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Sample records for advanced medical life

  1. Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service.

    NARCIS (Netherlands)

    Gerritse, B.M.; Schalkwijk, A.; Pelzer, B.J.; Scheffer, G.J.; Draaisma, J.M.T.

    2010-01-01

    BACKGROUND: To determine the advanced life support procedures provided by an Emergency Medical Service (EMS) and a Helicopter Emergency Medical Service (HEMS) for vitally compromised children. Incidence and success rate of several procedures were studied, with a distinction made between procedures

  2. Effect of ionizing radiation on advanced life support medications

    International Nuclear Information System (INIS)

    Sullivan, D.J.; Hubbard, L.B.; Broadbent, M.V.; Stewart, P.; Jaeger, M.

    1987-01-01

    Advanced life support medications stored in emergency department stretcher areas, diagnostic radiology rooms, and radiotherapy suites are exposed to ionizing radiation. We hypothesized that radiation may decrease the potency and thus the shelf life of medications stored in these areas. Atropine, dopamine, epinephrine, and isoproterenol were exposed to a wide range of ionizing radiation. The potency of the four drugs was unaffected by levels of radiation found in ED stretcher areas and high-volume diagnostic radiograph rooms (eg, chest radiograph, computed tomography, fluoroscopy). The potency of atropine may be reduced by gamma radiation in high-use radiotherapy suites. However, dopamine, epinephrine, and isoproterenol were unaffected by high doses of gamma radiation. Atropine, dopamine, epinephrine, and isoproterenol may be safely kept in ED stretcher areas and diagnostic radiology rooms without loss of potency over the shelf life of the drugs

  3. [Organization of anesthesia management and advanced life support at military medical evacuation levels].

    Science.gov (United States)

    Shchegolev, A V; Petrakov, V A; Savchenko, I F

    2014-07-01

    Anesthesia management and advanced life support for the severely wounded personnel at military medical evacuation levels in armed conflict (local war) is time-consuming and resource-requiring task. One of the mathematical modeling methods was used to evaluate capabilities of anesthesia and intensive care units at tactical level. Obtained result allows us to tell that there is a need to make several system changes of the existing system of anesthesia management and advanced life support for the severely wounded personnel at military medical evacuation levels. In addition to increasing number of staff of anesthesiology-critical care during the given period of time another solution should be the creation of an early evacuation to a specialized medical care level by special means while conducting intensive monitoring and treatment.

  4. Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service

    Directory of Open Access Journals (Sweden)

    Scheffer Gert J

    2010-03-01

    Full Text Available Abstract Background To determine the advanced life support procedures provided by an Emergency Medical Service (EMS and a Helicopter Emergency Medical Service (HEMS for vitally compromised children. Incidence and success rate of several procedures were studied, with a distinction made between procedures restricted to the HEMS-physician and procedures for which the HEMS is more experienced than the EMS. Methods Prospective study of a consecutive group of children examined and treated by the HEMS of the eastern region of the Netherlands. Data regarding type of emergency, physiological parameters, NACA scores, treatment, and 24-hour survival were collected and subsequently analysed. Results Of the 558 children examined and treated by the HEMS on scene, 79% had a NACA score of IV-VII. 65% of the children had one or more advanced life support procedures restricted to the HEMS and 78% of the children had one or more procedures for which the HEMS is more experienced than the EMS. The HEMS intubated 38% of all children, and 23% of the children intubated and ventilated by the EMS needed emergency correction because of potentially lethal complications. The HEMS provided the greater part of intraosseous access, as the EMS paramedics almost exclusively reserved this procedure for children in cardiopulmonary resuscitation. The EMS provided pain management only to children older than four years of age, but a larger group was in need of analgesia upon arrival of the HEMS, and was subsequently treated by the HEMS. Conclusions The Helicopter Emergency Medical Service of the eastern region of the Netherlands brings essential medical expertise in the field not provided by the emergency medical service. The Emergency Medical Service does not provide a significant quantity of procedures obviously needed by the paediatric patient.

  5. Improving advanced cardiovascular life support skills in medical students: simulation-based education approach

    Directory of Open Access Journals (Sweden)

    Hamidreza Reihani

    2015-01-01

    Full Text Available Objective: In this trial, we intend to assess the effect of simulation-based education approach on advanced cardiovascular life support skills among medical students. Methods: Through convenient sampling method, 40 interns of Mashhad University of Medical Sciences in their emergency medicine rotation (from September to December 2012 participated in this study. Advanced Cardiovascular Life Support (ACLS workshops with pretest and post-test exams were performed. Workshops and checklists for pretest and post-test exams were designed according to the latest American Heart Association (AHA guidelines. Results: The total score of the students increased significantly after workshops (24.6 out of 100 to 78.6 out of 100. This demonstrates 53.9% improvement in the skills after the simulation-based education (P< 0.001. Also the mean score of each station had a significant improvement (P< 0.001. Conclusion: Pretests showed that interns had poor performance in practical clinical matters while their scientific knowledge, such as ECG interpretation was acceptable. The overall results of the study highlights that Simulation based-education approach is highly effective in Improving ACLS skills among medical students.

  6. Perceptions of basic, advanced, and pediatric life support training in a United States medical school.

    Science.gov (United States)

    Pillow, Malford Tyson; Stader, Donald; Nguyen, Matthew; Cao, Dazhe; McArthur, Robert; Hoxhaj, Shkelzen

    2014-05-01

    Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS) are integral parts of emergency resuscitative care. Although this training is usually reserved for residents, introducing the training in the medical student curriculum may enhance acquisition and retention of these skills. We developed a survey to characterize the perceptions and needs of graduating medical students regarding BLS, ACLS, and PALS training. This was a study of graduating 4th-year medical students at a U.S. medical school. The students were surveyed prior to participating in an ACLS course in March of their final year. Of 152 students, 109 (71.7%) completed the survey; 48.6% of students entered medical school without any prior training and 47.7% started clinics without training; 83.4% of students reported witnessing an average of 3.0 in-hospital cardiac arrests during training (range of 0-20). Overall, students rated their preparedness 2.0 (SD 1.0) for adult resuscitations and 1.7 (SD 0.9) for pediatric resuscitations on a 1-5 Likert scale, with 1 being unprepared. A total of 36.8% of students avoided participating in resuscitations due to lack of training; 98.2%, 91.7%, and 64.2% of students believe that BLS, ACLS, and PALS, respectively, should be included in the medical student curriculum. As per previous studies that have examined this topic, students feel unprepared to respond to cardiac arrests and resuscitations. They feel that training is needed in their curriculum and would possibly enhance perceived comfort levels and willingness to participate in resuscitations. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies.

    Science.gov (United States)

    Sanghavi, Prachi; Jena, Anupam B; Newhouse, Joseph P; Zaslavsky, Alan M

    2015-11-03

    Most Medicare patients seeking emergency medical transport are treated by ambulance providers trained in advanced life support (ALS). Evidence supporting the superiority of ALS over basic life support (BLS) is limited, but some studies suggest ALS may harm patients. To compare outcomes after ALS and BLS in out-of-hospital medical emergencies. Observational study with adjustment for propensity score weights and instrumental variable analyses based on county-level variations in ALS use. Traditional Medicare. 20% random sample of Medicare beneficiaries from nonrural counties between 2006 and 2011 with major trauma, stroke, acute myocardial infarction (AMI), or respiratory failure. Neurologic functioning and survival to 30 days, 90 days, 1 year, and 2 years. Except in cases of AMI, patients showed superior unadjusted outcomes with BLS despite being older and having more comorbidities. In propensity score analyses, survival to 90 days among patients with trauma, stroke, and respiratory failure was higher with BLS than ALS (6.1 percentage points [95% CI, 5.4 to 6.8 percentage points] for trauma; 7.0 percentage points [CI, 6.2 to 7.7 percentage points] for stroke; and 3.7 percentage points [CI, 2.5 to 4.8 percentage points] for respiratory failure). Patients with AMI did not exhibit differences in survival at 30 days but had better survival at 90 days with ALS (1.0 percentage point [CI, 0.1 to 1.9 percentage points]). Neurologic functioning favored BLS for all diagnoses. Results from instrumental variable analyses were broadly consistent with propensity score analyses for trauma and stroke, showed no survival differences between BLS and ALS for respiratory failure, and showed better survival at all time points with BLS than ALS for patients with AMI. Only Medicare beneficiaries from nonrural counties were studied. Advanced life support is associated with substantially higher mortality for several acute medical emergencies than BLS. National Science Foundation, Agency for

  8. End-of-Life Decisions and Advanced Old Age

    Directory of Open Access Journals (Sweden)

    Stoyles

    2014-07-01

    Full Text Available Despite the fact that most people die in advanced old age, little attention is given to cases involving older people in debates about the moral and legal dimensions of end-of-life decision making. The purpose of this paper is to establish some of the ways our discussions should change as we pay attention to important factors influencing end-of-life decisions for people in advanced old age. Focusing on the prevalence of comorbidities and the likelihood that people in advanced old age will experience an extended period of declining function before death, I argue that our debates should be expanded to include greater consideration of how we want to live in the final stages of life. With this, I am arguing against the tendency to think that “end-of-life” decision making concerns only making decisions about when and how it is appropriate to terminate a person’s life. I argue, further, that we should move away from the medicalization of dying.

  9. [End-of-life care and end-of-life medical decisions: the ITAELD study].

    Science.gov (United States)

    Miccinesi, Guido; Puliti, Donella; Paci, Eugenio

    2011-01-01

    To describe the attitudes towards end of life care and the practice of end-of-life medical decisions with possible life-shortening effect among Italian physicians. Cross sectional study (last death among the assisted patients in the last 12 months was considered). In the year 2007, 5,710 GPs and 8,950 hospital physicians were invited all over Italy to participate in the ITAELDstudy through anonymous mail questionnaire. Proportion of agreement with statements on end-of-life care issues. Proportion of deaths with an end-of-life medical decision. The response rate was 19.2%. The 65% of respondents agreed with the duty to respect any non-treatment request of the competent patient, the 55% agreed with the same duty in case of advanced directives, the 39% in case of proxy's request. The 53% of respondents agreed with the ethical acceptability of active euthanasia in selected cases. Among 1,850 deaths the 57.7% did not receive any end-of-life medical decision. For a further 21.0% no decision was possible, being sudden and unexpected deaths. In the remaining 21.3% at least one end-of-life medical decision was reported: 0.8% was classified as physician assisted death, 20.5% as non-treatment decision. Among all deceased the 19.6% were reported to have been deeply sedated. Being favourable to the use of opioids in terminal patients was associated to non-treatment decisions with possible but non-intentional life shortening effect; agreeing with the duty to fully respect any actual non-treatment request of the competent patient was associated to end-of life medical decisions with intentional life-shortening effect (adjusted OR>10 in both cases). The life stance and ethical beliefs of physicians determine their behaviour at the end of life wherever specific statements of law are lacking. Therefore education and debate are needed on these issues.

  10. Religiousness and Spiritual Support Among Advanced Cancer Patients and Associations With End-of-Life Treatment Preferences and Quality of Life

    Science.gov (United States)

    Balboni, Tracy A.; Vanderwerker, Lauren C.; Block, Susan D.; Paulk, M. Elizabeth; Lathan, Christopher S.; Peteet, John R.; Prigerson, Holly G.

    2008-01-01

    Purpose Religion and spirituality play a role in coping with illness for many cancer patients. This study examined religiousness and spiritual support in advanced cancer patients of diverse racial/ethnic backgrounds and associations with quality of life (QOL), treatment preferences, and advance care planning. Methods The Coping With Cancer study is a federally funded, multi-institutional investigation examining factors associated with advanced cancer patient and caregiver well-being. Patients with an advanced cancer diagnosis and failure of first-line chemotherapy were interviewed at baseline regarding religiousness, spiritual support, QOL, treatment preferences, and advance care planning. Results Most (88%) of the study population (N = 230) considered religion to be at least somewhat important. Nearly half (47%) reported that their spiritual needs were minimally or not at all supported by a religious community, and 72% reported that their spiritual needs were supported minimally or not at all by the medical system. Spiritual support by religious communities or the medical system was significantly associated with patient QOL (P = .0003). Religiousness was significantly associated with wanting all measures to extend life (odds ratio, 1.96; 95% CI, 1.08 to 3.57). Conclusion Many advanced cancer patients' spiritual needs are not supported by religious communities or the medical system, and spiritual support is associated with better QOL. Religious individuals more frequently want aggressive measures to extend life. PMID:17290065

  11. Teaching advance care planning to medical students with a computer-based decision aid.

    Science.gov (United States)

    Green, Michael J; Levi, Benjamin H

    2011-03-01

    Discussing end-of-life decisions with cancer patients is a crucial skill for physicians. This article reports findings from a pilot study evaluating the effectiveness of a computer-based decision aid for teaching medical students about advance care planning. Second-year medical students at a single medical school were randomized to use a standard advance directive or a computer-based decision aid to help patients with advance care planning. Students' knowledge, skills, and satisfaction were measured by self-report; their performance was rated by patients. 121/133 (91%) of students participated. The Decision-Aid Group (n = 60) outperformed the Standard Group (n = 61) in terms of students' knowledge (p satisfaction with their learning experience (p student performance. Use of a computer-based decision aid may be an effective way to teach medical students how to discuss advance care planning with cancer patients.

  12. Cost of Medical Care of Patients with Advanced Serious Illness in Singapore (COMPASS): prospective cohort study protocol.

    Science.gov (United States)

    Teo, Irene; Singh, Ratna; Malhotra, Chetna; Ozdemir, Semra; Dent, Rebecca A; Kumarakulasinghe, Nesaretnam Barr; Yeo, Wee Lee; Cheung, Yin Bun; Malhotra, Rahul; Kanesvaran, Ravindran; Yee, Alethea Chung Pheng; Chan, Noreen; Wu, Huei Yaw; Chin, Soh Mun; Allyn, Hum Yin Mei; Yang, Grace Meijuan; Neo, Patricia Soek Hui; Nadkarni, Nivedita V; Harding, Richard; Finkelstein, Eric A

    2018-04-23

    Advanced cancer significantly impacts quality of life of patients and families as they cope with symptom burden, treatment decision-making, uncertainty and costs of treatment. In Singapore, information about the experiences of advanced cancer patients and families and the financial cost they incur for end-of-life care is lacking. Understanding of this information is needed to inform practice and policy to ensure continuity and affordability of care at the end of life. The primary objectives of the Cost of Medical Care of Patients with Advanced Serious Illness in Singapore (COMPASS) cohort study are to describe changes in quality of life and to quantify healthcare utilization and costs of patients with advanced cancer at the end of life. Secondary objectives are to investigate patient and caregiver preferences for diagnostic and prognostic information, preferences for end-of-life care, caregiver burden and perceived quality of care and to explore how these change as illness progresses and finally to measure bereavement adjustment. The purpose of this paper is to present the COMPASS protocol in order to promote scientific transparency. This cohort study recruits advanced cancer patients (n = 600) from outpatient medical oncology clinics at two public tertiary healthcare institutions in Singapore. Patients and their primary informal caregiver are surveyed every 3 months until patients' death; caregivers are followed until 6 months post patient death. Patient medical and billing records are obtained and merged with patient survey data. The treating medical oncologists of participating patients are surveyed to obtain their beliefs regarding care delivery for the patient. The study will allow combination of self-report, medical, and cost data from various sources to present a comprehensive picture of the end-of-life experience of advanced cancer patients in a unique Asian setting. This study is responsive to Singapore's National Strategy for Palliative Care which

  13. Advanced life support for cardiac arrest beyond the algorithm

    DEFF Research Database (Denmark)

    Rudolph, Søren Steemann; Isbye, Dan Lou; Pfeiffer, Peter

    2018-01-01

    In an advanced emergency medical service all parts of the advanced life support (ALS) algorithm can be provided. This evidence-based algorithm outlines resuscitative efforts for the first 10-15 minutes after cardiac arrest, whereafter the algorithm repeats itself. Restoration of spontaneous...... circulation fails in most cases, but in some circumstances the patient may benefit from additional interventional approaches, in which case transport to hospital with ongoing cardiopulmonary resuscitation is indicated. This paper has summarized treatments outside the ALS algorithm, which may be beneficial...

  14. Advanced Hazmat Life Support (AHLS): A Feasibility Assessment

    International Nuclear Information System (INIS)

    Borron, S. W.; Walter, F. G.

    2007-01-01

    A prospective, descriptive, feasibility study aimed to determine whether an interdisciplinary group of health care experts could design and successfully deliver an international, life support, continuing education program that teaches the medical management of hazardous materials (hazmat) patients. The American Academy of Clinical Toxicology and the University of Arizona College of Medicine, Arizona Emergency Medicine Research Center partnered on July 1, 1998 to develop a two-day Advanced Hazmat Life Support (AHLS) Provider Course. Interdisciplinary expert clinicians designed and then delivered the first AHLS Provider Course in 1999. Prior to this, other courses focused on the management of hazmat incidents and almost exclusively on the prehospital care of hazmat victims by firefighters, hazardous materials technicians, and emergency medical technicians (EMTs), not on the medical management of patients from these incidents. Therefore, AHLS was developed for a broader interdisciplinary group of health care professionals, including both prehospital health care professionals and hospital-based, poison center-based, clinic-based, public health care-based, and other health care professionals. From 1999 through 2006, the AHLS Provider Course has trained 7,142 health care professionals from 48 countries. Of the 7,142 health care professionals worldwide, 43% are paramedics, 24% are physicians, 21% are nurses, 2% are pharmacists, 1% are physician assistants, and 9% are other professionals. Of the professionals trained, 88% are from the United States, 5% from Hong Kong, 2% from Canada, 2% from Australia, 1% from Mexico, and the remainder come from 43 other countries. The Advanced Hazmat Life Support Program is feasible and meets the continuing education needs of health care professionals around the world.(author)

  15. Effect of Advanced Trauma Life Support program on medical interns' performance in simulated trauma patient management.

    Science.gov (United States)

    Ahmadi, Koorosh; Sedaghat, Mohammad; Safdarian, Mahdi; Hashemian, Amir-Masoud; Nezamdoust, Zahra; Vaseie, Mohammad; Rahimi-Movaghar, Vafa

    2013-01-01

    Since appropriate and time-table methods in trauma care have an important impact on patients'outcome, we evaluated the effect of Advanced Trauma Life Support (ATLS) program on medical interns' performance in simulated trauma patient management. A descriptive and analytical study before and after the training was conducted on 24 randomly selected undergraduate medical interns from Imam Reza Hospital in Mashhad, Iran. On the first day, we assessed interns' clinical knowledge and their practical skill performance in confronting simulated trauma patients. After 2 days of ATLS training, we performed the same study and evaluated their score again on the fourth day. The two findings, pre- and post- ATLS periods, were compared through SPSS version 15.0 software. P values less than 0.05 were considered statistically significant. Our findings showed that interns'ability in all the three tasks improved after the training course. On the fourth day after training, there was a statistically significant increase in interns' clinical knowledge of ATLS procedures, the sequence of procedures and skill performance in trauma situations (P less than 0.001, P equal to 0.016 and P equal to 0.01 respectively). ATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns.

  16. End-of-life costs of medical care for advanced stage cancer patients

    Directory of Open Access Journals (Sweden)

    Kovačević Aleksandra

    2015-01-01

    Full Text Available Background/Aim. Cancer, one of the leading causes of mortality in the world, imposes a substantial economic burden on each society, including Serbia. The aim of this study was to evaluate the major cancer cost drivers in Serbia. Methods. A retrospective, indepth, bottom-up analysis of two combined databases was performed in order to quantify relevant costs. End-of-life data were obtained from patients with cancer, who deceased within the first year of the established diagnose, including basic demographics, diagnosis, tumour histology, medical resource use and related costs, time and cause of death. All costs were allocated to one of the three categories of cancer health care services: primary care (included home care, hospital outpatient and hospital inpatient care. Results. Exactly 114 patients were analyzed, out of whom a high percent (48.25% had distant metastases at the moment of establishing the diagnosis. Malignant neoplasms of respiratory and intrathoracic organs were leading causes of morbidity. The average costs per patient were significantly different according to the diagnosis, with the highest (13,114.10 EUR and the lowest (4.00 EUR ones observed in the breast cancer and melanoma, respectively. The greatest impact on total costs was observed concerning pharmaceuticals, with 42% of share (monoclonal antibodies amounted to 34% of all medicines and 14% of total costs, followed by oncology medical care (21%, radiation therapy and interventional radiology (11%, surgery (9%, imaging diagnostics (9% and laboratory costs (8%. Conclusion. Cancer treatment incurs high costs, especially for end-of-life pharmaceutical expenses, ensued from medical personnel tendency to improve such patients’ quality of life in spite of nearing the end of life. Reimbursement policy on monoclonal antibodies, in particular at end-stage disease, should rely on cost-effectiveness evidence as well as documented clinical efficiency. [Projekat Ministarstva nauke

  17. Methodological Challenges in Studies Comparing Prehospital Advanced Life Support with Basic Life Support.

    Science.gov (United States)

    Li, Timmy; Jones, Courtney M C; Shah, Manish N; Cushman, Jeremy T; Jusko, Todd A

    2017-08-01

    Determining the most appropriate level of care for patients in the prehospital setting during medical emergencies is essential. A large body of literature suggests that, compared with Basic Life Support (BLS) care, Advanced Life Support (ALS) care is not associated with increased patient survival or decreased mortality. The purpose of this special report is to synthesize the literature to identify common study design and analytic challenges in research studies that examine the effect of ALS, compared to BLS, on patient outcomes. The challenges discussed in this report include: (1) choice of outcome measure; (2) logistic regression modeling of common outcomes; (3) baseline differences between study groups (confounding); (4) inappropriate statistical adjustment; and (5) inclusion of patients who are no longer at risk for the outcome. These challenges may affect the results of studies, and thus, conclusions of studies regarding the effect of level of prehospital care on patient outcomes should require cautious interpretation. Specific alternatives for avoiding these challenges are presented. Li T , Jones CMC , Shah MN , Cushman JT , Jusko TA . Methodological challenges in studies comparing prehospital Advanced Life Support with Basic Life Support. Prehosp Disaster Med. 2017;32(4):444-450.

  18. The capabilities and scope-of-practice requirements of advanced life ...

    African Journals Online (AJOL)

    In South Africa (SA), advanced life support (ALS) paramedics undertake CCTs. The scope of ALS in SA has no extended protocol regarding procedures or medications in terms of dealing with these CCTs. Aim. The aim ... 16% of private healthcare facilities do not have intensive or ..... Professional Board for Emergency Care.

  19. Improving medical graduates' training in palliative care: advancing education and practice

    Directory of Open Access Journals (Sweden)

    Head BA

    2016-02-01

    Full Text Available Barbara A Head,1 Tara J Schapmire,1 Lori Earnshaw,1 John Chenault,2 Mark Pfeifer,1 Susan Sawning,3 Monica A Shaw,3 1Division of General Internal Medicine, Palliative Care and Medical Education, University of Louisville School of Medicine, 2Kornhouser Health Sciences Library, University of Louisville, 3Undergraduate Medical Education Office, University of Louisville School of Medicine, Louisville, KY, USA Abstract: The needs of an aging population and advancements in the treatment of both chronic and life-threatening diseases have resulted in increased demand for quality palliative care. The doctors of the future will need to be well prepared to provide expert symptom management and address the holistic needs (physical, psychosocial, and spiritual of patients dealing with serious illness and the end of life. Such preparation begins with general medical education. It has been recommended that teaching and clinical experiences in palliative care be integrated throughout the medical school curriculum, yet such education has not become the norm in medical schools across the world. This article explores the current status of undergraduate medical education in palliative care as published in the English literature and makes recommendations for educational improvements which will prepare doctors to address the needs of seriously ill and dying patients. Keywords: medical education, palliative care, end-of-life care

  20. Japanese citizens' attitude toward end-of-life care and advance directives: A qualitative study for members of medical cooperatives.

    Science.gov (United States)

    Hirayama, Yoko; Otani, Takashi; Matsushima, Masato

    2017-12-01

    Japanese citizens are interested in choosing their own end-of-life care, but few have created their own advance directive. This study examined changes among Japanese citizens' attitudes toward end-of-life care and advance directives and explored factors that affected these attitudes. We conducted five focus groups with 48 participants in 2009 and 2010. All participants were members of health cooperatives in Tokyo. We identified many barriers and reasons for creating and writing down advance directives. Experience caring for dying people and having a serious disease affected attitudes toward advance directives. Some participants changed their attitude toward end-of-life care by writing their own advance directive. When someone is writing advance directives, asking about his/her past experience of caring may be helpful. And learning about or filling out advance directives may help to break down resistance to using these documents.

  1. [Ethical issues in the practice of advance directives, living wills, and self-determination in end of life care].

    Science.gov (United States)

    Fang, Hui-Feng; Jhing, Huei-Yu; Lin, Chia-Chin

    2009-02-01

    The Hospice-Palliative Care Act, enacted in Taiwan in 2000, was designed to respect the end of life medical wishes of patients with incurable illnesses, safeguard the rights of these patients, and provide clinical guidelines for healthcare workers responsible to provide end of life care. Self-determination is a core element of human dignity. Advance directive documents include a living will, and durable power of attorney for healthcare. This article reviews current issues and ethical dilemmas with regard to advance directives. Patients, family members, and clinicians may require better education on the Hospice-Palliative Care Act in order to respect more appropriately patient end of life medical care wishes.

  2. Accuracy of advanced cancer patients' life expectancy estimates: The role of race and source of life expectancy information.

    Science.gov (United States)

    Trevino, Kelly M; Zhang, Baohui; Shen, Megan J; Prigerson, Holly G

    2016-06-15

    The objective of this study was to examine the source of advanced cancer patients' information about their prognosis and determine whether this source of information could explain racial disparities in the accuracy of patients' life expectancy estimates (LEEs). Coping With Cancer was a prospective, longitudinal, multisite study of terminally ill cancer patients followed until death. In structured interviews, patients reported their LEEs and the sources of these estimates (ie, medical providers, personal beliefs, religious beliefs, and other). The accuracy of LEEs was calculated through a comparison of patients' self-reported LEEs with their actual survival. The sample for this analysis included 229 patients: 31 black patients and 198 white patients. Only 39.30% of the patients estimated their life expectancy within 12 months of their actual survival. Black patients were more likely to have an inaccurate LEE than white patients. A minority of the sample (18.3%) reported that a medical provider was the source of their LEEs; none of the black patients (0%) based their LEEs on a medical provider. Black race remained a significant predictor of an inaccurate LEE, even after the analysis had been controlled for sociodemographic characteristics and the source of LEEs. The majority of advanced cancer patients have an inaccurate understanding of their life expectancy. Black patients with advanced cancer are more likely to have an inaccurate LEE than white patients. Medical providers are not the source of information for LEEs for most advanced cancer patients and especially for black patients. The source of LEEs does not explain racial differences in LEE accuracy. Additional research into the mechanisms underlying racial differences in prognostic understanding is needed. Cancer 2016;122:1905-12. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons

  3. Advanced Cancer and End-of-Life Preferences: Curative Intent Surgery Versus Noncurative Intent Treatment.

    Science.gov (United States)

    Schubart, Jane R; Green, Michael J; Van Scoy, Lauren J; Lehman, Erik; Farace, Elana; Gusani, Niraj J; Levi, Benjamin H

    2015-12-01

    People with cancer face complex medical decisions, including whether to receive life-sustaining treatments at the end of life. It is not unusual for clinicians to make assumptions about patients' wishes based on whether they had previously chosen to pursue curative treatment. We hypothesized that cancer patients who initially underwent curative intent surgery (CIS) would prefer more aggressive end-of-life treatments compared to patients whose treatment was noncurative intent (non-CIT). This study was a retrospective review of data from a large, randomized controlled trial examining the use of an online decision aid for advance care planning, "Making Your Wishes Known" (MYWK), with patients who had advanced cancer. We reviewed patients' medical records to determine which patients underwent CIS versus non-CIT. In the parent trial, conducted at an academic medical center (2007-2012), 200 patients were enrolled with stage IV malignancy or other poor prognosis cancer. Patients' preferences for aggressive treatment were measured in two ways: using patient-selected General Wishes statements generated by the decision aid and patient-selected wishes for specific treatments under various hypothetical clinical scenarios (Specific Wishes). We evaluated 79 patients. Of these, 48 had undergone initial CIS and 31 had non-CIT. Cancer patients who initially underwent CIS did not prefer more aggressive end-of-life treatments compared to patients whose treatment was non-CIT. Clinicians should avoid assumptions about patients' preferences for life-sustaining treatment based on their prior choices for aggressive treatment.

  4. Advanced Accelerators for Medical Applications

    Science.gov (United States)

    Uesaka, Mitsuru; Koyama, Kazuyoshi

    We review advanced accelerators for medical applications with respect to the following key technologies: (i) higher RF electron linear accelerator (hereafter “linac”); (ii) optimization of alignment for the proton linac, cyclotron and synchrotron; (iii) superconducting magnet; (iv) laser technology. Advanced accelerators for medical applications are categorized into two groups. The first group consists of compact medical linacs with high RF, cyclotrons and synchrotrons downsized by optimization of alignment and superconducting magnets. The second group comprises laser-based acceleration systems aimed of medical applications in the future. Laser plasma electron/ion accelerating systems for cancer therapy and laser dielectric accelerating systems for radiation biology are mentioned. Since the second group has important potential for a compact system, the current status of the established energy and intensity and of the required stability are given.

  5. Students' satisfaction to hybrid problem-based learning format for basic life support/advanced cardiac life support teaching.

    Science.gov (United States)

    Chilkoti, Geetanjali; Mohta, Medha; Wadhwa, Rachna; Saxena, Ashok Kumar; Sharma, Chhavi Sarabpreet; Shankar, Neelima

    2016-11-01

    Students are exposed to basic life support (BLS) and advanced cardiac life support (ACLS) training in the first semester in some medical colleges. The aim of this study was to compare students' satisfaction between lecture-based traditional method and hybrid problem-based learning (PBL) in BLS/ACLS teaching to undergraduate medical students. We conducted a questionnaire-based, cross-sectional survey among 118 1 st -year medical students from a university medical college in the city of New Delhi, India. We aimed to assess the students' satisfaction between lecture-based and hybrid-PBL method in BLS/ACLS teaching. Likert 5-point scale was used to assess students' satisfaction levels between the two teaching methods. Data were collected and scores regarding the students' satisfaction levels between these two teaching methods were analysed using a two-sided paired t -test. Most students preferred hybrid-PBL format over traditional lecture-based method in the following four aspects; learning and understanding, interest and motivation, training of personal abilities and being confident and satisfied with the teaching method ( P < 0.05). Implementation of hybrid-PBL format along with the lecture-based method in BLS/ACLS teaching provided high satisfaction among undergraduate medical students.

  6. Contents of life review and quality of life of advanced cancer patients

    OpenAIRE

    Ando, Michiyo; Ishiwara, Tatsuhiko; Kimura, Hideyuki; Tsuchida, Yoko

    2003-01-01

    The present study investigated the utility of life review for advanced cancer patients. In the investigation, we examined the contents of life review of advanced cancer patients, and the relation between specific contents and Quality of Life (QoL) issues.

  7. Effectiveness of the "Cancer Home-Life Intervention" on everyday activities and quality of life in people with advanced cancer living at home

    DEFF Research Database (Denmark)

    Brandt, Åse; Pilegaard, Marc Sampedro; Østergaard, Lisa Gregersen

    2016-01-01

    applied in the participant’s home environment was developed. The objective of this study is to examine the effectiveness and cost-effectiveness of the Cancer Home-Life Intervention compared to usual care on the performance of and participation in everyday activities and quality of life in people...... in everyday activities, and whether it contributes to their health-related quality of life. The economic evaluation alongside the RCT will show if the Cancer Home-Life Intervention is cost-effective. The trial will also show the acceptability of the intervention to the target group, and whether subgroups......Background During the past decade an increasing number of people live with advanced cancer mainly due to improved medical treatment. Research has shown that many people with advanced cancer have problems with everyday activities, which have negative impact on their quality of life...

  8. Patient-Clinician Communication About End-of-Life Care in Patients With Advanced Chronic Organ Failure During One Year.

    Science.gov (United States)

    Houben, Carmen H M; Spruit, Martijn A; Schols, Jos M G A; Wouters, Emiel F M; Janssen, Daisy J A

    2015-06-01

    Patient-clinician communication is an important prerequisite to delivering high-quality end-of-life care. However, discussions about end-of-life care are uncommon in patients with advanced chronic organ failure. The aim was to examine the quality of end-of-life care communication during one year follow-up of patients with advanced chronic organ failure. In addition, we aimed to explore whether and to what extent quality of communication about end-of-life care changes toward the end of life and whether end-of-life care communication is related to patient-perceived quality of medical care. Clinically stable outpatients (n = 265) with advanced chronic obstructive pulmonary disease, chronic heart failure, or chronic renal failure were visited at home at baseline and four, eight, and 12 months after baseline to assess quality of end-of-life care communication (Quality of Communication questionnaire). Two years after baseline, survival status was assessed, and if patients died during the study period, a bereavement interview was done with the closest relative. One year follow-up was completed by 77.7% of the patients. Quality of end-of-life care communication was rated low at baseline and did not change over one year. Quality of end-of-life care communication was comparable for patients who completed two year follow-up and patients who died during the study. The correlation between quality of end-of-life care communication and satisfaction with medical treatment was weak. End-of-life care communication is poor in patients with chronic organ failure and does not change toward the end of life. Future studies should develop an intervention aiming at initiating high-quality end-of-life care communication between patients with advanced chronic organ failure and their clinicians. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  9. Evolution of the Pediatric Advanced Life Support course: enhanced learning with a new debriefing tool and Web-based module for Pediatric Advanced Life Support instructors.

    Science.gov (United States)

    Cheng, Adam; Rodgers, David L; van der Jagt, Élise; Eppich, Walter; O'Donnell, John

    2012-09-01

    To describe the history of the Pediatric Advanced Life Support course and outline the new developments in instructor training that will impact the way debriefing is conducted during Pediatric Advanced Life Support courses. The Pediatric Advanced Life Support course, first released by the American Heart Association in 1988, has seen substantial growth and change over the past few decades. Over that time, Pediatric Advanced Life Support has become the standard for resuscitation training for pediatric healthcare providers in North America. The incorporation of high-fidelity simulation-based learning into the most recent version of Pediatric Advanced Life Support has helped to enhance the realism of scenarios and cases, but has also placed more emphasis on the importance of post scenario debriefing. We developed two new resources: an online debriefing module designed to introduce a new model of debriefing and a debriefing tool for real-time use during Pediatric Advanced Life Support courses, to enhance and standardize the quality of debriefing by Pediatric Advanced Life Support instructors. In this article, we review the history of Pediatric Advanced Life Support and Pediatric Advanced Life Support instructor training and discuss the development and implementation of the new debriefing module and debriefing tool for Pediatric Advanced Life Support instructors. The incorporation of the debriefing module and debriefing tool into the 2011 Pediatric Advanced Life Support instructor materials will help both new and existing Pediatric Advanced Life Support instructors develop and enhance their debriefing skills with the intention of improving the acquisition of knowledge and skills for Pediatric Advanced Life Support students.

  10. Medical futility in children's nursing: making end-of-life decisions.

    Science.gov (United States)

    Brien, Irene O; Duffy, Anita; Shea, Ellen O

    Caring for infants at end of life is challenging and distressing for parents and healthcare professionals, especially in relation to making decisions regarding withholding or withdrawal of treatment. The concept of medical futility must be considered under these circumstances. Parents and healthcare professionals should be involved together in making these difficult decisions. However, for some parents, emotions and guilt often are unbearable and, understandably, parents can be reluctant to make a decision. Despite the recognition of parental autonomy, if parents disagree with a decision made by medical staff, the case will be referred to and solved by the courts. The courts' decisions are often based on the best interest of the child. In this article, the authors discuss the concepts of 'parental autonomy' and 'the child's best interests' when determining medical futility for infants or neonates. The role of the nurse when caring for the dying child and their family is multifaceted. While nurses do not have a legitimate role in decision making at the end of life, it is often nurses who, through their advocacy role, inform doctors about parents' wishes and it is often nurses who support parents during this difficult time. Furthermore, nurses caring for dying children should be familiar to the family, experienced in end-of-life care and comfortable talking to parents about death and dying and treatment choices. Children's nurses therefore require advanced communication skills and an essential understanding of the ethical and legal knowledge relating to medical futility in end-of-life children's nursing.

  11. Medical futility in children's nursing: making end-of-life decisions.

    LENUS (Irish Health Repository)

    Brien, Irene O

    2012-02-01

    Caring for infants at end of life is challenging and distressing for parents and healthcare professionals, especially in relation to making decisions regarding withholding or withdrawal of treatment. The concept of medical futility must be considered under these circumstances. Parents and healthcare professionals should be involved together in making these difficult decisions. However, for some parents, emotions and guilt often are unbearable and, understandably, parents can be reluctant to make a decision. Despite the recognition of parental autonomy, if parents disagree with a decision made by medical staff, the case will be referred to and solved by the courts. The courts\\' decisions are often based on the best interest of the child. In this article, the authors discuss the concepts of \\'parental autonomy\\' and \\'the child\\'s best interests\\' when determining medical futility for infants or neonates. The role of the nurse when caring for the dying child and their family is multifaceted. While nurses do not have a legitimate role in decision making at the end of life, it is often nurses who, through their advocacy role, inform doctors about parents\\' wishes and it is often nurses who support parents during this difficult time. Furthermore, nurses caring for dying children should be familiar to the family, experienced in end-of-life care and comfortable talking to parents about death and dying and treatment choices. Children\\'s nurses therefore require advanced communication skills and an essential understanding of the ethical and legal knowledge relating to medical futility in end-of-life children\\'s nursing.

  12. Satisfaction with life during pregnancy and early motherhood in first-time mothers of advanced age: a population-based longitudinal study.

    Science.gov (United States)

    Aasheim, Vigdis; Waldenström, Ulla; Rasmussen, Svein; Espehaug, Birgitte; Schytt, Erica

    2014-02-25

    The trend to delay motherhood to the age of 30 and beyond is established in most high-income countries but relatively little is known about potential effects on maternal emotional well-being. This study investigates satisfaction with life during pregnancy and the first three years of motherhood in women expecting their first baby at an advanced and very advanced age. The study was based on the National Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Data on 18 565 nulliparous women recruited in the second trimester 1999-2008 were used. Four questionnaires were completed: at around gestational weeks 17 and 30, and at six months and three years after the birth. Medical data were retrieved from the national Medical Birth Register. Advanced age was defined as 32-37 years, very advanced age as ≥38 years and the reference group as 25-31 years. The distribution of satisfaction with life from age 25 to ≥40 years was investigated, and the mean satisfaction with life at the four time points was estimated. Logistic regression analyses based on generalised estimation equations were used to investigate associations between advanced and very advanced age and satisfaction with life when controlling for socio-demographic factors. Satisfaction with life decreased from around age 28 to age 40 and beyond, when measured in gestational weeks 17 and 30, and at six months and three years after the birth. When comparing women of advanced and very advanced age with the reference group, satisfaction with life was slightly reduced in the two older age groups and most of all in women of very advanced age. Women of very advanced age had the lowest scores at all time points and this was most pronounced at three years after the birth. First-time mothers of advanced and very advanced age reported a slightly lower degree of satisfaction with life compared with the reference group of younger women, and the age-related effect was greatest

  13. Egyptian Journal of Medical Laboratory Sciences: Advanced Search

    African Journals Online (AJOL)

    Egyptian Journal of Medical Laboratory Sciences: Advanced Search. Journal Home > Egyptian Journal of Medical Laboratory Sciences: Advanced Search. Log in or Register to get access to full text downloads.

  14. Gender Disparities in Faculty Rank: Factors that Affect Advancement of Women Scientists at Academic Medical Centers

    Directory of Open Access Journals (Sweden)

    Cristina M. López

    2018-04-01

    Full Text Available While a significant portion of women within academic science are employed within medical schools, women faculty in these academic medical centers are disproportionately represented in lower faculty ranks. The medical school setting is a critical case for both understanding and advancing women in basic sciences. This study highlights the findings from focus groups conducted with women faculty across Assistant, Associate, and Full Professor ranks (n = 35 in which they discussed barriers and facilitators for advancement of women basic scientists at an academic medical center. Qualitative analysis demonstrated several emergent themes that affect women’s advancement, including gendered expectation norms (e.g., good citizenship, volunteerism, work-life balance, mentorship/sponsorship, adoption of a team science approach, tenure process milestones, soft money research infrastructure, institution specific policies (or lack thereof, and operating within an MD-biased culture. These findings are compared with the extant literature of women scientists in STEM institutions. Factors that emerged from these focus groups highlight the need for evidence-based interventions in the often overlooked STEM arena of academic medical centers.

  15. Pediatric advanced life support and sedation of pediatric dental patients

    OpenAIRE

    Kim, Jongbin

    2016-01-01

    Programs provided by the Korea Association of Cardiopulmonary Resuscitation include Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Korean Advanced Life Support (KALS). However, programs pertinent to dental care are lacking. Since 2015, related organizations have been attempting to develop a Dental Advanced Life Support (DALS) program, which can meet the needs of the dental environment. Generally, for initial management of emergency ...

  16. Advances in medical image computing.

    Science.gov (United States)

    Tolxdorff, T; Deserno, T M; Handels, H; Meinzer, H-P

    2009-01-01

    Medical image computing has become a key technology in high-tech applications in medicine and an ubiquitous part of modern imaging systems and the related processes of clinical diagnosis and intervention. Over the past years significant progress has been made in the field, both on methodological and on application level. Despite this progress there are still big challenges to meet in order to establish image processing routinely in health care. In this issue, selected contributions of the German Conference on Medical Image Processing (BVM) are assembled to present latest advances in the field of medical image computing. The winners of scientific awards of the German Conference on Medical Image Processing (BVM) 2008 were invited to submit a manuscript on their latest developments and results for possible publication in Methods of Information in Medicine. Finally, seven excellent papers were selected to describe important aspects of recent advances in the field of medical image processing. The selected papers give an impression of the breadth and heterogeneity of new developments. New methods for improved image segmentation, non-linear image registration and modeling of organs are presented together with applications of image analysis methods in different medical disciplines. Furthermore, state-of-the-art tools and techniques to support the development and evaluation of medical image processing systems in practice are described. The selected articles describe different aspects of the intense development in medical image computing. The image processing methods presented enable new insights into the patient's image data and have the future potential to improve medical diagnostics and patient treatment.

  17. Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries.

    LENUS (Irish Health Repository)

    Coffey, Alice

    2016-01-28

    Nurses\\' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses\\' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients\\' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care.

  18. Use of medications of questionable benefit in advanced dementia.

    Science.gov (United States)

    Tjia, Jennifer; Briesacher, Becky A; Peterson, Daniel; Liu, Qin; Andrade, Susan E; Mitchell, Susan L

    2014-11-01

    Advanced dementia is characterized by severe cognitive impairment and complete functional dependence. Patients' goals of care should guide the prescribing of medication during such terminal illness. Medications that do not promote the primary goal of care should be minimized. To estimate the prevalence of medications with questionable benefit used by nursing home residents with advanced dementia, identify resident- and facility-level characteristics associated with such use, and estimate associated medication expenditures. Cross-sectional study of medication use by nursing home residents with advanced dementia using a nationwide long-term care pharmacy database linked to the Minimum Data Set (460 facilities) between October 1, 2009, and September 30, 2010. Use of medication deemed of questionable benefit in advanced dementia based on previously published criteria and mean 90-day expenditures attributable to these medications per resident. Generalized estimating equations using the logit link function were used to identify resident- and facility-related factors independently associated with the likelihood of receiving medications of questionable benefit after accounting for clustering within nursing homes. Of 5406 nursing home residents with advanced dementia, 2911 (53.9%) received at least 1 medication with questionable benefit (range, 44.7% in the Mid-Atlantic census region to 65.0% in the West South Central census region). Cholinesterase inhibitors (36.4%), memantine hydrochloride (25.2%), and lipid-lowering agents (22.4%) were the most commonly prescribed. In adjusted analyses, having eating problems (adjusted odds ratio [AOR], 0.68; 95% CI, 0.59-0.78), a feeding tube (AOR, 0.58; 95% CI, 0.48-0.70), or a do-not-resuscitate order (AOR, 0.65; 95% CI, 0.57-0.75), and enrolling in hospice (AOR, 0.69; 95% CI, 0.58-0.82) lowered the likelihood of receiving these medications. High facility-level use of feeding tubes increased the likelihood of receiving these

  19. NASA Advanced Exploration Systems: Advancements in Life Support Systems

    Science.gov (United States)

    Shull, Sarah A.; Schneider, Walter F.

    2016-01-01

    The NASA Advanced Exploration Systems (AES) Life Support Systems (LSS) project strives to develop reliable, energy-efficient, and low-mass spacecraft systems to provide environmental control and life support systems (ECLSS) critical to enabling long duration human missions beyond low Earth orbit (LEO). Highly reliable, closed-loop life support systems are among the capabilities required for the longer duration human space exploration missions assessed by NASA’s Habitability Architecture Team.

  20. Evaluation of Therapeutics for Advanced-Stage Heart Failure and Other Severely-Debilitating or Life-Threatening Diseases.

    Science.gov (United States)

    Prescott, J S; Andrews, P A; Baker, R W; Bogdanffy, M S; Fields, F O; Keller, D A; Lapadula, D M; Mahoney, N M; Paul, D E; Platz, S J; Reese, D M; Stoch, S A; DeGeorge, J J

    2017-08-01

    Severely-debilitating or life-threatening (SDLT) diseases include conditions in which life expectancy is short or quality of life is greatly diminished despite available therapies. As such, the medical context for SDLT diseases is comparable to advanced cancer and the benefit vs. risk assessment and development of SDLT disease therapeutics should be similar to that of advanced cancer therapeutics. A streamlined development approach would allow patients with SDLT conditions earlier access to therapeutics and increase the speed of progression through development. In addition, this will likely increase the SDLT disease therapeutic pipeline, directly benefiting patients and reducing the economic and societal burden of SDLT conditions. Using advanced-stage heart failure (HF) as an example that illustrates the concepts applicable to other SDLT indications, this article proposes a streamlined development paradigm for SDLT disease therapeutics and recommends development of aligned global regulatory guidance. © 2017 American Society for Clinical Pharmacology and Therapeutics.

  1. Treatment of Advanced Glaucoma Study: a multicentre randomised controlled trial comparing primary medical treatment with primary trabeculectomy for people with newly diagnosed advanced glaucoma-study protocol.

    Science.gov (United States)

    King, Anthony J; Fernie, Gordon; Azuara-Blanco, Augusto; Burr, Jennifer M; Garway-Heath, Ted; Sparrow, John M; Vale, Luke; Hudson, Jemma; MacLennan, Graeme; McDonald, Alison; Barton, Keith; Norrie, John

    2017-10-26

    Presentation with advanced glaucoma is the major risk factor for lifetime blindness. Effective intervention at diagnosis is expected to minimise risk of further visual loss in this group of patients. To compare clinical and cost-effectiveness of primary medical management compared with primary surgery for people presenting with advanced open-angle glaucoma (OAG). Design : A prospective, pragmatic multicentre randomised controlled trial (RCT). Twenty-seven UK hospital eye services. Four hundred and forty patients presenting with advanced OAG, according to the Hodapp-Parish-Anderson classification of visual field loss. Participants will be randomised to medical treatment or augmented trabeculectomy (1:1 allocation minimised by centre and presence of advanced disease in both eyes). The primary outcome is vision-related quality of life measured by the National Eye Institute-Visual Function Questionnaire-25 at 24 months. Secondary outcomes include generic EQ-5D-5L, Health Utility Index-3 and glaucoma-related health status (Glaucoma Utility Index), patient experience, visual field measured by mean deviation value, logarithm of the mean angle of resolution visual acuity, intraocular pressure, adverse events, standards for driving and eligibility for blind certification. Incremental cost per quality-adjusted life-year (QALY) based on EQ-5D-5L and glaucoma profile instrument will be estimated. The study will report the comparative effectiveness and cost-effectiveness of medical treatment against augmented trabeculectomy in patients presenting with advanced glaucoma in terms of patient-reported health and visual function, clinical outcomes and incremental cost per QALY at 2 years. Treatment of Advanced Glaucoma Study will be the first RCT reporting outcomes from the perspective of those with advanced glaucoma. ISRCTN56878850, Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial

  2. Medical technology advances from space research

    Science.gov (United States)

    Pool, S. L.

    1972-01-01

    Details of medical research and development programs, particularly an integrated medical laboratory, as derived from space technology are given. The program covers digital biotelemetry systems, automatic visual field mapping equipment, sponge electrode caps for clinical electroencephalograms, and advanced respiratory analysis equipment. The possibility of using the medical laboratory in ground based remote areas and regional health care facilities, as well as long duration space missions is discussed.

  3. Advanced Cardiac Life Support.

    Science.gov (United States)

    Kirkwood Community Coll., Cedar Rapids, IA.

    This document contains materials for an advanced college course in cardiac life support developed for the State of Iowa. The course syllabus lists the course title, hours, number, description, prerequisites, learning activities, instructional units, required text, six references, evaluation criteria, course objectives by units, course…

  4. Can basic life support personnel safely determine that advanced life support is not needed?

    Science.gov (United States)

    Cone, D C; Wydro, G C

    2001-01-01

    To determine whether firefighter/emergency medical technicians-basic (FF/EMT-Bs) staffing basic life support (BLS) ambulances in a two-tiered emergency medical services (EMS) system can safely determine when advanced life support (ALS) is not needed. This was a prospective, observational study conducted in two academic emergency departments (EDs) receiving patients from a large urban fire-based EMS system. Runs were studied to which ALS and BLS ambulances were simultaneously dispatched, with the patient transported by the BLS unit. Prospectively established criteria for potential need for ALS were used to determine whether the FF/EMT-B's decision to cancel the ALS unit was safe, and simple outcomes (admission rate, length of stay, mortality) were examined. In the system studied, BLS crews may cancel responding ALS units at their discretion; there are no protocols or medical criteria for cancellation. A convenience sample of 69 cases was collected. In 52 cases (75%), the BLS providers indicated that they cancelled the responding ALS unit because they did not feel ALS was needed. Of these, 40 (77%) met study criteria for ALS: 39 had potentially serious chief complaints, nine had abnormal vital signs, and ten had physical exam findings that warranted ALS. Forty-five (87%) received an intervention immediately upon ED arrival that could have been provided in the field by an ALS unit, and 16 (31%) were admitted, with a median length of stay of 3.3 days (range 1.1-73.4 days). One patient died. Firefighter/EMT-Bs, working without protocols or medical criteria, cannot always safely determine which patients may require ALS intervention.

  5. Effect of High-Fidelity Simulation on Medical Students' Knowledge about Advanced Life Support: A Randomized Study.

    Directory of Open Access Journals (Sweden)

    Andrea Cortegiani

    Full Text Available High-fidelity simulation (HFS is a learning method which has proven effective in medical education for technical and non-technical skills. However, its effectiveness for knowledge acquisition is less validated. We performed a randomized study with the primary aim of investigating whether HFS, in association with frontal lessons, would improve knowledge about advanced life support (ALS, in comparison to frontal lessons only among medical students. The secondary aims were to evaluate the effect of HFS on knowledge acquisition of different sections of ALS and personal knowledge perception. Participants answered a pre-test questionnaire consisting of a subjective (evaluating personal perception of knowledge and an objective section (measuring level of knowledge containing 100 questions about algorithms, technical skills, team working/early warning scores/communication strategies according to ALS guidelines. All students participated in 3 frontal lessons before being randomized in group S, undergoing a HFS session, and group C, receiving no further interventions. After 10 days from the end of each intervention, both groups answered a questionnaire (post-test with the same subjective section but a different objective one. The overall number of correct answers of the post-test was significantly higher in group S (mean 74.1, SD 11.2 than in group C (mean 65.5, SD 14.3, p = 0.0017, 95% C.I. 3.34 - 13.9. A significantly higher number of correct answers was reported in group S than in group C for questions investigating knowledge of algorithms (p = 0.0001; 95% C.I 2.22-5.99 and team working/early warning scores/communication strategies (p = 0.0060; 95% C.I 1.13-6.53. Students in group S showed a significantly higher score in the post-test subjective section (p = 0.0074. A lower proportion of students in group S confirmed their perception of knowledge compared to group C (p = 0.0079. HFS showed a beneficial effect on knowledge of ALS among medical students

  6. Learning to Control Advanced Life Support Systems

    Science.gov (United States)

    Subramanian, Devika

    2004-01-01

    Advanced life support systems have many interacting processes and limited resources. Controlling and optimizing advanced life support systems presents unique challenges. In particular, advanced life support systems are nonlinear coupled dynamical systems and it is difficult for humans to take all interactions into account to design an effective control strategy. In this project. we developed several reinforcement learning controllers that actively explore the space of possible control strategies, guided by rewards from a user specified long term objective function. We evaluated these controllers using a discrete event simulation of an advanced life support system. This simulation, called BioSim, designed by Nasa scientists David Kortenkamp and Scott Bell has multiple, interacting life support modules including crew, food production, air revitalization, water recovery, solid waste incineration and power. They are implemented in a consumer/producer relationship in which certain modules produce resources that are consumed by other modules. Stores hold resources between modules. Control of this simulation is via adjusting flows of resources between modules and into/out of stores. We developed adaptive algorithms that control the flow of resources in BioSim. Our learning algorithms discovered several ingenious strategies for maximizing mission length by controlling the air and water recycling systems as well as crop planting schedules. By exploiting non-linearities in the overall system dynamics, the learned controllers easily out- performed controllers written by human experts. In sum, we accomplished three goals. We (1) developed foundations for learning models of coupled dynamical systems by active exploration of the state space, (2) developed and tested algorithms that learn to efficiently control air and water recycling processes as well as crop scheduling in Biosim, and (3) developed an understanding of the role machine learning in designing control systems for

  7. Key role of social work in effective communication and conflict resolution process: Medical Orders for Life-Sustaining Treatment (MOLST) Program in New York and shared medical decision making at the end of life.

    Science.gov (United States)

    Bomba, Patricia A; Morrissey, Mary Beth; Leven, David C

    2011-01-01

    In this article, the authors review the development of the Medical Orders for Life-Sustaining Treatment (MOLST) Program and recent landmark legislation in New York State in the context of advance care planning and shared medical decision making at the end of life. Social workers are central health care professionals in working with patients, families, practitioners, health care agents, and surrogates in the health systems and in the communication and conflict resolution process that is integral to health care decision making. The critical importance of ethics and end-of-life training and education for social workers is also addressed. Data from a pilot study evaluating interdisciplinary ethics training on legal and ethical content in communication and conflict resolution skills in health care decision making are reported. Recommendations are made for research on education and training of social workers, and investigation of the role and influence of systems in shaping social work involvement in end-of-life and palliative care.

  8. A forgotten life-threatening medical emergency: myxedema coma

    Directory of Open Access Journals (Sweden)

    Elisa Pizzolato

    2016-08-01

    Full Text Available Nowadays myxedema coma is a rare medical emergency but, sometimes, it still remains a fatal condition even if appropriate therapy is soon administered. Although physical presentation is very non-specific and diversified, physicians should pay attention when patients present with low body temperature and alteration of neurological status; the presence of precipitating events in past medical history can help in making a diagnosis. Here we discuss one such case: an 83-year-old female presented with abdominal pain since few days. Laboratory tests and abdomen computed tomography scan demonstrated alithiasic cholecystitis; she was properly treated but, during the Emergency Department stay she experienced a cardiac arrest. Physicians immediately started advance cardiovascular life support algorithm and she survived. Later on, she was admitted to the Intensive Care Unit where doctors discovered she was affected by severe hypothyroidism. Straightway they started the right therapy but, unfortunately, the patient died in a few hours.

  9. Awareness of basic life support among medical, dental, nursing students and doctors

    Directory of Open Access Journals (Sweden)

    Shanta Chandrasekaran

    2010-01-01

    Full Text Available To study the awareness of Basic Life Support (BLS among students, doctors and nurses of medical, dental, homeopathy and nursing colleges. A cross-sectional study was conducted by assessing responses to 20 selected basic questions regarding BLS among students, doctors and nurses of medical, dental, homeopathy and nursing colleges. After excluding the incomplete response forms the data was analysed on 1,054 responders. The results were analysed using an answer key prepared with the use of the Advanced Cardiac Life Support manual. Out of 1,054 responders 345 were medical students, 75 were medical interns, 19 were dental students, 59 were dental interns, 105 were homeopathy interns, 319 were nursing students, 72 were doctors, 29 were dentists, 25 were nursing faculty and six were homeopathy doctors. No one among them had complete knowledge of BLS. Only two out of 1054 (0.19% had secured 80 - 89% marks, 10 out of 1054 (0.95% had secured 70 - 79% marks, 40 of 1054 (4.08% had secured 60 - 69% marks and 105 of 1054 (9.96% had secured 50 - 59% marks. A majority of them, that is, 894 (84.82% had secured less than 50% marks. Awareness of BLS among students, doctors and nurses of medical, dental, homeopathy and nursing colleges is very poor.

  10. Women seeking treatment for advanced pelvic organ prolapse have decreased body image and quality of life.

    Science.gov (United States)

    Jelovsek, J Eric; Barber, Matthew D

    2006-05-01

    Women who seek treatment for pelvic organ prolapse strive for an improvement in quality of life. Body image has been shown to be an important component of differences in quality of life. To date, there are no data on body image in patients with advanced pelvic organ prolapse. Our objective was to compare body image and quality of life in women with advanced pelvic organ prolapse with normal controls. We used a case-control study design. Cases were defined as subjects who presented to a tertiary urogynecology clinic with advanced pelvic organ prolapse (stage 3 or 4). Controls were defined as subjects who presented to a tertiary care gynecology or women's health clinic for an annual visit with normal pelvic floor support (stage 0 or 1) and without urinary incontinence. All patients completed a valid and reliable body image scale and a generalized (Short Form Health Survey) and condition-specific (Pelvic Floor Distress Inventory-20) quality-of-life scale. Linear and logistic regression analyses were performed to adjust for possible confounding variables. Forty-seven case and 51 control subjects were enrolled. After controlling for age, race, parity, previous hysterectomy, and medical comorbidities, subjects with advanced pelvic organ prolapse were more likely to feel self-conscious (adjusted odds ratio 4.7; 95% confidence interval 1.4 to 18, P = .02), less likely to feel physically attractive (adjusted odds ratio 11; 95% confidence interval 2.9 to 51, P body. Subjects with advanced pelvic organ prolapse suffered significantly lower quality of life on the physical scale of the SF-12 (mean 42; 95% confidence interval 39 to 45 versus mean 50; 95% confidence interval 47 to 53, P body image correlated with lower quality of life on both the physical and mental scales of the SF-12 as well as the prolapse, urinary, and colorectal scales and overall summary score of Pelvic Floor Distress Inventory-20 in subjects with advanced pelvic organ prolapse. Women seeking treatment for

  11. Improving basic life support training for medical students

    OpenAIRE

    Lami, Mariam; Nair, Pooja; Gadhvi, Karishma

    2016-01-01

    Mariam Lami, Pooja Nair, Karishma GadhviFaculty of Medicine, Imperial College, London, London, UKAbstract: Questions have been raised about basic life support (BLS) training in medical education. This article addresses the research evidence behind why BLS training is inadequate and suggests recommendations for improving BLS training for medical students.Keywords: medical education, basic life support

  12. AdvanceVT Work/Life Policies : Summary Report

    OpenAIRE

    AdvanceVT

    2010-01-01

    AdvanceVT’s 2008 Faculty Work/Life Survey showed that 59% of tenured and tenure-track faculty members at Virginia Tech believe it is difficult to have a personal life and earn tenure and 48% feel that their family responsibilities have slowed their career advancement. Female faculty members indicated that they have considered leaving the university in order to obtain better career opportunities for their spouse or partner (43%), as well as to achieve a better personal/professional balance (50...

  13. Work/Life Satisfaction Policy in ADVANCE Universities: Assessing Levels of Flexibility

    Science.gov (United States)

    Tower, Leslie E.; Dilks, Lisa M.

    2015-01-01

    Work/life satisfaction policies are seen as key to recruiting, retaining, and advancing high quality faculty. This article explores the work/life policies prevalent at NSF ADVANCE institutions (PAID, Catalyst, and IT). We systematically review ADVANCE university websites (N = 124) and rank 9 categories of work/life policy including dual career…

  14. Medical challenges at the end of the first ten decades of life.

    Science.gov (United States)

    Münzer, Thomas

    2017-07-11

    Demographic changes worldwide challenge the healthcare system. Advanced age is associated with a number of biological alterations that, together with concomitant comorbidities, increase the risk for functional decline by inducing functional disintegration. In this concept frailty and sarcopenia play an important role. Consequently the preservation of muscle mass and function are prominent targets of medicine in old age. In order to professionally care for persons in their last years of life several other factors influencing medical decisions regarding diagnostic and treatments are important. These factors concern the life expectancy, the person`s functional status the physicians involved in care and the family system. Balancing between over- and undertreatment in very old patients can be optimised by a goal-oriented decision making approach. Very old persons with poor decision making capacity might benefit from decisions made in a team. To be able to manage the challenges associated with the last decade of life, we need physicians who have the knowledge, the appropriate attitude towards frail old patients and the skills to communicate with different groups involved in care. Ideally old age medicine should become an integrative part of a unified national medical curriculum.

  15. MAXILLOFACIAL TRAUMA MANAGEMENT IN POLYTRAUMATIZED PATIENTS – THE USE OF ADVANCED TRAUMA LIFE SUPPORT (ATLS PRINCIPLES.

    Directory of Open Access Journals (Sweden)

    Elitsa G. Deliverska

    2013-03-01

    Full Text Available Management of the multiply injured patient requires a co-ordinated multi-disciplinary approach in order to optimise patients’ outcome. A working knowledge of the sort of problems these patients encounter is therefore vital to ensure that life-threatening injuries are recognised and treated in a timely pattern and that more minor associated injuries are not omitted. This article outlines the management of polytraumatized patients using the Advanced Trauma Life Support (ATLS principles and highlights the areas of specific involvement of the engaged medical team. Advanced Trauma Life Support is generally regarded as the gold standard and is founded on a number of well known principles, but strict adherence to protocols may have its drawbacks when facial trauma co-exists. These can arise in the presence of either major or minor facial injuries, and oral and maxillofacial surgeons need to be aware of the potential problems.

  16. Canadian advanced life support capacities and future directions

    Science.gov (United States)

    Bamsey, M.; Graham, T.; Stasiak, M.; Berinstain, A.; Scott, A.; Vuk, T. Rondeau; Dixon, M.

    2009-07-01

    Canada began research on space-relevant biological life support systems in the early 1990s. Since that time Canadian capabilities have grown tremendously, placing Canada among the emerging leaders in biological life support systems. The rapid growth of Canadian expertise has been the result of several factors including a large and technically sophisticated greenhouse sector which successfully operates under challenging climatic conditions, well planned technology transfer strategies between the academic and industrial sectors, and a strong emphasis on international research collaborations. Recent activities such as Canada's contribution of the Higher Plant Compartment of the European Space Agency's MELiSSA Pilot Plant and the remote operation of the Arthur Clarke Mars Greenhouse in the Canadian High Arctic continue to demonstrate Canadian capabilities with direct applicability to advanced life support systems. There is also a significant latent potential within Canadian institutions and organizations with respect to directly applicable advanced life support technologies. These directly applicable research interests include such areas as horticultural management strategies (for candidate crops), growth media, food processing, water management, atmosphere management, energy management, waste management, imaging, environment sensors, thermal control, lighting systems, robotics, command and data handling, communications systems, structures, in-situ resource utilization, space analogues and mission operations. With this background and in collaboration with the Canadian aerospace industry sector, a roadmap for future life support contributions is presented here. This roadmap targets an objective of at least 50% food closure by 2050 (providing greater closure in oxygen, water recycling and carbon dioxide uptake). The Canadian advanced life support community has chosen to focus on lunar surface infrastructure and not low Earth orbit or transit systems (i.e. microgravity

  17. Advanced medical interventions in pleural disease

    Directory of Open Access Journals (Sweden)

    Rahul Bhatnagar

    2016-06-01

    Full Text Available The burden of a number of pleural diseases continues to increase internationally. Although many pleural procedures have historically been the domain of interventional radiologists or thoracic surgeons, in recent years, there has been a marked expansion in the techniques available to the pulmonologist. This has been due in part to both technological advancements and a greater recognition that pleural disease is an important subspecialty of respiratory medicine. This article summarises the important literature relating to a number of advanced pleural interventions, including medical thoracoscopy, the insertion and use of indwelling pleural catheters, pleural manometry, point-of-care thoracic ultrasound, and image-guided closed pleural biopsy. We also aim to inform the reader regarding the latest updates to more established procedures such as chemical pleurodesis, thoracentesis and the management of chest drains, drawing on contemporary data from recent randomised trials. Finally, we shall look to explore the challenges faced by those practicing pleural medicine, especially relating to training, as well as possible future directions for the use and expansion of advanced medical interventions in pleural disease.

  18. Swedish medical students' expectations of their future life

    Science.gov (United States)

    Andersson, Jenny; Johansson, Eva E.; Verdonk, Petra; Lagro-Janssen, Antoine; Hamberg, Katarina

    2011-01-01

    Objectives: To investigate future life expectations among male and female medical students in their first and final year. Methods The study was cross-sectional and conducted at a Swedish medical school. Out of 600 invited students, 507 (85%) answered an open-ended question about their future life, 298 (59%) first-year students and 209 (41%) last-year students. Women constituted 60% of the respondents. A mixed model design was applied; qualitative content analysis was utilized to create statistically comparable themes and categories. Results Students’ written answers were coded, categorized and clustered into four themes: “Work”, “Family”, “Leisure” and “Quality of personal life”. Almost all students included aspects of work in their answers. Female students were more detailed than male ones in their family concerns. Almost a third of all students reflected on a future work-life balance, but considerations regarding quality of personal life and leisure were more common among last-year students. Conclusions Today’s medical students expect more of life than work, especially those standing on the doorstep of working life. They intend to balance work not only with a family but also with leisure activities. Our results reflect work attitudes that challenge the health care system for more adaptive working conditions. We suggest that discussions about work-life balance should be included in medical curricula.

  19. [Development of performance evaluation and management system on advanced schistosomiasis medical treatment].

    Science.gov (United States)

    Zhou, Xiao-Rong; Huang, Shui-Sheng; Gong, Xin-Guo; Cen, Li-Ping; Zhang, Cong; Zhu, Hong; Yang, Jun-Jing; Chen, Li

    2012-04-01

    To construct a performance evaluation and management system on advanced schistosomiasis medical treatment, and analyze and evaluate the work of the advanced schistosomiasis medical treatment over the years. By applying the database management technique and C++ programming technique, we inputted the information of the advanced schistosomiasis cases into the system, and comprehensively evaluated the work of the advanced schistosomiasis medical treatment through the cost-effect analysis, cost-effectiveness analysis, and cost-benefit analysis. We made a set of software formula about cost-effect analysis, cost-effectiveness analysis, and cost-benefit analysis. This system had many features such as clear building, easy to operate, friendly surface, convenient information input and information search. It could benefit the performance evaluation of the province's advanced schistosomiasis medical treatment work. This system can satisfy the current needs of advanced schistosomiasis medical treatment work and can be easy to be widely used.

  20. Establishing advanced practice for medical imaging in New Zealand

    International Nuclear Information System (INIS)

    Yielder, Jill; Young, Adrienne; Park, Shelley; Coleman, Karen

    2014-01-01

    Introduction: This article presents the outcome and recommendations following the second stage of a role development project conducted on behalf of the New Zealand Institute of Medical Radiation Technology (NZIMRT). The study sought to support the development of profiles and criteria that may be used to formulate Advanced Scopes of Practice for the profession. It commenced in 2011, following on from initial research that occurred between 2005 and 2008 investigating role development and a possible career structure for medical radiation technologists (MRTs) in New Zealand (NZ). Methods: The study sought to support the development of profiles and criteria that could be used to develop Advanced Scopes of Practice for the profession through inviting 12 specialist medical imaging groups in NZ to participate in a survey. Results: Findings showed strong agreement on potential profiles and on generic criteria within them; however, there was less agreement on specific skills criteria within specialist areas. Conclusions: The authors recommend that one Advanced Scope of Practice be developed for Medical Imaging, with the establishment of generic and specialist criteria. Systems for approval of the overall criteria package for any individual Advanced Practitioner (AP) profile, audit and continuing professional development requirements need to be established by the Medical Radiation Technologists Board (MRTB) to meet the local needs of clinical departments. It is further recommended that the NZIMRT and MRTB promote and support the need for an AP pathway for medical imaging in NZ

  1. Establishing advanced practice for medical imaging in New Zealand

    Energy Technology Data Exchange (ETDEWEB)

    Yielder, Jill, E-mail: j.yielder@auckland.ac.nz [University of Auckland, Auckland (New Zealand); Young, Adrienne; Park, Shelley; Coleman, Karen [University of Otago, Wellington (New Zealand); University of Auckland, Auckland (New Zealand)

    2014-02-15

    Introduction: This article presents the outcome and recommendations following the second stage of a role development project conducted on behalf of the New Zealand Institute of Medical Radiation Technology (NZIMRT). The study sought to support the development of profiles and criteria that may be used to formulate Advanced Scopes of Practice for the profession. It commenced in 2011, following on from initial research that occurred between 2005 and 2008 investigating role development and a possible career structure for medical radiation technologists (MRTs) in New Zealand (NZ). Methods: The study sought to support the development of profiles and criteria that could be used to develop Advanced Scopes of Practice for the profession through inviting 12 specialist medical imaging groups in NZ to participate in a survey. Results: Findings showed strong agreement on potential profiles and on generic criteria within them; however, there was less agreement on specific skills criteria within specialist areas. Conclusions: The authors recommend that one Advanced Scope of Practice be developed for Medical Imaging, with the establishment of generic and specialist criteria. Systems for approval of the overall criteria package for any individual Advanced Practitioner (AP) profile, audit and continuing professional development requirements need to be established by the Medical Radiation Technologists Board (MRTB) to meet the local needs of clinical departments. It is further recommended that the NZIMRT and MRTB promote and support the need for an AP pathway for medical imaging in NZ.

  2. Work-life policies for faculty at the top ten medical schools.

    Science.gov (United States)

    Bristol, Mirar N; Abbuhl, Stephanie; Cappola, Anne R; Sonnad, Seema S

    2008-10-01

    There exists a growing consensus that career flexibility is critical to recruiting and retaining talented faculty, especially women faculty. This study was designed to determine both accessibility and content of work-life policies for faculty at leading medical schools in the United States. The sample includes the top ten medical schools in the United States published by U.S. News and World Report in August 2006. We followed a standardized protocol to collect seven work-life policies at each school: maternity leave, paternity leave, adoption leave, extension of the probationary period for family responsibilities, part-time faculty appointments, job sharing, and child care. A review of information provided on school websites was followed by e-mail or phone contact if needed. A rating system of 0-3 (low to high flexibility) developed by the authors was applied to these policies. Rating reflected flexibility and existing opinions in published literature. Policies were often difficult to access. Individual scores ranged from 7 to 15 out of a possible 21 points. Extension of the probationary period received the highest cumulative score across schools, and job sharing received the lowest cumulative score. For each policy, there were important differences among schools. Work-life policies showed considerable variation across schools. Policy information is difficult to access, often requiring multiple sources. Institutions that develop flexible work-life policies that are widely promoted, implemented, monitored, and reassessed are likely at an advantage in attracting and retaining faculty while advancing institutional excellence.

  3. Java advanced medical image toolkit

    International Nuclear Information System (INIS)

    Saunder, T.H.C.; O'Keefe, G.J.; Scott, A.M.

    2002-01-01

    Full text: The Java Advanced Medical Image Toolkit (jAMIT) has been developed at the Center for PET and Department of Nuclear Medicine in an effort to provide a suite of tools that can be utilised in applications required to perform analysis, processing and visualisation of medical images. jAMIT uses Java Advanced Imaging (JAI) to combine the platform independent nature of Java with the speed benefits associated with native code. The object-orientated nature of Java allows the production of an extensible and robust package which is easily maintained. In addition to jAMIT, a Medical Image VO API called Sushi has been developed to provide access to many commonly used image formats. These include DICOM, Analyze, MINC/NetCDF, Trionix, Beat 6.4, Interfile 3.2/3.3 and Odyssey. This allows jAMIT to access data and study information contained in different medical image formats transparently. Additional formats can be added at any time without any modification to the jAMIT package. Tools available in jAMIT include 2D ROI Analysis, Palette Thresholding, Image Groping, Image Transposition, Scaling, Maximum Intensity Projection, Image Fusion, Image Annotation and Format Conversion. Future tools may include 2D Linear and Non-linear Registration, PET SUV Calculation, 3D Rendering and 3D ROI Analysis. Applications currently using JAMIT include Antibody Dosimetry Analysis, Mean Hemispheric Blood Flow Analysis, QuickViewing of PET Studies for Clinical Training, Pharamcodynamic Modelling based on Planar Imaging, and Medical Image Format Conversion. The use of jAMIT and Sushi for scripting and analysis in Matlab v6.1 and Jython is currently being explored. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  4. Work-life policies for Canadian medical faculty.

    Science.gov (United States)

    Gropper, Aaron; Gartke, Kathleen; MacLaren, Monika

    2010-09-01

    This study aims to catalogue and examine the following work-life flexibility policies at all 17 Canadian medical schools: maternity leave, paternity leave, adoption leave, extension of the probationary period for family responsibilities, part-time faculty appointments, job sharing, and child care. The seven work-life policies of Canadian medical schools were researched using a consistent and systematic method. This method involved an initial web search for policy information, followed by e-mail and telephone contact. The flexibility of the policies was scored 0 (least flexible) to 3 (most flexible). The majority of policies were easily accessible online. Work-life policies were scored out of 3, and average policy scores ranged from 0.47 for job sharing to 2.47 for part-time/work reduction. Across schools, total scores ranged from 7 to 16 out of 21. Variation in scores was noted for parenting leave and child care, whereas minimal variation was noted for other policies. Canadian medical schools are committed to helping medical faculty achieve work-life balance, but improvements can be made in the policies offered at all schools. Improving the quality of work flexibility policies will enhance working conditions and job satisfaction for faculty. This could potentially reduce Canada's loss of talented young academicians.

  5. Health-illness transition among persons using advanced medical technology at home.

    Science.gov (United States)

    Fex, Angelika; Flensner, Gullvi; Ek, Anna-Christina; Söderhamn, Olle

    2011-06-01

    This study aimed to elucidate meanings of health-illness transition experiences among adult persons using advanced medical technology at home. As an increasing number of persons perform self-care while using different sorts of advanced medical technology at home, knowledge about health-illness transition experiences in this situation may be useful to caregivers in supporting these patients. A qualitative design was used. Five women and five men, all of whom performed self-care at home, either using long-term oxygen therapy from a ventilator or oxygen cylinder, or performing peritoneal or haemodialysis, were interviewed. Ethics committee approval was obtained. Informed consent was received from all participants, and ethical issues concerning their rights in research were raised. The interviews were analysed using a phenomenological hermeneutical methodology, including both an inductive and a deductive structural analysis. This method offers possibilities to obtain an increased understanding by uncovering a deeper meaning of lived experiences through interviews transcribed as texts. The health-illness transition for adult persons in this context was found to mean a learning process of accepting, managing, adjusting and improving daily life with technology, facilitated by realizing the gain from technology at home. Further, the meaning of the health-illness transition experience was interpreted as contentment with being part of the active and conscious process towards transcending into a new state of living, in which the individual and the technology were in tune. The healthy transition experience was characterized by human growth and becoming. This study elucidates one meaning of health-illness transition experiences in relation to the use of advanced medical technology on a more generic level, independent of the specific type of technology used. A positive attitude towards technology at home facilitates the transition. © 2010 The Authors. Scandinavian Journal of

  6. 75 FR 52472 - Spectrum Requirements for Advanced Medical Technologies

    Science.gov (United States)

    2010-08-26

    ... medical devices. Under this framework, the rules for MedRadio service incorporates the MICS ``core'' band... Requirements for Advanced Medical Technologies AGENCY: Federal Communications Commission. ACTION: Final rule.... (Medtronic) regarding rules for the Medical Device Radiocommunication (MedRadio) service. The Commission...

  7. Teaching Medical Students About "The Conversation": An Interactive Value-Based Advance Care Planning Session.

    Science.gov (United States)

    Lum, Hillary D; Dukes, Joanna; Church, Skotti; Abbott, Jean; Youngwerth, Jean M

    2018-02-01

    Advance care planning (ACP) promotes care consistent with patient wishes. Medical education should teach how to initiate value-based ACP conversations. To develop and evaluate an ACP educational session to teach medical students a value-based ACP process and to encourage students to take personal ACP action steps. Groups of third-year medical students participated in a 75-minute session using personal reflection and discussion framed by The Conversation Starter Kit. The Conversation Project is a free resource designed to help individuals and families express their wishes for end-of-life care. One hundred twenty-seven US third-year medical students participated in the session. Student evaluations immediately after the session and 1 month later via electronic survey. More than 90% of students positively evaluated the educational value of the session, including rating highly the opportunities to reflect on their own ACP and to use The Conversation Starter Kit. Many students (65%) reported prior ACP conversations. After the session, 73% reported plans to discuss ACP, 91% had thought about preferences for future medical care, and 39% had chosen a medical decision maker. Only a minority had completed an advance directive (14%) or talked with their health-care provider (1%). One month later, there was no evidence that the session increased students' actions regarding these same ACP action steps. A value-based ACP educational session using The Conversation Starter Kit successfully engaged medical students in learning about ACP conversations, both professionally and personally. This session may help students initiate conversations for themselves and their patients.

  8. Pediatric advanced life support and sedation of pediatric dental patients.

    Science.gov (United States)

    Kim, Jongbin

    2016-03-01

    Programs provided by the Korea Association of Cardiopulmonary Resuscitation include Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Korean Advanced Life Support (KALS). However, programs pertinent to dental care are lacking. Since 2015, related organizations have been attempting to develop a Dental Advanced Life Support (DALS) program, which can meet the needs of the dental environment. Generally, for initial management of emergency situations, basic life support is most important. However, emergencies in young children mostly involve breathing. Therefore, physicians who treat pediatric dental patients should learn PALS. It is necessary for the physician to regularly renew training every two years to be able to immediately implement professional skills in emergency situations. In order to manage emergency situations in the pediatric dental clinic, respiratory support is most important. Therefore, mastering professional PALS, which includes respiratory care and core cases, particularly upper airway obstruction and respiratory depression caused by a respiratory control problem, would be highly desirable for a physician who treats pediatric dental patients. Regular training and renewal training every two years is absolutely necessary to be able to immediately implement professional skills in emergency situations.

  9. Medical futility and end-of-life care | Sidler | South African Medical ...

    African Journals Online (AJOL)

    treating physician is responsible for guiding this process by demonstrating sensitivity and compassion, respecting the values of patients, their families and the medical staff. The need for training to equip medical staff to take responsibility as empathetic participants in end-of-life decision-making is underscored. South African ...

  10. Evaluation of prototype Advanced Life Support (ALS) pack for use by the Health Maintenance Facility (HMF) on Space Station Freedom (SSF)

    Science.gov (United States)

    Krupa, Debra T.; Gosbee, John; Murphy, Linda; Kizzee, Victor D.

    1991-01-01

    The purpose is to evaluate the prototype Advanced Life Support (ALS) Pack which was developed for the Health Maintenance Facility (HMF). This pack will enable the Crew Medical Officer (CMO) to have ready access to advanced life support supplies and equipment for time critical responses to any situation within the Space Station Freedom. The objectives are: (1) to evaluate the design of the pack; and (2) to collect comments for revision to the design of the pack. The in-flight test procedures and other aspects of the KC-135 parabolic test flight to simulate weightlessness are presented.

  11. Flexibility in faculty work-life policies at medical schools in the Big Ten conference.

    Science.gov (United States)

    Welch, Julie L; Wiehe, Sarah E; Palmer-Smith, Victoria; Dankoski, Mary E

    2011-05-01

    Women lag behind men in several key academic indicators, such as advancement, retention, and securing leadership positions. Although reasons for these disparities are multifactorial, policies that do not support work-life integration contribute to the problem. The objective of this descriptive study was to compare the faculty work-life policies among medical schools in the Big Ten conference. Each institution's website was accessed in order to assess its work-life policies in the following areas: maternity leave, paternity leave, adoption leave, extension of probationary period, part-time appointments, part-time benefits (specifically health insurance), child care options, and lactation policy. Institutions were sent requests to validate the online data and supply additional information if needed. Each institution received an overall score and subscale scores for family leave policies and part-time issues. Data were verified by the human resources office at 8 of the 10 schools. Work-life policies varied among Big Ten schools, with total scores between 9.25 and 13.5 (possible score: 0-21; higher scores indicate greater flexibility). Subscores were not consistently high or low within schools. Comparing the flexibility of faculty work-life policies in relation to other schools will help raise awareness of these issues and promote more progressive policies among less progressive schools. Ultimately, flexible policies will lead to greater equity and institutional cultures that are conducive to recruiting, retaining, and advancing diverse faculty.

  12. Is advanced life support better than basic life support in prehospital care? A systematic review

    Directory of Open Access Journals (Sweden)

    Ryynänen Olli-Pekka

    2010-11-01

    Full Text Available Abstract Background - Prehospital care is classified into ALS- (advanced life support and BLS- (basic life support levels according to the methods used. ALS-level prehospital care uses invasive methods, such as intravenous fluids, medications and intubation. However, the effectiveness of ALS care compared to BLS has been questionable. Aim - The aim of this systematic review is to compare the effectiveness of ALS- and BLS-level prehospital care. Material and methods - In a systematic review, articles where ALS-level prehospital care was compared to BLS-level or any other treatment were included. The outcome variables were mortality or patient's health-related quality of life or patient's capacity to perform daily activities. Results - We identified 46 articles, mostly retrospective observational studies. The results on the effectiveness of ALS in unselected patient cohorts are contradictory. In cardiac arrest, early cardiopulmonary resuscitation and defibrillation are essential for survival, but prehospital ALS interventions have not improved survival. Prehospital thrombolytic treatment reduces mortality in patients having a myocardial infarction. The majority of research into trauma favours BLS in the case of penetrating trauma and also in cases of short distance to a hospital. In patients with severe head injuries, ALS provided by paramedics and intubation without anaesthesia can even be harmful. If the prehospital care is provided by an experienced physician and by a HEMS organisation (Helicopter Emergency Medical Service, ALS interventions may be beneficial for patients with multiple injuries and severe brain injuries. However, the results are contradictory. Conclusions - ALS seems to improve survival in patients with myocardial infarction and BLS seems to be the proper level of care for patients with penetrating injuries. Some studies indicate a beneficial effect of ALS among patients with blunt head injuries or multiple injuries. There is

  13. Train medical physicist-urgent need for advanced radiotherapy

    International Nuclear Information System (INIS)

    Hareyama, Masato; Teshima, Teruki; Yamamoto, Tokihiro; Haga, Akihiro; Nakagawa, Keiichi; Uesaka, Mitsuru

    2008-01-01

    A Japanese advanced charged particle therapy for cancer that places fewer physical burdens on patients is leading the world and stereotactic radiotherapy and intensity-modulated radiotherapy (IMRT) have been implemented also as a high precision radiotherapy. For the further advancement and dissemination of the therapy, training and qualification of medical physicists has become more needed. Cancer professional train course plan has been performed at many universities in Japan partly to train medical physicists. This special issue consists of seven relevant articles from experts of academia. Medical physicists have been qualified by the Japan Radiological Society, but should have national qualification such as to carry out the R and D of therapy equipment. This has been supported by many academia such as the Japanese Society for Therapeutic Radiology and Oncology (JASTRO) but not by the Japan Association of Radiological Technologists (JART). (T. Tanaka)

  14. The role of advance directives in end-of-life decisions in Austria: survey of intensive care physicians.

    Science.gov (United States)

    Schaden, Eva; Herczeg, Petra; Hacker, Stefan; Schopper, Andrea; Krenn, Claus G

    2010-10-21

    Currently, intensive care medicine strives to define a generally accepted way of dealing with end-of-life decisions, therapy limitation and therapy discontinuation.In 2006 a new advance directive legislation was enacted in Austria. Patients may now document their personal views regarding extension of treatment. The aim of this survey was to explore Austrian intensive care physicians' experiences with and their acceptance of the new advance directive legislation two years after enactment (2008). Under the aegis of the OEGARI (Austrian Society of Anaesthesiology, Resuscitation and Intensive Care) an anonymised questionnaire was sent to the medical directors of all intensive care units in Austria. The questions focused on the physicians' experiences regarding advance directives and their level of knowledge about the underlying legislation. There were 241 questionnaires sent and 139 were turned, which was a response rate of 58%. About one third of the responders reported having had no experience with advance directives and only 9 directors of intensive care units had dealt with more than 10 advance directives in the previous two years. Life-supporting measures, resuscitation, and mechanical ventilation were the predominantly refused therapies, wishes were mainly expressed concerning pain therapy. A response rate of almost 60% proves the great interest of intensive care professionals in making patient-oriented end-of-life decisions. However, as long as patients do not make use of their right of co-determination, the enactment of the new law can be considered only a first important step forward.

  15. A preliminary investigation of opinions and behaviors regarding advance directives for medical care.

    Science.gov (United States)

    Elpern, E H; Yellen, S B; Burton, L A

    1993-03-01

    Advance directives are a means of promoting patient autonomy in end-of-life decisions but are used infrequently. A recent federal law requires healthcare organizations to provide information to patients about advance directives. This study explored attitudes and behaviors related to the use of advance directives in three areas: familiarity with advance directives, reasons for completing or not completing advance directives and preferences for receiving information about advance directives. A questionnaire was administered by personal interview to a nonrandomized convenience sample of 46 inpatients and 50 outpatients at a large, tertiary care, urban academic medical center in the summer of 1991. Most respondents (77%) had heard of either the living will or durable power of attorney for healthcare, but only 52% correctly understood the purpose of these documents. Twenty-nine percent of the sample had executed an advance directive. Those who had advance directives were older and considered themselves less healthy than did those without advance directives. Unfamiliarity with advance directives and procrastination were cited most often as reasons for not having an advance directive. Most subjects (65%) had spoken with someone, usually a family member or close friend, about preferences for treatment during a critical illness. Although they had rarely discussed advance directives, 83% anticipated that they would be comfortable doing so with a physician or a nurse. Advance directives are used infrequently to document treatment preferences. The success of programs to promote greater use of advance directives depends on a clearer understanding of the factors that influence both decision and action to execute an advance directive. Patients claim to be comfortable in discussing the topic and prefer that such discussions occur in the outpatient setting.

  16. End-of-Life Medical Spending In Last Twelve Months of Life is Lower than Previously Reported

    DEFF Research Database (Denmark)

    French, Eric; Aragon, Maria; Mccauley, Jeremy

    2017-01-01

    Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009–11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiw...... but to spending on people with chronic conditions, which are associated with shorter life expectancies....

  17. Swedish medical students' expectations of their future life.

    OpenAIRE

    Diderichsen, S.; Andersson, J.; Johansson, E.E.; Verdonk, P.; Lagro-Janssen, T.; Hamberg, K.

    2011-01-01

    Objectives: To investigate future life expectations among male and female medical students in their first and final year. Methods: The study was cross-sectional and conducted at a Swedish medical school. Out of 600 invited students, 507 (85%) answered an open-ended question about their future life, 298 (59%) first-year students and 209 (41%) last-year students. Women constituted 60% of the respondents. A mixed model design was applied; qualitative content analysis was utilized to create stati...

  18. Improving basic life support training for medical students.

    Science.gov (United States)

    Lami, Mariam; Nair, Pooja; Gadhvi, Karishma

    2016-01-01

    Questions have been raised about basic life support (BLS) training in medical education. This article addresses the research evidence behind why BLS training is inadequate and suggests recommendations for improving BLS training for medical students.

  19. The role of advance directives in end-of-life decisions in Austria: survey of intensive care physicians

    Directory of Open Access Journals (Sweden)

    Schopper Andrea

    2010-10-01

    Full Text Available Abstract Background Currently, intensive care medicine strives to define a generally accepted way of dealing with end-of-life decisions, therapy limitation and therapy discontinuation. In 2006 a new advance directive legislation was enacted in Austria. Patients may now document their personal views regarding extension of treatment. The aim of this survey was to explore Austrian intensive care physicians' experiences with and their acceptance of the new advance directive legislation two years after enactment (2008. Methods Under the aegis of the OEGARI (Austrian Society of Anaesthesiology, Resuscitation and Intensive Care an anonymised questionnaire was sent to the medical directors of all intensive care units in Austria. The questions focused on the physicians' experiences regarding advance directives and their level of knowledge about the underlying legislation. Results There were 241 questionnaires sent and 139 were turned, which was a response rate of 58%. About one third of the responders reported having had no experience with advance directives and only 9 directors of intensive care units had dealt with more than 10 advance directives in the previous two years. Life-supporting measures, resuscitation, and mechanical ventilation were the predominantly refused therapies, wishes were mainly expressed concerning pain therapy. Conclusion A response rate of almost 60% proves the great interest of intensive care professionals in making patient-oriented end-of-life decisions. However, as long as patients do not make use of their right of co-determination, the enactment of the new law can be considered only a first important step forward.

  20. Early-life medical care and human capital accumulation

    DEFF Research Database (Denmark)

    Daysal, N. Meltem

    2015-01-01

    that both types of interventions may benefit not only child health but also long-term educational outcomes. In addition, early-life medical interventions may improve the educational outcomes of siblings. These findings can be used to design policies that improve long-term outcomes and reduce economic......Ample empirical evidence links adverse conditions during early childhood (the period from conception to age five) to worse health outcomes and lower academic achievement in adulthood. Can early-life medical care and public health interventions ameliorate these effects? Recent research suggests...

  1. “Personal mission statement”: An analysis of medical students’ and general practitioners’ reflections on personal beliefs, values and goals in life

    Directory of Open Access Journals (Sweden)

    Chew Boon How

    2014-08-01

    Full Text Available Personal mission in life can determine motivation, happiness, future career advancement and fulfilment in life of the medical students (MSs along with improvement in professional/ clinical performance of the family physicians.1–5 These personal internal qualities are largely represented by the professional functional knowledge base, which can be influenced by personal awareness (pre-propositional impressions that trigger experiential learning and moral principles.6 Physicians often deal with patients with complex medical and social problems.7 Therefore, a physician’s self-understanding, insight into the nature, limitations of the knowledge and capacity of applying it are crucial in professional practice.8

  2. Outcomes after out-of-hospital cardiac arrest treated by basic vs advanced life support.

    Science.gov (United States)

    Sanghavi, Prachi; Jena, Anupam B; Newhouse, Joseph P; Zaslavsky, Alan M

    2015-02-01

    Most out-of-hospital cardiac arrests receiving emergency medical services in the United States are treated by ambulance service providers trained in advanced life support (ALS), but supporting evidence for the use of ALS over basic life support (BLS) is limited. To compare the effects of BLS and ALS on outcomes after out-of-hospital cardiac arrest. Observational cohort study of a nationally representative sample of traditional Medicare beneficiaries from nonrural counties who experienced out-of-hospital cardiac arrest between January 1, 2009, and October 2, 2011, and for whom ALS or BLS ambulance services were billed to Medicare (31,292 ALS cases and 1643 BLS cases). Propensity score methods were used to compare the effects of ALS and BLS on patient survival, neurological performance, and medical spending after cardiac arrest. Survival to hospital discharge, to 30 days, and to 90 days; neurological performance; and incremental medical spending per additional survivor to 1 year. Survival to hospital discharge was greater among patients receiving BLS (13.1% vs 9.2% for ALS; 4.0 [95% CI, 2.3-5.7] percentage point difference), as was survival to 90 days (8.0% vs 5.4% for ALS; 2.6 [95% CI, 1.2-4.0] percentage point difference). Basic life support was associated with better neurological functioning among hospitalized patients (21.8% vs 44.8% with poor neurological functioning for ALS; 23.0 [95% CI, 18.6-27.4] percentage point difference). Incremental medical spending per additional survivor to 1 year for BLS relative to ALS was $154,333. Patients with out-of-hospital cardiac arrest who received BLS had higher survival at hospital discharge and at 90 days compared with those who received ALS and were less likely to experience poor neurological functioning.

  3. Law, autonomy and advance directives.

    Science.gov (United States)

    Willmott, Lindy; White, Ben; Mathews, Ben

    2010-12-01

    The principle of autonomy underpins legal regulation of advance directives that refuse life-sustaining medical treatment. The primacy of autonomy in this domain is recognised expressly in the case law, through judicial pronouncement, and implicitly in most Australian jurisdictions, through enactment into statute of the right to make an advance directive. This article seeks to justify autonomy as an appropriate principle for regulating advance directives and relies on three arguments: the necessity of autonomy in a liberal democracy; the primacy of autonomy in medical ethics discourse; and the uncontested importance of autonomy in the law on contemporaneous refusal of medical treatment. This article also responds to key criticisms that autonomy is not an appropriate organising principle to underpin legal regulation of advance directives.

  4. Premenstrual syndrome and quality of life in Iranian medical students.

    Science.gov (United States)

    Farrokh-Eslamlou, Hamidreza; Oshnouei, Sima; Heshmatian, Behnam; Akbari, Elham

    2015-03-01

    The purpose of this research was to investigate the prevalence of premenstrual syndrome (PMS) in medical students and to evaluate the hypothesis that PMS may result in a decrease in quality of life. In a cross-sectional study, 142 female medical students who study at Urmia University of Medical Sciences were included. The data were compiled using a PMS questionnaire based on the fourth version (DSM-IV) criteria, the questionnaire of "Premenstrual Syndrome Scale" as well as the "World Health Organization's Quality of Life (WHOQOL-BREF)" questionnaire. In total, 56 out of 142 (39.4%) female medical students met the DSM-IV criteria for PMS. In the PMS group, more than half of the girls, i.e. 60.6% had mild, 25.1% had moderate and 14.2% had severe PMS. PMS was found to be significantly high in students who have positive history of PMS in their first degree relatives and who have used drugs to relieve PMS symptoms (PLife quality score was low in more than half of the medical students, especially in psychological and social components (P>0.05). However, the quality of life score means in mental health (P=0.02) and environmental health (P=0.002) decreases as the PMS score average increases. The results of premenstrual syndrome prevalence and their severity suggest that PMS is common in medical students and this adversely affects some domains of the quality of life. Improving the life quality of female medical students needs some interventions related to the PMS and also other interventions not related to PMS. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. A Simulation-Based Program to Train Medical Residents to Lead and Perform Advanced Cardiovascular Life Support

    Science.gov (United States)

    Stefan, Mihaela S.; Belforti, Raquel K.; Langlois, Gerard; Rothberg, Michael B.

    2014-01-01

    Background Medical residents are often responsible for leading and performing cardiopulmonary resuscitation; however, their levels of expertise and comfort as leaders of advanced cardiovascular life support (ACLS) teams vary widely. While the current American Heart Association ACLS course provides education in recommended resuscitative protocols, training in leadership skills is insufficient. In this article, we describe the design and implementation in our institution of a formative curriculum aimed at improving residents’ readiness for being leaders of ACLS teams using human patient simulation. Human patient simulation refers to a variety of technologies using mannequins with realistic features, which allows learners to practice through scenarios without putting patients at risk. We discuss the limitations of the program and the challenges encountered in implementation. We also provide a description of the initiation and organization of the program. Case scenarios and assessment tools are provided. Description of the Institutional Training Program Our simulation-based training curriculum consists of 8 simulated patient scenarios during four 1-hour sessions. Postgraduate year–2 and 3 internal medicine residents participate in this program in teams of 4. Assessment tools are utilized only for formative evaluation. Debriefing is used as a teaching strategy for the individual resident leader of the ACLS team to facilitate learning and improve performance. To evaluate the impact of the curriculum, we administered a survey before and after the intervention. The survey consisted of 10 questions answered on a 5-point Likert scale, which addressed residents’ confidence in leading ACLS teams, management of the equipment, and management of cardiac rhythms. Respondents’ mean presimulation (ie, baseline) and postsimulation (outcome) scores were compared using a 2-sample t test. Residents’ overall confidence score improved from 2.8 to 3.9 (P simulation-based training

  6. Developing a Simulation-Based Mastery Learning Curriculum: Lessons From 11 Years of Advanced Cardiac Life Support.

    Science.gov (United States)

    Barsuk, Jeffrey H; Cohen, Elaine R; Wayne, Diane B; Siddall, Viva J; McGaghie, William C

    2016-02-01

    Curriculum development in medical education should follow a planned, systematic approach fitted to the needs and conditions of a local institutional environment and its learners. This article describes the development and maintenance of a simulation-based medical education curriculum on advanced cardiac life support skills and its transformation to a mastery learning program. Curriculum development used the Kern 6-step model involving problem identification and general needs assessment, targeted needs assessment, goals and objectives, educational strategies, implementation, and evaluation and feedback. Curriculum maintenance and enhancement and dissemination are also addressed. Transformation of the simulation-based medical education curriculum to a mastery learning program was accomplished after a 2-year phase-in trial. A series of studies spanning 11 years was performed to adjust the curriculum, improve checklist outcome measures, and evaluate curriculum effects as learning outcomes among internal medicine residents and improved patient care practices. We anticipate wide adoption of the mastery learning model for skill and knowledge acquisition and maintenance in medical education settings.

  7. Stressing the journey: using life stories to study medical student wellbeing.

    Science.gov (United States)

    Jenkins, Tania M; Kim, Jenny; Hu, Chelsea; Hickernell, John C; Watanaskul, Sarah; Yoon, John D

    2018-05-05

    While previous studies have considered medical student burnout and resilience at discrete points in students' training, few studies examine how stressors and resilience-building factors can emerge before, and during, medical school. Our study focuses on students' life stories to comprehensively identify factors contributing to student wellbeing. We performed a secondary analysis of life-story interviews with graduating fourth year medical students. These interviews were originally conducted in 2012 as part of the Project on the Good Physician, and then re-analyzed, focusing on student wellbeing. Respondents were encouraged to identify turning points in their life stories. De-identified transcripts were then coded using a consensus-based iterative process. 17 of 21 respondents reported feeling burned out at least once during medical school. Students identified three major stressors: negative role models, difficult rotations, and the United States Medical Licensing Examination Step 1. Two "motivational stressors"-financial concerns and personal life events-emerged as sources of stress that also motivated students to persevere. Finally, students identified four factors-positive role models, support networks, faith and spirituality, and passion-that helped them reframe stressors, making the struggle seem more worthwhile. These findings suggest that a life-story approach can add granularity to current understandings of medical student wellbeing. Initiatives to reduce stress and burnout should extend beyond the immediate medical school context and consider how past challenges might become future sources of resilience. This study also provides an example of secondary analysis of qualitative data, an approach which could be useful to future research in medical education.

  8. Quality-of-life assessment in advanced cancer.

    LENUS (Irish Health Repository)

    Donnelly, S

    2000-07-01

    In the past 5 years, quality-of-life (QOL) assessment measures such as the McGill, McMaster, Global Visual Analogue Scale, Assessment of QOL at the End of Life, Life Evaluation Questionnaire, and Hospice QOL Index have been devised specifically for patients with advanced cancer. The developers of these instruments have tried to respond to the changing needs of this specific population, taking into account characteristics including poor performance status, difficulty with longitudinal study, rapidly deteriorating physical condition, and change in relevant issues. Emphasis has been placed on patient report, ease and speed of completion, and the existential domain or meaning of life. Novel techniques in QOL measurement have also been adapted for palliative care, such as judgment analysis in the Schedule for the Evaluation of Individual Quality of Life. It is generally agreed that a single tool will not cover all QOL assessment needs.

  9. Prevalence and Contents of Advance Directives of Patients with ESRD Receiving Dialysis.

    Science.gov (United States)

    Feely, Molly A; Hildebrandt, Daniel; Edakkanambeth Varayil, Jithinraj; Mueller, Paul S

    2016-12-07

    ESRD requiring dialysis is associated with increased morbidity and mortality rates, including increased rates of cognitive impairment, compared with the general population. About one quarter of patients receiving dialysis choose to discontinue dialysis at the end of life. Advance directives are intended to give providers and surrogates instruction on managing medical decision making, including end of life situations. The prevalence of advance directives is low among patients receiving dialysis. Little is known about the contents of advance directives among these patients with advance directives. We retrospectively reviewed the medical records of all patients receiving maintenance in-center hemodialysis at a tertiary academic medical center between January 1, 2007 and January 1, 2012. We collected demographic data, the prevalence of advance directives, and a content analysis of these advance directives. We specifically examined the advance directives for instructions on management of interventions at end of life, including dialysis. Among 808 patients (mean age of 68.6 years old; men =61.2%), 49% had advance directives, of which only 10.6% mentioned dialysis and only 3% specifically addressed dialysis management at end of life. Patients who had advance directives were more likely to be older (74.5 versus 65.4 years old; Phydration (34.3%), and pain management (43.4%) than dialysis (10.6%). Although one-half of the patients receiving dialysis in our study had advance directives, end of life management of dialysis was rarely addressed. Future research should focus on improving discernment and documentation of end of life values, goals, and preferences, such as dialysis-specific advance directives, among these patients. Copyright © 2016 by the American Society of Nephrology.

  10. Life Impairments in Adults with Medication-Treated ADHD

    Science.gov (United States)

    Safren, Steven A.; Sprich, Susan E.; Cooper-Vince, Christine; Knouse, Laura E.; Lerner, Jonathan A.

    2010-01-01

    Objective: In developing psychosocial approaches to augment outcomes for medication-treated adults with ADHD, it is important to understand what types of life-impairments are most affected by continued ADHD symptoms that occur despite medication treatment. This may assist in delineating targets for interventions, as well as assessments of…

  11. Advanced Life Support Project Plan

    Science.gov (United States)

    2002-01-01

    Life support systems are an enabling technology and have become integral to the success of living and working in space. As NASA embarks on human exploration and development of space to open the space frontier by exploring, using and enabling the development of space and to expand the human experience into the far reaches of space, it becomes imperative, for considerations of safety, cost, and crew health, to minimize consumables and increase the autonomy of the life support system. Utilizing advanced life support technologies increases this autonomy by reducing mass, power, and volume necessary for human support, thus permitting larger payload allocations for science and exploration. Two basic classes of life support systems must be developed, those directed toward applications on transportation/habitation vehicles (e.g., Space Shuttle, International Space Station (ISS), next generation launch vehicles, crew-tended stations/observatories, planetary transit spacecraft, etc.) and those directed toward applications on the planetary surfaces (e.g., lunar or Martian landing spacecraft, planetary habitats and facilities, etc.). In general, it can be viewed as those systems compatible with microgravity and those compatible with hypogravity environments. Part B of the Appendix defines the technology development 'Roadmap' to be followed in providing the necessary systems for these missions. The purpose of this Project Plan is to define the Project objectives, Project-level requirements, the management organizations responsible for the Project throughout its life cycle, and Project-level resources, schedules and controls.

  12. Advanced Stirling Radioisotope Generator Life Certification Plan

    Science.gov (United States)

    Rusick, Jeffrey J.; Zampino, Edward J.

    2013-01-01

    An Advanced Stirling Radioisotope Generator (ASRG) power supply is being developed by the Department of Energy (DOE) in partnership with NASA for potential future deep space science missions. Unlike previous radioisotope power supplies for space exploration, such as the passive MMRTG used recently on the Mars Curiosity rover, the ASRG is an active dynamic power supply with moving Stirling engine mechanical components. Due to the long life requirement of 17 years and the dynamic nature of the Stirling engine, the ASRG project faced some unique challenges trying to establish full confidence that the power supply will function reliably over the mission life. These unique challenges resulted in the development of an overall life certification plan that emphasizes long-term Stirling engine test and inspection when analysis is not practical. The ASRG life certification plan developed is described.

  13. Cardiopulmonary Resuscitation Training for Medical Students in Anesthesiology Rotation in Ardabil Medical University (Iran

    Directory of Open Access Journals (Sweden)

    Kh Isazadehfar

    2009-11-01

    Full Text Available Background and purpose: Cardiopulmonary resuscitation (CPR training for undergraduate medical students has been noted to be poor in the past. Attempts have been made The aim of this study is to determine effect of CPR training in the anesthetic ward to improve knowledge and practice undergraduate medical student of CPR.Methods: A 12 month Educational experimental study with self control was done on all undergraduate medical student (n=30 at the medical university of Ardabil in 2006-2007. During I month of program allthis students have undergone CPR training including basic life support (BLS , advanced cardiac life support (ACLS and practical skills. Data were collected via questionnaire, demographic, pre/post knowledge and practice.Results: After training the acceptable score (good and very good about knowledge of BLS, ACLS and practical skill significantly increased %6.7 to %50 (p=0.0001 , %13.3 to %53.4 (p=0.001 and %3.3 to %100 (p=0.001 respectively. A significant relationship between knowledge of ACLS and practical skills was shown (p=0.005.Conclusion: The CPR training course in anesthetic ward leads to a significant increased in skills and knowledge. Adding this course to undergraduate curriculum of medical students especially in operaticallywards (e.g. Anesthetic ward is essential.Keywords: CARDIOPULMONARY RESUSCITATION; TRAINING; BASIC LIFE SUPPORT; ADVANCED CARDIAC LIFE SUPPORT

  14. Design and development of a virtual reality simulator for advanced cardiac life support training.

    Science.gov (United States)

    Vankipuram, Akshay; Khanal, Prabal; Ashby, Aaron; Vankipuram, Mithra; Gupta, Ashish; DrummGurnee, Denise; Josey, Karen; Smith, Marshall

    2014-07-01

    The use of virtual reality (VR) training tools for medical education could lead to improvements in the skills of clinicians while providing economic incentives for healthcare institutions. The use of VR tools can also mitigate some of the drawbacks currently associated with providing medical training in a traditional clinical environment such as scheduling conflicts and the need for specialized equipment (e.g., high-fidelity manikins). This paper presents the details of the framework and the development methodology associated with a VR-based training simulator for advanced cardiac life support, a time critical, team-based medical scenario. In addition, we also report the key findings of a usability study conducted to assess the efficacy of various features of this VR simulator through a postuse questionnaire administered to various care providers. The usability questionnaires were completed by two groups that used two different versions of the VR simulator. One version consisted of the VR trainer with it all its features and a minified version with certain immersive features disabled. We found an increase in usability scores from the minified group to the full VR group.

  15. The Added Value of Medical Testing in Underwriting Life Insurance

    NARCIS (Netherlands)

    Bronsema, J.; Brouwer, S.; de Boer, M.R.; Groothoff, J.W.

    2015-01-01

    Background In present-day life-insurance medical underwriting practice the risk assessment starts with a standard health declaration (SHD). Indication for additional medical screening depends predominantly on age and amount of insured capital. From a medical perspective it is questionable whether

  16. End-of-life practices: The opinions of undergraduate medical ...

    African Journals Online (AJOL)

    2017-12-01

    Dec 1, 2017 ... illness, injury or other physical or mental condition that, in medical judgment, will .... was all the registered first- to fifth-year medical students at the School ..... patient should have sole responsibility in end-of-life decisions. The.

  17. "Personal mission statement": An analysis of medical students' and general practitioners' reflections on personal beliefs, values and goals in life.

    Science.gov (United States)

    Chew, B H; Lee, P Y; Ismail, I Z

    2014-01-01

    Personal mission in life can determine the motivation, happiness, career advancement and fulfilment in life of the medical students (MSs) along with improvement in professional/clinical performance of the family physicians. This study explored the personal beliefs, values and goals in the lives of MSs and general practitioners (GPs). Fourth-year MSs at the Universiti Putra Malaysia and GPs who participated in a 2-hour session on 'Ethics in Family Medicine' in 2012 were invited. All the participants submitted the post-session written reflections about their personal missions in life. The written reflections were analysed using thematic analysis. A total of 87 MSs and 31 GPs submitted their written reflections. The authors identified 17 categories from the reflections contained by four themes-good vs. smart doctor, professional improvement vs. self-improvement, self-fulfilment and expressed motivation. The most common categories were "to be a good doctor" (97/330) and "professional improvement" (65/330). Many MSs had expressed motivation and wanted to be a smart doctor as compared to the GPs, whereas a larger number of GPs wished to have a fulfilled life and be a good doctor through professional improvement. The difference between the two student groups might indicate different levels of maturity and life experiences. Medical teachers should engage students more effectively in orientating them towards the essential values needed in medical practice.

  18. State of Health and Quality of Life of Women at Advanced Age

    Science.gov (United States)

    Pinkas, Jarosław; Gujski, Mariusz; Humeniuk, Ewa; Raczkiewicz, Dorota; Bejga, Przemysław; Owoc, Alfred; Bojar, Iwona

    2016-01-01

    Background Evaluation of the state of health, quality of life, and the relationship between the level of the quality of life and health status in a group of women at an advanced age (90 years of age and older) in Poland. Material/Methods The study was conducted in 2014 in an all-Polish sample of 870 women aged 90 years and older. The research instruments were: the authors’ questionnaire and several standardized tests: Katz Index of Independence in Activities of Daily Living (Katz ADL), Abbreviated Mental Test Score (AMTS), and the World Health Organization Quality of Life (WHOQOL)-BREF. The results of the study were statistically analyzed using significant t-test for mean and regression analysis. Results The majority of women at an advanced age suffered from chronic pain (76%) and major geriatric problems such as hypoacusis (81%), visual disturbances (69%) and urinary incontinence (60%); the minority of women at an advanced age suffered from falls and fainting (39%), stool incontinence (17%), severe functional impairment (24%), and cognitive impairment (10%). On a scale of 1 to 5, women at an advanced age assessed positively for overall quality of life (mean 3.3), social relationships (3.5), and environment (3.2), but negatively for general health, physical health, and psychological health (2.7, 2.7, and 2.8, respectively). The presence of chronic pain and geriatric problems, including urinary and stool incontinences, falls and faint ing, visual disturbances and hypoacusis, significantly decreased overall quality of life; general health, physical health, psychological health, social relationships, and environment. Overall quality of life, general health, physical health, psychological health, social relationships, and environment was correlated with functional and cognitive impairments. Conclusions Quality of life of women at an advanced age decreased if chronic pain, major geriatric problems, or functional or cognitive impairments occurred. PMID:27580565

  19. The patient perspective: Quality of life in advanced heart failure with frequent hospitalisations.

    Science.gov (United States)

    Nieminen, Markku S; Dickstein, Kenneth; Fonseca, Cândida; Serrano, Jose Magaña; Parissis, John; Fedele, Francesco; Wikström, Gerhard; Agostoni, Piergiuseppe; Atar, Shaul; Baholli, Loant; Brito, Dulce; Colet, Josep Comín; Édes, István; Gómez Mesa, Juan E; Gorjup, Vojka; Garza, Eduardo Herrera; González Juanatey, José R; Karanovic, Nenad; Karavidas, Apostolos; Katsytadze, Igor; Kivikko, Matti; Matskeplishvili, Simon; Merkely, Béla; Morandi, Fabrizio; Novoa, Angel; Oliva, Fabrizio; Ostadal, Petr; Pereira-Barretto, Antonio; Pollesello, Piero; Rudiger, Alain; Schwinger, Robert H G; Wieser, Manfred; Yavelov, Igor; Zymliński, Robert

    2015-07-15

    End of life is an unfortunate but inevitable phase of the heart failure patients' journey. It is often preceded by a stage in the progression of heart failure defined as advanced heart failure, and characterised by poor quality of life and frequent hospitalisations. In clinical practice, the efficacy of treatments for advanced heart failure is often assessed by parameters such as clinical status, haemodynamics, neurohormonal status, and echo/MRI indices. From the patients' perspective, however, quality-of-life-related parameters, such as functional capacity, exercise performance, psychological status, and frequency of re-hospitalisations, are more significant. The effects of therapies and interventions on these parameters are, however, underrepresented in clinical trials targeted to assess advanced heart failure treatment efficacy, and data are overall scarce. This is possibly due to a non-universal definition of the quality-of-life-related endpoints, and to the difficult standardisation of the data collection. These uncertainties also lead to difficulties in handling trade-off decisions between quality of life and survival by patients, families and healthcare providers. A panel of 34 experts in the field of cardiology and intensive cardiac care from 21 countries around the world convened for reviewing the existing data on quality-of-life in patients with advanced heart failure, discussing and reaching a consensus on the validity and significance of quality-of-life assessment methods. Gaps in routine care and research, which should be addressed, were identified. Finally, published data on the effects of current i.v. vasoactive therapies such as inotropes, inodilators, and vasodilators on quality-of-life in advanced heart failure patients were analysed. Copyright © 2015. Published by Elsevier Ireland Ltd.

  20. Advanced maternal age: ethical and medical considerations for assisted reproductive technology.

    Science.gov (United States)

    Harrison, Brittany J; Hilton, Tara N; Rivière, Raphaël N; Ferraro, Zachary M; Deonandan, Raywat; Walker, Mark C

    2017-01-01

    This review explores the ethical and medical challenges faced by women of advanced maternal age who decide to have children. Assisted reproductive technologies (ARTs) make post-menopausal pregnancy physiologically plausible, however, one must consider the associated physical, psychological, and sociological factors involved. A quasi-systematic review was conducted in PubMed and Ovid using the key terms post-menopause, pregnancy + MeSH terms [donations, hormone replacement therapy, assisted reproductive technologies, embryo donation, donor artificial insemination, cryopreservation]. Overall, 28 papers encompassing two major themes (ethical and medical) were included in the review. There are significant ethical considerations and medical (maternal and fetal) complications related to pregnancy in peri- and post-menopausal women. When examining the ethical and sociological perspective, the literature portrays an overall positive attitude toward pregnancy in advanced maternal age. With respect to the medical complications, the general consensus in the evaluated studies suggests that there is greater risk of complication for spontaneous pregnancy when the mother is older (eg, >35 years old). This risk can be mitigated by careful medical screening of the mother and the use of ARTs in healthy women. In these instances, a woman of advanced maternal age who is otherwise healthy can carry a pregnancy with a similar risk profile to that of her younger counterparts when using donated oocytes.

  1. Real life cost and quality of life associated with continuous intraduodenal levodopa infusion compared with oral treatment in Parkinson patients

    DEFF Research Database (Denmark)

    Lundqvist, C.; Beiske, A. G.; Reiertsen, O.

    2014-01-01

    Advanced-stage Parkinson's disease (PD) strongly affects quality of life (QoL). Continuous intraduodenal administration of levodopa (IDL) is efficacious, but entails high costs. This study aims to estimate these costs in routine care. 10 patients with advanced-PD who switched from oral medication...... was the dominant cost during IDL (45 % of total costs), it represented only 6.4 % of the total for conventional treatment. IDL improves function but is not cost effective using recommended thresholds for cost/QALY in Norway.......Advanced-stage Parkinson's disease (PD) strongly affects quality of life (QoL). Continuous intraduodenal administration of levodopa (IDL) is efficacious, but entails high costs. This study aims to estimate these costs in routine care. 10 patients with advanced-PD who switched from oral medication...... to IDL were assessed at baseline, and subsequently at 3, 6, 9 and 12 months follow-up. We used the Unified PD Rating Scale (UPDRS) for function and 15D for Quality of Life (QoL). Costs were assessed using quarterly structured patient questionnaires and hospital registries. Costs per quality adjusted life...

  2. The impact of population aging on medical expenses: A big data study based on the life table.

    Science.gov (United States)

    Wang, Changying; Li, Fen; Wang, Linan; Zhou, Wentao; Zhu, Bifan; Zhang, Xiaoxi; Ding, Lingling; He, Zhimin; Song, Peipei; Jin, Chunlin

    2018-01-09

    This study shed light on the amount and structure of utilization and medical expenses on Shanghai permanent residents based on big data, simulated lifetime medical expenses through combining of expenses data and life table model, and explored the dynamic pattern of aging on medical expenditures. 5 years were taken as the class interval, the study collected and did the descriptive analysis on the medical services utilization and medical expenses information for all ages of Shanghai permanent residents in 2015, simulated lifetime medical expenses by using current life table and cross-section expenditure data. The results showed that in 2015, outpatient and emergency visits per capita in the elderly group (aged 60 and over) was 4.1 and 4.5 times higher than the childhood group (aged 1-14), and the youth and adult group (aged 15-59); hospitalization per capita in the elderly group was 3.0 and 3.5 times higher than the childhood group, and the youth and adult group. People survived in the 60-64 years group, their expected whole medical expenses (105,447 purchasing power parity Dollar) in the rest of their lives accounted for 75.6% of their lifetime. A similar study in Michigan, US showed that the expenses of the population aged 65 and over accounted for 1/2 of lifetime medical expenses, which is much lower than Shanghai. The medical expenses of the advanced elderly group (aged 80 and over) accounted for 38.8% of their lifetime expenses, including 38.2% in outpatient and emergency, and 39.5% in hospitalization, which was slightly higher than outpatient and emergency. There is room to economize in medical expenditures of the elderly people in Shanghai, especially controlling hospitalization expenses is the key to saving medical expenses of elderly people aged over 80 and over.

  3. End-of-life medical spending in last twelve months of life is lower than previously reported

    NARCIS (Netherlands)

    French, E.; Klein, Tobias; a., e.

    Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009–11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan,

  4. Living Wills and Advance Directives for Medical Decisions

    Science.gov (United States)

    ... own thoughts and having conversations with others about medical care and end-of-life care are available through the American Bar Association, the Conversation Project and the Center for Practical Bioethics. You should address a number of possible end- ...

  5. Factors That Impact End-of-Life Decision Making in African Americans With Advanced Cancer

    Science.gov (United States)

    Campbell, Cathy L.; Williams, Ishan C.; Orr, Tamara

    2013-01-01

    Significance African Americans with cancer are less likely to use hospice services and more likely to die in the hospital than white patients with the same diagnosis. However, there is much that is not understood about the factors that lead African Americans to choose options for end-of-life care. Design A qualitative, descriptive design was used in this pilot study. Methods Interviews were conducted with two groups of African Americans with advanced-stage cancer (people enrolled in hospice and those who were not under hospice care). Findings End-of-life decisions were primarily guided by clinical factors, the patient-related physical, emotional, and cognitive symptoms that are sequelae of the underlying disease or medical treatments. The physician was the healthcare provider most likely to be involved in decision making with patients, family members, and caregivers. Individual factors, such as personal beliefs, influenced end-of-life decision making. Religion and spirituality were a topic in many interviews, but they did not consistently influence decision making. Discussion Future studies should include interviews with family members, caregivers, and healthcare professionals so that factors that impact end-of-life decision making can be fully described. Strategies to facilitate recruitment will need to be added to future protocols. PMID:23645999

  6. Effect of a life review program for Chinese patients with advanced cancer: a randomized controlled trial.

    Science.gov (United States)

    Xiao, Huimin; Kwong, Enid; Pang, Samantha; Mok, Esther

    2013-01-01

    Empirical data suggest that life review is an effective psychospiritual intervention. However, it has not been applied to Chinese patients with advanced cancer, and its effects on this population remain unknown. The aim of the study was to determine the effect of a life review program on quality of life among Chinese patients with advanced cancer. In this prospective randomized controlled trial, a total of 80 patients were randomly assigned to the life review program group and the control group. The 3-weekly life review program included reviewing a life and formulating a life review booklet. Outcome data were assessed by a collector who was blinded to group assignment before and immediately after the program and at a 3-week follow-up. Significantly better scores in overall quality of life, support, negative emotions, sense of alienation, existential distress, and value of life were found in the life review group immediately after the program and at the 3-week follow-up. This study provides additional data on the potential role of a life review in improving quality of life, particularly psychospiritual well being; it also indicates that the life review program could enable Chinese patients with advanced cancer to express their views on life and death. The life review program offers advanced cancer patients an opportunity to integrate their whole life experiences and discuss end-of-life issues, which lays the ground for further active intervention in their psychospiritual distress. The program could be integrated into daily home care to enhance the psychospiritual well-being of Chinese patients with advanced cancer.

  7. Physical activity, quality of life and medication in aging: differences between age and gender

    Directory of Open Access Journals (Sweden)

    Lilian Teresa Bucken Gobbi

    2009-04-01

    Full Text Available Studies have shown an inverse relationship between physical activity level (PAL, quality of life (QoL and use of medications in the elderly. The objective of this study was to analyze possible relationships and differences between PAL, QoL and use of medications in the elderly. A total of 192 subjects (≥ 60 years were selected by stratified random sampling according to census sector. The following assessment instruments were used: a Modified Baecke Questionnaire for older adults, b Medical Outcomes Study – 36-Item Short Form Health Survey, and c Sociodemographic and Health Factors Questionnaire. Descriptive statistics and parametric and nonparametric tests were used (p < 0.05. a With respect to chronological age, significant differences between groups were only observed for PAL, with G1 (60-69 years being more active than the other groups. b With respect to gender irrespective of age, analysis showed a difference in QoL and in the number of medications, with men reporting better perceived QoL and using fewer medications. c With respect to gender but considering chronological age, differences in PAL, QoL and medication use were observed between genders for specific age groups. In conclusion, in the elderly a PAL is low, declines even more during advanced age and is higher in men than in women during the first decade of old age, and b men report better perceived QoL and use fewer medications than women.

  8. Respiratory Symptoms, Sleep, and Quality of Life in Patients With Advanced Lung Cancer.

    Science.gov (United States)

    Lou, Vivian W Q; Chen, Elaine J; Jian, Hong; Zhou, Zhen; Zhu, Jingfen; Li, Guohong; He, Yaping

    2017-02-01

    Maintenance of quality of life and symptom management are important in lung cancer therapy. To the author's knowledge, the interplay of respiratory symptoms and sleep disturbance in affecting quality of life in advanced lung cancer remains unexamined. The study was designed to examine the relationships among respiratory symptoms, sleep disturbance, and quality of life in patients with advanced lung cancer. A total of 128 patients with advanced lung cancer (from chest oncology inpatient-units in Shanghai, China) participated in the study. They completed two questionnaires: the Functional Assessment of Cancer Therapy-Lung and the Pittsburgh Sleep Quality Index. Symptomatic breathing difficulty, coughing, shortness of breath, and tightness in the chest were reported in 78.1%, 70.3%, 60.9%, and 60.2% of the patients, respectively. Sleep disturbance affected 62.5% of the patients. The patients with severe respiratory symptoms were more likely to be poor sleepers and to have a lower quality of life. After the covariates were controlled for, regression analysis showed that respiratory symptoms and sleep disturbance were significant indicators of quality of life. In addition, some of the effect of the respiratory symptoms on quality of life was mediated by sleep disturbance. Respiratory symptoms and sleep disturbance were common in the advanced lung cancer patients and had a negative impact on their quality of life; sleep disturbance may mediate the relationship between respiratory symptoms and quality of life. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  9. End of Life Strategies Among Patients with Advanced Chronic Obstructive Pulmonary Disease (COPD).

    Science.gov (United States)

    Gershon, Andrea S; Maclagan, Laura C; Luo, Jin; To, Teresa; Kendzerska, Tetyana; Stanbrook, Matthew B; Bourbeau, Jean; Etches, Jacob; Aaron, Shawn D

    2018-06-11

    The burden of advanced COPD is high globally; however, little is known about how often end of life strategies are used by this population. To describe trends in the use of end of life care strategies by people with advanced COPD in Ontario, Canada. A population-based repeated cross-sectional study examining end of life care strategies in individuals with advanced COPD was conducted. Annual proportions of individuals who received formal palliative care, long-term oxygen therapy or opioids from 2004 to 2014 were determined. Results were age- and sex- standardized as well as stratified by age, sex, socioeconomic status, urban/rural residence and immigrant status. Measurement/Main Results: There were 151,912 persons with advanced COPD in Ontario between 2004 and 2014. Use of formal palliative care services increased 1% per year from 5.3% in 2004 to 14.3% in 2014 (p value for trend COPD using end of life strategies, although increasing, remains low. Efforts should focus on increasing access to such strategies as well as educating patients and providers of their benefits.

  10. Emergency feasibility in medical intensive care unit of extracorporeal life support for refractory cardiac arrest.

    Science.gov (United States)

    Mégarbane, Bruno; Leprince, Pascal; Deye, Nicolas; Résière, Dabor; Guerrier, Gilles; Rettab, Samia; Théodore, Jonathan; Karyo, Souheil; Gandjbakhch, Iradj; Baud, Frédéric J

    2007-05-01

    To report the feasibility, complications, and outcomes of emergency extracorporeal life support (ECLS) in refractory cardiac arrests in medical intensive care unit (ICU). Prospective cohort study in the medical ICU in a university hospital in collaboration with the cardiosurgical team of a neighboring hospital. Seventeen patients (poisonings: 12/17) admitted over a 2-year period for cardiac arrest unresponsive to cardiopulmonary resuscitation (CPR) and advanced cardiac life support, without return of spontaneous circulation. ECLS femoral implantation under continuous cardiac massage, using a centrifugal pump connected to a hollow-fiber membrane oxygenator. Stable ECLS was achieved in 14 of 17 patients. Early complications included massive transfusions (n=8) and the need for surgical revision at the cannulation site for bleeding (n=1). Four patients (24%) survived at medical ICU discharge. Deaths resulted from multiorgan failure (n=8), thoracic bleeding(n=2), severe sepsis (n=2), and brain death (n=1). Massive hemorrhagic pulmonary edema during CPR (n=5) and major capillary leak syndrome (n=6) were observed. Three cardiotoxic-poisoned patients (18%, CPR duration: 30, 100, and 180 min) were alive at 1-year follow-up without sequelae. Two of these patients survived despite elevated plasma lactate concentrations before cannulation (39.0 and 20.0 mmol/l). ECLS was associated with a significantly lower ICU mortality rate than that expected from the Simplified Acute Physiology Score II (91.9%) and lower than the maximum Sequential Organ Failure Assessment score (>90%). Emergency ECLS is feasible in medical ICU and should be considered as a resuscitative tool for selected patients suffering from refractory cardiac arrest.

  11. Student-Life Stress Level and its Related Factors among Medical Students of Hamadan University of Medical Sciences in 2015

    OpenAIRE

    Roya Nikanjam; Majid Barati; Saeed Bashirian*; Mohammad Babamiri; Ali Fattahi; Alireza Soltanian

    2016-01-01

    Background and Objectives: Student-life stress can lead to various negative consequences such as physical illness, mental disorders or exhaustion. The present study was conducted to evaluate the level of student life stress and its related factors among medical students of Hamadan University of Medical Sciences. Materials and Methods: This cross-sectional study applied multistage random sampling to select 500university students at Hamadan University of Medical Sciences during 2015. The dat...

  12. Clinical review: Ethics and end-of-life care for critically ill patients in China

    OpenAIRE

    Li, Li Bin

    2013-01-01

    Critical care medicine in China has made great advances in recent decades. This has led to an unavoidable issue: end-of-life ethics. With advances in medical technology and therapeutics allowing the seemingly limitless maintenance of life, the exact time of death of an individual patient is often determined by the decision to limit life support. How to care for patients at the end of life is not only a medical problem but also a social, ethical, and legal issue. A lot of factors, besides cult...

  13. Advanced Life Support Research and Technology Transfer at the University of Guelph

    Directory of Open Access Journals (Sweden)

    Dixon M.

    2017-02-01

    Full Text Available Research and technology developments surrounding Advanced Life-Support (ALS began at the University of Guelph in 1992 as the Space and Advanced Life Support Agriculture (SALSA program, which now represents Canada’s primary contribution to ALS research. The early focus was on recycling hydroponic nutrient solutions, atmospheric gas analysis and carbon balance, sensor research and development, inner/intra-canopy lighting and biological filtration of air in closed systems. With funding from federal, provincial and industry partners, a new generation of technology emerged to address the challenges of deploying biological systems as fundamental components of life-support infrastructure for long-duration human space exploration. Accompanying these advances were a wide range of technology transfer opportunities in the agri-food and health sectors, including air and water remediation, plant and environment sensors, disinfection technologies, recyclable growth substrates and advanced light emitting diode (LED lighting systems. This report traces the evolution of the SALSA program and catalogues the benefits of ALS research for terrestrial and non-terrestrial applications.

  14. IT for advanced Life Support in English

    DEFF Research Database (Denmark)

    Sejerø Pedersen, Birgitte; Jeberg, Kirsten Ann; Koerner, Christian

    2009-01-01

    In this study we analyzed how IT support can be established for the treatment and documentation of advanced life support (ALS) in a hospital. In close collaboration with clinical researchers, a running prototype of an IT solution to support the clinical decisions in ALS was developed and tried out...... in a full scale simulation environment. We have named this IT solution the CardioData Prototype....

  15. Life Balance and Stress in Adults With Medical Conditions or Obesity.

    Science.gov (United States)

    Matuska, Kathleen; Bass, Julie

    2016-04-01

    This cross-sectional research examined differences in life balance and perceived stress by body mass index (BMI) levels and self-reported medical conditions that limited physical activity. The sample consisted of 2,338 participants between the ages of 18 and 49 years who took the Life Balance Inventory, the Perceived Stress Scale, and provided demographic information including height and weight. Findings showed that individuals who were obese (BMI > 30.0) reported significantly lower life balance scores and higher stress scores than participants without obesity (p life balance and more stress than individuals without medical conditions (p < .001). These findings highlight the importance of addressing activity participation as a means to promote health and wellness. © The Author(s) 2016.

  16. A new data architecture for advancing life cycle assessment

    Science.gov (United States)

    IntroductionLife cycle assessment (LCA) has a technical architecture that limits data interoperability, transparency, and automated integration of external data. More advanced information technologies offer promise for increasing the ease with which information can be synthesized...

  17. Can a manager have a life and a career? International and multisource perspectives on work-life balance and career advancement potential.

    Science.gov (United States)

    Lyness, Karen S; Judiesch, Michael K

    2008-07-01

    The present study was the first cross-national examination of whether managers who were perceived to be high in work-life balance were expected to be more or less likely to advance in their careers than were less balanced, more work-focused managers. Using self ratings, peer ratings, and supervisor ratings of 9,627 managers in 33 countries, the authors examined within-source and multisource relationships with multilevel analyses. The authors generally found that managers who were rated higher in work-life balance were rated higher in career advancement potential than were managers who were rated lower in work-life balance. However, national gender egalitarianism, measured with Project GLOBE scores, moderated relationships based on supervisor and self ratings, with stronger positive relationships in low egalitarian cultures. The authors also found 3-way interactions of work-life balance ratings, ratee gender, and gender egalitarianism in multisource analyses in which self balance ratings predicted supervisor and peer ratings of advancement potential. Work-life balance ratings were positively related to advancement potential ratings for women in high egalitarian cultures and men in low gender egalitarian cultures, but relationships were nonsignificant for men in high egalitarian cultures and women in low egalitarian cultures.

  18. [Burnout and quality of life in medical residents].

    Science.gov (United States)

    Prieto-Miranda, Sergio Emilio; Rodríguez-Gallardo, Gisela Bethsabé; Jiménez-Bernardino, Carlos Alberto; Guerrero-Quintero, Laura Guadalupe

    2013-01-01

    burnout and quality of life are poorly studied phenomena in postgraduate students, and its effects are unknown. The aim was to investigate the relationship between quality of life and burnout in medical residents. a longitudinal study was performed. We included medical residents who began their postgraduate studies in 2010. The Spanish version of the Quality of Life Profile for the Chronically Ill (PLC, according to its initials in German), and the Maslach Burnout Inventory specific to physicians were applied at the beginning, and six and 12 months later. Descriptive statistics were used for nominal variables. Chi-square and ANOVA were applied to numerical variables. we included 45 residents, the average age was 26.9 ± 2.93 years, 18 (40 %) were female and 27 (60 %) were male. The PLC survey found significant decrease in four of the six scales assessed in the three measurements. The Maslach Burnout Inventory found high levels of emotional exhaustion in the three tests, low levels of depersonalization and low personal gains at the beginning, rising at six and 12 months. The most affected specialty was Internal Medicine. burnout and impaired quality of life for residents exist in postgraduate physicians and it is maintained during the first year of residency.

  19. Medical-and-psychosocial factors influencing on the quality of life in patients with cervix cancer

    International Nuclear Information System (INIS)

    Chun, Mi Son; Kang, Seung Hee; Ryu, Hee Sug; Lee, Eun Hyun; Moon, Seong Mi

    2005-01-01

    Quality of life in patients with cancer may be influenced by various kinds of variables, such as personal, environmental, and medical factors. the purpose of this study was to identify the influencing factors on the quality of life in patients with cancer. One hundred and forty seven patients, who were taking medical therapy or following up after surgery for cervix cancer, participated in the present study. Quality of life, medical variables (cancer stage, type of treatment, follow-up status, and symptom distress), and psychosocial variables (mood disturbance, orientation to life, and social support) were measured. The obtained data were computed using multiple regression analyses. The medical-and-psychosocial variables explained 63.3% of the total variance in the quality of life (R 2 = 0.633, F = 16.969, ρ = .000). Cancer stage, symptom distress, mood disturbance, social support (family), and optimistic orientation to life were significant factors influencing on the quality of life in patients with cervix cancer. An integrative care program which includes medical-and-psychosocial characteristics of patients is essential to improve quality of life in patients with cervix cancer

  20. Medical-and-psychosocial factors influencing on the quality of life in patients with cervix cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chun, Mi Son; Kang, Seung Hee; Ryu, Hee Sug [Ajou University School of Medicine, Suwon (Korea, Republic of); Lee, Eun Hyun [Ajou Univerisity, Suwon (Korea, Republic of); Moon, Seong Mi [Ajou University Hospital, Suwon (Korea, Republic of)

    2005-12-15

    Quality of life in patients with cancer may be influenced by various kinds of variables, such as personal, environmental, and medical factors. the purpose of this study was to identify the influencing factors on the quality of life in patients with cancer. One hundred and forty seven patients, who were taking medical therapy or following up after surgery for cervix cancer, participated in the present study. Quality of life, medical variables (cancer stage, type of treatment, follow-up status, and symptom distress), and psychosocial variables (mood disturbance, orientation to life, and social support) were measured. The obtained data were computed using multiple regression analyses. The medical-and-psychosocial variables explained 63.3% of the total variance in the quality of life (R{sup 2} = 0.633, F = 16.969, {rho} = .000). Cancer stage, symptom distress, mood disturbance, social support (family), and optimistic orientation to life were significant factors influencing on the quality of life in patients with cervix cancer. An integrative care program which includes medical-and-psychosocial characteristics of patients is essential to improve quality of life in patients with cervix cancer.

  1. Life satisfaction and resilience in medical school – a six-year longitudinal, nationwide and comparative study

    Directory of Open Access Journals (Sweden)

    Gronvold Nina T

    2006-09-01

    Full Text Available Abstract Background This study examined the relationship between life satisfaction among medical students and a basic model of personality, stress and coping. Previous studies have shown relatively high levels of distress, such as symptoms of depression and suicidal thoughts in medical undergraduates. However despite the increased focus on positive psychological health and well-being during the past decades, only a few studies have focused on life satisfaction and coping in medical students. This is the first longitudinal study which has identified predictors of sustained high levels of life satisfaction among medical students. Methods This longitudinal, nationwide questionnaire study examined the course of life satisfaction during medical school, compared the level of satisfaction of medical students with that of other university students, and identified resilience factors. T-tests were used to compare means of life satisfaction between and within the population groups. K-means cluster analyses were applied to identify subgroups among the medical students. Analysis of Variance (ANOVA and logistic regression analyses were used to compare the subgroups. Results Life satisfaction decreased during medical school. Medical students were as satisfied as other students in the first year of study, but reported less satisfaction in their graduation year. Medical students who sustained high levels of life satisfaction perceived medical school as interfering less with their social and personal life, and were less likely to use emotion focused coping, such as wishful thinking, than their peers. Conclusion Medical schools should encourage students to spend adequate time on their social and personal lives and emphasise the importance of health-promoting coping strategies.

  2. Life satisfaction and resilience in medical school – a six-year longitudinal, nationwide and comparative study

    Science.gov (United States)

    Kjeldstadli, Kari; Tyssen, Reidar; Finset, Arnstein; Hem, Erlend; Gude, Tore; Gronvold, Nina T; Ekeberg, Oivind; Vaglum, Per

    2006-01-01

    Background This study examined the relationship between life satisfaction among medical students and a basic model of personality, stress and coping. Previous studies have shown relatively high levels of distress, such as symptoms of depression and suicidal thoughts in medical undergraduates. However despite the increased focus on positive psychological health and well-being during the past decades, only a few studies have focused on life satisfaction and coping in medical students. This is the first longitudinal study which has identified predictors of sustained high levels of life satisfaction among medical students. Methods This longitudinal, nationwide questionnaire study examined the course of life satisfaction during medical school, compared the level of satisfaction of medical students with that of other university students, and identified resilience factors. T-tests were used to compare means of life satisfaction between and within the population groups. K-means cluster analyses were applied to identify subgroups among the medical students. Analysis of Variance (ANOVA) and logistic regression analyses were used to compare the subgroups. Results Life satisfaction decreased during medical school. Medical students were as satisfied as other students in the first year of study, but reported less satisfaction in their graduation year. Medical students who sustained high levels of life satisfaction perceived medical school as interfering less with their social and personal life, and were less likely to use emotion focused coping, such as wishful thinking, than their peers. Conclusion Medical schools should encourage students to spend adequate time on their social and personal lives and emphasise the importance of health-promoting coping strategies. PMID:16984638

  3. Quality of life and antireflux medication use following laparoscopic Nissen fundoplication.

    Science.gov (United States)

    Bloomston, M; Zervos, E; Gonzalez, R; Albrink, M; Rosemurgy, A

    1998-06-01

    With the advent of minimally invasive techniques, the surgical treatment of gastroesophageal reflux disease has received renewed interest. The efficacy of laparoscopic Nissen fundoplication in eliminating reflux has been documented. This study was undertaken to determine changes in quality of life and cost of antireflux medications after laparoscopic Nissen fundoplication. One hundred patients undergoing laparoscopic Nissen fundoplication between 1992 and 1997 completed questionnaires assessing changes in pre- and postoperative cost and number of antireflux medications, reflux symptoms, and quality of life. The average number of antireflux medications was significantly reduced (1.8 versus 0.3, P < 0.0001) as was the average monthly cost ($170 versus $30, P < 0.0001). Patients reported significant (P < 0.05) symptomatic improvement in postprandial heartburn, nocturnal heartburn, postprandial nausea, postprandial vomiting, dysphagia, and gas/bloating. Patients in this series noted fewer symptoms and used fewer antireflux medications at less cost after laparoscopic Nissen fundoplication. Symptoms commonly thought of as complications of fundoplication (vomiting, dysphagia, gas/bloating) were less common after fundoplication. This report documents the efficacy of laparoscopic fundoplication in improving quality of life and reducing use and cost of antireflux medications.

  4. Managing occupations in everyday life for people with advanced cancer at home

    DEFF Research Database (Denmark)

    Peoples, Hanne; Brandt, Åse; Wæhrens, Eva Elisabet Ejlersen

    “Everyday life under change” and two sub-categories 1) Appling strategies to manage occupations in everyday life and 2) Preserving a meaningful everyday life. Significance: The findings suggest that people with advanced cancer, to a greater extent, should be supported in exploring familiar as well as new...

  5. Interrelationships between romance, life quality, and medical training of female residents.

    Science.gov (United States)

    Wang, Yu-Jung; Hsu, Kan-Lin; Chang, Chin-Sung; Wu, Chih-Hsing

    2012-08-01

    For the past 30 years, there has been a steady increase in the number of female physicians, but the relationship between their romantic lives and their pattern of training has been inadequately reported. This study was designed to investigate the interrelationships between medical training, quality of life, and the attitudes that female residents have toward romance. Of the 106 female medical residents at our medical center in 2009, a total of 78 residents (73.6%) were enrolled for the study. Structured questionnaires (Cronbach α = 0.878), which included questions about female resident quality of life, attitude toward spousal choice, and the impact of programmed professional medical training, were self-administered through an anonymous process. Female residents, especially ward-care specialists, were determined to have excessively long working hours (84.6% > 88 work hours/week), insufficient and irregular sleep (44.9%), and inadequate personal time (73.1% friends, differences in values, and work-related stress. Those presumptive factors influencing romance between the assumed partner being a doctor or a "nondoctor" were significantly different with regard to lack of time (p = 0.002), values (p work-related stress (p life were significantly influenced by the pattern of medical training in female residents. Setting duty-hour limits and initiating a new hobby were determined to be potentially beneficial to their quality of life and attitudes toward romance. Copyright © 2012. Published by Elsevier B.V.

  6. Quality of Life in Medical Students With Internet Addiction

    Directory of Open Access Journals (Sweden)

    Farzad Fatehi

    2016-11-01

    Full Text Available The widespread use of internet has caused new psychological, social, and educational problems for the students. The aim of this study was to examine the quality of life in medical students who suffer from internet addiction. This cross-sectional survey was carried out in Tehran University of Medical Sciences, and a total of 174 fourth-to seventh-year undergraduate medical students were enrolled. The quality of life was assessed by WHOQOL-BREF questionnaire which covers four domains of physical health, psychological, social relationships, and the environment. For assessing internet addiction, we used Internet Addiction Test (IAT of Young. The students with IAT score higher than 50 were considered as addicted. For evaluating academic performance, the students were requested to report their grade point average (GPA. The mean IA score (±SD was 34.13±12.76. Twenty-eight students (16.90% had IAT score above 50. The mean quality of life score in internet addicted group was 54.97±11.38 versus 61.65±11.21 in normal group (P=0.005. Furthermore, there was a negative correlation between IA score and physical domain (r=-0.18, P=0.02; psychological domain (r=-0.35, P=0.000; and social relation domain (r=-0.26, P=0.001. Mean GPA was significantly lower in the addicted group. It seems that quality of life is lower in the internet addicted medical students; moreover, such students academically perform poorer in comparison with non-addicts. Since internet addiction is increasing at a rapid pace which may provoke considerable academic, psychological and social implications; as a result, it may require screening programs to the immediate finding of such problem to give consultations to prevent unwanted complications.

  7. Quality of Life in Medical Students With Internet Addiction.

    Science.gov (United States)

    Fatehi, Farzad; Monajemi, Alireza; Sadeghi, Anahita; Mojtahedzadeh, Rita; Mirzazadeh, Azim

    2016-10-01

    The widespread use of internet has caused new psychological, social, and educational problems for the students. The aim of this study was to examine the quality of life in medical students who suffer from internet addiction. This cross-sectional survey was carried out in Tehran University of Medical Sciences, and a total of 174 fourth-to seventh-year undergraduate medical students were enrolled. The quality of life was assessed by WHOQOL-BREF questionnaire which covers four domains of physical health, psychological, social relationships, and the environment. For assessing internet addiction, we used Internet Addiction Test (IAT) of Young. The students with IAT score higher than 50 were considered as addicted. For evaluating academic performance, the students were requested to report their grade point average (GPA). The mean IA score (±SD) was 34.13±12.76. Twenty-eight students (16.90%) had IAT score above 50. The mean quality of life score in internet addicted group was 54.97±11.38 versus 61.65±11.21 in normal group (P=0.005). Furthermore, there was a negative correlation between IA score and physical domain (r=-0.18, P=0.02); psychological domain (r=-0.35, P=0.000); and social relation domain (r=-0.26, P=0.001). Mean GPA was significantly lower in the addicted group. It seems that quality of life is lower in the internet addicted medical students; moreover, such students academically perform poorer in comparison with non-addicts. Since internet addiction is increasing at a rapid pace which may provoke considerable academic, psychological and social implications; as a result, it may require screening programs to the immediate finding of such problem to give consultations to prevent unwanted complications.

  8. "It's like playing with your destiny": Bosnian immigrants' views of advance directives and end-of-life decision-making.

    Science.gov (United States)

    Searight, H Russell; Gafford, Jennifer

    2005-07-01

    Patient autonomy is a primary value in US health care. It is assumed that patients want to be fully and directly informed about serious health conditions and want to engage in advance planning about medical care at the end-of-life. Written advance directives and proxy decision-makers are vehicles to promote autonomy when patients are no longer able to represent their wishes. Cross-cultural studies have raised questions about the universal acceptance of these health care values among all ethnicities. In the current investigation, Bosnian immigrants were interviewed about their views of physician-patient communication, advance directives, and locus of decision-making in serious illness. Many of the respondents indicated that they did not want to be directly informed of a serious illness. There was an expressed preference for physician- or family-based health care decisions. Advance directives and formally appointed proxies were typically seen as unnecessary and inconsistent with many respondents' personal values. The findings suggest that the value of individual autonomy and control over the health care decisions may not be applicable to cultures with a collectivist orientation.

  9. Ethical decisions in endof- life care | Norval | Continuing Medical ...

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 21, No 5 (2003) >. Log in or Register to get access to full text downloads.

  10. Audience responses to television news coverage of medical advances: The mediating role of audience emotions and identification.

    Science.gov (United States)

    Hong, Hyehyun

    2015-08-01

    Exemplifying a real person in news stories has become a popular journalistic technique to describe an event or issue. With the frequent appearance of medical news reports in local television in recent years, this news presentation style is widely believed to help audiences better engage in and understand complex medical information and to influence their perceptions and judgments. In terms of television news coverage of medical advances, this study investigates how audiences respond to embedded human examples (mainly patients who experience benefits from the advances) and to overall news stories, and how such responses are related to their perception of portrayed medical advances. The experimental results indicate that news stories with a human example were more likely to intensify the audience's positive emotions than those without, which in turn influenced favorable perceptions of the described medical advance. In addition, the extent to which the audience identified with a human example (in particular, sympathy) mediated the relationship between the audience's involvement in the news story and its perception of the portrayed medical advance. © The Author(s) 2014.

  11. Advancing life cycle economics in the Nordic countries

    DEFF Research Database (Denmark)

    Haugbølle, Kim; Hansen, Ernst Jan de Place

    2005-01-01

    Advancing construction and facilities management requires the ability to estimate and evaluate the economic consequences of decisions in a lifetime perspective. A survey of state-of-the-art on life cycle economics in the Nordic countries showed that, despite a number of similarities, no strong...... that the configuration of the roles as client, owner and user is indicative of a client's interest in life cycle economics. Second, a proposal for a common Nordic cost classification was put forward. Third, it was argued that there is a strong need to develop tools and methodologies to depict the cost/value ratio...

  12. Physical activity, quality of life and medication in aging: differences between age and gender

    Directory of Open Access Journals (Sweden)

    Émerson Sebastião

    2009-01-01

    Full Text Available http://dx.doi.org/10.5007/1980-0037.2009v11n2p210   Studies have shown an inverse relationship between physical activity level (PAL, quality of life (QoL and use of medications in the elderly. The objective of this study was to analyze possible relationships and differences between PAL, QoL and use of medications in the elderly. A total of 192 subjects (≥ 60 years were selected by stratified random sampling according to census sector. The following assessment instruments were used: a Modified Baecke Questionnaire for older adults, b Medical Outcomes Study – 36-Item Short Form Health Survey, and c Sociodemographic and Health Factors Questionnaire. Descriptive statistics and parametric and nonparametric tests were used (p < 0.05. a With respect to chronological age, significant differences between groups were only observed for PAL, with G1 (60-69 years being more active than the other groups. b With respect to gender irrespective of age, analysis showed a difference in QoL and in the number of medications, with men reporting better perceived QoL and using fewer medications. c With respect to gender but considering chronological age, differences in PAL, QoL and medication use were observed between genders for specific age groups. In conclusion, in the elderly a PAL is low, declines even more during advanced age and is higher in men than in women during the first decade of old age, and b men report better perceived QoL and use fewer medications than women.

  13. Law on advance health care directives: a medical perspective.

    Science.gov (United States)

    Di Luca, A; Del Rio, A; Bosco, M; Di Luca, N M

    2018-01-01

    The paper's authors aim to elaborate on law 22 dicembre 2017, n. 219 , designed to regulate informed consent practices and advance health care directives", which has sparked a passionate debate centered on the substantial innovation achieved over the past decades in bio-medical science and at the same time, the noteworthy accomplishments made in enforcing human and personal rights. Within the paper, article three is delved into, which covers the creation of the so-called DAT ("Disposizioni anticipate di trattamento", advance health care directives), by which patients, in light of possible future incapacity to choose, can express their convictions and decisions on how to be treated and their consent or dissent to undergo treatments and procedures, including artificial nutrition and hydration. The authors peruse the new law's provisions through a medical perspective, and observe how they are heavily tilted towards patient choice, thus making doctors little more than mere tools of such decisions.

  14. [From freshmanship to the first "Staatsexamen"--increase of depression and decline in sense of coherence and mental quality of life in advanced medical students].

    Science.gov (United States)

    Burger, Pascal H M; Tektas, Ozan Y; Paulsen, Friedrich; Scholz, Michael

    2014-08-01

    Psychiatric disorders (Burnout, depression, anxiety disorders) are common among medical students with a distinctly higher prevalence compared to the general public. Although medi-cal students show a normal health status at the beginning of their university study period, a deterioration of these aspects in higher semesters is evident and continues when they become residents. In our study ESTRELLAS we examined 530 medical students in the preclinical semesters (1st-4th) before their first "Staatsexamen" with validated psychological questionnaires for depression, anxiety, quality of life and sense of coherence. Students in their 1st semester show normal values like the general public. During the 4 semesters a slow and continuous rise of depressive symptoms and anxiety was detected. Quality of life and sense of coherence constantly deteriorated. An increase of physical symptoms was not detected. In the 4th semester the number of depressive students had already doubled. The development of worsening psychological problems and resulting psychiatric disorders seems to be a continuous process, starting with the beginning of the medical studies and growing continuously during the preclinical semesters. Effect-ive strategies for coping with distress should be integrated in the medical curriculum at universities from the very first semester on. Relaxation techniques could thus be an opportunity. © Georg Thieme Verlag KG Stuttgart · New York.

  15. The Added Value of Medical Testing in Underwriting Life Insurance.

    Directory of Open Access Journals (Sweden)

    Jan Bronsema

    Full Text Available In present-day life-insurance medical underwriting practice the risk assessment starts with a standard health declaration (SHD. Indication for additional medical screening depends predominantly on age and amount of insured capital. From a medical perspective it is questionable whether there is an association between the level of insured capital and medical risk in terms of mortality. The aim of the study is to examine the prognostic value of parameters from the health declaration and application form on extra mortality based on results from additional medical testing.A history register-based cohort study was conducted including about 15.000 application files accepted between 2007 and 2010. Blood pressure, lipids, cotinine and glucose levels were used as dependent variables in logistic regression models. Resampling validation was applied using 250 bootstrap samples to calculate area under the curves (AUC's. The AUC was used to discriminate between persons with and without at least 25% extra mortality.BMI and the overall assessment of the health declaration by an insurance physician or medical underwriter showed the strongest discrimination in multivariable analysis. Including all variables at minimum cut-off levels resulted in an AUC of 0.710 while by using a model with BMI, the assessment of the health declaration and gender, the AUC was 0.708. Including all variables at maximum cut-off levels lead to an AUC of 0.743 while a model with BMI, the assessment of the health declaration and age resulted in an AUC of 0.741.The outcome of this study shows that BMI and the overall assessment of the health declaration were the dominant variables to discriminate between applicants for life-insurance with and without at least 25 percent extra mortality. The variable insured capital set by insurers as factor for additional medical testing could not be established in this study population. The indication for additional medical testing at underwriting life

  16. Impact of medical intervention on stress and quality of life in patients with cancer

    Directory of Open Access Journals (Sweden)

    Vijay Prasad Barre

    2015-01-01

    Full Text Available Context: Many studies have explored stress and quality of life in (QOL patients with cancer, under several phases of disease and treatment. However, the impact of medical intervention on psychological parameters, such as stress and quality of life focusing on psychological intervention has been sparsely studied. Aims: The main aim of the study was to examine the impact of medical intervention on the level of stress and quality of life of patients with lung, breast, and head and neck cancers. Settings and Design: The study was carried out in hospital settings by following a one-group pre-test-post-test pre-experimental design. Statistical analysis used: The quantitative data were analysed by means of descriptive statistics, paired t-tests, Cohen′s d, and bar graphs accordingly. Results: The effect of medical intervention was medium in case of reduction of overall stress in participants. So far as the components are concerned, the effect was high in case of psychosomatic complaints, medium in case of fear and information deficit, and low in case of everyday life restrictions. The effect of medical intervention in respect of the quality of life was found to be high in case of symptom scale (pain and additional symptoms (constipation; medium in case of functional scale (emotional functioning, cognitive functioning and symptoms scale (nausea, vomiting. In additional symptoms scale the effect of medical intervention was found to be medium in dyspnoea and appetite loss. Conclusions: The findings revealed that though the medical intervention reduced stress and improved the quality of life, it was not instrumental in bringing down the stress to minimal level and enhancing the quality of life to optimum level. Therefore, the findings point to the need of inclusion of psychological intervention along with the medical intervention for minimizing stress and optimizing the quality of life of patients with cancer.

  17. Advanced aircraft service life monitoring method via flight-by-flight load spectra

    Science.gov (United States)

    Lee, Hongchul

    This research is an effort to understand current method and to propose an advanced method for Damage Tolerance Analysis (DTA) for the purpose of monitoring the aircraft service life. As one of tasks in the DTA, the current indirect Individual Aircraft Tracking (IAT) method for the F-16C/D Block 32 does not properly represent changes in flight usage severity affecting structural fatigue life. Therefore, an advanced aircraft service life monitoring method based on flight-by-flight load spectra is proposed and recommended for IAT program to track consumed fatigue life as an alternative to the current method which is based on the crack severity index (CSI) value. Damage Tolerance is one of aircraft design philosophies to ensure that aging aircrafts satisfy structural reliability in terms of fatigue failures throughout their service periods. IAT program, one of the most important tasks of DTA, is able to track potential structural crack growth at critical areas in the major airframe structural components of individual aircraft. The F-16C/D aircraft is equipped with a flight data recorder to monitor flight usage and provide the data to support structural load analysis. However, limited memory of flight data recorder allows user to monitor individual aircraft fatigue usage in terms of only the vertical inertia (NzW) data for calculating Crack Severity Index (CSI) value which defines the relative maneuver severity. Current IAT method for the F-16C/D Block 32 based on CSI value calculated from NzW is shown to be not accurate enough to monitor individual aircraft fatigue usage due to several problems. The proposed advanced aircraft service life monitoring method based on flight-by-flight load spectra is recommended as an improved method for the F-16C/D Block 32 aircraft. Flight-by-flight load spectra was generated from downloaded Crash Survival Flight Data Recorder (CSFDR) data by calculating loads for each time hack in selected flight data utilizing loads equations. From

  18. Allowing Family to be Family: End-of-Life Care in Veterans Affairs Medical Foster Homes.

    Science.gov (United States)

    Manheim, Chelsea E; Haverhals, Leah M; Jones, Jacqueline; Levy, Cari R

    2016-01-01

    The Medical Foster Home program is a unique long-term care program coordinated by the Veterans Health Administration. The program pairs Veterans with private, 24-hour a day community-based caregivers who often care for Veterans until the end of life. This qualitative study explored the experiences of care coordination for Medical Foster Home Veterans at the end of life with eight Veterans' family members, five Medical Foster Home caregivers, and seven Veterans Health Administration Home-Based Primary Care team members. A case study, qualitative content analysis identified these themes addressing care coordination and impact of the Medical Foster Home model on those involved: (a) Medical Foster Home program supports Veterans' families; (b) Medical Foster Home program supports the caregiver as family; (c) Veterans' needs are met socially and culturally at the end of life; and (d) the changing needs of Veterans, families, and caregivers at Veterans' end of life are addressed. Insights into how to best support Medical Foster Home caregivers caring for Veterans at the end of life were gained including the need for more and better respite options and how caregivers are compensated in the month of the Veteran's death, as well as suggestions to navigate end-of-life care coordination with multiple stakeholders involved.

  19. Advanced Composite Air Frame Life Cycle Cost Estimating

    Science.gov (United States)

    2014-06-19

    the ACCA based on the cost . This cost analysis takes into account the increased performance parameters of the new airframe structure. This research...20 Advanced Composite Cargo Aircraft ( ACCA ) ..........................................................23 viii Cost Estimation...establishing the procurement strategies and life cycle cost (LCC) model cost estimations. The current LCC models do not take into account the potential cost

  20. Geographic Medical History: Advances in Geospatial Technology Present New Potentials in Medical Practice

    Science.gov (United States)

    Faruque, F. S.; Finley, R. W.

    2016-06-01

    Genes, behaviour, and the environment are known to be the major risk factors for common diseases. When the patient visits a physician, typical questions include family history (genes) and lifestyle of the patient (behaviour), but questions concerning environmental risk factors often remain unasked. It is ironic that 25 centuries ago Hippocrates, known as the father of medicine, noted the importance of environmental exposure in medical investigation as documented in his classic work, "Airs, Waters, Places", yet the practice of routinely incorporating environmental risk factors is still not in place. Modern epigenetic studies have found that unhealthy lifestyle and environmental factors can cause changes to our genes that can increase disease risk factors. Therefore, attempting to solve the puzzle of diseases using heredity and lifestyle alone will be incomplete without accounting for the environmental exposures. The primary reason why environmental exposure has not yet been a routine part of the patient's medical history is mostly due to our inability to provide clinicians useful measures of environmental exposures suitable for their clinical practices. This presentation will discuss advances in geospatial technology that show the potential to catalyse a paradigm shift in medical practice and health research by allowing environmental risk factors to be documented as the patient's "Geographic Medical History". In order to accomplish this we need information on: a) relevant spatiotemporal environmental variables, and b) location of the individual in that person's dynamic environment. Common environmental agents that are known to interact with genetic make-up include air pollutants, mold spores, pesticides, etc. Until recently, the other component, location of an individual was limited to a static representation such as residential or workplace location. Now, with the development of mobile technology, changes in an individual's location can be tracked in real time if

  1. GEOGRAPHIC MEDICAL HISTORY: ADVANCES IN GEOSPATIAL TECHNOLOGY PRESENT NEW POTENTIALS IN MEDICAL PRACTICE

    Directory of Open Access Journals (Sweden)

    F. S. Faruque

    2016-06-01

    Full Text Available Genes, behaviour, and the environment are known to be the major risk factors for common diseases. When the patient visits a physician, typical questions include family history (genes and lifestyle of the patient (behaviour, but questions concerning environmental risk factors often remain unasked. It is ironic that 25 centuries ago Hippocrates, known as the father of medicine, noted the importance of environmental exposure in medical investigation as documented in his classic work, “Airs, Waters, Places”, yet the practice of routinely incorporating environmental risk factors is still not in place. Modern epigenetic studies have found that unhealthy lifestyle and environmental factors can cause changes to our genes that can increase disease risk factors. Therefore, attempting to solve the puzzle of diseases using heredity and lifestyle alone will be incomplete without accounting for the environmental exposures. The primary reason why environmental exposure has not yet been a routine part of the patient’s medical history is mostly due to our inability to provide clinicians useful measures of environmental exposures suitable for their clinical practices. This presentation will discuss advances in geospatial technology that show the potential to catalyse a paradigm shift in medical practice and health research by allowing environmental risk factors to be documented as the patient’s “Geographic Medical History”. In order to accomplish this we need information on: a relevant spatiotemporal environmental variables, and b location of the individual in that person’s dynamic environment. Common environmental agents that are known to interact with genetic make-up include air pollutants, mold spores, pesticides, etc. Until recently, the other component, location of an individual was limited to a static representation such as residential or workplace location. Now, with the development of mobile technology, changes in an individual’s location

  2. Embracing a broad spirituality in end of life discussions and advance care planning.

    Science.gov (United States)

    Churchill, Larry R

    2015-04-01

    Advance care planning for end of life typically focuses on the mechanics of completing living wills and durable power of attorney documents. Even when spiritual aspects of end of life care are discussed, the dominant assumptions are those of traditional religious systems. A broad view of spirituality is needed, one that may involve traditional religious beliefs but also includes personal understandings of what is holy or sacred. Embracing this broad practice of spirituality will help both familial and professional caregivers honor an essential aspect of end of life discussions and promote greater discernment of the deep meaning in advance care documents.

  3. Advances in through-life engineering services

    CERN Document Server

    Roy, Rajkumar; Shaw, Andy

    2017-01-01

    This edited book offers further advances, new perspectives, and developments from world leaders in the field of through-life engineering services (TES). It builds up on the earlier book by the same authors entitled: “Through-life Engineering Services: Motivation, Theory and Practice.” This compendium introduces and discusses further, the developments in workshop-based and 'in situ' maintenance and support of high-value engineering products, as well as the application of drone technology for autonomous and self-healing product support. The links between ‘integrated planning’ and planned obsolescence, risk and cost modelling are also examined. The role of data, information, and knowledge management relative to component and system degradation and failure is also presented. This is supported by consideration of the effects upon the maintenance and support decision by the presence of 'No Fault Found' error signals within system data. Further to this the role of diagnostics and prognostics is also discusse...

  4. Spirituality, depression and quality of life in medical students in KwaZulu-Natal

    Directory of Open Access Journals (Sweden)

    Narushni Pillay

    2016-03-01

    Full Text Available Background: The majority of studies on spirituality demonstrate its positive association with mental health. Despite the increasing number of studies, there remains a dearth of studies emanating from African countries looking at the relationship between mental illness, quality of life and measures of spirituality. The present study evaluates the role of spirituality in relation to current depression and quality of life in medical students, who are known to be at high risk for depression. Objectives: The aim of this study was to determine the prevalence of moderate and severe depressive symptoms in this population and explore potential correlations between spirituality, depression and quality of life. Methods: 230 medical students were surveyed at the University of KwaZulu-Natal Medical School, using the Zung Self-Rating Depression Scale (Zung SDS, Spiritual Involvement and Beliefs Scale (SIBS, WHO Quality of Life Scale (WHOQOL and a demographic data sheet. Results: There was a high prevalence of depressive symptoms in the medical students, with a significant proportion (15.6% showing evidence of severe depressive symptoms (indicating likely depressive illness. Those with a history of mental illness or of having attended traditional, complementary or alternate medical practitioners showed higher levels of depression. Lower spirituality was associated with non-adherence to a major religion and a history of mental illness. Quality of life was better in second and fifth year students and poorer in those with a history of mental illness. Conclusion: Medical students’ experiences of depression (most probably due to stress and its relationship with spirituality and quality of life merit further investigation with a view to establishing policy guidelines for dealing with this issue.

  5. Encountering Challenges with the EU Regulation on Advance Therapy Medical Products.

    Science.gov (United States)

    Mansnérus, Juli

    2015-12-01

    This article aims at analysing how well the Advanced Therapy Medical Product Regulation (EC) No. 1394/2007 (ATMP Regulation) meets the needs of small and medium-sized enterprises (SMES), academia and public tissue establishments developing advanced therapy medical products (ATMPS). Benefits and shortcomings of the ATMP Regulation are identified, and possible amendments are proposed to accelerate the translation of research into advanced therapies and to facilitate the commercialisation of ATMPS whilst ensuring safety. It was set up as a lex specialis to ensure the free movement of ATMPS within the EU in order to facilitate their access to the internal market and to foster the competitiveness of European pharmaceutical companies, while guaranteeing the highest level protection of public health. Since the adoption of the ATMP Regulation in late 2008, only 5 ATMPS have been granted marketing authorisations thus far. Hence, there is a need to analyse whether the ATMP Regulation meets its objectives.

  6. The current format and ongoing advances of medical education in the United States.

    Science.gov (United States)

    Gishen, Kriya; Ovadia, Steven; Arzillo, Samantha; Avashia, Yash; Thaller, Seth R

    2014-01-01

    The objective of this study was to examine the current system of medical education along with the advances that are being made to support the demands of a changing health care system. American medical education must reform to anticipate the future needs of a changing health care system. Since the dramatic transformations to medical education that followed the publication of the Flexner report in 1910, medical education in the United States has largely remained unaltered. Today, the education of future physicians is undergoing modifications at all levels: premedical education, medical school, and residency training. Advances are being made with respect to curriculum design and content, standardized testing, and accreditation milestones. Fields such as plastic surgery are taking strides toward improving resident training as the next accreditation system is established. To promote more efficacious medical education, the American Medical Association has provided grants for innovations in education. Likewise, the Accreditation Council for Graduate Medical Education outlined 6 core competencies to standardize the educational goals of residency training. Such efforts are likely to improve the education of future physicians so that they are able to meet the future needs of American health care.

  7. Frontier of Advanced Accelerator Applications and Medical Treatments Using Nuclear Techniques. Abstract

    International Nuclear Information System (INIS)

    2015-01-01

    To address the challenges of research-based practice, developing advanced accelerator applications, and medical treatments using nuclear tecniqoes, researchers from Rajamakala University of Technology Lanna, Office of Atoms for Peace, and Chiang Mai University have joined in hosting this conference. Nuclear medicine, amedical specialty, diagnoses and treats diseases in a safe and painless way. Nuclear techniques can determine medical information that may otherwise be unavailable, require surgery, or necessitate more expensive and invasive diagnostic tests. Advance in nuclear techniques also offer the potential to detect abnormalities at earlier stages, leasding to earlier treatment and a more successful prognosis.

  8. IOMP - Challenges for advancing medical physic globally

    International Nuclear Information System (INIS)

    Nusslin, F.

    2010-01-01

    IOMP stands for International Organization for Medical Physics. The determinants of health care include; science, research, academia, education, technology, engineering, industry, politics, economic, society, ethics, culture and medicine. However, physics and engineering are the driving forces of progress in health care. Medical Physics is a branch of Applied Physics, pursued by medical physicists, which uses physics principles, methods and techniques in practice and research for the prevention, diagnosis and treatment of human diseases with a specific goal of improving human health and well-being. How can we achieve Health Care improvement through Medical Physics globally? By forming international alliances in the Medical Physics community to develop and implement coherent concepts of • Appropriate University / Hospital Structures • Education & Training and Certification Schemes • Research & Development Platforms • Professional Career Development • International Cooperation within the Science Community IOMP represents ca. 18.000 medical physicists worldwide, it is affiliated to 80 national member organizations, six regional organizations as Members plus Corporate Members. The mission of IOMP is to advance medical physics practice worldwide by disseminating scientific and technical information, fostering the educational and professional development of medical physics and promoting the highest quality medical services for patients. 6 Medical physicists are professionals with education and specialist training in the concepts and techniques of applying physics in medicine. They work in clinical, academic or research institutions. Challenges, Efforts and Achievements of the International Organization for Medical Physics Recognition of the Medical Physics profession by the National Health Authorities. Medical Physicists are essential to ensure adequate and safe use of radiation equipment, Radiation Protection of patients, workers and public in a clinical

  9. Perspectives on the value of advanced medical imaging: a national survey of primary care physicians.

    Science.gov (United States)

    Hughes, Christine M; Kramer, Erich; Colamonico, Jennifer; Duszak, Richard

    2015-05-01

    To understand perceptions of primary care physicians (PCPs) about the value of advanced medical imaging. A national quantitative survey of 500 PCPs was conducted using an online self-administered questionnaire. Questions focused on advanced medical imaging (CT, MRI, and PET) and its perceived impact on the delivery of patient care. Responses were stratified by physician demographics. Large majorities of the PCPs indicated that advanced imaging increases their diagnostic confidence (441; 88%); provides data not otherwise available (451; 90%); permits better clinical decision making (440; 88%); increases confidence in treatment choices (438; 88%), and shortens time to definitive diagnosis (430; 86%]). Most (424; 85%) believe that patient care would be negatively affected without access to advanced imaging. PCPs whose clinical careers predated the proliferation of advanced imaging modalities (>20 years of practice) assigned higher value to advanced imaging on several dimensions compared with younger physicians whose training overlapped widespread technology availability. By a variety of metrics, large majorities of PCPs believe that advanced medical imaging provides considerable value to patient care. Those whose careers predated the widespread availability of advanced imaging tended to associate it with even higher value. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  10. Satisfaction with life and depression among medical students in Auckland, New Zealand.

    Science.gov (United States)

    Samaranayake, Chinthaka B; Fernando, Antonio T

    2011-08-26

    The aim of this study was to assess the satisfaction with life among undergraduate medical and other students in Auckland and identify associations with depression and anxiety disorders. The study was conducted at The University of Auckland, New Zealand in 2008 and 2009. The sample population was derived from five undergraduate classes in four courses (medicine (two classes), nursing, health science and architecture). A battery of questionnaires including the Satisfaction with Life Scale (SWLS), Patient Health Questionnaire (PHQ) for depression and Generalised Anxiety Disorder Questionnaire (GAD) were administered to the cohort. Subgroup analysis between medical and other students were also carried out. A total of 778 students were eligible, and 594 (76.4%) students (255 medical, 208 health science, 36 nursing and 95 architecture) completed the questionnaire. The median age was 20 years (range 17-45) and women represented 67.2% (n=399) of the total group. The mean SWLS score for the total group was 24.9 (SD 6.4), with medical students on average having higher satisfaction with life compared to other students. The rate of depression (PHQ = 10) and anxiety (GAD score = 8) among medical students was 16.9% (95% CI 12.2-21.5) and 13.7% (95%CI 9.5-18.0) respectively. Female students had higher rates of depression and anxiety compared to males. A statistically significant moderate correlation between SWLS score and PHQ score [r = -0.37 (pstudents are more satisfied with life compared to other students. A significant proportion of students surveyed in this study have clinically significant depression and anxiety. Promoting positive wellbeing and improving satisfaction with life may enhance the quality of life as well as the social and academic performance of university students.

  11. Premenstrual syndrome in Turkish medical students and their quality of life.

    Science.gov (United States)

    Goker, A; Artunc-Ulkumen, B; Aktenk, F; Ikiz, N

    2015-04-01

    This study aimed to analyse the frequency and symptoms of premenstrual syndrome (PMS) and its effect on quality of life in medical students. Sociodemographic data, a symptom calendar for the following consecutive two menstrual periods and SF-36 quality of life questionnaire were collected. A total of 228 students joined the survey. The average age of the students was 20.77 ± 1.90. The frequency of PMS was 91.8%. The most frequent symptoms were abdominal bloating (89.5%), irritability (88.3%) and breast tenderness (82.6%). Quality of life scores ranged from 17.00 to 97.00 and were lowest in the severe PMS group. Alcohol consumption, stress events and fat rich diets increased the severity of PMS. Family history significantly affected the severity of PMS and quality of life scores. Premenstrual syndrome was found to be a frequent entity among medical students and seemed to affect quality of life in a moderate way.

  12. Health technology assessment to improve the medical equipment life cycle management.

    Science.gov (United States)

    Margotti, Ana E; Ferreira, Filipa B; Santos, Francisco A; Garcia, Renato

    2013-01-01

    Health technology assessment (HTA) is a tool to support decision making that is intended to assist healthcare managers in their strategic decisions. The use of HTA as a tool for clinical engineering is especially relevant in the domain of the medical equipment once it could improve the performance of the medical equipment. It would be done by their systematically evaluation in several aspects, in their life cycle. In Brazil, the Institute of Biomedical Engineering (IEB-UFSC) through the clinical engineering area has been working on the development of methodologies and improvements on HTA for medical equipment. Therefore, this paper presents the effort to create specific methodologies that will improve the dissemination of HTA, focusing on incorporation and utilization phase of the medical equipment life cycle. This will give a better support to the decision makers in the management of the health care system.

  13. Considering Intermittent Dormancy in an Advanced Life Support Systems Architecture

    Science.gov (United States)

    Sargusingh, Miriam J.; Perry, Jay L.

    2017-01-01

    Many advanced human space exploration missions being considered by the National Aeronautics and Space Administration (NASA) include concepts in which in-space systems cycle between inhabited and uninhabited states. Managing the life support system (LSS) may be particularly challenged during these periods of intermittent dormancy. A study to identify LSS management challenges and considerations relating to dormancy is described. The study seeks to define concepts suitable for addressing intermittent dormancy states and to evaluate whether the reference LSS architectures being considered by the Advanced Exploration Systems (AES) Life Support Systems Project (LSSP) are sufficient to support this operational state. The primary focus of the study is the mission concept considered to be the most challenging-a crewed Mars mission with an extensive surface stay. Results from this study are presented and discussed.

  14. Self-reported extracurricular activity, academic success, and quality of life in UK medical students.

    Science.gov (United States)

    Lumley, Sophie; Ward, Peter; Roberts, Lesley; Mann, Jake P

    2015-09-19

    To explore the relationship between academic performance, extracurricular activity, and quality of life at medical school in the UK to aid our understanding of students' work-life balance. A cross-sectional study, using an electronic questionnaire distributed to UK final year medical students across 20 medical schools (4478 students). Participants reported the hours of self-regulated learning and extracurricular activities undertaken each year at medical school; along with their academic decile (1 = highest, 10 = lowest). Self-reported quality of life (QoL) was assessed using an established screening tool (7 = highest, 1 = lowest). Seven hundred responses were obtained, across 20 participating medical schools, response rate 16% (700/4478). Factors associated with higher academic achievement were: graduate entry course students (2 deciles higher, p students attain higher decile scores despite similar self-reported duration of study.

  15. Assessment of life skills of medical students in Mashhad, Iran, in 2015.

    Science.gov (United States)

    Rezayat, Arash Akhavan; Niroumand, Shabnam; Shiehzadeh, Elham; Saghebi, Ali; Oskooie, Reza Rahimzadeh; Dadgarmoghaddam, Maliheh

    2017-10-01

    Developing social skills and mental health is a crucial part of the psychosocial health status of medical students. The aim of this study was to assess the life skills of medical students in Mashhad University of Medical Sciences (MUMS). This cross-sectional study was performed in Mashhad University of Medical Sciences, Iran in 2015. By census method, 146 interns were entered into the study. The life skill questionnaire, consisting of 144 questions, was used as the measurement tool. Over 3 months, all the medical students in internship period were asked to complete the questionnaire. Data were analyzed by independent-samples t-test, one-way ANOVA, and Mann-Whitney with SPSS version 11.5 software. Women were shown to have higher decision-making ability than men (p=0.046). It was also shown in the study that social behavior (p=0.018), participation in activities that improve benefits (p=0.006), critical thinking (p=0.007), observing and using safety points (p=0.005), and mental health status (p=0.034) were significantly lower in men than in women. The data also suggests that men (13.97±4.7249) are more likely to become global citizens than women (12.15±3.6298) (p=0.010). Furthermore, there was a significant difference when comparing smoking and non-smoking in freedom and justice (p=0.003) and becoming a global citizen (p=0.012). Our study provides helpful information about medical students' life skills for policy makers and university authorities. We suggest that gender differences should be considered during life skill training.

  16. Social and medical determinants of quality of life and life satisfaction in women with Turner syndrome.

    Science.gov (United States)

    Jeż, Wacław; Tobiasz-Adamczyk, Beata; Brzyski, Piotr; Majkowicz, Mikołaj; Pankiewicz, Piotr; Irzyniec, Tomasz J

    2018-02-01

    Turner syndrome (TS) appears in women as a result of the lack of part or the whole of one of the X chromosomes. It is characterized by the occurrence of low height, hypogonadism, numerous developmental defects, and is often accompanied by psychological disturbances. Although the phenotype characteristics of women with TS are quite well documented, the knowledge of the impact of Turner syndrome on the satisfaction with life is still insufficient. The aim of our study was to assess the impact of TS on selected variables of quality of life, and hence also life satisfaction in women with this syndrome. The research was carried out in a group of 176 women with TS starting March 1995. The patients underwent anthropological and medical examinations, and their medical histories were taken using a questionnaire that included demographic and psychosocial items as well as issues related to selected variables of quality of life. In our research model, general life satisfaction was a dependent variable. The statistical analysis was conducted using the eta and Cramer's V correlation coefficients as well as a multidimensional logistic regression model. The main determinants of dissatisfaction with life in women with TS were short stature and feelings of loneliness and being handicapped. The determinants of life satisfaction in women with Turner syndrome were closely related to the private life of the study participants, in particular self-perception and feelings concerning their health status.

  17. 76 FR 71982 - Advancing Regulatory Science for Highly Multiplexed Microbiology/Medical Countermeasure Devices...

    Science.gov (United States)

    2011-11-21

    ... Multiplexed Microbiology Devices: Their clinical application and public health/clinical needs; inclusion of...] Advancing Regulatory Science for Highly Multiplexed Microbiology/ Medical Countermeasure Devices; Public... Multiplexed Microbiology/ Medical Countermeasure Devices'' that published in the Federal Register of August 8...

  18. Image analysis and modeling in medical image computing. Recent developments and advances.

    Science.gov (United States)

    Handels, H; Deserno, T M; Meinzer, H-P; Tolxdorff, T

    2012-01-01

    Medical image computing is of growing importance in medical diagnostics and image-guided therapy. Nowadays, image analysis systems integrating advanced image computing methods are used in practice e.g. to extract quantitative image parameters or to support the surgeon during a navigated intervention. However, the grade of automation, accuracy, reproducibility and robustness of medical image computing methods has to be increased to meet the requirements in clinical routine. In the focus theme, recent developments and advances in the field of modeling and model-based image analysis are described. The introduction of models in the image analysis process enables improvements of image analysis algorithms in terms of automation, accuracy, reproducibility and robustness. Furthermore, model-based image computing techniques open up new perspectives for prediction of organ changes and risk analysis of patients. Selected contributions are assembled to present latest advances in the field. The authors were invited to present their recent work and results based on their outstanding contributions to the Conference on Medical Image Computing BVM 2011 held at the University of Lübeck, Germany. All manuscripts had to pass a comprehensive peer review. Modeling approaches and model-based image analysis methods showing new trends and perspectives in model-based medical image computing are described. Complex models are used in different medical applications and medical images like radiographic images, dual-energy CT images, MR images, diffusion tensor images as well as microscopic images are analyzed. The applications emphasize the high potential and the wide application range of these methods. The use of model-based image analysis methods can improve segmentation quality as well as the accuracy and reproducibility of quantitative image analysis. Furthermore, image-based models enable new insights and can lead to a deeper understanding of complex dynamic mechanisms in the human body

  19. Quantifying quality of life and disability of patients with advanced schistosomiasis japonica.

    Directory of Open Access Journals (Sweden)

    Tie-Wu Jia

    Full Text Available BACKGROUND: The Chinese government lists advanced schistosomiasis as a leading healthcare priority due to its serious health and economic impacts, yet it has not been included in the estimates of schistosomiasis burden in the Global Burden of Disease (GBD study. Therefore, the quality of life and disability weight (DW for the advanced cases of schistosomiasis japonica have to be taken into account in the re-estimation of burden of disease due to schistosomiasis. METHODOLOGY/PRINCIPAL FINDINGS: A patient-based quality-of-life evaluation was performed for advanced schistosomiasis japonica. Suspected or officially registered advanced cases in a Schistosoma japonicum-hyperendemic county of the People's Republic of China (P.R. China were screened using a short questionnaire and physical examination. Disability and morbidity were assessed in confirmed cases, using the European quality of life questionnaire with an additional cognitive dimension (known as the "EQ-5D plus", ultrasonography, and laboratory testing. The age-specific DW of advanced schistosomiasis japonica was estimated based on patients' self-rated health scores on the visual analogue scale of the questionnaire. The relationships between health status, morbidity and DW were explored using multivariate regression models. Of 506 candidates, 215 cases were confirmed as advanced schistosomiasis japonica and evaluated. Most of the patients reported impairments in at least one health dimension, such as pain or discomfort (90.7%, usual activities (87.9%, and anxiety or depression (80.9%. The overall DW was 0.447, and age-specific DWs ranged from 0.378 among individuals aged 30-44 years to 0.510 among the elderly aged ≥ 60 years. DWs are positively associated with loss of work capacity, psychological abnormality, ascites, and active hepatitis B virus, while splenectomy and high albumin were protective factors for quality of life. CONCLUSIONS/SIGNIFICANCE: These patient-preference disability

  20. Advanced maternal age: ethical and medical considerations for assisted reproductive technology

    Directory of Open Access Journals (Sweden)

    Harrison BJ

    2017-08-01

    Full Text Available Brittany J Harrison,1 Tara N Hilton,1 Raphaël N Rivière,1 Zachary M Ferraro,1–3 Raywat Deonandan,4 Mark C Walker1–3,51Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; 2Division of Maternal-Fetal Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; 3Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada; 4University of Ottawa Interdisciplinary School of Health Sciences, Ottawa, ON, Canada; 5Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON, CanadaObjectives: This review explores the ethical and medical challenges faced by women of advanced maternal age who decide to have children. Assisted reproductive technologies (ARTs make post-menopausal pregnancy physiologically plausible, however, one must consider the associated physical, psychological, and sociological factors involved.Methods: A quasi-systematic review was conducted in PubMed and Ovid using the key terms post-menopause, pregnancy + MeSH terms [donations, hormone replacement therapy, assisted reproductive technologies, embryo donation, donor artificial insemination, cryopreservation]. Overall, 28 papers encompassing two major themes (ethical and medical were included in the review.Conclusion: There are significant ethical considerations and medical (maternal and fetal complications related to pregnancy in peri- and post-menopausal women. When examining the ethical and sociological perspective, the literature portrays an overall positive attitude toward pregnancy in advanced maternal age. With respect to the medical complications, the general consensus in the evaluated studies suggests that there is greater risk of complication for spontaneous pregnancy when the mother is older (eg, >35 years old. This risk can be mitigated by careful medical screening of the mother and the use of ARTs in healthy women. In these instances, a woman of advanced maternal age who is otherwise healthy can carry a

  1. Canadians' support for radical life extension resulting from advances in regenerative medicine.

    Science.gov (United States)

    Dragojlovic, Nick

    2013-04-01

    This paper explores Canadian public perceptions of a hypothetical scenario in which a radical increase in life expectancy results from advances in regenerative medicine. A national sample of 1231 adults completed an online questionnaire on stem cell research and regenerative medicine, including three items relating to the possibility of Canadians' average life expectancy increasing to 120 years by 2050. Overall, Canadians are strongly supportive of the prospect of extended lifespans, with 59% of the sample indicating a desire to live to 120 if scientific advances made it possible, and 47% of respondents agreeing that such increases in life expectancy are possible by 2050. The strongest predictors of support for radical life extension are individuals' general orientation towards science and technology and their evaluation of its plausibility. These results contrast with previous research, which has suggested public ambivalence for biomedical life extension, and point to the need for more research in this area. They suggest, moreover, that efforts to increase public awareness about anti-aging research are likely to increase support for the life-extending consequences of that research program. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. Interrelationships between romance, life quality, and medical training of female residents

    Directory of Open Access Journals (Sweden)

    Yu-Jung Wang

    2012-08-01

    Conclusion: Romance and quality of life were significantly influenced by the pattern of medical training in female residents. Setting duty-hour limits and initiating a new hobby were determined to be potentially beneficial to their quality of life and attitudes toward romance.

  3. Factors influencing the quality of life of patients with advanced cancer.

    Science.gov (United States)

    Park, Sun-A; Chung, Seung Hyun; Lee, Youngjin

    2017-02-01

    The present study aimed to determine the predictors of quality of life (QOL) of patients with advanced cancer. A cross-sectional study involving 494 patients with advanced cancer was conducted using the Memorial Symptom Assessment Scale-Short Form, the Karnofsky Performance Status Scale, the World Health Organization Disability Assessment Schedule (Korean version), and the European Organization for Research and Treatment of Cancer Quality of Life Core 30. Regression analyses showed that physical and psychological symptoms significantly predicted the patients' QOL and explained 28.8% of the variance in QOL. Moreover, lack of energy was the patients' most prevalent symptom. The results of the present study will serve as fundamental data upon which the development of an intervention will be based so as to enhance the patients' QOL. Accordingly, an effective management of symptoms and performance maintenance should be considered in the future as key factors in providing support and establishing palliative care systems for patients with advanced cancer. Copyright © 2016. Published by Elsevier Inc.

  4. End of life care preferences among people of advanced age: LiLACS NZ.

    Science.gov (United States)

    Gott, Merryn; Frey, Rosemary; Wiles, Janine; Rolleston, Anna; Teh, Ruth; Moeke-Maxwell, Tess; Kerse, Ngaire

    2017-12-19

    Understanding end of life preferences amongst the oldest old is crucial to informing appropriate palliative and end of life care internationally. However, little has been reported in the academic literature about the end of life preferences of people in advanced age, particularly the preferences of indigenous older people, including New Zealand Māori. Data on end of life preferences were gathered from 147 Māori (aged >80 years) and 291 non- Māori aged (>85 years), during three waves of Te Puawaitangi O Nga Tapuwae Kia Ora Tonu, Life and Living in Advanced Age (LiLACs NZ). An interviewer-led questionnaire using standardised tools and including Māori specific subsections was used. The top priority for both Māori and non-Māori participants at end of life was 'not being a burden to my family'. Interestingly, a home death was not a high priority for either group. End of life preferences differed by gender, however these differences were culturally contingent. More female Māori participants wanted spiritual practices at end of life than male Māori participants. More male non-Māori participants wanted to be resuscitated than female non- Māori participants. That a home death was not in the top three end of life priorities for our participants is not consistent with palliative care policy in most developed countries where place of death, and particularly home death, is a central concern. Conversely our participants' top concern - namely not being a burden - has received little research or policy attention. Our results also indicate a need to pay attention to diversity in end of life preferences amongst people of advanced age, as well as the socio-cultural context within which preferences are formulated.

  5. Parental perspectives on suffering and quality of life at end-of-life in children with advanced heart disease: an exploratory study*.

    Science.gov (United States)

    Blume, Elizabeth D; Balkin, Emily Morell; Aiyagari, Ranjit; Ziniel, Sonja; Beke, Dorothy M; Thiagarajan, Ravi; Taylor, Laura; Kulik, Thomas; Pituch, Kenneth; Wolfe, Joanne

    2014-05-01

    To describe parent perspectives regarding the end-of-life experience of children with advanced heart disease. Cross-sectional multicenter survey study of bereaved parents. Two tertiary care pediatric hospitals. Parents of children younger than 21 years with primary cardiac diagnoses who died in the hospital 9 months to 4 years before the survey date. Parents were excluded if they were non-English speakers or had previously denied permission to contact. The Survey for Caring for Children with Advanced Heart Disease was developed, piloted, and then sent to parents of all children who died at two sites. Fifty bereaved parents responded (39% response rate) a mean of 2.7 years after their child's death. Median age at death was 6 months (3.6 d to 20.4 yr). At end-of-life, 86% of children were intubated and 46% were receiving mechanical circulatory support. Seventy-eight percent died during withdrawal of life-sustaining interventions and 16% during resuscitative efforts. Parents realized that their child had no realistic chance of survival a median of 2 days prior to death (0-30 d). According to parents, 47% of children suffered "a great deal," "a lot," or "somewhat" during the end-of-life period. The symptoms parents perceived to be causing the most suffering were breathing and feeding difficulties in children under 2 years and fatigue and sleeping difficulties in older children. Seventy-one percent of parents described the quality of life of their child during the last month of life as "poor" or "fair." Most parents (84%) described the quality of care delivered as "very good" or "excellent." According to their parents, many children with advanced heart disease experience suffering in the end-of-life care period. For most, realization that their child has no realistic chance of survival does not occur until late, some not until death is imminent. Once this realization occurs, however, parents perceive peacefulness, a "good death," and excellent quality of care

  6. [Current recommendations for basic/advanced life support : Addressing unanswered questions and future prospects].

    Science.gov (United States)

    Fink, K; Schmid, B; Busch, H-J

    2016-11-01

    The revised guidelines for cardiopulmonary resuscitation were implemented by the European Resuscitation Council (ERC) in October 2015. There were few changes concerning basic and advanced life support; however, some issues were clarified compared to the ERC recommendations from 2010. The present paper summarizes the procedures of basic and advanced life support according to the current guidelines and highlights the updates of 2015. Furthermore, the article depicts future prospects of cardiopulmonary resuscitation that may improve outcome of patients after cardiac arrest in the future.

  7. Hospital policies on life-sustaining treatments and advance directives in Canada.

    OpenAIRE

    Rasooly, I; Lavery, J V; Urowitz, S; Choudhry, S; Seeman, N; Meslin, E M; Lowy, F H; Singer, P A

    1994-01-01

    OBJECTIVE: To determine the prevalence and content of hospital policies on life-sustaining treatments (cardiopulmonary resuscitation [CPR], mechanical ventilation, dialysis, artificial nutrition and hydration, and antibiotic therapy for life-threatening infections) and advance directives in Canada. DESIGN: Cross-sectional mailed survey. SETTING: Canada. PARTICIPANTS: Chief executive officers or their designates at public general hospitals. MAIN OUTCOME MEASURES: Information regarding the exis...

  8. Advancing palliative and end-of-life science in cardiorespiratory populations: The contributions of nursing science.

    Science.gov (United States)

    Grady, Patricia A

    Nursing science has a critical role to inform practice, promote health, and improve the lives of individuals across the lifespan who face the challenges of advanced cardiorespiratory disease. Since 1997, the National Institute of Nursing Research (NINR) has focused attention on the importance of palliative and end-of-life care for advanced heart failure and advanced pulmonary disease through the publication of multiple funding opportunity announcements and by supporting a cadre of nurse scientists that will continue to address new priorities and future directions for advancing palliative and end-of-life science in cardiorespiratory populations. Published by Elsevier Inc.

  9. SOCIO-CULTURAL AND MEDICAL INDICATORS OF THE SCHOOLCHILDREN'S QUALITY OF LIFE

    Directory of Open Access Journals (Sweden)

    Slobodanka Bašić

    2003-01-01

    Full Text Available An estimate of life quality is based upon medical, psychological and social indicators. It increasingly engages the attention of doctors of medicine, sociologists and psychologists.The aim of this research is to headlight some more relevant socio-cultural parametres in order to determine the quality of life of schoolchildren, that is, to determine whether the crisis in which our society has found itself has produced such socio-cultural conditions that could have induced changes in the children's quality of life and, if they have, to what extent the crisis has been reflected upon their health. The research has comprised 398 schoolchildren and their parents, three elementary schools from Nish and one in Sokobanja.The research of the socio-cultural and medical indicators of their quality of life has shown that the parent's education and ther material position have had an important influence upon the children's life quality.Since there has been no significant presence of any disease recorded in the observed children's sample, it can be concluded that the socio-cultural features have affected the children's life but they have not any significant impact upon their health.

  10. 41 CFR 102-36.460 - Do we report excess medical shelf-life items held for national emergency purposes?

    Science.gov (United States)

    2010-07-01

    ... medical shelf-life items held for national emergency purposes? 102-36.460 Section 102-36.460 Public... Disposal Requires Special Handling Shelf-Life Items § 102-36.460 Do we report excess medical shelf-life items held for national emergency purposes? When the remaining shelf life of any medical materials or...

  11. Medical student debt and major life choices other than specialty

    Directory of Open Access Journals (Sweden)

    James Rohlfing

    2014-11-01

    Full Text Available Background: Median indebtedness at graduation is now more than $170,000 for graduates of US Medical Schools. Debate still exists as to whether higher debt levels influence students to choose high paying non-primary care specialties. Notably, no previous research on the topic has taken into account cost of attendance when constructing a debt model, nor has any research examined the non-career major life decisions that medical students face. Methods: Medical students were surveyed using an anonymous electronic instrument developed for this study. The survey was delivered through a link included in a study email and students were recruited from school wide listservs and through snowball sampling (students were encouraged to share a link to the survey with other medical students. No incentives were offered for survey completion. Results: Responses were recorded from 102 US Allopathic medical schools (n=3,032, with 22 institutions (11 public, 11 private meeting inclusion criteria of 10% student body response proportion (n=1,846. Students with higher debt relative to their peers at their home institution reported higher frequencies of feeling callous towards others, were more likely to choose a specialty with a higher average annual income, were less likely to plan to practice in underserved locations, and were less likely to choose primary care specialties. Students with higher aggregate amounts of medical student loan debt were more likely to report high levels of stress from their educational debt, to delay getting married and to report disagreement that they would choose to become a physician again, if given the opportunity to revisit that choice. Increases in both aggregate and relative debt were associated with delaying having children, delaying buying a house, concerns about managing and paying back educational debt, and worrying that educational debt will influence one's specialty choice. Conclusions: Medical student debt and particularly debt

  12. Medical student debt and major life choices other than specialty.

    Science.gov (United States)

    Rohlfing, James; Navarro, Ryan; Maniya, Omar Z; Hughes, Byron D; Rogalsky, Derek K

    2014-01-01

    Median indebtedness at graduation is now more than $170,000 for graduates of US Medical Schools. Debate still exists as to whether higher debt levels influence students to choose high paying non-primary care specialties. Notably, no previous research on the topic has taken into account cost of attendance when constructing a debt model, nor has any research examined the non-career major life decisions that medical students face. Medical students were surveyed using an anonymous electronic instrument developed for this study. The survey was delivered through a link included in a study email and students were recruited from school wide listservs and through snowball sampling (students were encouraged to share a link to the survey with other medical students). No incentives were offered for survey completion. Responses were recorded from 102 US Allopathic medical schools (n=3,032), with 22 institutions (11 public, 11 private) meeting inclusion criteria of 10% student body response proportion (n=1,846). Students with higher debt relative to their peers at their home institution reported higher frequencies of feeling callous towards others, were more likely to choose a specialty with a higher average annual income, were less likely to plan to practice in underserved locations, and were less likely to choose primary care specialties. Students with higher aggregate amounts of medical student loan debt were more likely to report high levels of stress from their educational debt, to delay getting married and to report disagreement that they would choose to become a physician again, if given the opportunity to revisit that choice. Increases in both aggregate and relative debt were associated with delaying having children, delaying buying a house, concerns about managing and paying back educational debt, and worrying that educational debt will influence one's specialty choice. Medical student debt and particularly debt relative to peers at the same institution appears to

  13. Advanced Medication Dispenser

    Directory of Open Access Journals (Sweden)

    A.I. Alexan

    2013-12-01

    Full Text Available Medication dispensing is an important activity that can have major implications if done improperly. Dispensing must be done in the correct time interval, at the correct user, with the correct drug and dose. We propose a smart medication dispenser that can satisfy these needs and provide a mechanism for supervision. In order to ensure that the dispensing process is error free, the concept of a new smart medication container is used. A smart medication container is “smart” as it holds the medication dispensing parameters for the drugs it contains: dispensing time and date and name. Based on this information, the actual dispensing is done.

  14. The consequences of using advanced physical assessment skills in medical and surgical nursing: A hermeneutic pragmatic study.

    Science.gov (United States)

    Zambas, Shelaine I; Smythe, Elizabeth A; Koziol-Mclain, Jane

    2016-01-01

    The aim of this study was to explore the consequences of the nurse's use of advanced assessment skills on medical and surgical wards. Appropriate, accurate, and timely assessment by nurses is the cornerstone of maintaining patient safety in hospitals. The inclusion of "advanced" physical assessment skills such as auscultation, palpation, and percussion is thought to better prepare nurses for complex patient presentations within a wide range of clinical situations. This qualitative study used a hermeneutic pragmatic approach. Unstructured interviews were conducted with five experienced medical and surgical nurses to obtain 13 detailed narratives of assessment practice. Narratives were analyzed using Van Manen's six-step approach to identify the consequences of the nurse's use of advanced assessment skills. The consequences of using advanced assessment skills include looking for more, challenging interpretations, and perseverance. The use of advanced assessment skills directs what the nurse looks for, what she sees, interpretation of the findings, and her response. It is the interpretation of what is seen, heard, or felt within the full context of the patient situation, which is the advanced skill. Advanced assessment skill is the means to an accurate interpretation of the clinical situation and contributes to appropriate diagnosis and medical management in complex patient situations. The nurse's use of advanced assessment skills enables her to contribute to diagnostic reasoning within the acute medical and surgical setting.

  15. The relationship between quality of life and spirituality, religiousness, and personal beliefs of medical students.

    Science.gov (United States)

    Krägeloh, Christian U; Henning, Marcus A; Billington, Rex; Hawken, Susan J

    2015-02-01

    This study investigated the effects of spirituality, religiousness, and personal beliefs on the quality of life (QOL) of medical students affiliated with a religious faith and those without affiliation. Using a cross-sectional design, 275 medical students (78 % response rate) in their fourth and fifth year of study completed the WHOQOL-BREF quality of life instrument and the WHOQOL-SRPB module for spirituality, religiousness, and personal beliefs. For religious students, a larger range of characteristics of existential beliefs were positively related to quality of life. For all students, hope and optimism and meaning of life predicted higher scores on psychological. For religious and nonreligious medical students, reduced meaning in life and hope were the strongest indicators of psychological distress. Interventions to improve the mental well-being of medical students may be more effective if aimed at teaching students how to find meaning and purpose in their lives and how to foster an enduring sense of hope and optimism.

  16. 2005 AdvanceVT Work/Life Survey Leadership Report

    OpenAIRE

    Glass, Valerie Q.

    2005-01-01

    The AdvanceVT Faculty Work-Life Survey, distributed to all teaching and research faculty in January 2005, addressed, among other things, leadership issues at Virginia Tech. This report presents findings from tenured and tenure- track faculty members (N=816) about items on the questionnaire related to leadership including: aspirations of Virginia Tech faculty members towards leadership positions, their views about the possibility of maintaining a balance between leadership and other responsibi...

  17. Medical image computing for computer-supported diagnostics and therapy. Advances and perspectives.

    Science.gov (United States)

    Handels, H; Ehrhardt, J

    2009-01-01

    Medical image computing has become one of the most challenging fields in medical informatics. In image-based diagnostics of the future software assistance will become more and more important, and image analysis systems integrating advanced image computing methods are needed to extract quantitative image parameters to characterize the state and changes of image structures of interest (e.g. tumors, organs, vessels, bones etc.) in a reproducible and objective way. Furthermore, in the field of software-assisted and navigated surgery medical image computing methods play a key role and have opened up new perspectives for patient treatment. However, further developments are needed to increase the grade of automation, accuracy, reproducibility and robustness. Moreover, the systems developed have to be integrated into the clinical workflow. For the development of advanced image computing systems methods of different scientific fields have to be adapted and used in combination. The principal methodologies in medical image computing are the following: image segmentation, image registration, image analysis for quantification and computer assisted image interpretation, modeling and simulation as well as visualization and virtual reality. Especially, model-based image computing techniques open up new perspectives for prediction of organ changes and risk analysis of patients and will gain importance in diagnostic and therapy of the future. From a methodical point of view the authors identify the following future trends and perspectives in medical image computing: development of optimized application-specific systems and integration into the clinical workflow, enhanced computational models for image analysis and virtual reality training systems, integration of different image computing methods, further integration of multimodal image data and biosignals and advanced methods for 4D medical image computing. The development of image analysis systems for diagnostic support or

  18. Italian medical students quality of life: years 2005-2015.

    Science.gov (United States)

    Messina, G; Quercioli, C; Troiano, G; Russo, C; Barbini3, E; Nisticò, F; Nante, N

    2016-01-01

    Quality of Life (QoL) is a concept used to indicate the general wellness of persons or societies. University students report a low quality of life and a worse perception of their health status, because of a situation of greater discomfort in which they live during the course of the study, especially in faculties with an important emotional burden, such as medical schools. The aim of the study was to evaluate the perceived health status of first year medical students. We conducted a cross sectional study in the time span 2005-2015, administering the questionnaire Short Form 36 (SF-36) to first-year students of the School of Medicine of the University of Siena, Italy. In addition to demographic information such as gender and the age we investigated the region of residence, marital status, employment status, and smoking habits; height and weight were required to calculate the body mass index (BMI) to evaluate a possible physical discomfort connected with the perception of health status. The data from the questionnaires were organized and processed by software Stata® SE, version 12.1. 1,104 questionnaires were collected. Medical students reported lower SF-36 scores, compared to the Italian population of the same age. Female gender and smoking habits influence negatively the score of several scales. Body Mass Index is positively correlated with the Physical Activity, while Age is negatively correlated with Social Activities. The perceived quality of life of the Italian medical students is lower when compared to the general population. This confirms that the condition of student implies additional problems, as other studies reports. It would be better to improve it, developing students' resilience. It would be interesting to extend this research to students of other years, from other faculties and other locations, to gain a broader view about the QoL of the Italian students.

  19. The influences of patient's satisfaction with medical service delivery, assessment of medical service, and trust in health delivery system on patient's life satisfaction in China.

    Science.gov (United States)

    Tang, Liyang

    2012-09-14

    Patient's satisfaction with medical service delivery/assessment of medical service/trust in health delivery system may have significant influence on patient's life satisfaction in China's health delivery system/in various kinds of hospitals.The aim of this study was to test whether and to what extent patient's satisfaction with medical service delivery/patient's assessments of various major aspects of medical service/various major aspects of patient's trust in health delivery system influenced patient's life satisfaction in China's health delivery system/in various kinds of hospitals. This study collaborated with National Bureau of Statistics of China to carry out a 2008 national urban resident household survey in 17 provinces, autonomous regions, and municipalities directly under the central government (N = 3,386), and specified ordered probit models were established to analyze dataset from this household survey. The key considerations in generating patient's life satisfaction involved patient's overall satisfaction with medical service delivery, assessment of doctor-patient communication, assessment of medical cost, assessment of medical treatment process, assessment of medical facility and hospital environment, assessment of waiting time for medical service, trust in prescription, trust in doctor, and trust in recommended medical examination. But the major considerations in generating patient's life satisfaction were different among low level public hospital, high level public hospital, and private hospital. The promotion of patient's overall satisfaction with medical service delivery, the improvement of doctor-patient communication, the reduction of medical cost, the improvement of medical treatment process, the promotion of medical facility and hospital environment, the reduction of waiting time for medical service, the promotion of patient's trust in prescription, the promotion of patient's trust in doctor, and the promotion of patient's trust in

  20. Recent advances in medical device triage technologies for chemical, biological, radiological, and nuclear events.

    Science.gov (United States)

    Lansdowne, Krystal; Scully, Christopher G; Galeotti, Loriano; Schwartz, Suzanne; Marcozzi, David; Strauss, David G

    2015-06-01

    In 2010, the US Food and Drug Administration (Silver Spring, Maryland USA) created the Medical Countermeasures Initiative with the mission of development and promoting medical countermeasures that would be needed to protect the nation from identified, high-priority chemical, biological, radiological, or nuclear (CBRN) threats and emerging infectious diseases. The aim of this review was to promote regulatory science research of medical devices and to analyze how the devices can be employed in different CBRN scenarios. Triage in CBRN scenarios presents unique challenges for first responders because the effects of CBRN agents and the clinical presentations of casualties at each triage stage can vary. The uniqueness of a CBRN event can render standard patient monitoring medical device and conventional triage algorithms ineffective. Despite the challenges, there have been recent advances in CBRN triage technology that include: novel technologies; mobile medical applications ("medical apps") for CBRN disasters; electronic triage tags, such as eTriage; diagnostic field devices, such as the Joint Biological Agent Identification System; and decision support systems, such as the Chemical Hazards Emergency Medical Management Intelligent Syndromes Tool (CHEMM-IST). Further research and medical device validation can help to advance prehospital triage technology for CBRN events.

  1. ORIGINAL ARTICLES Medical futility and end-of-life care

    African Journals Online (AJOL)

    2008-04-01

    Apr 1, 2008 ... It is based on the probability of a treatment not having the desired effect ... as empathetic participants in end-of-life decision-making is underscored. .... growing awareness of the limits of medical science's propensity to cure ...

  2. A new chart to assist with advanced trauma life support.

    Science.gov (United States)

    Palmer, I P; Baskett, P J; McCabe, S E

    1992-10-01

    Many studies have drawn attention to deficiencies in the management of major trauma, both in the UK and elsewhere. One area that has received little attention is the documentation of such cases in the Emergency Room. When outcome may be sub-optimal, documentation assumes greater importance if advances are to be made in the organisation of trauma care. Based upon the American College of Surgeons Advanced Trauma Life Support (ATLS) protocols, the authors have designed a document that records dynamically what happens to the multiply injured victim on arrival in the Emergency Room. It unifies the recording of vital signs, whilst acting as an assessment and resuscitation template. By ensuring no life-threatening illness is missed it is likely to improve patient survival. The document can act as a basis for teaching and a medico-legal record, whilst providing the necessary data for quality assurance and outcome audit.

  3. Role of accelerator science and technology in medical science

    International Nuclear Information System (INIS)

    Uesaka, Mitsuru

    2006-01-01

    Updated status of compact and advanced-compact medical accelerator development is reviewed. In their applications, medical physics and medical physicist are necessary. Their educational programs have started in several universities and institutes. As one important new trend on life-science, the research on the synergy of DDS (Drug Delivery System) and physical energies are proposed. (author)

  4. [End-of-life in specialized medical pediatrics department: A French national survey].

    Science.gov (United States)

    Ravanello, Alice; Desguerre, Isabelle; Frache, Sandra; Hubert, Philippe; Orbach, Daniel; Aubry, Régis

    2017-03-01

    In France, most of children die in the hospital. This national survey aimed to achieve better understanding of end-of life care in specialized medical pediatrics departments for children facing the end-of-life, identify the available resources, put forward the difficulties encountered by professionals and describe end-of-life paths of children who died in these departments. This study is based on a nationwide survey conducted among all existing specialized medical pediatrics departments (onco-haematology, neurology, reanimation) in France in 2015. Among 94 specialized medical pediatrics departments in France, 53 participated in our survey (response rate=56%). At the time of the survey, 13% of inpatients were facing the end-of-life. Regarding training, 13% of departments did not have personnel trained in palliative care and 21% did not set up any professional support. However, when taking care of a child's end of life in 2014, 77% of these departments solicited a regional resource team of pediatric palliative care. This survey helps describe 225 end-of-life paths of children decease of a terminal illness in the specialized pediatrics departments. Seventy-two percent suffered from refractory symptoms before their death, 64% were concerned by a terminal sedation and 75% by a limitation of life-sustaining treatment decision. End-of-life care is a reality for specialized pediatrics departments. The frequency of major and refractory symptoms often requires the completion of sedation. The resources of service are acceptable but some deficiencies have been noted especially concerning training and support for caregivers, adaptation of premises or family support. Copyright © 2017. Published by Elsevier SAS.

  5. NASA Advanced Explorations Systems: Advancements in Life Support Systems

    Science.gov (United States)

    Shull, Sarah A.; Schneider, Walter F.

    2016-01-01

    The NASA Advanced Exploration Systems (AES) Life Support Systems (LSS) project strives to develop reliable, energy-efficient, and low-mass spacecraft systems to provide environmental control and life support systems (ECLSS) critical to enabling long duration human missions beyond low Earth orbit (LEO). Highly reliable, closed-loop life support systems are among the capabilities required for the longer duration human space exploration missions assessed by NASA's Habitability Architecture Team (HAT). The LSS project is focused on four areas: architecture and systems engineering for life support systems, environmental monitoring, air revitalization, and wastewater processing and water management. Starting with the international space station (ISS) LSS systems as a point of departure (where applicable), the mission of the LSS project is three-fold: 1. Address discrete LSS technology gaps 2. Improve the reliability of LSS systems 3. Advance LSS systems towards integrated testing on the ISS. This paper summarized the work being done in the four areas listed above to meet these objectives. Details will be given on the following focus areas: Systems Engineering and Architecture- With so many complex systems comprising life support in space, it is important to understand the overall system requirements to define life support system architectures for different space mission classes, ensure that all the components integrate well together and verify that testing is as representative of destination environments as possible. Environmental Monitoring- In an enclosed spacecraft that is constantly operating complex machinery for its own basic functionality as well as science experiments and technology demonstrations, it's possible for the environment to become compromised. While current environmental monitors aboard the ISS will alert crew members and mission control if there is an emergency, long-duration environmental monitoring cannot be done in-orbit as current methodologies

  6. Managing occupations in everyday life for people with advanced cancer living at home.

    Science.gov (United States)

    Peoples, Hanne; Brandt, Åse; Wæhrens, Eva E; la Cour, Karen

    2017-01-01

    People with advanced cancer are able to live for extended periods of time. Advanced cancer can cause functional limitations influencing the ability to manage occupations. Although studies have shown that people with advanced cancer experience occupational difficulties, there is only limited research that specifically explores how these occupational difficulties are managed. To describe and explore how people with advanced cancer manage occupations when living at home. A sub-sample of 73 participants from a larger occupational therapy project took part in the study. The participants were consecutively recruited from a Danish university hospital. Qualitative interviews were performed at the homes of the participants. Content analysis was applied to the data. Managing occupations were manifested in two main categories; (1) Conditions influencing occupations in everyday life and (2) Self-developed strategies to manage occupations. The findings suggest that people with advanced cancer should be supported to a greater extent in finding ways to manage familiar as well as new and more personally meaningful occupations to enhance quality of life.

  7. Advances in intelligent analysis of medical data and decision support systems

    CERN Document Server

    Iantovics, Barna

    2013-01-01

    This volume is a result of the fruitful and vivid discussions during the MedDecSup'2012 International Workshop bringing together a relevant body of knowledge, and new developments in the increasingly important field of medical informatics. This carefully edited book presents new ideas aimed at the development of intelligent processing of various kinds of medical information and the perfection of the contemporary computer systems for medical decision support. The book presents advances of the medical information systems for intelligent archiving, processing, analysis and search-by-content which will improve the quality of the medical services for every patient and of the global healthcare system. The book combines in a synergistic way theoretical developments with the practicability of the approaches developed and presents the last developments and achievements in  medical informatics to a broad range of readers: engineers, mathematicians, physicians, and PhD students.

  8. Mediation effects of medication information processing and adherence on association between health literacy and quality of life.

    Science.gov (United States)

    Song, Sunmi; Lee, Seung-Mi; Jang, Sunmee; Lee, Yoon Jin; Kim, Na-Hyun; Sohn, Hye-Ryoung; Suh, Dong-Churl

    2017-09-16

    To examine whether medication related information processing defined as reading of over-the-counter drug labels, understanding prescription instructions, and information seeking-and medication adherence account for the association between health literacy and quality of life, and whether these associations may be moderated by age and gender. A sample of 305 adults in South Korea was recruited through a proportional quota sampling to take part in a cross-sectional survey on health literacy, medication-related information processing, medication adherence, and quality of life. Descriptive statistics and structural equation modeling (SEM) were performed. Two mediation pathways linking health literacy with quality of life were found. First, health literacy was positively associated with reading drug labels, which was subsequently linked to medication adherence and quality of life. Second, health literacy was positively associated with accurate understanding of prescription instructions, which was associated with quality of life. Age moderation was found, as the mediation by reading drug labels was significant only among young adults whereas the mediation by understanding of medication instruction was only among older adults. Reading drug labels and understanding prescription instructions explained the pathways by which health literacy affects medication adherence and quality of life. The results suggest that training skills for processing medication information can be effective to enhance the health of those with limited health literacy.

  9. Health-related quality-of-life outcomes: a reflexology trial with patients with advanced-stage breast cancer.

    Science.gov (United States)

    Wyatt, Gwen; Sikorskii, Alla; Rahbar, Mohammad Hossein; Victorson, David; You, Mei

    2012-11-01

    To evaluate the safety and efficacy of reflexology, a complementary therapy that applies pressure to specific areas of the feet. Longitudinal, randomized clinical trial. Thirteen community-based medical oncology clinics across the midwestern United States. A convenience sample of 385 predominantly Caucasian women with advanced-stage breast cancer receiving chemotherapy and/or hormonal therapy. Following the baseline interview, women were randomized into three primary groups: reflexology (n = 95), lay foot manipulation (LFM) (n = 95), or conventional care (n = 96). Two preliminary reflexology (n = 51) and LFM (n = 48) test groups were used to establish the protocols. Participants were interviewed again postintervention at study weeks 5 and 11. Breast cancer-specific health-related quality of life (HRQOL), physical functioning, and symptoms. No adverse events were reported. A longitudinal comparison revealed significant improvements in physical functioning for the reflexology group compared to the control group (p = 0.04). Severity of dyspnea was reduced in the reflexology group compared to the control group (p Reflexology may be added to existing evidence-based supportive care to improve HRQOL for patients with advanced-stage breast cancer during chemotherapy and/or hormonal therapy. Reflexology can be recommended for safety and usefulness in relieving dyspnea and enhancing functional status among women with advanced-stage breast cancer.

  10. Cardiopulmonary resuscitation: update, controversies and new advances

    Directory of Open Access Journals (Sweden)

    Alexandre C. Zago

    1999-03-01

    Full Text Available Cardiopulmonary arrest is a medical emergency in which the lapse of time between event onset and the initiation of measures of basic and advanced support, as well as the correct care based on specific protocols for each clinical situation, constitute decisive factors for a successful therapy. Cardiopulmonary arrest care cannot be restricted to the hospital setting because of its fulminant nature. This necessitates the creation of new concepts, strategies and structures, such as the concept of life chain, cardio-pulmonary resuscitation courses for professionals who work in emergency medical services, the automated external defibrillator, the implantable cardioverter-defibrillator, and mobile intensive care units, among others. New concepts, strategies and structures motivated by new advances have also modified the treatment and improved the results of cardiopulmonary resuscitation in the hospital setting. Among them, we can cite the concept of cerebral resuscitation, the application of the life chain, the creation of the universal life support algorithm, the adjustment of drug doses, new techniques - measure of the end-tidal carbon dioxide levels and of the coronary perfusion pressure - and new drugs under research.

  11. The Impact of a Revised Curriculum on Academic Motivation, Burnout, and Quality of Life Among Medical Students.

    Science.gov (United States)

    Lyndon, Mataroria P; Henning, Marcus A; Alyami, Hussain; Krishna, Sanjeev; Yu, Tzu-Chieh; Hill, Andrew G

    2017-01-01

    The purpose of this study was to determine the impact of a revised curriculum on medical student academic motivation, burnout, and quality of life. This cross-sectional comparative study involved 2 medical school cohorts of second year and fourth year medical students at The University of Auckland: a cohort under a traditional curriculum (n = 437) and a cohort under a revised curriculum (n = 446). Participants completed self-reported questionnaires measuring academic motivation, burnout, and quality of life. Two multivariate analyses of covariance (MANCOVAs) were conducted. The response rate was 48%. No statistically significant differences were found between curriculum cohorts for mean scores of academic motivation, personal burnout, and quality of life. However, differences were found when comparing preclinical medical students and students in their clinical years of training. In comparison with Year 2 medical students, the MANCOVA for Year 4 students showed a significant main effect for the revised curriculum with respect to both physical and environmental quality of life. A revised medical curriculum had a differential effect on quality of life for Year 4 students in the latter years of medical school who are based in a clinical learning environment.

  12. [Truth telling and advance care planning at the end of life].

    Science.gov (United States)

    Hu, Wen-Yu; Yang, Chia-Ling

    2009-02-01

    One of the core values in terminal care the respect of patient 'autonomy'. This essay begins with a discussion of medical ethics principles and the Natural Death Act in Taiwan and then summarizes two medical ethical dilemmas, truth telling and advance care planning (ACP), faced in the development of hospice and palliative care in Taiwan. The terminal truth telling process incorporates the four basic principles of Assessment and preparation, Communication with family, Truth-telling process, and Support and follow up (the so-called "ACTs"). Many experts suggest practicing ACP by abiding by the following five steps: (1) presenting and illustrating topics; (2) facilitating a structured discussion; (3) completing documents with advanced directives (ADs); (4) reviewing and updating ADs; and (5) applying ADs in clinical circumstances. Finally, the myths and challenges in truth telling and ADs include the influence of healthcare system procedures and priorities, inadequate communication skills, and the psychological barriers of medical staffs. Good communication skills are critical to truth telling and ACP. Significant discussion about ACP should help engender mutual trust between patients and the medical staffs who take the time to establish such relationships. Promoting patient autonomy by providing the opportunity of a good death is an important goal of truth telling and ACP in which patients have opportunities to choose their terminal treatment.

  13. Evaluation of the Effectiveness of an Advance Organizer in a Medical Microbiology Course.

    Science.gov (United States)

    Slock, James A.; And Others

    1980-01-01

    An advance organizer is a set of conceptual statements about the unifying ideas of a topic in terms already familiar to the learner. A study is reported that sought to determine whether two presentations of an advance organizer for a unit on pathogenic bacteria would result in increasing medical students' knowledge and ability to solve problems in…

  14. Holistic integrative medicine: toward a new era of medical advancement.

    Science.gov (United States)

    Fan, Daiming

    2017-03-01

    Medicine has encountered unprecedented problems associated with changes in nature, society, and environment, as well as with new human quests for survival, longevity, and health. In the meantime, the development of medicine is facing challenges that resulted from the over-division and specialization of disciplines and the fragmentation of medical knowledge. To construct a new medical system that is more suitable for human health and disease treatment, holistic integrative medicine (HIM), which regards the human body as a holistic entity, organically integrates the most advanced knowledge and theories in each medical field and the most effective practices in various clinical specialties to revise and adjust on the basis of social, environmental, and psychological conditions. HIM is the inevitable and necessary direction for the future development of medicine. In this article, we illustrated the connotation of HIM, the differences between HIM and other medical conceptions, and the practice of HIM in recent years.

  15. [Quality of life, stress management and health promotion in medical and dental students. A comparative study].

    Science.gov (United States)

    Jurkat, H; Höfer, S; Richter, L; Cramer, M; Vetter, A

    2011-06-01

    Which are the differences in health-related quality of life and stress management in medical and dental students? 101 dental and 237 medical students from different years of Justus-Liebig University Giessen were examined during winter term 2008/09 and summer term 2009 using the specific Questionnaire on Health Promotion, Life Satisfaction, and Stress Management in Dental or Medical Students (addressing work satisfaction and choice of subject, private life, relaxation behavior and stress management, and health behavior), Beck Depression Inventory (BDI) and SF-36 Health Survey. For statistical analysis, Mann-Whitney-U-Test, analysis of variance (ANOVA), Pearson correlation and Chi2-Tests were primarily used. Dental and medical students showed considerable mental impairment in SF-36. Every fifth dental student suffered from slight to moderate depression. Though averaging more hours per week, medical students were more satisfied with their studies. More than half of the dental and medical students did not have appropriate strategies of coping with stress. Concerning the mental impairment in both groups and regarding a higher health-related quality of life, specific prevention courses or mentoring programs should already be offered at the beginning of medical training in order to cope with strains of medical school and future job strains in the medical or dental profession. © Georg Thieme Verlag KG Stuttgart · New York.

  16. Quality of Basic Life Support - A Comparison between Medical Students and Paramedics.

    Science.gov (United States)

    Körber, Maria Isabel; Köhler, Thomas; Weiss, Verena; Pfister, Roman; Michels, Guido

    2016-07-01

    Poor survival rates after cardiac arrest can partly be explained by poor basic life support skills in medical professionals. This study aimed to assess quality of basic life support in medical students and paramedics. We conducted a prospective observational study with 100 early medical students (group A), 100 late medical students (group B) and 100 paramedics (group C), performing a 20-minute basic life support simulation in teams of two. Average frequency and absolute number of chest compressions per minute (mean (±SD)), chest decompression (millimetres of compression remaining, mean (±SD)), hands-off-time (seconds/minute, mean (±SD)), frequency of switching positions between ventilation and chest compression (per 20 minutes) and rate of sufficient compressions (depth ≥50mm) were assessed as quality parameters of CPR. In groups A, B and C the rates of sufficiently deep chest compressions were 56%, 42% and 52%, respectively, without significant differences. Male gender and real-life CPR experience were significantly associated with deeper chest compression. Frequency and number of chest compressions were within recommended goals in at least 96% of all groups. Remaining chest compressions were 6 mm (±2), 6 mm (±2) and 5 mm (±2) with a significant difference between group A and C (p=0.017). Hands-off times were 6s/min (±1), 5s/min (±1) and 4s/min (±1), which was significantly different across all three groups. Overall, paramedics tended to show better quality of CPR compared to medical students. Though, chest compression depth as an important quality characteristic of CPR was insufficient in almost 50% of participants, even in well trained paramedics. Therefore, we suggest that an effort should be made to find better ways to educate health care professionals in BLS.

  17. 1st International Conference on Advancements of Medical Electronics

    CERN Document Server

    Bag, Sandip; Ganguly, Karabi; Sarkar, Indranath; Biswas, Papun

    2015-01-01

    The book is a collection of peer-reviewed scientific papers submitted by active researchers in the 1st International Conference on Advancements of Medical Electronics (ICAME2015). The conference is organized jointly by the Department of Biomedical Engineering and Electronics and Communication Engineering, JIS College of Engineering, West Bengal, India. The primary objective of the conference is to strengthen interdisciplinary research and its applications for the welfare of humanity. A galaxy of academicians, professionals, scientists, statesman and researchers from different parts of the country and abroad got together and shared their knowledge. The book presents research articles of medical image processing & analysis, biomedical instrumentation & measurements, DSP & clinical applications, embedded systems & its applications in healthcare. The book can be referred as a tool for further research.

  18. Medical student quality-of-life in the clerkships: a scale validation study.

    Science.gov (United States)

    Brannick, Michael T; Horn, Gregory T; Schnaus, Michael J; Wahi, Monika M; Goldin, Steven B

    2015-04-01

    Many aspects of medical school are stressful for students. To empirically assess student reactions to clerkship programs, or to assess efforts to improve such programs, educators must measure the overall well-being of the students reliably and validly. The purpose of the study was to develop and validate a measure designed to achieve these goals. The authors developed a measure of quality of life for medical students by sampling (public domain) items tapping general happiness, fatigue, and anxiety. A quality-of-life scale was developed by factor analyzing responses to the items from students in two different clerkships from 2005 to 2008. Reliability was assessed using Cronbach's alpha. Validity was assessed by factor analysis, convergence with additional theoretically relevant scales, and sensitivity to change over time. The refined nine-item measure is a Likert scaled survey of quality-of-life items comprised of two domains: exhaustion and general happiness. The resulting scale demonstrated good reliability and factorial validity at two time points for each of the two samples. The quality-of-life measure also correlated with measures of depression and the amount of sleep reported during the clerkships. The quality-of-life measure appeared more sensitive to changes over time than did the depression measure. The measure is short and can be easily administered in a survey. The scale appears useful for program evaluation and more generally as an outcome variable in medical educational research.

  19. Belonging and quality of life as perceived by people with advanced cancer who live at home

    DEFF Research Database (Denmark)

    Peoples, Hanne; Nissen, Nina; Brandt, Åse

    Purpose: In previous research (Peoples, Nissen, Brandt, & la Cour, 2017), we explored how people with advanced cancer who live at home perceive quality of life. Findings from our previous study indicate that dimensions of belonging in various ways may be connected to quality of life when living...... with an impending death. These findings prompted our curiosity to further explore, how perceived quality of life may be linked to belonging when living with advanced cancer. By drawing on our findings and the theoretical concept of belonging within occupational science, the purpose of this study was to gain...... a deeper understanding of the ways in which quality of life may be related to belonging as perceived by people with advanced cancer. Method: The study employed a qualitative approach using a combination of qualitative interviews and photo-elicitation. A thematic approach was used to analyse the data. Ten...

  20. The Medical Academic Advancement Program at the University of Virginia School of Medicine.

    Science.gov (United States)

    Fang, W L; Woode, M K; Carey, R M; Apprey, M; Schuyler, J M; Atkins-Brady, T L

    1999-04-01

    Since 1984 the University of Virginia School of Medicine has conducted the Medical Academic Advancement Program for minority and disadvantaged students interested in careers in medicine. The program is a six-week residential program for approximately 130 undergraduate and post-baccalaureate students per year. It emphasizes academic course work--biology, chemistry, physics, and essay writing--to prepare the participants for the Medical College Admission Test. Non-graded activities, such as a clinical medicine lecture series, clinical experiences, and a special lecture series, and special workshops are also offered. The participants take two simulated MCAT exams. Between 1984 and 1998, 1,497 students have participated in the program, with complete follow-up information available for 690 (46%). Of the 1,487 participants, 80 (5%) have graduated from the University of Virginia School of Medicine and 174 (12%) from other medical schools; 44 (3%) are attending the medical school now, and 237 (16%) are at other medical schools; 44 (3%) have graduated from other health professions schools, and 54 (3%) are attending such schools. The retention rate for participants at the University of Virginia School of Medicine is 91% (that is, all but seven of the 80 who matriculated have been retained past the first year). The Medical Academic Advancement Program has been successful in increasing the number of underrepresented minority students matriculating into and continuing in medical education. Such programs warrant continued support and encouragement.

  1. Rye bread consumption in early life and reduced risk of advanced prostate cancer.

    Science.gov (United States)

    Torfadottir, Johanna E; Valdimarsdottir, Unnur A; Mucci, Lorelei; Stampfer, Meir; Kasperzyk, Julie L; Fall, Katja; Tryggvadottir, Laufey; Aspelund, Thor; Olafsson, Orn; Harris, Tamara B; Jonsson, Eirikur; Tulinius, Hrafn; Adami, Hans-Olov; Gudnason, Vilmundur; Steingrimsdottir, Laufey

    2012-06-01

    To determine whether consumption of whole-grain rye bread, oatmeal, and whole-wheat bread, during different periods of life, is associated with risk of prostate cancer (PCa). From 2002 to 2006, 2,268 men, aged 67-96 years, reported their dietary habits in the AGES-Reykjavik cohort study. Dietary habits were assessed for early life, midlife, and current life using a validated food frequency questionnaire. Through linkage to cancer and mortality registers, we retrieved information on PCa diagnosis and mortality through 2009. We used regression models to estimate odds ratios (ORs) and hazard ratios (HRs) for PCa according to whole-grain consumption, adjusted for possible confounding factors including fish, fish liver oil, meat, and milk intake. Of the 2,268 men, 347 had or were diagnosed with PCa during follow-up, 63 with advanced disease (stage 3+ or died of PCa). Daily rye bread consumption in adolescence (vs. less than daily) was associated with a decreased risk of PCa diagnosis (OR = 0.76, 95 % confidence interval (CI): 0.59-0.98) and of advanced PCa (OR = 0.47, 95 % CI: 0.27-0.84). High intake of oatmeal in adolescence (≥5 vs. ≤4 times/week) was not significantly associated with risk of PCa diagnosis (OR = 0.99, 95 % CI: 0.77-1.27) nor advanced PCa (OR = 0.67, 95 % CI: 0.37-1.20). Midlife and late life consumption of rye bread, oatmeal, or whole-wheat bread was not associated with PCa risk. Our results suggest that rye bread consumption in adolescence may be associated with reduced risk of PCa, particularly advanced disease.

  2. Use of Bioregenerative Technologies for Advanced Life Support: Some Considerations for BIO-Plex and Related Testbeds

    Science.gov (United States)

    Wheeler, Raymond M.; Strayer, Richard F.

    1997-01-01

    A review of bioregenerative life support concepts is provided as a guide for developing ground-based testbeds for NASA's Advanced Life Support Program. Key among these concepts are the use of controlled environment plant culture for the production of food, oxygen, and clean water, and the use of bacterial bioreactors for degrading wastes and recycling nutrients. Candidate crops and specific bioreactor approaches are discussed based on experiences from the. Kennedy Space Center Advanced Life Support Breadboard Project, and a review of related literature is provided.

  3. The Impact of a Revised Curriculum on Academic Motivation, Burnout, and Quality of Life Among Medical Students

    Directory of Open Access Journals (Sweden)

    Mataroria P Lyndon

    2017-07-01

    Full Text Available Objective: The purpose of this study was to determine the impact of a revised curriculum on medical student academic motivation, burnout, and quality of life. Methods: This cross-sectional comparative study involved 2 medical school cohorts of second year and fourth year medical students at The University of Auckland: a cohort under a traditional curriculum (n = 437 and a cohort under a revised curriculum (n = 446. Participants completed self-reported questionnaires measuring academic motivation, burnout, and quality of life. Two multivariate analyses of covariance (MANCOVAs were conducted. Results: The response rate was 48%. No statistically significant differences were found between curriculum cohorts for mean scores of academic motivation, personal burnout, and quality of life. However, differences were found when comparing preclinical medical students and students in their clinical years of training. In comparison with Year 2 medical students, the MANCOVA for Year 4 students showed a significant main effect for the revised curriculum with respect to both physical and environmental quality of life. Conclusions: A revised medical curriculum had a differential effect on quality of life for Year 4 students in the latter years of medical school who are based in a clinical learning environment.

  4. Life science, agriculture and forestry and fishery and health and medical treatment

    International Nuclear Information System (INIS)

    1999-11-01

    This book gives descriptions of future technology in Korea, by field : Life science, agriculture and forestry and fishery and health and medical treatment. It indicates the purpose of survey, survey system survey outline, characteristic of this survey, how to read the prediction of survey result, the result of survey with the tasks of survey object, field on important survey and development period of realizable prediction, obstacle of realization, propel ways for survey and development, policy tasks, important future technology chronological table, characteristic of respondent, the result of survey : Life science, agriculture and forestry and fishery and health and medical treatment.

  5. Depression and insomnia are independently associated with satisfaction and enjoyment of life in medication-overuse headache patients.

    Science.gov (United States)

    Pompili, Maurizio; Innamorati, Marco; Lamis, Dorian A; Serafini, Gianluca; Ricci, Federica; Migliorati, Monica; Bellini, Samantha; Erbuto, Denise; Mazza, Marianna; Di Nicola, Marco; Janiri, Luigi; Gonda, Xenia; Rihmer, Zoltan; Amore, Mario; Girardi, Paolo; Martelletti, Paolo

    2016-07-01

    Objective Medication-overuse headache is often comorbid with emotional disturbances and disordered personality traits. The aim of the present study was to determine whether depression and insomnia complaints were associated with satisfaction and enjoyment with one's own life in medication-overuse headache patients, and whether insomnia complaints were able to explain part of the variance of Quality of Life explained by depression. Methods Participants were 187 consecutive adult outpatients admitted to the Regional Referral Headache Centre of the Sant'Andrea Hospital in Rome, Italy. Patients were administered the Quality of Life Enjoyment and Satisfaction Questionnaire, the Beck Depression Inventory - II, and the Athens Insomnia Scale. Results The Beck Depression Inventory was associated with all the dimensions of the Quality of Life Enjoyment and Satisfaction Questionnaire, with more severe depression being associated independently with lower satisfaction and enjoyment with one's own life. The Athens Insomnia Scale was independently and significantly associated only with physical health, such that patients with more insomnia complaints were 3.1 times ( p satisfaction. Conclusions Our findings confirmed that medication-overuse headache patients has a negative impact on quality of life and suggested that depression and insomnia were independently associated with satisfaction and enjoyment of life in medication-overuse headache patients. The early recognition and appropriate treatment of comorbid psychopathological symptoms are crucial to improve satisfaction and enjoyment of life in medication-overuse headache patients.

  6. Advanced robotics for medical rehabilitation current state of the art and recent advances

    CERN Document Server

    Xie, Shane

    2016-01-01

    Focussing on the key technologies in developing robots for a wide range of medical rehabilitation activities – which will include robotics basics, modelling and control, biomechanics modelling, rehabilitation strategies, robot assistance, clinical setup/implementation as well as neural and muscular interfaces for rehabilitation robot control – this book is split into two parts; a review of the current state of the art, and recent advances in robotics for medical rehabilitation. Both parts will include five sections for the five key areas in rehabilitation robotics: (i) the upper limb; (ii) lower limb for gait rehabilitation (iii) hand, finger and wrist; (iv) ankle for strains and sprains; and (v) the use of EEG and EMG to create interfaces between the neurological and muscular functions of the patients and the rehabilitation robots. Each chapter provides a description of the design of the device, the control system used, and the implementation and testing to show how it fulfils the needs of that specific ...

  7. Work/Life Balance Issues for Female Physicians and Implications for Medical Education

    Science.gov (United States)

    Corder, Paige Frances

    2016-01-01

    Work/life balance issues exist for all people who navigate both professional and personal responsibilities, regardless of profession, gender, marital status, or number of children. This research sought to better understand the specific work/life balance challenges faced by female physicians and how medical education can better prepare future…

  8. Aesthetic engagements: "being" in everyday life with advanced cancer.

    Science.gov (United States)

    la Cour, Karen; Hansen, Helle Ploug

    2012-03-01

    Living with advanced cancer can present an overwhelming challenge. It may impact the everyday life of the individual with respect to an array of psychological, physical, social, and existential issues. We focus on ways in which people with advanced cancer experience and use their engagement in daily activities when confronting nearing death. Through a phenomenological analysis based on Heidegger's thinking, we illuminate the complexities of "being toward death" and the human striving for authentic being through engagement in daily living. The main findings demonstrate how sensory experiences support being through an appreciation of everyday aesthetics. Furthermore, the making of material things was identified as a means to express the value of self and others in relation to the involved individual's past, present, and future.

  9. Seeking the Tricorder: Report on Workshops on Advanced Technologies for Life Detection

    Science.gov (United States)

    Reiss-Bubenheim, D.; Boston, P. J.; Partridge, H.; Lindensmith, C.; Nadeau, J. L.

    2017-12-01

    There's great excitement about life prospects on icy fluid-containing moons orbiting our Solar System's gas giant planets, newly discovered planet candidates and continuing long-term interest in possible Mars life. The astrobiology/planetary research communities require advanced technologies to explore and study both Solar System bodies and exoplanets for evidence of life. The Tricorder Workshop, held at Ames Research Center May 19-20, 2017, explored technology topics focused on non-invasive or minimally invasive methods for life detection. The workshop goal was to tease out promising ideas for low TRL concepts for advanced life detection technologies that could be applied to the surface and near-subsurface of Mars and Ocean Worlds (such as Europa and Enceladus) dominated by icy terrain. The workshop technology focus centered on mid-to-far term instrument concepts or other enabling technologies (e.g. robotics, machine learning, etc.) primarily for landed missions, which could detect evidence of extant, extinct and/or "weird" life including the notion of "universal biosignatures". Emphasis was placed on simultaneous and serial sample measurements using a suite of instruments and technological approaches with planetary protection in mind. A follow-on workshop, held July 24 at Caltech, sought to develop a generic flowchart of in situ observations and measurements to provide sufficient information to determine if extant life is present in an environment. The process didn't require participant agreement as to definition of extant life, but instead developed agreement on necessary observations and instruments. The flowchart of measurements was designed to maximize the number of simultaneous observations on a single sample where possible, serializing where necessary, and finally dividing it into parts for the most destructive analyses at the end. Selected concepts from the workshops outlined in this poster provide those technology areas necessary to solicit and develop

  10. Integrating advanced practice providers into medical critical care teams.

    Science.gov (United States)

    McCarthy, Christine; O'Rourke, Nancy C; Madison, J Mark

    2013-03-01

    Because there is increasing demand for critical care providers in the United States, many medical ICUs for adults have begun to integrate nurse practitioners and physician assistants into their medical teams. Studies suggest that such advanced practice providers (APPs), when appropriately trained in acute care, can be highly effective in helping to deliver high-quality medical critical care and can be important elements of teams with multiple providers, including those with medical house staff. One aspect of building an integrated team is a practice model that features appropriate coding and billing of services by all providers. Therefore, it is important to understand an APP's scope of practice, when they are qualified for reimbursement, and how they may appropriately coordinate coding and billing with other team providers. In particular, understanding when and how to appropriately code for critical care services (Current Procedural Terminology [CPT] code 99291, critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 min; CPT code 99292, critical care, each additional 30 min) and procedures is vital for creating a sustainable program. Because APPs will likely play a growing role in medical critical care units in the future, more studies are needed to compare different practice models and to determine the best way to deploy this talent in specific ICU settings.

  11. Paediatric End-of-LIfe CAre Needs in Switzerland (PELICAN) : Current end-of-life care practices and the persepctives of bereaved parents

    OpenAIRE

    Zimmermann, Karin

    2016-01-01

    Despite continued advancements in medical care and improved survival or life expectancy, childhood deaths due to complex chronic conditions (CCC) or prematurity are inevitable. Deaths during the first year of life constitute approximately 50% of disease-related deaths, the causes of which include perinatal complications, prematurity, or congenital anomalies. Beyond the age of one year, the three most common life-limiting CCCs are neurological/neuromuscular and cardiovascular conditions (inclu...

  12. Medication Use in the Last Days of Life in Hospital, Hospice, and Home Settings in the Netherlands

    NARCIS (Netherlands)

    Arevalo, J.J.; Geijteman, E.C.; Huisman, B.A.H.; Dees, M.K.; Zuurmond, W.W.A.; Zuylen, L. van; Heide, A. van der; Perez, R.

    2018-01-01

    BACKGROUND: The purpose of medication management in the last days of life is to optimize patient's comfort. Little is known about the medication use in the days before death and how this relates to the care setting. OBJECTIVE: To describe medication use in the last week of life for patients dying in

  13. 41 CFR 102-36.465 - May we transfer or exchange excess medical shelf-life items with other federal agencies?

    Science.gov (United States)

    2010-07-01

    ... exchange excess medical shelf-life items with other federal agencies? 102-36.465 Section 102-36.465 Public... Disposal Requires Special Handling Shelf-Life Items § 102-36.465 May we transfer or exchange excess medical shelf-life items with other federal agencies? Yes, you may transfer or exchange excess medical shelf...

  14. Life-Metaphors among Colombian Medical Students: Uncovering Core Values and Educational Implications

    Science.gov (United States)

    Hoffman, Edward; Acosta-Orozco, Catalina; Compton, William C.

    2015-01-01

    The present study utilized metaphor analysis to examine the core values of Colombian medical students. The entire 9th semester medical class of 60 students was invited to respond to a structured questionnaire. It asked participants to state their preferred life-metaphor, whether they had always preferred this metaphor since childhood or…

  15. Teaching basic life support to school children using medical students and teachers in a 'peer-training' model--results of the 'ABC for life' programme.

    Science.gov (United States)

    Toner, P; Connolly, M; Laverty, L; McGrath, P; Connolly, D; McCluskey, D R

    2007-10-01

    The 'ABC for life' programme was designed to facilitate the wider dissemination of basic life support (BLS) skills and knowledge in the population. A previous study demonstrated that using this programme 10-12-year olds are capable of performing and retaining these vital skills when taught by medical students. There are approximately 25,000 year 7 school children in 900 primary schools in Northern Ireland. By using a pyramidal teaching approach involving medical students and teachers, there is the potential to train BLS to all of these children each year. To assess the effectiveness of a programme of CPR instruction using a three-tier training model in which medical students instruct primary school teachers who then teach school children. School children and teachers in the Western Education and Library Board in Northern Ireland. A course of instruction in cardiopulmonary resuscitation (CPR)--the 'ABC for life' programme--specifically designed to teach 10-12-year-old children basic life support skills. Medical students taught teachers from the Western Education and Library Board area of Northern Ireland how to teach basic life support skills to year 7 pupils in their schools. Pupils were given a 22-point questionnaire to assess knowledge of basic life support immediately before and after a teacher led training session. Children instructed in cardiopulmonary resuscitation using this three-tier training had a significantly improved score following training (57.2% and 77.7%, respectively, p<0.001). This study demonstrates that primary school teachers, previously trained by medical students, can teach BLS effectively to 10-12-year-old children using the 'ABC for life' programme.

  16. [A Medical Devices Management Information System Supporting Full Life-Cycle Process Management].

    Science.gov (United States)

    Tang, Guoping; Hu, Liang

    2015-07-01

    Medical equipments are essential supplies to carry out medical work. How to ensure the safety and reliability of the medical equipments in diagnosis, and reduce procurement and maintenance costs is a topic of concern to everyone. In this paper, product lifecycle management (PLM) and enterprise resource planning (ERP) are cited to establish a lifecycle management information system. Through integrative and analysis of the various stages of the relevant data in life-cycle, it can ensure safety and reliability of medical equipments in the operation and provide the convincing data for meticulous management.

  17. Transition to life--a sendoff to the real world for graduating medical students.

    Science.gov (United States)

    Coates, Wendy C; Spector, Tahlia S; Uijtdehaage, Sebastian

    2012-01-01

    Graduating medical students will enter the workforce, often for the first time. Many have spent the past 20 years as students, receiving financial support from parents, and have not managed real-life issues such as financial planning, real estate, balancing well-being with employment, and integrating into a new community with stressful working conditions. To address a perceived need, we designed an intervention to introduce graduating medical students to financial planning, real estate choices, physician wellness during relocation/internship, and traits of efficient interns. The objectives of this study are to (a) assess baseline experience, knowledge, and comfort of seniors about "real-life" experiences, and (b) assess the efficacy of a 4-hr educational intervention on perceptions of understanding financial planning, real estate choices, intern preparedness, and physician wellness. Acute Care College seniors (classes of 2009 and 2010) attended the intervention after match day and completed a survey to gather demographic data and assess preexisting knowledge and a postintervention survey (1-7 Likert scale). Forty-nine students (45% male; M age = 25.5 years) participated. Prior experiences: 43% no break in education, 51% no full-time job, 38% never signed a rental lease and 94% had not purchased real estate, 90% did not have (or were not aware of having) disability insurance, and 82% had educational debt exceeding $50,000. Following the workshop, students felt more confident in their understanding of life skills topics (real estate, 83%; financial planning, 94%; well-being, 86%). Our workshop assisted in preparing for life after medical school for 98% of the participants. Graduating medical students can gain knowledge about real-life responsibilities and confidence during an educational session prior to starting residency.

  18. Do patients discharged from advanced practice physiotherapy-led clinics re-present to specialist medical services?

    Science.gov (United States)

    Chang, Angela T; Gavaghan, Belinda; O'Leary, Shaun; McBride, Liza-Jane; Raymer, Maree

    2017-05-15

    Objective The aim of the present study was to determine the rates of re-referral to specialist out-patient clinics for patients previously managed and discharged from an advanced practice physiotherapy-led service in three metropolitan hospitals. Methods A retrospective audit was undertaken of 462 patient cases with non-urgent musculoskeletal conditions discharged between 1 April 2014 and 30 March 2015 from three metropolitan hospitals. These patients had been discharged from the physiotherapy-led service without requiring specialist medical review. Rates and patterns of re-referral to specialist orthopaedic, neurosurgical, chronic pain, or rheumatology services within 12 months of discharge were investigated. Results Forty-six of the 462 patients (10.0%) who were managed by the physiotherapy-led service were re-referred to specialist medical orthopaedic, neurosurgical, chronic pain or rheumatology departments within 12 months of discharge. Only 22 of these patients (4.8%) were re-referred for the same condition as managed previously and discharged. Conclusions Ninety-five per cent of patients with non-urgent musculoskeletal conditions managed by an advanced practice physiotherapy-led service at three metropolitan hospitals did not re-present to access public specialist medical services for the same condition within 12 months of discharge. This is the first time that re-presentation rates have been reported for patients managed in advanced practice physiotherapy services and the findings support the effectiveness of these models of care in managing demand for speciality out-patient services. What is known about the topic? Advanced practice physiotherapy-led services have been implemented to address the needs of patients referred with non-urgent musculoskeletal conditions to hospital specialist out-patient services. Although this model is widely used in Australia, there has been very little information about whether patients managed in these services subsequently re

  19. A crusade against scorpion sting: Life and works of Dr. Himmatrao Bawaskar

    Directory of Open Access Journals (Sweden)

    Ajinkya A Kale

    2012-01-01

    Full Text Available In the times of rapid advancement of science and technology, advance medical equipment and hi tech hospitals represent the face of medical science. The aspirations and ambitions of medical professionals are also shifting, with growing concerns of deterioration of doctor patient relationship as well as disconnect between services and the community needs. The life of Dr Himmatrao Bawaskar defies several conventions of today′s medical practice. His outstanding dedication towards patients and commitment to provide high quality care in resource poor setting makes him an ideal role model for younger generation of physicians in India.

  20. Experimental Creep Life Assessment for the Advanced Stirling Convertor Heater Head

    Science.gov (United States)

    Krause, David L.; Kalluri, Sreeramesh; Shah, Ashwin R.; Korovaichuk, Igor

    2010-01-01

    The United States Department of Energy is planning to develop the Advanced Stirling Radioisotope Generator (ASRG) for the National Aeronautics and Space Administration (NASA) for potential use on future space missions. The ASRG provides substantial efficiency and specific power improvements over radioisotope power systems of heritage designs. The ASRG would use General Purpose Heat Source modules as energy sources and the free-piston Advanced Stirling Convertor (ASC) to convert heat into electrical energy. Lockheed Martin Corporation of Valley Forge, Pennsylvania, is integrating the ASRG systems, and Sunpower, Inc., of Athens, Ohio, is designing and building the ASC. NASA Glenn Research Center of Cleveland, Ohio, manages the Sunpower contract and provides technology development in several areas for the ASC. One area is reliability assessment for the ASC heater head, a critical pressure vessel within which heat is converted into mechanical oscillation of a displacer piston. For high system efficiency, the ASC heater head operates at very high temperature (850 C) and therefore is fabricated from an advanced heat-resistant nickel-based superalloy Microcast MarM-247. Since use of MarM-247 in a thin-walled pressure vessel is atypical, much effort is required to assure that the system will operate reliably for its design life of 17 years. One life-limiting structural response for this application is creep; creep deformation is the accumulation of time-dependent inelastic strain under sustained loading over time. If allowed to progress, the deformation eventually results in creep rupture. Since creep material properties are not available in the open literature, a detailed creep life assessment of the ASC heater head effort is underway. This paper presents an overview of that creep life assessment approach, including the reliability-based creep criteria developed from coupon testing, and the associated heater head deterministic and probabilistic analyses. The approach also

  1. The use of advanced medical technologies at home: a systematic review of the literature.

    Science.gov (United States)

    Ten Haken, Ingrid; Ben Allouch, Somaya; van Harten, Wim H

    2018-02-26

    The number of medical technologies used in home settings has increased substantially over the last 10-15 years. In order to manage their use and to guarantee quality and safety, data on usage trends and practical experiences are important. This paper presents a literature review on types, trends and experiences with the use of advanced medical technologies at home. The study focused on advanced medical technologies that are part of the technical nursing process and 'hands on' processes by nurses, excluding information technology such as domotica. The systematic review of literature was performed by searching the databases MEDLINE, Scopus and Cinahl. We included papers from 2000 to 2015 and selected articles containing empirical material. The review identified 87 relevant articles, 62% was published in the period 2011-2015. Of the included studies, 45% considered devices for respiratory support, 39% devices for dialysis and 29% devices for oxygen therapy. Most research has been conducted on the topic 'user experiences' (36%), mainly regarding patients or informal caregivers. Results show that nurses have a key role in supporting patients and family caregivers in the process of homecare with advanced medical technologies and in providing information for, and as a member of multi-disciplinary teams. However, relatively low numbers of articles were found studying nurses perspective. Research on medical technologies used at home has increased considerably until 2015. Much is already known on topics, such as user experiences; safety, risks, incidents and complications; and design and technological development. We also identified a lack of research exploring the views of nurses with regard to medical technologies for homecare, such as user experiences of nurses with different technologies, training, instruction and education of nurses and human factors by nurses in risk management and patient safety.

  2. Do stressful life events predict medical treatment outcome in first episode of depression?

    DEFF Research Database (Denmark)

    Bock, Camilla; Bukh, Jens Drachmann; Vinberg, Maj

    2009-01-01

    BACKGROUND: It is unclear whether medical treatment outcome in first episode depression differ for patients with and without stressful life events prior to onset of depression. METHODS: Patients discharged with a diagnosis of a single depressive episode from a psychiatric in- or outpatient hospital......-II) and the interview of recent life events (IRLE). Medical treatment history was assessed in detail using standardised procedures (TRAQ). Remission was defined as a score or= 4 on TRAQ following (1) first trial of antidepressant treatment (2) two adequate trials of antidepressant treatment. RESULTS: A total of 399...... patients participated in the interview and among these 301 patients obtained a SCAN diagnosis of a single depressive episode. A total of 62.8% of the 301 patients experienced at least one moderate to severe stressful life event in a 6 months period prior to symptom onset. The presence of a stressful life...

  3. A model for emergency department end-of-life communications after acute devastating events--part I: decision-making capacity, surrogates, and advance directives.

    Science.gov (United States)

    Limehouse, Walter E; Feeser, V Ramana; Bookman, Kelly J; Derse, Arthur

    2012-09-01

    Making decisions for a patient affected by sudden devastating illness or injury traumatizes a patient's family and loved ones. Even in the absence of an emergency, surrogates making end-of-life treatment decisions may experience negative emotional effects. Helping surrogates with these end-of-life decisions under emergent conditions requires the emergency physician (EP) to be clear, making medical recommendations with sensitivity. This model for emergency department (ED) end-of-life communications after acute devastating events comprises the following steps: 1) determine the patient's decision-making capacity; 2) identify the legal surrogate; 3) elicit patient values as expressed in completed advance directives; 4) determine patient/surrogate understanding of the life-limiting event and expectant treatment goals; 5) convey physician understanding of the event, including prognosis, treatment options, and recommendation; 6) share decisions regarding withdrawing or withholding of resuscitative efforts, using available resources and considering options for organ donation; and 7) revise treatment goals as needed. Emergency physicians should break bad news compassionately, yet sufficiently, so that surrogate and family understand both the gravity of the situation and the lack of long-term benefit of continued life-sustaining interventions. EPs should also help the surrogate and family understand that palliative care addresses comfort needs of the patient including adequate treatment for pain, dyspnea, or anxiety. Part I of this communications model reviews determination of decision-making capacity, surrogacy laws, and advance directives, including legal definitions and application of these steps; Part II (which will appear in a future issue of AEM) covers communication moving from resuscitative to end-of-life and palliative treatment. EPs should recognize acute devastating illness or injuries, when appropriate, as opportunities to initiate end-of-life discussions and to

  4. Relationship among Medical Student Resilience, Educational Environment and Quality of Life.

    Science.gov (United States)

    Tempski, Patricia; Santos, Itamar S; Mayer, Fernanda B; Enns, Sylvia C; Perotta, Bruno; Paro, Helena B M S; Gannam, Silmar; Peleias, Munique; Garcia, Vera Lucia; Baldassin, Sergio; Guimaraes, Katia B; Silva, Nilson R; da Cruz, Emirene M T Navarro; Tofoli, Luis F; Silveira, Paulo S P; Martins, Milton A

    2015-01-01

    Resilience is a capacity to face and overcome adversities, with personal transformation and growth. In medical education, it is critical to understand the determinants of a positive, developmental reaction in the face of stressful, emotionally demanding situations. We studied the association among resilience, quality of life (QoL) and educational environment perceptions in medical students. We evaluated data from a random sample of 1,350 medical students from 22 Brazilian medical schools. Information from participants included the Wagnild and Young's resilience scale (RS-14), the Dundee Ready Educational Environment Measure (DREEM), the World Health Organization Quality of Life questionnaire - short form (WHOQOL-BREF), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). Full multiple linear regression models were adjusted for sex, age, year of medical course, presence of a BDI score ≥ 14 and STAI state or anxiety scores ≥ 50. Compared to those with very high resilience levels, individuals with very low resilience had worse QoL, measured by overall (β=-0.89; 95% confidence interval =-1.21 to -0.56) and medical-school related (β=-0.85; 95%CI=-1.25 to -0.45) QoL scores, environment (β=-6.48; 95%CI=-10.01 to -2.95), psychological (β=-22.89; 95%CI=-25.70 to -20.07), social relationships (β=-14.28; 95%CI=-19.07 to -9.49), and physical health (β=-10.74; 95%CI=-14.07 to -7.42) WHOQOL-BREF domain scores. They also had a worse educational environment perception, measured by global DREEM score (β=-31.42; 95%CI=-37.86 to -24.98), learning (β=-7.32; 95%CI=-9.23 to -5.41), teachers (β=-5.37; 95%CI=-7.16 to -3.58), academic self-perception (β=-7.33; 95%CI=-8.53 to -6.12), atmosphere (β=-8.29; 95%CI=-10.13 to -6.44) and social self-perception (β=-3.12; 95%CI=-4.11 to -2.12) DREEM domain scores. We also observed a dose-response pattern across resilience level groups for most measurements. Medical students with higher resilience levels

  5. Relationship among Medical Student Resilience, Educational Environment and Quality of Life.

    Directory of Open Access Journals (Sweden)

    Patricia Tempski

    Full Text Available Resilience is a capacity to face and overcome adversities, with personal transformation and growth. In medical education, it is critical to understand the determinants of a positive, developmental reaction in the face of stressful, emotionally demanding situations. We studied the association among resilience, quality of life (QoL and educational environment perceptions in medical students.We evaluated data from a random sample of 1,350 medical students from 22 Brazilian medical schools. Information from participants included the Wagnild and Young's resilience scale (RS-14, the Dundee Ready Educational Environment Measure (DREEM, the World Health Organization Quality of Life questionnaire - short form (WHOQOL-BREF, the Beck Depression Inventory (BDI and the State-Trait Anxiety Inventory (STAI.Full multiple linear regression models were adjusted for sex, age, year of medical course, presence of a BDI score ≥ 14 and STAI state or anxiety scores ≥ 50. Compared to those with very high resilience levels, individuals with very low resilience had worse QoL, measured by overall (β=-0.89; 95% confidence interval =-1.21 to -0.56 and medical-school related (β=-0.85; 95%CI=-1.25 to -0.45 QoL scores, environment (β=-6.48; 95%CI=-10.01 to -2.95, psychological (β=-22.89; 95%CI=-25.70 to -20.07, social relationships (β=-14.28; 95%CI=-19.07 to -9.49, and physical health (β=-10.74; 95%CI=-14.07 to -7.42 WHOQOL-BREF domain scores. They also had a worse educational environment perception, measured by global DREEM score (β=-31.42; 95%CI=-37.86 to -24.98, learning (β=-7.32; 95%CI=-9.23 to -5.41, teachers (β=-5.37; 95%CI=-7.16 to -3.58, academic self-perception (β=-7.33; 95%CI=-8.53 to -6.12, atmosphere (β=-8.29; 95%CI=-10.13 to -6.44 and social self-perception (β=-3.12; 95%CI=-4.11 to -2.12 DREEM domain scores. We also observed a dose-response pattern across resilience level groups for most measurements.Medical students with higher resilience levels

  6. Advanced directives: open issues

    Directory of Open Access Journals (Sweden)

    Gabriella Negrini

    2013-05-01

    Full Text Available BACKGROUND In Italy Advanced directives have not been regulated by law yet. Moreover, there is a confusion of concepts: advanced directives, refusal of treatment, medical futility and euthanasia are not synonymous.DISCUSSION The following aspects are then discussed: object of directives; elapse of time between their expression and their application; knowledge of the directives and their obligatory nature. The refusal of a treatment that can save a person’s life is a critical subject. There are different ethical points of view: according to lay ethics, the patient’s self-determination prevails; the religious viewpoint, instead, says that life is a gift which we cannot dispose of. In any case, the patient will be confronted with the professional autonomy of the doctor. Should the doctor save a patient’s life in any case or should he achieve best clinical practice, in respect of his will? The doctor should interpret the patient’s will but with caution and judgment. An exemption from responsibility should be provided by law for doctors who respect patient’s living will.

  7. Symptoms and health-related quality of life in patients with advanced cancer

    DEFF Research Database (Denmark)

    Augustussen, Mikaela; Sjøgren, Per; Timm, Helle

    2017-01-01

    PURPOSE: The aims were to describe symptoms and health-related quality of life (HRQoL) in Greenlandic patients with advanced cancer and to assess the applicability and internal consistency of the Greenlandic version of the EORTC-QLQ-C30 core version 3.0. METHODS: A Greenlandic version of the EORTC...... functioning. This indicates a potential for improving palliative care service and increasing the focus on symptom management. The Greenlandic version of the EORTC-QLQ-C30 represents an applicable and reliable tool to describe symptoms and health-related quality of life among Greenlandic patients with advanced...... cancer receiving palliative treatment was conducted. Internal consistency was examined by calculating Cronbach's alpha coefficients for five function scales and three symptom scales. RESULTS: Of the 58 patients who participated in the study, 47% had reduced social functioning, 36% had reduced physical...

  8. Quality of life of glaucoma patients under medical therapy with different prostaglandins

    Directory of Open Access Journals (Sweden)

    Paletta Guedes RA

    2012-10-01

    Full Text Available Ricardo Augusto Paletta Guedes,1–3 Vanessa Maria Paletta Guedes,1–3, Sirley Maria Freitas,2 Alfredo Chaoubah11Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; 2Paletta Guedes Ophthalmological Center, Juiz de Fora, MG, Brazil; 3Santa Casa de Misericórdia Hospital, Juiz de Fora, Minas Gerais, BrazilPurpose: To assess the quality of life of glaucoma patients under medical therapy with different prostaglandin analogs.Methods: A cross-sectional study of consecutive glaucoma patients was designed. We assessed the patients' quality of life through the Brazilian 25-question version of the National Eye Institute Visual Functioning Questionnaire, comprising 12 subscales (general health, general vision, ocular pain, near vision, distance vision, social function, mental health, role limitations, dependency, driving, color vision, and peripheral vision and a total composite score. Clinical features, including current medical treatment, were obtained from each patient's medical record. Three groups of patients were identified according to the prostaglandin in use: bimatoprost, latanoprost, or travoprost. The main outcome measures were: mean score in each subscale and mean total composite score.Results: The mean total composite score for the whole group was 70.60. The bimatoprost, latanoprost, and travoprost groups had the following mean composite scores, respectively: 56.56, 77.36, and 71.08 (P = 0.001, analysis of variance [ANOVA]. Latanoprost and travoprost results were similar, and both were superior to bimatoprost. Most subscales had similar results. The subscale with the lowest score for all groups was general health. Groups were homogenous and comparable.Conclusion: There is a difference in the quality of life between glaucoma patients using prostaglandin analogs. It seems that bimatoprost users have lower QoL when compared to latanoprost and travoprost users.Keywords: glaucoma, medical treatment, prostaglandin analogs

  9. Health-related quality of life of medical students in a Brazilian student loan programme.

    Science.gov (United States)

    Lins, Liliane; Carvalho, Fernando Martins; Menezes, Marta Silva; Porto-Silva, Larissa; Damasceno, Hannah

    2016-08-01

    This study aimed to evaluate the health-related quality of life of medical students participating in a large Brazilian government loan programme for undergraduate students in private schools.A cross-sectional study in a stratified sample of students from a private medical school in Salvador, Brazil, evaluated their health-related quality of life by using a Brazilian Portuguese version of the 36-item Short Form Health Survey questionnaire (SF-36).Students supported by the loan programme consistently presented lower mean scores in all SF-36 domains and in the physical and mental component summary scores than those who were not in the programme. Students supported by the loan programme presented systematically lower physical and mental component mean scores, after stratification by age, gender, school year, physical activity, sleepiness, headache, having a car, having a housemaid, living with family, and living in a rented house.The loan programme has enabled less wealthy undergraduate students to attend private medical schools in Brazil. However, this support is insufficient to improve students' health-related quality of life during medical school, as compared with students who do not participate in the programme. Because of a poorer health-related quality of life, students supported by the loan programme deserve special attention from private medical schools.

  10. Cross-cultural Differences in Mental Health, Quality of Life, Empathy, and Burnout between US and Brazilian Medical Students.

    Science.gov (United States)

    Lucchetti, Giancarlo; Damiano, Rodolfo Furlan; DiLalla, Lisabeth F; Lucchetti, Alessandra Lamas Granero; Moutinho, Ivana Lúcia Damásio; da Silva Ezequiel, Oscarina; Kevin Dorsey, J

    2018-02-01

    This study aimed to compare mental health, quality of life, empathy, and burnout in medical students from a medical institution in the USA and another one in Brazil. This cross-cultural study included students enrolled in the first and second years of their undergraduate medical training. We evaluated depression, anxiety, and stress (DASS 21), empathy, openness to spirituality, and wellness (ESWIM), burnout (Oldenburg), and quality of life (WHOQOL-Bref) and compared them between schools. A total of 138 Brazilian and 73 US medical students were included. The comparison between all US medical students and all Brazilian medical students revealed that Brazilians reported more depression and stress and US students reported greater wellness, less exhaustion, and greater environmental quality of life. In order to address a possible response bias favoring respondents with better mental health, we also compared all US medical students with the 50% of Brazilian medical students who reported better mental health. In this comparison, we found Brazilian medical students had higher physical quality of life and US students again reported greater environmental quality of life. Cultural, social, infrastructural, and curricular differences were compared between institutions. Some noted differences were that students at the US institution were older and were exposed to smaller class sizes, earlier patient encounters, problem-based learning, and psychological support. We found important differences between Brazilian and US medical students, particularly in mental health and wellness. These findings could be explained by a complex interaction between several factors, highlighting the importance of considering cultural and school-level influences on well-being.

  11. Attitudes toward euthanasia, assisted suicide and termination of life-sustaining treatment of Puerto Rican medical students, medical residents, and faculty.

    Science.gov (United States)

    Ramirez Rivera, J; Rodríguez, R; Otero Igaravidez, Y

    2000-01-01

    To elicit the opinion of Puerto Rican medical students, residents and internal medicine faculty as to the appropriateness of euthanasia and physician-assisted suicide and end-of-life management. Survey using a 16-item questionnaire answered within a two-month period in the fall of 1996. Rounds or faculty meetings at teaching hospitals located in the north, south and southwest of the island of Puerto Rico. There were 424 participants. The questionnaires of 279 medical students, 75 medical residents, and 35 internal medicine faculty members were analyzed. Thirty-five questionnaires, which were incomplete or answered by non-Puerto Rican participants, were excluded. Frequency of support of active euthanasia, physician-assisted suicide, withholding or withdrawing life-sustaining treatment with informed consent was determined. Whether it was ethical to prescribe full doses of drugs needed to alleviate pain even if it would hasten death, or agree to limit or restrict resources for the terminally ill was also determined. Forty per cent of the students, 33% of the residents, and 20% of the faculty supported euthanasia. If physician-assisted suicide were legalized, 50 per cent of the students, 43 per cent of the residents and 45 percent of the faculty would not be opposed to it. Sixty-eight per cent of the students, 67 per cent of the residents and 88 per cent of the faculty would support withholding or withdrawing life-sustaining treatment for dying patients with informed consent. Seventy-nine per cent of residents, 80 per cent of the faculty but only 54 per cent of medical students would prescribe full doses of drugs needed to alleviate pain in dying patients even if they would hasten death. Thirty-six per cent of the residents and faculty would agree to limit the use of medical resources for the terminally ill but only sixteen per cent of medical students would do so. The acceptance of euthanasia was inversely proportional to the clinical experience of the respondents: 40

  12. Trends in biomedical engineering: focus on Patient Specific Modeling and Life Support Systems.

    Science.gov (United States)

    Dubini, Gabriele; Ambrosi, Davide; Bagnoli, Paola; Boschetti, Federica; Caiani, Enrico G; Chiastra, Claudio; Conti, Carlo A; Corsini, Chiara; Costantino, Maria Laura; D'Angelo, Carlo; Formaggia, Luca; Fumero, Roberto; Gastaldi, Dario; Migliavacca, Francesco; Morlacchi, Stefano; Nobile, Fabio; Pennati, Giancarlo; Petrini, Lorenza; Quarteroni, Alfio; Redaelli, Alberto; Stevanella, Marco; Veneziani, Alessandro; Vergara, Christian; Votta, Emiliano; Wu, Wei; Zunino, Paolo

    2011-01-01

    Over the last twenty years major advancements have taken place in the design of medical devices and personalized therapies. They have paralleled the impressive evolution of three-dimensional, non invasive, medical imaging techniques and have been continuously fuelled by increasing computing power and the emergence of novel and sophisticated software tools. This paper aims to showcase a number of major contributions to the advancements of modeling of surgical and interventional procedures and to the design of life support systems. The selected examples will span from pediatric cardiac surgery procedures to valve and ventricle repair techniques, from stent design and endovascular procedures to life support systems and innovative ventilation techniques.

  13. Student-Life Stress Level and its Related Factors among Medical Students of Hamadan University of Medical Sciences in 2015

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    Roya Nikanjam

    2016-03-01

    Full Text Available Background and Objectives: Student-life stress can lead to various negative consequences such as physical illness, mental disorders or exhaustion. The present study was conducted to evaluate the level of student life stress and its related factors among medical students of Hamadan University of Medical Sciences. Materials and Methods: This cross-sectional study applied multistage random sampling to select 500university students at Hamadan University of Medical Sciences during 2015. The data collection tool used in this study was a self-report questionnaire containing two parts: a section on subjects' demographic details and another section for Student-Life Stress Inventory (SLSI. Data were analyzed in SPSS20-using descriptive and inferential statistics, such as independent t-test, Pearson’s correlation test and one-way ANOVA. Results: This study revealed that %57of the students had moderate levels of stress. The most important stressors included self-impose and pressure, and also the most important reactions to stressors included cognitive appraisal and emotional reactions, respectively. There was a significant association between exam stressors and branch, educational level, and mother's and father's education level (P< 0.05. Conclusions: According to the high level of stress in students and the recognition of demographic factors, effective educational interventions can be conducted to reduce stress.

  14. Medical end-of-life practices among Canadian physicians: a pilot study.

    Science.gov (United States)

    Marcoux, Isabelle; Boivin, Antoine; Mesana, Laura; Graham, Ian D; Hébert, Paul

    2016-01-01

    Medical end-of-life practices are hotly debated in Canada, and data from other countries are used to support arguments. The objective of this pilot study was twofold: to adapt and validate a questionnaire designed to measure the prevalence of these practices in Canada and the underlying decision-making process, and to assess the feasibility of a nationally representative study. In phase 1, questionnaires from previous studies were adapted to the Canadian context through consultations with a multidisciplinary committee and based on a scoping review. The modified questionnaire was validated through cognitive interviews with 14 physicians from medical specialties associated with a higher probability of being involved with dying patients recruited by means of snowball sampling. In phase 2, we selected a stratified random sample of 300 Canadian physicians in active practice from a national medical directory and used the modified tailored method design for mail and Web surveys. There were 4 criteria for success: modified questions are clearly understood; response patterns for sensitive questions are similar to those for other questions; respondents are comparable to the overall sampling frame; and mean questionnaire completion time is less than 20 minutes. Phase 1: main modifications to the questionnaire were related to documentation of all other medical practices (including practices intended to prolong life) and a question on the proportionality of drugs used. The final questionnaire contained 45 questions in a booklet style. Phase 2: of the 280 physicians with valid addresses, 87 (31.1%) returned the questionnaire; 11 of the 87 declined to participate, for a response rate of 27.1% (n = 76). Most respondents (64 [84%]) completed the mail questionnaire. All the criteria for success were met. It is feasible to study medical end-of-life practices, even for practices that are currently illegal, including the intentional use of lethal drugs. Results from this pilot study

  15. [Medicalization of life at the GP level: Where are we headed to?].

    Science.gov (United States)

    Cerecedo Pérez, M Jesús; Tovar Bobo, Margarita; Rozadilla Arias, Aurora

    2013-12-01

    The power of medicine has lately enhanced the idea of medicalizing any aspects of life that can be perceived as medical problems. Medicine sometimes creates false needs and there is nowadays an increasing number of situations are medicalized with the pretext of treating fake diseases such as spring fatigue, shyness o natural biological processes like menopause. Despite the better life conditions, we now attend more people that complain about discomfort that may have more to do with «feeling sick» than with authentic disease. There is an endless list: sadness, hyperactive children, anorexia, bulimia, vigorexia or problematic teenagers, amongst others. In this article we revise some interventions that, contribute to promote these situations also from the own doctor's office. Everyday adversity acquires today the status of disease, hence the remarkable increase in these consultations in the diverse sanitary services. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  16. Is it safe? Talking to teens with HIV/AIDS about death and dying: a 3-month evaluation of Family Centered Advance Care (FACE planning – anxiety, depression, quality of life

    Directory of Open Access Journals (Sweden)

    Maureen E Lyon

    2010-02-01

    Full Text Available Maureen E Lyon1, Patricia A Garvie2, Linda Briggs3, Jianping He4, Robert Malow5, Lawrence J D’Angelo1, Robert McCarter41Children’s National Medical Center and George Washington School of Medicine and Health Sciences, Washington, District of Columbia; 2St Jude Children’s Research Hospital, Memphis, Tennessee; 3Gundersen Lutheran Medical Foundation, Inc., Madison, Wisconsin; 4Children’s Research Institute, Washington, District of Columbia; 5Florida International University, Miami, FloridaPurpose: To determine the safety of engaging HIV-positive (HIV+ adolescents in a Family Centered Advance Care (FACE planning intervention.Patients and methods: We conducted a 2-armed, randomized controlled clinical trial in 2 hospital-based outpatient clinics from 2006–2008 with HIV+ adolescents and their surrogates (n = 76. Three 60–90 minutes sessions were conducted weekly. FACE intervention groups received: Lyon FCACP Survey©, the Respecting Choices® interview, and completion of The Five Wishes©. The Healthy Living Control (HLC received: Developmental History, Healthy Tips, Future Planning (vocational, school or vocational rehabilitation. Three-month post-intervention outcomes were: completion of advance directive (Five Wishes©; psychological adjustment (Beck Depression, Anxiety Inventories; quality of life (PedsQL™; and HIV symptoms (General Health Self-Assessment.Results: Adolescents had a mean age, 16 years; 40% male; 92% African-American; 68% with perinatally acquired HIV, 29% had AIDS diagnosis. FACE participants completed advance directives more than controls, using time matched comparison (P < 0.001. Neither anxiety, nor depression, increased at clinically or statistically significant levels post-intervention. FACE adolescents maintained quality of life. FACE families perceived their adolescents as worsening in their school (P = 0.018 and emotional (P = 0.029 quality of life at 3 months, compared with controls.Conclusions: Participating

  17. Preliminary Study for Conceptual Design of Advanced Long Life Small Modular Fast Reactor

    Energy Technology Data Exchange (ETDEWEB)

    Tak, Taewoo; Choe, Jiwon; Jeong, Yongjin; Lee, Deokjung [Ulsan National Institute of Science and Technology, Ulsan (Korea, Republic of); Kim, T. K. [Argonne National Laboratory, Argonne (United States)

    2015-05-15

    As one of the non-water coolant Small-Modular Reactor (SMR) core concepts for use in the mid- to long-term, ANL has proposed a 100 MWe Advanced sodium-cooled Fast Reactor core concept (AFR-100) targeting a small grid, transportable from pre-licensed factories to the remote plant site for affordable supply. Various breed-and-burn core concepts have been proposed to extend the reactor cycle length, which includes CANDLE with a cigar-type depletion strategy, TerraPower reactors with fuel shuffling for effective breeding, et al. UNIST has also proposed an ultra-long cycle fast reactor (UCFR) core concept having the power rating of 1000 MWe. By adopting the breed-and-burn strategies, the UCFR core can maintain criticality for a targeting reactor lifetime of 60 years without refueling. The objective of this project is to develop an advanced long-life SMR core concept by adopting both the small modular design features of the AFR-100 and the long-life breed-and-burn concept of the UCFR. A conceptual design of long life small modular fast reactor is under development by adopting both the small modular design features of the AFR-100 and the long-life breed-and-burn concept of the UCFR. The feasibility of the long-life fast reactor concepts was reviewed to obtain the core design guidelines and the reactor design requirements of long life small modular fast reactor were proposed in this study.

  18. Quality of Life in Patients With Advanced Cancer: Differential Association With Performance Status and Systemic Inflammatory Response.

    Science.gov (United States)

    Laird, Barry J A; Fallon, Marie; Hjermstad, Marianne J; Tuck, Sharon; Kaasa, Stein; Klepstad, Pål; McMillan, Donald C

    2016-08-10

    Quality of life is a key component of cancer care; however, the factors that determine quality of life are not well understood. The aim of this study was to examine the relationship between quality of life parameters, performance status (PS), and the systemic inflammatory response in patients with advanced cancer. An international biobank of patients with advanced cancer was analyzed. Quality of life was assessed at a single time point by using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C-30 (EORTC QLQ-C30). PS was assessed by using the Eastern Cooperative Oncology Group (ECOG) classification. Systemic inflammation was assessed by using the modified Glasgow Prognostic Score (mGPS), which combines C-reactive protein and albumin. The relationship between quality of life parameters, ECOG PS, and the mGPS was examined. Data were available for 2,520 patients, and the most common cancers were GI (585 patients [22.2%]) and pulmonary (443 patients [17.6%]). The median survival was 4.25 months (interquartile range, 1.36 to 12.9 months). Increasing mGPS (systemic inflammation) and deteriorating PS were associated with deterioration in quality-of-life parameters (P quality-of-life parameters independent of PS. Systemic inflammation was associated with quality-of-life parameters independent of PS in patients with advanced cancer. Further investigation of these relationships in longitudinal studies and investigations of possible effects of attenuating systemic inflammation are now warranted. © 2016 by American Society of Clinical Oncology.

  19. Can Playing an End-of-Life Conversation Game Motivate People to Engage in Advance Care Planning?

    Science.gov (United States)

    Van Scoy, Lauren J; Green, Michael J; Reading, Jean M; Scott, Allison M; Chuang, Cynthia H; Levi, Benjamin H

    2017-09-01

    Advance care planning (ACP) involves several behaviors that individuals undertake to prepare for future medical care should they lose decision-making capacity. The goal of this study was to assess whether playing a conversation game could motivate participants to engage in ACP. Sixty-eight English-speaking, adult volunteers (n = 17 games) from communities around Hershey, Pennsylvania, and Lexington, Kentucky, played a conversation card game about end-of-life issues. Readiness to engage in 4 ACP behaviors was measured by a validated questionnaire (based on the transtheoretical model) immediately before and 3 months postgame and a semistructured phone interview. These behaviors were (1) completing a living will; (2) completing a health-care proxy; (3) discussing end-of-life wishes with loved ones; and (4) discussing quality versus quantity of life with loved ones. Participants' (n = 68) mean age was 51.3 years (standard deviation = 0.7, range: 22-88); 94% of the participants were caucasian and 67% were female. Seventy-eight percent of the participants engaged in ACP behaviors within 3 months of playing the game (eg, updating documents, discussing end-of-life issues). Furthermore, 73% of the participants progressed in stage of change (ie, readiness) to perform at least 1 of the 4 behaviors. Scores on measures of decisional balance and processes of change increased significantly by 3 months postintervention. This pilot study found that individuals who played a conversation game had high rates of performing ACP behaviors within 3 months. These findings suggest that using a game format may be a useful way to motivate people to perform important ACP behaviors.

  20. Empathy among Medical Students: Is There a Relation with Quality of Life and Burnout?

    Science.gov (United States)

    Paro, Helena B. M. S.; Silveira, Paulo S. P.; Perotta, Bruno; Gannam, Silmar; Enns, Sylvia C.; Giaxa, Renata R. B.; Bonito, Rosuita F.; Martins, Mílton A.; Tempski, Patricia Z.

    2014-01-01

    Background We aimed to assess medical students' empathy and its associations with gender, stage of medical school, quality of life and burnout. Method A cross-sectional, multi-centric (22 medical schools) study that employed online, validated, self-reported questionnaires on empathy (Interpersonal Reactivity Index), quality of life (The World Health Organization Quality of Life Assessment) and burnout (the Maslach Burnout Inventory) in a random sample of medical students. Results Out of a total of 1,650 randomly selected students, 1,350 (81.8%) completed all of the questionnaires. Female students exhibited higher dispositional empathic concern and experienced more personal distress than their male counterparts (p<0.05; d≥0.5). There were minor differences in the empathic dispositions of students in different stages of their medical training (p<0.05; f<0.25). Female students had slightly lower scores for physical and psychological quality of life than male students (p<0.05; d<0.5). Female students scored higher on emotional exhaustion and lower on depersonalization than male students (p<0.001; d<0.5). Students in their final stage of medical school had slightly higher scores for emotional exhaustion, depersonalization and personal accomplishment (p<0.05; f<0.25). Gender (β = 0.27; p<0.001) and perspective taking (β = 0.30; p<0.001) were significant predictors of empathic concern scores. Depersonalization was associated with lower empathic concern (β = −0.18) and perspective taking (β = −0.14) (p<0.001). Personal accomplishment was associated with higher perspective taking (β = 0.21; p<0.001) and lower personal distress (β = −0.26; p<0.001) scores. Conclusions Female students had higher empathic concern and personal distress dispositions. The differences in the empathy scores of students in different stages of medical school were small. Among all of the studied variables, personal accomplishment held the most important

  1. Advance Care Planning in palliative care: a qualitative investigation into the perspective of Paediatric Intensive Care Unit staff.

    Science.gov (United States)

    Mitchell, Sarah; Dale, Jeremy

    2015-04-01

    The majority of children and young people who die in the United Kingdom have pre-existing life-limiting illness. Currently, most such deaths occur in hospital, most frequently within the intensive care environment. To explore the experiences of senior medical and nursing staff regarding the challenges associated with Advance Care Planning in relation to children and young people with life-limiting illnesses in the Paediatric Intensive Care Unit environment and opportunities for improvement. Qualitative one-to-one, semi-structured interviews were conducted with Paediatric Intensive Care Unit consultants and senior nurses, to gain rich, contextual data. Thematic content analysis was carried out. UK tertiary referral centre Paediatric Intensive Care Unit. Eight Paediatric Intensive Care Unit consultants and six senior nurses participated. Four main themes emerged: recognition of an illness as 'life-limiting'; Advance Care Planning as a multi-disciplinary, structured process; the value of Advance Care Planning and adverse consequences of inadequate Advance Care Planning. Potential benefits of Advance Care Planning include providing the opportunity to make decisions regarding end-of-life care in a timely fashion and in partnership with patients, where possible, and their families. Barriers to the process include the recognition of the life-limiting nature of an illness and gaining consensus of medical opinion. Organisational improvements towards earlier recognition of life-limiting illness and subsequent Advance Care Planning were recommended, including education and training, as well as the need for wider societal debate. Advance Care Planning for children and young people with life-limiting conditions has the potential to improve care for patients and their families, providing the opportunity to make decisions based on clear information at an appropriate time, and avoid potentially harmful intensive clinical interventions at the end of life. © The Author(s) 2015.

  2. Evaluation of Retention of Knowledge and Skills Imparted to First-Year Medical Students through Basic Life Support Training

    Science.gov (United States)

    Pande, Sushma; Pande, Santosh; Parate, Vrushali; Pande, Sanket; Sukhsohale, Neelam

    2014-01-01

    Poor awareness among medical graduates about basic life support (BLS) is a matter of great concern. The presence of a trained rescuer is the key determinant of ultimate survival from life-threatening emergencies. To achieve this goal, early exposure to such life-saving skills is the right decision to foster these skills for medical students, which…

  3. Some advances in medical applications of low energy accelerators

    Science.gov (United States)

    Valković, V.; Moschini, G.

    1991-05-01

    Medical applications of low energy accelerators include: the use of nuclear analytical methods and procedures for laboratory studies and routine measurements; material productions and modifications to meet special requirements; radioisotope productions and their applications in radiopharmaceuticals as well as in positron emission tomography; and radiotherapy with ions, based on improved understanding of the interaction of charged particles with living tissue. Some of the recent advances in these fields are critically summarized. The plan for an improved charged particle facility in a hospital environment dedicated to applications in biology and medicine is presented.

  4. Safety evaluation in the development of medical devices and combination products

    CERN Document Server

    Gad, Shayne C

    2008-01-01

    Capturing the growth of the global medical device market in recent years, this practical new guide is essential for all who are responsible for ensuring safety in the use and manufacture of medical devices. It has been extensively updated to reflect significant advances, incorporating combination products and helpful case examples of current real-life problems in the field.The Third Edition explores these key current trends:global device marketscontinually advancing technologythe increasing harmonization of device safety regulation worldwideEach aspect of safety evaluation is considered in ter

  5. Attitude Towards End of Life Communication of Austrian Medical Students.

    Science.gov (United States)

    Rumpold, Tamara; Lütgendorf-Caucig, Carola; Löffler-Stastka, Henriette; Roider-Schur, Sophie; Pötter, Richard; Kirchheiner, Kathrin

    2018-04-23

    Medical students have to acquire theoretical knowledge, practical skills, and a personal attitude to meet the emerging needs of palliative care. The present study aimed to assess the personal attitude of Austrian medical students towards end of life communication (EOLC), as key part of palliative care. This cross-sectional, mono-institutional assessment invited all medical students at the Medical University of Vienna in 2015. The assessment was conducted web-based via questionnaire about attitudes towards EOLC. Additional socio-demographic and medical education-related parameters were collected. Overall, 743 medical students participated in the present report. Differences regarding the agreement or disagreement to several statements concerning the satisfaction of working with chronically ill patients, palliative care, and health care costs, as well as the extent of information about palliative disease, were found for age, gender, and academic years. The overall attitude towards EOLC in the present sample can be regarded as quite balanced. Nevertheless, a considerable number of medical students are still reluctant to inform patients about their incurable disease. Reservations towards palliative care as part of the health care system seem to exist. The influence of the curriculum as well as practical experiences seems to be important but needs further investigation.

  6. Medical end-of-life decisions: Does its use differ in vulnerable patient groups? A systematic review and meta-analysis

    NARCIS (Netherlands)

    Rietjens, J.A.C.; Deschepper, R.; Pasman, R.; Deliens, L.

    2012-01-01

    Medical end-of-life decisions, defined as end-of-life practices with a potential or certain life-shortening effect, precede almost 50% of deaths in Western countries, and receive ample medical-ethical attention. This systematic review aims to detect whether there are differences in the prevalence of

  7. Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals.

    Science.gov (United States)

    Peicius, Eimantas; Blazeviciene, Aurelija; Kaminskas, Raimondas

    2017-06-05

    This paper joins the debate over changes in the role of health professionals when applying advance directives to manage the decision-making process at the end of life care. Issues in relation to advance directives occur in clinical units in Lithuania; however, it remains one of the few countries in the European Union (EU) where the discussion on advance directives is not included in the health-care policy-making agenda. To encourage the discussion of advance directives, a study was designed to examine health professionals' understanding and preferences related to advance directives. In addition, the study sought to explore the views of health care professionals of the application of Advance Directives (AD) in clinical practice in Lithuania. A cross-sectional survey was conducted by interviewing 478 health professionals based at major health care centers in Kaunas district, Lithuania. The design of the study included the use of a questionnaire developed for this study and validated by a pilot study. The collected data were analyzed using standard descriptive statistical methods. The analysis of knowledge about AD revealed some statistically significant differences when comparing the respondents' profession and gender. The analysis also indicated key emerging themes among respondents including tranquility of mind, the longest possible life expectancy and freedom of choice. Further, the study findings revealed that more than half of the study participants preferred to express their will while alive by using advance directives. The study findings revealed a low level of knowledge on advance directives among health professionals. Most health professionals agreed that AD's improved end-of-life decision making while the majority of physicians appreciated AD as the best tool for sharing responsibilities in clinical practice in Lithuania. More physicians than nurses preferred the presence of advance directives to support their decision making in end-of-life situations.

  8. New players for advanced prostate cancer and the rationalisation of insulin-sensitising medication.

    Science.gov (United States)

    Gunter, Jennifer H; Sarkar, Phoebe L; Lubik, Amy A; Nelson, Colleen C

    2013-01-01

    Obesity and type 2 diabetes are recognised risk factors for the development of some cancers and, increasingly, predict more aggressive disease, treatment failure, and cancer-specific mortality. Many factors may contribute to this clinical observation. Hyperinsulinaemia, dyslipidaemia, hypoxia, ER stress, and inflammation associated with expanded adipose tissue are thought to be among the main culprits driving malignant growth and cancer advancement. This observation has led to the proposal of the potential utility of "old players" for the treatment of type 2 diabetes and metabolic syndrome as new cancer adjuvant therapeutics. Androgen-regulated pathways drive proliferation, differentiation, and survival of benign and malignant prostate tissue. Androgen deprivation therapy (ADT) exploits this dependence to systemically treat advanced prostate cancer resulting in anticancer response and improvement of cancer symptoms. However, the initial therapeutic response from ADT eventually progresses to castrate resistant prostate cancer (CRPC) which is currently incurable. ADT rapidly induces hyperinsulinaemia which is associated with more rapid treatment failure. We discuss current observations of cancer in the context of obesity, diabetes, and insulin-lowering medication. We provide an update on current treatments for advanced prostate cancer and discuss whether metabolic dysfunction, developed during ADT, provides a unique therapeutic window for rapid translation of insulin-sensitising medication as combination therapy with antiandrogen targeting agents for the management of advanced prostate cancer.

  9. First aid and basic life support: a questionnaire survey of medical schools in the Netherlands.

    NARCIS (Netherlands)

    Tan, E.C.T.H.; Hekkert, K.D.; Vugt, A.B. van; Biert, J.

    2010-01-01

    PURPOSE: Adequate education in first aid and basic life support (BLS) should be considered as an essential aspect of the medical curriculum. The objective of this study was to investigate the current medical training in first aid and BLS at all 8 medical schools in the Netherlands. SUMMARY: An

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

    Science.gov (United States)

    Gugliucci, Marilyn R.; Weiner, Audrey

    2013-01-01

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

  11. Retention of first aid and basic life support skills in undergraduate medical students

    OpenAIRE

    Pim A. de Ruijter; Heleen A. Biersteker; Jan Biert; Harry van Goor; Edward C. Tan

    2014-01-01

    Background: Undergraduate medical students follow a compulsory first aid (FA) and basic life support (BLS) course. Retention of BLS seems poor and only little information is provided on the retention of FA skills. This study aims at evaluating 1- and 2-year retention of FA and BLS training in undergraduate medical students.Methods: One hundred and twenty students were randomly selected from first year (n=349) medical students who successfully followed a compulsory FA and BLS course. From thes...

  12. Views of Japanese medical students on the work-life balance of female physicians

    OpenAIRE

    Takahashi, Keiko; Nin, Tomoni; Akano, Megumi; Hasuike, Yukiko; Iijima, Hiroko; Suzuki, Keiichirou

    2017-01-01

    Objectives To survey medical students on their ideas of future work-life balance and discuss topics for next-generation medical education. Methods First-year (n=372, 34.9% female) and sixth-year medical students (n=311, 44.1% female) responded to a questionnaire on future self, marriage and childcare, and gender differences at the workplace. Responses were compared between academic years and gender. Responses were evaluated by gender and academic year using the Mann-Whitney U test.? Significa...

  13. System Engineering and Integration of Controls for Advanced Life Support

    Science.gov (United States)

    Overland, David; Hoo, Karlene; Ciskowski, Marvin

    2006-01-01

    The Advanced Integration Matrix (AIM) project at the Johnson Space Center (JSC) was chartered to study and solve systems-level integration issues for exploration missions. One of the first issues identified was an inability to conduct trade studies on control system architectures due to the absence of mature evaluation criteria. Such architectures are necessary to enable integration of regenerative life support systems. A team was formed to address issues concerning software and hardware architectures and system controls.. The team has investigated what is required to integrate controls for the types of non-linear dynamic systems encountered in advanced life support. To this end, a water processing bioreactor testbed is being developed which will enable prototyping and testing of integration strategies and technologies. Although systems such as the water bioreactors exhibit the complexities of interactions between control schemes most vividly, it is apparent that this behavior and its attendant risks will manifest itself among any set of interdependent autonomous control systems. A methodology for developing integration requirements for interdependent and autonomous systems is a goal of this team and this testbed. This paper is a high-level summary of the current status of the investigation, the issues encountered, some tentative conclusions, and the direction expected for further research.

  14. Importance of bio-medical and socio-economic factors for increase of life expectancy

    Directory of Open Access Journals (Sweden)

    Radivojević Biljana M.

    2004-01-01

    Full Text Available This paper analyzes the connection between life expectancy according to sex and numerous factors on which its level depends on. Statistical analysis understood application of correlation and regression analysis for determining the connection strength of life expectancy and researched factors separately and then all factors together, as well as separately groups of health-medical and socio-economic factors. The analysis was carried out for a group of developed countries, medium developed, mixed group and Yugoslavia (now SCG on available data for the second half of the 20th century. Analysis results for Yugoslavia showed that the greatest influence on life expectancy of all factors together were setting aside funds for social security (p<0.05. If only health-medical factors are observed, then child mortality up to 5 years and tumor mortality are in question. With women, the greatest influence is with child mortality up to five years old among all factors (medical, but in that case it is far less than with men. In developed countries, the strongest connection with life expectancy were the number of sick-beds with men (p<0.05, and with women the parameter of potentially lost years due to tumor (p<0.01. In medium developed countries the most influence on women's life expectancy was maternal mortality (p=0.014, and with men no researched factor was statistically significant. In the mixed sample, the strongest connection with men was with gross national income per capita (p<0.01, and with women with child mortality up to five years old (p=0.017. Therefore on the basis of the determined statistical importance of certain factors analysis showed that the influence of socio-economic factors on life expectancy was very strong in present conditions of mortality, not only in positive, but in negative direction as well, and that their influence in that second half of the 20th century was greater than the influence of health-medical

  15. Urogenital disease: current medical need and recent advances.

    Science.gov (United States)

    Holoboski, M

    1998-11-01

    The Medicinal Chemistry Division session on Urogenital Disease began with an overview by Dr P-O Andersson (Pharmacia and Upjohn, MI, USA) of current medical need and recent advances in the field. Dr Andersson drew attention to the limited interest that pharmaceutical companies have historically shown in the area of non-malignant diseases of the urogenital tract. Conditions such as bladder overactivity and urinary incontinence, benign prostatic hyperplasia (BPH) and erectile dysfunction have been poorly understood and have been regarded as unavoidable consequences of old age. One factor, which further compounds the problem, is that many people do not seek treatment, a practice which tends to lower the awareness of these conditions.

  16. Medical futility at the end of life: the perspectives of intensive care and palliative care clinicians.

    Science.gov (United States)

    Jox, Ralf J; Schaider, Andreas; Marckmann, Georg; Borasio, Gian Domenico

    2012-09-01

    Medical futility at the end of life is a growing challenge to medicine. The goals of the authors were to elucidate how clinicians define futility, when they perceive life-sustaining treatment (LST) to be futile, how they communicate this situation and why LST is sometimes continued despite being recognised as futile. The authors reviewed ethics case consultation protocols and conducted semi-structured interviews with 18 physicians and 11 nurses from adult intensive and palliative care units at a tertiary hospital in Germany. The transcripts were subjected to qualitative content analysis. Futility was identified in the majority of case consultations. Interviewees associated futility with the failure to achieve goals of care that offer a benefit to the patient's quality of life and are proportionate to the risks, harms and costs. Prototypic examples mentioned are situations of irreversible dependence on LST, advanced metastatic malignancies and extensive brain injury. Participants agreed that futility should be assessed by physicians after consultation with the care team. Intensivists favoured an indirect and stepwise disclosure of the prognosis. Palliative care clinicians focused on a candid and empathetic information strategy. The reasons for continuing futile LST are primarily emotional, such as guilt, grief, fear of legal consequences and concerns about the family's reaction. Other obstacles are organisational routines, insufficient legal and palliative knowledge and treatment requests by patients or families. Managing futility could be improved by communication training, knowledge transfer, organisational improvements and emotional and ethical support systems. The authors propose an algorithm for end-of-life decision making focusing on goals of treatment.

  17. Health-related quality of life of students from a private medical school in Brazil.

    Science.gov (United States)

    Lins, Liliane; Carvalho, Fernando M; Menezes, Marta S; Porto-Silva, Larissa; Damasceno, Hannah

    2015-11-08

    To assess health-related quality of life (HRQOL) and to describe factors associated with its variation among undergraduate medical students at a Brazilian private medical school. A cross-sectional study in a sample (n=180) of medical students at a private medical school in Salvador, Brazil, stratified by year of medical course. Data about age, sex, year of course, physical activity, sleepiness, headaches, participation in a student loan program supported by the Brazilian government (FIES) and living arrangements were collected using a self-administered form. HRQOL was assessed by using a Brazilian Portuguese version of the SF-36 form. The eight domains of SF-36 and the Physical Component (PCS) and Mental Component (MCS) Summaries scales were calculated. The medical students showed poor HRQOL, mainly because of the mental component. Lower mean scores were found among those with FIES support, females, those suffering from sleepiness, headaches and lacking physical activity. No clear trend was observed in the variation of the SF-36 mean scores according to the year of medical school. However, students in the fifth year of the course had the highest HRQOL mean scores. Health-related quality of life of students at this private medical school was poor, mainly because of its mental component. Lower HRQOL was associated with FIES support, females, sleepiness, headaches and lack of regular physical activity. Higher scores were found among fifth year students.

  18. The Chinese community patient’s life satisfaction, assessment of community medical service, and trust in community health delivery system

    Science.gov (United States)

    2013-01-01

    Background Although the Chinese government put a lot of effort into promoting the community patient’s life satisfaction, there still lacked the holistic and systematic approaches to promote the community patient’s life satisfaction in various regions of China. On the basis of the literature, it was found that both the community patient’s assessment of community medical service and trust in community health delivery system were important considerations when the community patient comprehensively evaluated community medical service to generate life satisfaction. So this study was set up to test whether and to what extent the community patient’s assessments of various major aspects of community medical service/various major aspects of the community patient’s trust in community health delivery system influenced life satisfaction in whole China/in various regions of China. Methods In order to explore the situation of China’s community health delivery system before 2009 and provide a reference for China’s community health delivery system reform, the data that could comprehensively and accurately reflect the community patient’s life satisfaction, assessment of community medical service, and trust in community health delivery system in various regions of China was needed, so this study collaborated with the National Bureau of Statistics of China to carry out a large-scale 2008 national community resident household survey (N = 3,306) for the first time in China. And the specified ordered probit models were established to analyze the dataset from this household survey. Results Among major aspects of community medical service, the medical cost (particularly in developed regions), the doctor-patient communication (particularly in developed regions), the medical facility and hospital environment (particularly in developed regions), and the medical treatment process (particularly in underdeveloped regions) were all key considerations (ppatient’s life

  19. The mediating role of resilience in the relationship between stress and life satisfaction among Chinese medical students: a cross-sectional study.

    Science.gov (United States)

    Shi, Meng; Wang, XiaoXi; Bian, YuGe; Wang, Lie

    2015-02-13

    The psychological distress of medical students has been widely acknowledged. However, few studies focused on positive well-being among medical students. The purpose of this study was to investigate related demographic factors of life satisfaction among Chinese medical students, to examine the relationship between stress and life satisfaction among this group of people, and to explore the mediating role of resilience in this relationship. This multicenter cross-sectional study was carried out in June 2014. Self-reported questionnaires consisting of Perceived Stress Scale (PSS), Wagnild and Young Resilience Scale (RS-14), Satisfaction with Life Scale (SWLS), as well as demographic section were distributed to students at four medical colleges and universities in Liaoning province, China. A total of 2925 students (effective response rate: 83.6%) became our subjects. Hierarchical linear regression models were used to explore the mediating role of resilience. Among the demographic factors, life satisfaction was significantly different in gender (P = 0.001) and study programs (P life satisfaction (r = -0.35, P life satisfaction (β = -0.34, P life satisfaction among Chinese medical students. Both stress and resilience played a big role in life satisfaction among Chinese medical students. Besides reducing perceived stress, the university authorities should adopt evidence-based intervention strategies to enhance their resilience in order to promote life satisfaction among the students.

  20. Long-term intended and unintended experiences after Advanced Life Support training

    DEFF Research Database (Denmark)

    Rasmussen, M.B.; Dieckmann, Peter; Issenberg, Berry

    2012-01-01

    Highly structured simulation-based training (SBT) on managing emergency situations can have a significant effect on immediate satisfaction and learning. However, there are some indications of problems when applying learned skills to practice. The aim of this study was to identify long-term intended...... and unintended learner reactions, experiences and reflections after attending a simulation based Advanced Life Support (ALS) course....

  1. Views of Japanese medical students on the work-life balance of female physicians.

    Science.gov (United States)

    Takahashi, Keiko; Nin, Tomoni; Akano, Megumi; Hasuike, Yukiko; Iijima, Hiroko; Suzuki, Keiichirou

    2017-05-11

    To survey medical students on their ideas of future work-life balance and discuss topics for next-generation medical education. First-year (n=372, 34.9% female) and sixth-year medical students (n=311, 44.1% female) responded to a questionnaire on future self, marriage and childcare, and gender differences at the workplace. Responses were compared between academic years and gender. Responses were evaluated by gender and academic year using the Mann-Whitney U test.  Significance was set at pwork part-time. Also among first-year students, greater percentages of female students expected to work part-time or leave their jobs temporarily while raising their children. Compared with first-year male students, first-year female students expected to undertake larger portions of the childcare and housework burden than their partners. However, gender differences in work-life balance and childcare leave vanished in the sixth-year students. Female medical students accepted childcare and housework burdens as inevitable; the work environment they choose might affect their career development. While support from male partners and institutions must be increased, voluntary actions and change in mentality of female students need to be promoted through medical education to prevent them from waiting passively for the situation to change.

  2. Conceptualisation of the characteristics of advanced practitioners in the medical radiation professions

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Tony [University of Newcastle Department of Rural Health, Taree, New South Wales (Australia); Harris, Jillian [Crown Princess Mary Cancer Centre, Westmead, Sydney, New South Wales (Australia); Woznitza, Nick [Homerton University Hospital and School of Allied Health Professions, Canterbury Christ Church University, Canterbury (Australia); Maresse, Sharon [Department of Imaging and Applied Physics, Curtin University, Perth, Western Australia (Australia); Sale, Charlotte [School of Medical Science, RMIT University, Melbourne, Victoria (Australia); University of Newcastle Department of Rural Health, Taree, New South Wales (Australia)

    2015-09-15

    Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as ‘a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care’. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiences in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities.

  3. Conceptualisation of the characteristics of advanced practitioners in the medical radiation professions

    International Nuclear Information System (INIS)

    Smith, Tony; Harris, Jillian; Woznitza, Nick; Maresse, Sharon; Sale, Charlotte

    2015-01-01

    Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as ‘a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care’. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiences in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities

  4. Changes in Prescribing Symptomatic and Preventive Medications in the Last Year of Life in Older Nursing Home Residents

    NARCIS (Netherlands)

    van der Meer, Helene G.; Taxis, Katja; Pont, Lisa G.

    2018-01-01

    Background At the end of life goals of care change from disease prevention to symptomatic control, however little is known about the patterns of medication prescribing at this stage. Objectives To explore changes in prescribing of symptomatic and preventive medication in the last year of life in

  5. Health and Quality of Life

    DEFF Research Database (Denmark)

    Gimmler, Antje; Lenk, Christian (ed.); Aumüller, Gerhard (ed.)

    How could one define health and disease? On what presuppositions, and oughtwe look for such definitions? Does quality of life inherit a subjective orobjective evaluation? Are health and quality of life culture dependentconcepts? Under the conditions of technologically advanced medicine...... and thecommon tendency towards a hedonistic lifestyle such questions come intofocus. Hence, one question is of special relevance: which role does healthplay in our quality of life? The contributions of this interdisciplinaryvolume aim at the clarification of the various concepts in use.Internationally well......-known scholars and scientists such as AlfredMusschenga, Alfons Labisch, Lennart Nordenfelt, Peter Janich, Henrik Wulffand several others outline the framework for a more comprehensive anddemanding concept of health and quality of life including philosophical andcultural aspects as well as medical...

  6. 1st European Congress of Medical Physics September 1-4, 2016; Medical Physics innovation and vision within Europe and beyond.

    Science.gov (United States)

    Tsapaki, Virginia; Kagadis, George C; Brambilla, Marco; Ciocca, Mario; Clark, Catharine H; Delis, Harry; Mettivier, Giovanni

    2017-09-01

    Medical Physics is the scientific healthcare profession concerned with the application of the concepts and methods of physics in medicine. The European Federation of Organisations for Medical Physics (EFOMP) acts as the umbrella organization for European Medical Physics societies. Due to the rapid advancements in related scientific fields, medical physicists must have continuous education through workshops, training courses, conferences, and congresses during their professional life. The latest developments related to this increasingly significant medical speciality were presented during the 1st European Congress of Medical Physics 2016, held in Athens, September 1-4, 2016, organized by EFOMP, hosted by the Hellenic Association of Medical Physicists (HAMP), and summarized in the current volume. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  7. Teaching Advanced Leadership Skills in Community Service (ALSCS) to medical students.

    Science.gov (United States)

    Goldstein, Adam O; Calleson, Diane; Bearman, Rachel; Steiner, Beat D; Frasier, Pamela Y; Slatt, Lisa

    2009-06-01

    Inadequate access to health care, lack of health insurance, and significant health disparities reflect crises in health care affecting all of society. Training U.S. physicians to possess not only clinical expertise but also sufficient leadership skills is essential to solve these problems and to effectively improve health care systems. Few models in the undergraduate medical curriculum exist for teaching students how to combine needed leadership competencies with actual service opportunities.The Advanced Leadership Skills in Community Service (ALSCS) selective developed in response to the shortage of leadership models and leadership training for medical students. The ALSCS selective is designed specifically to increase students' leadership skills, with an emphasis on community service. The selective integrates classroom-based learning, hands-on application of learned skills, and service learning. More than 60 medical students have participated in the selective since inception. Short-term outcomes demonstrate an increase in students' self-efficacy around multiple dimensions of leadership skills (e.g., fundraising, networking, motivating others). Students have also successfully completed more than a dozen leadership and community service projects. The selective offers an innovative model of a leadership-skills-based course that can have a positive impact on leadership skill development among medical school students and that can be incorporated into the medical school curriculum.

  8. Health-related quality of life of medical students.

    Science.gov (United States)

    Paro, Helena B M S; Morales, Nívea M O; Silva, Carlos H M; Rezende, Carlos H A; Pinto, Rogério M C; Morales, Rogério R; Mendonça, Tânia M S; Prado, Marília M

    2010-03-01

    Mental problems such as stress, anxiety and depression have been described among medical students and are associated with poor academic and professional performance. It has been speculated that these problems impair students' quality of life (QoL). The authors aimed to assess the health-related QoL (HRQL) of medical students throughout their 6 years of training at a school with a traditional curriculum. Of a total of 490 students attending our institution's medical school, 38 were surveyed in February 2006 (incoming Year 1 group, surveyed when students were in the second week of Year 1 classes) and 352 were surveyed in February 2007 (students in Years 1-6). Students self-reported their HRQL and depressive symptoms using the Short-Form Health Survey (SF-36) and the Beck Depression Inventory (BDI). Comparisons were performed according to year in training, presence of depressive symptoms, gender, living arrangements and correlations with family income. The students' ages ranged from 18 to 31 years (median 22.3 years). Students in Years 2, 3, 4 and 6 had lower scores for mental and physical dimensions of HRQL compared with the incoming Year 1 group (P students. Students with depressive symptoms had lower scores in all domains of the SF-36 (P students had lower HRQL scores than males (P students living with versus without family and no correlation with family income was found. Major impairments in HRQL were observed among Year 3 students, students with depressive symptoms and women. Medical schools should institute efforts to ensure that students' HRQL and emotional support are maintained, particularly during critical phases of medical training.

  9. Second Life: an overview of the potential of 3-D virtual worlds in medical and health education.

    Science.gov (United States)

    Boulos, Maged N Kamel; Hetherington, Lee; Wheeler, Steve

    2007-12-01

    This hybrid review-case study introduces three-dimensional (3-D) virtual worlds and their educational potential to medical/health librarians and educators. Second life (http://secondlife.com/) is perhaps the most popular virtual world platform in use today, with an emphasis on social interaction. We describe some medical and health education examples from Second Life, including Second Life Medical and Consumer Health Libraries (Healthinfo Island-funded by a grant from the US National Library of Medicine), and VNEC (Virtual Neurological Education Centre-developed at the University of Plymouth, UK), which we present as two detailed 'case studies'. The pedagogical potentials of Second Life are then discussed, as well as some issues and challenges related to the use of virtual worlds. We have also compiled an up-to-date resource page (http://healthcybermap.org/sl.htm), with additional online material and pointers to support and extend this study.

  10. Using Survival Analysis to Evaluate Medical Equipment Battery Life.

    Science.gov (United States)

    Kuhajda, David

    2016-01-01

    As hospital medical device managers obtain more data, opportunities exist for using the data to improve medical device management, enhance patient safety, and evaluate costs of decisions. As a demonstration of the ability to use data analytics, this article applies survival analysis statistical techniques to assist in making decisions on medical equipment maintenance. The analysis was performed on a large amount of data related to failures of an infusion pump manufacturer's lithium battery and two aftermarket replacement lithium batteries from one hospital facility. The survival analysis resulted in statistical evidence showing that one of the third-party batteries had a lower survival curve than the infusion pump manufacturer's battery. This lower survival curve translates to a shorter expected life before replacement is needed. The data suggested that to limit unexpected failures, replacing batteries at a two-year interval, rather than the current industry recommendation of three years, may be warranted. For less than $5,400 in additional annual cost, the risk of unexpected battery failures can be reduced from an estimated 28% to an estimated 7%.

  11. Hope or hype: the obsession with medical advances and the high cost of false promises

    National Research Council Canada - National Science Library

    Patrick, Donald L; Deyo, Richard A

    2005-01-01

    .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XV PART I Can There Be Too Much of a Good Uncritically Embracing Medical Advances Thing? The Hazards of 1 What's the Problem? Don't We Need Lifesaving New...

  12. Increase in cerebral oxygenation during advanced life support in out-of-hospital patients is associated with return of spontaneous circulation.

    Science.gov (United States)

    Genbrugge, Cornelia; Meex, Ingrid; Boer, Willem; Jans, Frank; Heylen, René; Ferdinande, Bert; Dens, Jo; De Deyne, Cathy

    2015-03-24

    By maintaining sufficient cerebral blood flow and oxygenation, the goal of cardiopulmonary resuscitation (CPR) is to preserve the pre-arrest neurological state. To date, cerebral monitoring abilities during CPR have been limited. Therefore, we investigated the time-course of cerebral oxygen saturation values (rSO₂) during advanced life support in out-of-hospital cardiac arrest. Our primary aim was to compare rSO₂ values during advanced life support from patients with return of spontaneous circulation (ROSC) to patients who did not achieve ROSC. We performed an observational study to measure rSO₂ using Equanox (Nonin, Plymouth, MI) from the start of advanced life support in the pre-hospital setting. rSO₂ of 49 consecutive out-of-hospital cardiac arrest patients were analyzed. The total increase from initial rSO₂ value until two minutes before ROSC or end of advanced life support efforts was significantly larger in the group with ROSC 16% (9 to 36) compared to the patients without ROSC 10% (4 to 15) (P = 0.02). Mean rSO₂ from the start of measurement until two minutes before ROSC or until termination of advanced life support was higher in patients with ROSC than in those without, namely 39% ± 7 and 31% ± 4 (P = 0.05) respectively. During pre-hospital advanced life support, higher increases in rSO₂ are observed in patients attaining ROSC, even before ROSC was clinically determined. Our findings suggest that rSO₂ could be used in the future to guide patient tailored treatment during cardiac arrest and could therefore be a surrogate marker of the systemic oxygenation state of the patient.

  13. Developing a measure of medication-related quality of life for people with polypharmacy.

    Science.gov (United States)

    Tseng, Hsu-Min; Lee, Chia-Hui; Chen, Yin-Jen; Hsu, Hsiang-Hao; Huang, Li-Yueh; Huang, Jing-Long

    2016-05-01

    To develop a measure of medication-related quality of life (MRQoL) and to validate the measure in a hospital-based population of patients with polypharmacy. The Medication-Related Quality of Life Scale version 1.0 (MRQoLS-v1.0) included 14 items developed on the basis of interviews with elderly patients with polypharmacy, defined as taking five or more medications simultaneously. This scale was tested in 219 outpatients (99 with polypharmacy and 120 without polypharmacy). Two measures were used to establish construct validity the Psychological Distress Checklist, for convergent validity, and the Medication Adherence Behavior Scale (MABS), for discriminant validity. The 14-item scale was found to be both reliable and valid. Internal consistency reliability evaluated using Cronbach's alpha for this scale was 0.91. Scores on the MRQoLS-v1.0 correlated statistically significantly and negatively with those on the Psychological Distress Checklist. Discriminant validity was demonstrated by low correlation with MABS, indicating that the MRQoLS-v1.0 measured concepts different from medication adherence. Significant differences in the MRQoLS-v1.0 between patients with polypharmacy and those without polypharmacy provided evidence for known-group validity. The study presents a psychometric evaluation of a measure used to assess MRQoL of patients with polypharmacy. The instrument is practical to administer in clinics and provides a valuable adjunct to the outcome measurement for patients with polypharmacy. Further research on the sensitivity of this instrument to medication change in multi-medicated patients is warranted.

  14. Paramedics experiences and expectations concerning advance directives: a prospective, questionnaire-based, bi-centre study.

    Science.gov (United States)

    Taghavi, Mahmoud; Simon, Alfred; Kappus, Stefan; Meyer, Nicole; Lassen, Christoph L; Klier, Tobias; Ruppert, David B; Graf, Bernhard M; Hanekop, Gerd G; Wiese, Christoph H R

    2012-10-01

    Advance directives and palliative crisis cards are means by which palliative care patients can exert their autonomy in end-of-life decisions. To examine paramedics' attitudes towards advance directives and end-of-life care. Questionnaire-based investigation using a self-administered survey instrument. Paramedics of two cities (Hamburg and Goettingen, Germany) were included. Participants were questioned as to (1) their attitudes about advance directives, (2) their clinical experiences in connection with end-of-life situations (e.g. resuscitation), (3) their suggestions in regard to advance directives, 'Do not attempt resuscitation' orders and palliative crisis cards. Questionnaires were returned by 728 paramedics (response rate: 81%). The majority of paramedics (71%) had dealt with advance directives and end-of-life decisions in emergency situations. Most participants (84%) found that cardiopulmonary resuscitation in end-of-life patients is not useful and 75% stated that they would withhold cardiopulmonary resuscitation in the case of legal possibility. Participants also mentioned that more extensive discussion of legal aspects concerning advance directives should be included in paramedic training curricula. They suggested that palliative crisis cards should be integrated into end-of-life care. Decision making in prehospital end-of-life care is a challenge for all paramedics. The present investigation demonstrates that a dialogue bridging emergency medical and palliative care issues is necessary. The paramedics indicated that improved guidelines on end-of-life decisions and the termination of cardiopulmonary resuscitation in palliative care patients may be essential. Participants do not feel adequately trained in end-of-life care and the content of advance directives. Other recent studies have also demonstrated that there is a need for training curricula in end-of-life care for paramedics.

  15. Research on Life Science and Life Support Engineering Problems of Manned Deep Space Exploration Mission

    Science.gov (United States)

    Qi, Bin; Guo, Linli; Zhang, Zhixian

    2016-07-01

    Space life science and life support engineering are prominent problems in manned deep space exploration mission. Some typical problems are discussed in this paper, including long-term life support problem, physiological effect and defense of varying extraterrestrial environment. The causes of these problems are developed for these problems. To solve these problems, research on space life science and space medical-engineering should be conducted. In the aspect of space life science, the study of space gravity biology should focus on character of physiological effect in long term zero gravity, co-regulation of physiological systems, impact on stem cells in space, etc. The study of space radiation biology should focus on target effect and non-target effect of radiation, carcinogenicity of radiation, spread of radiation damage in life system, etc. The study of basic biology of space life support system should focus on theoretical basis and simulating mode of constructing the life support system, filtration and combination of species, regulation and optimization method of life support system, etc. In the aspect of space medical-engineering, the study of bio-regenerative life support technology should focus on plants cultivation technology, animal-protein production technology, waste treatment technology, etc. The study of varying gravity defense technology should focus on biological and medical measures to defend varying gravity effect, generation and evaluation of artificial gravity, etc. The study of extraterrestrial environment defense technology should focus on risk evaluation of radiation, monitoring and defending of radiation, compound prevention and removal technology of dust, etc. At last, a case of manned lunar base is analyzed, in which the effective schemes of life support system, defense of varying gravity, defense of extraterrestrial environment are advanced respectively. The points in this paper can be used as references for intensive study on key

  16. Advanced Technologies to Improve Closure of Life Support Systems

    Science.gov (United States)

    Barta, Daniel J.

    2016-01-01

    As NASA looks beyond the International Space Station toward long-duration, deep space missions away from Earth, the current practice of supplying consumables and spares will not be practical nor affordable. New approaches are sought for life support and habitation systems that will reduce dependency on Earth and increase mission sustainability. To reduce launch mass, further closure of Environmental Control and Life Support Systems (ECLSS) beyond the current capability of the ISS will be required. Areas of particular interest include achieving higher degrees of recycling within Atmosphere Revitalization, Water Recovery and Waste Management Systems. NASA is currently investigating advanced carbon dioxide reduction processes that surpass the level of oxygen recovery available from the Sabatier Carbon Dioxide Reduction Assembly (CRA) on the ISS. Candidate technologies will potentially improve the recovery of oxygen from about 50% (for the CRA) to as much as 100% for technologies who's end product is solid carbon. Improving the efficiency of water recycling and recovery can be achieved by the addition of advanced technologies to recover water from brines and solid wastes. Bioregenerative technologies may be utilized for water reclaimation and also for the production of food. Use of higher plants will simultaneously benefit atmosphere revitalization and water recovery through photosynthesis and transpiration. The level at which bioregenerative technologies are utilized will depend on their comparative requirements for spacecraft resources including mass, power, volume, heat rejection, crew time and reliability. Planetary protection requirements will need to be considered for missions to other solar system bodies.

  17. Imagining life with an ostomy: Does a video intervention improve quality-of-life predictions for a medical condition that may elicit disgust?☆

    Science.gov (United States)

    Angott, Andrea M.; Comerford, David A.; Ubel, Peter A.

    2014-01-01

    Objective To test a video intervention as a way to improve predictions of mood and quality-of-life with an emotionally evocative medical condition. Such predictions are typically inaccurate, which can be consequential for decision making. Method In Part 1, people presently or formerly living with ostomies predicted how watching a video depicting a person changing his ostomy pouch would affect mood and quality-of-life forecasts for life with an ostomy. In Part 2, participants from the general public read a description about life with an ostomy; half also watched a video depicting a person changing his ostomy pouch. Participants’ quality-of-life and mood forecasts for life with an ostomy were assessed. Results Contrary to our expectations, and the expectations of people presently or formerly living with ostomies, the video did not reduce mood or quality-of-life estimates, even among participants high in trait disgust sensitivity. Among low-disgust participants, watching the video increased quality-of-life predictions for ostomy. Conclusion Video interventions may improve mood and quality-of-life forecasts for medical conditions, including those that may elicit disgust, such as ostomy. Practice implications Video interventions focusing on patients’ experience of illness continue to show promise as components of decision aids, even for emotionally charged health states such as ostomy. PMID:23177398

  18. Research Strategies for Academic Medical Centers: A Framework for Advancements toward Translational Excellence

    Science.gov (United States)

    Haley, Rand; Champagne, Thomas J., Jr.

    2017-01-01

    This review article presents a simplified framework for thinking about research strategy priorities for academic medical centers (AMCs). The framework can serve as a precursor to future advancements in translational medicine and as a set of planning guideposts toward ultimate translational excellence. While market pressures, reform uncertainties,…

  19. [State policy at the end of life. The transformation of medical deontology].

    Science.gov (United States)

    Serrano Ruiz-Calderón, José Miguel

    2012-01-01

    The contemporary state invades privacy in ways that affect even the end of life process. It develops public policies that can affect medical ethics. This limitation of power leaves the doctor's attention to the profession and may become a convenient code.

  20. Preparation and Characterization of an Advanced Medical Device for Bone Regeneration

    OpenAIRE

    Dorati, Rossella; Colonna, Claudia; Genta, Ida; Bruni, Giovanna; Visai, Livia; Conti, Bice

    2013-01-01

    Tridimensional scaffolds can promote bone regeneration as a framework supporting the migration of cells from the surrounding tissue into the damaged tissue and as delivery systems for the controlled or prolonged release of cells, genes, and growth factors. The goal of the work was to obtain an advanced medical device for bone regeneration through coating a decellularized and deproteinized bone matrix of bovine origin with a biodegradable, biocompatible polymer, to improve the cell engraftment...

  1. Clinical review: Ethics and end-of-life care for critically ill patients in China.

    Science.gov (United States)

    Li, Li Bin

    2013-12-04

    Critical care medicine in China has made great advances in recent decades. This has led to an unavoidable issue: end-of-life ethics. With advances in medical technology and therapeutics allowing the seemingly limitless maintenance of life, the exact time of death of an individual patient is often determined by the decision to limit life support. How to care for patients at the end of life is not only a medical problem but also a social, ethical, and legal issue. A lot of factors, besides culture, come into play in determining a person's ethical attitudes or behaviors, such as experience, education, religion, individual attributes, and economic considerations. Chinese doctors face ethical problems similar to those of their Western counterparts; however, since Chinese society is different from that of Western countries in cultural traditions, customs, religious beliefs, and ethnic backgrounds, there is a great difference between China and the Western world in regard to ethics at the end of life, and there is also a huge controversy within China.

  2. Professional identity formation in the transition from medical school to working life

    DEFF Research Database (Denmark)

    De Lasson, Lydia; Just, Eva; Stegeager, Nikolaj W.M.

    2016-01-01

    Background The transition from student to medical doctor is challenging and stressful to many junior doctors. To practice with confidence and professionalism the junior doctors have to develop a strong professional identity. Various suggestions on how to facilitate formation of professional ident...... and acting as a doctor), adoption to medical culture, career planning and managing a healthy work/life-balance. Further studies in different contexts are recommended as well as studies using other methods to test the results of this qualitative study....

  3. Nursing home policies regarding advance care planning in Flanders, Belgium

    NARCIS (Netherlands)

    de Gendt, C.; Bilsen, J.; van der Stichele, R.; Deliens, L.

    2010-01-01

    Background: The aim of this study is to discover how many nursing homes (NHs) in Flanders (Belgium) have policies on advance care planning (ACP) and their content regarding different medical end-of-life decisions. Methods: A structured mail questionnaire was sent to the NH administrators of all 594

  4. Quality of life in patients with advanced cancer at the end of life as measured by the McGill quality of life questionnaire: a survey in China.

    Science.gov (United States)

    Cui, Jing; Fang, Fang; Shen, Fengping; Song, Lijuan; Zhou, Lingjun; Ma, Xiuqiang; Zhao, Jijun

    2014-11-01

    Quality of life (QOL) is the main outcome measure for patients with advanced cancer at the end of life. The McGill Quality of Life Questionnaire (MQOL) is designed specifically for palliative care patients and has been translated and validated in Hong Kong and Taiwan. This study aimed to investigate the QOL of patients with advanced cancer using the MQOL-Taiwan version after cultural adaptation to the Chinese mainland. A cross-sectional survey design was used. QOL data from patients with advanced cancer were gathered from 13 hospitals including five tertiary hospitals, six secondary hospitals, and community health care service centers in Shanghai and analyzed. QOL was assessed using the MQOL-Chinese version. Statistical analyses were performed using descriptive statistics, multiple regression analysis, and Spearman rank correlation analysis. A total of 531 cancer patients (297 male and 234 female) in 13 hospitals were recruited into the study and administered the MQOL-Chinese. The score of the support subscale was highest (6.82), and the score of the existential well-being subscale was the lowest (4.65). The five physical symptoms most frequently listed on the MQOL-Chinese were pain, loss of appetite, fatigue, powerless, and dyspnea. Participants' sex, educational level, number of children, disclosure of the disease, and hospital size were associated with their overall QOL. The Spearman rank correlation analysis found that Karnofsky Performance Status scores correlated with the MQOL-Chinese single-item score, physical well-being, psychological well-being, existential well-being, and support domains (P patients with advanced cancer. The association between the characteristics of patients, Karnofsky Performance Status, and their QOL also was identified. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  5. Aspects of communication in medical life. Doctor-patient communication: differentiation and customization.

    Science.gov (United States)

    Borţun, D; Matei, C S

    2017-01-01

    One of the weaknesses of the Romanian medical system is the absence of the communicational culture. This absence is felt at all levels of the healthcare system: doctor-patient relationship, doctor-patient's relatives relationship, labor relations within the medical teams and units, the management of the large hospitals and of the medical institutions from the public administration system and last, but not least, the relationships of these units and institutions with the public opinion and, particularly, with the stakeholders. This paper tackled with some of the principles and values that underlie an efficient communication, the default of which was felt in various domains of the Romanian medical life. They were analyzed from the perspective of the Romanian and international literature and the conclusions drawn might inspire proposals for the improvement of the medical education as well as for the professional development of the Romanian doctors.

  6. Clinical Impact of Education Provision on Determining Advance Care Planning Decisions among End Stage Renal Disease Patients Receiving Regular Hemodialysis in University Malaya Medical Centre.

    Science.gov (United States)

    Hing Wong, Albert; Chin, Loh Ee; Ping, Tan Li; Peng, Ng Kok; Kun, Lim Soo

    2016-01-01

    Advance care planning (ACP) is a process of shared decision-making about future health-care plans between patients, health care providers, and family members, should patients becomes incapable of participating in medical treatment decisions. ACP discussions enhance patient's autonomy, focus on patient's values and treatment preferences, and promote patient-centered care. ACP is integrated as part of clinical practice in Singapore and the United States. To assess the clinical impact of education provision on determining ACP decisions among end-stage renal disease patients on regular hemodialysis at University Malaya Medical Centre (UMMC). To study the knowledge and attitude of patients toward ACP and end-of-life issues. Fifty-six patients were recruited from UMMC. About 43 questions pretest survey adapted from Lyon's ACP survey and Moss's cardiopulmonary resuscitation (CPR) attitude survey was given to patients to answer. An educational brochure is then introduced to these patients, and a posttest survey carried out after that. The results were analyzed using SPSS version 22.0. Opinion on ACP, including CPR decisions, showed an upward trend on the importance percentage after the educational brochure exposure, but this was statistically not significant. Seventy-five percent of participants had never heard of ACP before, and only 3.6% had actually prepared a written advanced directive. The ACP educational brochure clinically impacts patients' preferences and decisions toward end-of-life care; however, this is statistically not significant. Majority of patients have poor knowledge on ACP. This study lays the foundation for execution of future larger scale clinical trials, and ultimately, the incorporation of ACP into clinical practice in Malaysia.

  7. Treatment of advanced laryngeal cancer and quality of life. Systematic review.

    Science.gov (United States)

    García-León, Francisco Javier; García-Estepa, Raúl; Romero-Tabares, Antonio; Gómez-Millán Borrachina, Jaime

    The objective was the comparison of the quality of life in patients with advanced laryngeal cancer treated with organ preservation versus surgical treatment. We performed a systematic review in the databases MedLine, EMBASE, and PubMed (2014 1991) and Web of Science (2012 - 2014). The search terms were: Laryngeal cancer, organ preservation, chemotherapy, laryngectomy, treatment outcomes and quality of life. Systematic reviews, meta-analysis, reports of health technology assessment and comparative studies with control group, published in Spanish, French or English were included. The selection and quality assessment was made by two researchers. The criteria of the Cochrane Collaboration were used to assess the risk of bias and Scottish Intercollegiate Guidelines Network (SIGN) for the level of evidence. Of the 208 studies identified in the search, three were included a clinical trial and two observational studies, with a total of 211 patients. Quality and level of evidence was low. The results were contradictory, on occasion they favoured surgery, and on other occasions chemotherapy, but in general there were no statistical differences between the treatments. The studies were heterogeneous, with different methodology, undersized, limitations in quality with high risk of bias and use of different measurement scales. There are not enough studies of quality to establish differences in the quality of life in patients with advanced laryngeal cancer according to the treatment received. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  8. Effect of a Patient-Centered Communication Intervention on Oncologist-Patient Communication, Quality of Life, and Health Care Utilization in Advanced Cancer

    Science.gov (United States)

    Epstein, Ronald M.; Duberstein, Paul R.; Fenton, Joshua J.; Fiscella, Kevin; Hoerger, Michael; Tancredi, Daniel J.; Xing, Guibo; Gramling, Robert; Mohile, Supriya; Franks, Peter; Kaesberg, Paul; Plumb, Sandy; Cipri, Camille S.; Street, Richard L.; Shields, Cleveland G.; Back, Anthony L.; Butow, Phyllis; Walczak, Adam; Tattersall, Martin; Venuti, Alison; Sullivan, Peter; Robinson, Mark; Hoh, Beth; Lewis, Linda; Kravitz, Richard L.

    2018-01-01

    IMPORTANCE Observational studies demonstrate links between patient-centered communication, quality of life (QOL), and aggressive treatments in advanced cancer, yet few randomized clinical trials (RCTs) of communication interventions have been reported. OBJECTIVE To determine whether a combined intervention involving oncologists, patients with advanced cancer, and caregivers would promote patient-centered communication, and to estimate intervention effects on shared understanding, patient-physician relationships, QOL, and aggressive treatments in the last 30 days of life. DESIGN, SETTING, AND PARTICIPANTS Cluster RCT at community- and hospital-based cancer clinics in Western New York and Northern California; 38 medical oncologists (mean age 44.6 years; 11 (29%) female) and 265 community-dwelling adult patients with advanced nonhematologic cancer participated (mean age, 64.4 years, 146 [55.0%] female, 235 [89%] white; enrolled August 2012 to June 2014; followed for 3 years); 194 patients had participating caregivers. INTERVENTIONS Oncologists received individualized communication training using standardized patient instructors while patients received question prompt lists and individualized communication coaching to identify issues to address during an upcoming oncologist visit. Both interventions focused on engaging patients in consultations, responding to emotions, informing patients about prognosis and treatment choices, and balanced framing of information. Control participants received no training. MAIN OUTCOMES AND MEASURES The prespecified primary outcome was a composite measure of patient-centered communication coded from audio recordings of the first oncologist visit following patient coaching (intervention group) or enrollment (control). Secondary outcomes included the patient-physician relationship, shared understanding of prognosis, QOL, and aggressive treatments and hospice use in the last 30 days of life. RESULTS Data from 38 oncologists (19 randomized

  9. Doctors’ Support – An important part of medical therapy and quality of life

    Directory of Open Access Journals (Sweden)

    Mariusz Jaworski

    2015-07-01

    Full Text Available Introduction: The correct patient – doctor relationship is important in shaping the whole process of treatment. The scientific studies highlight the various irregularities in this relationship and its negative impact on the effectiveness of medical treatment. The purpose of this study was to assess the relationship between levels of doctors’ support and attitude to certain aspects of the treatment process and quality of life among patients with psoriasis. Material and Methods: The study was conducted on 50 patients with psoriasis aged from 21 to 78 who are treated in dermatological clinics. The Psoriasis Area and Severity Index (PASI was used to assess the severity of psoriatic skin changes. The patients completed a questionnaire for the assessment of receive doctors’ support, and its relationship with the attitude towards the disease. The research tool was developed based on literature review. Results: The level of doctors’ support had a direct impact on the patients’ attitude the disease, including attitudes towards the treatment and medical personnel, as well as adherence to medical recommendations; and indirectly on satisfaction with the treatment and the quality of life. Conclusions: Results of this study have shown clear evidence the importance of the level of doctors’ support in psoriasis which could help to improve the overall functioning of these patients. The level of doctors’ support indirectly affects the quality of life in patients with psoriasis.

  10. Burnout, quality of life, motivation, and academic achievement among medical students: A person-oriented approach.

    Science.gov (United States)

    Lyndon, Mataroria P; Henning, Marcus A; Alyami, Hussain; Krishna, Sanjeev; Zeng, Irene; Yu, Tzu-Chieh; Hill, Andrew G

    2017-04-01

    The aim of this study was to identify burnout and quality of life profiles of medical students and determine their associations with academic motivation and achievement on progress tests using a person-oriented approach. Medical students (n = 670) in Year 3 to Year 5 at the University of Auckland were classified into three different profiles as derived from a two-step cluster analysis using World Health Organization Quality of Life-BREF scores and Copenhagen Burnout Inventory scores. The profiles were used as independent variables to assess differences in academic motivation and achievement on progress tests using a multivariate analysis of co-variance and repeated measures analysis of co-variance methods. The response rate was 47%. Three clusters were obtained: Higher Burnout Lower Quality of Life (n = 62, 20%), Moderate Burnout Moderate Quality of Life (n = 131, 41%), and Lower Burnout Higher Quality of Life (n = 124, 39%). After controlling for gender and year level, Higher Burnout Lower Quality of Life students had significantly higher test anxiety (p motivation (p students are associated with differences in academic motivation and achievement over time.

  11. Managing occupations in everyday life for people with advanced cancer living at home

    DEFF Research Database (Denmark)

    Peoples, Hanne; Brandt, Åse; Wæhrens, Eva Elisabet Ejlersen

    2017-01-01

    occupations in everyday life and 2) Self-developed strategies to manage occupations. Significance: The findings suggest that people with advanced cancer should be supported to a greater extent in finding ways to manage familiar as well as new and more personally meaningful occupations to enhance quality...

  12. Rare medical conditions and suggestive past-life memories: a case report and literature review.

    Science.gov (United States)

    Lucchetti, Giancarlo; dos Santos Camargo, Luizete; Lucchetti, Alessandra L G; Schwartz, Gary E; Nasri, Fabio

    2013-01-01

    We aim to report the case of a 38-year-old male with suggestive past-life memories during a regression session and to show how these memories were related to unusual medical conditions: (1) isolated obstruction of the right coronary artery in a young patient, (2) omental infarction, and (3) right aortic arch with isolation of the left subclavian artery. These conditions were related to the following suggestive past-life memories: (1) a priest who committed suicide with a crucifix nailed to his chest and (2) a medieval weapon (skull flail) hitting his cervical and left back region. There was an intriguing relation between the patient's suggestive past-life memories and rare medical conditions. In this article, the authors highlight possible explanations, rarity of findings, and similarities/differences from previous cases and potential pitfalls in this area. © 2013 Elsevier Inc. All rights reserved.

  13. Advance Directives for End-of-Life Care and the Role of Health Education Specialists: Applying the Theory of Reasoned Action

    Science.gov (United States)

    Tremethick, Mary Jane; Johnson, Maureen K.; Carter, Mary R.

    2011-01-01

    Quality end-of-life care is subjective and based on individual values and beliefs. An advance directive provides a legal means of communicating these values and beliefs, as well as preferences in regards to end-of-life care when an individual is no longer able to make his or her desires known. In many nations, advance directives are underused…

  14. Pharmacological management of co-morbid conditions at the end of life: is less more?

    LENUS (Irish Health Repository)

    McLean, S

    2013-03-01

    Co-morbid conditions (CMCs) are present in over half of patients with cancer over 50 years of age. As life-limiting illnesses progress, the benefits and burdens of treatments for CMCs become unclear. Relevant issues include physiological changes in advanced illness, time-to-benefit of medications, burden of medications, and psychological impact of discontinuing medications. Optimal prescribing is unclear due to lack of evidence.

  15. Evaluating the Effects of Medical Explorers a Case Study Curriculum on Critical Thinking, Attitude Toward Life Science, and Motivational Learning Strategies in Rural High School Students

    Science.gov (United States)

    Brand, Lance G.

    2011-12-01

    The purpose of this study was three-fold: to measure the ability of the Medical Explorers case-based curriculum to improve higher order thinking skills; to evaluate the impact of the Medical Explorers case-based curriculum to help students be self directed learners; and to investigate the impact of the Medical Explorers case-based curriculum to improve student attitudes of the life sciences. The target population for this study was secondary students enrolled in advanced life science programs. The resulting sample (n = 71) consisted of 36 students in the case-based experimental group and 35 students in the control group. Furthermore, this study employed an experimental, pretest-posttest control group research design. The treatment consisted of two instructional strategies: case-based learning and teacher-guided learning. Analysis of covariance indicated no treatment effect on critical thinking ability or Motivation and Self-regulation of Learning. However, the Medical Explorers case-based curriculum did show a treatment effect on student attitudes toward the life sciences. These results seem to indicate that case-based curriculum has a positive impact on students' perspectives and attitudes about the study of life science as well as their interest in life science based careers. Such outcomes are also a good indicator that students enjoy and perceive the value to use of case studies in science, and because they see value in the work that they do they open up their minds to true learning and integration. Of additional interest was the observationthat on average eleventh graders showed consistently stronger gains in critical thinking, motivation and self-regulation of learning strategies, and attitudes toward the life sciences as compared to twelfth grade students. In fact, twelfth grade students showed a pre to post loss on the Watson-Glaser and the MSLQ scores while eleventh grade students showed positive gains on each of these instruments. This decline in twelfth

  16. End-of-life, euthanasia, and assisted suicide: An update on the situation in France.

    Science.gov (United States)

    Aubry, R

    2016-12-01

    On February 2, 2016, the French parliament adopted legislation creating new rights for the terminally ill. The text modifies and reinforces the rights of patients to end-of-life care and strengthens the status of surrogate decision makers. Under the new regulations, advance directives become legally binding though not unenforceable. Two types of advance directives are distinguished depending on whether the person is suffering or not from a serious illness when drafting them. The attending physician must abide by the patient's advance directives except in three situations: there is a life-threatening emergency; the directives are manifestly inappropriate; the directives are not compatible with the patient's medical condition. There is no time limit on the validity of advance directives. They are to be written in concordance with a model elaborated by the French superior health authority. This model takes into account the person's knowledge (or not) of having a serious illness when drafting his/her advance directives. In all likelihood, physicians will be called upon to help patients elaborate their advance directives. The law also has a provision for a national registry - potentially the shared medical file - to be designed as a reference source to facilitate storage, accessibility and safety of advance directives. The law introduces the right to continuous deep sedation until death in three specific situations: (i) at the patient's request when the short-term prognosis is death and continuous deep sedation is the only alternative for relieving the patient's suffering or one or more otherwise uncontrollable symptoms; (ii) at the patient's request when the patient chooses to withdraw artificial life-sustaining treatment and such withdrawal would be rapidly life-shortening and susceptible to cause unbearable suffering; (iii) when the patient is unable to express his/her wishes and the collegiate medical decision is to withdraw aggressive futile life

  17. The use of opioids at the end-of-life and the survival of Egyptian palliative care patients with advanced cancer.

    Science.gov (United States)

    Alsirafy, Samy A; Galal, Khaled M; Abou-Elela, Enas N; Ibrahim, Noha Y; Farag, Dina E; Hammad, Ahmed M

    2013-10-01

    One of the barriers to cancer pain control and palliative care (PC) development is the misconception that the use of opioids may hasten death. This concern is exaggerated when higher doses of opioids are used at the end-of-life. The aim of this study was to investigate the relationship between survival and the dose of opioids used at the end-of-life of patients with advanced cancer in an Egyptian PC setting. Retrospective review of the medical records of 123 patients with advanced cancer managed in an Egyptian cancer center-based palliative medicine unit (PMU). Patients were classified according to the last prescribed regular opioid dose expressed in milligrams of oral morphine equivalent (OME) per day (mg OME/24 h) into three groups: no opioid or low-dose group (PMU to death. The median age of patients was 53 years, breast cancer was the most common diagnosis (18%) and the majority (68%) died at home. Opioids were prescribed for pain control in 94% of patients and were prescribed on regular basis in 89%. The mean last prescribed opioid dose for the whole group of patients was 167 (±170) mg OME/24 h and it was highest among patients with pleural mesothelioma [245 (±258) mg OME/24 h]. The last prescription included no opioids or low-dose opioids in 57 (46%) patients, intermediate-dose in 42 (34%) and high-dose in 24 (20%). The estimated median survival was 45 days for the no opioid/low-dose group, 75 days for the intermediate-dose group and 153 days for the high-dose group (P=0.031). The results suggest that the dose of opioids has no detrimental impact on the survival of patients with advanced cancer in an Egyptian PC setting. Further research is needed to overcome barriers to cancer pain control especially in settings with inadequate cancer pain control.

  18. Life sciences: Lawrence Berkeley Laboratory, 1988

    International Nuclear Information System (INIS)

    1989-07-01

    Life Sciences Research at LBL has both a long history and a new visibility. The physics technologies pioneered in the days of Ernest O. Lawrence found almost immediate application in the medical research conducted by Ernest's brother, John Lawrence. And the tradition of nuclear medicine continues today, largely uninterrupted for more than 50 years. Until recently, though, life sciences research has been a secondary force at the Lawrence Berkeley Laboratory (LBL). Today, a true multi-program laboratory has emerged, in which the life sciences participate as a full partner. The LBL Human Genome Center is a contribution to the growing international effort to map the human genome. Its achievements represent LBL divisions, including Engineering, Materials and Chemical Sciences, and Information and Computing Sciences, along with Cell and Molecular Biology and Chemical Biodynamics. The Advanced Light Source Life Sciences Center will comprise not only beamlines and experimental end stations, but also supporting laboratories and office space for scientists from across the US. This effort reflects a confluence of scientific disciplines --- this time represented by individuals from the life sciences divisions and by engineers and physicists associated with the Advanced Light Source project. And finally, this report itself, the first summarizing the efforts of all four life sciences divisions, suggests a new spirit of cooperation. 30 figs

  19. Attributes of advanced practice registered nurse care coordination for children with medical complexity.

    Science.gov (United States)

    Cady, Rhonda G; Kelly, Anne M; Finkelstein, Stanley M; Looman, Wendy S; Garwick, Ann W

    2014-01-01

    Care coordination is an essential component of the pediatric health care home. This study investigated the attributes of relationship-based advanced practice registered nurse care coordination for children with medical complexity enrolled in a tertiary hospital-based health care home. Retrospective review of 2,628 care coordination episodes conducted by telehealth over a consecutive 3-year time period for 27 children indicated that parents initiated the majority of episodes and the most frequent reason was acute and chronic condition management. During this period, care coordination episodes tripled, with a significant increase (p < .001) between years 1 and 2. The increased episodes could explain previously reported reductions in hospitalizations for this group of children. Descriptive analysis of a program-specific survey showed that parents valued having a single place to call and assistance in managing their child's complex needs. The advanced practice registered nurse care coordination model has potential for changing the health management processes for children with medical complexity. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

  20. Medication-related risk factors associated with health-related quality of life among community-dwelling elderly in China.

    Science.gov (United States)

    Zhang, Sha; Meng, Long; Qiu, Feng; Yang, Jia-Dan; Sun, Shusen

    2018-01-01

    Previous studies have demonstrated that medication adherence has an impact on health-related quality of life (HRQoL). However, other medication-related factors that may influence HRQoL have not been extensively studied, especially factors based on the Medication-Risk Questionnaire (MRQ), and such studies are mostly done in Western countries. Our objective was to explore risk factors associated with HRQoL among community-dwelling elderly with chronic diseases in mainland China, especially the medication-related risk factors regarding MRQ. The study was conducted in a community health service center through surveys to eligible patients. The main outcomes of HRQoL were assessed by the EuroQol-5D (EQ-5D) scale and EQ-visual analog scale (EQ-VAS). Medication-related risk factors according to MRQ associated with HRQoL were identified using a multiple linear regression. A total of 311 patients were analyzed, averaging 71.19±5.33 years, and 68.8% were female. The mean EQ-5D index was 0.72±0.09, and the mean EQ-VAS score was 71.37±11.97. The most prevalent problem was pain/discomfort, and 90.0% believed that they could take care of themselves without any problems. Sex, age, educational level, frailty, function status, and certain medication-related factors regarding MRQ were found to be significant factors impacting the HRQoL. A multivariate analysis showed that MRQ factors of polypharmacy, multimorbidity, feeling difficultly with taking medicines as prescribed, and taking medicines with narrow therapeutic index had negative impacts on the quality of life. Patient's internal characteristics and medication-related risk factors according to MRQ were associated with quality of life. The results of the MRQ is an indicator of quality of life that can identify patients who need interventions.

  1. Signal and image analysis for biomedical and life sciences

    CERN Document Server

    Sun, Changming; Pham, Tuan D; Vallotton, Pascal; Wang, Dadong

    2014-01-01

    With an emphasis on applications of computational models for solving modern challenging problems in biomedical and life sciences, this book aims to bring collections of articles from biologists, medical/biomedical and health science researchers together with computational scientists to focus on problems at the frontier of biomedical and life sciences. The goals of this book are to build interactions of scientists across several disciplines and to help industrial users apply advanced computational techniques for solving practical biomedical and life science problems. This book is for users in t

  2. Spirituality, depression and quality of life in medical students in KwaZulu-Natal

    OpenAIRE

    Pillay, Narushni; Ramlall, Suvira; Burns, Jonathan K.

    2016-01-01

    Background: The majority of studies on spirituality demonstrate its positive association with mental health. Despite the increasing number of studies, there remains a dearth of studies emanating from African countries looking at the relationship between mental illness, quality of life and measures of spirituality. The present study evaluates the role of spirituality in relation to current depression and quality of life in medical students, who are known to be at high risk for depression. ...

  3. Impact of Integrated Care Model (ICM) on Direct Medical Costs in Management of Advanced Chronic Obstructive Pulmonary Disease (COPD).

    Science.gov (United States)

    Bandurska, Ewa; Damps-Konstańska, Iwona; Popowski, Piotr; Jędrzejczyk, Tadeusz; Janowiak, Piotr; Świętnicka, Katarzyna; Zarzeczna-Baran, Marzena; Jassem, Ewa

    2017-06-12

    BACKGROUND Chronic obstructive pulmonary disease (COPD) is a commonly diagnosed condition in people older than 50 years of age. In advanced stage of this disease, integrated care (IC) is recommended as an optimal approach. IC allows for holistic and patient-focused care carried out at the patient's home. The aim of this study was to analyze the impact of IC on costs of care and on demand for medical services among patients included in IC. MATERIAL AND METHODS The study included 154 patients diagnosed with advanced COPD. Costs of care (general, COPD, and exacerbations-related) were evaluated for 1 year, including 6-months before and after implementing IC. The analysis included assessment of the number of medical procedures of various types before and after entering IC and changes in medical services providers. RESULTS Direct medical costs of standard care in advanced COPD were 886.78 EUR per 6 months. Costs of care of all types decreased after introducing IC. Changes in COPD and exacerbation-related costs were statistically significant (p=0.012492 and p=0.017023, respectively). Patients less frequently used medical services for respiratory system and cardiovascular diseases. Similarly, the number of hospitalizations and visits to emergency medicine departments decreased (by 40.24% and 8.5%, respectively). The number of GP visits increased after introducing IC (by 7.14%). CONCLUSIONS The high costs of care in advanced COPD indicate the need for new forms of effective care. IC caused a decrease in costs and in the number of hospitalization, with a simultaneous increase in the number of GP visits.

  4. Symptoms and medication management in the end of life phase of high-grade glioma patients

    NARCIS (Netherlands)

    Koekkoek, J.A.F.; Dirven, L.; Sizoo, E.M.; Pasman, H.R.W.; Heimans, J.J.; Postma, T.J.; Deliens, L.; Grant, R.; McNamara, S.; Stockhammer, G.; Medicus, E.; Taphoorn, M.J.B.; Reijneveld, J.C.

    2014-01-01

    During the end of life (EOL) phase of high-grade glioma (HGG) patients, care is primarily aimed at reducing symptom burden while maintaining quality of life as long as possible. In this study, we evaluated the prevalence of symptoms and medication management in HGG patients during the EOL phase. We

  5. Advanced intelligent computational technologies and decision support systems

    CERN Document Server

    Kountchev, Roumen

    2014-01-01

    This book offers a state of the art collection covering themes related to Advanced Intelligent Computational Technologies and Decision Support Systems which can be applied to fields like healthcare assisting the humans in solving problems. The book brings forward a wealth of ideas, algorithms and case studies in themes like: intelligent predictive diagnosis; intelligent analyzing of medical images; new format for coding of single and sequences of medical images; Medical Decision Support Systems; diagnosis of Down’s syndrome; computational perspectives for electronic fetal monitoring; efficient compression of CT Images; adaptive interpolation and halftoning for medical images; applications of artificial neural networks for real-life problems solving; present and perspectives for Electronic Healthcare Record Systems; adaptive approaches for noise reduction in sequences of CT images etc.

  6. Preferences for Advance Directives in Korea

    Directory of Open Access Journals (Sweden)

    So-Sun Kim

    2012-01-01

    Full Text Available Background. The goal of advance directives is to help patients retain their dignity and autonomy by making their own decisions regarding end-stage medical treatment. The purpose of this study was to examine preferences of advance directives among general population in Korea. Method. A descriptive cross-sectional survey was performed from October 2007 to June 2008 in Seoul, Korea. A total of 336 city-dwelling adults self-administered the questionnaire and returned it via mail. Data analyses were conducted using SPSS 17.0. Results. Subjects reported the need for healthcare providers' detailed explanations and recommendations regarding end-of-life care. When there is no hope of recovery and death is imminent, most subjects did not want to receive cardiopulmonary resuscitation nor an IV or tube feeding. However, most of the subjects wanted pain management care. Conclusions. The present study showed that many Korean people have an interest in advance directives. The results show that the autonomy and dignity of patient have increased in importance. To provide better end-of-life care, there is a need to educate patients on the definition and intent of an advance directive. Additional proactive communication between patients and their caregivers should be educated to healthcare providers.

  7. Development of an aging evaluation and life extension program for the Advanced Test Reactor

    International Nuclear Information System (INIS)

    Dwight, J.E. Jr.

    1988-01-01

    A life extension program has been developed for the US Department of Energy's Advanced Test Reactor. The program is an adaptation of life extension pilot programs at the Surry Unit 1 and Monticello generating stations and is being completed in three phases. In Phase 1, the critical plant components were identified. In Phase 2, existing lifetime analyses and support data for the critical components were reviewed. The results from the review give a preliminary indication that an overall plant lifetime in excess of forty years is feasible. In Phase 3, now in progress, detailed evaluations for component life extensions are being performed. 2 refs., 2 figs., 1 tab

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

    Science.gov (United States)

    2018-02-28

    Program HHQ Health History Questionnaire National Marrow Donor Program® N00014-16-1-2020 Development of Medical Technology for Contingency Response to...Report 3. DATES COVERED (From - To) DEC 2015 -November 2017 4. TITLE AND SUBTITLE Development of Medical Technology for Contingency Response to Marrow...immunobiologic and clinical research activities promote studies to advance the science and technology of HCT to improve outcomes and quality of life for

  9. Impact of nutritional status on the quality of life of advanced cancer patients in hospice home care.

    Science.gov (United States)

    Shahmoradi, Negar; Kandiah, Mirnalini; Peng, Loh Su

    2009-01-01

    Cancer patients frequently experience malnutrition and this is an important factor in impaired quality of life. This cross-sectional study examined the association between global quality of life and its various subscales with nutritional status among 61 (33 females and 28 males) advanced cancer patients cared for by selected hospices in peninsular Malaysia. The Patient Generated-Subjective Global Assessment (PG-SGA) and the Hospice Quality of Life Index (HQLI) were used to assess nutritional status and quality of life, respectively. Nine (14.7%) patients were well-nourished, 32 (52.5%) were moderately or suspected of being malnourished while 20 (32.8%) of them were severely malnourished. The total HQLI mean score for these patients was 189.9-/+51.7, with possible scores ranging from 0 to 280. The most problem areas in these patients were in the domain of functional well-being and the least problems were found in the social/spiritual domain. PG-SGA scores significantly correlated with total quality of life scores (r2= 0.38, pnutritional status exhibited a lower quality of life. Advanced cancer patients with poor nutritional status have a diminished quality of life. These findings suggest that there is a need for a comprehensive nutritional intervention for improving nutritional status and quality of life in terminally ill cancer patients under hospice care.

  10. Use of a Tourniquet by LIFE STAR Air Medical Crew: A Case Report.

    Science.gov (United States)

    Jacobs, Lenworth M; Burns, Karyl J; Priest, Heather Standish; Muskett, William

    2015-10-01

    For many years tourniquets were perceived as dangerous due to the belief that they led to loss of limb because of ischemia. Their use in civilian and military environments was discouraged. Emergency medical responders were not taught about tourniquets and commercial tourniquets were not available. However, research by the United States military during the wars in Iraq and Afghanistan has demonstrated that tourniquets are safe life-saving devices. As a consequence, they have been widely deployed in combat situations and there are now calls for the use of tourniquets in the civilian prehospital setting. This article presents a report of the successful application of a tourniquet by the LIFE STAR crew to control bleeding that local emergency medical services (EMS) personnel could not control with direct pressure. Tourniquets should be readily available in public places and carried by all EMS.

  11. The quality of life of medical students studying in New Zealand: a comparison with nonmedical students and a general population reference group.

    Science.gov (United States)

    Henning, Marcus A; Krägeloh, Christian U; Hawken, Susan J; Zhao, Yipin; Doherty, Iain

    2012-01-01

    Quality of life is an essential component of learning and has strong links with the practice and study of medicine. There is burgeoning evidence in the research literature to suggest that medical students are experiencing health-related problems such as anxiety, depression, and burnout. The aim of the study was to investigate medical students' perceptions concerning their quality of life. Two hundred seventy-four medical students studying in their early clinical years (response rate = 80%) participated in the present study. Medical students were asked to fill in the abbreviated version of the World Health Organization Quality of Life questionnaire to elicit information about their quality of life perceptions in relation to their physical health, psychological health, social relationships, and environment. Subsequently, their responses were compared with two nonmedical students groups studying at a different university in the same city and an Australian general population norm. The findings were compared using independent group's t tests, confidence intervals, and Cohen's d. The main finding of the study indicated that medical students had similar quality of life perceptions to nonmedical students except in relation to the environment domain. Furthermore, the medical student group scored lower than the general population reference group on the physical health, psychological health, and environment quality of life domains. The results suggest that all university students are expressing concerns related to quality of life, and thus their health might be at risk. The findings in this study provided no evidence to support the notion that medical students experience lower levels of quality of life compared to other university students. When compared to the general population, all student groups examined in this study appeared to be experiencing lower levels of quality of life. This has implications for pastoral support, educationalists, student support personnel, and the

  12. Human rights and the requirement for international medical aid.

    Science.gov (United States)

    Tolchin, Benjamin

    2008-08-01

    Every year approximately 18 million people die prematurely from treatable medical conditions including infectious diseases and nutritional deficiencies. The deaths occur primarily amongst the poorest citizens of poor developing nations. Various groups and individuals have advanced plans for major international medical aid to avert many of these unnecessary deaths. For example, the World Health Organization's Commission on Macroeconomics and Health estimated that eight million premature deaths could be prevented annually by interventions costing roughly US$57 bn per year. This essay advances an argument that human rights require high-income nations to provide such aid. The essay briefly examines John Rawls' obligations of justice and the reasons that their applicability to cases of international medical aid remains controversial. Regardless, the essay argues that purely humanitarian obligations bind the governments and citizens of high-income liberal democracies at a minimum to provide major medical aid to avert premature deaths in poor nations. In refusing to undertake such medical relief efforts, developed nations fail to adequately protect a fundamental human right to life.

  13. Islamic medical jurisprudence syllabus: A Review in Saudi Arabia.

    Science.gov (United States)

    Chamsi-Pasha, H; Albar, M A

    2017-10-01

    The ever-increasing technological advances of Western medicine have created new ethical issues awaiting answers and response. The use of genetic therapy, organ transplant, milk-banking, end-of-life care and euthanasia are of paramount importance to the medical students and need to be addressed. A series of searches were conducted of Medline databases published in English between January 2000 and January 2017 with the following keywords: medical ethics, syllabus, Islam, jurisprudence. Islamic medical jurisprudence is gaining more attention in some medical schools. However, there is still lack of an organised syllabus in many medical colleges. The outlines of a syllabus in Islamic medical jurisprudence including Islamic values and moral principles related to both the practice and research of medicine are explored.

  14. Withholding and withdrawing life-sustaining treatment: criminal responsibility for established medical practice?

    Science.gov (United States)

    White, Ben; Willmott, Lindy; Allen, John

    2010-05-01

    The law recognises the right of a competent adult to refuse medical treatment even if this will lead to death. Guardianship and other legislation also facilitates the making of decisions to withhold or withdraw life-sustaining treatment in certain circumstances. Despite this apparent endorsement that such decisions can be lawful, doubts have been raised in Queensland about whether decisions to withhold or withdraw life-sustaining treatment would contravene the criminal law, and particularly the duty imposed by the Criminal Code (Qld) to provide the "necessaries of life". This article considers this tension in the law and examines various arguments that might allow for such decisions to be made lawfully. It ultimately concludes, however, that criminal responsibility may still arise and so reform is needed.

  15. Medication adherence among Nigerians with schizophrenia: correlation between clinico-demographic factors and quality of life

    Directory of Open Access Journals (Sweden)

    Oluseun P. Ogunnubi

    2017-03-01

    Full Text Available Medication adherence contributes significantly to symptom remission, recovery and wellbeing in mental illnesses. We evaluated how medication adherence correlates with clinico-demographic factors and quality of life (QoL in a sample of Nigerians with schizophrenia. This descriptive crosssectional study involved 160 randomly selected participants with confirmed diagnosis of schizophrenia based on MINI International Neuropsychiatric Interview. Data on socio-demographic and clinical characteristics of participants were collected with a questionnaire. Medication adherence was assessed with Morisky Medication Adherence Questionnaire, and participants completed the World Health Organization Quality of Life Scale-BREF. The mean age of participants was 38.54 (±11.30 years, and all the participants were on antipsychotics, but only 45% were adherent to their medication. Out of all the participants, 45 (28.2% considered their overall QoL to be good, 97 (60.6% considered theirs to be fair, while 18 (11.2% reported poor QoL. Medication non-adherence correlated negatively with good QoL across multiple dimensions including overall QoL (r=- 0.175, health satisfaction (r=-0.161, physical (r=-0.186 and psychological domain (r=-0.175. Again, participant’s age (r=- 0.190 and age of onset of illness (r=-0.172 correlated negatively with medication nonadherence, and a trend towards relapse delay with medication adherence was also observed (r=-0.155. The effect size of these correlations were however small. Our findings suggest a link between medication adherence and QoL in schizophrenia, such that strategy that addresses medication nonadherence and its determinants may have potential benefits on wellbeing. Further hypotheses-driven studies are desirable.

  16. [The life of Dr. RO Kishun, a reflection of modern Korean medical history of the borders].

    Science.gov (United States)

    Shin, Young-Jeon; Park, Se-Hong

    2009-06-01

    RO Kishun was born on February 2, 1893 in Ongjin County, Hwanghae Province of Joseon Korea. He graduated from the Medical Training Center, a campus associated with the Joseon Government-General Hospital, in 1915, and from Kyushu Imperial University School of Medicine in 1917. He continued his medical study at the university in 1929, majoring in biochemistry, and earned a doctorate in medicine in 1932. Dr. RO, one of the earliest pioneers in Korean biochemistry, was active in his research, publishing four studies in the Japanese Journal of Biochemistry between 1931 and 1932. After returning from Japan in 1932, Dr. RO opened a medical practice in Mokpo and Busan, port cities situated on the southern tip of Korea. Later in 1936, he moved north to Manchuria (northeast China) to practice medicine at the International Hospital in Mukden (present-day Shenyang). He also served as president of Tumen Public Hospital between 1942 and 1946. When Japan signed unconditional surrender bringing World War II to an end, Dr. RO relocated to Yanbian and began providing medical training to ethnic Koreans. In October 1946, he was appointed dean of the First Branch School of China Medical University in Longjing, and in October 1948 the first dean of Yanbian Medical School, the predecessor of Yanbian University College of Medicine. Dr. RO dedicated his life to medical practice, teaching and training students, and mentoring younger faculty. A brilliant clinician, he also inspired and helped his colleagues with his outstanding ability to diagnose and treat patients. He was one of the founding members of Yanbian University College of Medicine. RO Kishun died on June 7, 1957 at age 64. Ethnic Koreans hailed him as Sinui (literally, the physician of God), and a bronze statue of himself was erected in front of the medical college in 1988. Dr. RO's life brings modern historians' attention to the issue of determining geographical territories and nationality, in that his life unfolded at the

  17. ERCC1, toxicity and quality of life in advanced NSCLC patients randomized in a large multicentre phase III trial

    DEFF Research Database (Denmark)

    Vilmar, Adam Christian; Santoni-Rugiu, Eric; Sørensen, Jens Benn

    2010-01-01

    Excision repair cross complementation group 1 (ERCC1) is a promising biomarker in advanced non-small cell lung cancer (NSCLC). However, current evidence regarding the impact of ERCC1 on toxicity and quality of life (QOL) is limited.......Excision repair cross complementation group 1 (ERCC1) is a promising biomarker in advanced non-small cell lung cancer (NSCLC). However, current evidence regarding the impact of ERCC1 on toxicity and quality of life (QOL) is limited....

  18. Individualised advance care planning in children with life-limiting conditions.

    Science.gov (United States)

    Loeffen, Erik A H; Tissing, Wim J E; Schuiling-Otten, Meggi A; de Kruiff, Chris C; Kremer, Leontien C M; Verhagen, A A Eduard

    2018-05-01

    In 2013, the Pediatric Association of the Netherlands launched an evidence-based guideline 'Palliative care for children'. To promote implementation in daily practice and hereby improve quality of paediatric palliative care, we aimed to develop a functional individualised paediatric palliative care plan (IPPCP) that covers physical, psychological, spiritual and social functioning, with great emphasis on the guideline's recommendations, advance care planning and patients' and parents' preferences and desires. A Dutch working group (28 individuals) with a strong multidisciplinary character developed a draft IPPCP, which was piloted retrospectively and prospectively. In the pilots we completed, the IPPCPs for patients who were recently diagnosed with a life-threatening or life-limiting condition and evaluated completeness, usability and user-friendliness. The final IPPCP comprised five domains: (1) IPPCP data, (2) basics, (3) social, (4) psychosocial and spiritual and (5) physical care. Each domain covered various components. In both pilots, the IPPCP was considered a comprehensive document that covered all areas of paediatric palliative care and was experienced as an improvement to the present situation. However, the current form was regarded to lack user-friendliness. We propose a set of essential components of a comprehensive IPPCP for paediatric palliative care with extra attention for advance care planning and anticipatory action. Patients' and parents' preferences and desires are included next to the recommendations of the evidence-based guideline 'Palliative care for children'. © 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.

  19. Influence of burnout and sleep difficulties on the quality of life among medical students

    OpenAIRE

    Pagnin, Daniel; de Queiroz, Val?ria

    2015-01-01

    This study assessed the influence of burnout dimensions and sleep difficulties on the quality of life among preclinical-phase medical school students. Data were collected from 193 students through their completion of the World Health Organization Quality of Life Instrument, the Maslach Burnout Inventory?Student Survey, the Mini-Sleep Questionnaire, the Social Readjustment Rating Scale, and the Beck Depression Inventory. This survey performed hierarchical multiple regressions to quantify the e...

  20. Analysis of edible oil processing options for the BIO-Plex advanced life support system

    Science.gov (United States)

    Greenwalt, C. J.; Hunter, J.

    2000-01-01

    Edible oil is a critical component of the proposed plant-based Advanced Life Support (ALS) diet. Soybean, peanut, and single-cell oil are the oil source options to date. In terrestrial manufacture, oil is ordinarily extracted with hexane, an organic solvent. However, exposed solvents are not permitted in the spacecraft environment or in enclosed human tests by National Aeronautics and Space Administration due to their potential danger and handling difficulty. As a result, alternative oil-processing methods will need to be utilized. Preparation and recovery options include traditional dehulling, crushing, conditioning, and flaking, extrusion, pressing, water extraction, and supercritical extraction. These processing options were evaluated on criteria appropriate to the Advanced Life Support System and BIO-Plex application including: product quality, product stability, waste production, risk, energy needs, labor requirements, utilization of nonrenewable resources, usefulness of by-products, and versatility and mass of equipment to determine the most appropriate ALS edible oil-processing operation.

  1. Suicidal Ideation, Depression, Anxiety, Stress, And Life Satisfaction Of Medical, Engineering, And Social Sciences Students.

    Science.gov (United States)

    Naseem, Sabahat; Munaf, Seema

    2017-01-01

    Pursuing higher education is not an easy task as it requires hard work, dedication, and motivation. Although there are many rewards involved in growing up academically, nevertheless, it contains a few hazards too. For instance, suicidal ideation is associated with presence of depression, anxiety, and stress with low level of satisfaction with life in students finding difficulty in handling educational demands of higher education. Therefore, the present study focused on the query that whether there is any difference or not among medical, engineering, and social sciences students of city of Karachi, Pakistan in the level of suicidal ideation, depression, anxiety, stress, and life satisfaction. Using comparative group design, total 300 students (150 males and 150 females) with age range of 19-26 were selected from faculties of medical, engineering, and social sciences of different universities of Karachi, Pakistan, through purposive sampling. Respondent Profile Form, The Suicide Behaviours Questionnaire-Revised, Depression Anxiety Stress Scale-21, and Satisfaction with Life Scale were administered to assess suicidal ideation; depression, anxiety, stress; and life satisfaction, respectively, of the students. Scores were analysed through ANOVA and Post Hoc (Tukey's HSD) test using SPSS. Social sciences and engineering students were significantly higher on depression, anxiety, and stress than medical students [F (2, 297) =8.701, p=.000] whereas insignificant differences in the level of suicidal ideation [F (2, 297) =1.914, p=.149] and life satisfaction [F (2, 297) = .726, p = .485] among these students were found. With the help of these findings, it would be easier to counsel students of different disciplines in time on the lines of suggested preventive measures.

  2. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents.

    Science.gov (United States)

    West, Colin P; Shanafelt, Tait D; Kolars, Joseph C

    2011-09-07

    Physician distress is common and has been associated with negative effects on patient care. However, factors associated with resident distress and well-being have not been well described at a national level. To measure well-being in a national sample of internal medicine residents and to evaluate relationships with demographics, educational debt, and medical knowledge. Study of internal medicine residents using data collected on 2008 and 2009 Internal Medicine In-Training Examination (IM-ITE) scores and the 2008 IM-ITE survey. Participants were 16,394 residents, representing 74.1% of all eligible US internal medicine residents in the 2008-2009 academic year. This total included 7743 US medical graduates and 8571 international medical graduates. Quality of life (QOL) and symptoms of burnout were assessed, as were year of training, sex, medical school location, educational debt, and IM-ITE score reported as percentage of correct responses. Quality of life was rated "as bad as it can be" or "somewhat bad" by 2402 of 16,187 responding residents (14.8%). Overall burnout and high levels of emotional exhaustion and depersonalization were reported by 8343 of 16,192 (51.5%), 7394 of 16,154 (45.8%), and 4541 of 15,737 (28.9%) responding residents, respectively. In multivariable models, burnout was less common among international medical graduates than among US medical graduates (45.1% vs 58.7%; odds ratio, 0.70 [99% CI, 0.63-0.77]; P $200,000 relative to no debt). Residents reporting QOL "as bad as it can be" and emotional exhaustion symptoms daily had mean IM-ITE scores 2.7 points (99% CI, 1.2-4.3; P ITE scores 5.0 points (99% CI, 4.4-5.6; P ITE scores.

  3. The Environmental Control and Life Support System (ECLSS) advanced automation project

    Science.gov (United States)

    Dewberry, Brandon S.; Carnes, Ray

    1990-01-01

    The objective of the environmental control and life support system (ECLSS) Advanced Automation Project is to influence the design of the initial and evolutionary Space Station Freedom Program (SSFP) ECLSS toward a man-made closed environment in which minimal flight and ground manpower is needed. Another objective includes capturing ECLSS design and development knowledge future missions. Our approach has been to (1) analyze the SSFP ECLSS, (2) envision as our goal a fully automated evolutionary environmental control system - an augmentation of the baseline, and (3) document the advanced software systems, hooks, and scars which will be necessary to achieve this goal. From this analysis, prototype software is being developed, and will be tested using air and water recovery simulations and hardware subsystems. In addition, the advanced software is being designed, developed, and tested using automation software management plan and lifecycle tools. Automated knowledge acquisition, engineering, verification and testing tools are being used to develop the software. In this way, we can capture ECLSS development knowledge for future use develop more robust and complex software, provide feedback to the knowledge based system tool community, and ensure proper visibility of our efforts.

  4. The Impact of Advanced Age on Driving Safety in Adults with Medical Conditions.

    Science.gov (United States)

    Moon, Sanghee; Ranchet, Maud; Akinwuntan, Abiodun Emmanuel; Tant, Mark; Carr, David Brian; Raji, Mukaila Ajiboye; Devos, Hannes

    2018-01-01

    Adults aged 85 and older, often referred to as the oldest-old, are the fastest-growing segment of the population. The rapidly increasing number of older adults with chronic and multiple medical conditions poses challenges regarding their driving safety. To investigate the effect of advanced age on driving safety in drivers with medical conditions. We categorized 3,425 drivers with preexisting medical conditions into four age groups: middle-aged (55-64 years, n = 1,386), young-old (65-74 years, n = 1,013), old-old (75-84 years, n = 803), or oldest-old (85 years and older, n = 223). All underwent a formal driving evaluation. The outcome measures included fitness to drive recommendation by the referring physician, comprehensive fitness to drive decision from an official driving evaluation center, history of motor vehicle crashes (MVCs), and history of traffic violations. The oldest-old reported more cardiopulmonary and visual conditions, but less neurological conditions than the old-old. Compared to the middle-aged, the oldest-old were more likely to be considered unfit to drive by the referring physicians (odds ratio [OR] = 4.47, 95% confidence interval [CI] 2.20-9.10) and by the official driving evaluation center (OR = 2.74, 95% CI 1.87-4.03). The oldest-old reported more MVCs (OR = 2.79, 95% CI 1.88-4.12) compared to the middle-aged. Advanced age adversely affected driving safety outcomes. The oldest-old are a unique age group with medical conditions known to interfere with safe driving. Driving safety strategies should particularly target the oldest-old since they are the fastest-growing group and their increased frailty is associated with severe or fatal injuries due to MVCs. © 2018 S. Karger AG, Basel.

  5. Pain and quality of life following palliative radiotherapy of bone metastases

    International Nuclear Information System (INIS)

    Sauer, N.; Wild, B.; Henningsen, P.; Jakobsen, T.; Leising, D.; Treiber, M.

    2006-01-01

    Pain and quality of life following palliative radiotherapy of bone metastases Background and purpose: palliative irradiation is used to provide pain relief and to increase quality of life. Most studies exclude patients with advanced cancer disease and, therefore, a positive selection results. This prospective clinical study investigates the effect of palliative radiotherapy on pain and quality of life of patients with painful bone metastases. Patients and methods: 263 patients with bone metastases due to advanced cancer were observed with respect to pain and quality of life during a 2-month course of radiotherapy. Missing data were substituted by the LOCF method (last observation carried forward) to prevent a biased reduction of data. Results: radiotherapy resulted in pain relief. In the complete group, pain medication was not increased. Quality of life was not affected positively. Side effects of radiotherapy increased remarkably. Conclusion: Radiotherapy leads to pain relief. However, risks and benefits must be considered critically due to side effects. (orig.)

  6. Stroke: advances in medical therapy and acute stroke intervention.

    Science.gov (United States)

    Barrett, Kevin M; Lal, Brajesh K; Meschia, James F

    2015-10-01

    Evidence-based therapeutic options for stroke continue to emerge based on results from well-designed clinical studies. Ischemic stroke far exceeds hemorrhagic stroke in terms of prevalence and incidence, both in the USA and worldwide. The public health effect of reducing death and disability related to ischemic stroke justifies the resources that have been invested in identifying safe and effective treatments. The emergence of novel oral anticoagulants for ischemic stroke prevention in atrial fibrillation has introduced complexity to clinical decision making for patients with this common cardiac arrhythmia. Some accepted ischemic stroke preventative strategies, such as carotid revascularization for asymptomatic carotid stenosis, require reassessment, given advances in risk factor management, antithrombotic therapy, and surgical techniques. Intra-arterial therapy, particularly with stent retrievers after intravenous tissue plasminogen activator, has recently been demonstrated to improve functional outcomes and will require investment in system-based care models to ensure that effective treatments are received by patients in a timely fashion. The purpose of this review is to describe recent advances in medical and surgical approaches to ischemic stroke prevention and acute treatment. Results from recently published clinical trials will be highlighted along with ongoing clinical trials addressing key questions in ischemic stroke management and prevention where equipoise remains.

  7. Life sciences: Lawrence Berkeley Laboratory, 1988

    Energy Technology Data Exchange (ETDEWEB)

    1989-07-01

    Life Sciences Research at LBL has both a long history and a new visibility. The physics technologies pioneered in the days of Ernest O. Lawrence found almost immediate application in the medical research conducted by Ernest's brother, John Lawrence. And the tradition of nuclear medicine continues today, largely uninterrupted for more than 50 years. Until recently, though, life sciences research has been a secondary force at the Lawrence Berkeley Laboratory (LBL). Today, a true multi-program laboratory has emerged, in which the life sciences participate as a full partner. The LBL Human Genome Center is a contribution to the growing international effort to map the human genome. Its achievements represent LBL divisions, including Engineering, Materials and Chemical Sciences, and Information and Computing Sciences, along with Cell and Molecular Biology and Chemical Biodynamics. The Advanced Light Source Life Sciences Center will comprise not only beamlines and experimental end stations, but also supporting laboratories and office space for scientists from across the US. This effort reflects a confluence of scientific disciplines --- this time represented by individuals from the life sciences divisions and by engineers and physicists associated with the Advanced Light Source project. And finally, this report itself, the first summarizing the efforts of all four life sciences divisions, suggests a new spirit of cooperation. 30 figs.

  8. [The problems of professional competence in the complementary professional forensic medical expertise programs of advanced training and professional requalification].

    Science.gov (United States)

    Shadymov, A B; Fominykh, S A; Dik, V P

    This article reports the results of the analysis of the new tendencies and normatives of the working legislation in the field of additional professional education in the speciality of «forensic medical expertise» and the application of the competency-based approach to the training of specialists in the framework of professional requalification and advanced training programs. Special attention is given to the problems of organization of the educational process and the elaboration of additional training programs based on the competency approach to the training of specialists at the Department of Forensic Medicine and Law with the professor V.N. Kryukov Course of Advanced Professional Training and Professional Requalification of Specialists at the state budgetary educational Institution of higher professional education «Altai State Medical University», Russian Ministry of Health. The study revealed the problems pertaining to the development of professional competencies in the framework of educational programs for the professional requalification and advanced training in the speciality «forensic medical expertise». The authors propose the legally substantiated approaches to the solution of these problems.

  9. Definition of Terms Used in Limitation of Treatment and Providing Palliative Care at the End of Life: The Indian Council of Medical Research Commission Report

    Science.gov (United States)

    Salins, Naveen; Gursahani, Roop; Mathur, Roli; Iyer, Shivakumar; Macaden, Stanley; Simha, Nagesh; Mani, Raj Kumar; Rajagopal, M. R.

    2018-01-01

    Background: Indian hospitals, in general, lack policies on the limitation of inappropriate life-sustaining interventions at the end of life. To facilitate discussion, preparation of guidelines and framing of laws, terminologies relating to the treatment limitation, and providing palliative care at the end-of-life care (EOLC) need to be defined and brought up to date. Methodology: This consensus document on terminologies and definitions of terminologies was prepared under the aegis of the Indian Council of Medical Research. The consensus statement was created using Nominal Group and Delphi Method. Results: Twenty-five definitions related to the limitations of treatment and providing palliative care at the end of life were created by reviewing existing international documents and suitably modifying it to the Indian sociocultural context by achieving national consensus. Twenty-five terminologies defined within the scope of this document are (1) terminal illness, (2) actively dying, (3) life-sustaining treatment, (4) potentially inappropriate treatment, (5) cardiopulmonary resuscitation (CPR), (6) do not attempt CPR, (7) withholding life-sustaining treatment, (8) withdrawing life-sustaining treatment, (9) euthanasia (10) active shortening of the dying process, (11) physician-assisted suicide, (12) palliative care, (13) EOLC, (14) palliative sedation, (15) double effect, (16) death, (17) best interests, (18) health-care decision-making capacity, (19) shared decision-making, (20) advance directives, (21) surrogates, (22) autonomy, (23) beneficence, (24) nonmaleficence, and (25) justice.

  10. The First Attempt at Initiating Problem-Based Learning as A Method of Teaching–Learning at the University of Medical Sciences in Poznan, Poland

    Directory of Open Access Journals (Sweden)

    Malgorzata Grzeskowiak

    2009-05-01

    Full Text Available The main objective of problem-based learning (PBL is to provoke students to solve a new problem by themselves. The aim of this study was to investigate whether PBL was a better method of teaching basic and advanced life support to medical students compared with the classical method. The research was undertaken in 2002 in accordance with the European Guidelines 2000 and involved 36 medical students in year 4. The students were divided into two groups: experimental PBL group (17 students and the control-classical method group (19 students. After the advanced life support course, the students wrote two tests to assess their knowledge on how to open the airway and how to perform basic and advanced resuscitation. The questions contained true or false answers. The students' skills of basic and advanced methods of opening the airway and advanced resuscitation were checked by practical tests. The Mann-Whitney test was used for statistical analysis. The experimental PBL group received significantly better results: 30–45 points (mean, 38.29 points and 30–47 points (mean, 40.94 points for the written and practical tests, respectively, compared with the control-classical group (22–34 points [mean, 29.36 points] and 22–35 points [mean, 28.63 points], respectively. Therefore, PBL offers a better method for teaching basic and advanced life support to medical students compared with the classical method.

  11. Quality of life in advanced maxillary sinus cancer after radical versus conservative maxillectomy.

    Science.gov (United States)

    Liu, Liting; Liu, Dan; Guo, Qiyun; Shen, Bin

    2013-07-01

    A study of patients with advanced maxillary sinus cancer who underwent radical or conservative maxillectomy was performed to show the differences between the 2 groups in patients' survival rate and quality of life (QOL). A total of 61 advanced maxillary sinus cancer patients from Weifang People's Hospital in China were traced: 27 radical maxillectomy and 34 conservative maxillectomy. Survival rate was compared between the 2 groups. Quality of life assessments were performed at the time of preoperation as well as 6, 12, and 18 months after the operation. Measures included the University of Washington-QOL scale (UW-QOL) and the Hospital Anxiety and Depression Scale. The UW-QOL scale scores of the composite score, appearance, activity, recreation, swallowing, speech, and chewing in the conservative surgical group were much higher than those in the radical surgical group. However, there is no big difference in total survival rate between these 2 groups. Also, no significant difference can be seen in the scores of pain, employment, and shoulder between the 2 groups. At the 6-month follow-up, the radical maxillectomy had more effects on anxiety than the conservative maxillectomy, while they are almost equally effective on depression. The 12-month and 18-month follow-ups showed that the radical maxillectomy made a greater impact on both anxiety and depression than the conservative maxillectomy. Conservative maxillectomy is more effective than radical maxillectomy to preserve the QOL of patients with advanced maxillary sinus cancer.

  12. Present status of medical treatment for patients of advanced lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kira, Shiro; Kuratomi, Yushiro; Matsuoka, Rokuro; Ishihara, Teruo (Jichi Medical School, Minamikawachi, Tochigi (Japan))

    1982-09-01

    Management of patients with inoperable, advanced lung cancer is one of the most important problems for many chest physicians, because those patients with stage 3 and stage 4 are over 70% of total patients. Although surgical treatment is attempted even in the case of stage 3 patients, many factors such as age, performance status, pulmonary and circulatory disorders accompanied with them and sometimes patient's refusal for surgical treatment preclude it. Therefore, therapeutic approach for these patients is focused on relieving their pains and troubles in their daily life. Radiation therapy is only a local treatment, but it can often control variable clinical manifestations with a highly probable estimation. Many patients can be free of disease even for a limited period. From this view-point, even at present, radiation therapy is a preferable therapeutic modality to maintain individual patient's better quality of life.

  13. Awareness, Attitude, and Knowledge of Basic Life Support among Medical, Dental, and Nursing Faculties and Students in the University Hospital.

    Science.gov (United States)

    Sangamesh, N C; Vidya, K C; Pathi, Jugajyoti; Singh, Arpita

    2017-01-01

    To assess the awareness, attitude, and knowledge about basic life support (BLS) among medical, dental, and nursing students and faculties and the proposal of BLS skills in the academic curriculum of undergraduate (UG) course. Recognition, prevention, and effective management of life-threatening emergencies are the responsibility of health-care professionals. These situations can be successfully managed by proper knowledge and training of the BLS skills. These life-saving maneuvers can be given through the structured resuscitation programs, which are lacking in the academic curriculum. A questionnaire study consisting of 20 questions was conducted among 659 participants in the Kalinga Institute of Dental Sciences, Kalinga Institute of Medical Sciences, KIIT University. Medical junior residents, BDS faculties, interns, nursing faculties, and 3 rd -year and final-year UG students from both medical and dental colleges were chosen. The statistical analysis was carried out using SPSS software version 20.0 (Armonk, NY:IBM Corp). After collecting the data, the values were statistically analyzed and tabulated. Statistical analysis was performed using Mann-Whitney U-test. The results with P life-threatening emergencies.

  14. Japan's advanced medicine.

    Science.gov (United States)

    Sho, Ri; Narimatsu, Hiroto; Murakami, Masayasu

    2013-10-01

    Like health care systems in other developed countries, Japan's health care system faces significant challenges due to aging of the population and economic stagnation. Advanced medicine (Senshin Iryou) is a unique system of medical care in Japan offering highly technology-driven medical care that is not covered by public health insurance. Advanced medicine has recently developed and expanded as part of health care reform. Will it work? To answer this question, we briefly trace the historical development of advanced medicine and describe the characteristics and current state of advanced medical care in Japan. We then offer our opinions on the future of advanced medicine with careful consideration of its pros and cons. We believe that developing advanced medicine is an attempt to bring health care reform in line rather than the goal of health care reform.

  15. [The implementation of innovative medical technologies: biological pharmaceuticals for the treatment of psoriasis--a case study].

    Science.gov (United States)

    Tal, Orna; Lomnicky, Yosef

    2012-06-01

    Advanced health systems worldwide strive to adopt new technologies that will ensure improved health and better clinical outcomes. The implementation of new medical technologies is affected by medical factors as well as economic and social forces, influencing both the individual and the health care providers. Chronic disease management is a major challenge to governments, as a result of the cumulative effects of chronic morbidity, life expectancy, quality of life and the national burden of disease due to accelerating medical expenditure. Psoriasis, a common chronic disease, for which advanced technologies were recently implemented, was chosen as a case study. The distribution of utility of various technologies for the treatment of psoriasis over the past nine years was analyzed to categorize "patterns of behavior" in accordance with the lifecycle of medical technology described in the Literature. It is expected that these changing trends will produce overall economic consequences, on direct expenditure combined with a reduction in some health services. Analyzing these clinical and economic trends, may add important considerations for the adoption of emerging medical technologies, presenting an important tool for policymakers at at all levels.

  16. [Discontinuation of potentially inappropriate medications at the end of life: perspectives from patients, their relatives, and physicians

    NARCIS (Netherlands)

    Geijteman, E.C.; Tempelman, M.M.; Dees, M.K.; Huisman, B.A.H.; Perez, R.S.; Zuylen, L. van; Heide, A. van der

    2017-01-01

    OBJECTIVE: To obtain insight into the perspectives of patients, relatives and physicians towards potentially inappropriate medications (PIMs) at the end of life. DESIGN: Qualitative interview study. METHOD: An analysis of in-depth interviews with 17 patients who were diagnosed as having a life

  17. Life Cycle Assessment as a tool for green Chemistry: Application to different advanced oxidation processes for wastewater treatment

    Energy Technology Data Exchange (ETDEWEB)

    Munoz Ortiz, I.; Domenech Antunez, X.; Malato Rodriguez, S.

    2006-07-01

    The development of chemistry during the twentieth century has changed our lives. In fact, chemistry and chemicals surrounds US in our daily activities, due to the huge supply of products aimed at improving our quality of life. Chemistry has resulted in the medical revolution of the past century, in which drugs as antibiotics have been used to cure diseases that affected mankind for centuries. These advances have led to the rise in the average life expectancy from 47 in 1900, to 75 years in the 1990s (Breslow 1997). On the other hand, the world's food supply has seen an explosive expansion because of the development of pesticides as well as fertilisers that protect crops and improve their productivity. Other common chemicals are those related to hygiene, such as soaps, detergents, disinfectants, toothpaste, etc. Therefore, there is practically no facet in material life-transportation communication, clothing, shelter, office- in which chemistry does not play an important role, either to supply consumer products or to improve services addressed to society in general (Domenech 2005). In spite of all these clear benefits, the chemical industry is often viewed by the general public as causing more harm than good (Lancaster 2002). A major reason for this is that the industry is perceived as being polluting and causing significant environmental damage. Indeed, the manufacture, use and disposal of chemicals consume large amounts of resources, and originates emissions of pollutants to all environmental compartments, not to mention the numerous accidents and disasters in which the chemical industry has been involved in the recent past. (Author)

  18. Life imitating art: depictions of the hidden curriculum in medical television programs.

    Science.gov (United States)

    Stanek, Agatha; Clarkin, Chantalle; Bould, M Dylan; Writer, Hilary; Doja, Asif

    2015-09-26

    The hidden curriculum represents influences occurring within the culture of medicine that indirectly alter medical professionals' interactions, beliefs and clinical practices throughout their training. One approach to increase medical student awareness of the hidden curriculum is to provide them with readily available examples of how it is enacted in medicine; as such the purpose of this study was to examine depictions of the hidden curriculum in popular medical television programs. One full season of ER, Grey's Anatomy and Scrubs were selected for review. A summative content analysis was performed to ascertain the presence of depictions of the hidden curriculum, as well as to record the type, frequency and quality of examples. A second reviewer also viewed a random selection of episodes from each series to establish coding reliability. The most prevalent themes across all television programs were: the hierarchical nature of medicine; challenges during transitional stages in medicine; the importance of role modeling; patient dehumanization; faking or overstating one's capabilities; unprofessionalism; the loss of idealism; and difficulties with work-life balance. The hidden curriculum is frequently depicted in popular medical television shows. These examples of the hidden curriculum could serve as a valuable teaching resource in undergraduate medical programs.

  19. Retention of first aid and basic life support skills in undergraduate medical students

    NARCIS (Netherlands)

    Ruijter, P.A. de; Biersteker, H.A.; Biert, J.; Goor, H. van; Tan, E.C.T.H.

    2014-01-01

    BACKGROUND: Undergraduate medical students follow a compulsory first aid (FA) and basic life support (BLS) course. Retention of BLS seems poor and only little information is provided on the retention of FA skills. This study aims at evaluating 1- and 2-year retention of FA and BLS training in

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

    Science.gov (United States)

    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

  1. Ethics teaching on 'Beginning of Life' issues in UK medical schools.

    Science.gov (United States)

    Oldroyd, Christopher; Fialova, Lydie

    2014-12-01

    Medical ethics forms an essential component of an undergraduate medical programme. In the UK the Institute of Medical Ethics has released a consensus statement detailing its recommendations for a minimum curriculum for ethics. One important issue it highlights for inclusion is 'Beginning of Life', which includes a wide range of themes. This paper presents an evaluation of the current teaching and assessment of these important issues in UK medical schools, complemented by a specific analysis of students' reaction to the teaching they received at the University of Edinburgh as part of their Obstetrics and Gynaecology rotation. Schools which responded to the survey reported a wide range of teaching and assessment methods. While there was a good overall coverage of topics, only one of them was covered by every institution and the religious/cultural elements of those topics were often neglected. The medical schools viewed better clinical integration of ethics teaching as the best route to improvement, but the students reported a desire for more ethics teaching in the form of specific tutorials, lectures or discussions. It is likely that a combination of these approaches will lead to significant improvements in the delivery of ethics teaching in this area and in others. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. Factors influencing the development of end-of-life communication skills: A focus group study of nursing and medical students.

    Science.gov (United States)

    Gillett, Karen; O'Neill, Bernadette; Bloomfield, Jacqueline G

    2016-01-01

    Poor communication between health care professionals and dying patients and their families results in complaints about end-of-life care. End-of-life communication skills should be a core part of nursing and medical education but research suggests that qualified doctors and nurses find this a challenging area of practice. The aim of this study was to explore factors influencing the development of end-of-life communication skills by nursing and medical students. A qualitative study comprising five focus groups. Second year undergraduate nursing (n=9 across 2 focus groups) and fourth year undergraduate medical students (n=10 across 3 focus groups) from a London University. Barriers and facilitators influenced nursing and medical students' experience of communication with dying patients and their families in clinical practice. Extrinsic barriers included gatekeeping by qualified staff and lack of opportunity to make sense of experiences through discussion. Intrinsic barriers included not knowing what to say, dealing with emotional responses, wasting patients' time, and concerns about their own ability to cope with distressing experiences. Facilitating factors included good role models, previous experience, and classroom input. In addition to clinical placements, formal opportunities for reflective discussion are necessary to facilitate the development of students' confidence and skills in end-of-life communication. For students and mentors to view end-of-life communication as a legitimate part of their learning it needs to be specified written practice-learning outcome. Mentors and supervisors may require training to enable them to facilitate students to develop end-of-life communication skills. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Mechanical circulatory treatment of advanced heart failure

    DEFF Research Database (Denmark)

    Løgstrup, Brian B; Vase, Henrik; Gjedsted, Jakob

    2016-01-01

    Heart failure is one of the most common causes of morbidity and mortality worldwide. When patients cease to respond adequately to optimal medical therapy mechanical circulatory support has been promising. The advent of mechanical circulatory support devices has allowed significant improvements...... in patient survival and quality of life for those with advanced or end-stage heart failure. We provide a general overview of current mechanical circulatory support devices encompassing options for both short- and long-term ventricular support....

  4. Trajectories of life satisfaction five years after medical discharge for traumatically acquired disability.

    Science.gov (United States)

    Hernandez, Caitlin L; Elliott, Timothy R; Berry, Jack W; Underhill, Andrea T; Fine, Philip R; Lai, Mark H C

    2014-05-01

    We studied the predictive impact of family satisfaction, marital status, and functional impairment on the trajectories of life satisfaction over the first 5 years following medical treatment for traumatic spinal cord injury, burns, or interarticular fractures (total N = 662). It was anticipated that fewer functional impairments, being married, and greater family satisfaction would predict higher life satisfaction trajectories. The Functional Independence Measure, the Family Satisfaction Scale, and the Life Satisfaction Index were administered 12, 24, 48, and 60 months postdischarge. Trajectory modeling revealed that greater functional impairment significantly predicted lower life satisfaction, regardless of injury type. However, this association diminished when marital status and family satisfaction were entered into the models. Greater family satisfaction and being married predicted greater life satisfaction across time. Moreover, there was no evidence for increases in life satisfaction trajectories over time: Trajectories were stable across time for all injury groups. Results suggest that being married and greater family satisfaction promote life satisfaction among those who traumatically acquire disability, and these beneficial effects may be more salient than the degree of functional impairment imposed by the condition. (c) 2014 APA, all rights reserved.

  5. Application of NASA's Advanced Life Support Technologies in Polar Regions

    Science.gov (United States)

    Bubenheim, David L.

    1997-01-01

    The problems of obtaining adequate pure drinking water and disposing of liquid and solid waste in the U.S Arctic, a region where virtually all water is frozen solid for much of the year, has led to unsanitary solutions. Sanitation and a safe water supply are particularly problems in rural villages. These villages are without running water and use plastic buckets for toilets. The outbreak of diseases is believed to be partially attributable to exposure to human waste and lack of sanitation. Villages with the most frequent outbreaks of disease are those in which running water is difficult to obtain. Waste is emptied into open lagoons, rivers, or onto the sea coast. It does not degrade rapidly and in addition to affecting human health, can be harmful to the fragile ecology of the Arctic and the indigenous wildlife and fish populations. Current practices for waste management and sanitation pose serious human hazards as well as threaten the environment. NASA's unique knowledge of water/wastewater treatment systems for extreme environments, identified in the Congressional Office of Technology Assessment report entitled An Alaskan Challenge: Native Villagt Sanitation, may offer practical solutions addressing the issues of safe drinking water and effective sanitation practices in rural villages. NASA's advanced life support technologies are being combined with Arctic science and engineering knowledge to address the unique needs of the remote communities of Alaska through the Advanced Life Systems for Extreme Environments (ALSEE) project. ALSEE is a collaborative effort involving the NASA, the State of Alaska, the University of Alaska, the North Slope Borough of Alaska, Ilisagvik College in Barrow and the National Science Foundation (NSF). The focus is a major issue in the State of Alaska and other areas of the Circumpolar North; the health and welfare of its people, their lives and the subsistence lifestyle in remote communities, economic opportunity, and care for the

  6. Surveying End-of-Life Medical Decisions in France: Evaluation of an Innovative Mixed-Mode Data Collection Strategy.

    Science.gov (United States)

    Legleye, Stephane; Pennec, Sophie; Monnier, Alain; Stephan, Amandine; Brouard, Nicolas; Bilsen, Johan; Cohen, Joachim

    2016-02-18

    Monitoring medical decisions at the end of life has become an important issue in many societies. Built on previous European experiences, the survey and project Fin de Vie en France ("End of Life in France," or EOLF) was conducted in 2010 to provide an overview of medical end-of-life decisions in France. To describe the methodology of EOLF and evaluate the effects of design innovations on data quality. EOLF used a mixed-mode data collection strategy (paper and Internet) along with follow-up campaigns that employed various contact modes (paper and telephone), all of which were gathered from various institutions (research team, hospital, and medical authorities at the regional level). A telephone nonresponse survey was also used. Through descriptive statistics and multivariate logistic regressions, these innovations were assessed in terms of their effects on the response rate, quality of the sample, and differences between Web-based and paper questionnaires. The participation rate was 40.0% (n=5217). The respondent sample was very close to the sampling frame. The Web-based questionnaires represented only 26.8% of the questionnaires, and the Web-based secured procedure led to limitations in data management. The follow-up campaigns had a strong effect on participation, especially for paper questionnaires. With higher participation rates (63.21% and 63.74%), the telephone follow-up and nonresponse surveys showed that only a very low proportion of physicians refused to participate because of the topic or the absence of financial incentive. A multivariate analysis showed that physicians who answered on the Internet reported less medication to hasten death, and that they more often took no medical decisions in the end-of-life process. Varying contact modes is a useful strategy. Using a mixed-mode design is interesting, but selection and measurement effects must be studied further in this sensitive field.

  7. Life prediction methodology for ceramic components of advanced heat engines. Phase 1: Volume 1, Final report

    Energy Technology Data Exchange (ETDEWEB)

    Cuccio, J.C.; Brehm, P.; Fang, H.T. [Allied-Signal Aerospace Co., Phoenix, AZ (United States). Garrett Engine Div.] [and others

    1995-03-01

    Emphasis of this program is to develop and demonstrate ceramics life prediction methods, including fast fracture, stress rupture, creep, oxidation, and nondestructive evaluation. Significant advancements were made in these methods and their predictive capabilities successfully demonstrated.

  8. Influence of burnout and sleep difficulties on the quality of life among medical students.

    Science.gov (United States)

    Pagnin, Daniel; de Queiroz, Valéria

    2015-01-01

    This study assessed the influence of burnout dimensions and sleep difficulties on the quality of life among preclinical-phase medical school students. Data were collected from 193 students through their completion of the World Health Organization Quality of Life Instrument, the Maslach Burnout Inventory-Student Survey, the Mini-Sleep Questionnaire, the Social Readjustment Rating Scale, and the Beck Depression Inventory. This survey performed hierarchical multiple regressions to quantify the effects of emotional exhaustion, cynicism, academic efficacy, and sleep difficulties on the physical, psychological, social, and environmental components of an individual's quality of life. The influence of confounding variables, such as gender, stress load, and depressive symptoms, were controlled in the statistical analyses. Physical health decreased when emotional exhaustion and sleep difficulties increased. Psychological well-being also decreased when cynicism and sleep difficulties increased. Burnout and sleep difficulties together explained 22 and 21 % of the variance in the physical and psychological well-being, respectively. On the other hand, physical health, psychological well-being, and social relationships increased when the sense of academic efficacy increased. Physical and psychological well-being are negatively associated with emotional exhaustion, cynicism, and sleep difficulties in students in the early phase of medical school. To improve the quality of life of these students, a significant effort should be directed towards burnout and sleep difficulties.

  9. 76 FR 52377 - Colorado Wyoming Reserve Co., Grant Life Sciences, Inc., NOXSO Corp., Omni Medical Holdings, Inc...

    Science.gov (United States)

    2011-08-22

    ... SECURITIES AND EXCHANGE COMMISSION [File No. 500-1] Colorado Wyoming Reserve Co., Grant Life Sciences, Inc., NOXSO Corp., Omni Medical Holdings, Inc., and TSI, Inc., Order of Suspension of Trading... Commission that there is a lack of current and accurate information concerning the securities of Grant Life...

  10. Radiation Protection in Medical Physics : Proceedings of the NATO Advanced Study Institute on Radiation Protection in Medical Physics Activities

    CERN Document Server

    Lemoigne, Yves

    2011-01-01

    This book introduces the fundamental aspects of Radiation Protection in Medical Physics and covers three main themes: General Radiation Protection Principles; Radiobiology Principles; Radiation Protection in Hospital Medical Physics. Each of these topics is developed by analysing the underlying physics principles and their implementation, quality and safety aspects, clinical performance and recent advances in the field. Some issues specific to the individual techniques are also treated, e.g. calculation of patient dose as well as that of workers in hospital, optimisation of equipment used, shielding design of radiation facilities, radiation in oncology such as use of brachytherapy in gynecology or interventional procedures. All topics are presented with didactical language and style, making this book an appropriate reference for students and professionals seeking a comprehensive introduction to the field as well as a reliable overview of the most recent developments.

  11. LLNL medical and industrial laser isotope separation: large volume, low cost production through advanced laser technologies

    International Nuclear Information System (INIS)

    Comaskey, B.; Scheibner, K. F.; Shaw, M.; Wilder, J.

    1998-01-01

    The goal of this LDRD project was to demonstrate the technical and economical feasibility of applying laser isotope separation technology to the commercial enrichment (>lkg/y) of stable isotopes. A successful demonstration would well position the laboratory to make a credible case for the creation of an ongoing medical and industrial isotope production and development program at LLNL. Such a program would establish LLNL as a center for advanced medical isotope production, successfully leveraging previous LLNL Research and Development hardware, facilities, and knowledge

  12. A cross-sectional study of sociodemographic factors and their influence on quality of life in medical students at Sao Paulo, Brazil.

    Science.gov (United States)

    Serinolli, Mario Ivo; Novaretti, Marcia Cristina Zago

    2017-01-01

    Various sociodemographic factors can affect the quality of life of medical students and interfere in their ability to study. A deeper understanding of these factors may facilitate improvements in learning and retention of medical students. We conducted a cross-sectional study of 405 medical students, representing 65.3% of the total student body (years 1-6), at a private medical school in São Paulo, Brazil. Among the entire study group, 177 students (43.7%) were male, and 228 (56.3%) were female. The mean age was 23.55 years (SD = 3.98 years, range: 18-40). The World Health Organization Quality of Life-Biomedical Research and Education Facility (WHOQOL-BREF) scale was used to evaluate the following sociodemographic factors: age, sex, academic year, daily traveling time, housing conditions, smoking, weight, height, participant's and his/her parents' education background, students who had a degree or not and religious beliefs. The reliability of the WHOQOL-BREF was evaluated using Cronbach's analysis, and the association of sociodemographic factors with quality of life was examined using multivariate regression analysis. Quality of life was significantly higher in medical students with religious beliefs (β 0.14 for psychological domain; β 0.11 for environmental domain) when compared with that in those with no religious beliefs. BMI was negative associated with QOL in medical students (β -0.11 for physical domain; β -18.9 for the psychological domain). In both male and female students, longer daily traveling time was negative related to QOL (β -0.11 for environmental domain). Having at least one parent who was a doctor was associated with a better quality of life (β 0.17 for environmental domain). Male students presented with significantly higher mean scores for three of the four domains evaluated (β 0.20 for physical domain; β 0.25 for psychological domain; β 0.14 for social domain). This study has provided novel insights into the effects of sociodemographic

  13. Disruptive technology: new medical advances are troublesome for even the most successful health systems and innovator health companies.

    Science.gov (United States)

    Michaelis, Lawrence; Vaul, Joanne; Chumer, Kathleen; Faul, Maureen; Sheehan, Lisa; DeCerce, Jack

    2004-01-01

    An independent expert panel conducted a multi-year research/education/advocacy initiative on the impact of the new drug-eluting stent technology. They conclude that this technology represents a "tipping point" in a series of transformative drugs and medical devices, often used in combination, and recommend that healthcare decision makers develop careful, data-based strategies to avoid the disruptiveness of these medical advances.

  14. Awareness of incurable cancer status and health-related quality of life among advanced cancer patients: a prospective cohort study.

    Science.gov (United States)

    Lee, Myung Kyung; Baek, Sun Kyung; Kim, Si-Young; Heo, Dae Seog; Yun, Young Ho; Park, Sook Ryun; Kim, Jun Suk

    2013-02-01

    Many patients near death report an interest in knowing their prognoses. Patients' awareness of disease status may lead to more appropriate care and maintained or improved quality of life. However, it is not known whether advanced cancer patients' awareness of disease status is associated with patients' quality of life. We aimed to examine the effect of patients' awareness of disease status on the health-related quality of life (HRQOL) among advanced cancer patients undergoing palliative chemotherapy. In this prospective cohort study, patients were followed-up at 4-6 weeks and 2-3 months after the initial palliative chemotherapy. Patients' awareness of disease status, and demographic and clinical characteristics were assessed at baseline, and depression and anxiety using the Hospital Anxiety and Depression Scale (HADS) and HRQOL using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were assessed three times. In total, 100 patients with advanced cancer starting palliative chemotherapy were recruited from two tertiary university hospitals and from the Korea National Cancer Center. Patients with advanced cancer undergoing palliative chemotherapy experienced deteriorated HRQOL. Of these, the patients who were aware of their disease status as incurable had significantly higher role (p=0.002), emotional (p=0.025), and social functioning (p=0.002), and lower fatigue (p=0.008), appetite loss (p=0.039), constipation (p=0.032), financial difficulties (p=0.019), and anxiety (p=0.041) compared with patients unaware of disease status. Our findings demonstrate the importance of patients' awareness of disease status to HRQOL.

  15. End-of-life care for advanced dementia patients in residential care home-a Hong Kong perspective.

    Science.gov (United States)

    Luk, James K H; Chan, Felix H W

    2017-08-28

    Dementia will become more common as the population ages. Advanced dementia should be considered as a terminal illnesses and end-of-life (EOL) care is very much needed for this disease group. Currently, the EOL services provided to this vulnerable group in Hong Kong, especially those living in residential care homes, is limited. The usual practice of residential care homes is to send older residents with advanced dementia to acute hospitals when they are sick, irrespective of their wish, premorbid status, diagnoses and prognosis. This may not accord with what the patients perceive to be a "good death". There are many barriers for older people to die in place, both at home and at the residential care home. In the community, to enhance EOL care to residential care home for the elderly (RCHE) residents, pilot EOL program had been carried out by some Community Geriatric Assessment Teams. Since 2015, the Hospital Authority funded program "Enhance Community Geriatric Assessment Team Support to End-of-life Patients in Residential Care Homes for the Elderly" has been started. In the program, advance care planning (ACP), Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) (non-hospitalized) order will be established and the program will be expected to cover all clusters in Hong Kong by 2018/2019. In hospital setting, EOL clinical plan and EOL ward in geriatric step-down hospitals may be able to improve the quality of death of older patients. In Sep 2015, the Hospital Authority Guidelines on Life-Sustaining Treatment in the Terminally Ill was updated. Amongst other key EOL issues, careful (comfort) hand feeding was mentioned in the guideline. Other new developments include the possible establishment of enduring power of attorney for health care decision and enhancement of careful hand feeding amongst advanced dementia patients in RCHEs.

  16. The present status of medical treatment for patients of advanced lung cancer

    International Nuclear Information System (INIS)

    Kira, Shiro; Kuratomi, Yushiro; Matsuoka, Rokuro; Ishihara, Teruo

    1982-01-01

    Management of patients with inoperable, advanced lung cancer is one of the most important problems for many chest physicians, because those patients with stage 3 and stage 4 are over 70% of total patients. Although surgical treatment is attempted even in the case of stage 3 patients, many factors such as age, performance status, pulmonary and circulatory disorders accompanied with them and sometimes patient's refusal for surgical treatment preclude it. Therefore, therapeutic approach for these patients is focused on relieving their pains and troubles in their daily life. Radiation therapy is only a local treatment, but it can often control variable clinical manifestations with a highly probable estimation. Many patients can be free of disease even for a limited period. From this view-point, even at present, radiation therapy is a preferable therapeutic modality to maintain individual patient's better quality of life. (author)

  17. A broadband multimedia collaborative system for advanced teleradiology and medical imaging diagnosis.

    Science.gov (United States)

    Gómez, E J; del Pozo, F; Ortiz, E J; Malpica, N; Rahms, H

    1998-09-01

    This paper presents a new telemedicine system currently in routine clinical usage, developed within the European Union (EU) ACTS BONAPARTE project (1). The telemedicine system is developed on an asynchronous transfer mode (ATM) multimedia hardware/software platform comprising the following set of telemedicine services: synchronous cooperative work, high-quality video conference, multimedia mail, medical image digitizing, processing, storing and printing, and local and remote transparent database access. The medical information handled by the platform conforms to the Digital Imaging and Communications in Medicine (DICOM) 3.0 medical imaging standard. The telemedicine system has been installed for clinical routines in three Spanish hospitals since November 1997 and has been used in an average of one/two clinical sessions per week. At each clinical session, a usability and clinical evaluation of the system was carried out. Evaluation is carried out through direct observation of interactions and questionnaire-based subjective data. The usability evaluation methodology and the results of the system usability study are also presented in this article. The experience gained from the design, development, and evaluation of the telemedicine system is providing an indepth knowledge of the benefits and difficulties involved in the installation and clinical usage of this type of high-usability and advanced multimedia telemedicine system in the field of teleradiology and collaborative medical imaging diagnosis.

  18. Incubation and Growth of Life Sciences, Medical and Biotechnology Businesses in Proteomics, Genomics, Medicine, and Dentistry

    Science.gov (United States)

    2007-04-01

    Medical and Biotechnology Businesses in Proteomics , Genomics, Medicine, and Dentistry PRINCIPAL INVESTIGATOR: Mark S. Long Brian C...2007 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Incubation and Growth of Life Sciences, Medical and Biotechnology Businesses in Proteomics ...aflatoxins B1 and G1 from Aspergillus flavus. All toxins studied were purchased from Sigma Aldrich and used without further purification. Solutions

  19. Advancing Medication Reconciliation in an Outpatient Internal Medicine Clinic through a Pharmacist-Led Educational Initiative

    Directory of Open Access Journals (Sweden)

    Sarah M. Westberg, Pharm.D.

    2010-01-01

    Full Text Available Objectives: To develop and deliver an effective pharmacist-led educational initiative to clinic staff to advance medication reconciliation in the electronic medical record of an outpatient internal medicine clinic.Methods: An educational initiative designed to improve the ability of nursing staff in medication reconciliation was launched in the outpatient internal medicine clinic of a regional healthcare system. The education was provided by the pharmacist to clinic nursing staff, including registered nurses, licensed practical nurses, and certified medical assistants. The impact of this training was measured through pre-initiation and post-implementation surveys, competency assessments and an audit. Results: The educational initiative was successfully designed and delivered to clinic nursing staff. Assessment of the initiative found that all nursing staff completing competency assessments successfully passed. Pre-initiation- and post-implementation- survey responses on the self-assessed ability to gather and document accurate medication lists did not show significant changes. Informal observations in the clinic indicated that this initiative changed the culture of the clinic, creating increased awareness of the importance of accurate medications and increased emphasis on medication reconciliation.Conclusions: The expertise of pharmacists can be utilized to educate nursing staff on the skills and abilities necessary to gather and document accurate medication lists. This study did not find measurable changes in the accuracy of medication lists in this clinic. Future research is needed to determine the best methods to train health professionals in medication reconciliation to ensure accurate medication lists in the outpatient setting.

  20. The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

    Directory of Open Access Journals (Sweden)

    Monique Venter

    2016-11-01

    Full Text Available Background. Critical care transfers (CCT refer to the high level of care given during transport (via ambulance, helicopter or fixed-wing aircraft of patients who are of high acuity. In South Africa (SA, advanced life support (ALS paramedics undertake CCTs. The scope of ALS in SA has no extended protocol regarding procedures or medications in terms of dealing with these CCTs. Aim. The aim of this study was to obtain the opinions of several experts in fields pertaining to critical care and transport and to gain consensus on the skills and scope-of-practice requirements of paramedics undertaking CCTs in the SA setting. Methods. A modified Delphi study consisting of three rounds was undertaken using an online survey platform. A heterogeneous sample (n=7, consisting of specialists in the fields of anaesthesiology, emergency medicine, internal medicine, critical care, critical care transport and paediatrics, was asked to indicate whether, in their opinion, selected procedures and medications were needed within the scope of practice of paramedics undertaking CCTs. Results. After three rounds, consensus was obtained in 70% (57/81 of procedures and medications. Many of these items are not currently within the scope of paramedics’ training. The panel felt that paramedics undertaking these transfers should have additional postgraduate training that is specific to critical care. Conclusion. Major discrepancies exist between the current scope of paramedic practice and the suggested required scope of practice for CCTs. An extended scope of practice and additional training should be considered for these practitioners.

  1. Exploring the relationship between the engineering and physical sciences and the health and life sciences by advanced bibliometric methods.

    Directory of Open Access Journals (Sweden)

    Ludo Waltman

    Full Text Available We investigate the extent to which advances in the health and life sciences (HLS are dependent on research in the engineering and physical sciences (EPS, particularly physics, chemistry, mathematics, and engineering. The analysis combines two different bibliometric approaches. The first approach to analyze the 'EPS-HLS interface' is based on term map visualizations of HLS research fields. We consider 16 clinical fields and five life science fields. On the basis of expert judgment, EPS research in these fields is studied by identifying EPS-related terms in the term maps. In the second approach, a large-scale citation-based network analysis is applied to publications from all fields of science. We work with about 22,000 clusters of publications, each representing a topic in the scientific literature. Citation relations are used to identify topics at the EPS-HLS interface. The two approaches complement each other. The advantages of working with textual data compensate for the limitations of working with citation relations and the other way around. An important advantage of working with textual data is in the in-depth qualitative insights it provides. Working with citation relations, on the other hand, yields many relevant quantitative statistics. We find that EPS research contributes to HLS developments mainly in the following five ways: new materials and their properties; chemical methods for analysis and molecular synthesis; imaging of parts of the body as well as of biomaterial surfaces; medical engineering mainly related to imaging, radiation therapy, signal processing technology, and other medical instrumentation; mathematical and statistical methods for data analysis. In our analysis, about 10% of all EPS and HLS publications are classified as being at the EPS-HLS interface. This percentage has remained more or less constant during the past decade.

  2. Exploring the relationship between the engineering and physical sciences and the health and life sciences by advanced bibliometric methods.

    Science.gov (United States)

    Waltman, Ludo; van Raan, Anthony F J; Smart, Sue

    2014-01-01

    We investigate the extent to which advances in the health and life sciences (HLS) are dependent on research in the engineering and physical sciences (EPS), particularly physics, chemistry, mathematics, and engineering. The analysis combines two different bibliometric approaches. The first approach to analyze the 'EPS-HLS interface' is based on term map visualizations of HLS research fields. We consider 16 clinical fields and five life science fields. On the basis of expert judgment, EPS research in these fields is studied by identifying EPS-related terms in the term maps. In the second approach, a large-scale citation-based network analysis is applied to publications from all fields of science. We work with about 22,000 clusters of publications, each representing a topic in the scientific literature. Citation relations are used to identify topics at the EPS-HLS interface. The two approaches complement each other. The advantages of working with textual data compensate for the limitations of working with citation relations and the other way around. An important advantage of working with textual data is in the in-depth qualitative insights it provides. Working with citation relations, on the other hand, yields many relevant quantitative statistics. We find that EPS research contributes to HLS developments mainly in the following five ways: new materials and their properties; chemical methods for analysis and molecular synthesis; imaging of parts of the body as well as of biomaterial surfaces; medical engineering mainly related to imaging, radiation therapy, signal processing technology, and other medical instrumentation; mathematical and statistical methods for data analysis. In our analysis, about 10% of all EPS and HLS publications are classified as being at the EPS-HLS interface. This percentage has remained more or less constant during the past decade.

  3. [Advances in the application of smart phones in modern medicine].

    Science.gov (United States)

    Wang, Lin; Hu, Jie; Li, Fei; Wei, Huilin; Li, Ying; Lu, Tianjian; Wang, Shuqi; Xu, Feng

    2014-02-01

    Since smart phones have been developed, significant advances in the function of mobile phone due to the development of software, hardware and accessories have been reached. Till now, smart phones have been engaged in daily life with an increasing impact. As a new medical model, mobile phone medicine is emerging and has found wide spread applications in medicine, especially in diagnosing, monitoring and screening various diseases. In addition, mo bile phone medical application shows great potential trend to improve healthcare in resource-limited regions due to its advantageous features of portability and information communication capability. Nowadays, the scientific and technological issues related to mobile phone medicine have attracted worldwide attention. In this review, we summarize state-of-the-art advances of mobile phone medicine with focus on its diagnostics applications in order to expand the fields of their applications and promote healthcare informatization.

  4. Awareness about basic life support and emergency medical services and its associated factors among students in a tertiary care hospital in South India.

    Science.gov (United States)

    Aroor, Akshatha Rao; Saya, Rama Prakash; Attar, Nazir Rahim; Saya, Ganesh Kumar; Ravinanthanan, Manikandan

    2014-07-01

    The knowledge and skills about the basic life support (BLS) and the advanced life support are the most important determining factors of the cardiopulmonary resuscitation (CPR) success rates. To determine the level of awareness on BLS and skills among undergraduate and postgraduate students of medical and dental profession, as well as nursing students and interns in a tertiary care hospital. This descriptive cross-sectional study was conducted in a tertiary care hospital in South India. The awareness level on BLS and factors associated which include age, sex, level of training (undergraduate, internship, and postgraduate groups), course of study (nursing, dental, and medical groups), and previous exposure to BLS were assessed by using a structured questionnaire. The association of these variables with awareness level was assessed by independent t test, analysis of variance, and linear regression analysis. Among 520 study subjects, 229 were students, 171 were interns, and 120 were postgraduate students. The overall mean score of awareness was 4.16 ± 1.40 (score range: 0-10). Age, sex, level of training, course of study, and previous exposure to BLS were significantly associated with awareness level in univariate analysis (P < 0.05). Linear regression model also showed that all the above variables were significantly associated with awareness level (P < 0.05). About 322 (61.9%) subjects attributed lack of awareness about BLS to lack of available professional training. About 479 (92.1%) responded that BLS training should be a part of medical curriculum. Awareness level on BLS is below average indicating the importance of professional training at all levels in a tertiary care health institution.

  5. Awareness about basic life support and emergency medical services and its associated factors among students in a tertiary care hospital in South India

    Directory of Open Access Journals (Sweden)

    Akshatha Rao Aroor

    2014-01-01

    Full Text Available Background: The knowledge and skills about the basic life support (BLS and the advanced life support are the most important determining factors of the cardiopulmonary resuscitation (CPR success rates. Objectives: To determine the level of awareness on BLS and skills among undergraduate and postgraduate students of medical and dental profession, as well as nursing students and interns in a tertiary care hospital. Materials and Methods: This descriptive cross-sectional study was conducted in a tertiary care hospital in South India. The awareness level on BLS and factors associated which include age, sex, level of training (undergraduate, internship, and postgraduate groups, course of study (nursing, dental, and medical groups, and previous exposure to BLS were assessed by using a structured questionnaire. The association of these variables with awareness level was assessed by independent t test, analysis of variance, and linear regression analysis. Results: Among 520 study subjects, 229 were students, 171 were interns, and 120 were postgraduate students. The overall mean score of awareness was 4.16 ± 1.40 (score range: 0-10. Age, sex, level of training, course of study, and previous exposure to BLS were significantly associated with awareness level in univariate analysis (P < 0.05. Linear regression model also showed that all the above variables were significantly associated with awareness level (P < 0.05. About 322 (61.9% subjects attributed lack of awareness about BLS to lack of available professional training. About 479 (92.1% responded that BLS training should be a part of medical curriculum. Conclusion: Awareness level on BLS is below average indicating the importance of professional training at all levels in a tertiary care health institution.

  6. [Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

    Science.gov (United States)

    Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

    2017-06-01

    In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

  7. Cost-Effectiveness of Ventricular Assist Device Destination Therapy for Advanced Heart Failure in Duchenne Muscular Dystrophy.

    Science.gov (United States)

    Magnetta, Defne A; Kang, JaHyun; Wearden, Peter D; Smith, Kenneth J; Feingold, Brian

    2018-05-17

    Destination ventricular assist device therapy (DT-VAD) is well accepted in select adults with medically refractory heart failure (HF) who are not transplant candidates; however, its use in younger patients with progressive diseases is unclear. We sought to evaluate the cost-effectiveness of DT-VAD in Duchenne muscular dystrophy (DMD) patients with advanced HF. We created a Markov-state transition model (5-year horizon) to compare survival, costs, and quality of life (QOL) between medical management and DT-VAD in DMD with advanced HF. Model input parameters were derived from the literature. We used sensitivity analyses to explore uncertainty around model assumptions. DT-VAD had higher costs ($435,602 vs. $125,696), survival (3.13 vs. 0.60 years), and quality-adjusted survival (1.99 vs. 0.26 years) than medical management. The incremental cost-effectiveness ratio (ICER) for DT-VAD was $179,086 per quality-adjusted life year (QALY). In sensitivity analyses that were widely varied to account for uncertainty in model assumptions, the DT-VAD strategy generally remained more costly and effective than medical management. Only when VAD implantation costs were <$113,142 did the DT-VAD strategy fall below the $100,000/QALY willingness-to-pay threshold commonly considered to be "cost-effective." In this exploratory analysis, DT-VAD for patients with DMD and advanced HF exceeded societal expectations for cost-effectiveness but had an ICER similar to the accepted practice of DT-VAD in adult HF patients. While more experience and research in this population is needed, our analysis suggests that DT-VAD for advanced HF in DMD should not be dismissed solely based on cost.

  8. End-of-life medical decisions in France: a death certificate follow-up survey 5 years after the 2005 act of parliament on patients' rights and end of life.

    Science.gov (United States)

    Pennec, Sophie; Monnier, Alain; Pontone, Silvia; Aubry, Régis

    2012-12-03

    The "Patients' Rights and End of Life Care" Act came into force in France in 2005. It allows withholding/withdrawal of life-support treatment, and intensified use of medications that may hasten death through a double effect, as long as hastening death is not the purpose of the decision. It also specifies the requirements of the decision-making process. This study assesses the situation by examining the frequency of end-of-life decisions by patients' and physicians' characteristics, and describes the decision-making processes. We conducted a nationwide retrospective study of a random sample of adult patients who died in December 2009. Questionnaires were mailed to the physicians who certified/attended these deaths. Cases were weighted to adjust for response rate bias. Bivariate analyses and logistic regressions were performed for each decision. Of all deaths, 16.9% were sudden deaths with no information about end of life, 12.2% followed a decision to do everything possible to prolong life, and 47.7% followed at least one medical decision that may certainly or probably hasten death: withholding (14.6%) or withdrawal (4.2%) of treatments, intensified use of opioids and/or benzodiazepines (28.1%), use of medications to deliberately hasten death (i.e. not legally authorized) (0.8%), at the patient's request (0.2%) or not (0.6%). All other variables held constant, cause of death, patient's age, doctor's age and specialty, and place of death, influenced the frequencies of decisions. When a decision was made, 20% of the persons concerned were considered to be competent. The decision was discussed with the patient if competent in 40% (everything done) to 86% (intensification of alleviation of symptoms) of cases. Legal requirements regarding decision-making for incompetent patients were frequently not complied with. This study shows that end-of-life medical decisions are common in France. Most are in compliance with the 2005 law (similar to some other European countries

  9. Medical guidelines for the patient: introducing the life assistance protocols.

    Science.gov (United States)

    Domínguez, David; Fernández, Carlos; Meneu, Teresa; Mocholí, Juan Bautista; Serafin, Riccardo

    2008-01-01

    This paper introduces our preliminary results in the modeling of Life Assistance Protocols, a new vision of medical guidelines and protocols through the lenses of p-Health. In this context the patient's role in the process is emphasized, the actions to be performed less defined and not only clinical situations considered, but also healthier lifestyle promotion processes accounted for, where the person's preferences and motivations play a key role. We propose a complete framework, balancing on classical clinical guideline models and covering both the theoretical and the practical aspects of the problem, describing it from conceptualization to the execution environment.

  10. "Hope for the best, prepare for the worst": A qualitative interview study on parents' needs and fears in pediatric advance care planning.

    Science.gov (United States)

    Lotz, Julia Desiree; Daxer, Marion; Jox, Ralf J; Borasio, Gian Domenico; Führer, Monika

    2017-09-01

    Pediatric advance care planning is advocated by healthcare providers because it may increase the chance that patient and/or parent wishes are respected and thus improve end-of-life care. However, since end-of-life decisions for children are particularly difficult and charged with emotions, physicians are often afraid of addressing pediatric advance care planning. We aimed to investigate parents' views and needs regarding pediatric advance care planning. We performed a qualitative interview study with parents of children who had died from a severe illness. The interviews were analyzed by descriptive and evaluation coding according to Saldaña. We conducted semi-structured interviews with 11 parents of 9 children. Maximum variation was sought regarding the child's illness, age at death, care setting, and parent gender. Parents find it difficult to engage in pediatric advance care planning but consider it important. They argue for a sensitive, individualized, and gradual approach. Hope and quality of life issues are primary. Parents have many non-medical concerns that they want to discuss. Written advance directives are considered less important, but medical emergency plans are viewed as necessary in particular cases. Continuity of care and information should be improved through regular pediatric advance care planning meetings with the various care providers. Parents emphasize the importance of a continuous contact person to facilitate pediatric advance care planning. Despite a need for pediatric advance care planning, it is perceived as challenging. Needs-adjusted content and process and continuity of communication should be a main focus in pediatric advance care planning. Future research should focus on strategies that facilitate parent engagement in pediatric advance care planning to increase the benefit for the families.

  11. Life sciences: Nuclear medicine, radiation biology, medical physics, 1980-1994. International Atomic Energy Agency Publications

    International Nuclear Information System (INIS)

    1994-11-01

    The catalogue lists all sales publications of the IAEA dealing with Life Sciences issued during the period 1980-1994. The publications are grouped in the following chapters: Nuclear Medicine (including Radiopharmaceuticals), Radiation Biology and Medical Physics (including Dosimetry)

  12. Medical and welfare device session. Toward medical treatment and welfare of tomorrow; Iryo fukushi kiki session. Ashita no iryo fukushi ni mukete

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-09-01

    This paper is the material distributed in the medical and welfare device session held under the auspices of NEDO in September 2000. Diversification of needs in the medical and welfare areas and handling of age advancement are the growing issue. NEDO is putting efforts toward enhancement of quality of life (QOL) and realization of the nation with great life by providing high-quality and high-efficiency medical and welfare services. The NEDO's efforts cover the areas of treating adult diseases such as cancers and cardiac diseases whose seriousness is growing, early diagnoses of diseases, medical treatment with low invasion, elderly people helping, reduction of helpers' burden, reduction of handicaps to elderly people and mentally and physically handicapped persons, and assistance to participation in the society. To achieve these goals, NEDO is implementing the following four projects: research and development of medical and welfare device technologies, researches of medical science and engineering collaboration type, and promotion of developing welfare techno-systems and practical application of welfare appliances. Developments are being made toward practical application of medical and welfare devices with excellent safety and convenience, of low cost and high performance. The session gave the keynote addresses related to medical treatment and prevention of brain diseases; brain, the universe and MRI (the world of mind as seen in images), and high-tech medical treatments to protect brain (challenge to brain that starts now). (NEDO)

  13. Learning by Computer Simulation Does Not Lead to Better Test Performance on Advanced Cardiac Life Support Than Textbook Study.

    Science.gov (United States)

    Kim, Jong Hoon; Kim, Won Oak; Min, Kyeong Tae; Yang, Jong Yoon; Nam, Yong Taek

    2002-01-01

    For an effective acquisition and the practical application of rapidly increasing amounts of information, computer-based learning has already been introduced in medical education. However, there have been few studies that compare this innovative method to traditional learning methods in studying advanced cardiac life support (ACLS). Senior medical students were randomized to computer simulation and a textbook study. Each group studied ACLS for 150 minutes. Tests were done one week before, immediately after, and one week after the study period. Testing consisted of 20 questions. All questions were formulated in such a way that there was a single best answer. Each student also completed a questionnaire designed to assess computer skills as well as satisfaction with and benefit from the study materials. Test scores improved after both textbook study and computer simulation study in both groups but the improvement in scores was significantly higher for the textbook group only immediately after the study. There was no significant difference between groups in their computer skill and satisfaction with the study materials. The textbook group reported greater benefit from study materials than did the computer simulation group. Studying ACLS with a hard copy textbook may be more effective than computer simulation for the acquisition of simple information during a brief period. However, the difference in effectiveness is likely transient.

  14. A comparison of attitudes toward length and quality of life between community-dwelling older adults and patients with advanced cancer.

    Science.gov (United States)

    Malhotra, Chetna; Xiang, Ling; Ozdemir, Semra; Kanesvaran, Ravindran; Chan, Noreen; Finkelstein, Eric Andrew

    2017-10-01

    Applying prospect theory to end-of-life decision making, we hypothesize that community-dwelling older adults (CDOAs) will be relatively less inclined towards extending length over improving quality of life compared with patients. We also hypothesize that differences in relative inclination for length over quality of life between the 2 groups will decrease with advancing age. We tested these hypotheses by administering the quality-quantity questionnaire to 1067 CDOAs and 320 stage IV cancer patients and applying a linear regression model to assess whether relative inclination for length over quality of life, as estimated by the questionnaire, differed between CDOAs and patients after controlling for differences in sociodemographic characteristics. We also assessed the effect of interaction between age and participant status (CDOA compared to patient) on relative inclination for length over quality of life. Consistent with prospect theory, a lower proportion of CDOAs (26%) than patients (42%) were relatively more inclined towards length over quality of life. Results were significant even after adjusting for differences in sociodemographics (P patients increased (P = .01). Findings indicate that attitudes towards length and quality of life differ by life stage. This has implications for end-of-life care decisions made by CDOAs, such as purchasing health or disability insurance and signing advance directives or care plans. Copyright © 2016 John Wiley & Sons, Ltd.

  15. A 40-Year History of End-of-Life Offerings in US Medical Schools: 1975-2015.

    Science.gov (United States)

    Dickinson, George E

    2017-07-01

    The purpose of this longitudinal study of US medical schools over a 40-year period was to ascertain their offerings on end-of-life (EOL) issues. At 5-year intervals, beginning in 1975, US medical schools were surveyed via a questionnaire to determine their EOL offerings. Data were reported with frequency distributions. The Institute of Medicine has encouraged more emphasis on EOL issues over the past 2 decades. Findings revealed that undergraduate medical students in the United States are now exposed to death and dying, palliative care, and geriatric medicine. The inclusion of EOL topics has definitely expanded over the 40-year period as findings reveal that US undergraduate medical students are currently exposed in over 90% of programs to death and dying, palliative care, and geriatric medicine, with the emphasis on these topics varying with the medical programs. Such inclusion should produce future favorable outcomes for undergraduate medical students, patients, and their families.

  16. Advancing Medication Reconciliation in an Outpatient Internal Medicine Clinic through a Pharmacist-Led Educational Initiative

    Directory of Open Access Journals (Sweden)

    Sarah M. Westberg

    2010-06-01

    Full Text Available Objectives: To develop and deliver an effective pharmacist-led educational initiative to clinic staff to advance medication reconciliation in the electronic medical record of an outpatient internal medicine clinic. Methods: An educational initiative designed to improve the ability of nursing staff in medication reconciliation was launched in the outpatient internal medicine clinic of a regional healthcare system. The education was provided by the pharmacist to clinic nursing staff, including registered nurses, licensed practical nurses, and certified medical assistants. The impact of this training was measured through pre-initiation and post-implementation surveys, competency assessments and an audit. Results: The educational initiative was successfully designed and delivered to clinic nursing staff. Assessment of the initiative found that all nursing staff completing competency assessments successfully passed. Pre-initiation- and post-implementation- survey responses on the self-assessed ability to gather and document accurate medication lists did not show significant changes. Informal observations in the clinic indicated that this initiative changed the culture of the clinic, creating increased awareness of the importance of accurate medications and increased emphasis on medication reconciliation. Conclusions: The expertise of pharmacists can be utilized to educate nursing staff on the skills and abilities necessary to gather and document accurate medication lists. This study did not find measurable changes in the accuracy of medication lists in this clinic. Future research is needed to determine the best methods to train health professionals in medication reconciliation to ensure accurate medication lists in the outpatient setting. Type: Original Research

  17. Three principles to improve clinician communication for advance care planning: overcoming emotional, cognitive, and skill barriers.

    Science.gov (United States)

    Weiner, Joseph S; Cole, Steven A

    2004-12-01

    Medical care of patients with life limiting illness remains fraught with serious deficiencies, including inadequate advance care planning, delayed hospice referral, and continued delivery of aggressive treatment that is overtly counter to patients' preferences. This paper describes clinicians' emotional, cognitive, and skill barriers to shared decision-making with seriously ill patients and their loved ones. Thematic literature review. Based on a literature review, as well as clinical and educational experience, we articulate three principles to address these barriers and guide future professional communication training for advance care planning. We argue that these barriers must be overcome before deficiencies in end-of-life care can be fully ameliorated.

  18. Self-expandable metal stent for palliation of malignant dysphagia & quality of life improvement in advanced cancer esophagus: Upper Egypt experience

    OpenAIRE

    Mohamed Abdelshafy; Mohammed A. Omar; Mohamed Abdel Bary; Mohamed Mostafa Wahaman; Rafaat Abd elaal Bakheet

    2017-01-01

    Background: In advanced cancer esophagus patients, self-expandable metallic stents (SEMS) are utilized to relieve malignant difficulty in swallowing and improve their quality of the life. Retrospectively, we evaluated the efficacy, feasibility, and outcomes of SEMS in palliation of malignant dysphagia in advanced cancer esophagus and its' complications. Methods: We retrospectively reviewed data of 350 patients with malignant dysphagia due to advanced cancer esophagus from December 2012 to ...

  19. Evaluation of a novel Web-based pediatric advanced life support course.

    Science.gov (United States)

    Gerard, James M; Scalzo, Anthony J; Laffey, Steven P; Sinks, Glen; Fendya, Diana; Seratti, Patrice

    2006-06-01

    To assess the educational efficacy of a Web-based pediatric advanced life support course (Web-PALS). Nonrandomized, prospective, cohort study. University medical center. Health care providers (includes physicians, nurses, paramedics, and respiratory therapists) taking either the Web-PALS or a traditional PALS course (Trad-PALS). Web-PALS. Postcourse written examination scores and scored videotapes of students performing 5 PALS procedures were compared between study groups. Students completed precourse and postcourse questionnaires, rating on a 5-point Likert scale their self-confidence to perform PALS assessments and procedures. A structured, course satisfaction survey was given after students had taken the Web-PALS course. Eighty-six students completed the study (44 Web-PALS and 42 Trad-PALS). All students achieved a passing score on the written examination on their first attempt. Compared with students in the Trad-PALS group, students in the Web-PALS group scored slightly lower (97.1% vs 95.4%; difference, 1.7%; 95% confidence interval, 0.1-3.2). Mean overall videotape scores were similar among the Web-PALS and Trad-PALS groups (75.0% vs 73.0%; difference, 2.0%; 95% confidence interval, -2.0 to 6.0). After completing the Web-PALS course, the mean level of confidence improved from 3.77 to 4.28 (difference, 0.51; 95% confidence interval, 0.33-0.69). Ninety-six percent of respondents indicated that Web-PALS met all of the stated objectives of the PALS course. All respondents indicated that they would recommend Web-PALS to a colleague. Students perceive Web-PALS as a positive educational experience. Though not identical to students taking the Trad-PALS course, they performed well on postcourse cognitive and psychomotor testing. These findings support Web-PALS as an acceptable format for administering the PALS course.

  20. Integration and health-related quality of life of undergraduate medical students with migration backgrounds ? Results of a survey

    OpenAIRE

    Kurr?, Jennifer; Scholl, Johanna; Bullinger, Monika; Petersen-Ewert, Corinna

    2011-01-01

    Objective: Most medical faculties in Germany are still lacking differentiated counseling programmes for specific target groups. The purpose of the present study was to determine the quality of life and integration of students with migration backgrounds and their interests in counseling programmes.Methods: Data was collected at the University Medical Center Hamburg-Eppendorf in Germany. Participants were students of the undergraduate medical course; n=890 (89.3%) students without migration b...

  1. Study for requirement of advanced long life small modular fast reactor

    Energy Technology Data Exchange (ETDEWEB)

    Tak, Taewoo, E-mail: ttwispy@unist.ac.kr; Choe, Jiwon, E-mail: chi91023@unist.ac.kr; Jeong, Yongjin, E-mail: yjjeong09@unist.ac.kr; Lee, Deokjung, E-mail: deokjung@unist.ac.kr [Ulsan National Institute of Science and Technology, 50, UNIST-gil, Eonyang-eup, Ulju-gun, Ulsan, 689-798 (Korea, Republic of); Kim, T. K., E-mail: tkkim@anl.gov [Argonne National Laboratory, 9700 South Cass Avenue, Argonne, IL 60564 (United States)

    2016-01-22

    To develop an advanced long-life SMR core concept, the feasibility of the long-life breed-and-burn core concept has been assessed and the preliminary selection on the reactor design requirement such as fuel form, coolant material has been performed. With the simplified cigar-type geometry of 8m-tall CANDLE reactor concept, it has demonstrated the strengths of breed-and-burn strategy. There is a saturation region in the graph for the multiplication factors, which means that a steady breeding is being proceeded along the axial direction. The propagation behavior of the CANDLE core can be also confirmed through the evolution of the axial power profile. Coolant material is expected to have low melting point, density, viscosity and absorption cross section and a high boiling point, specific heat, and thermal conductivity. In this respect, sodium is preferable material for a coolant of this nuclear power plant system. The metallic fuel has harder spectrum compared to the oxide and carbide fuel, which is favorable to increase the breeding and extend the cycle length.

  2. Consensus Statement of the International Summit on Intellectual Disability and Dementia Related to End-of-Life Care in Advanced Dementia

    Science.gov (United States)

    McCallion, Philip; Hogan, Mary; Santos, Flavia H.; McCarron, Mary; Service, Kathryn; Stemp, Sandy; Keller, Seth; Fortea, Juan; Bishop, Kathleen; Watchman, Karen; Janicki, Matthew P.

    2017-01-01

    Background: Adults with intellectual disability are affected by dementia at equivalent and elevated rates, many surviving into advanced age. End of life care and support considerations come into play among these individuals when most are in the advanced stage of dementia. Methods: A preliminary report summarizing available literature and making…

  3. Basic life support: knowledge and attitude of medical/paramedical professionals.

    Science.gov (United States)

    Roshana, Shrestha; Kh, Batajoo; Rm, Piryani; Mw, Sharma

    2012-01-01

    Basic life support (BLS), a key component of the chain of survival decreases the arrest - cardiopulmonary resuscitation interval and increases the rate of hospital discharge. The study aimed to explore the knowledge of and attitude towards basic life support (BLS) among medical/paramedical professionals. An observational study was conducted by assessing response to self prepared questionnaire consisting of the demographic information of the medical/paramedical staff, their personnel experience/attitude and knowledge of BLS based on the 2005 BLS Guidelines of European Resuscitation Council. After excluding incomplete questionnaires, the data from 121 responders (27 clinical faculty members, 21 dental and basic sciences faculty members, 29 house officers and 44 nurses and health assistants) were analyzed. Only 9 (7.4%) of the 121 responders answered ≥11, 53 (43%) answered 7-10, and 58 (48%) answered basic sciences faculty members attained a least mean score of 4.52 ±2.13 (P<0.001). Those who had received cardiopulmonary resuscitation (CPR) training within 5 years obtained a highest mean score of 8.62±2.49, whereas those who had the training more than 5 years back or no training obtained a mean score of 5.54±2.38 and 6.1±2.29 respectively (P=0.001). Those who were involved in resuscitation frequently had a higher median score of 8 in comparison to those who were seldom involved or not involved at all (P<0.001). The average health personnel in our hospital lack adequate knowledge in CPR/BLS. Training and experience can enhance knowledge of CPR of these personnel. Thus standard of CPR/BLS training and assessment are recommended at our hospital.

  4. The future of medical education is no longer blood and guts, it is bits and bytes.

    Science.gov (United States)

    Gorman, P J; Meier, A H; Rawn, C; Krummel, T M

    2000-11-01

    In the United States, medical care consumes approximately $1.2 trillion annually (14% of the gross domestic product) and involves 250,000 physicians, almost 1 million nurses, and countless other providers. While the Information Age has changed virtually every other facet of our life, the education of these healthcare professionals, both present and future, is largely mired in the 100-year-old apprenticeship model best exemplified by the phase "see one, do one, teach one." Continuing medical education is even less advanced. While the half-life of medical information is less than 5 years, the average physician practices 30 years and the average nurse 40 years. Moreover, as medical care has become increasingly complex, medical error has become a substantial problem. The current convulsive climate in academic health centers provides an opportunity to rethink the way medical education is delivered across a continuum of professional lifetimes. If this is well executed, it will truly make medical education better, safer, and cheaper, and provide real benefits to patient care, with instantaneous access to learning modules. At the Center for Advanced Technology in Surgery at Stanford we envision this future: within the next 10 years we will select, train, credential, remediate, and recredential physicians and surgeons using simulation, virtual reality, and Web-based electronic learning. Future physicians will be able to rehearse an operation on a projectable palpable hologram derived from patient-specific data, and deliver the data set of that operation with robotic assistance the next day.

  5. Effect of socioemotional stress on the quality of cardiopulmonary resuscitation during advanced life support in a randomized manikin study.

    Science.gov (United States)

    Bjørshol, Conrad Arnfinn; Myklebust, Helge; Nilsen, Kjetil Lønne; Hoff, Thomas; Bjørkli, Cato; Illguth, Eirik; Søreide, Eldar; Sunde, Kjetil

    2011-02-01

    The aim of this study was to evaluate whether socioemotional stress affects the quality of cardiopulmonary resuscitation during advanced life support in a simulated manikin model. A randomized crossover trial with advanced life support performed in two different conditions, with and without exposure to socioemotional stress. The study was conducted at the Stavanger Acute Medicine Foundation for Education and Research simulation center, Stavanger, Norway. Paramedic teams, each consisting of two paramedics and one assistant, employed at Stavanger University Hospital, Stavanger, Norway. A total of 19 paramedic teams performed advanced life support twice in a randomized fashion, one control condition without socioemotional stress and one experimental condition with exposure to socioemotional stress. The socioemotional stress consisted of an upset friend of the simulated patient who was a physician, spoke a foreign language, was unfamiliar with current Norwegian resuscitation guidelines, supplied irrelevant clinical information, and repeatedly made doubts about the paramedics' resuscitation efforts. Aural distractions were supplied by television and cell telephone. The primary outcome was the quality of cardiopulmonary resuscitation: chest compression depth, chest compression rate, time without chest compressions (no-flow ratio), and ventilation rate after endotracheal intubation. As a secondary outcome, the socioemotional stress impact was evaluated through the paramedics' subjective workload, frustration, and feeling of realism. There were no significant differences in chest compression depth (39 vs. 38 mm, p = .214), compression rate (113 vs. 116 min⁻¹, p = .065), no-flow ratio (0.15 vs. 0.15, p = .618), or ventilation rate (8.2 vs. 7.7 min⁻¹, p = .120) between the two conditions. There was a significant increase in the subjective workload, frustration, and feeling of realism when the paramedics were exposed to socioemotional stress. In this advanced life

  6. Symptom Clusters in Advanced Cancer Patients: An Empirical Comparison of Statistical Methods and the Impact on Quality of Life.

    Science.gov (United States)

    Dong, Skye T; Costa, Daniel S J; Butow, Phyllis N; Lovell, Melanie R; Agar, Meera; Velikova, Galina; Teckle, Paulos; Tong, Allison; Tebbutt, Niall C; Clarke, Stephen J; van der Hoek, Kim; King, Madeleine T; Fayers, Peter M

    2016-01-01

    Symptom clusters in advanced cancer can influence patient outcomes. There is large heterogeneity in the methods used to identify symptom clusters. To investigate the consistency of symptom cluster composition in advanced cancer patients using different statistical methodologies for all patients across five primary cancer sites, and to examine which clusters predict functional status, a global assessment of health and global quality of life. Principal component analysis and exploratory factor analysis (with different rotation and factor selection methods) and hierarchical cluster analysis (with different linkage and similarity measures) were used on a data set of 1562 advanced cancer patients who completed the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Core 30. Four clusters consistently formed for many of the methods and cancer sites: tense-worry-irritable-depressed (emotional cluster), fatigue-pain, nausea-vomiting, and concentration-memory (cognitive cluster). The emotional cluster was a stronger predictor of overall quality of life than the other clusters. Fatigue-pain was a stronger predictor of overall health than the other clusters. The cognitive cluster and fatigue-pain predicted physical functioning, role functioning, and social functioning. The four identified symptom clusters were consistent across statistical methods and cancer types, although there were some noteworthy differences. Statistical derivation of symptom clusters is in need of greater methodological guidance. A psychosocial pathway in the management of symptom clusters may improve quality of life. Biological mechanisms underpinning symptom clusters need to be delineated by future research. A framework for evidence-based screening, assessment, treatment, and follow-up of symptom clusters in advanced cancer is essential. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  7. Advance Directive in End of Life Decision-Making among the Yoruba of South-Western Nigeria.

    Science.gov (United States)

    Jegede, Ayodele Samuel; Adegoke, Olufunke Olufunsho

    2016-11-01

    End-of-life decision making is value-laden within the context of culture and bioethics. Also, ethics committee role is difficult to understand on this, thus need for ethnomethodological perspective in an expanding bioethical age. Anthropological approach was utilized to document Yoruba definition and perspective of death, cultural beliefs about end-of-life decision making, factors influencing it and ethics committee role. Interviews were conducted among selected Yoruba resident in Akinyele LGA, Oyo State, Nigeria. Content analytical approach was used for data analysis. Yoruba culture, death is socially constructed having spiritual, physical and social significance. Relationship between the dying and significant others influences decision making. Hierarchy of authority informs implementing traditional advance directive. Socialization, gender, patriarchy, religious belief and tradition are major considerations in end-of-life decision making. Awareness, resource allocation and advocacy are important ethics committees' roles. Further research into cultural diversity of end-of-life decision making will strengthen ethical practice in health care delivery.

  8. Assessing the feasibility of the Healthy Life in Suriname Study: using advanced hemodynamics to evaluate cardiovascular risk

    NARCIS (Netherlands)

    Aartman, Jet Q.; Diemer, Frederieke S.; Karamat, Fares A.; Bohte, Evelien; Baldew, Sergio M.; Jarbandhan, Ameerani V.; van Montfrans, Gert A.; Oehlers, Glenn P.; Brewster, Lizzy M.

    2017-01-01

    Objectives. To determine the feasibility of assessing population cardiovascular risk with advanced hemodynamics in the Healthy Life in Suriname (HELISUR) study. Methods. This was a preliminary study conducted in May - June 2012 using the Technical-Economic-Legal-Operational-Scheduling (TELOS) method

  9. Needs of people with advanced dementia in their final phase of life: A multi-perspective qualitative study in nursing homes.

    Science.gov (United States)

    Schmidt, Holger; Eisenmann, Yvonne; Golla, Heidrun; Voltz, Raymond; Perrar, Klaus Maria

    2018-03-01

    People with advanced dementia present an important target group for palliative care. They suffer a range of symptoms, and their verbal communication abilities are highly restricted. At present, little is known about their needs in the final phase of life. To identify the needs of people with advanced dementia in their final phase of life and to explore the aspects relevant to first recognize and then meet these needs. Multi-perspective qualitative study using grounded theory methodology conducting group discussions, individual interviews, and participant observation. The study encompassed nursing homes and involved health professionals, relatives, and residents with advanced dementia. Data were collected in six nursing homes. Nine group discussions and three individual interviews were conducted comprising 42 health professionals and 14 relatives. Participant observations aided in giving the perspective of 30 residents with advanced dementia. Data analysis generated a total of 25 physical, psychosocial, and spiritual needs divided into 10 categories. Physical needs were classified as follows: "food intake," "physical well-being," and "physical activity and recovery." Categories of psychosocial needs were classified as follows: "adaptation of stimuli," "communication," "personal attention," "participation," "familiarity and safety," as well as "self-determination." Spiritual needs addressed "religion." The results revealed a multitude of key aspects for recognizing and meeting these needs, stressing the importance of personhood. People with advanced dementia in their final phase of life have a multitude of individual and complex needs. This evidence contributes to narrowing the current research gap, offering an orientation framework for research and practice.

  10. A survey of views and practice patterns of dialysis medical directors toward end-of-life decision making for patients with end-stage renal disease.

    Science.gov (United States)

    Fung, Enrica; Slesnick, Nate; Kurella Tamura, Manjula; Schiller, Brigitte

    2016-07-01

    Patients with end-stage renal disease report infrequent end-of-life discussions, and nephrology trainees report feeling unprepared for end-of-life decision making, but the views of dialysis medical directors have not been studied. Our objective is to understand dialysis medical directors' views and practice patterns on end-of-life decision making for patients with ESRD. We administered questionnaires to dialysis medical directors during medical director meetings of three different dialysis organizations in 2013. Survey questions corresponded to recommendations from the Renal Physicians Association clinical practice guidelines on initiation and withdrawal of dialysis. There were 121 medical director respondents from 28 states. The majority of respondents felt "very prepared" (66%) or "somewhat prepared" (29%) to participate in end-of-life decisions and most (80%) endorsed a model of shared decision making. If asked to do so, 70% of the respondents provided prognostic information "often" or "nearly always." For patients with a poor prognosis, 36% of respondents would offer a time-limited trial of dialysis "often" or "nearly always", while 56% of respondents would suggest withdrawal from dialysis "often" or "nearly always" for those with a poor prognosis currently receiving dialysis therapy. Patient resistance and fear of taking away hope were the most commonly cited barriers to end-of-life discussions. Views and reported practice patterns of medical directors are consistent with clinical practice guidelines for end-of-life decision making for patients with end-stage renal disease but inconsistent with patient perceptions. © The Author(s) 2016.

  11. Flipping the advanced cardiac life support classroom with team-based learning: comparison of cognitive testing performance for medical students at the University of California, Irvine, United States

    Directory of Open Access Journals (Sweden)

    Megan Boysen-Osborn

    2016-02-01

    Full Text Available Purpose: It aimed to find if written test results improved for advanced cardiac life support (ACLS taught in flipped classroom/team-based Learning (FC/TBL vs. lecture-based (LB control in University of California-Irvine School of Medicine, USA. Methods: Medical students took 2010 ACLS with FC/TBL (2015, compared to 3 classes in LB (2012-14 format. There were 27.5 hours of instruction for FC/TBL model (TBL 10.5, podcasts 9, small-group simulation 8 hours, and 20 (12 lecture, simulation 8 hours in LB. TBL covered 13 cardiac cases; LB had none. Seven simulation cases and didactic content were the same by lecture (2012-14 or podcast (2015 as was testing: 50 multiple-choice questions (MCQ, 20 rhythm matchings, and 7 fill-in clinical cases. Results: 354 students took the course (259 [73.1%] in LB in 2012-14, and 95 [26.9%] in FC/TBL in 2015. Two of 3 tests (MCQ and fill-in improved for FC/TBL. Overall, median scores increased from 93.5% (IQR 90.6, 95.4 to 95.1% (92.8, 96.7, P=0.0001. For the fill-in test: 94.1% for LB (89.6, 97.2 to 96.6% for FC/TBL (92.4, 99.20 P=0.0001. For MC: 88% for LB (84, 92 to 90% for FC/TBL (86, 94, P=0.0002. For the rhythm test: median 100% for both formats. More students failed 1 of 3 tests with LB vs. FC/TBL (24.7% vs. 14.7%, and 2 or 3 components (8.1% vs. 3.2%, P=0.006. Conversely, 82.1% passed all 3 with FC/TBL vs. 67.2% with LB (difference 14.9%, 95% CI 4.8-24.0%. Conclusion: A FC/TBL format for ACLS marginally improved written test results.

  12. Building Brains, Forging Futures: A Call to Action for the Family-Centered Medical Home

    Science.gov (United States)

    Kraft, Colleen

    2013-01-01

    The family-centered medical home describes an approach to providing comprehensive primary care. Research advances in developmental neuroscience, genetics, and epigenetics offer a framework for understanding the dynamic process of brain development. It is this process that sets the life-course trajectory for an individual; in turn, a child's…

  13. Dietary habits and life style among the students of a private medical university Karachi.

    Science.gov (United States)

    Nisar, Nighat; Qadri, Majid Hafeez; Fatima, Kiran; Perveen, Shakeela

    2009-02-01

    To determine the dietary habits and life style of the students of a private medical university in Karachi. A cross-sectional study was conducted at Baqai Medical University, from August 2005 to September 2005. A total of 384 medical students from the batches of 2002 to 2005 participated in this study. A pre-tested semi structured questionnaire was self administered to the students after taking their consent. The data included sociodemographic characteristics, life style, exercise, dietary habits and family history of diabetes mellitus. The collected data was analyzed by statistical program SPSS version 11. Out of the total participants, 53.4% were male and 46.6% were female students. The mean age was 20 +/- 1.58 years. The average income of the household of students was 50,000 Pakistani rupees per month. Only 7% students were tobacco users. About 33% students had a history of diabetes mellitus among their parents. Nearly ninety-seven percent reported consumption of junk food while 60% reported use of whole grain food in their diet. Seventy percent students walked 30 minutes and 47% exercised daily. According to the body mass index, 58.3% students were of normal weight and 41.7% were overweight. No significant difference was found among male and female students when dietary habits and life style were compared by sex. Junk food and soft-drink consumption was associated with being overweight. Eating whole grain food and doing exercise showed a protective association against overweight. Unhealthy lifestyle and poor dietary habits were highly prevalent in the overweight study population. Type-2 diabetes mellitus was common among parents and grandparents of the students making them prone to this disorder. Our study concluded that dietary and exercise counselling is necessary as a preventive strategy.

  14. Quality of Work-Life Programs in U.S. Medical Schools: Review and Case Studies

    Science.gov (United States)

    Otto, Ann; Bourguet, Claire

    2006-01-01

    Quality of work life is being recognized more and more as a driving factor in the recruitment and retention of highly qualified employees. Before Northeastern Ohio Universities College of Medicine began development of its QWL initiative, it surveyed other medical schools across the U.S. to determine benchmarks of best practices in these programs.…

  15. Symptoms and health-related quality of life in patients with advanced cancer - A population-based study in Greenland.

    Science.gov (United States)

    Augustussen, Mikaela; Sjøgren, Per; Timm, Helle; Hounsgaard, Lise; Pedersen, Michael Lynge

    2017-06-01

    The aims were to describe symptoms and health-related quality of life (HRQoL) in Greenlandic patients with advanced cancer and to assess the applicability and internal consistency of the Greenlandic version of the EORTC-QLQ-C30 core version 3.0. A Greenlandic version of the EORTC QLQ-C30 v.3.0 was developed. The translation process included independent forward translation, reconciliation and independent back translation by native Greenlandic-speaking translators who were fluent in English. After pilot testing, a population-based cross-sectional study of patients with advanced cancer receiving palliative treatment was conducted. Internal consistency was examined by calculating Cronbach's alpha coefficients for five function scales and three symptom scales. Of the 58 patients who participated in the study, 47% had reduced social functioning, 36% had reduced physical and role functioning and 19% had reduced emotional and cognitive functioning. Furthermore, 48% reported fatigue, and 33% reported financial problems. The Greenlandic version of the EORTC had good applicability in the assessment of symptoms and quality of life. Acceptable Cronbach's alpha coefficients (above 0.70) were observed for the physical, role and social functioning scales, the fatigue scale and the global health status scale. Patients with undergoing palliative treatment in Greenland for advanced cancer reported high levels of social and financial problems and reduced physical functioning. This indicates a potential for improving palliative care service and increasing the focus on symptom management. The Greenlandic version of the EORTC-QLQ-C30 represents an applicable and reliable tool to describe symptoms and health-related quality of life among Greenlandic patients with advanced cancer. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Medical simulation technology: educational overview, industry leaders, and what's missing.

    Science.gov (United States)

    Spooner, Nicholas; Hurst, Stephen; Khadra, Mohamed

    2012-01-01

    Modern medical simulation technology (MST) debuted in 1960 with the development of Resusci Annie (Laerdal 2007), which assisted students in the acquisition of proper ventilation and compression techniques used during basic life support. Following a steady stream of subsequent technological advances and innovations, MST manufacturers are now able to offer training aids capable of facilitating innovative learning in such diverse areas as human patient simulators, simulated clinical environments, virtual procedure stations, virtual medical environments, electronic tutors, and performance recording. The authors list a number of the most popular MSTs presently available while citing evaluative efforts undertaken to date regarding the efficacy of MST to the medical profession. They conclude by proposing a variety of simulation innovations of prospective interest to both medical and technology personnel while offering healthcare administrators a series of recommended considerations when planning to integrate MST into existing medical systems.

  17. Benefits of Medical Home Care Reaching Beyond Chronically Ill Teens: Exploring Parent Health-Related Quality of Life.

    Science.gov (United States)

    Chavez, Laura J; Grannis, Connor; Dolce, Millie; Chisolm, Deena J

    2018-03-15

    Caring for teens with special health care needs places physical and mental health burdens on parents, which can be exacerbated by the stresses of transitions to independence. Medical homes can improve teen transitions to greater self-management and reduce health care-related time and financial burdens for families. We examined the association between parent-reported teen medical home status and caregiver health-related quality of life (HRQOL). The study sample included parents or caregivers of teens with special health care needs aged 15 to 18 recruited from a pediatric Medicaid accountable care organization who participated in a survey (response rate, 40.5%). The primary outcome was parent HRQOL scores (0-100 points) measured using the Pediatric Quality of Life Inventory Family Impact Module. Medical home status was based on parent report of teen's health care meeting medical home criteria. Linear regression models were used to estimate HRQOL scores, adjusted for demographic characteristics, health literacy, and teen functional limitation. Among 488 parents, 27% reported their teen received care consistent with a medical home. Adjusted parent HRQOL scores were significantly higher among those whose teens had a medical home (74.40; 95% confidence interval, 71.31-77.48), relative to those whose teens did not (65.78; 95% confidence interval, 63.92-67.65). Medical home subscale analyses showed HRQOL scores had significant positive associations with family-centered care and coordinated care, but not other subscales. Teen medical home status was positively associated with caregiver HRQOL, suggesting that the medical home may benefit overall caregiver well-being. In particular, receiving care that was family centered and coordinated appeared to be the most beneficial. Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  18. Are written advance directives helpful to guide end-of-life therapy in the intensive care unit? A retrospective matched-cohort study.

    Science.gov (United States)

    Hartog, Christiane S; Peschel, Ilka; Schwarzkopf, Daniel; Curtis, J Randall; Westermann, Isabella; Kabisch, Bjoern; Pfeifer, Ruediger; Guenther, Albrecht; Michalsen, Andrej; Reinhart, Konrad

    2014-02-01

    The purpose of the study was to determine whether treatment preferences in patients' advance directives (ADs) are associated with life-supporting treatments received during end-of-life care in the intensive care unit (ICU). This is a retrospective cohort study, including patients who died in 4 ICUs of a university hospital in Germany. Patients with ADs were matched with 2 patients each without ADs using propensity scores. Sixty-four (13%) of 477 patients had ADs, written a median of 109 weeks before admission. Five categories of applicability conditions were identified, most of them difficult to interpret in the ICU (eg, "advanced brain impairment" or "imminent death"). Advance directives contained a number of treatment refusals. Specifically, 63 of 64 refused "life-sustaining measures." Compared to patients without ADs, patients with ADs were less likely to receive cardiopulmonary resuscitation (9% vs 23%, P = .029) and more likely to have do-not-resuscitate orders (77% vs 56%, P = .007). Therapy-limiting decisions and ICU length of stay did not differ between those with or without ADs. Patients with ADs are less likely to receive cardiopulmonary resuscitation but otherwise receive similar life-sustaining treatments compared to matched patients without ADs. More research is needed to explore reasons for potential noncompliance with patient preferences. © 2013.

  19. Application of advanced validation concepts to oxide fuel performance codes: LIFE-4 fast-reactor and FRAPCON thermal-reactor fuel performance codes

    Energy Technology Data Exchange (ETDEWEB)

    Unal, C., E-mail: cu@lanl.gov [Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, NM 87545 (United States); Williams, B.J. [Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, NM 87545 (United States); Yacout, A. [Argonne National Laboratory, 9700 S. Cass Avenue, Lemont, IL 60439 (United States); Higdon, D.M. [Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, NM 87545 (United States)

    2013-10-15

    Highlights: ► The application of advanced validation techniques (sensitivity, calibration and prediction) to nuclear performance codes FRAPCON and LIFE-4 is the focus of the paper. ► A sensitivity ranking methodology narrows down the number of selected modeling parameters from 61 to 24 for FRAPCON and from 69 to 35 for LIFE-4. ► Fuel creep, fuel thermal conductivity, fission gas transport/release, crack/boundary, and fuel gap conductivity models of LIFE-4 are identified for improvements. ► FRAPCON sensitivity results indicated the importance of the fuel thermal conduction and the fission gas release models. -- Abstract: Evolving nuclear energy programs expect to use enhanced modeling and simulation (M and S) capabilities, using multiscale, multiphysics modeling approaches, to reduce both cost and time from the design through the licensing phases. Interest in the development of the multiscale, multiphysics approach has increased in the last decade because of the need for predictive tools for complex interacting processes as a means of eliminating the limited use of empirically based model development. Complex interacting processes cannot be predicted by analyzing each individual component in isolation. In most cases, the mathematical models of complex processes and their boundary conditions are nonlinear. As a result, the solutions of these mathematical models often require high-performance computing capabilities and resources. The use of multiscale, multiphysics (MS/MP) models in conjunction with high-performance computational software and hardware introduces challenges in validating these predictive tools—traditional methodologies will have to be modified to address these challenges. The advanced MS/MP codes for nuclear fuels and reactors are being developed within the Nuclear Energy Advanced Modeling and Simulation (NEAMS) program of the US Department of Energy (DOE) – Nuclear Energy (NE). This paper does not directly address challenges in calibration

  20. Medical futility decisions and physicians' legal defensiveness: the impact of anticipated conflict on thresholds for end-of-life treatment.

    Science.gov (United States)

    Swanson, J W; McCrary, S V

    1996-01-01

    Does legal defensiveness significantly influence physicians' assessments of medical futility, in ways that may adversely affect the rights of patients and their family members to make their own health care decisions at the end of life? This exploratory study addresses that question with attitudinal data from a survey of 301 physicians practicing in academic medical centers in Texas. The majority of respondents indicated that the probability of success defining futile treatment should hypothetically be lower for patients with potential to benefit more from life-sustaining medical intervention (e.g. typically patients who are sentient), and higher for patients with less potential to benefit (e.g. patients in a persistent vegetative state). That is to say, physicians normally perceive longer odds to be worth pursuing for greater potential gain - a position that seems logically consonant with patients' rational self-interest. However, physicians with an attitude of extreme legal defensiveness did not fit this pattern. Rather, they tended to define futility in a manner that would maximize the physician's latitude to justifiably oppose patient preferences for end-of-life treatment abatement. These findings suggest that some physicians assume an adversarial position in their consideration of medical futility issues - an attitude that anticipates conflict with terminally-ill patients or their surrogates. The analysis presented here is not definitive, but at least raises the question of whether some physicians may inappropriately use their prerogative over medical futility as a means to guard their professional autonomy against perceived threats.

  1. Impacts of extreme heat on emergency medical service calls in King County, Washington, 2007-2012: relative risk and time series analyses of basic and advanced life support.

    Science.gov (United States)

    Calkins, Miriam M; Isaksen, Tania Busch; Stubbs, Benjamin A; Yost, Michael G; Fenske, Richard A

    2016-01-28

    Exposure to excessive heat kills more people than any other weather-related phenomenon, aggravates chronic diseases, and causes direct heat illness. Strong associations between extreme heat and health have been identified through increased mortality and hospitalizations and there is growing evidence demonstrating increased emergency department visits and demand for emergency medical services (EMS). The purpose of this study is to build on an existing regional assessment of mortality and hospitalizations by analyzing EMS demand associated with extreme heat, using calls as a health metric, in King County, Washington (WA), for a 6-year period. Relative-risk and time series analyses were used to characterize the association between heat and EMS calls for May 1 through September 30 of each year for 2007-2012. Two EMS categories, basic life support (BLS) and advanced life support (ALS), were analyzed for the effects of heat on health outcomes and transportation volume, stratified by age. Extreme heat was model-derived as the 95th (29.7 °C) and 99th (36.7 °C) percentile of average county-wide maximum daily humidex for BLS and ALS calls respectively. Relative-risk analyses revealed an 8 % (95 % CI: 6-9 %) increase in BLS calls, and a 14 % (95 % CI: 9-20 %) increase in ALS calls, on a heat day (29.7 and 36.7 °C humidex, respectively) versus a non-heat day for all ages, all causes. Time series analyses found a 6.6 % increase in BLS calls, and a 3.8 % increase in ALS calls, per unit-humidex increase above the optimum threshold, 40.7 and 39.7 °C humidex respectively. Increases in "no" and "any" transportation were found in both relative risk and time series analyses. Analysis by age category identified significant results for all age groups, with the 15-44 and 45-64 year old age groups showing some of the highest and most frequent increases across health conditions. Multiple specific health conditions were associated with increased risk of an EMS call including abdominal

  2. e-Learning in Advanced Life Support-What factors influence assessment outcome?

    Science.gov (United States)

    Thorne, C J; Lockey, A S; Kimani, P K; Bullock, I; Hampshire, S; Begum-Ali, S; Perkins, G D

    2017-05-01

    To establish variables which are associated with favourable Advanced Life Support (ALS) course assessment outcomes, maximising learning effect. Between 1 January 2013 and 30 June 2014, 8218 individuals participated in a Resuscitation Council (UK) e-learning Advanced Life Support (e-ALS) course. Participants completed 5-8h of online e-learning prior to attending a one day face-to-face course. e-Learning access data were collected through the Learning Management System (LMS). All participants were assessed by a multiple choice questionnaire (MCQ) before and after the face-to-face aspect alongside a practical cardiac arrest simulation (CAS-Test). Participant demographics and assessment outcomes were analysed. The mean post e-learning MCQ score was 83.7 (SD 7.3) and the mean post-course MCQ score was 87.7 (SD 7.9). The first attempt CAS-Test pass rate was 84.6% and overall pass rate 96.6%. Participants with previous ALS experience, ILS experience, or who were a core member of the resuscitation team performed better in the post-course MCQ, CAS-Test and overall assessment. Median time spent on the e-learning was 5.2h (IQR 3.7-7.1). There was a large range in the degree of access to e-learning content. Increased time spent accessing e-learning had no effect on the overall result (OR 0.98, P=0.367) on simulated learning outcome. Clinical experience through membership of cardiac arrest teams and previous ILS or ALS training were independent predictors of performance on the ALS course whilst time spent accessing e-learning materials did not affect course outcomes. This supports the blended approach to e-ALS which allows participants to tailor their e-learning experience to their specific needs. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Interplay between Oral Hypoglycemic Medication Adherence and Quality of Life among Elderly Type 2 Diabetes Mellitus Patients.

    Science.gov (United States)

    Manan, Mohamed Mansor; Husin, Akhma Radzuanna; Alkhoshaiban, Ali Saleh; Al-Worafi, Yaser Mohammed Ali; Ming, Long Chiau

    2014-12-01

    Adherence to medications is an important factor that contributes to therapeutic success. With the current increase in the elderly population, information relating to adherence to treatment and quality of life (QoL) of diabetic elderly patients will help the healthcare provider to improve their treatment. Thus, this study aims to determine the factors affecting adherence to medications and the consequence of non adherence to QoL. This was a cross-sectional study using validated Morisky Medication Adherence Scale (MMAS) Questionnaire. This study was conducted to assess the level of adherence on oral hypoglycemic medications (OHM) and quality of life of the Type 2 diabetes mellitus (T2DM) elderly patients in an urban health centre in Malaysia. A retrospective medication record review was also conducted to collect and confirm data on patients' demographics, diagnosis, treatments, and outcomes. One hundred and seventy nine patients were recruited in this study. Median adherence score was 7.75 (IQR 6.50- 8.00). Good adherer was observed in 48.00% of the participants. A Chi-square test indicated significant correlation between adherence and HbA1c (p= 0.010). The mean elderly diabetes mellitus Problem Areas in Diabetes (PAID) score was 6.30 ±SD 8.50. A significant inversed association was observed between PAID score and the level of adherence (r = - 0.175, pwestern countries.

  4. Leisure time physical activity and quality of life in medical students: results from a multicentre study.

    Science.gov (United States)

    Peleias, Munique; Tempski, Patricia; Paro, Helena Bms; Perotta, Bruno; Mayer, Fernanda B; Enns, Sylvia C; Gannam, Silmar; Pereira, Maria Amelia D; Silveira, Paulo S; Santos, Itamar S; Carvalho, Celso Rf; Martins, Milton A

    2017-01-01

    We evaluated the association between leisure time physical activity (PA) and quality of life (QoL) in medical students. Our hypothesis was that there was a positive association between volume of PA and various domains of perception of QoL. Data were evaluated from a random sample of 1350 medical students from 22 Brazilian medical schools. Information from participants included the WHO Quality of Life questionnaire-short form (WHOQOL-BREF), a questionnaire specifically designed to evaluate QoL in medical students (VERAS-Q) and questions for both global QoL self-assessment and leisure time PA. According to the amount of metabolic equivalents (METs) spend during PA, volunteers were divided into four groups, according to the volume of PA: (a) no PA; (b) low PA, ≤540 MET min/week; (c) moderate PA, from 541 to 1260 MET min/week and (d) high PA, > 1261 MET min/week. Forty per cent of the medical students reported no leisure time PA (46.0% of females and 32.3% of males). In contrast, 27.2% were classified in the group of high PA (21.0% of females and 34.2% of males). We found significant associations between moderate and high levels of PA and better QoL for all measurements. For low levels of PA, this association was also significant for most QoL measurements, with the exceptions of WHOQOL physical health (p=0.08) and social relationships (p=0.26) domains. We observed a strong dose-effect relationship between the volume of leisure time PA and QoL in both male and female medical students.

  5. The CELSS Antarctic Analog Project: An Advanced Life Support Testbed at the Amundsen-Scott South Pole Station, Antarctica

    Science.gov (United States)

    Straight, Christian L.; Bubenheim, David L.; Bates, Maynard E.; Flynn, Michael T.

    1994-01-01

    CELSS Antarctic Analog Project (CAAP) represents a logical solution to the multiple objectives of both the NASA and the National Science Foundation (NSF). CAAP will result in direct transfer of proven technologies and systems, proven under the most rigorous of conditions, to the NSF and to society at large. This project goes beyond, as it must, the generally accepted scope of CELSS and life support systems including the issues of power generation, human dynamics, community systems, and training. CAAP provides a vivid and starkly realistic testbed of Controlled Ecological Life Support System (CELSS) and life support systems and methods. CAAP will also be critical in the development and validation of performance parameters for future advanced life support systems.

  6. [Discussion on Quality Evaluation Method of Medical Device During Life-Cycle in Operation Based on the Analytic Hierarchy Process].

    Science.gov (United States)

    Zheng, Caixian; Zheng, Kun; Shen, Yunming; Wu, Yunyun

    2016-01-01

    The content related to the quality during life-cycle in operation of medical device includes daily use, repair volume, preventive maintenance, quality control and adverse event monitoring. In view of this, the article aims at discussion on the quality evaluation method of medical devices during their life cycle in operation based on the Analytic Hierarchy Process (AHP). The presented method is proved to be effective by evaluating patient monitors as example. The method presented in can promote and guide the device quality control work, and it can provide valuable inputs to decisions about purchase of new device.

  7. Early bedside care during preclinical medical education: can technology-enhanced patient simulation advance the Flexnerian ideal?

    Science.gov (United States)

    Gordon, James A; Hayden, Emily M; Ahmed, Rami A; Pawlowski, John B; Khoury, Kimberly N; Oriol, Nancy E

    2010-02-01

    Flexner wanted medical students to study at the patient bedside-a remarkable innovation in his time-so that they could apply science to clinical care under the watchful eye of senior physicians. Ever since his report, medical schools have reserved the latter years of their curricula for such an "advanced" apprenticeship, providing clinical clerkship experiences only after an initial period of instruction in basic medical sciences. Although Flexner codified the segregation of preclinical and clinical instruction, he was committed to ensuring that both domains were integrated into a modern medical education. The aspiration to fully integrate preclinical and clinical instruction continues to drive medical education reform even to this day. In this article, the authors revisit the original justification for sequential preclinical-clinical instruction and argue that modern, technology-enhanced patient simulation platforms are uniquely powerful for fostering simultaneous integration of preclinical-clinical content in a way that Flexner would have applauded. To date, medical educators tend to focus on using technology-enhanced medical simulation in clinical and postgraduate medical education; few have devoted significant attention to using immersive clinical simulation among preclinical students. The authors present an argument for the use of dynamic robot-mannequins in teaching basic medical science, and describe their experience with simulator-based preclinical instruction at Harvard Medical School. They discuss common misconceptions and barriers to the approach, describe their curricular responses to the technique, and articulate a unifying theory of cognitive and emotional learning that broadens the view of what is possible, feasible, and desirable with simulator-based medical education.

  8. Medical student and patient perceptions of quality of life associated with vision loss.

    Science.gov (United States)

    Chaudry, Imtiaz; Brown, Gary C; Brown, Melissa M

    2015-06-01

    Because most medical schools in the United States and Canada require no formal ophthalmology training, the authors queried medical student and ophthalmic patients to compare their perceptions of the quality of life (QOL) associated with vision loss. Cross-sectional comparative study of consecutive medical students and patients with vision loss using a validated, reliable, time trade-off utility instrument. Consecutive Jefferson Medical College medical students (cohort 1: 145 second-year student; cohort 2: 112 third-year/fourth-year students) and 283 patients with vision loss (patient cohort). Time trade-off vision utilities with anchors of 0.0 (death) to 1.0 (normal vision permanently) were used to quantify the QOL associated with vision loss. Students were asked to assume they had: (i) mild vision loss (20/40 to 20/50 vision in the better-seeing eye), (ii) legal blindness (20/200 in the better-seeing eye), and (iii) absolute blindness (no light perception bilaterally). Mean utilities for cohort 1/cohort 2 were 0.96/0.95 (p = 0.20) for mild vision loss, 0.88/0.84 for legal blindness (p = 0.009), and 0.80/0.67 (p student/patient mean utilities were 0.96/0.79 (p students underestimated the QOL associated with vision loss referent to patients with vision loss by 153%-425%. Medical students dramatically underestimated the impact of vision loss on patient QOL. Clinical training slightly improved medical student perceptions. Trivialization of vision loss could result in systemic health harm, less ophthalmic research dollars, loss of the finest medical students entering ophthalmology, and overall adverse financial effects for the field. Copyright © 2015. Published by Elsevier Inc.

  9. Enhancing the prospects for palliative care at the end of life: A statewide educational demonstration project to improve advance care planning.

    Science.gov (United States)

    Litzelman, Debra K; Cottingham, Ann H; Griffin, Wilma; Inui, Thomas S; Ivy, Steven S

    2016-12-01

    Although patients want to participate in discussions and decisions about their end-of-life care, studies show that providers frequently fail to invite them to explore advanced care preferences or goals for living. The purpose of our demonstration project was to provide education and coaching to individuals, health providers, and organizations across the state of Indiana intended to facilitate these conversations, documenting and honoring individuals' life goals and preferences for care during the final stages of life. Education and training engaged community members as well as healthcare providers to: (1) improve participant comfort and facility discussing end-of-life issues; (2) improve knowledge of healthcare choices, including palliative and hospice care; and (3) prepare all participants to explore and document personal values, life goals, and priorities as well as goals of care. Between January of 2013 and June of 2015, the team educated close to 5,000 participants. Participants' ratings of the quality and perceived usefulness of the educational events ranged from 4 to 5 (using a 5-point scale, with 5 = most effective). Participant comments were overwhelmingly favorable and indicated an intention to put the advance care planning resources, communication skills, knowledge of palliative and hospice care, and personal renewal techniques into practice. Participant motivation to foster advance care planning, discussions of palliative care, and end-of-life conversations was facilitated by the reframing of these conversations as identifying goals of care and priorities for living well during an important stage of life. Successful strategies included helping providers and patients to adopt a broader meaning for "sustaining hope" (not for cure, but for engaging in highly valued activities), developing provider communication skills and comfort in initiating potentially difficult discussions, engaging a new community health workforce who will develop trusting

  10. Advances in Psychotherapy for Depressed Older Adults.

    Science.gov (United States)

    Raue, Patrick J; McGovern, Amanda R; Kiosses, Dimitris N; Sirey, Jo Anne

    2017-09-01

    We review recent advances in psychotherapies for depressed older adults, in particular those developed for special populations characterized by chronic medical illness, acute medical illness, cognitive impairment, and suicide risk factors. We review adaptations for psychotherapy to overcome barriers to its accessibility in non-specialty settings such as primary care, homebound or hard-to-reach older adults, and social service settings. Recent evidence supports the effectiveness of psychotherapies that target late-life depression in the context of specific comorbid conditions including COPD, heart failure, Parkinson's disease, stroke and other acute conditions, cognitive impairment, and suicide risk. Growing evidence supports the feasibility, acceptability, and effectiveness of psychotherapy modified for a variety of health care and social service settings. Research supports the benefits of selecting the type of psychotherapy based on a comprehensive assessment of the older adult's psychiatric, medical, functional, and cognitive status, and tailoring psychotherapy to the settings in which older depressed adults are most likely to present.

  11. Advanced vs. Basic Life Support in the Treatment of Out-of-Hospital Cardiopulmonary Arrest in the Resuscitation Outcomes Consortium.

    Science.gov (United States)

    Kurz, Michael Christopher; Schmicker, Robert H; Leroux, Brian; Nichol, Graham; Aufderheide, Tom P; Cheskes, Sheldon; Grunau, Brian; Jasti, Jamie; Kudenchuk, Peter; Vilke, Gary M; Buick, Jason; Wittwer, Lynn; Sahni, Ritu; Straight, Ronald; Wang, Henry E

    2018-04-30

    Prior observational studies suggest no additional benefit from advanced life support (ALS) when compared with providing basic life support (BLS) for patients with out-of-hospital cardiac arrest (OHCA). We compared the association of ALS care with OHCA outcomes using prospective clinical data from the Resuscitation Outcomes Consortium (ROC). Included were consecutive adults OHCA treated by participating emergency medical services (EMS) agencies between June 1, 2011, and June 30, 2015. We defined BLS as receipt of cardiopulmonary resuscitation (CPR) and/or automated defibrillation and ALS as receipt of an advanced airway, manual defibrillation, or intravenous drug therapy. We compared outcomes among patients receiving: 1) BLS-only; 2) BLS + late ALS; 3) BLS + early ALS; and 4) ALS-first care. Using multivariable logistic regression, we evaluated the associations between level of care and return of spontaneous circulation (ROSC), survival to hospital discharge, and survival with good functional status, adjusting for age, sex, witnessed arrest, bystander CPR, shockable initial rhythm, public location, EMS response time, CPR quality, and ROC site. Among 35,065 patients with OHCA, characteristics were median age 68 years (IQR 56-80), male 63.9%, witnessed arrest 43.8%, bystander CPR 50.6%, and shockable initial rhythm 24.2%. Care delivered was: 4.0% BLS-only, 31.5% BLS + late ALS, 17.2% BLS + early ALS, and 47.3% ALS-first. ALS care with or without initial BLS care was independently associated with increased adjusted ROSC and survival to hospital discharge unless delivered greater than 6 min after BLS arrival (BLS + late ALS). Regardless of when it was delivered, ALS care was not associated with significantly greater functional outcome. ALS care was associated with survival to hospital discharge when provided initially or within six minutes of BLS arrival. ALS care, with or without initial BLS care, was associated with increased ROSC, however it was

  12. Physical sciences and engineering advances in life sciences and oncology a WTEC global assessment

    CERN Document Server

    Fletcher, Daniel; Gerecht, Sharon; Levine, Ross; Mallick, Parag; McCarty, Owen; Munn, Lance; Reinhart-King, Cynthia

    2016-01-01

    This book presents an Assessment of Physical Sciences and Engineering Advances in Life Sciences and Oncology (APHELION) by a panel of experts. It covers the status and trends of applying physical sciences and engineering principles to oncology research in leading laboratories and organizations in Europe and Asia. The book elaborates on the six topics identified by the panel that have the greatest potential to advance understanding and treatment of cancer, each covered by a chapter in the book. The study was sponsored by the National Cancer Institute (NCI) at the National Institute of Health (NIH), the National Science Foundation (NSF) and the National Institute of Biomedical Imaging and Bioengineering at the NIH in the US under a cooperative agreement with the World Technology Evaluation Center (WTEC).

  13. Commercializing medical technology.

    Science.gov (United States)

    Scanlon, Kevin J; Lieberman, Mark A

    2007-04-01

    As medicine moves into the 21st century, life saving therapies will move from inception into medical products faster if there is a better synergy between science and business. Medicine appears to have 50-year innovative cycles of education and scientific discoveries. In the 1880's, the chemical industry in Germany was faced with the dilemma of modernization to exploit the new scientific discoveries. The solution was the spawning of novel technical colleges for training in these new chemical industries. The impact of those new employees and their groundbreaking compounds had a profound influence on medicine and medical education in Germany between 1880 and 1930. Germany dominated international science during this period and was a training center for scientists worldwide. This model of synergy between education and business was envied and admired in Europe, Asia and America. British science soon after evolved to dominate the field of science during the prewar and post World War (1930's-1970's) because the German scientists fled Hitler's government. These expatriated scientists had a profound influence on the teaching and training of British scientists, which lead to advances in medicine such as antibiotics. After the Second World War, the US government wisely funded the development of the medical infrastructure that we see today. British and German scientists in medicine moved to America because of this bountiful funding for their research. These expatriated scientists helped drive these medical advances into commercialized products by the 1980's. America has been the center of medical education and advances of biotechnology but will it continue? International scientists trained in America have started to return to Europe and Asia. These American-trained scientists and their governments are very aware of the commercial potential of biotechnology. Those governments are now more prepared to play an active role this new science. Germany, Ireland, Britain, Singapore

  14. Life satisfaction in patients with and without spinal cord ischemia after advanced endovascular therapy for extensive aortic disease at mid-term follow-up.

    Science.gov (United States)

    Mehmedagic, Irma; Santén, Stefan; Jörgensen, Sophie; Acosta, Stefan

    2016-11-11

    Advanced endovascular aortic repair can be used to treat patients with extensive and complex aortic disease who are at risk of spinal cord ischaemia. The aim of this study was to compare whether life satisfaction differs between patients with and without spinal cord ischaemia at mid-term follow-up. Nested case-control study. Among patients undergoing advanced endovascular aortic repair between 2009 and 2012, 18 patients with spinal cord ischaemia and 33 without were interviewed at home. The Life Satisfaction Questionnaire (LiSat-11) and the Satisfaction With Life Scale (SWLS) were used. LiSat-11 found that patients with spinal cord ischaemia were more dissatisfied with their activities of daily living than were patients without spinal cord ischaemia (p=0.012). Both groups had similar, very low, scores in the sexual life domain; median 2.0 (interquartile range (IQR) 1.5-3.0) and 3.0 (IQR 2.0-4.0), respectively. There was no difference in SWLS between the groups. This study cohort of patients who underwent advanced endovascular aortic repair was rather homo-genous in their rating of life satisfaction and there was little difference between mid-term survivors who had spinal cord ischaemia and those who did not.

  15. Dances With Denial: Have Medical Oncology Outpatients Conveyed Their End-of-Life Wishes and Do They Want To?

    Science.gov (United States)

    Waller, Amy; Douglas, Charles; Sanson-Fisher, Rob; Zdenkowski, Nicholas; Pearce, Angela; Evans, Tiffany; Walsh, Justin

    2018-05-01

    Objectives: This study surveyed a sample of medical oncology outpatients to determine (1) the proportion who have already discussed and documented their end-of-life (EOL) wishes; (2) when and with whom they would prefer to convey their EOL wishes; (3) the EOL issues they would want to discuss; and (4) the association between perceived cancer status and advance care planning (ACP) participation. Methods: Adult medical oncology outpatients were approached in the waiting room of an Australian tertiary treatment center. Consenting participants completed a pen-and-paper survey assessing participation in ACP, preferences for conveying EOL wishes, timing of EOL discussions, and EOL issues they want to be asked about. Results: A total of 203 patients returned the survey (47% of eligible). EOL discussions occurred more frequently with support persons (47%) than with doctors (7%). Only 14% had recorded their wishes, and 45% had appointed an enduring guardian. Those who perceived their cancer as incurable were more likely to have participated in ACP. If facing EOL, patients indicated that they would want family involved in discussions (85%), to be able to write down EOL wishes (82%), and to appoint enduring guardians (91%). Many (45%) preferred the first discussion to happen when their disease became incurable. Slightly less than one-third thought discussions regarding EOL should be patient-initiated. Most agreed doctors should ask about preferred decision-making involvement (92%), how important it is that pain is managed well (95%), and how important it is to remain conscious (82%). Fewer (55%) wanted to be asked about the importance of care extending life. Conclusions: Many patients would like to have discussions regarding EOL care with their doctor and involve their support persons in this process. Only a small percentage of respondents had discussed EOL care with their doctors, recorded their wishes, or appointed an enduring guardian. The first step requires clinicians to

  16. Knowledge, attitude and anxiety pertaining to basic life support and medical emergencies among dental interns in Mangalore City, India.

    Science.gov (United States)

    Somaraj, Vinej; Shenoy, Rekha P; Panchmal, Ganesh Shenoy; Jodalli, Praveen S; Sonde, Laxminarayan; Karkal, Ravichandra

    2017-01-01

    This cross-sectional study aimed to assess the knowledge, attitude and anxiety pertaining to basic life support (BLS) and medical emergencies among interns in dental colleges of Mangalore city, Karnataka, India. The study subjects comprised of interns who volunteered from the four dental colleges. The knowledge and attitude of interns were assessed using a 30-item questionnaire prepared based on the Basic Life Support Manual from American Heart Association and the anxiety of interns pertaining to BLS and medical emergencies were assessed using a State-Trait Anxiety Inventory (STAI) Questionnaire. Chi-square test was performed on SPSS 21.0 (IBM Statistics, 2012) to determine statistically significant differences ( P <0.05) between assessed knowledge and anxiety. Out of 183 interns, 39.89% had below average knowledge. A total of 123 (67.21%) reported unavailability of professional training. The majority (180, 98.36%) felt the urgent need of training in basic life support procedures. Assessment of stress showed a total of 27.1% participants to be above high-stress level. Comparison of assessed knowledge and stress was found to be insignificant ( P =0.983). There was an evident lack of knowledge pertaining to the management of medical emergencies among the interns. As oral health care providers moving out to the society, a focus should be placed on the training of dental interns with respect to Basic Life Support procedures.

  17. Medical deontology, meetings, journals, candidacy for higher posts and how to better enjoy life.

    Science.gov (United States)

    Grammaticos, Philip C

    2014-01-01

    Unfortunately, today few physicians care about medical deontology and medical ethics, that is how to behave and respect others when exercising our medical profession. Some of us may not show the care and kindness we should show towards our students or the due respect to our senior colleagues. Occasionally, when examining our patients we may not pay the proper attention to their problems, being tired from work overload. Another issue of deontology is medical meetings. Do they offer us enough knowledge or mainly pleasure? Is our curriculum vitae comprised by useful to society and to medicine original or confirmatory research work? Few examples to illustrate what the situation is at present are included in this paper. Our financial success in practice should not compete with the "old" Hippocratic oath and ideals. The pursuit of happiness in our life is not achieved through untruthfulness, dishonesty or only high financial status. "The Lancet"mentioned long ago (1969; September 27; 681-4) a phrase by John Keats: "Truth is beauty‥this only exists on Earth and this is what we need to know".

  18. Balancing Act: A View of Benefits and Work-Life Balance through the Eyes of Advancement Professionals

    Science.gov (United States)

    Collins, Mary Ellen

    2011-01-01

    People who choose careers in advancement know they're not entering a 9-to-5, 40-hours-a-week profession. Staffers juggle personal lives with their commitment to stressful jobs that involve travel, long hours, weekend events, and deadlines. Work-life balance means different things to different people, but flexibility seems to be a priority for…

  19. A multimedia intervention on cardiopulmonary resuscitation and advance directives.

    Science.gov (United States)

    Yamada, R; Galecki, A T; Goold, S D; Hogikyan, R V

    1999-09-01

    To assess the effects of a multimedia educational intervention about advance directives (ADs) and cardiopulmonary resuscitation (CPR) on the knowledge, attitude and activity toward ADs and life-sustaining treatments of elderly veterans. Prospective randomized controlled, single blind study of educational interventions. General medicine clinic of a university-affiliated Veterans Affairs Medical Center (VAMC). One hundred seventeen Veterans, 70 years of age or older, deemed able to make medical care decisions. The control group (n = 55) received a handout about ADs in use at the VAMC. The experimental group (n = 62) received the same handout, with an additional handout describing procedural aspects and outcomes of CPR, and they watched a videotape about ADs. Patients' attitudes and actions toward ADs, CPR and life-sustaining treatments were recorded before the intervention, after it, and 2 to 4 weeks after the intervention through self-administered questionnaires. Only 27.8% of subjects stated that they knew what an AD is in the preintervention questionnaire. This proportion improved in both the experimental and control (87.2% experimental, 52.5% control) subject groups, but stated knowledge of what an AD is was higher in the experimental group (odds ratio = 6.18, p CPR. This improved after the intervention in the experimental group (OR = 4.27, p =.004), but did not persist at follow-up. In the postintervention questionnaire, few subjects in either group stated that they discussed CPR or ADs with their physician on that day (OR = 0.97, p = NS). We developed a convenient means of educating elderly male patients regarding CPR and advance directives that improved short-term knowledge but did not stimulate advance care planning.

  20. Recent advancements in medical simulation: patient-specific virtual reality simulation.

    Science.gov (United States)

    Willaert, Willem I M; Aggarwal, Rajesh; Van Herzeele, Isabelle; Cheshire, Nicholas J; Vermassen, Frank E

    2012-07-01

    Patient-specific virtual reality simulation (PSVR) is a new technological advancement that allows practice of upcoming real operations and complements the established role of VR simulation as a generic training tool. This review describes current developments in PSVR and draws parallels with other high-stake industries, such as aviation, military, and sports. A review of the literature was performed using PubMed and Internet search engines to retrieve data relevant to PSVR in medicine. All reports pertaining to PSVR were included. Reports on simulators that did not incorporate a haptic interface device were excluded from the review. Fifteen reports described 12 simulators that enabled PSVR. Medical procedures in the field of laparoscopy, vascular surgery, orthopedics, neurosurgery, and plastic surgery were included. In all cases, source data was two-dimensional CT or MRI data. Face validity was most commonly reported. Only one (vascular) simulator had undergone face, content, and construct validity. Of the 12 simulators, 1 is commercialized and 11 are prototypes. Five simulators have been used in conjunction with real patient procedures. PSVR is a promising technological advance within medicine. The majority of simulators are still in the prototype phase. As further developments unfold, the validity of PSVR will have to be examined much like generic VR simulation for training purposes. Nonetheless, similar to the aviation, military, and sport industries, operative performance and patient safety may be enhanced by the application of this novel technology.

  1. Ethical, moral, and theological insights into advances in male pediatric and adolescent fertility preservation.

    Science.gov (United States)

    Ramstein, J J; Halpern, J; Gadzinski, A J; Brannigan, R E; Smith, J F

    2017-07-01

    The successful treatment of boys with cancer has led to increasing attention to preserving their quality of life after completing cancer therapy. One of the top priorities for living a full life is keeping open the opportunity to have children. While sperm banking for males facing sterilizing cancer treatment can be effective, this approach requires subsequent use of reproductive procedures such as in vitro fertilization (IVF) or intrauterine insemination (IUI) to achieve a pregnancy. Advances in fertility preservation techniques may allow pre-pubertal boys to conceive using advanced stem cell technologies and stem cell transplantation in the future. This review summarizes the ethical positions of leading medical societies and explores the religious and moral stances of major religious institutions regarding these options. © 2017 American Society of Andrology and European Academy of Andrology.

  2. Effect of an End-of-Life Planning Intervention on the completion of advance directives in homeless persons: a randomized trial.

    Science.gov (United States)

    Song, John; Ratner, Edward R; Wall, Melanie M; Bartels, Dianne M; Ulvestad, Nancy; Petroskas, Dawn; West, Melissa; Weber-Main, Anne Marie; Grengs, Leah; Gelberg, Lillian

    2010-07-20

    Few interventions have focused on improving end-of-life care for underserved populations, such as homeless persons. To determine whether homeless persons will complete a counseling session on advance care planning and fill out a legal advance directive designed to assess care preferences and preserve the dignity of marginalized persons. Prospective, single-blind, randomized trial comparing self-guided completion of an advance directive with professionally assisted advance care planning. (ClinicalTrials.gov registration number: NCT00546884) 8 sites serving homeless persons in Minneapolis, Minnesota. 262 homeless persons recruited between November 2007 and August 2008. Minimal, self-guided intervention consisting of advance directive forms and written educational information versus a one-on-one advance planning intervention consisting of counseling and completing an advance directive with a social worker. Rate of advance directive completion, assessed by inspection of completed documents. The overall completion rate for advance directives was 26.7% (95% CI, 21.5% to 32.5%), with a higher rate in the counselor-guided group (37.9%) than in the self-guided group (12.8%) (CI of adjusted difference, 15.3 to 34.3 percentage points). This difference persisted across all sites and most subgroups. The advance directive's 4 clinical scenarios found a preference for surrogate decision making in 29% to 34% of written responses. Sampling was limited to a more stable subset of the homeless population in Minneapolis and may have been subject to selection bias. Modest compensation to complete the preintervention survey could have influenced participants to complete advance directives. Both a simple and complex intervention successfully engaged a diverse sample of homeless persons in advance care planning. One-on-one assistance significantly increased the completion rate. Homeless persons can respond to an intervention to plan for end-of-life care and can express specific preferences

  3. The relationship between quality of work life and job satisfaction of faculty members in Zahedan University of Medical Sciences.

    Science.gov (United States)

    Kermansaravi, Fatihe; Navidian, Ali; Navabi Rigi, Shahindokht; Yaghoubinia, Fariba

    2014-10-29

    Quality of work life is one of the most important factors for human motivating and improving of job satisfaction. The current study was carried out aimed to determine the relationship between quality of work life and job satisfaction in faculty members of Zahedan University of Medical Sciences. In this descriptive-analytic study, 202 faculty members of Zahedan University of Medical Sciences in 2012 were entered the study through census. The job satisfaction questionnaire of Smith and Kendall and Walton Quality of Work Life questionnaire were used for data collection. Validity and reliability of questionnaires were confirmed in previous studies. Data analysis was done using SPSS 18. The Pearson correlation coefficient and multiple regression tests were used for data analysis. The mean score of quality of work life was 121/30±37/08 and job satisfaction was 135/98 ±33/78. There was a significant and positive correlation between job satisfaction of faculty members and their quality of work life (P=0.003). In addition, two components of quality of work life "adequate and fair compensation" (β=0.3) and "Social Integration" (β=0.4) can predict job satisfaction of faculty members. According to correlation between job satisfaction and quality of work life in faculty members, job satisfaction can be improved through the changing and manipulating the components of quality of work life and in this way; the suitable environment for organization development should be provided.

  4. Osteoporosis Medication and Quality of Life in Older Women - Original Investigation

    Directory of Open Access Journals (Sweden)

    Ayşe Dicle Turhanoğlu

    2008-04-01

    Full Text Available Aim: We aimed to investigate the effect of drug therapy on quality of life in older women with osteoporosis. Material and Methods: One hundred seventy seven women over 65 years were enrolled in this study. Quality of life was evaluated by Short-Form-36 (SF-36. Participants’ quality of life was compared according to their medication use for osteoporosis by comparing Physical Component Summary (PCS and Mental Component Summary (MCS score of SF-36 between groups. Results: While one hundred twenty two(68.9% of the participants had not used any drug, 20 (11.3% women had used only vitamin D-calcium and, 35 (19.8% women had used antiresorptive agents plus vitamin D-calcium. There were no statistically difference between groups in respect to age and bone mineral density (p>0.05. The mean values of PCS were 34.80±11.24, 30.33±9.49, and 31.56±7.28 respectively in the groups 1, 2 and 3. The mean values of MCS were 44.91±9, 44.15±11.93, and 44.42±12.09 respectively in the groups 1, 2 and 3. There were no significant differences between the PCS and MCS values (p>0.05, p>0.05. Conclusion: The findings of this study were considered that vitamin D plus calcium and antiresorptive agents were not sufficient to improve the quality of life in the older women with osteoporosis. (From the World of Osteoporosis 2008;14:7-11

  5. The 'Cancer Home-Life Intervention': A randomised controlled trial evaluating the efficacy of an occupational therapy-based intervention in people with advanced cancer.

    Science.gov (United States)

    Pilegaard, Marc Sampedro; la Cour, Karen; Gregersen Oestergaard, Lisa; Johnsen, Anna Thit; Lindahl-Jacobsen, Line; Højris, Inger; Brandt, Åse

    2018-04-01

    People with advanced cancer face difficulties with their everyday activities at home that may reduce their health-related quality of life. To address these difficulties, we developed the 'Cancer Home-Life Intervention'. To evaluate the efficacy of the 'Cancer Home Life-Intervention' compared with usual care with regard to patients' performance of, and participation in, everyday activities, and their health-related quality of life. A randomised controlled trial ( ClinicalTrials.gov NCT02356627). The 'Cancer Home-Life Intervention' is a brief, tailored, occupational therapy-based and adaptive programme for people with advanced cancer targeting the performance of their prioritised everyday activities. Home-living adults diagnosed with advanced cancer experiencing functional limitations were recruited from two Danish hospitals. They were assessed at baseline, and at 6 and 12 weeks of follow-up. The primary outcome was activities of daily living motor ability. Secondary outcomes were activities of daily living process ability, difficulty performing prioritised everyday activities, participation restrictions and health-related quality of life. A total of 242 participants were randomised either to the intervention group ( n = 121) or the control group ( n = 121). No effect was found on the primary outcome (between-group mean change: -0.04 logits (95% confidence interval: -0.23 to 0.15); p = 0.69). Nor was any effect on the secondary outcomes observed. In most cases, the 'Cancer Home-Life Intervention' was delivered through only one home visit and one follow-up telephone contact, which not was effective in maintaining or improving participants' everyday activities and health-related quality of life. Future research should pay even more attention to intervention development and feasibility testing.

  6. More attention on the application of interventional radiology in patients with severe symptoms of advanced malignant tumor

    International Nuclear Information System (INIS)

    Mao Aiwu; Cheng Yongde

    2007-01-01

    Along with the development of medical science and the improvement of interventional medical products, the clinical experience and operational skills of relevant interventional physicans, the interventional techniques have broken through the traditional limitation and being used more and more often and widely in the patients of advanced malignant tumor and played an important role; including intraarterial chemotherapy, perfusion, nerve block and percutaneous vertebroplasty for suppressing pain; stent placement for esophageal, tracheal, intestinal strictures and fistula; percutaneous centesis for hydrocele, etc. Taking this profit, for further extension of interventional diagnosis and treatment in late-stage cancer patients outcomes with a positive role in prolonging life span and improving the life qualities while they are alive. (authors)

  7. A cluster randomized controlled trial on the effects and costs of advance care planning in elderly care: study protocol

    NARCIS (Netherlands)

    I.J. Korfage; B.J. Hammes; J. Severijnen; S. Polinder; A. van der Heide; A. Overbeek; F.E. Witkamp; E. Hansen - van der Meer; L.J. Jabbarian; P. Billekens; S.J. Swart; J.A.C. Rietjens

    2015-01-01

    Abstract Background: Currently, health care and medical decision-making at the end of life for older people are often insufficiently patient-centred. In this trial we study the effects of Advance Care Planning (ACP), a formalised process of timely communication about care preferences at the end of

  8. A cluster randomized controlled trial on the effects and costs of advance care planning in elderly care: Study protocol

    NARCIS (Netherlands)

    I.J. Korfage (Ida); J.A.C. Rietjens (Judith); A. Overbeek (Anouk); L.J. Jabbarian (Lea J.); P. Billekens (Pascalle); B.J. Hammes (Bernard J.); E. Hansen-Van Der Meer (Ellen); S. Polinder (Suzanne); J. Severijnen (Johan); S.J. Swart (Siebe); F.E. Witkamp (Frederika); A. van der Heide (Agnes)

    2015-01-01

    textabstractBackground: Currently, health care and medical decision-making at the end of life for older people are often insufficiently patient-centred. In this trial we study the effects of Advance Care Planning (ACP), a formalised process of timely communication about care preferences at the end

  9. Advanced condition monitoring techniques and plant life extension studies at EBR-2

    International Nuclear Information System (INIS)

    Singer, R.M.; Gross, K.C.; Perry, W.H.; King, R.W.

    1991-01-01

    Numerous advanced techniques have been evaluated and tested at EBR-2 as part of a plant-life extension program for detection of degradation and other abnormalities in plant systems. Two techniques have been determined to be of considerable assistance in planning for the extended-life operation of EBR-2. The first, a computer-based pattern-recognition system (System State Analyzer or SSA) is used for surveillance of the primary system instrumentation, primary sodium pumps and plant heat balances. This surveillance has indicated that the SSA can detect instrumentation degradation and system performance degradation over varying time intervals and can be used to provide derived signal values to replace signals from failed sensors. The second technique, also a computer-based pattern-recognition system (Sequential Probability Ratio Test or SPRT) is used to validate signals and to detect incipient failures in sensors and components or systems. It is being used on the failed fuel detection system and is experimentally used on the primary coolant pumps. Both techniques are described and experience with their operation presented

  10. Adaptation through Collaboration: Developing Novel Platforms to Advance the Delivery of Advanced Therapies to Patients.

    Science.gov (United States)

    Papadaki, Magdalini

    2017-01-01

    For the nascent field of advanced therapies, collaboration will be a game-changer, turning scientific progress that was once unimaginable into transformative medical practice. Despite promise for lifelong management and even cure of disease, skepticism remains about the feasibility of their delivery to patients, fueling investment risks. With the potential for long-term effectiveness in need of frequent reassessment, current approaches to predict real-life drug performance bear little relevance, necessitating novel and iterative schemes to monitoring the benefit-risk profiles throughout the life span of advanced therapies. This work explains that reinventing an adoption route for Advanced Therapy Medicinal Products is as much about the scientific and clinical components, as it is about the organizational structures, requiring an unprecedented level of interactions between stakeholders not traditionally connected; from developers and regulators, to payers, patients, and funders. By reflecting on the successes and lessons learned from the growing space of global precompetitive consortia and public-private partnerships, as well as a number of emerging accelerated development pathways, this work aims to inform the foundations for a future roadmap that can smooth the path to approval, reimbursement, and access, while delivering value to all stakeholders. Echoing the growing demands to bring these transformative products to patients, it provides critical insights to enhance our capacity in three fundamental domains: deploying the operational flexibilities offered by the growing space of collaborations, utilizing emerging flexible and accelerated pathways to tackle challenges in quantifying long-term effectiveness, and building the necessary digital and clinical infrastructure for knowledge development.

  11. Adaptation through Collaboration: Developing Novel Platforms to Advance the Delivery of Advanced Therapies to Patients

    Directory of Open Access Journals (Sweden)

    Magdalini Papadaki

    2017-05-01

    Full Text Available For the nascent field of advanced therapies, collaboration will be a game-changer, turning scientific progress that was once unimaginable into transformative medical practice. Despite promise for lifelong management and even cure of disease, skepticism remains about the feasibility of their delivery to patients, fueling investment risks. With the potential for long-term effectiveness in need of frequent reassessment, current approaches to predict real-life drug performance bear little relevance, necessitating novel and iterative schemes to monitoring the benefit–risk profiles throughout the life span of advanced therapies. This work explains that reinventing an adoption route for Advanced Therapy Medicinal Products is as much about the scientific and clinical components, as it is about the organizational structures, requiring an unprecedented level of interactions between stakeholders not traditionally connected; from developers and regulators, to payers, patients, and funders. By reflecting on the successes and lessons learned from the growing space of global precompetitive consortia and public–private partnerships, as well as a number of emerging accelerated development pathways, this work aims to inform the foundations for a future roadmap that can smooth the path to approval, reimbursement, and access, while delivering value to all stakeholders. Echoing the growing demands to bring these transformative products to patients, it provides critical insights to enhance our capacity in three fundamental domains: deploying the operational flexibilities offered by the growing space of collaborations, utilizing emerging flexible and accelerated pathways to tackle challenges in quantifying long-term effectiveness, and building the necessary digital and clinical infrastructure for knowledge development.

  12. Cancer patient preferences for quality and length of life.

    Science.gov (United States)

    Meropol, Neal J; Egleston, Brian L; Buzaglo, Joanne S; Benson, Al B; Cegala, Donald J; Diefenbach, Michael A; Fleisher, Linda; Miller, Suzanne M; Sulmasy, Daniel P; Weinfurt, Kevin P

    2008-12-15

    Optimal patient decision making requires integration of patient values, goals, and preferences with information received from the physician. In the case of a life-threatening illness such as cancer, the weights placed on quality of life (QOL) and length of life (LOL) represent critical values. The objective of the current study was to describe cancer patient values regarding QOL and LOL and explore associations with communication preferences. Patients with advanced cancer completed a computer-based survey before the initial consultation with a medical oncologist. Assessments included sociodemographics, physical and mental health state, values regarding quality and length of life, communication preferences, and cancer-related distress. Among 459 patients with advanced cancer, 55% placed equal valued on QOL and LOL, 27% preferred QOL, and 18% preferred LOL. Patients with a QOL preference had lower levels of cancer-related distress (P LOL over QOL desired a more supportive and less pessimistic communication style from their oncologists. These data indicate that a values preference for LOL versus QOL may be simply measured, and is associated with wishes regarding the nature of oncologist communication. Awareness of these values during the clinical encounter could improve decision making by influencing the style and content of the communication between oncologists and their patients.

  13. [End-of-life-care and euthanasia: medical assistance in dying or help to die].

    Science.gov (United States)

    Müller-Busch, H Christof

    2008-01-01

    The debate on euthanasia that has been started all over Europe, but especially in Germany has been particularly complicated by unclear and inconsistent definitions. Medical decisions in end-of-life care gain increasing importance not only for the time of death but also for the kind and quality of the dying process. Though legal regulations can help to diminish doubts about the permissibility of various measures in end-of-life care, teaching and knowledge of ethical principles, communication skills, respect, transparency and knowledge of palliative care options seem to be the most important factors in accompanying the dying professionally and with dignity and even in achieving a consented compromise when aid in hastening death is asked for.

  14. Systematic Education of Self-Medication at Tokyo University of Pharmacy and Life Sciences.

    Science.gov (United States)

    Narui, Koji; Samizo, Kazuo; Inoue, Michiko; Watanabe, Kinzo

    2016-01-01

    The promotion of self-medication by pharmacies, with the aim of encouraging a patient's self-selection of proper OTC drug, is written about in the national action plan "Japan is Back". The subject of self-medication has been improved in the 2013 revised edition of "Model Core Curriculum for Pharmaceutical Education". At Tokyo University of Pharmacy and Life Sciences, the systematic education of self-medication was started from the onset of the six-year course in the third, fourth and fifth grade. We introduce here a new approach in our systematic education of self-medication. In the practice of the fourth grade, groups of around 5-6 students are formed. The pharmacy students assume various roles-of pharmacist, rater, observer, and chairman-and perform role-playing. We prepared a standardized patient (SP) showing various symptoms. The student of the role of pharmacist asks about the SP's symptoms, chooses an OTC drug suitable for the SP, and explains the OTC drug to the SP. After the role-playing, those in the roles of rater, observer, SP, and faculty give feedback to the student who played the role of pharmacist. Because we conduct this role-playing using SPs with a variety of symptoms, we can create a situation similar to a real drugstore.

  15. Opioid overdose prevention training with naloxone, an adjunct to basic life support training for first-year medical students.

    Science.gov (United States)

    Berland, Noah; Fox, Aaron; Tofighi, Babak; Hanley, Kathleen

    2017-01-01

    Opioid overdose deaths have reached epidemic proportions in the United States. This problem stems from both licit and illicit opioid use. Prescribing opioids, recognizing risky use, and initiating prevention, including opioid overdose prevention training (OOPT), are key roles physicians play. The American Heart Association (AHA) modified their basic life support (BLS) algorithms to consider naloxone in high-risk populations and when a pulse is appreciated; however, the AHA did not provide OOPT. The authors' intervention filled this training deficiency by teaching medical students opioid overdose resuscitation with a Train-the-Trainer model as part of mandatory BLS training. The authors introduced OOPT, following a Train-the-Trainer model, into the required basic life support (BLS) training for first-year medical students at a single medical school in a large urban area. The authors administered pre- and post-evaluations to assess the effects of the training on opioid overdose knowledge, self-reported preparedness to respond to opioid overdoses, and attitudes towards patients with substance use disorders (SUDs). In the fall 2014, 120 first-year medical students received OOPT. Seventy-three students completed both pre- and posttraining evaluations. Improvements in knowledge about and preparedness to respond to opioid overdoses were statistically significant (P support dissemination of OOPT as a part of BLS training for all medical students, and potentially all BLS providers.

  16. A person-centred approach in medicine to reduce the psychosocial and existential burden of chronic and life-threatening medical illness.

    Science.gov (United States)

    Grassi, Luigi; Mezzich, Juan E; Nanni, Maria Giulia; Riba, Michelle B; Sabato, Silvana; Caruso, Rosangela

    2017-10-01

    The psychiatric, psychosocial, and existential/spiritual pain determined by chronic medical disorders, especially if in advanced stages, have been repeatedly underlined. The right to approach patients as persons, rather than symptoms of organs to be repaired, has also been reported, from Paul Tournier to Karl Jaspers, in opposition and contrast with the technically-enhanced evidence-based domain of sciences that have reduced the patients to 'objects' and weakened the physician's identity deprived of its ethical value of meeting, listening, and treating subjects. The paper will discuss the main psychosocial and existential burden related to chronic and advanced medical illnesses, and the diagnostic and therapeutic implications for a dignity preserving care within a person-centred approach in medicine, examined in terms of care of the person (of the person's whole health), for the person (for the fulfilment of the person's health aspirations), by the person (with physicians extending themselves as total human beings), and with the person (working respectfully with the medically ill person).

  17. The rights of the dying: the refusal of medical treatments in Argentine courts

    Directory of Open Access Journals (Sweden)

    Juan Pedro Alonso

    2016-10-01

    Full Text Available This paper addresses the judicialization of end of life medical decision-making, as part of the advance of the justice system in the regulation of medical practice and the rise of recognition of patient autonomy. The article analyzes, from a sociological standpoint, legal decisions regarding treatment refusal at the end of life produced by the Argentine courts between 1975 and 2015. Based on a qualitative design, 38 sentences collected from jurisprudential databases using key terms were analyzed. First, judicialized cases during the period are described; these are characterized by a high proportion of claims presented by health institutions, a pro-treatment bias in the legal actions requested, and a high percentage of unnecessary litigation in the absence of conflicts or in situations that do not require court intervention. Second, legal and extralegal factors affecting the justiciability of decisions to refuse or withdraw medical treatments, such as changes in the law and processes of politicization of claims, are analyzed.

  18. Medical Students' Perception of Their Educational Environment and Quality of Life: Is There a Positive Association?

    Science.gov (United States)

    Enns, Sylvia Claassen; Perotta, Bruno; Paro, Helena B; Gannam, Silmar; Peleias, Munique; Mayer, Fernanda Brenneisen; Santos, Itamar Souza; Menezes, Marta; Senger, Maria Helena; Barelli, Cristiane; Silveira, Paulo S P; Martins, Milton A; Zen Tempski, Patricia

    2016-03-01

    To assess perceptions of educational environment of students from 22 Brazilian medical schools and to study the association between these perceptions and quality of life (QoL) measures. The authors performed a multicenter study (August 2011 to August 2012), examining students' views both of (1) educational environment using the Dundee Ready Education Environment Measure (DREEM) and (2) QoL using the World Health Organization Quality of Life Assessment, abbreviated version (WHOQOL-BREF). They also examined students' self-assessment of their overall QoL and medical-school-related QoL (MSQoL). The authors classified participants' perceptions into four quartiles according to DREEM total score, overall QoL, and MSQoL. Of 1,650 randomly selected students, 1,350 (81.8%) completed the study. The mean total DREEM score was 119.4 (standard deviation = 27.1). Higher total DREEM scores were associated with higher overall QoL and MSQoL scores (P student QoL.

  19. Barriers and facilitators to end-of-life communication in advanced chronic organ failure.

    Science.gov (United States)

    Van den Heuvel, Liza Amc; Spruit, Martijn A; Schols, Jos Mga; Hoving, Ciska; Wouters, Emiel Fm; Janssen, Daisy Ja

    2016-05-01

    The aim of this quantitative, cross-sectional study was to identify barriers and facilitators to end-of-life communication experienced by family caregivers of patients with advanced chronic organ failure and to examine agreement in barriers and facilitators between family caregivers and patients. Patients and family caregivers were interviewed using the barriers and facilitators questionnaire. Agreement was determined using intraclass correlation coefficients for continuous variables and Cohen's kappa for categorical variables. A total of 158 patients and family caregiver dyads were included. The most important barriers for family caregivers were related to uncertainty about expected care and focus on staying alive instead of dying. The facilitators were related to trust in and competence of their physician and earlier experiences with death in their (social) environment. For most barriers and facilitators, agreement between patients and family caregivers was fair to moderate. Differences in barriers and facilitators between patients and family caregivers ask for an individual approach to facilitate end-of-life communication.

  20. Advancing Life Projects: South African Students Explain Why They Come to FET Colleges

    Directory of Open Access Journals (Sweden)

    Lesley Powell

    2014-10-01

    Full Text Available Vocational Education and Training (VET policy in South Africa is based on a narrow set of assumptions regarding the identity of learners and the reasons that they are in public further education and training (FET colleges. These assumptions reflect an international orthodoxy about the centrality of employability that is located within what Giddens (1994 has described as 'productivism', a view that reduces life to the economic sphere. Through exploring the stories of a group of South African public FET college learners' regarding their reasons for choosing FET colleges, this paper shows that VET is valued by these students for a range of reasons. These include preparation for the world of work, but also a desire to improve their ability to contribute to their communities and families; raise their self-esteem; and expand their future life possibilities. Thus, the paper advances the largely hitherto theoretical critique of productivist VET accounts by offering empirical evidence of counter-narratives.

  1. Oral health Status, Medical History, Xerostomia dan Quality of Life of elderly In Luwu Timur, Sulawesi Selatan

    OpenAIRE

    Samad, Rasmidar

    2013-01-01

    Xerostomia is a common condition in elderly people which may result in permanent impairtment that would be one risk factor for decreased quality of life Objective the aim of this study is to determine the relathionship of sociodemographic status, medical history, xerostomia, tooth loss and caries status with quality of life of elderly in luwu timur Xerostomia is a common condition in elderly people which may result in permanent impairtment that would be one risk factor for decreased qua...

  2. [Emergency Medical Technician profile in Spain].

    Science.gov (United States)

    Martínez-Isasi, Santiago; Rodríguez-Lorenzo, María José; Vázquez-Santamariña, David; Abella-Lorenzo, Javier; Castro Dios, Diana Josefa; Fernández García, Daniel

    2017-12-11

    The emergency medical technician plays a fundamental role and is the most important figure quantitatively in pre-hospital emergencies. The aim was to asses the socio-demographic, work-related, health characteristics and technical skills of an Emergency Medical Technician in Spain. Cross-sectional descriptive study. An ad hoc questionnaire was managed using Google Docs® that was delivered between April-June 2014 via email and social networks. A total of 705 questionnaires were collected. Statistical analysis was performed with SPSS ® 20.0 Windows version. A significance level p≤0.05 was used for all analyzes. The data analyzed show that the profile of the Emergency Medical Technician in Spain is an 39 year-old man, married or living as a couple and has a child. The average BMI is 27 kg/m2, does regular exercise, does not smoke. His seniority in the company is 10 years and has the Medium Cycle of Emergency Medical Technician. The analysis for gender shows that men have an average of 40, an average BMI of 27, 5 kg/m2 and work in an advanced life support unit; while women have an average of 36,5 years, an average BMI of 24,7 kg/m2, mainly work in Basic Life Support Unit and her seniority in the company is 6,76 years. Emergency Medical Technician profile is a overweight men, who refer to practise regular exercise, his seniority in the company is 10 years and is in possession of CMTES; differences were observed according to gender in BMI, resource where they perform their work, seniority and age.

  3. Impact of physical activity on fatigue and quality of life in people with advanced lung cancer: a randomized controlled trial.

    Science.gov (United States)

    Dhillon, H M; Bell, M L; van der Ploeg, H P; Turner, J D; Kabourakis, M; Spencer, L; Lewis, C; Hui, R; Blinman, P; Clarke, S J; Boyer, M J; Vardy, J L

    2017-08-01

    Physical activity (PA) improves fatigue and quality of life (QOL) in cancer survivors. Our aim was to assess whether a 2-month PA intervention improves fatigue and QOL for people with advanced lung cancer. Participants with advanced lung cancer, Eastern Cooperative Oncology Group performance status (PS) ≤2, >6 months life expectancy, and ability to complete six-min walk test, were stratified (disease stage, PS 0-1 versus 2, centre) and randomized (1:1) in an open-label study to usual care (UC) (nutrition and PA education materials) or experimental intervention (EX): UC plus 2-month supervised weekly PA and behaviour change sessions. Assessments occurred at baseline, 2, 4, and 6 months. The primary endpoint was fatigue [Functional Assessment of Cancer Therapy-Fatigue (FACT-F) questionnaire] at 2 months. The study was designed to detect a difference in mean FACT-F subscale score of 6. Analysis was intention-to-treat using linear mixed models. We recruited 112 patients: 56 (50.4%) were randomized to EX, 55(49.5%) to UC; 1 ineligible. Male 55%; median age 64 years (34-80); 106 (96%) non-small cell lung cancer; 106 (95.5%) stage IV. At 2, 4 and 6 months, 90, 73 and 62 participants were assessed, respectively, with no difference in attrition between groups. There were no significant differences in fatigue between the groups at 2, 4 or 6 months: mean scores at 2 months EX 37.5, UC 36.4 (difference 1.2, 95% CI - 3.5, 5.8, P = 0.62). There were no significant differences in QOL, symptoms, physical or functional status, or survival. Adherence to the intervention was good but the intervention group did not increase their PA enough compared to the control group, and no difference was seen in fatigue or QOL. Australian New Zealand Clinical Trials Registry No. ACTRN12609000971235. © The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  4. Hidden Consequences of Success in Pediatrics: Parental Health-Related Quality of Life-Results From the Care Project

    NARCIS (Netherlands)

    Hatzmann, Janneke; Heymans, Hugo S. A.; Ferrer-I-Carbonell, Ada; van Praag, Bernard M. S.; Grootenhuis, Martha A.

    2008-01-01

    CONTEXT. The number of parents who care for a chronically ill child is increasing. Because of advances in medical care, parental caring tasks are changing. A detailed description of parental health-related quality of life will add to the understanding of the impact of caring for a chronically ill

  5. "It's Not that Easy"--Medical Students' Fears and Barriers in End-of-Life Communication.

    Science.gov (United States)

    Romotzky, V; Galushko, M; Düsterdiek, A; Obliers, R; Albus, C; Ostgathe, C; Voltz, R

    2015-06-01

    This study aims to assess and improve communication education for medical students in palliative care (PC) with the use of simulated patients (SP) in Germany. More specifically, to explore how students evaluate the use of SP for end-of-life communication training and which fears and barriers arise. A pilot course was implemented. Qualitative content analysis was used to analyse transcribed recordings of the course. Pre- and post-course questionnaires containing open-ended questions ascertained students' motivation for participating, their preparation within their degree programme and whether they felt they had learned something important within the course. Seventeen medical students in their third to fourth year of education (age 22-31) participated in the five-session course and answered the questionnaires (pre n = 17, post n = 12). Students felt insufficiently prepared and insecure. Discussing end-of-life issues was experienced as challenging and emotionally moving. Within the conversations, although students sometimes showed blocking behaviour in reaction to emotional impact, they valued the consideration of emotional aspects as very important. The course was overall highly appreciated and valued as being helpful. The communication situation with the SP was perceived as authentic. Ten out of 12 students confirmed to have learned something important (post course). Our results indicate an urgent need for better communication training for medical students. Due to the fact that bedside teaching in PC is not feasible for all students, training with standardized SP can be a way to generate an authentic learning situation. Techniques to address fears and blocking behaviour should, however, also be considered.

  6. Effect of antipsychotic medication on overall life satisfaction among individuals with chronic schizophrenia: findings from the NIMH CATIE study.

    Science.gov (United States)

    Fervaha, Gagan; Agid, Ofer; Takeuchi, Hiroyoshi; Foussias, George; Remington, Gary

    2014-07-01

    The field of schizophrenia is redefining optimal outcome, moving beyond clinical remission to a more comprehensive model including functional recovery and improved subjective well-being. Although numerous studies have evaluated subjective outcomes within the domain of subjective quality of life in patients with schizophrenia, less is known about global evaluations of subjective well-being. This study examined the effects of antipsychotic medication on overall life satisfaction in patients with chronic schizophrenia. Data were drawn from the Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE) study, where participants with a DSM-IV diagnosis of schizophrenia were randomized to receive olanzapine, perphenazine, quetiapine, risperidone or ziprasidone under double-blind conditions (N=753). The primary outcome measure was prospective change in subjectively evaluated overall life satisfaction scores following 12 months of antipsychotic treatment. Psychopathology, medication side effects and functional status were also evaluated, among other variables. Patients experienced modest improvements in overall life satisfaction (d=0.22, p0.05). Change in severity of positive, negative, and depressive symptoms as well as functional status each demonstrated a small, albeit statistically significant, association with change in life satisfaction (r=0.10-0.21, p׳slife satisfaction scores (explained variance satisfaction with life. Clinicians should be aware that these two domains are not inextricably linked. Copyright © 2014 Elsevier B.V. and ECNP. All rights reserved.

  7. Life cycle environmental impacts of advanced wastewater treatment techniques for removal of pharmaceuticals and personal care products (PPCPs).

    Science.gov (United States)

    Zepon Tarpani, Raphael Ricardo; Azapagic, Adisa

    2018-06-01

    Pharmaceutical and personal care products (PPCPs) are of increasing interest because of their ecotoxicological properties and environmental impacts. Wastewater treatment plants (WWTPs) are the main pathway for their release into freshwaters due to the inefficiency of conventional WWTPs in removing many of these contaminants from effluents. Therefore, different advanced effluent treatment techniques have been proposed for their treatment. However, it is not known at present how effective these treatment methods are and whether on a life cycle basis they cause other environmental impacts which may outweigh the benefits of the treatment. In an effort to provide an insight into this question, this paper considers life cycle environmental impacts of the following advanced treatment techniques aimed at reducing freshwater ecotoxicity potential of PPCPs: granular activated carbon (GAC), nanofiltration (NF), solar photo-Fenton (SPF) and ozonation. The results suggest that on average NF has the lowest impacts for 13 out of 18 categories considered. GAC is the best alternative for five impacts, including metals and water depletion, but it has the highest marine eutrophication. SPF and ozonation are the least sustainable for eight impacts, including ecotoxicity and climate change. GAC and NF are also more efficient in treating heavy metals while avoiding generation of harmful by-products during the treatment, thus being more suitable for potable reuse of wastewater. However, releasing the effluent without advanced treatment to agricultural land achieves a much higher reduction of freshwater ecotoxicity than treating it by any of the advanced treatments and releasing to the environment. Therefore, the use of advanced effluent treatment for agricultural purposes is not recommended. Copyright © 2018 Elsevier Ltd. All rights reserved.

  8. Completing advance directives for health care decisions: getting to yes.

    Science.gov (United States)

    Shewchuk, T R

    1998-09-01

    The concept of advance directives for health care decision making has been judicially condoned, legislatively promoted, and systematically implemented by health care institutions, yet the execution rate of advance directives remains low. Physicians should discuss with their patients advance care planning generally and end-of-life issues specifically, preferably when patients are in good health and not when they face an acute medical crisis. The physician-hospital relationship poses particular challenges for the optimal implementation of advance directives that must be addressed. Hospital administrators must improve education of patients and physicians on the value of such documents as well as internal mechanisms to ensure better implementation of directives. Health insurance plans may be better able to ensure optimal gathering and implementation of directives. Patients must become more familiar and more comfortable with advance care planning and the reality of death and dying issues. Full acceptance of the value of directives ultimately rests on achieving full participation of all involved--providers, patients, families, and payors--in this most profound process.

  9. Perspectives on death and an afterlife in relation to quality of life, depression, and hopelessness in cancer patients without evidence of disease and advanced cancer patients.

    Science.gov (United States)

    van Laarhoven, Hanneke W M; Schilderman, Johannes; Verhagen, Constans A H H V M; Vissers, Kris C; Prins, Judith

    2011-06-01

    It is unknown whether cancer patients with different life expectancies have different attitudes and emotions toward death and an afterlife. Also, it is unclear whether these attitudes and emotions toward death and afterlife influence patients' distress. To assess the relationship of attitudes and emotions towards death and an afterlife with quality of life, depression and hopelessness in cancer patients without evidence of disease and advanced cancer patients facing death. Ninety-one cancer patients without evidence of disease and 57 advanced cancer patients completed the Dutch Attitudes Toward Death and Afterlife Scale. Emotions toward death were measured using the Self-Confrontation Method. Quality of life was measured with the Satisfaction with Life Scale and the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire. Depression and hopelessness were measured with the Beck Depression Inventory for Primary Care and the Beck Hopelessness Scale. Average scores on attitudes and emotions toward death and an afterlife were not significantly different between the two groups. However, in the no evidence of disease group, a negative association between negative emotions and social functioning was observed, which was not present in the advanced cancer group. In the advanced cancer group, associations were observed that were not present in the no evidence of disease group: positive associations between an explicitly religious attitude and global health status and between reincarnation belief and role and cognitive functioning, and a negative association between other-directed emotions and social functioning. Patients without evidence of disease and advanced cancer patients do not differ in attitudes or emotions toward death, but the relationship between these attitudes and emotions and aspects of quality of life varies. When there is no evidence of disease, negative emotions play the most important role, whereas in the advanced

  10. Assessing Advanced Airway Management Performance in a National Cohort of Emergency Medical Services Agencies.

    Science.gov (United States)

    Wang, Henry E; Donnelly, John P; Barton, Dustin; Jarvis, Jeffrey L

    2018-05-01

    Although often the focus of quality improvement efforts, emergency medical services (EMS) advanced airway management performance has few national comparisons, nor are there many assessments with benchmarks accounting for differences in agency volume or patient mix. We seek to assess variations in advanced airway management and conventional intubation performance in a national cohort of EMS agencies. We used EMS data from ESO Solutions, a national EMS electronic health record system. We identified EMS emergency responses with attempted advanced airway management (conventional intubation, rapid sequence intubation, sedation-assisted intubation, supraglottic airway insertion, and cricothyroidotomy). We also separately examined cases with initial conventional intubation. We determined EMS agency risk-standardized advanced airway management and initial conventional intubation success rates by using mixed-effects regression models, fitting agency as a random intercept, adjusting for patient age, sex, race, cardiac arrest, or trauma status, and use of rapid sequence or sedation-assisted intubation, and accounting for reliability variations from EMS agency airway volume. We assessed changes in agency advanced airway management and initial conventional intubation performance rank after risk and reliability adjustment. We also identified high and low performers (reliability-adjusted and risk-standardized success confidence intervals falling outside the mean). During 2011 to 2015, 550 EMS agencies performed 57,209 advanced airway management procedures. Among 401 EMS agencies with greater than or equal to 10 advanced airway management procedures, there were a total of 56,636 procedures. Median reliability-adjusted and risk-standardized EMS agency advanced airway management success was 92.9% (interquartile range 90.1% to 94.8%; minimum 58.2%; maximum 99.0%). There were 56 advanced airway management low-performing and 38 high-performing EMS agencies. Among 342 agencies with

  11. Systematic review of psychosocial outcomes for patients with advanced melanoma.

    Science.gov (United States)

    Dunn, Jeff; Watson, Maggie; Aitken, Joanne F; Hyde, Melissa K

    2017-11-01

    New advanced melanoma therapies are associated with improved survival; however, quality of survivorship, particularly psychosocial outcomes, for patients overall and those treated with newer therapies is unclear. Synthesize qualitative and quantitative evidence about psychosocial outcomes for advanced (stage III/IV) melanoma patients. Five databases were searched (01/01/1980 to 31/01/2016). Inclusion criteria were as follows: advanced melanoma patients or sub-group analysis; assessed psychosocial outcomes; and English language. Fifty-two studies met review criteria (4 qualitative, 48 quantitative). Trials comprise mostly medical not psychosocial interventions, with psychosocial outcomes assessed within broader quality of life measures. Patients receiving chemotherapy or IFN-alpha showed decreased emotional and social function and increased distress. Five trials of newer therapies appeared to show improvements in emotional and social function. Descriptive studies suggest that patients with advanced, versus localized disease, had decreased emotional and social function and increased distress. Contributors to distress were largely unexplored, and no clear framework described coping/adjustment trajectories. Patients with advanced versus localized disease had more supportive care needs, particularly amount, quality, and timing of melanoma-related information, communication with and emotional support from clinicians. Limitations included: lack of theoretical underpinnings guiding study design; inconsistent measurement approaches; small sample sizes; non-representative sampling; and cross-sectional design. Quality trial evidence is needed to clarify the impact of treatment innovations for advanced melanoma on patients' psychosocial well-being. Survivorship research and subsequent translation of that knowledge into programs and services currently lags behind gains in the medical treatment of advanced melanoma, a troubling circumstance that requires immediate and focused

  12. Hydroponics Database and Handbook for the Advanced Life Support Test Bed

    Science.gov (United States)

    Nash, Allen J.

    1999-01-01

    During the summer 1998, I did student assistance to Dr. Daniel J. Barta, chief plant growth expert at Johnson Space Center - NASA. We established the preliminary stages of a hydroponic crop growth database for the Advanced Life Support Systems Integration Test Bed, otherwise referred to as BIO-Plex (Biological Planetary Life Support Systems Test Complex). The database summarizes information from published technical papers by plant growth experts, and it includes bibliographical, environmental and harvest information based on plant growth under varying environmental conditions. I collected 84 lettuce entries, 14 soybean, 49 sweet potato, 16 wheat, 237 white potato, and 26 mix crop entries. The list will grow with the publication of new research. This database will be integrated with a search and systems analysis computer program that will cross-reference multiple parameters to determine optimum edible yield under varying parameters. Also, we have made preliminary effort to put together a crop handbook for BIO-Plex plant growth management. It will be a collection of information obtained from experts who provided recommendations on a particular crop's growing conditions. It includes bibliographic, environmental, nutrient solution, potential yield, harvest nutritional, and propagation procedure information. This handbook will stand as the baseline growth conditions for the first set of experiments in the BIO-Plex facility.

  13. Requirements Development Issues for Advanced Life Support Systems: Solid Waste Management

    Science.gov (United States)

    Levri, Julie A.; Fisher, John W.; Alazraki, Michael P.; Hogan, John A.

    2002-01-01

    Long duration missions pose substantial new challenges for solid waste management in Advanced Life Support (ALS) systems. These possibly include storing large volumes of waste material in a safe manner, rendering wastes stable or sterilized for extended periods of time, and/or processing wastes for recovery of vital resources. This is further complicated because future missions remain ill-defined with respect to waste stream quantity, composition and generation schedule. Without definitive knowledge of this information, development of requirements is hampered. Additionally, even if waste streams were well characterized, other operational and processing needs require clarification (e.g. resource recovery requirements, planetary protection constraints). Therefore, the development of solid waste management (SWM) subsystem requirements for long duration space missions is an inherently uncertain, complex and iterative process. The intent of this paper is to address some of the difficulties in writing requirements for missions that are not completely defined. This paper discusses an approach and motivation for ALS SWM requirements development, the characteristics of effective requirements, and the presence of those characteristics in requirements that are developed for uncertain missions. Associated drivers for life support system technological capability are also presented. A general means of requirements forecasting is discussed, including successive modification of requirements and the need to consider requirements integration among subsystems.

  14. Palliative home care intervention to improve the quality of life of women with advanced breast cancer

    International Nuclear Information System (INIS)

    Figueredo Villa, Katiuska

    2013-01-01

    The quality of life is affected frequently observed in women with advanced breast cancer and is considered a leading indicator of effectiveness of palliative care. A descriptive, quasi-experimental study is presented ex-ante / ex-post, by applying open-ended interviews to explore the effects on the processes of adaptation of each patient and a self-administrable scale identified specific dimensions of quality of life, satisfaction with care and overall quality of life. The intervention was performed palliative home care to 52 women, according to the damages identified in the baseline diagnosis. The overall strategy included four steps: clinical and socio-demographic characterization of women; identification of the effects on the processes of adaptation by the theoretical model of Roy and dimensions of quality of life frequently affected, to design individually oriented actions on the drive shaft of Nursing Interventions Classification and evaluation of results intervention. The dimensions achieved higher frequency of involvement were: behavior, physical symptoms, pain interference and leisure activities, social life and family. Data were analyzed with qualitative methodologies and uni and multivariate statistical processing. After the intervention favorable changes in adaptive processes and dimensions of quality of life were observed; well as in the assessment of overall satisfaction with life. It was interesting that the dimensions of satisfaction assessed at the end of the intervention obtained an unfavorable assessment, outcome associated with sociodemographic variables. (author)

  15. Application of behavior-based ergonomics therapies to improve quality of life and reduce medication usage for Alzheimer's/dementia residents.

    Science.gov (United States)

    Mowrey, Corinne; Parikh, Pratik J; Bharwani, Govind; Bharwani, Meena

    2013-02-01

    Behavior-based ergonomics therapy (BBET) has been proposed in the past as a viable individualized non-pharmacological intervention to manage challenging behaviors and promote engagement among long-term care residents diagnosed with Alzheimer's/dementia. We evaluate the effect of BBET on quality of life and behavioral medication usage in an 18-bed dementia care unit at a not-for-profit continuing care retirement community in West Central Ohio. Comparing a target cohort during the 6-month pre-implementation period with the 6-month post-implementation period, our study indicates that BBET appears to have a positive impact on the resident's quality of life and also appears to correlate with behavioral medical reduction. For instance, the number of days with behavioral episodes decreased by 53%, the total Minimum Data Set (MDS) mood counts decreased by 70%, and the total MDS behavior counts decreased by 65%. From a medication usage standpoint, the number of pro re nata (PRN) Ativan doses decreased by 57%.

  16. Quality of life as predictor of survival: A prospective study on patients treated with combined surgery and radiotherapy for advanced oral and oropharyngeal cancer

    International Nuclear Information System (INIS)

    Oskam, Inge M.; Verdonck-de Leeuw, Irma M.; Aaronson, Neil K.; Kuik, Dirk J.; Bree, Remco de; Doornaert, Patricia; Langendijk, Johannes A.; Leemans, Rene C.

    2010-01-01

    Background and purpose: The relation between health-related quality of life (HRQOL) and survival was investigated at baseline and 6 months in 80 patients with advanced oral or oropharyngeal cancer after microvascular reconstructive surgery and (almost all) adjuvant radiotherapy. Materials and methods: Multivariate Cox regression analyses of overall and disease-specific survival were performed including sociodemographic (age, gender, marital status, comorbidity), and clinical (tumor stage and site, radical surgical, metastasis, radiotherapy) parameters, and HRQOL (EORTC QLQ-C30 global quality of life scale). Results: Before treatment, younger age and having a partner were predictors of disease-specific survival; younger age predicted overall survival. At 6 months post-treatment, disease-specific and overall survival was predicted by (deterioration of) global quality of life solely. Global health-related quality of life after treatment was mainly influenced by emotional functioning. Conclusion: Deterioration of global quality of life after treatment is an independent predictor of survival in patients with advanced oral or oropharyngeal cancer.

  17. MO-FG-BRC-00: Joint AAPM-ESTRO Symposium: Advances in Experimental Medical Physics

    International Nuclear Information System (INIS)

    2016-01-01

    Experimental research in medical physics has expanded the limits of our knowledge and provided novel imaging and therapy technologies for patients around the world. However, experimental efforts are challenging due to constraints in funding, space, time and other forms of institutional support. In this joint ESTRO-AAPM symposium, four exciting experimental projects from four different countries are highlighted. Each project is focused on a different aspect of radiation therapy. From the USA, we will hear about a new linear accelerator concept for more compact and efficient therapy devices. From Canada, we will learn about novel linear accelerator target design and the implications for imaging and therapy. From France, we will discover a mature translational effort to incorporate theranostic nanoparticles in MR-guided radiation therapy. From Germany, we will find out about a novel in-treatment imaging modality for particle therapy. These examples of high impact, experimental medical physics research are representative of the diversity of such efforts that are on-going around the globe. J. Robar, Research is supported through collaboration with Varian Medical Systems and Brainlab AGD. Westerly, This work is supported by the Department of Radiation Oncology at the University of Colorado School of Medicine. COI: NONEK. Parodi, Part of the presented work is supported by the DFG (German Research Foundation) Cluster of Excellence MAP (Munich-Centre for Advanced Photonics) and has been carried out in collaboration with IBA.

  18. A Detailed Analysis of Prehospital Interventions in Common Medical Priority Dispatch System Determinants

    Directory of Open Access Journals (Sweden)

    Sporer, Karl A

    2011-02-01

    Full Text Available Background: Medical Priority Dispatch System (MPDS is a type of Emergency Medical Dispatch (EMD system used to prioritize 9-1-1 calls and optimize resource allocation. Dispatchers use a series of scripted questions to assign determinants to calls based on chief complaint and acuity.Objective: We analyzed the prehospital interventions performed on patients with MPDS determinants for breathing problems, chest pain, unknown problem (man down, seizures, fainting (unconscious and falls for transport status and interventions.Methods: We matched all prehospital patients in complaint-based categories for breathing problems, chest pain, unknown problem (man down, seizures, fainting (unconscious and falls from January 1, 2004, to December 31, 2006, with their prehospital record. Calls were queried for the following prehospital interventions: Basic Life Support care only, intravenous line placement only, medication given, procedures or non-transport. We defined Advanced Life Support (ALS interventions as the administration of a medication or a procedure.Results: Of the 77,394 MPDS calls during this period, 31,318 (40% patients met inclusion criteria. Breathing problems made up 12.2%, chest pain 6%, unknown problem 1.4%, seizures 3%, falls 9% and unconscious/fainting 9% of the total number of MPDS calls. Patients with breathing problem had a low rate of procedures (0.7% and cardiac arrest medications (1.6% with 38% receiving some medication. Chest pain patients had a similar distribution; procedures (0.5%, cardiac arrest medication (1.5% and any medication (64%. Unknown problem: procedures (1%, cardiac arrest medication (1.3%, any medication (18%. Patients with Seizures had a low rate of procedures (1.1% and cardiac arrest medications (0.6% with 20% receiving some medication. Fall patients had a lower rate of severe illness with more medication, mostly morphine: procedures (0.2%, cardiac arrest medication (0.2%, all medications (28%. Unconscious

  19. Exploring the relationship between the engineering and physical sciences and the health and life sciences by advanced bibliometric methods

    NARCIS (Netherlands)

    Waltman, L.R.; Van, Raan A.F.J.; Smart, S.

    2014-01-01

    We investigate the extent to which advances in the health and life sciences (HLS) are dependent on research in the engineering and physical sciences (EPS), particularly physics, chemistry, mathematics, and engineering. The analysis combines two different bibliometric approaches. The first approach

  20. Advance care planning in CKD/ESRD: an evolving process.

    Science.gov (United States)

    Holley, Jean L

    2012-06-01

    Advance care planning was historically considered to be simply the completion of a proxy (health care surrogate designation) or instruction (living will) directive that resulted from a conversation between a patient and his or her physician. We now know that advance care planning is a much more comprehensive and dynamic patient-centered process used by patients and families to strengthen relationships, achieve control over medical care, prepare for death, and clarify goals of care. Some advance directives, notably designated health care proxy documents, remain appropriate expressions of advance care planning. Moreover, although physician orders, such as do-not-resuscitate orders and Physician Orders for Life-Sustaining Treatment, may not be strictly defined as advance directives, their completion, when appropriate, is an integral component of advance care planning. The changing health circumstances and illness trajectory characteristic of ESRD mandate that advance care planning discussions adapt to a patient's situation and therefore must be readdressed at appropriate times and intervals. The options of withholding and withdrawing dialysis add ESRD-specific issues to advance care planning in this population and are events each nephrologist will at some time confront. Advance care planning is important throughout the spectrum of ESRD and is a part of nephrology practice that can be rewarding to nephrologists and beneficial to patients and their families.