may be appropriate in the treatment of sleep issues in specific well-defined populations.

Med-psych units. Financial viability and quality assurance.

PubMed

Fogel, B S

1989-01-01

Although medical-psychiatric units may have unique advantages for treating patients with combined medical and psychiatric illness, they may be costly to run, and their success requires a sound financial basis. This begins with filling beds and instituting a waiting list, and then setting admission priorities to regulate case mix deliberately to address financial as well as ethical and clinical considerations. Development of short-stay geropsychiatric evaluation services may offset financial problems associated with long stays of elderly patients requiring definitive treatment for complex conditions. Data are presented to show the effectiveness of deliberate regulation of case mix. Regarding quality assurance, key issues include maintaining documentation to meet HCFA standards for DRG exemption, and effectively integrating physical and psychiatric care, with a special focus on drug interactions and psychiatric toxicities of medical drugs. Effective multidisciplinary treatment planning meeting help in this effort, as do periodic walking rounds focusing specifically on pharmacologic issues. Denials of payment by third parties are most likely to be a problem when both the medical and the psychiatric illness are subacute but their interaction requires conjoint inpatient treatment. Prospective work with PROs can minimize retrospective denials.

Doctor-patient communication on the telephone.

PubMed

Curtis, P; Evens, S

1989-01-01

Since its invention, the telephone has been an important tool in medical practice, particularly for primary care physicians. Approximately half the calls made to a physician's office during regular consulting hours are for clinical problems and most are handled effectively over the phone without an immediate office visit. Telephone encounters are generally very brief, and managing such calls requires a pragmatic approach that is often quite different from the approach taken in the office visit. The telephone encounter should be recognized and recorded as a specific medical interaction in the medical chart for both clinical and legal reasons. Effective telephone encounters depend on good communication skills; decision making regarding disposition is a major goal. The physician's perception of a medical problem may be different from the patient's; patients are frequently seeking advice and reassurance rather than diagnosis and treatment, and may call because of anxiety and psychological stress. For physicians and their families who are not prepared for after-hours telephone encounters, calls that interrupt more "legitimate" activities may result in anger or frustration for the physician and dissatisfaction for the patient.

Meeting the challenges of the digital medical enterprise of the future by reusing enterprise software components

NASA Astrophysics Data System (ADS)

Shani, Uri; Kol, Tomer; Shachor, Gal

2004-04-01

Managing medical digital information objects, and in particular medical images is an enterprise-grade problem. Firstly, there is the sheer amount of digital data that is generated in the proliferation of digital (and film-free) medical imaging. Secondly, the managing software ought to enjoy high availability, recoverability and manageability that are found only in the most business-critical systems. Indeed, such requirements are borrowed from the business enterprise world. Moreover, the solution for the medical information management problem should too employ the same software tools, middlewares and architectures. It is safe to say that all first-line medical PACS products strive to provide a solution for all these challenging requirements. The DICOM standard has been a prime enabler of such solutions. DICOM created the interconnectivity, which made it possible for a PACS service to manage millions of exams consisting of trillions of images. With the more comprehensive IHE architecture, the enterprise is expanded into a multi-facility regional conglomerate, which presents extreme demands from the data management system. HIPPA legislations add considerable challenges per security, privacy and other legal issues, which aggravate the situation. In this paper, we firstly present what in our view should be the general requirements for a first-line medical PACS, taken from an enterprise medical imaging storage and management solution perspective. While these requirements can be met by homegrown implementations, we suggest looking at the existing technologies, which have emerged in the recent years to meet exactly these challenges in the business world. We present an evolutionary process, which led to the design and implementation of a medical object management subsystem. This is indeed an enterprise medical imaging solution that is built upon respective technological components. The system answers all these challenges simply by not reinventing wheels, but rather reusing the best "wheels" for the job. Relying on such middleware components allowed us to concentrate on added value for this specific problem domain.

Sexual side effects associated with conventional and atypical antipsychotics.

PubMed

Compton, M T; Miller, A H

2001-01-01

The sexual side effects of psychotropic medications are becoming increasingly recognized in clinical psychiatry. The magnitude of the problem of sexual side effects associated with antipsychotic medications has yet to be fully elucidated, but a multitude of references in the literature demonstrate the importance of these side effects in both men and women. All currently used antipsychotic medications are associated with sexual side effects of various types. Although each antipsychotic medication may have a specific side effect profile determined by its various receptor affinities and by the degree to which it elevates serum prolactin, there is currently no evidence that specific side effects can be predicted. Sexual side effects can be categorized according to the phase of the sexual response cycle with which they interfere. Suggestions for clinical evaluation and treatment options are provided, including risk factor modification, dose reduction, switching agents, and addition of other agents. Sexual side effects associated with conventional and atypical antipsychotic medications represent an underestimated and understudied set of side effects that may diminish a patient's quality of life and lead to treatment noncompliance. Clinicians prescribing antipsychotic medications should be familiar with the classification, evaluation, and treatment of these side effects.

Applications of aerospace technology in the public sector

NASA Technical Reports Server (NTRS)

Anuskiewicz, T.; Johnston, J.; Zimmerman, R. R.

1971-01-01

Current activities of the program to accelerate specific applications of space related technology in major public sector problem areas are summarized for the period 1 June 1971 through 30 November 1971. An overview of NASA technology, technology applications, and supporting activities are presented. Specific technology applications in biomedicine are reported including cancer detection, treatment and research; cardiovascular diseases, diagnosis, and treatment; medical instrumentation; kidney function disorders, treatment, and research; and rehabilitation medicine.

Background on Establishing a Working Group to Create Home Clinical Cases for Education.

PubMed

Yoshitake, Taketo

2017-01-01

In Japan there are concerns that there will be a surge in social insurance costs such as medical and nursing care expenses as a result of the baby boom generation reaching the late stages of old age (75 years old and beyond) around 2025 ("The 2025 Problem"). In 2012, the "Outline on Social Insurance and Tax Reform" was approved by the Japanese cabinet and government, including "construction of regional comprehensive care". To promote participation in home medical care by pharmacists, this article presents the roles demanded of pharmacists in regional comprehensive care from the standpoint of physicians, and the discussion of case studies bridging the gap from knowledge learned in lectures to practical applications. In the field of medical education, "The 2023 Problem", regarding standards of education on a global level, caused medical schools across Japan to scramble for curriculum reform, specifically in the demand for increased time spent in clinical training and the expansion of community-based medical education. The current state of community-based medical education will be reviewed. In light of these developments, "the working group to create home clinical cases for education" was developed by clinical pharmacists in the field and university faculty members at Daiichi University of Pharmacy.

Malnutrition and subsequent ischemic heart disease in former prisoners of war of World War II and the Korean conflict.

PubMed

Page, W F; Ostfeld, A M

1994-12-01

The harsh treatment of former prisoners of war (POWs) of World War II and the Korean conflict resulted in severe malnutrition. Although rarely linked to specific long-term medical problems, a specific marker of malnutrition, self-reported lower limb edema (presumably due to a vitamin B deficiency) was associated with a three-fold increase in subsequent death attributed to ischemic heart disease (IHD) during the follow-up period from 1967 through 1975. Although there is at present no medical basis for linking edema, which is perhaps a marker for some unmeasured risk factor, to subsequent IHD, this finding may nonetheless have medical implications for the group of former POWs and other populations with severe dietary deficiency. It also suggests there may be a need to reexamine currently held theories on malnutrition and subsequent chronic disease.

Behavioral management of the hyperactive child.

PubMed

Murray, M E

1980-09-01

This paper provides a general outline of the principles of behavioral management of the hyperactive child. The use of stimulant medications and special considerations in school are briefly discussed and then suggestions for initial parent counseling, family assessment, and the analysis of specific behavior problems are reviewed. Techniques of behavioral management are presented for the younger hyperactive child (3 to 7 years) and for the older hyperactive child (8 to 13 years). Among management techniques discussed are positive reinforcement, extinction procedures, and punishment through isolation. The problems involved in the use of corporal punishment are outlined as well as specific guidelines for parents as to when and how corporal punishment can be used effectively. A step-by-step summary of how to employ a token economy to manage both home and school behavior problems in older hyperactive children is presented.

Medical serials control systems by computer--a state of the art review.

PubMed Central

Brodman, E; Johnson, M F

1976-01-01

A review of the problems encountered in serials control systems is followed by a description of some of the present-day attempts to solve these problems. Specific networks are described, notably PHILSOM (developed at Washington University School of Medicine Library), the UCLA Biomedical Library's system, and OCLC in Columbus, Ohio. Finally, the role of minicomputers in present and future developments is discussed, and some cautious guesses are made on future directions in the field. PMID:1247704

[Screening of diseases associated with asbestos. On-going activities, synthesis].

PubMed

Frimat, P; Paris, C; Letourneux, M; Catilina, P; Sobaszek, A

1999-12-01

Medical screening requires always assessment. On the basis of ongoing studies on occupational health asbestos programs, we suggest some recommendations for asbestos screening after occupational exposure. The proposal for asbestos workers post-exposure surveillance should take into account the medical but also the social aspects of the problem. Post-exposure screening of asbestos workers includes an evaluation of occupational exposure, compulsory basis medical check-up, the characteristics of the radiological investigations and schedule of the medical surveillance. In conclusion, we suggest some general recommendations for asbestos screening after occupational exposure, particularly the necessity to obtain a concerted approach of asbestos screening with regional and national networks, the concern of their assessment and the implementation of specific research studies.

Emerging applications of fluorescence spectroscopy in medical microbiology field.

PubMed

Shahzad, Aamir; Köhler, Gottfried; Knapp, Martin; Gaubitzer, Erwin; Puchinger, Martin; Edetsberger, Michael

2009-11-26

There are many diagnostic techniques and methods available for diagnosis of medically important microorganisms like bacteria, viruses, fungi and parasites. But, almost all these techniques and methods have some limitations or inconvenience. Most of these techniques are laborious, time consuming and with chances of false positive or false negative results. It warrants the need of a diagnostic technique which can overcome these limitations and problems. At present, there is emerging trend to use Fluorescence spectroscopy as a diagnostic as well as research tool in many fields of medical sciences. Here, we will critically discuss research studies which propose that Fluorescence spectroscopy may be an excellent diagnostic as well as excellent research tool in medical microbiology field with high sensitivity and specificity.

A Comparison of different learning models used in Data Mining for Medical Data

NASA Astrophysics Data System (ADS)

Srimani, P. K.; Koti, Manjula Sanjay

2011-12-01

The present study aims at investigating the different Data mining learning models for different medical data sets and to give practical guidelines to select the most appropriate algorithm for a specific medical data set. In practical situations, it is absolutely necessary to take decisions with regard to the appropriate models and parameters for diagnosis and prediction problems. Learning models and algorithms are widely implemented for rule extraction and the prediction of system behavior. In this paper, some of the well-known Machine Learning(ML) systems are investigated for different methods and are tested on five medical data sets. The practical criteria for evaluating different learning models are presented and the potential benefits of the proposed methodology for diagnosis and learning are suggested.

Segmentation of medical images using explicit anatomical knowledge

NASA Astrophysics Data System (ADS)

Wilson, Laurie S.; Brown, Stephen; Brown, Matthew S.; Young, Jeanne; Li, Rongxin; Luo, Suhuai; Brandt, Lee

1999-07-01

Knowledge-based image segmentation is defined in terms of the separation of image analysis procedures and representation of knowledge. Such architecture is particularly suitable for medical image segmentation, because of the large amount of structured domain knowledge. A general methodology for the application of knowledge-based methods to medical image segmentation is described. This includes frames for knowledge representation, fuzzy logic for anatomical variations, and a strategy for determining the order of segmentation from the modal specification. This method has been applied to three separate problems, 3D thoracic CT, chest X-rays and CT angiography. The application of the same methodology to such a range of applications suggests a major role in medical imaging for segmentation methods incorporating representation of anatomical knowledge.

Health-seeking behavior and the meaning of medications in Balochistan, Pakistan.

PubMed

Hunte, P A; Sultana, F

1992-06-01

A wide variety of health care options--home-based, indigenous, and cosmopolitan--exists in northern Balochistan, Pakistan. This paper examines health-seeking behavior in the area of mother and child health for villagers in this pluralistic medical setting. The analysis of a specific series of illness episodes shows that the majority of cases obtain treatment from different medical systems for a single episode. Interest in medications takes precedence over practitioners, and the meaning the villagers attach to such substances is explored. Long-established patterns of behavior relating to indigenous medicine continue to occur when cosmopolitan medicine is utilized. Information presented here helps to explain problems in utilization of cosmopolitan pharmaceuticals and delineates areas for future health programme activity.

Understanding the barriers to physician error reporting and disclosure: a systemic approach to a systemic problem.

PubMed

Perez, Bianca; Knych, Stephen A; Weaver, Sallie J; Liberman, Aaron; Abel, Eileen M; Oetjen, Dawn; Wan, Thomas T H

2014-03-01

The issues of medical errors and medical malpractice have stimulated significant interest in establishing transparency in health care, in other words, ensuring that medical professionals formally report medical errors and disclose related outcomes to patients and families. However, research has amply shown that transparency is not a universal practice among physicians. A review of the literature was carried out using the search terms "transparency," "patient safety," "disclosure," "medical error," "error reporting," "medical malpractice," "doctor-patient relationship," and "physician" to find articles describing physician barriers to transparency. The current literature underscores that a complex Web of factors influence physician reluctance to engage in transparency. Specifically, 4 domains of barriers emerged from this analysis: intrapersonal, interpersonal, institutional, and societal. Transparency initiatives will require vigorous, interdisciplinary efforts to address the systemic and pervasive nature of the problem. Several ethical and social-psychological barriers suggest that medical schools and hospitals should collaborate to establish continuity in education and ensure that knowledge acquired in early education is transferred into long-term learning. At the institutional level, practical and cultural barriers suggest the creation of supportive learning environments and private discussion forums where physicians can seek moral support in the aftermath of an error. To overcome resistance to culture transformation, incremental change should be considered, for example, replacing arcane transparency policies and complex reporting mechanisms with clear, user-friendly guidelines.

Performance enhancement using a balanced scorecard in a Patient-centered Medical Home.

PubMed

Fields, Scott A; Cohen, Deborah

2011-01-01

Oregon Health & Science University Family Medicine implemented a balanced scorecard within our clinics that embraces the inherent tensions between care quality, financial productivity, and operational efficiency. This data-driven performance improvement process involved: (1) consensus-building around specific indicators to be measured, (2) developing and refining the balanced scorecard, and (3) using the balanced scorecard in the quality improvement process. Developing and implementing the balanced scorecard stimulated an important culture shift among clinics; practice members now actively use data to recognize successes, understand emerging problems, and make changes in response to these problems. Our experience shows how Patient-centered Medical Homes can be enhanced through use of information technology and evidence-based tools that support improved decision making and performance and help practices develop into learning organizations.

Shared Decision Making and Motivational Interviewing: Achieving Patient-Centered Care Across the Spectrum of Health Care Problems

PubMed Central

Elwyn, Glyn; Dehlendorf, Christine; Epstein, Ronald M.; Marrin, Katy; White, James; Frosch, Dominick L.

2014-01-01

Patient-centered care requires different approaches depending on the clinical situation. Motivational interviewing and shared decision making provide practical and well-described methods to accomplish patient-centered care in the context of situations where medical evidence supports specific behavior changes and the most appropriate action is dependent on the patient’s preferences. Many clinical consultations may require elements of both approaches, however. This article describes these 2 approaches—one to address ambivalence to medically indicated behavior change and the other to support patients in making health care decisions in cases where there is more than one reasonable option—and discusses how clinicians can draw on these approaches alone and in combination to achieve patient-centered care across the range of health care problems. PMID:24821899

Evidence for underuse of effective medical services around the world.

PubMed

Glasziou, Paul; Straus, Sharon; Brownlee, Shannon; Trevena, Lyndal; Dans, Leonila; Guyatt, Gordon; Elshaug, Adam G; Janett, Robert; Saini, Vikas

2017-07-08

Underuse-the failure to use effective and affordable medical interventions-is common and responsible for substantial suffering, disability, and loss of life worldwide. Underuse occurs at every point along the treatment continuum, from populations lacking access to health care to inadequate supply of medical resources and labour, slow or partial uptake of innovations, and patients not accessing or declining them. The extent of underuse for different interventions varies by country, and is documented in countries of high, middle, and low-income, and across different types of health-care systems, payment models, and health services. Most research into underuse has focused on measuring solutions to the problem, with considerably less attention paid to its global prevalence or its consequences for patients and populations. Although focused effort and resources can overcome specific underuse problems, comparatively little is spent on work to better understand and overcome the barriers to improved uptake of effective interventions, and methods to make them affordable. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Health Care Financing Administration's new examination documentation criteria: minimum auditing standards for the neurologic examination to be used by Medicare and other payors. Report from the American Academy of Neurology Medical Economics and Management Subcommittee.

PubMed

Nuwer, M R; Sigsbee, B

1998-02-01

Medicare recently announced the adoption of minimum documentation criteria for the neurologic examination. These criteria are added to existing standards for the history and medical decision-making. These criteria will be used in compliance audits by Medicare and other payors. Given the current federal initiative to eliminate fraud in the Medicare program, all neurologists need to comply with these standards. These criteria are for documentation only. Neurologic standards of care require a more complex and diverse examination pertinent to the problem(s) under consideration. Further guidance as to the content of a neurologic evaluation is outlined in the article "Practice guidelines: Neurologic evaluation" (Neurology 1990; 40: 871). The level of history and examination required for specific services is defined in the American Medical Association current procedural terminology book. Documentation standards for examination of children are not yet defined.

Advantages and disadvantages of computer imaging in cosmetic surgery.

PubMed

Koch, R J; Chavez, A; Dagum, P; Newman, J P

1998-02-01

Despite the growing popularity of computer imaging systems, it is not clear whether the medical and legal advantages of using such a system outweigh the disadvantages. The purpose of this report is to evaluate these aspects, and provide some protective guidelines in the use of computer imaging in cosmetic surgery. The positive and negative aspects of computer imaging from a medical and legal perspective are reviewed. Also, specific issues are examined by a legal panel. The greatest advantages are potential problem patient exclusion, and enhanced physician-patient communication. Disadvantages include cost, user learning curve, and potential liability. Careful use of computer imaging should actually reduce one's liability when all aspects are considered. Recommendations for such use and specific legal issues are discussed.

Drug use and accidental falls in an intermediate care facility.

PubMed

Sobel, K G; McCart, G M

1983-01-01

The relationship between nonenvironment-caused falls and drug use was evaluated in an intermediate care facility over a 14-month period. The medical problems and selected drug use of 45 patients who had fallen were retrospectively compared with those of a matched control population of 30 patients who had not fallen during this same period. Antihypertensives, diuretics, tranquilizers, sedative/hypnotics, antidepressants, and antianginal agents were reviewed for all patients. The use of diuretics, specifically furosemide, and sedative/hypnotics was significantly greater in the population who had fallen. Observations of dizziness, confusion, insomnia, and ataxia were recorded more frequently in that group, as well. Closer monitoring of medications, especially in specific drug classes, may help prevent accidental falls in this type of institution.

Illness and treatment perceptions are associated with adherence to medications, diet, and exercise in diabetic patients.

PubMed

Broadbent, Elizabeth; Donkin, Liesje; Stroh, Julia C

2011-02-01

To investigate diabetic patients' perceptions of illness and treatments, and explore relationships to adherence and blood glucose control. Forty-nine type 1 and one hundred and eight type 2 diabetic patients completed questionnaires assessing illness perceptions, treatment beliefs, and adherence to medications, diet, and exercise. Blood glucose control was assessed from blood tests. Patients rated medication more important than diet and exercise, and reported higher adherence to medications. Insulin was perceived as more helpful for diabetes, while antihypertensives and cholesterol medication were perceived more helpful for preventing heart problems. Perceptions were associated with adherence to insulin, cholesterol and antihypertensive medications, exercise, and diet. Blood glucose control in type 1 diabetic patients was associated with insulin adherence and perceived personal control, and in type 2 diabetic patients to being prescribed insulin or antihypertensives, and perceived personal control. Patients hold specific mental models about diabetes treatments, which are associated with adherence.

Tuskegee redux: evolution of legal mandates for human experimentation.

PubMed

Levine, Robert S; Williams, Jamila C; Kilbourne, Barbara A; Juarez, Paul D

2012-11-01

Human health experiments systematically expose people to conditions beyond the boundaries of medical evidence. Such experiments have included legal-medical collaboration, exemplified in the U.S. by the Public Health Service (PHS) Syphilis Study (Tuskegee). That medical experiment was legal, conforming to segregationist protocols and specific legislative authorization which excluded a selected group of African Americans from any medical protection from syphilis. Subsequent corrective action outlawed unethical medical experiments but did not address other forms of collaboration, including PHS submission to laws which may have placed African American women at increased risk from AIDS and breast cancer. Today, anti-lobbying law makes it a felony for PHS workers to openly challenge legally anointed suspension of medical evidence. African Americans and other vulnerable populations may thereby face excess risks-not only from cancer, but also from motor vehicle crashes, firearm assault, end stage renal disease, and other problems-with PHS workers as silent partners.

Tuskegee redux: Evolution of legal mandates for human experimentation

PubMed Central

Levine, Robert S.; Williams, Jamila C.; Kilbourne, Barbara A.; Juarez, Paul D.

2013-01-01

Human health experiments systematically expose people to conditions beyond the boundaries of medical evidence. Such experiments have included legal-medical collaboration, exemplified in the US by the PHS Syphilis Study (Tuskegee). That medical experiment was legal, conforming to segregationist protocols and specific legislative authorization which excluded a selected group of African Americans from any medical protection from syphilis. Subsequent corrective action outlawed unethical medical experiments but did not address other forms of collaboration, including PHS submission to laws which may have placed African American women at increased risk from AIDS and breast cancer. Today, anti-lobbying law makes it a felony for PHS workers to openly question legally anointed suspension of medical evidence. African Americans and other vulnerable populations may thereby face excess risks -- not only from cancer, but also from motor vehicle crashes, firearm assault, end stage renal disease and other problems -- with PHS workers as silent partners. PMID:23124504

Child Health Encyclopedia: The Complete Guide for Parents.

ERIC Educational Resources Information Center

Feinbloom, Richard I., Ed.

This book is one of a series of health-related publications for parents written by members of the staff of the Boston Children's Medical Center. A reference guide for parents seeking information on health, safety, and diseases affecting children, the book discusses specific diseases as well as health problems related to contemporary society.…

Brief Trauma and Mental Health Assessments for Female Offenders in Addiction Treatment

ERIC Educational Resources Information Center

Rowan-Szal, Grace A.; Joe, George W.; Bartholomew, Norma G.; Pankow, Jennifer; Simpson, D. Dwayne

2012-01-01

Increasing numbers of women in prison raise concerns about gender-specific problems and needs severity. Female offenders report higher trauma as well as mental and medical health complications than males, but large inmate populations and limited resources create challenges in administering proper diagnostic screening and assessments. This study…

A layered abduction model of perception: Integrating bottom-up and top-down processing in a multi-sense agent

NASA Technical Reports Server (NTRS)

Josephson, John R.

1989-01-01

A layered-abduction model of perception is presented which unifies bottom-up and top-down processing in a single logical and information-processing framework. The process of interpreting the input from each sense is broken down into discrete layers of interpretation, where at each layer a best explanation hypothesis is formed of the data presented by the layer or layers below, with the help of information available laterally and from above. The formation of this hypothesis is treated as a problem of abductive inference, similar to diagnosis and theory formation. Thus this model brings a knowledge-based problem-solving approach to the analysis of perception, treating perception as a kind of compiled cognition. The bottom-up passing of information from layer to layer defines channels of information flow, which separate and converge in a specific way for any specific sense modality. Multi-modal perception occurs where channels converge from more than one sense. This model has not yet been implemented, though it is based on systems which have been successful in medical and mechanical diagnosis and medical test interpretation.

Medicine and patriarchal violence: the social construction of a "private" event.

PubMed

Stark, E; Flitcraft, A; Frazier, W

1979-01-01

Our objectives are to describe the pattern of abuse associated with battering and to evaluate the contribution of the medical system and of broader social forces to its emergence. A pilot study of 481 women who used the emergency service of a large metropolitan hospital in the U.S. shows that battering includes a history of self-abuse and psychosocial problems, as well as repeated and escalating physical injury. In addition, although the number of battered women using the service is 10 times higher than medical personnel identify, the pattern of abuse that constitutes battering emerges only after its initial effects are presented and in conjunction with specific medical intervnetions and referrals. Examination of intervention and referral patterns suggests a staging process by which battering is socially constructed. At first, the physical trauma associated with abuse is medicated symptomatically. But the patient's persistence, the failure of the cure, and the incongruity between her problems and available medical explanations lead the provider to label the abused woman in ways that suggest she is personally responsible for her victimization. Although secondary problems such as depression, drug abuse, suicide attempts, or alcoholism derive as much from the intervention strategy adopted as from physical assault or psychopathology, they are treated as the primary problems at psychiatric and social service referral points where family maintenance is often the therapeutic goal. One consequence of this referral strategy is the stabilization of "violent families" in ways that virtually insure women will be abused in systematic and arbitrary ways. The use of patriarchal logic by medical providers ostensibly responding to physical trauma has less to do with individual "sexism" than with the political and economic constraints under which medicine operates as part of an "extended patriarchy." Medicine's role in battering suggests that the services function to reconstitute the "private" world of patriarchal authority, with violence if necessary, against demands to socialize the labors of love.

Addressing dual agency: getting specific about the expectations of professionalism.

PubMed

Tilburt, Jon C

2014-01-01

Professionalism requires that physicians uphold the best interests of patients while simultaneously insuring just use of health care resources. Current articulations of these obligations like the American Board of Internal Medicine (ABIM) Foundation's Physician Charter do not reconcile how these obligations fit together when they conflict. This is the problem of dual agency. The most common ways of dealing with dual agency: "bunkering"--physicians act as though societal cost issues are not their problem; "bailing"--physicians assume that they are merely agents of society and deliver care typically based on a strongly consequentialist public health ethic; or "balancing"--a vaguely specified attempt to uphold both patient welfare and societal need for judicious resource use simultaneously--all fail. Here I propose how the problem of dual agency might begin to be addressed with rigor and consistency. Without dealing with the dual agency problem and getting more specific about how to reconcile its norms when they conflict, the expectations of professionalism risk being written off as cute, nonbinding aphorisms from the medical profession.

A multiple-drawer medication layout problem in automated dispensing cabinets.

PubMed

Pazour, Jennifer A; Meller, Russell D

2012-12-01

In this paper we investigate the problem of locating medications in automated dispensing cabinets (ADCs) to minimize human selection errors. We formulate the multiple-drawer medication layout problem and show that the problem can be formulated as a quadratic assignment problem. As a way to evaluate various medication layouts, we develop a similarity rating for medication pairs. To solve industry-sized problem instances, we develop a heuristic approach. We use hospital ADC transaction data to conduct a computational experiment to test the performance of our developed heuristics, to demonstrate how our approach can aid in ADC design trade-offs, and to illustrate the potential improvements that can be made when applying an analytical process to the multiple-drawer medication layout problem. Finally, we present conclusions and future research directions.

Automated monitoring of medical protocols: a secure and distributed architecture.

PubMed

Alsinet, T; Ansótegui, C; Béjar, R; Fernández, C; Manyà, F

2003-03-01

The control of the right application of medical protocols is a key issue in hospital environments. For the automated monitoring of medical protocols, we need a domain-independent language for their representation and a fully, or semi, autonomous system that understands the protocols and supervises their application. In this paper we describe a specification language and a multi-agent system architecture for monitoring medical protocols. We model medical services in hospital environments as specialized domain agents and interpret a medical protocol as a negotiation process between agents. A medical service can be involved in multiple medical protocols, and so specialized domain agents are independent of negotiation processes and autonomous system agents perform monitoring tasks. We present the detailed architecture of the system agents and of an important domain agent, the database broker agent, that is responsible of obtaining relevant information about the clinical history of patients. We also describe how we tackle the problems of privacy, integrity and authentication during the process of exchanging information between agents.

Primary care and addiction treatment: lessons learned from building bridges across traditions.

PubMed

Stanley, A H

1999-01-01

A primary care unit combined with residential addiction treatment allows patients with addictive disease and chronic medical or psychiatric problems to successfully complete the treatment. These are patients who would otherwise fail treatment or fail to be considered candidates for treatment. Health care providers should have a background in primary care and have the potential to respond professionally to clinical problems in behavioral medicine. Ongoing professional training and statistical quality management principles can maintain morale and productivity. Health education is an integral part of primary care. The costs of such concurrent care when viewed in the context of the high societal and economic costs of untreated addictive disease and untreated chronic medical problems are low. The principles used to develop this primary care unit can be used to develop health care units for other underserved populations. These principles include identification of specific health care priorities and continuity of rapport with the target population and with addiction treatment staff.

Classification of Medical Datasets Using SVMs with Hybrid Evolutionary Algorithms Based on Endocrine-Based Particle Swarm Optimization and Artificial Bee Colony Algorithms.

PubMed

Lin, Kuan-Cheng; Hsieh, Yi-Hsiu

2015-10-01

The classification and analysis of data is an important issue in today's research. Selecting a suitable set of features makes it possible to classify an enormous quantity of data quickly and efficiently. Feature selection is generally viewed as a problem of feature subset selection, such as combination optimization problems. Evolutionary algorithms using random search methods have proven highly effective in obtaining solutions to problems of optimization in a diversity of applications. In this study, we developed a hybrid evolutionary algorithm based on endocrine-based particle swarm optimization (EPSO) and artificial bee colony (ABC) algorithms in conjunction with a support vector machine (SVM) for the selection of optimal feature subsets for the classification of datasets. The results of experiments using specific UCI medical datasets demonstrate that the accuracy of the proposed hybrid evolutionary algorithm is superior to that of basic PSO, EPSO and ABC algorithms, with regard to classification accuracy using subsets with a reduced number of features.

A national profile of the health care experiences and family impact of autism spectrum disorder among children in the United States, 2005-2006.

PubMed

Kogan, Michael D; Strickland, Bonnie B; Blumberg, Stephen J; Singh, Gopal K; Perrin, James M; van Dyck, Peter C

2008-12-01

We sought to examine the health care experiences of children with autism spectrum disorder and the impact of autism spectrum disorder on the family and to assess whether having a medical home is associated with less family impact. We used the 2005-2006 National Survey of Children With Special Health Care Needs to compare 2088 children with special health care needs, aged 3 to 17 years, reported by their parents to have autism spectrum disorder, with children with special health care needs with "other emotional, developmental, or behavioral problems" (excluding autism spectrum disorder; n=9534) and 26751 other children with special health care needs. We used weighted logistic regression to examine unmet needs for specific health care and support services, delayed care, no usual care source or personal physician, difficulty receiving referrals, and financial, employment, or time problems because of child's care. Nationally, an estimated 535000 children have special health care needs and autism spectrum disorder, a prevalence of 86 per 10000 children aged 3 to 17 years. Among children with special health care needs, 5.6% have autism spectrum disorder. Compared with other children with special health care needs without emotional, developmental, or behavioral problems, children with special health care needs with autism spectrum disorder were more likely to have unmet needs for specific health care services, family support services, delayed or foregone care, difficulty receiving referrals, and care that is not family centered. Children with special health care needs with autism spectrum disorder were more likely to live in families that report financial problems, need additional income for the child's medical care, reduce or stop work because of the child's condition, spend >or=10 hours per week providing or coordinating care, and paid more than $1000 in the previous year for the child's care. The financial impacts of autism spectrum disorder were significantly more burdensome when children with special health care needs did not have a medical home. Children with special health care needs with autism spectrum disorder are significantly more likely to have problems regarding access to care and unmet needs, and their families have greater financial, employment, and time burdens compared with other children with special health care needs. Receipt of primary care in a medical home may reduce these burdens.

Onsite medical rounds and fact-finding activities conducted by Nippon Medical School in Miyagi prefecture after the Great East Japan Earthquake 2011.

PubMed

Fuse, Akira; Igarashi, Yutaka; Tanaka, Toshihiko; Kim, Shiei; Tsujii, Atsuko; Kawai, Makoto; Yokota, Hiroyuki

2011-01-01

This report describes our onsite medical rounds and fact-finding activities conducted in the acute phase and medical relief work conducted in the subacute phase in Miyagi prefecture following the Great East Japan Earthquake and subsequent tsunami that occurred off northeastern Honshu on March 11, 2011. As part of the All-Japan Hospital Association medical team deployed to the disaster area, a Nippon Medical School team conducted fact-finding and onsite medical rounds and evaluated basic life and medical needs in the affected areas of Shiogama and Tagajo. We performed triage for more than 2,000 casualties, but in our medical rounds of hospitals, clinics, and nursing homes, we found no severely injured person but did find 1 case of hyperglycemia. We conducted medical rounds at evacuation shelters in Kesennuma City during the subacute phase of the disaster, from March 17 through June 1, as part of the Tokyo Medical Association medical teams deployed. Sixty-seven staff members (17 teams), including 46 physicians, 11 nurses, 3 pharmacists, and 1 clinical psychotherapist, joined this mission. Most patients complained of a worsening of symptoms of preexisting conditions, such as hypertension, respiratory problems, and diabetes, rather than of medical problems specifically related to the tsunami. In the acute phase of the disaster, the information infrastructure was decimated and we could not obtain enough information about conditions in the affected areas, such as how many persons were severely injured, how severely lifeline services had been damaged, and what was lacking. To start obtaining this information, we conducted medical rounds. This proved to be a good decision, as we found many injured persons in evacuation shelters without medication, communication devices, or transportation. Also, basic necessities for life, such as water and food, were lacking. We were able to evaluate these basic needs and inform local disaster headquarters of them. In Kesennuma City, we found that some evacuation shelters could not contact others even after 1 week after the earthquake. We realized from our experiences that, unlike our activities following more localized earthquake disasters, the first task following such large-scale disasters is to acquire information on basic life needs, including medication needs, and the number of persons requiring assistance. We must provide medical relief according to the unique characteristics of the disaster-affected areas as well as the specific nature of the disaster, in this case, a tsunami.

The Dementia Services Mini-Screen: A Simple Method to Identify Patients and Caregivers Needing Enhanced Dementia Care Services

PubMed Central

Borson, Soo; Scanlan, James M.; Sadak, Tatiana; Lessig, Mary; Vitaliano, Peter

2014-01-01

Objective The National Alzheimer’s Plan calls for targeted health system change to improve outcomes for persons with dementia and their family caregivers. We explored whether dementia-specific service needs and gaps could be predicted from simple information that can be readily acquired in routine medical care settings. Method Primary family caregivers for cognitively impaired older adults (n=215) were asked about current stress, challenging patient behaviors, and prior-year needs and gaps in 16 medical and psychosocial services. Demographic data, caregiver stress, and patient clinical features were evaluated in regression analyses to identify unique predictors of service needs and gaps. Results Caregiver stress and patient behavior problems together accounted for an average of 24% of the whole-sample variance in total needs and gaps. Across all analyses, including total, medical, and psychosocial services needs and gaps, all other variables combined (comorbid chronic disease, dementia severity, age, caregiver relationship, and residence) accounted for an accounted for a mean of 3%, with no variable yielding more than 4% in any equation. We combined stress and behavior problem indicators into a simple screen. In early/mild dementia dyads (n=111) typical in primary care settings, the screen identified gaps in total and psychosocial care in 84% and 77%, respectively, of those with high stress/high behavior problems vs. 25% and 23%, respectively, of those with low stress/low behavior problems. Medical care gaps were dramatically higher in high stress/high behavior problem dyads (66%) than all others (12%). Conclusion A simple tool (likely completed in 1–2 minutes) which combines caregiver stress and patient behavior problems, the Dementia Services Mini-Screen, could help clinicians rapidly identify high need, high gap dyads. Health care systems could use it to estimate population needs for targeted dementia services and facilitate their development. PMID:24315560

Inverse problems in quantum chemistry

NASA Astrophysics Data System (ADS)

Karwowski, Jacek

Inverse problems constitute a branch of applied mathematics with well-developed methodology and formalism. A broad family of tasks met in theoretical physics, in civil and mechanical engineering, as well as in various branches of medical and biological sciences has been formulated as specific implementations of the general theory of inverse problems. In this article, it is pointed out that a number of approaches met in quantum chemistry can (and should) be classified as inverse problems. Consequently, the methodology used in these approaches may be enriched by applying ideas and theorems developed within the general field of inverse problems. Several examples, including the RKR method for the construction of potential energy curves, determining parameter values in semiempirical methods, and finding external potentials for which the pertinent Schrödinger equation is exactly solvable, are discussed in detail.

Bladder Control Problems: Medications for Treating Urinary Incontinence

MedlinePlus

Bladder control: Medications for urinary problems Learn about medications used to treat bladder control problems, including how they work to treat urinary ... your doctor's suggestions for bladder retraining. But bladder control remains a problem. What else can you do? ...

Inclusive intake screening: shaping medical problems into specialist-appropriate cases.

PubMed

Jean, Yvette A

2004-05-01

This paper examines medical intake screening through the process of making appointments with medical specialists. By employing a multi-method, qualitative approach, it shows how decisions to schedule doctors' appointments are based on medical knowledge about physicians' specialties and specific organisational practices. It draws on insights from first-contact interactions between clients and institutional gatekeepers to enrich our understanding of intake screening. In relation to gatekeeping, rationing commonly gets framed as restrictive screening practices, with a preference for denying or limiting access to treatment. Restrictive screening practices are typically organised to elicit a narrow range of information ('facts') relevant to specific eligibility criteria; whereas inclusive intake screening tends to involve less scripted, more complex and open-ended interactional exchanges between workers and clients, wherein workers help clients frame their claims in ways that will increase their chances of getting accepted. Front-office workers hold a preference for inclusive intake screening, a preference that is undergirded by the referral-driven nature of this stage of patient processing, and by a work environment that favours inclusive screening. This finding builds on the literature within medical sociology, but also extends our understanding of frontline decision-making and the distribution of resources within a variety of people-processing institutions.

The human sexuality education of physicians in North American medical schools.

PubMed

Solursh, D S; Ernst, J L; Lewis, R W; Prisant, L Michael; Mills, T M; Solursh, L P; Jarvis, R G; Salazar, W H

2003-10-01

Individuals seeking treatment for sexual problems frequently would like to turn to a source they consider knowledgeable and worthy of respect, their doctor. The objective was to assess how well the 125 schools of medicine in the United States and the 16 in Canada prepare physicians to diagnose and treat sexual problems. A prospective cohort study was carried out. The main outcome results were description of the medical educational experiences, teaching time, specific subject areas, clinical programs, clerkships, continuing education programs in the domain of human sexuality in North American medical schools. The results were as follows. There were 101 survey responses (71.6%) of a potential of 141 medical schools (74% of United States and 50% of Canadian medical schools). A total of 84 respondents (83.2%) for sexuality education used a lecture format. A single discipline was responsible for this teaching in 32 (31.7%) schools, but a multidisciplinary team was responsible in 64 (63.4%) schools (five schools failed to respond to the question). The majority (54.1%) of the schools provided 3-10 h of education. Causes of sexual dysfunction (94.1%), its treatment (85.2%) altered sexual identification (79.2%) and issues of sexuality in illness or disability (69.3%) were included in the curriculum of 96 respondents. Only 43 (42.6%) schools offered clinical programs, which included a focus on treating patients with sexual problems and dysfunctions, and 56 (55.5%) provided the students in their clerkships with supervision in dealing with sexual issues. In conclusion, expansion of human sexuality education in medical schools may be necessary to meet the public demand of an informed health provider.

Overcoming challenges: life with an ostomy.

PubMed

Popek, Sarah; Grant, Marcia; Gemmill, Robin; Wendel, Christopher S; Mohler, M Jane; Rawl, Susan M; Baldwin, Carol M; Ko, Clifford Y; Schmidt, C Max; Krouse, Robert S

2010-11-01

Studies have demonstrated decreased health-related quality of life in patients with stomas. Using US Department of Veterans Affairs electronic medical records, veterans with stomas were surveyed using the City of Hope Quality of Life-Ostomy questionnaire. Focus groups were conducted segregated by type of stoma (ileostomy vs colostomy) and quality-of-life score (high vs low). Qualitative analysis was performed on the basis of the City of Hope Quality of Life for Ostomates format of health-related quality of life (physical, psychological, social, and spiritual). The findings of the colostomy focus groups are reported. Two new domains emerged: colostomy specific and health care specific. The most common domains discussed were colostomy specific, psychological, and social. The most frequently discussed colostomy-specific theme was effective and ineffective solutions to colostomy care. Family and spousal relationships were the main theme from the psychological category. The predominant social issue was sexual relationships. Awareness of patients' social, psychological, and medical status allows surgeons to identify those likely to have problems and devote resources to those veterans. Published by Elsevier Inc.

Understanding the value of mixed methods research: the Children’s Safety Initiative-Emergency Medical Services

PubMed Central

Hansen, Matthew; O’Brien, Kerth; Meckler, Garth; Chang, Anna Marie; Guise, Jeanne-Marie

2016-01-01

Mixed methods research has significant potential to broaden the scope of emergency care and specifically emergency medical services investigation. Mixed methods studies involve the coordinated use of qualitative and quantitative research approaches to gain a fuller understanding of practice. By combining what is learnt from multiple methods, these approaches can help to characterise complex healthcare systems, identify the mechanisms of complex problems such as medical errors and understand aspects of human interaction such as communication, behaviour and team performance. Mixed methods approaches may be particularly useful for out-of-hospital care researchers because care is provided in complex systems where equipment, interpersonal interactions, societal norms, environment and other factors influence patient outcomes. The overall objectives of this paper are to (1) introduce the fundamental concepts and approaches of mixed methods research and (2) describe the interrelation and complementary features of the quantitative and qualitative components of mixed methods studies using specific examples from the Children’s Safety Initiative-Emergency Medical Services (CSI-EMS), a large National Institutes of Health-funded research project conducted in the USA. PMID:26949970

Representing the work of medical protocols for organizational simulation.

PubMed Central

Fridsma, D. B.

1998-01-01

Developing and implementing patient care protocols within a specific organizational setting requires knowledge of the protocol, the organization, and the way in which the organization does its work. Computer-based simulation tools have been used in many industries to provide managers with prospective insight into problems of work process and organization design mismatch. Many of these simulation tools are designed for well-understood routine work processes in which there are few contingent tasks. In this paper, we describe theoretic that make it possible to simulate medical protocols using an information-processing theory framework. These simulations will allow medical administrators to test different protocol and organizational designs before actually using them within a particular clinical setting. PMID:9929231

A social media self-evaluation checklist for medical practitioners.

PubMed

Visser, Benjamin J; Huiskes, Florian; Korevaar, Daniel A

2012-01-01

Increasing numbers of medical practitioners and medical students are using online social and business-related networking websites such as Facebook, Doc2doc and LinkedIn. These rapidly evolving and growing social media have potential to promote public health by providing powerful instruments for communication and education. However, evidence is emerging from studies, legal cases, and media reports that the use of these new technologies is creating several ethical problems for medical practitioners as well as medical students. Improper online activities may harm not only individual reputations and careers, but also the medical profession as a whole, for example by breach of patient confidentiality, defamation of colleagues and employers, undisclosed conflict of interests that bias the medical practitioner's medical advice, posting of advice/information without an evidence base, and infringement of copyright. We developed a self-evaluation checklist for medical practitioners using social media. The checklist addresses three key elements in the use of social media: personal information and accessibility, connections, and postings. It contains questions specifically formulated to evaluate a medical practitioner's social media profile, to prevent unintended, improper online activities and to promote professional online behaviour.

The Two-Stage Examination: A Method to Assess Individual Competence and Collaborative Problem Solving in Medical Students

PubMed Central

Morton, David A.; Pippitt, Karly; Lamb, Sara; Colbert-Getz, Jorie M.

2016-01-01

Problem Effectively solving problems as a team under stressful conditions is central to medical practice; however, because summative examinations in medical education must test individual competence, they are typically solitary assessments. Approach Using two-stage examinations, in which students first answer questions individually (Stage 1) and then discuss them in teams prior to resubmitting their answers (Stage 2), is one method for rectifying this discordance. On the basis of principles of social constructivism, the authors hypothesized that two-stage examinations would lead to better retention of, specifically, items answered incorrectly at Stage 1. In fall 2014, they divided 104 first-year medical students into two groups of 52 students. Groups alternated each week between taking one- and two-stage examinations such that each student completed 6 one-stage and 6 two-stage examinations. The authors reassessed 61 concepts on a final examination and, using the Wilcoxon signed ranked tests, compared performance for all concepts and for just those students initially missed, between Stages 1 and 2. Outcomes Final examination performance on all previously assessed concepts was not significantly different between the one-and two-stage conditions (P = .77); however, performance on only concepts that students initially answered incorrectly on a prior examination improved by 12% for the two-stage condition relative to the one-stage condition (P = .02, r = 0.17). Next Steps Team assessment may be most useful for assessing concepts students find difficult, as opposed to all content. More research is needed to determine whether these results apply to all medical school topics and student cohorts. PMID:27049544

Using medication list--problem list mismatches as markers of potential error.

PubMed Central

Carpenter, James D.; Gorman, Paul N.

2002-01-01

The goal of this project was to specify and develop an algorithm that will check for drug and problem list mismatches in an electronic medical record (EMR). The algorithm is based on the premise that a patient's problem list and medication list should agree, and a mismatch may indicate medication error. Successful development of this algorithm could mean detection of some errors, such as medication orders entered into a wrong patient record, or drug therapy omissions, that are not otherwise detected via automated means. Additionally, mismatches may identify opportunities to improve problem list integrity. To assess the concept's feasibility, this study compared medications listed in a pharmacy information system with findings in an online nursing adult admission assessment, serving as a proxy for the problem list. Where drug and problem list mismatches were discovered, examination of the patient record confirmed the mismatch, and identified any potential causes. Evaluation of the algorithm in diabetes treatment indicates that it successfully detects both potential medication error and opportunities to improve problem list completeness. This algorithm, once fully developed and deployed, could prove a valuable way to improve the patient problem list, and could decrease the risk of medication error. PMID:12463796

American Academy of Asthma, Allergy & Immunology membership experience with venom immunotherapy in chronic medical conditions and pregnancy, and in young children.

PubMed

Calabria, Christopher W; Hauswirth, David W; Rank, Matthew; Sher, Lawrence; Larenas-Linnemann, Desiree

2017-03-01

Few data exist regarding the use of venom immunotherapy (VIT) in specific high-risk chronic medical conditions and pregnancy, and in young children. A Web-based survey was sent to American Academy of Asthma Allergy & Immunology members to explore their VIT experience in potential high-risk medical conditions and pregnancy, and in young children. Major problems were defined as "activation of underlying disease and/or VIT not well tolerated (systemic adverse events) and/or VIT discontinued for medical reasons." Results were expressed descriptively. A total of 697 of 5123 surveys (14%) were completed: 87% of the respondents were based in the United States, and 28% worked in an academic setting. Most respondents (71%) believed that pregnancy was a contraindication for starting VIT. Most were comfortable continuing VIT (51%) if the woman became pregnant after starting therapy. Of the allergists who treated children, many would give VIT down to age 5 years (42%) or younger, ages 1-4 years (35%). The following list is of the specific medical condition, the number of allergists who used VIT in patients with this condition, and the percentage who reported major problems: severe asthma, 212 (4.2%); hypertension, 287 (1.1%); coronary artery disease, 222 (3.6%); arrhythmias, 136 (3.4%); cerebrovascular disease, 104 (5.1%); cancer in remission, 166 (0%); cancer stable but still under treatment, 44 (7.2%); a history of bone marrow transplantation, 15 (4.9%); a history of solid organ transplantation, 29 (3.6%); human immunodeficiency virus, 53 (1.4%); acquired immunodeficiency syndrome, 24 (6.2%); stable autoimmune disease, 164 (2.8%); mastocytosis, 66 (18.4%); elevated serum tryptase, 101 (10.8%); immunodeficiency 59 (2.5%). Many allergists were comfortable using VIT in young children and continuing but not starting pregnant women on VIT. VIT was commonly used in patients with hypertension, coronary artery disease, arrhythmias, cancer in remission, and stable autoimmune disease. Major problems were most frequently reported in use with mastocytosis, elevated tryptase, and cancer still under treatment.

Predicting adherence of patients with HF through machine learning techniques.

PubMed

Karanasiou, Georgia Spiridon; Tripoliti, Evanthia Eleftherios; Papadopoulos, Theofilos Grigorios; Kalatzis, Fanis Georgios; Goletsis, Yorgos; Naka, Katerina Kyriakos; Bechlioulis, Aris; Errachid, Abdelhamid; Fotiadis, Dimitrios Ioannis

2016-09-01

Heart failure (HF) is a chronic disease characterised by poor quality of life, recurrent hospitalisation and high mortality. Adherence of patient to treatment suggested by the experts has been proven a significant deterrent of the above-mentioned serious consequences. However, the non-adherence rates are significantly high; a fact that highlights the importance of predicting the adherence of the patient and enabling experts to adjust accordingly patient monitoring and management. The aim of this work is to predict the adherence of patients with HF, through the application of machine learning techniques. Specifically, it aims to classify a patient not only as medication adherent or not, but also as adherent or not in terms of medication, nutrition and physical activity (global adherent). Two classification problems are addressed: (i) if the patient is global adherent or not and (ii) if the patient is medication adherent or not. About 11 classification algorithms are employed and combined with feature selection and resampling techniques. The classifiers are evaluated on a dataset of 90 patients. The patients are characterised as medication and global adherent, based on clinician estimation. The highest detection accuracy is 82 and 91% for the first and the second classification problem, respectively.

An investigation into the feasibility of locating portable medical devices using radio frequency identification devices and technology.

PubMed

Britton, J

2007-01-01

Portable medical devices represent an important resource for assisting healthcare delivery. The movement of portable devices often results in them being unavailable when needed. Tracking equipment using radiofrequency identification technology/devices (RFID) may provide a promising solution to the problems encountered in locating portable equipment. An RFID technology trial was undertaken at Royal Alexandra Hospital, Paisley. This involved the temporary installation of three active readers and attaching actively transmitting radio frequency tags to different portable medical devices. The active readers and computer system were linked using a bespoke data network. Tags and readers from two separate manufacturers were tested. Reliability difficulties were encountered when testing the technology from the first manufacturer, probably due to the casing of the medical device interfering with the signal from the tag. Improved results were obtained when using equipment from the second manufacturer with an overall error rate of 12.3%. Tags from this manufacturer were specifically designed to overcome problems observed with the first system tested. Findings from this proof of concept trial suggest that RFID technology could be used to track the location of equipment in a hospital.

Medication adherence as a learning process: insights from cognitive psychology.

PubMed

Rottman, Benjamin Margolin; Marcum, Zachary A; Thorpe, Carolyn T; Gellad, Walid F

2017-03-01

Non-adherence to medications is one of the largest contributors to sub-optimal health outcomes. Many theories of adherence include a 'value-expectancy' component in which a patient decides to take a medication partly based on expectations about whether it is effective, necessary, and tolerable. We propose reconceptualising this common theme as a kind of 'causal learning' - the patient learns whether a medication is effective, necessary, and tolerable, from experience with the medication. We apply cognitive psychology theories of how people learn cause-effect relations to elaborate this causal-learning challenge. First, expectations and impressions about a medication and beliefs about how a medication works, such as delay of onset, can shape a patient's perceived experience with the medication. Second, beliefs about medications propagate both 'top-down' and 'bottom-up', from experiences with specific medications to general beliefs about medications and vice versa. Third, non-adherence can interfere with learning about a medication, because beliefs, adherence, and experience with a medication are connected in a cyclic learning problem. We propose that by conceptualising non-adherence as a causal-learning process, clinicians can more effectively address a patient's misconceptions and biases, helping the patient develop more accurate impressions of the medication.

Extreme marginalization: addiction and other mental health disorders, stigma, and imprisonment

PubMed Central

Kreek, Mary Jeanne

2013-01-01

Major well-defined medical problems that are, in part, the unfortunate outcome of a negative social environment may include specific addictive diseases and other mental health disorders, in particular the affective disorders of anxiety, depression, social phobia, and post-traumatic stress syndrome. This overview touches on the topic of extreme marginalization associated with addiction and other mental health disorders, along with arrest, imprisonment, and parole. All of these are characterized by lasting stigma that hauntingly continues to impact upon each person suffering from any of these problems. PMID:21884162

World 2/DIAOLS - - A Project Report.

DTIC Science & Technology

1978-05-05

theory of “system dynamics” is finding widespread application, not only in industry, but also in medical research, sociolocy, financial analysis , and...problems facing mankind: poverty, environmental deterioration, loss of faith in...its environment . While it has certain limitations, it is significant in that it is an effort to make explicit a specific world model so that it may be

Will the Real Author Come Forward? Questions of Ethics, Plagiarism, Theft and Collusion in Academic Research Writing

ERIC Educational Resources Information Center

Sikes, Pat

2009-01-01

This paper raises some questions about academic authorial honesty under the headings of Plagiarism (including self-plagiarism), Theft, and Collusion. Compared with the medical sciences, the social sciences in general and education specifically, lag behind in terms of critical attention being paid to the problem of plagiarism, the peer review…

When learners become teachers: a review of peer teaching in medical student education.

PubMed

Benè, Kristen L; Bergus, George

2014-01-01

Peer teaching engages students as teachers and is widely used in K-12 education, many universities, and increasingly in medical schools. It draws on the social and cognitive congruence between learner and teacher and can be attractive to medical schools faced with a growing number of learners but a static faculty size. Peer teachers can give lectures on assigned topics, lead problem-based learning sessions, and provide one on one support to classmates in the form of tutoring. We undertook a narrative review of research on peer teachers in medical school, specifically investigating how medical students are impacted by being peer teachers and how having a peer teacher impacts learners. Studies have shown that peer teaching has a primarily positive impact on both the peer teacher and the learners. In the setting of problem-based learning courses or clinical skills instruction, medical students' performance on tests of knowledge or skills is similar whether they have faculty instructors or peer teachers. There is also strong evidence that being a peer teacher enhances the learning of the peer teacher relative to the content being taught. It is common for peer teachers to lack confidence in their abilities to successfully teach, and they appreciate receiving training related to their teaching role. We find evidence from several different educational settings that peer teaching benefits both the peer teachers and the learners. This suggests that peer teaching is a valuable methodology for medical schools to engage learners as teachers.

Resolving embarrassing medical conditions with online health information.

PubMed

Redston, Sarah; de Botte, Sharon; Smith, Carl

2018-06-01

Reliance on online health information is proliferating and the Internet has the potential to revolutionize the provision of public health information. The anonymity of online health information may be particularly appealing to people seeking advice on 'embarrassing' health problems. The purpose of this study was to investigate (1) whether data generated by the embarrassingproblems.com health information site showed any temporal patterns in problem resolution, and (2) whether successful resolution of a medical problem using online information varied with the type of medical problem. We analyzed the responses of visitors to the embarrassingproblems.com website on the resolution of their problems. The dataset comprised 100,561 responses to information provided on 77 different embarrassing problems grouped into 9 classes of medical problem over an 82-month period. Data were analyzed with a Bernoulli Generalized Linear Model using Bayesian inference. We detected a statistically important interaction between embarrassing problem type and the time period in which data were collected, with an improvement in problem resolution over time for all of the classes of medical problem on the website but with a lower rate of increase in resolution for urinary health problems and medical problems associated with the mouth and face. As far as we are aware, this is the first analysis of data of this nature. Findings support the growing recognition that online health information can contribute to the resolution of embarrassing medical problems, but demonstrate that outcomes may vary with medical problem type. The results indicate that building data collection into online information provision can help to refine and focus health information for online users. Copyright © 2018 Elsevier B.V. All rights reserved.

Mental health treatment needs for medical students: a national longitudinal study.

PubMed

Midtgaard, Mirim; Ekeberg, Øivind; Vaglum, Per; Tyssen, Reidar

2008-10-01

We aimed to study the occurrence and predictors of medical students' mental health problems that required treatment. Medical students from all Norwegian universities (N=421) were surveyed in their first term (T1), and 3 (T2) and 6 (T3) years later. The dependent variable was "Mental health problems in need of treatment". Predictor variables included personality traits, medical school stress and negative life events. The lifetime prevalence of mental health problems was 15% at T1. At T2, of the 31% who reported problems during the first 3years, a majority had not sought help. At T3, 14% reported problems during the preceding year. Adjusted predictors of problems at T2 were previous mental health problems (p<.001), low level of intensity personality trait (extraversion) (p<.01), reality weakness personality trait (p<.01), perceived medical school stress (p<.05) and negative life events (p<.05). Mental health problems during the first 3years were predicted by previous problems, personality, medical school stress and negative life events. A third of the students reported mental health problems during the first 3years. Intervention should focus on both individual problems and contextual stress.

[A bit of business administration--no problem for physicians: Master of Business Administration as panacea?].

PubMed

Tecklenburg, A; Liebeneiner, J

2010-08-01

Medical professionals with additional economic qualifications are in high demand. For doctors who aim for leading positions at medical institutions the most popular additional qualification is a Master of Business Administration (MBA). The demands on executive managers in hospitals have without any doubt changed in recent years requiring them to be trained in basic economic understanding, human resource management etc. in addition to having excellent medical training. However, MBA programs differ from one academic institution to the next. Due to the lack of standardized schedules in MBA programs it cannot be ascertained whether a candidate received adequate training and can offer the skills necessary for a higher level medical profession. In this paper the author suggests that specific training in individually required skills would be more reasonable and effective rather than encouraging medical staff to pursue academic studies leading to an MBA.

Overcoming the barriers to effective treatment for attention-deficit/hyperactivity disorder: a neuro-educational approach.

PubMed

Monastra, Vincent J

2005-10-01

Despite specific diagnostic criteria, published practice guidelines for assessing patients, and the availability of effective pharmacological treatments for children diagnosed with attention-deficit/hyperactivity disorder (AD/HD), a review of prescription practices in the United States indicates that as few as 25-50% of these patients receive even minimal medical treatment for this condition. Because untreated children with AD/HD are at increased risk for psychoactive substance abuse, criminal behavior, and other social problems as adults, the provision of effective care during childhood is essential. In order to clarify the factors impeding treatment during childhood and develop a targeted intervention to overcome these barriers, two studies involving 1514 families were conducted. Each family included one child diagnosed with AD/HD. Factors associated with treatment failure or non-compliance with medical advice included: dissatisfaction with a diagnostic process limited to brief observation, interview, and review of behavior rating scales; fear of stimulant medication; lack of medication response within the first month; development of side-effects during the first month; lack of understanding of the reasons stimulants were being prescribed for a child, and insufficient clinical response. Based on these findings, an intervention program consisting of a comprehensive evaluation process (that included neuropsychological and neurophysiological tests of attention, and medical screening for other health problems associated with inattention and hyperactivity) and parent education about the medical causes of AD/HD, the biochemical action of medications, the relationship between dietary habits and attention, and the educational rights of children with AD/HD was conducted. Following completion of this three session intervention, 95% of patients complied with medical recommendations, initiated pharmacological treatment, and continued medication for a 2-year follow-up period. Three percent of the patients were diagnosed and treated for other medical conditions.

[Pensions for the aged or housebound: discriminant factors. Study conducted in 4 districts of the canton of Fribourg (Switzerland)].

PubMed

Griffiths, A; Jeanneret, O; Christe, E; Borrini, C; Ingman, S; Demierre, G

1983-01-01

This research forms part of a two centre study (Fribourg et Geneva) on the use of medical and socio-medical services by elderly persons. It was undertaken under the auspices of the national research programme No 8 (Efficiency and effectiveness of the Swiss health system). The study covered 1173 persons aged 65 years or over receiving care in three services (partly medicalized nursing homes, retirement homes and home nursing services) in four french speaking districts of Fribourg Canton. The staff of these services provided cross sectional data on the personal characteristics of their clients or patients, their physical and mental capacities, the specific services provided to them, and some indications on their home circumstances. The results show differences between districts and services in terms of the overall utilisation rate, its structure, and the detailed profiles of specific needs and services. The discussion focusses on the possible interpretations of these differences and on the fundamental problem matching services to needs.

Seeing red: Americans driven into debt by medical bills. Results from a National Survey.

PubMed

Doty, Michelle M; Edwards, Jennifer N; Holmgren, Alyssa L

2005-08-01

New analysis of the 2003 Commonwealth Fund Biennial Health Insurance Survey reveals that an estimated 77 million Americans age 19 and older--nearly two of five (37%) adults--have difficulty paying medical bills, have accrued medical debt, or both. Working-age adults incur significantly higher rates of medical bill and debt problems than adults 65 and older, with rates highest among the uninsured. Even working-age adults who are continually insured have problems paying their medical bills and have medical debt. Unpaid medical bills and medical debt can limit access to health care: two-thirds of people with a medical bill or debt problem went without needed care because of cost--nearly three times the rate of those without these financial problems.

What are some of the cognitive, psychological, and social factors that facilitate or hinder licensed vocational nursing students' acquisition of problem-solving skills involved with medication-dosage calculations?

NASA Astrophysics Data System (ADS)

Allen, Arthur William

The purpose of this study was to examine the cognitive and psychological factors that either enhanced or inhibited Licensed Vocational Nurse (LVN) students' abilities to solve medication-dosage calculation problems. A causal-comparative approach was adopted for use in this study which encompassed aspects of both qualitative and quantitative data collection. A purposive, maximum-variation sample of 20 LVN students was chosen from among a self-selected population of junior college LVN students. The participants' views and feelings concerning their training and clinical experiences in medication administration was explored using a semi-structured interview. In addition, data revealing the students' actual competence at solving sample medication-dosage calculation problems was gathered using a talk-aloud protocol. Results indicated that few participants anticipated difficulty with medication-dosage calculations, yet many participants reported being lost during much of the medication-dosage problem solving instruction in class. While many participants (65%) were able to solve the medication-dosage problems, some (35%) of the participants were unable to correctly solve the problems. Successful students usually spent time analyzing the problem and planning a solution path, and they tended to solve the problem faster than did unsuccessful participants. Successful participants relied on a formula or a proportional statement to solve the problem. They recognized conversion problems as a two-step process and solved the problems in that fashion. Unsuccessful participants often went directly from reading the problem statement to attempts at implementing vague plans. Some unsuccessful participants finished quickly because they just gave up. Others spent considerable time backtracking by rereading the problem and participating in aimless exploration of the problem space. When unsuccessful participants tried to use a formula or a proportion, they were unsure of the formula's or the proportion's format. A few unsuccessful participants lacked an understanding of basic algebraic procedures and of metric measurements. Even participants who had great difficulty solving medication-dosage calculation problems could expeditiously solve more complex problems if the medication used in the problem was well known to them.

Insurance problems among inflammatory bowel disease patients: results of a Dutch population based study.

PubMed

Russel, M G V M; Ryan, B M; Dagnelie, P C; de Rooij, M; Sijbrandij, J; Feleus, A; Hesselink, M; Muris, J W; Stockbrugger, R

2003-03-01

The majority of patients with inflammatory bowel disease (IBD) have a normal life expectancy and therefore should not be weighted when applying for life assurance. There is scant literature on this topic. In this study our aim was to document and compare the incidence of difficulties in application for life and medical insurance in a population based cohort of IBD patients and matched population controls. A population based case control study of 1126 IBD patients and 1723 controls. Based on a detailed questionnaire, the frequency and type of difficulties encountered when applying for life and medical insurance in matched IBD and control populations were appraised. In comparison with controls, IBD patients had an 87-fold increased risk of encountering difficulties when applying for life assurance (odds ratio (OR) 87 (95% confidence interval (CI) 31-246)), with a heavily weighted premium being the most common problem. Patients of high educational status, with continuous disease activity, and who smoked had the highest odds of encountering such problems. Medical insurance difficulties were fivefold more common in IBD patients compared with controls (OR 5.4 (95% CI 2.3-13)) although no specific disease or patient characteristics were identified as associated with such difficulties. This is the first detailed case control study that has investigated insurance difficulties among IBD patients. Acquiring life and medical insurance constituted a major problem for IBD patients in this study. These results are likely to be more widely representative given that most insurance companies use international guidelines for risk assessment. In view of the recent advances in therapy and promising survival data on IBD patients, evidence based guidelines for risk assessment of IBD patients by insurance companies should be drawn up to prevent possible discriminatory practices.

Insurance problems among inflammatory bowel disease patients: results of a Dutch population based study

PubMed Central

Russel, M G V M; Ryan, B M; Dagnelie, P C; de Rooij, M; Sijbrandij, J; Feleus, A; Hesselink, M; Muris, J W; Stockbrugger, R

2003-01-01

Background and aims: The majority of patients with inflammatory bowel disease (IBD) have a normal life expectancy and therefore should not be weighted when applying for life assurance. There is scant literature on this topic. In this study our aim was to document and compare the incidence of difficulties in application for life and medical insurance in a population based cohort of IBD patients and matched population controls. Methods: A population based case control study of 1126 IBD patients and 1723 controls. Based on a detailed questionnaire, the frequency and type of difficulties encountered when applying for life and medical insurance in matched IBD and control populations were appraised. Results: In comparison with controls, IBD patients had an 87-fold increased risk of encountering difficulties when applying for life assurance (odds ratio (OR) 87 (95% confidence interval (CI) 31–246)), with a heavily weighted premium being the most common problem. Patients of high educational status, with continuous disease activity, and who smoked had the highest odds of encountering such problems. Medical insurance difficulties were fivefold more common in IBD patients compared with controls (OR 5.4 (95% CI 2.3–13)) although no specific disease or patient characteristics were identified as associated with such difficulties. Conclusions: This is the first detailed case control study that has investigated insurance difficulties among IBD patients. Acquiring life and medical insurance constituted a major problem for IBD patients in this study. These results are likely to be more widely representative given that most insurance companies use international guidelines for risk assessment. In view of the recent advances in therapy and promising survival data on IBD patients, evidence based guidelines for risk assessment of IBD patients by insurance companies should be drawn up to prevent possible discriminatory practices. PMID:12584216

Western herbal medicine consultations for common menstrual problems; practitioner experiences and perceptions of treatment.

PubMed

Fisher, Carole; Adams, Jon; Frawley, Jane; Hickman, Louise; Sibbritt, David

2018-03-01

To explore the prevalence with which Australian Western herbalists treat menstrual problems and their related treatment, experiences, perceptions, and interreferral practices with other health practitioners. Members of the Practitioner Research and Collaboration Initiative practice-based research network identifying as Western Herbalists (WHs) completed a specifically developed, online questionnaire. Western Herbalists regularly treat menstrual problems, perceiving high, though differential, levels of effectiveness. For menstrual problems, WHs predominantly prescribe individualised formulas including core herbs, such as Vitex agnus-castus, and problem-specific herbs. Estimated clients' weekly cost (median = $25.00) and treatment duration (median = 4-6 months) covering this Western herbal medicine treatment appears relatively low. Urban-based women are more likely than those rurally based to have used conventional treatment for their menstrual problems before consulting WHs (p = .001). Only 19% of WHs indicated direct contact by conventional medical practitioners regarding treatment of clients' menstrual problems despite 42% indicating clients' conventional practitioners recommended consultation with WH. Western herbal medicine may be a substantially prevalent, cost-effective treatment option amongst women with menstrual problems. A detailed examination of the behaviour of women with menstrual problems who seek and use Western herbal medicine warrants attention to ensure this healthcare option is safe, effective, and appropriately co-ordinated within women's wider healthcare use. Copyright © 2017 John Wiley & Sons, Ltd.

Information on actual medication use and drug-related problems in older patients: questionnaire or interview?

PubMed

Willeboordse, Floor; Grundeken, Lucienne H; van den Eijkel, Lisanne P; Schellevis, François G; Elders, Petra J M; Hugtenburg, Jacqueline G

2016-04-01

Information on medication use and drug-related problems is important in the preparation of clinical medication reviews. Critical information can only be provided by patients themselves, but interviewing patients is time-consuming. Alternatively, patient information could be obtained with a questionnaire. In this study the agreement between patient information on medication use and drug-related problems in older patients obtained with a questionnaire was compared with information obtained during an interview. General practice in The Netherlands. A questionnaire was developed to obtain information on actual medication use and drug-related problems. Two patient groups ≥65 years were selected based on general practitioner electronic medical records in nine practices; I. polypharmacy and II. ≥1 predefined general geriatric problems. Eligible patients were asked to complete the questionnaire and were interviewed afterwards. Agreement on information on medication use and drug-related problems collected with the questionnaire and interview was calculated. Ninety-seven patients participated. Of all medications used, 87.6 % (95 % CI 84.7-90.5) was reported identically in the questionnaire and interview. Agreement for the complete medication list was found for 45.4 % (95 % CI 35.8-55.3) of the patients. On drug-related problem level, agreement between questionnaire and interview was 75 %. Agreement tended to be lower in vulnerable patients characterized by ≥4 chronic diseases, ≥10 medications used and low health literacy. Information from a questionnaire showed reasonable agreement compared with interviewing. The patients reported more medications and drug-related problems in the interview than the questionnaire. Taking the limitations into account, a questionnaire seems a suitable tool for medication reviews that may replace an interview for most patients.

A design process for using normative models in shared decision making: a case study in the context of prenatal testing.

PubMed

Rapaport, Sivan; Leshno, Moshe; Fink, Lior

2014-12-01

Shared decision making (SDM) encourages the patient to play a more active role in the process of medical consultation and its primary objective is to find the best treatment for a specific patient. Recent findings, however, show that patient preferences cannot be easily or accurately judged on the basis of communicative exchange during routine office visits, even for patients who seek to expand their role in medical decision making (MDM). The objective of this study is to improve the quality of patient-physician communication by developing a novel design process for SDM and then demonstrating, through a case study, the applicability of this process in enabling the use of a normative model for a specific medical situation. Our design process goes through the following stages: definition of medical situation and decision problem, development/identification of normative model, adaptation of normative model, empirical analysis and development of decision support systems (DSS) tools that facilitate the SDM process in the specific medical situation. This study demonstrates the applicability of the process through the implementation of the general normative theory of MDM under uncertainty for the medical-financial dilemma of choosing a physician to perform amniocentesis. The use of normative models in SDM raises several issues, such as the goal of the normative model, the relation between the goals of prediction and recommendation, and the general question of whether it is valid to use a normative model for people who do not behave according to the model's assumptions. © 2012 John Wiley & Sons Ltd.

Role of occupational health services in the assessment and management of indoor air quality problems.

PubMed

Carrer, Paolo; Muzi, Giacomo

2011-01-01

The role of the occupational health services in the assessment and management of indoor air quality (IAQ) problems in non-industrial sectors (offices, banks, etc.) has been discussed by experts of the ICOH Scientific Committee on IAQ and Health and has been proposed as follow: 1. Collaboration in risk assessment--risk management; 2. Questionnaire survey; 3. Health surveillance (only when periodical health surveillance is already performed for other risks or when specific clinical examination of workers is required); 4. Health promotion (programs for a better IAQ management). A team approach with cooperation between medical and technical experts is recommended in the assessment and management of indoor air quality problems.

Social Media Mining for Toxicovigilance: Automatic Monitoring of Prescription Medication Abuse from Twitter.

PubMed

Sarker, Abeed; O'Connor, Karen; Ginn, Rachel; Scotch, Matthew; Smith, Karen; Malone, Dan; Gonzalez, Graciela

2016-03-01

Prescription medication overdose is the fastest growing drug-related problem in the USA. The growing nature of this problem necessitates the implementation of improved monitoring strategies for investigating the prevalence and patterns of abuse of specific medications. Our primary aims were to assess the possibility of utilizing social media as a resource for automatic monitoring of prescription medication abuse and to devise an automatic classification technique that can identify potentially abuse-indicating user posts. We collected Twitter user posts (tweets) associated with three commonly abused medications (Adderall(®), oxycodone, and quetiapine). We manually annotated 6400 tweets mentioning these three medications and a control medication (metformin) that is not the subject of abuse due to its mechanism of action. We performed quantitative and qualitative analyses of the annotated data to determine whether posts on Twitter contain signals of prescription medication abuse. Finally, we designed an automatic supervised classification technique to distinguish posts containing signals of medication abuse from those that do not and assessed the utility of Twitter in investigating patterns of abuse over time. Our analyses show that clear signals of medication abuse can be drawn from Twitter posts and the percentage of tweets containing abuse signals are significantly higher for the three case medications (Adderall(®): 23 %, quetiapine: 5.0 %, oxycodone: 12 %) than the proportion for the control medication (metformin: 0.3 %). Our automatic classification approach achieves 82 % accuracy overall (medication abuse class recall: 0.51, precision: 0.41, F measure: 0.46). To illustrate the utility of automatic classification, we show how the classification data can be used to analyze abuse patterns over time. Our study indicates that social media can be a crucial resource for obtaining abuse-related information for medications, and that automatic approaches involving supervised classification and natural language processing hold promises for essential future monitoring and intervention tasks.

Does the Health Maintenance Facility Provide Speciality Capabilities?

NASA Technical Reports Server (NTRS)

Boyce, Joey; Wurgler, James; Broadwell, Kim; Martin, William; Stiernberg, Charles M.; Bove, Alfred; Fromm, Rob; O'Neill, Daniel

1991-01-01

The Health Maintenance Facility (HMF) is capable of handling all minor illnesses, most moderate illnesses, and some major illnesses on board a space station. Its primary purpose should be to treat problems that are mission threatening, not life threatening. The HMF will have greater medical capabilities than those currently on Navy submarines. Much of the discussion in this document focuses on the possibilities of treating specific medical conditions on board a space station. The HMF will be limited to caring for critically ill patients for a few days, so a crew return vehicle will be important.

A virtual intranet and data-warehousing for healthcare co-operation.

PubMed

Kerkri, E M; Quantin, C; Grison, T; Allaert, F A; Tchounikine, A; Yétongnon, K

2001-01-01

As patient's medical data is disseminated in different health structures, developing a medical or epidemiological patient-oriented data warehouse has some specific requirements compared to intra healthcare structure data-warehousing projects. The difference is that the healthcare structures implicated in a patient-oriented data warehouse project require some considerations about the confidentiality of the patient data and of the activities of healthcare structures. Building a data-warehousing system at a regional level, for example in cancerology, requires the participation of all concerned health structures, as well as different health professionals. The heterogeneity of sources medical data of has to be taken into account for choosing between several organizational configurations of the data warehousing system. In top of data warehousing, we propose a concept of Virtual Intranet, which provides a solution to the problem of medical information security arising from heterogeneous sources.

The protection of the patient's private life: the computer challenge. Second part.

PubMed

Van Overstraeten, M; Michel, Luc

2002-12-01

Today, medical practice is invaded by a growing number of technologies of all kinds, among which computer techniques have an important place. Although they have significant advantages, for instance in terms of medical record management, they give rise to several problems, particularly concerning the confidentiality of the patient's data with regards to third party. A great number of specific provisions, complementary to the general texts protecting private life (examined in the first part of this two parts article), endeavour to solve these problems. It is true that these provisions are recent, have various origins and often appear as rules difficult to understand. Yet, they are partially inspired by a common logic. Relying on these common features, the authors make two suggestions for the future, in order to avoid that the growing computerisation of medical practice eventually destabilises the health care relationship: a) Any dictatorship of confidentiality must be rejected b) Stimulating a sense of professionalism is most likely the way to avoid an anarchic and unrealistic development of rules aimed at regulating the health care relationship.

Sensitivity and specificity of ANA and anti-dsDNA in the diagnosis of systemic lupus erythematosus: a comparison using control sera obtained from healthy individuals and patients with multiple medical problems.

PubMed

Wichainun, Ramjai; Kasitanon, Nuntana; Wangkaew, Suparaporn; Hongsongkiat, Sith; Sukitawut, Waraporn; Louthrenoo, Worawit

2013-12-01

Antinuclear antibodies (ANA) and anti-double stranded DNA (anti-dsDNA) are often tested as a screening tool in patients with suspected systemic lupus erythematosus or connective tissue diseases. ANA can be seen in healthy controls (HC) and patients with multiple medical problems (MMP). To determine the sensitivity and specificity of ANA and anti-dsDNA in SLE patients, using sera from HC and MMP patients. Serum samples from HC, MMP and SLE patients, 100 in each group, were analyzed for the presence of ANA and anti-dsDNA, by indirect immunofluorescent assay, using a HEp-2 cell and Crithidia luciliae as substrates, respectively. The prevalence of ANA at a titer of ≥1:80 and ≥ 1:160 was 8% and 4%, respectively, in HC; and it was 12% and 6% respectively, in MMP patients. The prevalence of anti-dsDNA was 0% in HC and 3% in MMP patients. When using HC sera for the diagnosis of SLE, the sensitivity of ANA at a titer of ≥ 1:80 and ≥ 1:160 was 98% and 90%, respectively, with specificity of 92% and 96%, respectively. The specificity decreased to 88% and 94%, respectively, when using sera from MMP patients. The specificity of anti-dsDNA was 100% and 97%, when using sera from HC and MMP patients, respectively. ANA and anti-dsDNA gave high sensitivity and high specificity in patients with SLE, even when using MMP patient's sera as controls. Physicians should take care in interpreting ANA and anti-dsDNA results in MMP patients who do not have signs or symptoms of SLE or connective tissue diseases.

[Describe and convince: visual rhetoric of cinematography in medicine].

PubMed

Panese, Francesco

2009-01-01

The tools of visualisation occupy a central place in medicine. Far from being simple accessories of glance, they literally constitute objects of medicine. Such empirical acknowledgement and epistemological position open a vast field of investigation: visual technologies of medical knowledge. This article studies the development and transformation of medical objects which have permitted to assess the role of temporality in the epistemology of medicine. It firstly examines the general problem of the relationships between cinema, animated image and medicine and secondly, the contribution of the German doctor Martin Weiser to medical cinematography as a method. Finally, a typology is sketched out organising the variety of the visual technology of movement under the perspective of the development of specific visual techniques in medicine.

[Medical data security in medico-legal opinioning].

PubMed

Susło, Robert; Swiatek, Barbara

2005-01-01

Medical data security can be approached in medico-legal opinioning in three main situations: security of medical data, on which the opinion should be based, opinioning itself and whether the medical data security was properly ensured and ensuring medical data security during medico-legal opinion giving. The importance of medical data security, during collecting, processing and storing, as well in medical as in legal institutions, is of major importance for the possibility of providing a proper medico-legal opinion. Theoretically speeking, it is possible to give a proper medico-legal opinion using incorrect data, but the possibility is low. When the expert is given improper, unreadable, incomplete or even bogus in part or in the whole medical data it is extremely possible, that he fails in giving his opinion. The term "medical data" was defined and subsequently there was a brief review of medical data storing methods made and specific threats bound with them, based on modern literature. The authors also pointed out possible methods of preventing the threats. They listed Polish as well as international regulations and laws concerning the problem, accenting the importance of preserving medical data for the purposes of medico-legal opinioning.

The West Virginia Occupational Safety and Health Initiative: practicum training for a new marketplace.

PubMed

Meyer, J D; Becker, P E; Stockdale, T; Ducatman, A M

1999-05-01

Occupational medicine practice has experienced a shift from larger corporate medical departments to organizations providing services for a variety of industries. Specific training needs will accompany this shift in practice patterns; these may differ from those developed in the traditional industrial or corporate medical department setting. The West Virginia Occupational Health and Safety Initiative involves occupational medicine residents in consultation to a variety of small industries and businesses. It uses the expertise of occupational physicians, health and safety extension faculty, and faculty in engineering and industrial hygiene. Residents participate in multidisciplinary evaluations of worksites, and develop competencies in team-building, workplace health and safety evaluation, and occupational medical consulting. Specific competencies that address requirements for practicum training are used to measure the trainee's acquisition of knowledge and skills. Particular attention is paid to the acquisition of group problem-solving expertise, skills relevant to the current market in practice opportunities, and the specific career interests of the resident physician. Preliminary evaluation indicates the usefulness of training in evaluation of diverse industries and worksites. We offer this program as a training model that can prepare residents for the challenges of a changing marketplace for occupational health and safety services.

Considerations of education in the field of biophotonics in engineering: the experience of the subject fundamentals of biophotonics

NASA Astrophysics Data System (ADS)

Fanjul-Vélez, F.; Arce-Diego, J. L.

2017-12-01

Education in the field of photonics is usually somehow complex due to the fact that most of the programs include just a few subjects on the field, apart from specific Master programs in Photonics. There are also specific doctorate programs dealing with photonics. Apart from the problems shared with photonics in education in general, biophotonics specifically needs an interdisciplinary approach between biomedical and technical or scientific fields. In this work, we present our education experience in teaching the subject Fundamentals of Biophotonics, intended preferentially to engineering Bachelor and Master degrees students, but also to science and medicine students. First it was necessary to join a teaching group coming from the scientific technical and medical fields, working together in the subject. This task was easier as our research group, the Applied Optical Techniques group, had previous contacts and experience in working with medicine professors and medical doctors at hospitals. The orientation of the subject, intended for both technical and medical students, has to be carefully selected. All this information could be employed by other education institutions willing to implement studies on biomedical optics.

Occupational Health Screenings of the Virtual Warrior: Distributed Common Ground System Intelligence Operators Compared with Non-Combatant Support Personnel

DTIC Science & Technology

2014-02-01

long hours , shift work , relational conflict...reasons for an increase in medication. Such sleep problems were often explained in textual responses to be the result of long work hours , shift work ...to be operational in nature [1]. Specifically, long hours , shift work , organizational and leadership challenges, nature of work , additional

Skating Injuries and Their Treatment

PubMed Central

Lemasters, George S.

1972-01-01

There are approximately 682 figure skating clubs in Canada (not including hockey or general recreational figure skating), with anywhere up to 600 or more members. This means that there are probably over 200,000 figure skaters in Canada today. This article deals with the general and specific medical problems that face these skaters, and what a physician should know about treating them. PMID:20468795

Medical students' personal experience of high-stakes failure: case studies using interpretative phenomenological analysis.

PubMed

Patel, R S; Tarrant, C; Bonas, S; Shaw, R L

2015-05-12

Failing a high-stakes assessment at medical school is a major event for those who go through the experience. Students who fail at medical school may be more likely to struggle in professional practice, therefore helping individuals overcome problems and respond appropriately is important. There is little understanding about what factors influence how individuals experience failure or make sense of the failing experience in remediation. The aim of this study was to investigate the complexity surrounding the failure experience from the student's perspective using interpretative phenomenological analysis (IPA). The accounts of three medical students who had failed final re-sit exams, were subjected to in-depth analysis using IPA methodology. IPA was used to analyse each transcript case-by-case allowing the researcher to make sense of the participant's subjective world. The analysis process allowed the complexity surrounding the failure to be highlighted, alongside a narrative describing how students made sense of the experience. The circumstances surrounding students as they approached assessment and experienced failure at finals were a complex interaction between academic problems, personal problems (specifically finance and relationships), strained relationships with friends, family or faculty, and various mental health problems. Each student experienced multi-dimensional issues, each with their own individual combination of problems, but experienced remediation as a one-dimensional intervention with focus only on improving performance in written exams. What these students needed to be included was help with clinical skills, plus social and emotional support. Fear of termination of the their course was a barrier to open communication with staff. These students' experience of failure was complex. The experience of remediation is influenced by the way in which students make sense of failing. Generic remediation programmes may fail to meet the needs of students for whom personal, social and mental health issues are a part of the picture.

Evaluation of gene expression classification studies: factors associated with classification performance.

PubMed

Novianti, Putri W; Roes, Kit C B; Eijkemans, Marinus J C

2014-01-01

Classification methods used in microarray studies for gene expression are diverse in the way they deal with the underlying complexity of the data, as well as in the technique used to build the classification model. The MAQC II study on cancer classification problems has found that performance was affected by factors such as the classification algorithm, cross validation method, number of genes, and gene selection method. In this paper, we study the hypothesis that the disease under study significantly determines which method is optimal, and that additionally sample size, class imbalance, type of medical question (diagnostic, prognostic or treatment response), and microarray platform are potentially influential. A systematic literature review was used to extract the information from 48 published articles on non-cancer microarray classification studies. The impact of the various factors on the reported classification accuracy was analyzed through random-intercept logistic regression. The type of medical question and method of cross validation dominated the explained variation in accuracy among studies, followed by disease category and microarray platform. In total, 42% of the between study variation was explained by all the study specific and problem specific factors that we studied together.

Health on the Net Foundation: assessing the quality of health web pages all over the world.

PubMed

Boyer, Célia; Gaudinat, Arnaud; Baujard, Vincent; Geissbühler, Antoine

2007-01-01

The Internet provides a great amount of information and has become one of the communication media which is most widely used [1]. However, the problem is no longer finding information but assessing the credibility of the publishers as well as the relevance and accuracy of the documents retrieved from the web. This problem is particularly relevant in the medical area which has a direct impact on the well-being of citizens. In this paper, we assume that the quality of web pages can be controlled, even when a huge amount of documents has to be reviewed. But this must be supported by both specific automatic tools and human expertise. In this context, we present various initiatives of the Health on the Net Foundation informing the citizens about the reliability of the medical content on the web.

Ambulatory EHR functionality: a comparison of functionality lists.

PubMed

Drury, Barbara M

2006-01-01

There is a proliferation of lists intended to define and clarify the functionality of an ambulatory electronic health record system. These lists come from both private and public entities and vary in terminology, granularity, usability, and comprehensiveness. For example, functionality regarding a problem list includes the following possible definitions: * "Create and maintain patient-specific problem lists," from the HL7 Electronic Health Record Draft Standard for Trial Use. * "Provide a flexible mechanism for retrieval of encounter information that can be organized by diagnosis, problem, problem type," from the Bureau of Primary Health Care. * "The system shall associate encounters, orders, medications and notes with one or more problems," from the Certification Commission on Health Information Technology. * "Displays dates of problems on problem list," from COPIC Insurance Co. * "Shall automatically close acute problems using an automated algorithm," from the Physicians Foundations HIT Subcommittee. This article will compare the attributes of these five electronic health record functionality lists and their usefulness to different audiences-clinicians, application developers and payers.

Paediatric medical emergency calls to a Danish Emergency Medical Dispatch Centre: a retrospective, observational study.

PubMed

Andersen, Kasper; Mikkelsen, Søren; Jørgensen, Gitte; Zwisler, Stine Thorhauge

2018-01-05

Little is known regarding paediatric medical emergency calls to Danish Emergency Medical Dispatch Centres (EMDC). This study aimed to investigate these calls, specifically the medical issues leading to them and the pre-hospital units dispatched to the paediatric emergencies. We performed a retrospective, observational study on paediatric medical emergency calls managed by the EMDC in the Region of Southern Denmark in February 2016. We reviewed audio recordings of emergency calls and ambulance records to identify calls concerning patients ≤ 15 years. We examined EMDC dispatch records to establish how the medical issues leading to these calls were classified and which pre-hospital units were dispatched to the paediatric emergencies. We analysed the data using descriptive statistics. Of a total of 7052 emergency calls in February 2016, 485 (6.9%) concerned patients ≤ 15 years. We excluded 19 and analysed the remaining 466. The reported medical issues were commonly classified as: "seizures" (22.1%), "sick child" (18.9%) and "unclear problem" (12.9%). The overall most common pre-hospital response was immediate dispatch of an ambulance with sirens and lights with a supporting physician-manned mobile emergency care unit (56.4%). The classification of medical issues and the dispatched pre-hospital units varied with patient age. We believe our results might help focus the paediatric training received by emergency medical dispatch staff on commonly encountered medical issues, such as the symptoms and conditions pertaining to the symptom categories "seizures" and "sick child". Furthermore, the results could prove useful in hypothesis generation for future studies examining paediatric medical emergency calls. Almost 7% of all calls concerned patients ≤ 15 years. Medical issues pertaining to the symptom categories "seizures", "sick child" and "unclear problem" were common and the calls commonly resulted in urgent pre-hospital responses.

Babies at Double Jeopardy: Medically Fragile Infants and Child Neglect

ERIC Educational Resources Information Center

Fullar, Suzanne A.

2008-01-01

Medically fragile infants, those born prematurely or with other complex medical or genetic problems, are at risk of long-term health and developmental problems. When a medically fragile infant comes home to a family with significant social problems such as domestic violence, mental illness, or substance abuse, the infant is at double jeopardy--at…

Long-term neurodevelopmental outcomes of congenital diaphragmatic hernia survivors not treated with extracorporeal membrane oxygenation.

PubMed

Frisk, Virginia; Jakobson, Lorna S; Unger, Sharon; Trachsel, Daniel; O'Brien, Karel

2011-07-01

Although there has been a marked improvement in the survival of children with congenital diaphragmatic hernia (CDH) in the past 2 decades, there are few reports of long-term neurodevelopmental outcome in this population. The present study examined neurodevelopmental outcomes in 10- to 16-year-old CDH survivors not treated with extracorporeal membrane oxygenation (ECMO). Parents of 27 CDH survivors completed questionnaires assessing medical problems, daily living skills, educational outcomes, behavioral problems, and executive functioning. Fifteen CDH survivors and matched full-term controls completed standardized intelligence, academic achievement, phonological processing, and working memory tests. Non-ECMO-treated CDH survivors demonstrated high rates of clinically significant difficulties on standardized academic achievement measures, and 14 of the 27 survivors had a formal diagnosis of specific learning disability, attention deficit hyperactivity disorder, or developmental disability. Specific problems with executive function, cognitive and attentional weaknesses, and social difficulties were more common in CDH patients than controls. Perioperative hypocapnia was linked to executive dysfunction, behavioral problems, lowered intelligence, and poor achievement in mathematics. Non-ECMO-treated CDH survivors are at substantial risk for neurodevelopmental problems in late childhood and adolescence. Copyright © 2011 Elsevier Inc. All rights reserved.

Dysphoria and smoking among treatment seeking smokers: the role of smoking-related inflexibility/avoidance

PubMed Central

Buckner, Julia D.; Farris, Samantha G.; Zvolensky, Michael J.; Shah, Sonia M.; Leventhal, Adam M.; Minnix, Jennifer A.; Schmidt, Norman B.

2016-01-01

Background Emerging data suggest that dysphoria is one facet of depression that is especially related to various aspects of cigarette smoking. However, it is presently unknown what emotional processes may account for these relations. Objectives In the current cross-sectional study, the impact of avoidance and inflexibility to smoking (AIS), a smoking-specific form of experiential avoidance, was tested on the relationship of dysphoria to four specific smoking processes that are key factors in cessation: perceived barriers to cessation, severity of problems during prior quit attempts, negative reinforcement smoking expectancies, and motivation to quit smoking. Methods Participants (n = 465) were treatment-seeking adult daily smokers. Relative indirect effects were subjected to bootstrap analyses to test direct and indirect effects of dysphoria on smoking processes. Results After controlling for gender, nicotine dependence severity, drinking problems, cannabis use, negative affectivity, tobacco-related medical problems, and AIS, dysphoria remained directly, positively related to perceived barriers and cessation problems. Additionally, dysphoria was indirectly, positively related to perceived barriers, cessation problems, negative reinforcement smoking expectancies, and motivation to quit indirectly through higher levels of AIS. Conclusion In the context of dysphoria, AIS may explain a wide range of clinically-relevant smoking processes. PMID:25396705

Inflight Medical Events in the Shuttle Program

NASA Technical Reports Server (NTRS)

Baisden, Denise L.; Effenhauser, R. K.; Wear, Mary L.

1999-01-01

Since the first launch of the Space Shuttle in 1981, the astronauts and their flight surgeons have dealt with a variety of inflight medical issues. A review will be provided of these issues as well as medications used in the treatment of these medical problems. Detailed medical debriefs are conducted by the flight ,surgeon with the individual crewmembers three days after landing. These debriefs were review for Shuttle flights from 1988 through 1999 to determine the frequency of inflight medical events. Medical events were grouped by ICD category and the frequency of medical events within those categories were reviewed. The ICD category of Symptoms, Signs and Ill-defined Conditions had the most medical events. Facial fullness and headache were the most common complaints within this category. The ICD category of Respiratory System had the next most common medical events with sinus congestion being the most common complaint. This was followed by Digestive System complaints and Nervous System/Sense Organ complaints. A variety of inflight medical events have occurred throughout the Shuttle program. Fortunately, the majority of these problems have been minor and have been well within the capability of the medical equipment flown and the skills of the Crew Medical Officers. Medical ,problems/procedures that are routine on the ground often present unique problems in the space flight environment. It is important that the flight surgeon understand the common medical problems encountered.

Medical and legal problems in intermediate intensive units.

PubMed

Gherson, G

1994-12-01

Due to a lack of legislation on the subject (the only data concerns the standard of hospital personnel in the Ministerial Decree (DM) of 13th September 1988), the medical and legal problems are concerned, in the first instance, with defining the type of unit, the context within which it can be placed and the eventual access to essential services and minimum equipment. With regard to responsibility, bearing in mind that the medical team of the intermediary unit (as with all other hospital teams) is employed by the public National Health Service, medical malpractice can be associated with lack of equipment and an inadequate public health service, which is often the cause. If penal responsibility is strictly personal (art. 27 of the Constitution) the civil relationship is, on the one hand, a relationship between the administration and the patient (the physician as employee must give his services within the Health Service and does not have an official personal relationship with the patient) so the Hospital organisation has a contractual type of civil responsibility whereas the employed doctors have an extra-contractual responsibility with different obligations. These responsibilities, which are also determined by the functions of the physician within the USL Health Service (DPR n. 761/1979), can also include control of non-medical staff, control of the equipment, specific training of personnel, etc. Problems concerning the admission of patients to the intermediate unit must also be taken into account (precise evaluation of the indications and of the type of patient to be admitted, refusal of patients in such a condition as to require intensive care or invasive techniques.(ABSTRACT TRUNCATED AT 250 WORDS)

Data warehouse for detection of occupational diseases in OHS data.

PubMed

Godderis, L; Mylle, G; Coene, M; Verbeek, C; Viaene, B; Bulterys, S; Schouteden, M

2015-11-01

Occupational health and safety (OHS) services collect a wide range of data during health surveillance. To build a 'data warehouse' to make OHS data available for research and to investigate sector-specific health problems. Medical data were extracted, transformed and loaded into the data warehouse. After validation, data on lifestyle, categorized medication use, ICD-9-CM encoded sickness absences and health complaints, collected between 2010 and 2014, were analysed with logistic regression to compare proportions between employment sectors, taking into account age, gender, body mass index (BMI) and year of examination. The data set comprised 585000 employees. Average age and employment seniority were 39 ± 12 and 8 ± 9 years, respectively. BMI was 26 ± 5 kg/m(2). Health complaints, medication use and sickness absence significantly increased with BMI and age. The proportion of employees with health problems was highest in health care (64%), government (61%) and manufacturing (60%) and lowest in the service sector. In all sectors, 10% of workers reported locomotor health problems, apart from the service sector (8%) with similar results for medication consumption. Neuropsychological drugs were more frequently used by health care workers (8%). The transport sector contained the highest proportion of cardiological medication users (12%). Finally, 30-59% of employees reported at least one sickness absence episode. Sickness absence due to locomotor issues was highest in manufacturing (11%) and health care (10%), followed by government (9%) and construction (9%). Significant differences in indices of workers' health were observed between sectors. This information is now being used in the implementation of a sector-oriented health surveillance programme. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Prevalence and incidence of mental health problems among Dutch medical students and the study-related and personal risk factors: a longitudinal study.

PubMed

Borst, Jorien M; Frings-Dresen, Monique H W; Sluiter, Judith K

2016-11-01

A high prevalence of mental health problems (i.e. depression and/or anxiety) has been found in medical students in comparison with the general population. Therefore, the objective was first to study the prevalence and 1-year incidence of symptoms of depression, anxiety and any mental health problems among Dutch medical students and, second, to study which study-related and personal factors present a risk of these mental health problems. A 1-year prospective longitudinal study was performed among medical students of two medical faculties in the Netherlands (n=951). Health problems and study-related and personal factors were measured with an online questionnaire. Mental health problems were assessed by depression and/or anxiety symptoms (BSI-DEP and BSI-ANG). Univariate and multivariate hierarchical logistic regression analyses were performed to examine which of the study-related and personal factors predict mental health problems. At follow-up, 36%, 28% and 48% of the medical students reported symptoms of depression, anxiety and mental health problems, respectively. The incidence between 2010 and 2011 for depression was 20%, 17% for anxiety and 25% for mental health problems. Students who are worried about their own health during medical education are at an increased risk of future mental health problems (OR 2.0 [1.3-2.9], p=0.00). Excessive drinking behavior is a protective factor in this study (OR 0.7 [0.5-0.9], p=0.02). This study shows that only two out of nine factors are significantly associated with mental health problems among Dutch medical students, one risk factor and one protective factor.

Substance Misuse Education for Physicians: Why Older People are Important

PubMed Central

De Jong, Cornelis A.J.; Goodair, Christine; Crome, Ilana; Jokubonis, Darius; el-Guebaly, Nady; Dom, Geert; Schellekens, Arnt; Broers, Barbara; Subata, Emilis; Welle-Strand, Gabrielle Katrine; Luycks, Lonneke; Wolters, Michel; Schoof, Tamara

2016-01-01

This perspective article focuses on the need for training and education for undergraduate medical students on substance-related disorders, and describes initiatives undertaken in the United Kingdom (UK), Netherlands, United States (US), and Norway to develop the skills, knowledge, and attitudes needed by future doctors to treat patients adequately. In addition, we stress that in postgraduate training, further steps should be taken to develop Addiction Medicine as a specialized and transverse medical domain. Alcohol use disorder is a growing public health problem in the geriatric population, and one that is likely to continue to increase as the baby boomer generation ages. Prescription drug misuse is a major concern, and nicotine misuse remains problematic in a substantial minority. Thus, Addiction Medicine training should address the problems for this specific population. In recent years, several countries have started an Addiction Medicine specialty. Although addiction psychiatry has been a subspecialty in the UK and US for more than 20 years, in most countries it has been a more recent development. Additional courses on addiction should be integrated into the curriculum at both undergraduate and postgraduate levels, as well as form part of the continuous training of other medical specialists. It is recommended that further research and mapping of what is currently taught in medical programs be undertaken, so as to enhance medical education in addiction and improve treatment services. PMID:27505022

RBAC-Matrix-based EMR right management system to improve HIPAA compliance.

PubMed

Lee, Hung-Chang; Chang, Shih-Hsin

2012-10-01

Security control of Electronic Medical Record (EMR) is a mechanism used to manage electronic medical records files and protect sensitive medical records document from information leakage. Researches proposed the Role-Based Access Control(RBAC). However, with the increasing scale of medical institutions, the access control behavior is difficult to have a detailed declaration among roles in RBAC. Furthermore, with the stringent specifications such as the U.S. HIPAA and Canada PIPEDA etc., patients are encouraged to have the right in regulating the access control of his EMR. In response to these problems, we propose an EMR digital rights management system, which is a RBAC-based extension to a matrix organization of medical institutions, known as RBAC-Matrix. With the aim of authorizing the EMR among roles in the organization, RBAC-Matrix also allow patients to be involved in defining access rights of his records. RBAC-Matrix authorizes access control declaration among matrix organizations of medical institutions by using XrML file in association with each EMR. It processes XrML rights declaration file-based authorization of behavior in the two-stage design, called master & servant stage, thus makes the associated EMR to be better protected. RBAC-Matrix will also make medical record file and its associated XrML declaration to two different EMRA(EMR Authorization)roles, namely, the medical records Document Creator (DC) and the medical records Document Right Setting (DRS). Access right setting, determined by the DRS, is cosigned by the patient, thus make the declaration of rights and the use of EMR to comply with HIPAA specifications.

Friedreich's Ataxia

MedlinePlus

... and heart problems can be treated with medications. Orthopedic problems such as foot deformities and scoliosis can ... and heart problems can be treated with medications. Orthopedic problems such as foot deformities and scoliosis can ...

[Occupational brucellosis in the veterinary service of the Local Health Service in the Abruzzo Region (Italy)].

PubMed

Cieri, D; Turchi, C; Torzi, G

2007-01-01

During the health surveillance of the employees in the veterinary service of a Local Sanitary Service, we came across a medical case of occupational brucellosis in a veterinarian, identified by seriological data (Wright' seriological diagnosis + brucellosis specific test with identification of IgM and IgG), in a lack of significant anamnesis, anamnestic negativity of dangerous behaviours. Two medical cases of the sole seriological positivity have been identified in a veterinarian and in a health vigililant. In our Local Health Service the medical cases stated across the population have been 6 (in the period from 2000 to August 2007). The epidemiological flow of the animal brucellosis in the regional area, and in particular in our territory, shows one low incidence of positive stock farms, low incidence of oxes, sheep and goats infected. In Italy the medical cases of brucellosis denounced and approved from the National Institute for work-related Injury Insurance have been 38 out of 41, in the period from 1996 to 2006. This zoonosis represents a problem of relief in the sector the breeding of the animals and the butchery of the meats in all countries; the occupational health physician, within the area of prevention, has to exercise a specific health surveillance of biological risk and take part in specific programs of information and formation, in particular on the use of individual protection devices and correct behavioural rules.

An algorithm to improve diagnostic accuracy in diabetes in computerised problem orientated medical records (POMR) compared with an established algorithm developed in episode orientated records (EOMR).

PubMed

de Lusignan, Simon; Liaw, Siaw-Teng; Dedman, Daniel; Khunti, Kamlesh; Sadek, Khaled; Jones, Simon

2015-06-05

An algorithm that detects errors in diagnosis, classification or coding of diabetes in primary care computerised medial record (CMR) systems is currently available. However, this was developed on CMR systems that are episode orientated medical records (EOMR); and do not force the user to always code a problem or link data to an existing one. More strictly problem orientated medical record (POMR) systems mandate recording a problem and linking consultation data to them. To compare the rates of detection of diagnostic accuracy using an algorithm developed in EOMR with a new POMR specific algorithm. We used data from The Health Improvement Network (THIN) database (N = 2,466,364) to identify a population of 100,513 (4.08%) patients considered likely to have diabetes. We recalibrated algorithms designed to classify cases of diabetes to take account of that POMR enforced coding consistency in the computerised medical record systems [In Practice Systems (InPS) Vision] that contribute data to THIN. We explored the different proportions of people classified as having type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) and with diabetes unclassifiable as either T1DM or T2DM. We compared proportions using chi-square tests and used Tukey's test to compare the characteristics of the people in each group. The prevalence of T1DM using the original EOMR algorithm was 0.38% (9,264/2,466,364), and for T2DM 3.22% (79,417/2,466,364). The prevalence using the new POMR algorithm was 0.31% (7,750/2,466,364) T1DM and 3.65% (89,990/2,466,364) T2DM. The EOMR algorithms also left more people unclassified 11,439 (12%), as to their type of diabetes compared with 2,380 (2.4%), for the new algorithm. Those people who were only classified by the EOMR system differed in terms of older age, and apparently better glycaemic control, despite not being prescribed medication for their diabetes (p < 0.005). Increasing the degree of problem orientation of the medical record system can improve the accuracy of recording of diagnoses and, therefore, the accuracy of using routinely collected data from CMRs to determine the prevalence of diabetes mellitus; data processing strategies should reflect the degree of problem orientation.

From sick role to practices of health and illness.

PubMed

Frank, Arthur W

2013-01-01

Health care research generally, and medical education research specifically, make increasingly sophisticated use of social science methods, but these methods are often detached from the theories that are the substantive core of the social sciences. Enhanced understanding of theory is especially valuable for gaining a broader perspective on how issues in medical education reflect the social processes that contextualise them. This article reviews five social science theories, emphasising their relevance to medical education, beginning with the emergence of the sociology of health and illness in the 1950s, with Talcott Parsons' concept of the 'sick role'. Four turning points since Parsons are then discussed with reference to the theory developed by, respectively, Harold Garfinkel, Michel Foucault and Pierre Bourdieu, and what is called the 'narrative or dialogical turn'. In considering these, the author argues for a theory-grounded research that relates specific problems to what Max Weber called the 'fate of our times'. The conclusion considers how medical education research can critique the reproduction of a discourse of scarcity in health care, rather than participating in this discourse and legitimating the disciplinary techniques that it renders self-evident. © Blackwell Publishing Ltd 2013.

Parental reporting of adverse drug reactions associated with attention-deficit hyperactivity disorder (ADHD) medications in children attending specialist paediatric clinics in the UK.

PubMed

Tobaiqy, Mansour; Stewart, Derek; Helms, Peter J; Williams, Justin; Crum, Jackie; Steer, Christopher; McLay, James

2011-03-01

The development of systems to ensure appropriate and informed use of medicines in children is a global priority. Current pharmacovigilance systems, such as the UK Yellow Card Scheme, are limited by opportunistic reporting of adverse drug reactions (ADRs), lack of a denominator and lower than expected reporting rates. To develop a pharmacovigilance system able to target specific patient populations such as children, and specific medicines of interest, using specialist medical clinics. Between January and March 2010, parents of 578 children (3-16 years of age) receiving pharmacological therapy for attention-deficit hyperactivity disorder and attending a child and adolescent clinic in the UK were sent an ADR questionnaire to elicit information on possible ADRs associated with their child's medication use. Two approaches, free text and a symptom tick list, were used to elicit possible ADRs. Two hundred and seven questionnaires were returned, of which 200 were evaluable, giving a response rate of 35.9%. 123 questionnaires reported a total of 213 free-text ADRs perceived by the parents to be due to the medications under study. Two-thirds of reported ADRs were considered to be ongoing at the time of reporting. Duration of reported ADRs ranged from 1 week to 3 years. 81 returned questionnaires reported 134 different ADRs for methylphenidate monotherapy. For methylphenidate, the most frequently reported ADRs were loss of appetite (34.3%), headache (17.9%), mood and emotional problems (14.9%), stomach upset (14.9%), sleep disturbance (10.4%), and rash and other skin problems (5.2%). 467 possible drug-related symptoms were reported using the tick-list approach. Using the tick list, the most frequently reported symptoms were mood and emotional problems (28.1% [131/467]), stomach and abdominal problems (13.3% [62/467]), insomnia (12.8% [60/467]) and lack of appetite (12.6% [59/467]). The symptom tick list identified a broader range of possible adverse effects not reported as free-text ADRs, such as schooling difficulties, hearing problems, cough and blurred vision. The results of our study demonstrate the feasibility of using specialist clinics to target both at-risk patient populations and/or medicines of interest. We have also clearly demonstrated the practicality and feasibility of parental reporting. Parents reported common and less common ADRs, such as suicidal ideation, using both the free text and symptom tick-list approach.

Glossary on the environmental impact of a nuclear war. Technical note

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

Verstraete, M.M.

1986-02-01

The glossary defines a number of words, expressions, and acronyms used in the description of the impact of nuclear war on the environment, and associated issues. Selected additional words related to the problems of armaments, disarmament, and nuclear war in general were also added for convenience, although terms and expressions specifically related to the medical aspects of the problem were not included. The glossary is an enlarged and updated version of the glossary that was published as part of the SCOPE-Enuwar study on the same subject, and published by Wiley (Pittock et al., 1986).

Predictors of Trajectories of Epilepsy-Specific Quality of Life among Children Newly Diagnosed with Epilepsy

PubMed Central

Ramsey, Rachelle R.; Loiselle, Kristin; Rausch, Joseph R.; Harrison, Jordan; Modi, Avani C.

2016-01-01

Objective To identify two year trajectories of epilepsy-specific health-related quality of life (HRQOL) among children newly diagnosed with epilepsy and to evaluate the predictive value of a comprehensive set of medical, psychosocial, and family factors. Methods Ninety-four children with epilepsy (8.14 ± 2.37 years of age and 63% male) and their caregivers participated in this study. Caregivers completed the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE) and measures of psychological and family functioning at one month post-diagnosis. The QOLCE was also given at eight additional time points during the subsequent two years as a part of a large observational study in children with epilepsy. Adherence data was collected via MEMS TrackCaps and medical information was collected through chart review. Results Unique trajectories were identified for the overall QOLCE scale, as well as the subscales. Most trajectory models for the QOLCE subscales contained at least one at-risk trajectory for children, indicating that there is a subgroup of children experiencing poor long-term HRQOL. Health-related quality of life trajectories remained predominantly stable during the two year period following treatment initiation. Number of AEDs, Internalizing Problems, and Externalizing Problems emerged as the most consistent predictors across the HRQOL domains. Significance Medical and psychosocial interventions, such as cognitive-behavioral strategies, should target modifiable factors (e.g., internalizing symptoms, externalizing symptoms, number of AEDs trialed) shortly after diagnosis to improve HRQOL for children with epilepsy over the course of their disease. PMID:26974247

Adaptive controller for volumetric display of neuroimaging studies

NASA Astrophysics Data System (ADS)

Bleiberg, Ben; Senseney, Justin; Caban, Jesus

2014-03-01

Volumetric display of medical images is an increasingly relevant method for examining an imaging acquisition as the prevalence of thin-slice imaging increases in clinical studies. Current mouse and keyboard implementations for volumetric control provide neither the sensitivity nor specificity required to manipulate a volumetric display for efficient reading in a clinical setting. Solutions to efficient volumetric manipulation provide more sensitivity by removing the binary nature of actions controlled by keyboard clicks, but specificity is lost because a single action may change display in several directions. When specificity is then further addressed by re-implementing hardware binary functions through the introduction of mode control, the result is a cumbersome interface that fails to achieve the revolutionary benefit required for adoption of a new technology. We address the specificity versus sensitivity problem of volumetric interfaces by providing adaptive positional awareness to the volumetric control device by manipulating communication between hardware driver and existing software methods for volumetric display of medical images. This creates a tethered effect for volumetric display, providing a smooth interface that improves on existing hardware approaches to volumetric scene manipulation.

The deep play of medicine: discursive and collaborative processing of evidence in medical problem solving.

PubMed

Måseide, Per

2006-01-01

Ethnographic research was conducted in the thoracic ward of a Norwegian university hospital in order to study collaborative medical problem solving. As a general principle, evidence-based medicine is supposed to lead the process of medical problem solving. However, medical problem solving also requires evidence of a different kind. This is the more concrete form of evidence, such as X rays and other representations, that guides medical practice and makes sure that decisions are grounded in sound empirical facts and knowledge. In medicine, 'evidence' is on the one hand an abstract category; on the other hand, it is a tool that is practically enacted during the problem-solving work. Medical evidence does not 'show itself'. As such it has an emergent quality. Medical evidence has to be established and made practically useful in the collaborative settings by the participants in order to make conclusions about diagnoses and treatment. Hence, evidence is an interactional product; it is discursively generated and its applicability requires discourse. In addition, the production of medical evidence requires more than medical discourse and professional considerations. This paper looks at the production processes and use of medical evidence and the ambiguous meaning of this term in practical medicine.

Malaria remains a military medical problem.

PubMed

World, M J

2001-10-01

To bring military medical problems concerning malaria to the attention of the Defence Medical Services. Seven military medical problems related to malaria are illustrated by cases referred for secondary assessment over the past five years. Each is discussed in relation to published data. The cases of failure of various kinds of chemoprophylaxis, diagnosis and treatment of malaria may represent just a fraction of the magnitude of the overall problem but in the absence of reliable published military medical statistics concerning malaria cases, the situation is unclear. Present experience suggests there are a number of persisting problems affecting the military population in relation to malaria. Only publication of reliable statistics will define their magnitude. Interim remedies are proposed whose cost-effectiveness remains to be established.

Drug therapy problems and medication discrepancies during care transitions in super-utilizers.

PubMed

Surbhi, Satya; Munshi, Kiraat D; Bell, Paula C; Bailey, James E

First, to investigate the prevalence and types of drug therapy problems and medication discrepancies among super-utilizers, and associated patient characteristics. Second, to examine the outcomes of pharmacist recommendations and estimated cost avoidance through care transitions support focused on medication management. Retrospective analysis of the pharmacist-led interventions as part of the SafeMed Program. A large nonprofit health care system serving the major medically underserved areas in Memphis, Tennessee. Three hundred seventy-four super-utilizing SafeMed participants with multiple chronic conditions and polypharmacy. Comprehensive medication review, medication therapy management, enhanced discharge planning, home visits, telephone follow-up, postdischarge medication reconciliation, and care coordination with physicians. Types of drug therapy problems, outcomes of pharmacist recommendations, estimated cost avoided, medication discrepancies, and self-reported medication adherence. Prevalence of drug therapy problems and postdischarge medication discrepancies was 80.7% and 75.4%, respectively. The most frequently occurring drug therapy problems were enrollee not receiving needed medications (33.4%), underuse of medications (16.9%), and insufficient dose or duration (11.2%). Overall 50.8% of the pharmacist recommendations were accepted by physicians and patients, resulting in an estimated cost avoidance of $293.30 per drug therapy problem identified. Multivariate analysis indicated that participants with a higher number of comorbidities were more likely to have medication discrepancies (odds ratio 1.23 [95% CI 1.05-1.44]). Additional contributors to postdischarge medication discrepancies were difficulty picking up and paying for medications and not being given necessary prescriptions before discharge. Drug therapy problems and medication discrepancies are common in super-utilizers with multiple chronic conditions and polypharmacy during transitions of care, and greater levels of comorbidity magnify risk. Pharmacist-led interventions in the SafeMed Program have demonstrated success in resolving enrollees' medication-related issues, resulting in substantial estimated cost savings. Preliminary evidence suggests that the SafeMed model's focus on medication management has great potential to improve outcomes while reducing costs for vulnerable super-utilizing populations nationwide. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Impact of Pharmacist-Conducted Comprehensive Medication Reviews for Older Adult Patients to Reduce Medication Related Problems.

PubMed

Kiel, Whitney J; Phillips, Shaun W

2017-12-31

Older adults are demanding increased healthcare attention with regards to prescription use due in large part to highly complex medication regimens. As patients age, medications often have a more pronounced effect on older adults, negatively impacting patient safety and increasing healthcare costs. Comprehensive medication reviews (CMRs) optimize medications for elderly patients and help to avoid inappropriate medication use. Previous literature has shown that such CMRs can successfully identify and reduce the number of medication-related problems and improve acute healthcare utilization. The purpose of this pharmacy resident research study is to examine the impact of pharmacist-conducted geriatric medication reviews to reduce medication-related problems within a leading community health system in southwest Michigan. Furthermore, the study examines type of pharmacist interventions made during medication reviews, acute healthcare utilization, and physician assessment of the pharmacist's value. The study was conducted as a retrospective post-hoc analysis on ambulatory patients who received a CMR by a pharmacist at a primary care practice. Inclusion criteria included patients over 65 years of age with concurrent use of at least five medications who were a recent recipient of a CMR. Exclusion criteria included patients with renal failure, or those with multiple providers involved in primary care. The primary outcome was the difference in number of medication-related problems, as defined by the START and STOPP Criteria (Screening Tool to Alert doctors to Right Treatment/Screening Tool of Older Persons' Prescriptions). Secondary outcomes included hospitalizations, emergency department visits, number and type of pharmacist interventions, acceptance rate of pharmacist recommendations, and assessment of the pharmacist's value by clinic providers. There were a total of 26 patients that received a comprehensive medication review from the pharmacist and were compared to a control group, patients that did not receive a CMR. The average patient age for both groups was 76 years old. A total of 11 medication-related problems in the intervention group patients were identified compared with 24 medication-related problems in the control group ( p -value 0.002). Pharmacist-led comprehensive medication reviews were associated with a statistically significant different in the number of medication-related problems as defined by the START and STOPP criteria.

Addressing medication nonadherence by mobile phone: development and delivery of tailored messages.

PubMed

Gatwood, Justin; Balkrishnan, Rajesh; Erickson, Steven R; An, Lawrence C; Piette, John D; Farris, Karen B

2014-01-01

Medication nonadherence remains a significant public health problem, and efforts to improve adherence have shown only limited impact. The tailoring of messages has become a popular method of developing communication to influence specific health-related behaviors but the development and impact of tailored text messages on medication use is poorly understood. The aim of this paper is to describe an approach to developing theory-based tailored messages for delivery via mobile phone to improve medication adherence among patients with diabetes. Kreuter's five-step tailoring process was followed to create tailored messages for mobile phone delivery. Two focus group sessions, using input from 11 people, and expert review of message content were used to adapt the survey instrument on which the messages were tailored and edit the developed messages for the target population. Following established tailoring methods a library of 168 theory-driven and 128 medication-specific tailored messages were developed and formatted for automated delivery to mobile phones. Concepts from the Health Belief Model and Self-Determination Theory were used to craft the messages and an algorithm was applied to determine the order and timing of messages with the aim of progressively influencing disease and treatment-related beliefs driving adherence to diabetes medication. The process described may be applied to future investigations aiming to improve medication adherence in patients with diabetes and the effectiveness of the current messages will be tested in a planned analysis. Copyright © 2014 Elsevier Inc. All rights reserved.

Are multidose drug dispensing systems initiated for the appropriate patients?

PubMed

Mertens, Bram J; Kwint, H F; van Marum, Rob J; Bouvy, Marcel L

2018-05-16

It is unknown if multidose drug dispensing (MDD) systems are initiated for the appropriate patients. Therefore, the objective of this study was to compare the medication management problems of patients who were about to start with a MDD system (MDD patients) and patients who continued manually dispensed medication (non-MDD users) in order to identify if the appropriate patients receive a MDD system. Patient interviews (semi-structured) were conducted by 44 community pharmacists at the patient's home. Patients over 65 years of age, home dwelling and using at least five chronic drugs, were eligible for the study. An assessment tool was developed including 22 potential medication management problems, covering four domains: functional (7), organizational (7), medication adherence (6), and medication knowledge (2). Median scores were calculated with the interquartile range. Additionally, cognitive function was assessed with the Mini-Cog and frailty using the Groningen Frailty Indicator. One hundred eighty-eight MDD users and 230 non-MDD users were interviewed. MDD users were older, more often female, and using more drugs. Forty-two percent of the MDD users were possibly cognitively impaired and 63% were assessed as frail compared to 20 and 27% respectively of the non-MDD users. MDD users had more potential organizational problems (3 vs. 1; p < 0.01), functional problems (2 vs. 1; p < 0.01), medication adherence problems (1 vs. 0; p < 0.01), and medication knowledge problems (1 vs. 0; p < 0.01) compared to non-MDD users. Seventy percent of the MDD users scored six or more potential medication management problems while this was 22% among non-MDD users. The majority of MDD systems were initiated for patients who experienced multiple potential medication management problems suggesting a decreased medication management capacity.

The stories they tell: How third year medical students portray patients, family members, physicians, and themselves in difficult encounters.

PubMed

Shapiro, Johanna; Rakhra, Pavandeep; Wong, Adrianne

2016-10-01

Physicians have long had patients whom they have labeled "difficult", but little is known about how medical students perceive difficult encounters with patients. In this study, we analyzed 134 third year medical students' reflective essays written over an 18-month period about difficult student-patient encounters. We used a qualitative computerized software program, Atlas.ti to analyze students' observations and reflections. Main findings include that students described patients who were angry and upset; noncompliant with treatment plans; discussed "nonmedical" problems; fearful, worried, withdrawn, or "disinterested" in their health. Students often described themselves as anxious, uncertain, confused, and frustrated. Nevertheless, they saw themselves behaving in empathic and patient-centered ways while also taking refuge in "standard" behaviors not necessarily appropriate to the circumstances. Students rarely mentioned receiving guidance from attendings regarding how to manage these challenging interactions. These third-year medical students recognized the importance of behaving empathically in difficult situations and often did so. However, they often felt overwhelmed and frustrated, resorting to more reductive behaviors that did not match the needs of the patient. Students need more guidance from attending physicians in order to approach difficult interactions with specific problem-solving skills while maintaining an empathic, patient-centered context.

Child and parent attributions in chronic pediatric conditions: phenylketonuria (PKU) as an exemplar.

PubMed

Antshel, Kevin M; Brewster, Scott; Waisbren, Susan E

2004-03-01

Attribution theory, self-regulation, self-handicapping and sick role theories all suggest that children with chronic disease may be held to different standards. This study assesses child and parent attributions in pediatric chronic health conditions and addresses how attributional style may be related to treatment adherence. Four different vignettes were utilized to compare the attributional style of children with phenylketonuria (PKU) and parents of children with PKU to two comparison groups: children with other chronic medical conditions and medically healthy children. In addition, the relationship between metabolic control and attribution ratings was assessed in the PKU sample. Parents of children with medical conditions provided attributions of less child control and more stability as well as more positive affective reactions when compared to parents of healthy children. Children without a medical condition viewed childhood problems as less controllable and more stable. Mothers were more disturbed affectively by behavioral dysregulation and fathers were more disturbed by academic difficulties. In the PKU sample, the higher the phenylalanine level in the child, the more likely the parent and child alike were to attribute childhood problems to external loci of control. Attributional styles appear not to be diagnosis-specific in pediatric populations. Attributional style may be an important variable to consider when targeting treatment adherence.

Medical team interdependence as a determinant of use of clinical resources.

PubMed Central

Sicotte, C; Pineault, R; Lambert, J

1993-01-01

OBJECTIVE. Our objective, based on organization theory, is to examine whether interdependence among physicians leads to coordination problems that in turn may explain variations observed in the use of clinical resources. DATA SOURCES/STUDY SETTING. Secondary data about episodes of in-hospital care were collected over a 14-month period in two midsize acute care hospitals located in two suburbs of Montreal, Quebec. STUDY DESIGN. Hierarchical regression analysis was used to assess the marginal effect of medical team interdependence on clinical resource utilization after taking into account the effect attributable to the nature of several morbidities taken as specific and distinct tasks. PRINCIPAL FINDINGS. Medical team interdependence is found within medical specialties as well as between specialties. The largest portion of resource utilization was explained by morbidity characteristics, whereas team interdependence had a weaker, but systematic effect for all morbidities studied (15 regression models out of 18 performed). Task coordination was found to become more difficult as the number of physicians coming from different specialties increased in the context of teamwork. CONCLUSIONS. Results suggest that team practice does not entirely overcome coordination problems inherent to task (morbidity) interdependence. In considering the individual (especially the attending) physician as the main factor responsible for resource utilization, other factors related to team practice may too readily be overlooked. PMID:8270423

Sleep phenotypes in infants and toddlers with neurogenetic syndromes.

PubMed

Abel, Emily A; Tonnsen, Bridgette L

2017-10-01

Although sleep problems are well characterized in preschool- and school-age children with neurogenetic syndromes, little is known regarding the early emergence of these problems in infancy and toddlerhood. To inform syndrome-specific profiles and targets for intervention, we compared parent-reported sleep problems in infants and toddlers with Angelman syndrome (AS), Williams syndrome (WS), and Prader-Willi syndrome (PWS) with patterns observed among same-aged typically developing (TD) controls. Mothers of 80 children (18 AS, 19 WS, 19 PWS, and 24 TD) completed the Brief Infant Sleep Questionnaire. Primary dependent variables included (1) sleep onset latency, (2) total sleep duration, (3) daytime and nighttime sleep duration, and (4) sleep problem severity, as measured by both maternal impression and National Sleep Foundation guidelines. Sleep problems are relatively common in children with neurogenetic syndromes, with 41% of mothers reporting problematic sleep and 29% of children exhibiting abnormal sleep durations as per national guidelines. Across genetic subgroups, problems are most severe in children with AS and WS, particularly in relation to nighttime sleep duration. Although atypical sleep is characteristically reported in each syndrome later in development, infants and toddlers with PWS exhibited largely typical patterns, potentially indicating delayed onset of sleep problems in concordance with other medical features of PWS. Our findings suggest that sleep problems in neurogenetic syndromes emerge as early as infancy and toddlerhood, with variable profiles across genetic subgroups. This work underscores the importance of early sleep screenings as part of routine medical care of neurosyndromic populations and the need for targeted, syndrome-sensitive treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

Medical Libraries of the Soviet Union *

PubMed Central

Morozov, A.

1964-01-01

Medical libraries are a part of the Soviet library system. The total number of medical libraries in the country is more than 4,000, with a collection of over 42,000,000 volumes that are used by over a million readers. The State Central Medical Library occupies a special place among these libraries. It carries out the functions of a methodological, bibliographic, and coordinating center. It has a collection of over 1,000,000 units of books and periodicals. All the bibliographic work of medical libraries as well as any other work is provided to help medical institutions. Libraries prepare special bibliographies of medical literature for publication according to a plan. The libraries also conduct reference and information work. The methodological work helps to solve the most important problems that arise in libraries with reference to the specific character of their work and tasks. The chief means of rendering methodological guidance are to analyze the work of various libraries, to hold conferences, to exchange visits with libraries, to give both field and correspondence consultations, and to organize qualification courses for librarians and bibliographers. PMID:14119299

Prevalence and Polysomnographic Correlates of Insomnia Comorbid with Medical Disorders

PubMed Central

Budhiraja, Rohit; Roth, Thomas; Hudgel, David W.; Budhiraja, Pooja; Drake, Christopher L.

2011-01-01

Study Objectives: To determine the prevalence and polysomnographic correlates of insomnia in subjects with self-reported medical disorders. Design: Prospective cross-sectional study. Participants: Community-based sample of 3282 men and women aged 18 to 65 years old, with a subset who underwent polysomnography. Measurements: Self-reported measures of sleep habits and current health, and polysomnographic sleep variables. Results: The prevalence of insomnia was 21.4%. The adjusted odds of insomnia were 2.2 times as high in persons with any medical disorders as in those without medical disorders. Specifically, odds of insomnia were higher in people with heart disease (OR = 1.6 [95% CI: 1.2-23], P = 0.004), hypertension (1.5 [12-18], P < 0.001), diabetes (1.4 [105-20], P = 0.04), stomach ulcers (2.1 [1.6-2.7], P < 0.001), arthritis (1.8 [1.5-2.2], P < 0.001), migraine (1.8 [1.5-2.1], P < 0.001), asthma (1.6 [1.3-2.0], P = 0.04), COPD (1.9 [1.5-2.5], P < 0.001), neurological problems (2.0 [1.5-2.7], P < 0.001), and menstrual problems (1.7 [1.3-2.1], P < 0.001) than in people without these disorders. Prevalence of insomnia increased with increasing number of medical disorders. However, polysomnographic sleep was not significantly different in persons with or without medical disorders for most disorders assessed. Conclusion: This large population-based study suggests that insomnia is highly prevalent in diverse chronic medical disorders. However, polysomnographic evidence of disturbed sleep is present in only a subset of comorbid insomnia populations. Citation: Budhiraja R; Roth T; Hudgel DW; Budhiraja P; Drake CL. Prevalence and polysomnographic correlates of insomnia comorbid with medical disorders. SLEEP 2011;34(7):859-867. PMID:21731135

Differences in behavioral health disorders and unmet treatment needs between medical marijuana users and recreational marijuana users: Results from a national adult sample.

PubMed

Park, Ji-Yeun; Wu, Li-Tzy

2017-11-01

Available data suggest that medical marijuana users may have more mental health problems than recreational marijuana users. There is limited information about differences in behavioral health disorders and unmet treatment needs between medical and recreational marijuana users. We compared past-year prevalence of behavioral health disorders and unmet treatment needs across three marijuana subgroups (recreational use only, medical use only, and both). Sex-stratified logistic regression was performed to determine their associations with marijuana use status. We analyzed data from adults (≥18 years) who used marijuana in the past year (N=15,440) from 2013 to 2014 National Surveys on Drug Use and Health. Among 15,440 past-year marijuana users, 90.2% used recreational marijuana only, 6.2% used medical marijuana only, and 3.6% used both. Both users had the highest prevalence of behavioral health disorders and unmet treatment needs overall, with no significant sex differences. In the sex-specific logistic regression analysis, medical only users and both users showed somewhat different patterns of associations (reference group=recreational only users). Medical only users had decreased odds of alcohol or drug use disorders, and unmet need for alcohol or drug treatment among males and females. Additionally, female medical only users had decreased odds of opioid use disorder. Both users had increased odds of major depressive episode, hallucinogen use disorder, and unmet need for mental health services among males, and cocaine use disorder among females. Different approaches tailored to individuals' sex and motives for marijuana use is needed for the prevention and treatment of behavioral health problems. Copyright © 2017 Elsevier B.V. All rights reserved.

Problems and hopes perceived by mothers, fathers and physicians of children receiving palliative care.

PubMed

Hill, Douglas L; Miller, Victoria A; Hexem, Kari R; Carroll, Karen W; Faerber, Jennifer A; Kang, Tammy; Feudtner, Chris

2015-10-01

The quality of shared decision making for children with serious illness may depend on whether parents and physicians share similar perceptions of problems and hopes for the child. (i) Describe the problems and hopes reported by mothers, fathers and physicians of children receiving palliative care; (ii) examine the observed concordance between participants; (iii) examine parental perceived agreement; and (iv) examine whether parents who identified specific problems also specified corresponding hopes, or whether the problems were left 'hopeless'. Seventy-one parents and 43 physicians were asked to report problems and hopes and perceived agreement for 50 children receiving palliative care. Problems and hopes were classified into eight domains. Observed concordance was calculated between parents and between each parent and the physicians. The most common problem domains were physical body (88%), quality of life (74%) and medical knowledge (48%). The most common hope domains were quality of life (88%), suffering (76%) and physical body (39%). Overall parental dyads demonstrated a high percentage of concordance (82%) regarding reported problem domains and a lower percentage of concordance on hopes (65%). Concordance between parents and physicians regarding specific children was lower on problem (65-66%) and hope domains (59-63%). Respondents who identified problems regarding a child's quality of life or suffering were likely to also report corresponding hopes in these domains (93 and 82%, respectively). Asking parents and physicians to talk about problems and hopes may provide a straightforward means to improve the quality of shared decision making for critically ill children. © 2013 John Wiley & Sons Ltd.

The costs of caring: medical costs of Alzheimer's disease and the managed care environment.

PubMed

Murman, D L

2001-01-01

This review summarizes the medical costs associated with Alzheimer's disease (AD) and related dementias, as well as the payers responsible for these medical costs in the US health care system. It is clear from this review that AD and related dementias are associated with substantial medical costs. The payers responsible for a majority of these costs are families of patients with AD and the US government through the Medicare and Medicaid programs. In an attempt to control expenditures, Medicare and Medicaid have turned to managed care principles and managed care organizations. The increase in "managed" dementia care gives rise to several potential problems for patients with AD, along with many opportunities for systematic improvement in the quality of dementia care. Evidence-based disease management programs provide the greatest opportunities for improving managed dementia care but will require the development of dementia-specific quality of care measures to evaluate and continually improve them.

An academic practice's transition to the business of medicine in the community. A case study.

PubMed

Griffin, S L; Schryver, D L

2000-01-01

This case study highlights the problems confronting a clinical practice corporation affiliated with a major medical school, and the business realizations it made in the acquisition of a community-based clinic. Launching a financially viable enterprise requires careful planning, determination of formal goals and expectations, an appropriate mix of physicians and services, a specific marketing campaign and community support.

Methods for Cataloguing, Storing, and Retrieving Large Volumes of Tape-Recorded Conversations. Working Papers in Sociolinguistics, No. 32.

ERIC Educational Resources Information Center

Skopek, Lucienne; And Others

A major problem in doing linguistic research from tape-recorded material is finding specific tape content for later, detailed analysis of data. A project on use of language in medicine being carried out at the Cornell University Medical College has developed a method of cataloguing taped material that eliminates the need for transcriptions and…

U. S. Army Medical Research and Development Technical Report

DTIC Science & Technology

1978-09-30

skin preparation prior to cathe- ter insertion, thi- type of catheter care following insertion, and the duration of central venous catheterization . An...NO. 3 A study is now underway to determine the optimal techniques for central venous catheter dressing care. A specially designed dress- ing tray that...chronically maintained male rhesus monkeys with indwelling central venous catheters. Two specific problems were en- countered. (1) Available data

Computer-Based Training at a Military Medical Center: Understanding Decreased Participation in Training among Staff and Ways to Improve Completion Rates

ERIC Educational Resources Information Center

Lavender, Julie

2013-01-01

Military health care facilities make extensive use of computer-based training (CBT) for both clinical and non-clinical staff. Despite evidence identifying various factors that may impact CBT, the problem is unclear as to what factors specifically influence employee participation in computer-based training. The purpose of this mixed method case…

Pharmacotherapy consultation on polypharmacy patients in ambulatory care.

PubMed

Jameson, J P; VanNoord, G R

2001-01-01

To investigate actual cost and adverse effect outcomes associated with a phamacotherapy consultation in ambulatory care patients receiving polypharmacy. Patients receiving five or more chronic medications were randomized to receive pharmacotherapy consultation or usual medical care. Outcomes measured were changes in drug costs, medical costs, and drug-related symptoms six months after the consultation. Data were analyzed with unpaired Student's t-test for continuous data. Chi2 Analysis was used for categorical data. Patients and physicians were surveyed about their perceptions of the consultations after the study period. Drug and medical costs did not differ before and after the consultation. More patients in the consultation group had adverse symptom scores improve by two or more points, and fewer had symptom scores worsen by two or more points than in the control group. Seventy percent of patients and 76% of physicians believed that the consult was beneficial. Polypharmacy patients are the most likely to have drug-related problems and require intervention. Of all the interventions performed in this study, 73% of the original problems were recognized only through a patient interview, suggesting that an interpersonal relationship remains critical to the provision of pharmaceutical care. Although patients and physicians see intuitive value in pharmaceutical care, pharmacists need to exert more energy in the direction of marketing the profession. Finally, there are numerous difficulties in measuring the benefits of these interventions, possibly making broad-based interventions in complicated patients too difficult to assess accurately. Future studies should focus on patients with limited, specific problems or on interventions with narrow goals.

Medical treatment of dementia patients at the end of life: can the law accommodate the personal identity and welfare problems?

PubMed

Lewis, Penney

2006-09-01

This article considers whether two significant philosophical objections to autonomy-based legal approaches to decision-making for incompetent individuals could be accommodated by the law. These philosophical objections are known as the personal identity and welfare problems. The article first sets out the autonomy-based approaches and their objections. Next, the present legal position is briefly canvassed in a comparative vein. Finally, the article suggests how the personal identity and welfare problems might be accommodated were legislators minded to do so, by proposing specific statutory amendments to the recent English legislation on advance decisions and evaluating their viability, particularly in light of the European Convention on Human Rights.

Progress in developing Poisson-Boltzmann equation solvers

PubMed Central

Li, Chuan; Li, Lin; Petukh, Marharyta; Alexov, Emil

2013-01-01

This review outlines the recent progress made in developing more accurate and efficient solutions to model electrostatics in systems comprised of bio-macromolecules and nano-objects, the last one referring to objects that do not have biological function themselves but nowadays are frequently used in biophysical and medical approaches in conjunction with bio-macromolecules. The problem of modeling macromolecular electrostatics is reviewed from two different angles: as a mathematical task provided the specific definition of the system to be modeled and as a physical problem aiming to better capture the phenomena occurring in the real experiments. In addition, specific attention is paid to methods to extend the capabilities of the existing solvers to model large systems toward applications of calculations of the electrostatic potential and energies in molecular motors, mitochondria complex, photosynthetic machinery and systems involving large nano-objects. PMID:24199185

Identifying substance misuse in primary care: TAPS Tool compared to the WHO ASSIST.

PubMed

Schwartz, R P; McNeely, J; Wu, L T; Sharma, G; Wahle, A; Cushing, C; Nordeck, C D; Sharma, A; O'Grady, K E; Gryczynski, J; Mitchell, S G; Ali, R L; Marsden, J; Subramaniam, G A

2017-05-01

There is a need for screening and brief assessment instruments to identify primary care patients with substance use problems. This study's aim was to examine the performance of a two-step screening and brief assessment instrument, the TAPS Tool, compared to the WHO ASSIST. Two thousand adult primary care patients recruited from five primary care clinics in four Eastern US states completed the TAPS Tool followed by the ASSIST. The ability of the TAPS Tool to identify moderate- and high-risk use scores on the ASSIST was examined using sensitivity and specificity analyses. The interviewer and self-administered computer tablet versions of the TAPS Tool generated similar results. The interviewer-administered version (at cut-off of 2), had acceptable sensitivity and specificity for high-risk tobacco (0.90 and 0.77) and alcohol (0.87 and 0.80) use. For illicit drugs, sensitivities were >0.82 and specificities >0.92. The TAPS (at a cut-off of 1) had good sensitivity and specificity for moderate-risk tobacco use (0.83 and 0.97) and alcohol (0.83 and 0.74). Among illicit drugs, sensitivity was acceptable for moderate-risk of marijuana (0.71), while it was low for all other illicit drugs and non-medical use of prescription medications. Specificities were 0.97 or higher for all illicit drugs and prescription medications. The TAPS Tool identified adult primary care patients with high-risk ASSIST scores for all substances as well moderate-risk users of tobacco, alcohol, and marijuana, although it did not perform well in identifying patients with moderate-risk use of other drugs or non-medical use of prescription medications. The advantages of the TAPS Tool over the ASSIST are its more limited number of items and focus solely on substance use in the past 3months. Copyright © 2017 Elsevier Inc. All rights reserved.

Health inequalities in Thailand: geographic distribution of medical supplies in the provinces.

PubMed

Nishiura, Hiroshi; Barua, Sujan; Lawpoolsri, Saranath; Kittitrakul, Chatporn; Leman, Martinus Martin; Maha, Masri Sembiring; Muangnoicharoen, Sant

2004-09-01

The purpose of this study was to analyze the regional characteristics and geographic distribution of the medical staffs (physicians and nurses) and the patient beds in relation to the population and average death rates in each of the provinces in Thailand, by using the Lorenz curve and Gini coefficients. Those data were obtained from surveys conducted by the Ministry of Public Health and the Office of the National Education Commission. It was demonstrated that there are certain clear uneven distributions in medical personnel, especially physicians (Gini index = 0.433), by province. For physicians, nurses, and patient beds, approximately 39.6%, 25.8% and 20.6% are concentrated in the Bangkok Metropolis. Specific ideas to solve those problems are discussed in order to overcome this health care crisis by the year 2025.

Medical treatment of acquired nystagmus.

PubMed

Ehrhardt, David; Eggenberger, Eric

2012-11-01

This article synthesises recent findings and addresses relevant anatomy, pathophysiologic considerations, and current treatment options for common forms of acquired nystagmus including vestibular and gaze holding dysfunction. Some forms of nystagmus have relatively specific treatments, such as baclofen for periodic alternating nystagmus, and repositioning for benign paroxysmal positional vertigo. Recent studies have brought changes to many of the treatments of nystagmus variants. Additionally, other recent advances in nystagmus treatment, like the usage of 4-aminopyridine, have added potent medications to the physician's armamentarium. Nystagmus is a commonly encountered entity in clinical practice. However, evidence supported treatments are scarce. Medical treatment of nystagmus is difficult, with often limited and variable response to pharmacologic therapies. This mandates a continued re-evaluation of patients and creation of an individualized approach to this common clinical problem.

The clinical chemistry and immunology of long-duration space missions.

PubMed

Wu, A H; Taylor, G R; Graham, G A; McKinley, B A

1993-01-01

Clinical laboratory diagnostic capabilities are needed to guide health and medical care of astronauts during long-duration space missions. Clinical laboratory diagnostics, as defined for medical care on Earth, offers a model for space capabilities. Interpretation of laboratory results for health and medical care of humans in space requires knowledge of specific physiological adaptations that occur, primarily because of the absence of gravity, and how these adaptations affect reference values. Limited data from American and Russian missions have indicated shifts of intra- and extracellular fluids and electrolytes, changes in hormone concentrations related to fluid shifts and stresses of the missions, reductions in bone and muscle mass, and a blunting of the cellular immune response. These changes could increase susceptibility to space-related illness or injury during a mission and after return to Earth. We review physiological adaptations and the risk of medical problems that occur during space missions. We describe the need for laboratory diagnostics as a part of health and medical care in space, and how this capability might be delivered.

[Use of cognitive aids in pediatric emergency care : Interdisciplinary consensus statement].

PubMed

Wirtz, S; Eich, C; Becke, K; Brenner, S; Callies, A; Harding, U; Höhne, C; Hoffmann, F; Kaufmann, J; Landsleitner, B; Marung, H; Nicolai, T; Reifferscheid, F; Trappe, U; Jung, P

2017-05-01

Preclinical pediatric emergencies are rare events and are therefore often associated with stress and uncertainty for emergency medical service personnel. To ensure adequate treatment of pediatric patients a variety of different cognitive aids exist (e.g. books, apps, rulers, weight-adapted bag systems). Especially the size specifications of the medical equipment and the dosage of emergency medication are individually very different in children and are dependent on parameters, such as body height and weight. Therefore, cognitive aids often enable length measurement whereby it is possible to draw conclusions on body weight for calculating the child's medication dosage. These aids may help to avoid the wrong medication dose or the wrong therapy of children but uncritical and untrained usage of these aids carries a potential risk of mistakes. This recommendation gives an overview of the general requirements and different problems of cognitive aids and should help improve the general framework and the rational basis for the use and further development of cognitive aids in emergency medicine.

Nurses' reported thinking during medication administration.

PubMed

Eisenhauer, Laurel A; Hurley, Ann C; Dolan, Nancy

2007-01-01

To document nurses' reported thinking processes during medication administration before and after implementation of point-of-care technology. Semistructured interviews and real-time tape recordings were used to document the thinking processes of 40 nurses practicing in inpatient care units in a large tertiary care teaching hospital in the northeastern US. Content analysis resulted in identification of 10 descriptive categories of nurses' thinking: communication, dose-time, checking, assessment, evaluation, teaching, side effects, work arounds, anticipating problem solving, and drug administration. Situations requiring judgment in dosage, timing, or selection of specific medications (e.g., pain management, titration of antihypertensives) provided the most explicit data about nurses' use of critical thinking and clinical judgment. A key element was nurses' constant professional vigilance to ensure that patients received their appropriate medications. Nurses' thinking processes extended beyond rules and procedures and were based on patient data and interdisciplinary professional knowledge to provide safe and effective care. Identification of thinking processes can help nurses to explain the professional expertise inherent in medication administration beyond the technical application of the "5 rights."

Prospects and problems of medical tourism in Bangladesh.

PubMed

Mamun, Muhammad Z; Andaleeb, Syed Saad

2013-01-01

The growing trend of Bangladeshi patients travelling abroad for medical services has led to some soul-searching in policy circles. While other countries of the Southeast Asia region are profiting from medical tourism, Bangladesh not only lags behind, it also loses patients to these countries in a continuous stream. This exodus for medical treatment is seemingly driven by the higher perceived quality of treatment abroad, despite the fact that similar treatment is available more cost-effectively within the country. Certainly the Bangladesh health care system is not without its problenis, which have diminished the perception of quality in the sector. Thus, this study focuses on key factors for Bangladeshi health service providers to address. By doing so, they will be better able to develop the local health care sector and retain Bangladeshi patients within the country. Subsequently, by identifying strategic niches, Bangladesh could focus on delivering higher quality health care services to develop medical tourism and attract patients from abroad in specific categories of health care.

Medicine, religion and ayahuasca in Catalonia. Considering ayahuasca networks from a medical anthropology perspective.

PubMed

Apud, Ismael; Romaní, Oriol

2017-01-01

Ayahuasca is a psychoactive beverage from the Amazon, traditionally used by indigenous and mestizo populations in the region. Widespread international use of the beverage began in the 1990s in both secular contexts and religious/spiritual networks. This article offers an analysis of these networks as health care systems in general and for the case of Spain and specifically Catalonia, describing the emergence and characteristics of their groups, and the therapeutic itineraries of some participants. The medical anthropology perspective we take enables us to reflect on the relationship between medicine and religion, and problematize the tensions between medicalization and medical pluralism. Closely linked to the process of medicalization, we also analyze prohibitionist drug policies and their tensions and conflicts with the use of ayahuasca in ritual and 'health care' contexts. The paper ends with a reflection on the problem of ayahuasca as 'medicine', since the connection between religion and medicine is a very difficult one to separate. Copyright © 2016 Elsevier B.V. All rights reserved.

Role for Automated Communication Strategies in Medication Adherence Management

PubMed Central

Ross, S. Michael

2008-01-01

Lack of medication adherence is a prevalent problem that causes a broad range of health-and health-economics-related issues. Adherence management is therefore an important strategy, but it also presents its own set of challenges. Interventional communication from care support teams at managed care organizations and disease management and wellness programs has proved effective at modifying patients' medication adherence and reporting behaviors. However, these communications do not work well from an economic standpoint. It is not economically feasible to scale call centers and the numbers of clinical and professional staff to communicate with the increasing number of patients with chronic diseases who require ongoing medication use. Using communication automation to augment traditional call center outreach can help to mediate patient medication-taking behaviors. Specific design criteria for the automation of this interaction are discussed in this article, offering supporting data from a recent trial of 304 elderly patients with hypertension, and showing the benefits of using such a system for effective blood pressure monitoring, at reduced costs. PMID:25126263

Role for automated communication strategies in medication adherence management.

PubMed

Ross, S Michael

2008-11-01

Lack of medication adherence is a prevalent problem that causes a broad range of health-and health-economics-related issues. Adherence management is therefore an important strategy, but it also presents its own set of challenges. Interventional communication from care support teams at managed care organizations and disease management and wellness programs has proved effective at modifying patients' medication adherence and reporting behaviors. However, these communications do not work well from an economic standpoint. It is not economically feasible to scale call centers and the numbers of clinical and professional staff to communicate with the increasing number of patients with chronic diseases who require ongoing medication use. Using communication automation to augment traditional call center outreach can help to mediate patient medication-taking behaviors. Specific design criteria for the automation of this interaction are discussed in this article, offering supporting data from a recent trial of 304 elderly patients with hypertension, and showing the benefits of using such a system for effective blood pressure monitoring, at reduced costs.

Medical malpractice in perspective. I--The American experience.

PubMed Central

Quam, L; Dingwall, R; Fenn, P

1987-01-01

Concern over the possibility of an American style medical malpractice "crisis" in the United Kingdom has recently been voiced by members of both medical and legal professions. The validity of such fears is examined by reviewing the conditions that have given rise to the current American difficulties. It is argued that the rise in malpractice insurance premiums and associated restrictions in availability should be seen against the background of underwriting problems specific to medical liability in conjunction with a general decline in reinsurance cover. The evidence in relation to the clinical and resource implications of malpractice is analysed. In particular, arguments that increased litigation has influenced the practice of "defensive" medicine and the choice of specialty are critically examined. Medical malpractice claims and insurance are only part of a professional environment which is undergoing dramatic social and economic changes, many of which seem more plausible candidates to be treated as important influences on the nature and organisation of health care in the United States. Images p1532-a PMID:3111624

The changing role of the medical technologist from technologist to information specialist.

PubMed

Miller, W G

2000-01-01

Pathology laboratory services are dependent on the laboratory information system (LIS) to organize the work, manage the operation, and communicate the results for effective laboratory medicine. For maximum efficiency, staffing for the LIS should be an integral component of laboratory operations and is facilitated by a two-tier structure. A core LIS staff provides system support and continuous services. A group of bench medical technologists have multitasking responsibilities, including LIS support for a specific laboratory work area. The two components form a team that uses staff efficiently to provide ongoing operational services and flexibility for problem solving and new functionality implementation.

Do sleep problems mediate the link between adverse childhood experiences and delinquency in preadolescent children in foster care?

PubMed

Hambrick, Erin P; Rubens, Sonia L; Brawner, Thomas W; Taussig, Heather N

2018-02-01

Adverse childhood experiences (ACEs) are associated with multiple mental and physical health problems. Yet, mechanisms by which ACEs confer risk for specific problems are largely unknown. Children in foster care typically have multiple ACEs and high rates of negative sequelae, including delinquent behaviors. Mechanisms explaining this link have not been explored in this population. Impaired sleep has been identified as a potential mechanism by which ACEs lead to delinquency in adolescents, because inadequate sleep may lead to poor executive function and cognitive control - known risk factors for delinquency. Interviews were conducted with 516 maltreated children in foster care, ages 9-11 years, and their caregivers regarding child exposure to ACEs, sleep problems, engagement in delinquent acts, symptoms of posttraumatic stress disorder, and current psychotropic medication use. ACEs data were also obtained from child welfare case records. After controlling for age, gender, race/ethnicity, placement type (residential, kin, foster), length of time in placement, posttraumatic stress symptoms, and current psychotropic medication use, sleep partially mediated the association between ACEs and delinquency. Although delinquency is likely multiply determined in this population, improving sleep may be one important strategy to reduce delinquency. © 2017 Association for Child and Adolescent Mental Health.

Medical device problem reporting for the betterment of healthcare.

PubMed

1998-08-01

Given that there are nearly 5,000 individual classes of medical devices, tens of thousands of medical device suppliers, and millions of healthcare providers around the world, device-related problems are bound to happen. But effective problem reporting can help reduce or eliminate many of these problems--not only within an institution, but also potentially around the world. In this article, we trace the problem reporting process from its beginnings in the hospital to its global impact in making critical information available throughout the healthcare community.

Adaptive tight frame based medical image reconstruction: a proof-of-concept study for computed tomography

NASA Astrophysics Data System (ADS)

Zhou, Weifeng; Cai, Jian-Feng; Gao, Hao

2013-12-01

A popular approach for medical image reconstruction has been through the sparsity regularization, assuming the targeted image can be well approximated by sparse coefficients under some properly designed system. The wavelet tight frame is such a widely used system due to its capability for sparsely approximating piecewise-smooth functions, such as medical images. However, using a fixed system may not always be optimal for reconstructing a variety of diversified images. Recently, the method based on the adaptive over-complete dictionary that is specific to structures of the targeted images has demonstrated its superiority for image processing. This work is to develop the adaptive wavelet tight frame method image reconstruction. The proposed scheme first constructs the adaptive wavelet tight frame that is task specific, and then reconstructs the image of interest by solving an l1-regularized minimization problem using the constructed adaptive tight frame system. The proof-of-concept study is performed for computed tomography (CT), and the simulation results suggest that the adaptive tight frame method improves the reconstructed CT image quality from the traditional tight frame method.

Evolution of a Patient Information Management System in a Local Area Network Environment at Loyola University of Chicago Medical Center

PubMed Central

Price, Ronald N; Chandrasekhar, Arcot J; Tamirisa, Balaji

1990-01-01

The Department of Medicine at Loyola University Medical Center (LUMC) of Chicago has implemented a local area network (LAN) based Patient Information Management System (PIMS) as part of its integrated departmental database management system. PIMS consists of related database applications encompassing demographic information, current medications, problem lists, clinical data, prior events, and on-line procedure results. Integration into the existing departmental database system permits PIMS to capture and manipulate data in other departmental applications. Standardization of clinical data is accomplished through three data tables that verify diagnosis codes, procedures codes and a standardized set of clinical data elements. The modularity of the system, coupled with standardized data formats, allowed the development of a Patient Information Protocol System (PIPS). PIPS, a userdefinable protocol processor, provides physicians with individualized data entry or review screens customized for their specific research protocols or practice habits. Physician feedback indicates that the PIMS/PIPS combination enhances their ability to collect and review specific patient information by filtering large amount of clinical data.

[Nursing care priorities and problems: the nurses point of view].

PubMed

Piccoli, Michele; Di Giulio, Paola; Ruffino, Emanuele; Zollesi, Germana; Dello Russo, Carolina

2006-01-01

An experience of a tentative contribution of the nurses to the health policy planning is described. Fifty one focus groups were organized, with nurses from different contexts (hospital, district, free lance nurses; caring for paediatric, geriatric surgical and medical patients) and nurses were asked to identify problems encountered in patients care, select one, discuss contributing causes assign a weight (from 1 to 100) and define the nurses' contribution to the resolution/improvement of each cause. The problems were discussed in groups and possible solutions identified, with specific attention to the potential implications of regional health policies. The main difficulties identified were the lack of continuity in patients care (for geriatric and paediatrics patients), 12 groups, and the management of chronic patients (7 groups); the lack of information to patients, 6 groups; the appropriateness of care, from hospital admissions to waiting lists, 5 groups; the management of surgical patients, 5 groups; the lack of nursing personnel, 5 groups; the safety of patients and health personnel, 4 groups; and other problems reported by less than 3 groups. This experience allowed nurses to reflect on health care problems throughout the trajectory from the specific problem to its general implications, also for the health care policies. The solutions identified in fact, encompass a dimension relevant for health policy planning. It is also an experience of opportunity (and feasibility) of involvement of the "general nurses" and not only nurse managers, to reflect on practice and propose a specific and original contribution to the development of regional and local policies.

Benefits of Hindsight: Design Problems in Evaluating Innovation in Medical Education.

ERIC Educational Resources Information Center

Skipper, James K., Jr.; And Others

1989-01-01

An evaluation of an experimental problem-based medical education curriculum used with 18 first-year students at the Bowman Gray Medical School of Wake Forest University is discussed. The study, which included a matched group of students experiencing a traditional curriculum, provides insights into design problems in such evaluations. (TJH)

A new virtual-reality training module for laparoscopic surgical skills and equipment handling: can multitasking be trained? A randomized controlled trial.

PubMed

Bongers, Pim J; Diederick van Hove, P; Stassen, Laurents P S; Dankelman, Jenny; Schreuder, Henk W R

2015-01-01

During laparoscopic surgery distractions often occur and multitasking between surgery and other tasks, such as technical equipment handling, is a necessary competence. In psychological research, reduction of adverse effects of distraction is demonstrated when specifically multitasking is trained. The aim of this study was to examine whether multitasking and more specifically task-switching can be trained in a virtual-reality (VR) laparoscopic skills simulator. After randomization, the control group trained separately with an insufflator simulation module and a laparoscopic skills exercise module on a VR simulator. In the intervention group, insufflator module and VR skills exercises were combined to develop a new integrated training in which multitasking was a required competence. At random moments, problems with the insufflator appeared and forced the trainee to multitask. During several repetitions of a different multitask VR skills exercise as posttest, performance parameters (laparoscopy time, insufflator time, and errors) were measured and compared between both the groups as well with a pretest exercise to establish the learning effect. A face-validity questionnaire was filled afterward. University Medical Centre Utrecht, The Netherlands. Medical and PhD students (n = 42) from University Medical Centre Utrecht, without previous experience in laparoscopic simulation, were randomly assigned to either intervention (n = 21) or control group (n = 21). All participants performed better in the posttest exercises without distraction of the insufflator compared with the exercises in which multitasking was necessary to solve the insufflator problems. After training, the intervention group was significantly quicker in solving the insufflator problems (mean = 1.60Log(s) vs 1.70Log(s), p = 0.02). No significant differences between both the groups were seen in laparoscopy time and errors. Multitasking has negative effects on the laparoscopic performance. This study suggests an additional learning effect of training multitasking in VR laparoscopy simulation, because the trainees are able to handle a secondary task (solving insufflator problems) quicker. These results may aid the development of laparoscopy VR training programs in approximating real-life laparoscopic surgery. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Mineral waters, electricity, and hemlock: devising therapeutics for children in eighteenth-century institutions.

PubMed

Mathisen, Ashley

2013-01-01

The development of paediatric medicine as a formal field of medical specialisation is usually traced to the mid-nineteenth century at the earliest. While it is true that formal specialisation in children's medicine was not, on the whole, typical for eighteenth-century medical practitioners, many displayed a deep and lasting interest in the diseases of children, and were consequently eager to develop therapeutic practices which could be targeted at infants and children. This led to a variety of attempts at innovation, many of which benefitted from the co-operation of, and opportunities afforded by, institutions. By examining the efforts of several medical practitioners at the London Foundling Hospital and at the Dispensary for the Infant Poor, this article explores how eighteenth-century medical practitioners used their affiliations with institutions to address the problems of devising or adapting therapeutic practices and treatments for children. In tailoring medical practice to suit children and, more specifically, in using institutions to do so, medical practitioners were demonstrating that child patients required special consideration, that children's diseases could be managed medically and with the benefit of new approaches and methods, and that children's health, as a whole, was the province of medical practitioners.

[Knowledge of AIDS of the medical students from three Mexican universities].

PubMed

Jarillo Soto, E C; Delgadillo Gutiérrez, H J; Granados Cosme, J A

2000-01-01

The Hegemonic Medical Model is discussed and is articulated with the postulates of the sociology of the professions. The information takes Aids as a specific topic, because it involves the aspects of recent scientific development, of clinical and epidemiological importance and due to the research which is being done for its treatment and the production of immunizations. This is a case study of students enrolled in different years of study for medical degrees at the three main universities in México City. A closed-question questionnaire was handed out, checked and corrected, the variables of which were related to three types of knowledge, that is, basic, technical and general. The students were revealed to master this subject to only a minor extent the extensions of the knowledge of the disciplines of the profession however being applied to new cases without the suitable accuracy. A certain degree of dissociation was found to exist among the different types of knowledge which were researched, the professional know-how having been noted to clearly conform within specialized, segmented, curative logic of the Hegemonic Medical Model. The technical, problem-solving knowledge employed in clinical use prevails over the systematic, abstract knowledge of the general knowledge of medicine. A clear notion of the processes based on the dominant medical pattern is revealed in the single-causal relations of the disease. There is an extension of the basic knowledge a the resolving of clinical problems. The medical students are oriented toward taking in knowledge which will be useful to them in clinical practice.

Perspectives in medical education 9. Revisiting the blueprint for reform of medical education in Japan.

PubMed

Rao, R Harsha; Rao, Kanchan H

2010-01-01

Reform of medical education at Keio University has been underway since 2003. We measure the progress made since then in five specific categories that span fifteen recommendations presented in our "Blueprint for Reform" at the outset of the effort. These are effectiveness of leadership, curriculum reform, recognition of teaching, clinical competence, and comprehensive training in general internal medicine (GIM). First, effective leadership is being sustained through a succession of Deans, although a potentially crippling loss of leadership in the Department of Medical Education must be offset through timely appointment. Second, curriculum reform is awaiting the implementation in 2012 of an integrated, organ system-based curriculum with an emphasis on ward clerkships, but the introduction of PBL has been delayed indefinitely. Third, teaching is being recognized through the use of student feedback to reward good teachers and through funds for six full-time equivalent salaries dedicated to medical education, but promotions still depend exclusively on research, without consideration of teaching ability. Fourth, clinical skills training is still lacking, although enthusiasm for it seems to be building, thanks to the presence on the wards of a (still miniscule) cadre of dedicated teachers. Finally, exposure to GIM remains non-existent; however, visionary leadership in a newly-independent Emergency Department and the wide variety of medical problems seen there provide a remarkable opportunity to craft a uniquely Japanese solution to the problem. The changes implemented to date are impressive, and we remain enthusiastic about the future, even as we recognize the magnitude of the task that lies ahead.

In-flight cardiac arrest and in-flight cardiopulmonary resuscitation during commercial air travel: consensus statement and supplementary treatment guideline from the German Society of Aerospace Medicine (DGLRM).

PubMed

Hinkelbein, Jochen; Böhm, Lennert; Braunecker, Stefan; Genzwürker, Harald V; Kalina, Steffen; Cirillo, Fabrizio; Komorowski, Matthieu; Hohn, Andreas; Siedenburg, Jörg; Bernhard, Michael; Janicke, Ilse; Adler, Christoph; Jansen, Stefanie; Glaser, Eckard; Krawczyk, Pawel; Miesen, Mirko; Andres, Janusz; De Robertis, Edoardo; Neuhaus, Christopher

2018-05-05

By the end of the year 2016, approximately 3 billion people worldwide travelled by commercial air transport. Between 1 out of 14,000 and 1 out of 50,000 passengers will experience acute medical problems/emergencies during a flight (i.e., in-flight medical emergency). Cardiac arrest accounts for 0.3% of all in-flight medical emergencies. So far, no specific guideline exists for the management and treatment of in-flight cardiac arrest (IFCA). A task force with clinical and investigational expertise in aviation, aviation medicine, and emergency medicine was created to develop a consensus based on scientific evidence and compiled a guideline for the management and treatment of in-flight cardiac arrests. Using the GRADE, RAND, and DELPHI methods, a systematic literature search was performed in PubMed. Specific recommendations have been developed for the treatment of IFCA. A total of 29 specific recommendations for the treatment and management of in-flight cardiac arrests were generated. The main recommendations included emergency equipments as well as communication of the emergency. Training of the crew is of utmost importance, and should ideally have a focus on CPR in aircraft. The decision for a diversion should be considered very carefully.

Engineering RNA for Targeted siRNA Delivery and Medical Application

PubMed Central

Guo, Peixuan; Coban, Oana; Snead, Nick; Trebley, Joe; Hoeprich, Steve; Guo, Songchuan; Shu, Yi

2010-01-01

RNA engineering for nanotechnology and medical applications is an exciting emerging research field. RNA has intrinsically defined features on the nanometer scale and is a particularly interesting candidate for such applications due to its amazing diversity, flexibility and versatility in structure and function. Specifically, the current use of siRNA to silence target genes involved in disease has generated much excitement in the scientific community. The intrinsic ability to sequence-specifically down-regulate gene expression in a temporally- and spatially-controlled fashion has led to heightened interest and rapid development of siRNA-based therapeutics. Though methods for gene silencing with high efficacy and specificity have been achieved in vitro, the effective delivery of nucleic acids to specific cells in vivo has been a hurdle for RNA therapeutics. This review covers different RNA-based approaches for diagnosis, prevention and treatment of human disease, with a focus on the latest developments of nonviral carriers of siRNA for delivery in vivo. The applications and challenges of siRNA therapy, as well as potential solutions to these problems, the approaches for using phi29 pRNA-based vectors as polyvalent vehicles for specific delivery of siRNA, ribozymes, drugs or other therapeutic agents to specific cells for therapy will also be addressed. PMID:20230868

Action research to promote medical students' motivation in an English for Specific Purposes class.

PubMed

Dehnad, Afsaneh; Nasser, Hayedeh

2014-01-01

Action research is an attempt to seek immediate solutions to the problems experienced in educational settings. In this type of research, teachers are the researchers who intend to make instant reforms to develop, and improve their teaching styles and reflect on pedagogical practices. The purpose of this study was to conduct an action research to tackle the problem of students' low motivation in English classes at the medical school of Iran University of Medical Sciences in fall 2010. Participants of this study were 98 third-semester ESP students of medicine. To reform the situation and promote students' motivation to participate in classes more actively and eagerly, the researchers changed the syllabus by applying Kemmis and McTaggart's (1988) cyclical model of action research, and adopting task-based teaching. Data was collected by means of interviews with both teachers and students to determine the changes to be made in the syllabus, classroom observations to monitor students' behavioral changes, and a questionnaire to assess students' attitudes towards the changes. This research study had a number of valuable outcomes the most important of which was a change in classroom behavior of the students.

Optimal distribution of medical backpacks and health surveillance assistants in Malawi.

PubMed

Kunkel, Amber G; Van Itallie, Elizabeth S; Wu, Duo

2014-09-01

Despite recent progress, Malawi continues to perform poorly on key health indicators such as child mortality and life expectancy. These problems are exacerbated by a severe lack of access to health care. Health Surveillance Assistants (HSAs) help bridge this gap by providing community-level access to basic health care services. However, the success of these HSAs is limited by a lack of supplies and long distances between HSAs and patients. To address this issue, we used large-scale weighted p-median and capacitated facility location problems to create a scalable, three-tiered plan for optimal allocation of HSAs, HSA designated medical backpacks, and backpack resupply centers. Our analysis uses real data on the location and characteristics of hospitals, health centers, and the general population. In addition to offering specific recommendations for HSA, backpack, and resupply center locations, it provides general insights into the scope of the proposed HSA backpack program scale-up. In particular, it demonstrates the importance of local health centers to the resupply network. The proposed assignments are robust to changes in the underlying population structure, and could significantly improve access to medical supplies for both HSAs and patients.

The Role of Specific Alcohol-Related Problems in Predicting Depressive Experiences in a Cross-Sectional National Household Survey.

PubMed

McBride, Orla; Cheng, Hui G; Slade, Tim; Lynskey, Michael T

2016-11-01

This study examines the type of alcohol-related problems that commonly occur before the onset of depressive experiences to shed light on the mechanisms underlying the alcohol-depression comorbidity relationship. Data were from the 1992 USA National Longitudinal Alcohol Epidemiologic Survey. Analytical sample comprised of drinkers with a prior to past year (PPY) history of alcohol-related problems with or without any experiences of depressed mood in the past year (PY). The prevalence of PPY alcohol-related problems was examined, as well as the ability of specific alcohol problems to predict PY experiences of depressed mood. The type of depressed mood experienced by drinkers with PPY history of alcohol-related problems was compared to those without. All but one alcohol-related problem PPY was more frequently endorsed among drinkers with PY experiences of depressed mood. Controlling for confounders, five alcohol-related problems experienced PPY were significantly predictive of depressed mood PY: tolerance, drinking longer than intended, inability to perform important social and occupational roles/obligations, as well as drinking in physically hazardous situations. Drinkers with alcohol-related problems PPY more frequently experienced difficulties with concentration, energy, and thoughts of death, than those without. Alcohol-related problems are likely associated with depressive experiences through a complex network, whereby experiences of physical dependence and negative consequences increase the likelihood of negative affect. Novel study designs are necessary to fully understand the complex mechanisms underlying this comorbidity. © The Author 2016. Medical Council on Alcohol and Oxford University Press. All rights reserved.

MUNICIPAL WASTE COMBUSTION ASSESSMENT ...

EPA Pesticide Factsheets

The report defines and characterizes types of medical waste, discusses the impacts of burning medical waste on combustor emissions, and outlines important handling and operating considerations. Facility-specific design, handling, and operating practiced are also discussed for municipal waste combustors (MWCs) that reportedly accept medical waste in the U.S., Europe, and Canada. nly very limited data are available on the emission impacts associated with the combustion of medical waste in MWGs. Especially lacking is information needed to fully evaluate the impacts on acid gas, dioxin, and metals emissions, as well as the design and operating requirements for complete destruction of solvents, cytotoxic chemicals, and pathogens. The EPA's Office of Air Quatity Planning and Standards is developing emission standards and guidelines for new and existing MWCs under Sections 111(b) and 111(d) of the Clean Air Act. In support of these regulatory development efforts, the Air and Energy Engineering Research Laboratory in EPA's Office of Research and Development has conducted an assessment to examine the incineration of medical waste in MWGs from an emission standpoint. Potential worker safety and health problems associated with handling of medical wastes and residues were also identified. information

Medical overuse in the Iranian healthcare system: a systematic review protocol.

PubMed

Arab-Zozani, Morteza; Pezeshki, Mohammad Zakaria; Khodayari-Zarnaq, Rahim; Janati, Ali

2018-04-17

Lack of resources is one of the main problems of all healthcare systems. Recent studies have shown that reducing the overuse of medical services plays an important role in reducing healthcare system costs. Overuse of medical services is a major problem in the healthcare system, and it threatens the quality of the services, can harm patients and create excess costs for patients. So far, few studies have been conducted in this regard in Iran. The main objective of this systematic review is to perform an inclusive search for studies that report overuse of medical services in the Iranian healthcare system. An extensive search of the literature will be conducted in six databases including PubMed, Embase, Scopus, Web of Science, Cochrane and Scientific Information Database using a comprehensive search strategy to identify studies on overuse of medical care. The search will be done without time limit until the end of 2017, completed by reference tracking, author tracking and expert consultation. The search will be conducted on 1 February 2018. Any study that reports an overuse in a service based on a specific standard will be included in the study. Two reviewers will screen the articles based on the title, abstract and full text, and extract data about type of service, clinical area and overuse rate. Quality appraisal will be assessed using the Joanna Briggs Institute checklist. Potential discrepancies will be resolved by consulting a third author. Recommendations will be made to the Iranian MOHME (Ministry of Health and Medical Education) in order to make better evidence-based decisions about medical services in the future. CRD42017075481. © 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.

EPA guidance on improving the image of psychiatry.

PubMed

Möller-Leimkühler, A M; Möller, H-J; Maier, W; Gaebel, W; Falkai, P

2016-03-01

This paper explores causes, explanations and consequences of the negative image of psychiatry and develops recommendations for improvement. It is primarily based on a WPA guidance paper on how to combat the stigmatization of psychiatry and psychiatrists and a Medline search on related publications since 2010. Furthermore, focussing on potential causes and explanations, the authors performed a selective literature search regarding additional image-related issues such as mental health literacy and diagnostic and treatment issues. Underestimation of psychiatry results from both unjustified prejudices of the general public, mass media and healthcare professionals and psychiatry's own unfavourable coping with external and internal concerns. Issues related to unjustified devaluation of psychiatry include overestimation of coercion, associative stigma, lack of public knowledge, need to simplify complex mental issues, problem of the continuum between normality and psychopathology, competition with medical and non-medical disciplines and psychopharmacological treatment. Issues related to psychiatry's own contribution to being underestimated include lack of a clear professional identity, lack of biomarkers supporting clinical diagnoses, limited consensus about best treatment options, lack of collaboration with other medical disciplines and low recruitment rates among medical students. Recommendations are proposed for creating and representing a positive self-concept with different components. The negative image of psychiatry is not only due to unfavourable communication with the media, but is basically a problem of self-conceptualization. Much can be improved. However, psychiatry will remain a profession with an exceptional position among the medical disciplines, which should be seen as its specific strength.

Group psychotherapy with older adults.

PubMed

Saiger, G M

2001-01-01

This article describes a psychodynamically oriented psychotherapy group for older adults conducted in an agency setting, highlighting the problems specific to such groups. The literature on such groups for older adults is reviewed. The issues discussed are the psychology of late life, diagnostic considerations, medical illness and dementia as complicating factors, the issue of caretaking, and the centrality of shame. A systems-oriented approach to understanding the group's success is suggested.

Study of aerospace technology utilization in the civilian biomedical field

NASA Technical Reports Server (NTRS)

1976-01-01

The treatment of patients with acute pulmonary or cardiovascular diseases is used to demonstrate the benefits to be derived from a more extensive application of NASA technology in public health care. Significant and rather universal problems faced by the medical profession and supporting services are identified. The required technology and specifications for its development and evaluation are delineated. Institutional relationships and collaboration needed to accomplish technology transfer are developed.

Post-Hospital Discharge Care: A Retrospective Cohort Study Exploring the Value of Pharmacist-Enhanced Care and Describing Medication-Related Problems.

PubMed

Hawes, Emily M; Pinelli, Nicole R; Sanders, Kimberly A; Lipshutz, Andrew M; Tong, Gretchen; Sievers, Lauren S; Chao, Sarah; Gwynne, Mark

2018-01-01

BACKGROUND Medication-related problems occur at high rates during care transitions. Evidence suggests that pharmacists are well-suited to identify and resolve medication-related problems during hospital admission and at discharge. Additional evidence is needed to understand the impact of face-to-face pharmacist visits in primary care after discharge. The purpose of the study was to describe medication-related problems found during face-to-face pharmacist visits in a medical home after hospital discharge. METHODS A retrospective cohort study was conducted within an academic primary care center staffed by family medicine trained physicians that evaluated patients who attended a hospital follow-up visit with pharmacist-enhanced care (N = 86) versus usual care (N = 86). The primary objective was to describe medication-related problems identified by pharmacists using a modified individualized Medication Assessment and Planning tool for patients receiving pharmacist-enhanced care. Secondary analyses were also conducted to compare 30-day and 60-day hospital readmission and emergency department visit rates in those exposed to pharmacist-enhanced care versus those who were not. RESULTS At baseline, the mean hospitalizations in the prior year were 1.1 ± 1.7 (pharmacist-enhanced care) and 0.76 ± 1.2 (usual care), indicating a low initial readmission risk. Of patients receiving pharmacist-enhanced care, 97.7% were found to have at least 1 medication-related problem, with an average of 4.36 medication-related problems per patient. The 30-day readmission rate was lower, but not significantly different between groups (8.1% for pharmacist-enhanced care versus 12.8% for usual care; adjusted odds ratio (OR), 0.47; 95% confidence interval (CI), 0.16-1.36). LIMITATIONS Limitations include the retrospective cohort study design and small sample size. Medication-related problems were identified and collected prospectively during pharmacist visits. CONCLUSION Medication-related problems are ubiquitous after hospital discharge. Larger prospective studies will be needed to understand the potential value of pharmacist-enhanced care during hospital follow-up visits on readmission rates in low-risk patient populations receiving care within a primary care medical home. ©2018 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Process-outcome interrelationship and standard setting in medical education: the need for a comprehensive approach.

PubMed

Christensen, Leif; Karle, Hans; Nystrup, Jørgen

2007-09-01

An outcome-based approach to medical education compared to a process/content orientation is currently being discussed intensively. In this article, the process and outcome interrelationship in medical education is discussed, with specific emphasis on the relation to the definition of standards in basic medical education. Perceptions of outcome have always been an integrated element of curricular planning. The present debate underlines the need for stronger focus on learning objectives and outcome assessment in many medical schools around the world. The need to maintain an integrated approach of process/content and outcome is underlined in this paper. A worry is expressed about the taxonomy of learning in pure outcome-based medical education, in which student assessment can be a major determinant for the learning process, leaving the control of the medical curriculum to medical examiners. Moreover, curricula which favour reductionism by stating everything in terms of instrumental outcomes or competences, do face a risk of lowering quality and do become a prey for political interference. Standards based on outcome alone rise unclarified problems in relationship to licensure requirements of medical doctors. It is argued that the alleged dichotomy between process/content and outcome seems artificial, and that formulation of standards in medical education must follow a comprehensive line in curricular planning.

Health Problems during Compulsory Military Service Predict Disability Retirement: A Register-Based Study on Secular Trends during 40 Years of Follow-Up.

PubMed

Frilander, Heikki; Lallukka, Tea; Viikari-Juntura, Eira; Heliövaara, Markku; Solovieva, Svetlana

2016-01-01

Disability retirement causes a significant burden on the society and affects the well-being of individuals. Early health problems as determinants of disability retirement have received little attention. The objective was to study, whether interrupting compulsory military service is an early indicator of disability retirement among Finnish men and whether seeking medical advice during military service increases the risk of all-cause disability retirement and disability retirement due to mental disorders and musculoskeletal diseases. We also looked at secular trends in these associations. We examined a nationally representative sample of 2069 men, who had entered military service during 1967-1996. We linked military service health records with cause-specific register data on disability retirement from 1968 to 2008. Secular trends were explored in three service time strata. We used the Cox regression model to estimate proportional hazard ratios and their 95% confidence intervals. During the follow-up time altogether 140 (6.8%) men retired due to disability, mental disorders being the most common cause. The men who interrupted service had a remarkably higher cumulative incidence of disability retirement (18.9%). The associations between seeking medical advice during military service and all-cause disability retirement were similar across the three service time cohorts (overall hazard ratio 1.40 per one standard deviation of the number of visits; 95% confidence interval 1.26-1.56). Visits due to mental problems predicted disability retirement due to mental disorders in the men who served between 1987 and 1996 and a tendency for a similar cause-specific association was seen for musculoskeletal diseases in the men who served in 1967-1976. In conclusion, health problems-in particular mental problems-during late adolescence are strong determinants of disability retirement. Call-up examinations and military service provide access to the entire age cohort of men, where persons at risk for work disability can be identified and early preventive measures initiated.

Is IPT Time-Limited Psychodynamic Psychotherapy?

PubMed Central

Markowitz, John C.; Svartberg, Martin; Swartz, Holly A.

1998-01-01

Interpersonal psychotherapy (IPT) has sometimes but not always been considered a psychodynamic psychotherapy. The authors discuss similarities and differences between IPT and short-term psychodynamic psychotherapy (STPP), comparing eight aspects: 1) time limit, 2) medical model, 3) dual goals of solving interpersonal problems and syndromal remission, 4) interpersonal focus on the patient solving current life problems, 5) specific techniques, 6) termination, 7) therapeutic stance, and 8) empirical support. The authors then apply both approaches to a case example of depression. They conclude that despite overlaps and similarities, IPT is distinct from STPP.(The Journal of Psychotherapy Practice and Research 1998; 7:185–195) PMID:9631340

An introductory pharmacy practice experience based on a medication therapy management service model.

PubMed

Agness, Chanel F; Huynh, Donna; Brandt, Nicole

2011-06-10

To implement and evaluate an introductory pharmacy practice experience (IPPE) based on the medication therapy management (MTM) service model. Patient Care 2 is an IPPE that introduces third-year pharmacy students to the MTM service model. Students interacted with older adults to identify medication-related problems and develop recommendations using core MTM elements. Course outcome evaluations were based on number of documented medication-related problems, recommendations, and student reviews. Fifty-seven older adults participated in the course. Students identified 52 medication-related problems and 66 medical problems, and documented 233 recommendations relating to health maintenance and wellness, pharmacotherapy, referrals, and education. Students reported having adequate experience performing core MTM elements. Patient Care 2 may serve as an experiential learning model for pharmacy schools to teach the core elements of MTM and provide patient care services to the community.

What makes up good consultations? A qualitative study of GPs' discourses.

PubMed

Van Roy, Kaatje; Vanheule, Stijn; Deveugele, Myriam

2013-05-16

In medical literature, several principles that define 'good consultations' have been outlined. These principles tend to be prescriptive in nature, overlooking the complexity of general practitioners (GPs)' perspectives of everyday practice. Focusing on perspectives might be particularly relevant, since they may affect decisions and actions. Therefore, the present study adopts a bottom-up approach, analyzing GPs' narratives about 'good' and 'bad' consultations. We aimed at describing the range of discourses GPs use in relating on their practice. Semi-structured interviews were conducted with 19 Belgian GPs. By means of a qualitative analysis, the authors mapped patterns in the interview narratives and described the range of different discourses. Four discourses were identified: a biomedically-centered discourse, a communication-focused discourse, a problem-solving discourse and a satisfaction-oriented discourse. Each discourse was further specified in terms of predominant themes, problems the GPs prefer to deal with and inherent difficulties. Although most participants used elements from all four discourses, the majority of the GPs relied on an individual set of predominant discourses and focused on a limited number of themes. This study clearly indicates that there is no uniform way in which GPs perceive clinical practice. Each of the participants used a subtle mix of different criteria to define good and bad medical consultations. Some discourse elements appear to be rooted in medical literature, whereas others are of a more personal nature. By focusing on the limitations of each discourse, this study can shed new light on some of the difficulties GPs encounter in their daily practice: being confronted with specific problems might be an effect of adhering to a specific discourse. The typification of different discourses on consultations may function as a framework to help GPs reflect on how they perceive their practice, and help them manage some of the challenges met in daily practice.

Effective chronic disease management: patients' perspectives on medication-related problems.

PubMed

Gordon, Karen; Smith, Felicity; Dhillon, Soraya

2007-03-01

To examine medication-related problems from the perspective of patients with a chronic condition and to identify how they may be supported in managing their medication. Patients prescribed medication for cardiovascular disease were recruited through five general medical surgeries and four community pharmacies in south London. Data were collected in 98 face-to-face interviews in participants' own homes. Interviews were designed to enable a detailed and holistic exploration of medication-related problems from participants' perspectives. Data were audio-recorded and transcribed verbatim to allow qualitative analysis. Five broad categories of medication-related problem emerged which were examined in the context of patients' perspectives on, and experiences of, the use of medicines and health services. These were concerns about and management of side effects; differing views regarding the use of medicines; cognitive, practical and sensory problems; lack of information or understanding; and problems with access to, and organisation of, services. All categories of problem had potential implications for the success of therapy in that they created barriers to adherence, access to medication or informed decision-making. The study demonstrated how patients actively engage in decision-making about their medicines in the home, if not in the consultation. The five categories of problem provide a focus for interventions by health professionals to support patients in achieving optimal theory outcomes. They demonstrate the need for a comprehensive approach, spanning patient education to the systems of delivery of care. Within the NHS in Britain, policy and practice initiatives are being designed to achieve this end. Further research should focus on the evaluation of professional practices and service developments in supporting patients in the self-management of their medicines.

Predictors of trajectories of epilepsy-specific quality of life among children newly diagnosed with epilepsy.

PubMed

Ramsey, Rachelle R; Loiselle, Kristin; Rausch, Joseph R; Harrison, Jordan; Modi, Avani C

2016-04-01

The objective of this study was to identify two-year trajectories of epilepsy-specific health-related quality of life (HRQOL) among children newly diagnosed with epilepsy and to evaluate the predictive value of a comprehensive set of medical, psychosocial, and family factors. Ninety-four children with epilepsy (8.14 ± 2.37 years of age and 63% male) and their caregivers participated in this study. Caregivers completed the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE) and measures of psychological and family functioning at one month postdiagnosis. The QOLCE was also given at eight additional time points during the subsequent two years as a part of a large observational study in children with epilepsy. Adherence data were collected via MEMS TrackCaps, and medical information was collected through chart review. Unique trajectories were identified for the overall QOLCE scale, as well as the subscales. Most trajectory models for the QOLCE subscales contained at least one at-risk trajectory for children, indicating that there is a subgroup of children experiencing poor long-term HRQOL. Health-related quality-of-life trajectories remained predominantly stable during the two-year period following treatment initiation. The number of AEDs, internalizing problems, and externalizing problems emerged as the most consistent predictors across the HRQOL domains. Medical and psychosocial interventions, such as cognitive-behavioral strategies, should target modifiable factors (e.g., internalizing symptoms, externalizing symptoms, number of AEDs trialed) shortly after diagnosis to improve HRQOL for children with epilepsy over the course of their disease. Copyright © 2016 Elsevier Inc. All rights reserved.

[Limitations and Problems with Treatment of Eating Disorders in a Psychiatric Hospital].

PubMed

Amayasu, Hideaki; Okubo, Momoe; Itai, Takahiro

2015-01-01

Treating patients who have eating disorders in psychiatric hospitals is difficult for several reasons. The first reason is that there is a shortage of qualified psychiatrists. For each psychiatrist, there are approximately thirty hospitalized patients. In addition to this limited number of psychiatrists, funding in psychiatric hospitals only provides for a limited number of other medical staff when compared with funding available for general hospitals. The second reason is that there is a problem with the national medical treatment fee system. Specifically, in the current system, patients are not permitted to stay in hospitals long-term; outpatient treatment is preferred. The third reason is that psychiatric hospitals are not equipped to deal with patients who have physical illnesses. The following two case studies highlight the problems and limitations associated with treating patients who have eating disorders. Ways in which psychiatric hospitals can collaborate with other organizations, including low enforcement officials, are also considered. Although it is clear that an integrated and collaborative approach is necessary, implementation of such a system is still a long way from being realized, and greater effort is needed to provide patients suffering from eating disorders with the best possible treatment.

Quantitative Evaluation of Third Year Medical Students' Perception and Satisfaction from Problem Based Learning in Anatomy: A Pilot Study of the Introduction of Problem Based Learning into the Traditional Didactic Medical Curriculum in Nigeria

ERIC Educational Resources Information Center

Saalu, L. C.; Abraham A. A.; Aina, W. O.

2010-01-01

Problem-based learning (PBL) is a method of teaching that uses hypothetical clinical cases, individual investigation and group process. In recent years, in medical education, problem-based learning (PBL) has increasingly been adopted as the preferred pedagogy in many countries around the world. Controversy, however, still exists as the potential…

Hypochondria as withdrawal and comedy as cure in Dr. Willibald's Der Hypochondrist (1824).

PubMed

Potter, Edward T

2012-01-01

Balthasar von Ammann's comedy Der Hypochondrist, published in 1824 under the pseudonym Dr. Willibald, foregrounds the social, sexual, and political implications of hypochondria. The play engages with early nineteenth-century medical and popular conceptions of hypochondria to co-opt potentially subversive elements and to promote a specific social, sexual, and political agenda. The text promotes literature — specifically comedic drama — as a cure for hypochondria. Hypochondria functions as a code for withdrawal. The hypochondriac withdraws medically from healthy society, gaining exceptional status. He withdraws sexually from society by remaining a bachelor, possibly engaged in non-normative sexual behaviour. Furthermore, the politically disenfranchised protagonist voices his political frustrations via a coded medical metaphor. The hypochondriac poses a threefold challenge to the social, sexual, and political order, and the play engages with contemporary conceptions of the disease to provide the solution: comedy. The text, presented as a cure for hypochondria, replaces the coded questioning of the social order via hypochondria with the less threatening code of heraldry. A comedy-within-the-comedy uses the hypochondriac's love of heraldry to cure him, resulting in the elimination of his medical problems and exceptional status, in the purification of his bachelorhood from non-normative elements, and in the pre-emption of political frustrations.

Understanding the value of mixed methods research: the Children's Safety Initiative-Emergency Medical Services.

PubMed

Hansen, Matthew; O'Brien, Kerth; Meckler, Garth; Chang, Anna Marie; Guise, Jeanne-Marie

2016-07-01

Mixed methods research has significant potential to broaden the scope of emergency care and specifically emergency medical services investigation. Mixed methods studies involve the coordinated use of qualitative and quantitative research approaches to gain a fuller understanding of practice. By combining what is learnt from multiple methods, these approaches can help to characterise complex healthcare systems, identify the mechanisms of complex problems such as medical errors and understand aspects of human interaction such as communication, behaviour and team performance. Mixed methods approaches may be particularly useful for out-of-hospital care researchers because care is provided in complex systems where equipment, interpersonal interactions, societal norms, environment and other factors influence patient outcomes. The overall objectives of this paper are to (1) introduce the fundamental concepts and approaches of mixed methods research and (2) describe the interrelation and complementary features of the quantitative and qualitative components of mixed methods studies using specific examples from the Children's Safety Initiative-Emergency Medical Services (CSI-EMS), a large National Institutes of Health-funded research project conducted in the USA. 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/

Mental health in young adults and adolescents - supporting general physicians to provide holistic care.

PubMed

Jurewicz, Izabela

2015-04-01

In the era of an ageing population, young adults on medical wards are quite rare, as only 12% of young adults report a long-term illness or disability. However, mental health problems remain prevalent in the younger population. In a recent report, mental health and obesity were listed as the most common problems in young adults. Teams set up specifically for the needs of younger adults, such as early intervention in psychosis services are shown to work better than traditional care and have also proven to be cost effective. On the medical wards, younger patients may elicit strong emotions in staff, who often feel protective and may identify strongly with the young patient's suffering. In order to provide holistic care for young adults, general physicians need to recognise common presentations of mental illness in young adults such as depression, deliberate self-harm, eating disorders and substance misuse. Apart from treating illness, health promotion is particularly important for young adults. © 2015 Royal College of Physicians.

Concept-oriented indexing of video databases: toward semantic sensitive retrieval and browsing.

PubMed

Fan, Jianping; Luo, Hangzai; Elmagarmid, Ahmed K

2004-07-01

Digital video now plays an important role in medical education, health care, telemedicine and other medical applications. Several content-based video retrieval (CBVR) systems have been proposed in the past, but they still suffer from the following challenging problems: semantic gap, semantic video concept modeling, semantic video classification, and concept-oriented video database indexing and access. In this paper, we propose a novel framework to make some advances toward the final goal to solve these problems. Specifically, the framework includes: 1) a semantic-sensitive video content representation framework by using principal video shots to enhance the quality of features; 2) semantic video concept interpretation by using flexible mixture model to bridge the semantic gap; 3) a novel semantic video-classifier training framework by integrating feature selection, parameter estimation, and model selection seamlessly in a single algorithm; and 4) a concept-oriented video database organization technique through a certain domain-dependent concept hierarchy to enable semantic-sensitive video retrieval and browsing.

Flexible endoscopes: structure and function. The suction and biopsy channel.

PubMed

Holland, P

2001-01-01

Flexible endoscopes are complex medical instruments that are easily damaged. To maintain the flexible endoscope in optimum working condition, the user must have a thorough understanding of the structure and function of the instrument. This is the second in a series of articles presenting an in-depth look at the care and handling of the flexible endoscope. The first article discussed the air and water system. This article will focus specifically on the suction and biopsy channel system. The flexible endoscope is constructed of several systems that operate simultaneously to produce a highly technical, yet effective diagnostic and therapeutic medical device. These systems include the air and water system, the suction or operating channel system, the mechanical system, the endoscopic retrograde cholangiopancreatography (ERCP) elevator system, the optical system, and the electrical system. A review of the internal and external structure of the flexible endoscope and the functions of the channel system, including infection control issues, potential problems and evaluation, and prevention of minor problems to avoid expensive repairs, will be addressed.

Isolation of sulfur reducing and oxidizing bacteria found in contaminated drywall.

PubMed

Hooper, Dennis G; Shane, John; Straus, David C; Kilburn, Kaye H; Bolton, Vincent; Sutton, John S; Guilford, Frederick T

2010-02-05

Drywall from China has been reported to release sulfur producing products which are corrosive to metals, result in noxious odors, and represent a significant health risk. It has been reported that these emissions produce medical symptoms such as respiratory or asthma type problems, sinusitis, gastrointestinal disorders, and vision problems in home owners and their household pets. We report here a method of identifying a causative agent for these emissions by sampling affected gypsum wallboard and subjecting those samples to Real Time Polymerase Chain Reaction [RT-PCR] studies. Specific DNA probes and primers have been designed and patented that detect a specific iron and sulfur reducing bacterium (i.e., Thiobacillus ferrooxidans). One hundred percent of affected drywall samples obtained from homes located in the southeastern United States tested positive for the presence of T. ferrooxidans. All negative controls consisting of unaffected wallboard and internal controls, Geotrichum sp., tested negative within our limits of detection.

Isolation of Sulfur Reducing and Oxidizing Bacteria Found in Contaminated Drywall

PubMed Central

Hooper, Dennis G.; Shane, John; Straus, David C.; Kilburn, Kaye H.; Bolton, Vincent; Sutton, John S.; Guilford, Frederick T.

2010-01-01

Drywall from China has been reported to release sulfur producing products which are corrosive to metals, result in noxious odors, and represent a significant health risk. It has been reported that these emissions produce medical symptoms such as respiratory or asthma type problems, sinusitis, gastrointestinal disorders, and vision problems in home owners and their household pets. We report here a method of identifying a causative agent for these emissions by sampling affected gypsum wallboard and subjecting those samples to Real Time Polymerase Chain Reaction [RT-PCR] studies. Specific DNA probes and primers have been designed and patented that detect a specific iron and sulfur reducing bacterium (i.e., Thiobacillus ferrooxidans). One hundred percent of affected drywall samples obtained from homes located in the southeastern United States tested positive for the presence of T. ferrooxidans. All negative controls consisting of unaffected wallboard and internal controls, Geotrichum sp., tested negative within our limits of detection. PMID:20386658

Adaptation and readaptation medical concerns of a Mars trip

NASA Technical Reports Server (NTRS)

Johnson, Philip C.

1986-01-01

The ability of the human body to adapt to microgravity environments and to later readapt to a gravity environment was examined. Issues specifically relating to the effects of long duration space flight on the adaptation/readaptation process are discussed. The need for better health prediction techniques is stressed in order to be able to better anticipate crew health problems and to perform corrective actions. Several specific examples are discussed of latent diseases which could occur during a long duration space mission, even after having subjected the crew to thorough premission checkups. The need for learning how to prevent or ameliorate such problems as space adaptation syndrome, bone and muscle (and possibly tissue) atrophy, immune system atrophy, and heart arrythmias is also discussed. The implications of the age of the crew, the influence of an onboard low level gravity field, and drugs are briefly addressed as factors in the adaptation/readaptation process.

[Ethnic origin of patients remains important].

PubMed

Stronks, Karien

2013-01-01

The ethnic diversity in medical practices is increasing rapidly. In the Netherlands, ethnic groups are predominantly defined on the basis of their geographical origin, e.g. inhabitants of Turkish, Moroccan or Surinamese origin. The prevalence of health problems and the utilisation of health care differ between ethnic groups. This ethnic variation arises, firstly, from characteristics that are inherent to these groups such as genetic profile and culture, and, secondly, from characteristics that reflect their position in Dutch society such as socio-economic position and discrimination on the other. If we could fully understand which of these specific characteristics leads to a specific pattern of health problems or health care use, the classification of patient into ethnic groups would then become redundant. As long as we do not completely understand this variation, however, ethnic origin is a good entry-point for targeting health care to groups of patients.

Role of the pharmacist in reducing healthcare costs: current insights

PubMed Central

Dalton, Kieran; Byrne, Stephen

2017-01-01

Global healthcare expenditure is escalating at an unsustainable rate. Money spent on medicines and managing medication-related problems continues to grow. The high prevalence of medication errors and inappropriate prescribing is a major issue within healthcare systems, and can often contribute to adverse drug events, many of which are preventable. As a result, there is a huge opportunity for pharmacists to have a significant impact on reducing healthcare costs, as they have the expertise to detect, resolve, and prevent medication errors and medication-related problems. The development of clinical pharmacy practice in recent decades has resulted in an increased number of pharmacists working in clinically advanced roles worldwide. Pharmacist-provided services and clinical interventions have been shown to reduce the risk of potential adverse drug events and improve patient outcomes, and the majority of published studies show that these pharmacist activities are cost-effective or have a good cost:benefit ratio. This review demonstrates that pharmacists can contribute to substantial healthcare savings across a variety of settings. However, there is a paucity of evidence in the literature highlighting the specific aspects of pharmacists’ work which are the most effective and cost-effective. Future high-quality economic evaluations with robust methodologies and study design are required to investigate what pharmacist services have significant clinical benefits to patients and substantiate the greatest cost savings for healthcare budgets. PMID:29354549

Algorithms for Image Analysis and Combination of Pattern Classifiers with Application to Medical Diagnosis

NASA Astrophysics Data System (ADS)

Georgiou, Harris

2009-10-01

Medical Informatics and the application of modern signal processing in the assistance of the diagnostic process in medical imaging is one of the more recent and active research areas today. This thesis addresses a variety of issues related to the general problem of medical image analysis, specifically in mammography, and presents a series of algorithms and design approaches for all the intermediate levels of a modern system for computer-aided diagnosis (CAD). The diagnostic problem is analyzed with a systematic approach, first defining the imaging characteristics and features that are relevant to probable pathology in mammo-grams. Next, these features are quantified and fused into new, integrated radio-logical systems that exhibit embedded digital signal processing, in order to improve the final result and minimize the radiological dose for the patient. In a higher level, special algorithms are designed for detecting and encoding these clinically interest-ing imaging features, in order to be used as input to advanced pattern classifiers and machine learning models. Finally, these approaches are extended in multi-classifier models under the scope of Game Theory and optimum collective deci-sion, in order to produce efficient solutions for combining classifiers with minimum computational costs for advanced diagnostic systems. The material covered in this thesis is related to a total of 18 published papers, 6 in scientific journals and 12 in international conferences.

Knowledge discovery with classification rules in a cardiovascular dataset.

PubMed

Podgorelec, Vili; Kokol, Peter; Stiglic, Milojka Molan; Hericko, Marjan; Rozman, Ivan

2005-12-01

In this paper we study an evolutionary machine learning approach to data mining and knowledge discovery based on the induction of classification rules. A method for automatic rules induction called AREX using evolutionary induction of decision trees and automatic programming is introduced. The proposed algorithm is applied to a cardiovascular dataset consisting of different groups of attributes which should possibly reveal the presence of some specific cardiovascular problems in young patients. A case study is presented that shows the use of AREX for the classification of patients and for discovering possible new medical knowledge from the dataset. The defined knowledge discovery loop comprises a medical expert's assessment of induced rules to drive the evolution of rule sets towards more appropriate solutions. The final result is the discovery of a possible new medical knowledge in the field of pediatric cardiology.

Summary Time Oriented Record (STOR)—A Progress Report

PubMed Central

Simborg, Donald W.; Whiting-O'Keefe, Quinn E.

1981-01-01

A Summary Time Oriented Medical Record System (STOR) has been designed as a potential replacement for the medical record for use in ambulatory care. As described at the Fourth Annual Symposium, this system has unique characteristics aimed specifically for management of patients with chronic diseases. It is hypothesized that this record design will improve information flow to practitioners at the time of decision-making in ambulatory care, while at the same time reducing manual recording requirements by the practitioner. This system has now been implemented in three specialty clinics at the University of California, San Francisco Medical Center. Rigorous evaluation techniques using prospective randomized control studies are being used in its evaluation. The clinical information includes patient problems, diagnoses, therapies, and ancillary test results. It is implemented on an IBM 4331 computer using the RAMIS data base management system.

Assessment of the use of xerogenic medications for chronic medical and dental conditions among adult day health participants.

PubMed

Lam, Annie; Kiyak, Asuman; Gossett, Allison M; McCormick, Lawrence

2009-10-01

To describe the health conditions, dental problems, and use of xerogenic medications among dental patients in adult day health (ADH) centers. Cross-sectional descriptive study. ADH centers in King County, Washington. ADH clients who were patients of a mobile dental service. Pharmacist-conducted chart reviews and in-person medication reviews with patients. Demographic description, mean numbers of medical and dental problems, medications, xerogenic medications used per subject, and identification of xerogenic medications by therapeutic class. At five sites, 97 patients were interviewed (average age 73.8 +/- 11.8 years, 61% female); ethnicities included: Asian-American (37.1%), Caucasian (30.9%), Russian (29%), and African-American (3%). Mean numbers of chronic health problems, medications, and xerogenic medications per patient were 5.2 +/- 2.7, 10.9 +/- 4.4, and 3.3 +/- 1.8, respectively. Antidepressants were the most commonly used xerogenic medication, followed by antipsychotics, antiemetics, analgesics, and antihistamines. Among 74 patients who received dental treatment, 33 (44.6%) wore dentures. Among 58 patients with teeth, a mean number of 2.8 dental problems per patient was identified. Dental caries (51.7%) was the most prevalent problem, followed by periodontitis (29.3%), soft tissue lesions (10.3%), gingivitis (5.2%), and candidiasis (3.4%). Multiple systemic diseases, use of multiple xerogenic medications, and poor oral health were prevalent among the ADH clients in this study. However, self-reports of dry mouth were unrelated to number of xerogenic medications or oral conditions. Further research is needed to determine the association between self-reported dry mouth, chronic health conditions, use of xerogenic medications, tooth loss, and/or denture use.

Early Exposure to Stimulant Medications and Substance-Related Problems: The Role of Medical and Nonmedical Contexts

PubMed Central

McCabe, Sean Esteban; Veliz, Phil; Boyd, Carol J.

2016-01-01

Background The age of onset (early vs. late) and context (medical vs. nonmedical) of exposure to stimulant medications for attention-deficit/hyperactivity disorder (ADHD) have been identified as important factors in the addictive potential of these controlled medications. This study examines the role of medical and nonmedical contexts in the association between early exposure to stimulant medications and substance use and substance-related problems among adolescents. Methods A Web-based survey was self-administered by Detroit-area secondary school students (N = 4,755) between the 2009–10 and 2012–13 school years. The sample consisted of 51% females, 62% Whites, 32% African-Americans, and 6% from other racial categories. Results During the study period, an estimated 11.7% of respondents were ever diagnosed with ADHD. Approximately 6.7% (n = 322) of respondents indicated lifetime medical use of prescription stimulants while 2.6% (n = 124) indicated lifetime nonmedical use. The odds of substance use and substance-related problems were significantly lower among those who initiated earlier medical use of stimulant medications relative to later medical initiation. In contrast, the odds of substance use and substance-related problems were significantly greater among those who initiated earlier nonmedical use of stimulant medications relative to later nonmedical initiation. Conclusions More than one in every ten adolescents in this epidemiologically-derived community-based sample was diagnosed with ADHD. This is the first investigation to demonstrate that context (medical vs. nonmedical) plays a critical role in the relationship between early exposure to stimulant medications and the subsequent risk of substance-related problems during adolescence within the same diverse youth sample. PMID:27129621

Automated interviews on clinical case reports to elicit directed acyclic graphs.

PubMed

Luciani, Davide; Stefanini, Federico M

2012-05-01

Setting up clinical reports within hospital information systems makes it possible to record a variety of clinical presentations. Directed acyclic graphs (Dags) offer a useful way of representing causal relations in clinical problem domains and are at the core of many probabilistic models described in the medical literature, like Bayesian networks. However, medical practitioners are not usually trained to elicit Dag features. Part of the difficulty lies in the application of the concept of direct causality before selecting all the causal variables of interest for a specific patient. We designed an automated interview to tutor medical doctors in the development of Dags to represent their understanding of clinical reports. Medical notions were analyzed to find patterns in medical reasoning that can be followed by algorithms supporting the elicitation of causal Dags. Clinical relevance was defined to help formulate only relevant questions by driving an expert's attention towards variables causally related to nodes already inserted in the graph. Key procedural features of the proposed interview are described by four algorithms. The automated interview comprises questions on medical notions, phrased in medical terms. The first elicitation session produces questions concerning the patient's chief complaints and the outcomes related to diseases serving as diagnostic hypotheses, their observable manifestations and risk factors. The second session focuses on questions that refine the initial causal paths by considering syndromes, dysfunctions, pathogenic anomalies, biases and effect modifiers. A case study concerning a gastro-enterological problem and one dealing with an infected patient illustrate the output produced by the algorithms, depending on the answers provided by the doctor. The proposed elicitation framework is characterized by strong consistency with medical background and by a progressive introduction of relevant medical topics. Revision and testing of the subjectively elicited Dag is performed by matching the collected answers with the evidence included in accepted sources of biomedical knowledge. Copyright © 2011 Elsevier B.V. All rights reserved.

A comparison of course-related stressors in undergraduate problem-based learning (PBL) versus non-PBL medical programmes.

PubMed

Lewis, Alexander D; Menezes, Darryl A Braganza; McDermott, Helen E; Hibbert, Louise J; Brennan, Sarah-Louise; Ross, Elizabeth E; Jones, Lisa A

2009-09-13

Medical students report high levels of stress related to their medical training as well as to other personal and financial factors. The aim of this study is to investigate whether there are differences in course-related stressors reported by medical students on undergraduate problem-based learning (PBL) and non-PBL programmes in the UK. A cross-sectional study of second-year medical students in two UK medical schools (one PBL and one non-PBL programme) was conducted. A 16-question self-report questionnaire, derived from the Perceived Medical Student Stress Scale and the Higher Education Stress Inventory, was used to measure course-related stressors. Following univariate analysis of each stressor between groups, multivariate logistic regression was used to determine which stressors were the best predictors of each course type, while controlling for socio-demographic differences between the groups. A total of 280 students responded. Compared to the non-PBL students (N = 197), the PBL students (N = 83) were significantly more likely to agree that: they did not know what the faculty expected of them (Odds Ratio (OR) = 0.38, p = 0.03); there were too many small group sessions facilitated only by students resulting in an unclear curriculum (OR = 0.04, p < 0.0001); and that there was a lack of opportunity to explore academic subjects of interest (OR = 0.40, p = 0.02). They were significantly more likely to disagree that: there was a lack of encouragement from teachers (OR = 3.11, p = 0.02); and that the medical course fostered a sense of anonymity and feelings of isolation amongst students (OR = 3.42, p = 0.008). There are significant differences in the perceived course-related stressors affecting medical students on PBL and non-PBL programmes. Course designers and student support services should therefore tailor their work to minimise, or help students cope with, the specific stressors on each course type to ensure optimum learning and wellbeing among our future doctors.

The Documentation of Health Problems in Relation to Prescribed Medication in People with Profound Intellectual and Multiple Disabilities

ERIC Educational Resources Information Center

van der Heide, D. C.; van der Putten, A. A. J.; van den Berg, P. B.; Taxis, K.; Vlaskamp, C.

2009-01-01

Background: Persons with profound intellectual and multiple disabilities (PIMD) suffer from a wide range of health problems and use a wide range of different drugs. This study investigated for frequently used medication whether there was a health problem documented in the medical notes for the drug prescribed. Method: Persons with PIMD with an…

Differences in Problems Paying Medical Bills between African Americans and Whites from 2007 and 2009: the Underlying Role of Health Status.

PubMed

Wiltshire, Jacqueline C; Elder, Keith; Allison, Jeroan J

2016-06-01

Although the proportion of people reporting problems paying medical bills has declined in the aftermath of the Great Recession, it is unclear if this decline has been caused by self-rationing of care, particularly among disadvantaged groups. We examined African American-White differences in problems paying medical bills prevalence along with factors which may account for observed differences. We used cross-sectional data from 2007 (N = 13,064) and 2010 (N = 11,873) waves of the nationally representative, Health Tracking Household Survey. Logistic regression analyses, accounting for complex survey design and weights, were performed to compute population-based estimates. Overall, the prevalence of problems paying medical bills was 18.3 % in 2007 and 19.8 % in 2010. African Americans more frequently reported having problems paying medical bills than Whites. Among African Americans, problems paying medical bills decreased from 30 % in 2007 to 25 % in 2010, which was largely explained by fewer problems reported by those in poor/fair health. Problems paying medical bills significantly declined from 44 % in 2007 to 33 % in 2010 for African Americans in poor/fair health, but remained almost constant for those in good health and very good/excellent health. Our findings suggest that African Americans in poor health may be rationing or forgoing necessary care as a result of the recession, which could increase existing health disparities and future health spending. Efforts to reduce racial/ethnic disparities may depend on the extent to which the lingering effects of the Great Recession are mitigated.

The MMPI-2 Symptom Validity Scale (FBS) not influenced by medical impairment: a large sleep center investigation.

PubMed

Greiffenstein, Manfred F

2010-06-01

The Symptom Validity Scale (Minnesota Multiphasic Personality Inventory-2-FBS [MMPI-2-FBS]) is a standard MMPI-2 validity scale measuring overstatement of somatic distress and subjective disability. Some critics assert the MMPI-2-FBS misclassifies too many medically impaired persons as malingering symptoms. This study tests the assertion of malingering misclassification with a large sample of 345 medical inpatients undergoing sleep studies that standardly included MMPI-2 testing. The variables included standard MMPI-2 validity scales (Lie Scale [L], Infrequency Scale [F], K-Correction [K]; FBS), objective medical data (e.g., body mass index, pulse oximetry), and polysomnographic scores (e.g., apnea/hypopnea index). The results showed the FBS had no substantial or unique association with medical/sleep variables, produced false positive rates <20% (median = 9, range = 4-11), and male inpatients showed marginally higher failure rates than females. The MMPI-2-FBS appears to have acceptable specificity, because it did not misclassify as biased responders those medical patients with sleep problems, male or female, with primary gain only (reducing sickness). Medical impairment does not appear to be a major influence on deviant MMPI-2-FBS scores.

Accuracy of self-reported medical problems in patients with alcohol dependence and co-occurring schizophrenia or schizoaffective disorder.

PubMed

Meszaros, Zsuzsa Szombathyne; Dimmock, Jacqueline A; Ploutz-Snyder, Robert; Chauhan, Sumerendra Vir Singh; Abdul-Malak, Ynesse; Middleton, Frank A; Batki, Steven L

2011-11-01

Schizophrenia and alcohol dependence (AD) are both major risk factors for a variety of medical problems, yet little is known about the medical status of patients in whom both conditions coexist. The objectives of this study are to assess accuracy of self-reported medical problems and to compare the accuracy reports in patients with schizophrenia or schizoaffective disorder and co-occurring AD compared to patients with AD only and to controls. Our hypothesis was that medical problems are under-reported in patients with co-occurring disorders, possibly due to the combination of alcohol use and symptoms of schizophrenia. Self-reported medical diagnoses were recorded and compared to medical records obtained from all area hospitals in 42 patients with schizophrenia and AD, 44 patients with schizoaffective disorder and AD, 41 patients with AD only, and 15 control subjects. Patients underwent medical history, physical examination, and review of medical records. Patients with schizophrenia or schizoaffective disorder and co-occurring AD underreported their medical problems significantly more than patients with AD only and controls. Accuracy of self report was significantly lower in patients with schizophrenia-spectrum disorders plus co-occurring alcohol dependence than in AD alone or in controls. The most commonly underreported diagnoses included coronary artery disease, chronic renal failure, seizure disorder, hyperlipidemia, asthma and hypertension. In order to detect potentially unreported medical conditions in patients with co-occurring schizophrenia/schizoaffective disorder and alcohol dependence, the use of targeted screening questionnaires is recommended in addition to physical examination and thorough review of medical records. Copyright © 2011 Elsevier B.V. All rights reserved.

Determinants of a successful problem list to support the implementation of the problem-oriented medical record according to recent literature.

PubMed

Simons, Sereh M J; Cillessen, Felix H J M; Hazelzet, Jan A

2016-08-02

A problem-oriented approach is one of the possibilities to organize a medical record. The problem-oriented medical record (POMR) - a structured organization of patient information per presented medical problem- was introduced at the end of the sixties by Dr. Lawrence Weed to aid dealing with the multiplicity of patient problems. The problem list as a precondition is the centerpiece of the problem-oriented medical record (POMR) also called problem-oriented record (POR). Prior to the digital era, paper records presented a flat list of medical problems to the healthcare professional without the features that are possible with current technology. In modern EHRs a POMR based on a structured problem list can be used for clinical decision support, registries, order management, population health, and potentially other innovative functionality in the future, thereby providing a new incentive to the implementation and use of the POMR. On both 12 May 2014 and 1 June 2015 a systematic literature search was conducted. From the retrieved articles statements regarding the POMR and related to successful or non-successful implementation, were categorized. Generic determinants were extracted from these statements. In this research 38 articles were included. The literature analysis led to 12 generic determinants: clinical practice/reasoning, complete and accurate problem list, data structure/content, efficiency, functionality, interoperability, multi-disciplinary, overview of patient information, quality of care, system support, training of staff, and usability. Two main subjects can be distinguished in the determinants: the system that the problem list and POMR is integrated in and the organization using that system. The combination of the two requires a sociotechnical approach and both are equally important for successful implementation of a POMR. All the determinants have to be taken into account, but the weight given to each of the determinants depends on the organizationusing the problem list or POMR.

Can items used in 4-year-old well-child visits predict children's health and school outcomes?

PubMed

Smithers, Lisa G; Chittleborough, Catherine R; Stocks, Nigel; Sawyer, Michael G; Lynch, John W

2014-08-01

To examine whether items comprising a preschool well-child check for use by family doctors in Australia with 4-5-year old children predicts health and academic outcomes at 6-7 years. The well-child check includes mandatory (anthropometry, eye/vision, ear/hearing, dental, toileting, allergy problems) and non-mandatory (processed food consumption, low physical activity, motor, behaviour/mood problems) items. The predictive validity of mandatory and non-mandatory items measured at 4-5 years was examined using data from the Longitudinal Study of Australian Children. Outcomes at 6-7 years included overweight/obesity, asthma, health care/medication needs, general health, mental health problems, quality of life, teacher-reported mathematics and literacy ability (n = 2,280-2,787). Weight or height >90th centile at 4-5 years predicted overweight/obesity at 6-7 years with 60% sensitivity, 79% specificity and 40% positive predictive value (PPV). Mood/behaviour problems at 4-5 predicted mental health problems at 6-7 years with 86% sensitivity, 40% specificity and 8% PPV. Non-mandatory items improved the discrimination between children with and without mental health problems at 6-7 years (area under the receiver operating characteristic curve 0.75 compared with 0.69 for mandatory items only), but was weak for most outcomes. Items used in a well-child health check were moderate predictors of overweight/obesity and mental health problems at 6-7 years, but poor predictors of other health and academic outcomes.

Medical Issues in Playing the Oboe: A Literature Review.

PubMed

Banzhoff, Sofia; Del Mar Ropero, Maria; Menzel, Gabriele; Salmen, Tatjana; Gross, Manfred; Caffier, Philipp P

2017-12-01

Playing a musical instrument can affect physical and mental health. A literature review was conducted to determine the prevalence of health problems among oboists, which medical conditions can be caused or exacerbated by playing, whether oboe playing can be a protective factor, and whether recommendations are possible as to who should or should not play the oboe. Searches in 7 databases (Medline, Embase, Cochrane Library, Web of Science, SocIndex, PsyIndex, Psychinfo) yielded a total of 950 studies; after exclusion of duplicates and those not meeting eligibility criteria, 37 articles were selected for final analysis. In addition, Google Scholar and a musicology library served as additional sources, revealing another 6 publications for inclusion. As a result, some evidence was found for musculoskeletal problems, focal dystonia, stress velopharyngeal incompetence, increased intraocular pressure and glaucoma, gastroesophageal reflux disease, lower pulmonary function, disease transmission via instruments, and hearing loss due to noise exposure. Playing the oboe may be protective against obstructive sleep apnea. However, due to small sample sizes, uncertain reproducibility of findings, and lack of accurate descriptions of problems reported by oboists, far more evidence would be necessary to answer the research questions conclusively. There was no evidence for causal relationships, and thus no recommendations can be made regarding who should (not) play the oboe. To improve the quality of medical care for these musicians and to implement prevention strategies, future investigations with more in-depth instrument-specific analyses and higher numbers of participants are needed.

A medical digital library to support scenario and user-tailored information retrieval.

PubMed

Chu, W W; Johnson, D B; Kangarloo, H

2000-06-01

Current large-scale information sources are designed to support general queries and lack the ability to support scenario-specific information navigation, gathering, and presentation. As a result, users are often unable to obtain desired specific information within a well-defined subject area. Today's information systems do not provide efficient content navigation, incremental appropriate matching, or content correlation. We are developing the following innovative technologies to remedy these problems: 1) scenario-based proxies, enabling the gathering and filtering of information customized for users within a pre-defined domain; 2) context-sensitive navigation and matching, providing approximate matching and similarity links when an exact match to a user's request is unavailable; 3) content correlation of documents, creating semantic links between documents and information sources; and 4) user models for customizing retrieved information and result presentation. A digital medical library is currently being constructed using these technologies to provide customized information for the user. The technologies are general in nature and can provide custom and scenario-specific information in many other domains (e.g., crisis management).

Bisphosphonate-Induced Osteonecrosis of the Maxilla Resembling a Persistent Endodontic Lesion.

PubMed

Mosaferi, Hossein; Fazlyab, Mahta; Sharifi, Sanaz; Rahimian, Sepideh

2016-01-01

A 52-year-old Caucasian woman suffering from pain in the anterior maxillary region, presented to the clinic. Examination revealed a draining sinus tract in the buccal vestibule of the maxilla in the left anterior segment and expansion in the middle of palate. On conventional radiographic examination the lesion was initially assumed to be a periapical problem related to the incisors but subsequently it was diagnosed to be a bisphosphonate osteonecrosis. Acquiring a comprehensive medical history from the patients, conducting the clinical vitality tests and most importantly being familiar with the non-odontogenic lesions that can be side effects of specific medications are important requirements for reaching a correct diagnosis.

Bisphosphonate-Induced Osteonecrosis of the Maxilla Resembling a Persistent Endodontic Lesion

PubMed Central

Mosaferi, Hossein; Fazlyab, Mahta; Sharifi, Sanaz; Rahimian, Sepideh

2016-01-01

A 52-year-old Caucasian woman suffering from pain in the anterior maxillary region, presented to the clinic. Examination revealed a draining sinus tract in the buccal vestibule of the maxilla in the left anterior segment and expansion in the middle of palate. On conventional radiographic examination the lesion was initially assumed to be a periapical problem related to the incisors but subsequently it was diagnosed to be a bisphosphonate osteonecrosis. Conclusion: Acquiring a comprehensive medical history from the patients, conducting the clinical vitality tests and most importantly being familiar with the non-odontogenic lesions that can be side effects of specific medications are important requirements for reaching a correct diagnosis. PMID:26843881

Factors that influence a career choice in primary care among medical students from high-, middle-, and low-income countries: a systematic review.

PubMed

Puertas, E Benjamín; Arósquipa, Carlos; Gutiérrez, Daniela

2013-11-01

To determine which factors influence a medical student's decision to choose a career in primary care; and to establish if these factors are similar or different among students in high-, middle- and low-income countries. An extensive search was done of PubMed, Google Scholar, and Virtual Library of Health for articles on primary care careers published in 2003-2013 in English, Spanish, and/or Portuguese. Initially, 600 records were identified; 74 full-text articles were assessed for eligibility and 55 were selected (42 from high-income countries; 13 from middle- and low-income). These were assessed to identify intrinsic and extrinsic factors that influence career choice among medical students from high-, middle-, and low-income countries. A comparison framework with common and specific factors that influence career choice in primary care among medical students from high-, middle- and low-income was developed. Factors were classified as extrinsic or intrinsic, and as facilitators or barriers. Several factors common to all countries were identified: facilitators were exposure to rural location, role models, working conditions; barriers were low income, prestige, and medical school environment. Some factors specific to middle- and low-income countries were: understanding of rural needs and intellectual challenge. Other factors specific to high-income countries were: attitude towards social problems, voluntary work, influence of family, and length of residency. Further studies on the subject are needed, especially in low- and middle-income countries. Identifying factors as barriers or facilitators for career choice will promote a better understanding of the reasons behind the shortage of primary care professionals and will contribute to policy building, improved training, and recruitment and retention of these professionals.

Nurses' perceptions and problems in the usability of a medication safety app.

PubMed

Ankem, Kalyani; Cho, Sookyung; Simpson, Diana

2017-10-16

The majority of medication apps support medication adherence. Equally, if not more important, is medication safety. Few apps report on medication safety, and fewer studies have been conducted with these apps. The usability of a medication safety app was tested with nurses to reveal their perceptions of the graphical user interface and to discover problems they encountered in using the app. Usability testing of the app was conducted with RN-BSN students and informatics students (n = 18). Perceptions of the graphical components were gathered in pretest and posttest questionnaires, and video recordings of the usability testing were transcribed. The significance of the difference in mean performance time for 8 tasks was tested, and qualitative analysis was deployed to identify problems encountered and to rate the severity of each problem. While all participants perceived the graphical user interface as easy to understand, nurses took significantly more time to complete certain tasks. More nurses found the medication app to be lacking in intuitiveness of user interface design, in capability to match real-world data, and in providing optimal information architecture. To successfully integrate mobile devices in healthcare, developers must address the problems that nurses encountered in use of the app.

Non-Psychiatric Health Problems among Psychiatric Inpatients with Intellectual Disabilities

ERIC Educational Resources Information Center

Charlot, L.; Abend, S.; Ravin, P.; Mastis, K.; Hunt, A.; Deutsch, C.

2011-01-01

Background: Physical distress resulting from medical problems has been found to cause increased behaviour problems in patients with intellectual disabilities (ID). Despite this fact, little has been documented on the medical problems of individuals with ID admitted for inpatient psychiatric care. We conducted an exploratory investigation based on…

[The efficiency of the application of the modern computed technologies in the clinical practice and the prospects for the further use of the biomechanical 3D-models in forensic medicine].

PubMed

Makarov, I Yu; Svetlakov, A V; Sotin, A V; Shigeev, S V; Gusarov, A A; Smirenin, S A; Emelin, V V; Stragis, V B; Fetisov, V A

2018-01-01

To-day, the computer-assisted 3D-technologies for the mathematical simulation of the engineering facilities are extensively used for the purpose of technical calculations in all branches of industry and building. The positive experience gained with the application of the 3D-models finds wide application in the joined investigations on the topical problems of the prosthetic and surgical treatment of bones, teeth, joints, cardiac valves, blood vessels, etc. The objective of the present study was the analysis of the positive experience with the involvement of the specialists in the design and practical application of 3D-models for the solution of problems facing the medical prosthetics and the management of various pathological conditions. Another objective was to discuss the possible prospects for the interdisciplinary collaboration in these fields with a view to improving the quality of expert conclusions in the framework of forensic medical and criminalistics examinations. The data readily available from the official domestic and foreign Internet resources were used for the purpose of the study. The analysis of the published data has demonstrated the obvious advantages of the application of the mathematical 3D-models and the biomechanical studies for the solution of the concrete medico-biological problems. The currently available positive experience gained due to the participation of domestic specialists in biomechanics in the solution of the specific clinical problems gives hope that their collaboration between themselves and with the forensic medical experts will open up the promising prospects for the further investigations of the issues of common interest.

Medical Students’ Perceptions of Peer Assessment in a Problem-based Learning Curriculum

PubMed Central

Tayem, Yasin I.; James, Henry; Al-Khaja, Khalid A. J.; Razzak, Rima L. A.; Potu, Bhagath K.; Sequeira, Reginald P.

2015-01-01

Objectives: Peer assessment (PA) is believed to support learning and help students develop both professionally and personally. The aim of this study was to examine medical students’ perceptions of intragroup PA in a problem-based learning (PBL) setting. Methods: This study was carried out between September and November 2014 and involved six random groups of fourth-year undergraduate medical students (n = 60) enrolled at the Arabian Gulf University in Manama, Bahrain. While working on set tasks within a curriculum unit, each student evaluated a randomly selected peer using an English language adapted assessment tool to measure responsibility and respect, information processing, critical analysis, interaction and collaborative skills. At the end of the unit, students’ perceptions of PA were identified using a specifically-designed voluntary and anonymous self-administered questionnaire in English. Results: A total of 55 students participated in the study (response rate: 92%). The majority of students reported that their learning (60%), attendance (67%), respect towards group members (70%) and participation in group discussions (71%) improved as a result of PA. Regarding problem analysis skills, most participants believed that PA improved their ability to analyse problems (65%), identify learning needs (64%), fulfil tasks related to the analysis of learning needs (72%) and share knowledge within their group (74%). Lastly, a large proportion of students reported that this form of assessment helped them develop their communication (71%) and self-assessment skills (73%), as well as collaborative abilities (75%). Conclusion: PA was well accepted by the students in this cohort and led to self-reported improvements in learning, skills, attitudes, engagement and other indicators of personal and professional development. PA was also perceived to have a positive impact on intragroup attitudes. PMID:26355668

Safety in numbers 4: The relationship between exposure to authentic and didactic environments and nursing students' learning of medication dosage calculation problem solving knowledge and skills.

PubMed

Weeks, Keith W; Clochesy, John M; Hutton, B Meriel; Moseley, Laurie

2013-03-01

Advancing the art and science of education practice requires a robust evaluation of the relationship between students' exposure to learning and assessment environments and the development of their cognitive competence (knowing that and why) and functional competence (know-how and skills). Healthcare education translation research requires specific education technology assessments and evaluations that consist of quantitative analyses of empirical data and qualitative evaluations of the lived student experience of the education journey and schemata construction (Weeks et al., 2013a). This paper focuses on the outcomes of UK PhD and USA post-doctorate experimental research. We evaluated the relationship between exposure to traditional didactic methods of education, prototypes of an authentic medication dosage calculation problem-solving (MDC-PS) environment and nursing students' construction of conceptual and calculation competence in medication dosage calculation problem-solving skills. Empirical outcomes from both UK and USA programmes of research identified highly significant differences in the construction of conceptual and calculation competence in MDC-PS following exposure to the authentic learning environment to that following exposure to traditional didactic transmission methods of education (p < 0.001). This research highlighted that for many students exposure to authentic learning environments is an essential first step in the development of conceptual and calculation competence and relevant schemata construction (internal representations of the relationship between the features of authentic dosage problems and calculation functions); and how authentic environments more ably support all cognitive (learning) styles in mathematics than traditional didactic methods of education. Functional competence evaluations are addressed in Macdonald et al. (2013) and Weeks et al. (2013e). Copyright © 2012. Published by Elsevier Ltd.

Health-related quality of life and emotional problems in children surviving brain tumor treatment: A descriptive study of 2 cohorts.

PubMed

Dessens, Arianne B; van Herwerden, Michael C; Aarsen, Femke K; Birnie, Erwin; Catsman-Berrevoets, Coriene E

2016-08-01

The survival of childhood brain tumors has improved in the past 30 years, but acquired brain injury due to damage caused by tumor invasion and side effects of different treatment modalities frequently occurs. This study focused on residual impairments, health-related quality of life (HRQoL), and emotional and behavioral problems in 2 cohorts of survivors diagnosed and treated for various types of brain tumors. Survivors in the 2004 cohort visited the Erasmus Medical Centre for standardized follow-up between 2003 and 2004, and in the 2014 cohort, between 2012 and 2014. Data of neurologically impairments of all children were extracted from medical records. Parents and survivors filled out questionnaires on quality of life and emotional and behavioral problems. In both cohorts, approximately 55% of the survivors displayed neurologic impairments. In comparison with the healthy reference group, a reduced parent-reported quality of life was found on the Motor, Cognition, and Autonomy (Cohort 2004) scales. Comparison between the cohorts showed that parents in the 2004 cohort reported a higher HRQoL on the Motor and Cognitive functioning scales. In the 2014 cohort, children reported less negative emotions than healthy children. No increase in emotional or behavioral problems were reported by children in both cohorts, whereas parents reported problems in social functioning and isolation related to a delay in emotional development. Children surviving brain tumor treatment have a reduced quality of life. The authors therefore recommend regular screening of HRQoL and emotional and behavioral problems and referral to specific aftercare.

Making medical research clinically friendly: a communication-based conceptual framework.

PubMed

McGrath, John; Lawrence, Valerie; Richardson, W Scott

2004-11-01

It often takes a long time before the results of medical research are actually used by health care practitioners in day-to-day clinical settings. This problem, referred to as "the evidence-to-practice gap", has significant implications for patient health care. Practitioners have difficulty keeping up with the latest information in part because it is reported in hundreds of journals that may not be easily accessed and understood. This essay conceptualizes the evidence-to-practice gap as a communication problem and suggests how academic research can be translated into messages that are easier for practitioners to access, comprehend and incorporate into their medical practice. A "translation framework" shows the importance of targeting messages to specific audiences and provides a communication-based conceptual approach for summarizing research for clinicians. Targeting the results of academic research to practitioners will decrease the time it takes for patients to benefit from the latest medical evidence. Translation guidelines can help health researchers write more effectively for both academic and practitioner audiences. Since the evidence-to-practice gap is a systemic problem that begins with how we train our health researchers, educators should consider addressing this topic in the health professions classroom. The framework presented here can serve as the basis for an instructional unit on interpreting and reporting research findings. Finally, information technology can play a much larger role in the communication process because of the enormous advantages of quick access and data organization that computers and the Internet provide. Practitioner-targeted research summaries could be made available on government or not-for-profit sponsored websites as well as by journals themselves. Funding opportunities exist for research that focuses on how technology can help improve health care, and so the time is right for health researchers to investigate ways of making their studies more accessible and quickly usable via web-based distribution. The potential of medical science should not be limited by an information delivery system that we have the knowledge, expertise and resources to improve.

Dynamic Geometry Capture with a Multi-View Structured-Light System

DTIC Science & Technology

2014-12-19

funding was never a problem during my studies . One of the best parts of my time at UC Berkeley has been working with colleagues within the Video and...scientific and medical applications such as quantifying improvement in physical therapy and measuring unnatural poses in ergonomic studies . Specifically... cases with limited scene texture. This direct generation of surface geometry provides us with a distinct advantage over multi-camera based systems. For

Secondary medical diagnosis in fragile X syndrome with and without autism spectrum disorder.

PubMed

García-Nonell, Catalina; Ratera, Eugenia Rigau; Harris, Susan; Hessl, David; Ono, Michele Y; Tartaglia, Nicole; Marvin, Emily; Tassone, Flora; Hagerman, Randi J

2008-08-01

This study examined whether secondary medical diagnoses that affect CNS function (i.e., seizures, malformations, or genetic disorders), are more likely to occur in individuals with fragile X syndrome (FXS) and autism spectrum disorder (FXS + ASD) or FXS alone. Ninety males (3-25 years) with FXS or FXS + ASD were evaluated for secondary medical diagnoses by medical history and examination. A significant difference in the incidence of medical problems was found between patients with FXS + ASD (38.6%) and FXS alone (18.2%, P < 0.05). Medical problems that affect the CNS are more likely to occur in those with FXS + ASD and it is probable that additional brain dysfunction associated with these medical problems enhance the risk of autism in those with FXS. Copyright 2008 Wiley-Liss, Inc.

Agreement between questionnaire and medical records on some health and socioeconomic problems among poisoning cases

PubMed Central

Fathelrahman, Ahmed I

2009-01-01

Background The main objective of the present study was to evaluate the agreement between questionnaire and medical records on some health and socioeconomic problems among poisoning cases. Methods Cross-sectional sample of 100 poisoning cases consecutively admitted to the Hospital Pulau Pinang, Malaysia during the period from September 2003 to February 2004 were studied. Data on health and socioeconomic problems were collected both by self-administered questionnaire and from medical records. Agreement between the two sets of data was assessed by calculating the concordance rate, Kappa (k) and PABAK. McNemar statistic was used to test differences between categories. Results Data collected by questionnaire and medical records showed excellent agreement on the "marital status"; good agreements on "chronic illness", "psychiatric illness", and "previous history of poisoning"; and fair agreements on "at least one health problem", and "boy-girl friends problem". PABAK values suggest better agreements' measures. Conclusion There were excellent to good agreements between questionnaire and medical records on the marital status and most of the health problems and fair to poor agreements on the majority of socioeconomic problems. The implications of those findings were discussed. PMID:19751526

[SIMBO: a Screening Instrument for Identification of Work-Related Disabilities--analyses of construct and prognostic validity].

PubMed

Streibelt, M; Gerwinn, H; Hansmeier, T; Thren, K; Müller-Fahrnow, W

2007-10-01

For a number of years, work-related interventions in medical rehabilitation (MBO) have been developed. Basically, these interventions concentrate on vocational problems of rehabilitees whose health disorders are strongly associated with contextual factors of the environment as well as personal factors. Previous studies showed a close relationship between the success of an intervention and identification of a specific demand. In fact there are several clinical concepts regarding specific demand. But there still is a lack of appropriate instruments for use in identification of occupational challenges. Therefore SIMBO (Screening Instrument for Identification of a Demand for Medical-Vocational Oriented Rehabilitation) has been developed recently. By using a scale for the intensity of work-related problems as well as a cut-off point, SIMBO is able to identify patients with and without a demand for work-related interventions. Analyses relative to construct validity and predictive validity were carried out on two different samples--a multi-clinic sample (patients with musculoskeletal disorders) and a sample from the German statutory pension insurance agency DRV Westfalen (successful applications for medical rehabilitation). In this context the cut-off level discussion is very important. By means of the multi-clinic sample--irrespective of cut-off definition--the SIMBO-decision and the clinical identification of MBO-demand were found to agree in 74-78% of the cases. This corresponds to a maximum adjusted correlation of r=0.59 (phi coefficient). Compared to the external ratings of vocational problems given by DRV staff in handling the applications, however, only little agreement is found (64%, r=0.25). In fact, SIMBO had in 77% (r=0.50) of the cases been able to correctly predict work-related problems to be expected. So the result obtained using this instrument is far better than prediction of these problems in the external ratings by DRV staff (54%, r=0,21). Also, return to work (RTW) in good health after six months can be predicted correctly by SIMBO in 77% of the cases. This means that the probability of RTW in good health is reduced by 90% (Odds Ratio=0.1) if work-related problems had been identified by SIMBO. Concerning its clinical as well as predictive quality, the validity of SIMBO-based ratings of work-related problems has been proven. Further, it has become obvious that SIMBO is suitable as an easy-to-handle tool for identification of a need for vocationally-focused interventions for use by the social insurance agencies which finance rehabilitation. Further interesting questions arise relative to application in different indications as well as potential uses as an outcome instrument.

Unsuccessfully Treated Hypertension: A Major Public Health Problem With a Potential Solution.

PubMed

Furberg, Curt D; Sealey, Jean E; Blumenfeld, Jon D

2017-09-01

About one-half of all hypertensive adults do not have their blood pressure controlled. They are often prescribed medications that conform to national guidelines but they continue to have elevated blood pressure. This public health problem might be improved by applying plasma renin guided therapy. A contributor to the public health problem of unsuccessfully treated hypertension is that the circulating renin-angiotensin system (RAS) is not recognized in treatment guidelines as clinically relevant for the treatment of hypertension or as important as the body salt status for determining blood pressure levels. Another contributor to the problem is the lack of specificity in the package inserts for antihypertensive drugs. They do not specifically state under the heading "Indications" that RAS blockers are primarily most effective in hypertensive subjects with medium and high plasma renin levels; by contrast, natriuretic drugs are most effective in those with low plasma renin levels. Literature review. To address the problem of unsuccessfully treated hypertension, we recommend that the "Indications" section of package inserts for antihypertensive drugs be more specific. The primary indication for RAS blockers ought to be hypertension with medium and high plasma renin levels, and natriuretic agents for those with low plasma renin levels. Similar language ought to be added to treatment guidelines. Additionally, 3 other reasons for lack of blood pressure control also need to be addressed-failure to prescribe antihypertensive drugs to hypertensive subjects, failure of patients to fill prescriptions, and low drug adherence. © American Journal of Hypertension, Ltd 2017. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Perspective: Whither the problem list? Organ-based documentation and deficient synthesis by medical trainees.

PubMed

Kaplan, Daniel M

2010-10-01

The author argues that the well-formulated problem list is essential for both organizing and evaluating diagnostic thinking. He considers evidence of deficiencies in problem lists in the medical record. He observes a trend among medical trainees toward organizing notes in the medical record according to lists of organ systems or medical subspecialties and hypothesizes that system-based documentation may undermine the art of problem formulation and diagnostic synthesis. Citing research linking more sophisticated problem representation with diagnostic success, he suggests that documentation style and clinical reasoning are closely connected and that organ-based documentation may predispose trainees to several varieties of cognitive diagnostic error and deficient synthesis. These include framing error, premature or absent closure, failure to integrate related findings, and failure to recognize the level of diagnostic resolution attained for a given problem. He acknowledges the pitfalls of higher-order diagnostic resolution, including the application of labels unsupported by firm evidence, while maintaining that diagnostic resolution as far as evidence permits is essential to both rational care of patients and rigorous education of learners. He proposes further research, including comparison of diagnostic efficiency between organ- and problem-oriented thinkers. He hypothesizes that the subspecialty-based structure of academic medical services helps perpetuate organ-system-based thinking, and calls on clinical educators to renew their emphasis on the formulation and documentation of complete and precise problem lists and progressively refined diagnoses by trainees.

Can ill-structured problems reveal beliefs about medical knowledge and knowing? A focus-group approach

PubMed Central

Roex, Ann; Clarebout, Geraldine; Dory, Valerie; Degryse, Jan

2009-01-01

Background Epistemological beliefs (EB) are an individual's cognitions about knowledge and knowing. In several non-medical domains, EB have been found to contribute to the way individuals reason when faced with ill-structured problems (i.e. problems with no clear-cut, right or wrong solutions). Such problems are very common in medical practice. Determining whether EB are also influential in reasoning processes with regard to medical issues to which there is no straightforward answer, could have implications for medical education. This study focused on 2 research questions: 1. Can ill-structured problems be used to elicit general practice trainees' and trainers' EB? and 2. What are the views of general practice trainees and trainers about knowledge and how do they justify knowing? Methods 2 focus groups of trainees (n = 18) were convened on 3 occasions during their 1st year of postgraduate GP training. 2 groups of GP trainers (n = 11) met on one occasion. Based on the methodology of the Reflective Judgement Interview (RJI), participants were asked to comment on 11 ill-structured problems. The sessions were audio taped and transcribed and an adapted version of the RJI scoring rules was used to assess the trainees' reasoning about ill-structured problems. Results Participants made a number of statements illustrating their EB and their importance in clinical reasoning. The level of EB varied widely form one meeting to another and depending on the problem addressed. Overall, the EB expressed by trainees did not differ from those of trainers except on a particular ill-structured problem regarding shoulder pain. Conclusion The use of focus groups has entailed some difficulties in the interpretation of the results, but a number of preliminary conclusions can be drawn. Ill-structured medical problems can be used to elicit EB. Most trainees and trainers displayed pre-reflective and quasi-reflective EB. The way trainees and doctors view and justify knowledge are likely to be involved in medical reasoning processes. PMID:19775425

Transfer of financial risk and alternative financing solutions.

PubMed

Levitt, Jeffrey C

2004-01-01

The high cost of health care in the United States has created a number of alarming economic and social problems. It has contributed to a greater number of underinsured and uninsured individuals living in the United States, and forced people to either ration or not purchase the care they need. Accumulated medical debt is grossly disproportionate to the US median AGI, and accounted for at least 25 percent of all personal bankruptcies. For patients, a guaranteed loan program specifically for medical procedures and treatments with below market interest rates would help alleviate bankruptcies related to medical debt by lowering payments and extending the loan maturities. A guaranteed loan program would also improve the debt charge-off rate for medical providers that carry patient receivables and reduce the risk of their balance sheets. This might hold or reduce the rate at which health care inflation grows. The health care loan program could model the current student loan programs and produce significant economic and societal benefits.

The Use of Herbal Medications and Dietary Supplements by People with Mental Illness

PubMed Central

Shatkin, Jess P.; Hamilton, Alison B.; Unützer, Jürgen; Klap, Ruth; Young, Alexander S.

2009-01-01

This study examined the relationship between herbal medication and dietary supplement (HMDS) use and mental health characteristics. Data are drawn from a national household survey of the United States’ civilian, non-institutionalized population (N = 9,585). Psychiatric medication and HMDS use, psychiatric diagnoses and treatment needs, utilization and satisfaction were assessed. Compared to non-users, HMDS users were more likely to perceive themselves as having mental health needs, to have received mental health and primary care treatment, and to be dissatisfied with their overall healthcare. Psychiatric medication use was not related to HMDS use, and in multivariate analyses, HMDS use was associated with perceived mental health needs. Differences in use of specific HMDS between those with and without a psychiatric disorder were also examined. The use of HMDS warrants particular attention in persons with perceived mental health problems as these individuals may be turning to HMDS use for treatment of their symptoms. PMID:19688594

The View Behind and Ahead: Implications of Certification *

PubMed Central

Darling, Louise

1973-01-01

The Medical Library Association's certification plan, never of real significance in employment and promotion practices in health sciences librarianship, does not reflect the many changes which have occurred in swift progression since adoption of the code in 1949. Solutions to the problems which have accumulated since then are sought in a brief examination of trends in credentialing and certification in the health professions and in the library field, both general and special. Emphasis is given to the historical development of provisions in the MLA Code for the Training and Certification of Medical Librarians, the limited opportunity for practical implementation of most of the provisions, the importance of the code in stimulating the Association's educational programs, the impact of the Medical Library Assistance Act, Regional Medical Programs, and increases in demand for health information on manpower requirements for health science libraries, the specific dissatisfactions MLA members have expressed over certification, and the role of the Ad Hoc Committee to Develop a New Certification Code. PMID:4744343

[Aesthetic medicine and aspects related to liability, medical professional and social law].

PubMed

Jansen, Christoph

2006-01-01

There are no special legal arrangements for the field of aesthetic medicine; rather, the general medico-legal regulations apply although they raise specific questions as far as aesthetic medicine is concerned. Legally, a contract exists between physician and patient which is also applicable to aesthetic medicine. This means that the physician owes the patient only the provision of a proper, non-defective service, but does not need to guarantee that it actually leads to the desired outcome. Before performing a medically non-indicated procedure the physician is obliged to provide the patient with particularly thorough information about this procedure. Various problems and issues are raised by the advertising limitations for medical professionals and the maintenance of the boundaries confining the special field of aesthetic medicine. Medically indicated procedures are suitable for statutory reimbursement if the patient suffers from "physical disfigurement" or somatic complaints that lead to considerable impairment and if there are no other, cheaper treatment options available.

Spontaneous mental associations with the words "side effect": Implications for informed and shared decision making.

PubMed

Izadi, Sonya; Pachur, Thorsten; Wheeler, Courtney; McGuire, Jaclyn; Waters, Erika A

2017-10-01

To gain insight into patients' medical decisions by exploring the content of laypeople's spontaneous mental associations with the term "side effect." An online cross-sectional survey asked 144 women aged 40-74, "What are the first three things you think of when you hear the words 'side effect?"' Data were analyzed using content analysis, chi-square, and Fisher's exact tests. 17 codes emerged and were grouped into 4 themes and a Miscellaneous category: Health Problems (70.8% of participants), Decision-Relevant Evaluations (52.8%), Negative Affect (30.6%), Practical Considerations (18.1%) and Miscellaneous (9.7%). The 4 most frequently identified codes were: Risk (36.1%), Health Problems-Specific Symptoms (35.4%), Health Problems-General Terms (32.6%), and Negative Affect-Strong (19.4%). Code and theme frequencies were generally similar across demographic groups (ps>0.05). The term "side effect" spontaneously elicited comments related to identifying health problems and expressing negative emotions. This might explain why the mere possibility of side effects triggers negative affect for people making medical decisions. Some respondents also mentioned decision-relevant evaluations and practical considerations in response to side effects. Addressing commonly-held associations and acknowledging negative affects provoked by side effects are first steps healthcare providers can take towards improving informed and shared patient decision making. Copyright © 2017 Elsevier B.V. All rights reserved.

Medical image processing using neural networks based on multivalued and universal binary neurons

NASA Astrophysics Data System (ADS)

Aizenberg, Igor N.; Aizenberg, Naum N.; Gotko, Eugen S.; Sochka, Vladimir A.

1998-06-01

Cellular Neural Networks (CNN) has become a very good mean for solution of the different kind of image processing problems. CNN based on multi-valued neurons (CNN-MVN) and CNN based on universal binary neurons (CNN-UBN) are the specific kinds of the CNN. MVN and UBN are neurons with complex-valued weights, and complex internal arithmetic. Their main feature is possibility of implementation of the arbitrary mapping between inputs and output described by the MVN, and arbitrary (not only threshold) Boolean function (UBN). Great advantage of the CNN is possibility of implementation of the any linear and many non-linear filters in spatial domain. Together with noise removing using CNN it is possible to implement filters, which can amplify high and medium frequencies. These filters are a very good mean for solution of the enhancement problem, and problem of details extraction against complex background. So, CNN make it possible to organize all the processing process from filtering until extraction of the important details. Organization of this process for medical image processing is considered in the paper. A major attention will be concentrated on the processing of the x-ray and ultrasound images corresponding to different oncology (or closed to oncology) pathologies. Additionally we will consider new structure of the neural network for solution of the problem of differential diagnostics of breast cancer.

Validation of a Crowdsourcing Methodology for Developing a Knowledge Base of Related Problem-Medication Pairs.

PubMed

McCoy, A B; Wright, A; Krousel-Wood, M; Thomas, E J; McCoy, J A; Sittig, D F

2015-01-01

Clinical knowledge bases of problem-medication pairs are necessary for many informatics solutions that improve patient safety, such as clinical summarization. However, developing these knowledge bases can be challenging. We sought to validate a previously developed crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large, non-university health care system with a widely used, commercially available electronic health record. We first retrieved medications and problems entered in the electronic health record by clinicians during routine care during a six month study period. Following the previously published approach, we calculated the link frequency and link ratio for each pair then identified a threshold cutoff for estimated problem-medication pair appropriateness through clinician review; problem-medication pairs meeting the threshold were included in the resulting knowledge base. We selected 50 medications and their gold standard indications to compare the resulting knowledge base to the pilot knowledge base developed previously and determine its recall and precision. The resulting knowledge base contained 26,912 pairs, had a recall of 62.3% and a precision of 87.5%, and outperformed the pilot knowledge base containing 11,167 pairs from the previous study, which had a recall of 46.9% and a precision of 83.3%. We validated the crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large non-university health care system with a widely used, commercially available electronic health record, indicating that the approach may be generalizable across healthcare settings and clinical systems. Further research is necessary to better evaluate the knowledge, to compare crowdsourcing with other approaches, and to evaluate if incorporating the knowledge into electronic health records improves patient outcomes.

Validation of a Crowdsourcing Methodology for Developing a Knowledge Base of Related Problem-Medication Pairs

PubMed Central

Wright, A.; Krousel-Wood, M.; Thomas, E. J.; McCoy, J. A.; Sittig, D. F.

2015-01-01

Summary Background Clinical knowledge bases of problem-medication pairs are necessary for many informatics solutions that improve patient safety, such as clinical summarization. However, developing these knowledge bases can be challenging. Objective We sought to validate a previously developed crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large, non-university health care system with a widely used, commercially available electronic health record. Methods We first retrieved medications and problems entered in the electronic health record by clinicians during routine care during a six month study period. Following the previously published approach, we calculated the link frequency and link ratio for each pair then identified a threshold cutoff for estimated problem-medication pair appropriateness through clinician review; problem-medication pairs meeting the threshold were included in the resulting knowledge base. We selected 50 medications and their gold standard indications to compare the resulting knowledge base to the pilot knowledge base developed previously and determine its recall and precision. Results The resulting knowledge base contained 26,912 pairs, had a recall of 62.3% and a precision of 87.5%, and outperformed the pilot knowledge base containing 11,167 pairs from the previous study, which had a recall of 46.9% and a precision of 83.3%. Conclusions We validated the crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large non-university health care system with a widely used, commercially available electronic health record, indicating that the approach may be generalizable across healthcare settings and clinical systems. Further research is necessary to better evaluate the knowledge, to compare crowdsourcing with other approaches, and to evaluate if incorporating the knowledge into electronic health records improves patient outcomes. PMID:26171079

[Problem areas and examples of best practice in intersectoral medication treatment--a literature review].

PubMed

Mehrmann, Lena; Ollenschläger, Günter

2014-01-01

Transitions between the outpatient and inpatient sector are a critical phase in medication treatment. This article provides an overview of published problem areas and examples of best practice in the intersectoral medication treatment. Data with regard to related problem areas and examples of best practice was collected in August 2011 by a systematic literature research. The relevant literature was identified using the following databases and search engines: MEDLINE, The Cochrane Library, EMBASE, Google, and Google Scholar. Additionally, a hand search was done on the websites of SpringerLink and Thieme Connect. The initial search yielded a total of 4,409 records which were further selected in two screening steps and analysed according to their relevance. Of the remaining 63 records, 3 exclusively described problem areas, 11 of them examples of best practice, and 49 provided information on both problem areas and examples of best practice with regard to intersectoral medication treatment. Among other things, problem areas include varying legal regulations in inpatient and outpatient medication treatment, drug therapy interruptions after hospital discharge, or deficits in communication and continuity of care. Examples of best practice are projects, programmes, initiatives, recommendations, and points to consider with respect to medication reconciliation, pharmaceutical support, or transitions of care. Problem areas as well as examples of best practice are mainly focused on the transition from inpatient to outpatient care. Copyright © 2013. Published by Elsevier GmbH.

TME2/342: The Role of the EXtensible Markup Language (XML) for Future Healthcare Application Development

PubMed Central

Noelle, G; Dudeck, J

1999-01-01

Two years, since the World Wide Web Consortium (W3C) has published the first specification of the eXtensible Markup Language (XML) there exist some concrete tools and applications to work with XML-based data. In particular, new generation Web browsers offer great opportunities to develop new kinds of medical, web-based applications. There are several data-exchange formats in medicine, which have been established in the last years: HL-7, DICOM, EDIFACT and, in the case of Germany, xDT. Whereas communication and information exchange becomes increasingly important, the development of appropriate and necessary interfaces causes problems, rising costs and effort. It has been also recognised that it is difficult to define a standardised interchange format, for one of the major future developments in medical telematics: the electronic patient record (EPR) and its availability on the Internet. Whereas XML, especially in an industrial environment, is celebrated as a generic standard and a solution for all problems concerning e-commerce, in a medical context there are only few applications developed. Nevertheless, the medical environment is an appropriate area for building XML applications: as the information and communication management becomes increasingly important in medical businesses, the role of the Internet changes quickly from an information to a communication medium. The first XML based applications in healthcare show us the advantage for a future engagement of the healthcare industry in XML: such applications are open, easy to extend and cost-effective. Additionally, XML is much more than a simple new data interchange format: many proposals for data query (XQL), data presentation (XSL) and other extensions have been proposed to the W3C and partly realised in medical applications.

Floor vibration evaluations for medical facilities

NASA Astrophysics Data System (ADS)

Himmel, Chad N.

2003-10-01

The structural floor design for new medical facilities is often selected early in the design phase and in renovation projects, the floor structure already exists. Because the floor structure can often have an influence on the location of vibration sensitive medical equipment and facilities, it is becoming necessary to identify the best locations for equipment and facilities early in the design process. Even though specific criteria for vibration-sensitive uses and equipment may not always be available early in the design phase, it should be possible to determine compatible floor structures for planned vibration-sensitive uses by comparing conceptual layouts with generic floor vibration criteria. Relatively simple evaluations of planned uses and generic criteria, combined with on-site vibration and noise measurements early in design phase, can significantly reduce future design problems and expense. Concepts of evaluation procedures and analyses will be presented in this paper. Generic floor vibration criteria and appropriate parameters to control resonant floor vibration and noise will be discussed for typical medical facilities and medical research facilities. Physical, economic, and logistical limitations that affect implementation will be discussed through case studies.

Your brain on drugs: imaging of drug-related changes in the central nervous system.

PubMed

Tamrazi, Benita; Almast, Jeevak

2012-01-01

Drug abuse is a substantial problem in society today and is associated with significant morbidity and mortality. Various drugs are associated with serious complications affecting the brain, and it is critical to recognize the imaging findings of these complications to provide prompt medical management. The central nervous system (CNS) is a target organ for drugs of abuse as well as specific prescribed medications. Drugs of abuse affecting the CNS include cocaine, heroin, alcohol, amphetamines, toluene, and cannabis. Prescribed medications or medical therapies that can affect the CNS include immunosuppressants, antiepileptics, nitrous oxide, and total parenteral nutrition. The CNS complications of these drugs include neurovascular complications, encephalopathy, atrophy, infection, changes in the corpus callosum, and other miscellaneous changes. Imaging abnormalities indicative of these complications can be appreciated at both magnetic resonance (MR) imaging and computed tomography (CT). It is critical for radiologists to recognize complications related to drugs of abuse as well as iatrogenic effects of various medications. Therefore, diagnostic imaging modalities such as MR imaging and CT can play a pivotal role in the recognition and timely management of drug-related complications in the CNS.

Evaluating Learning among Undergraduate Medical Students in Schools with Traditional and Problem-Based Curricula

ERIC Educational Resources Information Center

Meo, Sultan Ayoub

2013-01-01

This study aimed to assess knowledge and skills in a respiratory physiology course in traditional versus problem-based learning (PBL) groups in two different medical schools. Two different undergraduate medical schools were selected for this study. The first medical school followed the traditional [lecture-based learning (LBL)] curriculum, and the…

The Early Interventionist and the Medical Problems of the Child with Down Syndrome.

ERIC Educational Resources Information Center

Roizen, Nancy J.

2003-01-01

This article describes medical problems that occur more frequently in young children with Down syndrome. These include common cardiac, hearing, and vision problems and less common thyroid and celiac diseases. Guidelines for preventing dental and obesity problems are followed by suggestions to early interventionists for watching for leukemia, neck…

Clinical Problem Analysis (CPA): A Systematic Approach To Teaching Complex Medical Problem Solving.

ERIC Educational Resources Information Center

Custers, Eugene J. F. M.; Robbe, Peter F. De Vries; Stuyt, Paul M. J.

2000-01-01

Discusses clinical problem analysis (CPA) in medical education, an approach to solving complex clinical problems. Outlines the five step CPA model and examines the value of CPA's content-independent (methodical) approach. Argues that teaching students to use CPA will enable them to avoid common diagnostic reasoning errors and pitfalls. Compares…

Pre and post-amputation mobility of trans-tibial amputees: correlation to medical problems, age and mortality.

PubMed

Johnson, V J; Kondziela, S; Gottschalk, F

1995-12-01

This retrospective study compares pre and post-amputation mobility and the influence of age and associated medical problems. Data from the charts of 120 male patients who underwent unilateral trans-tibial (below-knee) amputation at the Dallas Veteran's Administration Hospital between June, 1983 and October, 1991, were collected and analyzed. Mobility was assessed with a six level scale developed by Volpicelli et al. (1983). The presence of cardiac disease, pulmonary disease (COPD), peripheral vascular disease (PVD), diabetes mellitus, degenerative joint disease, blindness, cerebral vascular accident (CVA), and age are correlated with changes in mobility after amputation. Older patients had more medical problems and lower post-amputation scores Individual medical problems did not influence mobility scores, but the presence of COPD and PVD lowered pre-amputation mobility scores. Cardiac disease and diabetes mellitus influenced post-amputation mobility scores by lowering them, either together or individually. Regardless of age, however, patients with more medical problems were poor ambulators. The cause of amputation per se did not influence mobility scores.

Structured Medication Review to Improve Pharmacotherapy in People with Intellectual Disability and Behavioural Problems.

PubMed

Scheifes, Arlette; Egberts, Toine C G; Stolker, Joost Jan; Nijman, Henk L I; Heerdink, Eibert R

2016-07-01

Polypharmacy and chronic drug use are common in people with intellectual disability and behavioural problems, although evidence of effectiveness and safety in this population is lacking. This study examined the effects of a structured medication review and aimed to improve pharmacotherapy in inpatients with intellectual disability. In a treatment facility for people with mild to borderline intellectual disability and severe behavioural problems, a structured medication review was performed. Prevalence and type of drug-related problems (DRPs) and of the recommended and executed actions were calculated. In a total of 55 patients with intellectual disability and behavioural problems, 284 medications were prescribed, in which a DRP was seen in 106 (34%). No indication/unclear indication was the most prevalent DRP (70). Almost 60% of the recommended actions were also executed. This high prevalence of DRPs is worrying. The structured medication review is a valuable instrument to optimize pharmacotherapy and to support psychiatrists in adequate prescribing of both psychotropic and somatic drugs. © 2015 John Wiley & Sons Ltd.

Sexual harassment in medical education: liability and protection.

PubMed

Recupero, Patricia Ryan; Heru, Alison M; Price, Marilyn; Alves, Jody

2004-09-01

The prevalence and frequency of sexual harassment in medical education is well documented. On the graduation questionnaire administered by the Association of American Medical Colleges in 2003, 15% of medical students reported experiences of mistreatment during medical school. On items that specifically address sexual mistreatment, over 2% of students reported experiencing gender-based exclusion from training opportunities, and unwanted sexual advances and offensive sexist comments from school personnel. Sexual harassment of medical trainees by faculty supervisors is obviously unethical and may also be illegal under education discrimination laws. In two cases in 1998 and 1999, the U.S. Supreme Court clarified that schools may be held liable under Title IX of the Education Amendments of 1972 for the sexual harassment of their students. In 2001, the Office of Civil Rights of the Department of Education released revised policy guidelines on sexual harassment that reflect the Supreme Court rulings. Medical school administrators should undertake formal assessments of the educational environment in their training programs as a first step toward addressing the problem of sexual harassment. The authors recommend that medical schools implement measures to both prevent and remedy sexual harassment in their training programs. These constructive approaches include applying faculty and student education, establishing a system for notification and response, and creating an institutional structure to provide continuous evaluation of the educational environment.

[The directional axes in the reform of medical teaching. A strategic proposal].

PubMed

Martins e Silva, J

1993-10-01

The circumstances preceding the future revision of the medical curriculum are analysed, main internal and external stimuli are described, and sources of resistance to changes in medical training require new educational philosophy, privileging oriented training during undergraduation, as a preliminary phase of medical education. The definition and accompaniment of the general and specific objectives, the strategy and programme used, the design and adequacy of the available support, and the related engagement of all political, academic and socially responsible persons and institutions, are fundamental factors for successful change. The education and training of polyvalent medical doctors requires methodological modifications, namely the definition of a core curriculum, made dynamic through the teaching of interdependent subjects and earlier contact with common clinical problems. Learning through interconnected basic and clinical matters will benefit the technical and psychosocial education of future doctors. The education resulting from a renewal in undergraduate medical education will be mostly determined by organizational and institutional frameworks, teaching methods and the evaluation process used, as well as by teacher commitment, pedagogic and scientific capacities. Professional competence should be the end product of efficient training. Otherwise, undergraduate medical education would not prepare the professional development of the young doctors, thus diminishing the quality of medical training in the future.

Development of a surveillance case definition for heat-related illness using 911 medical dispatch data.

PubMed

Bassil, Kate L; Cole, Donald C; Moineddin, Rahim; Gournis, Effie; Schwartz, Brian; Craig, Alan M; Lou, W Y Wendy; Rea, Elizabeth

2008-01-01

The adverse effects of hot weather on public health are of increasing concern. A surveillance system using 911 medical dispatch data for the detection of heat-related illness (HRI) could provide new information on the impact of excessive heat on the population. This paper describes how we identified medical dispatch call codes, called "determinants", that could represent HRI events. Approximately 500 medical dispatch determinants were reviewed in focus groups composed of Emergency Medical Services (EMS) paramedics, dispatchers, physicians, and public health epidemiologists. Each group was asked to select those determinants that might adequately represent HRI. Selections were then assessed empirically using correlations with daily mean temperature over the study period (June 1-August 31,2005). The focus groups identified 12 determinant groupings and ranked them according to specificity for HRI. Of these, "Heat/cold exposure" was deemed the most specific. The call determinant groupings with the clearest positive associations with daily mean temperature empirically were "Heat/cold exposure" (Spearman's correlation coefficient (SCC) 0.71, p < 0.0001) and "Unknown problem (man down)" (SCC 0.21, p = 0.04). Within each grouping, the determinant "Unknown status (3rd party caller)" showed significant associations, SCC = 0.34 (p = 0.001) and SCC = 0.22 (p = 0.03) respectively. Clinically-informed expertise and empirical evidence both contributed to identification of a group of 911 medical dispatch call determinants that plausibly represent HRI events. Once evaluated prospectively, these may be used in public health surveillance to better understand environmental health impacts on human populations and inform targeted public health interventions.

[A survey of medical information education in radiological technology schools].

PubMed

Ohba, Hisateru; Ogasawara, Katsuhiko; Hoshino, Shuhei; Hosoba, Minoru; Okuda, Yasuo; Konishi, Yasuhiko; Ikeda, Ryuji

2010-08-20

The purpose of this study was to clarify actual conditions and problems in medical information education and to propose the educational concept to be adopted in medical information. A questionnaire survey was carried out by the anonymous method in June 2008. The survey was intended for 40 radiological technology schools. The questionnaire items were as follows: (1) educational environment in medical information education, (2) content of a lecture in medical information, (3) problems in medical information education. The response rate was 55.0% (22 schools). Half of the responding schools had a laboratory on medical information. Seventeen schools had a medical information education facility, and out of them, approximately 50% had an educational medical information system. The main problems of the medical information education were as follows: (a) motivation of the students is low, (b) the educational coverage and level for medical information are uncertain, (c) there are not an appropriate textbook and educational guidance. In conclusion, these findings suggest that it is necessary to have a vision of medical information education in the education of radiological technologists.

Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis

PubMed Central

Potts, Henry W W; McManus, I C

2011-01-01

Objective To determine whether the ethnicity of UK trained doctors and medical students is related to their academic performance. Design Systematic review and meta-analysis. Data sources Online databases PubMed, Scopus, and ERIC; Google and Google Scholar; personal knowledge; backwards and forwards citations; specific searches of medical education journals and medical education conference abstracts. Study selection The included quantitative reports measured the performance of medical students or UK trained doctors from different ethnic groups in undergraduate or postgraduate assessments. Exclusions were non-UK assessments, only non-UK trained candidates, only self reported assessment data, only dropouts or another non-academic variable, obvious sampling bias, or insufficient details of ethnicity or outcomes. Results 23 reports comparing the academic performance of medical students and doctors from different ethnic groups were included. Meta-analyses of effects from 22 reports (n=23 742) indicated candidates of “non-white” ethnicity underperformed compared with white candidates (Cohen’s d=−0.42, 95% confidence interval −0.50 to −0.34; P<0.001). Effects in the same direction and of similar magnitude were found in meta-analyses of undergraduate assessments only, postgraduate assessments only, machine marked written assessments only, practical clinical assessments only, assessments with pass/fail outcomes only, assessments with continuous outcomes only, and in a meta-analysis of white v Asian candidates only. Heterogeneity was present in all meta-analyses. Conclusion Ethnic differences in academic performance are widespread across different medical schools, different types of exam, and in undergraduates and postgraduates. They have persisted for many years and cannot be dismissed as atypical or local problems. We need to recognise this as an issue that probably affects all of UK medical and higher education. More detailed information to track the problem as well as further research into its causes is required. Such actions are necessary to ensure a fair and just method of training and of assessing current and future doctors. PMID:21385802

[Medical research-ethics applied to social sciences: relevance, limits, issues and necessary adjustments].

PubMed

Desclaux, A

2008-04-01

Social sciences are concretely concerned by the ethics of medical research when they deal with topics related to health, since they are subjected to clearance procedures specific to this field. This raises at least three questions: - Are principles and practices of medical research ethics and social science research compatible? - Are "research subjects" protected by medical research ethics when they participate in social science research projects? - What can social sciences provide to on-going debates and reflexion in this field? The analysis of the comments coming from ethics committees about social science research projects, and of the experience of implementation of these projects, shows that the application of international ethics standards by institutional review boards or ethics committees raises many problems in particular for researches in ethnology anthropology and sociology. These problems may produce an impoverishment of research, pervert its meaning, even hinder any research. They are not only related to different norms, but also to epistemological divergences. Moreover, in the case of studies in social sciences, the immediate and differed risks, the costs, as well as the benefits for subjects, are very different from those related to medical research. These considerations are presently a matter of debates in several countries such as Canada, Brasil, and USA. From another hand, ethics committees seem to have developed without resorting in any manner to the reflexion carried out within social sciences and more particularly in anthropology Still, the stakes of the ethical debates in anthropology show that many important and relevant issues have been discussed. Considering this debate would provide openings for the reflexion in ethics of health research. Ethnographic studies of medical research ethics principles and practices in various sociocultural contexts may also contribute to the advancement of medical ethics. A "mutual adjustment" between ethics of medical research and social sciences is presently necessary: it raises new questions open for debate.

Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis.

PubMed

Woolf, Katherine; Potts, Henry W W; McManus, I C

2011-03-08

To determine whether the ethnicity of UK trained doctors and medical students is related to their academic performance. Systematic review and meta-analysis. Online databases PubMed, Scopus, and ERIC; Google and Google Scholar; personal knowledge; backwards and forwards citations; specific searches of medical education journals and medical education conference abstracts. The included quantitative reports measured the performance of medical students or UK trained doctors from different ethnic groups in undergraduate or postgraduate assessments. Exclusions were non-UK assessments, only non-UK trained candidates, only self reported assessment data, only dropouts or another non-academic variable, obvious sampling bias, or insufficient details of ethnicity or outcomes. Results 23 reports comparing the academic performance of medical students and doctors from different ethnic groups were included. Meta-analyses of effects from 22 reports (n = 23,742) indicated candidates of "non-white" ethnicity underperformed compared with white candidates (Cohen's d = -0.42, 95% confidence interval -0.50 to -0.34; P<0.001). Effects in the same direction and of similar magnitude were found in meta-analyses of undergraduate assessments only, postgraduate assessments only, machine marked written assessments only, practical clinical assessments only, assessments with pass/fail outcomes only, assessments with continuous outcomes only, and in a meta-analysis of white v Asian candidates only. Heterogeneity was present in all meta-analyses. Ethnic differences in academic performance are widespread across different medical schools, different types of exam, and in undergraduates and postgraduates. They have persisted for many years and cannot be dismissed as atypical or local problems. We need to recognise this as an issue that probably affects all of UK medical and higher education. More detailed information to track the problem as well as further research into its causes is required. Such actions are necessary to ensure a fair and just method of training and of assessing current and future doctors.

Glasgow marathons 1982-1987. A review of medical problems.

PubMed

Ridley, S A; Rogers, P N; Wright, I H

1990-02-01

The race statistics, whether conditions and incidence of medical problems for the six consecutive years of the Glasgow Marathon are reviewed. The results suggest that the popularity of marathon running is declining but that the competitors are becoming more experienced, seeking medical assistance earlier and, as a result, experiencing fewer and less serious problems at the finish. The effect of weather conditions on the runners' performance is discussed.

Direct medical cost and utility analysis of diabetics outpatient at Karanganyar public hospital

NASA Astrophysics Data System (ADS)

Eristina; Andayani, T. M.; Oetari, R. A.

2017-11-01

Diabetes Mellitus is a high cost disease, especially in long-term complication treatment. Long-term complication treatment cost was a problem for the patient, it can affect patients quality of life stated with utility value. The purpose of this study was to determine the medical cost, utility value and leverage factors of diabetics outpatient. This study was cross sectional design, data collected from retrospective medical record of the financial and pharmacy department to obtain direct medical cost, utility value taken from EQ-5D-5L questionnaire. Data analyzed by Mann-Whitney and Kruskal-Wallis test. Results of this study were IDR 433,728.00 for the direct medical cost and pharmacy as the biggest cost. EQ-5D-5L questionnaire showed the biggest proportion on each dimension were 61% no problem on mobility dimension, 89% no problems on self-care dimension, 54% slight problems on usual activities dimension, 41% moderate problems on pain/discomfort dimension and 48% moderate problems on anxiety/depresion dimension. Build upon Thailand value set, utility value was 0.833. Direct medical cost was IDR 433,728.00 with leverage factors were pattern therapy, blood glucose level and complication. Utility value was 0.833 with leverage factors were patients characteristic, therapy pattern, blood glucose level and complication.

76 FR 45268 - Reprocessing of Reusable Medical Devices

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-28

... personal information provided. For additional information on submitting comments, see the ``Comments... problems in all steps of medical device reprocessing,\\1\\ including cleaning, disinfecting, and sterilizing... following issues: 1. What are the nature, scope, and impact of reusable medical device reprocessing problems...

Maternal prenatal felt security and infant health at birth interact to predict infant fussing and crying at 12 months postpartum.

PubMed

Sawada, Natsumi; Gagné, Faby M; Séguin, Louise; Kramer, Michael S; McNamara, Helen; Platt, Robert W; Goulet, Lise; Meaney, Michael J; Lydon, John E

2015-08-01

Infants born with medical problems are at risk for less optimal developmental outcomes. This may be, in part, because neonatal medical problems are associated with maternal distress, which may adversely impact infants. However, the reserve capacity model suggests that an individual's bank of psychosocial resources buffers the adverse effects of later-encountered stressors. This prospective longitudinal study examined whether preexisting maternal psychosocial resources, conceptualized as felt security in close relationships, moderate the association between neonatal medical problems and infant fussing and crying 12 months postpartum. Maternal felt security was measured by assessing its indicators in 5,092 pregnant women. At birth, infants were classified as healthy or having a medical problem. At 12 months, experience sampling was used to assess daily maternal reports of fussing and crying in 135 mothers of infants who were healthy or had medical problems at birth. Confirmatory factor analyses revealed that attachment, relationship quality, self-esteem, and social support can be conceptualized as indicators of a single felt security factor. Multiple regression analyses revealed that prenatal maternal felt security interacts with infant health at birth to predict fussing and crying at 12 months. Among infants born with medical problems, higher felt security predicted decreased fussing and crying. Maternal felt security assessed before birth dampens the association between neonatal medical problems and subsequent infant behavior. This supports the hypothesis that psychosocial resources in reserve can be called upon in the face of a stressor to reduce its adverse effects on the self or others. (c) 2015 APA, all rights reserved).

The identification of clinically important elements within medical journal abstracts: Patient-Population-Problem, Exposure-Intervention, Comparison, Outcome, Duration and Results (PECODR).

PubMed

Dawes, Martin; Pluye, Pierre; Shea, Laura; Grad, Roland; Greenberg, Arlene; Nie, Jian-Yun

2007-01-01

Information retrieval in primary care is becoming more difficult as the volume of medical information held in electronic databases expands. The lexical structure of this information might permit automatic indexing and improved retrieval. To determine the possibility of identifying the key elements of clinical studies, namely Patient-Population-Problem, Exposure-Intervention, Comparison, Outcome, Duration and Results (PECODR), from abstracts of medical journals. We used a convenience sample of 20 synopses from the journal Evidence-Based Medicine (EBM) and their matching original journal article abstracts obtained from PubMed. Three independent primary care professionals identified PECODR-related extracts of text. Rules were developed to define each PECODR element and the selection process of characters, words, phrases and sentences. From the extracts of text related to PECODR elements, potential lexical patterns that might help identify those elements were proposed and assessed using NVivo software. A total of 835 PECODR-related text extracts containing 41,263 individual text characters were identified from 20 EBM journal synopses. There were 759 extracts in the corresponding PubMed abstracts containing 31,947 characters. PECODR elements were found in nearly all abstracts and synopses with the exception of duration. There was agreement on 86.6% of the extracts from the 20 EBM synopses and 85.0% on the corresponding PubMed abstracts. After consensus this rose to 98.4% and 96.9% respectively. We found potential text patterns in the Comparison, Outcome and Results elements of both EBM synopses and PubMed abstracts. Some phrases and words are used frequently and are specific for these elements in both synopses and abstracts. Results suggest a PECODR-related structure exists in medical abstracts and that there might be lexical patterns specific to these elements. More sophisticated computer-assisted lexical-semantic analysis might refine these results, and pave the way to automating PECODR indexing, and improve information retrieval in primary care.

Barriers to treatment adherence among African American and white women with systemic lupus erythematosus.

PubMed

Mosley-Williams, Angelia; Lumley, Mark A; Gillis, Mazy; Leisen, James; Guice, Deena

2002-12-15

To determine whether African Americans with systemic lupus erythematosus (SLE) have poorer treatment adherence than whites, and to determine ethnic group differences in barriers to adherence, and how barriers affect adherence. We compared 68 African American and 54 white women with SLE on 19 potential barriers, on 2 adherence behaviors during the past year, and on how the potential barriers relate to each nonadherence behavior. African Americans and whites were similar on most barriers, although African Americans were more likely to rely on religion and were more concerned about long-term medication effects. The 2 ethnic groups were comparable on medication nonadherence, but whites tended to have poorer clinic appointment adherence than African Americans. Finally, we found that barriers related to negative affect (depression, medication concerns, physical symptoms) as well as short-term memory problems and the need for child or elder care were associated with nonadherence among African Americans, whereas perceived treatment inefficacy and lacking trust in physicians were associated with nonadherence among whites. Relationships between adherence barriers and nonadherence may be ethnicity specific, suggesting that interventions to address barriers should be targeted to specific groups.

Voluntary community service in medical school: a qualitative study on obstacles faced by student leaders and potential solutions

PubMed Central

Loh, Alvona Zi Hui; Tan, Julia Shi Yu; Lee, Jeannette Jen-Mai; Koh, Gerald Choon-Huat

2015-01-01

Purpose In medical school, students may participate in various community involvement projects (CIP), which serve disadvantaged communities. However, several obstacles may arise during these projects. The authors conducted a qualitative study with the primary aim of understanding the obstacles and corresponding potential solutions when medical students in Singapore participate in local CIP (LCIP) and overseas CIP (OCIP). Design The authors recruited medical students from Yong Loo Lin School of Medicine, National University of Singapore, who were also leaders of a specific community service project done in medical school. Twelve one-to-one interviews were held for the participants from 6 to 8 January 2013. Participants were led in a discussion based on an interview guide. The interviews were audio-recorded and transcribed into free-flow text. Subsequently, content and thematic analyses of the transcripts were performed independently by three researchers. Results The medical students faced many common obstacles during their community service projects. These obstacles include difficulties in recruiting and managing volunteers, attaining recognition or credibility for the project to acquire funding and resources, adjusting to a different culture or language, setting goals, and facing project-specific obstacles. Potential solutions were offered for some obstacles, such as building a strong executive committee for the project, grooming successive batches of leaders, and improving the project's public image, mentorship, reflections, and sustainability plans. Conclusions Mentorship, reflections, and sustainability are potential solutions that have been proposed to tackle the obstacles faced during community service participation in medical school. However, there may still be difficulty in solving some of the problems even after these measures are put into practice. Future research may focus on evaluating the effectiveness of these suggested solutions. PMID:26490690

Voluntary community service in medical school: a qualitative study on obstacles faced by student leaders and potential solutions.

PubMed

Loh, Alvona Zi Hui; Tan, Julia Shi Yu; Lee, Jeannette Jen-Mai; Koh, Gerald Choon-Huat

2015-01-01

In medical school, students may participate in various community involvement projects (CIP), which serve disadvantaged communities. However, several obstacles may arise during these projects. The authors conducted a qualitative study with the primary aim of understanding the obstacles and corresponding potential solutions when medical students in Singapore participate in local CIP (LCIP) and overseas CIP (OCIP). The authors recruited medical students from Yong Loo Lin School of Medicine, National University of Singapore, who were also leaders of a specific community service project done in medical school. Twelve one-to-one interviews were held for the participants from 6 to 8 January 2013. Participants were led in a discussion based on an interview guide. The interviews were audio-recorded and transcribed into free-flow text. Subsequently, content and thematic analyses of the transcripts were performed independently by three researchers. The medical students faced many common obstacles during their community service projects. These obstacles include difficulties in recruiting and managing volunteers, attaining recognition or credibility for the project to acquire funding and resources, adjusting to a different culture or language, setting goals, and facing project-specific obstacles. Potential solutions were offered for some obstacles, such as building a strong executive committee for the project, grooming successive batches of leaders, and improving the project's public image, mentorship, reflections, and sustainability plans. Mentorship, reflections, and sustainability are potential solutions that have been proposed to tackle the obstacles faced during community service participation in medical school. However, there may still be difficulty in solving some of the problems even after these measures are put into practice. Future research may focus on evaluating the effectiveness of these suggested solutions.

An Interprofessional Education and Collaborative Practice Model for Dentistry and Pharmacy.

PubMed

Branch-Mays, Grishondra L; Pittenger, Amy L; Williamson, Kristyn; Milone, Anna; Hein, Emily; Thierer, Todd

2017-12-01

The aims of this study were to evaluate the feasibility of an interprofessional education and collaborative practice model (IECPM) developed by the School of Dentistry (SOD) and College of Pharmacy (COP) for the University of Minnesota dental clinics and to report results of the needs assessment using specific primary care metrics and medication histories gathered through use of the model in 2015-16. Planning focused on establishing a workflow to implement the IECPM by the SOD and COP. The interprofessional team that provided patient care for the study consisted of 50 dental students, ten dental therapy students, one pharmacy student, one pharmacy resident, one faculty pharmacist, one dental assistant, one faculty dental hygienist, and two dentists. The team selected 190 patients in the SOD clinic for the study based on the inclusion criteria: patients with two or more chronic medical conditions who were taking medications. The 190 patients received a comprehensive dental exam, review of social and medical history, and medication therapy management assessment by the interprofessional team. Specific core primary care metrics (blood pressure, pulse, tobacco use, and diabetes status) and identification of drug therapy problems (DTPs) were monitored and/or screened for during the dental visit. The results showed that the IECPM helped identify that this cohort of patients presented with chronic conditions: 64% had hypertension, 34% had diabetes, and 10.5% reported smoking cigarettes. Several DTPs were identified, of which "needs additional drug therapy" was the most common. This cohort was taking multiple medications (2-34 per patient) to address a variety of medical conditions. The study concluded that the IECPM with the SOD and COP helped address a primary care need that often goes unmet in dental clinics.

Career opportunities in clinical engineering.

PubMed

Morse, W A

1992-01-01

The varied career opportunities open to clinical engineers are described in this paper. Many of these opportunities are within the medical device industry in research, development, manufacturing design, regulatory activities, production, operations, sales, marketing, service, and management. Additional opportunities are available in hospitals, with the Veterans Administration, or working as an entrepreneur or a consultant. Each of these careers requires specific training and skills, and they all require a fundamental scientific knowledge of physical principles and mathematics. Research and management, however, require different educational preparation. The research emphasis should be on theoretical principles and creativity; the management emphasis should be on financial and labor problems. In all clinical engineering careers, the individual is a problem solver.

Overcoming barriers to addressing education problems with research design: a panel discussion.

PubMed

Yarris, Lalena M; Gruppen, Larry D; Hamstra, Stanley J; Anders Ericsson, K; Cook, David A

2012-12-01

A plenary panel session at the 2012 Academic Emergency Medicine consensus conference "Education Research in Emergency Medicine: Opportunities, Challenges, and Strategies for Success" discussed barriers educators face in imagining, designing, and implementing studies to address educational challenges. This proceedings article presents a general approach to getting started in education research. Four examples of studies from the medical education literature that illustrate a distinct way to approach specific research questions are discussed. The study designs used are applicable to a variety of education research problems in emergency medicine (EM). Potential applications of studies are discussed, as well as effects and lessons learned. © 2012 by the Society for Academic Emergency Medicine.

Computer-mediated mobile messaging as collaboration support for nurses.

PubMed

Karpati, Peter; Toussaint, Pieter Jelle; Nytrø, Oystein

2009-01-01

Collaboration in hospitals is coordinated mainly by communication, which currently happens by face-to-face meetings, phone calls, pagers, notes and the electronic patient record. These habits raise problems e.g., delayed notifications and unnecessary interruptions. Dealing with these problems could save time and improve the care. Therefore we designed and prototyped a mobile messaging solution based on two specific scenarios coming from observations at a cardiology department of a Norwegian hospital. The main focus was on supporting the work of nurses. One prototype supported patient management while another one dealt with messages related to medication planning. The evaluation of the prototypes suggested that messaging-based collaboration support is worth to explore and also gave ideas for improvement.

A discrete choice experiment studying students' preferences for scholarships to private medical schools in Japan.

PubMed

Goto, Rei; Kakihara, Hiroaki

2016-02-09

The shortage of physicians in rural areas and in some specialties is a societal problem in Japan. Expensive tuition in private medical schools limits access to them particularly for students from middle- and low-income families. One way to reduce this barrier and lessen maldistribution is to offer conditional scholarships to private medical schools. A discrete choice experiment is carried out on a total of 374 students considering application to medical schools. The willingness to receive a conditional scholarship program to private medical schools is analyzed. The probability of attending private medical schools significantly decreased because of high tuition, a postgraduate obligation to provide a service in specific specialty areas, and the length of time of this obligation. An obligation to provide a service in rural regions had no significant effect on this probability. To motivate non-applicants to private medical schools to enroll in such schools, a decrease in tuition to around 1.2 million yen (US$ 12,000) or less, which is twice that of public schools, was found to be necessary. Further, it was found that non-applicants to private medical schools choose to apply to such schools even with restrictions if they have tuition support at the public school level. Conditional scholarships for private medical schools may widen access to medical education and simultaneously provide incentives to work in insufficiently served areas.

Rethinking medical humanities.

PubMed

Chiapperino, Luca; Boniolo, Giovanni

2014-12-01

This paper questions different conceptions of Medical Humanities in order to provide a clearer understanding of what they are and why they matter. Building upon former attempts, we defend a conception of Medical Humanities as a humanistic problem-based approach to medicine aiming at influencing its nature and practice. In particular, we discuss three main conceptual issues regarding the overall nature of this discipline: (i) a problem-driven approach to Medical Humanities; (ii) the need for an integration of Medical Humanities into medicine; (iii) the methodological requirements that could render Medical Humanities an effective framework for medical decision-making.

Toward Anatomical Simulation for Breath Training in Mind/Body Medicine

NASA Astrophysics Data System (ADS)

Sanders, Benjamin; Dilorenzo, Paul; Zordan, Victor; Bakal, Donald

The use of breath in healing is poorly understood by patients and professionals alike. Dysfunctional breathing is a characteristic of many unexplained symptoms and mind/body medical professionals seek methods for breath training to alleviate such problems. Our approach is to re-purpose and evolve a recently developed anatomically inspired respiration simulation which was created for synthesizing motion in entertainment for the use of visualization in breath training. In mind/body medicine, problems are often created from patients being advised to breathe according to some standard based on pace or volume. However, a breathing pattern that is comfortable and effortless for one person may not have the same benefits for the next person. The breathing rhythm which is most effortless for each person needs to be dynamically identified. To this end, in this chapter, we employ optimization to modify a generic model of respiration to fit the breath patterns of specific individuals. In practice, the corresponding visualization which is specific to individual patients could be used to train proper breath behavior, both by showing specific (abnormal) practice and recommended modification(s).

A continuous quality improvement project to reduce medication error in the emergency department.

PubMed

Lee, Sara Bc; Lee, Larry Ly; Yeung, Richard Sd; Chan, Jimmy Ts

2013-01-01

Medication errors are a common source of adverse healthcare incidents particularly in the emergency department (ED) that has a number of factors that make it prone to medication errors. This project aims to reduce medication errors and improve the health and economic outcomes of clinical care in Hong Kong ED. In 2009, a task group was formed to identify problems that potentially endanger medication safety and developed strategies to eliminate these problems. Responsible officers were assigned to look after seven error-prone areas. Strategies were proposed, discussed, endorsed and promulgated to eliminate the problems identified. A reduction of medication incidents (MI) from 16 to 6 was achieved before and after the improvement work. This project successfully established a concrete organizational structure to safeguard error-prone areas of medication safety in a sustainable manner.

A study of library use in problem-based and traditional medical curricula.

PubMed

Marshall, J G; Fitzgerald, D; Busby, L; Heaton, G

1993-07-01

A key question for librarians and medical educators who are planning for curriculum change is whether students and faculty in problem-based learning (PBL) programs use the library and its resources differently than do participants in traditional programs. During 1991, this research question was explored at three medical schools in the province of Ontario, Canada. At the time of the study, McMaster University medical school was totally problem-based, the University of Western Ontario had one PBL day each week for first-year medical students, and the University of Toronto, although planning for medical curriculum change, had not yet initiated PBL. Data collected in the study suggest that more medical students in the problem-based curriculum than in the more traditional programs use the library and that, when the PBL students use the library, they do so more frequently, for longer periods of time, and as a source of a greater proportion of their study materials. PBL students also use the library more than their counterparts as a place to study and meet other students. Students in the problem-based curriculum use the following resources more extensively: end-user MEDLINE searching, library journals, reserve or short-term loan materials, photocopy services, and audiovisual materials. PBL students also report purchasing more textbooks. In contrast to the differences found among medical students, however, patterns of library and resource use by medical faculty at the three schools were quite similar.

Correlation Research of Medical Security Management System Network Platform in Medical Practice

NASA Astrophysics Data System (ADS)

Jie, Wang; Fan, Zhang; Jian, Hao; Li-nong, Yu; Jun, Fei; Ping, Hao; Ya-wei, Shen; Yue-jin, Chang

Objective-The related research of medical security management system network in medical practice. Methods-Establishing network platform of medical safety management system, medical security network host station, medical security management system(C/S), medical security management system of departments and sections, comprehensive query, medical security disposal and examination system. Results-In medical safety management, medical security management system can reflect the hospital medical security problem, and can achieve real-time detection and improve the medical security incident detection rate. Conclusion-The application of the research in the hospital management implementation, can find hospital medical security hidden danger and the problems of medical disputes, and can help in resolving medical disputes in time and achieve good work efficiency, which is worth applying in the hospital practice.

Library collaboration with medical humanities in an american medical college in qatar.

PubMed

Birch, Sally; Magid, Amani; Weber, Alan

2013-11-01

The medical humanities, a cross-disciplinary field of practice and research that includes medicine, literature, art, history, philosophy, and sociology, is being increasingly incorporated into medical school curricula internationally. Medical humanities courses in Writing, Literature, Medical Ethics and History can teach physicians-in-training communication skills, doctor-patient relations, and medical ethics, as well as empathy and cross-cultural understanding. In addition to providing educational breadth and variety, the medical humanities can also play a practical role in teaching critical/analytical skills. These skills are utilized in differential diagnosis and problem-based learning, as well as in developing written and oral communications. Communication skills are a required medical competency for passing medical board exams in the U.S., Canada, the UK and elsewhere. The medical library is an integral part of medical humanities training efforts. This contribution provides a case study of the Distributed eLibrary at the Weill Cornell Medical College in Qatar in Doha, and its collaboration with the Writing Program in the Premedical Program to teach and develop the medical humanities. Programs and initiatives of the DeLib library include: developing an information literacy course, course guides for specific courses, the 100 Classic Books Project, collection development of 'doctors' stories' related to the practice of medicine (including medically-oriented movies and TV programs), and workshops to teach the analytical and critical thinking skills that form the basis of humanistic approaches to knowledge. This paper outlines a 'best practices' approach to developing the medical humanities in collaboration among the medical library, faculty and administrative stakeholders.

Library Collaboration with Medical Humanities in an American Medical College in Qatar

PubMed Central

Birch, Sally; Magid, Amani; Weber, Alan

2013-01-01

The medical humanities, a cross-disciplinary field of practice and research that includes medicine, literature, art, history, philosophy, and sociology, is being increasingly incorporated into medical school curricula internationally. Medical humanities courses in Writing, Literature, Medical Ethics and History can teach physicians-in-training communication skills, doctor-patient relations, and medical ethics, as well as empathy and cross-cultural understanding. In addition to providing educational breadth and variety, the medical humanities can also play a practical role in teaching critical/analytical skills. These skills are utilized in differential diagnosis and problem-based learning, as well as in developing written and oral communications. Communication skills are a required medical competency for passing medical board exams in the U.S., Canada, the UK and elsewhere. The medical library is an integral part of medical humanities training efforts. This contribution provides a case study of the Distributed eLibrary at the Weill Cornell Medical College in Qatar in Doha, and its collaboration with the Writing Program in the Premedical Program to teach and develop the medical humanities. Programs and initiatives of the DeLib library include: developing an information literacy course, course guides for specific courses, the 100 Classic Books Project, collection development of ‘doctors’ stories’ related to the practice of medicine (including medically-oriented movies and TV programs), and workshops to teach the analytical and critical thinking skills that form the basis of humanistic approaches to knowledge. This paper outlines a ‘best practices’ approach to developing the medical humanities in collaboration among the medical library, faculty and administrative stakeholders. PMID:24223240

Cultural Conundrums: The Ethics of Epidemiology and the Problems of Population in Implementing Pre-Exposure Prophylaxis

PubMed Central

2013-01-01

The impending implementation of pre-exposure prophylaxis (PrEP) has prompted complicated bioethical and public health ethics concerns regarding the moral distribution of antiretroviral medications (ARVs) to ostensibly healthy populations as a form of HIV prevention when millions of HIV-positive people still lack access to ARVs globally. This manuscript argues that these questions are, in part, concerns over the ethics of epidemiological science and knowledge production practices. Questions of distribution, and their attendant cost-benefit calculations, will rely on a number of presupposed, and therefore, normatively cultural assumptions within the science of epidemiology specifically regarding the ability of epidemiological surveillance to produce accurate maps of HIV throughout national populations. Specifically, ethical questions around PrEP will focus on who should receive ARVs given the fact that global demand will far exceed supply. Given that sexual transmission is one of the main modes of HIV transmission, these questions of “who” are inextricably linked to knowledge about sex, gender and sexuality. As a result, the ethics of epidemiology, and how the epidemiology of HIV in particular conceives, classifies and constructs sexual populations will become a critical point of reflection and contestation for bioethicists, health activists, physicians, nurses, and researchers in the medical humanities and biomedicine. This paper examines how cultural conundrums within the fields of bio- and public health ethics are directly implicated within the ethics of PrEP, by analyzing the problems of population inaugurated by the construction of the men who have sex with men (MSM) epidemiological category in the specific national context of South Africa. PMID:24373050

Medical Images Remote Consultation

NASA Astrophysics Data System (ADS)

Ferraris, Maurizio; Frixione, Paolo; Squarcia, Sandro

Teleconsultation of digital images among different medical centers is now a reality. The problem to be solved is how to interconnect all the clinical diagnostic devices in a hospital in order to allow physicians and health physicists, working in different places, to discuss on interesting clinical cases visualizing the same diagnostic images at the same time. Applying World Wide Web technologies, the proposed system can be easily used by people with no specific computer knowledge providing a verbose help to guide the user through the right steps of execution. Diagnostic images are retrieved from a relational database or from a standard DICOM-PACS through the DICOM-WWW gateway allowing connection of the usual Web browsers to DICOM applications via the HTTP protocol. The system, which is proposed for radiotherapy implementation, where radiographies play a fundamental role, can be easily converted to different field of medical applications where a remote access to secure data are compulsory.

Behind the scenes: A medical natural language processing project.

PubMed

Wu, Joy T; Dernoncourt, Franck; Gehrmann, Sebastian; Tyler, Patrick D; Moseley, Edward T; Carlson, Eric T; Grant, David W; Li, Yeran; Welt, Jonathan; Celi, Leo Anthony

2018-04-01

Advancement of Artificial Intelligence (AI) capabilities in medicine can help address many pressing problems in healthcare. However, AI research endeavors in healthcare may not be clinically relevant, may have unrealistic expectations, or may not be explicit enough about their limitations. A diverse and well-functioning multidisciplinary team (MDT) can help identify appropriate and achievable AI research agendas in healthcare, and advance medical AI technologies by developing AI algorithms as well as addressing the shortage of appropriately labeled datasets for machine learning. In this paper, our team of engineers, clinicians and machine learning experts share their experience and lessons learned from their two-year-long collaboration on a natural language processing (NLP) research project. We highlight specific challenges encountered in cross-disciplinary teamwork, dataset creation for NLP research, and expectation setting for current medical AI technologies. Copyright © 2017. Published by Elsevier B.V.

Finance issue brief: direct access: year end report-2002.

PubMed

Morgan, Rachel; MacEachern, Lillian

2002-12-31

Consumer demand for a less restrictive referral system has urged legislators, as well as the managed care industry and those in the medical field, to seek the best solution to the problem. The point of service (POS) plan was an early attempt by managed care plans to provide more freedom for enrollees. But POS plans are not always available or cost effective. Several of the larger managed care organizations, in an effort to improve enrollee and provider satisfaction, have eliminated or streamlined their referral processes. The American Medical Association has recommended that primary care and other medical specialty organizations collaborate in developing guidelines for specialty referrals, urging health plans to allow direct access in network without financial penalty as long as the access conforms with the established guidelines. In the meantime, legislators have responded to constituents by enacting measures that mandate direct access for specific types of care or standing referrals for ongoing treatment.

Finance issue brief: direct access: year end report-2003.

PubMed

MacEachern, Lillian

2003-12-31

Consumer demand for a less restrictive referral system has urged legislators, as well as the managed care industry and those in the medical field, to seek the best solution to the problem. The point of service (POS) plan was an early attempt by managed care plans to provide more freedom for enrollees. But POS plans are not always available or cost effective. Several of the larger managed care organizations, in an effort to improve enrollee and provider satisfaction, have eliminated or streamlined their referral processes. The American Medical Association has recommended that primary care and other medical specialty organizations collaborate in developing guidelines for specialty referrals, urging health plans to allow direct access in network without financial penalty as long as the access conforms with the established guidelines. In the meantime, legislators have responded to constituents by enacting measures that mandate direct access for specific types of care or standing referrals for ongoing treatment.

Problems for clinical judgement: 5. Principles of influence in medical practice

PubMed Central

Redelmeier, Donald A.; Cialdini, Robert B.

2002-01-01

THE BASIC SCIENCE OF PSYCHOLOGY HAS IDENTIFIED specific ingrained responses that are fundamental elements of human nature, underpin common influence strategies and may apply in medical settings. People feel a sense of obligation to repay a perceived debt. A request becomes more attractive when preceded by a marginally worse request. The drive to act consistently will persist even if demands escalate. Peer pressure is intense when people face uncertainty. The image of the requester influences the attractiveness of a request. Authorities have power beyond their expertise. Opportunities appear more valuable when they appear less available. These 7 responses were discovered decades ago in psychology research and seem intuitively understood in the business world, but they are rarely discussed in medical texts. An awareness of these principles can provide a framework for physicians to help patients change their behaviour and to understand how others in society sometime alter patients' choices. PMID:12126325

Innovation design of medical equipment based on TRIZ.

PubMed

Gao, Changqing; Guo, Leiming; Gao, Fenglan; Yang, Bo

2015-01-01

Medical equipment is closely related to personal health and safety, and this can be of concern to the equipment user. Furthermore, there is much competition among medical equipment manufacturers. Innovative design is the key to success for those enterprises. The design of medical equipment usually covers vastly different domains of knowledge. The application of modern design methodology in medical equipment and technology invention is an urgent requirement. TRIZ (Russian abbreviation of what can be translated as `theory of inventive problem solving') was born in Russia, which contain some problem-solving methods developed by patent analysis around the world, including Conflict Matrix, Substance Field Analysis, Standard Solution, Effects, etc. TRIZ is an inventive methodology for problems solving. As an Engineering example, infusion system is analyzed and re-designed by TRIZ. The innovative idea is generated to liberate the caretaker from the infusion bag watching out. The research in this paper shows the process of the application of TRIZ in medical device inventions. It is proved that TRIZ is an inventive methodology for problems solving and can be used widely in medical device development.

Understanding Patients' Process to Use Medical Marijuana: A Southern New Jersey Community Engagement Project.

PubMed

Crowell, Tara L

2016-09-01

Given the necessity to better understand the process patients need to go through in order to seek treatment via medical marijuana, this study investigates this process to better understand this phenomenon. Specifically, Compassion Care Foundation (CCF) and Stockton University worked together to identify a solution to this problem. Specifically, 240 new patients at CCF were asked to complete a 1-page survey regarding various aspects associated with their experience prior to their use of medicinal marijuana-diagnosis, what prompted them to seek treatment, level of satisfaction with specific stages in the process, total length of time the process took, and patient's level of pain. Results reveal numerous patient diagnoses for which medical marijuana is being prescribed; the top 4 most common are intractable skeletal spasticity, chronic and severe pain, multiple sclerosis, and inflammatory bowel disease. Next, results indicate a little over half of the patients were first prompted to seek alternative treatment from their physicians, while the remaining patients indicated that other sources such as written information along with friends, relatives, media, and the Internet persuaded them to seek treatment. These data indicate that a variety of sources play a role in prompting patients to seek alternative treatment and is a critical first step in this process. Additional results posit that once patients began the process of qualifying to receive medical marijuana as treatment, the process seemed more positive even though it takes patients on average almost 6 months to obtain their first treatment after they started the process. Finally, results indicate that patients are reporting a moderately high level of pain prior to treatment. Implication of these results highlights several important elements in the patients' initial steps toward seeking medical marijuana, along with the quality and quantity of the process patients must engage in prior to obtaining treatment. In addition, identifying patients' level of pain and better understanding the possible therapeutic value of medical marijuana are essential to patients and health practitioners.

Promoting Interdisciplinary Collaboration: Trainees Addressing Siloed Medical Education

ERIC Educational Resources Information Center

Kitts, Robert Li; Christodoulou, Joanna; Goldman, Stuart

2011-01-01

Objective: Professional siloing within medical institutions has been identified as a problem in medical education, including resident training. The authors discuss how trainees from different disciplines can collaborate to address this problem. Method: A group of trainees from psychiatry, developmental medicine, neurology, and education came…

[Selection of "surrogate" and "endpoints" evaluation of the efficacy of medical interventions].

PubMed

Lazebnik, L B; Gusein-Zade, M G; Efremov, L I

2011-01-01

With the advent of new medical technologies and medicines, as well as due to changes in disease patterns and demographic problems rises the need for continued increases in health spending. Increased costs can be totally inadequate, if it has been done without studying the effectiveness of medical interventions, based on the results of evidence-based medicine and economic of their feasibility. To evaluate the clinical effectiveness of medical interventions have been recently used specific criteria, so called points of clinical efficacy (surrogate and endpoints), that allow to conclude feasibility or harmfulness of the introduction or application of the intervention in clinical practice. The endpoint is reliable indicator the effectiveness of medical intervention. Surrogate point--is a biomarker that is intended to replace the endpoint and is a predictor of the effectiveness of medical intervention. The use of surrogate points has several advantages such as simple in identification and measurement, as well as more higher in compare with endpoints the vents frequency, that can significantly reduce the size of the selection and duration and cost of clinical trials, respectively. Finally, the surrogate points allow to evaluate treatment effect in situations where the use of endpoints is difficult or is unethical.

Paradigms and Problem-Solving: A Literature Review.

ERIC Educational Resources Information Center

Berner, Eta S.

1984-01-01

Thomas Kuhn's conceptions of the influence of paradigms on the progress of science form the framework for analyzing how medical educators have approached research on medical problem solving. A new paradigm emphasizing multiple types of problems with varied solution strategies is proposed. (Author/MLW)

Mobile technology supporting trainee doctors' workplace learning and patient care: an evaluation.

PubMed

Hardyman, Wendy; Bullock, Alison; Brown, Alice; Carter-Ingram, Sophie; Stacey, Mark

2013-01-21

The amount of information needed by doctors has exploded. The nature of knowledge (explicit and tacit) and processes of knowledge acquisition and participation are complex. Aiming to assist workplace learning, Wales Deanery funded "iDoc", a project offering trainee doctors a Smartphone library of medical textbooks. Data on trainee doctors' (Foundation Year 2) workplace information seeking practice was collected by questionnaire in 2011 (n = 260). iDoc baseline questionnaires (n = 193) collected data on Smartphone usage alongside other workplace information sources. Case reports (n = 117) detail specific instances of Smartphone use. Most frequently (daily) used information sources in the workplace: senior medical staff (80% F2 survey; 79% iDoc baseline); peers (70%; 58%); and other medical/nursing team staff (53% both datasets). Smartphones were used more frequently by males (p < 0.01). Foundation Year 1 (newly qualified) was judged the most useful time to have a Smartphone library because of increased responsibility and lack of knowledge/experience.Preferred information source varied by question type: hard copy texts for information-based questions; varied resources for skills queries; and seniors for more complex problems. Case reports showed mobile technology used for simple (information-based), complex (problem-based) clinical questions and clinical procedures (skills-based scenarios). From thematic analysis, the Smartphone library assisted: teaching and learning from observation; transition from medical student to new doctor; trainee doctors' discussions with seniors; independent practice; patient care; and this 'just-in-time' access to reliable information supported confident and efficient decision-making. A variety of information sources are used regularly in the workplace. Colleagues are used daily but seniors are not always available. During transitions, constant access to the electronic library was valued. It helped prepare trainee doctors for discussions with their seniors, assisting the interchange between explicit and tacit knowledge.By supporting accurate prescribing and treatment planning, the electronic library contributed to enhanced patient care. Trainees were more rapidly able to medicate patients to reduce pain and more quickly call for specific assessments. However, clinical decision-making often requires dialogue: what Smartphone technology can do is augment, not replace, discussion with their colleagues in the community of practice.

A formative evaluation of problem-based learning as an instructional strategy in a medical laboratory technician course

NASA Astrophysics Data System (ADS)

Nelson, Diane Patricia

2002-09-01

This study is a formative evaluation of problem-based learning as an effective course delivery strategy in a second year introductory Medical Laboratory Technician discipline-specific hematology course. This strategy can serve two purposes in this type of course: discipline specific content knowledge and process skills learning. A needs study identified that students required additional workplace skills as they entered the clinical internship. Students tested well on the national registry examinations, discipline-specific content knowledge, but group process skills needed improvement in the areas of collaboration, communication, and critical reasoning. Problem-based learning was identified as an change intervention to help provide these skills. A search of the literature revealed that the Baker College cultural and physical environment would support this intervention. Twelve cases were written, situated in a clinical laboratory environment, addressing learning issues identified in a modified Delphi survey of laboratory personnel e.g. fiscal responsibility, turn-around time, invasiveness of laboratory techniques, and holistic view of healthcare environment. A hematology class of 13 students received the intervention. The cases were structured to proceed from instructor-centered (guided) learning issues to learner-centered learning issues. Observations of the in-group collaboration processes were documented, as well as oral presentations and critical reasoning, with students given periodic feedback on these skills. Student surveys provided data about satisfaction, attitude to PBL process, and self-efficacy. Multiple choice discipline-specific content examinations were given and compared with classes from the previous four years. The study found that students receiving the PBL treatment scored as well as or better than students from previous years on traditional multiple choice exams. Recall questions showed positive significance and application/analysis questions showed no significance from previous years. Clinical correlations end-of-case evaluations addressing the issues of thoroughness of investigation, supporting evidence, accuracy of information, order and clarity of thought showed positive improvement across the intervention, as did the PBL processes of in-group collaboration skills, teamwork skills, and presentation skills. By the end of the intervention, students expressed preference for student-centered learning issues.

Insufficient sleep syndrome: An unrecognized but important clinical entity.

PubMed

Kohyama, Jun; Anzai, Yuki; Ono, Makoto; Kishino, Ai; Tamanuki, Keita; Takada, Kazuma; Inoue, Kento; Horiuchi, Maho; Hatai, Yoshiho

2018-04-01

A sleep clinic for adults and children was established in the Tokyo Bay Urayasu Ichikawa Medical Centre, in August 2012. Given that few sleep clinics are available in Japan specifically for children, this clinic provides the opportunity to provide data on child patients with sleep problems. Records of patients who visited the sleep clinic at the Tokyo Bay Urayasu Ichikawa Medical Centre aged ≤20 years at the first visit were retrospectively examined, along with the initial and final diagnoses. Of 2,157 patients who visited the sleep clinic at Tokyo Bay Urayasu Ichikawa Medical Centre between August 2012 and March 2017, 181 were ≤20 years old. In these 181 patients, the most frequent final diagnosis was insufficient sleep syndrome (ISS), n = 56, followed by circadian rhythm sleep-wake disorder, n = 28; insomnia, n = 28; and sleep-related movement disorder, n = 15. Insufficient sleep produces various brain dysfunctions in both adults and children, and is associated with behavioral, cognitive and physical problems, as well as with atypical early development. Insufficient sleep has also been reported to cause obesity. Insufficient sleep-induced obesity is often associated with the occurrence of metabolic syndrome. More effort is needed to ensure that children are receiving sufficient sleep. © 2018 Japan Pediatric Society.

[The treatment needs of migrant children according to child and adolescent psychiatrists from medical clinics and in private practice].

PubMed

Siefen, Georg; Kirkcaldy, Bruce; Adam, Hubertus; Schepker, Renate

2015-03-01

How does the German child and adolescent psychiatry system respond to the increasing number of migrant children and adolescents? Senior doctors from German child and adolescent psychiatric hospitals (Association of Medical Hospital Directors in Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy in Germany, BAG) completed a specially constructed questionnaire about the treatment needs of migrant children, while a «random, representative» sample of child and adolescent psychiatrists in private practice (German Professional Association for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, BKJPP) was administered a slightly modified version. The 100 psychiatrists in private practice represented only about one-eighth of their group, whereas the 55 medical directors comprised a representative sample. One-third of the hospitals has treatments tailored to the specific needs of migrants. In both settings, however, competent interpreters were rarely found, despite the treatment problems arising from the understanding the illness by the parents, language problems, and the clinical knowledge of the patient. Cultural diversity is perceived as enriching. The migration background and the sex of child and adolescent psychiatrists influence the treatment of migrants. Facilitating the process of «cultural opening» in child and adolescent psychiatry involves enacting concrete steps, such as the funding of interpreter costs.

[Utilities: a solution of a decision problem?].

PubMed

Koller, Michael; Ohmann, Christian; Lorenz, Wilfried

2008-01-01

Utility is a concept that originates from utilitarianism, a highly influential philosophical school in the Anglo-American world. The cornerstone of utilitarianism is the principle of maximum happiness or utility. In the medical sciences, this utility approach has been adopted and developed within the field of medical decision making. On an operational level, utility is the evaluation of a health state or an outcome on a one-dimensional scale ranging from 0 (death) to 1 (perfect health). By adding the concept of expectancy, the graphic representation of both concepts in a decision tree results in the specification of expected utilities and helps to resolve complex medical decision problems. Criticism of the utility approach relates to the rational perspective on humans (which is rejected by a considerable fraction of research in psychology) and to the artificial methods used in the evaluation of utility, such as Standard Gamble or Time Trade Off. These may well be the reason why the utility approach has never been accepted in Germany. Nevertheless, innovative concepts for defining goals in health care are urgently required, as the current debate in Germany on "Nutzen" (interestingly translated as 'benefit' instead of as 'utility') and integrated outcome models indicates. It remains to be seen whether this discussion will lead to a re-evaluation of the utility approach.

Constructivist, Problem-Based Learning Does Work: A Meta-Analysis of Curricular Comparisons Involving a Single Medical School

ERIC Educational Resources Information Center

Schmidt, Henk G.; van der Molen, Henk T.; te Winkel, Wilco W. R.; Wijnen, Wynand H. F. W.

2009-01-01

Effects of problem-based learning as reported in curricular comparison studies have been shown to be inconsistent over different medical schools. Therefore, we decided to summarize effects of a single well-established problem-based curriculum rather than to add up sometimes-conflicting findings from different problem-based curricula. Effect sizes…

Painful Medical Conditions and Alcohol Use: A Prospective Study Among Older Adults

PubMed Central

Brennan, Penny L.; Schutte, Kathleen K.; SooHoo, Sonya; Moos, Rudolf H.

2011-01-01

Objective To determine associations between older adults’ baseline painful medical conditions and their 10-year drinking behavior, and whether personal and life context characteristics moderate these associations. Method At baseline, then 1, 4, and 10 years later, late-middle-aged community residents (M=61 years; n=1,291) were surveyed regarding their painful medical conditions, use of alcohol, and personal and life context characteristics. Latent growth modeling was used to determine concurrent and prospective relationships between painful medical conditions and 10-year drinking behavior, and moderating effects of personal and life context characteristics on these relationships. Results At baseline, individuals reporting more numerous painful medical conditions consumed alcohol less frequently, but had more frequent drinking problems, than did individuals with fewer such conditions. Being female and having more interpersonal social resources strengthened the association between painful medical conditions and less ethanol consumed. For men more so than women, more numerous painful medical conditions were associated with more frequent drinking problems. Baseline painful medical conditions alone had no prospective effect on 10-year change in drinking behavior, but being older and having more interpersonal social resources made it more likely that baseline painful medical conditions would predict decline over time in frequency of alcohol consumption and drinking problems. Conclusions Late-middle-aged individuals who have more numerous painful medical conditions reduce alcohol consumption but nonetheless remain at risk for more frequent drinking problems. Gender, age, and interpersonal social resources moderate the influence of painful medical conditions on late-life alcohol use. These results imply that older individuals with pain are at little immediate or long-term risk for increased alcohol consumption, but clinicians should remain alert to drinking problems among their older pain patients, especially men. PMID:21668742

Renewed roles for librarians in problem-based learning in the medical curriculum.

PubMed

Mi, Misa

2011-01-01

Problem-based learning (PBL) is a teaching-learning process or method of instruction that is widely used in medical education curricula. Librarians play important roles as facilitators for PBL as well as guides for information resources. Involvement in PBL activities presents unique opportunities to incorporate library resources and instruction into the medical curriculum. This article reviews the problem-based learning method within the conceptual framework of the learning theory of constructivism. It describes how a medical librarian at a U.S. medical school used emerging technologies to facilitate PBL small group case discussions, guide students to quality information resources, and enhance the learning environment for the PBL process.

[Current problems in the data acquisition of digitized virtual human and the countermeasures].

PubMed

Zhong, Shi-zhen; Yuan, Lin

2003-06-01

As a relatively new field of medical science research that has attracted the attention from worldwide researchers, study of digitized virtual human still awaits long-term dedicated effort for its full development. In the full array of research projects of the integrated Virtual Chinese Human project, virtual visible human, virtual physical human, virtual physiome, and intellectualized virtual human must be included as the four essential constitutional opponents. The primary importance should be given to solving the problems concerning the data acquisition for the dataset of this immense project. Currently 9 virtual human datasets have been established worldwide, which are subjected to critical analyses in the paper with special attention given to the problems in the data storage and the techniques employed, for instance, in these datasets. On the basis of current research status of Virtual Chinese Human project, the authors propose some countermeasures for solving the problems in the data acquisition for the dataset, which include (1) giving the priority to the quality control instead of merely racing for quantity and speed, and (2) improving the setting up of the markers specific for the tissues and organs to meet the requirement from information technology, (3) with also attention to the development potential of the dataset which should have explicit pertinence to specific actual applications.

The diagnosis, prevalence and outcome of delirium in a cohort of older people with mental health problems on general hospital wards.

PubMed

Whittamore, Kathy H; Goldberg, Sarah E; Gladman, John R F; Bradshaw, Lucy E; Jones, Rob G; Harwood, Rowan H

2014-01-01

This paper aimed to measure the prevalence and outcomes of delirium for patients over 70 admitted to a general hospital for acute medical care and to assess the validity of the Delirium Rating Scale-Revised-98 (DRS-R-98) in this setting. Prospective study in a British acute general hospital providing sole emergency medical services for its locality. We screened consecutive patients over 70 with an unplanned emergency hospital admission and recruited a cohort of 249 patients likely to have mental health problems. They were assessed for health status at baseline and followed over 6 months. A sub-sample of 93 participants was assessed clinically for delirium. 27% (95% confidence interval (CI) 23-31) of all older medical patients admitted to hospital had DRS-diagnosed delirium, and 41% (95% CI 37-45) had dementia (including 19% with co-morbid delirium and dementia). Compared with clinician diagnosis, DRS-R-98 sensitivity was at least 0.75, specificity 0.71. Compared with reversible cognitive impairment, sensitivity was at least 0.50, specificity 0.67. DRS-diagnosed delirium was associated with cognitive impairment, mood, behavioural and psychological symptoms, activities of daily living, and number of drugs prescribed, supporting construct validity. Of those with DRS-diagnosed delirium, 37% died within 6 months (relative risk 1.4, 95% CI 0.97-2.2), 43% had reversible cognitive impairment, but only 25% had clinically important recovery in activities of daily living. Behavioural and psychological symptoms were common and mostly resolved, but new symptoms frequently developed. Delirium is common. Some, but not all, features are reversible. DRS-R-98 has reasonable validity in populations where co-morbid dementia is prevalent. Copyright © 2013 John Wiley & Sons, Ltd.

Implementation of a critical incident reporting system in a neurosurgical department.

PubMed

Kantelhardt, P; Müller, M; Giese, A; Rohde, V; Kantelhardt, S R

2011-02-01

Critical incident monitoring is an important tool for quality improvement and the maintenance of high safety standards. It was developed for aviation safety and is now widely accepted as a useful tool to reduce medical care-related morbidity and mortality. Despite this widespread acceptance, the literature has no reports on any neurosurgical applications of critical incident monitoring. We describe the introduction of a mono-institutional critical incident reporting system in a neurosurgical department. Furthermore, we have developed a formula to assess possible counterstrategies. All staff members of a neurosurgical department were advised to report critical incidents. The anonymous reporting form contained a box for the description of the incident, several multiple-choice questions on specific risk factors, place and reason for occurrence of the incident, severity of the consequences and suggested counterstrategies. The incident data was entered into an online documentation system (ADKA DokuPik) and evaluated by an external specialist. For data analysis we applied a modified assessment scheme initially designed for flight safety. Data collection was started in September 2008. The average number of reported incidents was 18 per month (currently 216 in total). Most incidents occurred on the neurosurgical ward (64%). Human error was involved in 86% of the reported incidents. The largest group of incidents consisted of medication-related problems. Accordingly, counterstrategies were developed, resulting in a decrease in the relative number of reported medication-related incidents from 42% (March 09) to 30% (September 09). Implementation of the critical incident reporting system presented no technical problems. The reporting rate was high compared to that reported in the current literature. The formulation, evaluation and introduction of specific counterstrategies to guard against selected groups of incidents may improve patient safety in neurosurgical departments. © Georg Thieme Verlag KG Stuttgart · New York.

[Medical safety management in the setting of a clinical reference laboratory--risk management efforts in clinical testing].

PubMed

Seki, Akira; Miya, Tetsumasa

2011-03-01

As a result of recurring medical accidents, risk management in the medical setting has been given much attention. The announcement in August, 2000 by the Ministry of Health committee for formulating a standard manual for risk management, of a "Risk management manual formulation guideline" has since been accompanied by the efforts of numerous medical testing facilities to develop such documents. In 2008, ISO/TS 22367:2008 on "Medical laboratories-Reduction of error through risk management and continual improvement" was published. However, at present, risk management within a medical testing facility stresses the implementation of provisional actions in response to a problem after it has occurred. Risk management is basically a planned process and includes "corrective actions" as well as "preventive actions." A corrective action is defined as identifying the root cause of the problem and removing it, and is conducted to prevent the problem from recurring. A preventive action is defined as identifying of the any potential problem and removing it, and is conducted to prevent a problem before it occurs. Presently, I shall report on the experiences of our laboratory regarding corrective and preventive actions taken in response to accidents and incidents, respectively.

Transdisciplinary translational science and the case of preterm birth

PubMed Central

Stevenson, D K; Shaw, G M; Wise, P H; Norton, M E; Druzin, M L; Valantine, H A; McFarland, D A

2013-01-01

Medical researchers have called for new forms of translational science that can solve complex medical problems. Mainstream science has made complementary calls for heterogeneous teams of collaborators who conduct transdisciplinary research so as to solve complex social problems. Is transdisciplinary translational science what the medical community needs? What challenges must the medical community overcome to successfully implement this new form of translational science? This article makes several contributions. First, it clarifies the concept of transdisciplinary research and distinguishes it from other forms of collaboration. Second, it presents an example of a complex medical problem and a concrete effort to solve it through transdisciplinary collaboration: for example, the problem of preterm birth and the March of Dimes effort to form a transdisciplinary research center that synthesizes knowledge on it. The presentation of this example grounds discussion on new medical research models and reveals potential means by which they can be judged and evaluated. Third, this article identifies the challenges to forming transdisciplines and the practices that overcome them. Departments, universities and disciplines tend to form intellectual silos and adopt reductionist approaches. Forming a more integrated (or ‘constructionist'), problem-based science reflective of transdisciplinary research requires the adoption of novel practices to overcome these obstacles. PMID:23079774

Transdisciplinary translational science and the case of preterm birth.

PubMed

Stevenson, D K; Shaw, G M; Wise, P H; Norton, M E; Druzin, M L; Valantine, H A; McFarland, D A

2013-04-01

Medical researchers have called for new forms of translational science that can solve complex medical problems. Mainstream science has made complementary calls for heterogeneous teams of collaborators who conduct transdisciplinary research so as to solve complex social problems. Is transdisciplinary translational science what the medical community needs? What challenges must the medical community overcome to successfully implement this new form of translational science? This article makes several contributions. First, it clarifies the concept of transdisciplinary research and distinguishes it from other forms of collaboration. Second, it presents an example of a complex medical problem and a concrete effort to solve it through transdisciplinary collaboration: for example, the problem of preterm birth and the March of Dimes effort to form a transdisciplinary research center that synthesizes knowledge on it. The presentation of this example grounds discussion on new medical research models and reveals potential means by which they can be judged and evaluated. Third, this article identifies the challenges to forming transdisciplines and the practices that overcome them. Departments, universities and disciplines tend to form intellectual silos and adopt reductionist approaches. Forming a more integrated (or 'constructionist'), problem-based science reflective of transdisciplinary research requires the adoption of novel practices to overcome these obstacles.

[Problem list in computer-based patient records].

PubMed

Ludwig, C A

1997-01-14

Computer-based clinical information systems are capable of effectively processing even large amounts of patient-related data. However, physicians depend on rapid access to summarized, clearly laid out data on the computer screen to inform themselves about a patient's current clinical situation. In introducing a clinical workplace system, we therefore transformed the problem list-which for decades has been successfully used in clinical information management-into an electronic equivalent and integrated it into the medical record. The table contains a concise overview of diagnoses and problems as well as related findings. Graphical information can also be integrated into the table, and an additional space is provided for a summary of planned examinations or interventions. The digital form of the problem list makes it possible to use the entire list or selected text elements for generating medical documents. Diagnostic terms for medical reports are transferred automatically to corresponding documents. Computer technology has an immense potential for the further development of problem list concepts. With multimedia applications sound and images will be included in the problem list. For hyperlink purpose the problem list could become a central information board and table of contents of the medical record, thus serving as the starting point for database searches and supporting the user in navigating through the medical record.

Are medical marijuana users different from recreational users? The view from primary care.

PubMed

Roy-Byrne, Peter; Maynard, Charles; Bumgardner, Kristin; Krupski, Antoinette; Dunn, Chris; West, Imara I; Donovan, Dennis; Atkins, David C; Ries, Richard

2015-10-01

Marijuana is currently approved for medical use in 23 states. Both clinicians and the lay public have questioned whether users of marijuana for medical purposes are different from users of marijuana for recreational purposes. This study examined similarities and differences in important clinical characteristics between users of medical marijuana and users of recreational marijuana. The sample consisted of 868 adult primary care patients in Washington State, who reported use of medical marijuana (n = 131), recreational marijuana (n = 525), or drugs other than marijuana (n = 212). Retention was over 87% at 3-, 6-, 9-, and 12-month assessments. The majority of medical, psychiatric, substance use, and service utilization characteristic comparisons were not significant. However, medical marijuana users had significantly more medical problems, a significantly larger proportion reported >15 days medical problems in the past month, and significantly smaller proportions reported no pain and no mobility limitations (p < .001). Medical marijuana users also had significantly lower drug problem severity, lower alcohol problem severity, and significantly larger proportions reported using marijuana alone and concomitant opioid use only (p < .001). There was no significant difference between medical and recreational users in the percentage using marijuana with at least two additional substances (48% vs. 58%, respectively, p = .05). Although our results suggest that there are few distinct differences between medical and recreational users of marijuana, the differences observed, while mostly very small in effect size (<.2), are consistent with at least some medical users employing marijuana to relieve symptoms and distress associated with medical illness. © American Academy of Addiction Psychiatry.

Clinicians’ and Patients’ Experiences and Satisfaction with Unscheduled, Nighttime, Internet-based Video Conferencing for Assessing Acute Medical Problems in a Nursing Facility

PubMed Central

Weiner, Michael; Schadow, Gunther; Lindbergh, Donald; Warvel, Jill; Abernathy, Greg; Perkins, Susan M.; Fyffe, Joanne; Dexter, Paul R.; McDonald, Clement J.

2003-01-01

Videoconferencing between patients and their physicians can increase patients’ access to healthcare. Unscheduled videoconferencing can benefit patients with acute medical problems but has not been studied extensively. We conducted a clinical trial of unscheduled, nighttime videoconferencing in a nursing home, where on-call physicians usually provide care by telephone from remote locations. Although most calls for medical problems did not lead to videoconferencing, physicians and nursing-home residents were satisfied with videoconferencing when it did occur, and physicians reported that making medical decisions was easier with videoconferencing. Videoconferencing was most often conducted to assess residents with changes in mental status, abnormal laboratory values, or falls. Physicians often lacked immediate access to videoconferencing equipment when medical problems with residents occurred. This application could benefit from improved access and portability of equipment. PMID:14728265

New fuzzy support vector machine for the class imbalance problem in medical datasets classification.

PubMed

Gu, Xiaoqing; Ni, Tongguang; Wang, Hongyuan

2014-01-01

In medical datasets classification, support vector machine (SVM) is considered to be one of the most successful methods. However, most of the real-world medical datasets usually contain some outliers/noise and data often have class imbalance problems. In this paper, a fuzzy support machine (FSVM) for the class imbalance problem (called FSVM-CIP) is presented, which can be seen as a modified class of FSVM by extending manifold regularization and assigning two misclassification costs for two classes. The proposed FSVM-CIP can be used to handle the class imbalance problem in the presence of outliers/noise, and enhance the locality maximum margin. Five real-world medical datasets, breast, heart, hepatitis, BUPA liver, and pima diabetes, from the UCI medical database are employed to illustrate the method presented in this paper. Experimental results on these datasets show the outperformed or comparable effectiveness of FSVM-CIP.

Longitudinal Retention of Anatomical Knowledge in Second-year Medical Students

ERIC Educational Resources Information Center

Doomernik, Denise E.; van Goor, Harry; Kooloos, Jan G. M.; ten Broek, Richard P.

2017-01-01

The Radboud University Medical Center has a problem-based, learner-oriented, horizontally, and vertically integrated medical curriculum. Anatomists and clinicians have noticed students' decreasing anatomical knowledge and the disability to apply knowledge in diagnostic reasoning and problem solving. In a longitudinal cohort, the retention of…

Inactivation of AKT Induces Cellular Senescence in Uterine Leiomyoma

PubMed Central

Xu, Xiaofei; Lu, Zhenxiao; Qiang, Wenan; Vidimar, Vania; Kong, Beihua

2014-01-01

Uterine leiomyomas (fibroids) are a major public health problem. Current medical treatments with GnRH analogs do not provide long-term benefit. Thus, permanent shrinkage or inhibition of fibroid growth via medical means remains a challenge. The AKT pathway is a major growth and survival pathway for fibroids. We propose that AKT inhibition results in a transient regulation of specific mechanisms that ultimately drive cells into cellular senescence or cell death. In this study, we investigated specific mechanisms of AKT inhibition that resulted in senescence. We observed that administration of MK-2206, an allosteric AKT inhibitor, increased levels of reactive oxygen species, up-regulated the microRNA miR-182 and several senescence-associated genes (including p16, p53, p21, and β-galactosidase), and drove leiomyoma cells into stress-induced premature senescence (SIPS). Moreover, induction of SIPS was mediated by HMGA2, which colocalized to senescence-associated heterochromatin foci. This study provides a conceivable molecular mechanism of SIPS by AKT inhibition in fibroids. PMID:24476133

Androgens and Androgen Derivatives: Science, Myths, and Theories: Explored From a Special Operations Perspective.

PubMed

Givens, Melissa L; Deuster, Patricia

2015-01-01

Androgen use outside of legitimate medical therapy is a perceived concern that is drawing attention across military and specifically Special Operations Forces (SOF) communities. For leadership and the medical community to properly address the issue and relate to those individuals who are using or considering use, it will be crucial to understand the scope of the problem. Limited data suggest that the prevalence of androgen use may be increasing, and inferences made from the scientific literature suggest that SOF may be a population of concern. While risks of androgen use are well known, there are little data specific to military performance that can be applied to a rigorous risk:benefit analysis, allowing myths and poorly supported theories to perpetuate within the community. Further efforts to define the potential benefits balanced against the short- and long-term risks should be undertaken. Providers within the SOF community should arm themselves with information to engage androgen users and leadership in meaningful discussion regarding androgen use. 2015.

Improving the Effectiveness of Medication Review: Guidance from the Health Literacy Universal Precautions Toolkit.

PubMed

Weiss, Barry D; Brega, Angela G; LeBlanc, William G; Mabachi, Natabhona M; Barnard, Juliana; Albright, Karen; Cifuentes, Maribel; Brach, Cindy; West, David R

2016-01-01

Although routine medication reviews in primary care practice are recommended to identify drug therapy problems, it is often difficult to get patients to bring all their medications to office visits. The objective of this study was to determine whether the medication review tool in the Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit can help to improve medication reviews in primary care practices. The toolkit's "Brown Bag Medication Review" was implemented in a rural private practice in Missouri and an urban teaching practice in California. Practices recorded outcomes of medication reviews with 45 patients before toolkit implementation and then changed their medication review processes based on guidance in the toolkit. Six months later we conducted interviews with practice staff to identify changes made as a result of implementing the tool, and practices recorded outcomes of medication reviews with 41 additional patients. Data analyses compared differences in whether all medications were brought to visits, the number of medications reviewed, drug therapy problems identified, and changes in medication regimens before and after implementation. Interviews revealed that practices made the changes recommended in the toolkit to encourage patients to bring medications to office visits. Evaluation before and after implementation revealed a 3-fold increase in the percentage of patients who brought all their prescription medications and a 6-fold increase in the number of prescription medications brought to office visits. The percentage of reviews in which drug therapy problems were identified doubled, as did the percentage of medication regimens revised. Use of the Health Literacy Universal Precautions Toolkit can help to identify drug therapy problems. © Copyright 2016 by the American Board of Family Medicine.

Glyburide

MedlinePlus

... problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), ... This branded product is no longer on the market. Generic alternatives may be available.

Chlorpropamide

MedlinePlus

... problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), ... This branded product is no longer on the market. Generic alternatives may be available.

Glipizide

MedlinePlus

... problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), ... This branded product is no longer on the market. Generic alternatives may be available.

Tolbutamide

MedlinePlus

... problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), ... This branded product is no longer on the market. Generic alternatives may be available.

Metformin

MedlinePlus

... problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), ... This branded product is no longer on the market. Generic alternatives may be available.

Tolazamide

MedlinePlus

... problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), ... This branded product is no longer on the market. Generic alternatives may be available.

Sitagliptin

MedlinePlus

... problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), ... This branded product is no longer on the market. Generic alternatives may be available.

Women who abuse prescription opioids: findings from the Addiction Severity Index-Multimedia Version Connect prescription opioid database.

PubMed

Green, Traci C; Grimes Serrano, Jill M; Licari, Andrea; Budman, Simon H; Butler, Stephen F

2009-07-01

Evidence suggests gender differences in abuse of prescription opioids. This study aimed to describe characteristics of women who abuse prescription opioids in a treatment-seeking sample and to contrast gender differences among prescription opioid abusers. Data collected November 2005 to April 2008 derived from the Addiction Severity Index Multimedia Version Connect (ASI-MV Connect) database. Bivariate and multivariable logistic regression examined correlates of prescription opioid abuse stratified by gender. 29,906 assessments from 220 treatment centers were included, of which 12.8% (N=3821) reported past month prescription opioid abuse. Women were more likely than men to report use of any prescription opioid (29.8% females vs. 21.1% males, p<0.001) and abuse of any prescription opioid (15.4% females vs. 11.1% males, p<0.001) in the past month. Route of administration and source of prescription opioids displayed gender-specific tendencies. Women-specific correlates of recent prescription opioid abuse were problem drinking, age <54, inhalant use, residence outside of West US Census region, and history of drug overdose. Men-specific correlates were age <34, currently living with their children, residence in the South and Midwest, hallucinogen use, and recent depression. Women prescription opioid abusers were less likely to report a pain problem although they were more likely to report medical problems than women who abused other drugs. Gender-specific factors should be taken into account in efforts to screen and identify those at highest risk of prescription opioid abuse. Prevention and intervention efforts with a gender-specific approach are warranted.

Indian medical students' perspectives on problem-based learning experiences in the undergraduate curriculum: One size does not fit all.

PubMed

Nanda, Bijli; Manjunatha, Shankarappa

2013-01-01

Problem-based learning (PBL) is a well-established method for facilitating the learning of basic science concepts in the context of clinical cases. Relevant evidence is lacking regarding PBL's effectiveness and acceptability as perceived by students accustomed to classical traditional teaching in India. Hence, this study gathered students' opinions on PBL versus Traditional teaching methods to generate a foundation for institutional policymaking and ultimately, changes in the policy of regulatory bodies. A total of 773 first year medical students admitted from 2007-2010 in Kasturba Medical College Manipal, Manipal University, India were asked to respond to a 15-item questionnaire evaluating their preferences for PBL or traditional methods such as lectures after undergoing a systematically conducted PBL session in physiology. Their responses were analyzed with an unpaired t-test. Their comments were also collected. PBL scored significantly higher for most items in the questionnaire for "learning efficiency" and "student-teacher relationship". The students' comments highlighted the importance of a trained tutor/facilitator to enhance the learning process. Our students are willing to adapt to the PBL method, although they recognize certain benefits of traditional pedagogy. For learning efficiency and the student-teacher relationship, the students feel that neither method holds an advantage. We recommend that the future medical curriculum in India be a hybrid form of PBL and traditional methods with specific training on the unfamiliar PBL approach for both faculty and students.

Explaining the increase in family financial pressures from medical bills between 2003 and 2007: do affordability thresholds change over time?

PubMed

Cunningham, Peter J

2011-06-01

This study examines whether affordability thresholds for medical care as defined by families change over time. The results from two nationally representative surveys show that while financial stress from medical bills--defined as the percent with problems paying medical bills--increased between 2003 and 2007, greater out-of-pocket spending accounted for this increase only for higher-income persons with employer-sponsored insurance coverage. Increased spending did not account for an increase in medical bill problems among lower-income persons. Moreover, the increase in medical bill problems among low-income persons occurred at relatively low levels of out-of-pocket spending rather than at higher levels. The results suggest that "affordability thresholds" for medical care as defined by individuals and families are not stable over time, especially for lower-income persons, which has implications for setting affordability standards in health reform.

Insulin Injection

MedlinePlus

... problems, nerve damage, and eye problems. Using medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), ... This branded product is no longer on the market. Generic alternatives may be available.

The knowledge of risk factors and prevention of breast cancer in Polish women.

PubMed

Chmaj-Wierzchowska, K; Jurczyk, M U; Czech-Szczapa, B; Wilczak, M

2017-01-01

Currently, breast cancer is one of the most common malignancies among women and it constitutes a significant medical, economic, and social problem. The study was conducted in a group of 600 healthy women (aged 18 to 88 years) between September 2011 and February 2015 living in the region of Wielkopolska (Poland) in a private gynecological practice. A survey questionnaire designed specifically for purposes of the study was a tool used to conduct the study. With regards to risk factors for breast cancer: 93% - familial history of breast cancer, 46% - use of hormone treatment, and 40.16% - taking contraceptive pills. A significant component of breast cancer prevention should be providing information regarding prevention tests and increasing accessibility to medical services.

Integrating medical and research information: a big data approach.

PubMed

Tilve Álvarez, Carlos M; Ayora Pais, Alberto; Ruíz Romero, Cristina; Llamas Gómez, Daniel; Carrajo García, Lino; Blanco García, Francisco J; Vázquez González, Guillermo

2015-01-01

Most of the information collected in different fields by Instituto de Investigación Biomédica de A Coruña (INIBIC) is classified as unstructured due to its high volume and heterogeneity. This situation, linked to the recent requirement of integrating it to the medical information, makes it necessary to implant specific architectures to collect and organize it before it can be analysed. The purpose of this article is to present the Hadoop framework as a solution to the problem of integrating research information in the Business Intelligence field. This framework can collect, explore, process and structure the aforementioned information, which allow us to develop an equivalent function to a data mart in an Intelligence Business system.

An American plague: Pro-market believers in health policy: Comment on "On Health Policy and Management (HPAM): mind the theory-policy-practice gap".

PubMed

de Kervasdoué, Jean

2015-02-01

Although American health policy debates address similar problems to other developed nations, it has factual and ideological specificities. I agree with Chinitz and Rodwin on the dominance of micro-economics thinking. However, I am not certain that learning from management theory or modifying medical education will be powerful enough to change the system. The vested interests of the stakeholders are too powerful, the more so when they are supported by economists who ideologically reinforce them and by neglecting the fact that the basic premises of market ideology are false when applied to medical care. There is enough empirical evidence to support that but, apparently, these facts do not dent these beliefs.

Identifying individuals with physician-diagnosed chronic obstructive pulmonary disease in primary care electronic medical records: a retrospective chart abstraction study.

PubMed

Lee, Theresa M; Tu, Karen; Wing, Laura L; Gershon, Andrea S

2017-05-15

Little is known about using electronic medical records to identify patients with chronic obstructive pulmonary disease to improve quality of care. Our objective was to develop electronic medical record algorithms that can accurately identify patients with obstructive pulmonary disease. A retrospective chart abstraction study was conducted on data from the Electronic Medical Record Administrative data Linked Database (EMRALD ® ) housed at the Institute for Clinical Evaluative Sciences. Abstracted charts provided the reference standard based on available physician-diagnoses, chronic obstructive pulmonary disease-specific medications, smoking history and pulmonary function testing. Chronic obstructive pulmonary disease electronic medical record algorithms using combinations of terminology in the cumulative patient profile (CPP; problem list/past medical history), physician billing codes (chronic bronchitis/emphysema/other chronic obstructive pulmonary disease), and prescriptions, were tested against the reference standard. Sensitivity, specificity, and positive/negative predictive values (PPV/NPV) were calculated. There were 364 patients with chronic obstructive pulmonary disease identified in a 5889 randomly sampled cohort aged ≥ 35 years (prevalence = 6.2%). The electronic medical record algorithm consisting of ≥ 3 physician billing codes for chronic obstructive pulmonary disease per year; documentation in the CPP; tiotropium prescription; or ipratropium (or its formulations) prescription and a chronic obstructive pulmonary disease billing code had sensitivity of 76.9% (95% CI:72.2-81.2), specificity of 99.7% (99.5-99.8), PPV of 93.6% (90.3-96.1), and NPV of 98.5% (98.1-98.8). Electronic medical record algorithms can accurately identify patients with chronic obstructive pulmonary disease in primary care records. They can be used to enable further studies in practice patterns and chronic obstructive pulmonary disease management in primary care. NOVEL ALGORITHM SEARCH TECHNIQUE: Researchers develop an algorithm that can accurately search through electronic health records to find patients with chronic lung disease. Mining population-wide data for information on patients diagnosed and treated with chronic obstructive pulmonary disease (COPD) in primary care could help inform future healthcare and spending practices. Theresa Lee at the University of Toronto, Canada, and colleagues used an algorithm to search electronic medical records and identify patients with COPD from doctors' notes, prescriptions and symptom histories. They carefully adjusted the algorithm to improve sensitivity and predictive value by adding details such as specific medications, physician codes related to COPD, and different combinations of terminology in doctors' notes. The team accurately identified 364 patients with COPD in a randomly-selected cohort of 5889 people. Their results suggest opportunities for broader, informative studies of COPD in wider populations.

What hospitals need to know about guidelines-A mixed-method analysis of guideline implementation in Dutch hospitals.

PubMed

Blume, Louise H K; van Weert, Nico J H W; Busari, Jamiu O; Stoopendaal, Annemiek M V; Delnoij, Diana M J

2017-12-01

This study provides insight into how Dutch hospitals ensure that guidelines are used in practice and identifies what key messages other hospitals can learn from existing practices. We examine current practices in handling compliance and, therefore, focus on hospitals that reported that they do not experience problems in the implementation of guidelines. A survey of Dutch hospital boards and 9 semistructured interviews were conducted with a purposive sample of 3 hospitals. Interviews were held with 3 representatives of each hospital, specifically, with a member of the board of directors, a member of the executive medical staff, and the manager of the quality and safety department. Hospitals find guidelines necessary and useful. Hospitals have the power to improve implementation if boards of directors and medical staff are committed, intrinsically motivated, cooperate with each other, and use guidelines pragmatically. Even then, they prioritize guidelines, as resources are scarce. Despite their good work, all hospitals in this study appeared to struggle to adhere to guidelines. If hospitals experience problems with guideline implementation, they tend to focus more on external expectations, leading to defensive behaviour. Hospitals that do not experience implementation problems focus more on integrating guidelines into their own policies. © 2017 John Wiley & Sons, Ltd.

US Epidemiology of Cannabis Use and Associated Problems

PubMed Central

Hasin, Deborah S

2018-01-01

This review provides an overview of the changing US epidemiology of cannabis use and associated problems. Adults and adolescents increasingly view cannabis as harmless, and some can use cannabis without harm. However, potential problems include harms from prenatal exposure and unintentional childhood exposure; decline in educational or occupational functioning after early adolescent use, and in adulthood, impaired driving and vehicle crashes; cannabis use disorders (CUD), cannabis withdrawal, and psychiatric comorbidity. Evidence suggests national increases in cannabis potency, prenatal and unintentional childhood exposure; and in adults, increased use, CUD, cannabis-related emergency room visits, and fatal vehicle crashes. Twenty-nine states have medical marijuana laws (MMLs) and of these, 8 have recreational marijuana laws (RMLs). Many studies indicate that MMLs or their specific provisions did not increase adolescent cannabis use. However, the more limited literature suggests that MMLs have led to increased cannabis potency, unintentional childhood exposures, adult cannabis use, and adult CUD. Ecological-level studies suggest that MMLs have led to substitution of cannabis for opioids, and also possibly for psychiatric medications. Much remains to be determined about cannabis trends and the role of MMLs and RMLs in these trends. The public, health professionals, and policy makers would benefit from education about the risks of cannabis use, the increases in such risks, and the role of marijuana laws in these increases. PMID:28853439

38 CFR 21.198 - “Discontinued” status.

Code of Federal Regulations, 2011 CFR

2011-07-01

... personal or other problems; or (ii) Inability of the veteran to benefit from rehabilitation services... of entitlement. (4) Medical and related problems. A veteran's case will be discontinued and assigned... program because of a serious physical or emotional problem for an extended period; and (ii) VA medical...

38 CFR 21.198 - “Discontinued” status.

Code of Federal Regulations, 2010 CFR

2010-07-01

... personal or other problems; or (ii) Inability of the veteran to benefit from rehabilitation services... of entitlement. (4) Medical and related problems. A veteran's case will be discontinued and assigned... program because of a serious physical or emotional problem for an extended period; and (ii) VA medical...

The impact of major earthquakes on the psychological functioning of medical students: a Christchurch, New Zealand study.

PubMed

Carter, Frances A; Bell, Caroline J; Ali, Anthony N; McKenzie, Janice; Wilkinson, Timothy J

2014-07-18

No previous studies have systematically assessed the psychological functioning of medical students following a major disaster. To describe the psychological functioning of medical students following the earthquakes in Canterbury, New Zealand, and identify predictors of adverse psychological functioning. 7 months following the most severe earthquake, medical students completed the Depression, Anxiety and Stress Scale (DASS), the Post-Traumatic Stress Disorder Checklist, the Eysenck Personality Questionnaire, the Connor Davidson Resilience Scale, the Work and Adjustment Scale, and Likert scales assessing psychological functioning at worst and currently. A substantial minority of medical students reported moderate-extreme difficulties on the DASS subscales 7 months following the most severe earthquake (Depression =12%; Anxiety =9%; Stress =10%). Multiple linear modelling produced a model that predicted 27% of the variance in total scores on the DASS. Variables contributing significantly to the model were: year of medical course, presence of mental health problems prior to the earthquakes, not being New Zealand European, and being higher on retrospectively rated neuroticism prior to the earthquakes. Around 10% of medical students experienced moderate-extreme psychological difficulties 7 months following the most severe earthquake on 22 February 2011. Specific groups at high risk for ongoing psychological symptomatology were able to be identified.

Recognizing and regulating cannabis as a temptation good.

PubMed

Caulkins, Jonathan P

2017-04-01

The U.S. appears to be on a path toward legalizing cannabis on the alcohol model, which is to say allowing for-profit corporations to produce, sell, and promote its use. Even after national legalization, it will take decades to observe the full effects on industry structure and behavior, or on use and misuse. However, we should not be surprised if after markets have matured and consumption patterns stabilized, legalization increases acute cannabis intoxication in the U.S. by 40 billion hours per year. This increase in use will be the most important cannabis-specific effect of legalization. The bulk of it will be consumption by daily and near-daily users, and it is possible that roughly half will be by people who meet the medical criteria for substance use disorder. Much resulting harms will be borne by the users, and their families, and the harms are not primarily "medical", at least not in the narrow sense. Hence, legalization replaces the current problems of crime and black markets not so much with a medical or public health problem, but rather with a problem of potentially excessive consumption of a "temptation good" whose acute effects are performance degrading, not performance-enhancing. As legalization removes formal social controls, it might be prudent for society to develop stronger informal social norms - akin to "friends don't let friends drive drunk" - to protect the public and more importantly the users themselves from the performance degradation of bouts of nearly perpetual intoxication. Copyright © 2017 Elsevier B.V. All rights reserved.

Musculoskeletal injuries in construction: a review of the literature.

PubMed

Schneider, S P

2001-11-01

The first step in addressing any problem is recognition of the problem and a measure of its size and scope. There have been few reviews to date of the evidence of a musculoskeletal disorders problem in construction, particularly in the United States. Construction contractors in the United States have questioned the existence of a musculoskeletal disorders problem in construction, so a review of the evidence is warranted. The types of evidence reviewed include: 1) historical evidence, 2) injury data, 3) workers' compensation data, 4) medical exam data, 5) survey data, and 6) exposure data. Injury data generally represent injuries that the employers have identified as work-related and recorded or reported. Workers' compensation data are from cases that have been filed by workers for compensation and quite often represent only "closed" cases where compensation has been awarded. Medical exam data are from physical examinations of workers. Symptom survey data are the most inclusive and show the number of workers who self-report musculoskeletal problems. Exposure data include measurements made of exposure to musculoskeletal risk factors. The existing data show construction workers to be at significant risk of musculoskeletal injury, specifically related to the work they do. Their risk of musculoskeletal injury is much higher than that of other workers who have less heavy work, about 50 percent higher than all other workers. Several trades have been extensively studied, while others have been studied to a lesser extent. While the exact relationship between exposures and injuries is complex and often multifaceted, it would be difficult to deny the existence of the problem and the fact that these injuries are, to a great extent, related to the work that construction workers perform.

User-generated quality standards for youth mental health in primary care: a participatory research design using mixed methods

PubMed Central

Graham, Tanya; Rose, Diana; Murray, Joanna; Ashworth, Mark; Tylee, André

2014-01-01

Objectives To develop user-generated quality standards for young people with mental health problems in primary care using a participatory research model. Methods 50 young people aged 16–25 from community settings and primary care participated in focus groups and interviews about their views and experiences of seeking help for mental health problems in primary care, cofacilitated by young service users and repeated to ensure respondent validation. A second group of young people also aged 16–25 who had sought help for any mental health problem from primary care or secondary care within the last 5 years were trained as focus groups cofacilitators (n=12) developed the quality standards from the qualitative data and participated in four nominal groups (n=28). Results 46 quality standards were developed and ranked by young service users. Agreement was defined as 100% of scores within a two-point region. Group consensus existed for 16 quality standards representing the following aspects of primary care: better advertising and information (three); improved competence through mental health training and skill mix within the practice (two); alternatives to medication (three); improved referral protocol (three); and specific questions and reassurances (five). Alternatives to medication and specific questions and reassurances are aspects of quality which have not been previously reported. Conclusions We have demonstrated the feasibility of using participatory research methods in order to develop user-generated quality standards. The development of patient-generated quality standards may offer a more formal method of incorporating the views of service users into quality improvement initiatives. This method can be adapted for generating quality standards applicable to other patient groups. PMID:24920648

Semi-Supervised Recurrent Neural Network for Adverse Drug Reaction mention extraction.

PubMed

Gupta, Shashank; Pawar, Sachin; Ramrakhiyani, Nitin; Palshikar, Girish Keshav; Varma, Vasudeva

2018-06-13

Social media is a useful platform to share health-related information due to its vast reach. This makes it a good candidate for public-health monitoring tasks, specifically for pharmacovigilance. We study the problem of extraction of Adverse-Drug-Reaction (ADR) mentions from social media, particularly from Twitter. Medical information extraction from social media is challenging, mainly due to short and highly informal nature of text, as compared to more technical and formal medical reports. Current methods in ADR mention extraction rely on supervised learning methods, which suffer from labeled data scarcity problem. The state-of-the-art method uses deep neural networks, specifically a class of Recurrent Neural Network (RNN) which is Long-Short-Term-Memory network (LSTM). Deep neural networks, due to their large number of free parameters rely heavily on large annotated corpora for learning the end task. But in the real-world, it is hard to get large labeled data, mainly due to the heavy cost associated with the manual annotation. To this end, we propose a novel semi-supervised learning based RNN model, which can leverage unlabeled data also present in abundance on social media. Through experiments we demonstrate the effectiveness of our method, achieving state-of-the-art performance in ADR mention extraction. In this study, we tackle the problem of labeled data scarcity for Adverse Drug Reaction mention extraction from social media and propose a novel semi-supervised learning based method which can leverage large unlabeled corpus available in abundance on the web. Through empirical study, we demonstrate that our proposed method outperforms fully supervised learning based baseline which relies on large manually annotated corpus for a good performance.

Interprofessional, simulation-based technology-enhanced learning to improve physical health care in psychiatry: The recognition and assessment of medical problems in psychiatric settings course.

PubMed

Akroyd, Mike; Jordan, Gary; Rowlands, Paul

2016-06-01

People with serious mental illness have reduced life expectancy compared with a control population, much of which is accounted for by significant physical comorbidity. Frontline clinical staff in mental health often lack confidence in recognition, assessment and management of such 'medical' problems. Simulation provides one way for staff to practise these skills in a safe setting. We produced a multidisciplinary simulation course around recognition and assessment of medical problems in psychiatric settings. We describe an audit of strategic and design aspects of the recognition and assessment of medical problems in psychiatric settings course, using the Department of Health's 'Framework for Technology Enhanced Learning' as our audit standards. At the same time as highlighting areas where recognition and assessment of medical problems in psychiatric settings adheres to these identified principles, such as the strategic underpinning of the approach, and the means by which information is collected, reviewed and shared, it also helps us to identify areas where we can improve. © The Author(s) 2014.

Cognitive emotions: depression and anxiety in medical students and staff.

PubMed

Ahmed, Isra; Banu, Haseena; Al-Fageer, Reem; Al-Suwaidi, Reem

2009-09-01

Medical students represent a highly educated population under significant pressures. They encounter multiple emotions during the transformation from insecure student to young knowledgeable physician. During the transition to clinical settings in the third year, the student may experience a loss of external control and may counter this with an increase in depression and/or anxiety symptoms. Studies suggest that mental health worsens after students begin medical school and remains poor throughout training. It is not just the undergraduate study period, which brings about these changes; it may continue later in internship, postgraduate study, and in physicians' practical life, and it may reach burnout level. The greater the psychosocial health, the greater is the well-being and the capacity for adaptation and overcoming problems and common life frustrations in family, relationships, and work. Medical students and practicing physicians, in comparison with the general population and that of other professions, are exposed to academic and professional stress and therefore are vulnerable to psychosocial health problems and certain specific dysfunctions that may compromise their physical, mental, and social health. Our study examines the phenomenology of depression and anxiety in medical doctors in 3 government hospitals, 3 primary health care centers and the students (all years) and staff of Dubai Medical College for Girls (DMCG). This cross-sectional study was conducted in November 2008. One hundred sixty-five medical students of DMCG and 93 doctors (including medical staff of DMCG) completed a set of 2 questionnaires regarding Beck Depression Inventory (BDI) & Beck Anxiety Inventory (BAI). Results were analyzed using SPSS 11, and adequate statistical significant tests were done. A P value of <.05 was considered statistically significant. Of medical students, 28.6% showed depression and 28.7% showed anxiety. Of medical staff, 7.8% showed depression and 2.2% of them showed anxiety. The second-year medical students exhibited the highest percentage of depression and anxiety. There was a significant correlation between depression and anxiety among medical students (r = 0.6). "Crying" was the most common depressive symptom, and "fear of worst happening" was the most common anxiety manifestation in medical students. The considerable amount of depression and anxiety found among doctors and students in this study should trigger further work. Studies using more powerful designs would help to illuminate the factors leading to depression and anxiety.

In Connecticut: improving patient medication management in primary care.

PubMed

Smith, Marie; Giuliano, Margherita R; Starkowski, Michael P

2011-04-01

Medications are a cornerstone of the management of most chronic conditions. However, medication discrepancies and medication-related problems-some of which can cause serious harm-are common. Pharmacists have the expertise to identify, resolve, monitor, and prevent these problems. We present findings from a Centers for Medicare and Medicaid Services demonstration project in Connecticut, in which nine pharmacists worked closely with eighty-eight Medicaid patients from July 2009 through May 2010. The pharmacists identified 917 drug therapy problems and resolved nearly 80 [corrected] percent of them after four encounters. The result was an estimated annual saving of $1,123 per patient on medication claims and $472 per patient on medical, hospital, and emergency department expenses-more than enough to pay for the contracted pharmacist services. We recommend that the Center for Medicare and Medicaid Innovation support the evaluation of pharmacist-provided medication management services in primary care medical homes, accountable care organizations, and community health and care transition teams, as well as research to explore how to enhance team-based care.

Bringing science to medicine: an interview with Larry Weed, inventor of the problem-oriented medical record

PubMed Central

Wright, Adam; Sittig, Dean F; McGowan, Julie; Ash, Joan S; Weed, Lawrence L

2014-01-01

Larry Weed, MD is widely known as the father of the problem-oriented medical record and inventor of the now-ubiquitous SOAP (subjective/objective/assessment/plan) note, for developing an electronic health record system (Problem-Oriented Medical Information System, PROMIS), and for founding a company (since acquired), which developed problem-knowledge couplers. However, Dr Weed's vision for medicine goes far beyond software—over the course of his storied career, he has relentlessly sought to bring the scientific method to medical practice and, where necessary, to point out shortcomings in the system and advocate for change. In this oral history, Dr Weed describes, in his own words, the arcs of his long career and the work that remains to be done. PMID:24872343

NASA biomedical applications team. Applications of aerospace technology in biology and medicine

NASA Technical Reports Server (NTRS)

Rouse, D. J.; Beadles, R.; Beall, H. C.; Brown, J. N., Jr.; Clingman, W. H.; Courtney, M. W.; Mccartney, M.; Scearce, R. W.; Wilson, B.

1979-01-01

The use of a bipolar donor-recipient model of medical technology transfer is presented. That methodology is designed to: (1) identify medical problems and aerospace technology that in combination constitute opportunities for successful medical products; (2) obtain the early participation of industry in the transfer process; and (3) obtain acceptance by the medical community of new medical products based on aerospace technology. Problem descriptions and activity reports and the results of a market study on the tissue freezing device are presented.

Association Between Anticipatory Grief and Problem Solving Among Family Caregivers of Persons with Cognitive Impairment

PubMed Central

Fowler, Nicole R.; Hansen, Alexandra S.; Barnato, Amber E.; Garand, Linda

2013-01-01

Objective Measure perceived involvement in medical decision making and determine if anticipatory grief is associated with problem solving among family caregivers of older adults with cognitive impairment. Method Retrospective analysis of baseline data from a caregiver intervention (n=73). Multivariable regression models testing the association between caregivers’ anticipatory grief, measured by the Anticipatory Grief Scale (AGS), with problem solving abilities, measured by the Social Problem Solving Inventory – Revised: Short Form (SPSI-R: S). Results 47/73 (64%) of caregivers reported involvement in medical decision making. Mean AGS was 70.1 (± 14.8) and mean SPSI-R:S was 107.2 (± 11.6). Higher AGS scores were associated with lower positive problem orientation (P=0.041) and higher negative problem orientation scores (P=0.001) but not other components of problem solving- rational problem solving, avoidance style, and impulsivity/carelessness style. Discussion Higher anticipatory grief among family caregivers impaired problem solving, which could have negative consequences for their medical decision making responsibilities. PMID:23428394

[Irrational use of drugs as a source of drug - induced diseases].

PubMed

Woroń, Jarosław; Porebski, Grzegorz; Kostka-Trabka, Elzbieta; Goszcz, Aleksandra

2007-01-01

The irrational use of medication, by which we understand the administration of drugs for indications where their effectiveness has not been confirmed, the disregard of restrictions and warnings against their use, and the use of drug combinations which do not increase the therapeutic effect but to the contrary increase the risk of adverse drug reactions, is a serious problem encountered in paediatric pharmacotherapy. Each year the centres for monitoring of adverse drug reactions receive many reports, the analysis of which show that the reasons of occurrence of adverse drug reactions after drug administration, are specifically due to irrational use of medications. In order to prevent in an active way the occurrence, of adverse drug reactions following drug administration it is worthwhile to bring to attention the reasons for their occurrence which not infrequently bring about pathological effects. Our work which is based on reports received by the Regional Centre for Adverse Drug Reactions Monitoring in Krakow concerning the occurrence of adverse drug reactions in an attempt to bring to attention in our view important problems in current pharmacotherapy.

AIDS-MEDICOLEGAL ASPECTS.

PubMed

Kotabagi, R B; Pathak, P R; Apte, V V

1999-04-01

AIDS/HIV Positivity has been the most widely debated disease of this century. Reasons for this are manifold, viz-the non-availability of cure and consequent 100% mortality of a full blown case; its mode of transmission-homosexual and heterosexual activities; widespread occurrence amongst 'main liners'; and patients receiving blood and blood products etc. These aspects have created a dreaded halo around AIDS as well as social stigma. Even the medical community is not exempt from these problems. Unfortunately, legislatures around the world, more so in India, have lagged behind in clarifying many legal issues involved by not enacting specific laws pertaining to AIDS. Consequently many legal & ethical doubts arise in the minds of doctors when confronted with a case of AIDS either in a live patient or in a dead body. In addition, the disease being incurable & 100% fatal, makes it essential to adopt effective preventive measures which in turn need thorough knowledge of social aspects of the epidemic. Certain medicolegal, and ethical aspects of the problem of AIDS are recapitulated in this article for the benefit of the medical community.

An acute post-sexual assault intervention to prevent drug abuse: updated findings.

PubMed

Resnick, Heidi S; Acierno, Ron; Amstadter, Ananda B; Self-Brown, Shannon; Kilpatrick, Dean G

2007-10-01

Sexual assault and rape routinely produce extreme distress and negative psychological reactions in victims. Further, past research suggests that victims are at increased risk of developing substance use or abuse post-rape. The post-rape forensic medical exam may itself exacerbate peritraumatic distress because it includes cues that may serve as reminders of the assault, thereby potentiating post-assault negative sequelae. To address these problems, a two-part video intervention was developed to take advantage of the existing sexual assault forensic exam infrastructure, and to specifically (a) minimize anxiety/discomfort during forensic examinations, thereby reducing risk of future emotional problems, and (b) prevent increased substance use and abuse following sexual assault. Updated findings with a sample of 268 sexual assault victims participating in the forensic medical exam and completing one or more follow-up assessments at: (1)<3 months post-assault; (2) 3 to 6 months post-assault; or (3) 6 months or longer post-assault indicated that the video was associated with significantly lower frequency of marijuana use at each time point, among women who reported use prior to the assault.

Experiences of women seeking medical care for obstetric fistula in Eritrea: implications for prevention, treatment, and social reintegration.

PubMed

Turan, Janet Molzan; Johnson, Khaliah; Polan, Mary Lake

2007-01-01

This article presents findings from qualitative interviews with women seeking medical care for obstetric fistula in Eritrea. The interviews were designed to inform programme design for the prevention and treatment of obstetric fistula. Interviews were conducted with 11 new fistula repair patients, 15 women returning for follow-up for their fistula repairs, and five accompanying family members at Massawa Hospital in the Northern Red Sea Zone of Eritrea during November-December 2004. The women described long delays in accessing emergency obstetric care due to delayed recognition of the seriousness of the problem and lack of transportation from remote villages. Follow-up patients described improvements in their conditions, but many continued to have problems with incontinence and sexual health. Both new and returning patients lacked specific information about their condition, what to expect in terms of treatment and recovery, and how to care for themselves. The findings point to a need for community mobilization and education on safe motherhood for prevention of fistula, as well as for improved information, counselling, follow-up, and social services for women who develop obstetric fistulas.

Human Trafficking: How Nurses Can Make a Difference.

PubMed

Scannell, Meredith; MacDonald, Andrea E; Berger, Amanda; Boyer, Nichole

Human trafficking is a human rights violation and a global health problem. Victims of human trafficking have medical and mental health sequelae requiring specific healthcare interventions. Healthcare professionals may be the initial contact that these victims make outside the world of trafficking. Healthcare professionals are key agents in the identification of human trafficking, which is essential in eliminating this public health problem. Unfortunately, healthcare professionals are not always able to detect signs of human trafficking. Failure to detect results in missed opportunities to assist victims. This is a case report of a victim of human trafficking who presented to an emergency department with medical and mental health issues. Despite numerous encounters with different healthcare professionals, signs and symptoms of human trafficking were not identified. Skilled assessment made by a forensic nurse alerted the healthcare team to clear features of human trafficking associated with this person. Through this case report we illustrate the key role the nurse played in identifying signs of human trafficking. Improvement of human trafficking educational programs is highlighted as a key adjunct to improving detection and facilitating the proper treatment of victims.

The social meaning of disability: a reflection on categorisation, stigma and identity.

PubMed

Grue, Jan

2016-07-01

As disability becomes an ever more salient concept in international political and legal discourse, its social meaning must be better understood. Traditionally defined in medical terms and as an individual problem, it has for the last several decades increasingly become a socio-politically defined phenomenon. Disability pride has emerged as a social movement patterned after ethnic minority and sexual orientation movements. The one billion people who count as disabled nevertheless have illnesses and impairments that are largely understood as medical problems. Medicine continues to exert great influence on the social meaning of disability in general and the social valuation of various illnesses and impairments in particular. Whereas specific conditions may be socially valued, the overall category and label of disability connotes marginality and stigma. Under these conditions, disability policy, which ought to be a universal concern, risks being construed as a marginal and special-interest issue rather than a broadly relevant topic; this has potentially negative consequences for the majority of disabled people. © 2016 Foundation for the Sociology of Health & Illness.

Integrating TRENCADIS components in gLite to share DICOM medical images and structured reports.

PubMed

Blanquer, Ignacio; Hernández, Vicente; Salavert, José; Segrelles, Damià

2010-01-01

The problem of sharing medical information among different centres has been tackled by many projects. Several of them target the specific problem of sharing DICOM images and structured reports (DICOM-SR), such as the TRENCADIS project. In this paper we propose sharing and organizing DICOM data and DICOM-SR metadata benefiting from the existent deployed Grid infrastructures compliant with gLite such as EGEE or the Spanish NGI. These infrastructures contribute with a large amount of storage resources for creating knowledge databases and also provide metadata storage resources (such as AMGA) to semantically organize reports in a tree-structure. First, in this paper, we present the extension of TRENCADIS architecture to use gLite components (LFC, AMGA, SE) on the shake of increasing interoperability. Using the metadata from DICOM-SR, and maintaining its tree structure, enables federating different but compatible diagnostic structures and simplifies the definition of complex queries. This article describes how to do this in AMGA and it shows an approach to efficiently code radiology reports to enable the multi-centre federation of data resources.

A model for medical decision making and problem solving.

PubMed

Werner, M

1995-08-01

Clinicians confront the classical problem of decision making under uncertainty, but a universal procedure by which they deal with this situation, both in diagnosis and therapy, can be defined. This consists in the choice of a specific course of action from available alternatives so as to reduce uncertainty. Formal analysis evidences that the expected value of this process depends on the a priori probabilities confronted, the discriminatory power of the action chosen, and the values and costs associated with possible outcomes. Clinical problem-solving represents the construction of a systematic strategy from multiple decisional building blocks. Depending on the level of uncertainty the physicians attach to their working hypothesis, they can choose among at least four prototype strategies: pattern recognition, the hypothetico-deductive process, arborization, and exhaustion. However, the resolution of real-life problems can involve a combination of these game plans. Formal analysis of each strategy permits definition of its appropriate a priori probabilities, action characteristics, and cost implications.

Mental health in adolescence and subsequent receipt of medical benefits in young adulthood: The mediating role of upper secondary school completion.

PubMed

Sagatun, Åse; Wentzel-Larsen, Tore; Heyerdahl, Sonja; Lien, Lars

2016-06-01

Mental health problems in adolescence are associated with impaired function in young adulthood. Our aim was to assess how a hypothetical reduction in mental health problems in adolescence was related to medical benefits in young adulthood and to examine the mediating role of completion of upper secondary school. We used a population-based sample of more than 10,000 10th-grade adolescents with self-reported data on internalizing and externalizing mental health problems. The sample was linked to the Norwegian national registers of education and medical benefits. The mediation analysis was based on a causal inference framework. During a three-year period in young adulthood, 6.4% of men and 5.9% of women received medical benefits. A two-point hypothetical reduction in externalizing problems was related to a lower probability of receiving medical benefits of 1.5 (95% confidence interval (CI) 1.0-2.1) percentage points in young men and 1.8 (95% CI 1.3-2.3) percentage points in young women. The proportion mediated by the completion of upper secondary school was 52% (95% CI 36-76) among boys and 42% (95% CI 29-60) among girls. The corresponding reduction in the probability of receiving medical benefits was 1.8 percentage points for internalizing problems in both sexes (95% CI boys 1.2-2.4 and girls 1.4-2.2). The proportion mediated was lower for internalizing problems and was only significant among girls (19%). CONCLUSIONS INTERVENTION AND PREVENTION STRATEGIES TARGETING INTERNALIZING AND EXTERNALIZING PROBLEMS IN ADOLESCENTS MAY HAVE THE POTENTIAL TO REDUCE THE RECEIPT OF MEDICAL BENEFITS IN YOUNG ADULTHOOD THE COMPLETION OF UPPER SECONDARY SCHOOL SEEMS TO BE A MECHANISM FOR THIS ASSOCIATION, ESPECIALLY FOR EXTERNALIZING PROBLEMS. © 2016 the Nordic Societies of Public Health.

From problem solving to problem definition: scrutinizing the complex nature of clinical practice.

PubMed

Cristancho, Sayra; Lingard, Lorelei; Regehr, Glenn

2017-02-01

In medical education, we have tended to present problems as being singular, stable, and solvable. Problem solving has, therefore, drawn much of medical education researchers' attention. This focus has been important but it is limited in terms of preparing clinicians to deal with the complexity of the 21st century healthcare system in which they will provide team-based care for patients with complex medical illness. In this paper, we use the Soft Systems Engineering principles to introduce the idea that in complex, team-based situations, problems usually involve divergent views and evolve with multiple solution iterations. As such we need to shift the conversation from (1) problem solving to problem definition, and (2) from a problem definition derived exclusively at the level of the individual to a definition derived at the level of the situation in which the problem is manifested. Embracing such a focus on problem definition will enable us to advocate for novel educational practices that will equip trainees to effectively manage the problems they will encounter in complex, team-based healthcare.

A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity.

PubMed

Gellad, Walid F; Grenard, Jerry L; Marcum, Zachary A

2011-02-01

Medication nonadherence is a common problem among the elderly. To conduct a systematic review of the published literature describing potential nonfinancial barriers to medication adherence among the elderly. The PubMed and PsychINFO databases were searched for articles published in English between January 1998 and January 2010 that (1) described "predictors," "facilitators," or "determinants" of medication adherence or that (2) examined the "relationship" between a specific barrier and adherence for elderly patients (ie, ≥65 years of age) in the United States. A manual search of the reference lists of identified articles and the authors' files and recent review articles was conducted. The search included articles that (1) reviewed specific barriers to medication adherence and did not solely describe nonmodifiable predictors of adherence (eg, demographics, marital status), (2) were not interventions designed to address adherence, (3) defined adherence or compliance and specified its method of measurement, and (4) involved US participants only. Nonsystematic reviews were excluded, as were studies that focused specifically on people who were homeless or substance abusers, or patients with psychotic disorders, tuberculosis, or HIV infection, because of the unique circumstances that surround medication adherence for each of these populations. Nine studies met inclusion criteria for this review. Four studies used pharmacy records or claims data to assess adherence, 2 studies used pill count or electronic monitoring, and 3 studies used other methods to assess adherence. Substantial heterogeneity existed among the populations studied as well as among the measures of adherence, barriers addressed, and significant findings. Some potential barriers (ie, factors associated with nonadherence) were identified from the studies, including patient-related factors such as disease-related knowledge, health literacy, and cognitive function; drug-related factors such as adverse effects and polypharmacy; and other factors including the patient-provider relationship and various logistical barriers to obtaining medications. None of the reviewed studies examined primary nonadherence or nonpersistence. Medication nonadherence in the elderly is not well described in the literature, despite being a major cause of morbidity, and thus it is difficult to draw a systematic conclusion on potential barriers based on the current literature. Future research should focus on standardizing medication adherence measurements among the elderly to gain a better understanding of this important issue. Published by EM Inc USA.

ADHD and Problem-Solving in Play

ERIC Educational Resources Information Center

Borg, Suzanne

2009-01-01

This paper reports a small-scale study to determine whether there is a difference in problem-solving abilities, from a play perspective, between individuals who are diagnosed as ADHD and are on medication and those not on medication. Ten children, five of whom where on medication and five not, diagnosed as ADHD predominantly inattentive type, were…

Treating an HIV/AIDS Patient's PTSD and Medication Nonadherence with Cognitive-Behavioral Therapy: A Principle-Based Approach

ERIC Educational Resources Information Center

Chernoff, Robert A.

2007-01-01

HIV/AIDS patients with medication adherence problems are vulnerable to developing drug resistance, immune system degradation, and opportunistic infections. Poor adherence to antiretroviral medication regimens can be aggravated by psychiatric problems, including depression and posttraumatic stress disorder. This article presents the case study of a…